CAFP has contracted with Atlantic Health Partners to help members save money on vaccine purchases.  Atlantic - a group purchasing program for physicians - is working directly with Sanofi Pasteur and Merck to obtain the most favorable pricing and purchasing terms for a wide variety of pediatric, adolescent, adult, flu and travel vaccines.  Atlantic works with more than 20 other AAFP chapters and serves more than 3,000 family physicians.  For more information and a free membership, please contact Jeff Winokur at Atlantic 800-741-2044. Additional information will be posted on the CAFP website shortly. 

Members interested in representing the issues facing California family physicians and shaping the AAFP's agenda are encouraged to contact CAFP to apply for nomination to AAFP Commissions on Continuing Professional Development*, Education*, Finance and Insurance, Governmental Advocacy*, Health of the Public and Science, Membership and Member Services, and Quality and Practice Enhancement. 

For more details regarding these Commissions, please visit:

http://www.aafp.org/online/en/home/aboutus/governance/commissions.html

*CAFP has members serving on these committees.  The likelihood of securing an additional seat for a Californian is not known.

If you are interested, please submit the following items by October 1 to Mariah Brooks at 1520 Pacific Avenue, San Francisco, CA 94109 or via email: 

1. Typed Commission Appointment Fact Sheet (prefer electronic version)
2. Current photo
3. Conflict of Interest form

You may complete the Conflict of Interest form by visiting:  https://nf.aafp.org/conflictofinterest/form/noncme/.

Physicians who are also interested in developing and implementing CAFP programs and projects are encouraged to apply for appointment to the following CAFP committees: 

• Communications
• Continuing Professional Development
• Legislative Affairs
• Medical Practice Affairs
• Medical Student and Resident Affairs

For information on the scope of activities and accomplishments of these committees, please visit http://www.familydocs.org/about-cafp/leadership/committees.php.

The CAFP Board of Directors met on July 10 in Los Angeles and took care of business.  Legislative Affairs Chair Taejoon Ahn, MD and Legislative Advocate Tom Riley updated the Board on two key sponsored pieces of legislation, AB 1542, CAFP's Patient Centered Home definition bill, and AB 2093, legislation to improve payment for purchase, storage and administration of vaccines.  Both bills were passed out of the Senate Health Committee on June 30, but still have obstacles to surmount before final passage.  The Board received a report on 25 other bills of concern and took positions on seven new bills ranging from mandatory CME for hepatitis to a prohibition of sales of electronic cigarettes to individuals younger than age 18.  The Board approved the Academy's audit report from Bregante + Company, which provided an unqualified opinion about CAFP's finances - a good thing - and noted CAFP's administrative expenses are a low 11 percent, meaning 89 percent of Academy spending is for programs.  The Board also appointed a new Health Care Workforce Task Force to address challenges in the family medicine pipeline and the CAFP delegation to the CMA, including Carla Kakutani, MD; Eric Ramos, MD; Steve Green, MD; Taejoon Ahn, MD; Patricia Samuelson, MD and Sam Applebaum, MD (a newbie!).  Thanks and congratulations to all. 

The Board also reviewed a 47-page report on progress toward achieving the goals and objectives of the 2010-12 CAFP Strategic Plan, approved a reduction by 50 percent of dues for new physicians in their first year of practice contingent upon the AAFP Board doing the same, and held a focused discussion on health care workforce opportunities in the new health care reform legislation.  A resolution opposing AAFP's contract with The Coca-Cola Company to support its patient-facing website, www.familydoctor.org, was approved for submission to the 2010 AAFP Congress of Delegates.  Finally, as you read elsewhere, the promotion of Atlantic Health Partners discount vaccine purchase organization to CAFP members in return for a minimal fee based on sales was approved.

Students and residents: time is running out to register for this year's National Conference, being held July 29-31 at Hotel Phillips in Kansas City, MO.  The theme of the conference is "Innovations in Education: Training Tomorrow's Family Physicians."

Students are also invited to the California Reception on July 30 at the Phillips Ballroom at the Hotel Philips, Kansas City.  The reception will be held from 4:30-6:30 pm; drinks and hors d'oeuvres will be served.

Learn more about the National Conference here or contact CAFP Student and Resident Coordinator Cody Mitcheltree at 415-345-8667.

