April 2009

• Physicians need to comply with identity theft rules by May 1
• ABOUT SCMA
• TO UNSUBSCRIBE

Physicians need to comply with identity theft rules by May 1

Physicians who bill theirpatients for services, including copays, only have until May 1 to comply withthe federal government’s new “Red Flag Rules” for identity theft detection andprevention. According to the FTC, physicians who bill their patients are“creditors” and are thus subject to the new rules.

CMA and SCMA are offering twoimportant resources to help physicians comply with the new rules:

First, CMA has prepared a free26-page Red Flag Rules Toolkit thatincludes recommendations for designing and implementing an identity theftdetection and prevention program. The toolkit is available on the CMA websiteat www.cmanet.org, or you can contact SCMA for a free copy at 525-4375or rpandolfi@scma.org.

The second resource is a CMA Webinar on the Red Flag Rules from12:30 to 1:15 p.m. on Thursday, April 16. The webinar will focus on howphysicians can comply with the new rules. To register, visit cmanet.org.

ABOUT SCMA

The Sonoma County Medical Association, a 501(c)(6) nonprofitassociation, supports local physicians and their efforts to enhance the healthof the community. Founded in 1858, SCMA is affiliated with the CaliforniaMedical Association and the American Medical Association.

© SCMA 2009
3033 Cleveland Ave. #104
Santa Rosa, CA 95403

TO UNSUBSCRIBE

April 2009

• Nominations sought for Partnership Health Plan board of directors
• Public Health urges increased vaccinations for local children
• RSVP now for SCMA Wine & Cheese Reception on May 28
• Reminder: Medicare billing seminar in Santa Rosa on April 7
• Sign up for CMA Legislative Day and Leadership Academy
• SCMA Alliance sponsors two fundraisers during May
• Physicians need to comply with identity theft rules by May 1
• CMA files class action suit against WellPoint
• Three health-related propositions on May 19 special election ballot
• Dr. Mark Sloan reads from his new book at Copperfield’s on April 3
• Drs. Rosa and Bernstein named to new posts at Palm Drive
• Volunteers needed for Neighbors in Health
• Medical debts seminar - May 6
• Office equipment for sale
• Free file cabinets
• How to submit an ad

Nominations sought for Partnership Health Plan board of directors

Partnership HealthPlan of California (PHC), a CountyOrganized Health System charged with operating the Managed Medi-Cal program inSolano, Napa and Yolo counties, is scheduled to begin operating in SonomaCounty this October. At that time, PHC will assume care management responsibilityfor almost 50,000 Medi-Cal beneficiaries in the county.

For the past three years, PHC has been working with aPlanning Group appointed by the Sonoma County Department of Health Services toimplement Managed Medi-Cal in the county. The SCMA representative on thePlanning Group is Dr. Kirk Pappas.

As part of the implementation plan for Sonoma County, PHCwill soon expand its board of directors to 22 members and provide Sonoma Countywith seven board seats. The PlanningGroup has requested that SCMA identify a physician for consideration as anominee to the PHC board. This is a very important position, as the directorwill represent all Sonoma County physicians on the board that will control howthe Medi-Cal Managed Care program is administered.

The nominee will be submitted for consideration to RitaScardaci, director of the Sonoma County Department of Health Services. She willsubmit the final recommendations to the Sonoma County Board of Supervisors forapproval.

Important considerations for identifying candidates includethe ability to:

* Travel to Fairfield for board meetings on a monthly basis(evenings, fourth Wednesday of the month).

* Carry out the fiduciary responsibilities of the board inmeeting the health care needs of Medi-Cal recipients in all counties served byPHC.

The SCMA board of directors is hereby requesting nominationsfor the PHC board position. Applicantsshould submit a letter of interest and a CV to SCMA by April 30. Applicantsshould also indicate if they are interested in participating in a PHC boardsubcommittee. For more information about PHC, visit www.partnershiphp.org.

Applications should be submitted by mail, fax or e-mail toSCMA Executive Director Cynthia Melody at the address below. For questions,call her at 525-4359.

Cynthia Melody
SCMA
3033 Cleveland Ave. #104
Santa Rosa, CA 95403
Fax 525-4328
cmelody@scma.org

Public Health urges increased vaccinations for local children

Sonoma County’s childhood vaccination rates, already among the lowest in California, have become front-page news. Recent reports indicate that vaccination rates in some local private schools are as low as 24%, with certain public districts reporting rates as low as 54%.

