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ACN e‐newsletter

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  • 1. ACN e‐newsletter   Association of California Neurologists March 2010 ACN: WHAT ARE WE, AND WHY ARE WE IMPORTANT? Are you as a neurologist concerned with: • Cancellation of Medicare consultation codes? • Lack of reimbursement for interpreting emergent CT brain scans prior to tPA infusion? • Large for-profit corporations purchasing and operating local hospitals and outpatient facilities, competing with local physicians? • Physical therapists performing needle electrodiagnosis? • Rising professional liability premiums in the face of threatened tort reform? • HMOs and insurance companies substituting AED brands with alternative generics without physician approval? • Unfunded neurology mandate of DPH and DMV reporting? Perhaps it is time to look closely at what the ACN is and what it does for you and your practice. ACNs Major Functions Are Supporting: Inside this issue: 1. Monitoring California healthcare legislation President’s Opinion Scope of practice issues MICRA/Tort reform Sleep Medicine Corporate Bar Mandatory Reporting Problems with 2. Inter/intrasocietal networking: Palmetto GBA? California Medical Association California First California Association of Neurosurgeons State County Neurological Societies 3. Patient Advocacy: Save the Date California NeuroAlliance Neurology on the Hill Association of California Palatucci Advocacy Leadership Forum Neurologists 4. Education: Foundation Annual CME Meeting ACN e-Newsletter ACN Board County Neurological Societies CME Meetings Membership Application
  • 2. 5. Liaison with AAN: GBS reporting initiative and Emerging Infections Program, representing California as a pilot state, in coordination with CDC and AAN AAN State Societies Committee California Advocacy Participation in national issues Conduit for AAN information specific to California issues Together we are stronger. Please join our effort to represent the neurologists of California. Join and participate actively in the ACN. OPINION: FROM THE PRESIDENT’S DESK: Neurology As We Know It: Destined for Extinction? Or…“By the way, who stole my consult code?” Notice from the California Medical Association 2010 Guide for Medicare Consultation Coding: “Effective January 1, 2010, Medicare will no longer recognize office and other outpatient consultation CPT codes (99241-99245) and inpatient consultation CPT codes (99251-99255) for payment…” and “…physicians should be aware that some specialties may suffer significant financial losses depending on their medical practice.” Shortly after U.S. neurologists woke up on the morning of January 1, 2010, perhaps while watching the Rose Parade or serial football bowl games, there was a stark realization that something significant had changed for our specialty and an unfavorable sea change was unfolding: consult codes had been summarily cancelled by Medicare. Approximately one month before New Year’s Day, AAN President-elect, Bruce Sigsbee, MD, FAAN made an impassioned plea in a congressional healthcare hearing on Capitol Hill, attempting to make neurology eligible to receive bonuses under the primary care incentive section of the congressional health care reform bills. He emphasized an increased importance of neurologists’ E&M code services compared with procedural activities, arguing that neurology provided basic medical care (akin to primary care) to those with neurological disorders, a so-called “principal care.” In so doing, he implied the appropriateness of a corresponding de-emphasis (and perhaps de-valuation) of neurological procedural services. As we all know now, not only did neurology not share in the PCPs’ financial largess, but all medical specialists, those like neurology who engage in “principal care” and otherwise, were “rewarded” by CMS with a de facto 18-20% reduction in payment for what used to be fondly known as “consultation services,” now euphemistically termed “new patient visits.” To illustrate: previously, outpatient 99245 code was paid ~$250 by Medicare; now the suggested replacement "new patient visit" pays a maximum of $199 for essentially the same service, a ~20% cut. CMS did honor our request to be generalist “wanna bees” by canceling the consultation codes, but declined to recognize our just plea for financial recognition of so-called “principal care” E&M services. As the AAN laudably struggles to explain to CMS the additional value in medical diagnosis and care inherent in neurological specialty consultations, certainly worthy of increased compensation over office
