ACCMA Bulletin May/June 2022 by ACCMA

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

May/June 2022

ACCMA EXECUTIVE COMMITTEE Robert Edelman, MD, President Edmon Soliman, MD, President Elect Albert Brooks, MD, SecretaryTreasurer Suparna Dutta, MD, Immediate Past President COUNCILORS & CMA DELEGATES Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD James Hanson, MD Terry Hill, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Arden Kwan, MD Terence Lin, MD Lilia Lizano, MD Irene Lo, MD Kristin Lum, MD Ross Pirkle, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Suresh Sachdeva, MD Jonathan Savell, MD Judith Stanton, MD Sonia Sutherland, MD Clifford Wong, MD CMA & AMA REPRESENTATIVES Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, CMA Trustee Katrina Peters, MD, CMA Trustee MEMBERSHIP & COMMUNICATIONS COMMITTEE Mark Kogan, MD, Chair Patricia Austin, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Michael McGlynn, MD Lamont Paxton, MD Katrina Peters, MD Bindoo Rellan, MD Frank Staggers, Jr., MD Ronald Wyatt, MD

Serving East Bay physicians since 1860

News & Comments

PRESIDENT’S PAGE MICRA Agreement Reached, Initiative Battle Averted By Robert Edelman, MD, ACCMA President

YOUR ADVOCACY 9

Legislative Advocacy Day Summary

May/June 2022 | Vol. LXXVIII, No. 3

IN YOUR PRACTICE 17

Independent Dispute Resolution Process under the No Surprises Act By the American Medical Association

COVID Therapeutics Updates: From the Contra Costa and Alameda County Public Health Departments

Our Advocacy on Other Key Health Care Issues

My Green Doctor: ACCMA’s Money-Saving, ClimateSaving Membership Benefit By Lee C. Ballance, MD and Todd L. Sack, MD, FACP

Join Us for the CMA House of Delegates in LA: Save the Date!

Putting Racial and Health Equity Goals into Action

Improving Outcomes for Youth in Extended Foster Care

Expanding Long-Term Care with CalAIM By Scott Coffin, CEO, Alameda Alliance for Health

New Members

Council Report

Classifieds

In Memoriam

CALPAC Endorsements in 2022 Elections

Physicians Restoring their Joy in Medicine, Together

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ACCMA STAFF Joseph Greaves, Executive Director Mae Lum, Deputy Director Griffin Rogers, Director, Napa & Solano County Medical Societies David Lopez, Assoc. Director of Advocacy and Strategic Initiatives Jennifer Mullins, Assoc. Director of Education and Events Alejandra Hinojosa, Communications Associate Christine Maki, Administrative Assistant

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION 6230 Claremont Avenue, Oakland, CA 94618 Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org

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ACCMA BULLETIN | MAY/JUNE 2022

NEWS & COMMENTS

MICRA MODERNIZATION BILL IN CALIFORNIA LEGISLATURE

CMA President Robert E. Wailes, MD testified in early May in the California Senate Judiciary Committee in support of AB 35, which will implement the historic agreement reached by Californians Allied for Patient Protection (CAPP) and the Consumer Attorneys of California to modernize MICRA. The modernized framework will ensure that health care is accessible and affordable, while balancing compensatory justice for injured patients. See page 7 for more about MICRA modernization.

SUPPORT UKRAINE RELIEF EFFORTS

To support the citizens of Ukraine, millions of whom have been forcibly displaced, CMA and its foundation, Physicians for a Healthy California (PHC), are raising funds to support the International Medical Corps (IMC). This relief organization has directly reached more than 3 million children, women, and men and distributed 41 tons of medical supplies and pharmaceuticals to 11 health facilities. Donate to IMC at phcdocs.org/Give.

FEDERAL REPORT FINDS MEDICARE ADVANTAGE PLANS OFTEN DENY NECESSARY CARE

The US Department of Health and Human Services recently released a report that found every year Medicare managed care organizations inappropriately deny medically necessary care to tens of thousands of people enrolled in private Medicare Advantage plans. The report found that Medicare Advantage plans denied prior authorization requests and payment requests that met Medicare coverage and billing rules. Use your voice to fight against prior authorization red tape by sharing your story at bit.ly/3yr8oR5.

CDPH URGES PHYSICIANS TO INCREASE GONORRHEA AND DGI TESTING

The California Department of Public Health (CDPH) is urging health care providers to expand testing for gonorrhea and Disseminated Gonococcal Infection (DGI) following a surge of new infections over the past few years. CDPH suspects the increase in cases is due to a decrease in STD screening, testing and treatment during the COVID-19 pandemic. Read the CDPH letter at bit.ly/3vZQBPk.

GOING GREEN GOES TO THE AMA

My Green Doctor was recently featured in an American Medical Association website article about maintaining an environmentally sustainable medical practice. It is also a free benefit for ACCMA members (see article on page 19). By registering at www.MyGreenDoctor.org using the ACCMA discount code MGDACCMA, physician practices can join as a Partner Society Member for free. While taking part in the long-term work of healing the environment, physicians can also experience an immediate and substantial drop in the cost of running a practice.

NOMINATIONS OPEN FOR 2022 CMA SERVICE AWARDS

Every year, CMA honors inspirational physician members during its annual House of Delegates in October. CMA is now accepting nominations for several awards. The deadline for nominations is June 10. Go to bit.ly/3ytZ9zx for more information.

MBC ELIMINATES PLASTIC PHYSICIAN LICENSES

The Medical Board of California recently phased out plastic medical license cards. Physicians can now use the medical board’s Wallet License Generator at mbc.ca.gov/WalletCard/ Ideal to generate a digital license and print it on any printer or house the card electronically.

MEDI-CAL OPEN TO OLDER CALIFORNIANS

On May 1, California expanded state-funded full-scope MediCal benefits to individuals who are 50 years of age or older, regardless of citizenship or immigration status. Under this expansion, eligible individuals will be able to access the full range of benefits available to Medi-Cal beneficiaries who have full-scope coverage, including no-cost/low-cost quality health, behavioral health, substance use disorder services, and dental services through organized delivery systems under the MediCal program. Go to bit.ly/3wDmwUX.

CMA FILES BRIEF IN CORPORATE BAR CASE

CMA filed an amicus brief in a case, American Academy of Emergency Medicine Physician Group (AAEMPG) v. Envision Healthcare Corp., that will shape the boundaries of California’s prohibition on the corporate practice of medicine. CMA’s brief sought to provide the court with a thorough picture of how Envision’s business model threatens the physicians involved in the lawsuit and could provide a roadmap for corporate entities to similarly disempower all California physicians. Read more at bit.ly/3wc9dKM.

MBC RECRUITING EXPERT REVIEWERS

The Medical Board of California (MBC) is seeking Board Expert Reviewers to provide reviews and opinions on Board cases and conduct physical and mental evaluations. Physicians who reside in California, have full-time active practice in California, and meet the minimum requirements can apply to be an expert for the Board. Go to bit.ly/3L46Oac to learn more.

ACES SCREENINGS REPORT RECENTLY RELEASED

Between January 1, 2020–when the state began paying for conducting ACE screenings for children and adults up to age 65–and March 31, 2021, more than 20,600 individuals took the ACEs Aware training, and about 10,900 Medi-Cal providers became ACEs Aware-certified. In that same time period, MediCal providers conducted approximately 640,700 ACE screenings for nearly 520,000 unique Medi-Cal beneficiaries. For the complete report, go to bit.ly/3PbZyfM.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEWS & COMMENTS

UPCOMING EVENTS

LEADERSHIP READING AND DISCUSSION GROUP

Wednesday, July 6 | 6:00 to 7:30 pm Free | CME Available | Online Physicians are free to join any meeting of the Leadership Reading and Discussion Group; reading the book is not required. Doctor Hilary Worthen, course director of the Physician Leadership Program, facilitates the online discussion group. The book selection for July is “Healing: Our Path from Mental Illness to Mental Health” by Thomas Insel, MD. This is a terrific book that gives a hard and well-informed overview of the state of care for people with mental illness. Register at pathlms. com/medical-society/courses/41913.

HELP CALIFORNIANS RETAIN HEALTH COVERAGE

When the COVID-19 continuous coverage requirement expires at the end of the public health emergency, California will need to conduct a full redetermination for all beneficiaries who use Medi-Cal or CHIP to access health care. DHCS has launched a webpage to recruit Coverage Ambassadors to raise awareness among Medi-Cal beneficiaries of actions they need to take and when they need to take them in order to maintain continuous coverage. Go to bit.ly/3Per0JX.

RESTORING JOY TO THE PRACTICE OF MEDICINE TOGETHER

Available on demand Free | CME Available | Online Physicians passionate about wellness can access recordings of the online conference that was held in late April, featuring keynote speakers Paul DeChant, MD, healthcare consultant; Marie Brown, MD, AMA Director of Practice Redesign; and John Chuck, MD, former TPMG regional chair for physician health and wellness leaders. Three panel discussions cover practice improvements in action, transforming leadership for a culture of wellness, and building evidence-based programs. Go to pathlms.com/medical-society/courses/40312.

