ACCMA March/April 2020 Bulletin by ACCMA

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

March/April 2020

COVID-19 Pandemic

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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 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

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

Financial Assistance for Medical Practices During the COVID-19 Pandemic

PRESIDENT’S PAGE Rising to Meet the Challenge By Katrina Peters, MD, ACCMA President

COVID-19 RESOURCES 5 On-Demand Programs

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

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

March/April 2020 | Vol. LXXVI, No. 2

ACCMA COVID-19 Resources

Updated Medicare Telemedicine Billing Info By Mary Jean Sage, The Sage Associates

List of Medicare Telehealth Services

PHYSICIAN WELLNESS 12 Caring for Ourselves

ADVOCACY 19

Medical Associations Letter to California Governor

AB 890 Heading to the Senate

Financial Assistance Program Resources

ASSOCIATION

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Getting Started in Telemedicine

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ACCMA STAFF Joseph Greaves, Executive Director Mae Lum, Deputy Director Jan Jackovic, Director of Operations Griffin Rogers, Director, Napa & Solano County Medical Societies David Lopez, Assoc. Dir. of Advocacy & Policy Essence Hickman, Operations Associate Jennifer Mullins, Education and Events Associate Hannah Robbins, Communications Associate

Tips for Getting Telemedicine Up and Running Quickly By David Ginsberg, CEO, PrivaPlan

R AT E D JA N

ASSOCIATION

INC

DA–CON TR AME AL

A COS1T8 6 0MEDIC

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Oppose the Costly MICRA Measure

Until Help Arrives Instructor Training By Thomas Sugarman, MD, ACCMA Emergency Committee Chair

ACCMA Responds to MFAR

NEW MEMBERS

Addressing COVID-19 In Our Community By Scott Coffin, CEO, Alameda Alliance for Health

COUNCIL REPORTS

CLASSIFIEDS

IN MEMORIAM

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 | MARCH/APRIL 2020

COVID-19

Financial Assistance for Medical Practices During the COVID-19 Pandemic (current as of March 31, 2020)

Prepared by the California Medical Association (CMA)

uring the COVID-19 pandemic, physician practices are confronting operational and business challenges as they continue to deliver high quality care to their patients. Medical practices will need to make difficult choices about whether to make significant changes that could include changing how they deliver care or even closing their practices. Many practices are currently facing: • Decreased patient visits and procedures resulting in reduced revenue and cash flow to the practice. This may be due to the postponement of non-essential visits and procedures; lack of personal protective equipment (PPE) and other supplies; and cancellation of appointments due to patient isolation and concerns about COVID-19 transmission. • Clinical and medical office staff being self-isolated/quarantined, unable to come to work because of childcare issues or re-directed to providing patient care outside of the practice, resulting in a smaller workforce available to manage the existing patient workload. This could result in higher costs for temporary staffing, overtime and locum tenens physicians. • Due to higher demand for PPE and testing supplies, the existing supply chain is strained such that the practice is either experiencing increased costs or is unable to procure the equipment and supplies to keep the practice functioning. • Practices may be required to divert reserves and other funding sources to continue to pay all of these higher costs. • High levels of uncertainty about practice viability, combined with anxiety about disease transmission and the welfare of their family, staff and patients can result in higher levels of stress and burnout for physicians. This resource guide provides an overview of financial assistance available to medical practices during and after this difficult time so physicians have the information they need to make the right decisions for their businesses and families.

GETTING ORGANIZED The American Medical Association (AMA) has developed a checklist for physician practices that provides high level guidance for practice owners and administrators so they can gain a comprehensive view of the financial status and resiliency of their practices. The checklist includes: 1. Implement a process for rapid decision-making and planning. 2. Understand your insurance coverage. 3. Evaluate ongoing financial obligations. 4. Make a financial contingency plan. 5. Assess current and future supply needs. 6. Understand how to continue business operations. 7. Consolidate administrative resources, including coding tools. 8. Manage workflow. 9. Use digital health tools. 10. Communicate guidelines to employees. FEDERAL STIMULUS The federal economic relief package, signed into law on March 27, 2020, includes: • $100 billion in direct assistance to physicians, hospitals and other health care workers for unreimbursed expenses and lost revenues due to reductions in other services as a result of the COVID-19 outbreak. Detailed guidance for eligibility and applications is forthcoming from the Department of Health and Human Services (HHS). • 2% increase in Medicare physician payments by temporarily lifting the Medicare sequestration cuts. • 20% enhanced Medicare inpatient payment for services provided to patients with a COVID-19 diagnosis. Hospitals can also request to receive Medicare payments in an upfront lump sum. • $454 billion to the Treasury Secretary’s Stabilization Fund to provide emergency relief to assist businesses, including physician practices impacted by the outbreak. • Congress updated the mandate for Medicare, Medicaid,

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID-19

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private insurers, TriCare, the VA and Indian Health Services to cover and pay for COVID-19 vaccines, testing and related physician visits and prohibit any patient cost-sharing for such services. Medicare will pay for 100% of the visit costs. Private insurers must pay the contracted rate. If there is no contract, insurers must pay the cash price posted by the physician. All U.S. residents with adjusted gross income up to $75,000 ($150,000 married) are eligible for a full $1,200 ($2,400 married) rebate. They are also eligible for an additional $500 per child. No action is required to receive a rebate check from the IRS.

TELEHEALTH Public and private entities have taken action to ensure that physicians participating in commercial managed care, Medi-Cal and Medicare are reimbursed for services provided via telehealth at the same rate that they would have been reimbursed if the service had been provided through an in-person visit. Some payers have expanded telehealth to include telephone visits. Expanded opportunities for telehealth payment may provide the opportunity for physicians to expand care delivery to include telehealth options.

ON-DEMAND PROGRAMS The ACCMA offers a library of on-demand programs, some of which are eligible for CME. Access the list of available on-demand programs online at learning. ACCMA.org/Recordings. If you’d like to claim CME for an on-demand event, please contact Jennifer Mullins, ACCMA Education & Events Associate, by emailing jmullins@accma.org. See additional ondemand programs on page 8. Managing Your Practice Through COVID-19 This one-hour recorded training provides private practice physicians with the information needed to manage the COVID-19 crisis while maintaining your practice. Learn how to handle layoffs with a labor law expert, manage the cash flow in your practice, and learn more about telemedicine codes as you navigate your practice through this challenging time. The audio recording is available for immediate download at https://bit.ly/2X33pmX. The presentation slides can also be downloaded at https://bit. ly/2UZ0lp0.

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See “Tips for Getting Telemedicine Up and Running Quickly” on page 6. MEDICARE ACCELERATED AND ADVANCE PHYSICIAN PAYMENTS The Centers for Medicare & Medicaid Services (CMS) on March 28, 2020, announced an expansion of its accelerated and advance payment program for participating Medicare physicians and hospitals. This expansion is intended to lessen the financial hardship of providers facing extraordinary challenges related to the COVID-19 pandemic and help with cash flow problems that many physician practices are experiencing. To qualify for accelerated or advance payments, the physician must: • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form; • Not be in bankruptcy; • Not be under active medical review or program integrity investigation; and • Not have any outstanding delinquent Medicare overpayments. Medicare will start accepting and processing the Accelerated/ continued on next page

Getting Telemedicine Started Quickly Listen in on a podcast with Joseph Greaves, Executive Director at the Alameda-Contra Costa Medical Association and David Ginsberg, HIPAA advisor for the ACCMA and the California Medical Association. This podcast provides great insight to support providers in implementing telemedicine in their practice during the current public health crisis while maintaining HIPAA compliance. Topics Include: • Current waived HIPAA enforcement for providers to facilitate telemedicine • What applications are recommended and which are not • Reimbursement for telemedicine and telephone visits • Remote employees, providing additional training This podcast is available for immediate download at https://bit.ly/2R5MagZ. Review key points on page 6.

