JANUARY/FEBRUARY 2015 VOLUME 21 | NUMBER 1
CMA'S 2014 LEGISLATIVE WRAP UP AND HOUSE OF DELEGATES
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2 | THE BULLETIN | JANUARY / FEBRUARY 2015
OR SCAN TO LEARN MORE!
BULLETIN THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
700 Empey Way • San Jose, CA 95128 • 408/998-8850 • www.sccma-mcms.org
MEMBER BENEFITS
Feature Articles
Billing/Collections
12 House of Delegates
CME Tracking
22 California Children’s Services
Discounted Insurance
26 CMA’s 2014 Legislative Wrap Up
Financial Services Health Information Technology Resources House of Delegates Representation Human Resources Services Legal Services/On-Call Library Legislative Advocacy/MICRA Membership Directory iAPP for the iPhone Physicians’ Confidential Line Practice Management
Departments 5 From the Editor’s Desk 6 Message From the SCCMA President 8 Message From the MCMS President 9 Letter From the CMA President 20 A Book Review: The Doctor and Mr. Dylan 32 Medical Times From the Past 34 MEDICO News
Resources and Education
42 Classified Ads
Professional Development
43 In Memoriam
Publications
45 Welcome New Members
Referral Services With Membership Directory/Website Reimbursement Advocacy/ Coding Services Verizon Discount JANUARY / FEBRUARY 2015 | THE BULLETIN | 3
THE SANTA CLARA COUNTY MEDICAL ASSOCIATION OFFICERS President James Crotty, MD President-Elect Eleanor Martinez, MD Past President Sameer Awsare, MD VP-Community Health Cindy Russell, MD VP-External Affairs Kenneth Blumenfeld, MD VP-Member Services Peter Cassini, MD VP-Professional Conduct Seema Sidhu, MD Secretary Seham El-Diwany, MD Treasurer Scott Benninghoven, MD
CHIEF EXECUTIVE OFFICER
COUNCILORS
William C. Parrish, Jr.
El Camino Hospital of Los Gatos: Vacant El Camino Hospital: Laura Cook, MD Good Samaritan Hospital: David Feldman, MD Kaiser Foundation Hospital - San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Anh Nguyen, MD O’Connor Hospital: Michael Charney, MD Regional Med. Center of San Jose: Erica McEnery, MD Saint Louise Regional Hospital: Diane Sanchez, MD Stanford Hospital & Clinics: Vanila Singh, MD Santa Clara Valley Medical Center: Richard Kramer, MD
CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Randal Pham, MD (Ethnic Member Organization Societies) Tanya Spirtos, MD (District VII)
BULLETIN
THE MONTEREY COUNTY MEDICAL SOCIETY
Printed in U.S.A.
OFFICERS
Editor
President Jeffrey Keating, MD President-Elect James Hlavacek, MD Secretary Patricia Ruckle, MD Treasurer Steven Vetter, MD
THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
Joseph S. Andresen, MD
Managing Editor Pam Jensen
Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/ MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising. Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org © Copyright 2015 by the Santa Clara County Medical Association.
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CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.
DIRECTORS Paul Anderson, MD Valerie Barnes, MD Ronald Fuerstner, MD Gary Gray, DO Steven Harrison, MD David Holley, MD John Jameson, MD
William Khieu, MD Eliot Light, MD Edward Moreno, MD Marc Tunzi, MD Craig Walls, MD Cary Yeh, MD
FROM THE EDITOR’S DESK
JOSEPH S. ANDRESEN, MD Editor, The Bulletin
I’m a Doctor Today Thanks to My Local Community College By Joseph Andresen, MD Physician Editor, The Bulletin It was a typical afternoon and I was just finishing a pre-operative patient consultation on the medicine ward. As I was putting the finishing touches on my EPIC entry, my cell phone rang and “unavailable” flashed across the screen. I hesitated for a moment, not wanting to be bothered by another nuisance call. I wasn’t about to be fooled again by “Rachael from Account Services” offering to lower my credit card interest rates despite numerous requests not to call again and being on the “Do Not Call” list. I decided to chance it and answer the call. “Is this Joseph Andresen?” a male voice said on the other end of the line. “Yes, this is,” I replied. “This is the White House calling,” the voice stated. My immediate reaction: this must be a prank call! “Hi, I’m Patrick Cunnane and calling from the White House,” the caller repeated. “You wrote a letter to the President. I get quite a few letters across my desk and yours really stood out.” Well, I did write a letter several months ago to President Obama entitled, “I’m a Doctor Today Thanks to My Local Community College” – this really was the White House calling! “I want to get some further background information on your letter. Do you have a few minutes to talk now?” Patrick asked. “Yes, I do,” I replied. For several years, I had hoped to share my circuitous educational path to medicine as a young college student. After graduation from high school in Oakland, I had no idea of my career path or immediate interest in higher education. However, after several months working as a janitor for the local phone company, I began taking evening classes at Laney Junior College in Oakland. With an interest in helping others, I was accepted into a two year allied health program in respiratory therapy at Merritt Junior College in Oakland. I continued to work full-time as a janitor and attended school full-time during my first year in this program. However, after the first year, I began working as a respiratory therapist trainee. Two days of work each week now paid me the same amount as five days of work a week in my previous job and I graduated with an associate arts degree the following June. I worked as a respiratory therapist for the next year in a busy city hospital with greater responsibility and a deep gratification from the patients I cared for. After that first year I knew that medicine was my calling. I returned as a full-time student at Foothill Community College
where I enrolled in the required pre-med courses in chemistry, physics, biology, and math. Thereafter, I was accepted as a junior transfer student at University of California, Berkeley where I completed my A.B. degree in genetics and went on to achieve my medical degree from the University of California, San Francisco. Looking back now at my community college experience, what stands out were smaller class sizes, excellent instruction, and the many teachers who mentored me. These were all reasons for my subsequent success. Last July, President Obama proposed the American Graduation Initiative to invest in community colleges and help American workers get the skills and credentials they need to succeed. As the President pointed out, “In the coming years, jobs requiring at least an associate degree are projected to grow twice as fast as jobs requiring no college experience. We will not fill those jobs – or keep those jobs on our shores – without the training offered by community colleges.” – With even more urgency and importance, President Obama unveiled “America’s College Promise” at this year’s State of the Union address. His proposal is to make higher education more accessible by providing twoyears of community college tuition-free for the nine million students a year who meet the eligibility requirements. University of Pennsylvania College President Dr. Amy Gutmann spoke out in strong support of the President’s latest proposal: “Making college more accessible to more people is absolutely critical… only gotten more and more essential to what makes for having the opportunity that has really defined the American dream for millions of people.” And how about our global partners and competitors? Germany has had a long tradition of free education recently abolishing all college tuition fees throughout the country, even for international students! Other countries include Brazil, Finland, France, Norway, and Sweden who offer university education free or with minimal registration fees. A highly trained and educated citizenry is the strategy for all nations’ future success and prosperity. Soon after the President’s State of the Union Address, pundits quickly took to the airways: Who is going to pay for it? The taxpayer! Community colleges are not up to the task others argued. And my response to those who doubt the worthiness of this investment in our youngest and future generation: I am a doctor thanks to my local community colleges!
Joseph S. Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area. JANUARY / FEBRUARY 2015 | THE BULLETIN | 5
MESSAGE FROM THE SCCMA PRESIDENT
JAMES R. CROTTY, MD, MBA President, Santa Clara County Medical Association
Population Health – Why It Matters By James R. Crotty, MD, MBA President, Santa Clara County Medical Association The increasing cost of health care in the United States is lamented by employers, state and federal government officials, and citizen advocacy groups. Not only does the United States spend more per capita on health care than any other country but comparative health outcome rankings are low. The good news is that we are witnessing changes in health care delivery wrought by the Affordable Care Act (ACA) to decrease the number of uninsured and increase the regulation of the health insurance industry; however, the ACA addressed the cost of health care in only a limited way. The ACA did set money aside to explore alternative health care systems, such as the Accountable Care Organization (ACO). In theory, this health care organization would deliver health care services across the continuum in an integrated manner, and be responsible for the global costs of care. The success of ACO’s is starting to be measured, and the results are mixed. One of the reasons that the cost problem has been so hard to address is the fragmented nature of health care delivery in the United States. The fee-for-service arrangement for health care services was inherited from our forefathers and was perpetuated with ardent fury by physicians in the United States after WWII, when other countries created national systems of care. When Medicare was created, in 1964, the fee-for-service (FFS) arrangement continued. It was not until the early 1970’s that commercial insurance premiums and Medicare expenses started to grow faster than other GDP economic growth. Attempts to control costs during Presidents Nixon, Carter, and Reagan were ineffective. In 1997, President Clinton signed the Balanced Budget Act, which included the Sustainable Growth Rate that tied physician reimbursement rates to GDP growth. This worked for two years, but in 2001 costs continued to climb and this resulted in decreased physician reimbursements, however, Congress has intervened in every year since 2003, nicknamed the “doc-fix,” that have prevented a decrease in physician payments. The problem of Medicare costs loom because of the predicated increase in beneficiaries (77 million in 2030 compared to 55 million today), the larger percentage of the federal budget and the decrease in ratio of workers to beneficiaries. More Federal spending on 6 | THE BULLETIN | JANUARY / FEBRUARY 2015
health means less spending on education and other Federally funded programs. The political debates about health care preceding the signing of the Affordable Care Act, and the enactment of this law have stimulated change in the U.S. health care landscape. One organization that has gained attention is the Institute for Health Improvement (IHI), founded in 1991. This organization has identified and spread best practices, to reduce waste, errors and other unnecessary untoward events like falls and pressure ulcers. In 2008, IHI created what they call the Triple Aim. They define the Triple Aim as a framework for optimizing health system performance by simultaneously focusing on the health of a population, the experience of care for individuals within that population, and decreasing the per capita cost of providing that care. Population health is not a new concept, consider Roman aqueducts, and indeed population health does include things like clean water, clean air, and affordable nutritious food. But population health has become a buzzword because population health is about creating systems to keep populations healthy. Population health at its best can combine healthy environments with modern disease prevention, disease screenings, treatments, and interventions with tracking systems to measure the health of a population. Population health is a goal that fee-for-service medicine has not addressed, nor is this arrangement conducive to improving population health. Many studies have shown that FFS drives volume, and health of the population is usually not considered. That is why improving population health has been included in efforts to find alternative payment arrangements that reward for a healthier population and consequently less hospitalization, less emergency visits, and more alternatives to traditional office visits (e.g. group appointments, and phone or video visits). What has been called “payment reform” includes concepts to reward health systems that share some financial risk for quality and utilization measures. Many studies have pointed out that physicians can only make a limited contribution to population health because there are larger James R. Crotty, MD, MBA, is the 2014-2015 president of the Santa Clara County Medical Association. He is a urologist and is currently practicing with The Permanente Medical Group/Kaiser in San Jose.
problems such as medication compliance, lifestyle issues, care environment issues, poverty, and language/cultural issues that are beyond the realm of physician control. Physicians value autonomy and have not usually been accountable to measures of population health, however, new physician payment arrangements are being created that link population health to pay. Currently, these pay-for-performance incentives are small, however, it is clear that the Triple Aim is also a framework for changing financial incentives. The AMA has launched efforts to address two medical diseases to improve population health. One is hypertension, and the other is pre-diabetes. For hypertension the AMA is collaborating with Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities at 10 clinical sites in Illinois and Maryland. For pre-diabetes the AMA
is collaborating with the YMCA in three pilot locations: the state of Delaware, Indianapolis, and Minneapolis/St. Paul. It may be necessary that county medical societies in California become more active to discover what efforts and what resources are available to address population health. For example, it seems like it would be possible to work with the YMCA and pre-diabetes screening efforts on a county level, since AMA has already helped launch this initiative. What is clear is that physicians need to be seen as leaders in these efforts. It is a natural extension that physicians who are very dedicated to the health of their patients would also lead efforts dedicated to the health of a larger defined population.
