SDCMS "News You Can Use" (2009.12.17)

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SDCMS "News You Can Use"
— December 18, 2009

Executive Director Personal Comment: I hope all of you take the time to enjoy the December issue of San Diego Physician magazine ("The Joy of Being a Doctor") to remember why you got into medicine!

Executive Director Comment: Every nonmember who takes the survey (see directly below) will have access to the detailed data for their specialty! Conversely, if you don't take the survey, nonmembers will not have access to the specialty data!

Nonmember Physicians: Please Take SDCMS' 2009 Physician Workforce and Compensation Survey
We have a statistically significant number of member physicians who have taken SDCMS' 2009 Workforce and Compensation Survey; however, we need more nonmembers to take the survey — five (5) minutes top! Click here to take the survey now.

Executive Director Comment: Congress appears to be working toward a two-month "kick-the-can-down-road" non-solution to the un-Sustainable non-Growth Rate (SGR) problem. AMA and many other physician organizations have made it clear that they will only support a long-term fix that obviates future cuts, as was noted in a coalition letter sent last month to the House of Representatives urging support for HR 3961.

House Postpones 21.2% SGR Cut to March 1, 2010
The House has just passed a two-month extension of expiring appropriations for the Department of Defense that included a two-month extension of the sustainable growth rate (SGR) formula. The legislation would stop the 21.2% Medicare pay cut scheduled to take effect on January 1, 2010, for a period that will end March 1, 2010. Importantly, the legislation does not affect any of the other payment policies included in the final 2010 fee schedule rule; those will take effect on schedule. A vote in the Senate will most likely be completed this weekend.

Non-safety-related Voluntary Recall of 3,700 (in San Diego) Sanofi Pasteur H1N1 Pediatric (0.25 mL, for 6-35 month olds) Vaccine in Pre-filled Syringes
Sanofi Pasteur has issued a voluntary recall for four lots of its injectable H1N1 influenza vaccine made for children 6-35 months. Each of the county's seven clinics received and administered 100 doses from the lots that were recalled (700 total). Five hundred (500) doses were used in schools - 220 were administered, 280 remain in inventory and will be returned per the manufacturer's instructions. Three thousand seven hundred (3,700) doses were distributed to private providers in San Diego County on December 2, 2009. See below for further details on the Sanofi Pasteur recall.

Key Points (Sanofi Pasteur)

  • The antigen content in the affected lots of vaccine is only slightly below the specification limit.
  • This means that doses from these four vaccine lots no longer meet the specifications for antigen content.
  • The manufacturer is conducting a non-safety related voluntary recall of these affected lots of vaccine.
  • These lots were shipped in November and December and are intended for children 6 months through 35 months of age.

What This Means (Sanofi Pasteur)

  • While the antigen content of these lots is now below the specification limit for the product, CDC and FDA advise that the small decrease in antigen content is unlikely to result in a clinically significant reduction in immune response for those who have received the vaccine.
  • The FDA and the CDC are reassuring parents that this recalled vaccine is still expected to be effective in stimulating a protective immune response.
  • There is no need to re-administer vaccine to those who received doses of the recalled vaccine.

Actions Required (Sanofi Pasteur)

  • Parents
    • For this reason (see above), there is no need to for parents to revaccinate their children.
    • For all those children 6 to 35 months of age who have received their first dose of H1N1 vaccine, parents and providers should ensure that children in this group obtain their second dose of vaccine approximately 3-4 weeks from the first dose.
  • Providers
    • There is no need for physicians to call or bring patients back in for re-vaccination.
    • The manufacturer will send directions to providers for returning unused recalled vaccine.

Deadline for Determining Medicare Participation Extended to January 31, 2010
In light of the uncertainty surrounding the SGR and health reform, the Center for Medicare and Medicaid Services has extended the deadline for providers to determine their Medicare participation status. Physicians who wish to change their participation status for 2010 now have until January 31, 2010, to do so. The effective date of the decision will be January 1, 2010, retroactively if necessary. Participation decisions are binding for one year, unless physicians choose to opt out entirely. Once you opt out, you cannot opt back in for two years. Physicians, as always, have three choices regarding Medicare: be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.

  • A participating provider must accept Medicare-allowed charges as payment in full for all Medicare patients.
  • A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. Nonparticipating physician fees are 95% of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25% more than the amounts allowed in the participating physician fee schedule.
  • Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare's limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract.

For more information on physicians' Medicare participation options, see CMA ON-CALL document #0151, "Medicare Participation (and Nonparticipation) Options." For assistance in logging in to CMA's website, contact Marisol Gonzalez at (858) 300-2783 or at MGonzalez@SDCMS.org.

