ACCMA September/October 2018 Bulletin by ACCMA

ACCMA BULLETIN Serving East Bay physicians since 1860

September/October 2018

COVER STORY: Celebrating the 150th ACCMA Annual Meeting (p. 11) MIEC Launches Safe Prescribing Incentive Program (p. 9)

Seminars/Webinars with Free CME to ACCMA Members (p. 5)

November Election Issues of Concern to Physicians (p. 13)

Cut Your Practiceâ&#x20AC;&#x2122;s Accounts Receivables Balance in Half (p. 22)

ACCMA is Working for You and Your Patients (p. 18)

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ACCMA Executive Committee Thomas Sugarman, MD, President Lubna Hasanain, MD, President-Elect Katrina Peters, MD, Secretary-Treasurer Kurt Wharton, MD, Immediate Past-President Suparna Dutta, MD, Councilor-at-Large Councilors & CMA Delegates Darcy Baird, MD Eric Chen, MD Suparna Dutta, MD Robert Edelman, MD Rollington Ferguson, MD James Hanson, MD Margaret Hegg, MD Shakir Hyder, MD Irina Kolomey, MD Terence Lin, MD Lilia Lizano, MD Abbas Mahdavi, MD Michael McGlynn, Jr., MD Rahul Parikh, MD Andrew Pienkny, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Judith Stanton, MD Michael Stein, MD Brad Volpi, MD CMA & AMA Representatives Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, AMA Alternate Delegate (at Large) Simpson So, MD, CMA Trustee Membership & Communications Committee Mark Kogan, MD, Chair Patricia Austin, MD Sharon Drager, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Robert Nicholson, MD Juan Ordonez, MD Lamont Paxton, MD Katrina Peters, MD Michael Ranahan, MD Ahmed Sadiq, MD Frank Staggers, Jr., MD Michael Stein, MD Ronald Wyatt, MD

Vol. LXXIV, No. 5

Serving East Bay physicians since 1860

NEWS & COMMENTS

PRESIDENT’S PAGE

Medical Insurance Exchange of California Launches Safe Prescribing Incentive Program

By Thomas Sugarman, MD, Co-chair, East Bay Prescribing Coalition 11

Celebrating the 150th ACCMA Annual Meeting

November Election Issues of Concern to Physicians

By ACCMA Staff 15

Medical Staff Prevails in Legal Battle over Medical Staff Self-Governance

By the California Medical Association 17

Addressing the Climate Crisis: Calling on Physicians to Act

By Lee Balance, MD and Cynthia Mahoney, MD 18

ACCMA is Working for You and Your Patients

Three Steps to Cut Your Practice’s Accounts Receivable Balance in Half

By Jesse Meddaugh, 360 Payments 23

How to Pay Off Student Loans

By Molly Carapiet, First Republic Bank 25

Coding Corner: CPT Reporting for Preventive Medicine Services

By G. John Verhovshek, American Association of Professional Coders 27

Improving Measures for Treating Diabetes Patients

By Scott Coffin, CEO, Alameda Alliance for Health

NEW MEMBERS

IN MEMORIAM

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September/October 2018

Giving Voice to the Needs of Our Patients By Thomas Sugarman, MD, ACCMA President

ACCMA Staff Joseph Greaves, Executive Director Jan Jackovic, Director of Operations Griffin Rogers, Director of Programs Dianne Thompson, Director, Napa-Solano Medical Societies David Lopez, Assoc. Dir. of Advocacy & Policy Mae Lum, Assoc. Dir. of Membership & Comms. Essence Hickman, Operations Coordinator Aimee Robinson, Physician Engagement Coordinator Wendy (Gwen) Roeder, Office 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

ACCMA BULLETIN | September/October 2018

NEWS & COMMENTS

Livermore Measure U Threatens Access to Care Measure U seeks to limit the amount that a physician, hospital, clinic, or other health care providers can charge for patient care to 115% of the cost of treatment. The initiative uses a definition of “cost” that excludes all managerial functions that are not directly related to providing patient care. The measure will also add an extra layer of regulations that forces the City of Livermore to administer this new regulation, costing taxpayers money and may potentially put other public services at risk. The ACCMA has joined local health care providers to form the Protect Livermore No on U coalition to ensure that Livermore physicians can remain in practice and to preserve patient access to care. To support the ACCMA in strongly opposing this ballot measure, please contact the ACCMA at (510) 654-5383.

Have you Received Your Supplemental Medi-Cal Payments? Physicians should have received their supplemental payments by August 31 in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. These supplemental payments are being made from Prop 56 funds to increase access to care for Medi-Cal patients. Practices that have not received their supplemental payments should contact the plan or the delegated entity; to find out which to contact, physicians can refer to a list created by the California Medical Association (CMA) identifying who distributed the payments. Physicians can also obtain assistance by calling the CMA at (888) 401-5911.

Online Drug Take-Back Database The California State Board of Pharmacy has launched a searchable online database (https://bit.ly/2NTBQVy) to help patients find a pharmacy anywhere in the state to safely dispose of unwanted or expired prescription or over-the-counter drugs, including controlled substances. These pharmacies may offer onsite collection bins and/or envelopes for mailing back medications. Additional drug take-back locations can be found on the federal Drug Enforcement Administration, Don’t Rush to Flush, and the California Department of Public Health websites.

New Medi-Cal Provider Enrollment System Is Live The California Department of Health Care Services has launched its new Medi-Cal provider enrollment system, PAVE 3.0. The 3.0 update includes even more provider types, auto-population of data, secured inter-practice communication, real-time status tracking, and streamlined forms to cut the average time to complete and process an application. DHCS is offering free weekly provider Q&A webinars and labs. To learn more, go to the PAVE portal at https://bit.ly/2N3fdgl. Urgent questions can be directed to the PAVE Help Desk at (866) 252-1949.

Help Oakland Shoo the Flu Shoo the Flu is a community-based initiative to prevent flu in Oakland through a school-located flu vaccination program. Shoo the Flu provides free flu vaccines for students at over 90 participating Oakland-area elementary schools from October 1 to November 9. This program aims to increase flu vaccine coverage rates of Oakland schoolchildren. Pediatricians can recommend that their patients get vaccinated against the flu each year in their office or at the patient’s school. For more information, go to shootheflu.org.

Sutter Health & Aetna Joint Health Plan Begins in 2019 The new joint venture health plan between Sutter Health and Aetna will begin offering care in Alameda and Contra Costa counties on January 1, 2019. Providers should verify their participation in the new network and member eligibility before seeing patients with the Sutter Health | Aetna ID cards. Questions about eligibility may be directed to the toll-free number on the member ID card or the Provider Service Center at (888) 6323862, or by going to www.sutterhealthaetna.com.

New ICD-10 Codes to Report Human Trafficking Beginning October 1, 2018, ICD-10 included new diagnostic codes to report confirmed and suspected cases of human trafficking. Additionally, new codes are available for patient history of labor or sexual exploitation. For guidance on documenting and coding human trafficking, medical providers and coders are encouraged to go to the Hospitals Against Violence website at https://bit.ly/2CQOaVM, or to contact the California Medical Association at (888) 401-5911.

Patient Right to Know Act Effective in July 2019 Under a new law signed by Governor Brown, physicians on probation for certain disciplinary actions after July 1, 2019 will be required to notify patients about their status before an appointment. The requirement applies only to physicians who are on probation for hurting patients through sexual misconduct, drug abuse, or improper prescribing, or if the physician has been convicted of a crime that involves harm to a patient. The California Medical Association ensured that amendments to the law guaranteed due process and appropriately defined patient harm. To read more, go to https://lat.ms/2MS1gBX.

ACCMA Member Irene Lo, MD, Recognized by Diablo Magazine Irene Lo, MD, was recently named a recipient of Diablo Magazine’s annual “40 Under 40 in the East Bay” award. The distinction recognized her as one of the youngest surgeons— and the only female—to lead the general surgery division at

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEWS & COMMENTS

Contra Costa Regional Medical Center. Doctor Lo is also very active in organized medicine, serving on both the ACCMA Legislative and ACCMA Membership & Communications committees, as well as in her surgical specialty, and earlier this year successfully completed the Berkeley Physician Leadership Program. She also generously supports organizations such as the Junior League. Her physician leadership is greatly appreciated by the ACCMA, and we look forward to her even greater success.

Confirmed Flu Cases in California The California Department of Public Health (CDPH) has confirmed 12 flu cases in the state as of October 6. Ten of the cases were Type A while the remaining two were Type B. The federal Centers for Disease Control and Prevention (CDC) is recommending yearly flu vaccines for everyone 6 months and older. Physicians can refer their patients to the following free or low-cost vaccine options. Local health departments offer free or low-cost influenza vaccines; Alameda County residents can check their county public health department website (http:// www.acphd.org) and Contra Costa County residents can go to the Contra Costa Health Services website (https://cchealth. org/public-health). Eligible children 18 years and younger may be able to get no-cost vaccines through the California Vaccines for Children program (http://eziz.org/vfc/provider-locations). To read more, go to https://bit.ly/2ykJFOA.

Defining Medical Necessity for Children in Medi-Cal SB 1287, which clarifies California’s definition of medical necessity for children enrolled in Medi-Cal, was signed into law by Governor Jerry Brown in September. The definition is now aligned with federal standards; it will allow children to get broader coverage than adults for a variety of physical, mental, and dental health services. Previously children had been denied necessary services because some Medi-Cal providers mistakenly use eligibility rules meant for adults instead of the broader standard for children under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. To read more, go to https://bit.ly/2E9Wq3A.

