California Medical Association

Monday, May 2, 2016

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Providing news to the San Francisco Medical Community.


CMS Releases Notice of Proposed Rulemaking for MACRA

CMS released a notice of proposed rulemaking (NPRM) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Supported by a bipartisan majority and stakeholders, such as patient and medical associations, the MACRA legislation ended more than a decade of last-minute fixes and potential payment cliffs for Medicare doctors and clinicians. It also made numerous improvements to America’s health care system. 

Currently, Medicare measures the value and quality that physicians and other clinicians provide through a patchwork of programs. In the MACRA legislation, Congress streamlined these programs into a single framework to help clinicians transition to payments based on value from payments based on volume. The proposed rule would implement changes through this unified framework known as the Quality Payment Program, which includes two paths: 

  1. Merit-based Incentive Payment System (MIPS): Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS. MIPS allows Medicare clinicians to be paid for providing high value care through success in four performance categories:
  • Quality (50% of total score in year 1)
  • Advancing Care Information (25$ of total score in year 1)
  • Clinical Practice Improvement Activities (15% of total score in year 1)
  • Resource Use (10% of total score in year 1)
  1. Advanced Alternative Payment Models (APMs): Clinicians who take a further step toward care transformation would be exempt from MIPS reporting requirements and qualify for financial bonuses. These models include:
  • Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)
  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program – Track 2
  • Medicare Shared Savings Program – Track 3
  • Next Generation ACO Model
  • Oncology Care Model Two-Sided Risk Arrangement (available in 2018) 

Click here to review the press release on the MACRA proposed rule

Additional resources


SFMS Advocates for Public Health Protections to Help Prevent Diabetes, Heart Disease, and Stroke

Today, the SFMS joined the American Heart Association and other public health experts in a press briefing in support of World Health Day and San Francisco’s sugar-sweetened beverage warning label for advertisements legislation.

The City’s warning label ordinance, endorsed by SFMS, is widely recognized as a consumer-friendly tool to increase health awareness and information. Supervisor Scott Wiener and Dean Schillinger, MD, from the UCSF Diabetes Center highlighted the importance of educating communities and consumers most negatively impacted by sugary drinks. SFMS was represented by board member John Maa, MD, and UCSF medical students.


Open Payments Review and Dispute Period Now Open

Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians and teaching hospitals during 2015. Physicians and teaching hospitals now have 45 days to review and dispute records attributed to them. The review and dispute period is open from April 1 until May 15, 2016. The review and dispute process is voluntary, but encouraged.

The Centers for Medicare and Medicaid Services (CMS) will publish the 2015 payment data and updates to the 2013 and 2014 data on June 30, 2016.

Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” were reported to CMS for publication in the online database.

Physicians who are not already registered should be aware that there is a two-step process to register for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Identity Management System portal, a step many physicians may have already completed as the gateway enables access to a number of other CMS programs. Step two is to register in CMS’ Open Payments system.

Physicians who have already registered but have not accessed their account in the past 60 days will need to unlock their account by going to the CMS Enterprise Portal, which will prompt you to enter your user ID and correctly answer all challenge questions. You will then be prompted to enter a new password.

Users who registered last year, but have been inactive for more than 180 days, will need to reactivate their account by contacting the Open Payments Help Desk via email or by phone at (855) 326-8366.

CMS will also be hosting a provider call on April 12, 2016, to help physicians understand the program and how they can review applicable data on payments or transfers of value prior to publication. Advance registration is required to participate in the call. Click here to register for the call.

Physicians and authorized representatives can also submit questions to the CMS Help Desk at openpayments@cms.hhs.gov or (855) 326-8366, Monday through Friday, from 8:30 am to 7:30 pm EST, excluding federal holidays.


Article References for April 2016 San Francisco Medicine

References cited for "Gun Science, Safety, and Sanity" by Richard Podolin, MD, FACC.

  1. http://ww2.kqed.org/stateofhealth/2015/12/14/doctors-call-for-end-to-20-year-ban-on-gun-violence-research/
  2. http://www.apa.org/science/about/psa/2013/02/gun-violence.aspx
  3. JAMA. 2013;309(6):549-550. doi:10.1001/jama.2012.208207.
  4. Title X, starting on page 2,037, line 23. 
  5. http://journalofethics.ama-assn.org/2014/04/pfor2-1404.html
  6. Washington post July 27, 2012

References cited for "Data Security and the Dawn of Digital Medicine" by Tiffany Leung, MPH, FACP.

  1. Pharmaion Consultants. Telemedicine market in the U.S. estimated to cross $ 13 billion by 2021. 2016. http://www.news-medical.net/news/20160216/Telemedicine-market-in-the-US-estimated-to-cross-24-13-billion-by-2021.aspx. Accessed March 9, 2016.
  2. Department of Health and Human Services. Breach Notification Rule. http://www.hhs.gov/hipaa/for-professionals/breach-notification/index.html. Accessed March 12, 2016.
  3. Office of Civil Rights Department of Health and Human Services. Breaches Affecting 500 or More Individuals. https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf. Accessed March 12, 2016.
  4. Davis J. Nest, other IoT devices, sent user info in the clear. SC Mag. http://www.scmagazine.com/nest-other-iot-devices-sent-user-info-in-the-clear/article/466616/. Accessed March 14, 2016.
  5. The Office of the National Coordinator for Health Information Technology (ONC). Guide to Privacy and Security of Electronic Health Information. https://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf. Accessed March 14, 2016.
  6. The Office of the National Coordinator for Health Information Technology (ONC). Health IT Privacy and Security Resources. https://www.healthit.gov/providers-professionals/ehr-privacy-security/resources. Accessed March 14, 2016.

4/20: San Francisco Physician Investing Discussion Group Meeting

Ever wonder why Warren Buffet is so successful? Want to know how to choose equities, options and mutual funds? Interested in becoming a better investor for retirement or to supplement your income? Local physicians are starting up a new discussion group where doctors help doctors achieve their financial goals. Come join your colleagues for a stimulating evening. Novices to experienced investors are welcome!

Wednesday, April 20
6:00 pm - 7:30 pm
First Republic Bank, 1088 Stockton Street

For more information, please email George Fouras, MD by clicking here.

San Francisco Physician Investing Discussion Group (“SFPIDG”) is not affiliated with the San Francisco Medical Society (SFMS). SFMS has no responsibility for any of the information, advice, suggestions offered by any participant at any SFPIDG meeting.


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