JANUARY / FEBRUARY 2015 | THE BULLETIN | 7
MESSAGE FROM THE MCMS PRESIDENT
JEFFREY KEATING, MD President, Monterey County Medical Society
Happy 2015 By Jeffrey Keating, MD President, Monterey County Medical Society Happy 2015. I hope everyone else shares my guarded optimism for the coming year. At this point, it is good to reflect upon the challenges and accomplishments of 2014. The biggest challenge and, at the same time accomplishment, would of course be the rejection of proposition 46 by the electorate. This was a major victory for both the medical community and the people of California. Once again, the most important tool we have in our armamentarium is being organized at both the local, county, and state level. It has been estimated by some that if proposition 46 passed, the cost to each physician would be in the range of $20,000. Obviously, if it had passed, everyone would then realize that they each have a stake in the fight, but as it often seems it is the minority that provides the benefit for the many. If you are reading this article you were already part of the effort and I don’t need to convince you; nevertheless, it is still important to always try to get new members. On a personal note, I always find it strange to have flowers and warm days in January. I was born and raised in a small town in northwest Indiana, about 50 miles from Chicago, on the northern shore of Lake Michigan – in the Snow Belt. I remember some January’s when we would get four feet of snow at a time. The yearly accumulations could be astounding, 10 feet or more, some years. Everything stopped – schools, businesses, stores closed. Woe to him who was low on provisions. Sometimes the roads were closed for days as our city coped with clearing roads and towing vehicles abandoned in drifts. Nothing moved until the snow stopped and cleanup began. These were times when one might think that we became hostage to the January weather. This was long before I moved to California and experienced the gentler side of winter.
sense of peace, of nature’s might, of expectation in that scene. On clear days, I would be able to see the Chicago Skyline 30 miles across the water seeming to rise from the very waters of the lake. In the opposite direction, I could see 30 miles or so of the shore along the state of Michigan dotted by dunes and frozen beaches. As wild and wonderful and awesome as the snow was, the frigid air brought down from Canada by the jet stream was fearsome – cold that, sometimes, hovered well below zero for days on end. Winds tore at our clothes and peppered us with snow and ice, making it hard to see – dangerous cold – killing cold. And yet, as children, the cold could be exhilarating after spending days indoors. I remember how my brothers and I would revel in our escape from the house. We would build snow forts and follow the tracks of small animals in the snow. And then there were the deer that foraged for dune grass. We felt so adventurous, so strong, so free as we cavorted in the snow. The cold, the snow, the winds did not diminish us but they strengthened us. Winter was hard and glorious and temporary. Spring would come – eventually. We are in the midst of trying times. In speaking with my colleagues, I feel a sense of despair in the face of serious challenges on many fronts from hospitals, government whim, and insurance companies. If we are to survive this winter and make it through what many of us feel are dark times, I think we need to first and foremost remember why we went in to Medicine in the first place and we truly need to pull together and work together as a profession. If we do then I am cautiously optimistic that things will get better – eventually.
And yet, at this time of year I always keenly and longingly visualize the huge drifts, some six or eight feet high, the dunes stark and beautiful in the snow, the lake leaden a no man’s land that even the boisterous gulls avoided. And yet one could feel the most improbable Jeffrey Keating, MD, is the 2014-2015 president of the Monterey County Medical Society. He is a pathologist and is currently practicing with Community Hospital of Monterey Peninsula in Monterey. 8 | THE BULLETIN | JANUARY / FEBRUARY 2015
California Medical Association California Medical Association Physicians dedicated to the health of Californians Physicians dedicated to the health of Californians
Dear Colleagues: Although 2014 will long be remembered as the year that all modes of practice and specialties of the House of Medicine came together in a group effort to defeat Proposition 46, it is imperative that we maintain the momentum we have gained as we confront the issues of the coming year and beyond. Following such a historic year, I would like to take a moment to reflect on what we have accomplished and what we can look forward to over the next 12 months. I have, for over three decades, been a firm believer in the institution of organized medicine and the good that we can accomplish with unified action. As the President of the Humboldt-Del Norte Medical Society and Chair of the Council on Legislation, and in my time as Vice Speaker and Speaker of the House of Delegates, I have seen you all accomplish remarkable feats together. Whether it has been determining our stance on the sweeping changes of health system reform; combating unwarranted extensions of allied health professionals’ scope of practice; fighting for access to care; working to ensure the practice of medicine is dedicated to patient welfare rather than the insurance bottom line; redefining Medicare geographic payments, and on and on; we have been able to get all this done because we work together for the benefit of all. Our political power was evidenced this November when we handed the trial attorneys’ Proposition 46 an unprecedented two for one electoral defeat, in conjunction with an unparalleled coalition across all party and advocacy lines. We distributed over three million lab coat cards, hundreds of thousands of patient brochures, posters and yard signs all over the state, mostly because of the ground game we mobilized. Such a victory would never have been possible if not for the dedication we all had to one another and to the future of the practice of medicine. It is indeed a great honor to follow in the footsteps of Richard Thorp, M.D., who as last year’s president led an incomparable team effort to victory, not only with Proposition 46, but also the other battles and challenges we faced. So what does that mean for the year ahead? Already, the California Medical Association (CMA) has been involved in a public launch to increase the tobacco tax in California. We currently stand 47th in the nation in that regard. A broad coalition of public health advocates will be working all across the state. This action may end up being a legislative effort, or perhaps a ballot initiative, but we will be pressing forward this year. We know that as millions of citizens are signing up for health insurance coverage, it is more important than ever to ensure that they have real access to quality medical care, not just a card promising care without the infrastructure to deliver. To that end, CMA has been working with partners to educate physicians and patients about their choices. Many other issues are sure to arrive in the coming year; they always do. As a group, united, we can accomplish great things, as we have already proven. I look forward to working with you all in the exciting new year.
Luther F. Cobb, M.D. CMA President
Headquarters: 1201 J Street, Suite 200, Sacramento, CA 95814-2906 • 916.444.5532 Headquarters: 1201 J Street, SuiteStreet, 200, Sacramento, CAFrancisco, 95814-2906 • 916.444.5532 San Francisco office: 221 Main Suite 560, San CA 94105-1930 JANUARY / FEBRUARY 2015 San Francisco office: 221 Main Street, Suite 560, San Francisco, CA 94105-1930
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CAMPBELL LOCATION 3425 S. Bascom Avenue Suite I Campbell, CA 95008
ATHERTON LOCATION 3351 El Camino Real Suite 200 Atherton, CA 94027
appointments & referrals: 408-377-3331 online spine encyclopedia at: SanJoseNeurospine.com
Physician Profile Adebukola Onibokun, MD Board-certified Neurological Surgeon
Announcing a new Silicon Valley spine center option for those wanting freedom from back and neck pain We’re pleased to announce a new option for back and neck pain patients: San Jose Neurospine, which began seeing patients in early September through its offices in Campbell and Atherton. The spine center includes the expertise of Adebukola Onibokun, MD, a board-certified neurological surgeon who specializes in minimally invasive spine surgery. Over his career, he has done more than 2,000 successful surgeries. Dr. Adebukola Onibokun emphasizes a conservative approach to the care of his patients and encourages non-surgical treatment first. Some of these non-surgical treatment options for back and neck pain can include pain relieving spinal injections that reduce inflammation around a nerve root and spine-specialized therapy which increases the flexibility of the back, strengthens muscles and ligaments and reduces likelihood of future strain. In this regard, he works very closely and collaboratively with outside pain management specialists and therapists to coordinate non-surgical treatment options. If non-surgical options fail, or when symptoms progress to weakness/numbness in an arm or leg, the center uses minimally invasive spine surgery techniques that enable most patients to be home later the same day.
Minimally invasive spine surgeries performed MIS Lumbar Discectomy & Posterior Cervical Discectomy This procedure is done by making a small 1-inch incision over the herniated disc and inserting a tubular retractor. Then the surgeon removes a small amount of the lamina bone that allows the surgeon to view the spinal nerve and disc. Once the surgeon can view the spinal nerve and disc, the surgeon will retract the nerve, remove the damaged disc, and replaces it with bone graft material. MIS Lumbar Fusion A minimally invasive lumbar fusion can be performed the same way as traditional open lumbar fusion, either from the back, through the abdomen, or from the side. Lateral interbody fusion (LIF) A lateral interbody fusion, often used to treat spondylolysis, degenerative disc disease and herniated discs, is performed by removing a disc and replacing it with a spacer that will fuse with the surrounding vertebra. The procedure is completed on the side of the body in order to reduce the effect on the nerves and muscles.
Posterior cervical microforaminotomy (PCMF) A PCMF is performed to help relieve pressure and discomfort in the spine by making a small incision in the back of the neck and removing excess scar tissue and bone graft material. Anterior cervical discectomy An anterior cervical discectomy is used to reduce pressure or discomfort in the neck by removing a herniated disc through a small incision in the front of the neck. The space is then filled with bone graft material and plates or screws may be used to increase stability. Artificial Disc Replacement Artificial disc replacement is intended to be an alternative to spinal fusion surgery. Unlike a fusion that locks the two vertebrae in place, an artificial disc retains movement in the spine by simulating the natural rotational function of the disc.
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San Jose Neurospine includes the expertise of Adebukola Onibokun, MD, a board-certified neurological surgeon who specializes in minimally invasive spine surgery. Dr. Onibokun (pronounced “Oh-kneebow-kun”) is Board Certified by the American Board of Neurological Surgery and is a fellow of the American Association of Neurological Surgeons. Dr. Onibokun received his medical degree from the prestigious Northwestern University Medical School, graduating with honors. He then completed 7 years of Neurosurgery Residency training at UCLA Medical Center, a program that consistently ranks as one of the top five neurosurgery programs in the country. Dr. Onibokun has previously served as Chief of Neurosurgery at Elmhurst Memorial Hospital in the Chicago area, where he established their Minimally Invasive Spine Surgery program. Prior to relocating to California, he was a Health System Clinician at the Northwestern Medicine Regional practice.
Home Remedy Book We provide a free 36-page Home Remedy Book that includes symptom charts that show when to see a doctor; home remedies; stretches that can relieve pain symptoms; and exercises that make the back stronger, more flexible and resistant to future strain. Call us, or email us at admin@ SanJoseNeurospine.com, and we’ll send 10 copies to your office for your patients. Our educational Internet presence at SanJoseNeurospine.com also has educational videos, medical illustrations, information on minimally invasive spine surgery options and a referral form.
View our video library to learn more about our practice online at: SanJoseNeurospine.com/videos
JANUARY / FEBRUARY 2015 | THE BULLETIN | 11
HOUS
DELEGA 2 HOUSE
OF OF DELEGATES DELEGATES
California Medical Association delegates set California Medical Association delegates set policy and elect officers at annual meeting policy and elect officers at annual meeting
More than 500 California physicians convened in San Diego, December 5-7 More than 500 California physicians convened in San Diego, December 5-7 for the 2014 House of Delegates (HOD), the annual meeting of the California for the 2014 House of Delegates (HOD), the annual meeting of the California Medical Association (CMA). Each year, physicians from all 58 California Medical Association (CMA). Each year, physicians from all 58 California counties, representing all modes of pr actice, meet to discuss issues related to counties, representing all modes of pr actice, meet to discuss issues related to health care policy, medicine and patient care and to elect CMA officers. >> health care policy, medicine and patient care and to elect CMA officers. >>
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SE OF
ATES 2014
JANUARY / FEBRUARY 2015 | THE BULLETIN | 13
This year, nearly 100 resolutions and reports were introduced and debated in reference committees (both in person and online prior to the meeting). During the HOD weekend, the delegates met to debate and vote on reference committee recommendations. A total of 63 resolutions were adopted. This year also saw an expanded “virtual” reference committee process that will enable a shorter, two-day meeting in future years. Reference Committees A (Science and Public Health), B (Government Health Programs and Health System Reform) and F (Health Professions and Facilities) conducted all testimony online in advance of the meeting. All CMA members were invited to participate in the online debate, and nearly 500 online comments were recorded. The reference committee members then met via conference call in advance of the meeting to develop their recommendations, which were presented to the House for floor debate. The House also elected a new president, Humboldt surgeon Luther F. Cobb, M.D., while Riverside physician Steven E. Larson, M.D., was tapped as president-elect.
The full 2014-2015 CMA Executive Committee includes: • President Luther F. Cobb, M.D., Eureka • President-Elect Steven E. Larson, M.D., Riverside • Speaker of the House of Delegates Theodore M. Mazer, M.D., San Diego • Vice-Speaker of the House of Delegates Lee T. Snook, M.D., Sacramento • Chair of the Board of Trustees David Aizuss, M.D., Los Angeles • Vice-Chair of the Board of Trustees Robert E. Wailes, M.D., Encinitas • Immediate Past President Richard E. Thorp, M.D., Paradise
Reports and Resolutions
The following are summaries of some of the resolutions that were adopted as policy. (The full actions of the HOD are available to members at www.cmanet.org/hod, under the “documents” tab.)
Tobacco CMA has been a tireless advocate for stronger restrictions on the tobacco industry for decades. The House continued that tradition, adopting five antismoking resolutions.
