Monday Rx: Provider Resources, Physician Advocacy and Upcoming Events March 28, 2022 2022 Billing and Coding Updates, At-Home COVID Test, Center for Economic Services, Cooperative of American Physicians, Expanding Coverage Town Hall Series, Latina Women, Legislative Advocacy Day, Medical Practice Makeover, medical providers, physician coach support, physicians, primary care physicians, provider reimbursement, Provider Relief Fund, U.S. Physicians Workforce, Virtual Grand Rounds, Webinar, well-being, Young Physicians Mixer 1066 Provider Well Being, Pre Auths, and Coaching LACMA is constantly looking for ways to address medical providers' well-being. As several members have shared, prior authorizations and reimbursement (lack thereof) are two contributors to stress and anxiety. More than nine in 10 physicians (92 percent) say that prior authorization programs have a negative impact on patient clinical outcomes, according to AMA. The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed. “Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment,” said AMA Chair-elect Jack Resneck Jr., M.D. “In practice, insurers eventually authorize most requests, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care. In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.” According to the AMA survey, which examined the experiences of 1,000 patient care physicians, two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers – and a third (30 percent) said they wait three business days or longer. The high wait times for preauthorized medical care have consequences for patients. More than nine in 10 physicians (92 percent) said that the prior authorization process delays patient access to necessary care; and four in five physicians (78 percent) report that prior authorization can sometimes, often, or always lead to patients abandoning a recommended course of treatment. In January 2017, AMA created a set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce administrative burdens. More than 100 other health care organizations have supported those principles. A year later, AMA joined major healthcare organizations to develop the Consensus Statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care. It is time to streamline or eliminate low-value prior-authorization requirements and implement policies to minimize delays or disruptions in the continuity of care. I’ve asked a handful of LACMA members to join me in strategic discussions to find a definitive solution and will have more concrete answers going forward. As always, I would like to hear your ideas. When it comes to medical provider reimbursement, CMA has a variety of resources to advocate on issues that directly affect physician practices, including reimbursement, regulatory burdens, payor practices and other key issues. In addition, CMA’s Center for Economic Services (CES) is charged with providing one-on-one practice management assistance to physician members and their staff. CES provides resources and guidance to improve the success of the practice. Assistance ranges from coaching and education to direct intervention with payors or regulators. CES also develops resources and tools to assist practices. The center is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Over the past 12 years, CES successfully recouped more than $33 million from payors on behalf of our physician members. Visit here to learn more. Yet, as members well know, California ranks 48th among all states in what it pays physicians for treating Medi-Cal patients, according to a recent and widely cited Urban Institute study. For primary care physicians, California ranks next to last—only Rhode Island pays less. We need to do more. In the coming months, we will discuss these two fundamentally undeniable causes of physician stress: the archaic prior authorization process and the correlating problem of poor reimbursement. We will look for real solutions. Let me know your thoughts by email info@lacmanet.org. Peer to Peer Coaching is Available As I’ve shared previously, the MD/DO Lifeline is here to provide members information, resources, grants, retreats and now Physician Coach Support, the free and confidential physician support platform for members to access. Here are comments from physicians: “I cannot thank you enough for doing this. So incredibly helpful and needed! The availability and ability to schedule this when I need has enabled me to maintain a grasp on my life and myself. I have had only positive experiences.” “I had a very productive session with the coach. She listened carefully and had insightful, specific feedback which helped me re-frame my situation.” “My appointment was great! It was easy to schedule and to connect. I was paired with a coach who suited my needs well. The physician colleague helped me to organize my thoughts and find concrete and feasible steps forward. She encouraged me and made me feel much more comfortable and positive about where I am in my journey.” “Fantastic. Thank you so much! I gained clarity. Super helpful coach!” “You have no idea how much I needed this in my life now!” “This is an amazing resource you have created.” Click here to learn more. Provider Relief Fund Deadline is March 31st Physicians are reminded that the U.S. Department of Health and Human Services (HHS) Provider Relief Fund (PRF) reporting portal is open for providers who need to report on the use of funds in Reporting Period 2. Providers who received one or more payments exceeding $10,000, in the aggregate, during a “payment received period” are required to report in each applicable “reporting time period.” The current reporting period is for payments exceeding $10,000 received between July 1, 2020, to December 31, 2020. Providers who are required to report during this second reporting period have until March 31, 2022, to do so. More information, including reporting user guides, a data entry worksheet, frequently asked questions, and more can be found on the PRF web page. Practices that need assistance can