National health care payment summit offers discounted registration for CMA member physicians Discounted registration is now available for California Medical Association (CMA) members who wish to attend the 11th National Value-Based Payment and Pay for Performance Summit, taking place at the Hyatt Regency San Francisco and online February 17-19, 2016. Co-sponsored by CMA, this summit is the leading forum on pay for performance, transparency and value-driven health care, providing an opportunity to engage with colleagues from across the country on the issues, opportunities and challenges facing the health care system in 2016. Leaders from industry, government and the non-profit sector will share ... January 25, 2016 General Payment, Payment Policy, Alternative Payment Models (APM) 0 0 Comment Read More »
CMA publishes physician guidance for the End of Life Option Act The California Medical Association (CMA) has published new legal guidance intended to help physicians and patients understand the End of Life Option Act, which was passed in 2015 and makes physician aid-in-dying legal in California. The document is in a question-and-answer format, and is intended to help both physicians and patients navigate the complicated law. “As physicians, there are a lot of questions about requirements under the new law, required documentation and forms, requests for the drug, consulting physicians and so on,” said CMA President Steve Larson, M.D. “There certainly will ... January 25, 2016 General Physician Aid in Dying, End of Life Issues 0 0 Comment Read More »
CMA urges CDC to revise its proposed guidelines on prescribing opioids for chronic pain The California Medical Association (CMA) has submitted written comments on the Centers for Disease Control and Prevention (CDC) draft guidelines that provide clinical practice recommendations on the prescribing of opioids for treatment of chronic pain. CMA previously submitted comments on the CDC guidelines that raised concerns regarding the lack of transparency and public input involved in developing the guidelines. While the CDC guidelines claim to be advisory recommendations for use by primary care providers who are treating patients with chronic pain in outpatient settings, CMA is concerned that the CDC ... January 25, 2016 General Opioids, Pain Medicine, Prescription Drugs, Regulatory Advocacy, Drug Prescribing 0 0 Comment Read More »
Noridian posts updated Medicare Physician Fee Schedule California's Medicare contractor, Noridian, has posted an updated 2016 Medicare Physician Fee Schedule on its website. Last week, Noridian had removed the fee schedule because it contained several technical errors that needed to be fixed. This update is not expected to cause any delays in reimbursement for physicians, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. The updated fees are valid for dates of service from January 1 through December 31, 2016. To see the ... January 25, 2016 Medicare Medicare, Noridian, Fee Schedule 0 0 Comment Read More »
CMA Capitol Insight: Jan. 19, 2016 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. __________________________________________________________________________________________________________________ The Budget Battle Begins Gov. Jerry Brown introduced his budget this month, and it was about what was expected for anyone watching the governor in recent years. Brown did propose a solution to the fight over the managed care organization (MCO) tax, though no final deal has been announced. Passing such a tax would require a two-thirds vote, and Republicans have said they’re skeptical of the need for the tax. If ... January 25, 2016 General Anthony Yorki, CMA Capitol Insight 0 0 Comment Read More »
IMQ's Stepping Up to Leadership early-bird pricing ends Feb. Early-bird pricing for the Institute for Medical Quality (IMQ) Stepping Up to Leadership conference ends February 9. The program, offered in conjunction with the University of California at San Diego PACE Program, is a practical hands-on training for medical staff leaders. The 2016 Stepping Up to Leadership program, widely recognized as the “go to” course for acquiring knowledge and skills to successfully lead a medical staff, will take place March 10-11 in San Diego. The conference offers unique hands-on and interactive learning opportunities, as well as excellent faculty and course work ... January 15, 2016 General IMQ, Institute for Medical Quality, Conferences 0 0 Comment Read More »
UHC to introduce new primary care assessment program United Healthcare (UHC) recently notified approximately 800 contracted primary care physicians, introducing them to its new educational performance evaluation program. Slated to run concurrently with the UHC Premium Designation program, primary care physicians whose claims data demonstrates a high utilization rate in one of the following measures will receive a performance evaluation report: Emergency department utilization Inpatient admission utilization Average length of stay Laboratory/pathology utilization Levels 4 and 5 visits Modifier ... January 15, 2016 Managed Care United Healthcare 0 0 Comment Read More »
New approval timeframes for prescription drug prior authorizations took effect Jan. 1 A new law took effect Jan. 1, 2016, that requires health plans and health insurers to respond to prescription drug prior authorization requests within 72 hours for non-urgent requests and 24 for urgent requests. The law (SB 282) deems such requests to be granted if the payor fails to respond within these timeframes. A previous law (SB 866) had required a determination within two business days or the request was deemed approved. SB 282 also requires the Department of Managed Health Care and the Department of Insurance to create a ... January 15, 2016 General Department of Managed Health Care, Preauthorization, Prescription Drugs, Department of Insurance 0 0 Comment Read More »
HHS modifies HIPAA Privacy Rule as part of executive actions to curb gun violence Last week, the Obama Administration unveiled a number of executive actions to address gun violence in the United States, including an amendment to the Health Insurance Portability and Accountability Act (HIPAA) that would make it easier for mental health providers to disclose the identities of individuals who are disqualified from shipping, transporting, possessing or receiving a firearm. Both the Brady Handgun Violence Prevention Act of 1993 and the Gun Control Act of 1968 prohibit gun ownership and gun sales to individuals that have been involuntarily committed to a mental institution ... January 15, 2016 General Guns, HIPAA, HIPAA Privacy Rule, Mental Health, Public Health, CPLH 0 0 Comment Read More »
AMA publishes guide to physician-focused alternative payment models The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System). In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association ... January 15, 2016 Medicare AMA, American Medical Association, Medicare, Alternative Payment Models (APM) 0 0 Comment Read More »
