Marin Medical Society

MMS News Briefs


February 2012

Judge blocks state’s attempt to slash Medi-Cal reimbursement rates

By CMA President Dr. James Hay


On Feb. 1, because of the efforts of a coalition led by the California Medical Association, a final ruling was issued by Judge Christina Snyder of the California Central Federal District Court, which blocks a 10% Medi-Cal reimbursement rate reduction. Her decision is a huge win for physicians in California and for the patients they treat.


California faces a budget deficit every year, and to close that widening gap, programs are cut and services are slashed. Medi-Cal is a program that is constantly targeted, and proposals always seem to include reducing reimbursement rates for physicians as a short-term solution. CMA has repeatedly informed the state, the federal government and the courts about the unacceptable impact of those cuts.


Year after year, we’re obliged to tell the same story: if Medi-Cal rates are cut, physicians will be forced to stop accepting the patients that need care the most. Thanks to the hard work of CMA’s legal and legislative staff, our voices have been heard, yet again. As we argued, Judge Snyder’s ruling stated that “fiscal crisis does not outweigh the serious irreparable injury plaintiffs would suffer absent the issuance of an injunction.”


It is more important than ever that we fight these fights and that we set a precedent for other states to follow. As the nation faces a changing health care landscape over the coming years, it is also critical that we physicians stand together. We thank our members for helping us accomplish this important outcome, preventing deterioration of access to care. My hope is that this achievement will serve as a reminder to those who are not yet members, and encourage them to join CMA today. To have continued success winning these battles for all California physicians and patients, it is crucial that we gain the support of those who benefit most.

Public health officer steps down; search for new one underway

After less than a year on the job, Dr. Jason Eberhart-Phillips has resigned as public health officer for Marin County. He has been replaced on an interim basis by Dr. Craig Lindquist as the county begins searching for a new officer. The deputy health officer, Dr. Anju Goel, resigned last fall.


No official reason was given for the abrupt change, but the county has been dealing with budget shortfalls the last few years. The rapid turnover of key personnel stands in stark contrast to the long tenure of the previous officer, Dr. Fred Schwartz, who served from 1993 to 2010.


Nominations needed for MMS election

In preparation for the upcoming MMS election, all members are urged to submit nominations for leadership positions by March 14. Nominees must be MMS members in good standing. Nominations are requested for the following positions:

• MMS president-elect

• MMS board of directors (3)

• CMA delegate (1)

• CMA alternate delegate (1)


All positions require a three-year commitment, beginning July 1. Nominations can be emailed to, or faxed to 415-924-2749, or mailed to MMS, PO Box 246, Corte Madera 94976. Each nomination should include a brief statement about the nominee’s qualifications.


For more details, contact Cynthia Melody at or 415-924-3891.


Take the CMA survey about Medicare audits by Feb. 3

Physicians throughout California are urged to complete a brief survey from CMA about how repeated Medicare audit requests are affecting their practices. Palmetto, the Medicare administrator contractor for California, has been sending multiple requests for medical records to physician offices and is delaying payment to physicians for claims associated with the records.


If your office has received requests for medical records from Palmetto, please complete the survey at The results will assist CMA in its negotiations with Medicare. The deadline is Feb. 3.


Enroll now for important Medicare seminar in Santa Rosa

Physicians and office staff are encouraged to attend “Medicare 2012 & Beyond: Know Your Rights,” a 6-hour seminar scheduled for April 18 at the Fountaingrove Inn in Santa Rosa. The seminar, which runs from 8 a.m. to 2 p.m., is cosponsored by the Sonoma County Medical Association and CMA. Topics include the Medicare physician fee schedule, 2012 updates and reminders, medical review audits, and preparing for ICD-10. The presenter is Michele Kelly, associate director of the CMA Center for Economic Services. Continental breakfast and lunch will be provided.