CONTENTS

  • Delaying Medicare Consultations Policy Change
  • Provide Feedback to CMS on the Change to Consultation Codes
  • CMA Letters to Senators Feinstein and Boxer on Senate Health Reform Legislation
  • Public Cooling to Healthcare Reform As Debate Drags On, Poll Finds
  • The Congressional Budget Office (CBO) on Tort Reform
  • Rescission Lawsuit Against Blue Cross of California to Proceed
  • Significant New California Laws of Interest to Physicians for 2010
  • The County of San Diego Has an Exciting Opportunity for Deputy Public Health Officer
  • SDCMS Legislative Advocacy Training: Saturday, January 9, 2010, 8:00am-11:30am
  • SDCMS Young and Resident Physicians Social • February 11, 2010
  • SDCMS New Member Social • April 2, 2010
  • Please View These Recently Recorded Videos on H1N1
  • Sanofi Pasteur Voluntary Recall Q&A
  • SDCMS Seminars / Webinars / Events
  • San Diego County Healthcare Events

FEDERAL

Delaying Medicare Consultations Policy Change
In the 2010 Medicare physician payment final rule, the Centers for Medicare and Medicaid Services (CMS) finalized its proposal to eliminate Medicare payment for consultations and use the money from these services to increase payments for visits. Click here for further information on the road that led to this change. Click here to see SDCMS' letter to our delegation on this issue. AMA met with senior CMS staff to discuss the technical and practical concerns this policy presents, and the serious consequences it will have on physicians and their patients if the agency moves forward on January 1, 2010. In addition, we pointed out that a January implementation date will likely result in substantial confusion and claims processing problems, and sent a letter to delay implementation of the new consultation policy.

Executive Director Comment: This is really important (see directly above and below) — if CMS does not hear from you, they'll do whatever they please!

Provide Feedback to CMS on the Change to Consultation Codes
Click here to provide input to CMS on the elimination of consultation code issue until December 31, 2009.

CMA Letters to Senators Feinstein and Boxer on Senate Health Reform Legislation
Click here to access CMA's letter to Senator Feinstein and click here to access CMA's letter to Senator Boxer, both detailing CMA's position on the Senate health reform legislation — sent December 17, 2009.

Public Cooling to Healthcare Reform As Debate Drags On, Poll Finds
As the Senate struggles to meet a self-imposed, year-end deadline to complete work on legislation to overhaul the nation's healthcare system, a new Washington Post-ABC News poll finds the public generally fearful that a revamped system would bring higher costs while worsening the quality of their care. Click here for more information. Among the findings:

  • 53% see higher costs for themselves if the proposed changes go into effect than if the current system remains intact.
  • 55% say the overall cost of the national healthcare system would go up more sharply.
  • 37% say the quality of their care would be better under a new system; 50% see it as better under the current set-up.
  • Those without insurance are evenly divided on the question of whether their care would be better if the system were overhauled.

The Congressional Budget Office (CBO) on Tort Reform
Click here to read the CBO's report that MICRA-type tort reform lowers healthcare costs without harm to patients, systematically rejecting the plaintiff lawyers' arguments that medical malpractice lawsuits improve healthcare quality and lower costs. To access CMA's Health Reform Issue Brief on medical liability, click here.

STATE

Rescission Lawsuit Against Blue Cross of California to Proceed
A state appeals court sided with CMA and the Los Angeles Medical Association in a decision clearing the way for a lawsuit against Blue Cross of California for illegally canceling healthcare coverage for patients after they got gravely sick. The ruling means a lawsuit filed by the Los Angeles city attorney can move forward in its pursuit of civil penalties, injunctive relief, and monetary restitution for patients and providers. The court rejected the idea that the state has sole authority to enforce the laws governing health maintenance organizations (HMOs) through the Knox-Keene Act, as Blue Cross and the state argued. The case is People v. Blue Cross, Case No. B215035, California Court of Appeals, 2nd Appellate District.

Significant New California Laws of Interest to Physicians for 2010
SDCMS members may click here for a summary of the most significant new statutes enacted in California, along with references to the most relevant ON-CALL document that discusses the topic more fully. The major areas covered include:

  • Coverage for Off-label Medications
  • Rescission of Individual Health Coverage Policies or Plans
  • Medi-Cal Coverage
  • Authorization for Treatment
  • Osteopathic Physicians Disclosure to Medical Board
  • Medical Board Enforcement
  • Medical Records Request From Medical Board
  • Nurse Practitioners Scope of Practice
  • Physician Assistants Scope of Practice
  • Elective Cosmetic Surgery Process
  • Immunities for Psychiatric Release
  • Hospital Security Plans
  • Management of Medical Records

LOCAL

The County of San Diego Has an Exciting Opportunity for Deputy Public Health Officer
The full posting can be found here. For questions, contact Carmen A. Padilla-Baluis, human resources analyst, at (619) 531-5144 or Carmen.PadillaBaluis@sdcounty.ca.gov.