Expanded Emergency Health Services A new state law (AB 2576) will ensure that patients impacted by a disaster can continue to receive the care they need. During an emergency, providers can deliver health services in the field, such as check-ups at shelters for evacuated patients, as well as phone and home visits. Previously services delivered outside the “four walls” of a community health center facility were not reimbursed. The new law also creates an accelerated process for health centers to create temporary pharmacy sites when the clinic is inaccessible. The California Medical Association supported this legislation. To read more, go to https://bit. ly/2QCXMW0.

UPCOMING EVENTS ACCMA 150th Annual Meeting

Friday, Nov. 2 | 6:00 – 9:00 pm (dinner included) $150 per person; Claremont Club & Spa, Berkeley Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

Benchmarking Your Practice: Intro to Practice Finances

Friday, Nov. 30 | 9:00 – 11:00 am (refreshments served) $99 (ACCMA members); $199 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

For the latest news, go to the ACCMA website at www.accma.org/news.

ACCMA NOW AN ACCREDITED CME PROVIDER! As part of their membership benefits, ACCMA members will be able to claim CME for FREE for most eligible events. Please see below for a list of upcoming CME events and check the events calendar at accma.org for the most current lineup:

Surviving the Stress of Being Sued

Thursday, Nov. 8 | 6:00 – 8:30 pm 6230 Claremont Ave., Oakland CME FREE FOR MEMBERS, DINNER INCLUDED

Struggling with Your EHR: Tips to Optimize Use and Other Best Practices Friday, Nov. 9 | 12:15 – 1:15 pm Webinar CME FREE FOR MEMBERS

To register for events, go to www.accma.org/ events or call the ACCMA at (510) 654-5383.

ACCMA BULLETIN | September/October 2018

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PRESIDENT’S PAGE

Giving Voice to the Needs of Our Patients By Thomas J. Sugarman, MD, ACCMA President

Thomas Sugarman, MD

s I reflect on my term as your ACCMA President, I am struck by the power we have as physicians when we come together and speak with one voice. That is what the ACCMA has always been about: bringing doctors together to give voice to the needs of our patients and our profession. The ACCMA continues in this tradition and I am very proud of our accomplishments. Due to our collective voice and action, we have seen Medi-Cal funding increase by $1 billion over the past two years. In 2016, under the leadership of the California Medical Association (CMA), we led the coalition to get California voters to overwhelmingly approve Proposition 56, which increased the tobacco tax to generate additional Medi-Cal funding. We also fought to ensure that the Legislature appropriated these new funds in the manner the voters intended. As a consequence, California physicians are receiving substantially higher reimbursements for outpatient office

visits and mental health services—an average increase of 40% for 23 CPT codes. Unfortunately, California still lags behind most other states when it comes to Medicaid funding, but Proposition 56 has made an enormous step in the right direction. Impressively, CMA was able to leverage a $1 million investment in Proposition 56 into a $1 billion return benefitting California physicians, medical groups, and most importantly Medi-Cal patients. Our collective voice also helped defeat AB 3087, a short-sighted proposal from San Jose Assemblyman Ash Khalra that would have established an 11-member commission of political appointees to set the prices that physicians, hospitals, and health plans can charge patients. This bill reflected growing concern among California elected officials about healthcare affordabilty, but went about addressing the problem in a way that would have exacerbated California’s physician shortage and limited our patients’ access to care. AB 3087 was a terribly conceived bill, and state legislators heard resoundingly from physicians all across California that it would harm access to care for our patients. As a result of our efforts, the bill died early in the process before making it out of committee. On the issue of healthcare affordability, more than 50 ACCMA members recently participated in the CMA House of Delegates meeting in Sacramento, where we focused exclusively on addressing the cost of healthcare. Our goal was to develop a comprehensive, proactive plan to lower healthcare costs, addressing four primary areas: promoting more rational utilization of healthcare services,

enhancing competitiveness, reducing administrative burdens and costs, and lowering pharmaceutical costs. ACCMA members were very active in the debate and helped improve the final report that was adopted by the House, which will be summarized in an upcoming issue of the ACCMA Bulletin. We were also proud to continue the second year of the Berkeley Physician Leadership Program, a partnership between ACCMA and the UC Berkeley School of Public Health that provides an introduction to physician leadership across specialties and modes of practice. We had nearly 35 rising leaders participate in the 2018 cohort. The program was once again very well received by all participants. Planning is underway to continue our physician leadership program in 2019 and beyond. We also continued our efforts to address the opioid epidemic through our leadership of the East Bay Safe Prescribing Coalition. ACCMA recently received additional funding for the project through two new grants, which has enabled us to accelerate our efforts. We have hosted numerous educational programs and webinars on medication assisted treatment (MAT), naloxone, and the CURES database, and continue to host regular meetings to share and disseminate best practices. Recently the ACCMA launched an effort to get all East Bay hospitals to implement MAT in their emergency departments. We are also finalizing a toolkit of best practices for managing patients with chronic pain and patients on long-term opioids. These efforts are making a difference: continued on next page

ACCMA BULLETIN | September/October 2018

PRESIDENT’S PAGE

(continued from page 7)

community. The ACCMA received a grant from the California Healthcare Foundation (CHCF) to launch an electronic POLST registry in Contra Costa County. The ACCMA also leads the East Bay Conversation Project (EBCP), a community coalition that

from 2015 to 2017, opioid overdose deaths in Alameda County decreased by nearly 50% and in Contra Costa County by 10%. The ACCMA has also continued taking a leadership role on issues related to end-of-life care in our

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promotes advance care planning. We recently held our second annual EBCP summit, which was attended by over 100 advance care planning advocates. In addition, the ACCMA was accredited this year to provide continuing medical education (CME) credits. We have already hosted many CME programs and plan to offer many more. In addition to live in-person seminars, we are building a robust library of online CME courses that can accessed by ACCMA members on demand from our Learning Center portal (http://learning.accma.org). We plan to offer CME credits to ACCMA members at no additional charge as a benefit of membership. These are just a few of many accomplishments the ACCMA has achieved over the past year; please review pages 18 and 19 in this issue for a summary of what your ACCMA membership has supported. I would like to thank my colleagues on the ACCMA Council and my fellow ACCMA Officers for the trust and confidence you have placed in me. It has been rewarding to lead this incredible organization and accomplish so many wonderful things for our profession and our patients. I have every confidence that our incoming ACCMA President, Doctor Lubna Hasanain, will continue the fine tradition of ACCMA leadership, and I wish her and our other ACCMA Officers tremendous success in the coming year. Thank you for the honor of serving as your ACCMA President.

The most effective way to ensure elected officials promote legislative positions supported by the medical profession is to help elect candidates who share our perspective. If you can, please consider making a donation to ACCMA’s Political Action Committee (ACCPAC), or CMA’s PAC (CALPAC), at www.accma.org/donate.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

PRSM CREDIT PROGRAM

Medical Insurance Exchange of California Launches Safe Prescribing Incentive Program By Tom Sugarman, MD, Co-chair, East Bay Safe Prescribing Coalition

Thomas Sugarman, MD

he Medical Insurance Exchange of California (MIEC) has launched a Patient Safety and Risk Management (PSRM) credit program to support and incentivize safe prescribing best practices and safe and effective pain management among their policyholders. Qualified policyholders that receive MIEC-sponsored pain management Continuing Medical Education (CME) and implement safe prescribing best practices within their practice will receive a 5% credit on their liability premiums for the following year. This program was developed in close collaboration with the ACCMA and the East Bay Safe Prescribing Coalition.

To receive the 5% premium credit, policyholders must complete an MIEC-recommended pain management CME program and develop policies and procedures for their practice that limits risk to patients and treats pain safely. These policies and procedures can include using alternatives to opioids as a front-line treatment prior to initiating opioid therapy and conducting a screening or risk assessment of patients using a validated clinical tool such as the Opioid Risk Tool (ORT). If opioids are prescribed, other policies and procedures can include co-prescribing naloxone to prevent overdose and communicate the risks of opioids to patients, evaluating recovery by measuring functional improvement using a validated tool such as the PEG Scale, learning how to communicate with patients about chronic pain management and managing patient expectations via the use of a pain management agreement. As the opioid epidemic continues to ravage communities across the nation, changing physician prescribing practices has become widely recognized and accepted as a key tool for preventing opioid misuse and abuse. From legislators and policymakers, changing how physician prescribe opioids has most often taken the form of increasing administrative burdens,

mandates, and penalties on physician practices. MIEC is taking the approach of working with their policyholders to encourage safe prescribing best practices and effective pain management that limits risks to patients. The ACCMA and East Bay Safe Prescribing Coalition have taken a collaborative approach to addressing the opioid epidemic and are partnering with organizations such as MIEC that are in a position to influence prescribing practices and to support physicians providing safer and more effective pain management. The collaborative approach that the East Bay Safe Prescribing Coalition has taken is paying off, as both Alameda and Contra Costa County had double-digit declines in opioid overdose deaths from 2015â&#x20AC;&#x201C;2017. This sharp decline in overdose deaths has come even as overdose deaths have unfortunately climbed nationwide to a record high of 49,000 in 2017. To learn more about the East Bay Safe Prescribing Coalition, please visit www.eastbaysaferx@accma.org. Please note that the deadline to apply for the PSRM credit on your 2019 MIEC premiums has passed. To learn more about the PSRM credit program, please visit http://www. miec.com/MANAGEYOURRISK/ PSRMPremiumCredit.aspx.

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

ACCMA BULLETIN | September/October 2018

CELEBRATING The

1868 2018

Nov. 2, 2018 Reception: 6 p.m. Dinner: 7 p.m. The Claremont Club & Spa 41 Tunnel Rd., Berkeley, CA

Sponsor and Reserve Your Table Today! Individual tickets also on sale now.