This year, nearly
100 resolutions and reports were introduced SAN JOAQUIN PHYSICIAN 14 | THE14 BULLETIN | JANUARY / FEBRUARY 2015
SPRING 2015
CMA has been a tireless advocate for stronger restrictions on the tobacco industry for decades Resolution 104-14 asks CMA to support the removal of the tobacco control pre-emption from the California Penal Code so that local governments would have the ability to increase the legal age of tobacco sales to 21. Resolutions 101-14, 102-14 and 103-14 address the sales, advertising regulation and taxation of electronic cigarettes. These resolutions seek legislation to ban the usage of electronic cigarette devices in public places, to ban advertising of electronic cigarettes and to urge state government to tax these items to generate funds to support research into their efficacy as smoking cessation aids, the health impacts of electronic cigarettes and for education. Resolution 105-15 asks CMA to support the concept of a tobacco-free military, including ending sales on military bases and establishing smoke-free military installations, and to refer this for national action. These resolutions come at a time when CMA is dedicating itself to smoking cessation in the state in an effort to save lives and taxpayer money. In December, CMA announced it had joined an unprecedented coalition of health care groups seeking to increase the tobacco tax by $2-per-pack by the end of 2016 to save lives and to defray the cost of diseases caused by smoking. Called the Save Lives California coalition, other members include the American Heart Association, American Lung Association, American Cancer Society Cancer Action Network, SEIU California, Health Access California and the California Hospital Association. The group will seek an increase in tobacco taxes either through legislation or ballot measure.
SPRING 2015
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CMA must use the political capital it has “banked” by recently defeating the trial lawyers’ Proposition 46 to further reshape the future of medical liability. It is hoped that a tax increase will lower the cost of providing care to smokers in the state. A recent study on California’s tobacco use by the University of California at San Francisco School of Nursing’s Institute for Health and Aging found that smoking costs $18.1 billion in California – $487 for each resident, or $4,603 per smoker – in direct health care costs and indirect costs from lost productivity due to illness and premature death. By increasing tobacco taxes the group hopes to save more than 100,000 lives per year, prevent more than 150,000 young people from ever smoking and save billions in health care dollars spent on tobacco-related diseases.
End of Life Issues
Resolution 402-14 urges that all public and private health insurers be required to reimburse for counseling for end-of-life planning as an integral part of good medical care. This resolution was referred for national action. Resolution 501-14 supports the goal of developing a Physician Orders for Life-Sustaining Treatment (POLST) online registry in California that would be secure, easy to fill out online, have real time updates, be HIPAA compliant, contain a review of forms for proper completion and allow accessibility from any electronic health record system.
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Resolution 502-14 supports allowing trained nurse practitioners/advance practice nurses and physician assistants to be authorized to complete and sign POLST orders to improve the use of this type of end-of-life authorizations and also allow for a review by the patient’s supervising physicians, when appropriate.
Other Issues Parent to parent education of child vaccination: In an effort to stem the tide of personal belief vaccine exemptions and prevent more vaccine-preventable disease outbreaks, CMA passed Resolution 115-14 supporting the development and evaluation of educational efforts, based on science and in collaboration with health care providers, for parents who want to help educate and encourage other parents reluctant to vaccinate their children. This resolution was referred for national action. Physician reimbursement: The CMA delegates passed Resolution 408-14, which asks that CMA continue to advocate for noncontracted physicians’ ability to bill and collect usual, customary and reasonable charges. The resolution also asks CMA to support legislation or regulation requiring that payors reimburse out-ofnetwork providers an interim payment amount at an amount no less than the provider’s charges or a fair payment standard based on an unbiased database of charges, according to specialty and geography. Once made, the interim payment may be disputed via an appropriate dispute resolution mechanism, such as binding arbitration.
SPRING 2015
Electronic Health Records: Resolution 513-14 asks CMA to support efforts to harmonize standards and specifications that would enable interoperability of electronic health record systems and facilitate the exchange of health information among health care providers.
Awards and Elections
New CMA president sets sights on tort reform, burdensome regulations and membership growth The new CMA president Luther Cobb, M.D., during his inaugural speech at the association’s annual meeting, said that CMA must use the political capital it has “banked” by recently defeating the trial lawyers’ Proposition 46 to further reshape the future of medical liability. “Now that the trial attorneys have so amply demonstrated the wrong way to do it, CMA can chart a course for meaningful and durable reform, that is fair to those truly injured by medical mishaps, while protecting the overwhelming majority of doctors who try their best every single day to do the right thing,” said Dr. Cobb, a board-certified, selfemployed physician practicing in general, thoracic and vascular surgery in Humboldt County. “If we can cut out the gross waste on the overhead of the adversarial tort system, all will benefit.” Dr. Cobb also spoke on the necessity of regulatory reform, saying there were many unnecessary, burdensome regulations that need to be struck from the books. One example he cited was the need for a minimum level of humidity in operating rooms to prevent the risk of sparks from ether anesthesia, which is highly flammable. “We no longer use flammable anesthetics and haven’t for a half century, yet this regulation persists. This makes ORs uncomfortable for surgeons, can interfere with the vision of those wearing protective eyewear and make the patients sweat, increasing the risk of infection,” he said. Looking out at the diverse members of the CMA HOD, Dr. Cobb said recent growth in CMA membership, which now exceeds 40,000, has been unprecedented in its history. “For many years, we on the board and the executive committee watched as membership numbers slowly declined. The conventional wisdom was that this was inevitable, that physicians just weren’t joiners,” he said. “But, with diligent organization and effort at the grassroots level, our membership has been steadily growing. We set what many thought was a ludicrous goal of 5 percent annual growth and we have achieved that.”
SPRING 2015
“And yet, all of us know many physicians who, for whatever reason, have declined to join,” he said. “If it were only for the Proposition 46 victory, they will have saved in a single year’s worth of malpractice premiums enough to pay for a lifetime of membership,” he said. “But our nonmember friends have to be reminded of how powerful and successful our CMA is, and this is a one-on-one collegial conversation. All of us as individuals and as groups can do better to recruit new membership or re-recruit those who have lapsed. We must pledge ourselves to that effort.” In addition to his involvement in organized medicine, Dr. Cobb serves as chief of staff of the Mad River Community Hospital in
Arcata, where he has been an active member of the medical staff since 1997. He previously served as the hospital’s chief of staff from 2000 to 2002 and vice-chief of staff from 2009 to 2011. Dr. Cobb is also on the medical staff of St. Joseph Hospital in Eureka. Previously, Dr. Cobb served as attending surgeon, director of trauma services and director of the vascular surgery clinic at Santa Clara Valley Medical Center in San Jose, as well as clinical associate professor of surgery at Stanford University School of Medicine and the chairman of the surgery department at Mad River Community Hospital.
CMA HOD chooses president-elect, speaker and vice speaker At CMA’s annual meeting, Riverside physician Steven E. Larson, M.D., was named CMA president-elect. He will serve as presidentelect for one year, and will take office as president during the October 2015 annual meeting. Dr. Larson has served as chair of the CMA Board of Trustees since 2011. He is the current CEO and chairman of the board of Riverside Medical Clinic, a multi-specialty medical group. He has been affiliated with the clinic since 1980.
JOAQUIN PHYSICIAN 17 JANUARY / FEBRUARYSAN 2015 | THE BULLETIN | 17
He is an assistant clinical professor of medicine at Loma Linda University School of Medicine and a clinical professor of biomedical sciences at University of California at Riverside. His medical staff appointments include Riverside Community Hospital, Parkview Community Hospital and Riverside County Regional Medical Center. Dr. Larson earned his medical degree from the Medical College of Wisconsin in Milwaukee, graduating in 1975. He completed his residency in internal medicine in 1978 and a fellowship in infectious diseases in 1980, both at the Medical College of Wisconsin Affiliated Hospital in Milwaukee. He earned a master’s degree in public health from Loma Linda University in 1988. He is board certified in both internal medicine and infectious diseases. Also reelected to the 2014-2015 CMA Executive Committee were Speaker of the House Theodore M. Mazer, M.D., a San Diego otolaryngologist, and Vice Speaker Lee T. Snook Jr., M.D., a Sacramento pain management specialist. Dr. Mazer is a board-certified otolaryngologist running a small, solo practice. He served on the association’s Board of Trustees from 2002-2010 and has chaired various committees, including those focusing on medical services and access to specialty care. Dr. Mazer served as vice speaker of the CMA House of Delegates for two years before being elected to the post of speaker in 2013. Dr. Snook is a medical director, president and founder of the Metropolitan Pain Management Consultants, Inc., in Sacramento. He is board certified in anesthesiology, internal medicine, addiction medicine and pain medicine. Dr. Snook is also a certified medical review officer and a qualified medical evaluator. He is also chair of the CMA Worker’s Compensation Technical Advisory Committee and spent nine years as a member of CMA’s Board of Trustees representing the Solo and Small Group Practice Forum.
CMA elects new chair and vice chair of its board of trustees The CMA Board of Trustees elected David H. Aizuss, M.D., as its new chair and Robert E. Wailes, M.D., as vice chair. Dr. Aizuss is a board certified ophthalmologist practicing in Los Angeles. Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He also serves as an assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine. Dr. Aizuss is a medical staff member at Tarzana Hospital and West Hills Hospital in Los Angeles County, and belongs to several professional societies, including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society and the American Medical Association. Dr. Aizuss has served as vice chair of the board since 2011. He is also a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons. Dr. Wailes, a pain specialist and board certified anesthesiologist, is the founder, co-owner and medical director of Pacific Pain Medicine Group in Oceanside and Encinitas. He has served as president of the San Diego County Medical Society and represents the American Academy of Pain Medicine at the American Medical Association. Two other new members of the Board of Trustees were also elected: Jerry Abraham, M.D., Resident and Fellow Section, and Mark Ard, Medical Student Section. For a complete list of the Board of Trustees, visit www.cmanet.org/bot.
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Firebaugh internist wins CMA’s annual “country doctor” award More than 30 years ago, Oscar M. Sablan, M.D., an internist, and his wife Marcia Sablan, M.D., a family physician, decided to work in a rural area for three years to get their medical loans forgiven as part of the National Health Service Corp, a federal program to supply debt relief to newly graduated physicians who agree to work in underserved areas. The couple moved from tropical Hawaii, where Dr. Sablan was serving his integrated medicine residency at the Queen’s Medical Center, Honolulu, to the dusty rural town of Firebaugh, 100 miles east of Fresno. The plan was for the couple to do their three-year service in rural Fresno County and then walk away with their debts forgiven. They started their practice on the corner of O and 9th streets and have been there ever since. During the 2014 CMA House of Delegates, Dr. Sablan received the Frederick K.M. Plessner Memorial Award, an award given each year to honor the California physician who best exemplifies the ethics and practice of a rural country practitioner. Dr. Sablan and his wife are the only full-time doctors in the tiny town of 7,800 and they are still treating many of the same families as when they arrived three decades ago. The whole town, from wealthy ranchers to migrant farm workers, relies on the couple. The Sablans have guided Firebaugh families through pneumonias, accidents, injuries, cancers and bypass surgeries to better health. As the Sablans built up their medical practice, they realized that they could only do so much in the exam room. So they turned to politics. Dr. Sablan has served on the local school board for close to 20 years and his wife has served as Firebaugh’s mayor for 10 years and has sat on the city council for over 30 years.
SPRING 2015
In addition to practicing medicine and community service in public positions, in 1981 the couple started the community’s annual free Christmas day dinner, which feeds 650 plus people every year. Dr. Sablan has also served as the Firebaugh-Las Deltas Unified School District team physician for all sports for 33 years.
including more than 35 medical students and residents. Also in attendance was the largest ever contingent of past CMA presidents (20) attending the event.
It is common knowledge that rural regions of California have long faced shortages of doctors. While small towns near Firebaugh struggle to hang onto doctors, Dr. Sablan’s long-standing commitment to the community makes him an exception. Learn more about Dr. Sablan by watching the award video, available on CMA’s YouTube channel, www.youtube.com/cmaphysicians.
