San Francisco Medical Society Blog

FAQs: Affordable Care Act Primary Care Rate Increase & Medi-Cal State Plan Amendment

Fri, 12 Apr 2013 12:41:22 GMT

Under the provisions of the federal Affordable Care Act (ACA), Medi-Cal is required to pay primary care physicians at Medicare rates for primary care services for two years. The increase is fully funded by the federal government. The requirement began January 1, 2013 and ends December 31, 2014.

The California Department of Health Care Services (DHCS) submitted their state plan amendment (SPA) to implement the rate increase on March 29, 2013. Approval of the SPA is required by the Centers for Medicare and Medicaid Services (CMS) before the state can implement the rate adjustment. It is unclear when the rate adjustment will be approved by CMS and implemented by DHCS. In previous communications, DHCS has indicated that they expect implementation will begin in July 2013. However, the rate adjustment will be retroactive to the beginning of the year.

Below are answers to frequently asked questions about implementation of the rate adjustment as outlined in the SPA. Please note these provisions are subject to change pending approval by the CMS.

Why is the SPA just being filed now?

Federal guidance on the implementation of the rate increase was delayed until November 2012. The DHCS claims that the federal delay and the complications involved with applying the rate increase to managed care delayed the submission of the SPA.

Who qualifies as a “primary care physician”?

Any physician who is board-certified in internal medicine, family medicine, or pediatrics by the American Board of Physician Specialties, the American Board of Medical Specialties, or the American Osteopathic Association. This includes recognized physician subspecialties of the above board certified specialties.

Or, any physician who practices (but is not board certified) in a specialty or sub-specialty of internal medicine, family medicine, or pediatrics who also bills at least 60% of services rendered for qualifying codes. DHCS has indicated that billing 60% of services for qualifying codes alone does not qualify a physician unless they also can legitimately attest to practicing in internal medicine, family medicine or pediatric medicine or a subspecialty of internal medicine family medicine or pediatric medicine recognized by the ABMS, ABPS or AOA.

Click here to view the list of qualifying primary care providers (PCP).

How will physicians prove that they qualify?

Generally, physicians will self-attest that they qualify for the increased rates. DHCS is developing an online registry that physicians will use to register. However, managed care plans are allowed to choose to either use the DHCS attestation tool or develop their own.

What counts as a primary care service?

The rate increase applies to:

Evaluation and management codes 99201-99499
Vaccine administration codes 90460, 90461, and 90471-90474
Preventive care codes 99381-99387 and 99391-99397
Counseling risk/behavior intervention codes 99401, 99404, 99408-409, 99411, 99412, 99420 and 99429

The rate increase also applies to state-specific “Z” codes—Z0100, Z0102, Z0104, Z0106 and Z0108. These codes are relevant to some state-only programs, such as Family PACT, as well as many services provided in neonatal and prenatal intensive care units (NICU and PICU).

What Medicare rates will Medi-Cal use? Will they apply the GPCIs?

Per the SPA, rates will be based on the 2009 Medicare Fee Schedule. Geographic Payment Center Indices (GPCIs) will apply. SFMS/CMA urged the DHCS to adopt this approach based on our analysis that this approach would benefit California physicians.

Are clinics or physician employers eligible for the Medi-Cal reimbursement adjustment?

No, only the physician who is personally providing the service is eligible for the increase.

Does the increase apply to managed care?

Yes. Plans will be receiving increased payments, through the State of California, to pay providers at Medicare rates. The increase is fully funded by the federal government for 2 years beginning January 1, 2013 and ending December 31, 2014.

How will the state guarantee that the money actually makes it to the physician?

Plans will be contractually obligated to prove that they are paying primary care physicians at least the Medicare rates. The payments made to plans to cover the increased cost of higher rates will be separate from their general capitation payments, allowing for separate accounting. The SPA included plan reporting requirements to ensure the rate adjustment funding is going to the service providing physician.

Questions & Assistance

SFMS/CMA members with questions about Medi-Cal reimbursements can receive complimentary one-on-one assistance by contacting our Member Helpline at (800) 786-4262.

Stephanie Oltmann, MD: SFMS January 2013 Member of the Month

Wed, 09 Jan 2013 15:08:31 GMT

Stephanie Oltmann, MD is a board-certified family physician with the Dignity Health Medical Group – Saint Francis/St. Mary’s.

A native of Germany, Dr. Oltmann spent an intern year in Neurology, worked as a house officer in Australia and the U.K. specializing in urgent care and emergency medicine, and completed her residency in Family Medicine in Long Island, NY, where she also served as chief resident. Her special clinical interests include neurology, chronic disease management, preventive care and travel medicine. To view Dr. Oltmann’s practice information, please click here.

I am a SFMS member because I believe the SFMS is one of the best ways that we, as physicians, can stay informed and engaged with each other and active as a community resource on issues of health, wellness and better living.