On Tuesday, July 13 the Centers for Medicare and Medicaid Services (CMS) announced the release of the final rule defining how health care providers can demonstrate "meaningful use" of electronic health records (EHRs) to qualify for federal incentive payments under the American Recovery and Reinvestment Act of 2009 (ARRA).  This final rule governs what providers must do with their EHRs to be considered meaningful users in 2011 and 2012, the first two years of this multiyear incentive program; subsequent rules will govern later phases.

Family physicians and other health care providers can draw on incentive payments through Medicare (up to $44,000) and Medicaid (up to $63,750) over five years if they meet certain eligibility requirements.  ARRA required that providers meet specific "meaningful use" criteria to obtain these incentive payments and called on the Secretary of Health and Human Services to develop and promulgate them.  In January, CMS published proposed meaningful use requirements.  CMS received extensive input from the health care community on the proposed rule; more than 2,000 comments were submitted, including comments from CAFP and AAFP.  CMS reviewed the comments and made significant, generally positive changes to the regulations.

The final rule grants physicians greater flexibility in meeting and reporting certain objectives for demonstrating meaningful use.  The proposed rule, published in January, required providers to meet 25 core objectives.  The final rule requires providers to meet 15 core measures and five additional measures from a "menu" of 10 options.  Core objectives comprise basic functions that enable EHRs to support improved health care, including the entry of basic data, the use of clinical decision support tools and providing patients with electronic versions of their health information.  The menu items include capacities to perform drug formulary checks, incorporate clinical laboratory results into EHRs and provide reminders to patients for needed care.

For most of the core and menu items, the rule also specifies the rates at which providers will have to use particular functions to be considered meaningful users.  Here as well, the final rule represents an improvement as it reduced the threshold for some of the measures that CAFP and others deemed particularly onerous.  For example, the threshold for e-prescribing that originally called for 75 percent of all permissible prescriptions to be transmitted electronically has been reduced to 40 percent.  In another example, providers were required to use computerized physician order entry (CPOE) systems for 80 percent of their medication, laboratory and diagnostic orders and under the final rule are only required to use CPOE systems for 30 percent of their medication orders.

In the coming weeks, CAFP will comprehensively analyze the meaningful use rule and launch the results of this analysis on the Health Information Technology page of our new online Patient Centered Medical Home Resource Center.  We will develop resources to help family physician members meet meaningful use requirements, particularly in those areas that present the greatest challenges.

The Sonoma Academy of Family Physicians invites you to volunteer at the Fifth Annual Neighbors in Health in Santa Rosa on Sunday, August 1.  The Sonoma Chapter will be working with United Way, Kaiser Permanente and several other community organizations to offer free health care screening and prevention education to uninsured and underinsured children of Sonoma County.  If you would like to get involved in this community outreach, please contact Walt Mills, MD. 

CAFP is jumping into the virtual world environment.  As part of the Cease Smoking Today initiative, we are proposing a Second Life virtual community for education in the clinical and behavioral aspects of assisting patients on their cessation path. 

Second Life is a free online virtual world where users can socialize, connect and create using free voice and text chat.  Users interact with each other by using avatars; we're hoping to engage family physicians, other primary care physicians and their team members in this innovative way to learn and practice skills.  Here's where you come in ... we need to know who among our members is already a "Second Lifer" - avatar and all.  We'd also like to know if you are interested in entering the world of avatars, teleporting and virtual learning. 

Please contact Senior Vice President Cynthia Kear - let her know if you are already on board, or interested in joining us for a spin around the virtual world.  

The California Department of Public Health (CDPH) has issued new recommendations on pertussis  available here.  Five years after the last peak in California and the United States, there has been a 412 percent increase in the number of reported pertussis cases in California (912) compared to the same time period in 2009. This includes the deaths of five infants three months of age or younger.  CDPH has initiated a short term project to make additional Tdap (tetanus, reduced diphtheria and acellular pertussis) vaccine available to hospitals with birthing centers or NICUs to immunize post-partum women and their close household contacts and has written clinical guidance for clinicians providing care for infants with pertussis (also available on the new recommendations document).  The Department and CAFP note it is important that both health care providers and their patients receive protection against pertussis through vaccination (Tdap, DTaP).  Make sure that you, your staff and your patients are protected against pertussis now!

