CMS is anticipating Congressional action to avert the negative update for the 2012 Medicare Physician Fee Schedule. CMS is extending the 2012 Annual Participation Enrollment Period through February 14, 2012. The enrollment period now runs November 14, 2011 through February 14, 2012. The effective date for any participation status change during the extension, however, remains January 1, 2012, and will be enforced for the entire year. Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before February 14, 2012.

The 2011 Congressional legislative session comes to a bitter end today. Members of Congress will go home for the holidays in a rare standoff that will not result in a last-minute agreement to stop the Medicare SGR 27.4% fee-for-service program payment cut, or extend the payroll tax cut and unemployment benefits. SFMS/CMA is absolutely outraged that Congress will adjourn and let this devastating nearly 30% payment cut take effect.  For a decade, CMA and organized medicine has been calling upon Congress to eliminate the Medicare SGR. All year, Members of Congress made commitments to CMA physicians and seniors that they would stop the cuts and adopt a long-term solution to the failed Medicare SGR physician payment formula. In the height of irresponsibility, Congress will go home for the holidays and deal a terrible blow to physician practices and their patients. Most physicians will not be able to sustain such a cut and remain in the Medicare program. Others could be forced to close their doors. Seniors in California are already experiencing difficulty finding physicians. This will have a devastating impact on access to physicians for California’s 5 million seniors and nearly 1 million military families. Late last week, when negotiations failed between the House and the Senate, a bipartisan group of Republican and Democratic Senators crafted a short term two-month extension on the Medicare SGR, payroll tax cut, and unemployment issues to avoid the devastating cuts that will occur next week. The Senate passed the measure with overwhelming support 89-11. However, under the direction of Speaker Boehner, the House leadership rejected the 2 month extension and are holding out for a longer term deal. The standoff will remain unresolved until Congress returns in January 2012. SFMS/CMA has been advocating for legislation that eliminates the SGR and adopts a longer-term path to an alternative payment system. Within the last few days, to avoid the inevitable, CMA supported the 2-month stop-gap on the Medicare SGR to avoid devastating cuts and a retroactive payment restoration. Unfortunately, the Medicare SGR was tied to much larger controversial issues in the year-end legislative package. While no formal statements have been made by either the Senate or House leadership about their intent to return in January to stop the cuts, we expect Congress to return on January 3 rather than January 17 to address these issues. The House has created a conference committee to bargain over the differing House and Senate bills. The Centers for Medicare and Medicaid Services (CMS) announced that they would hold claims starting January 1 through January 17 to avoid paying physicians at the lower rate and to avoid a retroactive reconciliation of claims in the event Congress acts in early January to stop the cut. CMS said they will be forced to process claims at the lower rate starting January 18 if Congress does not stop the cut.  SFMS/CMA will keep you informed as the debate continues. We have expressed our anger to our Congressional delegation for failing to keep their obligation to appropriately finance the Medicare program and to protect access to care.

SFMS members who are in solo/small group practices, please note there are several key updates and new regulations in San Francisco labor laws, effective January 1, 2012.

New Minimum Wage: $10.24/Hour

Beginning January 1, 2012, all employers must pay to each employee who performs work in San Francisco (including temporary and part-time employees) wages not less than $10.24 per hour. The minimum wage requirement, set forth in the San Francisco Minimum Wage Ordinance, applies to adult and minor employees who work two (2) or more hours per week. Each year, the City will adjust the amount of the minimum wage based on increases in the regional consumer price index.

New Health Care Security Ordinance (HCSO) 

The Health Care Security Ordinance (HCSO) requires Covered Employers to spend a minimum amount of money each quarter on their Covered Employees' health care. Beginning January 1, 2012, health care expenditure rate for large employers (100+ employees) will be $2.20/hour. For medium-sized employers (20-99 employees), the rate will be $1.46/hr. Employers with 19 or less employees are exempt from the HCSO requirements. Please email HCSO@sfgov.org or call (415) 554-7892 with any questions regarding your rights and responsibilities under the San Francisco Health Care Security Ordinance.

