WHAT'S HAPPENING 4442 http://www.sfmms.org/news-publications/sfmms-blog/a-letter-to-doctors-from-cms-administrator-seema-verma.aspx?PostId=4442&tabid=2622 CMS A Letter to Doctors from CMS Administrator Seema Verma <img src="http://www.sfmms.org/Portals/27/assets/images/seema%20verma.jpg?ver=2018-07-20-082126-647" class="img-border-right" align="right">Dear Doctor,<br> <br> Thank you for the difference you make in your patients&rsquo; lives. Many of our nation&rsquo;s best and brightest students go into medicine &ndash; the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.<br> <br> Your dedication and commitment have enabled you to join the profession that makes up the core of our healthcare system. But after years of education, training, and hard work, our system is not fully leveraging your expertise. Instead, doctors today spend far too much of their time on burdensome and often mindless administrative tasks.<br> <br> From reporting on measures that demand that you follow complicated and redundant processes, to documenting lines of text that add no value to a patient&rsquo;s medical record, to hunting down records and faxes from other physicians and sifting through them, wasteful tasks are draining energy and taking time away from patients. Our system has taken our most brilliant students and put them to work clicking through screens and copying and pasting. We have arrived at the point where today&rsquo;s physicians are burning out, retiring early, or even second-guessing their decision to go into medicine. <br> <br> <p> In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout. Enough is enough. CMS&rsquo;s focus is on putting patients first, and that means protecting the doctor-patient relationship. We believe that you should be able to focus on delivering care to patients, not sitting in front of at a computer screen.</p> <p> Washington is to blame for many of the frustrations with the current system, as policies that have been put forth as solutions either have not worked or have moved us in the opposite direction. Electronic Health Records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake. But the inability to exchange records between systems &ndash; and the increasing requirements for information that must be documented &ndash; has turned this tool into a serious distraction from patient care.</p> <p> CMS is committed to turning the tide. President Trump has made it clear that he wants all agencies to cut the red tape, and CMS is no exception. Last year, we launched our &ldquo;Patients Over Paperwork&rdquo; initiative, under which we have been working to reduce the burden of unnecessary rules and requirements. As part of this effort, we have proposed an overhaul of the Evaluation &amp; Management (E&amp;M) documentation and coding system to dramatically reduce the amount of time you have to spend inputting unnecessary information into your patients&rsquo; records. E&amp;M visits make up 40 percent of all charges for Medicare physician payment, so changes to the documentation requirements for these codes would have wide-reaching impact.</p> The current system of codes includes 5 levels for office visits &ndash; level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5. The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing.<br> <br> <p> We&rsquo;ve proposed to move from a system with separate documentation requirements for each of the 4 levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients. Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. If you add up the amount of time saved for clinicians across America in one year from our proposal, it would come to more than 500 years of additional time available for patient care.</p> <p> In addition to streamlining documentation, under the leadership of the White House&rsquo;s Office of American Innovation, we are advancing the MyHealthEData Initiative which promotes the interoperability of electronic medical records. Patients must have control of their medical information; and physicians need visibility into a patient&rsquo;s complete medical record. Having all of a patient&rsquo;s information available to inform clinical decision-making saves time, improves quality, and reduces unnecessary and duplicative tests and procedures. CMS is taking action to make this vision a reality, including recently proposing a redesign of the incentives in the Merit-Based Incentive Payment System or &ldquo;MIPS&rdquo; to focus on rewarding the sharing of healthcare data securely with patients and their providers.</p> <p> We welcome your thoughts on our proposals, and we look forward to partnering with you to make them successful. Patients and their families put their trust in your hands, and you should be able to focus on keeping them healthy. And to secure the future strength of our system, we must make sure that the nation&rsquo;s best students continue to choose to go into medicine.</p> <p> We need your input to improve the healthcare system. Once again, thank you for your service to your patients.</p> Sincerely,<br> Seema Verma Fri, 20 Jul 2018 15:22:11 Z 2018-07-20 15:22 +00:00 2018-07-20 08:22 -07:00 4436 http://www.sfmms.org/news-publications/sfmms-blog/welcome-to-the-next-generation-of-cma.aspx?PostId=4436&tabid=2622 CMA Welcome to the Next Generation of CMA <a href="http://www.cmadocs.org" target="_blank"><img src="http://www.sfmms.org/Portals/27/assets/images/Blog/cma-next-generation-680x260.png?ver=2018-07-16-132133-960" class="img-border" style="margin-bottom: 3px;"></a><br> <p>Since 1856, the California Medical Association (CMA) has supported physicians and the practice of medicine to keep the Golden State healthy and thriving. CMA&rsquo;s success is rooted in our ability to effectively connect, communicate and engage with members. Because together, we are stronger.</p> &ldquo;Diverse organizations like CMA need a bold brand and modern website to reinforce our mission through impactful design, messaging and imagery,&rdquo; said CMA Vice President of Strategic Communications Laura Braden Quigley. &ldquo;Our website was last updated in 2011, and our brand family had been untouched since the early 1990s. Given that CMA&rsquo;s family includes 37 county medical societies, a political action committee, a foundation and other partners, it is critically important to demonstrate a cohesive and consistent brand across all communications channels, affiliates and platforms.&rdquo;<br> <br> CMA&rsquo;s website functionality, design and content strategy was reimagined with a focus on membership recruitment and engagement. Enhanced features of the new website include: <br> <br> <ol> <li><strong style="">One Login</strong>: We&rsquo;ve simplified the login process so you don&rsquo;t have to keep track of multiple usernames and passwords. The joint CMA/county login means that your county medical society login now grants access to your CMA account.&nbsp;</li> <li><strong style="">My CMA</strong>: From public health to Medi-Cal, <a href="https://www.cmadocs.org/my-cma" target="_blank" style=""><strong>choose your preferences</strong></a> for custom content and personalized alerts.&nbsp;</li> <li><strong style="">Mobile Responsive Design</strong>: CMA's new site is optimized for mobile devices, so you can stay engaged from your phone or tablet.</li> <li><strong style="">Search</strong>: The new and improved search function returns more relevant results, making it easier for you to find what you need.</li> <li><strong style="">Grassroots Action Center</strong>: The <a href="https://www.cmadocs.org/grassroots-action-center" target="_blank" style=""><strong>Grassroots Action Center</strong></a> is the new hub for all of CMA&rsquo;s advocacy efforts. Make your voice heard, join the Physician Advocate program, receive training from CMA experts and more!</li> <li><strong style="">Policymaking</strong>: Submit and comment on resolutions through CMA&rsquo;s year-round <a href="https://www.cmadocs.org/resolutions" target="_blank" style=""><strong>policymaking process</strong></a>.</li> <li><strong style="">Discussion Forums</strong>: With improved features, we&rsquo;ve made it much easier and faster to connect with physician colleagues.</li> <li><strong style="">Legislative Hot List</strong>: Receive real-time updates on health care legislation impacting your patients and medical practice.</li> <li><strong style="">Newsroom</strong>: In addition to press releases and breaking news, CMA now has media training and other resources available, just for members. You can also join our Social Media Ambassador program or become a Media Surrogate!</li> <li><strong style="">Join CMA</strong>: We have streamlined the application process so it is fully integrated with our membership database. Join or renew today and immediately get full access to your &ldquo;My CMA&rdquo; dashboard and valuable member benefits.</li> </ol> <br> <p>&ldquo;CMA&rsquo;s brand and website serve as powerful recruitment and engagement tools to keep California&rsquo;s physicians at the forefront of an ever-changing health care landscape,&rdquo; said CMA President Theodore M. Mazer, M.D. &ldquo;It also sends a bold message to physicians that we continue to be ready to embrace tomorrow&rsquo;s challenges and opportunities. Much has changed since 1856, but CMA&rsquo;s mission remains constant: to promote the science and art of medicine, protect public health, and better the medical profession.&rdquo;</p> <p><a href="https://www.cmadocs.org/newsroom/news/view/ArticleId/27474/-172-Welcome-to-the-Next-Generation-of-CMA" target="_blank"><strong>Read more here</strong></a>.</p> <h3><span style="color: rgb(192, 0, 0);"><strong>For additional information and resources:</strong></span></h3> <ul> <li>Customize Your Website Content: <a href="https://www.cmadocs.org/my-cma" target="_blank"><strong>cmadocs.org/my-cma</strong></a> </li> <li>Website How-to Webinar and Usage Guide: <a href="https://www.cmadocs.org/cma-next-generation" target="_blank"><strong>cmadocs.org/cma-next-generation</strong></a> </li> <li>Contact the CMA Communications Team: <a href="mailto:communications@cmadocs.org" class="ApplyClass"><strong>communications@cmadocs.org</strong></a>. </li> </ul> Mon, 16 Jul 2018 20:42:56 Z 2018-07-16 20:42 +00:00 2018-07-16 13:42 -07:00 4434 http://www.sfmms.org/news-publications/sfmms-blog/cms-published-the-proposed-physician-fee-schedule-rule-for-2019.aspx?PostId=4434&tabid=2622 CMA CMS Published The Proposed Physician Fee Schedule Rule For 2019 <span>Today, CMS published the proposed Physician Fee Schedule Rule for 2019.&nbsp; It includes provisions for the Quality Payment Program (QPP) for 2019 as well as the physician fee schedule.<img src="http://www.sfmms.org/Portals/27/assets/images/Blog/Capture.JPG?ver=2018-07-13-100512-590" style="border-width: 3px; border-style: solid; border-color: rgb(255, 255, 255);" align="right" width="240" height="160"></span><br> <span>&nbsp;</span><br> <span>This is a brief summary of the key Medicare Fee Schedule proposals:</span><br> <span>&nbsp;</span><br> <span>&bull; With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2019 PFS conversion factor is $36.05, a slight increase above the 2018 PFS conversion factor of $35.99.</span><br> <span>&bull; CMS has proposed to collapse payment for office and outpatient visits.&nbsp; New patient office visit (99202-99205) payments would be blended to be $135. Established office visits (99212-99215) would be blended to be paid at $93. New codes would be created to provide add-on payments to office visits for specific specialties ($9) and primary care physicians ($5).&nbsp;&nbsp;</span><br> <span>&bull; To replace existing documentation guidelines, CMS proposes to allow use of (1) 1995 or 1997 documentation guidelines; (2) medical decision-making or (3) time. Documentation for history and exam will focus on interval history since <g class="gr_ gr_51 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins replaceWithoutSep" id="51" data-gr-id="51">last</g> visit. Physicians will be allowed to review and verify certain information in the medical record entered by ancillary staff or the beneficiary, rather than re-entering the information.</span><br> <span>&bull; When physicians report an E/M service and a procedure on the same date, CMS proposes to implement a 50% multiple procedure <g class="gr_ gr_52 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="52" data-gr-id="52">reduction</g> to the lower paid of the two services.</span><br> <span>&bull; CMS will implement new CPT codes and payment for remote monitoring and interprofessional consultations.</span><br> <span>&bull; CMS updated supplies and equipment pricing. The re-pricing of antigens has a significant impact on allergy and immunology payments, with an estimated 6% reduction for the specialty.</span><br> <span>&nbsp;</span><br> <span>Here are some of the highlights of the Merit-based Incentive Payment System (MIPS) proposals:</span><br> <span>&nbsp;</span><br> <span>&bull; Retain the low-volume threshold but add <g class="gr_ gr_46 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="46" data-gr-id="46">a third criteria</g> of providing fewer than 200 covered professional services to Part B patients.&nbsp; &nbsp;</span><br> <span>&bull; Retaining bonus points for:</span><br> <span>Care of complex patients</span><br> <span>End-to-end reporting</span><br> <span>Small practices</span><br> <span>&bull; Allowing eligible clinicians to opt-in if they meet one or two, but not all, of the low volume threshold criterion.</span><br> <span>&bull; Consolidating the low-volume threshold determination periods with the determination period for identifying a small practice.</span><br> <span>&bull; Eliminate the base and performance categories and reduced the number of measures in the Promoting Interoperability category.</span><br> <span>&bull; Require Eligible clinicians to move to 2015 CEHRT.</span><br> <span>&bull; Providing the option to use facility-based scoring for facility-based clinicians.</span><br> <span>&bull; For 2019 performance year the weights are:</span><br> <span>Quality&nbsp; - 45%</span><br> <span>Cost- 15%</span><br> <span>Promoting Interoperability &ndash; 25%</span><br> <span>Improvement Activities- 15%&nbsp;</span><br> <span>&nbsp;</span><br> <span>As a reminder, as a result of AMA advocacy, the Bipartisan Budget Act of 2018 provided additional flexibility for CMS on several MIPS issues including:&nbsp;</span><br> <span>&nbsp;</span><br> <span>&bull; Excluding Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;</span><br> <span>&bull; Allowing CMS to reweight the cost performance category to not less than 10 percent and not more than 30 percent for 2019-2021 performance years; and</span><br> <span>&bull; Allowing CMS flexibility in setting the performance threshold for performance years 2019-2021 to provide a gradual and incremental transition for physicians.