Marin Medical Society

MMS News Briefs


January 2013

• Medicare to implement 26.5% rate cut because of Congressional inaction

• Urge Rep. McCarthy and Sen. Feinstein to pass Medicare Locality update

• All local doctors invited to take MMS strategic planning survey

• County approves 10-year trauma contract with Marin General Hospital

• Medi-Cal primary care rate hikes delayed

• Pay your MMS/CMA dues by Jan. 15 and get a 5% discount

• More than 100 gifts for needy children donated at Operation Access event

• MMS office to be closed Dec. 24 to Jan. 1





Medicare to implement 26.5% rate cut because of Congressional inaction

The Centers for Medicare & Medicaid (CMS) issued a statement on Dec. 19 that because of Congressional inaction the agency will be forced implement the Medicare sustainable growth rate (SGR) formula cut of 26.5% beginning Jan. 1.

If Congress does adjourn without addressing the payment cut, CMS has said it will follow normal claims processing procedures. That is, claims will not be held and Medicare carriers will process payments for physician services provided after Dec. 31 under the normal 14-day cycle required by law. Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376.

The California Medical Association (CMA) has spoken with California leadership in Congress to confirm that the “fiscal cliff” negotiations have broken down. There is also no agreement within Congress to pass a stand-alone SGR bill.

Both Republican and Democratic leaders understand that physicians cannot sustain a 26.5% Medicare payment cut, but it is now caught up in the politics of the fiscal cliff. It is critical that physicians keep contacting their members of Congress to demand action.

In addition to the SGR cut, physicians are facing a potential 2% “sequestration” cut. The sequestration cuts are part of the $1.2 trillion in cuts required by the budget deal worked out to end last year’s debt-ceiling crisis.

Ultimately, CMA does not think Congress will allow the cuts to go forward on any long-term basis. At this time, it is impossible to predict whether the 112th Congress will find a way to pass a stop-gap measure before adjourning, how long such a measure would last, or how long payment cuts will be in effect until legislation can be passed after the 113th Congress convenes in January.

Congress is once again putting Medicare patients and the practices of physicians who treat them at significant risk.

“The health care delivery system is going to see an influx of patients in the next 18 months,” said CMA President Dr. Paul Phinney. “We simply cannot continue to cut resources while adding more patients. The result will be millions of patients with insurance coverage, unable to see a physician. This is especially true in California, where we are also battling cuts to the state’s Medicaid program at the same time.”

The financial disruption this situation will cause for physicians and their practices is unacceptable. CMA will continue to fervently convey this message in the strongest possible terms to Congress and the Administration. Our grassroots network has been activated, and we are seeking your voices to tell Congress just how deeply its inaction will affect you.

Despite these efforts, CMA feels compelled to advise physicians to start making plans to mitigate this disruption and meet their own financial obligations in January. Given the potential impact on practice revenue in early January, physicians should be certain that adequate arrangements are in place to sustain their practices. For those physicians who are forced into the untenable position of limiting their involvement with the Medicare program because it threatens the viability of their practices, we urge that patients be notified promptly so that they, too, can explore other options for obtaining needed medical care.

Physicians should also be aware that they have until Dec. 31 to make changes to their Medicare participation status for 2013. For more information on your participation options, see the AMA Medicare toolkit at

CMA will remain engaged throughout the holidays and keep you informed of any new developments. Meanwhile, contact your members of Congress and urge them to work together to stop the Medicare payment cuts before they take effect on Jan. 1. Use the AMA Grassroots Hotline at 800-833-6354. You will be asked to enter your zip code and select your Representative. Please select your Representative first, then call back to connect with Senators Boxer and Feinstein.

Though phone calls are most effective, you may also contact your members of Congress via email. Talking points and sample letters are available in CMA's grassroots action center.