  • 3. visits, this much is clear: We as neurologists confront an economic reality of diminished financial compensation (and some would say diminished public recognition for our practices) and face the possible specter of a contracting specialty. In the considered opinion of many wise and well-meaning neurologists, our specialty’s best approach in the current environment is to embrace and emphasize both E&M and appropriate procedural services (as with critical care neurology, electrodiagnosis, neuroimaging, pain management, etc.), distinguishing our selves as true experts in the field of neurological disease. This emphasis needs to be reinforced and validated through the advocacy measures at the national level through the AAN and at our State level through the Association of California Neurologists. Respectfully Submitted: William Preston, MD, FAAN (2/25/10) ” There are 2 types of medical  textbooks—those written for the  SLEEP MEDICINE – JAMA Book Review generalist, who needs to know  Edited by Harold R, Smith, Cynthia L. Cornelia, and Birgit Hogl more but has‐less time to do so,  270 pp, $63 New York, NY, Cambridge University Press, 2008 and those written for the sub  ISBN-13: 978-0-5216-9957-0 specialist, who occasionally  requires information on a topic  SLEEP MEDICINE BEGINS WITH A with which she or he is less  SIMPLE BUT PROFOUND STATEMENT: familiar.”  "sleep is not an inactive state." In the subsequent 225 pages, the internationally respected editors and authors then present a period analysis, and transformation into thorough review of the full complexity of the wave-lets, along with further reading science of sleep medicine. Edited by Smith, recommendations, would be useful for some Cornelia, and Hogl, the book includes sleep physicians and sleep researchers. The sections on normal sleep, sleep disorders, chapter continues with a description of sleep and sleep m specialty areas; in short, nearly state characteristics throughout life, from all a clinician needs to know and understand newborns to older adults. Readers might find when evaluating and treating patients with the section on sleep in extreme excessive sleepiness or sleeplessness and the environments—e.g., in polar regions, in the broad array of disturbances that occur during tropics, at altitude, and in space—particularly the sleep state. interesting. The book begins with an introduction to The book contains information that a the basic neurology of sleep, which serves as general clinician might find quite useful and a useful prelude to subsequent chapters. The pragmatic. Management algorithms, first chapter, "Normal Sleep," pro-vides a assessment tools, and questionnaires (chapter concise review of the development of sleep 2) are provided. The patient symptom staging and polysomnography. The basics of descriptions of cataplexy, sleep paralysis, polysomnography acquisition techniques and and hypnagogic hallucination (chapter 5) and conventional sleep and wakefulness analysis the practical review of the basic components are then clearly described. A brief review of of cognitive behavior therapy for insomnia automatic analysis of sleep and signal (chapter 6) will like-wise be useful to any preprocessing, including spectral analysis clinician. A thoughtful overview of the using fast Fourier transform algorithms, evaluation and treatment of primary and
  • 4. secondary causes of restless legs syndrome substantive discussion on the guidelines of and periodic limb movement disorder The AA5M Manual for the Scoring of Sleep (chapter 7) is exceptionally well written, as and Associated Events: Rules, Terminology is a de-tailed review of the epidemiology, and Technical Specifications (2007) or on pathophysiology, consequences, and ambulatory monitoring; both topics would be treatment of central and obstructive sleep important and worthwhile inclusions in any apnea (chapter 8). The synopsis of medical future editions. Other recommendations for disorders and how they might contribute to future editions include more case examples, risk factors for sleep disturbances is detailed separate chapters on women and sleep, and a but not daunting and includes a wide variety specific summary chapter to provide quick of disorders (asthma, coronary artery reference to the effects of medication on disease, connective tissue and rheumatologic sleep and to pharmacological therapy for disease). The book also provides diagnostic sleep disorders, which were adequately and treatment recommendations (chapter addressed in each section. 