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Monday Rx: Pfizer Vaccine Approval, Provider Reimbursement, Physician Wellness and LACMA Event Updates

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FDA Approves Pfizer Vaccine

Today, the U.S. Food and Drug Administration approved the first COVID-19 vaccine. The vaccine has been known as the Pfizer-BioNTech COVID-19 Vaccine and will now be marketed as Comirnaty (koe-mir’-na-tee), for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals. To learn more, click here.

President Biden announced several additional actions Wednesday aimed at fighting increasing numbers of COVID-19 cases, largely from the Delta variant of the virus. The president instructed the Federal Emergency Management Agency to extend full reimbursement through the end of the year to state deployments of the National Guard in support of COVID-19 response. Nearly 18,000 National Guard members are supporting our response nationwide from caring for patients to administering vaccines to running testing sites to distributing supplies." This action will help states "shore up their budgets, meet the needs of their communities, and continue on our economic recovery," he added.

Late last week, members of the White House COVID-19 Response Team announced that the Biden administration will be making booster shots available to recipients of either the Moderna or Pfizer vaccines; shots will be given 8 months after the second vaccine has been administered, starting on September 20. The move was pending approval by the FDA (today) and by the CDC's Advisory Committee on Immunization Practices.

While Cases Drop, Vaccination Rates Need Improvement

Los Angeles County reported 2,781 new cases of COVID-19 and 10 additional deaths Sunday, though health officials said the case numbers and deaths may reflect delays in weekend reporting.

In a slight bit of good news, the number of coronavirus patients in county hospitals dropped for the fourth consecutive day, declining from 1,746 on Saturday to 1,722, according to state figures. That number was 1,786 on Thursday. However, there were 439 COVID patients in intensive care on Sunday, up from 435 the day before.

Sunday’s figures brought the county’s totals to 1,383,186 cases and 25,071 fatalities since the pandemic began, according to the Los Angeles County Department of Public Health.

On Saturday, the department once again reminded residents that vaccinated people have greater protection against negative health outcomes should they contract the virus.

Reimbursement for Vaccinating Providers

As more and more physicians participate in the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program, health plans and insurers are required to reimburse for COVID-19 vaccine administration regardless of whether the services are provided by an in or out of network provider. For uninsured patients, providers can be reimbursed through the U.S. Department of Health and Human Services’ Provider Relief Fund.

In recent weeks CMA has heard from some physicians about challenges with reimbursement for vaccine administration services. If your practice is experiencing challenges with COVID-19 vaccine administration reimbursement, CMA can help.

Providers should be aware, however, there are some nuances to successfully submitting claims for COVID-19 vaccine administration services that differ from the normal claim submission process. For example, Blue Shield has assumed all financial responsibility of payment for COVID-19 vaccine administration services. For Blue Shield HMO patients, this means that rather than billing the delegated group, practices should bill Blue Shield directly COVID-19 vaccine administration services. All other vaccines will continue to be billed to the delegated groups. For more information click here.

Also, Medi-Cal managed care claims must be submitted to Medi-Cal fee-for-service (FFS) rather than the Medi-Cal managed care plans for reimbursement. Additionally, Medicare Advantage claims must be submitted directly to Noridian, the Medicare FFS Administrative Contractor in order to be paid.

CMA has published several resources including CMA’s COVID-19 Vaccine Reimbursement Quick Guide and COVID-19 Vaccine Toolkit for Physician Practices to provide answers to frequently asked physician questions about the COVID-19 vaccine rollout and billing guidance on the administration of the vaccine. Both resources are updated frequently with the latest information regarding COVID-19 Vaccines.

If your practice has questions regarding COVID-19 vaccine billing or is experiencing reimbursement challenges, please contact CMA at EconomicServices@cmadocs.org or at (888) 401-5911.

LACMA Continues to Address Physician Wellness

The rising prevalence of burnout among clinicians (over 50 percent in some studies) has led to questions on how it affects access to care, patient safety, and care quality. Burned-out doctors are more likely to leave a practice, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients and when burned-out physicians suffer from impaired attention, memory, and executive function. LACMA has launched MD Lifeline which includes support for physicians in crisis, retreats to get away and recharge, PPE supplies, financial grants in 2020 and again later this year with our 20+ preferred partners to help practices thrive. Take the Well Being Index Assessment. It is 100% confidential and will help us help you.

Click here to take the 4-minute assessment. The invitation code is LACMA WELLNESS. 

To learn more contact: gustavo@lacmanet.org.

Los Angeles Country Department of Public Health Needs You to Speak!