ACCMA BULLETIN | MARCH/APRIL 2020

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Advance Payment Requests immediately. California physicians should submit a request to Noridian, California’s Medicare contractor. Physicians can request 100% of their historical Medicare payment amount for a three-month period. CMS anticipates that the payments will be issued within seven days of the provider’s request. Repayment of the advance payments are due 120 days after the issuance of the advance payment. Physicians have 210 days from the issuance of the advance payment to repay the entire balance due to CMS. For more information, visit accma.org/covid-19 FINANCIAL ASSISTANCE PROGRAMS The following is a list of funding programs that could assist

physicians in maintaining financial viability. Please note that the federal economic relief legislation was signed into law on March 27, 2020. Federal regulators are now charged with providing detailed guidance on how to apply for the new funding. CMA will post the new rules as soon as they are released. New Paycheck Protection Program: The federal economic relief law includes nearly $350 billion in funding to create a Paycheck Protection Program (PPP) that will provide small businesses and other entities with zero-fee loans of up to $10 million. Up to 8 weeks of average payroll and other costs will be forgiven if the business retains its employees and their salary levels. Principal and interest are deferred for up to a year and all borrower fees are continued on page 8

TIPS FOR GETTING TELEMEDICINE UP AND RUNNING QUICKLY By David Ginsberg, CEO, PrivaPlan

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If you are affiliated with a group/foundation/ IPA, check with them first for vetted solutions

• If you need to come up with your own solution, you should try to do so in a HIPAA compliant manner: • HIPAA penalties are not being enforced for a limited time, but will eventually be enforced again • Even though penalties won’t be levied, investigations may still occur, and corrective actions can still be ordered • As of now (3/20/20), California Medical Information Act (CMIA) remains in place •

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Permanent solutions that are HIPAA compliant (will enter into Business Associates agreement): • Skype for Business • UpDocs • Vsee • Zoom for Healthcare • Doxy.me • Google G-Suite Hangouts Meet Temporary solutions that are secure/encrypted and can be used during public health emergency, but are not HIPAA compliant (i.e. no Business Associates agreement): • GoToMeeting • WebEx

• RingCentral • FaceTime • Facebook Messenger Videochat • Google Hangouts • Skype • WhatsApp •

Solutions that should NOT be used because they are not secure and: • Facebook Live • Tik Tok • Twitch • Similar public facing video messaging apps

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Note that for HIPAA-compliant products, you will be required to use vendor’s Business Associate agreement; will not use your BA agreement

• Costs for HIPAA compliant solutions range from $30 per provider per month and up • Nearly all solutions are accessible across platforms (mobile, desktop, app, etc.) • Telephone-only may not be sufficient for telemedicine. For example, CMS requires “use of interactive audio and video telecommunications system that permits real time communication between the distant site and the patient at home.”

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

PRESIDENT’S PAGE

Rising to Meet the Challenge By Katrina Peters, MD, ACCMA President

his is, without question, a challenging time for our community, for our patients, and for our profession. Most of us have never witnessed such a far-reaching pandemic in our own community. Recent public health measures ordering Bay Area residents to “shelter at home,” while necessary and appropriate to protect our patients and assure the health of the community, have been a startling reminder of the seriousness of the COVID-19 threat to our community, nation, and world. For physicians, this is what we do. We are up to the challenges that lie before us and we will do whatever needs to be done to care for our community during this crisis. We are used to putting our patients first. We are used to working long, tireless shifts. We are used to doing the best we can for our patients despite resource limitations. We are used to rolling up our sleeves and doing what needs to be done. We are ready for this. Just like you are there for your patients, please know that ACCMA is there for you. Our physical office may not be open and we may not be hosting in-person meetings right now, but the ACCMA hasn’t missed a beat – we are open for business and our staff members are available (working from home) to support you during this challenging time. You can reach the ACCMA the same way as always – call 510-654-5383 or send an email to accma@accma.org. Our staff are standing by to answer your questions and help with anything you need. ACCMA has already done a lot to help our community respond to the COVID-19 situation: • ACCMA is coordinating weekly calls with medical directors from medical groups, foundations, IPAs, and is coordinating weekly calls for SNF medical directors. The purpose of these calls is to monitor the situation on the ground, track issues/concerns that need to be addressed, share best practices, and coordinate resources (including manpower, supplies, etc.). • ACCMA is participating broader coordinating efforts with Alameda County, Contra Costa County, the Community Health Center Network, the Hospital Council, and is also coordinating with CMA and AMA

on state and federal issues. and the Counties (and potentially others). Our goal is to make sure efforts across the healthcare delivery system are aligned and coordinated. • ACCMA is tracking a range of issues and is using our advocacy resources to elevate and address these concerns. • ACCMA has formed a Covid-19 Task Force, which is comprised of a small group of ACCMA leaders with a range of experiences and perspectives to serve as a “kitchen cabinet” to strategize ACCMA’s response to the unfolding pandemic in our community. • ACCMA is compiling and developing practice management guidance to help medical practices remain operational and to help bridge short terms financial challenges. We are also compiling questions from members and working with CMA to get answers. • ACCMA is sending regular situation updates and new/ updated public health guidance to members, which is always accessible at www.accma.org/COVID-19. • ACCMA is creating a number of services, programs and guidance to help members and their families cope with emotional stress. • ACCMA is developing timely educational programs on telemedicine, crisis in leadership, practice operations, and more. In addition, the ACCMA remains committed to advancing the many priorities that are important to our members – we are actively gearing up to protect MICRA this November, our Council and committees are continuing to meet using videoconferencing, we plan to have virtual meetings with state and local elected officials, we have several online seminars being offered in the coming weeks (visit learning.accma.org to see a list of upcoming events), we are continuing to grow our leadership and wellness programs, and our community health projects are moving ahead. This is a troubling time, but we hope it gives you some comfort to know that ACCMA is here to help you. If there is anything ACCMA can do for you, please call 510-654-5383 or email accma@accma.org. ACCMA BULLETIN | MARCH/APRIL 2020

COVID-19

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GETTING STARTED IN TELEMEDICINE – LIVE VIDEO SEMINARS & ON-DEMAND WEBINARS Telehealth services are expanding rapidly during the COVID-19 crisis. The ACCMA is providing a quick guide to help physicians swiftly ramp up their telemedicine capabilities, from technology to practice implementation to coding. Join the ACCMA for a 6-part webinar series on Getting Started in Telemedicine – this series will be recorded and available on-demand following the live sessions. Visit learning.ACCMA.org/Recordings to access all available on-demand content. Some on-demand programs will be eligible for CME. This series is suited for small to medium medical group practices that want to start or expand their telehealth services. Experts will discuss choosing a telemedicine platform; compliance; privacy and security considerations; billing and payment; policies, procedures, and workflow; informing your patients; and malpractice. Physicians who have experience practicing telemedicine will share their practical reflections. Visit learning.ACCMA.org or call the ACCMA at (510) 654-5383 for more information.

TELEMEDICINE 101: GETTING STARTED

Get practical tips on choosing a technology platform that is right for your practice. Learn about how the right telehealth technology can save you and your staff valuable time in set up, onboarding, and patient flow. Set the right expectations about what telehealth can and cannot do. Find out best practices for launching your telehealth service fast. Presenter: Milton Chen, MD, cofounder and CEO of VSee On-demand recording is available at learning. ACCMA.org/Recordings

TELEMEDICINE AND MALPRACTICE CONSIDERATIONS

Participants in this webinar will learn the risk management basics of medical practice using telehealth. From the simple telephone, to sophisticated, often EHR imbedded applications this mode of practice is becoming increasingly more ubiquitous especially during the current COVID-19 pandemic. Presenter: David Feldman, MD, MAB, CPE, FAAPL, FACS, Chief Medical Officer of The Doctors On-demand recording is available at learning. ACCMA.org/Recordings

TELEMEDICINE REIMBURSEMENT

Anjali and Mary Jean will present on the changing landscape of telemedicine reimbursement what it was in the past, where it is now during the National Emergency, and probable future outcomes based on her experience and insight. Additionally, she will provide practical guidance on coding to avoid fraud and abuse issues to avoid post-pandemic audits and investigations. Presenters: Anjali Dooley, Managing Partner of

Law Office of Anjali B. Dooley, LLC; Mary Jean Sage, The Sage Associates On-demand recording is available at learning. ACCMA.org/Recordings

PATIENT-CENTERED CARE THROUGH TELEMEDICINE

Telemedicine is the new normal for patient care through the COVID-19 Emergency. This webinar will focus on using telemedicine to enhance patient-centered care, including exploring new and upcoming technology solutions that will help support physicians in providing optimal person-centered care to patients. Presenter: Michael Harbour, MD On-demand recording is available at learning. ACCMA.org/Recordings