Which SFMS member resource is most helpful to you?

The most helpful resource in the medical society is the membership. Whether it is learning from other members about how to meet the professional and personal challenges that physicians often face, or hearing from others about career directions that I never thought possible, I get more out of being a physician by being part of the organized physician community.

My greatest achievement outside of practicing medicine was helping a young person, who delayed becoming a physician in order to work and support his family, return to school and successfully apply to and graduate from medical school. After years of hard work, presenting him with his own doctoral hood was more satisfying than the day I was presented with my own.

What is the most important thing you learned in medical school or residency?

I was once advised that, in order to achieve personal balance, I should always pursue my life, outside of medicine, with the same intensity that I’ve pursued my medical career. Since finishing residency, I’ve gone back to school to study art and foreign language, ran for public office, maintained pre-med school friendships and started new ones with people who know me from the local community or the interest group, not the clinic. This has helped me avoid professional burn out and make medicine that fun thing I do, when I’m not working hard at enjoying the rest of my life.

What are some of the biggest opportunities or challenges you see in health care within the next five years?

Moving this country from a “health cost system” to a “health care system” will either be the biggest challenge to us, or the biggest opportunity for us. It will be difficult, but we must decide if health care in this country is going to be an economic privilege or a human right and how best to make the path we choose a viable and sustainable reality for everyone.

I love practicing Family Medicine because I love that my clinics are in the neighborhoods and communities where I live and am also active in. Most of my patients come from the local area around the clinics, so I get to know them and their families, not just as patients, but as neighbors, too. It’s like being a small town doctor…in a big city!

What is your favorite restaurant in San Francisco?

I admit, on special occasions, I treat myself to a Bacon Double Del Cheese Burger at the Del Taco fast food restaurant on Market Street. I think it’s the special sauce that makes it taste so good!

If I wasn't a physician, I would likely ended up a comic book or animation artist. It’s the other thing I’m good at.

Primary Care Payment Struggles

Wed, 12 Sep 2012 11:38:05 GMT

By Toni Brayer, MD

The way doctors bill and get paid is a byzantine process and it is no wonder the "private practice" doctor is an endangered species. It takes a keen sense of business, a love of medicine-not money, and a sense of humor to survive. Here is my latest story. You can't make this stuff up....

I saw a patient in September 2001 (note the date...11 years ago). I billed her insurance company, Employers Mutual, LLC for $185.00. I never got paid.

Now fast forward to September 2012. I received a document from an attorney who informs me that he is a receiver in a class action suit and $48 million in unpaid claims is being claimed. It appears I am a Category B creditor and will receive a pro-rata share. He recovered $16, 559, 576.88 and took $4,831,214.40 in attorney fees.

It looks like in the future (?) I may receive a check for $37.00. No promises are given.

I remember my practice back in 2001. I worked about 80 hours a week and never even had enough money to fund a retirement plan for myself. Getting paid a fraction of my charges was common and getting stiffed by insurers completely was also par for the day.

I am happy for the windfall of $37.00 for the work I did 11 years ago. I still see patients in a private practice but my main income now comes from my employed administrative position. Waiting 11 years for a fraction of payment is not a sustainable business model.

Toni Brayer is an internist who blogs at EverythingHealth.

Originally published in EverythingHealth on September 7, 2012.

USPSTF Turns Thumbs Down on PSA Testing

Wed, 23 May 2012 12:20:33 GMT

Healthy men should no longer have PSA measurements as a screening test for prostate cancer, according to a final recommendation from the United States Preventive Services Task Force (USPSTF).

The so-called grade D recommendation applies to men of all ages but does not apply to the use of PSA testing for monitoring patients after a prostate cancer diagnosis or treatment.

Calling prevention of prostate cancer deaths the primary goal of screening, the task force cited a lack of evidence that PSA testing has an impact on that goal.

The USPSTF based its recommendation largely on data from two large trials of PSA screening for prostate cancer. One trial showed no difference in prostate cancer mortality between screened and unscreened men. The other showed an adjusted reduction in mortality risk of 29% among screened men, which the USPSTF translated into too few lives saved to offset the potential harms of screening.

The American Cancer Society weighed in on the issue, and generally supported the USPSTF decision.

The American Urological Association also responded. The AUA vice chair of the health policy council David Penson, MD, said the recommendation was not unexpected but was nonetheless disappointing.

Click here to view the full USPSTF recommendation statement on prostate cancer screening.

Click here to view the full article.

Source: MedPage Today, May 21, 2012.

