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CONTENTS SAN FRANCISCO MEDICINE January/February 2007 Vol. 80, No. 1 Neighborhood Medicine FEATURE ARTICLES
10 Curry Senior Center: Personalized Care for Seniors in the Tenderloin Gay Kaplan
4 On Your Behalf
12 Haight Ashbury Free Clinic: Health Care for the Homeless, Addicted, and Mentally Ill John Nienow, MD
7 President’s Message Steve Follansbee, MD
5 SFMS Election Results
13 Native American Health Center: Diabetes, Alcohol, and Depression in a Displaced Community Mark Espinosa 14 Lyon-Martin Women’s Health Services: A Safe Place to Turn Dawn Harbatkin, MD
16 Mission Neighborhood Health Center: Continuous Care From Birth to Death for a Primarily Latino Community Antonia Sachetti, MD 17 San Francisco Free Clinic: Serving Uninsured People from All Walks of Life Richard Gibbs, MD 18 North East Medical Services: Culturally and Linguistically Competent Care Tailored to Chinese Immigrants Linda Bein 19 South of Market Health Center: Innovative Health Care for a Diverse Population Peter Berman, MD, MPH 21 San Francisco Community Clinic Consortium: Providing Advocacy for All Underserved Neighborhoods John W. Gressman, MSW, MA
24 Public Health Update: HPV and Cervical Cancer Carol A. Lee, Esq. 25 Hospital News
15 Bayview Hunters Point: Illness and Cure Amidst the Violence Mitchell Katz, MD
23 Universal Health Access: A True “San Francisco Value”? Steve Heilig, MPH, and Gordon Fung, MD
9 Editorial Mike Denney, MD, PhD
Editorial and Advertising Offices: 1003 A O’Reilly Ave. San Francisco, CA 94129 Phone: 415.561.0850 ext.261 Fax: 415.561.0833 Email: email@example.com Web: www.sfms.org Subscriptions: $45 per year; $5 per issue Please contact Amanda Denz for subscriptions, firstname.lastname@example.org or (415) 561-0850 ext. 261 Advertising: Information is available on our website, www.sfms.org, or can be sent upon request. Please contact Galen Foster, email@example.com or (415) 561-0850 ext. 240 Printing: Sundance Press P.O. Box 26605 Tuscon, AZ 85726-6605
january/february 2006 San Francisco Medicine
January/February 2007 Volume 80, Number 1
ON YOUR BEHALF A sampling of activities and actions of interest to SFMS members
Editor Mike Denney Managing Editor Amanda Denz Copy Editor Mary VanClay
Notes from the Membership Department
Cover Artist Nico Johnston Editorial Board Chairman Mike Denney Obituarist Nancy Thomson Stephen Askin
Shieva Khayam-Bashi SFMS Officers President Stephen E. Follansbee President-Elect Stephen H. Fugaro Secretary Michael Rokeach Treasurer Charles J. Wibbelsman Editor Mike Denney Immediate Past President Gordon L. Fung SFMS Executive Staff Executive Director Mary Lou Licwinko Director of Public Health & Education Steve L. Heilig Director of Administration Posi Lyon Director of Membership Therese Porter
New Year Notes from the Membership Department In 2007 the Membership Committee plans to expand the number and variety of both social and professional events for the SFMS membership. This year, in addition to the January Tennis Mixer and the Symphony Night in the fall, watch for another Gallery Mixer event. Opera and/or Ballet Nights, a baseball game, wine tasting, lectures and seminars of interest to various sections of SFMS membership, and a golf event are all being explored as possibilities. As always, the input of our membership is invaluable for inspiration. Contact Therese Porter in the Membership Department (firstname.lastname@example.org or  561-0850 extension 268) with your suggestions for making membership more fun, interesting, and beneficial. 2007 is going to be a great year to be a member of the San Francisco Medical Society. If your physician peers are not yet members, encourage them to join!
Director of Communications Amanda Denz Board of Directors Term:
Carolyn D. Mar
Jan 2007-Dec 2009
Rodman S. Rogers
Brian T. Andrews
John B. Sikorski
Lucy S. Crain
Peter W. Sullivan
Jane M. Hightower
John I. Umekubo
Donald C. Kitt
Jan 2005-Dec 2007
Lily M. Tan
Gary L. Chan
George A. Fouras
Thomas J. Peitz
Jan 2006-Dec 2008
John W. Pierce
Mei-Ling E. Fong
Daniel M. Raybin
Thomas H. Lee
Michael H. Siu
CMA Trustee Robert J. Margolin AMA Representatives H. Hugh Vincent, Delegate Judith L. Mates, Alternate Delegate
Gordon Fung Appointed to California Council on Multicultural Health California Department of Health Services (CDHS) Director Sandra Shewry announced the appointments of twelve new members to the California Council on Multicultural Health, a twenty-four–member statewide group of health policy experts who advise and assist the director and CDHS’ Office of Multicultural Health (OMH). Among those appointed is Gordon Fung, MD, MPH, immediate past president of the San Francisco Medical Society. “The council is an invaluable resource to key programs throughout the department and helped us establish our goal of closing the gaps in health status and access to care among the state’s diverse populations,” said Shewry. “We deeply appreciate the expertise, commitment, and passion of these
San Francisco Medicine january/february 2006
community leaders to improve the health of all Californians.” OMH was created in 1993 to expand the ability of CDHS, health care providers, and other community partners to eliminate health disparities and improve the quality of life of California’s diverse populations.
