Winter 2023 Bulletin: Advocacy - Where Do You Fit In? by SCCMA

Official Magazine of the Santa Clara County Medical Association

Vol. 30 | No. 3 Winter 2023

SCCMA Gala | CMA Year in Review | CMA’s 152nd House of Delegates 2023 CMA Legislative Wrap Up | Overcome Medicine’s Crisis www.sccma.org

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In this issue SCCMA is a professional association representing over 4,500 physicians in all specialties, practice types, and stages of their careers. We support physicians like you through a variety of practice management resources, coding and reimbursement help, training, and up to the minute news that could affect your practice. The Bulletin is our quarterly publication.

SCCMA COUNCILORS El Camino Hospital of Los Gatos | Shahram S. Gholami, MD El Camino Hospital – Mountain View | Fahd Khan, MD Good Samaritan Hospital | CK Park, MD Kaiser Foundation Hospital - San Jose | David Hensley, MD Kaiser Permanente Hospital | Reena Bhargava, MD O’Connor Hospital | David Cahn, MD Regional Medical Center | Raj Gupta, MD Saint Louise Regional Hospital | Kevin Stuart, MD Santa Clara Valley Medical Center | Patricia Salmon, MD Stanford Health Care/Children’s Health | Laurice Yang, MD Managing Editor | Erin Henke Production Editor | Prime42 – Design | Market | Host Opinions expressed by authors are their own, and not necessarily those of The Bulletin or SCCMA. 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 of products or services advertised. The Bulletin and SCCMA reserve the right to reject any advertising.

Feature Articles 10 15

SCCMA 2023 Gala Advocate Christine Doyle, MD, Chair of the SCCMA External Affairs Committee

Regular Columns 4 5 6 8 33

President’s Message CEO’s Message Membership Insider Featured Member Upcoming Events

Community News 32

Public Health Department Update

New and Noteworthy 16 18 20 30

CMA Year in Review Highlights from the CMA’s 152nd House of Delegates 2023 CMA Legislative Wrap Up We Know How to Overcome Medicine’s Crisis. Let’s Find the Will. Jesse M. Ehrenfeld, MD, MPH, AMA President

Gratitude Matters! Its Impact on Employee Engagement Marcia Daszko

Address all editorial communication, reprint requests, and advertising to: Erin Henke, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850 Fax: 408/289-1064 erin @sccma.org © Copyright 2023, Santa Clara County Medical Association

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A Message from the President

Time flies! With a blink of an eye, 2023 is almost in the rear-view mirror. Anlin Xu, MD SCCMA President

I would like to wish my colleagues and fellow physicians in Santa Clara County a very happy, festive holiday season! I wish you and your family great health, prosperity, and happiness! It has been a challenging but fruitful year for SCCMA. As the first Chinese American woman and the first allergist ever holding the position of President in SCCMA’s long 147-year history, it has been my great privilege and honor to serve the amazing physicians and patients of such an important, vibrant, and diverse county in California. This is the season of celebration and reflection. Looking back on 2023, gratitude fills my heart, and I am compelled to express our deepest thanks to all who have played a pivotal role. It is with genuine appreciation that I ack nowledge your indispensable contributions. Without your support, the remarkable achievements of this year would have been unattainable. First, I would like to give thanks to my fellow SCCMA Councilors and Officers. You’re some of the smartest people I have known. I don’t know how you can save people’s lives every day and solve the world’s big problems at the same time, such as global warming and Medicare rate cuts (well, that’s still in progress). It must be magic! Finally, I would like to thank you – our members! Our membership has continued to grow this year. Thank you for your support and participation in SCCMA’s new and ongoing programs this year. You are the reason SCCMA exists – you are the inspiration for all that we do. We have accomplished a lot at SCCMA this year.

For our members, our focus this year has been on physician wellness and helping private practices navigate the complex healthcare landscape. We launched the “Saving Private Practice” program, including monthly educational webinars for independent physicians and their staff. We also held our first annual physician wellness retreat at 1440 Multiversity in Scotts Valley, welcoming 30 physicians and their guests for a weekend of nurturing both their bodies and minds. We have continued our overwhelmingly popular quarterly physician wellness webinar series, Wellness Matters, with inspiring guest speakers, and began a quarterly wellness book club this fall. We held our 2nd Annual Summer Social with an Aloha Spirit theme, that was so well attended. Everybody had a blast! SCCMA became a registered “Walk with a Doc” chapter of the national program and started holding monthly community walks led by a physician. We have been very active this year on the legislative front. We had a very successful turnout of physicians and residents from Santa Clara County during CMA’s Legislative Advocacy Day in Sacramento this past April where we met with nine legislative offices. We also held several meetings with and continued to develop our relationships with local legislators. Under the leadership of Dr. Christine Doyle and our External Affairs Committee, we continued to define the legislative priorities of SCCMA, and actively participated and voiced our opinions

We have continued our overwhelmingly popular quarterly physician wellness webinar series, Wellness Matters, with inspiring guest speakers, and began a quarterly wellness book club this fall.

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A Message from the SCCMA CEO

Taking the Helm at SCCMA: A Personal Journey in Healthcare Leadership As the newly appointed CEO of the Santa Clara County Medical Association (SCCMA), I am honored to take on this role in an organization with a remarkable history of supporting physicians. Coming from a legacy of physicians, my interest was not in the science of medicine but rather in the system of organized medicine and healthcare. I sought to understand the complex policies, organizations, and management that underpin the delivery of healthcare to individuals and communities across the United States. I earned my Bachelor of Arts in Sociology from the University of San Francisco and my Master of Science from George Washington University in Washington DC. With over 25 years of experience in healthcare leadership, strategy, and health policy, I came to SCCMA after serving as the Executive Director of the Renal Healthcare Association and the Renal Services Exchange. I am originally from San Francisco, my family and I relocated to Palo Alto in the Summer of 2022 after being in Santa Cruz for nearly 19 years. I am excited to contribute to SCCMA and make a meaningful impact in the community I now call home.

Physician Wellness: The Foundation of Exceptional Care Physician members, alongside your dedicated teams, are the heart of SCCMA, and we recognize the importance of your well-being in delivering exceptional care. Your teams include nurses, administrative staff, and everyone who plays a crucial role in the patient care journey. We are deeply committed to offering resources that focus on wellness and strength. Managing stress, finding work-life balance, and maintaining physical and emotional health are pivotal for your success. By prioritizing your wellness, we aim to empower you to provide the best care possible to our diverse patient population. We will continue to strive to offer programs such as our Wellness www.sccma.org

Retreat, Wellness Webinars, Walk with a Doc, and Book Club.

Marc E. Chow, MS SCCMA CEO

Advancing Healthcare Opportunities: Leading the Way in Innovation Situated in the heart of Silicon Valley, our unique location presents a strategic advantage. This position grants us access to groundbreaking healthcare startups, technology companies, and AI pioneers. SCCMA will provide you the ability to learn about advancements in healthcare technology and AI so that you are informed and equipped to make decisions in alignment with high standards of patient care.

Strengthening Relationships: Building a Strong Community Our relationships within the healthcare community are invaluable. SCCMA is committed to strengthening and developing relationships with public health, hospitals, healthcare systems, and other entities that play a role in the medical ecosystem. Your experiences and insights are central to our efforts in creating a healthcare environment that benefits patients. Together, we can address the complex healthcare challenges facing our community. By fostering these relationships, we aim to develop resources and programs that directly benefit you, your staff, and your practice, regardless of your size or setting.

Closing In my role as CEO of SCCMA, my vision is clear: to support and empower physician members and their teams. Together, we can create a brighter and healthier future for our community, reflecting the values of the Santa Clara County Medical Association.

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MEMBERSHIP SCCMA Annual Meeting On November 14, the Santa Clara County Medical Association (SCCMA) hosted the Annual Meeting and Ratification of 2024 officers over Zoom. Guest speaker, Immediate Past President of the California Medical Association (CMA), Donaldo Hernandez, MD, spoke to attendees about the work CMA and coalition partners are doing to invest in Medi-Cal and improve access to health care for everyone in the state through the Protect Access to Care Initiative (www.accesstohealthcareca.com). SCCMA President, Anlin Xu, MD summarized programs and events organized by SCCMA in 2023 as well as advocacy efforts from our membership. Marc Chow, the new CEO/Executive Director of SCCMA, made his first address to SCCMA members. In addition, the election of 2024 SCCMA officers and councilors was held. Congratulations to the following who represent the 2024 SCCMA officers and councilors:

2024 OFFICERS Dr. Fahd Khan - President-elect Dr. Randal Pham – Secretary (incumbent) Dr. Shahram Gholami – Treasurer Dr. Santosh Pandipati - VP of Community Health Dr. Christine Doyle - VP of External Affairs (incumbent) Dr. Sam Wald - VP of Member Services (incumbent) Dr. Lewis Osofsky - VP of Professional Conduct (incumbent) Dr. Gloria Wu – President (transitions from President-elect) Dr. Anlin Xu – Immediate Past President (transitions from President)

2024 COUNCILORS El Camino Hospital Los Gatos – Jaideep Iyengar, MD El Camino Mountain View – Carol Somersille, MD Good Samaritan Hospital – CK Park, MD (incumbent) Kaiser San Jose – Veena Vanchinathan, MD Kaiser Santa Clara – Reena Bhargava, MD (incumbent) O’Connor Hospital – OPEN Regional Medical Center – Raj Gupta, MD (incumbent) Saint Louise Regional – Kevin Stuart, MD (incumbent) Santa Clara Valley Medical Center – Patricia Salmon, MD (incumbent) Stanford – OPEN 6 | The Bulletin | Winter 2023

Lockton Affinity Offers SCCMA Members Customized Insurance Services Whether you operate independently or as part of a group practice, are beginning your career or considering retirement, a new insurance program from the California Medical Association (CMA) offers key benefits to help protect you through all stages as a medical provider. The CMA has partnered with Lockton Affinity to offer Group Medical insurance for practices of all sizes, along with 10 other insurance options including Medical Malpractice. With coverage from Lockton Affinity, you receive broker support, online benefit enrollment system, and access to HR and compliance services and platform. Explore coverage options today at LocktonAffinityCMA.com.

www.sccma.org

First Phase of Historic MediCal Rate Increases Take Effect January 1 CMA President, Dr. Tanya Spirtos, shared a letter recently regarding details of the upcoming Medi-Cal rate increases. Starting January 1, 2024, the largest and long-overdue Medi-Cal provider rate increase in California history will begin to go into effect. The historic rate increases are made possible by the passage of a Managed Care Organization (MCO) Tax that will draw down federal matching dollars, passed as part of the 2023-24 budget deal that was negotiated by the CMA-led Coalition to Protect Access to Care. Over the past several years, CMA has proudly supported California’s massive expansions in Medi-Cal eligibility and benefits, but the missing piece of the puzzle has always been funding to support access. With California ranking near the bottom of all states in Medicaid provider reimbursements, moving the needle on access for Medi-Cal patients has been frustratingly slow. But the historic rate increases over the next two years should increase provider participation in the Medi-Cal program and will make great strides towards improving equity in our health care system. Read more at https://bit.ly/3sXbNXz.

