Medicare SGR Fix - Short Term  

Since our last email Congress did take action at the last hour to implement a fix that eliminated the SGR reductions to Medicare physician fees that would have occurred on 1/1/12. Its only good for two months so expect the drill to be played out again very soon.

Medi-Cal 10% Provider Rate Reduction

DHCS has notified provider groups that they intend to implement the 10% provider rate reduction retroactive to June 1, 2011. We still expect that they would be able to inform individual providers what the total amount of the recoupment would be and provide a schedule for the take backs to occur, i.e. not recouping the total amount in one check write. We will provide additional information as it becomes available and will be meeting with ACS and DHCS this week.

In the meantime a lawsuit has been filed in federal court in an effort to block implementation of this reduction for physician fees and other provider services. It is possible that DHCS might implement the reductions before the hearing, which will be on 1/30/12,  but not likely. In a related matter the federal court did issue a final ruling last week in favor of an injunction sought by the California Hospital Association to block a similar 10% reduction in their rates. We will obviously keep you informed on these developments.

CT Radiation Safety Legislation

Last year SB 38 was signed by the Governor to codify a July 1, 2012 effective date for all provisions of SB 1237 ( Padilla) passed in 2010. That bill requires a number of changes for CT units including recording of dose where the machine is capable of doing so, accreditation, and reporting of CTs performed on wrong patients, repeated CTs that are not ordered and exceeding certain dose levels among other provisions. It has companion provisions for radiation therapy use that exceeds the prescribed dose, wrong patient, or body part. Full details are available on the CRS website at www.calrad.org in both the Annual Report and an FAQ document prepared by the Radiologic Health Branch (RHB).

This year the CRS is working with the California Hospital Association on further refinements to the statute and will be contained in AB 510 ( Lowenthal), which is a bill introduced last year on a different subject that is being used as a vehicle to achieve passage prior to or shortly after the July 1 effective date. The bill is still being developed but will refine the following areas;

• Required medical physicists calculations of specific CT procedures displayed dose to only the three procedures required under ACR accreditation.
• Clarification requiring reporting of radiation exposure to adjacent anatomic areas to the organ being imaged , i.e. the statute already exempts radiation of overlapping treatment area but the language can be improved.
• Exempting CT units used solely for radiation therapy simulation or image guidance for IR. The former is exempt under the interpretation provided by the RHB, but the latter needs to be specified.  
• Changing the reporting timeline for  5 days to 10 days.

The CRS is seeking clarification of the provision involving recording of dose in the PACs system or attached to the radiology report. This language is awkward at best and needs to reflect the use of EMR systems and digital record retention. We continue to work with all parties on improving that language. AB 510 will be move to the Senate after passage in the Assembly later this month.   

CRS Says Good-bye to Longtime Member Richard B. Hoffman, M.D.

Richard B. Hoffman
April 23, 1937 - November 30, 2011

Torrance Memorial Medical Center Foundation President and Diagnostic Radiologist, Richard (Dick) B. Hoffman, MD, succumbed to complications of acute leukemia on the night of Wednesday, November 30, 2011 at the age of 74. Dick was a one-of-a-kind man who touched and influenced the lives of many both professionally and personally. He grew up in St. Paul, Minnesota, where he attended the University of Minnesota. After only two years of college he entered University of Minnesota Medical School. He completed his Residency in Diagnostic Radiology at UCLA, where he remained on staff as an Assistant Professor. Dick then entered the US Army, where he served as the Chief of the Department of Radiology at the main US Army Hospital in Europe in Landstuhl, Germany, setting up the first cardiac catheterization laboratory. In 1969 Dick joined the staff at St. Francis Hospital in Linwood, California as an Interventional Radiologist. He left St. Francis to come to Torrance Memorial Hospital in 1973, recognizing the potential of this new facility with its dynamic young medical staff. The decision to come to Torrance Memorial was one of his most important and gratifying. Together with the progressive Hospital Administration he pioneered the development of the Radiology Department into what he believed was one of the best in Southern California. Dick spent 38 years at Torrance Memorial, serving as a many time Chief of the Radiology Department and prominent hospital Foundation Board member and ultimate Foundation Board President. His passion and commitment to his specialty and the hospital were unparalleled. Dick had a unlimited zest for learning and quest for new knowledge. He was Board Certified in Diagnostic and Interventional Radiology and Nuclear Medicine. He introduced ultrasound and PET/CT to Torrance Memorial, and at the age of 74 was certified by the Board of Cardiology in Cardiac CT. Dick's devotion to his work was only paralleled by his devotion to his family. His 48-year marriage to his wife, partner and best friend, Carole, was his proudest accomplishment. They raised Dr. Rex Hoffman, Medical Director of Radiation Oncology at the Disney Family Cancer Center, Providence St. Josephs Hospital in Burbank, California and Dr. Heidi Hoffman, who followed in her father's footsteps and became a partner in the Department of Radiology at Torrance Memorial. His children and their accomplishments, as well as his two grandsons, were sources of tremendous joy and pride. Dick will be remembered as a man of unparalleled passion, dignity, strength, drive, humility and wisdom. In September, 2011, he was fortunate enough to enjoy the honor of a Living Tribute at Torrance Memorial, wherein many of his professional colleagues shared their admiration, respect and love for him. Dick is survived by his wife Carole, son Rex, daughter Heidi, daughter-in-law Erin, brother Stuart, and grandsons Grady and Ethan. A Reception and Celebration of his Life were held at Rolling Hills Country Club in Rolling Hills Estates on Sunday, December 4, 2011. The family requested in lieu of flowers, donations  be made to the Torrance Memorial Medical Center Foundation.