Medi-Cal Primary Care Rates to Increase to Medicare Levels in 2013

Mon, 21 May 2012 12:38:11 GMT

Medi-Cal primary care physicians will receive a two-year, $11 billion pay increase, under a proposal released last week by U.S. Department of Health and Human Services. The proposal, which implements a provision of the Affordable Care Act (ACA), would on average result in a 50 to 60 percent increase in Medi-Cal rates for primary care physicians, including family medicine, pediatrics and internists, plus related subspecialties. The ACA calls for Medicaid payments to primary care physicians to be raised to Medicare levels for 2013 and 2014.

The increase, effective in 2013 and 2014, bring Medicaid payments to primary care physicians in line with those for Medicare. Although Medicaid is jointly funded by states and the federal government, the increase would be paid for entirely by the feds.

“The payment increase proposed today will be an important tool for states to ensure their primary care networks are prepared for increased enrollment as the health care law is implemented,” said Marilyn Tavenner, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), in a statement issued last Wednesday. “Today’s action will help encourage primary care physicians to continue and expand their efforts to provide checkups, preventive screenings, vaccines and other care to Medicaid beneficiaries.”

SFMS/CMA have been working closely with CMS to ensure that the definition of primary care used is as broad as possible. We believe this two-year pay increase is a step in the right direction; however, it is critical that we find a long-term solution that will ensure that the influx of new Medi-Cal patients will be able to find a doctor.

SFMS/CMA believe the two-year pay bump will prevent many primary care physicians from leaving the program, but it may not be enough to attract new physicians. Some primary care physicians will not want to enroll in the program and establish patient relationships, only to have to pull out in two years and leave their patients, she says.

Currently, California’s rates rank 47th in the nation and are on average 50 percent below Medicare rates. Because of these low rates, two-thirds of California’s physicians cannot afford to participate in the program and more than 50 percent of Medi-Cal patients report they can’t find a doctor.

After Hours Medical Clinic Fills Void in San Francisco

Tue, 24 Apr 2012 15:30:42 GMT

Americans work longer hours than workers in most other developed countries. The typical American middle-income family put in an average of 11 more hours a week in 2006 than it did in 1979. Although more than 805,000 people reside in San Francisco, there were no after-hours clinics available to accommodate busy families until the establishment of the After Hours Medical Clinic in March 2012.

Staffed by the Pacific Family Practice Medical Group, the clinic provides much-needed non-office, after-hours medical care at reduced cost for both patients and insurers. The clinic operates from 5:00 pm to 9:00 pm on weekdays and from 10:00 am to 4:00 pm on Saturdays.

An after-hours clinic provides walk-in care that focuses on acute conditions and exacerbations of chronic conditions. In a study done by the California HealthCare Foundation, the most common diagnoses seen in non-emergent and non-primary care settings are upper respiratory infections (60.6 percent); preventive care, such as vaccinations and preventive exams (21.6 percent); other minor conditions such as allergies, insect bites, rashes, and conjunctivitis (9.5 percent); and urinary tract infections (3.7 percent). These four groups of diagnoses accounted for more than 95 percent of all visits to acute care clinic sites.

According to “Health Matters in San Francisco” and the California Office of Statewide Health Planning and Development, 18,000 emergency department visits were preventable. Dr. Robin Weinick of RAND Health, one of the largest private health research groups in the world, estimates that 13.7 to 27.1 percent of all emergency room (ER) visits could occur in less intensive, walk-in-based care facilities. A combination of increased working hours for patients and diminished primary care access result in unnecessary use of emergency departments.

Delays in care and additional costs incurred in ER visits are a drain on health care resources. Several studies have estimated that costs of care in nonemergency, nonprimary care clinics are $279 to $460 less per visit than ER costs for similar cases.

“Extended hours have become a big concept of how to bring our practice to the people, to make it more available to the people,” explained SFMS member Sophia Mirviss, MD. “It’s for existing patients, and also for people who come home and find themselves sick and really want to be seen but had to work all day. And for people who do not have insurance but want to get their strep throat checked but cannot go to the ER because it’s prohibitively expensive.”

The clinic does not provide ongoing primary care services. It transmits all medical encounters to patients’ primary care physicians via an electronic medical records system so that the primary care physicians retain control of all referrals and follow-up.

The community has embraced this concept; many physicians have been strongly positive in their responses. It has also garnered support from Brown & Toland and other insurers as it has the potential for reducing inappropriate ER and hospital use rates.

WellPoint To Revamp Primary Care Pay

Fri, 27 Jan 2012 12:38:26 GMT

The nation's second-largest health insurer is shaking up its approach to paying doctors, putting a major investment behind the idea that spending more for better primary care can save money down the road. Starting this summer, WellPoint Inc., which insures some 34 million Americans, will offer primary-care doctors a fee increase, typically of around 10%, with the possibility of additional payments that could boost what they get for treating the patients it covers by as much as 50%. Wellpoint said Friday it will increase the fees it pays to doctor practices, and it will start paying for services like preparing care plans for patients with complex medical problems. It also will offer doctors an opportunity to share in some savings when better patient care leads to a reduction in costs. WellPoint said it wants to give doctors a chance to do more for patients outside of episodic care, or just treating people when they become sick. That means, for example, working with overweight people who have diabetes to develop an exercise plan and then making sure they stay on it. Source: Associated Press, January 27, 2012.