A Message From The SCCMA President on matters important to our communities by sending letters to and participating in meetings with our local legislators. Our Environmental Health Committee, under the leadership of Dr. Cindy Russell, Dr. Steve Jackson, and Dr. Ken Yew, has been very active and worked hard on several resolutions related to climate change and environmental health issues, such as the use of artificial turf, water reuse and safe technology in schools. Our letter of support was instrumental in Sunnyvale City Council’s 6:0 passing of the resolution to keep natural grass turf in its public parks. Dr. Ken Yew and Dr. Santosh Pandipati were invited and attended the national Water Reuse Symposium representing SCCMA this spring in Atlanta, participating on a panel regarding the water reuse program in the Santa Clara County. Operationally, we accomplished a lot this year. Under the leadership of Dr. Anh Nguyen and our Financial Committee, we reorganized our organization’s liquid assets to optimize both security and return. We formed a Building and Property Manage-

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Preferred LanguageLine® Rates for SCCMA Members SCCMA has partnered with LanguageLine® Solutions to provide medical interpretation services in 240 languages. Imagine the uncertainty your limited-English, Deaf, and Hard-of-Hearing patients face as they try to access care, to say nothing of the frustration your staff experiences as they attempt to overcome communication hurdles. By partnering with LanguageLine® Solutions, SCCMA is offering members customized on-demand access to reliably fast and accurate interpretation services at a discounted rate. For more information, visit https://bit.ly/46LEzIq.

SCCMA Would Like to Hear from You! We invite you to take the 2023 SCCMA Member Survey that is designed to understand your experience with SCCMA and how we can best support you individually, as well as the practice of medicine in Santa Clara County more broadly. As a token of our appreciation for completing the Member Survey, we’d like to treat you to a cup of coffee with a Starbucks gift card! Visit https://www.surveymonkey.com/r/3RDVK8P to take the survey.

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ment Committee under the leadership of Dr. Reena Bhargava to provide oversight of ongoing maintenance, improvements and commercial use of the property owned by SCCMA. Finally, under the strong leadership of Dr. Clifford Wang, our Immediate Past President, and with guidance from the CMA, our search committee undertook a long, hard, but successful search for a new CEO, which resulted in finding our highly qualified, charismatic CEO, Mr. Marc Chow. I am confident he will lead us into a vibrant new era at SCCMA. Now, with 2023 almost over, we turn our eyes to 2024. Dr. Gloria Wu, a distinguished ophthalmologist and retinal surgeon will take over the leadership reins. She has been a dear friend of mine for almost 20 years, and one of the most intelligent and energetic people that I have ever known. I have no doubt that Dr. Wu will bring her vision and energy to her presidency, and lead SCCMA into a very bright future!

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Valerie C. Kwai Ben, MD, FACC, FASE

FEATURED MEMBER

r. Valerie Kwai Ben is a Cardiologist with Kaiser San Jose, and has served as an SCCMA Delegate to the CMA House of Delegates for District VII for several years.

Born in the Canal Zone, Panama, Dr. Kwai Ben was raised in a large Asian family of multiple aunts, uncles and cousins and enjoyed growing up in a Latin/ Hispanic country. Her fluency in Spanish has been her greatest asset in taking care of the Latin community. Dr. Kwai Ben graduated Summa Cum Laude with a BS degree from the University of San Francisco, Honors Degree at the Flinders University of South Australia, followed by medical school at the Medical College of Wisconsin. She then returned to the Bay Area and completed her Internship, Residency and Chief Residency at Kaiser Santa Clara and pursued her Cardiology Fellowship at the California Pacific Medical Center in San Francisco. During her residency and fellowship years, she worked as an Internal Medicine pool physician at various Kaiser Medical Centers including Santa Clara, Redwood City, and San Francisco. She joined Kaiser San Jose as an Invasive Cardiologist where she has been the Director of the Echocardiography Lab since 1997. She worked as Chief of Pharmacy for 10 years followed by Chief of Cardiology for 12 years and is currently the Co-Chair of the Physician Health and Wellness Program at Kaiser San Jose. Dr. Kwai Ben has a passion for teaching and is the Director for the Cardiac Sonography Program at the Kaiser Permanente School of Allied Health Sciences. She is the Cardiology Elective Course Director for the Boston University Medical School and mentors and teaches BU students who do their clinical rotations at Kaiser San Jose. She has also led, directed and moderated sev-

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What is the most important thing you learned in medical school or residency? Joy in medicine is not about the destination (reaching retirement), but rather the secret sauce is in the journey. Enjoy the medical school training, the residency journey. Beyond residency, continue being passionate about every patient, case and or procedure in your practice. There is always something different, interesting and educational about every encounter. What are some of the biggest opportunities or challenges you see in health care within the next five years? With advancements in technology and artificial intelligence the Physician Patient relationship may suffer. We need to continue to foster this relationship and maintain joy and meaning in medicine. eral Kaiser Regional Echocardiography Conferences and leads monthly Echo CME Forums for her Cardiology Department. Outside of her work at Kaiser Permanente, Dr. Kwai Ben has worked in the local community as President of the American Heart Association Silicon Valley Branch from 2005-2009 and President of the Bay Area Society of Echo since 2002. She has been the recipient of several awards including the Ralph Clark Echocardiography Award in 1997, the Kaiser Permanente Heroes Award in 2002, the Kaiser Permanente Wellness Warrior Award in 2010 and the Consultant Physician of the Year Award in 2016. Why are you a SCCMA member? I feel it is important to network with local community solo practicing physicians as well as physicians who work in different medical groups. Networking fosters a better understanding of the practice of medicine outside of my own organization within Kaiser Permanente. It is also necessary to have a voice on health policies which can affect how we practice medicine in the present and future.

What do you love most about practicing Cardiology? I enjoy the diversity of my practice in Cardiology: outpatient clinic, inpatient hospital and call work, procedures both invasive and non-invasive as well as teaching technicians, staff, nurses, medical students, residents and colleagues. Who’s your favorite music artist/band? Jim Brickman, pianist. What is your favorite restaurant in the Bay Area? Mio Vicino in Santa Clara. If you weren’t a physician, what profession would you like to try? I would like to be an astronaut.

Which SCCMA member resource is most helpful to you? The Bulletin, the local meetings and annual delegate meetings. I also have enjoyed the variety of wellness programs and seminars. What do you like to do when you’re not at work? I swim one or two miles every day before going to work, and on weekends, I swim two to five miles per day as well as go biking and hiking. I enjoy attaching my world travels to adventurous events such as international marathons, open water swim events and bike trips.

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The 2023 Annual SCCMA Awards Gala

he Santa Clara County Medical Association (SCCMA) hosted the 145th Annual Awards Gala at the Westin Hotel in downtown San Jose on Friday, December 8. Nearly 190 physicians, special guests, and partners joined SCCMA to honor distinguished physicians that have made a positive difference in medicine, medical education, community, and the association.

Physician members were reunited to enjoy the evening with a reception to network before the program and dinner. California Medical Association (CMA) President-elect, Shannon Udovic-Constant, MD, was the guest speaker for the night. Outgoing president, Anlin Xu, MD, received recognition for her service as the SCCMA 2023 president from California Senator Dave Cortese, and Santa Clara County Supervisor Otto Lee, California Assemblymember Evan Low, and Assemblymember Alex Lee. Dr. Xu delivered her presidential speech and introduced the SCCMA 2024 president, Gloria Wu, MD. Dr. Wu is a board-certified ophthalmologist and retinal surgeon practicing in a solo practice in San Jose, CA. She graduated from Harvard for her undergraduate studies, received her medical degree from Columbia University Vagelos College of Physicians and Surgeons, trained at Mt. Sinai for her general surgery internship in New York City, then completed her Ophthalmology Residency at New York Presbyterian Hospital Cornell Campus, then Retina-Vitreous Fellowship at Harvard Medical School’s Massachusetts Eye and Ear Infirmary in Boston. She was Associate Clinical Professor at Tufts University School of Medicine from 1998-2014 and 2019 to present. Dr. Wu is a clinical Instructor at the University of California San Francisco School of Medicine, Department of Ophthalmology, from 2012 to present. In 2009, she created the Journal of Asian Health, which is now part of the Stanford Center for Asian Research and Education. Dr. Wu has a passion for teaching. She is a Fellow of the 10 | The Bulletin | Winter 2023

American Society of Retinal Specialists and was the 6th woman to be included in The Retina Society. Dr. Wu is a four-time awardee of the Honor Award for teaching at the American Academy of Ophthalmology. She is the past Chief of Surgery at El Camino Health Los Gatos. Dr. Wu has a long history of service in medical societies. She has been an SCCMA member and Council Member since 2004, and a District VII Delegate to the CMA since 2008. She was elected to the Women Physicians Section and Governing Council of the American Medical Association since 2021 and has been the South Bay American Medical Women’s Association President or Co-President for 7 terms. Dr. Wu is also an author of 3 textbooks in Ophthalmology and holds one patent and 6 copyrights for mobile apps, the most recent being EyeQuix on the Apple Store. SCCMA and guests honored awardees including Cindy L. Russell, MD for the Robert D. Burnett, MD Legacy Award, Quan Dong Nguyen, MD for the Benjamin J. Cory, MD Award, Baldev Singh, MD for the William C. Parrish Jr. Leadership in Healthcare Award, and Supervisor Joe Simitian for the Citizen’s Award. Other physicians that have executed outstanding work in medicine that were honored at the Gala are Elyssa, F. Guslits, MD, Anh T. Nguyen, MD, Padma Mallipeddi, MD, and Anjali Gulati, MD. SCCMA would like to thank our members, special guests, and Dr. Udovic-Constant for their support of the event and of SCCMA. Special thanks to our event sponsors LongHealth, Cooperative of American Physicians, El Camino Health, El Camino Medical Staff, Bank of America Practice Solutions, Legacy Wealth Advisors, LLC, Lockton Affinity, Precision Pathology, Grail Bio, Ophthalmology 360, and Stanford Health Care. The Annual Awards Gala is the best opportunity to reconnect at the biggest event of the year. We hope to see you at the next SCCMA Annual Gala! www.sccma.org

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Santa Clara County Medical Association

2023 Award Recipients AWARD

NAME / AWARD RECIPIENT

Robert D. Burnett, MD Legacy Award Awarded physician member who has demonstrated ex-traordinary visionary leadership, tireless effort, selfless long-term commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exalted goals of the medical profession.

Cindy L. Russell, MD

Benjamin J. Cory, MD Award Given to a physician member of the Medical Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.

Quan Dong Nguyen, MD

Outstanding Achievement in Medicine For a member who has made unique contributions to the betterment of patient care with widespread recognition.

Elyssa F. Guslits, MD

Outstanding Contribution to the Medical Association Awarded to a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the Association over and above that expected of the membership at-large.

Anh T. Nguyen, MD

Outstanding Contribution in Medical Education For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large.

Padma Mallipeddi, MD

Outstanding Contribution in Community Service For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large.

Anjali Gulati, MD

Citizen’s Award The citizen’s award is for an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field.

Supervisor Joe Simitian

William C. Parrish Jr. Leadership in Healthcare Award This award recognizes an individual whose leadership, innovation, and dedication have resulted in profound improvement to healthcare in Santa Clara County.