LEGAL CONSIDERATIONS OF TELEMEDICINE

With the COVID-19 Emergency requiring physicians to adopt telehealth and position more of their staff to work from home, important patient privacy and security risks emerge. This webinar will address those along with practical tips for compliance. Presenters: David Ginsberg, co-founder and president of PrivaPlan Associates, Inc.; Allen Briskin, Senior Counsel, Pillbury Winthrop Saw Pittman LLP On-demand recording is available at learning. ACCMA.org/Recordings

PANEL DISCUSSION: TELEMEDICINE IN PRACTICE

Panelists: Marc Dean, MD; Uli K. Chettipally, MD On-demand recording is available at learning. ACCMA.org/Recordings

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID-19

waived. This temporary emergency assistance through the Small Business Administration (SBA) and the Department of Treasury can be used in coordination with other COVID-financing assistance established in the bill or any other existing SBA loan program. The bill requires the SBA Administrator to set a cap on how much a bank can earn to process loan applications and prioritize underserved borrowers, including those in rural communities, minorities, women and veterans. Lenders may begin processing loan applications as soon as April 3, 2020. You can apply through any existing SBA lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating. Other regulated lenders will be available to make these loans once they are approved and enrolled in the program. You should consult with your local lender as to whether it is participating. Visit www.sba.gov for a list of SBA lenders. For more information, please visit the U.S. Department of Treasury Fact Sheet and to view the application please visit the SBA website. Existing Economic Injury Disaster Loan Program: SBA will work directly with state governors and private financial institutions to provide targeted, low-interest loans to small businesses and non-profits that have been severely impacted by the Coronavirus (COVID-19). The SBAâ&#x20AC;&#x2122;s Economic Injury Disaster Loan (EIDL) program provides small businesses with working capital loans that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. EIDLs are loans of up to $2 million that carry interest rates up to 3.75% for companies and up to 2.75% for nonprofits, as well as principal and interest deferment for up to 4 years. The loans may be used to pay for expenses that could have been met had the disaster not occurred, including payroll and other operating expenses. A business that receives an EIDL between January 31, 2020, and June 30, 2020, as a result of a COVID-19 disaster declaration is eligible to apply for a PPP loan or the business may refinance their EIDL into a PPP loan. In either case, the emergency EIDL grant award of up to $10,000 would be subtracted from the amount forgiven in the payroll protection plan. To apply for the Existing Economic Injury Disaster Loan Program please visit the SBA website. New Economic Injury Disaster Grant Program: The federal economic relief law includes $10 billion in grant funding to provide an advance of $10,000 to small businesses and nonprofits that apply for an SBA economic injury disaster loan (EIDL) within three days of applying for the loan. The new $10,000 EIDL grant does not need to be repaid, even if the grantee is subsequently denied an EIDL, and may be used to provide paid

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sick leave to employees, maintaining payroll, meet increased production costs due to supply chain disruptions, or pay business obligations, including debts, rent and mortgage payments. Eligible grant recipients must have been in operation on January 31, 2020. The grant is available to small businesses, private nonprofits, sole proprietors and independent contractors, tribal businesses, as well as cooperatives and employee-owned businesses. The SBA will issue additional details and guidance on the new program shortly. Express Bridge Loans: Express Bridge Loan Pilot Program allows small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 with less paperwork. These loans can provide vital economic support to help small businesses overcome the temporary loss of revenue and can be term loans or used to bridge the gap while applying for a direct SBA Economic Injury Disaster loan. If a small business has an urgent need for cash while waiting for decision and disbursement on Economic Injury Disaster Loan, they may qualify for an SBA Express Disaster Bridge Loan. After an eligible applicant receives the minimum acceptable FICO Small Business Scoring Service Score or greater during the initial E-Tran screening, the Lender must submit the guaranty application using E-Tran or SBA One to receive an SBA loan number. Prior to any disbursement of EBL loan proceeds, Lender must submit a signed IRS Form 4506-T to the Internal Revenue Service (IRS) and obtain an IRS tax transcript for the EBL applicant business for the purpose of verifying the existence of the business as of the date the applicable disaster commenced and confirming that the EBL applicant has filed required tax returns. The Lender must have an existing banking relationship with the EBL applicant as of the date of the applicable disaster in order to help mitigate the risks associated with the streamlined underwriting process under the EBL Pilot Program. For more information please visit the SBA Express Bridge Program Guide. Debt Relief for Existing and New SBA Borrowers: The federal economic relief law includes $17 billion in funding to provide immediate relief to small businesses with standard SBA 7(a), 504, or microloans. Under this provision, SBA will cover all loan payments for existing SBA borrowers, including principal, interest, and fees, for six months. This relief will also be available to new borrowers who take out an SBA loan within six months after the President signs the bill. The measure also encourages banks to provide further relief to small business borrowers by allowing them to extend the duration of existing loans beyond existing limits; and enables small business lenders to assist more new and existing borrowers by providing a temporary extension on certain reporting requirements. While SBA borrowers are receiving the continued on page 11 ACCMA BULLETIN | MARCH/APRIL 2020

2020 NEW HEALTH LAWS

About the Program

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Alameda-Contra Costa Medical Association

Business Affiliates Program

Visit ACCMA.org/BusinessAffiliates

COVID-19

six months debt relief, they may apply for a PPP loan that provides capital to keep their employees on the job. The six months of SBA payment relief may not be applied to payments on PPP loans. The stimulus also includes a permanent fix that allows SBA to waive fees for veterans and their spouses in the 7(a) Express Loan Program, regardless of the President’s budget. Under current law, SBA may only waive fees on 7(a) Express loans to veterans when the President’s budget does not project a cost above zero for the overall 7(a) loan program. Small Business Finance Center: California IBank has a Small Business Loan Guarantee Program for guarantees up to $1 million and a micro lending program for loans up to $10,000 with accommodations for disasters. The program is run through local mission-based lenders, the Financial Development Corporations. Qualifying small business owners may apply directly with a lender (LIST to be announced soon) or get additional information by contacting one of the participating Financial Development Corporations (FDCs), which can be found on the IBank Website. California Capital Access Program for Small Businesses: The California Capital (CalCAP) Access Program for Small Business encourages banks and other financial institutions to make loans to small businesses that have difficulty obtaining financing. If you own a small business and need a loan for startup, expansion or working capital, you may receive more favorable loan terms from a lender if your loan is enrolled in the CalCAP Loan Loss Reserve Program. This program helps communities

CMA’S HEALTH LAW LIBRARY CMA’s online health law library contains over 5,400 pages of up-to-date information on a variety of subjects of everyday importance to physicians, including current laws, regulations and court decisions that affect the practice of medicine. Examples of content that may be relevant at this time include: • Medical Practice Option Overview • Retaining a practice consultant • Covering Physicians (Locum Tenums) • Retirement Notice • Termination of the Physician-Patient Relationship CMA members can access the library documents free at cmadocs.org/health-law-library. Nonmembers can purchase documents for $2 per page.

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by providing financing to businesses that create jobs and improve the economy. CalCAP is a loan loss reserve program which may provide up to 100% coverage on losses as a result of certain loan defaults. With CalCAP portfolio support, a lender may be more comfortable underwriting small business loans. Check to see if your commercial lender or financial institution participates in CalCAP or find a participating lender. If your financial institution does not currently participate, it is easy for lenders to sign up. Please have your institution complete the Financial Institution Application and send to CalCAP to get started. BUSINESS COUNSELING SERVICES The federal stimulus provides $275 million in grants to the nation’s network of Small Business Development Centers (SBDCs) and Women’s Business Centers (WBCs), as well as the Minority Business Development Agency’s Business Centers (MBDCs), to provide mentorship, guidance and expertise to small businesses. The funding will allow SBDCs, WBCs, and MBDCs to hire staff and provide programming to help small businesses and minorityowned businesses respond to COVID-19. DEFERRED MORTGAGE PAYMENTS On March 25, 2020, Governor Newsom announced that financial institutions would offer, consistent with applicable guidelines, mortgage payment forbearances of up to 90 days to borrowers economically impacted by COVID-19. In addition, those institutions must: • Provide borrowers a streamlined process to request a forbearance for COVID-19-related reasons, supported with available documentation; • Confirm approval of and terms of forbearance program; and • Provide borrowers the opportunity to request additional relief, as practicable, upon continued showing of hardship due to COVID-19. In addition, under federal law, borrowers will receive 180 days of forbearance for federally backed mortgage loans (Fannie Mae, Freddie Mac, HUD, VA, USDA). The law also prohibits foreclosures on all federally-backed mortgage loans for a 60-day period beginning on March 18, 2020. This benefit terminates at the end of the national emergency or December 31, 2020. NO NEGATIVE CREDIT IMPACTS RESULTING FROM RELIEF Under the new federal law, financial institutions may not report derogatory tradelines (e.g., late payments) to credit reporting continued on page 12 ACCMA BULLETIN | MARCH/APRIL 2020