Call 510-654-5383 Incoming ACCMA President Lubna Hasanain, MD

Join the East Bay medical community this fall as we celebrate 150 Years of the ACCMA Annual Meeting, an entertaining evening to support medical students and install ACCMA ofďŹ cers.

GIVE All proceeds support medical student scholarships CONNECT Enjoy dinner and a reception with friends and peers ENJOY Each Annual Meeting features a new and engaging keynote speaker PARTICIPATE Enter the rafďŹ&#x201A;e for your chance to win a stockpile of wine! SUPPORT LOCAL MEDICAL STUDENTS

Table for 10 at ACCMA Annual Meeting, including hosted reception, dinner program and valet parking Prominent Recognition at the Event, including verbal recognition during program, logo sign during reception, logo on table and in program Recognition in Promotional Materials, including logo on event promo materials Acknowledgement in the ACCMA Bulletin, distributed to nearly 4,000 East Bay physicians and community leaders Tax Deductible

Sustainer Champion $10,000 $5,000

85%

Supporter $3,000

Sponsor $1,500

100%

50%

Help us continue to support medical students in the UC Berkeley-UCSF Joint Medical Program

ACCMA ANNUAL MEETING

Celebrating the 150th ACCMA Annual Meeting

CCMA will be celebrating its history, the achievements of East Bay physicians, and the installation of its 2019 officers—while also raising funds for medical student scholarships—during the organization’s 150th Annual Meeting, to be held November 2 from 6 to 9 p.m. at the Claremont Club & Spa in Berkeley. Sponsorships and single tickets are now available for purchase. Over the decades, the Annual Meeting has served as a fun and entertaining evening through which the East Bay health care community can connect with one another, enjoy dinner and a program together, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program. This year’s program is packed with engaging speakers, highlights of local physician accomplishments, and fun diversions, and will include a raffle for a chance to win a variety of prizes. About 250 people are expected to attend. All proceeds from the Annual Meeting go to the ACCMA’s scholarship fund, which support students doing local health care research in the UC Berkeley–UCSF Joint Medical Program (JMP). In light of its 150th anniversary celebration, the ACCMA has set a goal this year of raising $150,000 to endow its student scholarship fund and support JMP students for years to come. ACCMA is now accepting sponsorships from medical staffs, practice groups, hospitals, and health care advocates who would like to support or attend this year’s event. Starting at $1,500, the Sponsor level includes

a table for 10 and acknowledgement in the ACCMA Bulletin, a bi-monthly publication sent to nearly 4,000 physicians. Higher sponsorships at the $3,000 (Supporter), $5,000 (Champion) and $10,000 (Sustainer) levels also include prominent recognition at the event and in promotional

materials. Please call the ACCMA at (510) 654-5383 for a complete breakdown of sponsor benefits and to reserve your table today. To purchase individual tickets, please go to www.accma.org/events.

California Medical Association Political Action Committee

Fighting for you! CALPAC needs your help to support candidates and legislators who understand and embrace medicine’s agenda.

Our top priorities are: 1. Protect MICRA 2. Preserve the ban on the corporate practice of medicine 3. Provide solutions to our physician shortage crisis!

Please visit www.calpac.org for more information

ACCMA BULLETIN | September/October 2018

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NOVEMBER ELECTION

November Election Issues of Concern to Physicians By ACCMA Staff

he November 2018 midterm election is fast approaching and there are a few different measures and key races that we must keep an eye out on. This article summarizes the position of the California Medical Association (CMA) on critically important state ballot measures, as well as any endorsements made by CMA. Also, this article discusses local ballot measures and races that ACCMA is closely watching.

Prop. 4: Children’s Hospital Bond Act of 2018

Position: CMA Supports (YesOnProposition4.org) Prop. 4 would allow children’s hospitals to expand, upgrade and improve their facilities. In doing so, children’s hospitals would acquire the latest technology and life-saving medical equipment, giving doctors the tools needed to save more lives. With this bond measure, children’s hospitals can focus their attention and resources on caring for sick children, regardless of their families’ income. Additionally, the bond would improve care for children with serious diseases such as cystic fibrosis, heart disease, and leukemia. Some key supporters for this measure are the California Hospital Association, the California American Academy of Pediatrics, CMA, and Children Now. Currently, there are no major groups or elected officials opposing this measure.

Prop. 8: Limits on Dialysis Clinics’ Revenue and Required Refunds Initiative

Position: CMA Opposes (NoProp8.

com) Prop. 8 would require dialysis clinics to issue refunds to patients or patients’ payers for revenue above 115% of the costs of direct patient care and healthcare improvements, such as training, patient education, and technology support. The measure would require rebates and penalties if charges exceed the set limit. There is also an annual reporting requirement to the state regarding clinic costs, patient charges, and revenue. Prop. 8 would also prohibit dialysis clinics from discriminating or refusing services based on a patient’s payer. An independent study by the Berkeley Research Group found that 83% of dialysis clinics in California would operate at a loss under this measure. The groups that oppose this measure include the American Nurses Association of California, CMA, the American College of Emergency Physicians of California, and the California Hospital Association. Some key supporters to this measure are the California Public Employees’ Retirement System (CalPERS), the California Labor Federation, and SEIU-United Healthcare Workers.

Measure U: Healthcare Cost Limitations

Position: ACCMA and CMA Oppose (ProtectLivermore.org) Measure U seeks to limit the amount that a physician, hospital, clinic, or other health care providers can charge for patient care to 115% of the cost of treatment. Furthermore, the initiative uses a definition of “cost” that excludes all managerial functions

that are not directly related to providing patient care. In so doing, the measure would result in reimbursements that are likely below the actual costs of operating a practice. This ballot measure will also add an extra layer of regulations that will force the City of Livermore to administer this new regulation, costing taxpayers money and may potentially put other public services at risk. While the measure only applies to the City of Livermore, we anticipate that similar efforts will follow suit if Measure U is approved. The groups that are joining ACCMA and CMA to oppose this measure are the Hospital Council of Northern and Central California, John Muir Health, Kaiser Foundation Health Plan, Livermore Valley Chamber of Commerce, and Stanford University. Backers of this measure include the SEIU-United Healthcare Workers and individuals from the community.

Statewide Race: Governor of California

Position: CMA Endorses Gavin Newsom (GavinNewsom.com) John H. Cox (R) is an accountant, business executive, broadcaster, attorney, and politician. Mr. Cox wants the government out of healthcare and if elected governor he would use the free market to make healthcare less expensive and more responsive to patients. Gavin Newsom (D) is the current Lt. Governor of California and former Mayor of San Francisco. One of Lt. Governor Newsom’s pitch for his gubernatorial campaign is a continued on next page

ACCMA BULLETIN | September/October 2018

NOVEMBER ELECTION

(continued from page 13)

single-payer healthcare system but he is open to other universal healthcare plans. CMA President Theodore M. Mazer, MD, stated, “California’s physicians are proud to support Gavin Newsom for Governor. Gavin is a lifelong champion for healthcare in California, and we know he will continue to fight for pragmatic solutions to our most crucial healthcare challenges, including working to achieve universal access and tackling our state’s physician shortage.”

Statewide Race: Lieutenant Governor of California

Position: CMA Endorses Eleni Kounalakis (EleniForCa.com) Ed Hernandez (D) represents the nd 22 Senate District and was the former State Senator for the 24th Senate District. Senator Hernandez supports expanding access to quality and affordable healthcare, reducing overall healthcare costs, and addressing the provider shortage throughout California. Eleni Kounalakis (D) is a politician, former diplomat, and business executive who served as the U.S. Ambassador to Hungary. Former Ambassador Kounalakis is in favor of universal healthcare coverage and Medicare for all; she also wants to ensure Medi-Cal is protected and underserved communities can have access to the care they need. CMA President Theodore M. Mazer, MD, stated, “Today’s political environment demands leaders focused on pragmatic solutions to improve quality access to healthcare, address our looming

physician shortage crisis and champion public health initiatives. We believe Eleni has the passion, temperament, and experience to best represent California’s citizens and interests.”

Local Race: Assembly District (AD) 15

Position: CALPAC Supports Buffy Wicks (BuffyWicks.com) Assemblymember Tony Thurmond (AD 15) is seeking election for State Superintendent of Public Instruction and thus his assembly seat will be vacant. Jovanka Beckles (D) is a City of Richmond Councilmember and Vice Mayor of Richmond. Councilmember Beckles wants a healthcare and Medicare system for all, intends to address drug addiction as a public health issue, and seeks to protect existing healthcare coverage. Buffy Wicks (D) is a political strategist who served as a senior staff member in President Obama’s 2008 and 2012 presidential campaigns, and as Deputy Director in the White House Office of Public Engagement. Ms. Wicks supports protecting East Bay access to emergency healthcare, bolstering our public health system, promoting responsible use of advancements in medical technology, and ensuring healthcare for all Californians. Ms. Wicks believes that California can and should be committed to single-payer healthcare. For your review, the following candidates are seeking reelection either at the state or federal level:

