THIS WEEK: AAFP News Now: ACIP Makes Universal Vaccination Reccomendation

Message from the California Department of Public Health (CDPH) Office of Public Affairs:

To enhance the effort to educate your community on steps to stop the spread of H1N1 and seasonal flu, CDPH is pleased to provide a new poster for download and distribution.  CDPH also has a suite of materials with tips and information for preventing H1N1 and the seasonal flu. These resources are available in multiple languages, and may be downloaded at http://www.cdph.ca.gov/Pages/InformationalFactSheetsonFluPrevention.aspx and include:

• Flu Prevention poster, in English, Spanish, Chinese, Korean and Vietnamese (Additional Asian languages available soon)
• Stop the Flu tip sheet, in English and Spanish (Asian languages available soon)
• Flu Facts, in English and Spanish (Asian languages available soon)
• What is the Flu and How to Stop It, in English and Spanish (Asian languages available soon)
• How to Take Care of Someone with the Flu, in English and Spanish (Asian languages available soon)

We encourage you to co-brand these materials with your local information.  If you would like to receive any materials in Word format, or should you have any questions, please contact Melinda Beer at melinda.beer@cdph.ca.gov or 916.440.7652.

Also, following is a current status report on H1N1 in California. 

H1N1 Status Update from the CDPH
Friday, January 15,2010

Statewide Overview

CDPH is concerned that half of all Californians are still susceptible to the H1N1 virus, which means a third wave could still have very serious consequences.

High-Risk Ethnic Groups

The data shows that, compared to whites, H1N1 has hit certain ethnic communities harder than others:

• African Americans are THREE TIMES more likely to be hospitalized for H1N1 and 50 percent more likely to actually die from H1N1.
• The Hispanic community is TWICE as likely to be hospitalized and TWICE as likely to actually die from H1N1.
• Asian populations throughout the state are 70 percent as likely to be hospitalized by H1N1; however, the actual rate of death for Asians is low.

There are a couple reasons that African Americans, Hispanics and Asians may be at higher risk for H1N1:  

• They may be avoiding the vaccine.
• When sick, these groups may be delaying medical attention until complications have already developed.
• H1N1 disproportionately affects people who are obese or have a weakened immune system. We know that among African-Americans and Hispanics, obesity and diabetes are significant problems.

Vaccination

The most important thing you can do to protect yourself from H1N1 and the seasonal flu is to get vaccinated.  

There is enough H1N1 and seasonal flu vaccine available right now for everyone in California. We know the H1N1 vaccine is safe and has been well received by those who have received it.

CDPH and our partners on the community level continue to host free vaccination clinics statewide, and we're reaching out aggressively to high risk populations with new approaches, such as:

• Dispatching free mobile clinics for farm workers and homeless populations
• Hosting free clinics at rapid transit stations, banks, parades and other high traffic venues

And because so many Californians live in a world of texting, CDPH has launched a great new text service. Simply text 30644, type in the words "NO FLU" followed by a SPACE and you ZIP CODE. The nearest vaccinator will be sent to you almost instantaneously.

You can also visit http://www.cdph.ca.gov/ for a flu vaccine locator to find available flu shots in your area.

General Protection Tips

The most important this you can do is get vaccinated for H1N1 and seasonal flu.

It is also important to wash your hands often with soap and water. Alcohol-based sanitizers can be effective too.

Always cover your mouth and nose when you cough or sneeze, using a tissue, your sleeve or the inside of your arm.

And, if you are sick, stay home for 24 hours after your fever is gone without the use of fever-reducing medicines.

It's very important not to spread germs. People can get sick when touching a surface or object with flu viruses on it and then touching their eyes, nose or mouth.

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Once again family physicians will be at the forefront of the flu season - and we may be in for a doozy.  In addition to seasonal influenza, H1N1 may be pandemic.  Now is the time to prepare your family, practice team, patients - and yourself.  There are numerous Web sites with the epidemiology, precautions, CDC warnings, and immunizations recommendations - we've found a handful of sites that should be most helpful, and linked them here on CAFP's Flu Resource Center.  In addition to resources and Web links, we'll keep you posted on statistics and alerts.  CAFP will have a regular question and answer forum with infectious disease expert, Amy Kindrick, MD, San Francisco General Hospital, to give you the information you need for your practice. 

The AAFP and CAFP urge members to:

• 1. Become familiar with and act on the clinical guidance for H1N1 issued by the Centers for Disease Control and Prevention, which is posted at: http://www.cdc.gov/h1n1flu/
• 2. Stay informed on a regular basis regarding this rapidly changing situation through the above CDC link and other important sites such as the overall CDC H1N1 site at http://www.cdc.gov/h1n1flu/, the federal pandemic flu site at http://www.pandemicflu.gov/ and the World Health Organization site at http://www.who.int/en/.
• 3. Work in both your practice and community with the state and local health departments to address this growing health problem.
• 4. Educate your patients and office staff about the steps they can take to lessen the risk of infection.
• 5. Prepare for dealing with a possible pandemic, including the illness of practice staff, closed schools, and other contingencies.

HANDOUTS

• CDPH - H1N1 Facts
• CDPH - What is H1N1?
• CDPH - How to take care of someone with H1N1
• CDPH - Prevent H1N1 basics
• Click here to view and print out a low literacy patient education sheet that you can hand out to patients and acquaintances.
• Click here for a version in Chinese.

Also, check out this AAFP News Now article on "How to Get Paid for Administering H1N1 Vaccine" 

As community-based physicians caring for the entire family, family physicians are on the front line in combating this H1N1 Flu.

NEW CPT CODES
The CMA reports that AMA has published a new CPT code specific to H1N1 vaccine administration (90470) and revised existing code 90663 to include the H1N1 vaccine. The new CPT codes are effective immediately. The Centers for Medicare and Medicaid Services (CMS) has also created unique HCPCS codes for administration of the H1N1 vaccine (G9141) and for the vaccine itself (G9142).

Physicians will not be paid for the cost of the vaccine, which is being provided for free by the federal government.  CMA says practices should submit claims for the vaccine, but for zero dollars, so the vaccine may be tracked.  As reported previously by CAFP, physicians WILL be paid for the cost of administering the vaccine.

CMA further reports there continues to be significant uncertainty regarding billing for H1N1 vaccinations. For example, some payors, clearinghouses, and physician billing systems may not be able to accommodate a zero dollar charge, requiring that practices bill vaccine claims with a $0.01 charge. CMA is awaiting clarification from CMS to ensure that it would not be considered fraud to bill with $0.01 to accommodate systems that can't process a $0.00 charge.

For more information about the new CPT codes for H1N1, visit the AMA's Web site: http://www.ama-assn.org/ama/pub/h1n1/resources/cpt-codes.shtml.

MORE HELPFUL INFO
California's six largest health plans have announced they will waive the co-pays and deductibles for patients wishing to get the H1N1 vaccine. Information is available here.

Learn how to appropriately code H1N1 and flu vaccine: CAFP's coding consultant, Mary Jean Sage, has provided guidance on coding for vaccine administration in the October edition of Practice Management News. In addition, the American Medical Association has fact sheets and the California State Department of Public Health has issued provider guidance.