Saturday, April 18, 2015

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

SGR Repealed with Passage of H.R. 2

The San Francisco Medical Society (SFMS) applauds the House of Representatives, the Senate, and President Obama for milestone passage of the "Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act" (H.R. 2) that permanently repeals the sustainable growth rate (SGR) formula, which has plagued the nation's health care infrastructure for more than a decade.

The SGR, originally enacted as part of the Balanced Budget Act of 1997, has been patched 17 times in the years since then, and a 21.2% rate reduction for all physicians was scheduled to take effect on April 15, 2015. The House of Representative passed H.R. 2 on April 2, 2015 with an overwhelming vote of 392-37. Last night, the Senate approved the bill with a 92-8 vote, and President Obama formally enacted H.R. 2 with his signature.

The bill, drafted by House Speaker John A. Boehner and Minority Leader Nancy Pelosi, not only repeals the Sustainable Growth Rate (SGR) payment formula that perennially threatened patients’ access to care, but also extends the Children’s Health Insurance Program for two years through 2017.

Medicare should begin processing claims for services provided in April at the rates that were effective before the 21% cut was scheduled to take effect. Under the provisions of H.R. 2, the fee schedule conversion factor will be increased by 0.5% on July 1, 2015, and by another 0.5% on January 1, 2016.

SFMS thanks Leader Pelosi and Senators Boxer and Feinstein for their efforts to repeal SGR. We would also like to extend a sincere thank you to all physicians for the extraordinary campaign this last decade to end the SGR. This feat could not have been achieved without the unity within organized medicine. We celebrate this achievement for our patients.

Key provisions of H.R. 2

  • Repeals the SGR
  • Provides automatic, stable 0.5% updates each year for 4 years
  • In 2019, physicians can choose to participate in one of two payment track options: Fee-for-Service Track that simplifies and consolidates the existing quality reporting programs, reinstates large bonuses up to 9% and reduces current penalties; or, Alternative Payment Model Track that provides 5% bonus payments and allows physicians to develop the new models, such as primary care/specialty medical homes.
  • $125 million in funding to help small practice physicians transition to the alternative models or quality reporting programs.
  • Reinstates bundled payments for the 10-day and 90-day global surgical services
  • Provides total cost of care data to help physicians better manage their practices
  • Mandates interoperability of EHR systems
  • Extends the expiring Children’s Health Insurance Program (CHIP) for 2 years at the higher ACA funding levels. It covers nearly 1 million children in California who would otherwise lose their insurance.
  • Extends the important National Health Service Corps Program and the Teaching Health Centers Rural Primary Care Residency Training Programs (created in the ACA) through 2017. There are several teaching health center residency programs in California.
  • Extends the moratorium on RAC audits of the hospital two-midnight rule which helps hospitals and physicians
  • Delays the ACA cuts to Disproportionate Share Hospitals for one more year

SGR Update: U.S. Senate Expected to Vote on SGR on April 14

The Senate leaders (McConnell and Reid) are working on a time certain agreement to hold the vote on HR 2, the Medicare SGR and Children’s Health Insurance Program Reauthorization Act, tomorrow, April 14. 

There are several potential floor amendments but the Leadership are trying to discourage all amendments. SFMS and CMA are asking Senators Feinstein and Boxer to support HR 2 without amendment.

If the Senate amends the bill, it will have to go back to the House for concurrence which could spell problems for the SGR. The House Republicans are not likely to compromise on Children's Health Insurance Program (CHIP) and it emboldens the tea party to wreak havoc with the funding package. Most importantly, the 21% Medicare payment cut took effect on April 1 and CMS must pay the claims at the lower rate starting on April 15. Thus, the Senate only has 1-2 days (after they return from recess) to get this done before the cut really occurs. Every day that the cut is in effect, it causes major disruptions and chaos for physician practices. Even if there is a retroactive solution, it can cause disruptions and payment delays for up to 6 months. Last time this happened, some physicians did not get paid for 6 months and they had to take out bank loans; many patient visits were delayed.

Along with more than 780 physician organizations, SFMS and CMA continue to believe that passage of HR 2 is important because it repeals the SGR and brings stability to physician practices. HR 2 simplifies and consolidates the burdensome, penalty-based, quality reporting programs and reinstitutes bonus incentive payments – up to 12%. It maintains the fee-for-service program and also allows physicians to participate in alternative payment models with a 5% bonus payment. And finally, it provides $125 million in funding to help small practices transition to the new models or participate in quality reporting. With the costly SGR ($140-370 billion) behind us, it will be much easier to work with Congress to make improvements to the payment system at a much lower cost. The SGR has posed a barrier to achieving any payment reform for a decade. 

Physician Call to Action

  • Call your senators using the AMA's toll-free Grassroots Hotline: (800) 833-6354.
  • Send an urgent email to your senators reinforcing the need for SGR repeal now.
  • Contact key senators still undecided on this most critical issue directly through their own social media channels and share with your own Facebook friends and Twitter followers as well!

Join SFMS to Support SB 277 with “I Heart Immunity” Campaign

The California Medical Association (CMA), American Academy of Pediatrics, California (AAPCA), California Immunization Coalition (CIC), Vaccinate California, and Health Officers Association of California (HOAC) have joined forces to launch the “I Heart Immunity” campaign in an ongoing effort to promote the importance of vaccines and Senate Bill 277 (Pan/Allen).

