Friday February 11, 2011Annual Meeting Brochure Coming Soon
This year’s Annual Meeting, Pacific Northwest Dermatological 78th Annual Scientific Conference is fast approaching. Make sure your calendar is marked for July 22-24, 2011. Look for your registration brochure to arrive next month. We are looking forward to seeing you in Vancouver British Columbia for another great meeting!
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WSDA Sends Powerful Message to Olympia
The WSDA’s advocacy plan to regulate indoor tanning is live. HB 1363 and SB 5593
received a public hearing on Thursday. The WSDA orchestrated a panel of experts who provided a powerful and emotional testimony yesterday. Our panel consisted of Sasha Kramer, MD (Dermatologist, Olympia), Peter Rasumssen (advocate, lost his daughter to melanoma at the age of 34), Maggie Moore and Michelle Spencer (patient advocates). Despite the misinformation provided by the Indoor Tanning Association during the hearing, we believe committee members heard our message about this public health issue and the need to act now!
Remember: Legislators make decisions that reflect the views of their constituency. Therefore, please contact your legislators now to encourage them to support these measures. You can identify your legislators here. We suggest that you use some of these
talking points during your discussion. By personally calling or emailing your legislators, WSDA members can demonstrate the importance of passing this legislation and regulating the tanning industry in our state.
Please spread the word to your patients and others who can help us make a difference!
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Senate/House Supplemental Budgets: Hope for Some Health Care Services
The Senate last Friday approved its supplemental budget for the remainder of the 2009-2011 biennium (ending June 30, 2011). Now all three supplemental budget proposals – Governor, House and Senate – are on the table and negotiations can proceed. The longer lawmakers dally, the deeper will be the cuts necessary to get the state through the end of June. Action this week is a must, says the Governor; otherwise she’ll have to resort to more across-the-board cuts.
Interpreter Services – The Senate budget fully funds interpreter services through June 30, requires the work be performed by Washington State interpreters, and requires reform of how interpreter services are provided to be enacted by September 2011. Both the Governor’s and House budgets eliminate the program entirely, effective March 1. Statewide, an estimated 4,900 patients a week use this program.
Basic Health Plan – The Governor’s budget eliminates the program entirely on March 1, 2011. The House budget finagles a 30-day reprieve for about 38,000 of the 60,000 people covered by the program (via dropping those not eligible for federal matching funds, those under 19, over 65, or whose citizenship has not been documented). It then eliminates the program entirely as of May 1. The Senate budget eliminates the program for adults whose citizenship has not been verified by March 1, then freezes overall enrollment, and uses Life Science Discovery Fund money to support the program for the remainder of the biennium.
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Truth-in-Advertising Legislation Introduced in U.S. House
A recent survey
indicates that America's patients prefer a physician-led approach to healthcare and are often confused about the level of training and education of their healthcare providers. The survey results confirm the need for increased transparency and clarity in healthcare advertisements. To that end, on January 26, 2011, U.S. Reps. John Sullivan (R-OK) and David Scott (D-GA) introduced H.R. 451, the "Healthcare Truth and Transparency Act of 2011." This important legislation empowers patients by improving transparency in healthcare provider-related advertisements and marketing.
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New Law Clarifies Who is Subject to the Red Flags Rule
Last month, the President signed into law the "Red Flag Program Clarification Act of 2010," which clarifies the type of "creditor" that must comply with the Red Flags Rule. This law states the Red Flags Rule should not be applied to physicians generally.
The new law indicates that creditors that fall under the Red Flags Rule are only those who regularly and in the ordinary course of business: (1) obtain or use consumer reports, directly or indirectly, in connection with a credit transaction; (2) furnish information to certain consumer reporting agencies in connection with a credit transaction; or (3) advance funds to or on behalf of a person, based on the person's obligation to repay the funds or on repayment from specific property pledged by them or on their behalf (this does not include creditors who advance funds on behalf of a person for expenses incidental to a service provided by the creditor to that person). Creditors that fall under one of the above-mentioned categories must comply with the Red Flags Rule by December 31, 2010. Creditors that do not fall under one of these categories are not subject to the Red Flags Rule.
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The 2011 Electronic Prescribing (eRx) Incentive Program with Penalty
CMS has been offering since 2009 an incentive for eligible professionals to implement and use electronic prescribing to improve the quality, efficiency and safety of health care delivered to beneficiaries. This initiative will continue in 2011, with successful e-prescribers earning a bonus of 1% of their total allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule.
