May 26, 2023

Take Action for Prior Authorization Reform 

Please contact your Members of Congress today and encourage them to sign a “Dear Colleague” letter, urging the Centers for Medicare and Medicaid Services (CMS) to promptly finalize its proposed prior authorization rules and hold big insurance companies accountable for the undue burden their policies put on physicians and patients. The deadline to sign on has been extended to June 9 due to overwhelming support. 

Keep the Medical Board a Physician Majority

We urge you to contact your representative and urge them to vote NO on SB 815, the Medical Board of California Sunset Review bill. Several proposed changes are alarming to physicians across the state, including: a nearly 60% fee increase (from $863 to $1,350), that will go primarily toward building a $150 million reserve fund, and the addition of two board members to create a public member majority instead of the current physician member majority. If SB 815 is passed in its current form, it would have vast, negative impacts on the practice of medicine and health care delivery in California.

Updated Guidance for Breast Cancer Screenings 



The U.S. Preventive Services Task Force released new guidance for breast cancer screenings, recommending they begin at age 40 instead of 50. This recommendation applies to all those assigned female at birth who have an average risk of breast cancer. The recommendation could help reduce breast cancer mortality in the U.S. by 20 percent, particularly among Black women, who are 40 percent more likely than white women to die from breast cancer.

Cigna Delays Implementation of Modifier 25 Policy



As of May 22, Cigna has updated its modifier 25 policy to announce a delay in implementing the required submission of documentation to support the use of modifier 25 when billed with E/M CPT codes 99212 – 99215 and a minor procedure. Cigna will look to implement this policy later, when it can optimize the provider experience and perform additional provider education in partnership with key national medical associations. 

Medi-Cal's Annual Checkwrite Delay to Begin June 22

DHCS recently announced the details of its annual “checkwrite” delay. DHCS will delay certain payments for two weeks in June so that those claims are paid out of the 2023-2024 fiscal year budget. This checkwrite delay will impact providers who render services through Medi-Cal funded programs. Read here for more information.

Physicians Who Relied on PTANs Must Complete a CMS-855



During the COVID-19 PHE, physicians and other providers who previously would have had to complete a CMS-855 Medicare enrollment application were granted temporary provider transaction access numbers, or PTANs. The lifting of the PHE on May 11 means those who had relied on temporary PTANs for their Medicare enrollment will have to revert back to the normal process of completing a CMS-855 enrollment application. MACs will begin issuing letters to that effect on June 1. Physicians and other providers will have 90 days from the date of the letter to submit their CMS-855 enrollment application. 

New FDA Approvals in the Opioid World

The FDA recently approved Brixadi (buprenorphine) extended-release injection for subcutaneous use to treat moderate to severe opioid use disorder. Brixadi is available in two formulations, a weekly injection that can be used in patients who have started treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine, and a monthly version for patients already being treated with buprenorphine. The FDA also recently approved Opvee, the first nalmefene hydrochloride nasal spray for the emergency treatment of known or suspected opioid overdose. This is the first FDA approval of nalmefene hydrochloride nasal spray for health care and community use.

Free Access to Group Purchasing Program

The Cooperative of American Physician’s group purchasing program is available to you and your practice for free with no obligation for significant savings on essential supplies. Independent physician offices, surgery centers and their employees can access money saving contracts for medical/surgical and non-medical supplies. The program extends cost savings not only to the practice, but also to all physician and non-physician members of the practice through its Employee Perks feature. Perks include discounts on cell phones, car rentals and office supplies. 

Emerging Substances in the Illicit Drug Landscape: Xylazine 

Tuesday, May 30 | 11:00 am to 12:30 pm

Hosted by the Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP)

The first webinar in the series will serve as an introduction to two decades of trends in the illicit drug landscape using fatal overdose data. Silvana Mazzella from Prevention Point Philadelphia will detail the association between these trends and drug use behaviors, especially as it pertains to the use of synthetic opioids like fentanyl, and the emerging co-use trends with stimulants and the introduction of xylazine in the region. Dr. Megan Reed from Thomas Jefferson University will then discuss research on the perspectives of people in Philadelphia, Pennsylvania, who use fentanyl adulterated with xylazine and community interest in detecting this and other cutting agents. In addition, Dr. Reed and Ms. Mazzella will detail efforts to address emerging harms associated with xylazine.

Register here.

Suffer in Silence No More 

Wednesday, May 31 | 10:00 am to 12:00 pm 

Speakers Dr. Russel Jeung, PhD and Dr. Seeba Anam, MD will facilitate this webinar to help participants understand sources of anti-Asian racism and reflect on its impact on the community, identify barriers to mental health treatment in Asian American communities, and discuss strategies for culturally informed approaches to address and advocate for mental health. The session also offers practical clinical interventions for working with the AAPI community on racial trauma and stress. 

More information and registration link here. 

Bay Area Reading and Discussion Group

Wednesday, June 7 | 6:00 to 7:30 pm

The book being discussed is "Emotional Intelligence: How it Can Matter More Than IQ" by Daniel Goleman. This is the classic, first published in 1995 and then updated, that launched an entire field. Please be careful that you choose Daniel Goleman's book - there are very similar titles by a Brandon Goleman and a Charles Goleman, which I think are copycat efforts. All physicians are welcome to join the meeting and do not need to read the book.

Register here. 

Taking Back Control: Practical Strategies to Reduce the Admin Hassles of Daily Medical Practice

Friday, June 16 | 9:00 am to 3:00 pm

Lafayette Library | FREE for all members

Join physician colleagues from across the Bay Area for a robust day of thought leadership and information sharing through interactive workshops and panel discussions focused on tackling the daily pain points of medical practice. This conference will equip you with practical tools and skills that you can apply immediately to your medical practice. You should leave feeling empowered with new ideas to minimize administrative burdens and restore joy to the practice of medicine.

Register here.

Focus on the Heart 

Friday, August 25 | 12:00 to 6:00 pm 

Hosted By NorthBay Health & Vascular 

Join us for an afternoon of education and networking. Expert faculty will provide up-to-date education on a wide spectrum of the latest updates in hypertension, CHF, A-Fib, DVT/PE therapy, AS and TAVR, Aortic disease and rapid-fire ECG reading among others. The program will have didactic lectures integrated with case discussion. Our guest keynote speaker is Regis Fernandes, MD, from Mayo Clinic. Come for the education and stay the weekend in the beautiful Suisun Valley wine country. Physician early bird tickets are $100, and student/resident tickets are $20.

For full details, including the 5 CME credit information, and registration, visit www.NorthBay.org/focus today.