&nbsp;</span><br> <span>&nbsp;</span><br> <span>CMS has provided Fact Sheets on the major components of the rule which are available at the following links:&nbsp;&nbsp;</span><br> <span><a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-QPP-proposed-rule-fact-sheet.pdf" target="_blank"><strong>https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12-2.html&nbsp;</strong></a></span><br> <span><a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-QPP-proposed-rule-fact-sheet.pdf" target="_blank"><strong>https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-QPP-proposed-rule-fact-sheet.pdf</strong></a> . In addition, the specialty impact table from the rule is attached for your information.</span><br> <div><br> </div> Fri, 13 Jul 2018 17:05:50 Z 2018-07-13 17:05 +00:00 2018-07-13 10:05 -07:00 4422 http://www.sfmms.org/news-publications/sfmms-blog/medical-studentresident-writing-contest.aspx?PostId=4422&tabid=2622 Resident/Young Physicians,UCSF Medical Student/Resident Writing Contest <p> <img src="https://news.pieperbar.com/hs-fs/hubfs/PieperBarReview-Blog-WritingVsTypingNotes.jpg?t=1529598839574&amp;width=800&amp;name=PieperBarReview-Blog-WritingVsTypingNotes.jpg" alt="Image result for writing contest stock photo" align="right" width="250" height="167"> The San Francisco Marin Medical Society invites all current medical students and residents to enter our writing contest.<br> <p class="">The guidelines are simple:&nbsp; In 350 words or so, respond to this question:<br> <br> <em><span style="font-size: 16px;">"Of all the patients you have encountered thus far, which one has been the most memorable and/or had the most impact on you and why?"</span></em><br> <br> <strong>Deadline is <span class="gmail-m-423951908304084918gmail-aqj">August 1</span></strong>.&nbsp; Reply to Steve Heilig <g class="gr_ gr_14 gr-alert gr_gramm gr_inline_cards gr_run_anim Punctuation only-del replaceWithoutSep" id="14" data-gr-id="14"><g class="gr_ gr_14 gr-alert gr_gramm gr_inline_cards gr_run_anim Punctuation only-del replaceWithoutSep" id="14" data-gr-id="14">at:</g></g> <a href="mailto:heilig@sfmms.org" class="ApplyClass"><strong>heilig@sfmms.org</strong></a><br> <br> Winners will be published in the September edition of our journal, <em>San Francisco Marin Medicine</em>.&nbsp; The top winner will receive a cash prize to be determined. Please use anonymous re-naming for any patients, and others as judged necessary. <g class="gr_ gr_16 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="16" data-gr-id="16">Publication</g> can be anonymous if requested and appropriate.</p> </p> Tue, 10 Jul 2018 17:09:46 Z 2018-07-10 17:09 +00:00 2018-07-10 10:09 -07:00 4421 http://www.sfmms.org/news-publications/sfmms-blog/leading-health-organizations-announced-filing-of-statewide-soda-tax-measure-for-2020.aspx?PostId=4421&tabid=2622 CMA,Public Health Leading Health Organizations Announced Filing Of Statewide Soda Tax Measure For 2020 <span>On July 2, 2018, a ballot measure to protect public health through a state soda tax was filed for the 2020 ballot by two of<img class="irc_mi" src="https://experiencelife.com/wp-content/uploads/2018/05/Soda-Tax.jpg" alt="soda tax" style="margin-top: 5px;" align="right" width="300" height="188">&nbsp;California&rsquo;s leading <g class="gr_ gr_21 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del" id="21" data-gr-id="21">health care</g> provider organizations &ndash; the California Medical Association (CMA), representing 43,000 California physicians, and the California Dental Association (CDA), representing 27,000 California dentists.&nbsp;</span><br> <span><br> </span><span>This announcement comes four days after the multibillion-dollar soda industry held the state of California hostage with a dangerous ballot threat that jeopardized the fiscal outlook of local governments, forcing the state to pre-empt local authority and pass an unprecedented 12-year moratorium on any local soda tax.</span><br> <span><br> </span><span>This 2020 ballot initiative would implement a statewide tax on sugar-sweetened drinks, providing at least $1.7 billion in revenue for critical health programs and constitutionally <g class="gr_ gr_19 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="19" data-gr-id="19"><g class="gr_ gr_19 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="19" data-gr-id="19"><g class="gr_ gr_19 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="19" data-gr-id="19">preserving</g></g></g> the ability of California&rsquo;s local communities to make their own decisions regarding future soda taxes.&nbsp; &nbsp;</span><br> <span><br> </span><span>Dustin Corcoran, CMA chief executive officer, and Carrie Gordon, CDA chief strategy officer, issued the following statement:&nbsp; &nbsp; &nbsp;&nbsp;</span><br> <span><br> </span><span>&ldquo;In the face of growing public support for local health taxes on sugar-sweetened beverages, the billion-dollar global soda industry last week put corporate profits ahead of public health and forced an ultimatum upon the leadership of California&rsquo;s state government.</span><br> <span><br> </span><span>&ldquo;Big Soda may have won a cynical short-term victory but, for the sake of our children&rsquo;s health, we cannot and will not allow them to undermine California&rsquo;s long-term commitment to health care and disease prevention.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span><br> <span><br> </span><span>&ldquo;There is overwhelming evidence of the link between obesity, diabetes, tooth decay, and heart disease and the consumption of <g class="gr_ gr_18 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del" id="18" data-gr-id="18">sugary-sweetened</g> beverages such as soft drinks, energy drinks, sweet teas and sports drinks.</span><br> <span><br> </span><span>&ldquo;Around the world and in local communities, reasonable soda taxes have been proven effective in dramatically reducing consumption of sugary drinks and improving the public health, especially among children.&nbsp;</span><br> <span><br> </span><span>&ldquo;California&rsquo;s health care provider community is united behind ensuring that California voters have the opportunity to protect our children&rsquo;s well-being &ndash; not the profit margins of soda conglomerates.&rdquo;</span><br> <div><br> </div> Mon, 02 Jul 2018 22:46:54 Z 2018-07-02 22:46 +00:00 2018-07-02 15:46 -07:00 4419 http://www.sfmms.org/news-publications/sfmms-blog/hr6-support-for-patients-and-communities-act.aspx?PostId=4419&tabid=2622 Medicaid,Medicare HR6 SUPPORT for Patients and Communities Act <a href="http://www.sfmms.org/Portals/27/assets/docs/Blog/HR%206%20Committee%20summary%20highlights.pdf?ver=2018-06-28-155959-473"></a><img src="data:image/png;base64,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" align="top" width="600" height="113"> <p>&nbsp;</p> <p style="text-align: left;">H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, is a bipartisan bill that will help in our overall efforts to combat the opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting our communities, and bolstering our efforts to fight deadly illicit synthetic drugs like fentanyl.<br> The underlying text of H.R. 6 includes several Medicaid, Medicare, and public health reforms to help combat the opioid crisis. The policies contained in the bill were advanced through <g class="gr_ gr_302 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="302" data-gr-id="302">regular</g> order by the House Energy and Commerce and Ways and Means Committees.<br> <br> <em style=""><strong>Medicaid</strong></em><br> <br> ▪ Require state Medicaid programs to not terminate a juvenile&rsquo;s medical assistance eligibility because the juvenile is incarcerated. A state may suspend coverage while the juvenile is an inmate, but must restore coverage upon release without requiring a new application unless the individual no longer meets the eligibility requirements for medical assistance (H.R. 1925)<br> ▪ Enable former foster youth who are in care by their 18th birthday and previously enrolled in Medicaid to receive health care until the age of 26 if they move out of state (H.R. 4998)<br> ▪ Require the Centers for Medicare and Medicaid Services (CMS) to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity (H.R. 5477)<br> ▪ Require all state Medicaid programs to have a beneficiary assignment program that identifies Medicaid beneficiaries at-risk for substance use disorder (SUD) and assigns them to a pharmaceutical home program, which must set reasonable limits on the number of prescribers and dispensers that beneficiaries may utilize (H.R. 5808)<br> ▪ Require state Medicaid programs to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children (H.R. 5799)<br> ▪ Require CMS to issue guidance on Neonatal Abstinence Syndrome (NAS) treatment options under Medicaid and require a study by the nonpartisan Government Accountability Office (GAO) on coverage gaps for pregnant women with SUD (H.R. 5789)<br> ▪ Provide additional incentives for Medicaid health homes for patients with substance use disorder (H.R. 5810)<br> <br> <strong><em>Medicare<br> </em></strong><br> ▪ Instruct CMS to evaluate the utilization of telehealth services in treating SUD (H.R. 5603)<br> ▪ Create a pass-through payment extension under Medicare to encourage the development of non-opioid drugs (H.R. 5809)<br> ▪ Add a review of current opioid prescriptions and, as appropriate, a screening for opioid use disorder (OUD) as part of the Welcome to Medicare initial examination (H.R. 5798)<br> ▪ Incentivize post-surgical injections as a pain treatment alternative to opioids by reversing a reimbursement cut for these treatments in the Ambulatory Service Center setting, as well as collect data on a subset of codes related to these treatments (H.R. 5804)<br> ▪ Require e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program (H.R. 3528)<br> ▪ Require prescription drug plan sponsors under the Medicare program establish drug management programs for at-risk beneficiaries (H.R. 5675)<br> ▪ Provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service (Section 2 of H.R. 5776)<br> <br> <strong><em>Public Health</em></strong><br> <br> ▪ Direct the Food and Drug Administration (FDA) to issue or update guidance on ways existing pathways can be used to bring novel non-addictive treatments for pain and addiction to patients. Several approaches have proven successful in speeding the availability of treatments for serious conditions through the FDA (H.R. 5806)<br> ▪ Authorize grants to state and local agencies for the establishment or operation of public health laboratories to detect fentanyl, its <g class="gr_ gr_309 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="309" data-gr-id="309">analogues</g>, and other synthetic opioids (H.R. 5580)<br> ▪ Makes the buprenorphine prescribing authority for physician assistants and nurse practitioners permanent. Temporarily allows advanced practice registered nurses to prescribe buprenorphine. In addition, H.R. 6 will permit a waivered-practitioner to immediately start treating 100 patients at a time with buprenorphine (skipping the initial 30 patient cap) if the practitioner has board certification in addiction medicine or addiction psychiatry; or if practitioner provides MAT in a qualified practice setting. Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder (H.R. 3692)<br> <br> <span style="text-decoration: underline;">In addition to the underlying bill, H.R. 6 also includes the following provisions, which previously passed by the House:</span><br> <br> Section 5001 - H.R. 5583, to amend title XI of the Social Security Act to require states to annually report on certain adult health quality measures, and for other purposes, authored by Rep. Yvette Clarke (D-NY), will require state Medicaid programs to report on the 11 behavioral health measures that are included in CMS&rsquo; 2018 Core Set of Adult Health Care Quality Measures for Medicaid. On June 12, 2018, H.R. 5583 passed the House by voice vote.<br> <br> Section 5011, 5012 - H.R. 5800, the Medicaid IMD ADDITIONAL INFO Act, authored by Rep. Fred Upton (R-MI), will direct the Medicaid and CHIP Payment and Access Commission (MACPAC) to conduct a study on institutions for mental disease (IMD) that receive Medicaid reimbursement. The study will report on the requirements and standards that state Medicaid programs have for IMDs. MACPAC, considering input from stakeholders, will summarize the findings and make recommendations on improvements and best practices and data collection. The report would be due no later than January 2020. On June 12, 2018, H.R. 5800 passed the House by voice vote.<br> <br> Section 5021, 5022 - H.R. 3192, the CHIP Mental Health Parity Act, authored by Rep. Joe Kennedy, III (D-MA), will require state Children&rsquo;s Health Insurance Programs (CHIP) to cover mental health benefits, including substance use disorder services for pregnant women and children. In addition, states would not be allowed to impose financial or utilization limits on mental health treatment that are lower than limits placed on physical health treatment. On June 19, 2018, H.R. 3192 passed the House by voice vote.<br> <br> Section 5031, 5032 - H.R. 4005, the Medicaid Reentry Act, authored by Rep. Paul Tonko (D-NY), will require the Secretary of the Department of Health and Human Services (HHS) to convene a stakeholder group that will produce a report of best practices for states to consider in health care related transitions for inmates of public institutions. On June 19, 2018, H.R. 4005 passed the House by voice vote.<br> <br> Section 5041, 5042 - H.R. 5801, the Medicaid PARTNERSHIP Act, authored by Rep. Morgan Griffith (R-VA), will require Medicaid providers to check the prescription drug monitoring program (PDMP) before prescribing a Schedule II controlled substance. H.R. 5801 will encourage Medicaid providers to integrate PDMP usage into a Medicaid provider&rsquo;s clinical workflow. The bill also establishes standard criteria that a PDMP must meet to be counted as a qualified PDMP and requires state Medicaid programs to report to CMS on PDMP data and information. On June 19, 2018, H.R. 5801 passed the House by voice vote.<br> <br> Section 6001 - H.R. 3331, To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology, authored by Reps. Lynn Jenkins (R-KS) and Doris Matsui (D-CA), will promote the testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. On June 12, 2018, H.R. 3331 passed the House by voice vote.<br> <br> Section 6011, 6012 - H.R. 5582, the Abuse Deterrent Access Act of 2018, authored by Reps. Buddy Carter (R-GA), David Loebsack (D-IA), and Tom Reed (R-NY<g class="gr_ gr_300 gr-alert gr_gramm gr_inline_cards gr_run_anim Punctuation only-del replaceWithoutSep" id="300" data-gr-id="300">),</g> will direct the Centers for Medicare and Medicaid Services (CMS) to evaluate the use of abuse-deterrent opioids in Medicare plans. On June 12, 2018, H.R. 5582 passed the House by voice vote.