Marin Medical Society

MMS News Briefs


November 2011

CMS approves Medi-Cal rate cuts

The Centers for Medicare and Medicaid Services (CMS) has approved a sweeping array of Medi-Cal cuts, including a 10% reduction in physician reimbursement for outpatient services. “With these cuts, physicians will only be reimbursed $11 per Medi-Cal patient visit, when it costs the physician several times that to provide,” said Dr. James Hay, president of the California Medical Association (CMA). “Physicians will be forced to reduce the number of Medi-Cal patients they accept, if they can continue to see any at all.”


The cuts, which are projected to save the state $623 million, were passed by the Legislature earlier this year but had to be approved by CMS, which determined that the cuts met federal access requirements. In a statement, CMS said, “The state has submitted extensive data demonstrating that the remaining cuts will not jeopardize Californians’ access to care.”


CMA disputed those findings, pointing to the state’s own data showing a 30% increase in emergency room usage by Medi-Cal patients from 2007 to 2009, the most recent reporting period. “The approval of provider payment reductions will ensure overcrowding in emergency rooms and will absolutely mean less access to care for all Californians,” said Dustin Corcoran, CMA’s chief executive.


CMA has filed a petition with CMS asking that corrective action be taken to address Medi-Cal reimbursement rates and access standards. According to research by the Urban Institute, Medi-Cal reimburses providers at 56% of the Medicare rate for the same service. For primary care services, Medi-Cal pays less than half of the Medicare rates.

MedPAC: Repeal SGR but freeze or cut physician pay

The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment policy, has recommended repealing Medicare’s sustainable growth rate (SGR) formula, but to offset the cost of repeal by freezing or cutting physician rates for the next 10 years.


Under MedPAC’s plan, primary care physician payments from Medicare would be frozen at current levels for 10 years, and specialists would see their pay cut by 5.9% a year over the next three years, followed by a seven-year freeze. The plan would avert the 29% physician pay cut that the SGR formula mandates on Jan. 1.


CMA strongly opposes MedPAC’s plan, arguing that a long-term payment freeze in an era of 6% average annual practice cost increases essentially equates to a significant payment cut. The association will continue to work with the AMA and others in organized medicine on a permanent repeal of the SGR.


CMA is urging physicians to tell Congress that repealing the SGR not only ensures patients can see a doctor when they need one, but also makes economic sense. A package of Medicare SGR materials--including an advocacy kit, a patient poster and a sample letter to Congress--has been posted at

Dr. Bason-Mitchell named medical director of county fire department

Dr. Mark Bason-Mitchell, an emergency medicine physician at Marin General Hospital, has been named medical director of the Marin County Fire Department. Because of ongoing budget cuts at the county, the position will be funded by the hospital. “As a district hospital, we view this collaboration as part of our mission,” said hospital CEO Lee Domanico.


Bason-Mitchell will provide medical direction to more than 70 paramedics at almost two dozen fire stations south of San Rafael. His responsibilities include teaching paramedics, reviewing cases and consulting on active cases. He will also direct the county’s search and rescue team and will serve as a liaison with the county’s emergency medical services agency.


The agreement between Marin General and the county marks a return to the original arrangement of the 1980s, where the hospital provided a physician consultant to the fire department. The county subsequently funded the position but can no longer afford to do so.

Last chance to register for Nov. 2 practice management workshop

Time is running out to register for a Nov. 2 practice management workshop cosponsored by the Sonoma and California medical associations. The workshop, scheduled for noon to 2 p.m. at the Fountaingrove Inn in Santa Rosa, will be conducted by Frank Navarro, associate director of the CMA Center for Economic Services. Topics include finding and keeping qualified staff, controlling costs, and understanding your revenue stream.


Cost is just $45 for MMS members; nonmembers pay $95. To register, print the form attached below and fax to MMS at 415-924-2749. You can also register by phone with a credit card by calling Rachel Pandolfi at 415-924-3891, or you can throw caution to the winds and register at the door.


Practice Management Workshop registration form

CMA urges legalization and regulation of medical cannabis

CMA has adopted official policy recommending legalization and regulation of medical cannabis (marijuana). The decision was based on a CMA white paper concluding that physicians should have access to better research, which is not possible under current drug policy. (To read the white paper, visit


“CMA may be the first organization of its kind to take this position,” said CMA President Dr. James Hay, “but we won’t be the last. This was a carefully considered, deliberative decision made exclusively on medical and scientific grounds. As physicians, we need to have a better understanding about the benefits and risks of medicinal cannabis so that we can provide the best care possible to our patients.”


