January 2013

• Urge Rep. McCarthy and Sen. Feinstein to pass Medicare Locality update

• All local doctors invited to take SCMA strategic planning survey

• Medi-Cal primary care rate hikes delayed

• SCMA Awards Dinner photos posted on Flickr

• Pay your SCMA/CMA dues by Jan. 15 and get a 5% discount

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Medicare to implement 26.5% rate cut because of Congressional inaction

The Centers for Medicare & Medicaid (CMS) issued a statement on Dec. 19 that because of Congressional inaction the agency will be forced implement the Medicare sustainable growth rate (SGR) formula cut of 26.5% beginning Jan. 1.

If Congress does adjourn without addressing the payment cut, CMS has said it will follow normal claims processing procedures. That is, claims will not be held and Medicare carriers will process payments for physician services provided after Dec. 31 under the normal 14-day cycle required by law. Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376.

The California Medical Association (CMA) has spoken with California leadership in Congress to confirm that the “fiscal cliff” negotiations have broken down. There is also no agreement within Congress to pass a stand-alone SGR bill.

Both Republican and Democratic leaders understand that physicians cannot sustain a 26.5% Medicare payment cut, but it is now caught up in the politics of the fiscal cliff. It is critical that physicians keep contacting their members of Congress to demand action.

In addition to the SGR cut, physicians are facing a potential 2% “sequestration” cut. The sequestration cuts are part of the $1.2 trillion in cuts required by the budget deal worked out to end last year’s debt-ceiling crisis.

Ultimately, CMA does not think Congress will allow the cuts to go forward on any long-term basis. At this time, it is impossible to predict whether the 112th Congress will find a way to pass a stop-gap measure before adjourning, how long such a measure would last, or how long payment cuts will be in effect until legislation can be passed after the 113th Congress convenes in January.

Congress is once again putting Medicare patients and the practices of physicians who treat them at significant risk.

“The health care delivery system is going to see an influx of patients in the next 18 months,” said CMA President Dr. Paul Phinney. “We simply cannot continue to cut resources while adding more patients. The result will be millions of patients with insurance coverage, unable to see a physician. This is especially true in California, where we are also battling cuts to the state’s Medicaid program at the same time.”

The financial disruption this situation will cause for physicians and their practices is unacceptable. CMA will continue to fervently convey this message in the strongest possible terms to Congress and the Administration. Our grassroots network has been activated, and we are seeking your voices to tell Congress just how deeply its inaction will affect you.

Despite these efforts, CMA feels compelled to advise physicians to start making plans to mitigate this disruption and meet their own financial obligations in January. Given the potential impact on practice revenue in early January, physicians should be certain that adequate arrangements are in place to sustain their practices. For those physicians who are forced into the untenable position of limiting their involvement with the Medicare program because it threatens the viability of their practices, we urge that patients be notified promptly so that they, too, can explore other options for obtaining needed medical care.

Physicians should also be aware that they have until Dec. 31 to make changes to their Medicare participation status for 2013. For more information on your participation options, see the AMA Medicare toolkit at www.cmanet.org.

CMA will remain engaged throughout the holidays and keep you informed of any new developments. Meanwhile, contact your members of Congress and urge them to work together to stop the Medicare payment cuts before they take effect on Jan. 1. Use the AMA Grassroots Hotline at 800-833-6354. You will be asked to enter your zip code and select your Representative. Please select your Representative first, then call back to connect with Senators Boxer and Feinstein.

Though phone calls are most effective, you may also contact your members of Congress via email. Talking points and sample letters are available in CMA's grassroots action center.

Urge Rep. McCarthy and Sen. Feinstein to pass Medicare Locality update

Rep. Darrel Issa (R-San Diego) and Rep. Sam Farr (D-Monterey/Santa Cruz) are pushing a compromise Medicare Locality pilot program that would update California’s Medicare physician payment regions and payment rates and help to improve access to care. Because of the Medicare formula, physicians in California’s rural areas would experience a corresponding payment cut, so the proposal would hold rural physicians harmless from cuts.

A California administrative Medicaid funding source has been identified to pay for the “hold harmless,” so there is no cost to the federal government. Once the funding expires in 2017, the localities would revert back to the 2012 locality designations. While this is not the permanent solution that CMA has been seeking, it is a short-term compromise to help improve access to physicians in the 14 negatively impacted counties while protecting access to care in rural areas.

