Tuesday, January 22, 2019
SCMA News Briefs
707-525-4375  | Executive Director: Wendy Young | exec@scma.org

December 2008


Physicians need to request performance data by Dec. 16


Physicians have until Dec. 16 to request the data used to determine their California Physician Performance Initiative (CPPI) “performance scores.” Payors such as Blue Cross or Blue Shield may soon be using these scores to determine pay-for-performance rates or to create tiered networks.

CPPI recently sent about 20,000 California physicians their performance scores on 15 quality measures based on claims data from Medicare and from United Health, Blue Cross, and Blue Shield PPOs. The letters do not contain the underlying data.

CMA has expressed serious concerns about the accuracy and integrity of the data used to establish these scores. In order to address CMA’s concerns and to improve the quality of the data, CPPI has created a reconsideration process that physicians should use to verify the data.

All physicians should request their data from CPPI and verify its accuracy. If you do not raise concerns now, payors will use the data in the future to adjust your reimbursements and change the flow of patients to your practice.

Step-by-step instructions for obtaining and reviewing your patient data are available at www.cmanet.org/cppi. After finishing the reconsideration process, you should also complete the online survey at the same address to tell CMA what, if anything, was wrong with your performance scores.

For more information, contact the CMA member help line at 800-786-4262.

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Pay SCMA dues by Dec. 31 to qualify for 5% discount


SCMA members who pay their 2009 dues by Dec. 31 qualify for a 5% discount. Payments need to be at SCMA by Dec. 31; there is no grace period.

Invoices were mailed earlier this fall. If you need a copy of your invoice or have any dues questions, contact Rachel Pandolfi at rpandolfi@scma.org or 525-4375.

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More than 200 attend SCMA’s 150th Anniversary Celebration


SCMA’s 150th anniversary celebration at the Vintner’s Inn on Nov. 11 drew more than 200 local physicians, spouses and community members, making it by far the best attended SCMA event in recent memory.

“The attendance spoke for itself,” said SCMA president-elect Dr. Richard Powers, noting that the event promoted collegiality among physicians and encouraged them to resume their role as community leaders.

SCMA has received many complimentary notes and e-mails about the event from physicians. “The food and the setting were terrific,” wrote former SCMA president Dr. Heather Furnas, “but best of all was the camaraderie of the Sonoma County physicians, the SCMA staff, and physician leaders from our CMA district. … It was a very special evening with an extraordinary group of people.”

“The whole spirit was reassuring,” observed another former SCMA president, Dr. Fred David. “Despite all the troubles with medicine, we get a lot of support from seeing our colleagues in a social setting.”

Complimentary copies of the 16-page commemorative program distributed at the event are still available. To get a copy, contact Cynthia Melody at cmelody@scma.org or 525-4359.

Event photos will soon be posted on the SCMA website at www.scma.org.

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Palmetto GBA seminar at SCMA on Jan. 26


Palmetto GBA, the new Medicare administrator for California,will be conducting a free seminar on Medicare billing at SCMA from noon to 2p.m. on Monday, Jan. 26. Attendees need to bring their own lunch.

The seminar will be conducted by Sandra Siddall, a provideroutreach consultant for Palmetto. She noted, “We realize that during thetransition period, many physicians have encountered numerous problems [withMedicare billing].” She will address any billing topics of concern toattendees.

To reserve a spot and suggest topics, contact RachelPandolfi at rpandolfi@scma.org or 525-4375. Space is limited, so early reservationsare recommended.

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Inpatient psychiatric care may return to Sonoma County


Inpatient psychiatric care,which has been unavailable in Sonoma County since last spring, may return earlynext year, depending on the outcome of negotiations between several interestedparties.

Drs. Daniel Marrin and JimBerger--owners of the Fulton Road general acute care facility in Santa Rosaclosed by Memorial Hospital earlier this year--are negotiating with twopsychiatric hospital groups that want to reopen the facility. A third companyhas also expressed interest, as has the Joint Powers Authority (JPA) thatrepresents the county’s district hospitals.

Negotiations are complex becauseMarrin and Berger also own a general acute care facility on Sotoyome, acrossfrom Memorial Hospital. Under one scenario, the Fulton facility would be soldto a psychiatric group for inpatient psychiatric care, and the JPA wouldacquire the Sotoyome building for general acute care, possibly establishing anew Santa Rosa hospital district.

“It now costs $3 million to $5million per bed to build a new general acute care hospital,” said Marrin,noting that the Fulton and Sotoyome facilities already have 138 beds, and thatdemand for acute care is likely to increase as the population ages.

If the Fulton Road facility isused for psychiatric care, Sonoma County Mental Health would contract for beds,along with Kaiser and other providers. “Our average daily need is approximately8 to 10 beds, sometimes higher,” said Art Ewart, the county’s mental healthdirector. “This would solve virtually all the needs for psychiatric inpatientcare for adults.”

Further complicatingnegotiations is the possible sale of a portion of the Fulton Road property tothe Southwest Community Health Center, which would construct a 50,000 squarefoot facility to house the Santa Rosa Family Medicine Residency.

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Southwest Health Center acquires two more clinics


Southwest Community Health Center has acquired the SantaRosa Homeless Clinic (formerly the Santa Rosa Free Clinic) and the RoselandChildren’s Health Center. Both clinics were threatened with closure because of risingcosts, decreased funding and increasing patient loads.

 “It is verydifficult for these smaller clinics to be financially sustainable in today’shealth care environment,” said SCHC CEO Naomi Fuchs. “Bringing these clinicsinto the SCHC organization will improve access, strengthen programs, andprovide financial sustainability. It is the right thing to do.”

