august 2015 | physician magazine

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A PUBLICATION OF PNNwww.PhysiciansNewsNetwork.com

R E P O R T I N G O N T H E E C O N O M I C S O F H E A L T H C A R E D E L I V E R Y

C M A W O R K S W I T H C M S T O M I T I G A T E M E D I C A R E I C D - 1 0 D I S R U P T I O N S

CONNECTED CARE medical devices | remote patient monitoring | data analytics

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AUGUST 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 1

Volume 146 Issue 8

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Advertising rates and information sent upon request.

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COVER STORY8 CONNECTED CARE

We offer real-world practice management tips on some of the key components of connected care — from medical devices and remote patient monitoring to electronic health records and their linked elements of interoperability and analytics. Find out what those means for you in terms of helping you make the transition into a connected care practice. We’ll also provide some legal, practical and reimbursement issues to think about.

6 Employing Advanced Practice Providers: Balancing Benefits and Potential Malpractice Risks

14 CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions

FROM YOUR ASSOCIATION

4 President’s Letter | Peter Richman, MD

16 CEO’s Letter | Rocky Delgadillo

42 SAN JOAQUIN PHYSICIAN FALL 2015

CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions With implementation of the ICD-10 code set just around the corner, many physicians

have been understandably wary about the transition and the potential for payment

disruptions and claims processing errors that could interfere with patient care. Fortunately,

the California Medical Association (CMA) – working closely with the American Medical

Association (AMA) and other medical associations – has secured provisions that will ease

this transition, particularly for physicians in practices with limited resources.

Thanks to CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently

announced that it will provide a one-year grace period during which it will allow for

flexibility in the Medicare claims payment, auditing and quality reporting processes as

the medical community gains experience using the new ICD-10 code set. The ICD-10

implementation date of October 1, 2015, has not changed.

THE CHANGES ANNOUNCED INCLUDE:CLAIM DENIALS: Medicare review contractors will not deny claims based solely on the

specificity of the ICD-10 diagnosis code as long as a valid code from the right family of

codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10

coding mistakes during the grace period.

QUALITY REPORTING: Physicians also will not be penalized under the quality reporting

programs for errors related to the additional specificity of the ICD-10 diagnosis code,

again as long as a code from the correct family of codes is used.

ADVANCE PAYMENTS: If Medicare contractors are unable to process claims within

established time limits because of administrative problems, such as contractor system

malfunction or implementation problems, advance payment may be available to keep

resources flowing to physician practices.

ICD-10 COMMUNICATION CENTER: CMS will set up a communication center to monitor

the implementation of ICD-10 in an effort to quickly identify and resolve issues related to

the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive

and triage physician and provider issues.

For the latest ICD-10 news and updates, see CMA’s ICD-10 resource page at

www.cmanet.org/icd10.

CMA PUBLISHES

ICD-10 TRANSITION GUIDE

CMA has published the

“ICD-10 Transition Guide”

to help practices of all

sizes successfully make the

switch to the new ICD-10

coding system. The guide

will answer frequently asked

questions and includes

CMA’s “ICD-10 Transition

Preparation Checklist” to

help ensure the transition is

a smooth one. The guide is

free to members-only at


CMA reimbursement help line, (888) 401-5911 or [email protected]

Page 2 of 6

ICD-10 Transition Preparation ChecklistPrEParaTIon

☐ Awareness of effective date – Verify that all staff, including physicians, are aware of the ICD-10 change and the

implementation date.☐ Create a project team – In larger practices, create an ICD-10 project team to handle and oversee the transition. In

smaller practices, this may be an assigned individual or a few individuals.

☐ Create an action plan – To address the ICD-10 transition, assign tasks to members of the project team and

set deadlines for completion of each task assigned. Timelines of when to complete various tasks may differ

depending on the size of the practice. CMS has created detailed implementation timelines based on practice

size, which are available on their website at www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html (click

“Online ICD-10 implementation guide,” then under the blue “Start” tab, select your practice size).

☐ Create a budget – Estimate and secure budget (potential costs include updates to practice management

systems, new coding guides and superbills, staff training).

☐ Identify areas impacted by the transition – Discuss with all staff members how/where they use/see ICD-9 codes

(e.g., superbill, chart documentation, practice management system, coders, EHR, clearinghouse, etc.) to identify

how ICD-10 will affect your staff and processes.

• Run a report to identify your most frequently billed ICD-9 codes.

◊ Review the medical record documentation to determine whether the documentation would be sufficient

to select an ICD-10 code. ◊ This will help the practice identify the corresponding ICD-10 codes for training purposes, as well as help

the practice identify training opportunities.

☐ Talk to your vendors – Identify all of your vendors that will have an impact on the ICD-10 transition (practice

management system, EHR, clearinghouse, etc.) to discuss their readiness and timelines.

• When are they conducting testing with the practice and other vendors?

• What are their timelines for testing or implementation of any necessary upgrades?

• Are upgrades needed and if so, are there any costs associated with the upgrades (or is it included in your

maintenance price)?• Ensure your system(s) will have the ability to maintain both ICD-9 for dates of service through September

30, 2015, and ICD-10 codes for dates of service October 1, 2015, forward.