A major cause of the low rates appears to be the “personal belief exemptions” (PBEs) that parents can sign to exempt their children from vaccinations. Many parents are signing PBEs because they fear vaccines can cause autism—a theory that has long since been discredited.

“Vaccines are safe and they don’t cause autism,” said Deputy Public Health Director Dr. Mark Netherda. He urged local physicians to present the facts about vaccines, along with this stark reminder: “The diseases that these vaccines prevent can kill your child.”

Childhood vaccines are used to prevent more than a dozen once-common contagious diseases, including measles and pertussis.

Netherda, who has an article about the county’s low vaccination rates in the current issue of Sonoma Medicine, said the situation is becoming more acute. “We are seeing these diseases in Northern California,” he noted. “They are on the rise because people aren’t vaccinating.”

Public Health is developing a plan to improve immunization rates and will probably hold a stakeholder meeting on the topic later this spring. Patient-education materials about vaccines are available from the CDC at www.cdc.gov and from the American Academy of Pediatrics at www.aap.org.

RSVP now for SCMA Wine & Cheese Reception on May 28

All SCMA members and their spouses or guests are invited toSCMA’s annual Wine & Cheese Reception on Thursday evening, May 28. Thisyear’s reception will be hosted by Dr. Richard and Julie Andolsen at theirprivate vineyard near Healdsburg. The event offers a wonderful opportunity togather with colleagues in a relaxed, convivial setting.

In addition to cheese and Andolsen Vineyard wines, thereception includes an informal alfresco dinner. There is no cost for SCMAmembers and their spouses or guests; the cost for nonmembers is $35 per person.

Reminder: Medicare billing seminar in Santa Rosa on April 7

Registration is still open forthe Palmetto GBA Medicare billing seminar in Santa Rosa on April 7. All staffinvolved with Medicare billing are urged to attend.

The seminar will run from 8:30a.m. to 12:30 p.m. on Tuesday, April 7, in the Vesalius Room at the SutterMedical Center of Santa Rosa. The address is 3325 Chanate Rd.

To register, visit www.PalmettoGBA.com/J1B and click on the“Learning and Education” tab. Please note that registration for the seminarmust be completed through Palmetto, not SCMA.

Sign up for CMA Legislative Day and Leadership Academy

There’s still time to sign up for CMA’s Legislative Day on April 14, and for their Leadership Academy on April 24-26. Both events help get physicians more involved in the all-important political process.

On Legislative Day, physicians from across the state will gather in Sacramento to hear Attorney General Jerry Brown and others discuss health care policy in a series of morning and luncheon briefings. During the afternoon, SCMA members will be able to meet face-to-face with legislators from Sonoma County.

CMA provides all Legislative Day meals and conference materials free of charge. To RSVP, contact Rachel Pandolfi at 525-4375 or rpandolfi@scma.org. SCMA is coordinating carpools.

The Leadership Academy, which offers 17.5 hours of CME, will be held April 24-26 at the Disneyland Hotel in Anaheim.

Topics include health system reform in a new era of Washington politics; the “medical home” and other emerging models for delivering quality care; the promises and perils of hospital EHR initiatives; and health disparities.

The cost is just $745 for SCMA members or $1,045 for nonmembers. Reduced rates are available for staff and for single-day tickets. To register, call 800-795-2262 or visit www.caleadershipacademy.com. 

SCMA Alliance sponsors two fundraisers during May

The SCMA Alliance will be busy raising funds for local nonprofits during May.

On May 9, Team Alliance will participate in the annual Human Race, which raised more than $1 million for charity last year. Funds raised by Team Alliance will fund breast cancer awareness, safety for school-aged children, and health promotion programs.

Physicians and staff can support Team Alliance by signing up to participate in the race or helping at the Team Alliance booth. To sign up, contact Ann Hurd at 537-1031 or annhurd08@comcast.net or Kathleen Cortez at 483-4953 or kkcortez@sonic.net.

For the less athletically inclined, the Alliance is also sponsoring their annual Garden Tour in Sonoma on May 15 and 16. Participants can take self-guided tours of five spectacular private gardens, enroll in gardening workshops, and participate in a raffle whose prizes includes dinners at Cyrus or the Farmhouse Inn.

Tickets for the Garden Tour are just $40; an optional lunch at Meritage Restaurant is $22. To purchase tickets, visit www.scmaa.org or call Janet Shane at 578-4537.