<br> <br> Section 6021, 6022 - H.R. 5685, the Medicare Opioid Safety Education Act, authored by Reps. John Faso (R-NY), Peter Welch (D-VT), and Jim Renacci (R-OH), will direct the Centers for Medicare and Medicaid Services (CMS) to compile education resources for beneficiaries regarding opioid use, pain management, and alternative pain management treatments, and include these resources in the &ldquo;Medicare and You&rdquo; Handbook. On June 12, 2018, H.R. 5685 passed the House by voice vote.<br> <br> Section 6031, 6032 - H.R. 5590, the Opioid Addiction Action Plan Act, authored by Reps. Adam Kinzinger (R-IL), Yvette Clarke (D-NY), Darin LaHood (R-IL), and Danny Davis (D-IL), will establish an action plan, including studies, reports to Congress authored by the Department of Health and Human Services (HHS), as well as meetings with stakeholders, for the purpose of addressing the opioid crisis. On June 19, 2018, H.R. 5590 passed the House by voice vote.<br> <br> Section 6041, 6042 - H.R. 5605, the Advancing <g class="gr_ gr_297 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling multiReplace" id="297" data-gr-id="297">High Quality</g> Treatment for Opioid Use Disorders in Medicare Act, authored by Rep. Raul Ruiz (D-CA), will create a demonstration project for treating substance use disorder (SUD). This model includes the development of measures to evaluate the quality and outcomes of treatment. On June 19, 2018, H.R. 5605 passed the House by voice vote.<br> <br> Section 6051, 6052 - H.R. 5796, the REACH OUT Act of 2018, authored by Reps. Brian Fitzpatrick (R-PA), Carlos Curbelo (R-FL), and Mike Thompson (D-CA), will direct the Centers for Medicare and Medicaid Services (CMS) to work with eligible entities, including Quality Improvement Organizations, to engage in outreach with prescribers identified as clinical outliers to share best practices to evaluate their prescribing behavior. On June 19, 2018, H.R. 5796 passed the House by voice vote.<br> <br> Section 6061, 6062 (HR4841); 6063 (HR5715); 6065 (HR5716); 6064 (HR5684) - H.R. 5773, the PASS Act of 2018, authored by Reps. Peter Roskam (R-IL) and Terri Sewell (D-AL), contains a number of provisions passed by the Energy and Commerce <g class="gr_ gr_294 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del multiReplace" id="294" data-gr-id="294">committee</g>, including H.R. 4841, H.R. 5716, H.R. 5715, and H.R. 5684.<br> Collectively, this bill will combat opioid abuse <g class="gr_ gr_293 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="293" data-gr-id="293">through</g> providing more resources to beneficiaries and improving program integrity. On June 19, 2018, H.R. 5773 passed the House by voice vote.<br> <br> Section 6071, 6072 - H.R. 5723, the Expanding Oversight of Opioid Prescribing and Payment Act of 2018, authored by Rep. Claudia Tenney (R-NY), will require the Medicare Payment Advisory Commission to report to Congress on: (1) how Medicare pays for opioid and non-opioid pain management treatments in inpatient and outpatient hospital settings; (2) current incentives for prescribing opioid and non-opioid treatments under Medicare inpatient and outpatient prospective payment systems, along with recommendations to address any identified adverse incentives; and (3) how opioid use data is currently tracked and monitored through Medicare claims data. On June 19, 2018, H.R. 5723 passed the House by voice vote.<br> <br> Section 6081, 6082, 6083, 6084, 6085, 6086 - H.R. 6110, the Dr. Todd Graham Pain Management, Treatment, and Recovery Act of 2018, authored by Rep. Jackie Walorski (R-IN), will direct the Department of Health and Human Services (HHS) to study ways to improve access to non-opioid pain management treatments. On June 19, 2018, H.R. 6110 passed the House by voice vote.<br> <br> Section 6091, 6092, 6093, 6094, 6095 - H.R. 5774, the COACH Act of 2018, authored by Rep. Carlos Curbelo (R-FL), will require the Centers for Medicare &amp; Medicaid Services (CMS) to: (1) publish guidance for hospitals on pain management and opioid-use disorder prevention strategies for Medicare beneficiaries, (2) convene a technical expert panel to recommend opioid and opioid-use disorder quality measures for possible use in value-based payment and reporting models under Medicare; and (3) publish and periodically update all guidance issued since January 1, 2016 related to the prescription of opioids for Medicare beneficiaries. On June 19, 2018, H.R. 5774 passed the House by voice vote.<br> <br> Section 6101, 6102 - H.R. 5676, the SENIOR Communities Protection Act of 2018, authored by Reps. Tom MacArthur (R-NJ), Chris Collins (R-NY), David Schweikert (R-AZ), and Earl Blumenauer (D-OR), will allow Medicare Advantage and prescription drug plans to suspend potentially fraudulent payments, mirroring their authority in Medicare fee-for-service. On June 19, 2018, H.R. 5776 passed the House by a vote of 356 to 3.<br> <br> Section 6111,6112, 6113, 6114 - H.R. 5775, the Providing Reliable Options for Patients and Educational Resources (PROPER) Act, authored by Reps. Erik Paulsen (R-MN) and Ron Kind (D-WI), will increase educational resources for Medicare beneficiaries. This bill includes language from H.R. 5686, the Medicare CHOICE Act, authored by Reps. Paulsen, Chris Collins (R-NY), Terri Sewell (D-AL), and Connor Lamb (D-PA), which will require prescription drug plans under Medicare Part D to include information on the adverse effects of opioid overutilization and coverage of non-pharmacological therapies and non-opioid medications or devices used to treat pain. On June 19, 2018, H.R. 5775 passed the House by voice vote.<br> <br> Section 7001, 7002 - H.R. 449, Synthetic Drug Awareness Act of 2017, authored by Reps. Hakeem Jeffries (D-NY) and Chris Collins (R-NY), will require the U.S. Surgeon General to submit a comprehensive report to Congress on the public health effects of the rise in synthetic drug use among youth aged 12 to 18 in order to further educate parents and the medical community on the health effects of synthetics. On June 12, 2018, H.R. 449 passed the House by voice vote.<br> Section 7011, 7012 - H.R. 4275, Empowering Pharmacists in the Fight Against Opioid Abuse Act, authored by Reps. Mark DeSaulnier (D-CA) and Buddy Carter (R-GA), will help pharmacists detect fraudulent prescriptions. H.R. 4275 will help develop and disseminate materials, giving pharmacists greater understanding and ability to decline to fill controlled substances when they suspect the prescriptions are fraudulent, forged, or appear to be for abuse or diversion. On June 12, 2018, H.R. 4275 passed the House by voice vote.<br> <br> Section 7021, 7022, 7023 - H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2017, authored by Rep. Bob Latta (R-OH), will direct the Department of Health and Human Services (HHS) to create a public and easily accessible electronic dashboard linking to all of the nationwide efforts and strategies to combat the opioid crisis. On June 12, 2018, H.R. 4284 passed the House by voice vote.<br> <br> Section 7031, 7032 - H.R. 4684, the Ensuring Access to Quality Sober Living Act of 2017, authored by Reps. Judy Chu (D-CA), Mimi Walters (R-CA), Gus Bilirakis (R-FL), and Raul Ruiz (D-CA), will authorize the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop, publish, and disseminate best practices for operating recovery housing that promotes a safe environment for sustained recovery from substance use disorder (SUD). On June 12, 2018, H.R. 4684 passed the House by voice vote.<br> <br> Section 7041, 7042 - H.R. 5002, ACE Research Act, authored by Reps. Debbie Dingell (D-MI) and Fred Upton (R-MI), will provide the National Institutes of Health (NIH) with new, flexible authorities to conduct innovative research and spur urgently needed research on new non-addictive pain medications. On June 12, 2018, H.R. 5002 passed the House by voice vote.<br> <br> Section 7051, 7052 - H.R. 5009, Jessie&rsquo;s Law, authored by Reps. Tim Walberg (R-MI) and Debbie Dingell (D-MI), will ensure medical professionals have access to a consenting patient&rsquo;s complete health history when making treatment decisions by requiring the Department of Health and Human Services (HHS) to develop and disseminate best practices regarding the prominent display of substance use disorder (SUD) history in patient records of patients who have previously provided this information to a <g class="gr_ gr_290 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del" id="290" data-gr-id="290">health care</g> provider. On June 12, 2018, H.R. 5009 passed the House by voice vote.<br> <br> Section 7061, 7062 - H.R. 5041, Safe Disposal of Unused Medication Act, authored by Reps. Tim Walberg (R-MI) and Debbie Dingell (D-MI), will help reduce the number of unused controlled substances at risk of diversion or misuse by allowing hospice employees to safely dispose of these medications on site after the death of a patient. On June 12, 2018, the House passed H.R. 5041 by a vote of 398-0.<br> <br> Section 7071 - H.R. 5102, Substance Use Disorder Workforce Loan Repayment Act of 2018, authored by Reps. Katherine Clark (D-MA) and Hal Rogers (R-KY), will create a loan repayment program for substance use disorder (SUD) treatment <g class="gr_ gr_288 gr-alert gr_gramm gr_inline_cards gr_run_anim Punctuation only-ins replaceWithoutSep" id="288" data-gr-id="288">providers</g>. Specifically, the bill will offer student loan repayment of up to $250,000 for participants who agree to work as a SUD treatment professional in areas most in need of their services. The program will be available to a wide range of direct care providers, including physicians, registered nurses, social workers, and other behavioral health professionals. On June 12, 2018, H.R. 5102 passed the House by voice vote.<br> <br> Section 7081, 7082 - H.R. 5176, Preventing Overdoses While in Emergency Rooms (POWER) Act of 2018, authored by Reps. David McKinley (R-WV) and Michael Doyle (D-PA), will provide resources for hospitals to develop protocols on discharging patients who have presented with an opioid overdose. These protocols would address the provision of naloxone upon discharge, connection with peer-support specialists, and the referral to treatment and other services that best fit the patient&rsquo;s needs. On June 12, 2018, H.R. 5176 passed the House by voice vote.<br> <br> Section 7091, 7092 - H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act, authored by Reps. Bill Pascrell, Jr. (D-NJ) and David McKinley (R-WV), will establish a demonstration program to test alternative pain management protocols to limit the use of opioids in hospital emergency departments. On June 12, 2018, H.R. 5197 passed the House by voice vote.<br> <br> Section 7101, 7102, 7103, 7104, 7105, 7106 - H.R. 5228, the Stop Counterfeit Drugs by Regulating and Enhancing Enforcement Now (SCREEN) Act, authored by Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ), will provide the Food and Drug Administration (FDA) with stronger recall and seizure authority to disrupt the entry of counterfeit and illicit drugs through International Mail Facilities (IMFs). On June 12, 2018, H.R. 5228 passed the House by voice vote.<br> <br> Section 7111, 7112 - H.R. 5261, TEACH to Combat Addiction Act of 2018, authored by Reps. Bill Johnson (R-OH) and Paul Tonko (D-NY), will support Centers of Excellence, or institutions of learning that have championed substance use disorder (SUD) treatment education to improve how health professionals are taught about both SUD and pain. On June 12, 2018, H.R. 5261 passed the House by voice vote.<br> <br> Section 7121 - H.R. 5272, a bill to ensure that programs and activities that are funded by a grant, cooperative agreement, loan, or loan guarantee from the Department of Health and Human Services, and whose purpose is to prevent or treat a mental health or substance use disorder, are evidence-based, authored by Reps. Steve Stivers (R-OH) and Eliot Engel (D-NY), will direct the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide guidance for entities applying for substance use disorder (SUD) and mental illness grants, including guidance to grantees on how best to articulate the rationale for a given program or activity. Additionally, it will also encourage the funding of evidence-based interventions and the replication of promising or effective practices. On June 12, 2018, H.R. 5272 passed the House by voice vote.<br> <br> Section 7131, 7132 - H.R. 5327, Comprehensive Opioid Recovery Centers Act 2018, authored by Reps. Brett Guthrie (R-KY), Gene Green (D-TX), Larry Bucshon (R-IN), and Ben Ray Lujan (D-NM), will establish Comprehensive Opioid Recovery Centers (CORCs) that will serve as models for comprehensive treatment and recovery. CORCs would utilize the full range of FDA-approved medications and evidence-based treatments, have strong linkages with the community, generate meaningful outcomes data, and dramatically improve the opportunities for individuals to establish and maintain long-term recovery as productive members of society. On June 12, 2018, the House passed H.R. 5041 by a vote of 383-13.<br> <br> Section 7141, 7142, 7143, 7144 - H.R. 5329, the Poison Center Network Enhancement Act of 2018, authored by Reps. Susan Brooks R-IN), Eliot Engel (D-NY), and Joe Barton (R-TX), will reauthorize the national network of Poison Control Centers, which offer free, confidential, and expert medical advice 24 hours a day, seven days a week. Often times these programs serve as the primary resource for poisoning information and help reduce Emergency Room visits through in-home treatment. On June 12, 2018, H.R. 5329 passed the House by voice vote.<br> <br> Section 7151, 7152 - H.R. 5353, Eliminating Opioid-Related Infectious Diseases Act of 2018, authored by Reps. Leonard Lance (R-NJ) and Joe Kennedy III (D-MA), will authorize the CDC to undertake an injection drug use-associated infection elimination initiative and work with states to improve education, surveillance <g class="gr_ gr_263 gr-alert gr_gramm gr_inline_cards gr_run_anim Punctuation only-ins replaceWithoutSep" id="263" data-gr-id="263">and</g> treatment of injection drug-use associated infections, like human immunodeficiency virus (HIV) and hepatitis. On June 12, 2018, H.R. 5353 passed the House by voice vote.<br> <br> Section 7161, 7162 - H.R. 5473, the Better Pain Management Through Better Data Act of 2018, authored by Reps. Barbara Comstock (R-VA) and Ben Ray Lujan (D-NM), will direct the Food and Drug Administration (FDA) to articulate clear data collection methods that could be used to inform opioid-sparing labeling claims for products that may replace, delay, or reduce or the use of opioid analgesics. On June 12, 2018, H.R. 5473 passed the House by voice vote.