ACCMA July/August 2020 Bulletin

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

ISSUE FOCUS:

July/August 2020

Advocacy, Leadership, and Wellness Through Troubling Times

Telemedicine for our members As a medical society member you have free access to Medici.

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Conduct virtual visits from the Medici app

eReferrals

HIPAA compliant text, video, and voice communication with colleagues and patients

For more information, visit

medici.md/connect-members to learn more or download the app.

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ACCMA EXECUTIVE COMMITTEE Katrina Peters, MD, President Suparna Dutta, MD, President-Elect Robert Edelman, MD, SecretaryTreasurer Lubna Hasanain, MD, Immediate Past President Edmon Soliman, MD, Councilor-atLarge COUNCILORS & CMA DELEGATES Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD Russ Granich, MD James Hanson, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Arden Kwan, MD Terence Lin, MD Lilia Lizano, MD Abbas Mahdavi, MD Ross Pirkle, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Katrina Saba, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Edmon Soliman, MD Judith Stanton, MD Clifford Wong, 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) Ronald Wyatt, Jr., MD, CMA Trustee

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

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PRESIDENT’S PAGE Ending Systemic Racism

By Katrina Peters, MD, ACCMA President

COMMUNITY RESOURCES 6

ACCMA, CMA Distribute Free PPE to Local Physician Practices

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Exploring Leadership with the ACCMA Physician Leadership Program

By Hilary Worthen, MD, Physician Leadership Program Course Director

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July/August 2020 | Vol. LXXVI, No. 4

CURRENT TOPICS 8

AB 890 Heading to the Senate

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Member Spotlight: Sonia Sutherland, MD

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Hospital-Based Nurses Help Mitigate COVID-19 in Nursing Homes

By Terry E. Hill, MD, FACP; Taejoon Ahn, MD, FACP; Rebecca Rozen, MSc; Joe Greaves, MA

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Increasing Access to Naloxone

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Prioritize Childhood Immunizations

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ACCMA & CMA Oppose Prop. 23 – Regulating Dialysis Clinics

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Responding to the COVID-19 Pandemic

By Scott Coffin, CEO, Alameda Alliance for Health

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NEW MEMBERS

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COUNCIL REPORT

ACCMA Clinician Wellness Program

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 Lamont Paxton, MD Katrina Peters, MD Frank Staggers, Jr., MD Ronald Wyatt, MD

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ACCMA STAFF Joseph Greaves, Executive Director Mae Lum, Deputy Director Griffin Rogers, Director, Napa & Solano County Medical Societies David Lopez, Assoc. Dir. of Advocacy and Strategic Initiatives Takhmina Amin-Rahbar, Communication & Research Associate Essence Hickman, Operations Associate Jennifer Mullins, Education and Events Associate Hannah Robbins, Policy Associate

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

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ACCMA BULLETIN | JULY/AUGUST 2020

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PRESIDENT’S PAGE

A program of the Alameda-Contra Costa Medical Association Enhance your leadership effectiveness Learn from nationally recognized experts Expand your network with local colleagues Earn a Certificate of Completion and up to 24 hours of CME Credit

DATES

Eight Evening Sessions: October 6, 2020 October 20, 2020 November 10, 2020 November 17, 2020 December 1, 2020 Deccember 15, 2020 January 5, 2021 January 19, 2021

FEES $1,900 $1,400 (Medical Society members) Group Discounts: • 10% off for groups of 3-4 from the same organization • 15% off for groups of 5 or more from the same organization

* Register by Tuesday, September 15 to save $100

LOCATION

Interactive Online Series For additional information, please contact Jennifer Mullins, ACCMA Education & Events Associate, at jmullins@accma.org, or (510) 654-5383.

SESSION 1: PRINCIPLES OF LEADERSHIP AND LEADING CHANGE

Tuesday, October 6, 2020 | 6:00 - 8:00 PM Common models of leadership, its importance to organizations, ways that clinical skills can inform leadership, and the interdependency of leadership and followership will be presented.

SESSION 2: UNDERSTANDING OURSELVES AND OTHERS THROUGH PERSONALITY PREFERENCE TYPES

Tuesday, October 20, 2020 | 6:00 - 8:00 PM We will focus on how self-understanding makes us more effective leaders. The use of tools, such as the Meyers-Briggs Type Indicator®, to discover our style preferences and those of others will be demonstrated, as well as strategies on how to collaborate around those preferences.

SESSION 3: MOVING TOWARDS AN ANTI-RACIST WORKPLACE

Tuesday, November 10, 2020 | 6:00 - 8:00 PM We will be addressing what an anti-racist workplace looks like and the change needed to achieve this, as well as what each of us can do, from our unique positions to support and lead the change.

SESSION 4: EFFECTIVE COMMUNICATION

Tuesday, November 17, 2020 | 6:00 - 8:00 PM We will examine how we tell, hear, elicit, validate, and suppress stories. The power of reframing and vulnerabilities to persuasion will be discussed, as well as how to create effective presentations and meetings as forms of narrative.

SESSION 5: NEGOTIATION

Tuesday, December 1, 2020 | 6:00 - 8:00 PM This session will build on our earlier discussion of teams and look at our style preferences for dealing with conflicting aims within and across teams, departments, and institutions.

SESSION 6: INSPIRING, MOTIVATING & MOBILIZING OTHERS

Tuesday, December 15, 2020 | 6:00 - 8:00 PM Having tools for balancing competing values and aims in complex situations can enlist the team’s best efforts toward shared organizational purpose.

SESSION 7: MANAGING CONFLICT - DIFFICULT CONVERSATIONS

Tuesday, January 5, 2021 | 6:00 - 8:00 PM Team collaboration is essential to maintaining a healthy workplace and delivering high-quality patient care. How can we navigate the dynamics of managing up, across, and down? How do we build productive relationships with toxic colleagues and bosses? What collaborative approaches can we take with our to the structure and functions (and dysfunctions) of teams.

SESSION 8: PLANNING AND SUCCEEDING AT PROJECTS To register, visit

learning.ACCMA.org/Leadership

Tuesday, January 19, 2021 | 6:00 - 8:00 PM This sessions is an introduction to the formal project management framework and its connections with clinical management. Use clinical skills to build credibility with administrators and management.

PRESIDENT'S PAGE

Ending Systemic Racism

By Katrina Peters, MD, MPH, ACCMA President

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ndependence Day 2020 was a sobering time for our country to ponder the meaning of freedom and equality as we continue to battle a pandemic that keeps us 6 feet apart and are forced to face again the enduring effects of our nations dark past of excluding whole other groups of people from the American Dream of life, liberty and the pursuit of happiness. Although the first Patriot killed in the Revolutionary War was an American Black man, Crispus Attucks, as a former slave, it would be almost a hundred years before he could be counted as a full man by the 14th Amendment of the Constitution.

In the midst of what has become another dark time in our nation’s history, it is heartening for many of us to see people coming together across different races, ages, geographies, genders, sexual orientations, and political parties to say enough is enough: we need to achieve racial equity and put an end to systemic racism.