U.S. House Representatives Seeking Re-Election • District 5: Mike Thompson, Incumbent (D) v. Anthony Mills (Independent) • District 9: Jerry McNerney, Incumbent (D) v. Marla Livengood (R) • District 11: Mark DeSaulnier, Incumbent (D) v. John Fitzgerald (R) • District 13: Barbara Lee, Incumbent (D) v. Laura Wells (Green) • District 15: Eric Swalwell, Incumbent (D) Rudy L. Peters Jr. (R) • District 17: Ro Khanna, Incumbent (D) v. Ron Cohen (R) California State Assemblymembers Seeking Re-Election • AD 11: Jim Frazier, Incumbent (D) v. Lisa Romero (R) • AD 14: Tim Grayson, Incumbent (D) v. Aasim Yahya (D) • AD 16: Catharine Baker, Incumbent (R) v. Rebecca BauerKahan (D) • AD 18: Rob Bonta, Incumbent (D) v. Stephen Slauson (R) • AD 20: Bill Quirk, Incumbent (D) v. Joseph Grcar (R) • AD 25: Kansen Chu, Incumbent (D) v. Bob Brunton (R) California State Senate Senator Seeking Re-Election • SD 10: Bob Wieckowski, Incumbent (D) v. Victor G. San Vicente (R)

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

TULARE VICTORY

Medical Staff Prevails in Legal Battle Over Medical Staff Self-Governance By the California Medical Association

ulare, California is a small town in the Central Valley best known as the milk-producing capital of America. More than half of its 60,000 residents are enrolled in Medi-Cal and served by a small, 108-bed health care district hospital—Tulare Regional Medical Center (TRMC)—with a separate medical staff of about 175 physicians. Two years ago, this small agricultural community became ground zero in a high-profile battle testing the legal scope of a hospital medical staff ’s independence and right to be self-governing. Fundamentally, the question was raised who should be in charge of patient care and safety in a hospital—lay administrators or physician leaders? In 2016, hospital administrators at TRMC executed a coup to take unilateral control over patient care at the hospital by terminating the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital installed handselected individuals to serve as leaders of the new medical staff, dictated standards of medical care, seized control of the disciplinary process without legal or factual justifications, and prohibited members of the terminated medical staff from voting on medical staff matters or holding leadership positions in the replacement staff. The California Medical Association (CMA) supported the medical staff in its lawsuit against the hospital. CMA and the medical staff sought to enforce California law

requiring all hospitals to recognize and honor the self-governance rights of their medical staffs. Had TRMC’s actions been left unchallenged, it would have created a dangerous precedent that could have had a negative effect on patient care across the country. This July, a favorable settlement of the lawsuit was reached that dissolved the replacement medical staff and fully reinstated the original medical staff, its officers and bylaws. The hospital also consented to a stipulated judgment agreed upon by the parties and issued by the Tulare Superior Court that, among other things, expressly recognizes that the 2016 actions of the hospital board violated the medical staff ’s rights to self-governance under California law. “The Tulare case was not just about one hospital medical staff that was being wrongly treated by its governance structure,” said Theodore M. Mazer, MD, President of the CMA. “It’s about every medical staff. It’s about autonomy of physicians to make medical decisions and the clear division of power between a governing body, which is administrative, and the medical staff and making sure that that separation of powers and duties and responsibilities stayed in place was important for Tulare and every medical staff in California and frankly, in the nation.” “Medical staff is there to oversee the quality of care provided to patients in the hospital,” said Damodara Rajasekhar, MD, CMA Board Trustee, Organized Medical Staff Section. “That role is not designated to the CEO of the

hospital or the board members.” “What the hospital was doing was a blatant violation of very clear law in California that requires hospitals to honor a medical staff ’s independence and self-governance,” said Long Do, JD, CMA’s Director of Litigation. CMA worked with the medical staff ’s attorneys and filed two amicus briefs to support the medical staff and take on the hospital, which had loaded up its defense from three different law firms. “This was a case involving 125 doctors. There’s no possible way they could have afforded to prosecute the case themselves,” said John Harwell, JD, the medical staff ’s attorney. “It’s only by the collective action of organized medicine through the California Medical Association that this was possible.” “This case moved quickly in large part because we were there to help the medical staff and then to seek outside resources and help in getting this resolved,” said Doctor Mazer. In collaboration with CMA, the Litigation Center of the American Medical Association (AMA) and state medical societies provided significant legal and financial support in the California medical staff ’s lawsuit. “The narrative, when the case started, was that this was a group of troublemaking doctors who were making it impossible for the hospital to run as an efficient hospital,” said Michael Amir, JD, lead trial attorney. “We had to dispel that notion.” TRMC filed for bankruptcy before closing arguments in the medical staff ’s trial could take place, closing its continued on next page

ACCMA BULLETIN | September/October 2018

TULARE VICTORY

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doors and significantly challenging the availability of care to the community. “It was very devastating for the community to have the hospital close,” said Anil Patel, MD, immediate past Chief of Staff of Tulare Regional Medical Center. “But they knew that they had to wipe out all the previous administration, the board.” Patients seeking care at other hospitals reportedly had to wait 10 to 15 hours for care. The lawsuit, however, enabled the medical staff to get its story out to the community. In turn, the community changed hospital leadership, which ultimately resulted in the favorable settlement. As part of the settlement, TRMC has also agreed to: • Not recognize the replacement staff, its leaders, or bylaws. • Reinstate the original medical staff, its duly-elected officers, with all the privileges, rights, and status that existed before the January 26, 2016 termination. • Reinstate the pre-existing medical staff bylaws, rules, and policies.

•

Pay $300,000 for the TRMC medical staff ’s attorneys’ fees and costs. • Waive all rights to appeal or challenge the settlement’s validity. Perhaps most importantly, the settlement allows for the hospital to begin the process of reopening its doors and once again serving its community. “The importance of this case is it’s an example of what will happen to a hospital and the hospital’s leadership when it tries to trample the rights of the medical staff,” said Mr. Amir. “Doctors can take comfort that when their rights get trampled and their autonomy, self-governance is questioned, they have a remedy.” This case sends a message well beyond Tulare; it will likely have ramifications statewide, if not nationwide. The support of CMA and AMA enabled the medical staff to stand up to a large and well-funded hospital. In fact, AMA’s contributions to the litigation in this case represent the single largest legal contribution in the history of the AMA. “I learned a lot what CMA means.

It’s not only an organization, it is a partner,” said Abraham Betre, DO, Chief of Staff at Tulare Regional Medical Center. “The litigation fund that is housed in the CMA Center for Legal Affairs is the bloodline of our work. Without the support from medical staffs and individual physicians, CMA would not be able to advocate for doctors,” said Mr. Do. It cannot be understated how grave the consequences could have been on patient care and safety if the hospital’s illegal actions were left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is selfgoverning and democratic. If your medical staff is interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, please email Nathan Skadsen at NSkadsen@cmadocs.org.

THE IMPORTANCE OF MEDICAL STAFF-SELF GOVERNANCE Medical staff self-governance is a vital part of a carefully crafted system designed to ensure the delivery of quality patient care. This system recognizes that the hospital’s medical staff is the only body with the medical expertise to conduct quality assurance activities integral to the health and welfare of the public. Under state law and Medicare regulations, hospitals are required to have an independent, self-governing medical staff charged with the professional work of the hospital. The medical staff works with the hospitals to ensure quality of care and insulate medical decision makers from undue influences driven by profit motives or other reasons unrelated to patient care. To preserve this autonomy, medical staffs have a variety of rights provided for under California law, including the ability to retain legal counsel, elect leadership, conduct peer review and manage a separate bank account dedicated to medical staff funds.

Medical staff associations also have the option to sue a hospital, should they feel their right to self-governance has been violated. “Many physician members of a hospital’s medical staff often are not fully aware of the California laws that establish medical staff self-governance,” said Long Do, JD, CMA’s Director of Litigation. “CMA offers informational materials and makes speakers available to educate medical staffs of the importance of self-governance.” CMA provides hospital physicians with a variety of resources to help medical staffs maintain and assert self-governance. If you are interested in consulting with representatives from CMA’s Center for Legal Affairs or would like to schedule a CMA speaker on this topic, contact the CMA Member Service Center at (800) 7864262 or medstaffhelp@cmadocs.org

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CLIMATE CRISIS

Addressing the Climate Crisis: Calling on Physicians to Act By Lee Balance, MD and Cynthia Mahoney, MD

Cynthia Mahoney, MD

The ACCMA Public Health Committee heard a presentation by Doctor Mahoney on the health impacts of climate change on February 27. Part 1 of this article was published in the May/June 2018 issue of the ACCMA Bulletin. These articles express the opinion of the authors and do not reflect ACCMA policy. The Lancet has called climate change the greatest public health threat of the 21st century, stating “Human symptoms of climate change are unequivocal and potentially irreversible.” [1] In our earlier article, “Health and the Climate Connection“ (May/ June 2018 issue), we highlighted the many serious human health impacts of climate change. We see these impacts on human health here and now, with heat waves and drought, fires and wildfire smoke across California, despite just 1 ºC of warming. The fever is rising. The window to avoid the potential for runaway

warming is closing. Urgent action is required to avoid the likelihood of catastrophic consequences. What role can and should physicians play in confronting the public health challenges of climate change, in a way that “puts human health and welfare at the center of the conversation”? [2] Major US medical societies, including ACP, ACOG, AAFP, AAP, the AMA, the NMA, and many others (representing over 60% of U.S. physicians), issued this statement as the Medical Society Consortium for Climate and Health: We support educating the public and policymakers in government and industry about the harmful human health effects of global climate change, and about the immediate and long-term health benefits associated with reducing greenhouse gas emissions (i.e., heat-trapping pollution) and taking other preventive and protective measures that contribute to sustainability. We support actions by physicians and hospitals within their workplaces to adopt sustainable practices and reduce the carbon footprint of the health delivery system. We recognize the importance of health professionals’ involvement in policymaking at the local, state, national, and global level, and support efforts to implement comprehensive and economically sensitive approaches to limiting climate change to the fullest extent possible. Let’s look at five areas where we as physicians can play a critical role. EDUCATION The first step is to educate ourselves and to talk with our friends, colleagues, communities, and

leaders at every level about our concerns. The simple act of raising awareness is critical to building the will for further action. A health frame is nonpartisan, and immediately brings the issue to one of great concern to each individual, bringing “more focus and resolve to the global climate crisis.” [3] Physicians are one of the most highly respected sources of climate change information across the political perspective; communicating our concern is critical to moving others. And the public expects us to take responsibility. A recent poll shows that 68% of Americans believe that health professionals bear responsibility to “prepare for extreme weather events and climate change.” GREENING THE HEALTH CARE SECTOR The US healthcare system accounts for about 10% of US greenhouse gas (GHG) emissions. The number of deaths nationwide attributable to air pollution from these emissions is comparable to the number attributed to medical errors (44,000– 98,000). The good news is that many of the changes that health care systems are making to reduce emissions are actually saving them money and improving their communities’ health now. These include reducing energy use, choosing anesthetic gasses with lower GHG impact, favoring renewables, reducing disposables and food waste, recycling, and encouraging staff and patient use of public and active transport. Four of California’s largest health systems (Kaiser Permanente, Dignity Health, Providence St. Joseph Health, and Sutter Health) recently continued on page 21

ACCMA BULLETIN | September/October 2018

ACCMA ACCOMPLISHMENTS

The ACCMA provides a forum for East Bay physicians to come together to address professional challenges and improve care for their patients. In partnership with the California Medical Association, ACCMA is actively working to protect the interests of physicians and the patients they serve.