Healthy San Francisco a Finalist for Harvard Innovations Award

Mon, 28 Nov 2011 15:36:19 GMT

In a political era in which government is often blamed as a problem rather than a solution, Harvard University's Innovations in American Government Awards hopes to show the converse can be true. And one of its six finalists—out of 563 applicants from around the country—is Healthy San Francisco, a program a supported by the San Francisco Medical Society. The city's first-of-its-kind universal health care program is up against New York City's NYC Service, which connects volunteers with service opportunities; a separate New York City antipoverty program; Littleton, Colo.'s home-grown business program; a job creation program in Oregon; and an apprenticeship program for Boston teachers. Richard Scheffler, a professor of health economics at UC Berkeley, evaluated Healthy San Francisco this year for Harvard and said it's well coordinated, broadly supported by business and labor groups, culturally sensitive to its diverse population of patients, stresses primary care and prevention, and has grown to involve public and private health providers.

'Creative solution'

Created in 2007, the city's universal health care program now serves 55,000 patients who are treated at 33 locations. More than 85 percent of the city's uninsured residents now have a primary care doctor, and emergency room visits have dropped as a result. Any uninsured adult living in the city who doesn't qualify for Medicare or Medi-Cal is eligible. Patients' immigration status, pre-existing medical conditions and employment status aren't factors in qualifying for the program. Children and young adults up to age 24 are covered under a separate program. The program isn't considered insurance because it doesn't follow participants outside city limits; it wouldn't apply, say, to someone who has a heart attack while traveling. It cost $177 million last year - $100 million of which came from taxpayer funds. The rest was paid through a mix of participants' fees and mandatory employer contributions. Healthy San Francisco could change significantly if President Obama's health care program—and particularly its mandate that everybody purchase insurance—stands up at the Supreme Court. 60 percent of Healthy San Francisco patients would be expected to shift to regular health insurance, said Tangerine Brigham, director of Healthy San Francisco. She said millions around the country still won't be covered, though—because they get waivers for their religious convictions or because they prove they can't afford it, they're undocumented immigrants or they're incarcerated. "We'll still need Healthy San Francisco," she said, saying it could be a model for other counties that grapple with how to cover those who still don't get health insurance.

Great accomplishment

Scheffler said that just because millions of additional people stand to gain health insurance if Obama's plan stands up in court doesn't mean there will automatically be enough doctors and other medical staff to treat them. "San Francisco has done this already in a very cost-effective way, so I think the city will have an easier time implementing that, and other cities will look to what they've done to provide access," he said. Source: San Francisco Chronicle, November 28, 2011

An Unfolding Success Story: Electronic Medical Records Transition Moves Ahead

Mon, 28 Nov 2011 13:30:27 GMT

It’s hard to think of any major portion of President Obama’s health policy that hasn’t engendered intense argument. But one at least comes close: the provision of the 2009 federal stimulus law that pushes medical practices to update their record-keeping for the 21^st century. The aim is to ensure that all of the nation’s medical records are computerized by 2014. There seems to be a broad consensus that increased use of electronic data will improve the quality of health care in the country and ultimately lower costs. And here’s why. In roughly three out of four doctors’ offices in the country, patient charts are still updated by hand and stored in vast, color-coded filing cabinets. If a patient changes doctors, the file has to be mailed or faxed and the new doctor often has trouble reading the previous doctor’s hen scratching. Patients walk out of a medical office with one or more tiny pieces of paper to get prescription drugs filled. When they come back for a follow-up, they have to bring a bag full of drugs so the doctor will know what the patient is taking. Given such cumbersome procedures, few would argue that computerization isn’t needed. But the federal program did lead to complaints in the beginning. Critics warned that doctors who serve mostly low-income patients would lack the time or inclination to make the painstaking switch to electronic records. They worried that the nationwide push would widen the so-called “digital divide” that already exists between doctors in affluent parts of the country and those in underserved urban and rural areas. So far, that hasn’t happened. The $19 billion medical records law—which pays doctors to switch to an electronic system or upgrade one they’re already using—is having an impact on the entire health care industry. And small primary care practices that treat Medicaid patients are no exception. As of last week, the U.S. Department of Health and Human Services reported, more than 100,000 primary care doctors across the country had taken advantage of federal incentives to adopt a certified electronic medical record system. Half of the doctors were members of small practices that serve Medicaid and Medicare patients, and the rest worked in community health centers, public hospitals, rural health clinics and other public settings.