For many of us, racism is not just a social ill, it has shaped our personal lives and careers. The loneliness and isolation that comes with being among the first in a medical school class or residency program, and the associated pressure to conform and fit in, is familiar to many of us. Some of us have even been excluded outright from opportunities that have been afforded to our white colleagues. And too many of us know what it’s like to be underestimated, to be met with the surprised reaction of “Oh, you’re the doctor?” when we meet a new patient. Sometimes the skepticism comes from our peers.

For all of us, systemic racism has had a profound impact on the health of our patients. History has given us the Tuskegee experiment, the case of Henrietta Lacks, the horrors of Dr. James Marion Sims, among others. We know how the linkage between race and socioeconomic opportunity still contributes to enormous health care disparities. We know that the best predictor of life expectancy is the zip code where someone lives, with people in white neighborhoods living years longer than their neighbors in black and brown neighborhoods. We know that there are differences in the quality of insurance coverage and major disparities in access to care that correlates with race and ethnicity.

Even enormous wealth and celebrity are not enough to protect against unconscious bias and racism in receiving health care.

Serena Williams, arguably the greatest tennis player of all time, had severe complications and almost died after the birth of her daughter, after health care clinicians initially ignored and dismissed some of her symptoms of pulmonary embolism despite having a history of life threatening pulmonary embolisms.

Systemic racism is pervasive in America, permeating far beyond health care. The national historic tragedy of slavery and the unrealized promise of emancipation and equality that followed have left deep wounds in our country. Throughout our society, we see systems and structures with deeply rooted processes that systematically disadvantage people of color, especially black and brown people. We see this in the criminal justice system, housing, education, and economic opportunity, in addition to health care, to name only a few.

I truly believe that Dr. Martin Luther King Jr. was correct when he said that the arc of the moral universe is long, but it bends towards justice. But that happens only when we commit ourselves to doing the hard work of healing our nation’s wounds and breaking down the systems that reify white supremacy and perpetuate racism. In other words, it is up to all of us to bend the arc towards justice.

The Alameda-Contra Costa Medical Association (ACCMA) has a long and proud history of diversity and inclusion. We regularly advocate to improve health equity for our most marginalized patients, to strengthen public health, and to enhance all patients’ access to care. But we also know there is more we can do to dismantle systemic racism. At our meeting in June, the ACCMA Council voted unanimously to form a task force comprised of ACCMA members to guide our advocacy priorities, programs, services, and activities related to health equity, the elimination of disparities, improving cultural competency among physicians, and reducing bias in the delivery of care.

We are currently recruiting ACCMA members with the experience and interest to serve on this task force. The time commitment should be manageable; although meetings may be held more frequently initially, we expect that the task force will meet quarterly in the evenings for approximately 1.5 hours. Meetings continued on page 13 ACCMA BULLETIN | JULY/AUGUST 2020

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PPE DISTRIBUTION

ACCMA, CMA Distribute Free PPE to Local Physician Practices

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ver the last several months, many physicians have had to limit hours or close their doors completely because they cannot find the Personal Protective Equipment (PPE) they need to safely keep their offices open. In response to the tremendous need for PPE across the country, the Alameda-Contra Costa Medical Association (ACCMA) worked with the California Medical Association (CMA) and the California Office of Emergency Services to organize two drive-thru PPE distribution events in the East Bay, distributing over 600 PPE kits to local practices. The State of California made millions of pieces of medical-grade PPE – including N95 masks, surgical masks, shields, gowns and gloves – available for free to physician practices.

ACCMA President, Doctor Katrina Peters, participating in the Alameda County PPE event.

Bay, the PPE kits were made available to all qualifying physician practices, whether or not they are members.

Financial support for the distribution of this PPE was provided by Altais, a new health care services company that helps physicians maximize the health and well-being of their patients in a way that is sustainably affordable and maintains professional satisfaction.

Volunteers Lori Orr and Victoria Warner checking participants in at the Contra Costa County PPE event.

The two local PPE distribution events took place on July 29 and August 3 in Oakland and Pleasant Hill. Although many hands went into making these events a success, we would like to offer a special thank you to our esteemed ACCMA President, Dr. Katrina Peters, as well as Drs. Irina Kolomey and Michael Melewicz, for volunteering. We would also like to offer a big thank you to Dr. Ronald Wyatt, who was instrumental in connecting us with a space in Oakland and with young, strong volunteers for all of our events.

This PPE will help fortify California’s health care infrastructure as we continue to wrestle with the COVID-19 pandemic and issues with the PPE supply chain. PPE Relief kits included up to a two-month supply of masks, shields, gowns, gloves, and hand sanitizer. In an effort to help physician practices across the East 6

Volunteer Cynthia Carbin, MD, checking participants in at the Alameda County PPE event.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

PPE DISTRIBUTION

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ACCMA staff, MIEC volunteer Philip Stiles, and ACCMA President Doctor Katrina Peters supporting local physicians at the Alameda County PPE event.

ACCMA President Doctor Katrina Peters and volunteer Vionna Liu checking in participants at the Alameda County PPE event.

Volunteers from the Oakland Temple loading PPE kits into vehicles at the Alameda County PPE event.

Volunteer Aenor Sawyer, MD, checking in participants at the Alameda County PPE event.

ACCMA staff directing traffic at the Alameda County PPE event.

ACCMA BULLETIN | JULY/AUGUST 2020

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COVID-19

AB 890 Heading to the Senate (continued from page 6)

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ver the past year, physicians across the State of California have been advocating for the opposition of Assembly Bill 890 (Woods): Nurse Practitioner’s Scope of Practice. AB 890 would remove critical patient protections by allowing nurse practitioners (NPs) to practice independently without physician supervision.

This bill has cleared out of the Assembly Floor and has made its way into the Senate, where it will be referred to the Senate Business and Professions Committee (B&P). The Senate B&P Committee is chaired by a local Senator, Senator Steve Glazer. The ACCMA sent the following letter to Senator Steve Glazer.

Dear Senator Glazer: I am writing on behalf of the Alameda-Contra Costa Medical Association (ACCMA) – representing nearly 5,000 East Bay physicians – to urge you to oppose AB 890 (Wood). This bill would remove critical patient protections by allowing nurse practitioners (NPs) to practice independently without physician supervision. We urge you to protect patient safety and quality of care for all Californians by voting no on AB 890.

We appreciate and share the Legislature’s desire to improve access to care for Californians. However, we believe the best way to improve access to care is by increasing the number of medical schools in California, increasing funding for residency slots, expanding loan repayment programs for physicians in underserved areas, and increasing Medi-Cal’s dismal reimbursement rates to a level that actually covers the cost of providing care. Permitting NPs to practice without physician supervision will create more fragmentation in our health care system at a time when health care is trending towards increased integration, collaboration and team-based care.

Proponents have suggested that AB 890 is necessary to bring primary care and mental health treatment to underserved and rural areas, but the bill does not actually require either of those elements to be met. AB 890 would allow NPs to provide any type of care - including specialty care – to any area of California. In states where NPs have been granted independent practice, data has shown that NPs do not actually move to underserved areas to practice but rather stay in the same geographic areas, serving the same patients, as physicians. Studies have shown that without any statutory parameters in place, unsupervised nurse practitioners won’t relocate to, or practice in, rural and underserved areas.