11), a useful section on sleep in dementia There are 2 types of medical textbooks— (chapter 13), and an excellent and intriguing those written for the generalist, who needs to summary of forensic issues in sleep medicine know more but has-less time to do so, and (chapter 14). those written for the sub specialist, who The tables and figures are helpful and the occasionally requires information on a topic references are adequate. Treatment options with which she or he is less familiar. Sleep for obstructive sleep apnea, issues of Medicine caters to both audiences in a adherence to positive airway pressure concise, easily readable fashion. therapy, and ways to improve compliance are clearly outlined in both text and tabular form. John Harrington, MD, MPH Management of the care of per-sons with National Jewish Health obstructive sleep apnea and residual Denver, Colorado sleepiness as well as assessment of harringtonj @njhhealth.org individuals with obstructive sleep apnea Financial Disclosures: None reported. employed at high-risk occupations, however, are not adequately addressed. Other JAMA, October 7, 2009—Vol. 302, No. 13 1469 limitations include the lack of any PROBLEMS WITH PALMETTO GBA? Members can present their problems to the ACN and we will try to channel your request to the appropriate person. The ACN can contact the Palmetto Neurology Ombudsman. You may also take your case to the CMA Reimbursement Hotline at 800-786-4262 Nerve Conductions: 95900 and 95903 When billing for these two services on two different nerves you must append modifier -59 to the 95900. The reason is that 95903 already includes 95900 and the system considers the second 95900 as the same procedure. In other words a median motor nerve conduction study would be billed as 95900-59 and an ulnar nerve motor conduction plus F wave as 95903
  • 5. Confused about NCCI the National Correct Coding Initiative? NCCI explains which services can be combined and which ones are bundled. These NCCI’s are frequently updated and can be found under http://www.cms.hhs.gov/NationalCorrectCodInitEd/ and type NCCI in the search box. Look in the left hand column for NCCI Edits - Physicians. You can select a series of CPT codes by number. Once the appropriate page is loaded in PDF format you may find confusing columns which are not self explanatory. Here is an attempt to clarify these. There are 6 columns Column 1 =.....................this one will be paid Column 2 = ....................this one will not be paid if combined with column 1, unless: see below Column 3 "Pre-1996 = ..was in existence before 1996 - Is provided for historical information Column 4 = ....................Effective date Column 5 = …………… Deletion date-The policy was in effect between these dates only, or if an * it means that the policy is still in effect Column 6 =.....................Modifiers 9: has no significance 1: you can use a modifier for CPTs in column 2 0: a modifier cannot be used. The two codes are bundled. No exception I hope this helps. Eric H. Denys, M.D. CALIFORNIA BECOMES FIRST STATE TO SHORTEN PATIENT WAIT TIMES FOR APPOINTMENTS By Cindy Ehnes, Director, California Department of Managed Health Care One of the common consumer complaints received at the DMHC Help Center is not being able to see a doctor on a timely basis. A recent study found that the average wait time for new patients to see a family practice physician in Los Angeles is 59 days. This is not just a California problem or unique to HMOs -- patients across the country are literally sick of having to wait weeks to see an in-network doctor. This is simply unacceptable, and in January, California became the first state in the nation to provide patients with predictable ” These regulations  wait times. are not a cure‐all for  what ails health care  – but they take a big  These regulations are not a cure-all for what ails health care – but they take a big step forward in improving quality of care by shortening the time a California HMO patient has step forward in  to wait to see the doctor. Part of the promise of health insurance is that patients will be able improving quality of  care” to find a doctor taking new patients or be within driving distance. The DMHC’s timely access regulations will make a significant difference for the approximately 21 million California HMO enrollees by ensuring that they have timely access to care that is appropriate for their conditions and consistent with good professional practice.