POLITICAL & ECONOMIC ADVOCACY Improving Access for All Patients

• Led efforts to increase Medi-Cal reimbursement rates. Prop 56 funds supplemental payments, an average increase of 40% for 23 CPT codes. • Lobbied hard to defeat AB 3087, a proposed law that would have created a commission of political appointees to set caps on physician rates. • Fighting against Livermore Measure U on November ballot that seeks to limit patient care charges to 115% of the cost of treatment.

Holding Health Plans Accountable

• Led the fight to force Anthem and Health Net to rescind their modifier 25 and emergency services payment reductions. • Sponsoring AB 2674 to require state investigation of provider payment complaints and penalties for under payment.

Defending MICRA

• Protecting MICRA by regularly meeting with local legislators and candidates to emphasize physicians’ stand on MICRA. This keeps down medical liability insurance premiums, saving an average of $75,000 per physician, and prevents frivolous lawsuits.

Reducing Regulatory Burdens

• Sponsored state law that prohibited denial of prior authorizations. • Helped further reduce 2018 MACRA quality and EHR reporting burdens and provided free help and resources with MACRA compliance.

Saving Money for You and Your Practice

• Up to 25 free CME credits per year for educational seminars and webinars, and free or discounted rate for practice management training for your staff. • Free personal assistance for billing, contracting, and reimbursement issues • Free online health law library and free access to CMA’s legal department to help you find legal information and resources on health law–related issues.

Expanding Physician Workforce in California

• Steve Thompson Loan Repayment Program offers medical school loan repayment grants to physicians practicing in medically underserved areas. • Song-Brown Workforce Training Program supports more than 175 primary care residency slots. • Special low rates and terms for refinancing medical school student loans through our banking partner. CMA

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ACCMA ACCOMPLISHMENTS

(continued)

PHYSICIAN WELLNESS • Partnering with Stanford Wellness to provide a statewide wellness program • The ACCMA Physicians Advisory Committee provides confidential support for physicians and medical staffs, and can assist with best practices for forming your own in-house wellness committee.

PHYSICIAN LEADERSHIP DEVELOPMENT • • • •

Berkeley Physician Leadership Program (with CME credits) Created by physicians and UC Berkeley experts, specifically for physicians Gain the skills to ensure organizational and individual success Manageably sequenced and scheduled to accommodate busy physicians

PHYSICIAN ENGAGEMENT IN THE COMMUNITY • Community Health: ACCMA physician members lead our community-wide efforts to improve patient outcomes in addressing the opioid epidemic, advance care planning education, and reducing hypertension. • ACCMA Committees and CMA Councils: Contribute your expertise in areas such as medical ethics, medical services and quality of care, child welfare, mental health, and public health to drive local and statewide advocacy agendas.

REPRESENTATION FOR YOU AND YOUR PRACTICE IN ORGANIZED MEDICINE • Networking: Recruit and promote your practice through the CMA Career Center and ACCMA publications, and attending ACCMA meetings and events • ACCMA Council and CMA House of Delegates: Local and statewide policy-making bodies to provide strategic direction and establish organizational policy • Direct Physician Advocacy • ACCMA Legislative Committee • CMA Legislative Advocacy Day • Meetings with local legislators and candidates

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CLIMATE CRISIS

formed the California Health Care Climate Alliance. They are reducing their own carbon footprint, while calling for coordinated action to address climate change, and bringing an expert healthcare perspective to climate change regulations and legislation. [4] Physician support and advocacy are critical to implementing all these changes. RESILIENCE Healthcare facilities themselves need to be prepared for the effects of climate change on their own infrastructure and personnel, such as the evacuation forced by the fires in Santa Rosa (see photo). How is your facility preparing for the heat waves that are coming? Are there adequate cooling facilities in your community to prevent heat-related illnesses before they become emergency room cases? What plans are in place in the event of prolonged power shortages or surges of injuries due weather-related events? What about air purification for hazardous smoke days? DIVESTMENT The AMA recently divested from fossil fuels. This is a powerful tool that is worth exploring, but outside the scope of this article. POLICY Because only one-third of GHG emissions are under individual control, our personal and even facility-level actions alone are not sufficient to address the scope, scale and urgency of climate change. The Medical Consortium on Climate and Health states, “The most important action we can take to protect our health is to accelerate the inevitable transition to clean renewable energy.” Although many actions and policies will be required, economists across the political spectrum agree that putting price on carbon emissions is the most effective policy. Effective carbon pricing must take into account the social cost of carbon, including the health effects of air pollution.

Taking Action

Avoiding the worst extremes of climate change will save tens of thousands of lives and untold suffering here in the US each year. [5] As a bonus, a clean energy economy also cleans the air the air we breathe of dangerous fossil fuel air pollution. This will improve our health almost immediately, saving 200,000 lives per year across the US. [6] If the revenue from carbon pricing is returned as a dividend to American households, it will protect vulnerable populations from rising prices while growing the economy and improving access to health care. [7] What is our role – what specific, concrete steps could we take? Could the ACCMA sponsor education for members, health facilities, and the public on the health impacts of climate change that will affect us all? Could we coordinate with our local Public Health Departments? Could we use our organizational strength to advocate for effective policies, both at the local level, through the CMA, and directly with our legislators? Just as physicians have come to understand the need to implement the most effective treatments for septic shock during the critical window, physicians can advocate for federal level carbon pricing as the most effective policy for addressing the human health threat that is climate change,

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within the limited time window before we reach potentially irreversible tipping points. What else could we as physicians do? Lee Balance, MD (lballance@mac.com) worked as an ER physician in Berkeley and Hayward; Cynthia Mahoney, MD (cam8ross@comcast.net) is an East Bay nephrologist. Both are members of the ACCMA, the Medical Society Consortium on Climate & Health, and the Citizens’ Climate Lobby. Please contact the authors for general interest or CME lectures on climate impacts. REFERENCES 1 N. Watts et al., The Lancet Countdown on health and climate change: From 25 years of inaction to a global transformation for public health. Lancet 391 (10120): 581–630 (February 10, 2018). DOI: https://doi.org/10.1016/S0140-6736(17)32464-9 2 Medical Consortium on Climate and Health, Mission & Consensus Statement: https://medsocietiesforclimatehealth.org/about/mission-andconsensus-statement/ 3 J.A. Patz, Solving the global climate crisis: The greatest health opportunity of our times? Public Health Reviews 37: 30 (December 7, 2016). DOI: https://doi.org/10.1186/s40985-016-0047-y 4 California Health Care Climate Alliance: https:// noharm-uscanada.org/content/us-canada/californiahealth-care-climate-alliance 5 The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment: https://health2016.globalchange.gov 6 Robert McSweeney, Cutting emissions could prevent nearly 300,000 US air pollution deaths. Carbon Brief website, February 22, 2016: https:// www.carbonbrief.org/cutting-emissions-couldprevent-nearly-300000-us-air-pollution-deaths 7 The Environmental, Economic, and Health Impact of Carbon Fee and Dividend. Citizens’ Climate Lobby website: https://citizensclimatelobby.org/ remi-report/

Santa Rosa Kaiser evacuating critically ill patients, with smoke and flames of the Tubbs fire licking at their heels (10/9/2017).

