Wednesday, March 4, 2015

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

Medi-Cal Deactivates Some Physicians in Error

In early February, the California Department of Health Care Services (DHCS) performed a periodic review of activity and deactivated all providers that had not billed Medi-Cal for 12 consecutive months. All deactivated providers were notified by letter of the deactivation of their record.

On February 17, however, DHCS found that a small subgroup of providers, those with multiple locations under the same National Provider Identifier (NPI), were incorrectly deactivated due to a system error.

Physicians who received a deactivation letter and believe they were deactivated in error should contact DHCS at Physicians who were deactivated because they had not billed Medi-Cal in 12 months can re-apply through the Provider Enrollment Division.

DHCS has advised that providers who are only utilizing their NPIs for rendering, ordering, referring or prescribing purposes can continue to do so, even if their record was deactivated.

Additional questions about the deactivation can be directed to DHCS at

SFMS Joins Supervisor Mark Farrell to Propose Tobacco Ban Legislation

The San Francisco Medical Society joined San Francisco Supervisor Mark Farrell (District 2) to introduce a legislation to eliminate the use of all tobacco products—including smokeless tobacco—at all baseball venues and city athletic fields in San Francisco. A similar statewide measure was slated to be introduced in Sacramento by Richmond Assemblyman Tony Thurmond.

The SFMS and the California Medical Association, representing more than 40,000 California physicians, will be working closely with the “Knock Tobacco Out of the Park” campaign to promote tobacco-free baseball and provide visibility to the issue of smokeless tobacco in baseball.

Smokeless tobacco is a dangerous, addictive product that contains at least 28 cancer-causing chemicals. SFMS President Roger Eng, MD stated, "Chewing tobacco is a dangerous substance that has no place near our nation’s children and no place in our national pasttime.”

The International Agency for Research on Cancer (IARC) and the Department of Health and Human Services′ National Toxicology Program have concluded that smokeless tobacco is a known human carcinogen. IARC has concluded that smokeless tobacco causes oral cancer and pancreatic cancer. Smokeless tobacco use is also associated with pre-cancerous lesions in the mouth or leukoplakia, gum recession and disease of the gums, and tooth decay.

In addition, there is reason to worry that smokeless tobacco use by young persons may serve as a gateway to cigarette smoking, this nation’s leading preventable cause of premature death and disease. Even as cigarette use continues a steady decline among youth, smokeless tobacco use has remained troublingly steady. The Centers for Disease Control and Prevention found 14.7 % of high school boys (and 8.8% of all high school students) reported current use of smokeless tobacco products in 2013. Each year, about 535,000 kids ages 12-17 use smokeless tobacco for the first time.

SFMS is calling on the local health care community as well as all San Franciscans to support Knock Tobacco Out of the Park. The proposed legislation will make the game of baseball safer for our kids, safer for the players, and safer for the future.

Click here the media coverage from the San Francisco Chronicle, KTVU Channel 2 News, and Sports Illustrated.

CMA Foundation Releases Adult Vaccine Schedule

To help physicians answer questions posed by the recent measles outbreak in California and to educate adult patients about their vaccination needs, the California Medical Association Foundation has release an adult vaccine schedule that physicians can hand out during patient visits. 

Many adults may be skipping vaccinations for a variety of conditions, leaving them susceptible to disease. For example, the tetanus vaccine can prevent a deadly bacterial toxin. While adults should get a booster every 10 years, the Centers for Disease Control and Prevention reported last week that only 62.9% of people ages 19 to 49 had received the vaccine in the 10 years before 2013. Among people ages 50 to 64, only 64% had received the vaccine, and for those older than 65, only 56.4% were vaccinated.

Click here for a copy of the adult vaccine schedule. 

Covered California Launches Special Enrollment Period

Covered California has launched a special enrollment period for consumers who say they were not aware of the tax penalty for remaining uninsured.