LACMA is working closely with many organizations to provide accurate information to those communities impacted by the virus. The Los Angeles County Department of Public Health is launching a speaker’s bureau to communities with low vaccination rates and those individuals who continue to be hesitant when it comes to getting vaccinated.

In this role, COVID-19 Speakers would lead group discussions for community members or clinical providers who want an opportunity to have their questions and concerns answered by a clinical professional whom they can identify with based on language, culture, faith group, or clinical expertise. As a result, the department is recruiting a cadre of providers who would participate in COVID-19 related training and conduct presentations to allay community members or provider concerns and address misinformation or rumors about the COVID-19 vaccine.

Click here, to express your interest in serving as a COVID-19 Speaker.

HOD Update

Important CMA House of Delegates Update

Once again, the leadership of the California Medical Association (CMA) met to discuss how to best handle this year's annual session of the House of Delegates (HOD) considering the continuation of the COVID-19 pandemic and emergence of the delta variant. While they greatly desired to have HOD meet in-person in a safe way, it is with a sense of responsibility and disappointment that they have moved to cancel their in-person meeting and replace it with a virtual session of the House.

CMA has directed staff to cancel their contract with the hotel and to begin planning a virtual program, as well as to develop timelines and other guidance for how the meeting can be conducted and what the agenda will likely look like. CMA asks that you continue to hold the Annual Session on your calendars for October 23-24 while they determine the form and agenda of the meeting.

While CMA does not yet have a settled-upon vision for the virtual meeting, they are rapidly exploring what options are left to them that can be successfully implemented in such a tight timeline. CMA hopes to be able to bring you that outline in the next week or so. In the meanwhile, if you have made hotel accommodations or travel plans – they ask that you cancel them as soon as possible.

CMA appreciates your cooperation and your patience as they work to build this important meeting. If you have questions, please direct them to CMA's Vice President of Governance & Business Administration, Michelle Chapanian.

Membership Appreciation

We will be celebrating LACMA’s 150th Anniversary with our members at the Huntington Library in the Rose Hills Garden Court on Saturday, November 6, 2021, from 3:00 pm - 5:00 pm. We would love for you to join us!

Click here to RSVP or email Lisa La at Lisa@lacmanet.org.

ACEs Online Wellness Engagement Groups - Tuesday Series

Join CMA's Free, Online Wellness Engagement Groups for Physicians Screening/Treating Patients with ACEs or Toxic Stress

The California Medical Association's (CMA) wellness program (CMA Wellness) is pleased to launch free, online wellness engagement groups for health care providers that conduct patient screenings for adverse childhood experiences (ACEs).

Treating patients with multiple ACEs or toxic stress can potentially impact your personal wellness and increase feelings of burnout. CMA Wellness' engagement groups will support providers by offering subject matter experts, best practices and an open forum to share experiences, facilitated by trained, volunteer physicians.

Each monthly webinar is organized around a prevailing theme with a stakeholder co-host to provide a variety of perspectives with a general discussion and breakout rooms. Registration is required, and providers will be joining the Tuesday series for a 6-month duration.

Event Date: September 7, 2021 - December 14, 2021

Next Session: Tuesday, September 7, 7:00 p.m. - 8:00 p.m.

Register Here

Virtual Grand Rounds: The Nocturnists and Variants vs Vaccines

Join CMA's Virtual Grand Rounds: The Nocturnists and Variants vs Vaccines Update on Tuesday, September 14, 2021, from 12:00 p.m. PT to 1:30 p.m. PT.

More than a year and a half into the unprecedented COVID-19 pandemic, physicians, NPs, PAs, nurses and many other caregivers in the healthcare system are tired. Just months ago, most of us began to feel like we could breathe again. But over the summer we have faced a resurgence with the Delta strain of COVID-19 that makes one begin to wonder when, and if, it will all end.

During this Virtual Grand Rounds we will hear from Dr Erica Pan, California’s State Epidemiologist, about the state of COVID-19 in California, efforts to keep the virus at bay, progress on vaccinations and the hope for keeping schools open this year.

We are also honored to hear from Emily Silverman, MD, the creator of The Nocturnists, a medical storytelling live show and podcast where healthcare workers can pause and examine their inner landscapes. The Nocturnists helps us examine the forces that drive burnout and moral distress, and in doing so provides hope that we can find ways to flourish in the face of the extreme stresses of medical practice in general, and practice in the setting of a pandemic in particular.

Date: September 14, 2021

Time: 12:00 pm - 1:30 pm

Register Here

#MondayMotivation

"A hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles."

Gustavo Friederichsen

Chief Executive Officer

Los Angeles County Medical Association

“If it matters to our LACMA members, it matters to me.”

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