The force of nature that is Paul Grundy, MD, MPH, IBM's Global Director for Health Care Transformation, visited California to collaborate with CAFP and others to promote the Patient Centered Medical Home (PCMH) for the second time last week.  CAFP's own Kevin Grumbach, MD, hosted a roundtable on PCMH on Monday, July 12 at UCSF to discuss related health care workforce policy issues and to examine why California is behind the curve on PCMH adoption.  OUTCOME: representatives of business, medical groups, health plans and others expressed an interest in developing an organization similar to the Patient Centered Primary Care Consortium, which Dr. Grundy chairs, in California as a means of promoting PCMH.

On Tuesday, July 13, other meetings included those with physician representatives of Sutter Health, Brown and Toland Medical Group and Blue Shield Medical Director Meredith Mathews, MD, along with Andy Halpert, MD.  On Wednesday, July 14, CAFP and Dr. Grundy headed to Fresno for a meeting with members of the community and the Fresno Unified School District Joint Health Management Board, which is interested in a PCMH model of care for its members.  CAFP Board member for District VI Adriana Padilla, MD (pictured right) was present along with member Kathy Flores, MD to participate in the discussion. 

As a result of all of these meetings, CAFP learned there is a good deal of interest from family physicians in the PCMH model - in Sacramento, Fresno, San Francisco, San Diego and elsewhere.  Our challenge now is to bring folks together and help provide the tools need to transform practices and provide the policy pressure to improve payment for PCMH services.

CAFP President Jack Chou, MD and chair of CAFP's Committee on Continuing Professional Development Geoffrey Leung, MD along with Executive Vice President Susan Hogeland, CAE had lunch with C. Richard Olds, MD, Dean of the new UC Riverside School of Medicine on July 8.  The discussion centered on the new school's mission of educating and training more primary care physicians for the Inland Empire, which suffers from a serious shortage.  The meeting was facilitated by Riverside County Medical Association Executive Director Dolores Green, who also joined the group.  CAFP pledged its continuing support for the school's mission and the Dean.

Cynthia Kear, CAFP's Senior Vice President, will testify this week at the Food and Drug Administration panel meeting to further consider the Risk Evaluation and Management Strategy (REMS) for long-acting opioids.  CAFP has been actively involved in this discussion out of concern that patients continue to have access to whatever pain medications are efficacious for them and to ensure that REMS requirements are not burdensome for physicians.

Thanks to the many CAFP members who reached out to legislators early last week urging support of CAFP's sponsored bill, AB 1542 (Jones), and CAFP's co-sponsored bill, AB 2093 (M. Pérez). Both bills were voted out of the Senate Health Committee last Wednesday. The Academy especially thanks CAFP past president Eric Ramos, MD (pictured) for his thoughtful testimony in support of our patient centered medical home definition bill (AB 1542). AB 2093, co-sponsored with the California Medical Association and the American Academy of Pediatrics (District IX), would ensure adequate payment for purchasing, storing and administering vaccines, will now be heard in the Senate Appropriations Committee in August. AB 1542 will also be heard in committee in August.  

The Centers for Medicare and Medicaid Services (CMS) announced it will not, for the time being, implement changes that would automatically reject claims made by physicians and eligible professionals who have not yet enrolled in, and had their applications approved by, the Provider Enrollment Chain and Ownership System (PECOS).

In May, CMS published an interim final rule that implements certain Patient Protection and Affordable Care Act (PPACA) provisions governing enrollment, ordering and referring and documentation under Medicare. Among other things, these provisions require that physicians ordering and referring specified items and services be enrolled in PECOS by July 6, 2010. CMS is now delaying the requirement. While the rule took effect July 6, CMS will not implement automatic rejections of claims submitted by providers who have attempted to enroll in PECOS. Until the automatic rejections are operational, providers should not see any change in the processing of submitted claims. Claims will continue to be reviewed and paid as they have historically been reviewed and paid.

CMS announced it is working with providers to address concerns about PECOS enrollment. While more than 800,000 physicians and eligible professionals have enrolled and approved applications, some providers have encountered problems.  

CMS's interim final rule permits only a Medicare-enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and certain items and services under Medicare Part B.  The new rule applies to orders, referrals and certifications made on or after July 1.  The comment period for the regulation closed July 6, after which the comments will be reviewed and considered before a final regulation is issued. 

CMS describes these provisions as an effort to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.