San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

Tobacco Bills Headed for Senate Floor; SFMS Physicians to Participate in Coalition Lobby Day

The SFMS/CMA endorsed tobacco legislation package heads to the Senator floor after Monday’s approval by the Senate Appropriation Committee.

Among the approved package of special session tobacco bills were SBX2-5, authored by Senator Mark Leno, which seeks to apply the same regulations imposed on traditional cigarettes to electronic cigarettes, and SBX2-7, by Senator Ed Hernandez, which would raise the age requirement to buy tobacco products from 18 to 21.

In his testimony on Monday, Leno cited a statement by the California Department of Public Health, “which recommends that existing laws that currently protect minors and the general public from traditional tobacco products should be extended to cover e-cigarettes, and that’s what our bill will do,” he said.

Hernandez said there were about 18 billion fiscal reasons to raise the legal age to purchase tobacco up to 21. That's the estimated health care cost associated with tobacco products, he said, along with an estimated $3.5 billion spent every year in Medi-Cal to treat tobacco-related conditions.

Hernandez said his bill will significantly reduce the number of young people who take up smoking and result in significantly lower health costs.

“It should not be so easy for our children to get a hold of this deadly drug,” Hernandez told the panel.

The other four tobacco bills passed yesterday were:

  • SBX2-6 would add hotel lobbies, small businesses, break rooms and tobacco retailers to the list of smoke-free workplaces;
  • SBX2-8 would require schools to be smoke-free, including charter schools;
  • SBX2-9  would allow voters in local jurisdictions and counties to tax tobacco distributors; and
  • SBX2-10 would start a tobacco licensing fee program for all tobacco products, including e-cigarettes.

SFMS is coordinating a lobby day with the Save Lives CA (a coalition with CMA, American Heart Association, American Lung Association, Planned Parenthood, American Academy of Pediatrics, California Dental Association, SEIU, and more) to call attention and support for this broad group of tobacco bills.

Click here for more information about August 26 Tobacco Tax Lobby Day.

Proposed Rule Released Update to Physician Fee Schedule (i.e., changes to compensation and reimbursement rules)

In July, CMS released the first update to the Physician Fee Schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposal includes a number of provisions focused on person-centered care, and continues the Administration’s commitment to transform the Medicare program to a system based on quality and healthy outcomes. 

In the proposed CY 2016 Physician Fee Schedule rule, CMS is also seeking comment from the public on implementation of certain provisions of the MACRA, including  the new Merit-based Incentive payment system (MIPS). This is part of a broader effort at the Department to move the Medicare program to a health care system focused on the delivery of quality care and value. 

The proposed rule includes updates to payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes, updates to the Physician Quality Reporting System (PQRS), which measures the quality performance of physicians participating in Medicare, and updates to the Physician Value-Based Payment Modifier (VM), which ties a portion of physician payments to performance on measures of quality and cost. CMS is also seeking comment on the potential expansion of the Comprehensive Primary Care Initiative, a CMS Innovation Center initiative designed to improve the coordination of care for Medicare beneficiaries.  

The proposed rule also seeks comment on a proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers. The proposal follows the American Medical Association’s recommendation to make advance care planning services a separately payable service under Medicare.  

CMS is accepting public comments on the CY 2016 PFS proposed rule until September 8, 2015, and will issue the final rule by November 1. More information about the proposed rule can be found at

CMS to Host Webinars in September About Physician Compare Website and Quality Data

The Centers for Medicare and Medicaid Services (CMS) will host a series of one-hour webinars about public quality reporting and the Physician Compare website.

Section 10331 of the Patient Protection and Affordable Care Act (ACA) of 2010 required CMS to establish a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. The Physician Compare website was launched on in 2010, and provides contact information, specialties and clinical training, hospital affiliations and group practice information.

In 2014, the website also began phasing in physician quality data from the Physician Quality Reporting System (PQRS), including the Group Practice Reporting Option, the Electronic Prescribing (eRx) Incentive Program and the Electronic Health Record (EHR) Meaningful Use Program.