ACCMA BULLETIN | September/October 2018

PRACTICE FINANCES

Three Steps to Cut Your Practice’s Accounts Receivable Balance in Half By Jesse Meddaugh, 360 Payments

Jesse Meddaugh

ne of the most common payments complaints we hear from ACCMA members concerns how much time they spend chasing down revenue. Practice managers and administrative staff spend hours trying to track down payment, often eventually giving up and referring the account to collections. This is a messy and time-consuming process that takes energy away from other practice management responsibilities. In our experience, simply keeping a copy of the patient’s credit card information on file through a virtual terminal setup can alleviate many of these issues and cut your accounts receivables balance in half. Here’s how: 1. Make Sure Your Financial Policies are Legal and Fair Before you can start collecting payment information, you need to take a step back and make sure your financial policies and procedures are clear

and well documented. The last thing you want is a chargeback because a patient didn’t understand how you would be using their credit card information! Explain what kind of information you’ll collect, when you’ll charge their method of payment, how the charge will appear on their credit card statement, how long you’ll keep the information on file, how you will protect and safeguard the information, and what will happen in the event the card is declined. You’ll want to put all this together for your patients in a short document to sign that indicates that they have read and understand all of the above. 2. Gather Payment Information at Patient Intake When the patient first arrives at your practice and meets with your intake staff, you already gather a significant amount of information about them— their medical history, demographic information, etc. With your financial policies and procedures firmly in place, now you can collect payment information as well. If your patients question why they are being asked to provide credit card information prior to receiving treatment, you can explain that this is a time-saving procedure designed to streamline their checkout and after-care process. Make sure to store and handle the payment information carefully to stay out of scope of PCI compliance. Your credit card processor can and should help you manage this data in your virtual terminal system, so you don’t have to worry about this.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

3. Have a Backup Plan Of course, no system is perfect. Every once in a while, a card will be declined due to insufficient funds, an outdated expiration date, or even fraud. You may still encounter a chargeback here or there if a patient doesn’t recognize the charge or forgets that they gave you their credit card information. This is where your excellent customer service comes in. By maintaining clear and consistent communication with your patients, you’ll be able to clear up issues quickly, update outdated information smoothly, and head off potential disputes. You’ll still also want to keep nearby the name of a collections agency you trust. Although you should need to use them far less than you do today, it’s always good to have options.

360 Payments Can Help You Set This Up!

If you’re ready to get started with keeping credit card data on file, 360 Payments is the preferred credit card processing partner of the ACCMA. We would be happy to help you set up a virtual terminal for your medical practice so you can quickly and safely manage saved credit card information. Most ACCMA member practices with whom we work have seen credit card processing savings that have exceeded the annual cost of their ACCMA membership. Reach out to your dedicated representative Jenelle Bouchard at 360 Payments at (408) 755-0360 or jbouchard@360payments.com to learn how we can do the same for you.

STUDENT LOANS

How to Pay Off Student Loans By Molly Carapiet, First Republic Bank

t’s no secret that many Americans are challenged to pay off their student loan debt. Roughly 44.2 million Americans have a combined total of more than $1.5 trillion in student loan debt. Grads with this type of debt may find it difficult to focus on other future financial goals, like buying a first home, traveling, starting a family or even getting married. You can save thousands of dollars in the long run by paying off your student loans fast — and start working toward other saving and investing goals. Although your student loan debt may seem intimidating, there are more ways than ever to help pay down those loans faster. The following is your comprehensive guide to the best ways to pay off student loans, so you can get out of debt and take back your financial freedom.

7 Steps to Pay Off Student Loans

1. Assess your current financial health. You can’t begin to pay down your student loan debt responsibly until you get a full view of your entire financial picture. To do this, figure out your total annual income (after taxes), your total debt and other financial obligations, and your credit score. The stronger you are financially, the better position you’ll be in to secure the best interest rate if refinancing is in your future. Bonus tip: If you have debts with higher interest rates than your student loans (like credit cards, for example), it might make sense to work on paying those off completely first, before putting any of the following plans into place to pay down student loan debt. 2. Try consolidating and refinancing. What’s the difference

between consolidating and refinancing student loans? Consolidating combines all your student loans from different lenders under one financial roof so you can keep better track of them. Refinancing is paying off all of your existing student loans into a completely new loan, potentially with a lower interest rate or a different loan term. Often refinancing results in reduced monthly payments and helping you pay your loans down faster. Many graduates who are able to refinance their student loans have found that it’s a great way to accomplish other financial goals while still paying off their student loan debt. For example, once she got her first job, Theresa Nguyen knew she wanted to make buying a home a priority, so she reached out to First Republic for help. After refinancing her student loans she was able to save more to put toward her down payment while her personal banker helped her secure a great loan for her new home. Bonus tip: Keep in mind that these new loans may require you to give up special features of federal student loans like loan forgiveness and income-based repayments. 3. Make higher monthly payments. You might think finding extra money each month to pay more toward your debt is impossible, but here are some smart ways to make it happen: • Go over your monthly expenses line by line to cut back on (or cut out) wasteful spending, such as paying for cable or a gym membership you never use. You should also take a full inventory of leisure expenses—like coffee, eating out at restaurants, etc.—and prioritize

your spending to achieve your goals. • Make a plan to accelerate your career growth and increase your monthly income so you can put the difference toward your student loan debt every month. • Take on a second job or side gig and put that money directly towards your debt. • Put extra cash like bonuses or gifts toward your student loans. Bonus tip: Change your student loan payment plan to make half of the required payment every two weeks instead of a full one monthly. Since there are 52 weeks in a year, you’ll end up making 13 full payments (made up of 26 biweekly half payments) instead of 12. 4. See if your job offers forgiveness options. You can’t always plan your career around jobs that will help you pay your student loans more quickly, but keep in mind that certain fields offer loan forgiveness programs that could significantly decrease your loan balance and how much you end up paying in the long term. If you happen to work in one of these fields— like public work or teaching, for example—check with your company to see if you qualify for full or partial student loan forgiveness. Bonus tip: Many job listing sites allow you to search for jobs that offer loan forgiveness as part of their incentive packages. For example, on indeed. com, simply type “loan forgiveness” in the What box and add your location for a list of companies that offer loan forgiveness perks in your area. 5. Get your job to pay for your debt. Some employers are now offering continued on next page

ACCMA BULLETIN | September/October 2018

STUDENT LOANS

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student loan repayment as a benefit. These types of programs are gaining in popularity. For example, First Republic’s Gradifi program is a seamless, scalable student loan repayment benefit that more and more employers are offering as a way to attract, retain, and engage talented professionals. Bonus tip: These kinds of payments are meant to help you pay your loan off faster, not reduce your contribution. Always pay at least your minimum and let your company’s payment be extra. 6. Sign up for automatic payments. You’ll need to check with your loan provider for specifics, but many providers offer discounted interest rates for automatic payment enrollment. You can even set up the payment date every month based on when it’s convenient for you. This can save you money every month and prevent you from missing payments (which can cause fees and negatively impact your credit score). Bonus tip: Most providers send you a notification before they deduct the payment from your bank account, so you can be sure you have the funds to cover it.

7. Start making payments while you’re still in school. Most students don’t even think about making payments on their student loans until after they graduate. However, paying down student loans as soon as possible could help you save significantly in the long run — even small payments can add up. If you have the means to make payments on your federal loans while in school, it’s best to tackle unsubsidized loans first. These loans begin accruing interest as soon as funds are disbursed, so making early payments could help you pay less interest over the life of the loan. Subsidized loans, on the other hand, don’t actually accrue any interest while you’re in school. For private loans, direct any prepayments to the loans with the highest interest rates—especially if they are variable—to save the most money. If you plan to make early loan payments, work with your loan provider to make sure the payments are being applied as you want them to. Also, double check that your payments are going towards the principle of your loan, not just the interest. This is the best way to decrease the amount of

interest you’ll owe over the course of your loan.

Remember: It’s a Marathon, Not a Sprint

If you’re currently paying off student loans, it might be hard to envision a life without them. The best thing to do is to focus on the future and everything you can do once you’re free of your student loan debt. The methods above can help you eliminate those loans more quickly, so you can get on with reaching your other goals in life. If you’re still unsure what the right move is for you, consider speaking with a financial advisor who can provide you with advice on how to pay down your student loans faster and prepare for the future.

The strategies mentioned in this article may have tax and legal consequences; therefore, you should consult your own attorneys and/or tax advisors to understand the tax and legal consequences of any strategies mentioned in this document. First Republic does not provide tax or legal advice.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CODING CORNER

Coding Corner: CPT Reporting for Preventive Medicine Services By John Verhovshek, American Association of Professional Coders

reventive medicine services, or “well visits,” are evaluation and management (E/M) services provided to a patient without a chief complaint. The reason for the visit is not an illness or injury (or signs or symptoms of an illness or injury), but rather to evaluate the patient’s overall health, and to identify potential health problems before they manifest. The CPT® codebook includes a dedicated set of codes to describe preventive medicine services, as follows: 99381 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year) • 99382 …early childhood (age 1 through 4 years) • 99383 … late childhood (age 5 through 11 years) • 99384 …adolescent (age 12 through 17 years) • 99385 …18–39 years • 99386 …40–64 years • 99387 …65 years and older • 99391 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/ risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year) • 99392 …early childhood (age 1

through 4 years) 99393 … late childhood (age 5 through 11 years) • 99394 …adolescent (age 12 through 17 years) • 99395 …18–39 years • 99396 …40–64 years • 99397 …65 years and older Code assignment is determined by the patient’s age (as detailed in the code descriptor), and whether the patient is new (99381–99387) or established (99391–99397). CPT® applies a “three-year rule” to determine “new” vs. “established” status. A patient is established if any physician in a group practice (or, more precisely, any physician of the same specialty billing under the same group number) has seen that patient for a face-to-face service within the past 36 months. The “Decision Tree for New Vs Established Patients” in the Evaluation and Management Services Guidelines portion of the CPT® codebook can help you to select the appropriate patient status. •