AB 890 also does not require a standard of competency to be met before independent practice is granted, which will diminish quality of care and increase the risk to patients. Practicing medicine requires years of education and training that many NPs do not receive. Although AB 890 requires an ill-defined 2-3 year “transition to practice”, it doesn’t require that the 2-3 years be spent training under the supervision of an actual physician.

Physician after physician can recite the tremendous value that NPs provide as part of an integrated, physician-led care team.

Unfortunately, many can also share numerous individual circumstances where physician oversight of nurse practitioners and intervention prevented patient harm or avoided unnecessary tests and procedures. Ensuring safety depends on preserving a relationship between physicians and nurse practitioners where there are boundaries of care that the nurse practitioner will function within based on their education and experience, and beyond which they would only proceed under physician guidance and support.

The wrong approach to expanding access is to reduce the quality and safety of our health care system. The right approach is to increase the number of physicians in California through added residency slots, additional medical schools and incentivized programs that help add doctors to underserved areas. We urge you to oppose AB 890.

Sincerely, Katrina Peters, MD, MPH, ACCMA President

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Cc: Janus Norman, CMA SVP of Government Relations

PHYSICIAN LEADERSHIP PROGRAM

Exploring Leadership with the ACCMA Physician Leadership Program

By Hillary Worthen, MD, Physician Leadership Program Course Director

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his fall the ACCMA will offer the fourth iteration of its successful Physician Leadership Course. But this version will be different, as we respond to the COVID-19 pandemic with the tools of distance learning with which we are all becoming more familiar. To respond to this challenge, we have been working with Deborah Barnett, Ph.D., Chief of Curriculum and Instruction and Director of the on-campus/online MPH program for the UC Berkeley School of Public Health. We believe we have created an exciting, engaging, and convenient way to help physicians increase their leadership skills and expertise.

Why is this important? In times like these, when crises global and local have brought forth examples of leadership ranging from outstanding to appalling, the impact of leaders seems obvious. But leadership is needed not only in times of crisis. I will go so far as to say that without leadership, very little would happen beyond individual actions and those rare random instances when those actions of a few people just happen to align and complement each other. How can that be? Think of what we do all day and how much of it involves being influenced by and influencing others. In other words, changing what we do and what others do to align, mobilize, inspire, focus, and collaborate in the interest of a mutually desired goal. From a clinical encounter to setting policy for a health system, we are continuously involved in leadership and followership relationships. Sometimes this is exhilarating, sometimes excruciating, often tedious, frustrating, and variably effective. But it is necessary, and the good news is that we can all learn to do it better.

There is a long history to leadership – it is identifiable in some form in species from ants to chimps – but the written exploration also goes way back, to Homer, the Bible, and ancient China.

Historically, most of this has focused on military, political, and religious leadership, but in the last century interest in leadership in other kinds of organizations has exploded. I once measured the shelf space devoted to business leadership at the Harvard Coop bookstore – 33 feet, 7 shelves high. And that doesn’t count periodicals. Healthcare is a bit of a late entry into this literary sweepstakes, but we are catching up. And a great deal of the best ideas from the other domains can be useful in some form to us, as

we move increasingly toward working in teams and organizations.

What parts of this avalanche of leadership wisdom is likely to be most helpful to us as physicians? First, let’s look at the key challenges we are facing. At the most personal level, we all need to find ways to organize our lives in relationship to our families, friends, communities, workplaces, and goals. The responsibilities and strategies involved often seem to conflict with each other and with our relationships with ourselves, and the sum can leave us exhausted. At the other end of the spectrum, physicians are increasingly finding themselves working in larger organizations with more hierarchical structures, where there seems to be a dichotomy between practicing medicine and influencing the direction of the organization. All of these challenges represent opportunities to apply the principles and tools of leadership.

Our leadership course is a direct descendant of the longstanding 2-year leadership fellowship of the California Healthcare Foundation. Graduates of that program started the Institute for Physician Leadership at the UCSF Center for the Health Professions in 2007, and many of the current faculty and leadership of this course are veterans of that program. The faculty includes experienced physician leaders and people with deep backgrounds in healthcare and physician education. We use as an organizing framework the model developed by Management Sciences for Health, a large NGO that has been working in global health for over 30 years. Although this model was developed and refined in the context of the developing world, it is broadly applicable to our current healthcare system, which, as has been revealed by the COVID-19 experience, has many issues in common with far less-resourced settings. It has the benefit of borrowing the best of leadership ideas and tools from other domains while remaining fully focused on healthcare.

Leadership is a huge topic, and the study of it can, and probably should be, lifelong. In this course, we will use a combination of readings, listenings, viewings, didactic talks, small group activities, and ongoing topical threads to deepen understanding of core principles, concepts, skills, and tools that make leaders effective.

Synchronous online sessions will address: continued on page 13 ACCMA BULLETIN | JULY/AUGUST 2020

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CLINICIAN WELLNESS PROGRAM

ACCMA Clinician Wellness Program

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n this Bulletin issue, we are featuring two components of the ACCMA Clinician Wellness Program. Our wellness program is part of ACCMA’s mission to empower physicians in their profession and to bring physicians together to improve the quality of the practice of medicine. One of our many program components that focus on wellness at the individual level is our free group psychotherapy sessions with vetted psychologists and counselors.

Another component of our wellness program focuses on supporting clinician wellness at the organizational level and addressing systemic causes of clinician burnout.

FREE VIRTUAL GROUP THERAPY SESSIONS To help physicians cope with emotional stress, the ACCMA partners with Bay Area therapists who are experienced in working with physicians to offer free online group therapy. Small groups of three to eight physicians will meet together, confidentially and privately, with a vetted psychologist or therapist for six sessions. Convenient times are available. Physicians sign up directly with the mental health professionals for these virtual appointments, and there is no charge. This peer support and counseling service is available to all physicians and medical residents (MDs and DOs) in Alameda and Contra Costa counties, both members and non-members. Go to accma.org/Sponsored-Psychotherapy to learn more and to contact the therapists directly. Physicians can also reach the ACCMA confidentially at wellbeing@accma.org, or (510) 654-5383, ext. 6307 with any questions.

COLLABORATING TO ADDRESS SYSTEM DRIVERS OF BURNOUT The availability of peer support, and developing individual wellness habits and resilience capabilities, can be effective responses to chronic job stressors or the inability to resolve work-life conflicts. However, many influential factors that affect physician professional satisfaction are at the organization and health care system level: new methods of health care delivery, reporting and documentation requirements, operational policies of being employed physicians, and so on. The East Bay Clinician Wellness Consortium was established in 2019 as a joint project of the ACCMA and the East Bay Health Workforce Partnership to bring 10

together representatives from health systems, medical groups, hospitals, clinics, and other provider organizations to work collaboratively to promote clinician wellness and combat burnout through regional collaborations and system-level interventions.

The purpose of the Consortium is to identify and disseminate best practices; identify and/or develop programs, services, and resources that can help support clinician wellness; and, identify drivers of clinician burnout that can inform local, state, and national advocacy priorities. Working collaboratively on a systems-based approach to identifying and combating root causes of physician burnout as a consortium supports and amplifies physicians’ ability to lead changes at the organization and health care system level.