Cost is $55 for MMS members and $105 for nonmembers. To register, fax the flyer below to SCMA at 707-525-4328 or contact Rachel Pandolfi at 707-525-4375 or


April 18 Medicare Seminar flyer

Unspent military funds could be used to repeal the Medicare SGR formula

Now that Congress is back in session, one of the first orders of business is to address the looming 27% cuts in Medicare payments to physicians. The cuts have been delayed until March 1 in the hopes that some kind of compromise can be found. One such possibility is a plan recently floated by House Democrats to use unspent military funding from early troop withdrawals in Iraq and Afghanistan to repeal the Medicare SGR payment formula.


That idea and others will be considered by a House-Senate conference committee that includes two strong physician advocates from California: Rep. Henry Waxman (D-Los Angeles) and Rep. Xavier Becerra (D-Los Angeles). CMA, AMA and many other medical associations have united to push for the House Democrats’ plan, which could cover the $300 billion cost of eliminating the SGR formula. The AARP has joined in as well, launching a campaign with the message, “Medicare patients could lose access to the doctors they know and trust in just a few weeks.”


CMA continues to urge physicians to call Senators Dianne Feinstein and Barbara Boxer and ask them to protect access to care in California by using unspent military funds to repeal the Medicare SGR. Let them know that the SGR cuts must be stopped before the March 1 deadline. Call the AMA Grassroots Hotline at 800-833-6354, plug in your zip code, and you will automatically be connected to your senator.


Physicians invited to meet legislative candidates

With the election year in full swing, MMS is arranging for interviews with local candidates for the U.S. Congress and the California Assembly. Dates and locations have yet to be established, but if you are interested in attending, please contact MMS Executive Director Cynthia Melody at or 415-924-3891.


Blue Cross ordered to pay money owed to doctors, dating back to 2007

The California Department of Managed Health Care has ordered Anthem Blue Cross to pay physicians money owed to them, with interest, for services provided dating back to 2007. The action is a result of Anthem’s refusal to remediate physicians and other providers following a financial claims audit that identified errors in payment of medical claims.


CMA President Dr. James Hay applauded the DMHC order. “We provide necessary care to our patients based on the assumption that the health plans will promptly and accurately reimburse us for services rendered,” he said. “Anthem Blue Cross’s refusal to pay for a mistake on their end puts an undue burden on those of us who provide care.”


In 2008, DMHC launched claims audits of the seven largest health plans in California due to a growing pattern of complaints regarding late and inaccurate payments and inappropriate claim denials. These audits found claims payment violations above the threshold allowed under California law at all seven health plans.


In response to the audits, DMHC required the plans to pay providers the money they were owed and to demonstrate improvements to claims processes to prevent future errors. In addition, each plan entered into settlement agreements to pay administrative fines. To date, six of the seven plans have undertaken remediation efforts, but Anthem has refused to pay for claims violations uncovered in the audit. The company has to send DMHC a corrective action plan this month to identify the claims that were not correctly paid and pay the providers as prescribed by law.

Blue Shield begins recontracting with physicians across state

Blue Shield is in the process of recontracting with physicians across California and has begun mailing notices to physicians in selected counties, including several in the North Bay. The company explained that they have not recontracted with physicians in over a decade, and that they will be offering various tiered networks in anticipation of California’s health insurance exchange, a key feature of the federal health reform law.


The initial mailing will go to physicians in Marin, Napa and Lake counties, with others to follow later. Physicians are under no obligation to participate in any of these products, and there are no fee schedule changes at this time, other than for Medicare lines of business. The cover letter asks that physicians review, sign and return the new agreement to Blue Shield by Feb. 17, but the company has assured CMA that failure to return the new agreement will not affect a physician’s participation status.


To assist physicians, CMA has completed an analysis of the new Blue Shield contract, available to members at Physicians are encouraged to review and understand the legal and practical implications of the contract. For additional information, see CMA’s contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations,” also available at


Physicians with concerns about the new contract should contact Blue Shield Provider Services at 800-258-3091 or CMA’s reimbursement helpline at 888-401-5911 or

Still time to get free EHR assistance from CalHIPSO

Primary care physicians who are transitioning to electronic health records have until Feb. 29 to sign up for free assistance from CalHIPSO, a nonprofit organization that offers technical advice, access to vendors, educational webinars, reduced pricing on software, and many other benefits.