Service Content Varies by Patient Circumstance Preventive medicine services must include a comprehensive history and examination, and age-appropriate anticipatory guidance. In the context of preventive medicine services 99381–99397, a comprehensive exam is not the comprehensive exam as defined by either the 1995 or 1997 Evaluation and Management Documentation Guidelines. Instead, the exam should reflect an appropriate assessment, given the specific patient’s age and sex. For example, the specifics of the exam will differ for a 4-year-old

male and a 22-year-old female. Services for a young child will assess physical growth (height, weight, head circumference) and developmental milestones such as speech, crawling and sleeping habits. Anticipatory guidance may include use of car seats and other safety issues, introducing new foods, etc. An adolescent preventive service may include scoliosis screening, assessment of growth and development, and a review of immunizations. Anticipatory guidance may focus on developing positive health habits and self-care, including discussion of drug, alcohol and tobacco use, and sexual activity. A comprehensive preventive visit for an adult female patient will include a gynecologic examination, Pap smear and breast exam. An adult male’s exam would include an examination of the scrotum, testes, penis and the prostate for older patients. Anticipatory guidance may focus on issues of health maintenance, such as alcohol and tobacco use, safe sex practices, nutrition and exercise. The patient’s employment status and other family issues may be discussed. As patient age advances, cholesterol levels, blood sugar and prostate-specific antigen testing may become increasingly relevant. Diagnoses Must Support Preventive Nature of the Visit Every billed service must be supported by an ICD-10 code(s) that describe the reason for that service. In the case of a well visit—because there is no patient continued on next page

ACCMA BULLETIN | September/October 2018

CODING CORNER

(continued from page 25)

complaint—you should turn to socalled “Z codes” (factors influencing health status and contact with health services). For example: • Z00.110 Health examination for newborn under 8 days old • Z00.111 Health examination for newborn 8 to 28 days old • Z00.121 Encounter for routine child health examination with abnormal findings • Z00.129 Encounter for routine child health examination without abnormal findings • Z00.00 Encounter for general adult medical examination without abnormal findings • Z00.01 Encounter for general adult medical examination with abnormal findings • Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings • Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings You should also code for any abnormalities found, regardless of whether the finding requires an additionally reported service. Testing and ProblemFocused Testing Are Separate Per CPT® coding guidelines: If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201–99215 should also be reported. Modifier 25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service

was provided on the same day as the preventive medicine service. To determine whether a problem requires “significant” work, consider whether the available documentation is sufficient to support each service (the preventive service and the problem-oriented service), separately. Additionally, per CPT® coding guidelines, as supported by CPT Assistant (April 2005): The codes in the preventive medicine services include the ordering of appropriate immunization(s) and laboratory or diagnostic procedures. The performance of immunization and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately. Payor Coverage May Vary The Affordable Care Act (ACA) requires insurers to cover recommended preventive services without any patient cost-sharing, but exact coverage and reporting requirements may vary from payor to payor. As CPT Assistant (April 2005) notes: Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient. For example, E/M preventive

services for a 28-year-old adult female may include a pelvic examination including obtaining a pap smear, breast examination, and blood pressure check. Counseling is provided regarding diet and exercise, substance use, and sexual activity. Therefore, based upon this information, it would not be appropriate to separately report for a pelvic exam including obtaining of the pap smear, nor the breast exam as these services are considered part of a comprehensive preventive medicine E/M services. Although this reporting method reflects the intent of CPT coding guidelines, third-party payers may request that these services be reported differently. Third-party payers should be contacted for their specific reporting guidelines. Note: Although the CPT Assistant article cited pre-dates the ACA, the advice to contact your payers regarding their reporting requirements remains valid. Be aware, as well, that Medicare reporting requirements, as stipulated by the Centers for Medicare and Medicaid Services (CMS) often differ from CPT® guidelines. For more information about Medicare Preventive and Screening Services, go to https://www.medicare.gov/coverage/preventive-screening-services.

To place a classified ad, go to www.accma.org > About Us > Advertising, 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

Improving Measures for Treating Diabetes Patients By Scott Coffin, CEO, Alameda Alliance for Health

Scott Coffin

lameda Alliance for Health (the Alliance) is proud to serve nearly 270,000 low-income children and adults in Alameda County. In this article, you will learn about the Alliance’s improved diabetes quality ratings and our commitment to tackling health care disparities. You will also receive an update on the California Department of Health Care Services’ enrollment requirement for Medi-Cal managed care providers. Improved Quality Ratings and Tackling Diabetes Diabetes is a complex disease that affects an estimated 30.3 million people in the United States and nearly 103,000 Alameda County residents. According to the Centers for Disease Control (CDC), diabetes was the seventh leading cause of death in the United States in 2015. At the Alliance, we are committed to providing high-quality care and improving the health of our most vulnerable

members. That is why we are happy to report that our measures for treating diabetic patients increased to 67 percent, a significant improvement from a previous 57 percent in just one year. The 10 percent improvement from 2016 to 2017 are the results of the Health Care Effectiveness Data and Information Set (HEDIS), a tool used by a majority of America’s health plans to measure performance on important dimensions of care and services. The HEDIS measures included how often providers monitor diabetic patients’ blood pressure control, perform retinal eye exams, nephropathy screening tests, and complete other blood tests that provide information about individuals’ blood sugar levels. Diabetes can take a heavy toll on the mental and physical health of impacted individuals and their families. In particular, racial and ethnic minorities have a high risk of complications from diabetes, such as lower limb amputation, retinopathy and kidney failure. In late 2017, the Alliance recognized that African American men have a lower rate of Hemoglobin A1C (A1C) testing compared to our general member population. As part of our efforts to address this disparity, the Alliance began crafting an intervention to tackle the lower rate of A1C testing. The Alliance has partnered with Alameda Health System’s network of federally qualified health centers to assess barriers for members in completing this lab and to find innovative solutions to improve the diabetic care of African American

men in Alameda County. Another strategy we have implemented is the Alliance’s Pay for Performance (P4P) Program, aimed at improving the care and outcomes of members by incentivizing our providers on various standards that encourage evidence-based practices and improve access to care. Our 2018 P4P incentivizes providers on three measures including: increasing A1C lab testing, increasing the number of kidney level blood tests, and controlling the blood pressure of members with diabetes. In addition to practicing intervention strategies, the Alliance will be adopting a population health approach that uses data collection from internal, external, and social sources to classify members who are at high risk of developing an illness. Using this data, the Alliance will provide support to members who have pre-diabetes, mild to moderate diabetes and those with long-standing diabetic complications. As part of this strategy, the Alliance will be looking to implement a CDC-recognized National Diabetes Prevention Program for members who are overweight and pre-diabetic. The program includes a CDC- approved curriculum, facilitation by a trained lifestyle coach, and submission of impact data to the CDC. The Alliance is committed to continuing to tackle this complex disease that impacts many of Alameda County’s most vulnerable residents. DHCS Required Enrollment for Medi-Cal Managed Care Providers continued on page 29

ACCMA BULLETIN | September/October 2018

NEW MEMBERS

NEW & RETURNING MEMBERS Gretchen D. Graves, MD Pediatrics 2240 Gladstone Dr., Pittsburg

Karin L. Klika, MD Anesthesiology

Christine Simone Koniaris-Rambaud, MD Internal Medicine 355 Lennon Lane, Walnut Creek Rekha Angappa Murali, MD Internal Medicine 2160 Appian Way, Pinole

Paul Mayer Monasevitch, MD Anesthesiology Justin Edward Pollock, MD Anesthesiology

Elie M. Richa, MD Hematology

Marc Schroeder, MD Anesthesiology

Diablo Valley Oncology & Hematology Medical Group 400 Taylor Blvd., Pleasant Hill Aditi Choudhry, MD Hospitalist

East Bay Anesthesiology Medical Group 3000 Colby St., Berkeley

Curtis Alfred Chong, MD Anesthesiology Stephen Cooper, MD Anesthesiology Gerard Duc Chinh Dang, MD

Anesthesiology NEWS & COMMENTS John Francis Donovan, MD Anesthesiology Daniel Fazio, MD Anesthesiology Matthew John Garced, MD Anesthesiology Gary Alan Goldman, MD Anesthesiology Thayer Ashley Heath, MD Anesthesiology Jill M. Kacher Cobb, MD Anesthesiology Alexander Kao, MD Anesthesiology Timur Jonathan Karaca, MD Anesthesiology

Jesse Daniel Shurter, MD Anesthesiology

Catherine Anne Stapleton, MD Anesthesiology

Jeffrey Rotwein Zweig, MD Internal Medicine

Johnny Chew, MD Anesthesiology

Jenifer Rae Shriver, MD Anesthesiology

Jason James Joseph Sloan, MD Anesthesiology

Yelena Krupitskaya, MD Hematology Oncology

Mark Dwayne Carlisle, MD Anesthesiology

Perry Pei-Yi Lee, MD Anesthesiology

Laurent Menut, MD Anesthesiology

Contra Costa Oncology 500 Lennon Lane, Walnut Creek

Christopher Robert Burak, MD Anesthesiology

Hansen Huan Le, DO Anesthesiology

Ludwig Haw-Bair Lin, MD Anesthesiology

Manijeh Ryan, MD Pain Medicine 4180 Treat Blvd., Concord

Joseph Anthony Bermudez, MD Anesthesiology

Gregory Kelly, MD Anesthesiology

Ryan Yoshio Swartz Suda, MD Anesthesiology Clifford C. Tom, MD Anesthesiology Jamie Juliana Van Hoften, MD Anesthesiology Micah Fleming Wakamatsu, MD Anesthesiology Joe Wong, MD Anesthesiology Tom Chieh-Ming Yu, MD Anesthesiology East Bay Anesthesiology Medical Group 3600 Broadway, Oakland Eric Yu-Kai Lin, MD Anesthesiology

(continued from page 5)

Epic Care 2345 Country Hills Dr., Antioch Steven Mark Kaplan, MD General Practice Jana Tomsky, MD Family Medicine Epic Care 365 Hawthorne Ave., Oakland Azure Adkins, MD General Surgery Epic Care 3003 Oak Road, Walnut Creek Salvador Gallardo Guevara, MD Colon and Rectal Surgery

