Monday, November 24, 2014

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

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.

Article References for November 2014 San Francisco Medicine

References cited in Meat and the Microbiome: From Farm to Fork to Gut by David Wallinga, MD

  1. American Meat Institute.
  2. Blaser M. Missing Microbes. 2014. New York, New York: Henry Holt and Company, LLC.
  3. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013. Department of Health and Human Services. December 2013. Accessed October 5, 2014, at
  4. Centers for Disease Control and Prevention. Antibiotic Resistance from Farm to Table (infographic). Accessed October 5, 2014, at
  5. Foley J. It’s time to rethink America’s corn system. Scientific American. 2013. Accessed October 5, 2014 at
  6. President’s Council of Advisors on Science and Technology. Combating Antibiotic Resistance. Executive Office of the President. September 2014. Accessed online at
  7. U.S. Food and Drug Administration Website. NAMRS 2011 Executive Report - Interactive Data Displays. Accessed online October 2, 2014, at
  8. U.S. Food and Drug Administration. Annual summary report on antimicrobials sold or distributed in 2012 for use in food-producing animals. Department of Health and Human Services. Accessed on October 2, 2014, at

References cited in Climate Action and Health: The New Deal for Our Health and Our Children’s Health by Génon K. Jensen and Peter van den Hazel, MD, MPH, PhD

  1. Chan Dr. M. How climate can rattle the foundations of public health. September 15, 2014.
  2. Global Climate and Health Alliance (GCHA) Event Summary: Climate Change Is a Public Health Issue.
  3. Civil Society Call to Action.
  4. HEAL. Parent information leaflet: Children with Asthma and Allergies. 2014. (Other leaflets focus on lung disease, lung cancer, and cardiovascular disease.
  5. United Nations Framework Convention on Climate Change, COP 21, Paris 2015.
  6. World Health Organization Summit report.
  7. WHO assesses risk to health, 22 September 2014
  8. Health Section, U.S. National Climate Assessment.
  9. Perera F et al. Prenatal exposure to air pollution, maternal psychological distress, and child behavior, Pediatrics. October 2014.
  10. HEAL. Acting NOW for better health. 2010.
  11. HEAL. The unpaid health bill: How coal power plants make us sick. 2013.
  12. GCHA. Civil society call to action. 2014.

References cited in A New Era: Climate Change and Human Health by Ross Bowling, PhD; Nyron Rouse; John Balbus, MD, MPH

  1. Balbus JM, Malina C. Identifying vulnerable subpopulations for climate change health effects in the United States. Journal of Occupational and Environmental Medicine. 2009. 51:33–37. 
    Bernstein AS, Myers SS. Climate change and children’s health. Current Opinion in Pediatrics. 2011. 23(2):221–226.
    Sheffield, PE, Landrigan PJ. Global climate change and children’s health: Threats and strategies for prevention. Environmental Health Perspectives. 2011. 119:291-298.
  2. Xu Z, Sheffield PE, Hu W, Su H, Yu W, Qi X, Tong S. Climate change and children’s health—A call for research on what works to protect children. International Journal of Environmental Research and Public Health. 2012. 9(9):3298-3316.
  3. Basu, R, Ostro, BD. A multicounty analysis identifying the populations vulnerable to mortality associated with high ambient temperature in California. Am. J. Epidemiol. 2008. 168(6):632-637.
    Yip F, Flanders W, Wolkin A, Engelthaler D, Humble W, Antonio N et al. The impact of excess heat events in Maricopa County, Arizona: 2000–2005. Int J Biometeorol. 2008. 52:765–772. 
  4. Lin S, Liu X, Le L, Hwang SA. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environmental Health Perspectives. 2008. 116:1725-1730.
  5. McCormack MC, Breysse PN, Eggleston PA, Matsui EC, Hansel NN, Brosnan JC, Eggleston PA, Diette GB. In-home particle concentrations and childhood asthma morbidity. Environmental Health Perspectives. 2009. Feb;117(2):294-8.
  6. 6 The Health Impacts of Climate Change on Americans.
  7. Basu R, Malig B, Ostro B. High ambient temperature and the risk of preterm delivery. Obstetrical & Gynecological Survey. 2011. 66(3):125. 
    Strand LB, Barnett AG, Tong S. Maternal exposure to ambient temperature and the risks of preterm birth and stillbirth in Brisbane, Australia. American Journal of Epidemiology. 2012. 175(2):99-107.
  8. Perera F, Li TY, Zhou ZJ, Yuan T, Chen YH, Qu L, Rauh V, Zhang Y, Tang D. Benefits of reducing prenatal exposure to coal-burning pollutants to children's neurodevelopment in China. Environmental Health Perspectives. 2008. 116(10): 1396–1400.
    Ritz B, Wilhelm M, Hoggatt KJ, Ghosh JKC. Ambient air pollution and preterm birth in the UCLA environment and pregnancy outcomes study. American Journal of Industrial Medicine 2007. 166(9):1045-52.
    Jayachandran S. Air quality and early-life mortality during Indonesia’s massive wildfires in 1997. Journal of Human Resources. 2009. 44(4):916–954.
  9. National Climate Assessment. 2014.
  11. Assessing Health Vulnerability to Climate Change: A Guide for Health Departments.