New HCSO Regulations

Posting: Beginning January 1, 2012, new HCSO provisions take effect. Below is a summary of the key changes, but for more details, visit the OLSE website at www.sfgov.org/olse/hcso, or contact the OLSE at (415) 554-7892 or hcso@sfgov.org. All "Covered Employers" (i.e., businesses with 20 or more employees) are subject to the HCSO and must post an Official OLSE Notice at every workplace. You can download and print a copy of the Official OLSE Notice at www.sfgov.org/olse/hcso. HRA Accounts: The following provisions apply to businesses that utilize Health Reimbursements Accounts (HRAs) to satisfy, in whole or in part, the HCSO spending requirement. In order for HRA contributions to qualify as health care expenditures, all of the following criteria must be met:

1. Any HRA funds available at the end of 2011 must roll-over to 2012;
2. The contributions must be reasonably calculated to benefit the employee;
3. The contributions must remain available to the employee for a minimum of twenty-four months from the date of the contribution;
4. The employee must receive a written summary of the contribution within 15 days of the date of the contribution; and,
5. Upon separation, employees must be provided with a written summary of their account within 3 days, and the funds must remain available for a minimum of 90 days.

Businesses with Surcharges: The following provisions apply to businesses that impose a surcharge on customers to cover, in whole or in part, the costs of the HCSO spending requirement.

• You will be required to report two pieces of data to the OLSE during the annual reporting process: 1) the amount of money collected from the surcharge for employee health care and 2) the amount of money spent on employee health care.

• If the amount collected from the surcharge is greater than the amount spent on employee health care, the Covered Employer must irrevocably pay or designate an amount equal to that difference for health care expenditures for its employees.

A study conducted by the Joint Commission reported that miscommunication between caregivers during patient hand-offs plays a role in an estimated 80% of serious preventable adverse events. In a time when medical professionals are exploring ways to improve quality of care, why haven’t we tackled the simplest and most cost effective way to achieve this—improving communication? More than 90% of physicians report using a smart phone, and SFMS is excited to announce a new member benefit that leverages this technology to share patient information throughout the local medical community. All SFMS resident and practicing physician members enjoy exclusive and free member-only access to DocBookMD, a HIPAA-compliant smartphone app to connect with local physicians and pharmacies. DocBookMD gives you the entire San Francisco physician database on your mobile devices. You can:

• Network with local physicians to develop relationships for referrals
• Find colleagues to consult on medical decisions
• Obtain second opinion from a fellow colleague immediately—getting a text or email back from a doctor who, in some cases, can save a patient’s life

As an added bonus, all new SFMS member registrations between December 13 and December 20 will be entered into a prize draw for a brand new iPad2.

"I find DocBook to be an extremely useful mobile application that allows me to communicate with my colleagues in a secure manner.  In fact, I use it to help colleagues with difficult dermatologic cases that cannot be seen at my office immediately.  I am so glad that the San Francisco Medical Society is able to offer this as a free service for its members." —Lawrence Cheung, MD, SFMS Member

To download...

Go to the App Store or Android Market to download DocBookMD. All you need is your SFMS ID number to register for free. Need help locating your ID number? Contact Lauren Estrada at lestrada@sfms.org or (415) 561-0850.

This evening, the House of Representatives passed HR 3630, the “Middle Class Tax Relief and Job Creation Act of 2011,” by a vote of 234 to 193. In addition to proposals to extend the pay-roll tax cut and Unemployment Insurance (UI) programs, the bill included a proposal to provide two years of Medicare SGR relief with one percent increases in each year. The Senate Democratic leader has indicated that the House proposal does not have the support to prevail in the Senate. Additionally, the White House today announced that should the President be presented with the bill, he would veto it. Senate and White House objections mostly revolve around provisions used to pay for the House bill as well as a provision requiring the President to make a determination on the future of the controversial Keystone pipeline. AMA, CMA, and county medical societies did not support the House bill. We noted in a statement issued last week that the two year extension and modest updates would provide needed stability for physicians. However, the continued utilization of so-called “cliff financing” to hold the cost of the SGR provision to $39 billion would result in a 2014 payment cut of 37% and increase the cost of repealing the SGR by more than $60 billion to a total of greater than $350 billion. In the coming days, the Senate will likely unveil their proposal to address the pay-roll tax, UI, and the SGR.  We will continue to provide you with updates as the final days of the current session of Congress wind down. CMA is in close contact with our Senators as they develop the Senate alternative this week. Please continue those calls and emails to Senators Feinstein and Boxer. Please ask your Medicare patients to make calls as well by using the CMA patient flyer on our website. Congress cannot go home without stopping the Medicare SGR fee-for-service payment cut! Please use the AMA hotline at (800) 833-6354. Enter your ZIP code and it will automatically connect you to your Representative. Please call the hotline again to reach Senators Boxer and Feinstein. You can also send emails via https://writerep.house.gov, www.boxer.senate.gov and www.feinstein.senate.gov. The sheer volume of calls is important so Congress knows you are watching closely and they must act.