CMA is urging physicians to contact Sen. Dianne Feinstein and Rep. Kevin McCarthy (R-Bakersfield) and ask them to include the “California GPCI locality pilot” in the Medicare SGR/fiscal cliff legislation.

To contact Sen. Feinstein, call 202-224-3841 or visit www.feinstein.senate.gov/public/index.cfm/e-mail-me.

To contact Rep. McCarthy, call 202-225-2915 or visit forms.house.gov/kevinmccarthy/webforms/issue_subscribe.html.

All local doctors invited to take SCMA strategic planning survey

The SCMA Board of Directors is launching an extensive strategic planning project and invites all local physicians to participate in an online survey about SCMA and healthcare issues. Survey results will help guide SCMA board members as they consider a strategic plan for 2013 and beyond. The goal of the plan is to ensure that SCMA fulfills its mission of supporting physicians and their efforts to enhance the health of the community.

The survey is confidential, but SCMA members who choose to identify themselves will be entered into a drawing for an iPad. Nonmembers who submit an SCMA application form and pay their 2013 dues will also be entered into the drawing.

The survey consists of 16 questions about community health and SCMA, with plenty of opportunities for additional comments. It should only take 5 minutes to complete.

To access the survey, visit www.surveymonkey.com/s/SCMA_Survey.

The deadline for completing the survey is Jan. 31.

Medi-Cal primary care rate hikes delayed

Medi-Cal primary care physicians will have to wait to receive the higher reimbursement rates that were set to go into effect on Jan. 1 under the Affordable Care Act (ACA). The delay has been caused by a state health plan amendment that must receive federal approval. It is not yet known when the federal approval process will be completed, but the California Department of Health Care Services (DHCS) has said the earliest it would be able to implement the increase is summer 2013. DHCS has been unable to provide any detailed information regarding the reason for the lengthy delay.

This 100% federally funded increase was intended to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the ACA. With the increase, primary care physicians should see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to Medicare, states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.

California is not alone in this delay; several other states are in the same boat as well. The final federal regulations governing the two-year primary care physician rate hike were released on Nov. 1, which did not give states much time to write and submit the necessary plan amendments.

DHCS has indicated that regardless of when it is implemented, the increase will be retroactive to Jan. 1, 2013. However, they have been unable to say when the rate increase will happen and exactly how retroactive payment will function, apart from indicating that physicians will not be required to resubmit claims.

An overflow crowd of more than 100 physicians, spouses, significant others and guests attended the annual SCMA Awards Dinner on Dec. 6 at the Vintners Inn in Santa Rosa. The evening began with a lively social hour, followed by dinner and awards presentations to five local physicians and the Redwood Community Health Coalition. The presentations were made by longtime colleagues of the awardees, and the stories they told were by turns amusing and inspiring. Every awardee received a standing ovation.

Photos of the event by Will Bucquoy have been posted on Flickr at www.flickr.com/photos/91183744@N07/.

Members who pay their 2013 SCMA/CMA dues by Jan. 15 get a 5% discount. To qualify for the discount, dues must be received in CMA’s Sacramento office by Jan. 15, not just postmarked by that date. Dues invoices were mailed earlier this fall. If you need a copy, contact Rachel Pandolfi at 707-525-4375 or rachel@scma.org.

PEOPLE

Longtime Sonoma County pulmonologist Dr. James Gude has received a Rural Health Champion award from the California State Rural Health Association. The award recognizes Dr. Gude for his achievements in bringing critical care to patients in rural hospitals via telemedicine. Dr. Gude, who is on staff at Healdsburg and Palm Drive hospitals, runs OffSiteCare, a telemedicine company that supports 10 rural hospitals in Northern California.

Former SCMA President Dr. Jan Sonander, a Santa Rosa family physician in private practice, was profiled in the Dec. 16 issue of the Press Democrat. The article focuses on Dr. Sonander’s work with the disabled population at group homes across Sonoma County. He is also in his second term as chief of staff at Memorial Hospital.