A national campaign

In addition to cash for doctors—$65,000 for every Medicaid physician and $44,000 for Medicare practitioners—states have been given millions of dollars to set up education programs aimed at helping the medical profession qualify. These advisory groups, called regional extension centers, have the job of translating some 700 pages of complex federal rules on so-called “meaningful use” of electronic health records. Some 22 states have set up regional centers, and several states have exceeded federally set goals for the number of doctors they enroll. For Medicaid doctors — those with 30 percent or more of their patients covered by the federal-state program — qualifying for the first $21,000 federal installment is relatively easy. They simply have to adopt or upgrade a certified electronic records system.

Meaningful Use

For Medicare doctors, who are paid higher rates, the first step is steeper. They must qualify under the meaningful use rules immediately. For example, physicians’ practices must maintain an up-to-date computerized list of medications and allergies for each patient, provide patients with summaries of every office visit, and transmit prescriptions electronically. Ultimately, Medicaid doctors will have to adhere to the same set of rules in order to get subsequent installments of their $66,000 total incentive payment. But they have quite a while to do that. Medicare doctors must be certified by 2012 in order to receive their full incentive. After that, they have until 2014 to qualify for a smaller incentive of $24,000. Medicaid doctors have until 2021 to fully qualify. In the meantime, states are developing what is known as a health information exchange that will allow doctors who convert to electronic systems to access patient records within the state through secure portals, and ultimately transfer records across the country.

Poll Proves Medi-Cal Patients Access Already Compromised

Thu, 20 Oct 2011 13:49:46 GMT

Independent firm Fairbank, Maslin, Maullin, Metz & Associates (FM3) recently conducted a survey of California adults to measure their use of health care, attitudes toward their health coverage, and reactions to proposed health care policy changes. Specifically, the survey was done to determine access to care that Medi-Cal patients currently have compared to privately and uninsured patients across the state. “The data presented in this survey is a clear indication that patients’ needs aren’t being met with the current system,” Dustin Corcoran, the California Medical Association (CMA) CEO said. “California needs to be an example for health care reform in this country, and limiting patient access while reducing provider resources is a recipe for disaster. The proposed cuts that have been submitted by the Department Health Care Services (DHCS) to the Centers for Medicare & Medicaid (CMS) are a clear violation of federal law. Access to care must be equal for Medi-Cal and privately insured patients and the facts are here- they’re simply not.” The survey was conducted after DHCS submitted state plan amendments (SPAs) that would reduce Medi-Cal reimbursements by 10%, limit patient visits and impose mandatory patient co-payments.

“Medi-Cal patients already are disadvantaged in obtaining health care and these payment cuts will make it worse,” C. Duane Dauner, the CEO of the California Hospital Association said.

Key findings of the survey as reported by the independent pollster include:

There are significant disparities in health status and access to primary care between Medi-Cal patients and other Californians.
When Medi-Cal patients needed health care, only half received it, compared to nearly 75% of privately insured patients.
Medi-Cal patients are far more likely than other Californians to be turned down by a physician who would not accept Medi-Cal payment.
Medi-Cal patients are more than four times more likely to get care in a hospital emergency room because they could not get an appointment with a doctor or clinic.

Click here for the survey summary.

5 Elements of Comprehensive Primary Care

Tue, 11 Oct 2011 16:38:39 GMT

Medicare has established five core primary care functions that payers will pledge to support under its new comprehensive primary care payment model. Physicians who apply and are chosen to participate in the demonstration would receive resources to perform these functions. Risk-stratified care management: Assessing all patients to identify and predict which ones need interventions, and developing care plans in consultation with patients. Access and continuity: Providing patients with 24-hour access to a designated health professional or care team. Planned care for chronic conditions and prevention: Offering proactive primary care through Medicare's annual wellness visit. Caregiver engagement: Establishing policies to ensure that patient preferences are determined and incorporated into treatment decisions. Coordinated care: Communicating key information during care transitions or referrals to other physicians. Source: Comprehensive primary care initiative, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services

Medicare Tests Monthly Incentives for Innovative Primary Care

Tue, 11 Oct 2011 16:30:36 GMT

Participating practices will receive an average of about $20 per patient per month to coordinate quality care for Medicare and private patients.

