Your Monthly News & Updates
|Grace Period for Membership Dues Payments End March 1st
If you are a 2017 member who has not paid your dues for 2018, your grace period will end March 1st. Avoid membership cancellation by contacting Kathy Hughes at 661-325-9025 or firstname.lastname@example.org.
Covered California 2018
With a number of changes occurring for 2018 including Anthem Blue Cross exiting California's exchange marketplace in all but three regions for 2018, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect. To help physicians understand how these changes will affect their practice, CMA has published a new tip sheet, "
Surviving Covered California: Preparing for changes in 2018
The tip sheet is available free to members at
Additionally, CMA has created a
sample patient letter
for physicians who are impacted by the Anthem pullback and wish to retain their Anthem Blue Cross patients through any other exchange plan(s) they are contracted under. Physicians may utilize the sample letter to advise their patients of the other plans offered on the exchange in which they still participate so the member may proactively switch coverage during open enrollment.
Anthem Blue Cross Modifier 25 Payment Policy
CMA has published a recent article on this critical issue,
Anthem dials back modifier 25 payment reduction policy; delays implementation - News - California Medical Association
, and will continue to provide updates as events occur. This past fall, Anthem Blue Cross
in several states that effective January 1, 2018, it would reduce reimbursement of evaluation and management (E&M) services billed with modifier 25 by 50 percent. The California Medical Association (CMA) quickly
jumped into action
and coordinated with the American Medical Association (AMA) and the American Association of Dermatologists, along with many other state and specialty organizations, to push back on the proposed change. Due to the overwhelming opposition from organized medicine, Anthem recently announced it would reduce the magnitude of its modifier 25 payment cut from 50 percent to 25 percent, and would delay implementation until March 1, 2018. Anthem will be issuing formal guidance to network physicians communicating these changes within the coming weeks. While this is an improvement on Anthem's original planned policy, CMA and AMA still strongly oppose this unjustified major reduction in physician payment. CMA will continue to work with AMA and others to seek full retraction of the Anthem policy.
Physicians launch new coalition to protect access to care
January 17, 2018
Today, the California Medical Association (CMA)
launched a new coalition
of more than 100,000 California physicians, dentists, nurse practitioners, community clinics and pharmacists to protect the gains California has made under the Affordable Care Act (ACA) and improve California's health care system.
Coalition to Protect Access to Care
will actively oppose efforts in Washington, D.C., to repeal and replace the ACA, as well as provide a more realistic and responsible solution to California's SB 562 - flawed legislation that would dismantle the health care marketplace and destabilize the state's economy. The Coalition also seeks to tie the current federal and state health care debate to practical realities that health care providers experience throughout the state.
The Golden State has made great strides under the ACA, expanding care to more than 5 million Californians who were previously without health coverage. According to the Public Policy Institute of California, nearly 60 percent of Californians view the ACA favorably, and only 18 percent want the law repealed. The Coalition will work with policymakers to protect and expand coverage to the remaining 2-3 million without access to care.
The Coalition also believes that with so much uncertainty in our nation's politics, now is
not the time to walk away from the ACA in favor of establishing a new and undefined health care system.
"We believe that every Californian deserves access to timely, quality health care and affordable coverage," said CMA President Theodore M. Mazer, M.D. "Unfortunately,
SB 562 would wreak havoc on the market
, forcing existing successful models aside while destabilizing the state budget - it's simply unaffordable and fails to recognize real-world access and market dynamics."
SB 562 would eliminate Medi-Cal, Medicare, all private insurance and the Covered California exchange for a singular health care insurance product provided by the state, without offering any way to pay for it. This measure threatens the health care marketplace for millions of California and is based on erroneous assumptions regarding how California can utilize health care funds provided by the federal government. It also ignores the fact that the state does not have the same powers as the federal government to effectuate a single-payer system.
What's more, the Legislative Analyst's Office (LAO) found that the proposal could "require new state tax revenues in the low hundreds of billions of dollars" and "could result in a lower minimum funding requirement for schools and community colleges" under Proposition 98. In other words, SB 562 would pit health care groups against public education advocates in an annual battle for state budget dollars, forcing Californians to choose between quality education and quality health care - an unfair, irresponsible and unnecessary request.
The Coalition is committed to the following principles:
- Aggressively protect and expand access to health care by building upon the successes of the Affordable Care Act.
- Work to expand access to care to the remaining 2-3 million Californians who are still without coverage.
- Oppose efforts to repeal or undermine the Affordable Care Act.
- Oppose Senate Bill 562 and any other health care proposal that destabilizes California's health care system by calling for unrealistic revenue increases that could destabilize our state budget.
- Commit to improving and expanding care for all Californians through an approach that builds upon California's existing health care delivery system.
California needs pragmatic and implementable solutions that benefit patients instead of scoring political points.
"A pluralistic health care delivery system can work, and we are committed to real solutions that improve and expand the current system without hurting patients or the economy of California," said Dr. Mazer.
In addition to CMA, Coalition members include the American College of Obstetricians and Gynecologists (District IX), California Association of Nurse Practitioners, California Dental Association, California Pharmacists Association, the Central California Partnership for Health and Kaiser Permanente.
Not a member?
or call 661-325-9025 to join.
||Kristopher L. Lyon, MD
KCMS 2018 President
Meet a Fellow KCMS Member
Dr. Kristopher Lyon grew up on the coast in beautiful and small town of Cayucos, between Cambria and Morro Bay.
He began his journey in medicine as a Paid Call Firefighter and full time Emergency Medical Technician with an ambulance company while he was still in college. He continued to cultivate his interest in this fast paced field as he went through his medical education at the Jefferson Medical College in Philadelphia and completed his Emergency Medicine residency at Loma Linda University.
He is board certified in Emergency Medicine and most recently EMS Medicine. He is the medical director for Kern County EMS and in his free time volunteers his time to provide medical support for the San Luis Obispo Sheriffs Office SWAT and Dive teams.
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