Wine Night! Join us and mingle with your colleagues!

Physician Mixer

Genesis Healthcare 

9333 Genessee Ave Ste. 300

San Diego, Ca 92121

Just for fun.........

Is your office OSHA compliant?

ALBANY, N.Y. - The U.S. Department of Labor's Occupational Safety and Health Administration has cited a small physician practice for alleged willful and serious violations of occupational health standards for failing to protect its workers adequately against potential bloodborne pathogen hazards. This medical practice faces a total of $44,800 in fines following a complaint inspection begun in September 2012 by OSHA's Albany Area Office. Click here to read the official press release....

If your office has any concerns regarding OSHA rules and regulations, please contact our office at 760-632-4244.

New HIPAA Omnibus Final Rule Takes Effect Tomorrow - 10 Steps to Ensure Compliance.

Click here for more information.....

Will your EHR vendor still be around next year?

 Meaningful Use Attestation Data Points to Future Vendor Success/Failure

A Great Article on Empathy

For years I have been speaking about empathy to my staff. I usually start the lecture in the first interview by telling candidates that empathy for patients is a job requirement and if they don't have it, they won't work for any of my offices. 

As we all know, running a medical office has become increasingly harder with the demands from the government, decreased revenue for the physicians, and a down economy for patients, staff and providers. Most of us show our stress as a result but in our day to day interactions with patients, we must not forget the reason we are all working in Healthcare; It's all about patients. 

The article below is a great handout to give your existing staff. It may remind them of exactly why they're in the job they chose and what they can remember about every patient encounter.

Click here for the article......

"Covered California" Obama Exchange Site Goes Live

As most California Physicians already know, the first patients insured by "Covered California" will arrive in offices on January 1, 2014. In the next few months, Connect the Docs, A Multi-Specialty Network, Inc. will keep you updated on how these additional patients will effect your practice by updating our blog weekly, holding informational meetings at the hospital and directing information through our newsletter. If you have any questions, you can also call us directly at 760-632-4242 or email us at acastro@ctdmso.com. 

                                                                   

                                                   

Click her to go to the "Covered California Website

March is Colorectal Cancer Awareness Month. Here's what you should know.....

Colorectal Cancer Screening

§  What is colorectal cancer?

Colorectal (large bowel) cancer is a disease in which malignant (cancer) cells form in the inner lining of the colon or rectum. Together, the colon and rectum make up the large bowel or large intestine. The large intestine is the last segment of the digestive system (the esophagus, stomach, and small intestine are the first three sections). The large bowel's main job is to reabsorb water from the contents of the intestine so that solid waste can be expelled into the toilet. The first several feet of the large intestine is the colon and the last 6 inches is the rectum.

Most colon and rectal cancers originate from benign wart-like growths on the inner lining of the colon or rectum called polyps or flat lesions. The difference between polyps and flat lesions is primarily just their shape, with polyps growing more into the lumen than flat lesions. Not all polyps and flat lesions have the potential to transform into cancer. Those that do have the potential are called adenomas and sessile serrated polyps (also called sessile serrated adenomas). It takes more than 10 years in most cases for a precancerous polyp or flat lesion to develop into cancer. This is why some colon cancer prevention tests are effective even if done at 10-year intervals. This 10-year interval is too long, in some cases, such as in persons with ulcerative colitis or Crohn's colitis, in persons with a strong family history of colorectal cancer or adenomas, in persons who themselves have previously had colorectal cancer, and some persons who have had precancerous polyps or flat lesions

§  How common is colorectal cancer?

Colorectal cancer is the second most common cancer killer overall and third most common cause of cancer-related death in the United States in both males and females. Lung and prostate cancers are more common in men and lung and breast in women. In 2012, there will be 143,000 new cases and 52,000 deaths from colorectal cancer. About 6% of persons who reach the age of 50 in the United States will develop colorectal cancer without screening.