<br> <br> Section 7171, 7172 - H.R. 5483, Special Registration for Telemedicine Clarification Act of 2018, authored by Reps. Buddy Carter (R-GA), Cheri Bustos (D-IL), Karen Handel (R-GA), Elise Stefanik (R-NY), and Bobby Rush (D-IL), will clarify telemedicine waivers. Federal law permits the Attorney General to issue a special registration to health care providers to prescribe controlled substances via telemedicine in legitimate emergency situations, such as a lack of access to an in-person specialist. Unfortunately, the waiver process has never been implemented through regulation, and some patients do not have the emergency access they need <g class="gr_ gr_283 gr-alert gr_gramm gr_inline_cards gr_run_anim Grammar multiReplace" id="283" data-gr-id="283">to</g> <g class="gr_ gr_284 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling" id="284" data-gr-id="284">treatment</g>. This bipartisan bill directs the Attorney General, with the Secretary of Health and Human Services, to promulgate interim final regulations within one year of passage of the law. On June 12, 2018, H.R. 5483 passed the House by voice vote.<br> <br> Section 7181, 7182 - H.R. 5587, the Peer Support Communities of Recovery Act, authored by Reps. Ben Ray Lujan (D-NM) and Bill Johnson (R-OH), will enhance CARA&rsquo;s Building Communities of Recovery Program and authorize the Department of Health and Human Services to award grants to peer support specialist organizations for the development and expansion of recovery services. Peer support specialists/peer recovery coaches are health workers who are in recovery from substance use disorder (SUD). New programs are emerging across the country to use peers in a range of settings, including hospitals, to provide immediate and ongoing support and treatment linkages to individuals who have overdosed from opioids, or support individuals newly in recovery. On June 12, 2018, H.R. 5587 passed the House by voice vote.<br> <br> Section 7191, 7192, 7193, 7194 - H.R. 5752, the Stop Illicit Drug Importation Act of 2018, authored by Rep. Marsha Blackburn (R-TN), will streamline and enhance FDA&rsquo;s tools to intercept illegal products. Illicit or unapproved drugs enter the U.S. supply chain through International Mail Facilities (<g class="gr_ gr_271 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del multiReplace" id="271" data-gr-id="271">IMFs</g>) and pose serious public health threats to individuals across the country. On June 13, 2018, H.R. 5752 passed the House by voice vote.<br> <br> Section 7201, 7202, 7203 - H.R. 5812, the Creating Opportunities that Necessitate New and Enhanced Connections That Improve Opioid Navigation Strategies (CONNECTIONS) Act, authored by Reps. Morgan Griffith (R-VA) and Frank Pallone, Jr. (D-NJ), will improve current federal support for state-run PDMPs. H.R. 5812 will authorize the Centers for Disease Control and Prevention (CDC) to carry out certain controlled substances overdose prevention and surveillance activities in order to improve data collection and integration into physician clinical workflow so that timely, complete, and accurate information will get into the hands of providers and dispensers so that they can make the best clinical decisions for their patients. On June 12, 2018, H.R. 5812 passed the House by voice vote.<br> <br> Section 7211, 7212 - H.R. 5687, the SOUND Disposal and Packaging Act, authored by Reps. Richard Hudson (R-NC), Rep. G.K. Butterfield (D-NC), and Ted Budd (R-NC) will direct the Food and Drug Administration (FDA) to work with manufacturers to establish programs for efficient return or destruction of unused Schedule II drugs, with an emphasis on opioids. These methods could include mail-back pouches to secure facilities for incineration, or methods to immediately inactivate/render unattractive unused drugs. In addition, this bill will facilitate utilization of packaging that may reduce overprescribing of opioids. Finally, this bill will require the Government Accountability Office (GAO) to study new and innovative technologies that claim to be able to safely dispose of opioids and other unused medications. GAO would review and detail the effectiveness of these disposal methods. On June 19, 2018, H.R. 5687 passed the House by a vote of 342 to 13.<br> <br> Section 7221 - H.R. 5811, to amend the Federal Food, Drug, and Cosmetic Act with respect to <g class="gr_ gr_272 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del multiReplace" id="272" data-gr-id="272">post approval</g> study requirements for certain controlled substances, and for other purposes, authored by Reps. Jerry McNerney (D-CA) and Morgan Griffith (R-VA), will enhance the Food and Drug Administration&rsquo;s (FDA&rsquo;s) authorities and enforcement tools to ensure timely post-marketing studies for chronically administered<br> opioids. Currently, there is limited data on the long-term efficacy of opioids, and their overall place in the treatment of pain. On June 19, 2018, H.R. 5811 passed the House by voice vote.<br> <br> Section 8001, 8002, 8003, 8004, 8005, 8006, 8007, 8008, 8009 - H.R. 5788, the Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018, authored by Rep. Mike Bishop (R-MI), will require the U.S. Postal Service (USPS) to transmit advance electronic data (AED) to Customs and Border Protection (CBP) on at least 70 percent of international packages by December 31, 2018, and 100 percent of international packages by December 31, 2020. On June 14, 2018, the House passed H.R. 5889 by a vote of 353-52.<br> <br> Section 8011, 8012 - H.R. 5889, the Recognizing Early Childhood Trauma Related to Substance Abuse Act of 2018, authored by Rep. Dave Brat (R-VA), will require the Department of Health and Human Services (HHS) to disseminate information to professionals working with young children on ways to recognize children impacted by trauma related to an adult&rsquo;s substance use, and how to respond in a manner that will provide the best support for the child. On June 13, 2018, the House passed H.R. 5889 by voice vote.<br> <br> Section 8021, 8022 - H.R. 5890, the Assisting States&rsquo; Implementation of Plans of Safe Care Act, authored by Rep. Tom Garrett (R-VA), will require the Department of Health and Human Services (HHS) to provide states with enhanced guidance to support the implementation of their &ldquo;plan of safe care&rdquo; assurance, which is required under the Child Abuse Prevention and Treatment Act (CAPTA) and designed to address to address the needs of infants affected by prenatal substance abuse. On June 13, 2018, the House passed H.R. 5890 by a vote of 406 to 3.<br> <br> Section 8031, 8032 - H.R. 5891, the Improving the Federal Response to Families Impacted by Substance Use Disorder Act, authored by Rep. Glenn Grothman (R-WI), will establish an interagency task force to develop a strategy on how federal agencies can implement a coordinated approach to responding to the opioid epidemic, with a particular focus on the existing programs that support infants, children, and their families. On June 13, 2018, the House passed H.R. 5891 by a vote of 409 to 8.<br> <br> Section 8041 - H.R. 5892, to establish an Advisory Committee on Opioids and the Workplace to advise the Secretary of Labor on actions the Department of Labor can take to address the impact of opioid abuse on the workplace, authored by Rep. Jason Lewis (R-MN), will create an Advisory Committee to advise the Secretary of Labor on actions the Department can take to address the impact of opioid abuse on the workplace. On June 13, 2018, the House passed H.R. 5889 by voice vote.<br> <br> Section 8051, 8052 - H.R. 2147, the Veterans Treatment Court Improvement Act of 2018, authored by Rep. Mike Coffman (R-CO), will require the Department of Veterans Affairs to hire at least 50 Veterans Justice Outreach (VJO) specialists at eligible VA medical centers to ensure veterans who become involved in the criminal justice system have greater access to Veterans Treatment Courts (VTCs). On June 13, 2018, the House passed H.R. 2147 by voice vote.<br> <br> Section 8061 - H.R. 4635, to direct the Secretary of Veterans Affairs to increase the number of peer-to-peer counselors providing counseling for women veterans, and for other purposes, authored by Rep. Mike Coffman (R-CO), will direct the Department of Veterans Affairs (VA) to increase the number of female peer counselors so that female veterans who are separating or newly separated from military service can receive support from other female veterans. On June 13, 2018, the House passed H.R. 2147 by voice vote.<br> <br> Section 8071, 8072 - H.R. 5294, the Treating Barriers to Prosperity Act of 2018, authored by Rep. Lou Barletta (R-PA), will clarify that the Appalachian Regional Commission (ARC) may enter into contracts with and provide grants to people and organizations in Appalachia for projects and other activities aimed at reducing drug<br> abuse and the negative effects of drug abuse, including opioid abuse, in the region. On June 13, 2018, the House passed H.R. 5294 by voice vote.<br> <br> Section 8081, 8082, 8083, 8084 - House Amendment to S. 1091, the Supporting Grandparents Raising Grandchildren Act, authored by Sen. Susan Collins (R-ME), will establish an Advisory Council to Support Grandparents Raising Grandchildren. On June 13, 2018, the House passed S.1091, as amended, by voice vote.<br> <br> Section 8091, 8092 - H.R. 6029, the REGROUP Act of 2018, authored by Rep. Keith Rothfus (R-PA), will amend the Omnibus Crime Control and Safe Streets Act of 1968 to reauthorize the comprehensive opioid abuse grant program through 2023. On June 13, 2018, the House passed H.R. 6029 by voice vote.<br> H.R. 2851, the Stop the Importation &amp; Trafficking of Synthetic Analogues (SITSA) Act, authored by Rep. John Katko (R-NY), will give law enforcement the tools they need to help get illicit synthetic drugs, like fentanyl, off our streets without compromising important public health and research protections. H.R. 2851 will also modernize scheduling guidelines to keep pace with the fast-changing nature of synthetic drugs. On June 15, 2018, the House passed H.R. 2851 by a vote of 239-142.<br> <br> H.R. 5735, the Transitional Housing for Recovery in Viable Environments (THRIVE) Demonstration Program Act, authored by Rep. Andy Barr (R-KY), establishes a pilot program to allocate a portion of federal Section 8 Housing Choice vouchers directly to nonprofit organizations that provide housing, job training and continued support for individuals who are transitioning out of a substance abuse rehabilitation program and back into the workforce. On June 14, 2018, the House passed H.R. 5735 by a vote of 230-173.<br> <br> H.R. 5797, the IMD CARE Act, authored by Rep. Mimi Walters (R-CA) and cosponsored by Reps. Steve Knight (R-CA), Brett Guthrie (R-KY), Marsha Blackburn (R-TN), French Hill (R-AR) and Chairman Greg Walden (R-OR), allows state Medicaid programs to remove the Institutions for Mental Diseases (IMD) exclusion for Medicaid beneficiaries aged 21 to 64 with an opioid use disorder for fiscal years 2019 to 2023. By removing the exclusion, Medicaid would pay for up to 30 total days of care in an IMD during a 12-month period for eligible individuals. Numerous experts have said that addressing the current Medicaid IMD exclusion is one of the most important things that can be done to help combat the opioid crisis because doing so will remove a barrier to care for those seeking treatment through Medicaid. On June 20, 2018, the House passed H.R. 5797 by a vote of 261 to 155.<br> <br> <a href="http://energycommerce.house.gov/opioids/" target="_blank" style=""><strong>energycommerce.house.gov/opioids/</strong></a></p> <p><a href="http://www.sfmms.org/Portals/27/assets/docs/Blog/HR%206%20Committee%20summary%20highlights.pdf?ver=2018-06-28-155959-473" target="_blank"><strong>HR 6 Committee summary highlights.pdf</strong></a></p> Thu, 28 Jun 2018 23:04:38 Z 2018-06-28 23:04 +00:00 2018-06-28 16:04 -07:00 4416 http://www.sfmms.org/news-publications/sfmms-blog/sb189-campaign-cma-saves-medical-groups-millions-in-workers-comp-premiums.aspx?PostId=4416&tabid=2622 CMA SB189 Campaign - CMA saves medical groups millions in workers’ comp premiums <img src="http://www.sfmms.org/Portals/27/assets/images/Blog/sb189-infographic-rgb-web.jpg?ver=2018-06-27-152017-727" align="right" width="300" height="332"> <h1><span style="color: rgb(0, 112, 192);">Premium savings for individual medical groups starting July 1, 2018</span></h1> <p> In 2016, the California Legislature passed a bill (AB 2883) that changed the definition of &ldquo;employee&rdquo; for the purposes of workers&rsquo; compensation coverage, setting an arbitrary 15 percent ownership threshold to be able to exempt owner/employees from such coverage. Unfortunately, the bill required many owners of medical corporations to pay drastically increased workers&rsquo; compensation insurance premiums for coverage they neither needed nor wanted. </p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px;">To assist affected medical groups and corporations, the California Medical Association (CMA) sponsored a law (SB 189) to once again allow appropriate coverage exemptions for owners. As a result of the new law, physician owners of professional corporations will be able, as of as of July 1, 2018, to exempt themselves from workers&rsquo; compensation coverage&mdash;regardless of the percentage of ownership. This will result in premium savings for individual medical groups ranging from hundreds to hundreds of thousands of dollars.</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px;">Under SB 189, all owners of medical corporations will be able to exempt themselves from workers&rsquo; compensation coverage as long as they submit a waiver and have health insurance coverage.</p> <span style="margin: 0px; padding: 0px; border: 0px;;margin: 0px; padding: 0px; border: 0px;"> <p style="font-style: italic; font-weight: bold;">The new rules for owner exemptions apply to all policies incepting or renewing on or after July 1, 2018. All owners of medical corporations must act now to take advantage of this significant savings opportunity.</p> <p style=""><span style="color: rgb(58, 58, 58);">For more information about SB 189 and the advocacy efforts, contact CMA's Associate Director of Government Relations, Amy Durbin, at&nbsp;</span><strong style=""><a href="mailto:" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" class="ApplyClass">adurbin@cmanet.org</a><span style="color: rgb(58, 58, 58);"><a href="mailto:" class="ApplyClass" style="">.</a></span></strong></p> </span> Wed, 27 Jun 2018 22:32:08 Z 2018-06-27 22:32 +00:00 2018-06-27 15:32 -07:00 4412 http://www.sfmms.org/news-publications/sfmms-blog/nih-precision-medicineall-of-us-research-program.aspx?PostId=4412&tabid=2622 Educational Event,Survey NIH Precision Medicine/All of Us Research Program <p style="text-align: center;"><img src="http://www.sfmms.org/Portals/27/assets/images/all%20of%20us.PNG?ver=2018-06-25-145714-260"></p> Precision medicine is an approach to disease treatment that takes the full diversity of the individual into account, including their environment, lifestyle, behaviors, and genes. For clinicians, it means having the best information and tools available to treat patients from all walks of life, and for patients, it is to get treatments tailored to their needs.