MEDICAL ORGANIZATIONS

Family and friends of the late Dr. Herbert Polesky, a well-known pathologist, have established the Polesky Memorial Fund to benefit Healdsburg District Hospital. The fund, to be administered by the Community Foundation of Sonoma County, will be used to facilitate access to care for underserved populations, support prevention and education services, and improve laboratory services.

United Healthcare and Sutter Health are teaming up to offer Signature Value Alliance, a new HMO product for Northern California. The plan, already available in Southern California, is targeted toward smaller employers. More than 1,600 physicians in the North Bay and San Francisco will be part of the HMO network.

The Palm Drive Medical Clinic, located across the street from Palm Drive Hospital in Sebastopol, will transition to the Prima Medical Foundation in February. The physicians who currently work in the clinic will join the Prima Medical Group.

Sonoma Valley Hospital has signed an agreement with Tacoma-based Sound Physicians for comprehensive hospitalist services at the 83-bed hospital. Sound Physicians, which recently acquired the Bay Area Inpatient Group, includes more than 500 hospitalists.

The Petaluma Health Center was recently honored by Partnership HealthPlan for achieving a range of goals established by the nonprofit plan, which offers managed Medi-Cal services to patients throughout the North Bay.

REACH Air Medical Services--established in 1987 by the late Dr. John McDonald, an emergency physician at Santa Rosa Memorial Hospital--has been acquired by Air Medical Group Holdings, a nationwide company that operates more than 200 medical airplanes and helicopters in 27 states.

RESOURCES

The following CMA webinars are scheduled for January. Webinars begin at 12:15 p.m. and run until 1:15 or later. To register, visit www.cmanet.org. Seminars are free for CMA members and their staff; cost for nonmembers is $99 per person.

• HIPAA and Meaningful Use (Jan. 9)

• Medi-Cal application forms training (Jan. 16)

• Understanding ARC and CARD revenue codes (Jan. 23)

• The aging physician (Jan. 24)

• Physician’s guide to protecting your practice (Jan. 29)

• Keys to successful contracting (Jan. 30)

Physicians who meet one of the Medicare electronic prescribing hardship exemptions but did not file by the June 30 deadline have another opportunity to apply before Jan. 31. To assist physicians with questions regarding the electronic prescribing rules and applying for an exemption, CMA has posted the Medicare Electronic Prescribing Overview in the Resource Library at www.cmanet.org.

The 20th annual HIV/AIDS Review will be held from 8 a.m. to 3:30 p.m. on Saturday, April 13, at the Hilton Hotel in Santa Rosa. Speakers includes Drs. Marshall Kubota, Danny Toub and Andy Desruisseau. For information and reservations, call the North Coast AIDS Center at 707-303-8904.

CLASSIFIEDS

Family physicians needed

Family medicine positions available with Annadel Medical Group in Sonoma County. Contact James.DeVore@stjoe.org.

Office space for lease, Santa Rosa

Small suite for lease. 800 sf. Reception, business office, 3 rooms, Summerfield Rd. on Sutter/Warrack campus. Contact Connie, 707-525-0211.

Office space needed, Petaluma

Medical office space needed in Petaluma near Petaluma Valley Hospital for physician to see patients, no staff needed. Need one day a week, Monday or Thursday. Contact Tammy at 707-252-8407 or nvna@napanet.net.

Office space needed, Santa Rosa

Medical office space needed in Santa Rosa for physician to see women’s health patients. Need one day a week. Contact Kristyn at 415-827-9945.

SCMA members get free classifieds!

SCMA members can place free classified ads in News Briefs or Sonoma Medicine. Cost for nonmember physicians and the general public is $1 per word. To place a classified ad, contact Erika Goodwin at erika@scma.org or 707-548-6491.

APPLICANTS

Mark Alan Friedman, MD, Orthopaedic Surgery*, 555 Petaluma Ave #B, Sebastopol 95472, Univ Chicago 2001

Madhavi Vetsa, MD, Internal Medicine*, Gastroenterology*, 401 Bicentennial Way MOB W 240, Santa Rosa 95403, Osmania Med Coll 2002

* = board certified; italics = special medical interest

ABOUT SCMA

The Sonoma County Medical Association, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. Founded in 1858, SCMA is affiliated with the California Medical Association and the American Medical Association.

© 2013 SCMA, 2901 Cleveland Ave. #202, Santa Rosa, CA 95403