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Nurse Practitioners Physician Assistants

Practice & Liability CONSULTANTS Health Care Practice Management In a special arrangement with Practice & Liability Consultants, ACCMA members may purchase the following practice management kit at a reduced price: • Office Staff Personnel Policies and Procedures Manual New 2022 updates including COVID-19 policies Practice consulting services available. Debra Phairas 952 School Street, #226 Napa, CA 94559 (415) 764-4800 Fax (415) 764-4802

Locum Tenens Permanent Placement Voice: 800- 919- 9141 or 805-6 41-91 41 FAX : 805- 641 -914 3 jnguyen@ t r acyzw eig.com w w w.t r acyzw eig.c om

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ACCMA BULLETIN | MAY/JUNE 2022

HEALTHY CHECKOUT

RESTORING JOY TO THE PRACTICE OF MEDICINE TOGETHER

Through the Bay Area Physician Wellness Collaborative

AVAILABLE ON-DEMAND https://www.pathlms.com/medical-society

Physicians passionate about wellness from medical groups, health clinics, medical staffs, residency programs, and other physician organizations throughout the Bay Area are invited to view this recorded conference.

KEYNOTE SPEAKERS

JOHN CHUCK, MD Former TPMG Regional Chair for Physician Health and Wellness Leaders

MARIE BROWN, MD AMA Director of Practice Redesign

PAUL DeCHANT, MD Healthcare Consultant

DAY 1

DAY 2

PRACTICE WISELY AND SAVE TWO HOURS PER DAY

PURSUING PROFESSIONAL FULFILLMENT: ADDRESSING THE DRIVERS OF BURNOUT IN THE CLINICAL WORKPLACE

Marie Brown, MD

Paul DeChant, MD

STRATEGIES AND BEST PRACTICES IN CLINICIAN WELLNESS: THE ROLES OF LEADERS, TEAMS, AND INDIVIDUALS IN PROMOTING JOY AND MEANING

SMOOTHING THE BUMPS ON THE ROAD TO CLINICIAN WELLNESS

John Chuck, MD

PRACTICE IMPROVEMENTS IN ACTION

Panel discussion with Marie Brown, MD; Vanessa Calderon, MD, Vituity Resiliency Director; Jill Jin, MD, AMA Senior Physician Advisor and Clinical Assistant Professor, Northwestern School of Medicine; Irene Lo, MD, Epic Care

Panel Discussion with Linda Clever, MD, MACP, President and Founder of RENEW; Marcia Nelson, MD, Chief Medical Officer, Enloe; Larissa Thomas, MD, Director of Well-being for UCSF GME; Beverly Joyce, MD, Founder of the Sequoia Hospital Physician Wellness Committee

TRANSFORMING LEADERSHIP FOR A CULTURE OF WELLNESS Panel Discussion with Anastasia Klick, MD, MPH, Salinas Valley Medical Clinic; Aman Sethi, MD, TPMG Director of Wellness Operations; Emily Shaw, MD, Sutter Medical Group of the Redwoods

Please contact the ACCMA at accma@accma.org or (510) 654-5383 if you have any questions.

PRESIDENT'S PAGE

MICRA Agreement Reached, Initiative Battle Averted By Robert Edelman, MD, ACCMA President

alifornians Allied for Patient Protection (CAPP) – the large and diverse coalition working to protect access to health care through MICRA, whose membership includes the California Medical Association (CMA), California Hospital Association, California Dental Association, medical malpractice insurance carriers, community clinics, Planned Parenthood Affiliates of California, and many more – and the Consumer Attorneys of California (CAOC) announced an agreement in April to pursue a legislative compromise on MICRA (AB 35) and avoid the potentially costly and dangerous so-called Fairness for Injured Patients Act (FIPA) ballot initiative in November. For decades, California’s landmark medical malpractice laws have successfully struck a balance between compensatory justice for injured patients and maintaining an overall health care system that is accessible and affordable for Californians. Over the years, California’s physician and provider communities have repeatedly defended MICRA through expensive battles at the ballot, in the courtroom, and in the legislature. This year, with the ballot initiative slated for the November 2022 election, we were again facing another costly battle that could obliterate existing safeguards for out-of-control medical lawsuits and result in skyrocketing health care costs. If approved by voters, FIPA would effectively eliminate MICRA’s cap on non-economic damages by introducing a new broadly defined “catastrophic injury” category, make attorney’s fees additive on top of damages, and allow trial lawyers to go after physicians’ personal assets. This would have resulted in a significant increase in litigation with unpredictably high verdicts and no less than an immediate doubling of malpractice insurance premiums. The non-partisan state legislative analyst predicted FIPA would have resulted in more than $11 billion a year in increased health care costs. This would have had a chilling effect on the entire health care system, with the trickle-down effect borne primarily by low-income patients, who would face higher costs and restricted access to care. The initiative also directly targeted physicians, putting personal assets at risk. The MICRA modernization bill (AB 35) preserves MICRA’s protections while providing a fair and reasonable increase to

MICRA’s established limit on non-economic damages for medical negligence starting on January 1, 2023, with gradual increases over the next 10 years and a 2.0% annual inflationary adjustment thereafter. Current law limits recovery of non-economic damages to $250,000, regardless of the number of defendants. The modernized framework would increase the existing limit to $350,000 for non-death cases and $500,000 for wrongful death cases on the effective date of January 1, 2023, followed by incremental increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases, after which a 2.0% annual inflationary adjustment will apply. The proposal will also create three separate categories of caps, which could apply depending on the facts of each case: • One cap for health care providers (regardless of the number of providers or causes of action) • One cap for health care institutions (regardless of the number of providers or causes of action) • One cap for unaffiliated health care institutions or providers at that institution that commit a separate and independent negligent act A health care provider or health care institution can only be held liable for damages under one category, regardless of how the categories are applied or combined. Other important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offers of proof for making punitive damages allegations, and allowing other sources of compensation to be considered in award determinations. Critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff ’s attorney’s contingency fees. AB 35 also establishes new evidentiary protection for all pre-litigation expressions of sympathy, regret, or benevolence, including statements of fault, by a health care provider. Allowing physicians and patients to have full and open conversations continued on page 10 ACCMA BULLETIN | MAY/JUNE 2022

NEW & RETURNING MEMBERS

KEY TAKEAWAYS: MICRA Modernization vs. FIPA MICRA Modernization

Key Provision

FIPA

Option for binding arbitration 90-day advance notice of claim Cap on non-economic damage awards One-year statute of limitations Allowing other sources of compensation to be considered in awards Limits on plaintiff’s attorney’s contingency fees The ability to pay awards over time Discovery and evidentiary protections for all pre-litigation expressions of sympathy, regret, or benevolence, and statements of fault by a provider to a patient/family Judicial discretion to throw out frivolous lawsuits1 Limits on qualifications of expert witnesses2 Protections from wage garnishments, liens & levies on personal assets3 Protection from paying prevailing plaintiff’s attorney’s fees out of pocket4 FOOTNOTES: 1) FIPA would have created a certificate of merit process that an attorney could satisfy by stating they attempted to contact three health care providers, but the providers declined or didn’t respond; 2) FIPA would have expanded who could testify as an expert against a health care provider; 3) FIPA would have included a new requirement that medical negligence awards be satisfied by lien, levy, or wage garnishment on health care providers’ personal assets; 4) FIPA would have contained a new mandate that health care providers pay prevailing plaintiff’s attorney’s fees in addition to damages (not reciprocal).

For more information, visit cmadocs.org/micra2022.

LEGISLATIVE DAY

Legislative Advocacy Day Summary

n April 19, the ACCMA hosted their virtual legislative day in conjunction with the California Medical Association (CMA)’s 48th Annual Legislative Day in Sacramento. Each year CMA’s Legislative Advocacy Event hosts more than 400 California physicians, medical students, and CMA Alliance members as they lobby legislative leaders in the state’s capital. This year we had the opportunity to meet virtually with our East Bay legislators to discuss AB 2132 (Villapudua), California Future Physician Fund, and SB 250 (Pan), Prior Authorization Reform. AB 2132 would create a pilot program, administered by the California Student Aid Commission (CSAC), to identify and select individuals from diverse underrepresented communities to fund their education from community college/undergraduate school through the completion of their medical residency program. In developing the eligibility criteria, CSAC is to prioritize students who are underrepresented in medicine based on race, ethnicity, language proficiency in language other than English, and demonstrated financial need. The individual must commit to practicing in medically underserved areas after completing their residency program. The program will be supported by a $20 million budget ask, which is part of the California Latino Legislative Caucus priorities.

THANK YOU, ACCMA MEMBERS!

AB 2132 reimagines the way California funds and cultivates the next generation of physicians and surgeons. California has a one-in-a-generation opportunity to shift the traditional paradigm for medical education and take more concrete steps to diversify the profession to reflect the state’s population. SB 250 takes a comprehensive approach to reforming the prior authorization process, and if passed, would require health plans to create a prior authorization exemption program to allow physicians who are practicing within the plan’s criteria 80% of the time to get a blanket exemption for two years from the plan’s prior authorization requirements. It also would allow a treating physician who does not have a prior authorization exemption the right to have an appeal of a prior authorization be conducted by a physician in the same or similar specialty. Furthermore, the bill would require that physicians be included in the development and updating of plan utilization management criteria. (On the federal level, ACCMA and CMA are also supporting legislation, HR 3173, authored by Rep. Ami Bera, MD [D - CA 7th District] and others, to standardize and streamline prior authorization processes.) We would like to thank our East Bay legislators and attendees for making this virtual legislative day a success. For any questions regarding AB 2132 or SB 250, contact Mr. David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at dlopez@accma.org or (510) 654-5383.