Baldev Singh, MD

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SCCMA THANKS OUR GENEROUS SPONSORS

Presenting Gold Silver

Bronze SCCMA_AwardsGalaPoster (23-1201)).indd 1

www.sccma.org

12/4/23 2:18 PM

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+ April 10, 2024 + Sacramento + cmadocs.org/legday24

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Advocacy: Come join in! BY CHRISTINE DOYLE, MD Chair of the SCCMA External Affairs Committee Advocacy is a part of our daily lives. Really. Advocacy can be self-advocacy, individual advocacy, or systems advocacy. Many only think about the latter, but all are important. We are all subject matter experts on something, starting with ourselves, and then going outward to bigger and more diverse environments. Self-advocacy is being able to identify and express your unique voice. It may be the 30 second elevator pitch. It may be your personal website or social media. It may even be explaining why you always do something a certain way. Individual advocacy involves learning how to advocate for others, which includes being mentors and sponsors. Our individual advocacy can help people grow into new roles, make new connections, and teach them how to be their own self-advocates. Systems advocacy is what most people think of, but it is not limited to political advocacy. It includes understanding how to assert yourself into decision-making processes, using management strategies to effect change. SCCMA’s External Affairs committee focuses on systems advocacy. Our members interact with city, county, and state leaders, both at home, and in Sacramento. We take our subject matter expertise about health care to them as we explain about issues like healthcare access, private insurance payments, government payments, pharmaceutical costs, increasing overhead, etc. impact the practice of medicine. All members of SCCMA are welcome to join us. Regular www.sccma.org

meetings are usually held virtually in the evening, and meetings with legislators may be in the SCCMA office, the legislator’s office, a clinic, or virtually. With a few exceptions, such meetings do not need to take a lot of time out of the office or workday. The one big exception that takes time out of the office is CMA’s annual Legislative Day. On April 10, Christine Doyle, MD

2024, physicians from across the state will visit Sacramento to hear from CMA leadership and to visit with legislators and their staff in person. There is often a chance to meet and greet legislators the evening before, as part of a CALPAC reception. The opportunity to meet people from across the state and learn about their problems (both unique and similar) is invaluable. We learn about the other influences on the legislature, such as housing or roads or other infrastructure issues. And, we are often able to provide useful information for those issues as well. Please consider joining us, whether for a committee meeting, a legislative meeting, or even a trip to Sacramento. Reach out to the office for more information and to get on the mailing list. For more information, please contact Emily Coren, the SCCMA Governance and Advocacy Associate at emily@sccma.org. The Bulletin | Winter 2023 | 15

Medi-Cal Rate Increase In a monumental victory for physicians and patients alike, the California Medical Association (CMA) achieved a historic milestone with the passage of budget legislation this year that will provide the largest Medi-Cal rate increase in the state’s history. This transformative step, which will make meaningful strides toward fulfilling Medi-Cal’s promise of access to health care for millions of Californians, will be implemented in stages. The first stage of Medi-Cal rate increases will be in 2024, with greater increases in 2025.

Initiative to Expand Access CMA and the Coalition to Protect Access to Care, a broad and diverse group of health care organizations, filed a statewide ballot initiative with the California Attorney General’s office to make permanent the transformative Medi-Cal rate increases established in the state budget. The Protect Access to Healthcare Act is critical to ensuring the accessibility and affordability of health care services for all Californians.

Fighting Burdensome Payor Policies CMA fought new policies from both Cigna and UnitedHealthcare that would have increased administrative and prior authorization burdens on physicians. After CMA mounted opposition to the polices, Cigna announced it was pausing implementation of its modifier 25 policy to re-evaluate, while UnitedHealthcare announced it would pause the planned expansion of prior authorization requirements.

Stopping Dangerous Bills CMA advocacy was responsible for defeating or keeping several pieces of legislation that would have been harmful to patients from moving this year. AB 616 (vetoed) would have required audited financial reports and statements from medical groups to be released to the public; SB 524 (held for next year) would have allowed retail chain pharmacists to furnish medications treating conditions identified through CLIA-waived tests performed by a pharmacist; AB 1570 (held for next year) would have allowed optometrists to perform delicate eye surgeries; and AB 1751 (held for next year) would have forced physicians to inform patients about nonpharmacological treatments for pain.

Legal Victories CMA-sponsored legislation requiring health plans to fairly reimburse health care providers for the costs of COVID-19 testing during the COVID-19 state of emergency was upheld by the Los Angeles Superior Court, while the California Supreme Court confirmed that CMA has legal standing to sue Aetna Health for alleged violations of the Unfair Competition Law. CMA also continued its amicus support of the Texas Medical Association’s various cases regarding the No Suprises Act, seeing numerous victories throughout the year.

Trusted Data Exchange Experts To help California physicians prepare for the new statewide Data Exchange Framework (DxF), CMA developed resource materials, partnered with the California Health and Human Services Agency on a six-part webinar series, and worked closely to encourage physicians to sign the Data Sharing Agreement (DSA) and receive grant funding. CMA was able to support 50+ physician practices and IPAs through educational assistance and grant opportunities, resulting in these practices achieving nearly $2.8 million in grant funding under the DxF. 16 | The Bulletin | Winter 2023

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Loan Forgiveness for California Physicians CMA won a long-fought victory with the U.S. Department of Education, who reversed its Public Service Loan Forgiveness Program (PSLF) rule by granting California physicians the ability to participate in the program. CMA then created multiple educational resources to help California physicians take advantage of loan forgiveness, including a step-by-step walkthrough of the process.

Diversity, Equity and Inclusion Champion The National Association of Asian Pacifics in Politics and Public Affairs (NAAPPPA) recognized CMA as one of its Diversity, Equity and Inclusion Champions for 2023. The award acknowledged CMA’s efforts to make diversity and inclusion a strategic focus for the organization. Through this focus, CMA worked to increase Medi-Cal access to care; assisted physicians in accessing Equity and Practice Transformation Payments from the Department of Health Care Services; and led promotions around the Physicians for a Healthy California (PHC) inaugural Health Equity Leadership Summit. In 2023, CMA also sponsored AB 470 (signed by the Governor), which recognizes California’s ever-increasing diversity of language by affirming the importance of cultural competency and language fluency as a core tenet of continuing medical education (CME).

Safeguarding Physician/Patient Relationship In its continued support of reproductive rights, CMA sponsored two bills: SB 487, which prevents providers from having their Medi-Cal provider eligibility threatened by states with abortion bans, and AB 571, to alter the insurance code to prevent insurance companies/ entities from unreasonably increasing liability premiums or denying coverage to providers based on the services they provide. Both bills were signed into law by Governor Newsom. Additionally, CMA updated the Reproductive Issues section of its Health Law Library with new documents to ensure that physicians, lawyers, policymakers and other stakeholders understand the impact of recent legal changes on the practice of medicine in California.

Increasing Access to Vaccines PHC wrapped up a multi-year program to support physicians who provide COVIDvaccinations. After five grant cycles, PHC had supported a total of 3,426 organizations representing 4,506 vaccination sites. Of the 4,506 vaccination sites awarded, 2,656 (62%) had sites in health equity areas that match high-priority zip codes. Overall, the program funded $59.3 million to lead efforts to increase the accessibility of vaccines in marginalized communities who are at greater risk for getting COVID-19 and becoming severely ill.

Leading in Health IT CMA’s first health IT conference, Health IT: Powering Value-Based Care, brought together over 150 thought leaders from across the country for a very important conversation on the evolution taking place in health IT. The sold-out conference welcomed physicians, medical groups and IPAs, health plans, health information organizations and others who took the learnings from this conference to better position themselves and their organizations.

Cultivating Membership CMA expanded physician medical group engagement strategies, which included multiple listening sessions, as well as the annual Group Advocacy Symposium. The Symposium had record attendance and participation from C-suite group leaders throughout the state. CMA also saw increases in membership from community health centers, with great participation from these physicians across our 2023 events.

Visit cmadocs.org/year-in-review to learn more!

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The Bulletin | Winter 2023 | 17

he California Medical Association (CMA) House of Delegates convenes every October to debate on the most important issues affecting members, the association, and the practice of medicine. The CMA HOD consists of more than 500 delegates elected by members of component medical societies, specialty societies, and CMA sections and forums, representing virtually every mode of practice and region of the state. However, this year due to an ongoing labor dispute at the JW Marriott hotel at L.A. LIVE and hotels throughout the region, the CMA Board of Trustees chose to postpone the annual House of Delegates scheduled for October 21st-22nd, 2023. The 152nd CMA House of Delegates was instead held as a hybrid virtual/in-person event rescheduled2 for Sunday, Nov. 5th, 2023. Los Angeles psychiatrist George Fouras, M.D., was newly elected as vice speaker3 of the California Medical Association (CMA) House of Delegates at the association’s annual meeting this past weekend. He will join Speaker Jack Chou, M.D., on 18 | The Bulletin | Winter 2023

the dais to lead delegates as they shepherd resolutions into successful policy. “During my professional career I have worked with numerous disadvantaged youth in several geographic areas across the state including the Central Valley from Modesto to Kern County. It has given me an important perspective regarding the diversity of issues California physicians and patients face,” Dr. Fouras said in a message to delegates during his campaign. “Nothing is more important to me than ensuring that the physician members of the CMA feel empowered to participate in the processes by which we set policy and lead the state.” Dr. Fouras has been a CMA member since 1996. He has served in the CMA House of Delegates for more than a decade and has held many leadership positions during his 27 years of membership. He is a past president of the San Francisco Marin Medical Society (SFMMS), the Northern California Regional Organization of Child and Adolescent Psychiatry and the Southern California Psychiatric Society. He is a past chair of the SFMMS Political Action Committee, the current chair of the Los Angeles County Medical Association (LACMA) Political Action Committee (LACPAC), a councilor- at- large for LACMA, and the www.sccma.org

current secretary-treasurer of CMA’s Political Action Committee (CALPAC). Dr. Fouras also serves as a California delegate to the American Medical Association. CMA Speaker Jack Chou, M.D. 4, was also re-elected by acclamation for a second term. A board-certified family medicine physician and a fellow of the American Academy of Family Physicians, Dr. Chou is a Partner of the Southern California Permanente Medical Group, where he is also Regional Chair for Health Information Management and Regional Co-Chair for Scanning Oversight Committee. Redwood City ob-gyn Tanya W. Spirtos, M.D.5, today was installed as the 155th president of the California Medical Association – only the fourth woman to hold that position – at the close of association’s annual House of Delegates meeting. “Serving an organization that represents the very heart of our states health care community, is a role that I take on with a deep sense of gratitude and humility,” Dr. Spirtos said in her address to the delegates. “I am mindful that I stand on the shoulders of pioneering women who shattered glass ceilings and blazed trails in the medical field. I am awed by the special responsibility I hold to empower the next generation of women physicians and leaders.” Dr. Spirtos is a board-certified obstetrician-gynecologist in full-time practice in a group of six physicians now part of foundation model Packard Medical Group/Stanford Medicine. She is also on the active medical staff of El Camino Hospital and Sequoia Hospital. The proceedings included a heartfelt video tribute to Dr. Lawrence Cheung honoring his long and memorable career. The House also voted to convene a midyear meeting to further discuss the Major Issues, which are at present the Office

of Health Care Affordability6, Consumer Health Technology/Artificial Intelligence7 and Climate Change 8 . The virtual Interim Session will be help on Saturday, February 10, 2024.

References 1. 2.