CMA’s 2014 Nye Award given to Santa Monica psychiatrist Santa Monica psychiatrist Maria T. Lymberis, M.D., was named the 2014 recipient of CMA’s Gary S. Nye, M.D., Award in recognition of her 30 years of leadership in the area of physician well-being. This award, given annually during the association’s House of Delegates meeting, was established in 2009 in recognition of Dr. Nye, who has been a leader in bringing attention to and developing solutions to the issue of physician impairment and rehabilitation. Dr. Lymberis’ career has been defined by a commitment to the development and defense of ethical medical standards. For the past three decades, she has also worked on issues involving physician health, rehabilitation of physicians and malpractice prevention. Dr. Lymberis has been in full-time solo private practice specializing in psychotherapy in Santa Monica since 1970. Certified by the American Board of Psychiatry and Neurology in both psychiatry and child/adolescent psychiatry, Dr. Lymberis is a clinical professor of psychiatry at the Geffen UCLA School of Medicine and a graduate psychoanalyst of the Los Angeles Psychoanalytic Institute, where she taught for over 20 years as a senior faculty member. She is also a senior expert consultant for the Medical Board of California. Among her many accomplishments, Dr. Lymberis is the founder and president of two nonprofit organizations: Hellenic American Psychiatric Association and The Psychiatric Education and Research Foundation.
Other News Annual gala r aises more than $50,000 for public health progr ams The CMA President’s Reception and Awards Gala hosted members of the CMA House of Delegates and guests for an evening of dinner, dancing and a live auction. The event raised more than $50,000 to support the public health projects of the CMA Foundation. Held at the elegant U.S. Grant Hotel in San Diego immediately following CMA’s annual House of Delegates session on Saturday evening, the event was sold out with over 450 people in attendance,
Among the big ticket items auctioned off were a trip to New York City, golfing in Scotland and a San Juan Island getaway. A special thank you goes out to the 2014 gala sponsors: NORCAL Mutual, Union Bank, The Doctors Company, Pfizer, Cooperative of American Physicians, Mercer, The Permanente Medical Group, Southern California Permanente Medical Group and United Healthcare.
Join the CMA Foundation’s antisugary bever age campaign! The CMA Foundation kicked off a social media campaign at the CMA House of Delegates to engage physicians in educating their patients about sugary drinks and how they increase the prospect of developing diabetes. The CMA Foundation and the Network of Ethnic Physician Organizations are both sponsoring the campaign with funding from the California Endowment. As part of the campaign, physicians can request a poster for their offices that shows a large can of soda with the lettering “Type 2 Diabetes” and “Did you know that one junk drink a day can increase your risk of Type 2 diabetes by 25 percent.” Physicians are encouraged to place the posters in their waiting rooms where patients can see it to help open a dialog on the topic of sugary drinks and their effect on health. Physicians are also asked to take pictures of themselves engaged in conversations with their patients and post them to social media, like Twitter or Facebook, with the hashtags #beatthesweet and/or #sugarlesspour. These hashtags will allow the foundation to find your post. The CMA Foundation will repost photos with these hashtags to its Facebook page. To get your free poster contact Lisa Kirkland at lkirkland@ cmafoundation.org or (916) 779-6643.
JANUARY / FEBRUARY 2015 | THE BULLETIN | 19
BOOK REVIEW A Book Review:
The Doctor and Mr. Dylan By Joseph S. Andresen, MD This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel, “The Doctor and Mr. Dylan.” Rick and I go way back. It was my first week of residency at Stanford when we first met. As a newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely. Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was news to me as I sat down and opened the first page of “The Doctor and Mr. Dylan.” I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words: ”Life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of any free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys. Rick, I can’t wait for your next book! Bravo!
FROM THE AUTHOR: RICK NOVAK, MD Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in a small Midwestern town with an exceptional high school. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged nurse anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who 20 | THE BULLETIN | JANUARY / FEBRUARY 2015
grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed. The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a series of twists that will keep readers guessing. The book brings the issue of CRNA independent practice to a national audience, and this conflict drives the plot. Most of all, The Doctor and Mr. Dylan is a page-turning mystery, guaranteed to keep readers riveted until the final page.
Save the Date: april 14, 2015 CALIFORNIA MEDICAL ASSOCIATION 41ST ANNUAL LegiSLATive AdvocAcy dAy Tuesday, April 14, 2015 • Sheraton Grand Sacramento
Activities include: • Webinar: Lobbying 101 and Legislative Training (March 26th) • Put your training into ACTION and visit your Legislator! Attendees can stay at the Sheraton Grand at a special rate of $170/night. To make a reservation, call (800) 325-3535 and mention the “California Medical Rate.” Please note: Scholarships may be available to medical students for travel and accommodations through their county medical societies.
Registration is FREE. Reserve your spot today at cal.md/legday2015 For more information, please contact Yna Shimabukuro, CMA Government Relations at 916.444.5532 or yshimabukuro@cmanet.org.
California Children’s Services (CCS) By Marilyn Cornier, MPA CCS Program Administrator The California Children’s Services (CCS) Program was established in 1927 and it is one of the oldest public health care programs in the nation. The CCS program provides coverage for essential health care services to more than 165,000 children, under the age of 21, with special health care needs. Examples of CCS-medically eligible conditions include, but are not limited to, chronic medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, diabetes, infectious diseases and conditions related to premature birth. CCS also provides medical therapy services that are delivered in public schools. The CCS program is administered as a partnership between county public health departments and the California Department of Health Care Services (DHCS). Currently, approximately 70% of CCS-eligible children are also Medi-Cal eligible. The Medi-Cal program reimburses their care. The cost of care for the other 30% of children is split equally between CCS Only and CCS Targeted Low Income Program (TLICP). The cost of care for CCS Only is funded equally between the state and counties. The cost of care for CCS TLICP is funded 65% federal Title XXI, 17.5% state, and 17.5% county funds. The state administers the CCS program through policy letters and regulation, and the state’s primary CCS functions are approving participating providers, facilitating payment of providers, and developing and implementing quality standards for providers.
CCS child at the Holiday Open House 22 | THE BULLETIN | JANUARY / FEBRUARY 2015
CCS IN SANTA CLARA COUNTY
In Santa Clara County, there are approximately over 6,000 CCS clients receiving medical services. The administrative role of the CCS public health department program is in determining CCS medical, financial, and residential eligibility. In addition, the medical staff provides authorization of services and medical case management of CCS clients. These functions are carried out by nurse case managers, medical social workers, and medical support and professional staff. The CCS Medical Therapy Program (MTP) provides a medically coordinated function of Occupational Therapy (OT) and Physical Therapy (PT) services to children with chronic neuromuscular or musculoskeletal conditions such as cerebral palsy, spina bifida, and muscular dystrophy. In Santa Clara County, there are approximately over 1,000 children receiving CCS medical therapy services. Therapies are typically delivered at Medical Therapy Units (MTUs) which are located at public schools throughout Santa Clara County. There are currently three MTUs, located at Chandler Tripp School in San Jose, Juana Briones School in Palo Alto, and Taylor Elementary School in South San Jose. There are also satellite sites at various schools throughout the county that allow families to receive services closer to their homes. The MTU program is directed by Chief Therapist, Louise Sumpter, OT with medical direction provided by Dr. Sara Copeland and CCS Program Administrator, Marilyn Cornier, MPA. The supervising therapists include: John Buchinski, PT; Darren Stephens, PT: Marsha Maruyama, PT; and Ann Nuno, PT. In addition, there are 15 occupational therapists and 22 physical therapists and support staff at each site.
MEDICAL THERAPY UNIT LOCATIONS
In all of the Medical Therapy Units, there are pediatric specialists who examine CCS patients on an annual or semi-annual basis. These physicians are as follows: Dr. Rokhsareh Charney, pediatrician; Dr. Sarah Copeland, pediatric neurologist; Dr. Megan Imrie, pediatric orthopedist; Dr. Benjamin Mandac, physiatrist; Dr. Quintana, pediatrician and Dr. Jeffrey Young, pediatric orthopedist. Chandler Tripp MTU is located in Central San Jose next to VMC hospital. It was started in 1947 and is named after a young man who had cerebral palsy. Children have been receiving therapy services there for more than 50 years. Juana Briones MTU is located in Palo Alto. It started in 1967 and is adjacent to Juana Briones Elementary School. The children attending this site reside in the northern part of the county. South Valley MTU is located in the southern part of San Jose, near Cottle Road. South Valley was just started in 2002.
HOLIDAY OPEN HOUSE AT CCS
These are children who receive services at the MTU sites.
In December, the CCS program hosted a fun-filled event for the CCS families and CCS partner agencies. We provided arts and crafts for children, healthy snacks, and CCS tote bags to give away. Santa visited us at the event and children had beaming smiles, especially when they had their own personalized keepsake Santa photo to take home. The CCS staff was elated to see how wonderful it was to sponsor and share this joyful event with our CCS community.
CCS PROGRAM CONTACT INFORMATION
CCS child at the MTU
Public Health Department County of Santa Clara California Children's Services (CCS) 720 Empey Way San Jose, CA 95128 408-793-6200 www.sccphd.org
JANUARY / FEBRUARY 2015 | THE BULLETIN | 23
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The Ultimate
Measure By Janus L. Norman, CMA Senior Vice President
C M A’S 2014 L e g I S L AT I v e W R A P U P
For more than 150 years, the California Medical Association has upheld the banner for practicing physicians. Year after year, the state medical society has partnered with the local medical societies to diligently strive to ensure the care and well-being of patients and to protect public health by working for the betterment of the profession. In years of prosperity, the challenge of carrying out this duty is restrained. In years of controversy, the same duty is laborious. This year was full of controversies.
The fight to defend the Medical Injury Compensation Reform Act (MIRCA) may have ended with a ballot box victory in November, but the threat of a statewide ballot measure loomed heavily from the onset of the 2014 Legislative Session. The leader of Senate, President Pro Tempore Darrell Steinberg, introduced Senate Bill 1429 as vehicle to execute the strong-arm strategy of the plaintiffs bar attorneys to eliminate MIRCA’s cap on non-economic damages. Tremendous political pressure and immature bullying tactics were employed in an attempt to force CMA to the bargaining table, but the association held fast to its principle of working to create an economic environment that allows physicians in all specialties the ability to practice throughout California. Rejecting the false choices presented by opponents of MICRA and choosing to make our case before the people of California, CMA united its political allies to ensure Senate Bill 1429 never received a hearing, leaving the trial attorneys’ Proposition 46 ballot measure the only available avenue for overturning MICRA.
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Senator Mark DeSaulnier’s Senate Bill 1258 contained another component of Proposition 46: the requirement for Schedule V controlled substance prescriptions to be reported to the Controlled Substance Utilization, Review and Evaluation (CURES) database. The bill also would have required the electronic prescribing of controlled substances, expanded government access to CURES and dictated the quantity of controlled substances allowed to be prescribed. Like the mandatory checking of CURES inserted into Prop. 46, SB 1258 was touted as a bill to address prescription drug abuse. However, the impact would have been to legislate the practice of medicine, undermine the patient/physician relationship and reduce patient access to care. CMA was instrumental in killing the bill, which was held in the Senate Appropriations Committee. The committee’s action prevented passage of bad policy and also extinguished Bob Pack’s ability to use the bill as a platform from which to campaign against CMA in the months leading up to the November vote on Prop. 46. Senate Bill 492, authored by Senator Ed Hernandez, sought to expand to scope of practice of optometrists to included surgical procedures and primary care services. Senator Hernandez, a practicing optometrist and Chair of the powerful Senate Health Committee, worked feverously toward the passage of Senate Bill 492, which passed out of the Senate in 2013 and was resting in the Assembly. Utilizing his great inf luence and charm, Senator Hernandez, along with the Optometric Association, battled with CMA, the California Academy of Eye Physicians and Surgeons, the California Academy of Family Physicians and the California Society of Plastic Surgeons to win the votes of the members of State Assembly. Hundreds of CMA members made phone calls and wrote emails and letters outlining the f laws within Senate Bill 492 and urging legislators to vote no on the measure. As the coordinated statewide effort moved forward, members of the Assembly began to acknowledge the harm that would have resulted from
irresponsibly expanding the scope of optometrists to perform surgeries and provide primary care services by publicly committing to stand with the physician community in opposition to Senate Bill 492. With a majority of the members poised to oppose the measure, Senator Hernandez and the optometrists agreed to drop the bill and allow it die quietly on the Assembly Floor. California’s physician shortage is consistently utilized as an argument for expansion the scope of allied health professionals. To combat this argument and the increase access to quality care, CMA has prioritized improving our state’s physician workforce by increasing the number of residency slots for medical school graduates. Studies have indicated that where a physician completes his or her residency is a primary indicator of where the physician will practice. CMA pushed the state to make an initial investment in its future medical workforce. The 2014-15 Budget Act signed by Governor Brown included $7 million to support primary care residency slots through the state’s Song-Brown program. Of that $7 million, $4 million will be prioritized to residency programs that wish to expand and train additional residents in internal medicine, pediatrics, obstetrics-gynecology and family medicine. The 2014-15 state budget also provided significant resources to physicians. Specifically, the budget includes $3.7 million to draw down $37.5 million in federal funds for technical assistance to Medi-Cal providers on implementing and achieving meaningful use of electronic health records (EHRs). The 10 percent contribution from the state will allow an additional estimated 7,500 Medi-Cal providers to participate in the MediCal meaningful use incentive program and receive the necessary training from the existing technical assistance infrastructure. In addition, CMA convinced the Governor to forgive the retroactive Medi-Cal cuts contained in AB 97 (Chapter 3, Statutes of 2011), which reduced Medi-Cal provider cuts by 10 percent.