It’s Time to Order Flu Vaccine for Next Season Physicians can now order flu vaccine for the 2007–2008 flu season. CMA encourages physicians to place their orders early to guarantee that they will receive their supply in time to vaccinate their high-risk patients in the autumn. Physicians can place orders directly with manufacturers or through their regular pharmaceutical distributor. Some manufacturers sell out quickly, so place your orders as soon as possible. To order the vaccine, contact: • ASD Healthcare at www.asdhealthcare. com or (866) 281-4FLU (4358). • CuraScript (Priority Healthcare) at (877) 599-7748. • Henry Schein, Inc., at www.henryschein. com or (800) 772-4346. • Henry Schein/GIV at www.giv.com or (800) 521-7468. Henry Schein/Caligor at www.caligor.com or (888) 225-4467. • McKesson: The first point of contact is your McKesson Medical-Surgical account manager. If you do not know your representative’s contact information, please call (800) 366-8990. • FFF Enterprises (Chiron vaccine) at www. fluvaccine.net or (800) 843-7477. • PSS/World Medical at www.pssworldmedical.com or (904) 332-3000. • Sanofi-Pasteur at www.vaccineshoppe. com (online orders receive a 2 percent discount) or (800) 822-2463. • Seacoast Medical at www.seacoastmedical.com or (800) 732-2115. • STAT Pharmaceuticals at www.fluvaccine.com. www.sfms.org
Save the Date: Legislative Leadership Day, April 24, 2007 CMA’s thirty-third annual Legislative Leadership Conference is Tuesday, April 24, in Sacramento. This is the most important day of the year for physician advocates! A revamped schedule will include more time than ever to meet with your elected officials in the State Assembly and Senate. Attendees will receive a CMA health policy briefing and a short course on “Lobbying 101,” which will train them to become strong physician advocates and prepare them for the legislative meetings later in the day. Don’t miss the opportunity to meet one-on-one with your legislators to discuss important health policy issues that affect the practice of medicine in California. For more information, contact Susan Bassett at (916) 444-5532 or sbassett@ cmanet.org.
Resubmission Period for Aetna Modifier 57 Claims Now Open Aetna is now accepting resubmissions of previously denied claims for E&M services provided on the same day as a decision for surgery, with dates of service between January 1, 2005, and February 11, 2006. In 2005, Aetna announced that it would begin reimbursing physicians for E&M services billed with a Modifier 57 and performed on the same day as a decision for major surgery (global, ninety-day procedure). Implementation of this policy change was delayed, and Aetna’s claims processing systems finally began recognizing E&M codes with these modifiers effective February 11, 2006. At that time, Aetna also announced that previously denied claims with dates of service of August 15, 2005, to February 11, 2006, could be resubmitted. This policy change was recommended by Aetna’s Physicians Advisory Board, which was created as part of Aetna’s RICO lawsuit settlement. A recently resolved RICO settlement compliance dispute has increased the number of claims eligible for retroactive reconsideration. Previously denied claims with dates of service back to www.sfms.org
January 1, 2005, can now be resubmitted. The resubmission period is January 1 to April 30, 2007. For more information, contact CMA’s legal information line at (415) 882-5144 or email@example.com.
Physicians Must Register NPIs with Medi-Cal by March 1 to Prevent Cash Flow Disruption Physicians must register their national provider identifiers (NPIs) with Medi-Cal by March 1 to ensure that their payments are not interrupted when Medi-Cal transitions from its current provider numbering system to the NPI system on May 23. Providers can register their NPIs online at the Medi-Cal website, www.medi-cal. ca.gov, or by mail. To request a paper NPI registration form, call (800) 541-5555 and select option 16, followed by option 18. If you haven’t already applied for your NPI, you should do so immediately. Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs. gov. If you do not have Internet access, call the NPI Enumerator at (800) 465-3203 and request a paper application form. For more information, ontact CMA’s legal information line at (415) 882-5144 or firstname.lastname@example.org.