Medicare will partner with private insurers to offer physicians patient management fees and the opportunity to share savings under a primary care payment initiative led by the Centers for Medicare & Medicaid Services. The Comprehensive Primary Care Initiative is a new collaboration between public and private payers to strengthen primary care. The Center for Medicare & Medicaid Innovation is inviting insurers to join government health plans in trying a new approach to paying for primary care starting in 2012. "We believe that if we can give primary care clinicians the time and resources to take care of their patients and coordinate their care across the spectrum, in the end we'll get happier and healthier patients," said Richard Gilfillan, MD, acting director of the innovation center. "We know we'll get providers who feel more fulfilled. And we know over time we'll improve overall costs of the system and make the system more sustainable." The initiative is designed to enhance the work being done by payers who have developed innovative models to pay for coordinated care and higher quality services, such as the patient-centered medical home. The Medicare agency wants to pay more for outpatient services that keep patients healthier and prevent costlier inpatient care. For instance, care coordination in the Community Care of North Carolina program, which initially launched as a Medicaid medical home project, has been able to lower preventable hospitalizations significantly for patients with chronic conditions, according to CMS. Once the participating private payers are selected, interested physician practices will be asked to apply through CMS to participate. CMS will require practices to provide comprehensive primary care services to Medicare patients and to those with coverage from a participating payer. Preference will be given to practices that have achieved meaningful use of an electronic medical record system, according to the application materials. Practices will receive patient management fees to pay for the new health care delivery methods, said Richard Baron, MD, director of the Seamless Care Models Group at the innovation center. This fee is expected to average about $20 per month for each patient covered by one of the participating payers. CMS also will provide practices with patient and resource use data so patients have more information on the quality of their care and their physicians' performance. Any savings that might be generated for the Medicare program would be shared with the practices.

Trying to transform primary care

CMS plans to select up to seven areas of the U.S. to participate in the demonstration, which will launch in the summer of 2012. Each market will include about 75 practices caring for roughly 300,000 Medicare or Medicaid patients over four years. Those participating in the initiative can't participate in other shared savings initiatives, such as the forthcoming Medicare accountable care organization program.

MedPac Mulls SGR Repeal with 10-Year Payment Freeze

Thu, 22 Sep 2011 11:54:51 GMT

The Medicare Payment Advisory Commission (MedPAC) late last week issued a draft proposal that would repeal the Medicare sustainable growth rate (SGR) and pay for it by freezing or cutting physician reimbursement for the next 10 years. Under the proposal, primary care physicians would see their payments frozen at current levels for 10 years, while specialists would have their pay cut by 5.9 percent a year for the next three years, followed by a 7 year freeze. These cuts and freezes are part of a proposal to eliminate the SGR and avert the 29.5 percent physician pay cut that the formula mandates on January 1, 2011. MedPAC, which that advises Congress on Medicare payment policy, estimates that its SGR repeal would cost about $200 billion. The cost would be offset by cuts to physicians, Medicare Part D drug plans, post-acute care facilities, hospitals, laboratories, durable medical equipment, Medicare Advantage, and others. Medicare patients would also see their benefits cut by 14 percent. This is the first time in a decade that MedPAC is not recommending a payment increase for physicians. The California Medical Association (CMA) is extremely concerned about this sudden departure from past MedPAC policy, which demonstrates the difficult fiscal environment that we are facing as we fight to once and for all repeal the SGR. Although there seems to be the political will to repeal the fatally flawed formula, the enormous price tag to will make any proposal controversial. CMA, AMA, and others in organized medicine strongly oppose the MedPAC proposal. A long-term payment freeze in an era of 6 percent average annual practice cost increases essentially equates to a significant payment cut. The freeze, plus the 5.9 percent cuts to specialists, will be devastating for seniors trying to find a physician in California. MedPac is scheduled to vote on this proposal, which is expected to be fleshed out in more detail in the coming weeks, when it meets again in early October.

HPV Vaccine Safety: Debunking the Myth

Thu, 15 Sep 2011 14:00:40 GMT

The medical community issued swift criticism Tuesday after Rep. Michele Bachmann dragged the safety of the vaccine against the human papillomavirus (HPV) into the political spotlight, reigniting the controversy over the risks and necessity of vaccinating children. “The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation,” the American Academy of Pediatrics said in a statement released Tuesday afternoon. “There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.” Last year, the American College of Obstetricians and Gynecologists recommended the HPV vaccination for all girls and young women between the ages of 9 and 26. The Centers for Disease Control and Prevention (CDC) suggest that doctors “strongly recommend” that all 11- or 12-year-old girls be vaccinated against HPV, which is the cause of almost all cases of cervical cancer. The vaccine is a series of three shots, and is approved for use in males and females from ages 9 to 26. A reality check: more than 95 percent of Americans have premarital sex, and more than 50 percent of sexually active Americans contract HPV at some point in their lives. The disease can cause genital warts in men, and a small percentage of affected women will develop cervical cancer. This is a vaccine that truly can save lives. Click here for more information about the HPV vaccine and why it’s safe and effective, written by SFMS Member Jennifer Gunter, MD, FRCS(C), FACOG, DABPM, board certified ob/gyn in the U.S. and Canada. Click here for information about HPV Vaccine from the CDC.

Flu, Rabies, Meningococcal... Prevent Any Sort of Debacle!

Wed, 14 Sep 2011 15:52:18 GMT

In partnership with the San Francisco Department of Public Health, San Francisco Immunization Coalition is hosting its annual Influenza and Infectious Disease Forum on September 28.