For the first time, a penalty has been introduced for 2011 that will affect Medicare payments in 2012 and 2013. Eligible professionals will be penalized if they do not report a minimum of 10 e-prescribing reporting events on a qualified system during the six-month period of Jan. 1 to June 30, 2011. A penalty of 1% will be assessed for all allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule during 2012. The payment cut is estimated to be from $2,000 to $3,000 for the typical internal medicine physician. In addition, physicians that do not report a minimum of at least 25 e-prescribing reporting events between Jan. 1 and Dec. 31, 2011 will be assessed a 1.5% penalty for all Medicare allowed charges submitted in 2013.
Physicians participating in the Medicare EHR Meaningful Use incentive program will not be eligible for the e-prescribing bonus. But, they will still have to submit at least 10 e-prescribing events by June 30, 2011 to avoid the e-prescribing penalty for 2012.
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Electronic Health Records and “Meaningful Use”
The third quarter 2010 issue of the WSMA Preceptor (www.wsma.org
, News & Events, WSMA Reports) provided guidance on the “meaningful use” standards in the Final Rule issued by the Centers for Medicare and Medicaid Services (CMS). Practices without EHRs should watch for further developments on the temporary and final certification of EHRs as they select their own system. Practices with EHRs should ask their vendors how their systems will be brought into alignment with the new requirements and if the practice would incur additional costs as a result. If their current systems cannot be upgraded, practices may need to switch to different models. Useful resources include:
Practices also should review the materials available from the Washington & Idaho Regional Extension Center (WIREC), offered through Qualis Health: www.wirecqh.org. See also the WSMA Practice Resource Center (www.wsma.org
, in the Practice Management Operations section under Health Information Technology). For questions, contact Bob Perna at rjp@wsma.org.
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Meet the University of Washington Residents
 Corinne Taraska, MD Corinne joins our program after a successfully completing internship at Virginia Mason Medical Center during her transitional year. She graduated from Stanford University with a BA in Human Biology in 2001. She then came to University of Washington for medical school, earning her M.D. in 2009. While in med school, she was elected to Alpha Omega Alpha, got a Howard Hughes Fellowship, and served as TA with Roy Colven in support of the HuBio 567 course in 2008.
Corinne reports: “I'm usually pretty easy to find in my p-patch garden plot ruthlessly pulling weeds. This year I have a 10x20 foot space and expect to be up to my eyeballs in beans, peas, onions, tomatoes, tomatillos, cukes, zukes, carrots, beets, chard, ozette potatoes and dahlias by the end of August. From the garden I find lots of inspiration to cook.” Corinne also enjoys getting out doors to hike and camp. “In between all of that getting dirty, I like to oil paint. I come from a family of artists & I lived in Florence Italy for a while indulging in oil painting, printmaking, and metalsmithing. Now my easel is set up in the corner of my garage, not quite as picturesque, but nonetheless fun.”
Corinne is a Florida native, a lefty, and an identical twin.
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 Ryan Falsey, MD, Ph.D. Ryan Falsey comes from the University of Arizona in Tucson. Ryan earned his undergraduate degree there in Microbiology with minors in Chemistry and Family Studies/Human Development in 2002 (Summa Cum Laude with Honors). He then earned his Ph.D. in Cancer Biology with a focus on natural products drug discovery in 2006 before earning his M.D. in 2009, where he received the Gold Humanism Honors Society Award.
Ryan is a martial arts instructor in mixed martial arts with a 3rd degree black belt and more than 20 years of experience. His volunteer work included membership in the scholarship committee of the Lupus Inspiration Foundation for Excellence, Commitment to Underserved People (CUP) and a number of special interest groups in the Tucson area such as Dermatology Interest Group, MedCamp & St. George’s Society Oncology Interest Group.
Ryan and his wife, Kerri Kislin, Ph.D., have made themselves at home in Seattle. In their free time they enjoy cooking, practicing martial arts (Ryan notes that Kerri is much more dangerous than he is), skiing, watching movies & learning how to play in all of the water around Seattle. Ryan also has enjoyed spelunking in Arizona caves, skydiving, racquetball, and road biking.