Risk Factors

§  Who is at risk for colorectal cancer?

§  Everyone age 50 and older.
The average age to develop colorectal cancer is 70 years, and 93% of cases occur in persons 50 years of age or older. Current recommendations are to begin screening at age 50 if there are no risk factors other than age for colorectal cancers. A person whose only risk factor is their age is said to be at average risk.

§  Men and women
Men tend to get colorectal cancer at an earlier age than women, but women live longer so they 'catch up' with men and thus the total number of cases in men and women is equal.

§  Anyone with a family history of colorectal cancer.
If a person has a history of two or more first-degree relatives (parent, sibling, or child) with colorectal cancer, or any first-degree relatives diagnosed under age 60, the overall colorectal cancer risk is three to six times higher than that of the general population. For those with one first-degree relative diagnosed with colorectal cancer at age 60 or older, there is an approximate two times greater risk of colon cancer than that observed in the general population. Special screening programs are used for those with a family history of colorectal cancer. A well-documented family history of adenomas is also an important risk factor.

§  Anyone with a personal history of colorectal cancer or adenomas at any age, or cancer of endometrium (uterus) or ovary diagnosed before age 50.
Persons who have had colorectal cancer or adenomas removed are at increased risk of developing additional adenomas or cancers. Women diagnosed with uterine or ovarian cancer before age 50 are at increased risk of colorectal cancer. These groups should be checked by colonoscopy at regular intervals, usually every 3 to 5 years. Woman with a personal history of breast cancer have only a very slight increase in risk of colorectal cancer.

Symptoms

§  What are the symptoms of colorectal cancer?

Symptoms of colorectal cancer vary depending on the location of the cancer within the colon or rectum, though there may be no symptoms at all. The prognosisis worse on average in symptomatic as compared to asymptomatic individuals (the latter refers to persons with cancer discovered by screening). The most common presenting symptom of colorectal cancer is rectal bleeding. Cancers arising from the left side of the colon generally cause bleeding, or in their late stages may cause constipation, abdominal pain, and obstructive symptoms. On the other hand, right-sided colon cancers may produce vague abdominal aching, but are unlikely to present with obstruction or altered bowel habit. Other symptoms such as weakness, weight loss, or anemia resulting from chronic blood loss may accompany cancer of the right side of the colon. You should promptly see your doctor when you experience any of these symptoms.

§  Why should you get checked for colorectal cancer even if you have no symptoms?

Precancerous polyps and flat lesions can grow for years and transform into cancer without producing any symptoms. By the time symptoms develop, it is often too late to cure the cancer, because it may have spread. Screening identifies cancers earlier and actually results in cancer prevention when it leads to removal of pre-cancerous growths

Screening

§  What is screening for colorectal cancer?

Screening means looking for cancer or polyps when patients have no symptoms. Finding colorectal cancer before symptoms develop dramatically improves the chance of survival. Identifying and removing polyps before they become cancerous actually prevents the development of colorectal cancer.

§  What tests are available for screening?

Several options are available for screening average-risk persons.

§  Colonoscopy
Your doctor can examine your entire colon and rectum during colonoscopy. The procedure is used to look for early signs of cancer in the colon and rectum where they could not be reached by sigmoidoscopy. Polyps and flat lesions can be removed during colonoscopy. Sedation is usually used for colonoscopy. Colonoscopy is currently the only test recommended for colorectal cancer screening in average-risk persons at 10 year intervals

§  Flexible Sigmoidoscopy
An examination in which a doctor uses a sigmoidoscope (a thin, lighted instrument) to view the inside of the lower colon and rectum (usually about the lower 2 feet) for polyps and cancers. If a precancerous growth is found, colonoscopy should be performed. Sigmoidoscopy does not examine the entire colon and so is less reliable than colonscopy for detecting polyps and flat lesions. Sedation is usually not used for sigmoidoscopy. Sigmoidoscopy is performed every 5 years, often in conjunction with an annual fecal occult blood test.