SB 277 would remove the personal belief exemption (PBE) option from the school and child care enrollment requirements. It would also require schools to publically provide information about their immunization rates. Removing the PBE will help protect the most vulnerable, including babies too young to be immunized and people who are immunocompromised, from the risks associated with contracting these diseases. It will also protect the community at large from increased outbreaks of vaccine-preventable disease.

“Immunizations have been a cornerstone of medical advancements in this century, eliminating the fear of death and permanent disability from diseases that once threatened communities across the world,” said CMA President Luther Cobb, MD. “The ‘I Heart Immunity’ campaign brings awareness to the legislation and education around the effort to keep communities safe.”

Vaccines have undergone significant rigorous scientific review and continue to have ongoing safety tracking. That rigorous analysis indisputably shows that vaccines are effective and have very low risks. Recent endorsements of SB 277 include the Santa Cruz County Board of Supervisors, the Alameda County Board of Supervisors, the Marin County Board of Supervisors, Berkeley City Council, the California State Parent Teacher Association, and the California School Nurses Association.

To show your support and to follow the latest updates via Twitter, use #IHeartImmunity, #vaccineworks, #YesonSB277.

2015 Open Payments Review and Dispute Period Begins April 6

Starting today, physicians have 45 days to review and dispute reports regarding their financial interactions with manufacturers of drugs and medical devices reported under the Physician Payments Sunshine Act.

The Centers for Medicare and Medicaid Services developed the Open Payments Program to comply with the Physician Payments Sunshine Act. This requires CMS to publicly report data on items of value that are given to physicians and teaching hospitals on an annual basis.  

Physicians can register in the Open Payments System and review their 2014 CY data beginning today, April 6. The official 45-day review and dispute period runs from April 6 to May 20. Disputes that are initiated by May 20 will flagged in the public release on June 30.   

To register and review your Open Payments data:

Step 1: Register with CMS’ Enterprise Portal. New users will be prompted to register with the portal before proceeding.

Step 2: Register with CMS’ Open Payments system via the Enterprise Portal.

Step 3: Review your data and dispute any inaccurate data. Disputes initiated by May 20 will be flagged as such when the data set is made public on June 30.

Fung Lam, MD: SFMS March 2015 Member of the Month

Fung Lam, MD is an obstetrician-gynecologist and senior partner at Golden Gate Obstetrics and Gynecology in San Francisco. 2015 marks his 30th year of practice at California Pacific Medical Center. Dr. Lam received his training in Cambridge at Harvard College and Tufts University. He completed his residency at the University of California, San Francisco in 1985. He has remained active in clinical research and teaching and has received over 20 teaching and research awards. Dr. Lam has authored over a dozen peer-reviewed articles and chapters in women’s health related topics. He currently is a Clinical Professor in Obstetrics and Gynecology at the University of California, San Francisco and the Dartmouth Geisel School of Medicine.
In addition to his clinical, research and teaching responsibilities, Dr. Lam has been an advocate for women’s health care. He has held leadership positions in the American College of Obstetricians and Gynecologists, served as President of the San Francisco Gynecological Society, and is currently Secretary-Treasurer of the Pacific Coast Obstetrical and Gynecological Society.

Click here to view Dr. Fung Lam's practice information.

Why are you a SFMS member?

Before the internet and social media, the SFMS annual membership directory was the “go to” source for physician referrals. It was a huge help when I established my practice. That reference book is on my desktop today and I continue to use it to find the best physicians for me to refer my patients to. SFMS provides an opportunity to network with physicians in OB/GYN and other specialties. From the new member mixers to the annual gala, the SFMS gives me the opportunity to meet and interact with my Bay Area colleagues.

Which SFMS member resource is most helpful to you? 

SFMS provides a platform to advocate for issues that impact medical practice. SFMS was a major contributor in the recent defeat of Proposition 46. This initiative proposed to lift the $250,000 MICRA cap on pain and suffering in medical negligence lawsuits. The resultant in malpractice liability premiums would have limited access to health care and resulted in higher health care costs.

What do you like to do when you’re not at work?

I am an avid golfer, it gives me a much needed “break from the office” and a chance for me to “catch up” with my friends and colleagues. I am a regular participant in fund-raising golf tournaments such as the those sponsored by CPMC and PlumpJack’s. I also have a passion for photography, which I consider my “second career.”

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

Medical practice is constantly evolving, many of the resources and requirements for practice are totally different than those needed when I started practice three decades ago. Whether it is minimally invasive surgery or electronic health records, continued medical education and training is essential. However, the most important constant continues to be the ability to communicate with your patients and to have empathy for their individual situations and needs.

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

With decreasing revenue and rising overhead costs, providing medical care is will be increasingly difficult, particularly for private practice. With the advent of hospitalists/laborists and the transition to shift work, maintenance of continuity of care will be a major concern. Also, as patients are routed to subspecialists, it will be more difficult for a new OB/GYN generalist to get enough cases to be credentialed and to maintain skills.

What do you love most about practicing OB/GYN?

OB/GYN provides me the opportunity to interact with women and their families at the most important stages of life…from childbirth, through her reproduction years, the challenges of menopause, and the management of geriatric and cancer screening. OB/GYN care encompasses primary care, surgery , endocrinology, and psycho-social evaluation.

What is your favorite restaurant in San Francisco?

La Folie. Chef Roland Passot and his wife Jaime have created a lovely restaurant and we often have meetings in their private dining room.

If you weren't a physician, what profession would you like to try? 

I have been a photo-journalist. Photography continues to be my passion.

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