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 Galya Stetsenko, MD
Galya is a University of Washington Medical School graduate, earning her M.D. in 2004 and a Masters of Health Administration in 2005. She earned a B.S in biology from Gonzaga University in Spokane in 1998 before coming to UW for medical school. Her route to Dermatology includes a residency in Pathology at the University of New Mexico in Albuquerque during the 2005-06 academic year. She continued and finished her Anatomic and Clinical Pathology residency training at University of Washington in 2006-2009. She recently returned to Seattle after completing a surgery internship in Honolulu. She also has volunteered at Camp Horizon for the Geisinger Institute, Danville, PA, and was a member of a team (Health Teams International) headed by Dr. Dan Wiklund that journeyed to Cameroon. Galya is fluent in Ukrainian and Russian.
Galya and her husband enjoy time with their son --- and recently gave birth to a daughter!
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 Jonathan Olson, MD – Jonathan moves into his second year in our program after a busy first year. Jonathan, also a University of Washington Medical School graduate in 2008, started his first year in Dermatology Residency after completing internship at Virginia Mason Medical Center during his transitional year. He earned his B.S. degree in Molecular Biology (summa cum laude) in 2003 at University of Wyoming, Laramie, prior to entering University of Washington School of Medicine.
Jonathan has a history of volunteering in the community, particularly to benefit homeless and inner-city youths. He also is a member of the United Steel Workers of America! Jonathan has worked with many of our faculty and previous residents on a long list of publications prior to joining our Residency program. In his free time, he enjoys rock-climbing, skiing, reading, and drinking gallons of coffee. He and his wife Laura are expecting their first child this summer!
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 Junko Takeshita, MD, PhD
– Junko is our Chief Resident for 2010-11 after completing another successful year in our program. She has decided to continue her clinical experience and will be concentrating her work primarily at the VA and other various sites. Her Internal Medicine internship was at the UW Department of Medicine. She earned her M.D. & Ph.D at Washington University School of Medicine, St. Louis, MO, from 1998-2007. Previously, she earned her Bachelor of Arts in Chemistry and Mathematics (Summa cum laude) from Wellesley College, Wellesley, MA, during 1994-1998.
A fascinating detail of Junko's experience is that before arriving in Seattle during, she was an ABC News Medical Unit Intern in Needham, MA, where she researched and wrote medical news stories for ABCNews.com during April and May 2007. Junko advises that in her free time, she likes to run - presently specializing in half marathons - hike, ski and she’s a big fan of karaoke.
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 Edward Esparza, MD, PhD
– After two years of clinical work, Ed will spend his third year doing research. This work will center on developing novel immunohistochemical markers for diagnosis and prognosis of cutaneous T cell lymphoma. He also will be applying for dermatopathology fellowships. His Internal Medicine internship was with the UW Department of Medicine. He earned his Ph.D. & M.D. from Washington University, School of Medicine, St. Louis, MO, 2007. He earned his B.A. in Molecular Biology, (magna cum laude), at Princeton University, Princeton, NJ, in 1999.
Last year Ed and Christina were married. They reside in Ballard where they enjoy jogging along the Burke-Gilman trail, playing tennis on the neighborhood court, and flying their kite when the breeze is right. He reports that their garden is producing lots of snow and sweet peas, lilies, roses, tomatoes, and strawberries. Their travels during the year included trips to Kauai and Taiwan, where Ed was nominated as king of the night markets.
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 Zarry Tavakkol, MD – Zarry enters her third year in our program. After two busy clinical years, she has opted for a third clinical year concentrating at the VA and various other clinical sites. Zarry spent her childhood in Iran and moved to Kansas when she was nine years old.
She earned her undergraduate degrees at Kansas State University (1995-2000), where she was elected to Phi Beta Kappa, followed by an M.D. from University of Michigan Medical School (2000-2004).
Originally, she planned a career in surgery and spent a year as a general surgery resident at UW in 2004. But Dermatology called to her and now she is an integral part of our Residency program. Prior to joining the program, she spent three years in the Dermatology Division Skin Biology Lab, working with Drs. Olerud and Fleckman. Her husband, Habib, is a radiologist, currently in fellowship specializing in breast imaging at the SCCA. Their son, Nima, is now an active and very happy toddler. She has no hobbies as all of her spare time is spent with her family.