• Ask your vendor specifically about the number of text characters they allow for the ICD-10 description in the

system. Some of the text descriptions are extremely long so if the vendor can’t accommodate the full description,

start thinking about how you will modify so that all staff is clear on the description of the new ICD-10 code.

Reminder: Clearinghouses will not be able to crosswalk your ICD-9 codes to ICD-10 codes as there is not a

one-to-one crosswalk between the two code sets.

☐ Ensure system edits are updated – If your EHR and/or practice management systems contain billing edits based

on ICD-9 codes, work with your vendor to ensure these are updated.

☐ Identify internal work flow processes that need to be updated – Disease management registries, data collection

processes, data reporting processes, or other work flow processes may need to be updated.

☐ Schedule follow up meetings to evaluate preparation progress – Schedule reoccurring meetings with team

members involved in the transition to evaluate progress and identify potential problems.


Page 1 of 6

GUIDEICD-10 Transition GuideWhat physicians need to know

On January 16, 2009, the Department of Health and Human Services (HHS) published a regulation requiring the

replacement of ICD-9 with ICD-10. Originally due to be implemented as of October 1, 2013, concerns regarding the

successful transition delayed implementation until October 1, 2015.

While the transition to ICD-10 has been criticized by some as unnecessary and costly, the arguments in support of

the transition are that ICD-9 has become outdated and fails to accurately reflect the complexities of 21st century

medicine. It is widely believed that the specificity of ICD-10 will meet the reporting needs of our modern health care

system while helping to identify diagnosis trends, improve quality and care management, and assist in the reporting

of the public health system.The California Medical Association (CMA) has developed a transition website, www.cmanet.org/icd10, that includes

important news articles and other ICD-10 transition information for physicians. CMA will also be hosting a number of

live training events to assist physicians with the transition.

To help physicians prepare for the transition, CMA has created this ICD-10 Transition Guide.

1. What is the ICD-10 transition date?ICD-9 will transition to ICD-10 effective October 1, 2015. Under ICD-9 there are approximately 14,000 codes, which

will transition to approximately 69,000 under ICD-10.

2. What will change on the transition date?

For dates of service on or after October 1, 2015, ICD-10 codes will be required on all claim transactions. However,

only a small percentage of the codes will be used by most providers.

3. What do I need to do to prepare?While preparations for ICD-10 should have already begun, practices should be focusing on addressing the transition

in the remaining months prior to conversion. Practices should immediately create a plan or checklist identifying key

areas that ICD-10 will impact in their practice. While ICD-10 will obviously impact the billing aspect of any practice,

the ramifications of this change will go far beyond just the coder or biller. Practices, including physicians, should be

aware of the increased medical record documentation that will need to occur in support of the specificity of new

ICD-10 diagnosis coding. To address these changes, additional training may be required for both physicians and

staff. In conjunction with documentation, practices need to consider whether their practice management system,

electronic health records (EHR) system, clearinghouse, billing office, etc. will be ready to accept the new ICD-10

format. Remember, practice management systems will be required to maintain previous ICD-9 information for dates of

service September 30, 2015, while incorporating new ICD-10 formats for dates of service October 1, 2015, forward.

CMA has created checklist to help practices prepare for a successful implementation.

166

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The Los Angeles County Medi-

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physicians from every medical

specialty and practice setting

as well as medical students,

interns and residents. For more

than 100 years, LACMA has

been at the forefront of cur-

rent medicine, ensuring that its

members are represented in the

areas of public policy, govern-

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relations. Through its advocacy

efforts in both Los Angeles

County and with the statewide

California Medical Association,

your physician leaders and staff

strive toward a common goal–

that you might spend more time

treating your patients and less

time worrying about the chal-

lenges of managing a practice.LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at [email protected] or 213-226-0304.

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4 P H YS I C I A N M AG A Z I N E | AUGUST 2015

THE GREECE FINANCIAL crisis is seeming-ly resolved and Grexit has been averted. Greece borrowed from the EU to maintain a standard of living that its own economy was incapable of sustaining. The people felt they deserved the best. The borrowing raised salaries, benefits

and pension payments to which the people became accustomed. The Greece na-tional debt rose from 22.6% of GDP in 1980 to 177% of GDP in 2015. When credi-tors would no longer roll over debt, the scheme came crashing down. (The credi-tors are at fault as well for not doing due diligence and loaning money to a country that could not afford the fu-ture payments.) Greece has agreed to raise taxes, cut benefits, lay off government employees, privatize func-tions and reduce pensions up to 40%. This will reset the economy to a level sustain-able by indigenous growth

and begin to pay back an exorbitant debt that should be reduced.

The United States has its own approaching version: Medicarexit. Medicare payments have been rising to an unsustainable level. In 2010 Medicare and Medicaid payments alone repre-sented 4.4% of GDP. This number is expected to rise to 12% of GDP in 2050. Medicare, Med-icaid, CHIP and healthcare subsidies currently account for 24% of the federal budget. A nearly threefold increase in the next 35 years will bank-rupt the country. The U.S. Government borrows money (our national debt is now at 101% of GDP) to pay for a standard of living and benefits to which we have become accustomed.