4. 5.

https://www.cmadocs.org/newsroom/news/view/ArticleId/50316/Important-Annual-Session-Update https://www.cmadocs.org/newsroom/news/view/ ArticleId/50333/Additional-Information-on-Nov-5-Hybrid-House-of-Delegates https://www.cmadocs.org/newsroom/news/view/ArticleId/50345/Los-Angeles-psychiatrist-George-Fouras-M-Delected-vice-speaker-of-the-CMA-House-of-Delegates https://www.cmadocs.org/speaker https://www.cmadocs.org/newsroom/news/view/ArticleId/50342/Redwood-City-ob-gyn-Tanya-W-Spirtos-MD-installed-as-CMA-39-s-155th-president chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.cmadocs.org/LinkClick.aspx?fileticket=TXdAXgL_WoI%3d&portalid=53 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.cmadocs.org/LinkClick.aspx?fileticket=JNkzXd05Gck%3d&portalid=53 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.cmadocs.org/LinkClick.aspx?fileticket=nRPNx-PeFFg%3d&portalid=53 https://www.cmadocs.org/newsroom/news/view/ArticleId/50375/Save-the-Date-CMA-Interim-House-of-DelegatesIs-Feb-10-2024

Health Professionals for Clean Air and Climate Action

98%

of Californians live in areas with unhealthy air Medical and healthcare voices are critical when calling for stronger policies to address air pollution and climate change. If you are a health professional, please take part in the American Lung Association’s Health Professionals for Clean Air and Climate Action community and sign up for our monthly newsletter at Lung.org/climatechangeshealth www.sccma.org

The Bulletin | Winter 2023 | 19

CMA’S 2023 Legislative Wrap-Up

By Stuart Thompson, CMA Senior Vice President of Government Relations

efore launching into the recap of the 2023 legislative session, I want to take a moment to express my gratitude for being back at CMA and I am honored to be given the responsibility of representing the profession in front of the California Legislature. I spent five years at CMA as a staff lobbyist from 2014 to 2018 and then spent four years in the Governor’s Office as the Chief Deputy Legislative Secretary. But coming back to CMA felt like coming home.

The theme of 2023 in the California State Legislature was one of change at the top. Robert Rivas became the new Assembly Speaker in July after a year-long tussle with the previous Speaker, Anthony Rendon, who held the position for seven years. Members loyal to Speaker Rivas will ascend to important chairmanships and key leadership positions over the coming months. The California Senate also saw a change in leadership, albeit with much less drama, as Senate President pro Tempore Toni Atkins announced she will be transitioning power to Senator Mike McGuire sometime next year. Pro Tem Atkins’ term expires in 2024, and she is ineligible to run for the state Legislature again. This transition will be watched very closely to determine when a new pro tem might take over and whether Senator McGuire will change the current pro tem leadership team.

Senator Atkins was the first woman elected as Senate president pro tem when she took the position in 2018. She has fiercely advocated for women’s reproductive rights, LGBTQ+ rights and affordable housing in California. In 2022, in the shadow of the U.S. Supreme Court’s decision to overturn Roe v. Wade, Senator Atkins introduced a state constitutional amendment permanently protecting abortion care as a fundamental right in California. Our physicians are grateful for the work Senator Atkins has done to protect patient access to reproductive care for Californians and the nation.

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The changes in leadership in both houses were preceded by an election that saw an enormous influx of new members in both the Assembly and Senate. The Assembly saw 30 new members, including Jasmeet Bains, M.D. Dr. Bains is a boardcertified family physician providing care in the Central Valley and has been a member of CMA and its House of Delegates for several years. Her focus during her first year in office has been fighting the fentanyl crisis plaguing California. The Senate also saw 10 new members, and we hope to see Assemblymember Akilah Weber, M.D., join their ranks in 2024! There is no advocacy that can rival having actual physicians on the floors of the state Legislature, and we are beyond thrilled to have these two physician champions in the state Legislature.

LEGISLATIVE MATTERS State Budget CMA was successful this year in advocating for the largest influx of new Medi-Cal dollars the state has ever invested into the program. That we were able to accomplish this in a budget environment where most programs were being cut is a testament to CMA’s advocacy. The funding is based on the renewal of the MANAGED CARE ORGANIZATION (MCO) TAX, which allows the state to tax managed care plans in an effort to draw down federal funding to support the Medi-Cal program. To secure this historic deal, CMA led a coalition effort that included the hospitals, clinics, Planned Parenthood, emergency transport providers, and health plans with the goal of ensuring Medi-Cal enrollees receive the same level of coverage as other members of their community. The MCO Tax – which is broadly supported by our health plan partners – will raise a total of $19.4 billion, with much of it being spent on the state’s health care infrastructure. Starting in 2024, Medi-Cal provider rates will be increased to at least 87.5% of Medicare for primary care, maternity care and non-specialty mental health services. Starting in 2025, the MCO Tax will also provide a new infusion of $6 billion for the Medi-Cal program and the health care workforce. Specifically, there will be an annual appropriation of $1.38 billion in primary care rate increases; $1.15 billion in specialty care rate increases; $700 million to increase emergency department access (including $200 million for emergency department physicians); at least $500 million for family planning and reproductive health care;

and $600 million for behavioral health facilities, including increasing inpatient psychiatric beds.

Prior Authorization CMA SPONSORED SB 598 (SKINNER) – a reintroduction of last year’s SB 250 (Pan) – which would provide physicians with an exemption from prior authorization if they had a good history of prior authorization approvals. Additionally, the bill would have discontinued prior authorization for a service if the health plan approves it 95% or more of the time and required insurance reviewers for denials to have the same medical expertise as the treating provider.

Unfortunately, Assembly Appropriations Committee Chair Chris Holden held SB 598 in committee and prevented prior authorization reform legislation from advancing for the second straight year (he also held SB 250 last year). This action would have required CMA to introduce a new bill next year and start the legislative process from the beginning for the third time. However, CMA was successful in lobbying the Speaker’s Office to allow us to gut and amend another bill currently in Assembly Appropriations Committee, SB 516, to include SB 598’s provisions. Adopting this approach will give us the necessary time to negotiate with the Newsom Administration to address their implementation concerns with the reform package and allow us to pick up right where we left off with SB 598. This bill will remain a top priority for CMA in the coming year.

Heal th Care Worker Minimum Wage SB 525 (DURAZO), which will gradually raise wages of health care workers to $25 an hour, has been signed by Governor Newsom.

CMA had an oppose unless amended position on SB 525 and was advocating in coalition with other stakeholder groups. When SB 525 was amended during the last week of the legislative session to reflect a deal negotiated between some health care industry stakeholders and labor, CMA engaged in kind to limit the impact to our members. CMA negotiated exemptions for IPAs and small practices with 24 physicians or less, as well as a gradual implementation of the wage increase. The ramp-up more closely aligns with wage trajectories that are anticipated to naturally occur due to economic pressures outside of SB 525, including other legislation that will raise the minimum wage for fast food workers to $20 per hour starting in April

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2024. Under that bill, a council will have the authority to increase the fast food minimum wage annually. All of this is against the backdrop that California now requires an annual assessment and adjustment of the minimum wage to reflect inflation. Such an adjustment will occur on January 1, 2024, bringing California’s minimum wage up to $16 per hour. SB 525 will neutralize efforts to enact health care worker minimum wages via local ballot measures across the state. Those efforts – assuming they resemble previous ballot measures in the cities of Inglewood and Downey – would have involved an immediate increase. The following chart shows when SB 525 wage increases would go into effect: SECTOR

2024

Physician groups with 25 or more physicians

$21

Physician groups part of large health systems with more than 10,000 workers and dialysis clinics

$23

Community clinics

$21

Hospitals with high mix of Medi-Cal and Medicare patients and rural independent hospitals

$18

CMA’s advocacy ensured that physician practices would not face more drastic and immediate wage increases that would be more difficult to weather. CMA will be closely monitoring how the new law impacts physician practices and patient care, especially small rural practices, hospitals and clinics.

Administrative Burden AB 1751 (GIPSON) was introduced at the request of the

California Chiropractic Association. The bill would have required physicians prescribing opioids to obtain signed consent that they talked to patients about alternative treatments to pain – including but not limited to chiropractic, mental health and acupuncture services – regardless of whether those treatments would even be beneficial. The bill was essentially an attempt to require physicians to talk to their patients about chiropractic services every single time they prescribed an opioid. AB 1751 was set to be heard in the Assembly Health Committee on two separate occasions but was never heard because of CMA’s grassroots and lobbying efforts. The bill must be acted upon in January 2024, or the bill will be considered dead.

2025

2026

2027

$23 $24

2028

$25

$25 $22

$25

Increase 3.5% annually until it reaches $25 in 2033 against the bill and prevented it from being taken up in its first committee, forcing it to become a two-year bill. AB 1570 must be acted upon by the end of January 2024, or the bill will be considered dead. We anticipate the proponents advancing some type of proposal in January, and CMA will be closely following any developments. SB 524 (CABALLERO) would have allowed pharmacists

at retail pharmacy chains to furnish medications to treat COVID-19, influenza, streptococcal pharyngitis, STIs and conjunctivitis as part of the large chains’ attempt to establish small clinics within pharmacies. Thanks to CMA’s advocacy, the bill was held in the Senate Appropriations Committee.

Reproductive Heal th

Scope of Practice

California has long been known for supporting reproductive rights and the right for women to have autonomy over their bodies. This year, the Legislature burnished California’s reputation for reproductive rights even further by helping to provide protections not just for patients, but also for providers. With 14 states having some form of a ban on abortion, patients are forced to seek reproductive care in other states, with California being a primary destination.

Last year, Assemblymember Evan Low introduced AB 2236, which would have allowed optometrists with minimal training to infringe on the scope of ophthalmologists, including widening their scope to allow them to perform surgery and use lasers. CMA worked hard to persuade Governor Newsom to veto the bill. This year, Assemblymember Low introduced AB 1570, which was identical to the bill that Governor Newsom had vetoed just a few months earlier. CMA lobbied

Senate Pro Tem Toni Atkins authored CMA-SPONSORED SB 487, which prevents providers from having their MediCal provider eligibility threatened by states with abortion bans. Previously, if a state were to take action against a provider’s license for performing reproductive services that are lawful in California, they would automatically become ineligible to be a Medi-Cal provider. SB 487 allows providers who fall into this category to avoid losing their Medi-Cal

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provider eligibility simply because a state they previously worked in passed laws to ban those services. Gov. Newsom signed this bill into law on September 27, 2023. Additionally, physicians have informed us that their liability insurance has been denied, terminated, or seen drastically increased premiums for providing reproductive and genderaffirming care services. CMA and other organizations in the California Future of Abortion Council co-sponsored AB 571, authored by Assemblymember Cottie Petrie-Norris, to alter the insurance code to prevent insurance companies from unreasonably increasing liability premiums or denying coverage to providers based on the services they provide. Gov. Newsom signed this bill into law on September 27, 2023.

Language Concordance Patients who receive linguistically concordant care experience better health outcomes. However, due to California’s diverse and growing population, physicians often need translators to communicate with their patients. CMA set out to help physicians close that communication gap and strengthen the patient-physician relationship by sponsoring AB 470, authored by Assemblymember Avelino Valencia. AB 470 allows physicians to take specific language courses to fulfill some continuing education requirements. The bill made it through the Legislature without opposition and was signed into law by Gov. Newsom on October 7, 2023.

Medical Board SB 815 is the bill extending the administration’s authority of the Medical Board of California. This bill amends various sections of the Medical Practice Act. CMA focused on six priority issues in the bill: license fee increase, public member majority, lowering the evidentiary standard to preponderance of evidence, license revocation related to felony convictions, postgraduate training licenses and the medical board’s financial reserves.