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Court upholds balance billing regulation--for now


The Sacramento Superior Courthas determined that the Department of Managed Health Care’s “balance billing”regulation is valid, but only insofar as it seeks to define balance billing asan unfair billing pattern. The court did not address whether the DMHC canenforce the regulation against providers, despite DMHC’s public assertions thatthis regulation “prohibits” balance billing. The DMHC, however, has indicatedthat it intends to take enforcement action against providers who balance bill.

CMA attorneys are reviewing theruling to determine the best strategy for an immediate appeal. They are alsoexploring separate litigation avenues to challenge the DMHC’s authority toprohibit balance billing or take any enforcement action based on thisregulation. 

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Influenza and pneumococcal vaccines pricing


The Medicare Part B paymentallowance limits for influenza and pneumococcal vaccines are 95% of the AverageWholesale Price, except where the vaccine is furnished in a hospital outpatientdepartment. In those situations, payment for the vaccine is based on reasonablecost.

Annual Part B deductible andcoinsurance amounts do not apply for the influenza virus and the pneumococcalvaccinations. All physicians, non-physician practitioners and suppliers whoadminister these vaccinations must take assignment on the claim for thevaccine.

The prices below reflect thepayment allowance for the listed CPT codes when the vaccines are furnishedoutside the hospital outpatient department:
* CPT 90655: $16.879
* CPT 90656: $18.198
* CPT 90657: $6.609
* CPT 90658: $13.218
* CPT 90660: $22.316

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Operation Access needs physician volunteers


Operation Access, a nonprofit organization that works with hospitals to provide elective outpatient surgeries and procedures to the uninsured, needs physician volunteers. The hospital waives all expenses and covers professional liability and malpractice insurance for physicians and other medical staff who volunteer. Participating hospitals include Petaluma Valley, Memorial and Kaiser Santa Rosa.

To volunteer, contact Daniel Rabkin at daniel@operationaccess.org or 415-733-0004.

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Electronic health records seminar in SF on Dec. 16


A seminar on electronic health records sponsored by the Healthcare Information and Management Systems Society will be held in San Francisco on Tuesday afternoon, Dec. 16. Topics include the current state of EHR systems and EHR usage among hospitals, physician offices, insurance companies and patients.

Tickets cost $55. To register, visit www.nocalhimss.org.

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Online CME program offers advice on helping veterans


Physicians can receive CME credit for accessing www.joiningforcesonline.org, a Web-based series of half-hour television programs that explore the medical, psychological and social issues that confront returning veterans and their families. The series is of particular benefit to doctors who are unfamiliar with the injuries, visible and invisible, that may be present in veterans.

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Buck Institute hosts session on drugs and aging


A free public session onpharmacological and non-pharmacological intervention in aging will be held at theBuck Institute in Novato on Tuesday morning, Dec. 9. Topics include drugindustry targeting of aging as a disease and use of yoga techniques assustainable health care. Reservations are required; phone 415-209-2030.

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Dr. James Dawson and Dr. Dick Lose pass away


Two longtime SCMA members, Drs.James Dawson and Dick Lose, died in November.

Dr. Dawson, who belonged to SCMAand CMA for more than 50 years, was 88. Originally a general practitioner inPetaluma and Forestville, he became an attending physician at Sonoma StateHospital in the 1960s. He then completed residencies in psychiatry andneurology and served as the facility’s chief of professional education.

Dr. Lose was a family physicianin Sonoma for many years. He served as president of the Sonoma County chapterof the American Academy of Family Physicians and as chief of staff at SonomaValley Hospital. He was 84.

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Guy Delorefice, MD
Internal Medicine*
401 Bicentennial Way
Santa Rosa 95403
393-4733 Fax 393-4556
guydhunter@aol.com
Creighton Univ 1996

Mark Hurd, MD
Anesthesiology*
837 Fifth St. 2nd Floor
Santa Rosa 95404
522-1800 Fax 524-4687
jmahurd007@comcast.net
Tulane Univ 1986

Amita Kachru, MD
Obstetrics & Gynecology
500 Doyle Park Dr. #103
Santa Rosa 95405
579-1102 Fax 579-1386
akachru@gmail.com
Michigan State Coll 2004

Phi-Nga Le, MD
Internal Medicine*
Pediatrics*
401 Bicentennial Way
Santa Rosa 95403
393-4150 Fax 393-4298
phi.n.le@kp.org
Creighton Univ 1992

Yasmin Nibbe, MD
Internal Medicine*
Pediatrics*
401 Bicentennial Way
Santa Rosa 95403
393-4300 fax 393-4558
yasmin.k.nibbe@kp.org
Chicago Med Sch 2001

Rudy Santos, MD
Internal Medicine*
1165 Montgomery Dr.
Santa Rosa 95405
547-5437 Fax 547-5430
rudy510s@hotmail.com
St. George Univ 1997

Jerome Smith, MD
Pediatrics*
430 W. Napa St. #F
Sonoma 95476
939-6070 Fax 939-6077
jsmith@svchc.org
George Washington Univ 1997

* board certified

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MEDICAL OFFICE SANTA ROSA
Office in class "A" medical building at 1111 Sonoma Ave., SantaRosa. Approx. 100 sq. ft., with sink. $795/mo., including utilities. Access toshared waiting room, reception area, kitchen, private restrooms. Handicapaccessible. Ample parking. Contact Judy at 707-528-0911.

MEDICAL OFFICE SONOMA
Suite available: Perkins Medical Center, Sonoma. 1800+/- sq ft. $2890/mo.707-996-4519.

To submit a classified ad forNews Briefs or Sonoma Medicine, contact Nan Perrott atnperrott@rhscommunications.com or 707-525-4226. The cost is one dollar perword.

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