Saturday, December 20, 2014

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

SFMS Mourns Passing of Past Executive Director Susan Waters

The San Francisco Medical Society is saddened to announce the death of Dr. Susan B. Waters, CEO and Executive Director of SFMS from 1979 to 1993.

Dr. Waters died peacefully at her home on December 16, 2014 at the age of 63. A nationally recognized association executive, Susan was born in Denton, Maryland, and grew up in Public Landing, Maryland, on the Chincoteague Bay. She is remembered by her many friends and colleagues for her warmth, compassion, and for going out of her way for others.

Susan's leadership experience is deep and wide ranging, most recently serving as the CEO of The National Association of Insurance and Financial Advisors. Among many other recognitions, she was the first woman to serve as president of the American Association of Medical Society Executives and the Board of Directors and was the recipient of the American Society of Association Executives' Key Award, which recognizes the association CEO who demonstrates exceptional qualities of leadership and displays a deep commitment to voluntary membership organizations.

A service is to be held by the family at Makemie Memorial Presbyterian Church in Snow Hill, MD, (date to be determined, arranged by Burbige Funeral Home, Berlin, MD, 410-641-2111) and a celebration of Susan's life will be held at the American Society of Association Executives (ASAE) headquarters in Washington, DC on February 7, 2015. The family asks that donations be made in Susan's name to two organizations she strongly supported:

  • "So Others Might Eat," an interfaith, community-based organization that helps the poor and homeless in Washington, DC, 71 O Street, NW, Washington, DC 20001
  • "Smile Train," an international charity dedicated to addressing children's cleft lip and palate

Physician Practices Urged to Verify Patients’ Eligibility and Benefits in 2015

SFMS is advising physician practices to be diligent in verifying patients’ eligibility and benefits to ensure reimbursements for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations start over. With open enrollment, there may also be changes to patients’ benefit plans, or they may even be insured through a new payor.

The new year also brings a host of other challenges that could impact physician reimbursements:

  • Medicare patients can modify their enrollment choices from October 15 through December 7, allowing them to switch between Medicare fee-for-service and Medicare Advantage, or switch from one Advantage plan to another.
  • The Covered California open enrollment period is November 15, 2014, through February 15, 2015. Existing exchange/mirror patients have the option to select a different plan and Covered California expects an additional 500,000 individuals will enroll in an exchange plan during 2015 open enrollment.

    Additionally, there will be some changes to exchange/mirror product names in 2015. Covered California notified all exchange plans that the product names must be the same for exchange and mirror products and that plans must also utilize a standard naming convention for all individual exchange/mirror products.

    The 2015 Covered California QHP naming convention is as follows:
    [carrier name] + [metal tier name] + [Actual Value ] + [product type (e.g., EPO, HMO, PPO)]
    Example: Blue Shield Bronze 60 PPO

Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit.

And, don't forget that deductibles are typically based on the calendar year and will reset on January 1. Many of the exchange/mirror plans have high deductibles (e.g., $5,000 deductible on the Bronze plan), as do some employer-based plans. This reinforces the importance of verifying patient eligibility – particularly for exchange patients – each time they are seen. Best practice is to communicate with patients upon scheduling to remind them that their plan has a deductible that may be resetting on January 1 and, if that is the case, payment will be due at the time of service. If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice as your ability to collect can decrease significantly after the patient leaves the office.

Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money. 

Vaccination Rates Up in California Schools

For the first time in a decade, the number of parents who filed personal belief exemption forms to exempt their kindergarteners from vaccinations has declined in California. According to new data from the California Department of Public Health, the personal belief exemption rate decreased by 20% from 2013 to 2014, with 2.5% of kindergarten children opting out this school year, down from 3.1% in 2013.

The decline coincides with the implementation of a new state law, sponsored by the San Francisco Medical Society and the California Medical Association, which requires a parent or guardian seeking a personal belief exemption from school immunization to first obtain a document signed by a licensed health care practitioner. In the form, the practitioner is asked to attest that the parent or guardian has been informed of the benefits and risks of the immunization, as well as the health risks of the diseases that a child could contract if left unvaccinated.