References cited in Exposure to Toxic Chemicals: Reproductive Health Professionals Speak about the First 1,000 Days by Patrice Sutton, MPH; Tracey J. Woodruff, PhD, MPH; Jeanne A. Conry, MD, PhD; Linda C. Giudice, MD, PhD, MSc

  1. Bergman A, Heindel JJ, Jobling S, Kidd KA, Zoeller RT. State of the Science of Endocrine Disrupting Chemicals 2012. An assessment of the state of the science of endocrine disruptors prepared by a group of experts for the United Nations Environment Programme and World Health Organization. Geneva: United Nations Environment Programme and World Health Organization. 2013.
  2. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women, American Society for Reproductive Medicine Practice Committee, the University of California San Francisco Program on Reproductive Health and the Environment. Exposure to Toxic Environmental Agents. No. 575. Washington, D.C.: The American College of Obstetricians and Gynecologists. 2013.
  3. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women; American Society for Reproductive Medicine Practice Committee; the University of California, San Francisco, Program on Reproductive Health and the Environment. Exposure to Toxic Environmental Agents. Committee Opinion No. 575 Companion Piece. 2013.
  4. Stotland N, Sutton P, Trowbridge J, Atchley D, Conry JA, Trasande L, Gerbert B, Charlesworth A, Woodruff T. Counseling patients on preventing prenatal environmental exposures: A mixed-methods study of obstetricians. PLoS ONE 2014; 9((6)):e98771.
  5. Birnbaum LS. When environmental chemicals act like uncontrolled medicine. Trends Endocrinol Metab. 2013; 24(7): 321-323.
  6. Johnson PI, Sutton P, Atchley DS, Koustas E, Lam J, Sen S, Robinson KA, Axelrad D, Woodruff TJ. The Navigation Guide—Evidence-based medicine meets environmental health: Systematic review of human evidence for PFOA effects on fetal growth. Environ Health Perspect. 2014.
  7. Koustas E, Lam J, Sutton P, Johnson PI, Atchley DS, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. The Navigation Guide—Evidence-based medicine meets environmental health: Systematic review of nonhuman evidence for PFOA effects on fetal growth. Environ Health Perspect. 2014.
  8. Lam J, Koustas E, Sutton P, Johnson P, Atchley DS, Sen S, Robinson K, Axelrad DA, Woodruff TJ. The Navigation Guide—Evidence-based medicine meets environmental health: Integration of animal and human evidence for PFOA effects on fetal growth. Environ Health Perspect. 2014.
  9. Woodruff TJ, Sutton P: The Navigation Guide sytematic review methodology: A rigorous and transparent method for translating environmental health science into better health outcomes. Environmenal Health Perspectives. 2014.

References cited in The First 1,000 Days: A Healthy Return on Investment by Elise Miller, MEd, and Ted Schettler, MD, MPH

  1. Harvard Center for Early Childhood Development.
  2. Boyle. Trends in the prevalence of developmental disabilities in U.S. children, 1997–2008. 2011.
  3. EPA. America’s Children and the Environment, third edition. 2013.
  4. CDC.
  5. Placenta, evolution and lifelong health.
  6. Women, Infants, and Children program (WIC).
  7. J Toxicol Environ Health B Crit Rev. 2008 May; 11(5-6):373-517.
  8. Centers for Disease Control and Prevention. National Report on Human Exposure to Environmental Chemicals. Available at
  9. Shalev I, Moffitt TE, Sugden K, Williams B, Houts RM, Danese A, Mill J, Arseneault L, Caspi A. Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: A longitudinal study. Mol Psychiatry. 2013 May; 18(5):576-81.
  10. Grandjean P. Only One Chance: How Environmental Pollution Impairs Brain Development—and How to Protect the Brains of the Next Generation. New York: Oxford University Press. 2013.
  11. Rauh V et al. Seven-year neurodevelopmental scores and prenatal exposure to chlorpyrifos, a common agricultural pesticide. Environ Health Perspect. Aug 2011; 119(8):1196–1201. Eskenazi B, Chevrier J, Rauch SA, Kogut K, Harley KG, Johnson C, Trujillo C, Sjödin A, Bradman A. In utero and childhood polybrominated diphenyl ether (PBDE) exposures and neurodevelopment in the CHAMACOS study. Environ Health Perspect. 2012 Nov 15. Rodríguez-Barranco M1, Lacasaña M, Aguilar-Garduño C, Alguacil J, Gil F, González-Alzaga B, Rojas-García A. Association of arsenic, cadmium, and manganese exposure with neurodevelopment and behavioral disorders in children: A systematic review and meta-analysis. Sci Total Environ. 2013 Jun 1; 454-455:562-77.
  12. UCSF Program on Reproductive Health and Environment: Research.
  13. Campbell R, Conti G, Heckman JJ, Moon SH, Pinto R, Pungello E, Pan Y. Early childhood investments substantially boost adult health. Science. 2014 Mar 28; 343(6178):1478-85.
  14. Trasande L. Reducing the staggering costs of environmental disease in children, estimated at $76.6 billion in 2008.

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