Wednesday, September 28, 2011 9:00 am to 12:00 pm

101 Grove Street, Room 300

Participants will learn about the new ways vaccine-preventable diseases are affecting our community and engage in an interactive discussion to identify sustainable solutions. CEU credits are available. Click here to download the registration flyer.

Physicians Find Ways To Treat Uninsured, Low-Income Residents

Tue, 13 Sep 2011 13:05:51 GMT

Physicians in California and other states increasingly are trying to find ways to provide care for low-income, uninsured individuals so that patients do not have to avoid seeking medical care, USA Today reports. According to the USA Today article, California has more uninsured residents— seven million—than any other state, as well as one of the highest percentages of uninsured residents. According to Gallup, the rate of uninsured residents in California increased to more than one in five last year, while the national rate reached one in six. In Los Angeles County, the uninsured rate has reached nearly 30%. Although many physician practices also are dealing with financial challenges, they are using a number of strategies to help patients. For example, some doctors are:

Asking drug representatives to give more samples that can be distributed to patients;
Connecting patients with federally funded programs or charitable organizations that provide prescription drugs at a discounted price or at no cost;
Offering discounted or no-cost care; and,
Providing advice to patients over the phone so they do not have to visit the physician's office in person.

Protecting Children: How Far Do We Go?

Mon, 12 Sep 2011 11:54:34 GMT

Hot off the presses! The September 2011 issue of San Francisco Medicine is now available and making its way to mailboxes throughout the San Francisco Bay Area. This issue marks the first installment in a three-part "Medicine for the Phases of Life" series, focusing on pediatric and adolescent medicine. The journal is also available as an eMagazine and can be viewed here. Scroll down to read an introduction about the theme of this month's SFM from SFMS President George Fouras, MD.

Over the years, we as a society have felt that the protection of children from specific items or events is in the best interest of the child. For example, we have legislation that prohibits youth under the age of eighteen from smoking and for youth under the age of twenty-one from drinking alcohol, and minors from having sexual intercourse. In addition, we have, as a society, prohibited advertisements for tobacco products and alcohol over network television. We have done this because we recognized that children are not developmentally ready to deal with such concepts, and to empower parents and caretakers of children to make the decisions they feel are appropriate in the raising of their children. Oddly enough, the depiction of extreme and gratuitous violence, on television and in movies targeted toward the teenage audience, is permitted. Recently, Senator Leland Yee authored legislation designed to protect children from violent video games and to empower families in controlling what media their children are exposed to. As expected, this issue finally reached the U.S. Supreme Court, which, in a seven-to-two decision, struck down this law on free-speech grounds, stating that children have a right to view such media. In a recently published op-ed piece, the gaming industry took this “win” as an affirmation of its position. The piece that was missing is that the basis of the argument was, in my opinion, flawed. These games were compared to Saturday morning cartoons. But the fallacy is that kids do have a capacity to tell fantasy from reality. They know that rabbits cannot speak. But shooting a “hooker” for points is a reflection of life. In another example of irony, the film industry may be compelled to give an R rating to a film that portrays normal, healthy, romantic, and sexual relationships among human beings or portrays violence in a historically accurate manner, yet may give a PG-13 rating to a movie that contains gratuitous violence. Much attention has been raised recently over the nutritional value of foods that are targeted toward children. This has most recently been brought into focus by the First Lady's campaign to raise awareness regarding childhood obesity and the increased incidence of diabetes among children. The medical community has long known of the poor nutritional value of foods targeted toward children, often in the form of high-calorie and high-fat meals with little nutritional value. We have had some wins over the years but are still challenged in trying to change societal norms versus overwhelming corporate influence to maintain the status quo. In the July 25, 2011, issue of American Medical News, the Opinion column noted that the June report of the Institute of Medicine that stated that approximately 10 percent of children from infancy to age two are obese, a figure that rises to 20 percent by age five. Excess weight gained early in life may affect metabolic systems, which may then raise the risk of chronic disease later in life. For another example of corporate influence, we have to look no further than the tobacco industry. After decades of trying to make a difference in how cigarettes and other tobacco products are marketed, and finally winning legislation that can control the tobacco industry, a new development has occurred. The introduction of e-cigarettes, a tobacco-less form of nicotine delivery, is being strongly marketed, especially to children and teenagers, by using fruity flavors and smells that are appealing to younger people and adults alike. E-cigarettes are nothing more than a smokeless nicotine delivery system and have the potential of addicting thousands and millions of people. They completely circumvent all tobacco legislation and present new challenges to efforts to control nicotine addiction. Working with our health department, which recently adopted new policy to bring e-cigs under tobacco regulations, the SFMS will be asking the CMA to look at this on a statewide basis as well. The common thread in all of these examples is that children and teenagers are still growing and developing both mentally and physically. Family members should be the primary people to set rules and boundaries and raise youth to be able to handle more adult choices and situations. Our role as a society is to empower families and to shield them from overwhelming influences that subvert their abilities to raise their children. This is why we must continue to pursue these goals and educate the people who have the political power to help. Click here to view the September 2011 issue of San Francisco Medicine.

