Saturday, January 31, 2015

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

State Health Officer Issues Health Advisory and New E-Cigarette Report; SFMS Policy on E-Cigarette Regulation

California Department of Public Health (CDPH) director and state health officer Dr. Ron Chapman issued a Health Advisory and the “State Health Officer’s Report on E-Cigarettes: A Community Health Threat,” warning about the hazards of electronic cigarettes (e-cigarettes).

“E-cigarettes pose a serious risk to smokers and those exposed to the aerosol [produced by e-cigarette vaporizers],” said CDPH director Ron Chapman.

Chapman said the department intends to increase public education and awareness efforts about the dangers of e-cigarettes. California voters passed Proposition 99 in 1988 that imposed a 25-cent-per-pack tax on cigarettes, some of which is earmarked for anti-tobacco advertising and education. Chapman said he expects to use part of that tax, which contributed $42 million in 2014 to anti-smoking campaigns, to e-cigarette public education.

The public health warning comes a few days after a new law was proposed in the Legislature to hold e-cigarettes to the same regulations governing traditional cigarettes. SB 140 by Senator Mark Leno (D-San Francisco) would include a ban on e-cigarette smoking in workplaces, restaurants, and other public places, and it would increase penalties for selling e-cigarettes to minors.

The San Francisco Medical Society applauds CDPH and Senator Mark Leno for seeking healthier regulation of electronic cigarettes. There are still many uncertainties about the health risks of these devices, but research is indicating that there are valid concerns regarding direct health impacts on users, addiction, and secondhand exposure, especially among young people. This is why SFMS and the California Medical Association now support regulations more in line with standard tobacco products. It is becoming clear there are many parallels with tobacco harms and industry practices, and we should to all we can do to prevent another widespread health disaster.

The California Medical Association adopted this San Francisco Medical Society policy in December 2014:

"Electronic Cigarettes: CMA supports a ban on the advertising of electronic cigarettes and other nicotine delivery devices not approved by the FDA as smoking cessation aids; and believes that e-cigarettes should be regulated, at the state and local level, consistent with tobacco products until such a time that they are approved by the FDA as smoking cessation aids; supports education of the public on the known and potential health impacts of electronic cigarettes and other nicotine delivery devices; and proposes that electronic cigarettes taxed to generate funds, which could be used for, but not be limited to 1) support for research into their efficacy as smoking cessation aids and their health impacts and 2) education on their known and potential health impacts."

SFDPH Health Advisory: Be Alert for Measles Cases

California is currently experiencing a measles outbreak, with at least 59 confirmed cases of this airborne, highly contagious disease. San Francisco has had no reported measles cases since 2013. Several other Bay Area counties, however, have reported cases in this outbreak. 

The outbreak originated with exposures at Disneyland in mid-December and early January, but additional secondary cases have occurred. The vast majority of case-patients for whom vaccination status is documented were unvaccinated. Although measles is no longer endemic in the United States, measles epidemics overseas have resulted in imported cases and resulting secondary cases. In addition, undetected community transmission may occur.   

Measles should be considered in patients presenting with fever and morbilliform or maculopapular rash. The purpose of this update is to provide guidance for clinicians who may be responding to inquiries from concerned patients, and to review proper infection control and testing procedures for patients presenting with potential measles symptoms. Suspected measles cases should be reported immediately to the SFDPH Communicable Disease Control 24-hour line: 415-554-2830. If calling after hours, listen to the instructions on the voicemail to page the on-call physician.

Clinical Guidance

Please see “Quick Guide for Clinicians: Measles” for detailed and updated information concerning measles reporting and diagnostic testing. The document is also available at:  

Patients presenting to a medical facility with fever and a maculopapular or morbilliform rash should immediately be masked and placed in isolation or a private exam room. Patients with rash who request advice over the telephone and who are advised to present for evaluation should travel to the medical facility in a private vehicle if possible and don a surgical mask upon arrival. 

Treatment of measles is supportive.   

Immunization is the most important preventive strategy for measles. Patients who have been vaccinated against measles or who have a history of measles disease are considered immune. Medical providers should work with all their patients to ensure up-to-date measles immunization status. In addition, measles immunity should be routinely documented for health care workers in order to prevent loss of work time if exposed. 

Individuals planning travel outside the USA should be up to date with measles immunization. Early immunization with MMR is recommended for infants aged 6-11 months before travel outside the USA. For detailed recommendations concerning measles vaccination for travelers, please click here
For the California Department of Public Health’s updates on the current measles outbreak, as well as measles alert flyers to post in clinical settings, click here.

Click here to view the SFDPH Health Advisory issued on January 22, 2015.

2/25 Seminar: Mastering the Art of Disclosing an Unexpected Outcome

When an unexpected outcome occurs, a discussion explaining what happened can help prevent a negative patient response, improve patient trust, and reduce the risk of a lawsuit, yet few physicians have been trained in this specialized set of communication skills in how to effectively manage these difficult conversations. Skillful physician communication and early disclosure of unintended outcomes can benefit all parties, including patients, doctors, health care systems and insurers without compromising meritorious defenses.

With this in mind, Medical Insurance Exchange of California (MIEC) has created an interactive workshop that examines the elements of providing timely and effective disclosure when an unexpected outcome occurs. The workshop will be facilitated by UCSF Associate Clinical Professor of Medicine Denise Davis, MD, who teaches communication skills for physicians nationally and is a Fellow of the American Academy on Communication in Healthcare.

Wednesday, February 25, 2015
6:00 pm - 9:00 pm; complimentary dinner served from 6:00 pm - 6:30 pm
Saint Francis Memorial Hospital

The program is FREE to SFMS members. Please email for registration information.

*MIEC is the first physician-owned medical liability insurer in the Western United States, and has been a SFMS-endorsed partner since its inception. Click here for more information on MIEC.

2015 Medicare Benefit Changes

Each year, the Centers for Medicare and Medicaid Services reviews and determines what changes are needed for deductibles, premiums, and other Medicare program limitations. The table below illustrates benefit changes from 2014 to 2015:




Part A deductible



Part B deductible






Annual physical therapy/speech pathology limit



Annual occupational therapy limit



Amount in controversy for ALJ hearing



Amount in controversy for judicial review



The Medicare Physician Fee Schedule for January through March 31, 2015, has been posted to the Noridian website. Changes in Relative Value Units (RVU) for malpractice, work values, geographic practice index values and others may have an impact on the amount paid. Please check the updated fee schedule for any changes.

Changes necessitated by legislative decisions made during the first quarter of 2015 will be posted as they become available.

New Reassignment of Medicare Benefits (855R) Enrollment Form

The Centers for Medicare and Medicaid Services (CMS) finalized a new 855R form, which is used to reassign an individual physician's Medicare billing privileges to an organization.

The revised form will become available on on December 29, 2014, and can be found by searching "855."

Once available, Medicare administrative contractors will accept both the current and revised versions of the form through May 31, 2015. The new version must, however, be used for applications received by the Medicare Administrative Contractor on or after June 1, 2015. Prior versions will be denied. The online Medicare Provider Enrollment, Chain and Ownership System (PECOS) will be updated to include the revised Medicare reassignment information.

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