All sessions will present the same information. Each webinar will offer physicians and other stakeholders an opportunity to ask questions about public reporting on Physician Compare and this year's 30-day measure preview period. 

Webinars will be conducted via WebEx at the following times:

  • Tuesday, September 22, 2015, at 10 am PST
  • Wednesday, September 23, 2015, at 1 pm PST
  • Thursday, September 24, 2015, at 8 am PST

Click here to register for the free webinar.

Click here for more information about the Physician Compare Initiative.

SFDPH Health Advisory: Spike in Opioid Overdose Cases in San Francisco

Opioid overdoses reported to the SF Drug Overdose Prevention & Education (DOPE) Project have recently spiked, with over 75 cases in July 2015 (vs. 25 in July 2014). Most have occurred in the Civic Center area and involved a fine white powder found to be pure fentanyl. Multiple doses of naloxone have often been required to reverse the overdose. There has not been a corresponding rise in overdose-related ambulance calls or deaths from opioid overdose, suggesting that programs designed to avert mortality by supplying naloxone to users and their close contacts have so far been effective. Health care providers should continue to promote appropriate provision of naloxone (see below).

Fentanyl is an extremely potent, short-acting opioid that is particularly dangerous when used illicitly as it is normally dosed in tiny (microgram) quantities. Fentanyl can be more difficult than other opiates to reverse with naloxone, often requiring extra doses.

Naloxone is a short-acting opioid antagonist that is sprayed intranasally or injected intramuscularly, intravenously, or subcutaneously to reverse an overdose. Naloxone is not a controlled substance, can be prescribed by any licensed health care provider, and can be administered by witnesses as a first aid measure.

Naloxone can be distributed and prescribed to lay persons in San Francisco who may experience or witness an opioid overdose. It is covered by Medi-Cal, Healthy SF, and most health plans, and can also be furnished by pharmacists registered to do so without a prescription. Naloxone is also available at no cost from the DOPE Project, targeting drug users and their friends and family via syringe exchange sites.  These means of naloxone provision and use are protected by California law (AB635 and AB1535).

SF Clinician are Asked to:

  1. Refer patients with opioid use disorder to treatment. San Francisco has treatment-on-demand at BAART Turk Street and BAART Market Street methadone clinics close to Civic Center area.
  2. Ensure patients with opioid use disorder have naloxone. Either direct patients to the DOPE Project or prescribe naloxone directly. Patients should be encouraged to keep the medication with them at all times.
  3. Consider providing naloxone to others who use opioids or might witness an opioid overdose. Family and friends of persons who use opioids are often very concerned about overdose, and could be the right people to keep a naloxone supply handy and administer it if needed.

Additional Resources for Substance Use Treatment and Naloxone

Treatment Referrals

Naloxone from DOPE Project: Contact Eliza Wheeler at or (510) 285-2871.

Naloxone prescribing information (scroll down to Naloxone Prescribing, Education, and Awareness).

Information on prescribing naloxone autoinjector.

Article summarizing usage of naloxone for opioid safety from Phillip Coffin, MD, SFDPH Director of Substance Use Research; from the July/August 2015 issue of San Francisco Medicine.

Covered California Health Plan Network Directory Accuracy

Last November, the California Department of Managed Health Care (DMHC) released the results of an audit of the Anthem Blue Cross and Blue Shield Covered California networks.

Among other things, the audit found that 12.8% of the physicians listed on Anthem’s network were not accepting Covered California patients, while 12.5% were not in practice at the location listed in Anthem’s directory. The audit also found only 56.7% of the physicians listed in Blue Shield's Covered California directory could be verified as accepting Covered California patients.

DMHC will be conducting a follow-up of its audit this fall to determine whether the health plans have resolved their inaccurate network directories. SFMS physicians who are misidentified as participating in a network by Anthem or Blue Shield when in fact they are not, or whose information in a network directory is inaccurate, are urged to contact CMA’s Center for Economic Services at (888) 401-5911 or

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