The ACCMA wishes to acknowledge and thank members who participated in the 2022 Legislative Advocacy Day.

THANK YOU, LEGISLATORS!

Lisa Asta, MD Timothy Chong, MD Jessa Culver, JMP Student Spoorthi Davala, MD Nassim Durali, MD Suparna Dutta, MD Robert Edelman, MD Harshkumar Gohil, MD William Gravley, MD James Hanson, MD Nate Kralik, DO

Senator Bill Dodd Senator Steve Glazer Senator Nancy Skinner Senator Bob Wieckowski Assemblymember Rebecca Bauer-Kahan Assemblymember Tim Grayson Assemblymember Alex Lee Assemblymember Buffy Wicks

Michael Melewicz, MD Emily Moody, MD Katrina Peters, MD Jay Rajan, MD Katrina Saba, MD Suresh Sachdeva, MD Jonathan Savell, MD Thomas Sugarman, MD Joseph Thomas, MD Renee Wachtel, MD Patricia Wang, MD Clifford Wong, MD

The ACCMA wishes to thank local legislators who met with ACCMA members on priority health care issues during the 2022 Legislative Advocacy Day.

ACCMA BULLETIN | MAY/JUNE 2022

PRESIDENT'S PAGE

(continued from page 7)

about adverse events and unexpected health care outcomes will foster greater trust and accountability, while facilitating improved patient safety. We know some members will be disappointed to learn that the $250,000 cap on noneconomic damages negotiated in 1975 is going to be increased for the first time ever. The cap was MICRA’s major vulnerability, and having it modified to allow for modest

increases should keep MICRA safe from future attacks for years to come. Like it or not, politics is about negotiation and tradeoffs. The proposal reflected in AB 35 strikes a prudent and patientfocused balance between fair compensation to injured patients and the need for universal, high-quality and cost-effective health care.

Put Your ACCMA Membership to Work! Go to www.accma.org > Membership, or call ACCMA at (510) 654-5383 for help.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

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KEY HEALTH CARE ISSUES

Our Advocacy on Other Key Health Care Issues

he ACCMA and CMA are advocating on other state legislative bills on key health care issues besides the two bills prioritized at CMA Legislative Advocacy Day. These bills include AB 1130 (Wood), Office of Health Care Affordability; AB 2060 (Quirk), Medical Board of California Public Member Majority; and AB 2080 (Wood), Health Care Consolidation and Contracting Fairness Act.

AB 1130 – OFFICE OF HEALTH CARE AFFORDABILITY This bill would create the Office of Health Care Affordability (Office) under the Department of Health Care Access and Information (HCAI) that would have broad authority to address the issue of rising costs in health care. AB 1130 would give the Office the authority to set cost-growth targets for the state as a whole and for each sector of the health care delivery system, collect data it deems necessary to set those targets, and penalize those entities that do not meet those cost targets. Additionally, the bill would give the Director of HCAI extraordinary powers to oversee health care market transactions, including mergers, acquisitions, agreements and transfers of control or governance for a broad range of health care entities. While ACCMA/CMA are supportive of efforts to curb costs within the health care system, increase competition within the marketplace, reduce administrative complexities, and increase care coordination and health outcomes, AB 1130 fails to take into account the nuances of the current health care landscape and is not targeted at those entities that have been shown to drive costs within the health care system. The amendments that went into the bill on February 14, 2022, make some progress in narrowing the bill. However, the construct of the bill continues to capture potentially every single physician practice in this obstructive and cumbersome regulatory scheme. We continue to believe that the definitions in the bill are too broad and do not focus the Office’s efforts on the cost-drivers within the delivery system. The ACCMA/CMA are being proactive about addressing the rising cost of health care and to achieve meaningful universal coverage. California has extended coverage to millions of people under the Affordable Care Act. We should be focused on real solutions that expand upon the gains made by the ACA to continue to expand coverage and drive down the cost of health care for

all Californians. These include increasing eligibility for health care subsidies, reducing practice overhead and administrative complexities through reduction and standardization, devoting more resources to health care workforce programs so coverage equates to timely access, increasing timely access to care for underserved populations, treating and coordinating care for patients with chronic conditions and investing in preventative care that addresses social determinants of health and health system inequities. AB 2060 – MBC PUBLIC MEMBER MAJORITY This bill would change the composition of the Medical Board of California (MBC) to a public member majority. AB 2060 would change the board composition to 8 public members and 7 physician/surgeon members. The bill would also make the MBC panels that review disciplinary cases and decisions to be a public member majority as well. This change in board composition would not occur until the next physician and surgeon member term expires and becomes vacant. The position would thereafter be converted to a public member position. The ACCMA/CMA supports the MBC’s mission to protect consumers and discipline deserving physicians and surgeons. We are requesting that the bill be amended to allow the disciplinary panels to remain a physician majority due to the often-complex standard of care questions. We are also requesting increased requirements for the public member appointees to include relevant health care, patient safety, or legal experience. This compromise will ensure that the Board regains public confidence. We have historically opposed all efforts to change the board’s composition to a public member majority. Because of the complex nature of the practice of medicine, it has been the associations’ position to have a majority of physicians and surgeons be the prominent voice in the enforcement of the Medical Practice Act and to proper oversight of the board’s licensing and regulatory functions. Currently only three healing arts boards in California have public member majorities: the Board of Behavioral Sciences, the Board of Vocational Nurses and Psychiatric Technicians, and the Acupuncture Board of California. If AB 2060 passes as is, the Medical Board of California will be the first medical board in the country to be public member majority. continued on page 12

ACCMA BULLETIN | MAY/JUNE 2022

KEY HEALTH CARE ISSUES

(continued from page 11)

YOUR POLITICAL VOICE! ACCPAC, the ACCMA Political Action Committee, and CALPAC, the CMA Political Action Committee, support candidates and legislators who understand and embrace medicine’s agenda. Health care in California is highly regulated and legislated. As government and the insurance industry continue their quest to control health care, your clinical autonomy is in great jeopardy. Now, more than ever, you need to fight to keep medical decisions in your well-trained hands. Fortunately, you do not have to wage the fight alone. Successful legislative advocacy depends upon an integrated approach, consisting of lobbying, continuing grassroots activity, and political action

AB 2080 – HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT This bill would require a health care practitioner, 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) at least 90 days before entering into an agreement to make a material change to the entity’s organizational or corporate structure with a value of $5,000,000 or more. AB 2080 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 or acquisition may not move forward. Additionally, AB 2080 would require a health plan that would like to acquire a medical group, hospital, or other health care entity to obtain the approval of the AG before the acquisition may move forward. Finally, AB 2080 would prohibit health plans and insurers from steering patients to another provider or facility or from requiring the plan or insurer to contract with other providers or facilities that are affiliated with the original provider or facility. AB 2080 is similar to SB 977 (Monning, 2020), which died on the Assembly floor, but is written even more broadly and sets up a more complicated oversight and regulatory structure. The bill is written in a way that would require practices, even those as small as a single-physician practice to report to the AG when they

through ACCPAC and CALPAC. Both PACs are operated by physicians, for physicians. By focusing physician resources, ACCPAC supports local physician-friendly candidates and CALPAC supports candidates for state and federal office who share our philosophy and vision of the future of health care and medical practice. Contributions to ACCPAC and CALPAC are voluntary and are not deductible for state or federal income tax purposes. To contribute to ACCPAC, go to accma.org/donate. To contribute to CALPAC and to see their participation levels from Sustaining to Diamond, go to cmadocs.org/CALPAC/donate or call (800) CALPAC-9.

want to acquire or be acquired by another entity. The bill vests new authority with the AG to approve or prevent these acquisitions or structural changes. It is also not clear how this bill connects to AB 1130 (see page 11), which contains the Office of Health Care Affordability and also includes provisions related to mergers, acquisitions, and changes in governance. Additionally, AB 2080 would stifle innovation. Requiring nearly every agreement, transaction or change in governance structure to go through this new approval process will only further limit and delay access to necessary resources for all providers, practices, and clinics. AB 2080 will also create barriers to moving the delivery system to value-based arrangements and further integrating care coordination, especially for those patients with chronic diseases. Physician practices cannot sustain additional administrative burdens such as these. Passing this legislation during a growing health care financial crisis will only further restrict the flexibility and resources health care providers desperately need simply to keep their doors open and provide vital care to patients. This approach will force smaller providers out of business. Now, more than ever, patients need a sense of predictability and reliability when it comes to their health care. Health care providers need to make difficult and prudent decisions to innovate and deliver quality care.