Obamacare enacted insurance reform and greatly expanded the insurance rolls. It also calls for payment reform and structural changes for the healthcare system. It has not been cost neutral as promoted and in fact is bringing sig-

nificant cost increases. For 2015, overall insur-ance costs are rising 2% to 5% with plan rates varying from -14% to +50%. Obamacare rates are parallel to overall private insurance increas-es. Bringing in 32.2 million new patients and instituting and integrating EMR would never be paid from “fraud, abuse and waste” savings. Those projected savings have eluded every government agency since the Founding Fa-thers. Obamacare, however, has withstood two constitutional challenges and remains in force. Having medical coverage for the population of the wealthiest country is a noble goal.

At some point, our debt payments will be-come too burdensome for our economy, and adjustments will be made. Taxes will rise and benefits will be reduced. Our national standard of living will be decreased.

To avert this crisis, many scenarios have been devised. (Obamacare shifted the cost curve but only for a few years.) Freezing overall Medicare expenditures and giving the money to states as block grants achieves this goal for the federal government but leaves the cost savings imple-mentation to the states. Freezing Medicare ex-penditures to a sustained growth rate (SGR) was attempted only for doctors, and it was never implemented. A Medicare sequestration would force limits on all sectors of healthcare. How the limits would be absorbed is not delineated. Lastly, insurance coverage could be modified to bring expenditures in line with budgeted in-come.

As stated, the ACA model may shift the cost curve for a few years once fully implemented. Additional changes will still be necessary. Many physicians are frustrated with the initial steps of Obamacare. There will be many more changes as the system evolves. We as physicians cannot stand by and let others dictate policy and pro-cedures that affect our daily lives and that of our patients. Nor can we wait until a financial crisis is imminent before we become involved inti-mately in the formulation of future healthcare policy. Being a member of LACMA and CMA al-lows members to have a significant voice in the process.

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PR ACTICES AND HOSPITALS that employ advanced practice providers (APPs), including

nurse practitioners and physician assistants, can experience many benefits, such as lower op-

erating overhead, increased physician time with patients, and improved patient education and

satisfaction. However, employers of APPs should consider implementing effective risk manage-

ment measures to help ensure that the benefits of using APPs are not at the expense of increased

liability exposure.

An APP is often covered under the physician’s or hospital’s malpractice insurance policy under vicarious li-ability coverage. APPs can be held directly liable for their own acts or omissions, but, in addition, under the legal theory of vicarious liability, physicians and hospitals can also be held liable for the actions of their employees, including APPs. Therefore, the physician or hospital is often named in malpractice claims involving their APPs.

To help decrease liability risks, the employing physician or hospital should have a written policy outlining the APP’s scope of practice. This policy should be signed by the APP and other staff members annually. In putting together this policy, it is important to know the laws in your state that govern the scope of practice of APPs. Other suggestions to decrease liability risks include:

• Ensure that all newly hired APPs undergo orientation with the practice or hospital.• When scheduling appointments, staff should inform patients when they are being scheduled with an APP. If

that patient requests to see his or her physician, the staff should provide the patient with that option. • Make certain APPs wear identification that indicates their name and their job title. • Develop treatment guidelines and clinical triggers for physician consultation. Meet with the APPs regularly to

discuss their roles and expectations within the practice, and document these meetings.• Regularly review the charts, including prescription monitoring, of patients seen by the APPs.• Make sure that all staff members, including APPs, have adequate professional liability coverage. For nonem-

ployed APPs, liability coverage should be equal to what the physician or practice carries.

To read case studies about employing APPs and for detailed risk management checklists, download The Doc-tors Company’s guide to an APP preventive action and loss prevention plan at http://ow.ly/OxqBm.

-------------------- Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.


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CONNECTED CARE medical devices | remote patient monitoring | data analytics

BY MARION WEBB

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REIt’s common knowledge that the more engaged and “connected”

patients are with their physicians, the more compliant they tend to be with treatments and medical advice, resulting in better outcomes, lower healthcare costs and reduced hospital readmission rates. In this issue, we’ll provide you with real-world practice management tips on some of the key components of connected care — from medical devices and remote patient monitoring to electronic health records and their linked elements of interoperability and analytics. Find out what these means for you in terms of helping you make the transition into a connected care practice. Finally, we’ll also provide some legal, practical and reim-bursement issues to think about.

1 0 P H YS I C I A N M AG A Z I N E | AUGUST 2015

According to Jan Oldenburg, a senior manager in Ernst & Young’s Advisory Health Practice, in this digital age, patients want to use their smart-phones, apps and instant access on

the Internet to connect with their physicians, as report-ed in Physicians Practice.

They also want to gain access to their health records and play a more active role in their own health manage-ment, Oldenburg told Physicians Practice.

To find out exactly what patients are interested in, Oldenburg and her colleagues on the HIMSS (Health-care Information and Management Systems Society) Connected Patient Committee, created a survey asking health consumers what they’d like to see improved in their personal health engagement.

The findings on a scale of one to five (with five be-ing the highest) showed that consumers were very in-terested in the following four criteria:

• Being able to make, cancel and view appointments online;

• Being able to refill prescriptions online;• Being able to complete a pre-visit form; and

• Being able to research health issues online.

Furthermore, 84% of respondents noted that they would like the healthcare system to be more consumer-friendly, with 75% saying they’d like to be able to see all clinical data in one place.

