News

Monday Rx | August 27, 2018 | Progress in the Wake of Chaos

Specify Alternate Text
Is it me or are there more distractions, more noise, more crisis around medicine and society as a whole than at any period in our lifetimes?  Or, is it simply we read more, listen more, are easily distracted and share more? One thing is certain: Despite local, national, and professional changes, LACMA as an organization, is moving forward. As we reach the end of one season, we enter another with promise. We are having exciting and fruitful dialogue with independent physicians, groups and hospitals each week.

What is the goal? To not simply expose practices and groups to the new and improved organization, but to build lasting relationships that yield membership and elevate us all.

From Olios Health to Martin Luther King, Jr Community Hospital to Adventist Health, LACMA is not just in the conversations about how to help physicians and improve the practice of medicine, but also leading the conversation in Los Angeles on a variety of fronts. This week, we are in critical conversations with LA Care, Huntington Hospital and AltaMed Health Services and will focus partnerships in support of physicians, physician wellness, primary care and community health.

Industry Update


 
Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products.

As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, UHC must demonstrate an adequate network of participating providers as part of its bid to the Department of Health Care Services (DHCS).

Under the terms of the amendment, physicians will automatically be opted into the Medicare Advantage network and/or Community Plan network unless a written request to opt out has been submitted to UHC Community Plan within 45 days of receipt of the amendment. Physicians may opt out of the amendment without affecting their underlying UHC commercial contracts by issuing a letter to:
UnitedHealthcare Physician Contracting 780 Shiloh Road Plano, TX 75074


Physicians with questions regarding the amendment can contact UnitedHealthcare's Network Management Resource Team at (866) 574-6088.

UnitedHealthcare Community Plan first launched into the Medi-Cal Managed Care program in Sacramento and San Diego counties beginning October 1, 2017. However, after only a year in the program, UHC recently issued notice that it will no longer provide services to approximately 4,400 Medi-Cal members in Sacramento County, effective November 1, 2018.

The notices mailed to Community Plan physicians in July 2018 advise that DHCS will transition all UHC Community Plan members in Sacramento County to other participating Medi-Cal Managed Care plans by November 1.

UHC Community Plan members who need assistance in selecting an alternative Medi-Cal health plan or who have questions regarding transitioning to a new plan can be directed to Health Care Options at (800) 430-4263.  Physicians with questions regarding the transition should contact UHC Provider Services at (866) 270-5785.
 

Important News on CURES


Effective October 2, 2018, physicians must consult California's prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES.

The California Medical Association recently co-hosted a live CURES webinar with the California Department of Justice and the Medical Board of California regarding this new duty-to-consult requirement. The webinar provides an overview of the new mandate and the requirements imposed by the law when checking CURES. It also includes an overview of the registration process and key features of the CURES database.

The webinar is now available for on-demand viewing, free to all interested parties.
 

On the National Front


 
With just a few months before midterm elections, Senate Republicans have taken a new tack toward the Affordable Care Act. Rather than mulling repealing the bill, they're looking to safeguard some of the law's most popular provisions. Sen. Thom Tillis (R-N.C.) on Friday introduced a bill meant to secure Obamacare's guaranteed issue provision. Insurers would have to cover everyone on the individual market regardless of health status and can't revise premiums based on health. Ten senators co-sponsored the bill including Senate health committee Chair Lamar Alexander (R-Tenn.) and Sens. Bill Cassidy (R-La.) and Lisa Murkowski (R-Alaska). The proposal comes just months after 20 GOP state attorneys general challenged the Affordable Care Act as a whole with a federal lawsuit in Texas. In June, the Trump administration sided with the red states and encouraged U.S. District Judge Reed O'Connor to eliminate the ACA's individual mandate, guaranteed issue and community ratings provisions.