Join the ACCMA at www.accma.org/membership/join-now

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

HOD 2022

Join Us for the CMA House of Delegates in LA SAVE THE DATE!

his year’s California Medical Association (CMA) House of Delegates (HOD) meeting will be held in Los Angeles at LA Live, starting on Saturday, October 22 and concluding in the afternoon or evening on Sunday, October 23. Additional premeeting events (Board of Trustees meeting, OMSS Assembly, YPS Assembly, etc.) will take place on Friday, October 21. We have open positions on the ACCMA Delegation to CMA HOD. If you want to influence health care policy, help shape CMA’s advocacy priorities, and connect with other California physicians who are passionate about health care policy, this is a great opportunity to get involved. The CMA HOD convenes annually to debate and determine

CMA policies and priorities on the most important issues affecting members, the association, and the practice of medicine. The CMA HOD consists of nearly 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. Within this body of 500 delegates, the ACCMA is represented by a delegation of 40 delegates – the largest county association delegation in the state! Please let us know if you are interested in joining the ACCMA Delegation by contacting Mr. David Lopez, ACCMA Associate Director of Advocacy and Policy, at dlopez@accma.org or (510) 654-5383.

CALPAC Endorsements in 2022 Elections

he 2022 California Primary Election is scheduled for June 7, with the General Election scheduled for November 8. During the 2022 election cycle, there are a few legislators who will either be termed out or will not be seeking re-election. The first open seat race is for Senate District 10 (SD 10). SD 10 is currently held by Senator Bob Wieckowski, who has reached his term limit in the Senate. SD 10 encompasses cities in both Alameda and Santa Clara counties. The candidates who are seeking Senator Wieckowksi’s seat are: • Aisha Wahab, City of Hayward Councilmember • Lily Mei, City of Fremont Mayor On April 4, the ACCMA and the Santa Clara County Medical Association (SCCMA) interviewed the candidates and made a recommendation to the California Medical Association (CMA) Political Action Committee (CALPAC). Toward the end of April, the CMA CALPAC Board voted to support Mayor Lily Mei in her campaign to replace Senator Wieckowski. The next open seat race is for Assembly District 20 (AD 20). AD 20 is currently held by Assemblymember Bill Quirk,

who will not be seeking re-election. AD 20 encompasses the following cities: Ashland, Castro Valley, Cherryland, Fairview, Fremont, Hayward, Pleasanton, San Lorenzo, Sunol, and Union City. The candidates who are seeking Assemblymember Quirk’s seat are: • Shawn Kumagai, City of Dublin Councilmember • Jennifer Esteen, RN, Vice President of Organizing for SEIU 1021 • Liz Ortega-Toro, Alameda Labor Council Executive Secretary-Treasurer On April 11, ACCMA members interviewed the candidates and made a recommendation to CALPAC. Toward the end of April, the CMA CALPAC Board voted to support Councilmember Shawn Kumagai in his campaign to replace Assemblymember Quirk. For questions regarding CMA’s CALPAC, please contact Mr. Micah Scheindlin, CMA Associate VP for Political Operations, at mscheindlin@cmadocs.org.

ACCMA BULLETIN | MAY/JUNE 2022

MICRA TALKING POINTS

“We want to make sure that California’s finest physicians are properly protected.”

A Team Approach to Medical Malpractice Coverage is a Winning Approach for Physicians More than 12,500 physicians rely on the Cooperative of American Physicians (CAP) to protect their practices every day.

Sarah E. Scher, JD Chief Executive Officer

Physician-founded and physician-governed, CAP provides superior medical malpractice coverage and solutions to help California physicians realize professional and personal success. CAP members also receive risk management services, claims support and a dedicated in-house defense firm, practice management resources, and so much more. Find out what makes CAP different.

CAPphysicians.com

800-252-7706

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.

WELLNESS CONFERENCE SUMMARY

Physicians Restoring their Joy in Medicine, Together

he ACCMA and other Bay Area medical societies hosted a very successful online conference on Restoring Joy to the Practice of Medicine Together on April 21 and 28. This conference was a kickoff to our joint regional effort to address the organizational and systemic drivers of physician burnout. You can access a recording of the conference and receive CME through our Learning Center at pathlms.com/medical-society/ courses/40312. The first day of the conference featured keynote speakers Marie Brown, MD, AMA Director of Practice Redesign, and John Chuck, MD, former TPMG Regional Chair for Physician Health and Wellness Leaders. Doctor Brown’s presentation, “Practice Wisely: Save Hours Each Day,” identified simple changes to improve access and efficiency in physician practices; showed how teamwork and planning can ease the physician burden; and provided examples of how these changes could take effect immediately. Doctor Chuck spoke about the roles of leaders, teams, and individuals in promoting joy and meaning in the practice of medicine. He elaborated on a framework for improving joy in work that included culture and organizational values, practice support, and personal wellness, and provided many examples of tools, resources, and improvements that were initiated and led by physician leaders and teams within his former organization. A panel discussion led by Doctor Brown focused on practice improvements in action. She was joined by Jill Jin, MD, AMA Senior Physician Advisor; Vanessa Calderon, MD, Resiliency Director at Vituity; and Irene Lo, MD, Epic Care. Doctor Jin discussed case studies of successfully implemented organizational strategies throughout the country that she supported in her AMA role. Doctor Calderon reviewed the data and creative solutions that her practice implemented to protect the physician-patient relationship. Doctor Lo spoke about what her practice has undergone in their drive for experiential excellence and in meeting the issues that physicians deemed essential to that excellence. The second day of the conference featured Paul DeChant, MD as the keynote speaker. His presentation, “Addressing the Drivers of Burnout in the Clinical Workplace,” gave an overview of the manifestations of burnout (emotional exhaustion, cynicism), their drivers (e.g., work overload is manifested as emotional exhaustion) and opportunities to conduct diagnosis assessments

and to design a “treatment” plan based on the diagnostic findings. A panel discussion led by Linda Hawes Clever, MD, Founder of RENEW, focused on setting up evidence-based interventions and key things to do and not to do. She was joined by Marcia Nelson, MD, Chief Medical Officer, Enloe; and Beverly Joyce, MD, Sequoia Hospital Physician Wellness Committee. Larissa Thomas, MD, Director of Well-being for UCSF GME, had to cancel her participation at the last minute, but Doctor Clever summarized the main points of the presentation she would have given. A second panel discussion on the second day was led by Anastasia Klick, MD, Salinas Valley Medical Clinic and focused on transforming leadership for a culture of wellness and key messages for the C-suite. She was joined by Aman Sethi, MD, TPMG Director of Wellness Operations, and Emily Shaw, MD, Sutter Medical Group of the Redwoods. The specific organizational strategies, best practices, and beneficial leadership behaviors mentioned by all the speakers will be covered in great depth in our regional effort, the Bay Area Physician Wellness Collaborative, which recognizes that we can work together to improve the work lives of physicians. The Collaborative aims to bring together medical group leaders, chief wellness officers, wellness committee chairs, and others who have been charged with “fixing the physician burnout problem” and provide them with expert guidance, tools and resources, a forum for sharing experiences, and a network of peers to support their work. The Collaborative will be led Doctor Paul DeChant, a nationally recognized physician wellness expert with a background in practice redesign and organizational change. Quarterly convenings will focus on actionable and tangible strategies for improving the practice environment. Participants will hear from national experts, share successes and challenges, and access curated resources so they can make and refine an action plan for their organization. We invite you and/or the wellness lead in your organization to join us to help your fellow physicians restore their joy in medicine. Our first introductory online convening will be on Tuesday, June 7 from 6 to 8 pm. Physician organizations are invited to enroll up to two wellness leads by completing the form at forms. office.com/r/tQEJsegmVj. You can also contact the ACCMA at accma@accma.org or (510) 654-5383 with any questions.

ACCMA BULLETIN | MAY/JUNE 2022

AMA NO SURPRISES TOOLKIT

Independent Dispute Resolution Process under the No Surprises Act By the American Medical Association

The American Medical Association (AMA) second toolkit on implementation of the No Surprises Act (NSA) assists physicians with the payment process for certain out-of-network care under the NSA (ama-assn.org/system/files/ama-nsa-idr-toolkit.pdf). The NSA prohibits surprise billing for emergency care and some non-emergency care at in-network facilities and establishes a process to determine payment for physicians that includes an Independent Dispute Resolution (IDR) process.

• •

he IDR process described here is available only in those situations in which balance billing is prohibited and the patient has not consented to pay out-of-network rates. Further, these rules apply only to patients covered under employment-based group health plans or individual market health insurance. It does not apply to uninsured patients or patients covered under government health programs. (This IDR process generally applies to individuals covered by qualified health plans through the Affordable Care Act state or federal health insurance exchanges.) The Centers for Medicare & Medicaid Services (CMS) recognize that the states can take on more authority through specified laws and/or cooperative enforcement agreements (CEAs). California has authority to resolve certain disputes about out-of-network rates based on a 2017 law that established a process for determining the out-of-network rate with respect to nonemergency services in certain cases. The California Department of Insurance (CDI) and the Department of Managed Health Care (DMHC) also had some authority over emergency services cases, but that authority was determined not to be a specified state law since it was based in case law rather than statute. CDI and DMHC have signed a CEA agreeing to pursue voluntary enforcement of the outcomes in federal IDR cases.