To make this happen, Oldenburg suggests that medical practices evaluate their digital tools and “think beyond basic requirements of meaningful use.” Eligi-ble professionals need to demonstrate meaningful use of certified electronic health records to qualify for an incentive payment through the Medicare EHR Incentive Program administered by the Centers for Medicare and Medicaid Services. Oldenburg believes that revamping work flow and incentives to support digital tools, and having staff and physicians encourage their use is also critical, as reported in Physicians Practice on April 15.

O l d e n b u r g also noted that the recently pro-posed rule by the Centers for Medicare and Medicaid Services to adjust the requirement in the Stage 2 rules (one of the meaningful use requirements) from a 5% threshold of patients downloading, viewing and trans-mitting their electronic health data to just one patient is “not enough.”

“(One patient) does not make it an organizational priority . . . and say that you’ve embraced this and made a cultural change,” Oldenburg told Physicians Practice.

Other experts agreed that while many practices have already or are still investing in electronic health

record (EHR) systems, the continuing drive to connec-tive care should be part of their consideration in EHR implementation.

Achieving meaningful use is a big part of the equa-tion, but not everything.

With some 71.4 million people in the United States turning 65 or older by 2029 and an expected short-age of 20,400 primary care doctors by 2020, reduc-ing the need for office visits and hospitalization will be paramount to reduce costs, Charles Settles, a product analyst at TechnologyAdvice, wrote in an article that ap-peared on June 26 in Physicians Practice.

Settles cited studies that show that these aging baby boomers have higher rates of chronic disease, more disability and lower self-rated health than mem-bers of previous generations.

Moving to an outcome-based reimbursement mod-el, he said, is seen as a way to control costs and to in-centivize improved outcomes.

The key to ensuring that outcome-based reimburse-ments are fair to physicians is having accurate analytics.

This, in turn, would require the creation of a nation-wide patient database (that would also include healthy individuals) and allow tracking of such metrics as mor-tality rates, average life expectancies and medication efficacies.

But this could only be realized if EHR vendors solved their interoperability issues, or ability of health information systems to work together and across orga-nizational boundaries, which, according to the experts, is unlikely in the near future.

The good news is that there are certain EHR “add-ons” avail-able today that can help doctors create ef-ficiencies in their own practices today and for the future.

In particular, there are three solutions that can help boost medical practices today, according to an article in Physicians Practice from May 21.

1. Scanning - Adding a scanning system is a great way to create a digital archive of patients’ insurance infor-mation, their contact details, and their HIPAA consent forms. This also helps the front-office staff resolve prob-lems, such as with insurers, faster.

2. Practice Management System - To streamline billing and scheduling, a practice management system that in-cludes both is a good fit. The key is to use one vendor to avoid duplicating data, and while this may initially be costly, it will save money and time in the long run, the experts noted.

3. Data Analytics - Data analytics should be on the short list as it can take revenue cycle data and pair

“add-ons” that help create efficiencies

analytics and interoperability

what health consumers want

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it with data from the clinical side of a practice to see how the practice is really taking care of its patients, the experts noted. This, in turn, allows physicians to make better decisions about what changes are needed to im-prove the delivery of care, improve patient outcomes and decrease cost of care.

With a data analytics system, practices also have greater insight into which patients are using their pa-tient portal successfully and align resources to make the patient portal more user-friendly.

According to Daniel Carlin, MD, founder and CEO of WorldClinic, an elite telemedicine concierge prac-tice (as quoted in Forbes Magazine), a platform that integrates telemedicine calls, episodes and data into a secure medical record system should also include a wellness checklist with follow-up capabilities.

This, according to the article, is in contrast to the Dial-a-Doc model, which provides simple episodic ur-gent care calls but lacks continuity for complex or chronic issues.

One solution that already exists to suc-cessfully capture data of individuals is the use of remote monitoring through implantable and wearable devices,

according to TechnologyAdvice analyst Settles. He said implantable and wearable devices have the

potential to save millions of dollars by reducing hospi-talization and providing comprehensive real-time mon-itoring of physical activity, vital signs and other metrics.

Many experts feel that the data derived from such devices will play a pivotal role in managing chronic care patients.

Danny Sands, chief medical officer at Conversa Health Inc., during a presentation at the HIMSS Confer-ence in Chicago in April, noted that such data will likely also be key for primary care offices.

Sands told Physicians Practice that while fitness trackers enjoy greater popularity with consumers, he cited a study that showed that health monitoring de-vices tracking chronic disease patients will be far more valuable for doctors.

According to a pilot study of 1,300 chronic disease patients Conversa Health did in partnership with an adult primary care practice, 73% of patients completed one or more digital checkups, 81% stayed engaged af-ter the first checkup, and 29% had a clinical intervention.

He noted that many issues that required interven-tion had to do with medication adherence that could be fixed with a quick call.

Also, 72% of patients stayed on track or even im-

remote monitoring


proved during the pilot.When it comes to implementation of connected care and

the convergence of digital health, Apple Inc. and Google are also major game players.

Apple’s HealthKit, a software framework used to aggre-gate data from health and fitness apps on smartphones, for instance, has led more than 20 large healthcare systems, in-cluding Cedars-Sinai in Los Angeles and UCLA Health, to test the software, Physicians News Network reported on May 11.