The Consortium convenes quarterly and beginning in March 2020, began to hold its meetings virtually via Zoom. The two co-chairs are Lubna Hasanain, MD, immediate past president of the ACCMA, and Calvin Wheeler, MD, Institutional Director of UME/GME at TPMG. Consortium members have gathered information about clinician wellness efforts currently underway, including the successful Joy of Medicine program developed by the Sierra Sacramento Valley Medical Society, the statewide wellness survey coming soon from the California Medical Association, and programs developed by RENEW and RechargedMD. When the COVID-19 crisis began, consortium members pivoted to focusing on providing mental health support and other practical resources for physicians, as well as supporting one another by sharing stories of how they are coping with the crisis. The next convening of the Consortium is on September 17, 2020.

Becoming a member of the East Bay Clinician Wellness Consortium is a great way to demonstrate your organization’s commitment to promoting clinician wellness and professional satisfaction. As a member of the Consortium, you and your organization will be invited to attend quarterly Consortium meetings and to help shape our work going forward.

The ACCMA Clinician Wellness Program is dedicated to providing a wide array of resources to support the wellness, wellbeing, and professional satisfaction of East Bay physicians, including emotional and financial wellness webinars, the ACCMA continued on page 14

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

MEMBER SPOTLIGHT

Member Spotlight: Sonia Sutherland, MD

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CCMA member Sonia Sutherland, MD, is no stranger to helping and supporting her patients, colleagues, and family, although the current COVID19 pandemic is a different matter altogether. Like many of her colleagues at Contra Costa Health Services (CCHS), she is on the front lines of an unprecedented crisis and experiencing its Sonia Sutherland, MD impact on her day-to-day practice as an internal medicine physician in hospital and ambulatory care.

But in her role as Medical Director of Quality and Safety, she is also responsible for, and needed to respond to the psychological impacts that this pandemic has on her colleagues, patients, and herself. Fortunately, Doctor Sutherland had already begun the journey in the fall of 2019 to address physician burnout, together with Chief Medical Officer Samir B. Shah, MD (now Chief Executive Officer as of July 1) and Medical Staff President Kristin Moeller, MD. The CCHS Wellness team began designing their Clinician Wellness Program by holding a roundtable discussion with their physician colleagues. Before they could brainstorm about activities that could mitigate the negative impacts of stress, the team was interested in hearing from their colleagues in order to come to a shared understanding of what wellness is and what activities were and could be successful, as well as collect a wish list. Specifically, they wanted to hear their colleagues’ answers to three questions: (1) What’s your definition of wellness? (2) What’s currently happening in your department to support wellness? and (3) What

Samir Shah, MD; Kristin Moeller, MD; Sonia Sutherland, MD

ideas do you have and what do you think is needed?

The CCHS Wellness team, whose tagline is “Inspiring WellBeing,” initially focused on supporting ambulatory providers and activities that could be implemented at the system level, and partnered early on with the Family Medicine Residency Program under the direction of Brian M. Johnson, MD. Doctor Sutherland co-led the effort to build self-care tools to strengthen wellness and stress resilience, which include mindful movement exercises, gratitude practice, and building healthy habits. When the COVID-19 pandemic began in March, the emotions triggered in physicians by caring for so many patients with the coronavirus underscored the importance of addressing physicians’ ability to function optimally. There was an urgent need for immediate strategies to mitigate and cope with these emotions. The CCHS Wellness team quickly responded by offering their first COVID-related wellness tip sheet on March 16, three days after California schools were ordered closed by the Governor’s Executive Order. The tip sheet included praise from CCHS patients for their physicians and free self-care resources that could be accessed from home.

At the same time, there was recognition that the Clinician Wellness Program had to be a more comprehensive program. The CCHS Wellness team did not want to limit their program only to physicians because of the important role that front-line staff and every medical team member can play in the overall health and safety of the patients they serve. Moreover, the program had succeeded in focusing attention on the intrinsic importance of clinician wellness and its impact on patient care. The logical next step was to make the program interdisciplinary and open to staff and everyone on the medical team.

On April 27, the CCHS Wellness team launched its internal website to crowdsource wellness tips, for medical staff to share their stories of resilience, and to collect and disseminate positive comments from patients and medical staff alike. The website has proven to be very popular. They have had over 2,000 visits to that website since its beginning, and over 600 hits on the personal stories alone. Their most popular tip sheets are “Staying Healthy at Home and at Work Beyond COVID-19” and “Adapting to the New Normal (+ A TikTok Video for Nurses Week).”

Doctor Sutherland credits the success of the CCHS Wellness program to its timeliness, its relevance, its multidisciplinary nature, the diverse contributions from its medical staff, and deep staff engagement in general. The wellness tip sheet is sent out regularly continued on page 13 ACCMA BULLETIN | JULY/AUGUST 2020

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SPECIALTY-SPECIFIC TIPS

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ACCMA MEMBERSHIP

JOIN OR RENEW TODAY! When you join the Alameda-Contra Costa Medical Association and the California Medical Association, you join more than 47,000 members statewide who are actively protecting the practice of medicine and defending public health.

EASY PAYMENT PLANS

SAVINGS PROGRAMS

MONTH-TO-MONTH MEMBERSHIP

SAVE

EARLY BIRD DISCOUNT: Renewing members save 5% when dues are paid by December 11, 2020.

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TWO-YEAR MEMBERSHIP: Pay two years in advance to save 10%.*

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THREE-YEAR MEMBERSHIP: Pay three years in advance to save 15%.*

Physicians can join at any time for only $89 per month! Your membership automatically renews each month for worry-free continuation of your member benefits.

ANNUAL DUES INSTALLMENT PLANS

Annual dues can be divided into monthly or quarterly installment payments to make your dues more manageable.

Call the ACCMA at (510) 654-5383 for more information.

5%

10% 15%

PLUS! FOR RETURNING MEMBERS ONLY Renewing members paying multi-year dues in advance can divide their total amount over four payments.† * No refunds for advance dues payments. † Final dues payment must be made by December 11, 2020.

MEMBER SPOTLIGHT

twice a week to 3,500 employees. It has addressed health inequities and offered a holistic toolkit for coping with racial trauma.

Personal stories from medical staff on coping with the pandemic, including TikTok videos, are popular features of the program, and ensure coverage of timely and relevant topics. The focus is on the medical team and front-line staff of all disciplines: physicians, residents, psychologists, nurses, and behavioral health wellness influencers, including staff in environmental services and health information management, and at the registration desk. And the program is more than just an online platform and communications tool: wellness care packages that include stress relief balls have been delivered to all staff to emphasize the inclusiveness of the CCHS Wellness Program.

As an ACCMA member, Doctor Sutherland is an active participant in the East Bay Clinician Wellness Consortium, a joint project of the ACCMA and the East Bay Health Workforce Partnership to identify best practices, develop programs that can

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support clinician wellness, and address system drivers of clinician burnout (see article on page 10).

Doctor Sutherland has her own personal story about dealing with the COVID-19 crisis and how she is coping with the stress.

