Marin Medical Society

MMS News Briefs


October 2009

Physician volunteers needed for H1N1 Alternate Care Site

MMS and the Marin County Public Health Department areseeking 30-40 physician volunteers to staff an H1N1 Alternate Care Site (ACS),in case all local hospitals are filled beyond functional surge capacity by theH1N1 pandemic. If this scenario occurs, physician volunteers will be needed for8-hour shifts at the ACS, which will function around the clock.

To volunteer for theACS, contact Dr. Peter Bretan by e-mail at In youre-mail, please list your specialty, your cell phone number and your e-mailaddress. You can also reach Dr. Bretan by phone at 382-0339 (voicemail) or892-0904 (office).

Physicians from all specialties are encouraged to volunteerfor the ACS, a key component of the H1N1 pandemic disaster response plandeveloped by Public Health and MMS earlier this year. Physician staffing at theACS will be provided by the MMS Disaster Preparedness Physician VolunteerGroup, which Dr. Bretan is organizing. Even if the group is not needed for H1N1response, it may be required for future disasters.

“The most important point is to have a core of doctors inMarin who are able to take care of any type of disaster situation,” said Dr.Bretan. “This is doable.”

To repeat, physician volunteers for the ACS should contactDr. Bretan at 382-0339 or 892-0904.

Physicians invited to lunch with State Senator Leno on Oct. 21

All MMS and Sonoma County Medical Association members areinvited to a brown-bag lunch with State Senator Mark Leno on Wednesday, Oct. 21,in Burns Hall at Petaluma Valley Hospital. The lunch, scheduled for 12:30 to1:30 p.m., will allow MMS and SCMA members to speak with Leno regarding currenthealth care legislation.

Petaluma Valley Hospital is located at 400 N. McDowell Petaluma, near the Washington Blvd. exit from Highway 101. To RSVP, contact RachelPandolfi at 707-525-4375 or

CMA’s Legislative Hot List at a summary and current status of CMA-sponsored bills in the CaliforniaLegislature, as well as the progress of other significant legislation followed byCMA’s Center for Government Relations. For more information on a specific bill,contact the lobbyist identified at the end of each bill summary.

MMS membership up 8% since 2008; invoices in the mail

Despite the recession and continuing turmoil in the healthcare system, membership in MMS has increased 8% since 2008. The current totalis 280 active members and 52 retired. Membership in CMA increased this year aswell, rising about 1% from 33,648 to 34,088, including retired members.

MMS members are reminded to return their 2010 Marin CountyPhysician Directory verification forms, which were mailed in September alongwith dues invoices for next year. Members who pay their dues by Dec. 31 qualifyfor a 5% discount. Payments need to be at MMS by Dec. 31; there is no grace period.

If you need a copy of your invoice or have any questionsabout dues, contact Jessica Whittom at jessica@marinmedicalsociety.orgor 924-3891. Nonmember physicians can complete a simple online application forMMS and CMA at

New CPT codes for H1N1 vaccine, but billing questions remain

AMA has published a new CPT code specific to H1N1 vaccine administration(90470) and revised existing code 90663 to include the H1N1 vaccine. The newCPT codes are effective immediately. The Centers for Medicare and MedicaidServices (CMS) has also created unique HCPCS codes for administration of theH1N1 vaccine (G9141) and for the vaccine itself (G9142).

Because the vaccine is provided free of charge by thefederal government, physicians will not be reimbursed for the vaccine itself.Practices have been instructed to submit claims for the vaccine, but for zero dollars.This will allow for proper vaccine tracking. Physicians will be reimbursed foradministration of the vaccine.

There continues to be significant uncertainty regardingbilling for H1N1 vaccinations. For example, some payors, clearinghouses, andphysician billing systems may not be able to accommodate a zero dollar charge,and the practice would have to bill vaccine claims with a $0.01 charge. CMS hasyet to clarify that billing $0.01 to accommodate systems that can't process a$0.00 charge would not be considered fraud.

For H1N1 billing questions, contact CMA’s reimbursement helpline at 888-401-5911 or

First doses of H1N1 vaccine to arrive Oct. 7

With H1N1 infections in California now classified as“widespread,” state public health officials have announced that selectedclinics and physician offices will receive small shipments of FluMist nasalspray vaccine by Oct. 7. If you have been identified to receive doses from thisfirst small batch of vaccine, you will be notified a few days before theshipment is set to arrive at your location. Physicians are reminded thatFluMist is not approved for pregnant women, or for patients with chronic healthconditions, weakened immune systems, or a history of asthma.