In some cases, the healthcare systems have opened their EHRs to HealthKit, allowing patients to directly share unfil-tered data with their doctors.

Given the increase in the number of chronic disease patients and the need to better engage with patients, doc-tors who provide “light touches” with relevant patients via remote monitoring will be part of the wave of the future, Sands said.

To successfully acquire patient-generated health data, Sands and other experts have put forth some key recommen-dations:

• Make sure acquiring patient-generated health data fits into your daily workflow.

• Ensure that received information is automated.• Make it simple for patients to provide the data and easy

for physicians to use it.• The data should not overwhelm the physician. • Have an appropriate care team staffing in place.

“Too much information is not a good idea, but if you can help create information from the data, then it will be useful,” Sands was quoted as saying.

As with all new technologies, connected care raises con-cerns, particularly on the reimbursement, legal and regula-tory fronts, which will affect doctors.

According to the Alliance for Connected Care, “to achieve the promise of connected care in our healthcare system, there must be renewed urgency among policy makers to de-velop a regulatory structure that enables safe and accessible use of technology.”

All experts agreed that the wave of patients walking into their practices looking to stay engaged via remote monitor-ing and smartphone applications will only get bigger.

To help you navigate this sea change, look for the Octo-ber issue of Physician Magazine, where we will dive deeper into mobile health, talk about what it means for your practice, and also identify the top physician apps to help you better connect and engage with your patients.

tracking patient-generated

health data

Leveraging Enterprise-Wide MDI for a Patient-Centric Approach to CareBY JANET DILLIONE

Medical device integration (MDI) is a hot topic in healthcare,

though the concept itself has been around for years.Several factors are driving MDI higher on the list of priorities for

hospitals, including the maturation of EMR systems and the asso-ciated Meaningful Use requirements, concerns over patient safety related to manual data entry errors, Virtual ICU applications for remote patient monitoring and alarm management system imple-mentation to address patient safety concerns.

Properly implemented, a comprehensive enterprise-wide MDI solution can also provide the foundation for smart alarms and pre-dictive analytics to aid in early intervention and clinical decision support, provided it is capable of collecting the high-fidelity, low-la-tency data needed to enable these types of advanced capabilities.

Implementation of an enterprise-wide, interoperable MDI plat-form presents multiple challenges. Here are some key consider-ations to take into account:

• Think Long Term. Consider not just where you are now, but where you might be in the future. Is the MDI platform capable to scale and adapt to your evolving needs? As new devices, technologies and physiological measurements emerge, will it be able to support them quickly and cost-effectively?

• Moving Together. Broad, multi-disciplinary involvement is criti-cal for a successful MDI implementation. Governance needs to be adaptive and to understand that the solution must contribute to the comprehensive assessment and treatment of a patient throughout the continuum of care.

• Consider Workflow. Every technology has a “people compo-nent.” How will an enterprise-wide MDI platform impact clini-cal workflows? How does the solution deal with mobile devices that are not mounted at the bedside? You don’t want clinicians spending time connecting and assigning devices when they should be focusing on the patient.

• Avoid Regulatory Pitfalls. The FDA recently reaffirmed their guid-ance that systems relied upon to provide timely clinical interven-tion must have Class II clearance, including all intermediary third party applications. Make sure MDI solutions you are considering have clearance for this intent.

• Go Big (Data). Don’t just consider MDI to push device data into an EMR at 1-minute increments. Make sure you capture all high-fidelity data available from your devices – as mentioned earlier, this is critical for emerging real-time applications such as Alarm Management, Virtual ICU or predictive analytics.

MDI holds a great deal of potential for hospitals and health sys-tems to create the right infrastructure to improve patient safety, out-comes and both patient and staff satisfaction. By making the right choices today, provider organizations will be well positioned to support evolving needs for years to come.

Janet Dillione is CEO of Cardiopulmonary Corp., in Milford, CT. Its flagship Bernoulli Enterprise system provides an extensible platform for medical device connectivity, alarm management, clinical surveillance, virtual ICU and analytics. Ms. Dillione has more than 25 years of experience leading global teams in the development and delivery of healthcare technology and services.


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LASER THERAPY HAS BEEN AROUND FOR OVER 35 YEARS, SO WHY DIOWAVE NOW? The effects of laser light energy have been well documented over the last 35 years. Laser energy affects the body by accelerating the healing process of damaged tissues, non-invasively and without side effects. However, the problem over time has been that because of the limited power output of therapeutic lasers, the results on deeper seated pa-thologies like herniated discs, spinal stenosis, sciatica, back and neck pain, arthritis and neuropathy were marginal at best. The Diowave platforms of therapeu-tic lasers now offer clinicians the most powerful and advanced healing technology available in medicine to-day. With that comes the ability to deliver significantly greater dosages of healing photonic energy along with penetration to depths never before seen in physical medicine. The key to better clinical outcomes accord-ing to Diowave’s chief medical officer, Scott Davis, MD, MA, FASAM, is higher dosage and deeper pen-etration, and Diowave delivers both.

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health care systems and even Small Animal and Equine veterinarians, to name a few. Cosmetic and plastic sur-geons are now starting to embrace the technology.