Not surprisingly, she finds her strength in helping her colleagues and patients. “Like so many, I’ve had to find my way through the COVID pandemic. As a physician, it was natural to be involved in the care of patients and helping to build our system’s COVID response. As a wife and mother, I’ve had to help our children navigate the changes in school and the disconnect from their friends. As a family member, I’ve dealt with the death of a loved one in the middle of the crisis. Yes, it has been a lot. I’m still finding my way. But a clear light was the CCHS Wellness team.

Supporting and helping those who are helping so many extended my personal healthcare reach. I am in awe of the work done by health care and first responders. These are trying times both in healthcare and beyond our walls.”

PRESIDENT'S PAGE (continued from page 5)

will be held by videoconference through at least the remainder of 2020. When we can convene again in person, we will continue to provide an option for remote participation.

If you or one of your colleagues is interested in getting involved with this task force and supporting our collective efforts to dismantle systemic racism within health care and address its adverse impacts on our patients, please consider volunteering. You

may contact Joe Greaves, Executive Director, at 510-654-5383 ext.

6301 or jgreaves@accma.org to nominate yourself or a colleague.

The mission of the ACCMA is –and always has been since it was established in 1868–to bring doctors together to improve the health of our community. We look forward to rolling up our sleeves and with your help, looking at how we can collectively make progress towards a more just and equitable health care system.

PHYSICIAN LEADERSHIP PROGRAM (continued from page 9)

• • • • • • • •

Principles of Leadership and Leading Change Understanding Ourselves and Others Through Personality Types Moving Toward an Anti-Racist Workplace Effective Communication Negotiation Inspiring, Mobilizing and Motivating Others Managing Conflict: Difficult Conversations Planning and Succeeding at Projects

In addition, there will be materials and discussion opportunities to delve into topics like trust, decision making, power and influence, systems thinking, developing and coaching others, values and ethics, dealing with toxic colleagues and bosses, and more.

In past years the ACCMA Physician Leadership Course has

drawn primarily from membership in the ACCMA or the immediate surrounding areas. This year, because of the online format, we hope to have a cohort that represents a broader geography.

One of the strengths of this course has been that it brings together people from different institutions, practice venues, and specialties, and we expect this to continue. Working with a diverse group of participants provides a rich array of perspectives as we discuss the common challenges to our work in healthcare.

We are excited about moving into the virtual world with this course and hope that you will join us, and send any interested colleagues our way.

For more information about the upcoming Physician Leadership Program, see the flyer on page 4. Visit learning.ACCMA.org/Leadership to register for the program.

ACCMA BULLETIN | JULY/AUGUST 2020

13

CLINICIAN WELLNESS PROGRAM

(continued from page 10)

East Bay Clinician Wellness Consortium meeting, June 6, 2019

Physician Leadership Program, free group counseling sessions with vetted therapists, small peer group meetings, confidential peer assistance from members of our physician well-being and litigation stress committees, socially distanced social events, an online wellness resource center, and the East Bay Clinician Wellness Consortium. These resources are available to all ACCMA members and some are open to non-members, including medical

students and residents, active members, and retired members.

Contact Mae Lum, ACCMA Deputy Director, at mlum@accma. org or (510) 654-5383, ext. 6307, to learn how our sponsored group psychotherapy sessions, the East Bay Clinician Wellness Consortium, or the ACCMA Clinician Wellness Program in general can support you and your medical practice.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID-19 IN NURSING HOMES

Hospital-Based Nurses Help Mitigate COVID-19 in Nursing Homes

By Terry E. Hill, MD, FACP, Taejoon Ahn, MD, FACP, Rebecca Rozen, MSc, Joe Greaves, MA

Original article in GeriPal at https://bit.ly/39MnfqT. Hyperlinks have been adapted for print. Permission to reprint at https:// bit.ly/3hGkVFa.

F

or some of us, the cruelest month was mid-March to midApril, during which our warnings about COVID-19 infections in long-term care (LTC) seemed to get little response.

Here in one Bay Area county, that changed when hospital nurses engaged LTC facilities and triggered county-wide public-private coordination. As a result, an opportunity for creativity rather than finger-pointing has emerged.

The wakeup call that everyone should have heard came from a March 18th report (https://bit.ly/2XdDRTu) of the index nursing home in King County, Washington: 81 of 130 residents had been infected, of whom 46 were hospitalized and 22 died.

According to the follow-up New England Journal of Medicine paper (https://bit.ly/33gezIa), those numbers quickly grew to 101 residents infected, of whom 55 were hospitalized and 34 died, in addition to 50 infections among health care workers and 16 among visitors. COVID-19 infections had spread to 30 other LTC facilities in the county.

Two days after the Washington State report, the California Department of Public Health released a letter telling nursing homes that they should “prepare to receive residents with suspected or confirmed COVID-19 infection.” The more detailed instructions included bullets such as the following: • Ensure the facility has an adequate supply of facemasks, N95 respirators, face shields or goggles for eye protection, gowns and gloves….

The New York State Department of Health advisory was more blunt: • No resident shall be denied re-admission or admission to the nursing home solely based on a confirmed or suspected diagnosis of COVID-19.

Nursing home advocates, trade associations, physicians and academics protested in unison that without adequate resources, staffing, and infection control expertise, this guidance was illinformed or delusional (https://lat.ms/39MZv5K).

THE CHALLENGES OF COMMUNITY TRANSMISSION AND ASYMPTOMATIC INFECTIVITY While this policy impasse continued, on-the-ground realities began emerging in photos of nurses donning garbage bags for gowns and in lurid headlines, e.g., “A California nursing home was evacuated after its staff didn’t show up” (https://cnn.it/2P9TXZQ).

It became increasingly obvious that community-based transmission was widespread and that LTC settings would not be spared.

Nursing homes were screening for symptomatic staff at the front door as per guidelines while infected asymptomatic staff were walking in with a viral load.

The loudest wakeup call about asymptomatic infection came in a March 27th report showing that over half of COVID-positive nursing home residents were asymptomatic. There was no difference in infectivity among asymptomatic, pre-symptomatic or symptomatic residents (https://bit.ly/3fiL0YK).

This information sat uncomfortably with one of the authors (TEH) who visited an outbreak nursing home in which staff had gone to enormous trouble to cohort COVID-positive residents and don full PPE in that wing. Their access to testing, however, had been only for symptomatic residents, making it likely that a nursing assistant in another wing with inadequate PPE was giving intimate care to an asymptomatic COVID-positive resident before moving to the next resident for a similarly close encounter.

Prospects for COVID-19 containment did not look good.

A PROMPT FOR COMMUNITY COLLABORATION A new model began to emerge when Contra Costa County public officials asked John Muir Health, a community hospital system, to provide emergency staffing and infection control training for a nursing home with a large outbreak. The Muir CEO asked all relevant departments to contribute immediately, foregoing concerns about competition, finances, or politics, all of which could be sorted out later. Beyond nursing, an array of departments pitched in, including medical staff, laboratory, purchasing, palliative care, and the family medicine residency program. John Muir Health and Kaiser Permanente began working together on continued on page 16 ACCMA BULLETIN | JULY/AUGUST 2020

15

COVID-19 IN NURSING HOMES

(continued from page 15)

another outbreak, this one in an assisted living facility, after which all hospitals in the county agreed to a division of responsibility for proactive outreach to all 32 nursing homes in the county, followed by a similar approach to the much larger number of assisted living facilities. A similar public-private partnership is shaping up next door in Alameda County.