<br> <br> Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) experience many health disparities. The reason being is that they have often not been included in researches that lead to the development of treatments and prevention programs. Also, there is not sufficient information about the health status of these communities. There is the need for more information on clinical trials in these populations, as well as their participation in research efforts. Some examples of how a lack of information or of precise treatments has impacted these communities:<br> <br> - &ldquo;Screen at 23&rdquo; / Diabetes Screening Practices: Asian Americans are at a higher risk of having type 2 diabetes than Whites, and that the disease happens at a lower body mass index (BMI) of 23. Up until 2015, national screening guidelines did not take into account this factor as they had not been included in large national studies. In 2016, the Amerian Diabetes Association has added to their guidelines screening for Asian patients at BMI equal to or higher than 23 (with one or two risk factors).<br> <br> - Adverse Drug Effects: Asian Americans, Native Hawaiians, and Pacific Islanders are extremely underrepresented in clinical trials. Drug therapies are not designed for them specifically, and sometimes this can lead to serious consequences. In 2005, the Food and Drug Administration (FDA) issued a warning and changed the label for a widely prescribed statin drug, with the study revealing an increased risk of muscle damage as a side effect for Asians. The new label recommended Asian patients be started at the lowest dose possible.<br> <br> The National Institutes of Health (NIH) has launched a national effort: The All of Us Research Program that seeks to recruit a million or more volunteers in the U.S. from every race/ethnicity, geographical location, and walk of life. The information this cohort provides will lead to studies that could make medical breakthroughs such as treatments and prevention programs tailored to the individual.<br> <br> For more information:<a href="http://www.sfmms.org/LinkClick.aspx?fileticket=uE7G1eDmDSk%3d&amp;portalid=27" target="_blank" style="font-size: 0.74em;"><strong> </strong></a><strong> <p><a href="http://www.sfmms.org/LinkClick.aspx?fileticket=uE7G1eDmDSk%3d&amp;portalid=27" target="_blank" style="font-size: 0.74em;"></a><a href="http://www.sfmms.org/Portals/27/Documents/PrecisionMedicine%20For%20Print.pdf?ver=2018-06-25-151945-510" target="_blank" style="font-size: 11.84px;">PrecisionMedicine For Print.pdf</a></p> <p><a href="http://www.sfmms.org/LinkClick.aspx?fileticket=uE7G1eDmDSk%3d&amp;portalid=27" style="font-size: 11.84px;">Provider Handout (1).pdf</a></p> </strong> <h3 style="text-align: left;"><span style="color: rgb(192, 0, 0);">Please join us!</span></h3> <p style="text-align: left;"><span style="font-size: 16px; color: rgb(165, 165, 165);">July 6, <g class="gr_ gr_30 gr-alert gr_gramm gr_inline_cards gr_run_anim Punctuation only-ins replaceWithoutSep" id="30" data-gr-id="30">2018</g> <strong>@&nbsp;Hilton Financial District, 6:30-8:00 PM</strong> for the NIH All of Us Research Program.</span></p> <p style="text-align: left;">&nbsp;</p> Mon, 25 Jun 2018 22:33:16 Z 2018-06-25 22:33 +00:00 2018-06-25 15:33 -07:00 4410 http://www.sfmms.org/news-publications/sfmms-blog/san-francisco-marin-medical-society-opposes-child-separation-practices-at-the-mexican-border.aspx?PostId=4410&tabid=2622 Advocacy,Local Events,SFMMS Member Events San Francisco Marin Medical Society Opposes Child Separation Practices at the Mexican Border <p style="text-align: center;"> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in; text-align: center;"><strong><span style="font-size: 14pt; color: rgb(0, 0, 0);">San Francisco Marin Medical Society </span></strong></p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in; text-align: center;"><strong><span style="font-size: 14pt; color: rgb(0, 0, 0);">Opposes Child Separation Practices at the Mexican Border</span></strong></p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">FOR IMMEDIATE RELEASE<span style="white-space: pre;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;</span>CONTACT:</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">June 22, 2018<span style="white-space: pre;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp;&nbsp;</span>Erin Henke</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;"><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<span style="white-space: pre;"> </span>&nbsp;&nbsp;<span style="white-space: pre;"> </span>&nbsp;<strong>&nbsp;</strong></span><a href="mailto:ehenke@sfmms.org"><strong>ehenke@sfmms.org</strong></a></p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;"><span style="white-space: pre;">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</span>(415) 302-2746</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;"><strong>San Francisco, CA</strong> &ndash; The leadership of the San Francisco Marin Medical Society (SFMMS), the 150-year old association representing more than 2,000 physicians in Marin and SF counties, joined the growing list of medical groups opposed to separating immigrant children from their parents or guardians at the Mexican border.</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">The American Academy of Pediatrics and American Psychiatric Association have already condemned the child separation and incarceration practices.<span>&nbsp; </span>SFMMS President John Maa, MD, stated: "We are grateful that the unnecessary federal policy of child separation at the border has been brought to an immediate end, but we must also work to ensure that it will never return." He has issued a call for SFMMS members to participate in the "Families Belong Together" rally on Saturday, June 23rd at Justin Herman Plaza.</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">Last week, the American Medical Association (AMA) also passed a resolution opposing the separation of children from their parents at the Mexican border. SFMMS, representing doctors across specialties who care for children and families, joins the AMA, pediatricians, and mental health physicians in condemning this horrific policy.</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">The negative health consequences of childhood traumatic events disrupt the natural development of a growing brain and body and increase the risk of physical and mental health illnesses. The negative effects on the family and community are far-reaching and long-lasting.</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">The SFMMS leadership have unanimously voted to oppose the child separation actions, with many in the physician leadership noting that they themselves, their parents, and many of their patients were immigrants and that the practice serves little practical purpose.<span>&nbsp; </span>SFMMS board member, Monique Schaulis, MD, remarked: &ldquo;We recommend explicit condemnation of these practices and the urgent reunification of families separated by this policy.&rdquo;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">Dr. Maa continued, &ldquo;As physicians in San Francisco and Marin who prioritize health over politics, we join the chorus of other physician organizations speaking out against this unnecessary and inhumane policy decision.&rdquo;</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin-bottom: 0.0001pt; text-align: center;">###</p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">&nbsp;</p> <p class="" style="margin: 0in 26.65pt 0.0001pt 0in;"><strong>San Francisco Marin Medical Society Leadership</strong>:<span>&nbsp; </span>Tom<span style="font-family: Calibri;">&aacute;</span>s Arag<span style="font-family: Calibri;">&oacute;</span>n, MD; Charles Binkley, MD;</p> <p class="" style="margin: 0in 26.65pt 0.0001pt 0in;">Alice Chen, MD; Lawrence Cheung, MD; Shannon Udovic-Constant, MD; Nida Degesys, MD;</p> <p class="" style="margin: 0in 26.65pt 0.0001pt 0in;">Irina <g class="gr_ gr_55 gr-alert gr_spell gr_inline_cards gr_run_anim ContextualSpelling ins-del multiReplace" id="55" data-gr-id="55">deFischer</g>, MD; George Fouras, MD; Ben Franc, MD; Gordon Fung, MD; Robert Harvey, MD;</p> <p class="" style="margin: 0in 26.65pt 0.0001pt 0in;">Man-Kit Leung, MD; John Maa, MD; Rob Margolin, MD; Jason Nau, MD; Kim Newell Green, MD;</p> <p class="" style="margin: 0in 26.65pt 0.0001pt 0in;">Stephanie Oltmann, MD; Heyman Oo, MD; Ray Oshtory, MD; Richard Podolin, MD; Justin Quock, MD; Monique Schaulis, MD; Jeff Stevenson, MD; Michael Schrader, MD; Winnie Tong, MD; Christina Wang;</p> <p class="" style="margin: 0in 26.65pt 0.0001pt 0in;">Eric Wang MD</p> <strong><span style="font-size: 11pt; font-family: &quot;Times New Roman&quot;;"><br clear="all"> </span></strong> <p class="" style="margin-bottom: 0.0001pt;"><strong>&nbsp;</strong></p> <p class="" style="margin-right: 22.15pt;"><strong>About the San Francisco Marin Medical Society: </strong>In 2017, the San Francisco Marin Medical Society (SFMMS) was created by combining the San Francisco Medical Society, and the Marin Medical Society. With more than 2,000 members, SFMMS unites dedicated physicians to champion quality health care and innovation for patients and the community and serves the professional needs of physicians in San Francisco and Marin. SFMMS aims for its membership to provide exemplary health care to the community, experience professional fulfillment and shape the future of medicine. For more information, visit <strong><a href="http://www.sfmms.org/" target="_blank">www.sfmms.org</a>.</strong></p> <p class="" style="margin: 0in 22.15pt 0.0001pt 0in;">PDF Version:</p> <p class="" style="margin-bottom: 0.0001pt;"><a href="http://www.sfmms.org/Portals/27/Documents/Rally%20Press%20Release.pdf?ver=2018-06-22-103017-567">Rally Press Release.pdf</a></p> <p class="" style="margin-bottom: 0.0001pt;">&nbsp;</p> <p class="" style="margin-bottom: 0.0001pt;">&nbsp;</p> <p class="" style="margin-bottom: 0.0001pt;">&nbsp;</p> <p class="" style="margin-bottom: 0.0001pt;">&nbsp;</p> </p> <p style="text-align: center;" _rdeditor_exists="1">&nbsp;</p> Fri, 22 Jun 2018 17:39:36 Z 2018-06-22 17:39 +00:00 2018-06-22 10:39 -07:00 4409 http://www.sfmms.org/news-publications/sfmms-blog/letter-to-the-editor-from-sfmms-leaders-opposing-separation-of-children-at-border.aspx?PostId=4409&tabid=2622 AMA,Politics and Medicine Letter to the Editor from SFMMS Leaders Opposing Separation of Children at Border <a href="https://www.sfchronicle.com/opinion/letterstoeditor/article/Letters-to-the-Editor-Another-blow-to-U-S-13012011.php?cmpid=gsa-sfgate-result" target="_blank">Letter to the Editor in the <em>San Francisco Chronicle </em>today</a>: <br> <br> <strong>Negative effects</strong><br> Last week, the American Medical Association passed a resolution opposing the separation of children from their parents at the Mexican border. The San Francisco Marin Medical Society, representing doctors across specialties who care for children and families, joins the AMA and condemns this horrific policy. The story of an 8-year-old who experienced a brief but traumatic separation from her mother during their immigration journey highlights the harm.<br> The child had no prior mental health issues, and even months after being reunified with her mother, threatened to hurt herself with a knife at the thought of going to school and leaving her mother&rsquo;s side again. The negative health consequences of childhood traumatic events disrupt the natural development of a growing brain and body, and increase the lifetime risk for heart problems, cancer, diabetes and stroke. The negative effects on the family and community are far-reaching and long-lasting. As physicians in San Francisco and Marin who prioritize health over politics, we join the chorus of other physician organizations speaking out against this unnecessary and inhumane policy decision. <br> <br> <p><em>John Maa and Heyman Oo,<br> San Francisco</em></p> Thu, 21 Jun 2018 15:24:47 Z 2018-06-21 15:24 +00:00 2018-06-21 08:24 -07:00 4408 http://www.sfmms.org/news-publications/sfmms-blog/sfdph-health-advisory-fentanyl-overdose-from-suspected-counterfeit-oxycodone-tablet-in-san-francisco.aspx?PostId=4408&tabid=2622 Public Health,SF Dept of Public Health Health Advisory: Fentanyl Overdose from Suspected Counterfeit Oxycodone Tablet in San Francisco <p><img src="http://www.sfmms.org/Portals/27/assets/images/Blog/pop%20health.jpg?ver=2018-06-20-095948-600"><br> June 19, 2018</p> An individual experiencing a near-fatal overdose after consuming a pill stamped with &ldquo;M30&rdquo; was cared for at Zuckerberg San Francisco General Hospital on June 11, 2018. No pill was available for testing, however such tablets are reportedly readily available in San Francisco. Similar events have been reported in Arizona. <br> <br> Fentanyl has been increasingly present in street-purchased drugs in San Francisco (including as a white powder, and contaminating methamphetamine, cocaine, heroin, and counterfeit benzodiazepines and prescription opioids). Fentanyl test strips provided by syringe access programs have identified the presence of fentanyl in many street-purchased drugs (e.g. counterfeit &ldquo;Xanax&rdquo; tablets). In 2016, 22 of 105 opioid overdose deaths were caused by fentanyl, double the number from 2015. Of these 22 cases, 45% also involved methamphetamine, 27% cocaine, and 41% another opioid. Death from fentanyl toxicity can be more rapid than from other opioids, thus prompt peer response is essential. <br> <br> We recommend that anyone using street-purchased drugs carry naloxone, the short-acting opioid antagonist. Naloxone can be administered by witnesses as a first aid measure, is covered by MediCal, Healthy SF, and most health plans, and can be furnished without a prescription by pharmacists registered to do so. Naloxone can be obtained from the Community Behavioral Health Services (CBHS) Pharmacy at 1380 Howard Street on a walk-in basis (see below). Naloxone is also available at no cost from the DOPE Project for people who use drugs via syringe access sites and other community-based programs. Additional measures include advising anyone who uses street-purchased drugs to test their drugs for fentanyl (test strips available at syringe access sites), use &ldquo;tester&rdquo; doses to ensure there are no unexpected effects, and if using in a group, stagger drug use so that someone is alert to help others if needed.<br> <br> <h3><span style="color: rgb(192, 0, 0);">Actions requested of SF Clinicians:</span></h3> <ul> <li><strong>Refer patients with opioid use disorder to treatment</strong>. San Francisco has treatment available on demand, which can be accessed at methadone programs or through the triage center at 1380 Howard St.