§  Fecal occult blood test
One of the presentations of colon cancer is chronic blood loss in the stool. Sometimes, such blood loss is so minimal, it cannot be seen when the stool is inspected in the toilet. Your doctor will ask you to collect a stool sample which is returned to the doctor or lab to test for occult (hidden) blood. There are two types of tests, called the fecal immunochemical test (FIT) and the guaiac test. The fecal immunochemical test (FIT) is the better test. Either test is done annually. If either test is positive, colonoscopy should be done

§  Computerized topographic (CT) colonography and magnetic resonance (MR) colonography
These tests are sometimes called "Virtual Colonoscopy". These two tests are fairly new methods that allow your doctor to look for colorectal polyps and cancers. Virtual Colonoscopy uses a CT scanner (CT colonography) or Magnetic Resonance scanner (MR colonography) along with computer-assisted software to look inside the body without having to insert a long colonoscope into the colon or without having to fill the colon with liquid barium. These two tests are performed by radiologists. The US Preventive Services Task Force and the Centers for Medicare and Medicaid Services do not endorse CT colonography or MR colonography for screening, so they may not be covered by your insurance program.

§  Double contrast barium enema (DCBE)
Barium is a white liquid that helps to show the inside image of the colon and rectum on an X-ray. The liquid barium is put into the colon using a rectal tube. Multiple X-rays are taken to look for polyps or cancers. DCBE is less expensive than colonoscopy but also less effective. DCBE has not been established as a reliable colorectal cancer screening test in any rigorous scientific studies. One scientific report, the National Polyp Study, found that DCBE detected only 50% of the larger adenomas (greater than 1 cm), and DCBE is inferior to colonoscopy for detection of colorectal polyps. Because of its limitations, DCBE is not widely used for colorectal cancer screening. If used for screening, it should be done every 5 years. If polyps are found, colonoscopy should be performed. Another X-ray test, single contrast barium enema (SCBE) is generally considered inferior to DCBE for detecting polyps and, thus, SCBE is not recommended for colorectal cancer screening.

§  Fecal DNA testing
Colorectal cancers contain abnormal DNA which is shed into the stool. In this a sample of stool is checked for abnormal DNA and colonoscopy is performed if any is found. This test should be repeated at 3 years if it’s negative.

Prevention

§  What else can I do to prevent the development of colorectal cancer?

The strategy for reducing colorectal cancer deaths is simple.

§  For normal risk individuals, screening tests begin at age 50 and the preferred approach is a screening colonoscopy every 10 years; an alternate strategy consists of annual stool test for blood and a flexible sigmoidoscopy every 5 years.

§  Colonoscopic surveillance (also called screening colonoscopy) needs to be available at more frequent intervals for individuals at high risk for colon cancer (for instance, those with a personal history of colorectal cancer or adenomatous polyps; family history of colorectal cancer; Hereditary Non-polyposis Ccolorectal Cancer; or a pre-disposing condition such as inflammatory bowel disease. (Medicare provides for surveillance colonoscopy no more frequently than once every two years for those at high risk.)

§  For both average and high risk individuals, all potential pre-cancerous polyps should be removed.

Recent observations suggest regular use of non-steroidal anti-inflammatory drugs or aspirin, reduce the chances of colorectal cancer death by 30-50%. These drugs also have risks, particularly intestinal bleeding, and patients should consult their physician as to whether regular use of these agents is appropriate. Folate, calcium, and post-menopausal estrogens each have a modest protective benefit against colon cancer. A normal blood level of Vitamin D is associated with lower risk of colorectal cancer. A diet high in fiber and fruits and vegetables and low in fat diet, regular exercise, maintenance of normal body weight and cessation of smoking are also beneficial. None of the measures is as effective as or should replace colorectal cancer screening.