  • 6. In crafting these regulations, the DMHC has worked countless hours with its health care partners to improve the entire system of care so that it is more responsive to enrollees' needs, whether they are an HMO, PPO or government-sponsored plan patient. We’ve all worked together to make good care even better. The regulations will also ensure that robust networks are also available to PPO patients so that they are not obliged to pay more for non- contracted specialists. The development of these regulations has been one of the most extensive and important endeavors in DMHC history. While it has been a challenge to incorporate so many diverse perspectives, the regulations have emerged with a strong, direct way to eliminate unnecessary delay for consumers, while also taking into consideration the realities of today’s healthcare marketplace, such as geographic differences, provider shortages, and the rising costs of providing care. The physician community has been genuinely concerned that they will need to use stop watches to meet the time standards, or that the regulations will potentially interfere with clinical judgment. This is not the case. In reality, the regulations put the burden of providing time-specific standards on the health plan, not the individual provider. That means that plans must have a strong and varied provider network to ensure that appointments can be made within the specified timeframes. Examples of some of the consumer protections included in the regulation include: • 48 hours for urgent care appointments that do not require prior authorization • 96 hours for urgent care appointments requiring prior authorization (including specialists) • 10 business days for non-urgent primary care appointments • 15 business days for non-urgent appointments with specialists • 10 business days for non-urgent appointments with a mental health care provider • 15 business days for non-urgent appointments for ancillary services (x-rays, lab tests, etc.) for diagnosis or treatment of injury, illness, or other health condition • Triage or screening by telephone 24-7 • Waiting time for telephone triage no longer than 30 minutes • During normal business hours, waiting time to speak to a plan’s customer service representative no longer than 10 minutes • Dental Plans • 72 hours for urgent care • 36 business days for non-urgent care • 40 business days for preventive care Another important benefit for consumers is triage or telephone screening 24-7. Under the new rules, patients must get a callback from a health professional within 30 minutes rather than simply a recording directing them to call 911. Consumer assistance is our main focus at the DMHC and our Help Center staff are specially trained to intervene on behalf of consumers with their health plans on any topic. I encourage consumers or providers who have questions or concerns about timely access to care or other health care issues to contact the DMHC’s Help Center at 1-888-466-2219 or online at www.healthhelp.ca.gov .
  • 7. SAVE THE DATE March 16, 2010 (one day this year!) Cal Neuro Alliance, Grand Sheraton, Sacramento, CA For questions or more information, contact: Stewart Ferry at 415 230-6678. ext 2003. March 27, 2010 USC Epilepsy Symposium – for on-line registration: www.peopleware.net/0128 and choose course #2505. For additional information on the symposium, call 323-442-2555 or 800-USC-1119, Office of Continuing Medical Education. April 10-April 17, 2010 Registration is now open for the 62nd AAN Annual Meeting in Toronto; early registration ends March 10, 2010. Visit www.aan.com April 9-11 2010, CMA’s - 13th Annual California Health Care Leadership Academy, The Era of Health Reform: Harnessing the Currents of Change, San Diego Marriott Hotel & Marina May 28, 2010 – deadline annual requests for nominations to CMA Councils & Committees – contact peggypearce2@sbcglobal.net for more information Thursday, June 17, 2010 – 4th Annual “Neuropathy Action Awareness Day”, Sacramento, CA. As a courtesy to those patients in the San Francisco Bay Area and Los Angeles the NAF will be providing up to 15 FREE on night stays in the Sheraton Grand for the night of June 17!! Registration materials, information and agenda coming soon! ASSOCIATION OF CALIFORNIA NEUROLOGISTS FOUNDATION If you would like to be involved with the Association of California Neurologists Foundation please contact the ACNF Executive Office, 916.457.2236, acnf_ca@sbcglobal.net Donations can be mailed to: ACNF - 5380 Elvas Ave., Suite 216, Sacramento, CA 95819 Donations to the ACNF are tax deductible – tax ID #: 26-3814573 Check us out at: http://acn.aan.com