Urge Rep. McCarthy and Sen. Feinstein to pass Medicare Locality update

Rep. Darrel Issa (R-San Diego) and Rep. Sam Farr (D-Monterey/Santa Cruz) are pushing a compromise Medicare Locality pilot program that would update California’s Medicare physician payment regions and payment rates and help to improve access to care. Because of the Medicare formula, physicians in California’s rural areas would experience a corresponding payment cut, so the proposal would hold rural physicians harmless from cuts.

A California administrative Medicaid funding source has been identified to pay for the “hold harmless,” so there is no cost to the federal government. Once the funding expires in 2017, the localities would revert back to the 2012 locality designations. While this is not the permanent solution that CMA has been seeking, it is a short-term compromise to help improve access to physicians in the 14 negatively impacted counties while protecting access to care in rural areas.

CMA is urging physicians to contact Sen. Dianne Feinstein and Rep. Kevin McCarthy (R-Bakersfield) and ask them to include the “California GPCI locality pilot” in the Medicare SGR/fiscal cliff legislation.

To contact Sen. Feinstein, call 202-224-3841 or visit

To contact Rep. McCarthy, call 202-225-2915 or visit

All local doctors invited to take MMS strategic planning survey

The MMS Board of Directors is launching an extensive strategic planning project and invites all local physicians to participate in an online survey about MMS and healthcare issues. Survey results will help guide MMS board members as they consider a strategic plan for 2013 and beyond. The goal of the plan is to ensure that MMS fulfills its mission of supporting physicians and their efforts to enhance the health of the community.

The survey is confidential, but MMS members who choose to identify themselves will be entered into a drawing for an iPad. Nonmembers who submit an MMS application form and pay their 2013 dues will also be entered into the drawing.

The survey consists of 16 questions about community health and MMS, with plenty of opportunities for additional comments. It should only take 5 minutes to complete.

To access the survey, visit

The deadline for completing the survey is Jan. 31.

County approves 10-year trauma contract with Marin General Hospital

Marin General Hospital, the county’s only designated trauma center, has received a new 10-year contract from the county. “Our partnership with Marin County Emergency Medical Services means that we will continue to provide high quality trauma care for all of Marin County,” said Mary Jane Boyd, director of trauma services at the hospital.

In related news, Marin General was recently reverified as a Level 3 trauma center by the American College of Surgeons. Level 3 is at the midpoint of the five levels of trauma center, with Level 1 being the most advanced. Dr. Edward Alfrey, medical director of the trauma center, noted that “Marin General functions more like a Level 2 center than a Level 3. For example, we have experienced neurosurgeons available 24/7, and the majority of patients requiring urgent or emergent surgery can be treated at Marin General, which matches the Level 2 requirement.”

Medi-Cal primary care rate hikes delayed

Medi-Cal primary care physicians will have to wait to receive the higher reimbursement rates that were set to go into effect on Jan. 1 under the Affordable Care Act (ACA). The delay has been caused by a state health plan amendment that must receive federal approval. It is not yet known when the federal approval process will be completed, but the California Department of Health Care Services (DHCS) has said the earliest it would be able to implement the increase is summer 2013. DHCS has been unable to provide any detailed information regarding the reason for the lengthy delay.

This 100% federally funded increase was intended to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the ACA. With the increase, primary care physicians should see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to Medicare, states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.

California is not alone in this delay; several other states are in the same boat as well. The final federal regulations governing the two-year primary care physician rate hike were released on Nov. 1, which did not give states much time to write and submit the necessary plan amendments.

DHCS has indicated that regardless of when it is implemented, the increase will be retroactive to Jan. 1, 2013. However, they have been unable to say when the rate increase will happen and exactly how retroactive payment will function, apart from indicating that physicians will not be required to resubmit claims.

