Monday Rx | January 7, 2019 | Planning for the Year Ahead January 8, 2019 Tag 899 A new year is here. To start 2019, I wanted to share progress on planning as well as important news on the advocacy (specifically AB 1753) and member benefits fronts. Looking Ahead for 2019 LACMA now has a playbook to use throughout the year regarding organizational priorities, measuring outcomes and comparing performance month to month and year to year. Let me know if you would like to receive and review a copy. We've begun planning for the 2019 Saving Private Practice Consortium to be held in early summer so if you have any thoughts and ideas please share whenever you can. This event is designed to help physicians and it takes invaluable member input to make it worthwhile, convenient and useful. Thanks to the incredible work by the LACMA board of directors, executive committee, staff and supporters, the organization completed the 2018 calendar in the positive from a financial perspective with high expectations for 2019 in terms of revenue, member retention and gains in areas such as member experience, sponsorships, member benefits and brand recognition. Your membership does make a difference and I thank every member for their loyalty and commitment to organized medicine. Together, we will make 2019 the best in our history and while LACMA continues to look for ways to deliver real value for members, one doesn't have to look very far to see that our partnership with CMA, which is stronger than ever, has delivered when it comes to problematic payors. CMA's Center for Economic Services (CES) is staffed by practice management experts with a combined experience of more than 125 years in medical practice operations. The CES team has recovered $29 million from payors on behalf of its physician members over the past 10 years. In 2018, CES had a record year, recovering nearly $11 million from payors on behalf of physician members, up from $3 million in 2017. This is money that would have likely gone unrecouped if not for CMA's direct intervention. LACMA/CMA members can call on CMA's practice management experts for FREE one-on-one help with contracting, billing and payment problems. Contact CMA's reimbursement helpline today at (888) 401-5911 or economicservices@cmadocs.org or contact me directly anytime. AB 1753 On January 1, 2019, a new California law (AB 1753) took effect that requires all security prescription forms to have a uniquely serialized number. This new law also requires California physicians who prescribe controlled substances to use updated controlled substance prescription forms effective January 1, 2019. The legislation did not include any transition or grandfathering period to allow for continued use of old controlled substance security prescription forms on or after January 1. And although this requirement went into effect January 1, the California Department of Justice (DOJ) only very recently issued any implementation guidance to security prescription printers. CMA has expressed concern to DOJ that this guidance was not given in a timely enough manner for it to be implemented by physician prescribers and will result in a serious disruption of patient care. The California Board of Pharmacy recently said it would "not make enforcement a priority" if pharmacists choose to fill prescriptions written on security prescription forms that were compliant prior to January 1, but are not compliant with the new serialization requirement. The pharmacy board has urged pharmacists and pharmacies to exercise their best professional judgement when handling these situations, to determine if it is in the best interest of the patient or public health or safety to nonetheless fill such prescriptions. Similarly, the Medical Board of California has also recently issued a memorandum emphasizing the pharmacy board's decision not to aggressively enforce the new requirement. CMA understands that reordering security prescription forms presents a great expense for many physician practices and has urged DOJ to work with CMA and other stakeholders to ensure compliance with this new requirement in a way that does not adversely affect patient care. Physicians should make sure their security prescription vendors are ready to comply with the new requirements. CMA's security prescription partner, RxSecurity, is now taking orders for the new uniquely serialized prescription forms. (The full list of DOJ-approved security prescription printers is available here.) As always, contact me directly or the CMA legal information line, (800) 786-4262 or legalinfo@cmadocs.org for more helpful information. Physician Wellness Update In the area of physician wellness, I want to continue sharing when it comes to the physician experience and how we can, together, reduce and ultimately eliminate physician burnout. CMA continues to make substantial progress in this area. One health system, Bellin Health in Green Bay, Wisconsin, recently unveiled how 92 percent of physicians and staff are satisfied with their jobs. That remarkable achievement can be attributed to the system's team-based care model. "Our focus really shifted from trying to deal with burnout to trying to take better care of the patients," said Dr. Jerzak, a family physician. Team-based care helped to "bring the joy back into practice," said Kathy Kerscher, team leader of achieving population health through team-based care at Bellin Health. There are 95 primary care teams using team-based care in the health system. The next step will be to look at the pediatric population to see how it mirrors the team-based model in primary care practices. "Not everything is a cookie cutter. We have to have the unique situations or be aware of those things because not everybody is the same," said Kerscher. "What an RN does in a family clinic is different than in a pediatric clinic." One major change at Bellin Health is to take the weight off physicians' shoulders by allowing other team members to do more. "The world that clinicians are in right now—if you're not in team-based care—is everything files right through you," said Dr. Jerzak. "It is very inefficient and frustrating for the providers." For example, after meeting with the patient, Dr. Jerzak goes to his computer to sign off on any pending orders that the care team coordinator (CTC) entered. But beyond that, he usually closes the chart immediately while the CTC finishes up with documentation for the patient. The goal is to close 90 percent of charts by 6 p.m., said Dr. Jerzak, "because we don't want that pajama time," he said. "We really try to get work done by the end of the day so people can leave." In-basket management in the new Bellin Health approach has improved dramatically. "In the old world, every time I clicked refresh after meeting with a patient 20–30 things pile into the in-basket and it was unsustainable. It really drove me crazy," said Dr. Jerzak. "If I had to go back to the old way, I would immediately retire." On experience of care, Bellin Health saw a 2.2 percent increase in top box likelihood of recommending the practice or physician. For the health of the population, there was an average of 8.8 percent improvement in seven key metrics. And revenue improved, with Bellin bringing in $724 more in payments per patient annually. And patients see and feel the difference that team-based care can make, Dr. Jerzak said. It was in the first week his office had transitioned to the new approach that a patient offered up a memorable assessment. "I feel," the patient said, "like I got my doctor back." I would like to hear from members about the Bellin Health model. Innovative? Or pretty standard? Gustavo Friederichsen Chief Executive Officer Los Angeles County Medical Association "If it matters to our LACMA members, it matters to me." CME Programs 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 here for 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.