FEDERAL IDR PROCESS AT A GLANCE • Commercial payer makes initial payment or issues a notice of denial of payment within 30 calendar days of claim. • Provider invokes open negotiation process within 30 business days of initial payment or denial by completing the Open Negotiation Notice available at bit.ly/3JUtHf Y. • If the plan and provider do not agree on an out-of-network rate, the negotiation period ends 30 business days after the 16

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date of the Open Negotiation Notice. IDR process must be initiated within four business days of end of open negotiation period by completing the Notice of IDR Initiation at bit.ly/3KXUjy2. The notice must also be submitted to nsa-idr.cms.gov, the federal IDR portal that opened in late April. Plan has three business days to object to provider’s proposed IDR entity. Within four business days of initiating IDR, provider submits notice of selection of IDR entity or failure to agree. A list of certified IDR entities is at go.cms.gov/36pjXwp. Provider and plan submit their proposed payment amount, along with the percentage of the qualifying payment amount (QPA) represented by the amount, to the IDR entity within ten business days of IDR initiation. (The QPA is generally based on the health plan’s median in-network rate for the same service in the same geographic area.) Within 30 business days of IDR initiation, IDR entity notifies parties of its determination. Any additional payment owed due to IDR must be made within 30 calendar days of decision.

HOW DOES THE IDR ENTITY DETERMINE THE OUT-OF-NETWORK PAYMENT? Within 30 business days of selection of the IDR entity, the IDR entity must select the out-of-network rate from among one of the offers submitted and notify the parties in a written decision via the federal IDR portal. The IDR entity must consider: • The QPA for the applicable year for the same or similar item or service. • Credible information submitted by a party at the request of the IDR entity • Credible information submitted by a party on: – Provider’s level of training, experience, quality and outcome measures – Market share of party – Patient acuity or complexity of care – Teaching status, case mix, and scope of services of nonparticipating facility continued on page 25

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID THERAPEUTICS

COVID Therapeutics Updates

FROM THE CONTRA COSTA AND ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENTS CONTRA COSTA COUNTY PUBLIC HEALTH DEPARTMENT t this time, supply of COVID-19 treatments in Contra Costa County is not limited and there is no scarcity. All outpatients with mild to moderate COVID-19 who are at risk for disease progression due to age (for example, > 50 years old), not up-todate on their COVID-19 vaccine, or are at a higher risk for disease progression, no matter their age, should be offered treatment if eligible based on the product Emergency Use Authorizations (EUA). Treatments should be offered regardless of vaccination status, and healthcare providers should ensure patients who are positive for COVID-19 have easy access to treatments.

Actions Requested of Healthcare Professionals and Organizations 1. Ensure patients are aware of treatment options if positive for COVID-19. • Review with patients the importance of reporting home test results promptly to ensure providers can link them to treatments within treatment window. 2. Prescribe COVID-19 treatment to all eligible individuals. • Provide patients with the EUA fact sheet with their prescriptions. 3. Know what pharmacies have oral COVID-19 antivirals available for prescribing, and confirm with the pharmacy the medications are available before prescribing them to patients. 4. Ensure patients are aware of and review appropriate tools and guides to aid in decision making for COVID-19 treatments. 5. Ensure low barriers for patients to access treatment: • Have ways patients can access treatments and review their eligibility through a healthcare provider 7 days a week. • Do not require repeat testing as a pathway for treatment (accept patient-reported antigen and PCR). • Provide a prescription for COVID-19 oral antivirals to any patient who is eligible, no matter their insurance coverage. 6. Consider outreach for your COVID-19 patients to review eligibility and link to treatments as appropriate. Treatment Guidelines. Currently one of the preferred treatments for COVID-19, as reviewed by the NIH treatment

guidelines for outpatients, is Paxlovid, an oral antiviral treatment. Paxlovid is available for adults and pediatric patients 12 years of age and older weighing at least 40 kg (90 lb). It should be started as soon as possible, but within 5 days of symptom onset. It is given twice a day for 5 days and has been shown to reduce the relative risk of COVID-19 related hospitalization or death by 88% when compared to placebo. Paxlovid includes nirmatrivir, a SARS-COVID-19 main protease, and ritonavir, an HIV-1 protease inhibitor and CYP3A inhibitor. Given this, Paxlovid is contraindicated with many commonly prescribed prescriptions and over-the-counter drugs, and also has some warnings and precautions. These warnings include renal dosing for individuals with an eGFR ≥30 to <60 mL/min, and contraindications for severe Hepatic Impairment (Child Pugh Class C) and severe renal disease (eGFR <30 mL/min). Recent updates to the EUA have allowed the availability of Paxlovid in dose package for the renal dosing to ease prescribing. The FDA released a Paxlovid Patient Eligibility Screening Tool in early May: fda.gov/media/158165/download. Health care providers should review the Paxlovid EUA and fact sheet for healthcare prior to prescribing Paxlovid for a complete list of contraindicated drugs, further details on administration, dosing, warnings, and precautions. For patients who have a contraindication to Paxlovid, alternative treatments options (e.g., monoclonal antibodies) should be reviewed to see if they are eligible and these patients should be linked to treatments as appropriate. In addition to the EUA, tools exist to aid providers in review of drug interactions and contraindication, as Paxlovid can safely be managed by medication adjustment in light of certain drug interactions. These resources include: • NIH Treatment Guidelines for Outpatient Management of COVID-19 (covid19treatmentguidelines. ni h.gov/management/clinical-management/ nonhospitalized-adults--therapeutic-management) • Liverpool COVID-19 Drug Interaction Tool (covid19druginteractions.org/checker) • HHS COVID-19 Therapeutics Decision Aid (aspr.hhs. gov/COVID-19/Therapeutics/Documents/COVIDTherapeutics-Decision-Aid.pdf) In addition to treatments for those infected with COVID-19, continued on page 18 ACCMA BULLETIN | MAY/JUNE 2022

COVID THERAPEUTICS

(continued from page 17)

certain adults and adolescents may also be eligible for pre-exposure prophylaxis, Evusheld, if they are moderately to severely immunocompromised or unable to get vaccine due to a history of severe adverse reaction to a COVID-19 vaccine or any component. For further information and guidance on use of Evusheld, please review NIH Treatment Guidelines Overview of Prevention: covid19treatmentguidelines.nih.gov/overview/ prevention-of-sars-cov-2. ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT The Alameda County Public Health Department is providing information to assist you in identifying and providing COVID-19 treatment and pre-exposure prophylaxis to your eligible high-risk patients. Effective treatment is available and should be offered to all high-risk patients for outpatients with mild to moderate COVID19 if they meet criteria for treatment based on EUAs. Therapeutics are not in a state of scarcity; all patients at high risk for disease progression with a positive COVID-19 test (PCR or antigen) who are within the treatment window should be offered treatment. For clinical questions about treatment with COVID-19 outpatient therapeutic products, contact Arnie Spanjers, MD, Alameda County Public Health Department, at arnie.spanjers@ acgov.org. For questions regarding the distribution of COVID-19 outpatient therapeutic products within Alameda County, contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead, at cynthia.frankel@acgov.org. A COVID-19 therapeutics locator for provider use is at covid-19-therapeuticslocator-dhhs.hub.arcgis.com.

Treatment Guidelines. The guidelines for Therapeutic Management of Nonhospitalized Adults With COVID-19 (covid19treatmentguidelines.nih.gov/management/clinicalmanagement/nonhospitalized-adults--therapeutic-management) and Prevention of SARS-CoV-2 Infection (covid19treatmentguidelines.nih.gov/overview/prevention-of-sars-cov-2) have been frequently updated due to changes in prevalence and susceptibilities of current COVID-19 subvariants. With the increased availability of most products, all eligible patients can and should be offered treatment. The NIH Panel currently recommends one of the following (see covid19treatmentguidelines.nih.gov/ about-the-guidelines/whats-new/): • Preferred Therapies (listed in order of preference): > Ritonavir-boosted nirmatrelvir (Paxlovid) (AIIa) (for more information, go to fda.gov/media/155050/

•

download) > Remdesivir (BIIa) Alternative Therapies (for use only when neither of the preferred therapies are available, feasible to use, or clinically appropriate – in alphabetical order): – Bebtelovimab (CIII) – Molnupiravir (CIIa)

Strategies for Identifying and Treating. The Alameda County PHD recommends the following strategies for identifying and treating your high-risk patients (see cdc.gov/ coronavirus/2019-ncov/need-extra-precautions/people-withmedical-conditions.html): • Pre-screen if possible. – Identify your patients at high risk of progression to severe COVID-19 illness (hospitalization/death). – Review their medical records routinely or during scheduled visits. – Notify high-risk patients that treatment is available if they get COVID-19 and what to do if they test positive. • Identify moderately and severely immunosuppressed patients and/or those unvaccinated/boosted due to severe vaccine allergies. – Screen these patients for Evusheld eligibility before they develop COVID-19 or are exposed. – Provide information and counseling; go to fda.gov/ media/154702/download for a fact sheet for patients. – Connect patients to a location where they can receive Evusheld: covid-19-therapeutics-locator-dhhs.hub. arcgis.com • Act quickly on positive test results or suspected COVID19 illness. – Accept positive home antigen test results! Have a procedure for having patients report positive home lab tests to you. – Consider using a point-of care-antigen test if COVID-19 illness is suspected and testing is needed. If ordering a PCR test, ensure that the lab has a quick turnaround time. – Have a process for checking lab results as soon as possible. – Have a procedure for quick notification of positive patients. – Screen patient for eligibility using current NIH criteria for treatment and prioritization. This can be done via a telehealth visit. – Provide script for staff who may be notifying patient of a continued on page 24