CMA’s Board of Trustees adopted the policy without objection at its Oct. 14 meeting in Anaheim.


The federal government currently lists cannabis as a Schedule I drug, which restricts research on the substance. Part of the policy adopted by CMA emphasizes that the drug should be rescheduled in addition to being legalized.


Physicians, who are currently only allowed to “recommend” medical cannabis, have been stuck in an uncomfortable position since California decriminalized the drug in 2006. “California has decriminalized marijuana, yet it’s still illegal on a federal level,” said Dr. Hay. “That puts physicians in an incredibly difficult legal position, since we’re the ones ultimately recommending the drug.”

CMA House targets hospital foundations, brand-name drugs and more

Physicians at the annual CMA House of Delegates meeting in October adopted a number of resolutions that will determine CMA policy during the coming year. The resolutions ask CMA to:


* Advocate for stronger regulatory enforcement of California’s ban on the corporate practice of medicine, such as hospital foundation ownership of medical groups.


* Oppose the profit-motivated removal of generic medications from the market in favor of more expensive brand-name products.


* Advocate for expanding the J-1 Visa program beyond 30 slots. Visa waivers should be granted for six years initially, and preference should be given to physicians serving in rural and underserved areas.


* Support allowing eligible uninsured patients to enroll in public health programs at the time they receive care.

Want more state and national news? Read CMA Alert

For more state and national news stories, physicians are encouraged to read CMA Alert, a biweekly electronic newsletter published by the California Medical Association. The newsletter is posted at CMA members can receive a free email subscription by clicking the Subscribe link.


Four Marin physicians have received awards in recognition of their work for Operation Access, a nonprofit agency that links uninsured patients with surgeons and other specialists. The winners include Dr. Alice Cheng-Bennett, an ophthalmologist at Kaiser San Rafael; Dr. Mark Lawler, an orthopedist at Novato Community Hospital; Dr. Malini Nijagal, an ob-gyn at Marin Community Clinics; and Dr. Jahangir Sadeghi, an ophthalmologist at Marin General.


CMA webinars for November are listed below. The webinars are free for CMA members. Nonmembers pay $99. To register, visit

* Electronic Health Records Update (12:15 p.m., Nov. 2). The latest news on the Medicare and Medi-Cal EHR programs.

* EHR Meaningful Use (12:15 and 6:15 p.m., Nov. 9). How to qualify for EHR incentive payments.

* Top 10 Ways To Save Your Practice Money (12:15 and 6:15 p.m., Nov. 16). How to curb expenses and improve revenue.


Marsh, the insurance broker endorsed by CMA, is offering a high deductible health plan/health savings account that offers lower rates than other types of health insurance. In 2012, for example, individuals can contribute at least $3,100 (or $6,250 for family coverage) to the tax-deductible account and access the funds without penalty for health-related expenses. For more details, contact Marsh at 800-842-3761 or visit


Tareq Elqousy, MD, Internal Medicine*, Pediatrics*, 101 Rowland Way #220, Novato 94945, 878-7200, Fax 878-7201,, Cairo Univ 1986


Adam Nevitt, MD, Diagnostic Radiology*, PO Box 6102, Novato 94948, 884-3418, Fax 883-8082,, Rush Med Coll 1994


* board certified


Medical director/staff physician wanted

Sonoma Valley Community Health Center is seeking a family practice physician for the Medical Director/Staff Physician position. This position provides medical supervision and direction to the Health Center’s clinical services, as well as direct patient care. Must work collaboratively and be willing to support and back-up the mid-level clinicians, and provide call coverage through group call services for peds and family practice. We are looking for an innovator, a change manager and a demonstrated leader. Must have a current CA physician’s license. Call 707-939-6075 to learn more about the position. Website:



On-site guaranteed service. Office console provided. Stay compliant. Free consultation. Contact Marie Anderson at 415-721-7278 or


How to submit a classified ad
To submit a classified ad for MMS News Briefs or Marin Medicine, contact Erika Goodwin at or 707-548-6491. The cost is one dollar per word.


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.


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