SFMS Election Results 2007 Officers (for one-year term): President-Elect: Steven H. Fugaro Secretary: Michael Rokeach Treasurer: Charles J. Wibbelsman Editor: Mike Denney Board of Directors (seven elected for threeyear term): Jordan Shlain Brian T. Andrews Lily M. Tan Lucy S. Crain Jane M. Hightower Shannon UdovicDonald C. Kitt Constant Runners up Corey S. Maas Paul M. Silvestre William A. Miller Nominations Committee (four elected for two-year term): Eileen G. Aicardi Keith E. Loring Mei-Ling E. Fong William A. Miller Solo/Small Group Practice Forum Delegate (two-year term): Eric Tabas Solo/Small Group Practice Forum Alternate (two-year term): Gary L. Chan
ACCMA Annual Dinner SFMS Past-President Dexter Louie, MD, CMA President Anmol Mahal, MD, and SFMS Executive Director Mary Lou Licwinko, JD, MHSA, are pictured below (left to right) at the Alameda-Contra Costa Medical Association’s Annual Dinner in November.
Delegates to the CMA House of Delegates (First four are delegates; next four are alternates; Steven H. Fugaro, President-Elect, will serve as the fifth Delegate according to the SFMS Bylaws) all for a two-year term: Delegates Gordon L. Fung Joshua H. Rassen E. Ann Myers H. Hugh Vincent Alternates Shannon UdovicTaissa Cherry * George A. Fouras Constant Thomas H. Lee * Dr. Cherry has resigned from the Delegation due to time constraints. Total number of qualified ballots: 324
january/february 2006 San Francisco Medicine
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president’s Message Stephen E. Follansbee, MD
It Takes a Village
lthough I did not coin this phrase, it feels appropriate, since this is my first message as your president in an issue devoted to neighborhood medicine. It has probably been a while since San Francisco was called a village. But, in some ways, it is. All of us in the San Francisco Medical Society work here. And whether we live in San Francisco or not, I suspect that most of us call this city home. It is in this village that we provide our professional services. For some of us, the San Francisco Medical Society is what provides the professional network that extends beyond our individual practices, our medical groups, or our medical staffs. The San Francisco Medical Society is an important venue in which we can discuss the successes and the challenges that we face as physicians. We are the physician network that provides and oversees professional health care throughout this village. Community health clinics play an integral role in San Francisco’s health care village. This issue covers the spectrum of neighborhood services provided throughout our community. If we were to drive by many of these practices, we might not even notice them. There is no fancy artwork, no modern lobby, no imposing marble-covered façade with large bronze lettering. But if we took the time to walk by these community clinics, we would notice them. We would feel the energy and commitment of the staff. We would note the crowd of people waiting for services. These clinics are an integral part of the fabric of our neighborhoods. For many San Franciscans, these health care centers contribute to their neighborhoods identities. They are not only places to receive care and advice; they have also become community centers. Most of us think that residents of San Francisco access these services because of lack of health care coverage. We see these clinics as part of a safety net for patients when they lose their health care insurance. That is true for some, but not all. What is very impressive, and should not be surprising, is that San Francisco residents often choose to obtain health care in these clinics. In communities where the health care news headlines often focus on the major medical centers and major medical groups, it is these clinics that usually provide the most accessible and specialized services to many citizens. Some clinics are known for their expert care to transgendered persons, who are often uncomfortable in other health care settings. Some clinics provide culturally competent health care in the patient’s native language or dialect—a service that is often www.sfms.org
inconsistently provided in other health care settings—and they do so without requiring proof of citizenship or residence. Other patients may need ongoing services that combine substance-abuse counseling and mental health support in ways that other physicians are ill-equipped to provide. Many people use these clinics for specialized services, such as STD screening, because they fear initiating discussion about sexual practices with their regular providers. Some clinics are supported by the Health Department of San Francisco, whose laboratory and staff have validated STD testing that cannot be provided by other medical centers or reference laboratories. Indeed, these clinics are not just the access of last resort but are in fact quality programs that help provide comprehensive care to San Francisco residents whose needs are not easily met in the larger, more obviously established settings. I suspect that many of us in clinical practice do not realize where our patients receive their health care when they suddenly disappear from our practice. Sometimes we know, because of a phone call or a request for medical records. But a lot of times we do not know until our patients show up again in our offices. This issue of San Francisco Medicine should convince all of us that the care patients receive can be quality care in all respects, regardless of the place of care. This issue should also reinforce our commitment to seeing that culturally appropriate health care is accessible to all, with adequate resources to address the multitude of needs, both simple and complex. Yes, we are a village. And it takes a village. None of us can do it alone. I am pleased to work alongside all physicians, and to learn more about the outstanding work done in all of our neighborhoods. Dr. Follansbee is the 139th President of the SFMS. An infectious disease specialist, he practices with the Permanente Medical Group and as Director of HIV Services and Module Chief, Adult Primary Care, Kaiser San Francisco. He has been Chief of Staff at Davies Medical Center, director of HIV research and treatment there, attending physician at San Francisco General Hospital, Assistant Director, Bay Area Consortium of AIDS Providers, and on the UCSF clinical faculty. He has been an SFMS delegate to the CMA since 2004.
january/february 2006 San Francisco Medicine
!TTENTION $OCTORS AND (OSPITALS