SDCMS Legislative Advocacy Training: Saturday, January 9, 2010, 8:00am–11:30am
Please consider this your formal invite to participate in our semi-annual Advocacy Training. Please RSVP in the affirmative to me. This is an exceptional learning opportunity that involves role playing the processes associated with advocacy. As has been said, "The more we sweat in peace, the less we bleed in war," so better to practice your advocacy skills among friends than on some "hot seat." To register or for further information, please email me at Gehring@SDCMS.org.

SDCMS Young and Resident Physicians Social • February 11, 2010
Mark your calendars to attend SDCMS' upcoming Young and Resident Physicians Social on Thursday, February 11, 2010, from 6:00pm to 9:00pm. Member and nonmember physicians and their guests are welcome. RSVP required. For location and additional information, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

SDCMS New Member Social • April 2, 2010
Mark your calendars to attend SDCMS' New Member Social on April 2, 2010. All new SDCMS member physicians and guest are invited to attend. RSVP required. For location and additional information, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

H1N1 UPDATES

Please View These Recently Recorded Videos on H1N1

  • Click here to view "Pandemic 2009 H1N1 Influenza: Treatment in Adults" (recorded December 14, 2009) by Wilma Wooten, MD, MPH, County of San Diego, HHSA.
  • Click here to view "H1N1 Pandemica Influenza: Treatment of Infants and Children" (recorded December 14, 2009) by John Bradley, MD, Pediatric Infectious Diseases, Rady Children's Hospital of San Diego, UCSD.

Sanofi Pasteur Voluntary Recall Q&A

  • What Is the Status of Any Doses of H1N1 Vaccine From the Recalled Lots in San Diego County? The California Department of Public Health (CDPH) reports that providers in San Diego received 4,900 doses of H1N1 vaccine from the product being voluntarily recalled. Each of the county's seven clinics received and administered 100 doses from the lots that were recalled (700 total). Five hundred (500) doses were used in schools — 220 were administered, 280 remain in inventory and will be returned per the manufacturer's instructions. Three thousand seven hundred (3,700) doses were distributed to private providers in San Diego County on December 2, 2009.
  • Why Are Some Lots of Pediatric H1N1 Vaccine Manufactured by Sanofi Pasteur in Pre-filled Syringes Being Recalled From the Market? As part of its quality assurance program, the manufacturer, Sanofi Pasteur, performs routine, ongoing stability testing of its influenza A (H1N1) vaccine after the vaccine has been shipped to providers. Stability testing means measuring the strength (also called potency) of a vaccine over time. It is performed because sometimes the strength of a vaccine can go down over time. On December 7, 2009, Sanofi Pasteur notified CDC and FDA that the potency in one batch (called a "lot") of pediatric syringes that had been distributed was later found to have dropped below a pre-specified limit. As a result of this finding, Sanofi Pasteur tested additional lots and found that three other lots that had been distributed also had an antigen content that, while properly filled at the time of manufacturing, was later measured to be below pre-specified limits. This means that doses from these four vaccine lots no longer meet the manufacturer's specifications for potency. Sanofi Pasteur will send providers directions for returning any unused vaccine from these lots.
  • What Does Potency Mean for the H1N1 Vaccine? Potency (or strength) is determined by the measurement of the concentration of the active ingredient (also called antigen) in the H1N1 vaccine.
  • Are There Any Concerns About Safety of Vaccines From These Lots? No. There are no safety concerns with these lots of H1N1 vaccine. All lots successfully passed pre-release testing for purity, potency and safety.
  • Should Infants and Children Who Received Vaccines From These Lots Be Revaccinated? No. The vaccine potency is only slightly below the "specified" range. The vaccine in these lots is still expected to be effective in stimulating a protective response despite this slight reduction in the concentration of antigen. There is no need to re-administer a dose to those who received vaccine from these lots. However, as is recommended for all 2009 H1N1 vaccines, all children less than 10 years old should get the recommended two doses of H1N1 vaccine approximately a month apart for the optimal immune response. Therefore, children less than 10 years old who have only received one dose of vaccine thus far should still receive a second dose of 2009 H1N1 vaccine.
  • What Action(s) Should Parents of Children Who Have Received Vaccine From the Recalled Lots Take? Parents of children who received vaccine from the recalled lots do not need to take any action, other than to complete the two-dose immunization series if not already completed.
  • What Are the Lot Numbers Affected by This Recall? Vaccine doses with the following lot numbers are included in the recall: 0.25 ml pre-filled syringes, 10-packs (NDC # 49281-650-25, sometimes coded as 49281-0650-25): UT023DA, UT028DA, UT028CB; 0.25 ml pre-filled syringes, 25-packs (NDC # 49281-650-70, sometimes coded as 49281-0650-70): UT030CA.
  • Is the Potency Issue Related to This Recall Isolated to Just the Pediatric H1N1 Vaccine for 6–35 Month Olds? The potency problem described here is specific to the four lots of Sanofi Pasteur's pediatric H1N1 vaccine in 0.25 mL pre-filled syringes. Sanofi Pasteur is investigating what caused the problem. The same vaccine packaged in other dosing forms, such as pre-filled syringes for older children adults, and multi-dose vials, continues to meet specifications. This recall does not affect H1N1 vaccine produced by other manufacturers.
  • Were These Lots of Vaccine Shipped After Failing a Required Test? No. The lots being recalled passed all quality controls and met all specifications before they were shipped. All vaccines are routinely tested for purity, potency, and safety prior to release. The four lots of vaccine met all required specifications at the time of release and shipment to distribution centers. The vaccine provided in multi-dose vials and the single-dose, 0.5 mL pre-filled syringes for persons 36 months and older continues to meet all specifications.
  • What Is Being Done to Notify Providers Who Received Vaccine From the Affected Lots? Sanofi Pasteur will send a notification to providers who received doses from any of the four lots of vaccine so that they can return any unused vaccine.
  • Where Were the Affected Lots of Vaccine Distributed? Vaccine from these four lots was distributed throughout the United States.
  • For U.S. Children 6–35 Months Old, What Other Options Are Available Currently for Vaccination Against H1N1 Influenza? For children six months of age and older, vaccine is available in multidose vials. The vaccine in multidose vials has not experienced this drop in potency and meets all standards of safety, purity, and potency. As with all multidose vials of vaccines, these multidose vials contain a preservative (thimerosal) to prevent potential contamination after the vial is opened. The standard dose for this preparation in the 6-35 month age group is the same as for the pre-filled syringes, 0.25 mL. For healthy children at least two years of age, the nasal spray (live, attenuated influenza vaccine) is also an option. This vaccine is produced in single units that do not contain thimerosal.