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agencies, consistent with applicable guidelines, for borrowers taking advantage of COVID-19-related relief. STUDENT LOANS AND CONTINUING MEDICAL EDUCATION The federal economic relief law: • Defers student loan payments, principals, and interests through September 30, 2020. Additionally, during this time, involuntary collection related to student loans will be suspended. • Allows students who withdraw from school as a result

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of COVID-19 to not return Pell grants, other grant assistance, or loans. Additionally, for students who withdraw from school as a result of COVID-19, the current academic term would be excluded from counting toward lifetime subsidized loan or Pell grant eligibility. Allows schools to use Supplemental Educational Opportunity Grants as emergency financial aid grants to assist graduate students with unexpected expenses and unmet financial needs that arise as the result of COVID-19. Allows institutions to transfer unused work-study funds

CARING FOR OURSELVES The ACCMA recognizes that the COVID-19 global outbreak has been stressful for physicians, and that this will likely continue in the coming weeks and months. It is quite normal to feel this way in the current situation. Managing your stress during this time is as important as managing your physical health. Taking care of yourself and encouraging others to practice self-care will sustain and extend your ability to care for patients in need. To help successfully navigate these challenging times, the ACCMA has been addressing how physicians can best care for themselves as they care for others as part of the ACCMA Physician Wellness Program. Mental Health and Peer Support Services Physicians can receive personal confidential support from fellow physicians or a vetted mental health professional. • Confidential assistance from trusted colleagues who serve on the ACCMA Advisory Committee on Physician Wellbeing. Committee members are available to provide immediate peer support at no cost. Call (510) 654-5383 or send an email to accma@accma.org. • Our resource list of counselors can provide you with confidential counseling or coaching services from vetted mental health specialists who are experienced in working with physicians. The ACCMA does not negotiate rates or pay for these consultations. Go to accma.org/ Mental-Health-Consultations. • The Care 4 Caregivers program from the California Medical Association provides free virtual emotional and professional support for

clinicians who have tested positive or have symptoms with the coronavirus and are in selfquarantine. Go to cmadocs.org/care4caregivers. Physician Wellness: Coping with COVID-19 This free one-hour webinar led by Linda Hawes Clever, MD, MACP, offers practical, creative, and effective remedies to deal with the crush on personal and professional lives during the COVID-19 pandemic. Go to learning.accma.org/recordings to access the recorded webinar. Peer Discussion Groups RechargedMD is offering ACCMA members complimentary online peer discussion groups specifically for physicians. With the guidance of a certified coach, physicians can receive and offer support, as well as learn from one another. Small groups will meet beginning on April 25 for 45 minutes per week for three facilitated sessions. Go to rechargedmd. com/covid19support. ACCMA Resources Toolkit The ACCMA has put together a free toolkit of resources that address the day-to-day needs of East Bay physicians of all career stages and in all modes of practice, from food and grocery delivery services to exercises that can be done at home. The toolkit can be accessed at accma.org/COVID-19. If you have any questions, or need more information, please contact the ACCMA at (510) 654-5383 or accma@accma.org.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID-19

•

to be used for supplemental grants. Additionally, it would give institutions the ability to issue work-study payments to student who are unable to work due to work-place closures, as a result of COVID-19, as a lump sum or in payments similar to paychecks. Supports foreign education institutions, including graduate medical programs, as they offer distance learning to U.S. students receiving Title IV funds for the duration of the COVID-19 pandemic. Governor Newsom issued an Executive Order on March 30, 2020 that extends physician Continuing Medical Education (CME) requirements for 60 days.

PROFESSIONAL LIABILITY The new federal law provides professional liability protections with exceptions under the Good Samaritan laws for physicians providing volunteer medical services during the COVID-19 public health emergency. UNEMPLOYMENT, PAID SICK AND MEDICAL LEAVE, CHILD CARE The economic relief law includes: • Child Care Block Grant: $3.5 billion to allow child care programs to remain open and meet priority emergency staffing needs for health care workers and first responders. • Expands unemployment benefits for employees who remain unemployed after state unemployment benefits are no longer available. (Earlier legislation enacted by Congress increased funding for state unemployment insurance funds.) An earlier Congressional bill provided the following expanded Paid Sick and Paid Family and Medical Leave for those impacted by the COVID-19 outbreak: • Up to two weeks of paid sick leave for workers who work for the government or employers with 500 employees or less. • 12 weeks of job-protected paid family and medical leave for government employees and employees who work for employers with less than 500 employees. The paid family and medical leave begins after the first 14 days of sick leave and is not less than two-thirds of the employee’s regular payment rate. It will be provided to employees adhering to requirements or recommendations for quarantine; to care for a family member required or recommended for quarantine; or to care for a child whose

(continued)

school or child care is closed. Tax credits to employers to offset the costs of emergency sick and medical leave. For additional information on direct employment related issues, see the CMA Covid-19 FAQ and the CMA Webinar on Employment Issues. •

FEDERAL AND STATE TAX RELIEF Internal Revenue Service: The deadlines to file and pay federal income taxes are extended to July 15, 2020. Small and midsize employers can also begin taking advantage of two new refundable payroll tax credits, designed to promptly and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirusrelated leave to their employees. Federal economic relief bill includes the following tax related provisions: • Allows advance refunding of tax credits for employers to offset the costs of the additional paid sick and medical leave for employees. • Refundable Employer Payroll Tax Credits for 50% of wages paid by employers to employees during the crisis. continued on page 14

FINANCIAL ASSISTANCE PROGRAM RESOURCES •

Visit www.sba.gov for a list of Small Business Administration (SBA) lenders. For more information, please visit the U.S. Department of Treasury Fact Sheet: https://bit.ly/3439Is8. To view the application please visit the SBA website: https://bit.ly/2UUkrkx. • To apply for the Existing Economic Injury Disaster Loan Program, which provides small businesses with working capital loans, please visit the SBA website: https://bit.ly/2wXfH5C. • For more information about the Express Bridge Loan Pilot Program, please visit the SBA Express Bridge Program Guide: https:// bit.ly/2UDLHEN. • Qualifying small business owners may get additional information about California IBank’s Small Business Loan Guarantee Program by contacting one of the participating Financial Development Corporations (FDCs), which can be found on the IBank Website: https://bit.ly/3bN92tG.

ACCMA BULLETIN | MARCH/APRIL 2020

COVID-19

•

(continued from page 13)

The credits are for employers whose (1) operations were fully or partially suspended due to a COVID19 related shut-down order, or (2) gross receipts are down by more than 50%. Credit is provided for the first $10,000 in compensation per employee from March 13, 2020 to December 31, 2020. Allows employers or self-employed individuals to defer payment of the employer share of the Social Security tax they otherwise are responsible for paying to the federal government for their employees. It requires the deferred employment tax be paid over the following two years with half of the amount required to be paid by December 31, 2020 and the other half by December 31, 2022. Allows modifications for business net operating losses to allow businesses to use losses and amend prior year tax returns which will provide critical cash flow. A net operating loss arising in ta tax year beginning in 2018, 2019, or 2020 can be carried back five years. Allows businesses to temporarily increase the amount of interest expense they are allowed to deduct on their tax returns by increasing the 30% limitation to 50% of taxable income for 2019 and 2020 with adjustments. Waives the 10% penalty on early withdrawal of distributions up to $100,000 from qualified retirement funds and allows more flexibility for loans from certain retirement plans. Such distributions may be made for individuals, spouses or dependents diagnosed with COVID-19, quarantined, furloughed, laid off, having work hours reduced, unable to work because of lack of child care, closing or reducing hours of business owned by the individual.