Free CalHIPSO enrollment is available to primary care physicians in small private practices, community health centers, rural health clinics or certain hospital ambulatory care clinics. Primary care physicians in other types of practice settings can enroll in CalHIPSO for just $150.


Interested physicians should visit or contact Kent Waldsmith at or 510-285-5745.

Physicians needed for statewide Clinical Laboratory Advisory Committee

CMA is soliciting nominations of physicians to serve on the Clinical Laboratory Technology Advisory Committee (CLTAC), which advises the California Department of Public Health on matters related to clinical laboratories. CMA is specifically seeking nominations for physicians who are engaged in office-based laboratory testing.


The CLTAC is a multidisciplinary committee comprised of 22 representatives from various interest groups related to clinical laboratories. Interested candidates are invited to submit a statement of interest and a current CV demonstrating their qualifications and background to Kimberly Henning by email to or by fax to 916-444-5689. The deadline is Feb. 17.


MMS President Dr. Peter Bretan, a Novato urologist, recently participated in a medical mission to the Philippines organized by the Philippine Medical Society of Northern California. A team of 12 surgeons from several specialties completed 140 surgeries and saw 23,000 patients.


Dr. Ted Hiatt, who served as Marin County’s public health officer from 1976 to 1992, passed away in January. Born in Canada in 1923, he subsequently moved to the United States and served in the Coast Guard during World War II. After graduating from medical school at the University of Colorado, he started as an on-call physician in Marin County in 1955. He became deputy public health officer in 1971 before assuming the top spot five years later. During his long tenure, he shaped public policy on emergency medical response, AIDS, pediatric health care and many other areas. After retiring, he published “The Power of Kings,” a book on political economy.


CMA is hosting two webinars this month. Key Financial Ratios To Increase Profitability, scheduled for 12:15 to 1:15 p.m. on Feb. 1, teaches critical skills for analyzing profit/loss statements for overhead expense, accounts receivable and staffing ratios, and how to access specialty comparison norms for benchmarking. HIPAA Risk Analysis for Meaningful Use, scheduled for 12:15 to 1:15 p.m. on Feb. 15, provides detailed instruction on the steps needed to complete a HIPAA risk analysis, a key element in qualifying for electronic health record funding. To register for either seminar, visit


The 19th annual HIV/AIDS Review will be held at the Hilton Hotel in Santa Rosa on Saturday, March 24, from 8:30 a.m. to 3:30 p.m. State and local HIV/AIDS experts will cover current issues in HIV, sexually transmitted diseases, hepatitis C, and other topics. The conference, worth 5 hours of Category 1 credit, costs just $45. To register, call 707-527-6223.


The Institute for Medical Quality is sponsoring a training program for physician leaders on Coronado Island from March 8 to 10. Participants will explore solutions and creative approaches to resolving problems encountered in leading a medical staff. To register, visit or contact Leslie Iacopi at 415-882-5167 or


The American Medical Association has made several new resources available to physicians. The Practice Management Center at offers easy access to tools and guidance for enhancing the operation of a medical practice. Three online educational tutorials available at can help physicians better implement health information technology. Finally, a Team Up To Stay Healthy brochure available at can help seniors receive preventive services covered by Medicare.


Daniel Blumkin, MD, Family Medicine*, 1033 Third St., San Rafael 94901, 444-2940, Fax 482-6863,, Univ Rochester 1973


* board certified


Psychiatrist referrals needed for Marin Services for Women

Marin Services for Women (MSW), a residential addiction treatment program for women, needs psychiatrists in the area who will see insured, county funded, and private pay MSW women clients (our clients have co-occurring psychiatric conditions). We are compiling a list for our clients and their families to provide linkage with psychiatric care. The psychiatrist would be responsible for the billing with the clients--health insurance companies can be billed directly and the remaining fee billed to the client. A sliding scale for clients with limited funding, along with direct bill pay for private-pay clients, would be part of the billing. For more information, contact Debbie Tate at or 415-924-5995, ext. 114, 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.


© 2012 MMS, PO Box 246, Corte Madera, CA 94976