</li> <li><strong>Ensure patients who access ANY street-purchased drugs have naloxone</strong>. Either prescribe naloxone directly or direct people to the pharmacy at 1380 Howard Street or to syringe access sites. Patients should be encouraged to keep the medication with them at all times.</li> <li><strong>Advise patients who use drugs to test their drugs, use &ldquo;tester&rdquo; doses, and stagger drug use.</strong></li> </ul> <h3><span style="color: rgb(192, 0, 0);"><br> Resources for Substance Use Treatment and Naloxone:</span></h3> <ul> <li>Treatment Referrals:&nbsp; <ul> <li>SFDPH triage center &ndash; Treatment Access Program (TAP) @ 1380 Howard Street, 8:00 a.m. &ndash; 4:30 p.m. weekdays</li> <li>BAART Clinic @ 433 Turk St, 7:30 a.m. - Noon for same day methadone; Call (415) 928 &ndash; 7800 and ask for intake counselor</li> <li>List of physicians who provide buprenorphine: <strong><a href="http://buprenorphine.samhsa.gov/bwns_locator/" target="_blank">http://buprenorphine.samhsa.gov/bwns_locator/</a>&nbsp;</strong></li> </ul> </li> <li>Naloxone from the CBHS Pharmacy at 1380 Howard Street, Monday-Friday walk-in 9:30 a.m. &ndash; 4:00 p.m. (no prescription required).</li> <li>Naloxone from the DOPE Project: Contact Kristen Marshall at <a href="mailto:marshall@harmreduction.org" class="ApplyClass"><strong>marshall@harmreduction.org</strong></a> or call (919) 637&ndash;8632 for the distribution schedule</li> <li>Naloxone prescribing information (scroll down to Naloxone Prescribing, Education, and Awareness): <a href="http://www.sfhealthnetwork.org/employee-physicians/pain-management-resources/ " target="_blank" style=""><strong style="">http://www.sfhealthnetwork.org/employee-physicians/pain-management-resources/&nbsp;</strong></a></li> </ul> <p> <br> <strong><span style="text-decoration: underline;">Program Contact Information</span></strong>:<br> Substance Use Research Unit<br> Tel (415) 437&ndash;6204<br> <strong><a href="mailto:nose.naloxone@sfdph.org" class="ApplyClass">nose.naloxone@sfdph.org</a> </strong><br> <br> </p> <p><a href="http://www.sfmms.org/Portals/27/assets/docs/Blog/Health-Advisory-Fentanyl-Overdose-SF-SFDPH-FINAL-06.19.2018.pdf?ver=2018-06-20-095840-567"><strong>View the SFDPH Health Advisory</strong></a></p> Wed, 20 Jun 2018 17:06:46 Z 2018-06-20 17:06 +00:00 2018-06-20 10:06 -07:00 4407 http://www.sfmms.org/news-publications/sfmms-blog/prevent-the-bleed-a-step-toward-the-firearm-endgame.aspx?PostId=4407&tabid=2622 Guest Blog Prevent the Bleed: A Step Toward the Firearm Endgame <p>[Article appeared in General Surgery News on June 13, 2018]</p> <p>By John Maa, MD, FACS, and Peter Masiakos, MD, FACS</p> <br> The recent tragedies in Florida, Nevada and Texas galvanized a national youth-led movement aimed at ending gun violence. State legislatures in Florida, Illinois, Massachusetts, New York, Tennessee and Washington enacted firearm safety laws that disarm dangerous or suicidal individuals, raise the minimum purchase age to 21, and strengthen background checks. Congress passed a spending package that incentivizes state and regional reporting into the national background check system, and the National Institutes of Health awarded $5 million to gun violence researchers. In a <em>General Surgery News</em> editorial [May 2018, page 3], Frederick Greene, MD, recognized that a &ldquo;tipping point&rdquo; of the national firearm debate has been reached and that the American College of Surgeons strategy of &ldquo;stopping the bleed&rdquo; cannot stand alone, and must be joined by the equally important concept of &ldquo;preventing the bleed.&rdquo;<br> <br> Some surgeons have become vocal advocates for firearm violence prevention. In March, Ara Darzi, MD, shared the British perspective into the American gun debate in the <em>Annals of Surgery</em> (2018;267[3]:430-431), urging a harm reduction approach and the adoption of a forward-thinking prevention strategy. In the <em>Annals of Surgery</em> in May (2018;267[6]:1009-1010), Natalie Yanchar, MD, MSc, and Suzanne Beno, MD, FRCPC, DABP, highlighted our professional responsibility to work within all levels of government to advocate for surveillance and funding of translatable research to help implement evidence-informed firearm policies. Joe Sakran, MD, a trauma surgeon and gunshot survivor, has worked to expand universal background checks, prevent straw purchases, and expand mental health treatment, and was featured by CNN in April. Andre Campbell, MD, a trauma surgeon at San Francisco General Hospital, refocused the world&rsquo;s attention when speaking to the media after the April YouTube shooting. His words redirected the discussion away from impersonal statistics in treating the victims to the frustration that gun violence ravages our country and almost seems unpreventable. Immediately afterward, social media and a worldwide media response confirmed that many surgical colleagues and the public shared his sentiment.<br> <br> Additionally, professional surgical societies added their voice through policy statements and productive discussions. The American Pediatric Surgical Association reaffirmed its 2013 position statement emphasizing the need to discuss gun safety and safe storage in households with children. The Society of American Gastrointestinal and Endoscopic Surgeons called for enhanced safety technology to minimize accidental and mass shooting events, while the Western Trauma Association called for a ban on assault weapons and bump stocks. Ronny Stewart, MD, FACS, and Deborah Kuhls, MD, FACS, of the ACS Committee on Trauma (COT) identified areas of consensus through a survey of COT members and ACS Governors, which empowered the ACS Board of Regents in February 2018 to approve a nine-point action plan including gun control. In addition, the ACS joined other medical organizations to produce a position statement to reduce preventable injuries from firearm violence, and signed onto a 75-member coalition letter spearheaded by the American Academy of Pediatrics to urge Congress to provide $50 million for CDC firearm research.<br> <br> One of the nine ACS Regent action items emphasized overturning the Dickey Amendment, which restricts funding for gun violence research. Soon after the ACS statement was made public, Health and Human Services Secretary Alex Azar II surprisingly announced that CDC funding for gun violence research would be permissible.<br> <br> What more can we as surgeons do to further affect this public health crisis? Just as former Surgeons General Luther Terry and C. Everett Koop held Big Tobacco accountable for the deaths of 20 million Americans, the next steps could include a U.S. surgeon general&rsquo;s report on the magnitude of firearm injuries across America. The ACS could assist in initiating and expediting the completion of that report, which over the long term, could reframe the conversation about the U.S. firearm problem into one focused on public health.<br> <br> Academic surgery programs can also play a key role in this campaign. Every department of surgery should feature a grand rounds on firearm injury prevention to educate surgeons how to discuss safe firearm storage with patients, and how to recognize mental health illness that may be a precursor to firearm violence. The ACS should partner with the American Medical Association and all other specialties that treat gunshot victims to publish joint statements on firearm violence prevention in their subspecialty journals. <em>JAMA Surgery</em>, <em>Surgery</em>, <em>Annals of Surgery</em>, and <em>Journal of the American College of Surgeons </em>should consider publishing theme issues about the treatment of firearm injuries, along with solutions to bring an end to the suffering and lives lost.<br> <br> In tobacco control, after decades of public health efforts to end the epidemic of death and disability from cigarette smoking, the final overarching strategy to permanently end the smoking-related health harms has become known as the Tobacco Endgame. A key to success in tobacco control was the Tobacco Master Settlement Agreement of 1998. To accelerate the path toward a firearm endgame, a collaborative effort by attorneys general across multiple states could focus on recouping a portion of the direct health care expenses for gun-related injuries (estimated between $7 and $9 billion) from firearm manufacturers. If control of the House of Representatives is flipped in the November elections, a Democratic majority could convene congressional hearings about new legislation in 2019. The ACS could then support Capitol Hill efforts to enforce the bump stock ban proposed by the Bureau of Alcohol, Tobacco, and Firearms and Explosives and the Department of Justice, and repeal the Protection of Lawful Commerce in Arms Act that grants immunity to the gun industry from lawsuits.<br> <br> In 1992, Dr. Koop argued in his editorial &ldquo;Time to Bite the Bullet Back&rdquo; (<em>JAMA </em>1992;267[22]:3075-3076) that violence is a public health issue that can be more effectively addressed by an interdisciplinary approach. We have now seen remarkable forward progress within the ACS on the topic of firearm violence prevention, which has evolved to a balance between individual rights and public health. It is important for the ACS to continue to lead this important discussion. A &ldquo;Prevent the Bleed&rdquo; campaign operationalizing the regents&rsquo; plan should join the ACS &ldquo;Stop the Bleed&rdquo; program, which is providing important training shown to save lives. This double-pronged strategy to both prevent and treat firearm injuries could move our country toward a safer society, and end the epidemic of preventable firearm morbidity and mortality in America.<br> <br> <em>Dr. Maa is the president of the San Francisco Marin Medical Society, and chief of the Division of General and Acute Care Surgery at Marin General Hospital; Dr. Masiakos is an associate professor at Harvard Medical School, and a pediatric general and thoracic surgeon at Massachusetts General Hospital, in Boston.</em> Wed, 20 Jun 2018 16:42:19 Z 2018-06-20 16:42 +00:00 2018-06-20 09:42 -07:00 4401 http://www.sfmms.org/news-publications/sfmms-blog/a-california-appeals-court-on-friday-reinstated-a-law-allowing-terminally-ill-patients-to-end-their-lives.aspx?PostId=4401&tabid=2622 Marin,Medications,News,Politics and Medicine,Primary Care A California Appeals Court On Friday Reinstated a Law Allowing Terminally Ill Patients to End Their Lives <img src="http://www.sfmms.org/Portals/27/assets/images/Blog/California%20Assisted%20Death%20Lawsuit.jpg?ver=2018-06-18-162111-713" align="right" width="250" height="148"> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px;">A state appellate court has stayed the Riverside County Superior Court&rsquo;s judgment issued on May 24, 2018, declaring California&rsquo;s End of Life Option Act void and unconstitutional. Due to the lower court&rsquo;s judgment, physicians had been advised against relying on the Act to prescribe aid-in-dying medication in caring for patients with terminal illnesses. The appellate court&rsquo;s stay effectively reinstates the California&rsquo;s aid-in-dying law for the time-being, while the courts consider the constitutional questions surrounding the Act.</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px;">The California Attorney General&rsquo;s Office requested the stay to alleviate the confusion caused by the Act&rsquo;s invalidation. Edward Damrose, M.D., chief of staff at Stanford Health Care hospital and clinics, submitted a supporting declaration and stated that the &ldquo;uncertainty over the Act is disrupting and impeding the ability of physicians to care for terminally-ill patients,&rdquo; and that a stay is needed to &ldquo;afford more time to physicians to transition their practice and treatment of terminally-ill patients.&rdquo; Fourteen other declarations were submitted by terminally-ill patients, other physicians and state officials. &ldquo;It is clear that, without a stay,&rdquo; the Attorney General argued, &ldquo;terminally ill patients will suffer great harm, and some will be forever foreclosed from benefiting from any relief that this Court might eventually provide in a decision on the merits.&rdquo;</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px;">While the Act currently remains in full force and effect due to the appellate court&rsquo;s stay order, the Act&rsquo;s fate ultimately remains unresolved. Under the California Constitution, the legislature has authority to pass laws in a special legislative session only if they fall within, or are reasonably related to, the scope of a governor&rsquo;s proclamation calling for the special session. The&nbsp;<a href="http://www.cmanet.org/news/detail/?article=end-of-life-options-act-invalidated-state-ag" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" target="_blank"><strong>lower court&rsquo;s judgment</strong></a>&nbsp;reasoned that the Act was unconstitutional because it was not reasonably related to the health care issues that were the subject of Governor Brown&rsquo;s proclamation for a special session in fall 2015. The appellate court has ordered full briefing on this constitutional question to be completed by July 25, 2018. Oral argument will then be scheduled and a decision from the appellate court can be expected within 30-45 days thereafter.</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px;">For more information, or if you would like to discuss the potential impact of the trial court&rsquo;s decision on your practice, contact the California Medical Association&rsquo;s Legal Information Line at (800) 786-4262 or<strong><a href="mailto:%20legalinfo@cmanet.org" class="ApplyClass">&nbsp;</a><a href="mailto:%20legalinfo@cmanet.org" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" class="ApplyClass">legalinfo@cmanet.org</a>.</strong></p> <p><span></span></p> Tue, 19 Jun 2018 16:36:43 Z 2018-06-19 16:36 +00:00 2018-06-19 09:36 -07:00 4400 http://www.sfmms.org/news-publications/sfmms-blog/are-you-ready-to-check-cures.aspx?PostId=4400&tabid=2622 CMA,CURES,News,Physician Resource Are you ready to check CURES? <h2 class=""><span style="color: rgb(0, 112, 192);">Starting October 2, all physicians must consult database before prescribing controlled substances</span></h2> <p class="">By Katherine Boroski</p> <img src="http://www.sfmms.org/Portals/27/assets/images/Blog/cures-doj-dca-logos.jpg?ver=2016-06-24-090011-953" align="right"> <p class="" style="margin-bottom: 15pt;">Effective October 2, 2018, physicians must&nbsp;<a href="https://cures.doj.ca.gov/" target="_blank"><strong>consult California&rsquo;s prescription drug monitoring database</strong></a>&nbsp;(the Controlled Substance Utilization Review and Evaluation System, or CURES) &ndash; prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be&nbsp;<a href="https://cures.doj.ca.gov/registration/confirmEmailPnDRegistration.xhtml" target="_blank"><strong>registered</strong></a>&nbsp;to use CURES.</p> <p class="" style="margin-bottom: 15pt;">Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload.</p> <p class="" style="margin-bottom: 15pt;">On April 2, 2018&mdash;two years after the law was enacted&mdash;DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018.</p> <h3 class="" style="margin-bottom: 15pt;"><span style="color: rgb(192, 0, 0);">What Physicians Need to Know</span></h3> <p class="">Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient&rsquo;s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.</p> <p class="">The law provides, however, that the requirement to consult CURES would&nbsp;not&nbsp;apply if doing so would result in the patient&rsquo;s inability to obtain a prescription in a timely manner and adversely impact the patient&rsquo;s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply.&nbsp;</p> <p class="" style="margin-bottom: 15pt;">Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are:</p> <ul style="margin-top: 0in;"> <li class="" style="color: rgb(58, 58, 58);">Admitted to a facility for use while on the premises;</li> <li class="" style="color: rgb(58, 58, 58);">In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply;</li> <li class="" style="color: rgb(58, 58, 58);">As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or</li> <li class="" style="color: rgb(58, 58, 58);">Receiving hospice care.</li> </ul> <p>In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.</p> <span style="color: rgb(192, 0, 0);"><strong> <h3><span style="color: rgb(192, 0, 0);">CMA Fights for CURES Protections</span></h3> </strong> </span> <p class="" style="margin-bottom: 15pt;">CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 481, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient&rsquo;s medical record, are not out of compliance with the CURES statute.</p> <p class="" style="margin-bottom: 15pt;"><strong><span style="font-size: 13px;">Save the Date: CURES webinar with DOJ on 8/22</span></strong></p> <p style="margin: 0in 0in 0.0001pt;">CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet.org/events.</p> <p style="margin: 0in 0in 0.0001pt;">&nbsp;</p> <p style="margin: 0in 0in 0.0001pt;"><strong><span style="font-size: 13px;">For More Information</span></strong></p> <p class="">For more information, see CMA On-Call document #3212,&nbsp;<a href="http://www.sfmms.org/news-publications/sfmms-blog.aspx?ctl=Admin_Posts_AddEditPost&amp;mid=1400&amp;PostID=4400" target="_blank"><strong>&ldquo;</strong></a><a href="http://www.sfmms.org/news-publications/sfmms-blog.aspx?ctl=Admin_Posts_AddEditPost&amp;mid=1400&amp;PostID=4400" target="_blank"><strong>California&rsquo;s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES)</strong></a>.&rdquo; On-Call documents are free to members in CMA's online resource library at&nbsp;<a href="http://www.sfmms.org/news-publications/sfmms-blog.aspx?ctl=Admin_Posts_AddEditPost&amp;mid=1400&amp;PostID=4400" target="_blank"><strong>www.cmanet.org/cma-on-call</strong></a><strong>.</strong>Nonmembers can purchase documents for $2 per page.</p> <p class="">Additional Resources:</p> <p class="">&middot;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://website: oag.ca.gov/cures" target="_blank"><strong>CURES</strong></a></p> <p class="">&middot;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://oag.ca.gov/cures/faqs" target="_blank"><strong>CURES FAQ</strong></a></p> <p class="">&middot;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://mbc.ca.gov/cures" target="_blank">&nbsp;<strong>Medical Board CURES webpage</strong></a></p> <p class="">&middot;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong>&nbsp;<a href="http://www.sfmms.org/news-publications/cmanet.org/cures" target="_blank">CMA CURES webpage</a></strong></p> <p class="">&middot;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<strong><a href="http://cmanet.org/safe-prescribing" target="_blank">CMA Safe Prescribing webpage</a></strong>:&nbsp;</p> <p class="">CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at&nbsp;(916) 227-3843&nbsp;or<strong>&nbsp;</strong><a href="mailto:cures@doj.ca.gov." target="_blank" class="ApplyClass"><strong>cures@doj.ca.gov</strong></a><a href="http://www.sfmms.org/news-publications/sfmms-blog.aspx?ctl=Admin_Posts_AddEditPost&amp;mid=1400&amp;PostID=4400" target="_blank">.</a></p> Mon, 18 Jun 2018 22:00:29 Z 2018-06-18 22:00 +00:00 2018-06-18 15:00 -07:00 4395 http://www.sfmms.org/news-publications/sfmms-blog/help-the-california-future-health-workforce-commission-with-a-short-survey.aspx?PostId=4395&tabid=2622 Survey Help The CFHWC With A Short Survey <h2><span style="color: rgb(0, 176, 240);">Our Health Workforce Needs You&nbsp;</span></h2> <img src="http://www.sfmms.org/Portals/27/assets/images/Blog/California%20Health%20line.PNG?ver=2018-06-14-105715-903" style="border-width: 3px; border-style: solid; border-color: rgb(242, 242, 242);" align="right" width="400" height="70"> <p><span style="color: rgb(63, 63, 63);">Last summer, CHCF helped to launch the <strong><a href="http://redirect.chcf.org/c/4/?T=NTIzMTM2OTY%3AMDItYjE4MTY0LWJmNTI1YjExOWNlMzQ3OGRiMzA2MzRiZDcyZjAzZWVh%3AZWhlbmtlQHNmbXMub3Jn%3AY29udGFjdC1jNDE0NWEyN2E0MjllNjExOTQwMjAwNTA1NmJhNWEzNi01YjQ4NWMyMmFhMTc0ZWJiODQ3Y2Q2NWQyN2M3NzQ4OQ%3AZmFsc2U%3AMw%3A%3AaHR0cHM6Ly93d3cuY2hjZi5vcmcvYmxvZy9mdXR1cmUtaGVhbHRoLWNvbW1pc3Npb24tdG8tbGF5LWdyb3VuZHdvcmstZm9yLWEtbW9kZXJuLWhlYWx0aC13b3JrZm9yY2UvP19jbGRlZT1aV2hsYm10bFFITm1iWE11YjNKbiZyZWNpcGllbnRpZD1jb250YWN0LWM0MTQ1YTI3YTQyOWU2MTE5NDAyMDA1MDU2YmE1YTM2LTViNDg1YzIyYWExNzRlYmI4NDdjZDY1ZDI3Yzc3NDg5JmVzaWQ9NDJiMzNkOTUtMWY2Zi1lODExLTgxNTYtZTAwNzFiNmFjMTYx&amp;K=-4tUocRCwyBqU5UsCNhZjw" target="_blank">California Future Health Workforce Commission</a></strong>. It brought together top leaders from education and health care to ensure that California&rsquo;s workforce will be able to meet the health needs of its people. The Commission has been working hard since then to develop a blueprint for action. Now, it needs YOUR help.&nbsp;</span><strong style="font-size: 0.74em;">.</strong></p> <strong><span style="font-size: 16px; color: rgb(192, 0, 0);">Share Your Expertise</span></strong><br> <span style="color: rgb(63, 63, 63);"> The Commission is asking key stakeholders like you to weigh in on its draft strategy so far.</span> <a href="http://redirect.chcf.org/c/4/?T=NTIzMTM2OTY%3AMDItYjE4MTY0LWJmNTI1YjExOWNlMzQ3OGRiMzA2MzRiZDcyZjAzZWVh%3AZWhlbmtlQHNmbXMub3Jn%3AY29udGFjdC1jNDE0NWEyN2E0MjllNjExOTQwMjAwNTA1NmJhNWEzNi01YjQ4NWMyMmFhMTc0ZWJiODQ3Y2Q2NWQyN2M3NzQ4OQ%3AZmFsc2U%3ANQ%3A%3AaHR0cHM6Ly93d3cuc3VydmV5bW9ua2V5LmNvbS9yL1RRTUpTUFA_X2NsZGVlPVpXaGxibXRsUUhObWJYTXViM0puJnJlY2lwaWVudGlkPWNvbnRhY3QtYzQxNDVhMjdhNDI5ZTYxMTk0MDIwMDUwNTZiYTVhMzYtNWI0ODVjMjJhYTE3NGViYjg0N2NkNjVkMjdjNzc0ODkmZXNpZD00MmIzM2Q5NS0xZjZmLWU4MTEtODE1Ni1lMDA3MWI2YWMxNjE&amp;K=0eKpgUgzGBj2x4af2olvgA" target="_blank"><strong>Please take a survey to share your feedback.</strong></a><br> <br> <strong><span style="font-size: 16px; color: rgb(192, 0, 0);">We Know You Are Busy</span></strong><br> <span style="color: rgb(63, 63, 63);"> There are some survey questions that concern overall health workforce and education needs. Other questions deal specifically with one of the Commission&rsquo;s three priority focus areas: (1) primary care and prevention, (2) behavioral health, and (3) aging population. You may choose to answer just a few questions, provide input on selected strategies, or review them all, depending on your interest. All feedback is welcome. </span><br> <br> <strong><span style="font-size: 16px; color: rgb(192, 0, 0);">Share with Your Partners!</span></strong><br> <span style="color: rgb(63, 63, 63);"> Please share the survey widely. The more participants there are, and the more diverse they are, the more grounded the Commission&rsquo;s recommendations will be in the knowledge and experience of the field as a whole. </span><br> <br> <a href="http://redirect.chcf.org/c/4/?T=NTIzMTM2OTY%3AMDItYjE4MTY0LWJmNTI1YjExOWNlMzQ3OGRiMzA2MzRiZDcyZjAzZWVh%3AZWhlbmtlQHNmbXMub3Jn%3AY29udGFjdC1jNDE0NWEyN2E0MjllNjExOTQwMjAwNTA1NmJhNWEzNi01YjQ4NWMyMmFhMTc0ZWJiODQ3Y2Q2NWQyN2M3NzQ4OQ%3AZmFsc2U%3ANg%3A%3AaHR0cHM6Ly93d3cuc3VydmV5bW9ua2V5LmNvbS9yL1RRTUpTUFA_X2NsZGVlPVpXaGxibXRsUUhObWJYTXViM0puJnJlY2lwaWVudGlkPWNvbnRhY3QtYzQxNDVhMjdhNDI5ZTYxMTk0MDIwMDUwNTZiYTVhMzYtNWI0ODVjMjJhYTE3NGViYjg0N2NkNjVkMjdjNzc0ODkmZXNpZD00MmIzM2Q5NS0xZjZmLWU4MTEtODE1Ni1lMDA3MWI2YWMxNjE&amp;K=uhbYRhctRAfJBNNRUBXdfg" target="_blank"><strong>Take the survey.</strong></a><br> <br> <br> Thu, 14 Jun 2018 18:55:00 Z 2018-06-14 18:55 +00:00 2018-06-14 11:55 -07:00 4394 http://www.sfmms.org/news-publications/sfmms-blog/cma-defeats-dangerous-rate-setting-proposals.aspx?PostId=4394&tabid=2622 CMA CMA Defeats Dangerous Rate Setting Proposal <h2><span style="color: rgb(0, 176, 240);">AB 3087 would have decimated California&rsquo;s health care delivery system</span></h2> <p>In late May, the California Medical Association (CMA) killed a reckless legislative proposal that would have put a new government bureaucracy in charge of health care. Assembly Bill 3087 (Kalra) would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. By unilaterally setting the price for all medical services, the bill would have essentially eliminated the commercial health care market in California.</p> <h3><span style="color: rgb(192, 0, 0);">A Groundswell of Physician Opposition</span></h3> <p>Key to the bill&rsquo;s demise was a groundswell of physician opposition. Through CMA&rsquo;s Grassroots Action Center, thousands of physician members contacted their legislators because AB 3087 would have:</p> &bull; Decimated California&rsquo;s health care delivery system.<br> &bull; Disrupted care and limited choice for millions of California patients.<br> &bull; Caused 175,000 health care workers to lose their jobs.<br> &bull; Forced hospitals to close and pushed health care providers into early retirement<br> &bull; Caused a &ldquo;brain drain&rdquo; of talented medical students and residents fleeing California for more ideal working conditions.<br> <br> <h3><span style="color: rgb(192, 0, 0);"> The Wrong Answer to a Real Problem<br> </span></h3> <p>This dangerous rate setting proposal would have also moved California away from value-based care and universal access, backwards to an antiquated fee-for-service model that discourages contracting and stifles innovation. Instead of addressing the underlying issues, this bill would have forced hospitals to close, pushed health care providers into early retirement and caused a &ldquo;brain drain&rdquo; of talented medical students and residents fleeing California for more ideal working conditions.</p> <h3><span style="color: rgb(192, 0, 0);"> AB 3087 Did Not Address Medi-Cal Rates </span></h3> California&rsquo;s Medi-Cal rates don&rsquo;t come close to covering the cost of providing care&mdash;meaning that physicians lose money for every Medi-Cal patient they serve. Due to low Medi-Cal rates, physicians must make up revenue through their commercial contracts to keep their doors open. Because the AB 3087 proposal did nothing to address California&rsquo;s sub-standard Medi-Cal rates, hospitals and health care providers would have continued to be underpaid by these governmental programs, putting them in an untenable situation. <br> <br> <h3><span style="color: rgb(192, 0, 0);"> AB 3087 Would Have Driven California&rsquo;s Physicians Out</span></h3> &ldquo;AB 3087 would have caused an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,&rdquo; said Dr. Mazer. &ldquo;When I look at the economics of my own practice, it&rsquo;s enough to tell me that I could not survive that environment and continue to see Medi-Cal patients. And probably at this stage of my career, it would drive me out of practice earlier that I might otherwise."<br> <br> <h3><span style="color: rgb(192, 0, 0);"> California Physicians: Thank You for Your Support</span></h3> "I want to thank each of you for your support and dedication to CMA,&rdquo; said Dr. Mazer. &ldquo;We could not have dealt this bill such a resounding defeat without the united voices of our physician members. Together, we stand stronger." Wed, 13 Jun 2018 23:23:47 Z 2018-06-13 23:23 +00:00 2018-06-13 16:23 -07:00 4390 http://www.sfmms.org/news-publications/sfmms-blog/new-parkinsons-reporting-requirements-take-effect-july-1.aspx?PostId=4390&tabid=2622 News,Public Health Required Parkinson's Reporting Starting July 1, 2018 <div style="color: rgb(58, 58, 58); width: 314px; margin: 0px 0px 15px 15px; padding: 0px; border: 0px; text-align: center;"></div> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px; text-align: left;">Health care providers diagnosing or providing treatment to Parkinson&rsquo;s disease patients will be required to report each case of Parkinson&rsquo;s disease to the California Department of Public Health (CDPH) beginning July 1, 2018. All providers who will be required to report must first register with CDPH through the designated provider gateway, which is available on the CDPH&nbsp;<strong><a href="http://www.cdph.ca.gov/parkinsons" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" target="_blank">Parkinson's Disease web page</a>.</strong></p> <em style="color: rgb(58, 58, 58); font-size: 11.84px; text-align: center; margin: 0px; padding: 0px; border: 0px;"><a href="http://www.cmanet.org/files/images/alert-graphics/infographics/2018-macra-rule-infographic.jpg" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;"><img src="http://www.sfmms.org/Portals/27/assets/images/Blog/cdph-parkinsons-reg.png?ver=2018-06-12-105607-597" style="border-width: 5px; border-style: solid; border-color: rgb(255, 255, 255);" align="right" width="300" height="194"></a></em> <div> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px; text-align: left;">In April, CDPH issued its initial version of the&nbsp;<a href="https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDSRB/CDPH%20Document%20Library/CPDR/CPDRImplementationGuide_v1.1.docx" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" target="_blank"><strong>California Parkinson&rsquo;s Disease Registry Implementation Guide</strong></a>&nbsp;that details how health care providers can comply with the reporting mandate. The guide, available at<strong>&nbsp;</strong><a href="http://www.cdph.ca.gov/parkinsons" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" target="_blank"><strong>www.cdph.ca.gov/parkinsons</strong></a>, provides information for reporting Parkinson&rsquo;s disease data, outlines who is required to report, the timeline for reporting, and the manual and electronic methods for transmitting data to the California Parkinson&rsquo;s Disease Registry.</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px; text-align: left;">Since the issuance of the initial implementation guide, the California Medical Association (CMA) and other stakeholders have expressed concerns to CDPH about the scope, breadth and timing of this new reporting obligation. CDPH is taking a number of steps in response to those concerns. CDPH will release an updated version of its implementation guide, as well as slide presentations and updated FAQs in early June. CDPH will also continue to work closely with physician offices, medical groups and large health systems to optimize integration of the reporting interface with electronic health record systems. Manual entry will remain an option for all providers.