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

MY GREEN DOCTOR

My Green Doctor

ACCMA’S MONEY-SAVING, CLIMATE-SAVING MEMBERSHIP BENEFIT By Lee C. Ballance, MD and Todd L. Sack, MD, FACP

y Green Doctor is a free benefit for ACCMA members that will save you money and help sustain the environment. We explain here why My Green Doctor is important, how it helps your practice’s bottom line, and how to get started today. Lee Ballance, Health care takes a big toll on the MD climate. A 2016 analysis from scholars at Yale and Northeastern found that the fossil fuels needed by the US health care industry are responsible for about 10% of America’s disease-causing air pollution and greenhouse gases.1 Outpatient care is about 26% of healthcare’s air toxins, meaning that our office practices have a significant environmental impact. The need for Todd L. Sack, health care to become environmentally MD sustainable recalls the fundamental ethical duty stated by Hippocrates in the 3rd century: “First do no harm.” Your practice needs to be environmentally sustainable today more than ever before. This is because the skills that lead to sustainability are the same skills that help you thrive in a competitive world: saving resources, efficiency, flexibility, decision-making by teams, continual process improvement, and strong community relations. My Green Doctor is a complete environmental sustainability and climate change practice management program for health care offices, clinics, and other outpatient facilities. It is written by health professionals, evidence-based, easy to use, requires no environmental knowledge, and is free for ACCMA members and their offices. Most practices will save money in the first month using My Green Doctor; one medical group has been saving more than $1000 per doctor annually for many years. This is why more than 800 practices from 62 countries and most US states have registered to use My Green Doctor.

SUSTAINABILITY IS PART OF OUR NEED TO “DO NO HARM.” Modern medical practices can use an environmental sustainability program to harness the creativity of everyone in the practice and find new ways to solve problems. My Green Doctor’s approach uses proven management tools to: • Lower business operating costs. • Increase employee team building. • Improve staff and patient communication. • Encourage office self-examination. • Support the values of employees who want to “make a difference” for others. • Create a healthier work environment. • Enhance the practice’s reputation. • Improve community health. The topics addressed in My Green Doctor include energy and water use, recycling, green purchasing, pharmaceuticals disposal, safe cleaning methods, healthy foods, wise transportation choices, climate change preparation, renewable energy, and more. Teaching is a big part of the My Green Doctor program, offering brochures, posters, and other teaching tools for sharing wise choices with your patients and their families. This is how doctors, nurses, and practice managers can help their patients save money in their homes, live healthier lives, and to prepare for the health threats of climate change such as extreme heat events, catastrophic storms, and wildfires. GETTING STARTED My Green Doctor is found at www.MyGreenDoctor.org and at www.MyGreenDoctor.es (en espanol). Register to become a Partner Society member. Using ACCMA’s discount code MGDACCMA will save you $60 instantly, to save more than $450 in the first year, and to make the service free for your entire office. Ask your practice manager and others to register with ACCMA’s discount code. Next, watch the three-minute video on the homepage. You’ll learn how easy it is to add five minutes of My Green Doctor business to the agenda of every practice planning meeting and about the Meeting-by-Meeting Guide that provides continued on page 24 ACCMA BULLETIN | MAY/JUNE 2022

AMA HEALTH EQUITY TOOLKIT

Putting Racial and Health Equity Goals into Action

ME modules are available from the American Medical Association to translate your commitment to racial and health equity into action, whether you work in a health system or a smaller practice. This article is a condensed version of the module focusing on the smaller practice setting; the module for health systems or large group practice is at edhub.ama-assn.org/stepsforward/module/2788862. The AMA toolkit adapts a practice transformation framework to offer 5 steps that can help practices advance racial and health equity for co-workers, patients, and the communities you serve. Recognizing that the path to equity is a dynamic, long-term journey, this toolkit focuses on initial steps and associated resources that motivated physicians and practices can use to translate that commitment to equity into action.

STEP 1: COMMIT TO DO THE WORK Like every practice transformation effort, advancing racial and health equity requires leadership. This first step involves identifying a leadership-supported champion for this work within your practice. It also requires courage—courage to approach this work with genuine respect, to facilitate and create a safe space for difficult conversations, to find comfort in discomfort, and to commit to meaningful action. Talking about racism, racial equity, or health equity in clinical practice may make some of your colleagues uncomfortable. A good place to start is by asking questions to help identify opportunities for improvement, such as “Do we know whether access to care, preventive screenings, treatments, or other quality measures differ by patient race, ethnicity, and language?” Physicians can also pose questions during the patient visit, such as “Many of my patients experience racism in their health care. Are there any experiences you would like to share with me?” As with other significant initiatives that seek to improve patient outcomes and advance the medical profession, leaders will need to allocate time and create space for all team members to have these conversations and participate in improvement efforts for racial and health equity. STEP 2: START SHIFTING GROUP NORMS It’s important for everyone in your practice to develop a better, shared understanding of racism and anti-racism. This process

requires a combination of individual and group learning to find out what you don’t know. Read and share articles and resources like those listed at the end of this article. Use dedicated time as well as informal opportunities at work to talk with colleagues. STEP 3: GET A HANDLE ON YOUR DATA To chart a course forward on racial equity, it’s important to know where you are. You can start by discussing a basic question as a practice—what does our data tell us about racial health disparities among our patients? It is important to routinely collect and analyze patient and practice performance data by race and/or ethnicity. The omission of data on race is just one way that structural racism manifests in health care. Support patient self-recording of race and ethnicity data through patient-facing tools online and/or at the point of service in your practice. Then focus on a few actionable measures to identify and target racial health disparities. Here’s how: • Identify 2-3 measures that are meaningful to you, your team, and your practice based on current patient care-related priorities, like improving diabetes management, COVID-19 testing, annual wellness visits, hypertension management, or flu shots. • If this is your first time looking at measures in this way, start small. For example, review patients 30-65 years old with uncontrolled hypertension. • Using those measures, analyze care delivery and practice performance to identify disparities by race, ethnicity, and language (REAL) data. Use graphs and charts to visualize the data. • Decide on one specific measure that can serve as a constant reminder that certain populations are disproportionately impacted or neglected (e.g., percentage of patients who have well-controlled and uncontrolled hypertension, stratified by REAL data). • Address challenges in data collection and getting the right data to the right place (e.g., data on race may be included in reports to health plans but not reviewed in team meetings). • Share data transparently with team members, engaging everyone in improvement. continued on page 22

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

IN YOUR CORNER

Improving Outcomes for Youth in Extended Foster Care presented also apply to this group of youth who receive even less support services than those in extended foster care. The report highlights gaps in current services and potential solutions to improve outcomes for youth in extended foster care. There is a need for ongoing collaboration among organizations and agencies to prioritize the gaps addressed in the report. Policy makers, agencies, providers, and leaders supporting youth in extended foster care are recommended to convene to determine which recommendations are most pressing and should be implemented. Distilling to: CONNECTION

CES UR O S RE

CUL T & RA URA L C ISSU IAL ES

Y, MIL FA NTS & RE PA EERS P

STIG MA

recently released report from an Alameda County interagency task force highlights the need for systemic change in the delivery of services for youth in extended foster care who are at high-risk of developing substance use disorder and experiencing an overdose. The need to support these youth is even more critical due to the impact of COVID-19. The ACCMA was part of the task force that produced the report, which also included the Alameda County Probation Department and a public health consultant. Youth in foster care face a significant amount of trauma and adversity in their lives. Research indicates that adverse events in childhood, such as abuse or neglect, increase an individuals’ risk to develop a wide range of enduring health problems, including substance use disorder. When youth in foster care reach the age of 18, they are eligible for California’s Extended Foster Care Program, which allows youth to remain in foster care until age 21. The transition from childhood to adulthood is difficult and takes a toll on their mental, emotional, and physical health. Youth in extended foster care face stigma surrounding substance use, which may affect their ability to receive the services they need. “Stigma is a major barrier for youth in accessing support and treatment for substance use disorder. The fear of stigma alone leads many youths to hide their struggles and navigate these systems on their own,” stated Michelle Schurig, program director of In Your Corner. One of the major themes that appeared among data and discussions was the need for connection to assist youth in transitioning to a stable adulthood. The Task Force identified eight major areas where youth need a strong connection including: substance use disorder treatment services, employment, housing and basic needs, mental health services, and peer support. Medical Director of Alameda County Health Care Services Agency, Dr. Kathleen Clanon, explained, “Healthy, meaningful and lasting connections will create a more stable and effective support system for foster youth transitioning to adulthood.” While the report focuses on improving these connections, the Task Force recognized that the strength and longevity of these connections is dependent upon environmental factors such as stigma, racial and cultural issues, resources, family, and peers. It is important to note that the struggles these youths face are parallel to the experience of all transitional age youth. As such, the recommendations

EFC YOUTH

SUD Treament Services

Health Care

Community Connection

Employment

Mentorship Peer Support

Housing Basic Needs Mental Health Services

Education Training

In Your Corner: Alameda County Young Adult Opioid Initiative is part of a comprehensive opioid initiative managed by the Alameda County Probation Department and funded by the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention under cooperative agreement # 2018-YB-FX-K003. The points of views expressed in this document are not necessarily representative of the official policies of OJJDP or the U.S. DOJ.