CMA successfully reduced the proposed $487 license fee increase (which would have been a nearly 60% increase) to a $288 increase (33% increase). Additionally, CMA successfully removed the provision to institute a public member majority on the board, as well as the sections of the bill related to a lowered evidentiary standard. CMA also ensured that the overly broad language in the bill relating to licensure revocation for felony convictions was explicitly clarified with specific serious crimes. In addition, SB 815 expanded the timelines and flexibility for postgraduate training licensure. This bill also establishes

a cap of six months for the financial reserves the medical board can retain; this is reduced from the original 24-month proposal. Lastly, SB 815 extends the sunset for the medical board for four years, until January 1, 2028.

Heal th IT An egregious problem physicians face is price gouging from electronic health record (EHR) vendors. When the state mandates a new EHR feature, software update or other change, vendors are charging physicians upwards of $30,000 to make the required changes. California physicians are forced to dig deep and pay outrageous fees or face being out of compliance. CMA investigated and found there were no regulations on how much EHR vendors can charge, nor was there a regulator to oversee vendor activities. To correct this oversight, CMA sponsored SB 582 by Senator Josh Becker to fold EHR vendors into the state’s Data Exchange Framework, placing them under an entity that can regulate and take enforcement actions against vendors in California. Unfortunately, this bill was vetoed by the governor for being “premature” since the Data Sharing Governing Board has not yet been established. CMA will pursue this policy again next fall.

Financial Disclosures Assemblymember Freddie Rodriguez introduced AB 616, which would require audited financial reports and statements from medical groups to be released to the public on the Department of Health Care Access and Information (HCAI) website. The bill would reverse a previous agreement made last year during the establishment of California’s Office of Health Care Affordability. This information becoming public could create an escalation of consolidation in the health care industry by allowing private equity and corporate interests to use the financial data to make acquisitions that will lead to higher costs and negatively impact patient outcomes. CMA led a coalition to oppose the bill in the Legislature. Despite CMA’s efforts, the bill made it to the governor’s desk during the last week of the session by the slimmest of margins. Ultimately, however, CMA succeeded in advocating for a veto of the bill by the governor.

On the following pages, you will f ind summaries of many of the key bills that CMA was involved with in 2023.

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SPONSORED AB 470 (VALENCIA): CONTINUING MEDICAL EDUCATION: PHYSICIANS & SURGEONS

are patient safety and fraud and waste protections built into the bill that are consistent with current practice and law. Additionally, SB 516 would require health plans to provide a true peer-to-peer, within the same or similar specialty, when a physician is appealing a prior authorization denial.

Status: Signed by Governor (Chapter 330, Statutes of 2023)

SB 582 (BECKER): HEALTH INFORMATION

AB 470 will affirm the importance of cultural competency and language fluency as a core tenet of continuing medical education. This legislation will help physicians better communicate with patients in diverse communities across the state. California is a melting pot of cultures and languages, making it a minority-majority state. These important adjustments in state law will improve the quality of care by helping physicians effectively communicate with patients in diverse communities where English is a second language. AB 571 (PETRIE-NORRIS): MEDICAL MALPRACTICE INSURANCE

Status: Signed by Governor (Chapter 256, Statutes of 2023)

AB 571 will ensure California’s reproductive and gender-affirming health care providers are able to obtain professional liability insurance without the fear of discrimination based on the services they provide. AB 571 prohibits insurers from refusing to issue professional liability insurance to licensed health care practitioners solely because they offer abortion, contraception or genderaffirming services. SB 487 (ATKINS): ABORTION – PROVIDER PROTECTIONS

Status: Signed by Governor (Chapter 261, Statutes of 2023)

SB 487 will strengthen the civil protections for California’s reproductive health care service providers. It will prohibit payors from discriminating or taking adverse actions against providers who are subjected to civil, criminal or professional license actions for providing reproductive health care services to patients that have traveled from out of state. SB 516 (SKINNER): HEALTH CARE COVERAGE – PRIOR AUTHORIZATION

Status: Two-Year Bill – In Assembly Appropriations Committee

SB 516 (previously SB 598) will reform the prior authorization process to ensure timely access to treatments and care, improve patient health outcomes and increase the efficiency and effectiveness of physician practices. SB 516 is a balanced approach that ensures physicians who practice within a plan’s criteria are exempt from prior authorization, thereby allowing physicians to care for the needs of their patients without undue burdens from health plans. There

Status: Vetoed by Governor

SB 582 would have authorized the California Health and Human Services (CalHHS) Data Exchange Framework to create policies and procedures for including EHR vendors in the legal structure of the framework and incorporate federal standards for the reasonableness of vendor fees. The bill was vetoed due to it being premature, with the advisory groups still in their infancy.

SUPPORT AB 33 (BAINS): FENTANYL MISUSE & OVERDOSE PREVENTION TASK FORCE

Status: Signed by Governor (Chapter 887, Statutes of 2023)

AB 33 will establish the Fentanyl Misuse & Overdose Prevention Task Force to undertake various duties relating to fentanyl abuse, including collecting and organizing data on the nature and extent of fentanyl abuse in California and evaluating approaches to increase public awareness of fentanyl abuse. AB 85 (WEBER): SOCIAL DETERMINANTS OF HEALTH – SCREENING AND OUTREACH

Status: Vetoed by Governor

AB 85 would have added social determinants of health screenings as a covered benefit under commercial coverage and Medi-Cal. Additionally, the bill would have required health plans to connect providers with community health workers to assist with patient care coordination. Finally, AB 85 would have required HCAI to convene a working group to develop a standardized model and procedures for providers to use to implement the requirements of the bill and identify gaps in research and data, which would help to improve state policies on social determinants of health. AB 360 (GIPSON): EXCITED DELIRIUM

Status: Signed by Governor (Chapter 431, Statutes of 2023)

AB 360 eliminates “excited delirium” as a medical diagnosis and prohibits the term from being listed as a cause of death on a death certificate. Amid concerns that physicians would be limited when describing a patient’s behavior, CMA staff assisted in crafting language to clarify that only the term excited delirium is prohibited.

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AB 576 (WEBER): MEDI-CAL – REIMBURSEMENT FOR ABORTION

AB 907 (LOWENTHAL): COVERAGE FOR PANDAS & PANS

Status: Vetoed by Governor

AB 907 would have required health plans to cover treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) prescribed by a licensed physician. The bill would not allow copays, deductibles or any other form of cost-sharing to be imposed if it was more than what is applied to similar covered benefits. The Governor vetoed the bill due to cost concerns.

AB 576 would have required the Medi-Cal program to reimburse providers prescribing medication to fully terminate a pregnancy. AB 765 (WOOD): PHYSICIANS & SURGEONS – MEDICAL SPECIALTY TITLES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 765, the “California Patient Protection, Safety, Disclosure and Transparency Act,” is aimed at strengthening protections for health care consumers by addressing gaps in our current prohibition on use of the term “physician” by non-physician providers. The bill does so by ensuring consumers are not misled or deceived into believing their health care provider is a physician or surgeon. The bill also ensures that non-physician health care providers with advanced degrees do not confuse the public with the use of “ologist” titles like anesthesiologist or dermatologist or other similar combination of “physician-equivalent” titles. AB 815 (WOOD): HEALTH CARE COVERAGE – PROVIDER CREDENTIALS

Status: Two-Year Bill – in Senate Health Committee

AB 815 would streamline the physician credentialing process with health plans and take significant steps in removing administrative waste within the care delivery system. AB 815 would require CalHHS to create a stakeholder board to approve independent entities credentialing physicians for health plans. If an approved entity credentials a physician, health plans would be required to accept physicians’ credentials from that entity. AB 874 (WEBER): HEALTH CARE COVERAGE – OUT-OF-POCKET EXPENSES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 874 would ban the use of copay accumulator programs and ensure that any offered copay assistance benefits patients. Copay accumulator programs prevent copay assistance given to patients from counting toward their deductible and other out-of-pocket spending, which leaves patients facing increased and unexpected costs once the copay card is maximized and their deductible is deemed to have not been met. The use of these programs means patients are often forced to leave the pharmacy without the medication they need due to an inability to pay.

Status: Vetoed by Governor

AB 977 (RODRIGUEZ): EMERGENCY DEPARTMENTS – ASSAULT & BATTERY

Status: Two-Year Bill – Held in Assembly Public Safety Committee

AB 977 makes an assault or battery committed against a physician, nurse or other health care worker of a hospital engaged in providing services within the emergency department punishable by imprisonment in a county jail not exceeding one year and by a fine not exceeding $2,000, making the crime a felony. AB 1089 (GIPSON): FIREARMS

Status: Signed by Governor (Chapter 243, Statutes of 2023)

AB 1089 prohibits unlicensed individuals from using a computer numerical control (CNC) milling machine or a 3D printer for manufacturing a firearm and a “digital firearm manufacturing code” to be shared or distributed. Additionally, AB 1089 sets criteria for how a person can lawfully relinquish possession of a CNC or 3D printer intended to manufacture firearms. AB 1194 (CARRILLO, WENDY): CA PRIVACY RIGHTS ACT OF 2020: EXEMPTIONS – ABORTION SERVICES

Status: Signed by Governor (Chapter 567, Statutes of 2023)

AB 1194 expands the exemptions under the California Privacy Rights Act of 2020 regarding protecting an individual’s information related to accessing or searching for services such as reproductive health care services, including contraception and abortion. AB 1203 (BAINS): SALES & USE TAXES: EXEMPTIONS – BREAST PUMPS & RELATED SUPPLIES

Status: Signed by Governor (Chapter 833, Statutes of 2023)

AB 1203 removes the sales tax on the sale of breast pumps and other related supplies, including breast milk storage bags, cleaning supplies, nursing bras, creams and ointments, etc.

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AB 1701 expands the scope of resources and interventions provided under the Black Infant Health Program.

meals meet nutritional standards recommended by leading health experts. Additionally, SB 348 will maximize the federal Summer Electronic Benefit Transfer Program for Children nutrition benefits and build upon the federal program to further prevent childhood hunger during the summer.

AB 1731 (SANTIAGO): CURES DATABASE – BUPRENORPHINE

SB 357 (PORTANTINO): VEHICLES – PHYSICIAN & SURGEON REPORTING

Status: Signed by Governor (Chapter 144, Statutes of 2023)

Status: Two-Year Bill

AB 1731 will exempt a physician from having to consult the CURES database when they prescribe or furnish buprenorphine in the emergency department of a hospital. The administration of buprenorphine in an emergency department must be done in the most efficient and timely manner to save a patient’s life. While the CURES database is an extremely valuable clinical tool to ensure the safe prescribing of opioids, consultation in an emergency department where a patient is experiencing an overdose can delay and inhibit a health care worker from administering life-saving treatment. This bill ensures that patients who need buprenorphine to save their lives can get the treatment as fast as possible.

SB 357 seeks to remove outdated language from the Vehicle Code that discriminates against specific conditions, including epilepsy, and to protect the patient-physician relationship by giving physicians greater discretion when reporting patients that experience lapses of consciousness to the Department of Motor Vehicles.