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Golden Gate Urology 2999 Regent St., Berkeley Gregory Adam Barme, MD Urology Daniel Thomas Oberlin, MD Urology Hospice East Bay 3740 Buskirk Ave., Pleasant Hill Russ David Granich, MD Internal Medicine Neurology Medical Group of Diablo Valley 400 Taylor Blvd., Pleasant Hill Anahita Aghaei Lasboo, MD Neurology Pacific Urology 100 N. Wiget Lane, Walnut Creek My-Linh Thi Nguyen, MD Obstetrics and Gynecology Palo Alto Foundation Medical Group 915 San Ramon Valley Blvd., Danville Chelsea Taber Bowman, MD Internal Medicine Michael Alexander Cheng, MD Pediatrics Palo Alto Foundation Medical Group 4000 Dublin Blvd., Dublin John A. M. Paro, MD Plastic Surgery Nancy Zhining Tang, MD Obstetrics and Gynecology Palo Alto Foundation Medical Group 4050 Dublin Blvd., Dublin Nishant Goyal, MD Pediatrics Renee Marie Rodriguez, MD Pediatric Cardiology Yatin Vipin Shah, MD Pediatrics Laura Nicole Silverstein, MD Obstetrics and Gynecology Nancy Zhining Tang, MD Obstetrics and Gynecology Geetanjali Julie Wadhavkar, MD Internal Medicine Jessica Rachel Yasnovsky, MD Pediatrics Palo Alto Foundation Medical Group 3200 Kearney St., Fremont Yasamin Vojdani Chowdhury, MD Internal Medicine Chiara Marie Itchon Espiritu, MD Pediatrics Veronica Lagos-Jaramillo, MD Internal Medicine David Mcnamara Lewis, MD Anesthesiology

NEW MEMBERS

The Permanente Medical Group 3600 Broadway, Oakland

Brian Kaoru Nagai, MD Diagnostic Radiology

Vineet Sagar Sharma, MD Radiology

UCB-UCSF Joint Medical Program Elyse Ariel Katz Nazineen Kandahari

The Permanente Medical Group 2500 Merced St., San Leandro

Shelly Verma, MD Family Medicine Lindsay Larson Watson, MD Pediatrics Helen Man Ying Wong, MD Internal Medicine

Noor Chadha

Mala Kokila Krishnamoorthy, MD Hospitalist

Raj Fadadu

Ellen Elizabeth Parker, MD Radiology

Anshu Gaur

Willow Frye Katie Gutierrez Bradley Heinz

The Permanente Medical Group 320 Lennon Lane, Walnut Creek

Jonathan Kay Shek Wong, MD Pediatrics Palo Alto Foundation Medical Group 39650 Liberty St., Fremont Laura J. Hollar-Wilt, MD Psychiatry

Madeline Kang

Ngoc Giao L. Ly, MD Occupational Medicine

Kamran Abri Lavasani Douglas Martin

VEP Healthcare 1001 Galaxy Way, Concord

Curtus Sera

Mitesh Bhulabhai Patel, MD, FACHE, MBA Emergency Medicine

The Permanente Medical Group 4501 Sand Creek Rd., Antioch

Luke Silverman-Lloyd Scott Swartz Shreya Thatai Kay Walker

West Coast Surgical Associates 130 La Casa Via, Walnut Creek

Jonathan Tak-Keung Wong, MD General Surgery

ALAMEDA ALLIANCE

NEW STUDENT MEMBERS

Samuel Janis Reiter, MD Ophthalmology

Sara Sanarin Prasertsit, MD Ophthalmology

(continued)

Arash Mohebati, MD General Surgery

(continued from page 27)

At the beginning of this year, the Department of Health Care Services (DHCS) began to require that managed care network providers be enrolled in the Medi-Cal program. DHCS gave managed care plans the option to develop and implement a managed care physician screening and enrollment process or direct providers to go through the DHCS enrollment portal. The Alliance’s contracted providers are required to enroll with the Medi-Cal program no later than December 31, 2018. Enrolling with the Medi-Cal program does not obligate providers to see or deliver services to

Medi-Cal fee-for-service members but it does allow providers to do so if they choose. Contracted providers must be enrolled in the Medi-Cal program by the end of 2018 or risk termination from enrollment in Alameda’s managed care delivery system. For more information on the enrollment process, visit www.dhcs.ca.gov or call (916) 323-1945.

About Alameda Alliance for Health

Alameda Alliance for Health (Alliance) is a local, public, not-for-profit 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 nearly 270,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care programs.

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

ACCMA BULLETIN | September/October 2018

CLASSIFIEDS

POSITIONS AVAILABLE – 1

OFFICE ADMINISTRATOR IN ANTIOCH: Busy Antioch medical practice is seeking an Office Administrator to manage four locations and a surgery center. We are looking for a candidate who can think critically and work independently. Must be a team player who is organized, innovative, energetic with good communication skills, and attention to detail. Will need three (3) years of experience in human resources, employee hiring, EHR RCM, and purchasing. It is important that candidates have experience in a medical practice. Responsibilities to include, but not limited to, facility management, including optical shop and surgery center. Administrator will communicate and report to managing partners. BA or equivalent experience. Competitive salary. Email cecmgr@pacbell.net. (1 – July/ Aug – Sept/Oct) PHYSICIAN IN EAST BAY: Epic Care is seeking an Internal Medicine or Family Practice physician to join our busy primary care practice in the East Bay. This is an outpatient-only clinic. Full-time or

part-time options are available. Please send CV and inquiries to hr@epic-care. com with your contact information. (1 – July/Aug – Sept/Oct)

OFFICE FOR RENT – 3

CASTRO VALLEY MEDICAL OFFICE SPACE AVAILABLE: 2,400 s.f. newly renovated office space on Lake Chabot Road directly across from Eden Hospital. Location ideal for many uses. Original design as two medical office suites but has been combined now into one large unit, or willing to divide into 1,000 s.f. and 1,400 s.f. office suites again, each with separate entrances and utilities. Ground-level single-story building with three suites. Ample off-street parking, seven exam rooms (three/four, six with sinks), very large reception area, and front office workspace. Break room and lab areas. Each unit has a private office. Tons of storage, windows, and natural light in all rooms. Two private courtyards. Owner occupies third suite. $6500/mo. ($2700/$3800, if divided), plus PG&E (separately metered) and garbage. Simple lease. Call (510) 914-3928

or stop by 20100 Lake Chabot Road. (3 – July/Aug – Sept/Oct) NORTH OAKLAND MEDICAL OFFICE SPACE AVAILABLE: Three exam rooms and an office consultation room available Mondays, Wednesdays, and Fridays at 80 Grand Ave., Suite 810, Oakland. $600 per day. Contact Elena DeLeon at edeleon@ebplasticsurgery.com or (510) 451-6950.

PRACTICE CLOSURE - PC

CLOSURE OF FREMONT RHEUMATOLOGY: Dr. Barry Shibuya and Dr. Christine Elias are announcing the closure of Fremont Rheumatology at 3775 Beacon Avenue, Suite 100, as of November 16, 2018. Patients who need help in selecting another rheumatologist should contact the practice staff at (510) 791-1300, their primary care physician, or their health insurance company. In order to receive a copy of their medical records, patients should submit a signed Medical Record Release Authorization Form to the practice office as soon as possible. (PC – Sept/Oct – Nov/Dec)

IN MEMORIAM SAMUEL B. HERSHENHOUSE, MD (1921–2018) passed away at his home in Fairfield on August 28. He was born on December 9, 1921 in Chicago, earned his MD in 1944 from the University of Illinois, and interned at Cook County Hospital in Chicago. He served honorably in the U.S. Navy Medical Corps as a Lieutenant Junior Grade during WWII. His first assignment was at the Naval Hospital in St. Albans, NY, and then at the U.S. Naval Hospital and Naval Air Dispensary in San Juan, Puerto Rico. In 1947, Dr. Hershenhouse returned to Chicago for his Internal Medicine residency at the Edward Hines, Jr. VA Hospital. He then entered private practice in Duluth, Minnesota before being called back to serve in the Korean War. He served in the Korean War from 1951 to 1953 as a Lieutenant and Flight Surgeon at Cherry Point, North Carolina. In 1954, he moved to Northern California where he was one of the founding members of the East Bay Medical Group in San Leandro. He was a group partner for 20 years before opening a solo practice in 1974 at Doctor’s Hospital (now San Leandro Hospital). He retired in 1998, but he maintained his medical license until he was 95 years old. Dr. Hershenhouse was a member of ACCMA for 47 years. Dr. Hershenhouse was married to Betty Rice of Ohio on January 6, 1945. They had three children: Donald, Jan, and Jo

Ann. Betty passed away in 1973 at age 53 from complications of multiple sclerosis. In 1975, he found love again on a blind date with Sandra Martin and they were married on September 6, 1975. They became a wonderfully blended family with Sandy’s three children: Skip, Marjie, and Russ. Dr. Hershenhouse was a devoted family man who loved spending time with his six children, eight grandchildren, and ten great-grandchildren.

JAMES KIERAN, MD (1920–2018) died peacefully at home with his family by his side. A graduate of Yale and Columbia School of Medicine, he served in the Philippines in WWII and led the first group of physicians to visit China decades later. He moved to the Bay Area to become a pioneer in pulmonary medicine. He was granted the Pottenger Award and the Will Ross Medal by the American Lung Association and earned emeritus status at Stanford and UCSF. He was an ACCMA member for 53 years. He visited Yosemite and AnzaBorrego Springs often, binoculars in hand, peering at tiny flowers and giant birds with equal delight as an avid bird watcher and naturalist. Married twice (Evelyn and Sonya), he is survived by 5 of his 6 children, 4 step-children, 10 grandchildren, and 10 great-grandchildren.

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