  • 8. BOARD ROSTER 2010 NAME OFFICE (term ends) PHONE FAX EMAIL BOARD MEMBERS William G. Preston MD, FAAN President (Jan '11) 949.837.1133 949.830.1154 wpreston@aol.com Steven J. Holtz, MD, FAAN Vice President (Jan '12) 925.939.9400 925.939.1819 sjholtz182@yahoo.com Eric H. Denys, MD Secretary/Treasurer (Jan '12) 415.923.3055 415.921.3969 eric.denys@ucsf.edu Marc R. Nuwer, MD, PhD Past President (Jan' 11) 310.206.3093 310.267.1157 mrn@ucla.edu John Hixson, MD Director North (Jan ‘13) 415.353.4817 415.353.2837 john.hixson@ucsf.edu Robyn Young, MD Director North (Jan’13) 510.748.5363 510.748.5425 rgyoungmd@comcast.net Christi Heck, MD Director South (Jan '11) 323.442.5710 323.442.5999 check@usc.edu Jeremy L. Hogan, MD Director South (Jan '12) 619.644.6701 619.544.1139 jeremy.hoganmd@sharp.com CONSULANTS Les Dorfman, MD Consultant 650.723.6888 650.725.5095 ldorfmann@stanford.edu Rebecca A. Hanson, MD, FAAN Consultant 310.825.5858 310.825.5290 rhanson@mednet.ucla.edu Marilyn M. Robertson, MD Consultant 415.561.1714 415.561.1715 mmrob@pacbell.net Jack Schim, MD Consultant 760.942.1390 760.942.4288 jschim@neurocenter.com Harold R. Smith, MD, FAAN Consultant 949.509.7726 949.509.7834 hrsmith@uci.edu David P. Richman, MD Consultant 530.754.5036 530-754-5020 dprichman@ucdavis.edu CMA LIAISON Susan R. Hansen, MD Consultant 650.691.1171 650.691.0148 srhansenmd@ix.netcom.com EXECUTIVE OFFICE Peggy Pearce Executive Secretary 916.457.2236 916.457.2211 peggypearce2@sbcglobal.net 5380 Elvas Avenue, Suite 216, Sacramento, CA 95816 http://acn.aan.com
  • 9. ACN Association of California Neurologists 5380 Elvas Avenue, Suite 216 Sacramento, CA 95819 916 457-2236 – Fax: 916 457-2211 Application for Membership Full Name ________________________________________________________________ Mailing address________________________________________________________________________ City ____________________________________ State_______ Zip Code________________________ Telephone___________________Fax____________________E-mail_____________________________ Date of Birth___________ Place of Birth of _________ Citizenship_______________ Medical School_________________________________________________________________________ Degree__________________________________________ Year of graduation_____________________ Internship ________________________________________ Year________________________________ Residency/Fellowship Training (indicate years) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Current Academic Appointment___________________________________________________________________________ _______________________________________________________________________________________ Current professional activity (resident, hospital based, research, private practice, etc.): _________________ _______________________________________________________________________________________ Sub-Specialty/Interests__________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ California License: Certificate Number____________________________ Year__________________ (over)
  • 10. American Board of Neurology status: Certified ________________________ Year___________________ Eligible____________________ Other ________________________________________________________________________________ Qualified Medical Examiner (QME): yes_____ no______ MEMBERSHIPS: yes no American Academy of Neurology ____ ____ California Medical Association ____ ____ American Medical Association ____ ____ Other regional or national neurological society memberships: _____________________________________________________________________________________ Membership in the association is limited to persons who are licensed physicians in the State of California and who specialize in the practice of neurology, in the teaching of neurological medicine, or in scientific research relating to the human nervous system and/or neurological practice; or are in an accredited post-graduate neurology training program. I hereby apply for membership in the Association of California Neurologists (ACN): Signature of applicant _________________________________________ Date___________________ Status requested: (circle one) ACTIVE ($95.00) - licensed neurologist in practice or research JUNIOR (no charge) - resident or fellow in neurology SENIOR ($25.00) - over 60 years of age and retired FOR CREDIT CARD PAYMENT ONLY (please print clearly) VISA_______ MasterCard________ 16-digit Card Number: ________________ - ___________________ - __________________ - __________________ Name as it appears on card: _______________________________________________Expiration Date: ________________ Address if different from on front of form: Contributions to the Association of California Neurologists are not tax deductible as charitable contributions; however, they may be tax deductible as ordinary and necessary business expenses. *************************************************************************************** ACN OFFICE USE: Date received ___________________ Date membership accepted ________________ Dues received _________________ Check number _________________Date__________________ Additional information requested _____________________________________________________