</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px; text-align: left;">The data collected will be used to measure the incidence and prevalence of&nbsp;Parkinson&rsquo;s disease. California&rsquo;s large and diverse population makes it ideal for expanding the understanding of this disease to improve the lives of Parkinson&rsquo;s patients.</p> <p style="color: rgb(58, 58, 58); margin-bottom: 20px; padding: 0px; border: 0px; text-align: left;">For more information, see&nbsp;<a href="https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDSRB/CDPH%20Document%20Library/CPDR/AtGlance_Parkinson_WebPost_v2.pdf" style="color: rgb(0, 86, 156); margin: 0px; padding: 0px; border: 0px;" target="_blank"><strong>CDPH&rsquo;s fact sheet</strong></a>, which provides more details related to the new law.</p> </div> Tue, 12 Jun 2018 18:21:01 Z 2018-06-12 18:21 +00:00 2018-06-12 11:21 -07:00 4389 http://www.sfmms.org/news-publications/sfmms-blog/physician-volunteer-telehealth-opportunities-with-the-maven-project.aspx?PostId=4389&tabid=2622 News,Volunteer Physician Volunteer Telehealth Opportunities With The MAVEN Project <h2>The MAVEN Project needs your expertise.</h2> <p><img width="250" height="176" align="right" class="ml-xl mb-xl" alt="Jill Einsten, MD" src="http://www.sfmms.org/Portals/27/620-ma-state-news-maven-brigell.jpg?ver=2018-06-06-145438-413"></p> <p>Jill Einstein, MD, Director of Physician Engagement for The MAVEN Project (Medical Alumni Volunteer Expert Network) which was founded by Laurie Green, MD, a San Francisco obstetrician-gynecologist and former board president of the Harvard Medical Alumni Association. The MAVEN Project connects physician volunteers with U.S. medical clinics caring for under served patient populations by supporting their primary care providers via telehealth technology (video conference, email and phone). Our physician volunteers provide <strong>advisory consultations</strong> (peer to peer advice on de-identified clinical cases or population health),<strong> educational sessions</strong> and <strong>mentoring.</strong></p> <p>Jill Einstein, MD, is looking to engage recently retired, semi-retired and active physicians with these volunteer opportunities, which are meaningful, convenient and flexible.</p> <ul> <li>Adult and pediatric specialists, as well as primary care physicians, are sought</li> <li>Active or volunteer medical licenses are accepted&nbsp;</li> <li>Physician volunteers may be located anywhere in the U.S.</li> <li>Minimum volunteer hours is 4 hours per month</li> <li>Malpractice insurance for MAVEN Project-related activities is provided</li> </ul> <h4 style="color: rgb(192, 0, 0); "> Enjoy reading about The MAVEN Project in the news</h4> <p> <a href="https://states.aarp.org/fl-maven-project-allows-docs-to-give-back/" target="_blank"> Project Allows Doctors to Give Back</a>,&nbsp;The AARP Bulletin/AARP Florida, by Michelle Cerulli McAdams, May 1, 2018<br> <a href="http://www.the-rheumatologist.org/article/telehealth-is-helping-the-underserved/" target="_blank"> <strong>Telehealth Is Helping the Underserved</strong></a>, The Rheumatologist, by Linda Childers, April 26, 2018<br> <a href="https://www.healthcarelawtoday.com/2018/04/26/making-a-tele-difference-by-using-telemedicine-to-aid-medically-vulnerable-populations/" target="_blank"> <strong>Making a &ldquo;Tele-Difference&rdquo; by Using Telemedicine to Aid Medically Vulnerable Populations</strong></a>, Foley &amp; Lardner LLP, April 26, 2018<br> <a href="https://www.sfgate.com/visionsf/article/Laurie-Green-keeps-retired-doctors-working-with-12622000.php"> <strong>Laurie Green keeps retired doctors working with health clinics for need</strong>y</a>, SFGATE (SF Chronicle), February 17, 2018</p> <p>If you or some one you know is interested, please fill out a Physician Volunteer Inquiry Form at their website.&nbsp;<a href="http://http//www.mavenproject.org/get-involved/volunteer-physician/volunteer-as-a-physician/" target="_blank"><strong>http://www.mavenproject.org/get-involved/volunteer-physician/volunteer-as-a-physician/</strong></a></p> Wed, 06 Jun 2018 21:44:07 Z 2018-06-06 21:44 +00:00 2018-06-06 14:44 -07:00 4388 http://www.sfmms.org/news-publications/sfmms-blog/san-francisco-voters-uphold-ban-on-flavored-tobacco-products-in-big-win-for-kids-over-tobacco-industry.aspx?PostId=4388&tabid=2622 Advocacy,Public Health San Francisco Voters Uphold Ban on Flavored Tobacco Products In Big Win for Kids over Tobacco Industry <h2><span style="color: rgb(0, 112, 192);">Statement of Matthew L. Myers, President, Tobacco-Free Kids Action Fund</span></h2> WASHINGTON, D.C. &ndash; San Francisco voters on Tuesday delivered a truly historic victory for kids and health over the tobacco industry by upholding the city&rsquo;s law banning the sale of flavored tobacco products, including menthol cigarettes. By a 68 percent to 32 percent margin, San Francisco voters overwhelmingly upheld the law. The city&rsquo;s voters rejected a nearly $12 million campaign by the R.J. Reynolds tobacco company aimed at overturning the law and preserving the tobacco industry&rsquo;s ability to target kids with candy-flavored products.<br> <br> San Francisco&rsquo;s groundbreaking law stands &ndash; and will stop the tobacco industry from targeting kids, African Americans and other populations with menthol- and candy-flavored products, as the industry has done for far too long. The San Francisco vote gives a powerful boost to growing efforts around the country to end the sale of flavored tobacco products.<br> <br> R.J. Reynolds spent more than $11.6 million on a self-serving and deceptive campaign to try to overturn the law because they want to sustain the pipeline of kids the tobacco industry needs to survive. Reynolds knows that menthol and other flavors &ndash; including candy flavors &ndash; play a key role in attracting kids to start and continue using tobacco products. Today&rsquo;s vote shows that voters can and will see through industry lies and stand up for kids.<br> <br> The Tobacco-Free Kids Action Fund was proud to join the many organizations and individuals supporting the Yes on Prop E campaign (see list of supporters at <a href="https://sfkidsvsbigtobacco.com/" target="_blank"><strong>sfkidsvsbigtobacco.com</strong></a>). We especially thank Michael R. Bloomberg for his exceptional leadership in supporting the Yes on E campaign, Supervisor Malia Cohen for her leadership on the Board of Supervisors and the African American Tobacco Control Leadership Council for its role throughout the campaign. <p> </p> <h3><span style="color: rgb(192, 0, 0);"> BACKGROUND</span></h3> The San Francisco Board of Supervisors voted unanimously on the bill introduced by Supervisor Malia Cohen in June 2017 to end the sale of flavored tobacco products, including menthol cigarettes. Reynolds subsequently launched a ballot initiative to overturn the law and provided nearly all of the funding for the campaign to do so. <br> <br> Tobacco companies have a long history of developing and marketing flavored tobacco products as &ldquo;starter&rdquo; products that attract kids. Flavors improve the taste and mask the harshness of tobacco products, making them more appealing and easier for kids to try the product and ultimately become addicted.<br> <br> As youth smoking rates have fallen, manufacturers have sought to entice kids with <a href="https://www.tobaccofreekids.org/microsites/flavortrap/" target="_blank"><strong>a new generation of candy-flavored tobacco products</strong></a>. Electronic cigarettes are sold in thousands of flavors, and flavored cigars make up more than half of the U.S. cigar market. These products come in flavors like gummy bear, cotton candy and banana smash that clearly appeal to kids, and they&rsquo;re often colorfully packaged to look just like candy and other kid-friendly products.<br> <br> In addition, tobacco companies continue to aggressively market menthol cigarettes to kids, African Americans and other demographic groups. R.J. Reynolds makes Newport, the best-selling menthol cigarette brand and the <a href="https://www.cdc.gov/mmwr/volumes/67/wr/mm6704a3.htm?s_cid=mm6704a3_w" target="_blank"><strong>second most popular cigarette brand among youth smokers</strong></a>.<br> <br> The evidence is clear that flavors play an important role in youth initiation and continued use of tobacco products. <a href="https://media.jamanetwork.com/news-item/survey-of-youth-finds-that-majority-who-used-tobacco-started-with-flavored-product/" target="_blank"><strong>A government study published in JAMA</strong></a> found that that 81 percent of kids who have ever tried tobacco started with a flavored product, and 80 percent of current youth tobacco users had used a flavored product in the past month.<br> <br> Youth smokers are also more likely to use menthol cigarettes than any other age group. Over half (54 percent) of youth smokers ages 12-17 use menthol cigarettes, compared to less than one-third of smokers ages 35 and older. Menthol use is even higher among African-American youth: seven out of 10 African-American youth smokers smoke menthol cigarettes. The popularity of menthol cigarettes among African Americans and youth is a direct result of a decades-long marketing campaign by the tobacco industry. The industry&rsquo;s targeting has had a destructive impact as African Americans smoke menthol cigarettes at high rates and quit smoking at lower rates, and African-American men have high death rates from lung cancer. A <a href="https://www.fda.gov/downloads/ucm361598.pdf" target="_blank"><strong>comprehensive report</strong></a> by the U.S. Food and Drug Administration, issued in 2013, found that menthol cigarettes led to 1) increased smoking initiation among youth and young adults; 2) greater addiction; and 3) decreased success in quitting smoking. Wed, 06 Jun 2018 20:51:37 Z 2018-06-06 20:51 +00:00 2018-06-06 13:51 -07:00 4383 http://www.sfmms.org/news-publications/sfmms-blog/op-ed-by-mark-leno.aspx?PostId=4383&tabid=2622 Advocacy,Guest Blog Op Ed by Mark Leno <img src="http://www.sfmms.org/LinkClick.aspx?fileticket=z74XwjjJi9Y%253d&amp;portalid=27" class="img-border-right" width="150" height="221" align="right">By Mark Leno <br> <br> Big Tobacco is at it again &mdash; marketing to children about deadly addiction. Thanks to Prop E, the industry&rsquo;s newest ads hoodwink voters by censuring the proposition and failing to disclose any details about its objective. <br> <br> This is because Big Tobacco doesn&rsquo;t want voters to know the truth. Prop E upholds San Francisco&rsquo;s common sense ban on the sale of candy-flavored tobacco products designed specifically to catalyze an interest in smoking among young people. The truth is that Big Tobacco knows most San Franciscans are likely to stand with American Cancer Society, the American Heart Association, and the Alice B. Toklas Democratic Club in saying Yes on E. <br> <br> The messaging against Prop. E is largely bankrolled by a single tobacco company, R.J. Reynolds. This company has already poured nearly $12 million dollars into the campaign. But while the ads might be new, the industry&rsquo;s motivation is not. Tobacco companies care only about creating the next generation of nicotine addicts. <br> <br> Now, this tobacco company &mdash; a major supporter of Trump&rsquo;s Republican Party &mdash; is trying to overturn a decision by our democratically-elected Board of Supervisors in the most progressive city in the nation. <br> <br> Thanks to decades of successful smoking prevention campaigns, the number of smokers in the United States continues to decline. Between 2005 and 2014, the percentage of Americans who smoke dropped from 20.9% to 16.8%, according to the Centers for Disease Control (CDC). Tobacco prevention programs are a victory for the health of millions of Americans. But it&rsquo;s bad news for Big Tobacco&rsquo;s bottom line. The more smoking, disease and death are reduced, the less money Big Tobacco rakes in. <br> <br> Recently, the tobacco industry created a cynical strategy to hook a new generation on nicotine: products designed to look and taste like candy. The gateway to nicotine addiction now comes disguised as popular candy flavors such as gummy bear, cotton candy, Sour Patch Kids, and peanut butter cup. <br> <br> At first glance, it&rsquo;s impossible to tell the difference between a nicotine-laced candy and the pure, popular kids&rsquo; candy brands. But just one look at these products &mdash; such as Double Stuffed Oreo flavor and Nilla Vapers &mdash; and there&rsquo;s no question about the target market: candy flavored tobacco targets kids. And it works. Candy-flavored tobacco products have become an epidemic in schools across the nation. <br> <br> One product, a vaping device disguised as a USB cartridge made by San Francisco-based JUUL, is so popular with children that they refer to vaping as &ldquo;juuling.&rdquo; <br> <br> &ldquo;I can&rsquo;t stop,&rdquo; said one JUUL-addicted high schooler profiled by the New York Times. At an age when he should be most worried about prom, his principal is recommending a nicotine patch. Such stories are in part why San Francisco Supervisors unanimously passed a law to ban flavored nicotine. They recognize the importance of protecting children from the dangerous tactics of tobacco companies. <br> <br> Campaigns like these from the tobacco industry are nothing new. In the 1950s and 1960s, tobacco companies ran their ads during shows popular with children. They even had Fred Flintstone smoking cigarettes and declaring, &ldquo;Winston tastes good like a cigarette should.&rdquo; <br> <br> Flavor has always been a key part of the Big Tobacco playbook as has targeting specific groups of people. In the 1970s and 1980s, tobacco companies carried out an advertising strategy to target African Americans with menthols. <br> <br> In 2000, leaked documents exposed &ldquo;Project SCUM,&rdquo; a plan by R.J. Reynolds Tobacco Company to heavily market nicotine addiction to the LGBT community and homeless people. (Clever acronym, R.J.) When cigarettes are the number one cause of preventable death in California, when people who smoke cigarettes are 20 times more likely to develop lung cancer than nonsmokers, when only 12% of teen smokers who tried to quit were able to do so successfully &mdash; we have to take a stand. <br> <br> Tobacco companies don&rsquo;t want to be your friend. They want to kill you. Remember this when voting on June 5. Please join us in voting Yes on E, and in saying &ldquo;no thanks&rdquo; to candy-flavored carcinogens pushed by Big Tobacco. Tue, 29 May 2018 18:08:35 Z 2018-05-29 18:08 +00:00 2018-05-29 11:08 -07:00