IS YOUR PRACTICE LOOKING FOR A NEW PRIVATE PAY-CASH PROFIT CENTER? There is no better time than the present to discover how high dose laser ther-apy is increasing medical and financial outcomes in today’s world of declining insurance reimbursements. With our company’s technology and training, physi-cians can now begin the process of breaking away from the addiction to insurance-based medicine by offering their patients outcomes never before seen in traditional pain care. According to Dr. Davis, another great feature of HDLT is that a therapist or medical as-sistant can readily administer it. The physician’s time spent in case management is minimal and the income is passive.

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14 P H YS I C I A N M AG A Z I N E | AUGUST 201542 SAN JOAQUIN PHYSICIAN FALL 2015

CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions With implementation of the ICD-10 code set just around the corner, many physicians

have been understandably wary about the transition and the potential for payment

disruptions and claims processing errors that could interfere with patient care. Fortunately,

the California Medical Association (CMA) – working closely with the American Medical

Association (AMA) and other medical associations – has secured provisions that will ease

this transition, particularly for physicians in practices with limited resources.

Thanks to CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently

announced that it will provide a one-year grace period during which it will allow for

flexibility in the Medicare claims payment, auditing and quality reporting processes as

the medical community gains experience using the new ICD-10 code set. The ICD-10

implementation date of October 1, 2015, has not changed.

THE CHANGES ANNOUNCED INCLUDE:CLAIM DENIALS: Medicare review contractors will not deny claims based solely on the

specificity of the ICD-10 diagnosis code as long as a valid code from the right family of

codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10

coding mistakes during the grace period.

QUALITY REPORTING: Physicians also will not be penalized under the quality reporting

programs for errors related to the additional specificity of the ICD-10 diagnosis code,

again as long as a code from the correct family of codes is used.

ADVANCE PAYMENTS: If Medicare contractors are unable to process claims within

established time limits because of administrative problems, such as contractor system

malfunction or implementation problems, advance payment may be available to keep

resources flowing to physician practices.

ICD-10 COMMUNICATION CENTER: CMS will set up a communication center to monitor

the implementation of ICD-10 in an effort to quickly identify and resolve issues related to

the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive

and triage physician and provider issues.

For the latest ICD-10 news and updates, see CMA’s ICD-10 resource page at


CMA PUBLISHES

ICD-10 TRANSITION GUIDE

CMA has published the

“ICD-10 Transition Guide”

to help practices of all

sizes successfully make the

switch to the new ICD-10

coding system. The guide

will answer frequently asked

questions and includes

CMA’s “ICD-10 Transition

Preparation Checklist” to

help ensure the transition is

a smooth one. The guide is

free to members-only at



Page 2 of 6

ICD-10 Transition Preparation ChecklistPrEParaTIon

☐ Awareness of effective date – Verify that all staff, including physicians, are aware of the ICD-10 change and the

implementation date.☐ Create a project team – In larger practices, create an ICD-10 project team to handle and oversee the transition. In

smaller practices, this may be an assigned individual or a few individuals.

☐ Create an action plan – To address the ICD-10 transition, assign tasks to members of the project team and

set deadlines for completion of each task assigned. Timelines of when to complete various tasks may differ

depending on the size of the practice. CMS has created detailed implementation timelines based on practice

size, which are available on their website at www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html (click

“Online ICD-10 implementation guide,” then under the blue “Start” tab, select your practice size).

☐ Create a budget – Estimate and secure budget (potential costs include updates to practice management

systems, new coding guides and superbills, staff training).

☐ Identify areas impacted by the transition – Discuss with all staff members how/where they use/see ICD-9 codes

(e.g., superbill, chart documentation, practice management system, coders, EHR, clearinghouse, etc.) to identify

how ICD-10 will affect your staff and processes.

• Run a report to identify your most frequently billed ICD-9 codes.

◊ Review the medical record documentation to determine whether the documentation would be sufficient

to select an ICD-10 code. ◊ This will help the practice identify the corresponding ICD-10 codes for training purposes, as well as help

the practice identify training opportunities.

☐ Talk to your vendors – Identify all of your vendors that will have an impact on the ICD-10 transition (practice

management system, EHR, clearinghouse, etc.) to discuss their readiness and timelines.

• When are they conducting testing with the practice and other vendors?

• What are their timelines for testing or implementation of any necessary upgrades?

• Are upgrades needed and if so, are there any costs associated with the upgrades (or is it included in your

maintenance price)?• Ensure your system(s) will have the ability to maintain both ICD-9 for dates of service through September

30, 2015, and ICD-10 codes for dates of service October 1, 2015, forward.

• Ask your vendor specifically about the number of text characters they allow for the ICD-10 description in the

system. Some of the text descriptions are extremely long so if the vendor can’t accommodate the full description,

start thinking about how you will modify so that all staff is clear on the description of the new ICD-10 code.

Reminder: Clearinghouses will not be able to crosswalk your ICD-9 codes to ICD-10 codes as there is not a

one-to-one crosswalk between the two code sets.

☐ Ensure system edits are updated – If your EHR and/or practice management systems contain billing edits based

on ICD-9 codes, work with your vendor to ensure these are updated.

☐ Identify internal work flow processes that need to be updated – Disease management registries, data collection

processes, data reporting processes, or other work flow processes may need to be updated.

