The SFMS Executive Committee has voted to support the Coalition opposing the San Francisco ballot initiative to criminalize performing circumcisions.  Please see below for excerpts from a MedPage article published yesterday, June 23, 2011: A proposal to ban male infant circumcision in San Francisco, scheduled for a city-wide vote in November, may be pulled off the ballot if a lawsuit filed by physicians, Jewish groups, and a Muslim family is successful. The ballot initiative was started by individuals who believe circumcision is a form of genital mutilation, sometimes called “intactivists.”  In May, they filed petitions with enough signatures to qualify for placement on the November ballot. It would make it “unlawful to circumcise, excise, cut, or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years,” with fines and jail terms possible for violators. The lawsuit against the proposal cited a California law prohibiting cities from setting restrictions on medical procedures. According to the suit, cities may not “prohibit a healing arts professional licensed within the state ... from engaging in any act or performing any procedure that falls within the professionally recognized scope of practice of that licensee.” One of the physician plaintiffs in the suit, Brian McBeth, MD, of San Francisco General Hospital's emergency department, said in a statement that circumcision has definite medical benefits that would be imperiled by the ban. He told of a six-year-old uncircumcised boy presenting with his foreskin stuck in a retracted position resulting in severe pain and swelling—all consequent to his parents' unsuccessful efforts to treat an infection of the foreskin. Pediatrician and obstetrician groups have endorsed parental rights to decide whether their children should be circumcised. Most city officials in San Francisco have stated their opposition to the proposed ban, as have the AAP's California chapter and the San Francisco Medical Society. Source: http://www.medpagetoday.com/Pediatrics/Parenting/27241

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.

The SFMS developed policy to curtail overuse of antibiotics in agriculture in 2002, and had that policy adopted by the AMA.  We have worked with Senator Feinstein on this topic in more recent years, and she has now taken on a leadership role. Washington—California Sen. Dianne Feinstein renewed a decade-long push Friday to phase out the routine use of antibiotics in livestock, hogs and poultry.  Her bill follows the emergence in Germany of a lethal antibiotic-resistant strain of E. coli linked to 35 food-poisoning deaths and the discovery this month in Britain of an antibiotic-resistant bacteria in cow’s milk. Government officials have warned that increasing antibiotic resistance in humans poses a serious public health threat.  In the United States, the Food and Drug Administration has confirmed that 80 percent of all antibiotics are given to farm animals in low doses intended to stave off disease in large livestock operations. The full article can be found at http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/06/18/MNT91JVE15.DTL.

This morning Governor Brown held a press conference announcing he would veto the budget sent to him by the Legislature just hours before.  Both the Senate and Assembly met yesterday and passed the main budget bill as well as various "trailer" bills that implement policy changes pursuant to appropriations and spending reductions contained in the main budget.  The main bill was passed on a party-line vote, and did not contain either a "bridge tax" to continue the current tax rates (raised in the 2009-10 budget) nor the requirement for a public vote to determine whether or not to extend those tax rates for another 2 to 5 years.  As a result, new cuts and spending shifts were included to close the remaining gap of approximately $9.6 billion. [youtube=http://www.youtube.com/watch?v=L7dHqjhJz8k] Fortunately the budget bills that were passed did not eliminate the Healthy Families program, which was a huge victory for the California Medical Association (CMA) and all county medical societies and our partners in this effort including the California Chapter of the American Academy of Pediatrics and the California Academy of Family Physicians.   However, the battle is far from over, as the main budget bill contained language to begin transferring the administrative function and expenditure authority for Healthy Families over to the Department of Healthcare Services (currently the Managed Risk Medical Insurance Board operates the program).  The main budget bill also required that a transition plan for Healthy Families be developed and put into law through separate legislation. As the process gets underway again following the Governor’s veto this morning, CMA will continue to be fully engaged in the process to protect against further devastating cuts to the safety net and ensure adequate coverage and access to care for California’s needy children. The budget package did include some good items, including $7.3 million for vaccines for low-income, uninsured Californians, $4.4 million in additional funds resulting from interest earnings to the Every Woman Counts breast and cervical cancer screening program, and the creation of the Keeping Adults Free from Institutions program to provide adult day health services to eligible individuals.  Another substantial policy change contained in the budget is to authorize the Department of Health Care Services to develop a new methodology for reimbursing pharmacy products utilizing Average Acquisition Price. It is important to note that while Gov. Jerry Brown has vetoed the main two budget bills (SB 69 and AB 98), he has not yet acted on the various trailer bills that also passed yesterday that contain policy changes to implement the budget’s spending directives. CMA/SFMS will continue to provide you with updates as the budget process moves toward a final resolution, and will continue to be actively involved in the process in order to ensure that all Californians have access to quality care when they need it. Should you have any questions please feel free to contact Carolyn Ginno at (916) 444-5532 or cginno@cmanet.org.

Communication can go a long way toward reducing health disparities, and improving care for all patients.  Communication Climate Assessment Toolkit (C-CAT), a new set of assessments developed by the AMA, can help keep physician practices measure how well they communicate with patients.  The free C-CAT contains surveys that can help you or the organization you work in measure whether effective communication is taking place. Questions focus on common communication problems facing diverse patient populations, such as culture, language, and health literacy gaps.  The C-CAT also features various data tools to demonstrate whether a practice’s policies, practices, and culture promote effective, patient-centered communication. The C-CAT's surveys are in the public domain and are available here for viewing. For more information about this tool and other resources available, please go to http://www.ethicalforce.org.