For the last several years, CMA led the effort to seek an injunction to invalidate and stop the implementation of the 10 percent Medi-Cal cuts, arguing that this reduction would threaten the ability of physicians to continue to treat Medi-Cal beneficiaries and would create significant gaps in access to care for this population. The legal process ran its course when the U.S. Supreme Court declined to hear our appeal. CMA was, however, able to convince Governor Brown to not attempt to retroactively collect the portion of the cuts during the period of time the injunction was in place. As a result, physicians will be able to retain $218 million in Medi-Cal payments. During the last months of the 2014 legislative session, CMA learned of the imminent closure of Doctors Medical Center in Contra Costa County. Doctors Medical Center (DMC) is the area’s main medical facility, serving over 250,000 patients in west Contra Costa County, including the city of Richmond and surrounding areas. Even though over 80 percent of its patient population is insured through Medi-Cal or Medicare, low reimbursement rates prevent DMC from creating a business model that would allow for sustained financial viability. CMA sponsored Senate Bill 883 (Hancock) to appropriate $3 million from the Major Risk Medical Insurance Fund to DMC to provide bridge funding to secure additional avenues of finance and create a new and viable business model for the facility going forward. CMA sponsored and strongly supported additional legislation that addresses the daily challenges faced by physicians and raised public awareness surrounding critical health care issues. Assembly Bill 1755, authored by Assembly Member Jimmy Gomez and co-sponsored by CMA and Planned Parenthood Affiliates of California, was signed by Governor Jerry Brown. The bill will improve California’s notice requirement specific to breaches of medical information in order to reduce administrative burdens on providers and health facilities, while also ensuring accurate notification to patients, thereby
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allowing health care providers to put those resources back into patient care. CMA, joined by various patient advocacy groups, worked with the Legislature and Governor to secure the enactment of Senate Bill 964 (Hernandez), which required Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks and to make the reports available online. Our successful advocacy did not come without sacrifices. As CMA battled in the Assembly to defeat Senate Bill 492, Senator Hernandez, Chair of Senate Health, held two CMA sponsored bills hostage in the Senate: Assembly Bill 2400 (Ridley-Thomas), which reintroduced an important discussion in the Legislature about the contracting relationship between physicians and health care plans and health care insurers, and Assembly Bill 1771 (Pérez), which would have ensured physician reimbursement for
non-face-to-face patient management services to help increase patient access to care. Ultimately, CMA stood strong in the midst of controversy and held to its core principle of ensuring the safety of patients, and as a result both measures were held in the Senate. However, CMA was able to convincingly make the policy argument for both measures and to secure bipartisan support for the underling policy, for which we will be advocating again in the near future. In its first year, the “My CMA Idea” contest produced one of the most hotly debated topics of the year: the negative impact of sugary drinks. CMA cosponsored SB 1000 (Monning), which would have required warning labels on sugary drinks. A strategy to help educate consumers about the risks associated with consuming sugary drinks, the bill was the first of its kind in the country. It generated unprecedented media attention, including coverage by international media outlets. Twenty-four California papers editorialized in support of the bill. Scholastic News magazine, a teaching
tool distributed throughout the country, included stories on the bill in a way that encouraged classroom debate on the issue. SB 1000 was even referenced in the nationally syndicated cartoon strip “Drabble.” SB 1000 faced a tough political environment from the outset, with the soda industry pulling out all the stops to defeat it. Though the bill died in the Assembly Health Committee, the campaign supporting the bill showed CMA’s strong commitment to reducing obesity, our willingness to pursue innovative public health policy and – most importantly – helped educate people about the risks associated with consuming sugary drinks. As Martin Luther King, Jr. famously said, “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.” In 2014, I am proud to say, CMA measured up!
Below are details on the major Bills that Cma followed this year. CMA-Sponsored Legislation AB 1755 (Gomez): Medical Information Status: Signed by the Governor. This bill improves California’s notice requirement specific to breaches of medical information to reduce administrative burdens on health facilities and ensure accurate notification to patients. Currently, health facilities in the state must report any unauthorized access of a patient’s medical information to the California Department of Public Health (CDPH) and directly to the patient within five business days or face a penalty. This bill makes three small changes to the law: it extends the notification timelines from 5 to 15 business days, providing a longer time frame for health facilities to complete an internal investigation before notifying the patient of the incident; allows patients to designate and alternate address or means for notification rather than the patient’s last known address, as required by current law; and lastly, provides CDPH with discretion on when to investigate a report of unauthorized access rather than requiring investigation of each and every incident no matter how minor.
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AB 1771 (V.M. Pérez): Medical Information Status: Held in Senate Appropriations Committee. This bill would have required health insurance companies licensed in the State of California to pay contracted physicians and qualified nonphysician health care providers for telephone patient management services. AB 1805 (Skinner and Pan): Medi-Cal Reimbursement – Provider Payments Status: This bill was an advocacy vehicle. Budget eliminated the retro-cut, which eliminated need for the bill. This bill sought to restore the 10 percent cut to Medi-Cal provider reimbursement rates that was enacted as part of the 2011 State Budget Act. The Governor presented a budget that included the elimination of the retroactive clawback, which eliminated any attempt to collect the uncollected 10 percent Medi-Cal reimbursement cuts in prior fiscal years, a savings of nearly $42.1 million for all MediCal providers.
AB 2400 (Ridley-Thomas): Health Care Coverage – Provider Contracts Status: Author pulled bill from Senate Health Committee. This bill would have prohibited health plan and health insurer contracts issued, amended or renewed on or after January 1, 2015, from containing the following terms: (1) Termination of the health care provider’s contract or participation status in the contract or the provider’s eligibility to participate in other product networks, if the provider exercises the right to negotiate, accept or refuse a material change to the existing contract. Physicians and physician groups and should not be forced to assume such obligations as a condition of maintaining access to their patients covered by commercial plans. (2) A requirement that a health care provider agree to accept or participate in other products or product networks, including future products that have not yet been developed or adopted by the plan, unless the plan discloses the reimbursement rate, method of payment and any other materially different contract terms for those products from the underlying agreement. The bill also would have extended to health plan and insurer contracts through a preferred provider arrangement (PPO) the existing prohibition on contract provisions allowing for material changes without the changes first having been negotiated and agreed to by the health care provider. It would also have increased from 45 days to 90 days the advance notice a health plan or insurer must give a provider before implementing a material change to the provider’s contract, where the changes are made by amending a manual, policy or procedure document referenced in the contract which, under existing law, triggers the provider’s right
to negotiate and agree to the change or, if agreement is not reached, the right to terminate the contract. SB 883 (Hancock): West Contra Costa Healthcare District Status: Signed by the Governor. This bill allocates $3 million in bridge funding from the Proposition 99 Special Fund to Doctors Medical Center in order to allow the hospital to develop a viable financial model for operations. SB 1000 (Monning): Sugar-Sweetened Beverages Status: Held in Assembly Health Committee. This bill would have prohibited the sale of most non-alcoholic beverages with added sugar and over 75 calories per 12 f luid ounces without the following warning label: “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.” In the last thirty years, Americans’ daily calorie consumption has increased by 250-300 calories. Sugary drinks represented the largest single source of that increase. This bill would have helped to alert consumers about the health risks associated with consuming the empty calories in these types of beverages. Strongly Supported Legislation AB 357 (Pan): Medi-Cal Children’s Health Advisory Panel Status: Signed by the Governor. This bill renames the Healthy Families Advisory Board as the Children’s Health Advisory Board and transfers the panel’s advisory and reporting capacity from Managed Risk Medical Insurance Board
to the Director of the Department of Health Care Services on matters relevant to all children enrolled in Medi-Cal and their families. AB 1522 (Gonzalez): Employment – Paid Sick Days Status: Signed by the Governor. This bill requires most California employers to provide paid sick leave from commencement of employment to employees who work 30 or more days within a year. Employees will earn a minimum of one hour of paid sick leave for every 30 hours worked. Expanding paid sick leave coverage will help workers avoid going to work when they are most likely to transmit communicable diseases, a public health intervention also supported by leading national public health organizations, the American Public Health Association and the National Association of County and City Health Officials. AB 1743 (Ting): Hypodermic Needles and Syringes Status: Signed by the Governor. This bill extends by six years the current sunset of pharmacists’ authority to sell hypodermic needles and syringes without a prescription. It also removes the existing 30 syringe limit. Finally, it establishes a sunset date of January 1, 2018, for the hypodermic needle/syringe exemption in the law that makes possession of drug paraphernalia illegal. SB 964 (Hernandez): Health Care Coverage Status: Signed by the Governor. This bill requires all Medi-Cal managed care plans to be surveyed on quality management, utilization review, timely access and network adequacy.
opposed legislation AB 1886 (Eggman): Medical Board of California (Neutral) Status: Signed by the Governor. The original language of AB 1886 would have required the Medical Board of California to post indefinitely all the
information it posts online about physician discipline, criminal convictions, and reportable malpractice settlements. After negotiations, the author accepted amendments that addressed CMA’s concerns. The amendments allowed for indefinite posting
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of most disciplinary actions (suspension, revoca tion, surrender, probation), but continued to maintain the current posting limit of 10 years for letters of public reprimand. It also reduced the posting of citations from five years to three years. Additionally, it provided physicians a 30-day window to resolve or appeal a citation before it is posted to the website. Under current law, citations are posted immediately. Amendments also reduced the posting requirements for malpractice settlements. The amendments limit the posting of settlement information to when a physician has 3 or 4 settlements (the threshold is based on low vs. high risk specialties) over $30,000 in the last five years and those settlements would be posted for five years. This is a decrease from current law, which requires posting when a physician has 3 or 4 settlements of over $30,000 in a 10 year period. Current posting requirements are 10 years for this settlement information. The amendments ref lect the concern that settlements are not a reliable measure of a physician’s competence. They also avoid indefinite posting of less severe disciplinary actions. AB 2015 (Chau): Health Care Coverage – Discrimination Status: Failed in Assembly Appropriations Committee. The bill would have required health plans to reimburse for services from alternative practitioners such as naturopaths and traditional Chinese medicine without referral from a physician. AB 2406 (Rodriguez): Emergency Medical Services Authority – Abuse of Emergency Medical Services Status: Failed in Senate Public Safety Committee. This bill would have expanded the scope of paramedics in the field and would have required Emergency Medical Services Authority to submit a report to the Legislature identifying programs that have been implemented by local
emergency medical services agencies to address “misuse and abuse” of emergency medical services. Due to the vague nature of the proposed language, there was concern that the “misuse and abuse” requirement of the report would have negatively affected physicians’ ability to provide care because they would be subject to state reporting on certain aspects of the emergency room. AB 2533 (Ammiano): Health Care Coverage – Noncontracting Providers Status: Failed on the Senate Floor. The bill would have prohibited a non-contracting provider that agrees to provide services under these provisions from billing an enrollee or insured for any amount in excess of the in-network reimbursement rate. SB 492 (Hernandez): Optometrist – Licensure Status: Held on the Assembly Floor This bill would have expanded optometrists’ scope by authorizing them to perform a range of therapeutic laser and scalpel procedures for superficial lesions of the eyelid and adnexa, as well as certain injections and immunizations. SB 1215 (Hernandez): Healing Arts Licensees – Referrals Status: Failed in Senate Business, Professions and Economic Development Committee. This bill would have eliminated the in-office exception to the self-referral law. In general, existing law prohibits physicians from referring patients for specified goods or services in which the physician or physician’s immediate family has a financial interest. However, there is an exception to this general prohibition that allows physicians to refer patients for goods or services that are supplied in the physician’s office or the office of a group practice. This bill would have amended existing law to eliminate this exception for in-office referrals for advanced imaging, anatomic pathology, radiation therapy and
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physical therapy. SB 1258 (DeSaulnier): Controlled Substances Prescriptions – Reporting Status: Held in Assembly Appropriations Committee. In its earlier iterations, SB 1258 required reporting to CURES of Schedule V controlled substances, created authority for non-sworn investigators who do investigations for Department of Consumer Affairs Boards to request reports from the database to investigate allegations of substance abuse of licensees, and mandated electronic prescribing of controlled substances. It also included a provision that limited controlled substance prescriptions to 30-day supplies unless prescribed for panic disorders, attention deficit disorder, chronic debilitating neurological condition, pain in patients with conditions known to be chronic or incurable or narcolepsy. The bill would have allowed controlled substance prescriptions associated with these conditions to be issued for a 90-day supply. It also prohibited prescriptions for controlled substances within 30 days of a patient receiving a controlled substance prescription, unless the patient has used all but a seven-day supply of the previous prescription. CMA requested the complete deletion of the sections being amended because the issues with them are so significant. The author did amend the bill in an effort to address our concerns, however the amendments were not negotiated with us and were so poorly crafted that they created more issues than they solved. SB 1303 (Torres): Public Health – Hepatitis C Status: Held in Senate Health Committee. This bill would have required health care providers to offer a Hepatitis C screening to individuals meeting certain criteria. The bill would have legislated the practice of medicine.