Peter Lee, executive director of Covered California, said the special enrollment period begins February 23 and runs through April 30. Eligible consumers who wish to sign up during the period must indicate on their applications that they were unaware of the tax penalty for foregoing health insurance.

Lee said that up to 600,000 Californians could face such penalties. The enrollment extension will not exempt individuals from 2014 penalties, but it can help them avoid larger penalties that begin in 2015.

Source: California Healthline, February 23, 2015.

SFDPH Health Advisory: Ocular Syphilis

Since December 2014, seven cases of ocular syphilis have been reported in San Francisco. Five of the affected individuals were men who have sex with men (MSM) and six were HIV-infected.

The cause of this cluster of cases is uncertain; an increase in cases was also recently reported in King County, WA. Several of the cases have resulted in a significant and permanent decline in visual acuity. Evidence suggests that certain strains of Treponema pallidum, the bacterium that causes syphilis, may be more likely to cause central nervous system (CNS) disease. It is not known whether there are strains of T. pallidum that have a greater likelihood of causing ocular infections, but the cluster of cases raises this possibility.

Clinician Requested Actions

  1. Test for syphilis in patients presenting with visual complaints, as well as in patients presenting with genital, oral, or anal ulcers, or rash.  The most common eye finding in ocular syphilis is uveitis. Optic neuropathy, keratitis and retinal vasculitis can also occur.
  2. Ask patients with known or suspected syphilis about changes in their vision and about headache and changes in their hearing (including hearing loss or tinnitus) in order to identify persons who may have ocular syphilis, otologic syphilis, or neurosyphilis.
  3. Refer patients with syphilis and ocular complaints for immediate ophthalmologic evaluation.
  4. Obtain a lumbar puncture to evaluate for neurosyphilis in all patients with syphilis and suspected neurologic, otologic or ocular disease.
  5. Promptly treat patients with ocular syphilis according to CDC guidelines for CNS syphilis, regardless of lumbar puncture results (i.e., intravenous penicillin G or intramuscular procaine penicillin plus oral probencid for 10-14 days).
  6. Report suspected syphilis cases within 24 hours of identification. Call (415) 487-5555 or fax a confidential morbidity report to SFDPH STD Control at (415) 431-4628. Please note on the CMR if ocular syphilis is confirmed or suspected. 

Additional Guidance Related to Diagnosis and Therapy of Syphilis  

Please keep in mind the following:

  • False negative RPRs can occur in the setting of high RPR titers. If you suspect syphilis and the RPR result is negative, ask the lab to check for prozone phenomenon.
  • All patients being evaluated for syphilis should be tested for HIV infection unless they already have a prior HIV diagnosis.
  • Initiate penicillin therapy in all patients in whom syphilis is suspected without waiting for laboratory confirmation of the diagnosis.
  • For consultation regarding a possible syphilis case, call (415) 487-5595.

Additional Guidance Related to STD Prevention

Rates of gonorrhea, chlamydia and syphilis continue to rise in MSM in San Francisco, and >90% of syphilis cases occur among MSM:

  • Test for syphilis, gonorrhea, chlamydial infection and HIV at least annually in all MSM who have had anal or oral sex in the prior year and who are not in a long-term, mutually monogamous sexual relationship.
    • MSM at elevated risk (e.g. those who report multiple sex partners or substance use) should be tested every 3 months.
    • Gonorrhea and chlamydial testing should include testing of the pharynx and rectum if those sites have been potentially exposed to infection.
    • Test for syphilis at each medical visit in HIV-infected MSM who are sexually active, unless the patient is in a long-term, mutually monogamous relationship1
    • Offer HIV pre-exposure prophylaxis (PrEP) to all HIV uninfected men who report unprotected anal sex with multiple partners, or who have a rectal infection or syphilis. For more information about accessing PrEP, call (415) 487-5537 or visit
    1Medical providers should not assume that patients in long-term relationships are mutually monogamous and should ask patients about their number of sex partners and the gender of those partners.

Click here to view the SFDPH Health Advisory on Ocular Syphilis, February 20, 2015.

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