AB 1701 (WEBER): BLACK INFANT HEALTH – CALIFORNIA PERINATAL EQUITY INITIATIVE

Status: Signed by Governor (Chapter 154, Statutes of 2023)

SB 2 (PORTANTINO): FIREARMS

Status: Signed by Governor (Chapter 249, Statutes of 2023)

SB 2 will strengthen the state’s existing concealed carry laws by developing new requirements for gun licensure applicants and renewals. Most notably, the bill increases the minimum age for a licensee to 21 years of age and develops a training program applicants must complete before receiving a license. SB 43 (EGGMAN): BEHAVIORAL HEALTH

Status: Signed by Governor (Chapter 637, Statutes of 2023)

SB 43 will update the definition of “gravely disabled” to include a new focus on preventing serious physical and mental harm stemming from a person’s inability to provide for their needs for nourishment, personal or medical care, or shelter, or to attend to self-protection or personal safety, due to their mental health condition or substance use disorder. SB 119 (COMMITTEE ON BUDGET & FISCAL REVIEW): MEDI-CAL: MANAGED CARE ORGANIZATION TAX

Status: Two-Year Bill – Referred to Budget Committee

SB 119 was this year’s budget trailer bill that contained the MCO Tax proposal that was successfully negotiated by CMA. The proposal will provide over $2 billion annually for Medi-Cal rate increases and provide new residency slots.

OPPOSE AB 236 (HOLDEN): HEALTH CARE COVERAGE – PROVIDER DIRECTORIES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

This bill would have required health plans to annually audit and meet accuracy standards for the provider information on their network directories and would have required a health plan to remove a provider from the directory if the plan has not compensated the provider for at least five claims in a year. The measure did not minimize the compliance burden on physician practices by failing to clarify that the burden to maintain accurate provider directories is the sole responsibility of the health plan. CMA was successful in holding the bill this year and will work constructively with the author to address the issue of inaccurate provider directories. AB 616 (RODRIGUEZ): MEDICAL GROUP FINANCIAL TRANSPARENCY ACT

Status: Vetoed by Governor

AB 616 would have required audited financial reports and financial statements from medical groups to be released to the public on the HCAI website. AB 616 would have erased critical antitrust and privacy laws that have protected patient access to high-quality, cost-efficient care and would have hindered the ability of physician groups to recruit providers and employees into rural and low-income communities.

SB 348 (SKINNER): PUPIL MEALS

AB 1036 (BRYAN): HEALTH CARE COVERAGE – EMERGENCY MEDICAL TRANSPORT

Status: Signed by Governor (Chapter 600, Statutes of 2023)

Status: Two-Year Bill

SB 348 will ensure children attending public or charter schools have access to free breakfast and lunch and that the

AB 1036 required a physician to certify in the treatment record whether an “emergency medical condition” existed

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for every single patient that was transported to the hospital by an ambulance. This bill would have created an enormous administrative burden on emergency room physicians and exposed them to unwarranted liability. AB 1091 (WOOD): HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT OF 2023

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1091 would prohibit health plans and insurers from steering patients to another provider or facility or require the plan or insurer to contract with other providers or facilities that are affiliated with the original provider/facility and would essentially codify the court case involving Sutter and exclusive contracting. The bill would require a medical group, hospital or hospital system, health care service plan, health insurer or pharmacy benefit manager (all defined very broadly) to provide written notice to the Attorney General (AG) before entering into an agreement to make a material change to the entity’s organizational structure/corporate structure with a value of $15 million or more. The bill would authorize the AG to consent to, give conditional consent to or not consent to the agreement. If the AG does not consent to the agreement, the structural change/acquisition may not move forward. AB 1094 (WICKS): DRUG & ALCOHOL TESTING – INFORMED CONSENT

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1094 would require health care providers to receive written and verbal consent from a pregnant or perinatal person or the person authorized to consent for a newborn before performing drug or alcohol tests. AB 1180 (RODRIGUEZ): EMERGENCY MEDICAL SERVICES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 1180 would remove the existing requirement that the Emergency Medical Services Authority Director be a licensed physician or surgeon. The administration has claimed it has struggled to find qualified candidates under this requirement. AB 1369 (BAUER-KAHAN): OUT-OF-STATE PHYSICIANS AND SURGEONS: TELEHEALTH – LICENSE EXEMPTION

Status: Signed by Governor (Chapter 837, Statutes of 2023)

AB 1369 allows for a physician or surgeon licensed in another state to provide care via telehealth, with the requirement that the patient has a life-threatening condition. The author of this bill has a constituent who had trouble accessing a California physician for an undisclosed rare disease. They believe this bill will solve the issue by allowing access to out-of-state physicians through telehealth.

AB 1570 (LOW): OPTOMETRY – CERTIFICATION TO PERFORM ADVANCED PROCEDURES

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1570 would expand the scope of practice for optometrists to perform advanced surgical and laser procedures with minimal training. These procedures include corneal crosslinking and laser trabeculoplasty, among others. Under this bill, optometrists would qualify to perform these advanced procedures after completing only 43 various surgical eye procedures. AB 1751 (GIPSON): OPIOID PRESCRIPTIONS – INFORMATION: NONPHARMACOLOGICAL TREATMENTS FOR PAIN

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1751 would force physicians to inform patients about nonpharmacological treatments for pain, including chiropractic, acupuncture and mental health services. Additionally, this bill would require physicians to provide redundant patient notifications and get patient signatures through a cumbersome informed consent process. Under this bill, the only exception to the above requirements would be a patient in hospice care. CMA was successful in ensuring this bill did not have the votes to be heard in its first policy committee. SB 481 (NIELLO): PHYSICIANS & SURGEONS – SPECIALTY CERTIFICATIONS & PRACTICE

Status: Two-Year Bill – Referred to Senate B&P

SB 4841 would have required the Medical Board of California and the Osteopathic Medical Board of California to annually post a report regarding the number of physicians and their specialty statewide and by county. CMA opposed this bill because this information is already publicly available and collected by other state departments. Additionally, this bill would have created a new cost for both boards, directly resulting in a request for more funding. CMA was successful in stopping this legislation. SB 524 (CABALLERO): PHARMACISTS: FURNISHING PRESCRIPTION MEDICATIONS

Status: Two-Year Bill – Held in Senate Appropriations Committee

SB 524 would have authorized pharmacists to furnish and prescribe treatments for any positive test outlined in this bill. This includes antibiotics for various illnesses, conditions, and diseases. Under this bill, physicians would have been removed from the patient care process if the patient chose to test and treat at a pharmacy. The California Retailers Association, including CVS, Walgreens and Rite Aid, were the sponsors of this bill. CMA was successful in stopping this legislation.

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The Bulletin | Winter 2023 | 27

SB 625 (NGUYEN): HEALING ARTS – PREGNANCY & CHILDBIRTH

Status: Two-Year Bill – Held in Senate Judiciary Committee

SB 625 would require the California Department of Public Health to get written consent from the parent of a minor if the minor’s blood sample is to be used for research purposes. This bill would also not allow a residual newborn screening specimen to be released for law enforcement or forensic database purposes. This bill would add unnecessary administrative burdens to physicians who frequently collect blood draws for the purposes of genetic disease detection, while also threatening the financial stability of the genetic screening program. SB 779 (STERN): PRIMARY CARE CLINIC DATA MODERNIZATION ACT

Status: Signed by Governor (Chapter 505, Statutes of 2023)

SB 779 will require all clinics, including those exempt from licensing requirements, to report information to HCAI related to patient demographics; payor mix; assigned enrollees in the Medi-Cal program and the prospective payment system rate they receive; an expansive and detailed workforce report; all mergers and acquisitions the clinic/system took part in; a report of quality and equity measures per patient; and a report of the workforce development programs the clinic/ system participates in (such as residency programs, allied health care professions degree programs and behavioral health professional degree programs). SB 784 (BECKER): HEALTH CARE DISTRICTS – EMPLOYMENT

Status: Two-Year Bill – Held in Senate Appropriations

SB 784 would create an exemption to the Ban on the Corporate Practice of Medicine (Corporate Bar) for health care districts and nonprofit corporations with a health care district as its sole corporate member that owns or controls a general acute care hospital. SB 784 does away with those patient protections and creates a permanent exemption to the Corporate Bar by allowing a health care district to employ physicians in their hospitals. The exemption contained in the bill would subject patient care decisions to the whims and pressures of financial or political interests. SB 815 (ROTH): HEALING ARTS

Status: Signed by Governor (Chapter 294, Statutes of 2023)

SB 815 amends various sections of the Medical Practice Act; however, there were six priority issues CMA tackled: license fee increase, public member majority, lowered evidentiary standard, license revocation related to felony convictions, post-graduate training licenses and the Medical

Board of California’s financial reserves. CMA successfully reduced the proposed $487 fee increase (which would have been a nearly 60% increase) to $288 (a 33% increase). Additionally, CMA successfully removed the public member majority board composition provision and the sections related to a lowered evidentiary standard. CMA ensured that the originally overly broad section related to licensure revocation for felony convictions was explicitly clarified with specific serious crimes. SB 815 also expanded timelines and flexibility for postgraduate training licensure. This bill also establishes a cap of six months for the financial reserves the medical board can retain; this is reduced from the original 24-month proposal. Lastly, SB 815 extends the sunset for the medical board for four years until January 1, 2028.

NEUTRAL AB 242 (WOOD): CRITICAL ACCESS HOSPITALS – EMPLOYMENT

Status: Signed by Governor (Chapter 641, Statutes of 2023)

AB 242 removed the sunset date for a current pilot program allowing critical access hospitals to employ physicians directly, which was due to expire on January 1, 2024, thus making the program permanent. In 2016, AB 2024 (Wood) established the pilot program and required a report to be created by the Office of Statewide Health Planning and Development (now HCAI) to determine the usage and efficacy of the program and its impact on patient care. AB 1005 (ALVAREZ): IN-HOME SUPPORTIVE SERVICES – TERMINAL ILLNESS DIAGNOSIS

Status: Two-Year Bill – Held in Senate Appropriations

AB 1005 would require a physician, upon diagnosing a patient with a terminal illness and before discharge, to disclose information about the In-Home Supportive Services program, including eligibility criteria and a physical application. AB 1029 (PELLERIN): ADVANCED HEALTH CARE DIRECTIVE FORM

Status: Signed by Governor (Chapter 171, Statutes of 2023)

AB 1029 would have allowed an individual to declare a separate agent for mental health services on an Advanced Health Care Directive Form. Following conversations with CMA staff, the author substantially amended the bill to clarify the treatments a health care agent has the authority to consent to on behalf of the patient.