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Levi Cooper Lane (1830-1902) By Michael A. Shea, MD Leon P. Fox Medical History Committee Scholar, multi linguist, author, philanthropist, surgeon, and visionary are qualities possessed by Levy Cooper Lane. Is it a small wonder that a person with these credentials would be responsible for the origin of Stanford Medical School? The parents of Lane were orthodox Quakers living north of Cincinnati on a farm, where he was born May 9, 1830. He received his first schooling from his mother, Hannah, and his aunt, Ruth Cooper; then in due time medical teachings from his two physician uncles, Elias Samuel Cooper and Esaias Cooper. His formal education began at Farmers College near Cincinnati in 1847. This was for one year. Following which, he spent another year at Union College in Schenectady, New York. He did not receive a degree from either school. Thus, his remarkable education in classical literature, 32 | THE BULLETIN | JANUARY / FEBRUARY 2015
history, and impressive command of Latin, Greek, German, Spanish, and French largely came by way of independent and tutorial study. Tracking his chronological studies, we find him in Hendersonville, Illinois, serving a medical apprenticeship under Uncle Esaias. This occurred over a three-year period. He received his MD degree from Jefferson Medical College at Philadelphia in 1851. Dr. Lane then spent three years in the practice of his craft, one with Uncle Elias in Peoria and two years with Uncle Esaias in Henderson, Illinois. Tiring of rural general practice, he moved to the East Coast in 1854 to become house surgeon to the Lying-in Department of the New York Emigrant Hospital. This hospital was located on Ward’s Island, New York City. He next served two terms as a surgeon on a merchant vessel, plying between New York and Liverpool. In December, 1855, Lane applied for a commission in the United States Navy. He was awarded his rank, placing first among all candidates.
He impressed the Board by submitting, as part of the examination, an essay on “External Urethrotomy,” written in Latin. In due course, Lane served on a navy ship that was stationed for a time off the coast of Central America. It was here that he performed a thyroidectomy on a Nicaraguan woman’s goiter, an operation he had not performed before. It was a success and the patient recovered uneventfully. Following his resignation from the navy, he spent over a year studying anatomy and clinical chemistry in Germany and France. This, he did in order to prepare for the position of Professor of Physiology, offered to him by his Uncle Elias Cooper, who had recently founded the first medical school in California (The Medical Department of the University of the Pacific). Thus, in July, 1861, L. C. Lane began his position on his uncle’s medical school’s staff. Due to his uncle’s failing health, he was also forced to take on the editorship of the San Francisco Medical Press. At the death of his uncle in 1862, Lane helped to maintain the school, occupying the chair of anatomy. When the school was suspended in 1864, he was among those who joined the new Toland Faculty (the future UCSF). In 1870, that same group, under the leadership of Dr. Lane, seceded from the Toland School and founded their own school. It was called the Medical Department of the University College. Lane had bigger plans for the school. In 1882, he renamed the school, the Cooper Medical School, in honor of his uncle. He then moved the school to a new brick building at Sacramento and Webster Streets, whose construction he had personally funded. As part of the move, he established an annual set of medical lectures for the public. He believed in educating the laity, even though the prevailing medical climate was “doctor knows best.” Following the construction of the medical school, two lots were added adjacent to the school. On this property Lane added two buildings. The first was a three-story building. On the first floor was a large clinical lecture hall, on the second a large public lecture hall, and on the third was an anatomical amphitheater. The second building was the new Lane Hospital. This was staffed by the medical school staff but was open to all practitioners. A training school for nurses was also established at this hospital. Dr. Lane was a prolific writer. He authored numerous papers on medical and surgical subjects. His painstakingly accurate and elegant styled articles are found in the local journals over a 40-year period beginning in 1862. He had intended to combine some of the surgical articles into a three volume textbook on surgery, but only the first volume, Surgery of the Head and Neck (1896) ever came to print. The renowned Lane Medical Library was another of his visions. It became a reality after he and his wife had died. They had set aside sufficient funds in their respective wills for its construction and Cooper Medical School, 1882
Levi Cooper Lane funding. After a long and exhausting illness, death came to Dr. Lane on February 18, 1902. The nurse in attendance reported that “he suddenly awoke from a drowse, partially sat up and said, oh it is death, it is death” and then expired. In 1908, Stanford University acquired Cooper Medical College as the nucleus for the Stanford Medical Department. The medical school and Lane Library were moved to the main campus in 1959.
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CMA Alert, February 9, 2015
NEJM study shows primary care rate increase for Medicaid patients increased access to care A study published in the New England Journal of Medicine in January shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in a 7.7% increase in new patient appointment availability without longer wait times. The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas. Calls were made in two time periods, from November 2012 through March 2013 and May 2014 through July 2014. While the study did not examine California specifically, it did find that “states with the largest increases in availability tended to be those with the largest increases in reimbursements.” In California, the primary care rate increase more than doubled the rate these providers would have gotten without this key provision in the ACA. The study provides the first research-based evaluation of the association between the ACA’s two-year Medicaid fee increase — for which federal funding expired on December 31, 2014 — and access to care for Medicaid patients seeking new patient primary care appointments at physician offices. For Medicaid patients, the average appointment availability increased 7.7 percentage points, from 58.7% to 66.4%, between the two time periods. There was no change in wait times for appointments. Low Medicaid reimbursement rates across the country are becoming a hot topic as more and more consumers gain access to care under the ACA. Several court cases that force the issue of access to care for Medicaid patients have shown up in court. Last month, a federal court judge ruled that the low Medicaid reimbursement rates in Florida deprived children of necessary care. Recently, the U.S. Supreme Court heard a case originally filed by providers in Idaho who were frustrated with their state’s Medicaid reimbursement rates. The high court is expected to rule on the case by the end of June. The Urban Institute estimated that provider rates are set to fall an average of 42.8% because Congress chose not to renew the rate increase. 34 | THE BULLETIN | JANUARY / FEBRUARY 2015
A Kaiser Family Foundation survey found that 15 states will continue some sort of rate increase with state funds. Twenty-four states will return to payment levels before 2013; and it is unknown what the remaining 12 will do to provide access to care. In California, physicians are faced not only with the expiring ACA pay bump, but also a 10% provider reimbursement cut authorized by AB 97 in 2011. California’s abysmally low provider reimbursement rates, which have not been adjusted for increasing costs in two decades make it very difficult for physicians to accept new Medi-Cal patients—placing roadblocks for patient access to care. Even before the AB 97 cuts, California’s Medi-Cal provider payment rates were some of the lowest in the nation. Low reimbursement rates have made it difficult for physicians to continue accepting new patients in the program. As a result, 56% of Medi-Cal patients report difficulty finding a doctor. California’s Medi-Cal rates often do not even come close to the cost of providing care. Medi-Cal physicians are currently paid roughly $16 for a regular, primary care visit. For many practices, this is simply unsustainable. The California Medical Association (CMA) continues to fight with the “We Care for California” coalition for increased Medi-Cal reimbursements. The unprecedented coalition includes the largest statewide organizations representing physicians, dentists, hospitals, and health care workers, as well as health plans, first responders, caregivers, and other health providers. “With over 12 million people to be enrolled in Medi-Cal, it is more important than ever to ensure that the program is adequately equipped to handle new patients,” says CMA President Luther F. Cobb, MD. “California pays some of the nation’s lowest Medicaid reimbursement rates and in order to properly serve the poorest and most vulnerable patients among us, at a minimum, a restoration of the provider cut made in 2011 needs to be restored.” ■
CMA Alert, February 9, 2015
Regulations requiring health insurers to have adequate networks and accurate directories go into effect Emergency regulations requiring health insurers regulated by the Department of Insurance to create and maintain adequate medical provider networks to provide timely access to medical care went into effect in January, after their approval by the Office of Administrative Law. California Insurance Commissioner Dave Jones issued the emergency regulations in early January. “Californians and California businesses deserve better than what they have gotten from most health insurers and HMOs,” Jones said. “This emergency regulation is necessary to make sure that health insurers establish and maintain adequate medical provider networks to meet the health care needs of their policyholders, to make sure medical provider directories are accurate, and to stop the practice of surprising consumers with huge charges for out-of-network providers who provide care without the patients’ consent or foreknowledge.” The emergency regulations strengthen current rules and regulations and add new medical provider network requirements that require insurers to, among other things, include an adequate number of primary care physicians accepting new patients and an adequate number of primary care physicians with admitting privileges at network hospitals; build a network capable of the treatment of mental health and substance use disorders; adhere to appointment waiting time standards; and require network facilities to inform patients if an out-of-network provider will participate in non-emergency procedure or care, before the care is provided, so the patient has an opportunity to decline the provider’s participation.