Franchise Tax Board: Because of COVID-19, California has moved various tax filing and payment deadlines to July 15, 2020. In addition, on March 30, Governor Newsom issues an Executive Order with the following provisions: • Extends the filing deadline for small businesses up to three months for tax returns that are less than $1 million in tax. Effective for the payment of taxes that are due on or by July 31, 2020. • Extends the filing deadline to receive tax refunds by 60 days for individuals and businesses. This is for all claims fore refunds that must be filed by July 31, 2020. • Extends the deadline for tax appeals for businesses and individuals by 60 days through July 31, 2020. California Department of Tax and Fee Administration (CDTFA): Pursuant to Governor Newsom’s Executive Order on March 12, 2020, the CDTFA has the authority to assist individuals and businesses impacted by complying with a state or local public health official’s imposition or recommendation of social distancing measures related to COVID-19, through May 11th. This assistance includes granting extensions for filing returns and making payments, relief from interest and penalties, and filing a claim for refund. Taxpayers may request assistance by contacting the CDTFA. Requests for relief of interest or penalties or requesting an extension for filing a return may be made through CDTFA’s online services. Numerous actions are being taken at the state and federal level to provide economic relief to individuals, businesses, and health care providers impacted by the COVID-19 pandemic and more relief is expected to be approved as the crisis progresses. As these relief packages are developed, both nationally and at the state, CMA and ACCMA will continue to advocate to include assistance for physicians and their practices. Please check accma. org/COVID-19 for regular updates.

ACCMA COVID-19 RESOURCES Physicians can stay abreast of local, state and national developments and access key COVID-19 resources by visiting the ACCMA COVID-19 website at accma.org/COVID-19. The ACCMA COVID-19 webpage contains links to local health departments as well as COVID-19specific contact information for the health departments, CADPH COVID-19 updates, CDC updates, and WHO updates. In addition, health care

professionals can access provider-specific information, such as CDC guidance for healthcare facilities, ACCMA telemedicine resources for integrating telemedicine into your workplace, information regarding Disaster Loan Assistance for Small Businesses, physician wellness links, and COVID-19 fact sheets. Community members and health care professionals may also access community resources, such as local, state, and federal COVID-19 websites for the public.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COVID-19

(continued)

UPDATED MEDICARE TELEMEDICINE BILLING INFO – RELEASE MARCH 30, 2020 By Mary Jean Sage, The Sage Associates

•

CMS added to the list of services that can be provided via telehealth to include additional hospital services, home visits, and domiciliary services • Additional services that are temporary additions to the services that may be performed via telehealth include care planning for patients with cognitive impairment, psychological and neuropsychological testing, physical therapy and occupation therapy • These services can be provided to new or established patient visits • See the full list of services on the following pages In order to bill office visits or any of the services mentioned in the bullets above, or on the full list referenced above you must have interactive, real-time audio visual with the patient. If phone only, look below at the phone codes that are now covered (full list of Telehealth codes is available in the online article; https://bit.ly/2JB9HCa). Place of service and modifier On March 30, CMS released an interim rule with other changes. These changes are effective March 1, 2020. CMS is changing the place of service for claims. Do not use POS 02 for CMS telehealth claims but use the place of service that would have been used if the patient had been face-to-face. This means, if it is an office visit, you will be paid the higher, non-facility rate, not the facility rate. This about $20 difference for office visits billed with POS 11. CMS now says to use modifier 95 (Synchronous Telemedicine Service Rendered Via A Real-Time Interactive Audio and Video Telecommunications System) the claim as well. Payment for phone calls • CMS will pay for phone calls using codes 99441 – 99443, and 98966 and 98968 • CMS stated in the 3/30/2020 rule that these codes may be used for new and established patient visits during the public health emergency • These codes previously had a non-covered status • Physicians, NPs and PAs should use codes 99441

– 99443 • Other qualified health care professionals who may bill Medicare for their services (registered dieticians, social workers, speech language pathologists, and physical and occupations therapists) should use codes 98966 – 98968 • These are not telehealth services, so do not use POS 02 • Per CPT definition, phone call codes 99441 – 99443 and 98966 – 98968 are services initiated by the patient - CMS did not discuss if this requirement was waived or not Keep this in mind Many professional and specialty societies told CMS that some Medicare patients did not have the technology available for real-time audio/visual visits. In order to bill office visits codes 99201 – 9215, as well as all of the other telehealth codes on the list of covered telehealth services, the practitioner must use real-time audio/visual. Code

Description

Facility Rate (National)

99441 / 98966

Telephone call 5-10 minutes

$13.32

99442 / 98967

Telephone call 11-20 minutes

$26.64

99443 / 98968

Telephone call 21-30 minutes

$39.60

These codes do not pay particularly well; if you have the ability to bill for telehealth (99201 – 99215) do that instead of just a phone call. On-line digital E/M (99241 – 99243 and G2061 and G2063), virtual check in and remote monitoring (G2010, G212), are not considered telehealth services, but are still payable by Medicare. The nuances of the service and billing requirements are the same as discussed in the March 27, 2020 ACCMA webinar – that webinar is available for on-demand listening through ACCMA Leaning Center COVID19 page. Review the article, including a full list of Telehealth Service codes, online at https://bit.ly/2JB9HCa.

ACCMA BULLETIN | MARCH/APRIL 2020

MEDICARE TELEHEALTH SERVICES

List of Medicare Telehealth Services Code

Short Descriptor

Status

77427

Radiation tx management X5

Temporary Addition for the PHE for the COVID-19 Pandemic

90785

Psytx complex interactive

90791

Psych diagnostic evaluation

90792

Psych diag eval w/med srvcs

90832

Psytx pt&/family 30 minutes

90833

Psytx pt&/fam w/e&m 30 min

90834

Psytx pt&/family 45 minutes

90836

Psytx pt&/fam w/e&m 45 min

90837

Psytx pt&/family 60 minutes

90838

Psytx pt&/fam w/e&m 60 min

90839

Psytx crisis initial 60 min

90840

Psytx crisis ea addl 30 min

90845

Psychoanalysis

90846

Family psytx w/o patient

90847

Family psytx w/patient

90853

Group psychotherapy

90951

Esrd serv 4 visits p mo <2yr

Temporary Addition for the PHE for the COVID-19 Pandemic

90952

Esrd serv 2-3 vsts p mo <2yr

90953

Esrd serv 1 visit p mo <2yr

90954

Esrd serv 4 vsts p mo 2-11

90955

Esrd srv 2-3 vsts p mo 2-11

90957

Esrd srv 4 vsts p mo 12-19

90958

Esrd srv 2-3 vsts p mo 12-19

90959

Esrd serv 1 vst p mo 12-19

90960

Esrd srv 4 visits p mo 20+

90961

Esrd srv 2-3 vsts p mo 20+

90962

Esrd serv 1 visit p mo 20+

90963

Esrd home pt serv p mo <2yrs

90964

Esrd home pt serv p mo 2-11

90965

Esrd home pt serv p mo 12-19

90966

Esrd home pt serv p mo 20+

90967

Esrd home pt serv p day <2

90968

Esrd home pt serv p day 2-11

90969

Esrd home pt serv p day 12-19

90970

Esrd home pt serv p day 20+

92507

Speech/hearing therapy

Temporary Addition for the PHE for the COVID-19 Pandemic

92521

Evaluation of speech fluenc

Temporary Addition for the PHE for the COVID-19 Pandemic

92522

Evaluation speech production

Temporary Addition for the PHE for the COVID-19 Pandemic

92523

Speech sound lang comprehen

Temporary Addition for the PHE for the COVID-19 Pandemic

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

MEDICARE TELEHEALTH SERVICES

92524

Behavral qualit analys voic

96116

Neurobehavioral status exam

96130

Psycl tst eval phys/qhp 1st

Temporary Addition for the PHE for the COVID-19 Pandemic

96131

Psycl tst eval phys/qhp ea

Temporary Addition for the PHE for the COVID-19 Pandemic

96132

Nrpsyc tst eval phys/qhp 1st

Temporary Addition for the PHE for the COVID-19 Pandemic

(continued)

Temporary Addition for the PHE for the COVID-19 Pandemic

96133

Nrpsyc tst eval phys/qhp ea

Temporary Addition for the PHE for the COVID-19 Pandemic

96136

Psycl/nrpsyc tst phy/qhp 1s

Temporary Addition for the PHE for the COVID-19 Pandemic

96137

Psycl/nrpsyc tst phy/qhp ea

Temporary Addition for the PHE for the COVID-19 Pandemic

96138

Psycl/nrpsyc tech 1st

Temporary Addition for the PHE for the COVID-19 Pandemic Temporary Addition for the PHE for the COVID-19 Pandemic