Author(s) and Publication Date(s)

Douglas K. Rex, MD, FACG, Division of Gastroenterology and Hepatology, Department of Medicine Indiana University School of Medicine, Indianapolis, Indiana – Updated April 2007. Updated December 2012.

Suthat Liangpunsakul, MD and Douglas K. Rex, MD, FACG, Indiana University School of Medicine, Indianapolis, IN – Published October 2002.

Can Your Boss Read Your Email?

Is it legal for your boss to read your emails? Click here to see what this article has to say......

February is Heart Health Month!

Click here for an article worth reading.......

Covered California Receives $674 Million Federal Grant

Click here to read the news release...

Be there! 2/1/2013!!!

Please join Connect the Docs, A Multi Specialty Network, Inc. for an informative look into the future for independent physicians.....

Presentation: What will they think of next? Peering into the Abyss

Presenter: Tom Gehring, Executive Director/CEO of San Diego Medical Society

When: Friday, February 1, 2013 from 12:00pm- 1:15pm

Where: Scripps Memorial Hospital Encinitas Conference Room

Co-sponsored by Physician Partners and Ximed

Hard liquor will be served. 

Just kidding but we will have a fabulous lunch!

Please RSVP by January 29, 2013 to acastro@ctdmso.com

Martin Luther King, Jr. Day

“When we look at modern man, we have to face the fact that modern man suffers from a kind of poverty of the spirit, which stands in glaring contrast with a scientific and technological abundance. We’ve learned to fly the air as birds, we’ve learned to swim the seas as fish, yet we haven’t learned to walk the Earth as brothers and sisters.” — Martin Luther King Jr.

National Blood Donor Month

The month of January has been dedicated to thank those who make a difference in their community by donating blood.  National Blood Donor Month is a time to show appreciation to volunteer blood donors and educate new donors about the importance of blood donation.   

Blood has a shelf life of only 42 days and must continually be replenished.  Every two seconds, someone in the United States has a need for blood. The American Red Cross relies on volunteer donors to ensure blood is available when patients need it.  A single blood donation could help save more than one life.

“National Blood Donor Month is a great opportunity for us to thank donors who help us maintain an adequate blood supply,” said Mario Sedlock, interim chief executive officer, American Red Cross Southern Blood Services Region.  “We also want to encourage those who have never donated before to consider giving an hour of their time to help save lives.”

The Red Cross Southern Blood Services Region provides lifesaving blood to patients in more than 120 hospitals. Approximately 1,200 people need to give blood or platelets each week day to meet hospital demands.

Blood can be safely donated every 56 days.  Most healthy people who are 17 years of age and older, or 16 with parental consent, and weigh at least 110 pounds are eligible to donate blood. Donors who are 18 years and younger must also meet specific height and weight requirements.

For more information or to schedule an appointment to donate, please call 1-800-RED CROSS (1-800-733-2767) or click here.

Articles Worth Reading..........

Fiscal Cliff Averted; Significant Health Policy Changes Enacted 

On January 1, Congress sent President Obama H.R. 8, the American Taxpayer Relief Act, legislation to avert the so-­‐called fiscal cliff. This bipartisan legislation (Senate vote 89–8, House vote 257–167) was developed in the Senate in the final days of 2012. In addition to making permanent numerous tax provisions and postponing for two months the scheduled across-­‐the-­‐ board spending cuts (“sequestration”), the bill contains significant health care provisions. 

Section I of this alert summarizes the major health policies and their budget impacts. Section II outlines noteworthy omissions. And Section III provides a brief look at likely health policy legislation in 2013. 

I. Health Provisions in H.R. 8

The Congressional Budget Office projects that the health provisions in H.R. 8 will increase federal spending by $13 billion in FY2013 and $5 billion in FY2014 but reduce such spending by $16.4 billion in FY2015–FY2022. (Note: due to interaction effects among provisions and with respect to other health policies, the sum of the budgetary impacts below does not match these net impacts.)