Jones said that if an insurance company does not comply with the new regulations, he can deny them the ability to sell insurance next year. These regulations will only apply to the preferred provider organization (PPO) plans regulated by the Department of Insurance, not plans regulated by the Department of Managed Health Care or those in the Medi-Cal program. The California Medical Association (CMA) and the American Medical Association see the regulations as a significant step toward ensuring that provider directories are accurate and that networks are adequate. The regulations are consistent with a number of CMA recommendations made over the past year, such as requiring that insurers have clear, publicly available criteria over who is included in a network, and that insurers demonstrate comprehensive quality assurance programs in many areas related to directories and networks. One significant point of opposition for CMA in the regulations involves a requirement that facilities disclose to patients any likely involvement from out-ofnetwork physicians, as well as an estimate of charges, for an episode of care involving inpatient services. CMA believes the provision needs significant revisions to be workable in practice and to achieve the state’s goals without disruption to California’s health care delivery system. The emergency regulations will be in effect for 180 days, at which time the state can submit them for readoption (another 180 days) or go through the regular rulemaking process to make them permanent. ■ JANUARY / FEBRUARY 2015 | THE BULLETIN | 35
CMA Alert, February 9, 2015 CMA Alert, February 9, 2015
Fraud alert: Recognizing relationships that may trigger fraud and abuse concerns for physicians The laws regarding fraud, abuse, and anti-kickback violations can be complicated and difficult for physicians to navigate. However, it is increasingly important that physicians be aware of relevant prohibitions to avoid being implicated in a potentially fraudulent scheme. The California Medical Association (CMA) has received reports that some clinical laboratories, especially those testing for cardiovascular markers, are offering physicians cash incentives for blood draws of Medicare patients. Accepting such incentives could put physicians afoul of laws governing fraud and abuse. Anti-kickback laws prohibit physicians from offering or receiving anything of value in exchange for referral of patients. Although a number of safe-harbor provisions exist to limit the breadth of this prohibition, it is strictly enforced. Additionally, self-referral laws prohibit physicians from referring their patients for specified goods or services to entities in which the physician or a member of the physician’s immediate family has a financial interest. Again, although exceptions do exist, the law presumes there is an ethical dilemma whenever a physician refers a patient to an entity in which he or she has a financial interest. CMA offers informational materials to help physicians understand these complex laws and the potential consequences of partnerships or agreements they enter into. Physicians with questions about specific arrangements should contact an attorney or their professional liability carrier to navigate the complexities of the anti-kickback and referral prohibitions applicable to their unique situation. To learn more about fraud and abuse laws, see the chapter titled “Fraud and Abuse: Referral Issues” in CMA’s online health law library. The health law library is free to members in CMA’s online resource library at www.cmanet.org/cma-on-call. ■ 36 | THE BULLETIN | JANUARY / FEBRUARY 2015
CMA survey finds workers’ comp reform has brought new challenges for physicians California’s workers’ compensation system is arguably undergoing its biggest period of transformation since its enactment in 1914. Senate Bill 863, signed into law on September 19, 2012, initiated changes to the utilization review process, implementation of an independent medical review and independent bill review process, and a migration to a resource-based relative value scale payment system, among other changes. In late 2014, after hearing complaints from physicians that these changes have resulted in patient care roadblocks, the California Medical Association (CMA) initiated a survey to solicit physician feedback on their experiences with the SB 863 reforms. More than 200 practices representing physicians in over 35 different specialties responded to the survey. Sixty-seven percent of physicians reported that they were unable to gain authorization for needed patient care. Of those who reported difficulties with authorizations, 54% of physicians cited inappropriate denials of medically necessary tests, procedures or services as the greatest problem. CMA’s survey also found that 68% of physicians do not believe the independent medical review process has been successful in ensuring medically necessary patient care is approved. Additionally, 60% of physicians reported that the new Independent Bill Review (IBR) process has not been successful. Physicians overwhelmingly (90% of respondents) cited the downcoding of claims, resulting in underpayment, as the most significant problem. Respondents also reported that the submission cost of $250 to utilize the IBR process is cost prohibitive. Physicians also report that oftentimes when they do file an IBR request, the contractor responsible for issuing a written determination is not compliant with the 60-day response timeframe. These survey results indicate significant challenges with workers’ compensation reforms and raise concerns as to whether the new processes actually incentivize the denial of necessary patient care and downcoding of physician claims. CMA is working with stakeholders to determine potential next steps to address the issues raised in the survey results. ■
CMA Alert, February 9, 2015
Legislation announced to ban personal belief exemptions for school vaccinations With the number of California measles cases now at 103 and growing, Sacramento pediatrician and State Senator Richard Pan, MD, has announced his intention to introduce legislation to repeal personal belief exemptions for school vaccinations. Cosponsoring the repeal with Dr. Pan is Sen. Ben Allen, D-Redondo Beach. Joining Senators Pan and Allen at the press conference announcing their bill were Senators Hannah Beth Jackson and Lois Wolk and Assemblymember Lorena Gonzalez. The same day, Senators Dianne Feinstein and Barbara Boxer urged California to revisit the law allowing personal belief exemptions. In addition, Governor Jerry Brown said that he “believes that vaccinations are profoundly important and a major public health benefit, and any bill that reaches his desk will be closely considered.” In 2012, Dr. Pan also authored California Medical Associationsponsored AB 2109, which requires a parent or guardian seeking a personal belief exemption from school immunization to first obtain a document signed by a licensed health care practitioner. Since the bill took effect in 2014, the number of parents in California who filed personal belief exemption forms to exempt their kindergarteners from vaccinations has dropped by 20%, with 2.5% of kindergarten children opting out this school year, down from 3.1% last year. In some communities, however, as many as 10% of parents continue to file personal belief exemptions. “As a pediatrician, I have personally witnessed children suffering life-long injury and death from vaccine-preventable infection,” said Dr. Pan. “While I am pleased that more families are choosing to immunize their children and the statewide rates are going in the right direction, it is important to know that there are pockets of the state where the low vaccination rates continue to put children at risk,” he said in a press release issued two weeks ago. The bill would still allow exemptions for children who cannot be vaccinated for medical reasons. It would also require that parents be notified of the vaccination rates at their children’s schools. ■
CMA Alert, January 26, 2015
Medical board approves amendment to regulation allowing PAs to conduct surgery without immediate physician supervision The Medical Board of California approved an amendment to California administrative law that would allow physicians assistants (PA) to perform surgery without the immediate physical presence of a supervising physician. Existing law permits PAs to act as first or second assistant in surgery under the supervision of a physician. In 2011, a concern was raised by a PA licensee to the Physician Assistant Board that the current regulation did not reflect current medical community standards and that the law was unclear on the degree of physician supervision required of a PA as an assistant in surgery. The final regulation, which goes into effect on April 1, 2015, clarifies that a PA may perform surgical procedures, without the physical presence of the supervising physician in the operating room if the physician is “immediately available” to the PA. The medical board defines “immediately available” as “able to return to the patient without delay, upon the request of the PA, or to address any situation requiring the supervising physician’s services.” During the course of the regulatory discussions, it was agreed that an update to the regulation to specify the degree of supervision required for the PA was necessary in light of the evolution of current medical practices for both professions. Under the new regulation, physicians could, for example, direct a PA to close the surgical site, allowing the physician to engage in other procedures or tasks on site. For more information on physician assistants, see CMA On-Call document #3007, “Physician Assistants.” This document, as well as the rest of the California Medical Association’s (CMA) online health law library, is available free to members in CMA’s online resource library at http://www.cmanet.org/resource-library/. ■ JANUARY / FEBRUARY 2015 | THE BULLETIN | 37
CMA Alert, December 15, 2014
Congress passes a number of health care provisions in the current budget Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key health care provisions in the bill. • Within the bill, Congress expressed concern that there had not been adequate opportunity for public comment on bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule. The budget bill says that the appropriate methodology has not been tested to ensure that patient care and patient access are not negatively impacted and ponderous administrative burdens placed on providers. It asks the Centers for Medicare and Medicaid Services (CMS) to reconsider that fee schedule provision. • The budget includes $5.4 billion of emergency funding to prepare for
and respond to the Ebola outbreak. • The National Institutes of Health will receive $30.3 billion (an increase of $150 million), including $283 million for Ebola-related research. • CMS receives no increase in funding over last year ($3.6 billion). • The Centers for Disease Control and Prevention (CDC) will receive money to combat prescription drug abuse around the country. Twenty million dollars has been set for prevention of drug abuse and another $12 million has been included under the Substance Abuse and Mental Health Services Administration for the states to expand treatment services for drug addiction. This funding is also expected to support activities to establish or expand prescription drug monitoring databases of physicians writing prescriptions for opiates and pharmacists filling prescriptions. • The bill looks at the Medicare Recovery Audit Contractors (RAC) and how audits may be reducing patient access to care. The bill directs CMS to provide education to providers on error reduction. It also asks the agency to develop procedures to reduce backlogs of claims and hearings and asks CMS to provide education to RAC contractors to improve the accuracy of their audits. • The bill urges the Office of the National Coordinator for Health Information Technology to decertify electronic health records products that block the sharing of information and to certify only those products that meet current meaningful use program standards. ■
CMA Alert, February 9, 2015
Participate in the MGMA Compensation and Production Survey; receive free access to survey results CMA members now have the opportunity to obtain credible benchmarks for physician compensation and production targets, as well as benchmarks to illustrate the relationship between provider production and compensation, just by taking the Medical Group Management Association (MGMA) Compensation and Production Survey at http://data.mgma.com/DataDive/rdPage.aspx. The MGMA Compensation and Production Survey collects data on provider and staff compensation, provider revenues, patient encounters, and other metrics for a one-year period. Practices of all sizes are eligible to participate.
All survey participants will receive free, online access to the survey results for the areas in which they submit feedback. For instance, if a physician/medical practice completes the physician component, but not the staff component, they will only receive access to physician results and vice versa. The results will provide compensation and production benchmarks at the national and state levels, as well as for custom regions designated by the state. The benchmarking report includes medical data across multiple indicators including specialty, geographic region, practice setting, years in specialty, and method of compensation.
38 | THE BULLETIN | JANUARY / FEBRUARY 2015
The survey is open through March 13, 2015. You do not have to be a member of MGMA to participate in the survey; however, free registration on the site is required in order to protect your confidential data. Practices are encouraged to download the Preparation Checklist to get a list of data that will be required to complete the survey questions. Download from http://www. cmanet.org/news/detail/?article=participate-inthe-mgma-compensation-and. Practices with questions about the survey can contact MGMA at 877-ASK-MGMA (2756462), ext. 1895, or survey@mgma.org. ■
CMA Alert, January 26, 2015
CDC encourages antiviral treatment for influenza With a poorly matched influenza vaccine and influenza activity high across much of the country, the Centers for Disease Control and Prevention (CDC) is urging physicians to prescribe antiviral drugs to patients who are very ill with flu-like symptoms, particularly those over age 65 and those at high risk of complications from the virus. According to the California Department of Public Health (CDPH), flu activity in California is beginning to increase. The first influenza death in the state of a person under the age of 65 for the 2014-2015 season was confirmed in January. CDC Director Thomas Frieden, MD, said
in a conference call last month that if administered in the first 48 hours of exposure antiviral drugs can impact the length and severity of patients’ illness. Because antivirals are most effective if administered in the first 48 hours, the CDC urges that they be prescribed for high-risk patients with flu-like symptoms, even before ordering tests to confirm the virus. Physicians are also encouraged to continue vaccinating patients against the flu, even though early reports indicate the vaccine is not well matched to this year’s strain. “Flu activity is beginning to increase statewide, including reports of hospitalizations and severe disease,” said California’s State Health Officer Ron Chap-
man, MD. “We are early on in what could be a severe flu season, and I encourage everyone who has not yet gotten a flu vaccination to do so. The influenza vaccine remains the most effective way to protect yourself from the flu.” For more information on the use of antivirals to treat influenza, see the updated CDC Influenza Antiviral Medications: Summary for Clinicians at http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. For more information on influenza activity in California, see the CDPH website at http:// www.cdph.ca.gov/HealthInfo/discond/Pages/ Influenza(Flu).aspx. ■
CMA Alert, February 9, 2015