The first shipments of vaccine to California providers arescheduled to total 400,000 doses. Larger shipments of the vaccine—in both thenasal spray and the traditional injectable form —are expected to arrive laterin October. California is supposed to receive 6.25 million doses by earlyNovember, which should be more than enough to vaccinate all high-risk people.The state should receive 22 million doses by December.

If you have questions about where you fall on the prioritylist for vaccine, contact Marin County Public Health at 473-6007. Vaccinedistribution decisions are being made at the local level based on a number offactors, including the number of patients in high-risk groups.

For more information, visit CMA’s H1N1 resource center at

CMA proposes medical liability amendments to health reform bills

CMA and Californians Allied for Patient Protection havedeveloped amendments to the House and Senate health reform bills that wouldprotect physicians from increased liability. CMA’s proposed amendments wouldensure that physicians are protected if they deviate from any clinicalguidelines produced through clinical effectiveness research and otherprovisions in the health reform legislation.

CMA believes that physicians must be allowed to deviate frompractice guidelines when in their clinical judgment it is in their patient'sbest interest, without being exposed to increased liability. CMA also believesthat data gleaned from such research must not be independently used toestablish standards of care or deny coverage, or be used as evidence in medicalmalpractice cases.

CMA’s amendments would also prevent governmentperformance-based value purchasing decisions—such as nonpayment forhospital-acquired conditions—from being used to create a presumption of medicalnegligence.

Rep. Henry Waxman, who chairs the Energy Commerce Committee,has expressed interest in including the CMA amendments in HR 3200, the Househealth reform bill. CMA has also approached Sen. Feinstein about offering thesechanges as floor amendments on the Senate side.

Three CMA-sponsored bills await signature

Three CMA-sponsored bills have passed the CaliforniaLegislature and now await the governor’s signature:

Unlawful rescission. AB2 (De La Torre) would prevent the practice of health plans and insurerswrongfully rescinding coverage for patients after they become seriously ill.The bill would require insurers to obtain approval from an independent revieworganization before rescinding a patient’s health insurance.

Peer review. AB120 (Hayashi) bill would increase fairness and transparency in the peer reviewsystem, helping to ensure high quality care in California hospitals.

Osteopathicphysicians. SB 606 (Ducheny) would make osteopathic physicians eligible forthe Steven M. Thomson Loan Repayment Program. The program, currently open onlyto MDs, provides medical school loan repayment grants of up to $105,000 inexchange for a three-year service commitment in a medically underserved area ofthe state.

For more information on these and other bills, visit CMA’sLegislative Hot List at


To the Editor:

I attended the August 25th Rep. Lynn Woolsey Town Hallmeeting on health care reform and came away extremely disappointed at thepresent state of affairs. I offer the following 10 points for debate. Myunstated general bias is that individual responsibility and local control arealways more efficient and friendly than centrally imposed solutions. I hopethat my 25 years on the front lines of clinical practice and many years inmedical practice administration allow me some traction with these ideas. These10 improvements probably “gore the ox” of both parties’ sacred constituenciesand therefore I hope have some merit.

1. Individuals whopurchase private health insurance privately should be allowed to get the sametax deductions as small business presently enjoys. This change would allowmore individuals to afford and choose to cover themselves with a healthinsurance policy. We should also encourage businesses to cover additionalworkers through incentives, not sticks (i.e., businesses need to be growing andhiring, not increasing overhead).

2. Force greatercompetition among Big Insurance by allowing companies from out of state toparticipate in contracts across state lines. There are only six majorprivate options in California. Companies must offer at least a basic medicalcoverage plan in each market—one that doesn't force non-health care prioritiesthat create contentiousness, e.g., cosmetic surgery, sex-change operations andabortion coverage (all could be optional, not mandated). More coverage planswould also mean a more competitive marketplace. We should also require insurersto pay a minimum “percentage of premium” for claims to providers andhospitals—say 85+% for all of us who are providing the services, the rest tothe insurer for marketing, profit, executive bonuses, etc.

3. Continue toencourage patient/consumer participation in health care priorities bysupporting HSAs, FSAs and high-deductible policies, where appropriate. Onlyif the consumer has a dollar in the game, will there be oversight of spendingon a grassroots level.