The nurses are going on-site to nursing homes to do readiness assessments and infection control training, along with action plans to address gaps in resources and care. They are following up to assist the nursing homes with those action plans. Telephonic outreach cannot rival this on-the-ground assessment and assistance. Staff at one nursing home had checked all the right readiness boxes during a telephonic assessment and announced that they were ready to accept COVID-positive patients. The hospital nurses arrived shortly thereafter and quickly concluded, “No, not yet.”

WHAT MAKES HOSPITAL NURSES DIFFERENT? COVID-19 checklists are plentiful and useful, but a checklist doesn’t make things happen. To achieve the goal of preventing infectious disease transmission, experienced infection control nurses bring critical thinking, confidence, determination, and problem-solving savvy. They have absorbed the lessons of the patient safety movement. They can leverage huddles to make rapid workflow adjustments, and they are accustomed to functioning in a culture of accountability.

Professionals in nursing homes, on the other hand, must make do with limited resources in a culture of low expectations.

Even under direct observation by regulatory authorities, the most basic of standards may not be met. An April 2nd CMS press release reported that “36 percent of facilities inspected in recent days did not follow proper hand washing guidelines and 25 percent failed to demonstrate proper use of PPE” while being actively observed by surveyors (https://go.cms.gov/39MI5pT).

The power differentials between the nurses on these hospital teams and the nurses in nursing homes cannot be overstated.

Hospital infection control managers pursue measurable objectives backed by hospital executives and supported by performance improvement systems with the active participation of physician leaders. The infection preventionist required by nursing home regulation can be a part-time licensed vocational nurse. The knowledge, power, and resources necessary for rapid workflow change is beyond the reach of most nursing home infection preventionists. ‘

16

WHAT MAKES ON-SITE TRAINING SO IMPORTANT NOW? The nursing home nurse leaders may be fully able and committed, but what the hospital nurses bring is a greater expectation that standards will be met, and while on-site they also see for themselves the barriers that must be overcome. Is enough PPE really available? Could donning and doffing be safely done in a clearedout equipment closet? Should it be done on an outside patio, and does the patio need an awning or tent? Have emergency drills and simulations been mastered? A bottom-line question is whether the hospital nurses think they themselves could safely care for COVID-positive patients in this setting, shift after shift.

Equally important as the infection control knowledge and know-how is the positive effect on nursing home staff confidence that can result from these sessions. In addition to illness, fear is decimating staff levels in nursing homes, most of whom have minimal or no health insurance coverage (https://bit.ly/2XwKKzt). If staff have more confidence that they can protect themselves and their families, they are more likely to come to work. Preserving current staff with their tacit knowledge and patient relationships is of paramount importance (https://bit.ly/33ddUHf). Many have become skilled in behavioral management of residents with dementia, for example. Volunteers or emergency personnel brought in as replacements may have never given much thought to preventing falls, dehydration, or pressure sores or comforting an older person at end of life.

WILL THESE HOSPITAL TEAMS FIX ALL OUR PROBLEMS? Two or three hospital nurses who spend a half-day several times in a week at a nursing home will not themselves overcome all the barriers to safe care in the COVID-19 era. They will, however, do better problem identification than could ever be done from a distance. Most hospitals already have an infrastructure for liaison with post-acute care, thanks to years of work on readmissions, bundled payments, and accountable care. In the usual model, hospital nurse leaders have invited staff from their preferred nursing homes to come to collaborative meetings at the hospital. In these meetings, now held virtually, the hospital nurses offer guidance and support similar to that offered by public health departments – but that’s where the typical liaison model tends to end.

Once the same nurses have done on-site assessments at the nursing home, they bring back compelling reports to their hospital leadership and public health officials, many of whom do not know, for example, that mask fit-testing is virtually unheard of in continued on next page

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

ACCESS TO NALOXONE

Increasing Access to Naloxone

N

aloxone is an opioid antagonist that reverses the effects of an opioid overdose, which was first approved for this use by the Food and Drug Administration (FDA) in 1971. In the decades since then, high rates of opioid overdose throughout the country have highlighted the need for Naloxone to be available and accessible both to individuals at risk of experiencing an opioid overdose, as well as community members who may be present at the scene of an opioid overdose.

Luckily, Naloxone Access Laws have decreased barriers for individuals to obtain Naloxone, so the life-saving drug is more widely available across the country. In California, residents are able to purchase naloxone from a pharmacist without a prior prescription from a healthcare provider (learn more at https://bit. ly/3f7eAQX). However, this is not always an easily accessible

option. Dispensing pharmacists must have first completed an approved training in order to distribute Naloxone and prices for the drug itself can vary, limiting its accessibility. The California Department of Public Health (CDPH) Naloxone Statewide Standing Order (https://bit.ly/2Eqmpo9) and the Department of Health Care Services (DHCS) Naloxone Distribution Project (https://bit.ly/2P0F0sP) provide solutions to both these obstacles. Issued by the California State Public Health Officer, the statewide standing order allows for the distribution and administration of Naloxone by eligible community organizations and entities. This allows organizations that are not currently working with a physician to distribute Naloxone to people at risk of an opioid overdose, and to that person’s networks. It also allows for continued on page 21

COVID-19 IN NURSING HOMES (continued)

nursing homes. Stories potentiate change. While the nurses cannot miraculously increase testing capacity, their descriptions of staff working without appropriate PPE can motivate procurement scrambles that pay off. As boundary-spanners they can facilitate relational coordination in which hospital and nursing home teams improve their mutual trust, communication, and problemsolving, all of which can ease the inevitable difficult discussions about patient transfers (https://bit.ly/3hW23BD). When these nurses say that the Riverbend facility is ready for COVID-19 care but Shady Grove isn’t even close, both public health officials and their own hospitals pay attention.

Our experience suggests that with a modest amount of coordination from local health departments, hospital-based teams can collaborate on who takes responsibility for outreach to which LTC facilities and can help resolve thorny issues of PPE, testing, staffing, and placement. Here in the East Bay, the Hospital Council Northern and Central California and Alameda-Contra Costa Medical Association participate in public health department deliberations, thus increasing the chances that appropriate settings with appropriate staffing can be found. LTC outbreaks will still continue, of course. In particular, nursing homes and their staffs will continue to be popular scapegoats. The current crisis should prompt reflection on the structural biases in the health economy that have led to this reality. These hospital nurses are not the entire solution,

but their proactive outreach can prevent “mini-surges” from LTC that can strain a neighboring hospital, and their problem-solving savvy facilitates creativity within the local health care ecosystem.

An example of collaborative creativity can be seen in this Saturday morning message from one hospital team to another, shortly after getting a list of priority facilities from the public health department (names removed): “Our team can take the first 9 buildings at the top of the list as we have the bandwidth to complete all 9 on-sites by next Friday. That would give you the bottom 5. Does that sound reasonable?” The way we can save the lives of nursing home residents during the COVID-19 era is to get hospital nurses like these to look up a nursing home address, drive over, find the parking lot and the front door, take a deep breath, and begin making things happen.