☐ Schedule follow up meetings to evaluate preparation progress – Schedule reoccurring meetings with team

members involved in the transition to evaluate progress and identify potential problems.


Page 1 of 6

GUIDEICD-10 Transition GuideWhat physicians need to know

On January 16, 2009, the Department of Health and Human Services (HHS) published a regulation requiring the

replacement of ICD-9 with ICD-10. Originally due to be implemented as of October 1, 2013, concerns regarding the

successful transition delayed implementation until October 1, 2015.

While the transition to ICD-10 has been criticized by some as unnecessary and costly, the arguments in support of

the transition are that ICD-9 has become outdated and fails to accurately reflect the complexities of 21st century

medicine. It is widely believed that the specificity of ICD-10 will meet the reporting needs of our modern health care

system while helping to identify diagnosis trends, improve quality and care management, and assist in the reporting

of the public health system.The California Medical Association (CMA) has developed a transition website, www.cmanet.org/icd10, that includes

important news articles and other ICD-10 transition information for physicians. CMA will also be hosting a number of

live training events to assist physicians with the transition.

To help physicians prepare for the transition, CMA has created this ICD-10 Transition Guide.

1. What is the ICD-10 transition date?ICD-9 will transition to ICD-10 effective October 1, 2015. Under ICD-9 there are approximately 14,000 codes, which

will transition to approximately 69,000 under ICD-10.

2. What will change on the transition date?

For dates of service on or after October 1, 2015, ICD-10 codes will be required on all claim transactions. However,

only a small percentage of the codes will be used by most providers.

3. What do I need to do to prepare?While preparations for ICD-10 should have already begun, practices should be focusing on addressing the transition

in the remaining months prior to conversion. Practices should immediately create a plan or checklist identifying key

areas that ICD-10 will impact in their practice. While ICD-10 will obviously impact the billing aspect of any practice,

the ramifications of this change will go far beyond just the coder or biller. Practices, including physicians, should be

aware of the increased medical record documentation that will need to occur in support of the specificity of new

ICD-10 diagnosis coding. To address these changes, additional training may be required for both physicians and

staff. In conjunction with documentation, practices need to consider whether their practice management system,

electronic health records (EHR) system, clearinghouse, billing office, etc. will be ready to accept the new ICD-10

format. Remember, practice management systems will be required to maintain previous ICD-9 information for dates of

service September 30, 2015, while incorporating new ICD-10 formats for dates of service October 1, 2015, forward.

CMA has created checklist to help practices prepare for a successful implementation.

AUGUST 2015 | W W W. P H YS I C I A N S N E W S N E T WO R K .COM 15FALL 2015 SAN JOAQUIN PHYSICIAN 43

2015 ICD-10-CM Code Set Boot Camps

For more information about CMA, please visit www.cmanet.org or call 800.786.4262

DISCOUNTED ICD-10 EDUCATION AND TRAINING FOR MEMBERS

Recognizing that health care providers need help with the transition, CMA, AMA and CMS are also working to make

sure physicians and other providers are ready for the October 1, 2015, transition to the new ICD-10 code sets.

CMA, in partnership with its local county medical societies and the California Medical Group Management

Association, is offering two-day ICD-10 code set seminars around the state. The two-day boot camps include 16

hours of intensive general ICD-10 code set training, along with hands-on coding exercises. To view the available

dates and locations, visit CMA’s ICD-10 event calendar at www.cmanet.org/aapc-icd10.

In addition to the two-day code set boot camps, CMA has negotiated deep discounts on other ICD-10 training

courses through AAPC. For details, visit www.cmanet.org/aapc.

CMS and AMA will also be offering webinars, educational articles and national

provider calls to help physicians and other health care providers prepare for

the transition. For more information, see CMS’s ICD-10 provider page at

www.cal.md/cms-icd10 and AMA’s ICD-10 web page at

www.cal.md/AMAICD10.

2015 ICD-10-CM Code Set Boot Camps

• ICD-10 format and structure

• Complete in-depth ICD-10 guidelines

• Nuances found in the new coding system, with coding tips

TRAINING FOCUSES ON:

Learn to code for ICD-10-Clinical Modification (ICD-10-CM) and prepare for the ICD-10 Proficiency Assessment. Training is led by a certified AAPC instructor and is provided onsite in a classroom format. Conducted over two days, attendees will receive 16 hours of intensive general ICD-10 code set training along with hands-on coding exercises.

• 16 CEUs

• AAPC ICD-10-CM Code Set Course Manual

• AAPC ICD-10-CM Code Set Draft Book

• AAPC Online ICD-10-CM Proficiency Assessment (Required for current AAPC CPCs to maintain their credential)

• Access to AAPC’s Online ICD-10-CM Assessment Training Course through December 31, 2015

WHAT’S INCLUDED:

• $399 for CMA members & members’ staff

• $499 for CA-MGMA members

• $599 for non-members*Comparable AAPC ICD-10 Boot Camp Costs $799

PRICING:

Save up to $400!

REGISTER: CALL (800) 786-4262 OR VISIT WWW.CMANET.ORG/AAPC-ICD10INFORMATION: CALL JULI REAVIS AT (916) 551-2046 OR EMAIL [email protected]

LOCATION/DATES

For more information about CMA, please visit:

www.cmanet.org

*Dates and locations subject to change. Please check www.cmanet.org/AAPC-ICD10 for updated information and new boot camps being added.