Judge O'Connor will hear oral arguments on motions in the case on Sept. 5 and could render a decision before the midterm elections in November. But the Senate bill doesn't necessarily stop insurers from denying coverage for pre-existing conditions, because it doesn't prohibit coverage exclusions, according to Larry Levitt of the Kaiser Family Foundation. GOP lawmakers are ignoring the block-grant proposal floated earlier this summer by former Sen. Rick Santorum (R-Pa.) and outside conservative groups, according to GOP staff. That proposal is based on the Graham-Cassidy bill Republican leadership shelved last year.
 
As always, please share your thoughts with me.

 

 


 

 

State of Reform Health Policy Conference
 
I hope you will consider joining LACMA and CMA at the  2018 Los Angeles State of Reform Health Policy Conference on September 19th at the Los Angeles Marriott Burbank Airport Hotel.Now in its third year in Los Angeles, and fourth year in Southern California, the 2018 Los Angeles State of Reform Health Policy Conference convenes one of the largest, most diverse gatherings of senior health care executives and health policy leaders from across the state.

All members are invited to attend on September 19th to connect, network, and discuss the most pressing, most practical health care issues facing the system today.


You may register here.

State of Reform pulls together practitioners, thought leaders, and policymakers – each working to improve our health care system in their own way – into a unified conversation in a single place. It is sure to be one of the most diverse gatherings of senior health care leaders in Southern California, and one of the most important statewide events in California health care.

Gustavo Friederichsen Chief Executive Officer Los Angeles County Medical Association "If it matters to our LACMA members, it matters to me."
 

EVENTS AND COMMUNITY



DoubleTree by Hilton, Thousand Cranes Ballroom, 120 S. Los Angeles Street Los Angeles, CA 90012 11 AM - 2 PM

 

WITH SPECIAL KEYNOTE SPEAKER

DR. BARBARA L. MCANENY

PRESIDENT AMERICAN MEDICAL ASSOCIATION

 
Interested in Concierge Medicine?

If you have ever wanted to learn more about the impact a concierge medicine model will have on your practice and patients, you should join us on August 28thin Sherman Oaks or August  29thin Santa Monica for a special program and meet n greet with Paragon Private Health.

Converting to a concierge model of care has helped countless independent physicians restore doctor patientrelationships and improve income.

RSVP: Brad Haines at 805.952.9593
 

 

CME Programs

 

FINDING EFFECTIVE CURATIVE OPTIONS IN THE TREATMENT OF SICKLE CELL DISEASE

WHEN: September 14, 2018 WHERE: Brookside at the Rose Bowl, Mediterranean Room, 1133 Rosemont Ave. Pasadena, CA 91103

Click herefor more information

This seminar will discuss the rapid development of new gene therapy and need for access to novel curative modalities for Sickle Cell Disease.


MULTIDISCIPLINARY APPROACHES TO CANCER SYMPOSIUM

WHEN: September 20 to 23, 2018 WHERE: Loews Coronado Bay Resort 4000 Coronado Bay Road Coronado, CA 92118

Click here for more information.

This intensive program will provide participants with an enhanced ability to interpret and apply best treatment options to their individual cancer practices.


NEOPLASTIC HEMATOPATHOLOGY UPDATE

WHEN: November 8 to 10, 2018 WHERE: The Waterfront Beach Resort, A Hilton Hotel 21100 Pacific Coast Highway Huntington Beach, CA 92648

Click herefor more information.

Join experts for this exclusive interactive conference. This is a unique opportunity for up-close learning and discussion with experts in the treatment of neoplastic hematopathology.


HOW THE EXPERTS TREAT HEMATOLOGIC MALIGNANCIES

WHEN: March 21 to 23, 2019 WHERE: Waldorf Astoria, Las Vegas 3752 S. Las Vegas Blvd. Las Vegas, NV 89109

Click herefor more information.

This two-and-a-half-day symposium has been designed by experts in the field of hematologic malignancies and affords the conference attendee specialized educational tracks for both physicians and nurses, providing an opportunity to learn about the most recent advances in the treatment of bone marrow transplant, multiple myeloma, lymphoma and leukemia.




For questions contact: cme@coh.org or 626-218-5622.