Wednesday, November 26, 2014

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

SFDPH Health Advisory: Recognizing and Handling Suspect Ebola Cases

This Advisory updates the Health Advisory “Recognizing and Handling Suspect Ebola Cases in Outpatient Settings.” Travelers to the US from Ebola-affected countries receive enhanced screening and risk assessment by US Customs and Border Protection and CDC upon arrival. Returning travelers from Ebola-affected countries are risk-stratified, and are subject to active daily monitoring and movement protocols by state and local public health departments for 21 days from the date of their departure from West Africa. These procedures greatly reduce, but do not fully eliminate, the likelihood that a patient with Ebola could present unannounced to a local healthcare setting, and so local facilities need to remain vigilant and prepared. 

1. All Healthcare Settings Should be Prepared to Identify and Isolate Possible Ebola Cases; Emergency Departments Should Also be Prepared to Receive and Manage Possible Cases

All healthcare settings should implement procedures to identify and immediately isolate patients who have travel/exposure risk for EVD plus symptoms compatible with EVD. Notification to SFDPH Communicable Disease Control Unit (CDCU) should also be made immediately to (415) 554-2830Ambulatory health care settings such as offices and clinics should follow the guidance in our Oct. 27, 2014 Health Advisory, as well as more recently published CDC guidance for ambulatory careEmergency departments should follow CDC guidance for Emergency settings and be prepared to identify, isolate, and also to receive and manage possible EVD patients, using PPE and infection control procedures designated for the care of hospitalized patients. 

2. Asymptomatic Persons with Ebola Travel/Exposure Risk

Persons reporting Ebola travel/exposure risk, but who are asymptomatic and therefore not in need of isolation and transport, should be reported promptly to CDCU at (415) 554-2830 so that appropriate public health action can be taken. Such action includes, but is not limited to, active daily monitoring of these individuals for symptoms during the 21-day incubation period.

3. Screening Questions: CDC Now Recommends Asking Travel/Exposure History First

CDC algorithms now advise screening patients for Ebola travel/exposure risk before asking about EVD-compatible symptoms. Only persons with Ebola travel/exposure risk require this second-level symptom screening. This is an efficient approach since few individuals in the US currently have travel/exposure risk for EVD. As before, a patient must answer ‘yes’ to both the travel/exposure questions and the EVD-compatible symptom questions to be considered a suspect case.

CMS Releases Final Rules for FY 2015 Medicare Physician Payments

CMS released finalized payment rules for different Medicare providers and services for 2015. Among other rules, CMS created new payments for chronic care management programs, launched efforts to streamline payments for individuals’ hospital care and expanded the agency’s Physician Compare website.

Rules on Physician Compare Website, Open Payments System

CMS said the rules expanding the Physician Compare website would significantly bolster “the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures”.

Separately, the rules also eliminate a reporting exemption under the Sunshine Act that excluded payments to physicians associated with accredited continuing medical education from the payments that have to be shared on the Open Payments System. CMS said the rule would now require group purchasing organizations and affected manufacturers to report compensation given to physician speakers at continuing education events in most cases.

Changes to Medicare Shared Savings Program

The rules also broaden quality performance penalties for all physicians and include additional quality criteria for the Medicare Shared Savings Program. Specifically, Medicare physician payments beginning in 2015 will be adjusted based on quality performance measures and penalties will no longer apply solely to larger physician practices.

CMS Increases Hospital Outpatient, Surgery Center Payments

In addition, CMS in the rules said it will increase Medicare payments for hospital outpatient services and ambulatory surgical centers in 2015.

Hospital outpatient departments will receive a 2.2% bump in reimbursement rates, while ambulatory surgical centers' payment rates will increase by 1.4%, effective January 1, 2015. The increase will affect more than 5,300 ambulatory surgical centers and 4,000 hospitals.

Further, CMS created comprehensive ambulatory payment classifications, which will provide lump sum payments to the centers for 25 particular outpatient services, such as hip replacements or pacemaker procedures.

CMS Cautions on SGR

In the rules, CMS noted that providers could see payment cuts around 21% in April 2014 if action is not taken on Medicare's sustainable growth rate formula.

Click here to view the 2015 Medicare Physician Payment Final Rules.

Source: California Healthline, November 3, 2014.

2014 SFMS Election Results

Thank you to all SFMS members who participated in this year's SFMS election. We are proud to announce the SFMS leadership for 2015. 