AB 2109, authored by Sacramento pediatrician and Senator Richard Pan, was borne out of a rising concern over the continued increase in personal belief exemptions in California and recent outbreaks of diseases such as measles, mumps, and pertussis. Exposure to these preventable diseases places the individual child at risk, as well as the entire community, including infants too young to be fully immunized and individuals with compromised immune systems.

In California, parents could previously exempt their child from all immunizations by simply signing a two-sentence standard exemption statement on the back of the California School Immunization Record or provide a separate written statement that proclaims they are exempting their child. No other information or explanation of reason was required. The law still allows the form to be signed, but after a parent has gained full understanding of the risks and benefits of vaccination from a licensed health care professional.

Covered California Extends Deadline for January 1 Coverage

Covered California has extended the deadline for consumers to enroll in health coverage that begins on January 1, 2015. Consumers now have until December 21 to sign up for coverage.

The Los Angeles Times reports that the deadline extension signals high consumer interest. However, the extension also could be the result of problems with the exchange’s website and call centers. Wait times last week for the call center averaged 18 minutes, while 32% of callers dropped their call.

Source: California Healthline, December 16, 2015.

Significant New California Laws of Interest to Physicians for 2015

The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on scope of practice for allied health professionals, prescription drug abuse, public health issues and health care coverage. A summary of the most significant new health laws of interest to physicians are listed below. For an extensive listing, click here


CMA Position: Sponsored
Revises provisions of law requiring licensed health facilities to prevent disclosure of patients' medical information by extending the deadline for health facilities to report unauthorized disclosures from five to 15 business days after unlawful or unauthorized access, use, or disclosure has been detected. This bill also authorizes the report made to the patient or the patient's representative to be made by alternative means, including email, as specified by the patient. This bill also extends the deadline when reporting is delayed for law enforcement purposes, as specified, from five to 15 days business days after the end of the delay. This bill gives the Department of Public Health full discretion to consider all factors when determining whether to conduct investigations under these provisions.

(Health & Safety Code §1280.15)


CMA Position: Support
Deletes the limit on the number of syringes a pharmacist has the discretion to sell to an adult without a prescription and extends, until January 1, 2021, the statewide authorization for pharmacists to sell syringes without a prescription, as specified. Exempts the possession of a specified amount of hypodermic needles and syringes that are acquired from an authorized source.

(Business & Professions Code §§4144.5, 4145.5, 4148.5, 4144, 4145 and 4148; Health & Safety Code §§4149.5 and 11364.)

SB 964 (Hernandez E.) - HEALTH CARE COVERAGE

CMA Position: Support
Increases oversight of health care service plans with respect to compliance with timely access and provider network adequacy standards. Authorizes a health plan to include in its contracts with providers, provisions requiring compliance with timely access and network adequacy data reporting requirements. Requires DMHC to annually review health plan compliance with timely access standards and to post its final findings from the review, and any waivers or alternative standards approved by DMHC, on its Web site. Authorizes DMHC to develop, and requires health plans to use, standardized methodologies for timely access reporting, and exempts the development and adoption of the standardized reporting methodologies from the Administrative Procedures Act, the body of law governing state regulations, until January 1, 2020.

(Health & Safety Code §§1367.03, 1367.035, and 1380.3; Welfare & Institutions Code §§14456 and 14456.3)


CMA Position: Support
Requires, effective January 1, 2016, most health plans and insurers to cover a variety of Food and Drug Administration-approved contraceptive drugs, devices, and products for women, as well as related counseling and follow-up services and voluntary sterilization procedures. Prohibits cost-sharing, restrictions, or delays in the provision of covered services, but allows cost-sharing and utilization management procedures if a therapeutic equivalent drug or device is offered by the plan with no cost-sharing.

(Health & Safety Code §1367.25; Insurance Code §10123.196; Welfare & Institutions Code §14132)

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