4. All healthinsurance companies must accept people with pre-existing conditions into acommon pool. No excuses. A nonpartisan actuary would assess risk in thispool over community risk rate and allow the pre-existing condition pool toreceive tax incentives or a tax subsidy from the government to maintain a“community rated policy cost” similar to the individual or business policies,regardless of prior illness. We should also consider reductions in cost ofpolicy to individuals for healthy behaviors, e.g. not smoking.

5. EMTALA law must beamended to allow the triage of non-ill patients from expensive hospital ERsettings to lower-cost facilities. In many cases people are takingadvantage of a system for critical emergencies for non-emergent, non-lifethreatening illness.

6. MICRA typemalpractice tort reform should be adopted nationwide. Shakespeare wasright—it's the lawyers.

7. Physicians,hospitals and other health providers who provide non-reimbursed necessary carefor uninsured people should be able to claim a tax deduction equal to thevalue of that service. If we arewilling to serve at all hours, the government should recognize our charitycare.

8. Pharmaceutical companies should not be ableto charge Americans an amount for the “average wholesale price” of a drugthat exceeds what they sell the same drug for anywhere abroad.

9. Encourage local physician and hospitalenterprise that allows more rational allocation of scarce monetary resources betweena health care delivery team. We can do better than Washington.

10. Any mandates passed by Congress must applyto the health care plan that covers government employees, e.g., members ofthe House and Senate.

Mark Wexman, MD


Note: Letters forMMS News Briefs or Marin Medicine should be addressed to the editor, SteveOsborn, at


Interested inattending a seminar on risk management?

NORCAL Mutual Insurance has offered to provide free two-hourseminars on risk management to interested physicians. The seminars, which wouldinclude CME, would help physicians improve patient follow-up and tracking,understand informed consent, and apply risk-management documentation practices.

If you are interested in such a seminar, contact JessicaWhittom at jessica@marinmedicalsociety.orgor 924-3891. Seminars will be scheduled based on physician response.


Wine tasting on Oct.10 to benefit medical student AMA/CMA delegation

A wine tasting to benefit the North Bay AMA/CMA medicalstudent delegation will be held in St. Helena on Saturday afternoon, Oct. 10.Medical students, physicians, spouses and guests from throughout the North Bayare invited to enjoy fine wines and cheeses at the Ehlers Estate Winery, 3222Ehlers Lane, St. Helena. Cost is $40 per person ($20 for students). To RSVP,contact Sarah Zitsman at sarah.zitsman@tu.eduor 894-5250.


Breast cancer forumin San Rafael on Oct. 15

A free public forum on breast cancer in Marin County will beheld at Osher Marin Jewish Community Center from 7 to 9 p.m. on Oct. 15.Speakers include Dr. Christopher Benz, a researcher at the Buck Institute, andDr. Bobbie Head, a medical oncologist at California Cancer Care. Together withother speakers, they will address how the medical community is investigatingbreast cancer prevalence in Marin County.

Advance registration is required. To register, contact or call 507-1949.


CEO of ColoradoMedical Society to take helm at CMA

Alfred Gilchrist, CEO of the Colorado Medical Society andformer director of government advocacy for the Texas Medical Association, willbecome chief executive of CMA in November. Gilchrist brings 30 years of experienceto CMA, including groundbreaking achievements in patient rights, medicalliability, and tobacco control measures.

“Alfred Gilchrist’s invaluable experience and demonstratedtalents at the state and federal level could not come at a more crucial time,as our nation discusses how to improve our health care system,” said CMAPresident Dev GnanaDev, MD. “Alfred’s leadership and vision will greatlyenhance our efforts to expand access to quality health care, improve the publichealth, and maintain practice viability for the physicians of California.” 


How to submit a classified ad
To submit a classified ad for MMS News Briefs or Marin Medicine, contact NanPerrott at nperrott@rhscommunications.comor 707-525-4226. The cost is one dollar per word.


The Marin Medical Society, a 501(c)(6) nonprofit association,supports local physicians and their efforts to enhance the health of thecommunity. We are affiliated with the California Medical Association and theAmerican Medical Association.

© MMS 2009
PO Box 246
Corte Madera, CA 94976


You are receiving MMS News Briefs because you are aphysician or an affiliated medical professional in Marin County. If you wish tounsubscribe, contact Steve Osborn at sosborn@marinmedicalsociety.orgor 707-525-4325.