2015 Officers (one-year term):

President: Roger S. Eng, MD, MPH, FACR (2014 President-Elect automatically succeeds to the office of President)

President-Elect: Richard A. Podolin, MD, FACC

Secretary: Kimberly L. Newell, MD

Treasurer: Man-Kit Leung, MD

Editor: Gordon L. Fung, MD, PhD, FACC, FACP

Immediate Past President: Lawrence Cheung, MD, FAAD, FASDS (2014 President automatically succeeds to the office of Immediate Past President)

Board of Directors (seven elected for three-year term 2015-2017):

Steven H. Fugaro, MD

Brian Grady, MD

John Maa, MD

Todd A. May, MD

Stephanie Oltmann, MD

William T. Prey, MD

Michael C. Schrader, MD, PhD, FACP

Nominations Committee (four elected for two-year term 2015-2016):

Konstantin Bukov, MD 

Meghan D. Gould, MD 

Ingrid T. Lim, MD, FACEP, FAAEM 

Ray Oshtory, MD, MBA

Solo/Small Group Practice Forum (SSGPF) Delegate and Alternate (one each elected for two-year term 2015-2016):

As the candidate receiving the highest number of votes, Eric Tabas, MD will be recommended to the California Medical Association (CMA) as the SSGPF Delegate. 

As the candidate with the next highest number of votes, Payal N. Bhandari, MD, will be recommended to CMA as the SSGPF Alternate Delegate.

Young Physicians Section Alternate (two-year term 2014-2015):

Shoshana R. Ungerleider, MD

District VIII CMA Trustee (Term: Oct. 2015 – Oct. 2018):

Shannon Udovic-Constant, MD, FAAP

Delegation to the CMA House of Delegates (two-year term 2015-2016):


Lawrence Cheung, MD, FAAD, FASDS

Mihal L. Emberton, MD, MPH, MS

Gordon L. Fung, MD, PhD, FACC, FACP (Delegation Chair)

Richard A. Podolin, MD, FACC (serves automatically as President-Elect) Andrea M. Wagner, MD


Steven H. Fugaro, MD

Pratima Gupta, MD

Jerry Y. Jew, MD, MBA

Robert J. Margolin, MD

Amy E. Whittle, MD

SFMS/CMA Lead Resounding Victory in Defeating Prop. 46 by 2 to 1 Margin

On November 4, the voters of California spoke loudly and definitively, sending the trial lawyers’ Proposition 46 to defeat by a 2 to 1 margin. The message is clear—Californians simply don’t want to increase health care costs and reduce health access so trial attorneys can file more lawsuits.

An increase in the Medical Injury Compensation Reform Act (MICRA) cap on non-economic damages has been rejected in California again and again: 10 times in court, 5 times in the Legislature and now overwhelmingly by voters. This idea now has its own dedicated spot in California’s political trash heap.
But this time, we energized the membership of SFMS and CMA as a whole to fight the fight together, as one unified voice of medicine, representing the patients we so deeply care about and the care that we have committed to provide them.

Despite the trial attorney proponents’ attempt to sweeten the deal by adding provisions that polled well—physician drug testing and mandatory checking of a prescription database—voters said NO on Election Night. As people throughout the state heard from physicians and No on 46 coalition members about the real intentions of the measure’s proponents, there was resounding opposition.

One of the secret weapons of this effort was the size and diversity of our coalition. We helped amass one of the largest and most diverse campaigns in California history. The breadth of the coalition—which includes labor, business, local government, health providers, community clinics, Planned Parenthood, ACLU, NAACP, taxpayers, teachers, firefighters and more—underscores just how important affordable, accessible health care is to every Californian.

In addition to the groups on the ground talking to voters about the deception and trickery behind Prop. 46, every major editorial board in California opposed the initiative.

The Los Angeles Times said, “As worthwhile as [Proposition 46’s] goals may be, the methods the measure would use to achieve them are too flawed to be enacted into law.”

The San Francisco Chronicle decried Prop. 46 saying that the measure, “overreached in a decidedly cynical way.”

The efforts of the San Francisco Medical Society and the California Medical Association across the state is a tremendous showing of what organized medicine can do for the future of health care, the quality of medicine and the dedication to patients everywhere. This was one of the most contentious and high-stakes ballot fights in California history and we rose to the occasion.

Please join SFMS/CMA as we work to make health care available to all Californians and to keep the practice of medicine in the hands of physicians.

Anthem Blue Cross Expanding Medi-Cal Managed Care Network

In an effort to expand its Medi-Cal managed care provider network across the state, Anthem Blue Cross is reaching out to San Francisco Medical Society (SFMS) and California Medical Association (CMA) member physicians who may be interested in joining the insurer's network.

While some of Anthem’s Medi-Cal managed care network is delegated to medical groups and IPAs, most of their provider networks in the rural areas are still through direct contracting with physicians. They also still have direct contracts with physicians outside of their delegated business in other areas of the state. Anthem is interested in expanding their provider network to ensure adequate access to care.

Physicians who would like to learn more about the opportunity to join Anthem's provider network are being asked to provide CMA with some basic information by filling out this brief form. Anthem will then follow up with physicians who have expressed interest with additional details.

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