Extension of Certain Current Policies 

Sec. 601. One-­‐year extension of Medicare physician payment 0% update (“Doc Fix”). The pending 27% cut to physician reimbursement is eliminated for 2013 through a one-­‐year “fix” to the Sustainable Growth Rate (SGR). Cost: $25.2 billion . 

Sec. 602–610. Various Medicare extenders. Extension of the 1.0 floor on the geographic adjustments to the work portion of the physician fee schedule through 2013; outpatient therapy service caps through 2013 (extends current two-­‐tier therapy cap exceptions process ($1,900 automatic KX modifier process, $3,700 manual medical review, and application of therapy cap to hospital outpatient department for one year); ambulance add-­‐on payment (through 2013 for ground ambulance, through June 30, 2013, for air ambulance, and mandated study by Secretary); Medicare inpatient adjustment for low-­‐volume hospitals through 2013; and Medicare-­‐dependent hospital program through October 1, 2013. Also, one-­‐year extension of Medicare Advantage Special Needs Plans and Medicare Cost Contracts, and extension of contract with so-­‐called consensus-­‐based entity for its services related to performance improvements, with modifications and mandated studies. Cost: $2.5 billion. 

Sec. 621–625. Other health extenders. The Qualifying Individual (QI) Program with additional funding allocation, extension of Transitional Medical Assistance (TMA), Medicaid and CHIP Express Lane, Family-­‐to-­‐Family Health Information Centers, and Special Diabetes Programs extended through 2013. Cost: $1.7 billion.

“Pay-­‐Fors” 

Sec. 631. IPPS documentation and coding adjustment for MS-­‐DRGs. Inpatient reimbursement is reduced through 2018 to adjust for past “overpayments” to hospitals resulting from a perceived excess increase in case mix due to the transition to a more sophisticated Medicare Severity Diagnosis Related Groups (MS-­‐DRGs). Savings: $10.5 billion (largest health care pay-­‐for in the bill). 

Sec. 639. Medicare Advantage coding intensity adjustment. The coding intensity adjustment minimum rate is increased by 0.2 percentage points. Savings: $2.0 billion. 

Sec. 632. Rebased end-­‐stage renal disease (ESRD) bundle. CMS is instructed to rebase ESRD bundled payment in 2014; implementation of oral drugs in the payment bundle is delayed for two years. Savings: $4.9 billion. (Note: while it was generally assumed that CMS had authority to rebase in 2014, GAO recently reported that was not the case. Hence, this provision mandates that CMS take such action, which CBO estimates will save almost $5 billion.) 

Sec. 637. Reduced payment for nonemergency ambulance transportation of ESRD beneficiaries. Payment rates for ambulance services for individuals with ESRD obtaining nonemergency basic life support services involving transport is reduced by 10%. Savings: $0.3 billion. 

Sec. 633. Reduced multiple service payment for therapy services. Applies the multiple procedure payment reduction (MPPR) to therapy services at 50%, up from 20% for office settings and 25% for facility settings, beginning April 1. Savings: $1.8 billion. 

Sec. 634. Reduced payment for stereotactic radiosurgery in certain hospitals. Payments are equalized for stereotactic radiosurgery services provided under Medicare hospital outpatient payment systems other than for rural hospitals and sole-­‐community hospitals. Savings: $0.3 billion. 

Sec. 635. Increased equipment utilization rate assumption for advanced imaging services. The utilization factor used in setting of payment for imaging services in Medicare is increased from 75% to 90%. Savings: $0.8 billion. 

Sec. 636. Competitive bidding for certain diabetic supplies. Competitive bidding is applied to diabetic test strips purchased at retail pharmacies. Savings: $0.6 billion. 

Sec. 638. Increased statute of limitations for recovering overpayments. The statute of limitations in sec42 U.S.C. § 1395gg(b) and (c) for recovering overpayments and waiver of liability is increased from three to five years. Savings: $0.5 billion. 