Physicians need to comply with identity theft rules by May 1

Despite objections from organized medicine, the FederalTrade Commission has ruled that physicians who regularly bill their patientsfor services (including copayments and coinsurance) are considered “creditors”and must develop and implement written identity theft prevention programs fortheir practices by May 1. The so-called Red Flag Rules are required for allfinancial institutions and creditors.

CMA has argued that the Red Flag Rules impose an unnecessaryburden on physician practices, which often operate under strained conditions.CMA also notes that HIPAA already imposes strict requirements to safeguardpatient information. Until further notice, however, physicians should begin toplan their Red Flag compliance programs.

CMA will be hosting alive webinar on April 16 from 12:30 to 1 p.m. to help members understand andcomply with the Red Flag Rules. To register, visit www.cmanet.org/calendar.CMA will also be posting a toolkit on www.cmanet.org to help physicians developand implement identity theft detection programs. 

CMA files class action suit against WellPoint

CMA has joined with other state medical groups and the AMA to file a class action lawsuit against WellPoint. The lawsuit alleges that WellPoint colluded with United Health Group on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care.

“Health insurers are data manipulating to set rates artificially low, forcing patients to pay more than they bargained for when they go to a doctor of their choice,” said Dr. Dev GnanaDev, CMA president.

WellPoint, which operates as Blue Cross in California, is legally bound to pay the “usual and customary rates” (UCR) for care provided to their enrollees by an out-of-network physician. To determine UCR rates, WellPoint uses a database run by Ingenix, a company owned and operated by United Health Group.

A recent investigation by New York Attorney General Andrew Cuomo concluded that the Ingenix data is intentionally manipulated to allow health plans to shortchange reimbursements on medical bills. WellPoint agreed to pay $10 million to help fund a new database run by an independent nonprofit organization to replace Ingenix. The company also agreed to quit feeding data into Ingenix and use the new system once it is up and running.

The class action suit has been filed because the settlement with Cuomo did not seek redress for patients and doctors. ”CMA,” said Dr. GnanaDev, “will continue fighting to obtain relief for patients and physicians who were harmed by the systemic flaws of the conflict-ridden Ingenix database.” 

Three health-related propositions on May 19 special election ballot

Election-weary Californians haveyet another set of ballot propositions to wade through, thanks to the state’shistoric budget agreement earlier this year. A special election set for May 19will include six budget measures, three of which are related to health care.

Proposition 1A would direct the state to spend any excess revenueon education, the Budget Stabilization Fund, and paying off debt, in thatorder. Because health care funding is unprotected, the proposal could result infurther cuts to Medi-Cal and Healthy Families.

Proposition 1D would redirect cigarette tax funds from First 5commissions to the state’s general fund. The proposal could hamper local First5 programs for children’s services but might benefit state-level programs.

Proposition 1E would redirect taxes on the wealthy from an accounttargeted for mental health programs to the general fund. As with Proposition1D, the results are likely to be mixed, with some mental health programsbenefitting and others not.

Dr. Mark Sloan reads from his new book at Copperfield’s on April 3

Dr. Mark Sloan, a pediatrician at Kaiser Santa Rosa, willread from his newly published book, BirthDay, at Copperfield’s Books in Santa Rosa’s Montgomery Village at 7 p.m. onFriday, April 3. The subtitle of the book gives a good idea of its contents: “Apediatrician explores the science, the history, and the wonder of childbirth.”

A longtime member of the SCMA Editorial Board, Dr. Sloan haswritten many articles and editorials for SonomaMedicine, including the editorial for the current issue on children’shealth.

Drs. Rosa and Bernstein named to new posts at Palm Drive

Drs. Greg Rosa and Allan Bernstein are assuming new dutiesat Palm Drive Hospital. Dr. Rosa, a veteran family physician, is directing thehospital’s new medical center, which will offer primary care to west countyresidents. Dr. Bernstein, former co-chief of neurology at Kaiser Santa Rosa, willdirect a headache clinic for Palm Drive.

Volunteers needed for Neighbors in Health

Last year, more than 500 children participated in Neighborsin Health, a day-long event that provides medical care, immunizations, wellchecks and dental exams to uninsured and underinsured children. Organizers hopeto serve even more children at this year’s event, scheduled for August 2. Tovolunteer, visit www.unitedwaywinecountry.org/nih.

Medical debts seminar - May 6

Office equipment for sale

Free file cabinets

How to submit an ad