96139

Psycl/nrpsyc tst tech ea

96156

Hlth bhv assmt/reassessment

96168

Hlth bhv ivntj indiv 1st 30

96159

Hlth bhv ivntj indiv ea addl

96164

Hlth bhv ivntj grp 1st 30

96165

Hlth bhv ivntj grp ea addl

96167

Hlth bhv ivntj fam 1st 30

96168

Hlth bhv ivntj fam ea addl

96160

Pt-focused hlth risk assmt

96161

Caregiver health risk assmt

97110

Therapeutic exercises

Temporary Addition for the PHE for the COVID-19 Pandemic

97112

Neuromusulcar reeducation

Temporary Addition for the PHE for the COVID-19 Pandemic

97116

Gait training therapy

Temporary Addition for the PHE for the COVID-19 Pandemic

97161

PT Eval low complex 20 min

Temporary Addition for the PHE for the COVID-19 Pandemic

97162

PT Eval mod complex 30 min

Temporary Addition for the PHE for the COVID-19 Pandemic

97163

PT Eval high complex 45 min

Temporary Addition for the PHE for the COVID-19 Pandemic

97164

PT re-eval est plan care

Temporary Addition for the PHE for the COVID-19 Pandemic

97165

OT eval low complex 30 min

Temporary Addition for the PHE for the COVID-19 Pandemic

97166

OT eval mod complen 45 min

Temporary Addition for the PHE for the COVID-19 Pandemic

97167

OT eval high complex 60 min

Temporary Addition for the PHE for the COVID-19 Pandemic

97168

OT re-eval est plan care

Temporary Addition for the PHE for the COVID-19 Pandemic

97535

Self care mngment training

Temporary Addition for the PHE for the COVID-19 Pandemic

97750

Physical Performance Test

Temporary Addition for the PHE for the COVID-19 Pandemic

97755

Assistive Technology Assess

Temporary Addition for the PHE for the COVID-19 Pandemic

97760

Orthotic mgmt&traing 1st en

Temporary Addition for the PHE for the COVID-19 Pandemic

97761

Prosthetic traing 1st enc

Temporary Addition for the PHE for the COVID-19 Pandemic

97802

Medical nutrition indiv in

97803

Med nutrition indiv subseq

97804

Medical nutrition group

99201

Office/outpatient visit new

99202

Office/outpatient visit new

99203

Office/outpatient visit new

99204

Office/outpatient visit new

99205

Office/outpatient visit new

continued on page 18

ACCMA BULLETIN | MARCH/APRIL 2020

MEDICARE TELEHEALTH SERVICES

99211

Office/outpatient visit est

99212

Office/outpatient visit est

99213

Office/outpatient visit est

99214

Office/outpatient visit est

99215

Office/outpatient visit est

(continued from page 17)

99217

Observation care discharge

Temporary Addition for the PHE for the COVID-19 Pandemic

99218

Initial observation care

Temporary Addition for the PHE for the COVID-19 Pandemic

99219

Initial observation care

Temporary Addition for the PHE for the COVID-19 Pandemic

99220

Initial observation care

Temporary Addition for the PHE for the COVID-19 Pandemic

99221

Initial hospital care

Temporary Addition for the PHE for the COVID-19 Pandemic

99222

Initial hospital care

Temporary Addition for the PHE for the COVID-19 Pandemic

99223

Initial hospital care

Temporary Addition for the PHE for the COVID-19 Pandemic

99224

Subsequent observation care

99225

Subsequent observation care

99226

Subsequent observation care

99231

Subsequent hospital care

99232

Subsequent hospital care

99233

Subsequent hospital care

99234

Obser/hosp same date

Temporary Addition for the PHE for the COVID-19 Pandemic

99235

Obser/hosp same date

Temporary Addition for the PHE for the COVID-19 Pandemic

99236

Obser/hosp same date

Temporary Addition for the PHE for the COVID-19 Pandemic

99238

Hospital discharge day

Temporary Addition for the PHE for the COVID-19 Pandemic

99239

Hospital discharge day

Temporary Addition for the PHE for the COVID-19 Pandemic

99281

Emergency dept visit

Temporary Addition for the PHE for the COVID-19 Pandemic

99282

Emergency dept visit

Temporary Addition for the PHE for the COVID-19 Pandemic

99283

Emergency dept visit

Temporary Addition for the PHE for the COVID-19 Pandemic

99284

Emergency dept visit

Temporary Addition for the PHE for the COVID-19 Pandemic

99285

Emergency dept visit

Temporary Addition for the PHE for the COVID-19 Pandemic

99291

Critical care first hour

Temporary Addition for the PHE for the COVID-19 Pandemic

99292

Critical care addl 30 min

Temporary Addition for the PHE for the COVID-19 Pandemic

99304

Nursing facility care init

Temporary Addition for the PHE for the COVID-19 Pandemic

99305

Nursing facility care init

Temporary Addition for the PHE for the COVID-19 Pandemic

99306

Nursing facility care init

Temporary Addition for the PHE for the COVID-19 Pandemic

99307

Nursing fac care subseq

99308

Nursing fac care subseq

99309

Nursing fac care subseq

99310

Nursing fac care subseq

99315

Nursing fac discharge day

Temporary Addition for the PHE for the COVID-19 Pandemic

99316

Nursing fac discharge day

Temporary Addition for the PHE for the COVID-19 Pandemic

99327

Domicil/r-home visit new pa

Temporary Addition for the PHE for the COVID-19 Pandemic

99328

Domicil/r-home visit new pa

Temporary Addition for the PHE for the COVID-19 Pandemic

99334

Domicil/r-home visit est pa

Temporary Addition for the PHE for the COVID-19 Pandemic

99335

Domicil/r-home visit est pa

Temporary Addition for the PHE for the COVID-19 Pandemic

continued on page 21 18

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

LETTER TO GOVERNOR NEWSOM

Medical Associations Letter to CA Gov.

n March 13, 2020, seven Bay Area medical associations, including the ACCMA, Napa County Medical Society, San Francisco-Marin Medical Society, San Mateo County Medical Association, Santa Clara County Medical Association, Solano County Medical Society, and the Sonoma County Medical Association, representing over 16,500 Bay Area physicians representing over 16,500 Bay Area physicians, penned a letter to

Governor Gavin Newsom, outlining key actions that the State of California and local jurisdictions should pursue in addressing COVID-19. The recommended actions focus on the need for increased public awareness of the COVID-19 threat, an increase in testing capacity, clear guidance for providers managing suspect patients, and the need for increased resources.

Dear Governor Newsom: On behalf of the undersigned Bay Area medical associations, representing over 16,500 Bay Area physicians, we would like to thank you for your ongoing leadership on California’s response to novel coronavirus, or COVID-19. As the Bay Area braces for more widespread community transmission of Covid-19, we are writing to urge the State of California and our local jurisdictions to take the following actions to minimize the transmission of Covid-19 and keep our health care workforce healthy: We need to protect patients and providers from Covid-19 exposure in health care facilities • There is an immediate need for aggressive, consistent public messaging that urges patients with upper respiratory infection (URI) who have mild to moderate symptoms to stay home and avoid seeking medical care unless their symptoms worsen. Patients should be encouraged to remain out of public contact entirely until after their symptoms have resolved. Patients should only leave their home to seek medical care if their condition worsens, and they should call their providers before arriving at a health care facility if they suspect they may have COVID-19 • Patients with mild to moderate URI symptoms should be encouraged to receive care at home through telemedicine. Any regulatory barriers to the utilization of technology should be lifted on an emergency basis so that physicians can easily and immediately provide telecare to patients without delay or additional cost. The state should enforce parity and require payors to reimburse telemedicine and telephone appointments the same as in-person visits and should remove all contracting or other barriers for providers. Physicians should be able to start communicating with patients virtually by simply using the smart phone in their pocket, without delay. • Home, “drive through” or other remote testing must be widely available throughout the Bay Area; patients with URI suspected for Covid-19 should have a means to be tested immediately without entering a healthcare facility and subjecting other patients and health care workers to possible exposure. • Screening should occur prior to entry into critical health care facilities (EDs, acute care hospitals, long term care facilities, etc.). • Any patient showing mild to moderate URI symptoms should be directed to self-isolate at home and seek care from a PCP through telemedicine or telephonically. Protocols should be established to ensure patients screening for a higher level of care are safely transported to a facility that is properly equipped per CDC guidelines. We urgently need more testing capacity • We still do not have readily available access to Covid-19 testing in our community despite announcements from elected officials that testing is available. Physicians in our community are reporting difficulty accessing testing. • Supply chain issues need to be addressed to ensure adequate access to test kits • Testing capacity and turnaround time need to be improved – commercial labs are backlogged with turnaround times up to 5 days, and physicians have reported having requests for tests declined continued on next page

ACCMA BULLETIN | MARCH/APRIL 2020

LETTER TO GOVERNOR NEWSOM •

(continued)

We have also heard reports from physicians that turnaround time for testing is far too long, as much as five days. We need the ability to get rapid results in order to help mitigate spread.