Sec. 640. Medicare Improvement Fund. Funding is eliminated for Medicare fee-­‐for-­‐service Improvement Fund. Savings: $1.7 billion. 

Sec. 641. Rebased Medicaid Disproportionate Share Hospital (DSH) payments. Changes from the Affordable Care Act (ACA) are extended for an additional year (through 2022). Savings: $4.2 billion. 

Sec. 644. Consumer Operated and Oriented Plan (CO-­‐OP) Program. Unobligated CO-­‐OP funds from ACA are rescinded; a contingency fund of 10% of the current unobligated funds is established to assist approved CO-­‐OPs. Savings: $0.2 billion.

Other Provisions 

Sec. 642. CLASS Program. The Community Living Assistance Services and Supports (CLASS) program established by ACA is repealed. (Note: HHS had previously suspended implementation of this authority due to budgetary issues.) 

Sec. 643. Commission on Long-­‐Term Care. A Commission on Long-­‐Term Care is established to develop a plan for the establishment, implementation, and financing of high-­‐quality systems that ensure the availability of long-­‐term services and support for individuals.

Beyond the extenders and pay-­‐fors, there are other provisions that build on the work of Congress and CMS over the past several years to move toward more “value-­‐based” payment. For example, Sec. 609 sets up a process for CMS to develop a performance improvement strategy with stakeholder input. The process this section establishes is similar to Congress’ and CMS’ development of the Hospital Value-­‐Based Purchasing system. Such a system may be attached to an eventual SGR reform, as well as further efforts to restrain spending in home health and inpatient rehabilitation facilities (IRFs). 

II. Provisions Not Included in H.R. 8

H.R. 8 extended numerous expiring Medicare and other health care provisions. However, over the past few years we have seen regular extender provisions fall off the list, even with strong support and advocacy from trade groups and facilities to return provisions such as extension for those hospitals that qualified for area wage index geographic reclassification pursuant to Section 508 of the Medicare Modernization Act of 2004 (MMA) and extension of payment for the technical component of certain physician pathology services. Both of these former annual extenders expired in mid 2012 and were not addressed in H.R. 8. The annual Medicare extender list is shrinking, and if there is ever to be a permanent SGR “fix,” to which the extenders typically attach themselves, an annual list may no longer exist—especially in this budget environment.

In addition, the medical device tax, enacted in the ACA, takes effect on January 1, 2013. Efforts to delay its implementation were unsuccessful. 

III. Health Policy Legislation in 2013

As dramatic as this bill was in the making, it is just a prelude to what is coming in 2013. The broader sequestration, including a 2% cut to all Medicare payments, that had been scheduled to take effect on January 1 has now been postponed until March 1, 2013. And, in a likely reprise of what we saw last year, the debt limit will also require Congressional consideration this spring—late February to mid-­‐March. On top of all this, the Continuing Resolution that funds much of the government will need to be extended by the end of March. 

We expect the House of Representatives to again try to pursue additional structural reforms to Medicare, such as age of eligibility, and other entitlement spending in conjunction with increasing the debt limit and stopping sequestration. However, even absent structural reform, there are a number of cost-­‐saving Medicare provisions that have been floated before and will likely be considered again. For example, there is growing concern about the rise in cost of E&M services in the hospital outpatient setting and the continued viability of provider Medicare bad debt reimbursement.

For additional information, please contact our legal staff or government relations and public policy staff or attorneys as follows: Martin Corry, Kelly Lavin or Alex Brill (non-­‐lawyer professionals) or Robert Roth (attorney) in Washington D.C. at 202.580.7700; or attorneys John Hellow in Los Angeles at 310.551.8111; Mark Reagan in San Francisco at 415.875.8500; or Stephen Treadgold or Mary Norvell in San Diego at 619.744.7300. 

Copyright © 2013 by Hooper, Lundy & Bookman, PC. Reproduction with attribution is permitted.