ACCMA BULLETIN | MAY/JUNE 2022

AMA HEALTH EQUITY TOOLKIT

(continued from page 20)

STEP 4: DEVELOPED A SHARED VISION AND GOALS With a focus on a few key actionable measures, the next step is to create a shared vision and goals to reduce or eliminate racial disparities in care delivery and practice performance. There are two components to remember when developing a compelling vision and goal for racial equity: 1. First, work with a small group of your most motivated colleagues to develop a draft quality-improvement-based project charter. Be sure to involve and ask at least one practice leader to review the draft charter and serve as an executive sponsor. 2. Second, draft SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goals based on your data analysis. Using our illustrative example of patients with uncontrolled hypertension for example, we could set the following SMART goals—Within 12 months, we will: a. Achieve a 20% increase from baseline in hypertension control among all adult patients ages 30-65, including Black women and Latino men and, b. Decrease disparities in uncontrolled hypertension rates between Black women, Latino men, and other groups by 20% from baseline. STEP 5: LAUNCH TARGETED IMPROVEMENT EFFORTS The next step in practice transformation is to launch focused quality improvement (QI) efforts that explicitly aim to advance racial and health equity. Community health centers have used quality improvement to reduce racial, ethnic, and socioeconomic disparities in care over the short-term (1-2 years) and key health

outcomes over longer 2-4 year periods. The key is not to use a “one-size-fits-all” approach in which quality improvement interventions are broadly targeted to the general population. Here are some considerations for developing equity-focused quality improvement goals and interventions: 1. If a QI effort only assesses potential improvements in baseline measures for a patient subgroup without comparing to others, it may have no impact on actual gaps in care between patient populations and may even inadvertently worsen racial health disparities. 2. Don’t involve a large number of patients in your quality improvement effort right out of the gate. The Model for Improvement takes the standard Plan, Do, Study, Act (PDSA) cycle from continuous quality improvement and emphasizes the goal of rapid cycle improvement—testing an intervention on a small group of patients to allow assessment and then revision of an intervention. To read the full module, go to edhub.ama-assn.org/steps-forward/ module/2782426. Further Reading K. Sivashanker and T.K. Gandhi (2020) Advancing Safety and Equity Together. New England Journal of Medicine 382 (4), 301-303. J.A. Endo (2016) Addressing Race in Practice. Institute for Healthcare Improvement blog. September 27. ihi.org/communities/blogs/addressing-racein-practice J.C. Williams (2014) Double Jeopardy? An Empirical Study with Implications for the Debates Over Implicit Bias and Intersectionality. Harvard Journal of Law & Gender 37, 185-242. repository.uchastings.edu/faculty_scholarship/1278 Southern Jamaica Plain Health Center. Liberation in the Exam Room: Racial Justice and Equity in Health Care. Institute for Healthcare Improvement. ihi.org/ resources/Pages/Tools/Liberation-in-the-Exam-Room-Racial-Justice-Equity-inHealth-Care.aspx

To place a classified ad, go to www.accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383. ACCMA members can place a classified ad for four months online and in two issues of the ACCMA Bulletin at NO CHARGE.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

ALAMEDA ALLIANCE

Expanding Long-Term Care with CalAIM By Scott Coffin, Alliance CEO

lameda Alliance for Health (the Alliance) is proud to serve over 310,000 children and adults in Alameda County. In this article, you will read about the Department of Health Care Services’ statewide integration of the long-term care benefit into Medi-Cal managed care, beginning in January 2023. You will also learn about the work the Alliance is leading to ensure a smooth integration, and how we will leverage other CalAIM initiatives that we have launched to provide the best care for Alliance members eligible for long-term care services and supports. ACCESS TO INSTITUTIONAL LONG-TERM CARE At the beginning of this year, the Alliance began to implement certain components of the Department of Health Care Services’ (DHCS) CalAIM initiative, including the launch of Enhanced Care Management, Community Supports, and the transition of major organ transplants into Medi-Cal managed care. These programs, along with other CalAIM reforms, aim to strengthen the Medi-Cal delivery system and are helping managed care health plans to administer a more equitable, coordinated, and person-centered system of care. On January 1st, 2023, another major CalAIM reform initiative – the institutional long-term care (LTC) carve-in will be launched, and care in nursing homes and other institutional settings will be provided as a benefit through the Alliance. Currently, the LTC benefit is “carved out” and any Alliance member who is admitted to a long-term care institution is disenrolled after spending more than 60 days there and enrolled in Fee-For-Service (FFS) Medi-Cal. Beginning January 1st, 2023, the Alliance will be responsible for institutional care for all of our members. Additionally, individuals who are currently living in LTC facilities and have Medi-Cal FFS will be enrolled into the Alliance. Tens of millions of people across the United States require long-term care – primarily seniors but also children and adults with intellectual and development disabilities, physical disabilities, or disabling chronic conditions. Long-term care can include personal care, such as help with eating, dressing, or bathing over a long period of time, and can be provided at an individual’s home or at a LTC facility. In order to adequately provide these services

to eligible members starting in the new year, our team has been working to identify and contract with high-quality LTC providers, such as skilled nursing facilities, intermediate care facilities, institutions for mental diseases, and subacute and pediatric subacute facilities. In partnership with our local provider partners, we are working to ensure that Medi-Cal beneficiaries residing in LTC facilities are transitioned without any interruptions, while leveraging our relationships with our community partners to deliver the best customer service to older adults and persons with disabilities. As part of the CalAIM effort, new Populations of Focus (PoFs) will be eligible for Enhanced Care Management and Community Supports. These new PoFs include nursing facility residents who are strong candidates for transitioning back to the community and have a desire to do so, and individuals at risk for institutionalization and are eligible for long term services in their home and have the ability to live safely with wrap-around supports. These services will be crucial with assisting certain members avoid institutionalization while helping others safely transition into the community. Over the last year, the Alliance has been participating in DHCS-sponsored stakeholder meetings to understand best practices and hear from stakeholders about the LTC benefit. We are committed to ensuring that our eligible members have access to high quality long-term services and supports, whether they are provided in the community or at an appropriate long-term care setting. ABOUT ALAMEDA ALLIANCE FOR HEALTH Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 310,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products. ACCMA BULLETIN | MAY/JUNE 2022

COVID THERAPEUTICS

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positive result and their eligibility for treatment. Prescribe/Direct patients to medications. – Review medication/allergy records, including OTC and herbal products. – Use available drug interaction data bases as needed, e.g., covid19-druginteractions.org/checker. – Identify locations for patients to get therapeutics. > In-house pharmacy if possible. > A nearby participating pharmacy at covid-19therapeutics-locator-dhhs.hub.arcgis.com. > An available infusion center if needed.

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Total Infusion: totalinfusion.com/ make-a-referral UCSF: infectioncontrol.ucsfmedicalcenter. org/sites/g/files/tkssra4681/f/Monoclonal_ Antibody_Outpatient_Treatment.pdf Stanford Medical Center, Palo Alto: Contact DL-SHC-Pharmacy-COVID@ stanfordhealthcare.org, call (650) 391-8503, or go to stanfordhealthcare.org/discover/ covid-19-resource-center/patient-care/covid19-monoclonal-antibody-patients.html

MY GREEN DOCTOR (continued from page 19)

a complete script for each five-minute segment so that there is nothing for the practice manager or physician to study or prepare. Finally, you’ll learn now to make gradual, money-saving changes in the practice that will qualify you for the handsome Green Doctor Office certificate from My Green Doctor and the ACCMA. This certificate costs $250 every three years, but is free for ACCMA member offices. We encourage you to make environmental sustainability a core value of your office or clinic, accompanying your other important values such as delivering excellent healthcare, respect for your colleagues, HIPAA compliance, and non-discrimination. Register today at www.MyGreenDoctor.org to take advantage of this free ACCMA membership benefit. Upon registering, you’ll

receive an attractive certificate to display in the office demonstrating that the practice has pledged to “go green” using My Green Doctor. You can do this! Lee C. Ballance, MD (leeballance@gmail.com) is an ACCMA member and a climate change advocate with the Citizens Climate Lobby. Todd L. Sack, MD (tsack8@gmail.com) is Executive Director of the My Green Doctor Foundation. ACCMA members can email him for advice on “greening” their offices. Note 1. M.J. Eckelman and J. Sherman (2016) Environmental Impacts of the US Health Care System and Effects on Public Health. PLoS One 11 (6): e0157014. doi:10.1371/journal.pone.0157014

Explore ACCMA Volunteer Opportunities! Visit ACCMA.org/Volunteer, or call ACCMA at (510) 654-5383 to find out more.