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Case Study
Submitted by Jonathan Olson, MD, 2nd Year Resident, University of Washington
Ms. H is a 47 year old homeless woman with congenital deaf-blindness secondary to Usher syndrome (the most common genetic cause of deaf-blindness in the U.S.[1]). On presentation, she was noted to have an erythematous rash on her face with thick, adherent, hyperkeratotic scale (Fig 1)
. Given her psychosis and violent behavior, she could not be examined; instead, multiple pieces of skin scale were recovered from her bed. KOH preparation demonstrated abundant hyphae with acute angle branching (Fig 2)
. Several days after beginning anti-psychotic therapy, Ms. H was able to give a history of several years of progressive skin changes, and exam showed that the majority of her body was covered with very large, sharply circumscribed erythematous patches with thick overlying scale (Fig 3). The intervening skin was entirely normal. She would not consent to a skin biopsy. She was started on fluconazole 150mg qweek, with almost total resolution of her skin eruption by the time of discharge 3 weeks later. Unfortunately, Ms. H was lost to follow up when she and her husband disappeared from the homeless shelter.
Our patient had a combination of mental, physical, and social challenges that allowed a normally minor dermatologic problem to achieve impressive proportions. Given the severity of her presentation, consideration was given an underlying inflammatory dermatosis, ectodermal dysplasia, or disorder of cornification with fungal super-infection. The dramatic response to oral anti-fungal therapy with return to normal-appearing skin in a very short time ultimately argues for the simplest explanation, overwhelming dermatophyte infection.
Weekly pulsed oral fluconazole is a safe and effective treatment for tinea corporis. There are very few side effects or drug interactions (important in a patient on anti-psychotic medication) and high levels are attained in the stratum corneum and nails within hours of initiating therapy.[2] Published cure rates range from 88-95% after 2-4 weeks of treatment, and a double-blinded, placebo controlled study of fluconazole vs. griseofulvin, showed similar cure rates after 4-6 weeks of treatment (> 90%) with significantly fewer side effects in the fluconazole group.[3]
References:
- Cohen M, Bitner-Glindzicz M, Luxon L. The changing face of Usher syndrome: clinical implications. Int J Audiol. Feb 2007;46(2):82-93.
- Wildfeuer A, Faergemann J, Laufen H, et al. Bioavailability of fluconazole in the skin after oral medication. Mycoses. 1994 Mar-Apr 1994;37(3-4):127-130.
- Lesher JL. Oral therapy of common superficial fungal infections of the skin. J Am Acad Dermatol. Jun 1999;40(6 Pt 2):S31-34.
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Medicaid ProviderOne: WSMA Advocacy Continues
The WSMA continues its ongoing advocacy on behalf of member physicians and their practices in addressing concerns with Washington Medicaid’s ProviderOne claims system. Working closely with Medicaid leadership, WSMA offers these recommendations:
- To better serve the practice community, Washington Medicaid is conducting “triage” of inquiries on claim related problems. Practices with a substantial volume of outstanding claims should make use of the Customer Service process, as Medicaid is using that mechanism to focus its efforts. Go to hrsa.dshs.wa.gov/contact/default.aspx. Note that the first option, WEBFORM, is a secure
online communication, enabling practices to include protected health information when necessary. In the “Select Topic” menu, “Claim Denial” is the preferred choice if your claims have been rejected for reasons such as provider taxonomy. IMPORTANT:
In the “Comments” section, if your practice is facing substantial amounts of outstanding or denied claims, with very high adverse impact on your practice, state that in your comments! Medicaid staff will assign a high “severity” rating to your inquiry.
- If your claims have encountered problems with selecting the correct “Provider Taxonomy,” be sure to review the guidance available at www.dshs.wa.gov/provider/index.shtml
. More specific detailed guidance on “Provider Taxonomy” is available in the ProviderOne Billing and Resource Guide at hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html. Go to Appendix L - Taxonomy and ProviderOne.
- Avoid submitting paper claims if at all possible! Medicaid notes that paper claims take much longer to process, and typically are only successfully processed on initial submission about 10% of the time! Also, paper claims pull Medicaid staff away from resolving electronic claims, adding to the backlog.
Please keep the WSMA apprised of your claim problems! We will continue our advocacy on your behalf. Contact Bob Perna at rjp@wsma.org.
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CMS launches physician compare website
CMS recently launched the first phase of a searchable online physician directory for Medicare patients called Physician Compare. The site currently includes information on contacts and addresses; gender, medical specialty, the professional' education, residency or other training; and languages the professional speaks besides English. Eventually, Physician Compare will show whether physician practices have submitted data to CMS on the Physician Quality Reporting System (PQRS).
Note that the majority of the information in the Physician Compare website comes from the Provider Enrollment, Chain, and Ownership System (PECOS) system. We anticipate that CMS will provide additional guidance on the appropriate process to update your information should you continue to find inaccuracies after the upcoming PECOS update.
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