Friday, October 31, 2014

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

Voter Support Down for Prop 45 and Prop 46

Support has dropped for two November ballot initiatives related to health insurance rate regulation and random drug testing of physicians, according to a new Field Poll.

The Field Poll surveyed 1,536 registered voters in California between Oct. 15 and 28, and has a margin of error of +/- 3.4% points.

Prop 45

30% - Yes

42% - No

28% - Undecided

Prop 45 would give the state insurance commissioner the authority to reject health insurance rate increases. It threatens physicians’ ability to provide the care that patients need by giving a single elected politician vast new power over health care benefits and rates. With recent cuts to the Medi-Cal program, we are already seeing the devastating impact it can have on patient access to care when politicians cut reimbursement rates below the cost of providing care. Additional cuts would result in an even more difficult time for patients that need care the most.

Prop 46

32% - Yes

49% - No

19% - Undecided

Prop 46 would cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs. Prop 46 would quadruple the limit on non-economic damages in medical lawsuit awards, causing many doctors and other medical care professionals to eliminate or reduce essential health care services to patients.

Click here for more information about Prop 45, Prop 46, and the SFMS recommended slate.

SFDPH Health Advisory: Recognizing and Handling Suspect Ebola Cases in Outpatient Settings

The first imported case of Ebola in the USA was not initially recognized upon presentation to a health care facility in Texas. Despite enhanced airline screening procedures, other persons with Ebola may enter the USA and become ill.

All health care facilities (clinics, offices, etc.) should be prepared to identify potential cases of Ebola and to handle such patients safely and expediently.


The incubation period for Ebola is a maximum of 21 days; persons whose last potential Ebola exposure was more than 21 days prior are no longer considered at risk. Symptoms include fever, vomiting, abdominal pain, diarrhea, headache, myalgia, and unexplained bleeding. Transmission is via direct contact with bodily fluids of a symptomatic, infected person, or via contact with a contaminated object. Asymptomatic individuals are not infectious.

Currently Ebola virus transmission is known to be occurring in the West African countries of Sierra Leone, Liberia, and Guinea.

Click here to view the SFDPH Health Advisory issued on October 27, 2014.

In-Person Screening

Establish processes to routinely and immediately ask every person entering a facility about compatible symptoms and exposure history. Post signs at entry points, but do not rely on signage alone. Suspect Ebola virus in persons who answer “yes” to BOTH questions listed below.

  1. Do you currently have fever, weakness, vomiting, diarrhea, stomach ache, muscle ache, or headache or have you been bleeding without knowing why?
  2. In the past 3 weeks have you been in Sierra Leone, Liberia, or Guinea in West Africa, or have you had contact with a person known or suspected to have Ebola?

Handling a Suspected Ebola Patient at Your Facility

For any patient who answered “yes” to BOTH questions, please follow these general recommendations, customizing them for your particular facility if necessary.

  • Immediately isolate the patient in a private room with closed door. Have the patient don a face mask.
  • Do not take vital signs or examine the patient. Avoid contact with the patient and his/her secretions, maintaining a distance of at least 3 feet at all times.
  • To maximize patient cooperation, inform the patient that further medical assistance is on the way.
  • If the patient is medically unstable or experiencing a life-threatening emergency: dial 911 and advise the operator that Ebola is suspected. Then contact SFDPH Communicable Disease Control Unit (CDCU) 24/7 at (415) 554-2830, and follow instructions to reach the On-Call Physician.
  • If the patient is medically stable: contact SFDPH Communicable Disease Control Unit (CDCU) 24/7 at (415) 554-2830 and follow instructions to reach the On-Call Physician. CDCU will assist with assessment of the patient and situation, and will arrange for transport to a hospital if needed.
  • Staff should not enter the patient room and should leave the door closed. If absolutely necessary to open the door or enter the room, only staff trained in proper donning and doffing of personal protective equipment (PPE) should do so, and only after donning appropriate PPE.
  • Before anyone leaves the area, record the name, address, and home/work/cell phone numbers for all persons (staff, patients, and visitors) present at the facility that could have had contact with the patient or with his/her bodily fluids, and inform them that they may be contacted by CDCU.
  • Clinic personnel should not attempt to clean or disinfect the facility. Discuss cleaning with SFDPH.

Resources for Medical Providers

CDC Ebola Information for Healthcare Providers:

SFDPH Ebola Information:

SFDPH Health Alerts:

SFDPH Website:

11/5 CMS Provider Call: ICD-10 Transition

With less than a year remaining to transition to ICD-10, the Centers for Medicare & Medicaid Services (CMS) is hosting a call to give insights into implementation issues, opportunities for testing, and available resources. A question and answer session will follow the presentations.

Wednesday, November 5

10:30 am PST (1:30 pm EST)

Click here to register for the CMS National Provider Call.

CMS experts will discuss:

  • National implementation of ICD-10
  • Medicare Fee-For-Service testing
  • Partial code freeze and annual code updates
  • Home health conversions
  • Claims that span the implementation date

Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers are encouraged to participate on the call.

Click here to register or for more information.

CDC Issues New Ebola Guidelines to Protect Health Professionals

The Centers for Disease Control and Prevention (CDC) Monday released tightened guidance on use of personal protective equipment (PPE) for U.S. health care workers to ensure they are better prepared to treat Ebola patients.

The guidance focuses on specific PPE health care workers should use and offers detailed, step-by-step instructions for how to put the equipment on and take it off safely.

The enhanced guidelines center on three principles:

  • All health care workers undergo rigorous training and are practiced and competent with PPE, including taking it on and off in a systemic manner.
  • No skin is exposed when PPE is worn.
  • All workers are supervised by a trained monitor who watches each worker taking PPE on and off.

The guidance reflects recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center, and National Institutes of Health Clinical Center.

Click here to view the CDC guidelines on PPE usage for health care workers treating Ebola patients.

Click here for the CDC fact sheet on the updated changes in the PPE guidance

California Issues Report Cards for HMOs, PPOs and Large Medical Groups

The California Office of the Patient Advocate released the 2014-2015 “California Health Care Quality Report Cards” that rate health plans and medical groups on a four-star scale.

The report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, 6 largest PPOs, and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys for 2013.

Although the report cards are usually published annually in January, officials have changed the release date so it would coincide with the fall open enrollment period for many Californians and their families, including those purchasing coverage through Covered California, the state's health benefit exchange. Covered California's next open enrollment period runs from November 15 to February 15. The report cards are part of a larger national push to bring greater transparency to the health care industry and help consumers choose services that best fit their needs.

Click here to access the California Health Care Quality Report Cards.

Click here to view the report card for large medical groups in San Francisco.

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