NEW & RETURNING MEMBERS Tri Dang Do, MD, FACP, MPH Internal Medicine Community Health Center Network Jyothi N. Marbin, MD Pediatrics UCSF-UCB Joint Medical Program Director

Arun Srivatsa, MD Gastroenterology Washington Township Medical Group

RESIDENTS UCSF Benioff Children’s Hospital Pediatric Residency Program

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Timothy Chong, MD Spoorthi Davala, MD Nassim Durali, MD Emily Moody, MD Joseph John Thomas, MD

COUNCIL REPORT

FEBRUARY 10, 2022

The Council meeting was called to order by Doctor Robert Edelman, President, who welcomed guest speaker Assemblymember Mia Bonta. Assemblymember Mia Bonta discussed the main health care priorities for the 18th Assembly District, which includes a large part of the city of Oakland and the cities of Alameda and San Leandro. She was elected in a special election on August 31, 2021. The Council approved the appointment of Doctor Irene Lo as Councilor-at-Large and the appointment of Doctor Stacey Hunt as Alternate Councilor for District 3. Doctor Edelman asked for nominations for alternate councilors in Districts 4 and 12. The Council discussed the call for nominations to serve on the California Delegation to the AMA, which is a twoyear term beginning January 1, 2022. Anyone interested can contact ACCMA staff by February 25. Doctor Edelman asked for nominations from Districts 2, 8, and 9 to serve on the Membership and Communications Committee. The Council approved the re-appointment of Doctor Vin Sawhney and Doctor Edmon Soliman to the Bylaws Committee for a three-year term. The Council approved the re-appointment of Doctor Patricia Austin, Doctor Sharon Drager, Doctor Lubna Hasanain, and Doctor Steven Una to the Judicial Council for a three-year term. The Council discussed the Executive Committee recommendation to appoint the ACCMA President as the Delegation Chair. The recommendation was approved. The Council discussed the Community Health Committee’s recommended policy statement on climate change. The policy seeks to improve health equity through addressing climate change and asks the ACCMA to support climate changerelated policy interventions to help improve the health of our patients and community. The Council voted to send the recommendation back to the committee for revisions. The Council discussed reports from the Emergency Committee, the Health Equity Committee, the Community Health Committee, the Finance Committee, and the Medical

Services, Technology & Quality of Care Committee. The Council discussed the January MICRA Fundraising report which has a total of $9,674,600.00 in asks for districts 1 through 11. Mr. Lopez gave an update on MICRA presentations at East Bay hospitals. The recent ACCMA Bulletin issue focused on MICRA. The Council was informed that AB 1400 (Kalra), the singlepayer bill, failed to pass off the Assembly floor and is thus no longer eligible for legislative action for the remainder of the session. Mr. Lopez gave an update on the Legislative Committee meeting scheduled for February 14; the committee will hear about CMA’s 2022 legislative priorities and the open seats in the 2022 local elections. The committee will also discuss Legislative Day, which is scheduled on April 19. Mr. Lopez also encouraged the Council to support ACCPAC. The Council discussed CMA 2022 legislative priorities. The focus areas are protecting MICRA; advancing physician led, equitable, and affordable health care; reducing administrative burdens; and developing and implementing an organizational membership model. These issues will be addressed in more depth at the March Delegation meeting. The Council received an update on COVID-19 cases, testing and vaccine access, the availability of COVID-19 therapeutics, and mask mandates in each county. A new health officer was appointed in Contra Costa County, Doctor Ori Tzvieli. The Council was updated on the ACCMA’s success plan by Mr. Greaves. We are moving forward on implementing the recommendations that were approved by the Council last fall. The Council discussed membership retention and was asked for assistance in following up with the remaining nonrenewed members. Talking points were provided. The Council reviewed the new ACCMA learning management system and the upcoming and on-demand webinars now on this platform. On March 10, the entire ACCMA Delegation, including all members of the Council, will meet via Zoom. The next Council meeting will be in person on May 12. There being no further business, the meeting was adjourned.

AMA NO SURPRISES TOOLKIT (continued from page 16)

– History of contracting between plan and provider The IDR entity must not consider usual and customary charges, billed charges, or Medicare and Medicaid rates. WHO PAYS THE IDR ENTITY’S FEES? If the parties settle the reimbursement dispute after the IDR is initiated and before the arbitration is decided, each party must pay half of the IDR entity’s fee. The party that loses the arbitration

is liable for the IDR entity’s fee (which will generally be between $200 and $500 for a single determination or between $268 and $670 for a batched determination); each party is responsible for paying a $50 administrative fee to the Departments. The fees are paid at the time each party submits its offer to the IDR entity, and the prevailing party’s IDR entity fee is refunded at the end of the process.

ACCMA BULLETIN | MAY/JUNE 2022

CLASSIFIEDS

Concierge Family Practice for Sale. Thriving East Bay Area concierge family practice with great growth potential. Above average net with seeing 10 to 15 patients/day, 4 days/week, and 6+ weeks of vacation. Great location. Loyal long-term staff. Everything is in place to someone to step in. Does require patience, compassion, and desire to develop doctorpatient relationships to make it work. Serious inquiries, email mtobmd@gmail.com.

Office Space to Rent/Lease in Oakland, across the street from Summit Medical Center. Beautiful medical office building with gorgeous view. Total space is 1580 sf, willing to rent half or what is needed. Two office spaces with exam room, shared waiting room, medical equipment, shared kitchen, and bathroom. Pharmacy, lab, and radiology services in building. We only do VA comp/pension exams and are not busy. Serious call to discuss pricing at (510) 919-1029.

IN MEMORIAM WILLIAM (BILL) GERALD GOTTFRIED, MD (1936–

2021) passed away on September 29 at his home in Orinda. He was born in Philadelphia, graduated from the University of Pennsylvania, and attended Jefferson Medical School. Dr. Gottfried received a Fulbright scholarship and worked at the Great Ormond Street Hospital for Sick Children in London. He was Chief Resident at Children’s Hospital of Philadelphia (CHOP) before being inducted into the US Army, where he served as a pediatrician at Martin Army Hospital, in Fort Benning, Georgia. Dr. Gottfried moved to Orinda in 1968, began his career as a pediatrician at Kaiser Walnut Creek, and spent the next 35 years dedicated to his patients and colleagues, providing some of the early programs and concepts establishing Kaiser’s education program that supported the preventative health model. He served as the Chief of Pediatrics, was a member of the Kaiser Medical Executive Committee, and ran hospital surveys for the Joint Commission. Dr. Gottfried served on the ACCMA Committee on Quality Care and Legislative Committee, the CMA Committee on Quality Care and Committee on Continuing Medical Education, and taught pediatrics at UCSF. Dr. Gottfried is survived by his wife of 61 years, Toby; his sons, Harry and Louis; and his four grandchildren. He was an ACCMA member for 45 years.

DONALD PANG, MD (1958–2022) was born in San Francisco and received his medical degree from Mt. Sinai School of Medicine in New York in 1984. He did a general surgery internship at Highland Hospital, completed his residency in orthopedic surgery at UC-Irvine in 1990, and did a post-doctoral clinical fellowship in hand surgery at Roosevelt Hospital in New York. He practiced as an orthopedic surgeon at Washington Hospital. He was an ACCMA member for 26 years.

ARTHUR STANTEN, MD (1932–

2022) passed away on March 20 at his home in Oakland. Dr. Stanten graduated from UCSF medical school in 1956 and did his internship and residency at Highland Hospital, which was interrupted by a two-year stint in the Air Force, where he served as a Captain and the only surgeon at the base hospital in

Roswell, New Mexico. Dr. Stanten moved back to Oakland in July 1961 to complete his residency and entered private practice in general surgery. He had a long and distinguished career in medicine, serving as Department Chair of Surgery, President of the East Bay Surgical Society, and as President of the San Francisco Surgical Society. He served on the ACCMA Mediation Committee starting in 1967 (and was its Chair in 1976), Child Welfare Committee, and Physicians Advisory Committee (now the Advisory Committee on Physician Wellbeing). He was a much beloved physician, mentoring many young doctors to follow in his footsteps. He retired in 2006, leaving thousands of patients indebted to him for his wonderful care. Dr. Stanten loved golf, making annual trips to Hawaii for nearly 50 years to play golf at the Mauna Kea Beach Hotel. He also loved body surfing in the ocean, and particularly enjoyed spending time on these trips with his extended family and grandchildren. Dr. Stanten is survived by his wife Meredith, sons Steven (Sally) and Russell (Patty), daughter Linda (Matt), nine grandchildren, and two greatgrandchildren. He was a member of the ACCMA for 59 years.

ROBERT D. WEYAND, MD (1923–2022) passed away on

April 12. He was born in Arbuckle, California and received his BA from UC Berkeley at age 19. He graduated from the UCSF medical school in 32 months, graduating in 1945. Dr. Weyand interned at SF County Hospital before joining the US Army Medical Corps as a First Lieutenant. He served as an orthopedic specialist in Munich, Germany and studied neurosurgery at the University of Vienna until March 1948. Upon his discharge from the Army, he opened a medical clinic in North Lake Tahoe and later moved to Rochester, Minnesota to earn an MS in Neurosurgery from the University of Minnesota. He established his private practice on Pill Hill in Oakland in October 1952. He taught neuroanatomy at UCSF, developed techniques that are still in use, and was on the clinical teaching staff until his retirement in 1998. He served as Chief of Neurosurgery at Highland, Children’s, Peralta, and Merritt Hospitals, and served as Medical Staff President at Children’s and Merritt Hospitals. He was on the ACCMA Rehabilitation Committee for 4 years and the Mediation Committee for 23 years. Dr. Weyand is survived by his wife of 53 years, two sons and two daughters, three grandchildren, and two great-grandchildren. He was an ACCMA member for 57 years.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COUNCIL REPORTS

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