call the PRF Provider Support Line at (866) 569-3522 between 7 a.m. to 10 p.m. Central Time, Monday through Friday. Medical Practice Makeover Helping One Practice at a Time LACMA president Dr. Jeffery Lee presented a grant of $5,000 for Pasadena based physician, Dr. Sharon Yegiaian. LACMA also provided PPEs and resources. On-Demand Webinar: Critical 2022 Billing and Coding Updates Proper implementation of new and revised CPT codes, Medicare rules, and other billing updates is key to ensuring that your practice is receiving the appropriate reimbursements. The Cooperative of American Physicians (CAP) is pleased to provide you with on-demand access to our popular webinar, presented by healthcare business operations and reimbursement expert Mary Jean Sage, addressing the latest billing and coding updates impacting your patients and bottom line. View Webcast Now This webinar will help participants: Update their revenue cycle management for all patients including Medicare patients. Discover what new revenue opportunities are possible. Demonstrate competency with new coding and billing changes. Respond compliantly to a request for documentation or a review by Medicare or any other third-party payer – either pre-payment or post payment. Understand the challenges in reporting all services, including new services, for their patient population in a compliant manner. Get an overview of updates to CPT codes, E/M changes, billing rules for NPP, telehealth reimbursements, MIPS guidelines, and more. As a leading provider of superior medical malpractice coverage in California for more than 40 years, CAP remains committed to providing physicians with secure and affordable protection and relevant practice and risk management resources, such as these webinars, to help them run safe and successful practices. To learn more about becoming a CAP member, please call 800-356-5672 or email MD@CAPphysicians.com. Request an Instant Quote today to see how much you can save on medical malpractice coverage through CAP. At-Home COVID Test at Wholesale Costs for Providers Capsule is excited to announce that they are launching a Community Wholesale Discount on their At-Home COVID Tests for all LACMA Members. Providers will be able to supply their staff and patients with these rapid tests at discounted pricing. Please email Capsule at LA@Capsule.com for more information Webinar: Legislative Advocacy Day Training Learn how to be an effective advocate. In preparation for the California Medical Association (CMA) Legislative Advocacy Day, CMA's Center for Government Relations will host a special webinar on Tuesday, March 29, 2022, from 7:00 - 8:00 p.m. This webinar will review CMA's list of legislative issues and bills to be lobbied, effective advocacy tips, and other relevant program information. Date: March 29, 2022 Time: 7:00 pm - 8:00pm Register here. Register for the Latina Women in the U.S. Physicians Workforce Webinar Join the Center for the Study of Latino Health and Culture (CESLAC) at UCLA in a conversation with Dr. Yohualli B. Anaya, MD, MPH, Assistant Clinical Professor, Department of Family Medicine David Geffen School of Medicine at UCLA and Dr. Carrie L. Byington, MD Executive Vice President, University of California Health, University of California Office of the President for the Latina Women in the U.S. Physician Workforce Webinar. Date: March 31, 2022 Time: 5:30 pm - 6:30pm Register here. Virtual Grand Rounds: Pediatric COVID and Vaccines, and Variants Overseas As we enter the spring with our lowest COVID case rates in two years and roll back various recommendations and requirements on masking and gathering, many cautiously hope for a new phase of the pandemic at home. Simultaneously, we watch in trepidation as a new variant takes hold across the globe and causes cases to increase across Europe and Asia. How will this variant impact our management of the pandemic and exposure to COVID-19 at home? In this edition of Virtual Grand Rounds, we will hear from an infectious disease expert who will review COVID-19 in children, pediatric vaccines and offer advice on methods to communicate with families regarding vaccinating their children. CMA will also welcome back the state epidemiologist, Erica Pan, M.D., who will share the latest information about the state of COVID-19, the potential for new variants, and the availability of therapeutics in California. Date: April 5, 2022 Time: 12:00 pm - 1:00pm Register here. LACMA Town Hall on Expanding Coverage is 2 Weeks Away! Join us for a deep dive into the healthcare changes in California as UC Berkley Professor, Dr. Stephen Shortall, Ph.D., MBA, MPH, talks about “The Future is Now: The Successful Medical Enterprise in Challenging Times”. Key areas to discuss include: Understanding the challenge and the opportunity. Listing the essential elements of integrated delivery models; including team-based care. Describing the role of value-based payment models in incenting continuous improvement in care. Highlighting the evidence to date. Defining and incorporating health equity under the capitation, integrated model. Date: April 11, 2022 Time: 6:00 pm Register here. Bowling, Great Conversation and Good Times! LACMA’s Young Physicians Committee is hosting its annual Young Physician Mixer on April 29th at the Lucky Strike at LA Live in Downtown LA! This is a great way to meet and connect with physicians, fellows, residents, and medical students from all over the county. You can bowl, play table games, or just come hang out! Hors d’oeuvres and beverages will be served. LACMA & CMA members are FREE! Please share with your peers and colleagues. Fellows, residents, and students have free membership. Join here. Date: April 29, 2022 Time: 8:00 pm Register #MondayMotivation "One small crack does not mean that you are broken, it means that you were put to the test and you didn’t fall apart." Gustavo Friederichsen Chief Executive Officer Los Angeles County Medical Association “If it matters to our LACMA members, it matters to me.”