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AB 1070 (LOW): PHYSICIAN ASSISTANTS – PHYSICIAN SUPERVISION: EXCEPTIONS

Status: Signed by Governor (Chapter 827, Statutes of 2023)

AB 1070 originally would have removed any sort of cap on the number of physician assistants that a physician could manage as it relates to gathering patient information and performing health examinations for patients in the in-home health evaluation setting. CMA worked through a cumbersome negotiating process with the author and stakeholders on this legislation to ensure there is a cap of eight physician assistants to one supervising physician for the tasks outlined in the bill and that this bill is explicitly limited to in-home health evaluations. AB 1286 (HANEY): PHARMACY

Status: Signed by Governor (Chapter 470, Statutes of 2023)

AB 1286 will give a pharmacist in charge the autonomy to make staffing decisions based on the pharmacy’s needs and the pharmacy staff’s condition, among other decisions unrelated to the practice of medicine. This bill originally allowed pharmacy technicians to perform Clinical Laboratory Improvement Amendments waived testing, administer vaccines and perform other duties if deemed qualified by the pharmacist in charge. However, CMA ensured that pharmacy technicians would have a severely limited ability to test or administer vaccines while also requiring them to be certified in basic life support. AB 1341 (BERMAN): PUBLIC HEALTH – ORAL THERAPEUTICS

Status: Signed by Governor (Chapter 276, Statutes of 2023)

AB 1341 originally would have allowed for pharmacists to furnish U.S. Food and Drug Administration (FDA) authorized COVID-19 oral therapeutics after administering and confirming a positive test for COVID-19, with minimal parameters. CMA worked closely with the author throughout the legislative process to ensure a sunset date of January 1, 2025, was added for furnishing oral therapeutics and to require all pharmacists who are furnishing oral therapeutics for COVID-19 to follow FDA clinical guidelines. SB 339 (WIENER): HIV PREEXPOSURE PROPHYLAXIS AND POSTEXPOSURE PROPHYLAXIS

Status: Two-Year Bill

SB 339 would allow pharmacists to indefinitely furnish a recurring 90-day supply of HIV preexposure prophylaxis without a prescription ever being issued. Existing law allows a pharmacist to furnish a 60-day supply of HIV preexposure prophylaxis every two years if certain criteria and documentation requirements are met. CMA ensured that a provision was added to explicitly clarify that this bill

cannot expand the scope of practice for a pharmacist related to furnishing PrEP and PEP. SB 525 (DURAZO): MINIMUM WAGES – HEALTH CARE WORKERS

Status: Signed by Governon (Chapter 890, Statutes of 2023)

This bill sets a $25 minimum wage for health care workers in virtually every health care setting and facility. Depending on the facility, location and practice size, the minimum wage will be increased incrementally to allow employers to adjust to the wage requirements. CMA negotiated exemptions for IPAs and small practices with 24 physicians or less as well as a gradual implementation of the increase. The ramp-up more closely aligns with wage trajectories that are anticipated to naturally occur due to economic pressures outside of SB 525. Without a legislative deal, labor unions were planning on filing a statewide ballot initiative to require a $25 statewide minimum wage requirement starting in 2025 that would apply to all health care settings. SB 667 (DODD): HEALING ARTS: PREGNANCY & CHILDBIRTH

Status: Signed by Governor (Chapter 497, Statutes of 2023)

SB 667 would have originally expanded the duties that a Certified Nurse Midwife (CNM) could perform, specifically allowing CNMs certain privileges related to furnishing and prescribing prescriptions; admitting and discharging patients on the CNM’s own authority; authorization to be a lab director of a birth center; and performing various minor surgical procedures, typically performed by physicians. CMA successfully removed the ability for CNMs to prescribe Schedule II and III controlled substances unless there are mutually agreed upon policies and protocols with a physician.

SAVE THE DATE FOR CMA’S LEGISLATIVE ADVOCACY DAY! April 10, 2024 | Sacramento CMA will host its 50th annual Legislative Advocacy Day in Sacramento on Wednesday, April 10, 2024. Attendees will have the opportunity to meet with legislators on priority health care issues. This unique event is free of charge to all CMA physician members, residents and medical students. Plan to join your colleagues as they prepare to lobby their legislative leaders and serve as champions for the house of medicine!

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The Bulletin | Winter 2023 | 29

We know how to overcome medicine’s crisis. Let’s find the will. BY JESSE M. EHRENFELD, MD, MPH AMA President

here is an insidious crisis in medicine today that is profoundly impacting on our ability to care for our patients, and yet isn’t receiving the attention it deserves. This crisis is physician burnout, and it’s driven largely by problems and inefficiencies that are deeply ingrained in our health care system and external forces that are complicating our jobs like never before. Prior authorization demands, shrinking Medicare payment amid sharply rising practice costs, attacks on science and medical disinformation, an increasingly impersonal and bureaucratic health system that places enormous administrative hassles and burdens in our lap each day, and leaves us feeling powerless to make any meaningful change. And that’s just the starting point. But it doesn’t have to be this way. Many of the pressures brought to bear on a shrinking physician workforce can be greatly reduced—and in some cases stripped away entirely—by advancing bipartisan legislation already pending in Congress. As I outlined in the remarks I delivered … at the National Press Club1, we should begin the process of rebuilding and revitalizing the tremendous resource that our physician workforce represents by taking five steps. These steps are to: • Provide physicians with proper financial resources, starting with Medicare reform. • Slash the administrative burdens posed by prior authorization. • Expand residency training and improving the J-1 visa waiver program. • Stop criminalizing evidence-based health care widely recognized as safe, and • Ensure that physicians are not punished for addressing their mental health needs. As one of the five pillars comprising the AMA Recovery Plan

30 | The Bulletin | Winter 2023

Jesse M. Ehrenfeld, MD, MPH

for America’s Physicians2, reforming an unsustainable Medicare payment system is essential to the long-term financial viability of physician practices. Adjusted for inflation, Medicare physician payments have plunged by 26%3 since 2001, with additional cuts planned next year. Physicians deserve payment models that recognize and invest in their contributions in providing high-value care to patients, while generating cost savings across all parts of Medicare and the broader health care system. A measure currently pending in Congress, the Strengthen Medicare for Patients and Providers Act4, represents a huge step in the right direction by providing annual physician payment updates pegged to the Medicare Economic Index.

Reduce prior authorization Mountains of paperwork, hours of phone calls and other administrative tasks tied to the prior authorization process imposed by insurers not only rob physicians of face time with

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patients, but also drive burnout by fostering a sense of powerlessness and a lack of autonomy. Excessive prior authorization directly harms patients by inappropriately delaying or even denying necessary care. While some progress is being made on this front, more action is needed. About a dozen states have already passed comprehensive prior authorization reforms this year, based on model legislation crafted by the AMA, and several more are currently considering doing the same. At the federal level, another bill now pending in Congress—the Improving Seniors Timely Access to Care Act5 —would further expand the steps taken by the Centers for Medicaid & Medicare Services to reform this onerous practice by insurers.

Expand residency training By prompting many physicians to accelerate plans to cut back their hours or leave the profession entirely, the COVID-19 pandemic only deepened the crisis our nation faces in a shrinking physician workforce. It is estimated that more than 83 million people in our nation live in areas that lack access to a primary care physician. Our population is aging, and of course this includes our physician workforce, nearly half of whom are over age 55. The Association of American Medical Colleges predicts a shortfall of at least 37,000 physicians—and possibly well over 100,000—over the next decade. Tackling this issue immediately and effectively is vitally important. The AMA enthusiastically supports several bipartisan measures pending in Congress that take on this task. One of those is the Conrad State 30 and the Physician Access Reauthorization Act6, would refine and improve J-1 visa waiver programs to ease physician shortages in rural and underserved areas, while promoting physician workforce diversification. Additional measures supported by the AMA include the Healthcare Workforce Resilience Act7 and the Retirement Parity for Student Loans Act8. The former would recapture some 15,000 unused employment-based physician immigrant visas, while the latter would permit retirement plans to make voluntary matching contributions to physicians during residency. The AMA also backs the Physician Shortage GME Cap Flex Act9, which would expand residency training programs in primary care and other specialties where shortages are the most severe.

Stop criminalizing care Last year’s U.S. Supreme Court decision overturning Roe v. Wade triggered an unprecedented amount of third-party intrusion—primarily by state governments—into the patient-physician relationship that continues to compromise access to safe, evidence-based clinical care. Legislatures in more than 20 states have enacted full or partial bans on abortion, while a similar number have adopted laws to greatly restrict or entirely ban gender-affirming care for transgender minors. These actions continue to inflict grave consequences upon patients and physicians alike. Measures like these jeopardize the health and well-being of patients by allowing lawmakers to impose their own views in place of a physician’s expert medical judgment in the practice of sound, evidence-based medicine and shared decision-making with patients. Such laws have also exposed physicians and other health care

workers to intimidation and the risk of physical harm. And in some cases, these laws impermissibly violate medical ethics by forcing physicians to choose between offering care that reflects their best medical judgment or risking the loss of their medical licenses.

Make it OK for doctors to get help Every physician I know has either dealt with burnout firsthand, or has a friend or colleague who has experienced its devastating effects. The solution to this complex problem must include removing the barriers that deter physicians from obtaining needed care, such as probing questions about past mental health or substance-use history contained on licensure and credentialing applications. The AMA favors providing a support system that enables physicians to address their own mental health needs without fear of a negative impact on their career. The AMA is working at the state and national levels to remove outdated and stigmatizing language on licensing and credentialing applications. In partnership with the Dr. Lorna Breen Heroes Foundation and the nation’s state medical societies, the AMA is seeking to remove questions that ask about “past diagnosis” and replace them with questions that only ask about “current impairment.” There isn’t much that our two major political parties see eye to eye on right now, but on these issues they do. We just need the will—and the urgency—to get it done. We need leaders in Congress to step forward and make this happen. Sadly, every day we wait the size of this public health crisis grows. There is no time to waste.

References 1.

2. 3.

6. 7.

https://www.ama-assn.org/press-center/speeches/jesse-mehrenfeld-md-mph-5-step-solution-address-physician-shortage https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-fell-26-2001-howdid-we-get-here https://www.ama-assn.org/practice-management/medicare-medicaid/key-medicare-physician-pay-reform-bill-introduced-congress https://www.ama-assn.org/practice-management/prior-authorization/big-step-forward-congress-fix-prior-authorization https://www.ama-assn.org/education/international-medical-education/advocacy-action-clearing-imgs-route-practice https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-7-Letter-to-Senate-re-Healthcare-Workforce-Resilence-Act-(2).pdf https://www.ama-assn.org/medical-residents/medical-residency-personal-finance/bill-enables-401k-match-doctorspaying-student https://www.ama-assn.org/medical-residents/medical-residency-personal-finance/bill-enables-401k-match-doctorspaying-student

Reprinted with permission from the American Medical Association (www.ama-assn.org). www.sccma.org

The Bulletin | Winter 2023 | 31

PUBLIC HEALTH DEPARTMENT UPDATE

mpox update in Santa Clara County Akanksha Vaidya, MD MPH and Harit Agroia, DrPH MPH