For more information about these and other CMA member discounted course offerings from

AAPC, please visit: www.cmanet.org/AAPC

Sacramento . . . .July 15-16

Roseville . . . . . August 4-5

Stockton . . . . August 10-11(French Camp)

Modesto . . . . August 12-13

Redding . . . . August 24-25

Eureka . . . . . August 26-27

Santa Maria . . . . . June 8-9

Fresno . . . . . . . June 15-16

Napa . . . . . . . . . June 18-19

Irvine . . . . . . . . June 23-24

San Diego . . . . June 25-26

San Jose . . June 30-July 1

Redlands . . . . . . . .July 7-8

Los Angeles . . . . . .July 8-9

Santa Rosa . . . . .July 13-14

Torrance . . . . . . .July 14-15

SIGN UP FOR ICD-10 NEWS ALERTS

The CMA website allows registered users to create custom

content alerts on the topics that are of interest to you. Once

signed up, you will be notified any time there is new content

posted in one of your areas, including ICD-10 issues. To

sign up, go to www.cmanet.org and visit your account

dashboard, click on “My Alerts,” then select “ICD-10.”


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CEO’s LETTER

T H I S S U M M E R , L A C M A physicians have won yet another victory in doing the right thing for their patients and the California community.

We thank all of our physicians who have supported LACMA’s efforts and taken the time to contact their legislators in support of SB 277, which removes the personal belief exemption

for vaccines and reduces preventable disease outbreaks in our communities.On June 30, Gov. Jerry Brown signed SB 277 into law, and as of January

2016, parents will be absolutely required to ensure that their children receive all mandatory vaccines, unless medically exempt, regardless of their religious or philosophical views.

This is exciting news, and now LACMA is inviting all members to reward those physicians who are also making a difference in our communities.

We are asking all LACMA members to nominate individuals you believe have made exemplary contributions in providing and improving access to quality healthcare in LA County.

We encourage everyone to participate in this important process, which cul-minates in LACMA’s biggest annual celebration dinner — the 2015 L.A. Health-care Awards dinner.

Please take a look at the categories and criteria to nominate outstand-ing physicians online at lahealthcareawards.org and submit the nomination forms and accompanying narrative responses via email to Ann D’Amato at [email protected]. The deadline for submissions is Tuesday, Sept. 15.

Finally, if you’re a graduating resident or physician looking for employment or services, you don’t want to miss LACMA’s upcoming Job Fair, which will be held from 5-9 p.m. on Sept. 16 at the Sofitel Los Angeles at Beverly Hills. 8555 Beverly Blvd., Los Angeles, CA 90048.

We hope you enjoy the rest of your summer. Back to school is just around the corner, and we will do our part to provide you with all

the supplies, education and up-to-date information you need to grow your practices and be in the know.

Regards,

Rocky DelgadilloChief Executive Officer

NEW Resource Centers Your LACMA/CMA Membership at work

For more information on your LACMA & CMA benefits, visit www.lacmanet.org/Membership

CME Resources Legal Resources

Career & Professional Development

Jury Duty Concierge

Physicians are required to complete 50 CME hours during every two-year licensure period. LACMA & CMA understand your need for easily accessible and convenient CME programming, and offer you a variety of resources to help you reach your educational requirements.

CME Tracking & Credentialing provided by CMA’s partnership with the Institute for Medical Quality

Online CME Resources

LACMA CME-Accredited Events

CMA’s Center for Legal Affairs helps CMA members comply with laws and regulations that impact the practice of medicine. In addition, LACMA & CMA provide you with countless legal resources—all at your fingertips:

CMA’s Legal Information Helpline

Health Law Library

Health Contract Analyses

Payor Contract Resources

LACBA’s Lawyer Referral System

CMA’s On-Call Index

We’ve simplified our Jury Duty process so that you can complete your request online and receive SMS text updates.

Reduce your call-in days from 5 to 1

Relocate your court house for your convenience

Reschedule your reporting date up to six months from your original reporting date

www.lacmanet.org/CME www.lacmanet.org/LegalResources

www.lacmanet.org/ProfessionalDevelopment

LACMA & CMA’s professional resources are all aimed towards supporting your career and profes-sional goals. Whether it be finding a new career path or a qualified staff member to join your prac-tice, to reaching your leadership potential, LACMA is here to help.

LACMA’s Career Center & Job Board

Media Training

Leadership Development and Opportunities

www.lacmanet.org/JuryDuty

1 8 P H YS I C I A N M AG A Z I N E | AUGUST 2015

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Financial Planning

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Specializing in the field of specialties

When you’re responsible for hiring healthcare professionals, you need the expertise of the Los Angeles County Medical Association Career Center. As a member of the National Healthcare Career Network, the LACMA Career Center gives you access to the best source of local and national candidates—its more than 250 member associations and professional societies. Save time and money by reaching the right people faster when your job is posted throughout a nationwide network that reaches over two million professionals dedicated to careers in healthcare. When you want the best, go where the best are: the LACMA Career Center

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Diowave lasers represent the next generation in advancing private pay for pain management thru a non-invasive drug and pain free platform.

august 2015 | physician magazine

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