Terry E. Hill, MD, FACP, is a geriatrician and COVID-19 Medical Director for the Alameda-Contra Costa Medical Association, supported in part by the Stupski Foundation. Taejoon Ahn, MD, MPH, is President and CEO at John Muir Medical Group and Assistant Clinical Professor in the Department of Family and Community Medicine at the University of California, San Francisco. Rebecca Rozen, MSc, is Regional Vice President, Hospital Council Northern and Central California. Joe Greaves, MA, is Executive Director for the Alameda-Contra Costa Medical Association

ACCMA BULLETIN | JULY/AUGUST 2020

17

CHILDHOOD IMMUNIZATIONS

Prioritize Childhood Immunizations

O

n July 15, 2020, the Alameda-Contra Costa Medical Association sent the following letter to Governor Gavin Newsom regarding childhood immunization during COVID-19.

During the pandemic, many health care needs have been pushed to the side as health care professionals have been focused on preparing for and treating COVID-19 patients. Many medical offices

have been closed or inaccessible for routine care services for safety reasons. The purpose of the following letter was to request that Governor Newsom address the need for parents to continue to have their children vaccinated now that many medical offices have re-opened for routine care.

RE: Childhood Immunization during COVID-19 Dear Governor Newson: I am writing on behalf of the Alameda-Contra Costa Medical Association (ACCMA), representing 5,000 East Bay physicians, to express concern about the potential negative health and safety impacts of delayed childhood immunization during COVID- 19. In agreement with the American Academy of Pediatrics, California (AAP-CA), California Academy of Family Physicians (CAFP), California Immunization Coalition (CIC), and the California School Nurses Organization (CSNO), we respectfully request that you publicly address the need for parents to continue to have their children vaccinated and to stay up-to-date on their vaccine schedules.

Vaccinations are an important part of keeping our children safe, and the need for them does not diminish during a pandemic like the one we have faced in recent months. Advocacy for childhood immunization will especially be crucial as our state reopens schools, given that children need to be up to date on their immunizations in order to enter school this fall and existing immunization requirement are still in place.

You can help ensure California families are aware of how they can protect their children’s health through vaccinations and overall well-child care by publicly communicating to parents that our hospitals are safe and eager to serve their communities. In addition, encouraging parents to be in constant communication with their healthcare providers to ensure that all measure are in place to vaccinate their children, especially newborns.

In light of these concerns, the ACCMA asks to safeguard the public’s health given the substantial and growing body of evidence about the negative health effects of delayed childhood immunization. If you have any questions or wish to discuss these concerns, please contact Joseph Greaves, ACCMA Executive Director, at 510-654-5383 or jgreaves@accma.org.

Sincerely,

Katrina Peters, MPA, MD President CC: Members, East Bay Legislative Delegation

Nadine Burke Harris, MD, MPH, FAAP, California Surgeon General

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

PROPOSITION 23

ACCMA & CMA Oppose Prop. 23 – Regulating Dialysis Clinics

T

he Alameda-Contra Costa Medical Association (ACCMA) and the California Medical Association (CMA) have taken an “oppose” position on Proposition 23, the Dialysis Clinic Requirements Initiative. This proposition threatens dialysis patients’ access to their life-saving treatment. The proposition would also directly and negatively impact all Californians by contributing to the physician shortage and unnecessarily driving up health care costs by hundreds of millions of dollars annually.

Among other provisions, this proposed ballot measure mandates that each of the roughly 600 dialysis clinics in California have a physician on site at each clinic during all operating hours.

These physicians would likely not be involved in patient care and would instead hold bureaucratic, non-care roles. Dialysis treatments are prescribed treatments by a patient’s personal nephrologist and administered by specially trained nephrology nurses, patient care technicians, and other licensed professionals. The existing treatment protocol does not require additional physician oversight. Existing federal law requires each dialysis clinic to have a physician medical director oversee patient care.

In addition to contributing to the current physician shortage by taking physicians out of care roles and placing them in supervisory, bureaucratic roles, analysis conducted by the Berkeley Research Group found that this measure would also increase dialysis treatment costs by $320 million every year. According to the Berkeley Research Group, nearly half of the dialysis clinics in the state would operate at a loss. This could force clinics to either scale back services or shut down completely. According to the independent, non-partisan Legislative Analyst’s review of the proposition: “Given the higher costs due to the measure, some governing entities may decide to close some clinics.”

Approximately 80,000 Californians with chronic kidney disease rely on dialysis to stay alive. Without convenient access to community clinics, patients will have to travel long distances or risk missing treatments. Missing even one treatment session increases a dialysis patients’ risk of death by 30%.

More information about the proposition can be found at ProtectPatients.com.

ACCMA BULLETIN | JULY/AUGUST 2020

19

ALAMEDA ALLIANCE

Responding to the COVID-19 Pandemic

By Scott Coffin, CEO, Alameda Alliance for Health

A

lameda Alliance for Health (the Alliance) is proud to serve over 250,000 children and adults in Alameda County. In this edition, you will learn about the Alliance’s efforts to combat the negative economic and health care impacts that the COVID-19 crisis has caused. You will also read the latest on the Alliance’s emergency crisis support funding for our contracted providers, and about the California Department of Health Care Service’s (DHCS) new Long Term Care at Home benefit that will support home care for qualifying Medi-Cal beneficiaries.

THE ALLIANCE’S RESPONSE TO THE COVID-19 PANDEMIC As the COVID-19 virus continues to spread throughout communities across California and the United States, it is clear that the severity of the health and economic effects, particularly to the low-income families that we serve, will be long-lasting. On June 30th, Governor Newsom signed the 2020 Budget Act that included a $202.1 billion spending plan focused on emergency response, public health and safety, and measures that promote economic recovery. While the Governor and state legislature were able to agree to a budget plan that would avoid the deep cuts to essential health services that the Governor had previously proposed, closing the $52.3 billion budget shortfall has significantly impacted funding and covered services to the Medi-Cal program. The Budget includes a 1.5 percent rate reduction for Medi-Cal managed care plans – including the Alliance – for the July 2019 to December 2020 period.

The Alliance will continue to monitor further rate reductions that will take effect in January 2021. These changes to the managed care capitation rates will exceed $30 million in revenue reductions to the Alliance.

As the state grapples with a substantial budget shortfall, enrollment for the Medi-Cal program continues to increase due to high unemployment rates. Corresponding with state trends, since the local Shelter-in-Place order went into effect, our membership has increased by 12,000 Alameda County residents and we expect that our peak enrollment could be upwards of 277,000 20

members – which would be an all-time high for the Alliance. As we take on new challenges of the ongoing pandemic, we remain committed to ensuring that we maintain high levels of customer service to our members and provider partners. As we continue to move through the COVID-19 pandemic, we will be focused on strategies to ensure that the Alliance gets through the next few years of financial uncertainty while focusing on initiatives that will improve the health of our members. One such benefit includes the Medi-Cal Long-Term Care at Home benefit, recently announced by the Department of Health Care Services (DHCS).

