Friday, August 17, 2018

Sick Leave ordinance approved

San Antonio City Council approves paid sick leave ordinance

By W. Scott Bailey  – Senior Reporter, San Antonio Business Journal

The San Antonio City Council on Thursday adopted an ordinance mandating that employers within the city provide paid sick time to workers.
The amendment to the city’s health code requires employers in San Antonio to let workers accrue such paid time off — one hour of paid sick time for every 30 hours worked — to use if they or a family member become sick or injured; are victims of stalking, domestic abuse or sexual assault; or otherwise require medical, mental or preventive care.
The San Antonio City Council's decision, by a 9-2 vote, follows a similar vote by the Austin City Council in February. That 9-2 vote triggered immediate criticism from some state lawmakers, who have vowed to enact legislation to negate the Capital City ordinance.
San Antonio Mayor Ron Nirenberg, who voted for the ordinance, said the City Council had limited options. He believes the ordinance will give the city more "flexibility to craft a San Antonio-specific policy," rather than having to deal with a voter-approved measure.
Under San Antonio's ordinance, employees at medium-size and large businesses can accrue at least 64 hours of paid sick leave per year — more if employers so choose. At smaller businesses, employees can accrue at least 48 hours per year.
The ordinance requires employees to be paid the wage they would have earned if at work and that they be allowed to carry over accrued sick leave to the following year.
The new ordinance is scheduled to take effect Aug. 1, 2019. Employers with five or fewer workers will have until Aug. 1, 2021, to comply.
There are certain protections for employers in the new ordinance. For example, businesses can restrict employees from using paid sick leave during their first 60 days on the job.
Meanwhile, employers are not permitted to retaliate against workers who use earned paid sick leave by transferring, demoting, firing or suspending them, or reducing their hours.
The City Council's vote comes less than three months after a coalition of labor leaders and community organizations delivered more than 66,000 signatures to San Antonio’s city clerk supporting a petition seeking to put a paid sick leave referendum before voters on the November ballot. Proponents said it will reduce the number of workers who are uncompensated when ill.
The San Antonio Metropolitan Health District will oversee and enforce the ordinance's provisions. It may impose civil penalties up to $500 per violation.
Louis Barrios, president and CEO of Los Barrios Enterprises, which operates several restaurants in San Antonio, warned in May that such an ordinance, which “looks good on the surface,” could inflict a significant amount of “collateral damage” on the city's economy.
Council members could have chosen to place the issue on the ballot in November. There was concern among some city officials that doing so would have created more confusion for voters who will see several charter amendments on the November ballot.

Thursday, July 19, 2018

Letter from CMS Administrator Seema Verma

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Special Edition – Tuesday, July 17, 2018

A Letter to Doctors from CMS Administrator Seema Verma

Dear Doctor,
Thank you for the difference you make in your patients’ lives. Many of our nation’s best and brightest students go into medicine – the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.
Your dedication and commitment have enabled you to join the profession that makes up the core of our health care system. But after years of education, training, and hard work, our system is not fully leveraging your expertise. Instead, doctors today spend far too much of their time on burdensome and often mindless administrative tasks.
From reporting on measures that demand that you follow complicated and redundant processes, to documenting lines of text that add no value to a patient’s medical record, to hunting down records and faxes from other physicians and sifting through them, wasteful tasks are draining energy and taking time away from patients. Our system has taken our most brilliant students and put them to work clicking through screens and copying and pasting. We have arrived at the point where today’s physicians are burning out, retiring early, or even second-guessing their decision to go into medicine.
In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout. Enough is enough. CMS’s focus is on putting patients first, and that means protecting the doctor-patient relationship. We believe that you should be able to focus on delivering care to patients, not sitting in front of at a computer screen.
Washington is to blame for many of the frustrations with the current system, as policies that have been put forth as solutions either have not worked or have moved us in the opposite direction. Electronic Health Records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake. But the inability to exchange records between systems – and the increasing requirements for information that must be documented – has turned this tool into a serious distraction from patient care.
CMS is committed to turning the tide. President Trump has made it clear that he wants all agencies to cut the red tape, and CMS is no exception. Last year, we launched our “Patients Over Paperwork” initiative, under which we have been working to reduce the burden of unnecessary rules and requirements. As part of this effort, we have proposed an overhaul of the Evaluation & Management (E&M) documentation and coding system to dramatically reduce the amount of time you have to spend inputting unnecessary information into your patients’ records. E&M visits make up 40 percent of all charges for Medicare physician payment, so changes to the documentation requirements for these codes would have wide-reaching impact.
The current system of codes includes 5 levels for office visits – level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5. The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing.
We’ve proposed to move from a system with separate documentation requirements for each of the 4 levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients. Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. If you add up the amount of time saved for clinicians across America in one year from our proposal, it would come to more than 500 years of additional time available for patient care.
In addition to streamlining documentation, under the leadership of the White House’s Office of American Innovation, we are advancing the MyHealthEData Initiative which promotes the interoperability of electronic medical records. Patients must have control of their medical information; and physicians need visibility into a patient’s complete medical record. Having all of a patient’s information available to inform clinical decision-making saves time, improves quality, and reduces unnecessary and duplicative tests and procedures. CMS is taking action to make this vision a reality, including recently proposing a redesign of the incentives in the Merit-Based Incentive Payment System or “MIPS” to focus on rewarding the sharing of health care data securely with patients and their providers.
We welcome your thoughts on our proposals, and we look forward to partnering with you to make them successful. Patients and their families put their trust in your hands, and you should be able to focus on keeping them healthy. And to secure the future strength of our system, we must make sure that the nation’s best students continue to choose to go into medicine.
We need your input to improve the health care system. Once again, thank you for your service to your patients.
Seema Verma

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