We need clear, consistent guidance for providers managing suspect patients and referrals • Most of the guidance issued thus far has been appropriately focused on containment, and there is a need for clear, practical guidance for outpatient practices reflect the growing realization that community transmission is occurring • We cannot afford to lose our physician workforce - especially primary care physicians – for two weeks at a time. We need clear pragmatic guidelines on how long someone with a URI illness must be home quarantined after recovery, with or without a positive Covid-19 test. • Local jurisdictions should be encouraged to adopt CDC guidelines allowing asymptomatic HCW to provide care, even if they have an exposure. • There needs to be reasonable protective measures an office-based physician can take to minimize risk to patients and to themselves that will enable our physician workforce to provide vitally needed care without being sidelined unnecessarily. • As already emphasized previously, a central strategy needs to be keeping mild to moderate URI patients at home and out of health care facilities. • Physicians—particularly independent community physicians—need better guidance on Covid-19 procedures, including when patients should be sent to hospitals or other local health care facilities for further testing. • Physicians need clear, consistent guidance on what to instruct patients who are tested for Covid-19 and their families/ household members to do while awaiting test results. • For those who are simply unable to stay home when they are not feeling well, we need guidance on what to instruct patients to do to minimize risk to others We need enough ventilators and general ICU resources to manage the most severe cases • The World Health Organization has warned that such shortages have already occurred in hard-hit areas such as Italy and China, forcing triage and increasing mortality • A new survey of American emergency physicians highlights this as a primary concern here as well, especially as hospital beds have consolidated and decreased • We urge that every hospital be urged to devote the necessary equipment and Human Resources to planning for this scenario and that regional cooperation among local hospitals and clinics be prioritized so that these most urgent needs can be most optimally deployed We also believe our efforts would be far more effective if all Bay Area counties followed a uniformly proactive and aggressive approach rather than continuing to wait and see. Community spread of a transmissible virus is not going to be confined by county lines. We believe the virus is likely more widespread than reported number suggest since we don’t have adequate testing capacity to know how many cases there are. If you have questions about this letter, please contact us or Joseph Greaves, ACCMA Executive Director, at 510-654-5383 or jgreaves@accma.org.

Katrina Peters, MD, MPH President Alameda-Contra Costa Medical Association

Andrea M. Clarke, MD President Napa County Medical Society

Brian Grady, MD President San Francisco-Marin Medical Society

Richard Moore, MD President San Mateo County Medical Association

Eric Leung, MD President Solano County Medical Society

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Seema Sidhu, MD, FACOG, FHPM President Santa Clara County Medical Association

Rajesh Ranadive, MD

Rajesh Ranadive, MD President Sonoma County Medical Association

MEDICARE TELEHEALTH SERVICES

99336

Domicil/r-home visit est pa

(continued from page 18)

Temporary Addition for the PHE for the COVID-19 Pandemic

99337

Domicil/r-home visit est pa

Temporary Addition for the PHE for the COVID-19 Pandemic

99341

Home visit new patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99342

Home visit new patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99343

Home visit new patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99344

Home visit new patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99345

Home visit new patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99347

Home visit est patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99348

Home visit est patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99349

Home visit est patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99350

Home visit est patient

Temporary Addition for the PHE for the COVID-19 Pandemic

99354

Prolonged service office

99355

Prolonged service office

99356

Prolonged service inpatient

99357

Prolonged service inpatient

99406

Behav chng smoking 3-10 min

99407

Behav chng smoking > 10 min

99468

Neonate crit care initail

Temporary Addition for the PHE for the COVID-19 Pandemic

99469

Neonate crit care subsq

Temporary Addition for the PHE for the COVID-19 Pandemic

99471

Ped critical care initial

Temporary Addition for the PHE for the COVID-19 Pandemic

99472

Ped critical care subsq

Temporary Addition for the PHE for the COVID-19 Pandemic

99473

Self-meas bp pt educaj/trai

Temporary Addition for the PHE for the COVID-19 Pandemic

99475

Ped crit care age 2-5 init

Temporary Addition for the PHE for the COVID-19 Pandemic

99476

Ped crit care age 2-5 subsq

Temporary Addition for the PHE for the COVID-19 Pandemic

99477

Init day hosp neonate care

Temporary Addition for the PHE for the COVID-19 Pandemic

99478

Ic lbw inf < 1500 gm subsq

Temporary Addition for the PHE for the COVID-19 Pandemic

99479

Ic lbw inf 1500-2500 g subs

Temporary Addition for the PHE for the COVID-19 Pandemic

99480

Ic inf pbw 2501-5000 g subs

Temporary Addition for the PHE for the COVID-19 Pandemic

99483

Assmt & care pln cog imp

Temporary Addition for the PHE for the COVID-19 Pandemic

99495

Trans care mgmt 14 day disch

99496

Trans care mgmt 7 day disch

99497

Advncd care plan 30 min

99498

Advncd are plan addl 30 min

G0108

Diab manage trn per indiv

G0109

Diab manage trn ind/group

G0270

Mnt subs tx for change dx

G0296

Visit to determ ldct elig

G0396

Alcohol/subs interv 15-30mn

G0397

Alcohol/subs interv >30 min

G0406

Inpt/tele follow up 15

G0407

Inpt/tele follow up 25

G0408

Inpt/tele follow up 35

G0420

Ed svc ckd ind per session

continued on page 21

ACCMA BULLETIN | MARCH/APRIL 2020

MEDICARE TELEHEALTH SERVICES

G0421

Ed svc ckd grp per session

G0425

Inpt/ed teleconsult30

G0426

Inpt/ed teleconsult50

G0427

Inpt/ed teleconsult70

G0436

Tobacco-use counsel 3-10 min

G0437

Tobacco-use counsel>10min

G0438

Ppps, initial visit

G0439

Ppps, subseq visit

G0442

Annual alcohol screen 15 min

G0443

Brief alcohol misuse counsel

G0444

Depression screen annual

G0445

High inten beh couns std 30m

G0446

Intens behave ther cardio dx

G0447

Behavior counsel obesity 15m

G0459

Telehealth inpt pharm mgmt

G0506

Comp asses care plan ccm svc

G0508

Crit care telehea consult 60

G0509

Crit care telehea consult 50

G0513

Prolong prev svcs, first 30m

G0514

Prolong prev svcs, addl 30m

G2086

Off base opioid tx first m

G2087

Off base opioid tx, sub m

G2088

Off opioid tx month add 30

(continued from page 21)

Tracy Zweig Associates INC.

REGISTRY

PLACEMENT

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

FIRM

MEDICARE TELEHEALTH SERVICES

AB 890 Heading to the Senate

ver the past year, physicians across California have been advocating against Assembly Bill 890 (Woods); Nurse Practitioner’s (NP’s) Scope of Practice, which would remove critical patient protections, allowing NPs to practice independently without physician supervision. This bill has cleared out of the

(continued from page 21)

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 one of our Senators, Senator Steve Glazer, who was sent the following letter on behalf of ACCMA.