This benefit is currently scheduled to begin in January of 2021 with the goal of addressing the need to decompress the state’s skilled nursing facilities (SNFs) in response to the COVID-19 pandemic. Additionally, it is anticipated that it will provide a longterm holistic, coordinated, and bundled set of medical, home, and community-based services that will allow individuals the option to remain healthy in their homes. This benefit will be available to qualifying Medi-Cal beneficiaries who would otherwise require skilled nursing or skilled nursing therapy services to treat, manage, or observe a condition at a SNF. In addition to participating in stakeholder meetings hosted by the DHCS, the Alliance has started to prepare the operations to implement this important benefit as soon as January 2021.

As part of our efforts to address the impacts that our providers have recently experienced due to the ongoing COVID-19 crisis, the Alliance established an emergency crisis fund in the month of May for eligible frontline safetynet providers that are treating or supporting patients impacted by the COVID-19 pandemic. The Safety-Net Sustainability Fund was established to help address the financial pressures that safetynet health care providers, such as physician practices, health centers, and hospitals have been dealing with over the last few months. In the month of May, the Alliance awarded funding totaling $4.2 million to safety-net hospitals for COVID-19 testing, to direct-contract primary care physicians, safety-net health centers and other safety-net providers. While we recognize that our health continued on next page

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

ALAMEDA ALLIANCE

care systems will be facing many challenges in the years ahead, we remain committed to working with our provider partners to continue to improve the quality of life of our members and people throughout our diverse community.

ABOUT ALAMEDA ALLIANCE FOR HEALTH Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality

health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 250,000 low-income children and adults through the National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care programs.

NEW MEMBERS

NEW RESIDENT MEMBERS

Joseph Jerome Deck, MD

Alameda Health System – EM Residency Program

Anesthesiology Vituity Michael Weldon Diana, MD Emergency Medicine Vituity Todd Alan Kessinger, MD Emergency Medicine Vituity Julie Marie Watkins-Torry, MD Emergency Medicine Vituity

(continued)

Jose Acosta, MD Elaine Maria Dellinger, MD Alexandra Friedman, MD

Lifelong Medical Care Family Medicine Residency Program Justin Chin, DO Olivia Park, MD UCSF Adult Psychiatry Residency Program Carmen Kilpatrick, MD

Megan Elizabeth Heeney, MD Jeffrey Robert Herrala, MD DaShawn Antwane Hickman, MD Claire Marie Lamneck, MD Azad Molla Hosseini, MD Henry David Schwimmer, MD Tushara Surapaneni, MD Ajeet Singh

INCREASING ACCESS TO NALOXONE (continued from page 17)

family members, friends, or bystanders to administer Naloxone to a person reasonably suspected of having experienced an opioid overdose. Additionally, the Naloxone Distribution Project is a grant-funded effort to provide free Naloxone to qualified organizations and entities. In conjunction, these laws and projects allow community organizations to readily access free Naloxone and distribute it to individuals as a harm-reduction approach to decreasing opioid overdose-related deaths in local communities.

The ACCMA’s East Bay Safe Prescribing Coalition (EBSPC) has developed a three-part on-demand webinar series that provides an educational opportunity for clinicians, community members, and pharmacists to learn about overdose prevention, lessen the stigma surrounding the use of substances, specifically with opioid use disorder (OUD), and informs participants on how to use Naloxone/Narcan, the lifesaving opioid overdose reversal drug. In these webinars, you will learn to identify signs of an

opioid overdose and will go through the steps of responding to an opioid overdose, including how to use Naloxone. Among those key parts of the presentation, you will also learn about the Good Samaritan Law, risks associated with using and mixing substances, fentanyl, and resources about how to access Naloxone, sterile supplies and other necessary resources. To access all three ondemand webinars please visit learning.accma.org/recordings.

The EBSPC has also published a resource guide of Naloxone Distribution sites, where community members can access free Naloxone. Some sites have physical locations throughout Alameda and Contra Costa Counties, and there is also an option for Naloxone delivered through the mail. These resources, including the on-demand webinars, are completely free, so please explore and share these resources with your communities and colleagues. To access the Naloxone Distribution List, visit eastbaysaferx.org.

ACCMA BULLETIN | JULY/AUGUST 2020

21

COUNCIL REPORT

MAY 14, 2020

The meeting was called to order by Doctor Katrina Peters, President.

Doctor. Sugarman provided an update on his trip to Elmhurst Hospital in New York where he provided relief and helped prepare for a potential COVID-19 surge. Dr. Sugarman discussed having good practices in place in case a surge does occur.

Dr. Peters announced that District 6 is seeking an Alternate Councilor and District 12 is seeking an Alternate Councilor B. Nominations will be made at the June Council meeting.

Mr. Lopez discussed the Request to Oppose Dialysis Initiative - a costly dialysis proposition that mandates that each dialysis clinic in California have a physician on the premises during operating hours. The Council voted to oppose the ballot measure.

Dr. Staggers provided an update on the Advisory Committee on Physician Wellbeing’s Proposed CMA Resolutions: That CMA support CSAM in opposing the Death Certificate Project and send a letter directly to the Medical Board of California that clearly states this position; That CMA encourage that more research be done on comparing physician opioid prescribing practices with actual patient opioid overdose rates; And that CMA encourage the Medical Board of California to consult with CSAM, the American Academy of Pain Medicine, the independent entity, such as the California Research Bureau, on the Death Certificate Project in order to make the appropriate modifications.

The Council agreed to table the discussion for the future.

The Council discussed the CALPAC Board of Directors Nominations.

Dr. Hill gave an update on COVID-19 stating that California has seen a decline in hospital usage but has seen a small rise in the last week and that all counties are using the same criteria as to when to re-open.

The Council discussed the need for PPE for solo and small practice physicians and the need to advocate for PPE for everyone.

Ms. Lum gave an update on the Physician Wellness Program and the Leadership Under Pressure series. The Frankenberg Family Foundation is making a gift of $10,000.00 to the ACCMA to provide direct support for physician wellness and mental health services to physicians in our community. The grant will support virtual small group counseling sessions and convener development for peer group meetings (including CME).

Dr. Kogan gave an update on the AMA Delegates Report, stating that the AMA Annual Meeting has been cancelled and replaced with virtual meetings.

Dr. Wyatt gave an update on the CMA Trustees Report. Dr Wyatt discussed the MICRA Initiative being delayed until 2022, the Medical Board of California’s 47% increase in licensing fees, the letter about CMA Activities being on hold, and the possibility of a virtual House of Delegates.

Dr. Peters discussed the J. Elliott Royer Award in Psychiatry and asked the Council to send any nominations to Mr. Greaves

by June 15, 2020.

Ms. Lum gave a membership update reporting that our year-end percentage is at 96 percent and that we are down by 152 members.

Ms. Lum invited the Council to the East Bay Clinician Wellness Consortium meeting co-hosted by Dr. Hasanian on June 30, 2020 with a focus on physician burnout. Ms. Lum discussed the three-part Re-Inventing and Re-Opening Your Practice series and recorded webinars that are available on the ACCMA webpage and also other upcoming educational events.

There being no further business, the meeting was adjourned.

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COUNCIL REPORTS

Helping People in Our Community Since 1996

A L A M E D A

C O U N T Y

www.alamedaalliance.org

(continued)

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