In mid-2022, mpox began spreading globally, including within Santa Clara County. While cases have greatly reduced since then, Public Health continues to see mpox cases locally, especially among men who have sex with men, and a disproportionate impact in the Hispanic/Latino community1. As of November 7, 2023, there were 226 confirmed mpox cases in the county. While nearly all were during the 2022 outbreak, 11 of these arose recentRisk factors for mpox transmission ly between September and October 2023. Rates of new cases and wastewater detection continue United States, August 19, 2022–March 31, 2023. MMWR Morb Mortal Wkly Rep. 2023;72. doi:10.15585/mmwr.mm7220a3 to increase while patients experience late diagnoses which, in many cases, is attributed to providers overlooking mpox in the 3. Deputy NP, Deckert J, Chard AN, et al. Vaccine Effectiveness of JYNNEOS against Mpox Disease in the United States. differential diagnosis during clinical evaluations. N Engl J Med. 2023;388(26):2434-2443. doi:10.1056/NEJThe JYNNEOS vaccine is 66-89% effective toward mpox preMoa2215201 vention with peak immunity reached approximately 14 days af2–4 5 4. Rosenberg ES. Effectiveness of JYNNEOS Vaccine Against ter the second dose, and reduces the risk of severe illness . Diagnosed Mpox Infection — New York, 2022. MMWR Morb However, as of January 2023, only 23% of the at-risk population 6 Mortal Wkly Rep. 2023;72. doi:10.15585/mmwr.mm7220a4 nationally had received vaccination . Locally, while 55% of the 5. Schildhauer S. Reduced Odds of Mpox-Associated Hospitalimpox cases are seen in the Hispanic/Latino community, only zation Among Persons Who Received JYNNEOS Vaccine — 26% of all vaccines were administered among this group, highCalifornia, May 2022–May 2023. MMWR Morb Mortal Wkly lighting ethnic disparities in vaccine uptake. Providers should Rep. 2023;72. doi:10.15585/mmwr.mm7236a4 7 offer vaccination to anyone at-risk for mpox, including people 6. Owens LE. JYNNEOS Vaccination Coverage Among Persons living with HIV, and to anyone who requests vaccination. at Risk for Mpox — United States, May 22, 2022–January 31, Mpox should be on the differential diagnosis for any rash, 2023. MMWR Morb Mortal Wkly Rep. 2023;72. doi:10.15585/ particularly in the genital or perianal areas. Mpox testing should mmwr.mm7213a4 be performed in conjunction with STIs and HIV testing given 7. CDC. Vaccination Basics for Healthcare Professionals. Centers the high rates of co-infections.8 Testing is also recommended for for Disease Control and Prevention. Published May 5, 2023. fully vaccinated or previously infected people given that mpox Accessed November 1, 2023. https://www.cdc.gov/poxvirus/ can still occur in these groups.9 mpox/clinicians/vaccines/vaccine-basics-healthcare.html While most cases of mpox are self-limited, the rash can be 8. HIV and Sexually Transmitted Infections Among Persons with painful and supportive care10 should be considered. Tecovirimat Monkeypox — Eight U.S. Jurisdictions, May 17–July 22, 2022 (TPOXX), an antiviral medication, is available through an Ex| MMWR. Accessed November 1, 2023. https://www.cdc.gov/ panded Access Investigational New Drug (EA-IND) protocol or mmwr/volumes/71/wr/mm7136a1.htm the 11 should be considered for those with severe diseas or risk 9. Increase in Mpox Cases in California: Updates on Identifor severe disease, or involvement of sensitive areas.12 fication, Laboratory Testing, Management and Treatment, Great strides helped control the 2022 mpox outbreak. Onand Vaccination for Mpox. Accessed November 1, 2023. https://www.cdph.ca.gov/Programs/OPA/Pages/CAHAN/ going efforts to vaccinate, test, and treat will ensure continued Increase-in-Mpox-Cases-in-California-Updates-on-Identificacontrol of the disease. tion,-Laboratory-Testing,-Management-Treatment-and-VaccinaProviders can visit publichealthproviders.sccgov.org/distion.aspx eases/monkeypox-resources-providers for information on what 10. Supportive Care Suggestions. Accessed November 1, 2023. to do if you have a patient with suspected mpox. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Mpox/ Resources for patients: sccphd.org/mpox

References: 1.

County of Santa Clara Public Health Department. (2023). Monkeypox, or mpox. Retrieved on November 13, 2023 from www.sccphd.org/mpox Dalton AF. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study —

32 | The Bulletin | Winter 2023

Supportive-Care-Suggestions.aspx 11. STOMP. Accessed November 1, 2023. https://www.stomptpoxx.org/main 12. Treatment Information for Healthcare Professionals | Mpox | Poxvirus | CDC. Published September 25, 2023. Accessed November 1, 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/treatment.html

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CMA Webinar: CMS Medicare Updates 2024

CMA Webinar: Managing Medicare in 2024

Tuesday, January 9 | 12:15-1:15pm | Virtual Register at https://bit.ly/4ac17VQ Centers for Medicare and Medicaid Services (CMS) Regional Chief Medical Officer Ashby Wolfe, MD will provide an update on CMS policy for the 2024 calendar year. Information presented is for practicing clinicians, including an overview of the updates to the 2024 Physician Fee Schedule.

Tuesday, January 30 | 12:15-1:15pm | Virtual Register at https://bit.ly/3RcC1NH This webinar will cover Medicare updates for the coming year.

CMA Webinar: Navigating Physician Employment Contracts - Understanding Clauses and Common Issues Tuesday, January 16 | 12:15-1:15pm | Virtual Register at https://bit.ly/3TdfMKj During this webinar, CMA attorney Shari Covington will comprehensively cover the intricacies of physician employment contracts, focusing on commonly encountered clauses and potential challenges. Participants will gain a deep understanding of the language used in these contracts, enabling them to make well-informed decisions and effectively navigate the negotiation process. Key areas of focus will include a detailed examination of typical contract clauses such as non-compete agreements, compensation structures, termination clauses, and more. This webinar will shed light on common issues and pitfalls that physicians often encounter in their employment contracts and provide practical guidance on identifying red flags and proactively addressing them.

CMA Webinar: New Laws Affecting Physicians in 2024 Tuesday, January 23 | 12:15-1:15pm | Virtual Register at https://bit.ly/46KNjhV This one-hour webinar will discuss the new 2024 laws that will affect physicians and their practices, highlight pending health legislation and explain CMA’s legal resources available to members.

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Virtual Grand Rounds: Behavioral Health - Trends and Tips for Front Line Providers Tuesday, February 13 | 12:00-1:00pm | Virtual Register at https://bit.ly/3uKwu9I Join CMA’s next Virtual Grand Rounds: Behavioral Health - Trends and Tips for Front Line Providers on Tuesday, February 13, 2024, from 12:00 p.m PT to 1:00 p.m. PT

AMA National Advocacy Conference February 12-14, 2024 | Grand Hyatt, Washington, D.C. More information at https://www.ama-assn.org/about/events/ national-advocacy-conference The American Medical Association’s (AMA’s) National Advocacy Conference (NAC) brings the power of organized medicine to our nation’s capital. Don’t miss your chance to connect with industry experts, members of Congress and the administration, and others about federal efforts to improve health care, as well as advocate on crucial health care issues affecting physicians and patients.

CMA Legislative Advocacy Day – SAVE THE DATE! April 10, 2024 | Sacramento Register at https://bit.ly/3TkJ1uF The California Medical Association (CMA) will host its 50th annual Legislative Advocacy Day on April 10, 2024, in Sacramento. CMA’s Legislative Advocacy Day consistently brings together more than 400 physician and medical student leaders from all specialties and modes of practice. Attendees will have the opportunity to meet with legislators on priority health care issues. Attendees can expect to get hands-on experience and learn the nuts and bolts of advocating for their patients and profession. Registered attendees will receive a webinar training on legislation and policy affecting the practice of medicine on March 26.

The Bulletin | Winter 2023 | 33

Gratitude Matters! Its Impact On Employee Engagement BY MARCIA DASZKO

It’s that time of year when we celebrate the holidays and pause to give thanks to those in our world, personally and professionally. How can we show our appreciation effectively? Verbalizing and showing appreciation is one of the most inexpensive, but most wealthy expressions of gratitude we can all experience. It also takes people out of their mindset to judge and criticize. BONUS IDEA: Pause to consider who helps and supports you. And who have you taken for granted? Make an extra effort to show your appreciation to them—today and always. Improve your ability to appreciate. Here are some ideas to show appreciate for your colleagues, peers, teams, vendors, teachers, mentors . . . make a list of people to reach out to. One of the easiest (and rare) ways to show appreciation is to say, “Thank you. I appreciate what you did and how you contributed your unique skill or perspective to achieve our goal.” It’s the shortest—and yet has powerful impact. A personalized handwritten note (or even email if colleagues are remote) acknowledging and celebrating a person and their contribution is often kept and re-read. To thank a team, holding all-employee (or all “department”) fun, learning events are powerfully engaging and rewarding. I recommend them at least quarterly; it depends on your location and team size. They can range from 2 hours to an annual one or two days. Together people learn, have fun, and work

34 | The Bulletin | Winter 2023

together—a huge example of appreciating and investing in your colleagues! Gifts can range from mugs and blankets or shirts to gifts cards (all the same denomination) for Starbucks, Target, etc. Together the team can bond and together contribute to their community by doing a volunteer project together for a non-profit. Bringing goodwill together is a powerful gift and also takes your staff/ team out of their usual environment. They are on a learning journey! Facilitated sessions foster a positive work environment, create self-motivation for people to contribute and share ideas. They engage to discuss opportunities, envision a future together, support each other, and celebrate accomplishments. Monthly lunchand-learn sessions are a great way to develop a healthy culture and workplace. CAUTION: Do not encourage Employee of the Month/Year awards. In short, these build internal competition and rank people. They are “management fads” and don’t foster collaboration. Marcia Daszko is a strategic management consultant, workshop/meeting facilitator, MBA professor, and professional speaker. Her bestselling leadership transformation book is “Pivot Disrupt Transform: How Leaders Beat the Odds and Survive.” You can reach her at md@mdaszko.com

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Customized health insurance solutions for CMA members The California Medical Association has partnered with Lockton Affinity to administer the

Group Health insurance options Fully funded group health insurance

CMA Insurance Program.

In this traditional approach, employers pay a premium

To meet the needs of all CMA members, we have several

to the insurance company, who assumes the financial risk

including Individual Health insurance, Dental and Group

behalf of the insured individuals.

approaches to help you reach your health insurance needs, Health plans.

and covers healthcare expenses and processes claims on

Level-funded group health insurance

Individual Health insurance

Individual plans are available to help meet the health insurance needs of you and your family.

Lockton Affinity agents can help you find individual plans on and off of the exchange.

Level-funded plans enable employers to make a set

payment each month that goes into a reserve account for claims, admin costs and premiums for stop-loss coverage. If claims are lower than expected, the remaining claim

funds may be refunded at the end of the policy contract. Our unique benefit funding arrangements also include ICHRA or QSEHRA.

Dental insurance

With the group dental program, you have options each

Self-funded group health insurance

your out-of-pocket expenses will be lower. Or you can visit

collects premiums from enrollees, paying employees’ and

time you need dental care. If you use an in-network dentist, any out-of-network licensed dentist and the plan will pay

a percentage of allowable (usual and customary) charges.

This option is typically used by larger groups. The employer dependents’ medical claims.These employers’ contract with a third-party administrator to manage the plan.

Build your customized health insurance package today. Contact Lockton Affinity’s dedicated representatives at Info@LocktonAffinityCMA.com or (800) 278-8130 to get started.

LocktonAffinityCMA.com The CMA Insurance Program is administered by Lockton Affinity, LLC d/b/a Lockton Affinity Insurance Brokers LLC in California #0795478. Coverage is subject to actual policy terms and conditions. Policy benefits are the sole responsibility of the issuing insurance company. The California Medical Association will receive a royalty fee for the licensing of its name and trademarks as part of the insurance program offered to the extent permitted by applicable law. Not available in all states.

www.sccma.org

The Bulletin | Winter 2023 | 35

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Celebrating Independent Physicians

More than 13,000 California physicians rely on CAP to protect their practices every day.

Scan the QR code to see how much you can save on your medical malpractice coverage

At the Cooperative of American Physicians (CAP), we celebrate you—the independent and solo practitioner who keeps healthcare personal. We are here to support you with exceptional medical malpractice coverage supplemented by a host of outstanding risk management and practice management services, so you can stay focused on what’s important—patient care. For over 40 years, CAP has delivered financially secure medical malpractice coverage options and practice solutions to help California physicians realize professional and personal success. Find out what makes CAP different.

CAPphysicians.com 800-356-5672 MD@CAPphysicians.com Medical professional liability coverage is provided to CAP members through the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.