SDCMS SEMINARS / WEBINARS / EVENTS [top]

  • JAN 7 (THU 11:30am-1:00pm) • Collections Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • JAN 9 (SAT 8:00am-11:00am) • Legislative Advocacy Training • Contact Tom Gehring at (858) 565-8888 or at Gehring@SDCMS.org
  • JAN 20 (WED 6:30pm-7:30pm) • Risk Management Webinar ("Scope of Practice of Allied Health Professionals") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • JAN 21 (THU 11:30am-12:30pm) • Risk Management Webinar ("Scope of Practice of Allied Health Professionals") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • JAN 27 (WED 11:30am-1:00pm) • Human Resources Law Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 4 (THU 11:00am-1:00pm) • Practice Management Seminar/Webinar ("Treating Patients Right") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 11 (THU 6:00pm-9:00pm) • Young and Resident Physicians Winter Social • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • FEB 17 (THU 10:00am-12:00pm) • Palmetto/Medicare Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 25 (THU 9:00am-7:00pm) • EMR/EHR Trunk Show • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 27 (SAT 9:00am-1:00pm) • Retirement Workshop ("End-game Planning") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAR 5-26 (4 FRIDAYS 9:00am-4:00pm) • Certified Medical Office Manager Course • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAR 18 (THU 11:30am-1:00pm) • Contract Management Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAR 24 (WED 9:00am-12:00pm) • Billing and Collections Procedures Seminar/Webinar ("Back to Basics") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 2 (FRI 6:00pm-9:00pm) • SDCMS New Member Social • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • APR 17 (SAT 8:30am-3:30pm) • Resident Physician Workshop ("Preparing to Practice") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 21 (WED 6:30pm-7:30pm) • Risk Management Seminar/Webinar ("eHealth: Telemedicine and Telehealth") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 22 (THU 11:30am-12:30pm) • Risk Management Seminar/Webinar ("eHealth: Telemedicine and Telehealth") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 28 (WED 11:30am-1:00pm) • Medi-Cal Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAY 6 (THU 11:30am-1:00pm) • IT Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAY 12 (WED 11:30am-12:30pm) • e-Town Hall • Contact Tom Gehring at (858) 565-8888 or at Gehring@SDCMS.org
  • MAY 20 (THU 11:30am-1:00pm) • Workers' Compensation Billing Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAY 21 (FRI 6:00pm-9:00pm) • Young and Resident Physicians Spring Social • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • JUN 5 (SAT 6:00pm-11:00pm) • SDCMS Inaugural SDCMS • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • JUN 18-19 (FRI-SAT 8:00am-4:00pm) • Leader's Toolbox Workshop • Contact Tom Gehring at (858) 565-8888 or at Gehring@SDCMS.org
  • JUN 24 (THU 11:30am-1:00pm) • Sexual Harassment Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org

SAN DIEGO COUNTY HEALTHCARE EVENTS

"When I no longer thrill to the first snow of the season, I'll know I'm growing old."
— Lady Bird Johnson (1912–2007)

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