CMS announces it will work to reduce meaningful use reporting burden After repeated calls for changes from the American Medical Association (AMA), the California Medical Association (CMA) and other physician groups nationwide, the Centers for Medicare and Medicaid Services (CMS) announced that it would address the meaningful use issues raised by providers and make changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program to “reduce the reporting burden, while supporting the long term goals of the program.” CMS said it would issue new rules governing the program this spring. Beginning January 1, 2015, Medicare physicians who have not successfully attested to meaningful use of an EHR system may incur payment penalties. Last fall, CMS made a stunning announcement that while 78% of physicians are using an EHR, more than 50% of eligible physicians will face penalties under the meaningful use program in 2015. Moreover, only half of eligible physicians participated in the Physician Quality Reporting System (PQRS) program in 2013. By 2017, physicians could face up to 11% in combined payment penalties from these and other Medicare penalty programs. (For more details about the various Medicare incentive and penalty programs, see “Medicare Incentive and Penalty Programs: What physicians need to know,” available free to members in CMA’s online resource library at http://www.cmanet.org/resource-library.) In a recent letter to CMS, AMA said that the meaningful use program, which was originally “intended to increase physician use of tech-
nology to improve patient care,” was hindering physician participation by setting a strict set of one-size-fits-all requirements that forced physicians to purchase expensive EHR systems with frustratingly poor usability that resulted in interfering with patient care. AMA and CMA have called on CMS to make the meaningful use program more practical and flexible to ensure the intended improvements in patient care and practice efficiencies. The reforms include the consolidation and alignment of the quality and meaningful use programs; requiring interoperability and the exchange of information in a meaningful format and the simplification of the certification process; a reduction in penalties and reinstatement incentive payments; allowing physicians to meet no more than 10 required measures; and expanding the options for specialists. For more information about the EHR incentive programs, go to http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. ■ JANUARY / FEBRUARY 2015 | THE BULLETIN | 39
CMA Alert, December 1, 2014
Medical board revises guidelines on controlled substances for pain The Medical Board of California recently announced the release of its revised “Guidelines for Prescribing Controlled Substances for Pain” (http://www.mbc.ca.gov/Licensees/Prescribing/Pain_Guidelines.pdf). The medical board guidelines were heavily influenced by the California Medical Association’s (CMA) white paper, “Prescribing Opioids: Care amid Controversy,” which is an extensive review of existing opioids prescribing guidelines conducted by the CMA Council on Scientific and Clinical Affairs. “The revised guidelines will provide physicians with guidance, useful tools and links to useful information as they prescribe controlled substances for pain,” the medical board wrote in a press release announcing the new guidelines. “This document provides helpful information for prescribers, while not losing track of the need to approach opioid prescribing on a patient by patient basis,” said CMA Vice Speaker Lee Snook, Jr., MD, a Sacramento
pain specialist, who worked closely with the MBC to create the guidelines. “Pain remains the most common reason people seek health care, and has been considered an epidemic by the Institute of Medicine,” said Dr. Snook. “Physicians have a professional, ethical, and legal obligation to mitigate the effects of illness, and pain is no exception. However, opioids are not panaceas. They seldom, by themselves, adequately address the complex issues that a patient with chronic pain faces. Nonetheless, opioids remain one important tool that may be considered and used in the management of chronic pain.” CMA’s white paper, “Prescribing Opioids: Care amid Controversy,” complements the June 2013 CMA report, “Opioid Analgesics in California: Relieving Pain, Preventing Abuse, Finding Balance,” which focused on legislative and policy aspects of opioid prescribing. Both resources are available in CMA’s online resource library at no charge. ■
CMA Alert, January 26, 2015
American Lung Association gives California failing grades for tobacco control, joins fight for higher tobacco taxes On January 21, the American Lung Association (ALA) released its annual State of Tobacco Control 2015 report giving California low scores for lagging behind the rest of the nation in its tobacco control policies. California received a B grade for its smokefree air policies, but then dropped to an F grade for its low tobacco taxes and failing to sufficiently fund tobacco prevention and control programs. The report also gave the state a D for poor coverage of smoking cessation and treatment services. These grades reflect the fact that while California was once a national leader in tobacco control policies, its current efforts in tobacco control are not enough. Exacerbating California’s weakened position on tobacco prevention is the fact that the state has not increased its cigarette tax since 1999 and now ranks 33rd in the country at 87 cents per pack. Texas, Oklahoma, and Montana now have higher tobacco taxes than California. The ALA also announced that it has joined the California Medical Association and the Save Lives California coalition in its effort to pass a lifesaving $2 per pack tobacco tax in California – either through the legislature or by ballot measure – by the end of 2016. The coalition believes that a tax increase on tobacco will not only save lives, but will also save California taxpayers billions in health care costs. The ALA report looked at all 482 incorporated cities and towns in California and all 58 counties. Local grades were awarded in three categories: smoke-free outdoor air, smoke-free housing, and reducing sales of tobacco products. ■ 40 | THE BULLETIN | JANUARY / FEBRUARY 2015
CMA Alert, February 9, 2015
United Healthcare amendment introduces narrow network product Setting the stage for its potential future entrance into California’s Exchange, Covered California, United Healthcare (UHC) has begun the process of building its provider networks by amending physician contracts. United Healthcare has advised CMA that its new Core plan, which will be marketed to employer groups seeking lower premiums and used for its potential future exchange product, will access a significantly narrowed network of approximately 45% of UHC’s current PPO provider network. UHC plans to send amendment notices to physicians selected to participate in the Core network sometime in March. UHC also reports that the terms of each physician’s United Healthcare base contract will apply to the new Core plan. In addition to the narrowed Core provider network, United will be utilizing a wrap network, named W500, that will include the remaining 55% of its PPO provider network not selected to participate in the Core provider network. However, patients can only access physicians in the W500 network for emergency services and related admissions, urgent care services, and other prior approved services. UHC sent notices to the 26,000 physicians it is automatically opting into the W500 product on January 20, 2015, with an effective date of April 20. The terms of the underlying UHC PPO contract will apply to physicians who are being opted into the W500 product. UHC stated that physicians were selected to participate in the Core plan network based on their performance in several cost containment areas including referrals to out-of-network physicians, average episodic cost of care,
and overall contractual fee-schedule reimbursement during calendar years 2012-2013. Although the cost criteria for the Core program mirrors that of the United Premium Designation program, UHC stated that the two evaluations are unrelated, and that physicians achieving Premium Designation status may not necessarily be included in the narrow Core product network. The amendment for the W500 product does not allow physicians the option to opt out of just the new product; rather, physicians would have to terminate their underlying United Healthcare PPO agreement in order to opt out of the new Core plan network. Physicians will have 45 days from the date of receipt of the amendment notice to notify UHC if they wish to terminate their participation prior to the April 20 effective date. As always, physicians are encouraged to carefully review all proposed amendments to payor contracts. Remember, you do not have to accept substandard contracts that are not beneficial to your practice. Physicians who are unsure whether or not they are affected by this change, those who have general questions about the amendment, or those who wish to dispute their performance rating for participation in the Core plan network can contact United Healthcare Network Management at 866/574-6088. ■
CMA Alert, February 9, 2015
CMA Alert, December 1, 2014
ICD-10 transition guide now available; new resource webpage available
CMA helps develop toolkit for physicians facing medical audits
With eight months until the transition to ICD-10, will your practice be ready be October 1, 2015? To help physicians prepare for the transition, the California Medical Association (CMA) has published a new resource, “ICD-10 Transition Guide – What physicians need to know,” which includes an ICD-10 transition preparation checklist. This is available free to members in the CMA resource library at http://www.cmanet.org/resource-library. CMA has also created an ICD-10 transition webpage, www.cmanet. org/icd10, that includes important news articles and other ICD-10 transition information. CMA will also be hosting a number of live training events to assist physicians with the transition, with details announced soon. You can also sign up for custom content alerts on the CMA website at https://www.cmanet.org/account/alerts. ■
Medical audits are disruptive to physician practices and often cause substantial financial hardship. However, physicians need to consider medical audits as a routine part of their businesses and plan accordingly. There are many actions that physicians can take to mitigate both the risk of being audited and the potential for adverse audit findings in the event of an audit, some of them quite simple. The California Medical Association worked with the Physicians Advocacy Institute and the American College of Emergency Physicians to develop a toolkit that contains practical tools for physicians facing medical audits. The toolkit provides information and tips to guide physicians in anticipating medical audits, responding to auditors’ requests for medical records and appealing erroneous audit findings. The toolkit also includes detailed information regarding the various types of governmental and private payer audits, appellate procedures and extrapolation methodologies used by some payers to calculate alleged overpayments. Download the toolkit at http://www.physiciansadvocacyinstitute.org. ■ JANUARY / FEBRUARY 2015 | THE BULLETIN | 41
Classifieds OFFICE SPACE FOR RENT/ LEASE WHY ENRICH YOUR LANDLORD? • MEDICAL OFFICE SPACE – MTN VIEW
Rent/Buy/or Option to purchase 2,000 sq. ft. office with minor surgical suite in first class building within walking distance of El Camino Hospital. Full service lease, with or without furnishings. Call 650/961-2652.
MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA
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MEDICAL SUITES • GILROY
First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also available. Call Betty at 408/848-2525.
MEDICAL/DENTAL/PROFESSIONAL OFFICE SUITE • SALINAS
Second story of professional building across from Salinas Valley Memorial Hospital. Private balcony. Freshly painted and carpeted, ready for occupancy. 1,235 sq. ft. at $0.963/sq. ft. Rent is $1,190/month. Contact Steven Gordon at 831/757-5246.
PRIME MEDICAL OFFICE FOR LEASE • SANTA CLARA
Ideal for medical, dental, physical therapy, optometry, office use. Approximately 1,700 sq. ft., near Santana Row. Excellent parking. Call owner at 408/858-9687.
OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY
State-of-the-art office near Good Sam. Up to four exam rooms and shared common areas. Ideal for dermatology-compatible specialist. For more information, contact 408/369-4210 or Davina@agedefy.com.
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INTERNAL MEDICINE PHYSICIAN NEEDED
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MEDICAL SPACE AVAILABLE • TO SHARE OR SUBLET
Convenient location. One large private office plus one exam room, shared waiting room and front office. Newly built, total 1,280 sq. ft. Available now. Please call 408/438-1593.
MEDICAL OFFICE SPACE TO SUBLET • MTN VIEW
Mountain View medical office space to sublet. 1,100 sq. ft. Available three days a week. In large medical complex, behind El Camino Hospital. Basement storage, untilities included. Large treatment rooms, small lab space, BR, private office, etc. Call Dr. Klein at cell 650/2691030.
OB/GYN practice that stopped the OB side of the practice in 2011, leaving a great growth opportunity for a buyer. Even without OB, this practice has prospered; 2014 revenue was $587,000 while doctor took eight weeks of vacation. Practice Fusion EMR in place. This is a very good opportunity in a visually pleasing office on a hospital campus, upstairs from the Labor and Delivery area of the hospital. Photos available. Offered at only $343,000. Contact Practice Consultants at info@PracticeConsultants.com or 800/576-6935.
EMPLOYMENT OPPORTUNITY
Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Rick Flovin, CEO at 408/2280454 or e-mail riflovin@allianceoccmed.com for additional information.
DOWNTOWN MONTEREY OFFICE FOR SUBLEASE
OB PRACTICE FOR SALE
We are looking for an internal medicine physician for our multi-specialty group. Please email your CV to kaajhealthcare@gmail.com.
FOR SALE PRACTICE FOR SALE • SANTA CLARA COUNTY
Family/General Practice for sale (will consider urgent care clinic or Internist). 35 years, well established. Very affordable sale price. Agents welcome. Call Sue at 408/666-4308 or email yoanlisu@yahoo.com.
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In Memoriam Arthur A. Basham, MD
Kirk C. McGuire, MD
Albert K. Mineta, MD
*Ophthalmology 10/26/43 – 1/11/15 SCCMA member since 1982
*Obstetrics and Gynecology 1/7/23 – 11/14/14 SCCMA member since 1953
*Anatomic Pathology *General Surgery 4/23/23 – 11/15/14 SCCMA member since 1958
Khodadad “Ted” Keyani, MD
Arthur L. Messinger, MD
Cardiovascular Disease 1/1/27 – 8/24/14 MCMS member since 1965
*Orthopaedic Surgery 8/9/25 – 12/8/14 SCCMA member since 1956
Richard O’Neill, MD *Pediatrics 6/11/23 – 11/19/14 SCCMA member since 1955
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MEMBERSHIP
Welcome 61 SCCMA Members Santa Clara County Medical Association
Name Dipti Agrawal Mythili Aingaran Antonette A Ajayi Derek Atkinson Dean Bowker David Lee Chan Linda H Chan Louis Kay-Shion Chang Cathy Ivory Cheng Daniel Cheng Tiffany Cheng Erin Connor David Victor Daniels Robert C Day Priya Duggal Michelle Y Engle Jennifer Fraser Anna Harter Sandra Hsu Maggie Jones Alexa P Kaskowtiz
City Specialty Palo Alto ID Santa Clara PD Santa Clara IM Palo Alto AN Palo Alto AN Santa Clara IM Santa Clara IM Mtn View OPH Santa Clara HOS Santa Clara IM Stanford AN Stanford AN Palo Alto CD Santa Clara OBG San Jose IM San Jose FP Stanford AN Stanford AN Stanford AN Palo Alto HOS Santa Clara OBG
Name Ahlia Kattan Irina Khachatryan Cynthia Khoo Chloe H Kim Elizabeth Koch Merrit A.H. Koskelo Christina Jia-Lin Lee Christina Audrey Lee Eric Lee Joshua T Lee Phoebe H Lee Michael Lin Adam C Luce Laura May Luke McCage Muniba Mohammed Heather E Narciso Quynh Tho-Thi Nguyen Tuong Van D Nguyen Grant Edward Nybakken Patrycja Olszynski
City Specialty Stanford AN San Jose IM Stanford AN Santa Clara IM Stanford AN Campbell OBG Palo Alto CCP Palo Alto HOS Stanford AN Mtn View IM Santa Clara AN Stanford AN Menlo Park R Stanford AN Stanford AN San Jose IM Santa Clara IM Stanford AN San Jose OBG Santa Clara PTH Stanford AN
Name Punam Vinod Patel Hung-Viet Pham Anne Margaret Porzig Rett Quattlebaum Nitya Rajeshuni Anitha Reddi Jordan Ruby Anirudh Saraswathula Kay T Saw Neha Saw Austin Schwab Ilana Michelle Sherer David C Shin Katherine Loring Taylor Virginia Worth Thomas Jimmy Ton Jennifer Tran Paula Trepman Meghana Yajnik
City Specialty Santa Clara FP San Jose IM Palo Alto END Palo Alto AN Santa Clara IM Santa Clara PD Stanford AN Stanford IM San Jose FP Stanford AN Stanford AN Palo Alto PEM San Jose FP Los Altos P Santa Clara OBG Santa Clara IM San Jose IM Stanford IM Stanford AN
Welcome 7 MCMS Members Monterey County Medical Society
Name Dan S Anghelescu Amy Lantis Defatta Anthony Rosario Galicia
City Specialty Salinas DR Salinas R Salinas IM
Name John Matthew Koostra Hans P Poggemeyer Kathryn Ann Swanson
City Specialty Monterey IM Monterey IM Monterey GE
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City Specialty Salinas DR
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