Pay your MMS/CMA dues by Jan. 15 and get a 5% discount

Members who pay their 2013 MMS/CMA dues by Jan. 15 get a 5% discount. To qualify for the discount, dues must be received in CMA’s Sacramento office by Jan. 15, not just postmarked by that date. Dues invoices were mailed earlier this fall. If you need a copy, contact Rachel Pandolfi at 415-924-3891 or

More than 100 gifts for needy children donated at Operation Access event

Guests at the Dec. 11 Operation Access celebration cosponsored by MMS brought more than 100 toys and other gifts for distribution by the Marin Advocates for Children. In a thank-you note, Marin Advocates Director Cyndy Doherty wrote, “We were amazed by the amount of toys that were gathered by your members and we promise they will all be put to good use brightening the lives of abused and neglected children.”

The well-attended event took place at the Lagunitas Brewery in Petaluma and featured special recognition for several physicians who volunteer for Operation Access, which coordinates donated surgical and specialty care for uninsured and underserved patients. In addition to MMS, cosponsors of the event included the Meritage Medical Network, Kaiser Permanente, Marin General Hospital, Sutter Health, St. Joseph Health and the Sonoma County Medical Association.

MMS office to be closed Dec. 24 to Jan. 1

The office of the Marin Medical Society will be closed from Dec. 24 to Jan. 1, reopening on Jan. 2. Messages can be left on voicemail at 415-924-3891 or sent to


Dr. Matt Willis, an internist at Marin Community Clinics, has been named Public Health Officer for Marin County. He received his MD from Temple University and his MPH from Harvard. Before coming to Marin, he spent six years in the US Public Health Service. He vowed to make effective disease prevention a top priority. “Health care reform is upon us,” he said, “and while specific reforms are being debated, one thing is clear--effective disease prevention will be necessary to any sustainable system. Public health, if nothing else, is about prevention.”

Dr. Robert Schulman, a board certified physiatrist and pain medicine specialist, has opened Marin Integrative Physiatry at 250 Bel Marin Keys Blvd. in Novato. The practice offers a range of services, including electrodiagnostic medicine, medical acupuncture, osteopathic manual therapy, opiate-avoidant pain medicine and movement re-education. Dr. Schulman previously practiced in New York City and is a senior faculty member at the Helms Medical Institute in Berkeley.


The second annual Childhood Obesity Bay Area Conference will be held on Saturday, Feb. 23, at the Commonwealth Club, 595 Market St., in San Francisco. Acclaimed science writer Gary Taubes, author of “Why We Get Fat,” headlines a distinguished panel of speakers. This year’s conference will provide fresh insights into the various factors contributing to childhood obesity, and how leaders in the field are addressing those challenges. To register, visit

The following CMA webinars are scheduled for January. Webinars begin at 12:15 p.m. and run until 1:15 or later. To register, visit Seminars are free for CMA members and their staff; cost for nonmembers is $99 per person.

• HIPAA and Meaningful Use (Jan. 9)

• Medi-Cal application forms training (Jan. 16)

• Understanding ARC and CARD revenue codes (Jan. 23)

• The aging physician (Jan. 24)

• Physician’s guide to protecting your practice (Jan. 29)

• Keys to successful contracting (Jan. 30)

Physicians who meet one of the Medicare electronic prescribing hardship exemptions but did not file by the June 30 deadline have another opportunity to apply before Jan. 31. To assist physicians with questions regarding the electronic prescribing rules and applying for an exemption, CMA has posted the Medicare Electronic Prescribing Overview in the Resource Library at

The 20th annual HIV/AIDS Review will be held from 8 a.m. to 3:30 p.m. on Saturday, April 13, at the Hilton Hotel in Santa Rosa. Speakers includes Drs. Marshall Kubota, Danny Toub and Andy Desruisseau. For information and reservations, call the North Coast AIDS Center at 707-303-8904.


Family physicians needed

Family medicine positions available with Annadel Medical Group in Sonoma County. Contact

MMS members get free classifieds!

MMS members can place free classified ads in News Briefs or Marin Medicine. Cost for nonmember physicians and the general public is $1 per word. To place a classified ad, contact Erika Goodwin at or 707-548-6491.


The Marin Medical Society, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. We are affiliated with the California Medical Association and the American Medical Association.

© 2013 MMS, PO Box 246, Corte Madera, CA 94976