Medical Schools Falls Short on LGBT Education

Wed, 07 Sep 2011 09:58:09 GMT

Medical students spend hours learning about human health, behavior and how to provide good patient care. But when it comes to caring for lesbian, gay, bisexual and transgender individuals, their training may fall short. According to a new survey of medical school deans in the U.S. and Canada, schools spent a median of just five hours teaching LGBT-related health content. Some 33 percent provided no LGBT-related instruction during students’ clinical years, which is when students receive the most hands-on training, and nearly 4 percent of schools reported not covering LGBT health at all. More than a quarter of the medical school deans said their school’s coverage of 16 related topics was “poor” or “very poor.” The topics included sex change surgery, mental health issues and HIV-AIDS. While nearly all medical schools taught students to ask patients if they “have sex with men, women or both” while obtaining a sexual history, the overall curriculum lacked deeper instruction to help “students carry that conversation as far as it needs to go,” said lead author Dr. Juno Obedin-Maliver of the University of California, San Francisco. Without such education, doctors are left guessing and can make faulty assumptions, Obedin-Maliver said. For instance, lesbians need Pap tests, which screens for the sexually spread virus that causes most cervical cancer, as often as heterosexual women do. But some doctors assume they don’t need them. Click here to read the JAMA study.

CMA tells Congress flexibility act will harm children, disrupt coverage

Mon, 11 Jul 2011 03:00:33 GMT

CMA and a coalition of organizations dedicated to the health of California's children have joined together in opposition of federal legislation that would repeal provisions of the federal health reform law, allowing states to drop children and other low-income populations from their Medicaid and children's health insurance programs (Medi-Cal and Healthy Families in California). This legislation, known as the "State Flexibility Act," would jeopardize the health coverage of millions of children nationwide by allowing states to roll back eligibility levels and erect new barriers to prevent eligible children from enrolling in coverage. Under this proposal, Children's Health Insurance Program (CHIP) funding is particularly vulnerable. If this bill becomes law, the Congressional Budget Office estimates that half of all states will eliminate their CHIP programs by 2016, and even more states will scale back coverage for kids. The coalition told the congressional delegation that cutting children’s coverage is not only bad for children’s health; it is bad for our economy. Children without health care and immunizations are more likely to use emergency rooms and be hospitalized for preventable illnesses, both of which come at a high cost to taxpayers. "We need our nation's children to drive tomorrow’s economy, and the negative effects of this proposal would be lifelong for those impacted,” the coalition said. "The health of our children should not be a partisan issue. Congress can and must move forward, not backwards, in ensuring that every child has comprehensive, affordable health coverage."

Assistance with EHR Selection and Implementation; CalHIPSO Waives Membership Fees for Priority Primary Care Providers

Thu, 23 Jun 2011 07:00:25 GMT

The transition from a paper-based practice to one that successfully uses electronic medical records (EHR) is no easy feat. The San Francisco Medical Society (SFMS) has partnered with the California Health Information Partnership and Services (CalHIPSO) to assist our physician members with EHR implementation. CalHIPSO is a non-profit, vendor-neutral organization that provides technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology. As a federally designed Regional Extension Center (REC), CalHIPSO is working with ten Local Extension Centers (LECs)—Lumetra is the San Francisco LEC—to ensure the availability of local technical assistance, guidance, and information on best practices to support safety net providers in Northern and Southern California in the attainment of Stage 1 meaningful use of EHRs. Help is available to physicians in all stages of EHR adoption, including:

EHR project management
Consultation on vendor selection
Strategic counsel on practice/workflow redesign
Support on system implementation, health information exchange (HIE), and privacy/security
Resources on patient education on EHRs

CalHIPSO developed a seven-minute orientation video, which is designed to provide CalHIPSO members with an overview of what they can expect from CalHIPSO and the LECs once they enroll in the REC program. [youtube=http://www.youtube.com/watch?v=DqX-3epDKyg] CalHIPSO’s services are available to Priority Primary Care Providers (certified in Internal Medicine, Family Practice, Pediatrics, Geriatrics, OB/GYN, and Adolescent Medicine - MD, DO, NP, PA, CNMW) who want help successfully implementing EHR systems and achieving federal meaningful use guidelines. Priority Primary Care Providers (PPCPs) who join CalHIPSO by December 31, 2011 will have their membership fees waived until January 2014. Non-PPCPS can access the services on a fee-for-service basis. For more information about CalHIPSO or to sign up, please contact SFMS at (415) 561-0850 or email membership@sfms.org.