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, President

ACCMA BULLETIN | MARCH/APRIL 2020

MICRA

Oppose the Costly MICRA Measure PROTECT ACCESS TO QUALITY HEALTH CARE

his fall, California voters will be asked to vote on a new ballot measure that would drive up health care costs, restrict access to care for low-income patients, and decimate the protections afforded to patients across California as part of the Medical Injury Compensation Reform Act (MICRA). This initiative, bankrolled with millions of dollars from an Iowa-based trial attorney, would effectively eliminate the cap on non-medical damage awards in malpractice cases, substantially raising health care costs for all Californians, while allowing attorneys to collect unlimited fees from medical malpractice awards. In short, this measure would provide new incentives for lawyers to file frivolous medical malpractice suits, creating a chilling effect on the practice of medicine and clearing the way for new financial windfalls for California’s trial lawyers at taxpayer expense. While current California law allows patients to recoup unlimited damages for medical expenses, lost wages and in cases of gross medical negligence, the law also caps non-economic damages in malpractice cases. The law was put in place to ensure injured patients receive fair compensation while also protecting doctors, hospitals, and other health care providers from frivolous, punitive lawsuits that drive up health care costs. This initiative would erase those protections and send taxpayers the bill. According to California’s independent Legislative Analyst, this measure would lead to “annual government costs likely ranging from the low tens of millions of dollars to the high hundreds of millions of dollars,” and will reduce access for those who need is most, including those who use Medi-Cal, county programs, safety net providers, and school-based health centers. County and state hospitals have to pay medical malpractice awards out of the budgets they receive from taxpayers. This means that if medical malpractice awards increase, government costs will increase too. Somebody has to pay, and that will be taxpayers through higher taxes and California citizens through higher health care premiums. According to one economic analysis, this measure would increase the average annual cost of health care for a family of four by $1,100. This push to eliminate MICRA is led by a rich trial attorney from Iowa, Nicholas Rowley, who has publicly said that he is willing to spend at least $20 million of his own money in support of the initiative. For Rowley, the investment makes sense. If he is successful, he and his law firm will be unshackled from current limits on attorneys’ fees, and stand to make millions while sending

California taxpayers the bill. Physicians take an oath to protect patients – and this dangerous proposal would put patients at risk of losing access to quality medical care. In 2014, voters were clear when they rejected Prop. 46 and changes to MICRA that would have quadrupled the cap on noneconomic damages because of the negative effects that it would have on their quality of care and pocketbooks at large. This measure goes well beyond what Prop. 46 would have done, and the cost to taxpayers would be far greater. The Alameda-Contra Costa Medical Association and the California Medical Association have joined Californians to Protect Patients and Contain Health Care Costs, a broad coalition of physicians, dentists, nurses, hospitals, safety net clinics, and other health care providers, to oppose this initiative. Together, we are vigorously fighting this initiative in order to protect access to quality health care for Californians across the state.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

HOW YOU CAN HELP Here’s what ACCMA members can do today to be part of our campaign to protect MICRA. • Commit yourself to voting NO on the new MICRA measure, and enlist your colleagues to make their own commitments, by going to cmadocs.org/micra/commit. • Distribute educational materials to your patients, colleagues, friends, and family. Contact the ACCMA at accma@accma.org or (510) 654-5383. • Participate in media training and learn how you can share your story via video, social media, and/or media interviews, by going to cmadocs.org/micra/commit. • Contact the ACCMA if you want to volunteer to speak to medical groups about the importance of protecting MICRA. Email accma@ accma.org or call (510) 654-5383. • For physicians who want to donate to the Protect MICRA campaign personally, please go to protectmicra.org and click the red Donate button.

UNTIL HELP ARRIVES

Until Help Arrives Instructor Training By Thomas Sugarman, MD, ACCMA Emergency Committee Chair

“U

ntil Help Arrives” is a program that aims to educate and provide training to the general public about compressiononly CPR, controlling bleeds, assessing scene safety, etc. The program emphasizes to community members that they are the help until further help arrives. A multi-agency effort led by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Medical Reserve Corps (MRC), the Uniformed Services University’s (USU) National Center for Disaster Medicine and Public Health (NCDMPH), and the Federal Emergency Management Agency’s (FEMA) Individual and Community Preparedness Division (ICPD) developed the base of the program. FEMA and collaborating federal agencies developed the Until Help Arrives program after research revealed there are simple steps that untrained individuals can take to increase the chances of survival for an injured person. Until Help Arrives is the first comprehensive, free-of-charge training program that broadly covers what you should do until help arrives. Cal-ACEP, the California American College of Emergency Physicians, is sponsoring the program and offers free, one-hour online training sessions for healthcare professionals to become volunteer community instructors for the program. Trained instructors are then able to conduct training sessions on a voluntary basis for the community. In addition to helping train bystanders in lifesaving techniques, the program offers a pathway for physicians to give back to the community. Information below republished from American College of Emergency Physicians (ACEP); https://www.acep.org/uha/ teach-a-course/ BECOME AN INSTRUCTOR The Until Help Arrives course is designed to be taught by emergency medical professionals. ACEP members are automatically eligible to become instructors, and anyone licensed in the following disciplines is welcome to apply to become an instructor: MD, DO, RN, NP, PA, DPM Paramedic, EMT, EMR/First Responder (or a student enrolled in any of these programs). To become an Until Help Arrives instructor, please watch the instructor video and fill out the Instructor Interest Form (https:// bit.ly/33ARlKS). ACEP members will then receive a follow-up email with access to the Instructor Portal. Those who are not ACEP members will receive follow-up communication from our

Until Help Arrives team to confirm credentials before receiving access to the Instructor Portal. The portal houses various resources to help you lead a successful Until Help Arrives course, including the course curriculum, a sample script, course handouts, registration sheets and more. INSTRUCTOR RESPONSIBILITIES Until Help Arrives instructors are responsible for organizing and leading training courses in their communities, and our staff is here to support you. Course instructors are expected to: • Secure a location for the course • Use Instructor Portal resources to allow people to register for the course • Procure the recommended course supplies, either by purchasing an Until Help Arrives Instructor Pack or providing your own supplies • Conduct the course, including pre- and post-test surveys at the beginning and end of the course to assess efficacy • Provide post-course feedback to ACEP in order to continually improve the program WHERE TO HOST If you’re interested in leading a course but aren’t sure where to host it, consider the following results from ACEP’s recent national poll (https://bit.ly/2xXP7tl). We asked respondents where the training course should be offered, and these were the top choices: 1. Local hospitals and clinics 4. Community centers 5. Your place of employment 2. High schools 3. Colleges/universities

INTERESTED IN VOLUNTEERING? If you’re interested in becoming a trained instructor, please contact Hannah Robbins, ACCMA Communications Associate, at hrobbins@accma.org. Instructor training is free and will be conducted entirely online through Cal-ACEP’s training program. The ACCMA would like to maintain a list of physician members who have completed training.

ACCMA BULLETIN | MARCH/APRIL 2020

MFAR

ACCMA Responds to MFAR

he Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on November 18, 2019— Medicaid Fiscal Accountability Regulation (CMS-2393-P)—that will significantly reduce our state’s Medicaid funding, exacerbate provider shortages and undermine patient access to medical care. The proposal limits the funding states can put up to receive

federal matching funds and it does not establish clear standards by which future state Medicaid funding will be reviewed. In light of this, ACCMA urged CMS to withdraw this proposed rule entirely and submitted the following comments to express our deep concerns with the proposed Medicaid Fiscal Accountability Regulation.

Dear Administrator Verma: The Alameda-Contra Costa Medical Association (ACCMA) – representing approximately 5,000 physicians in the San Francisco East Bay – respectfully submits the following comments to express our deep concerns with the proposed Medicaid Fiscal Accountability Regulation, released by the Centers for Medicare & Medicaid Services (CMS) on November 18, 2019. If adopted, the proposed regulations could have a catastrophic effect on the ability of Medi-Cal patients in our community to receive timely access to high quality care. In light of our concerns, which are further elaborated below, we are urging CMS to withdraw this proposed rule entirely. BACKGROUND California’s Medicaid Program (Medi-Cal) is the health care safety net that serves 13-million low-income Californians. Nearly half of all California’s children and disabled are enrolled in Medi-Cal. The ACCMA represents nearly 5,000 physicians practicing in Alameda and Contra Costa Counties (comprising the San Francisco East Bay). Collectively, our members provide medical care to 2.6 million East Bay residents, of which over 500,000 are enrolled in the Medi-Cal program. Our Medi-Cal population is served by a safety net system that includes two public health systems, three managed care plans, two public hospital systems with a total of six hospitals, and scores of primary care clinics, school-based clinics, mental health clinics, substance abuse clinics and programs. In addition, our community is home to multiple large integrated health systems, 19 different emergency departments, and hundreds of medical groups, private practices, urgent care centers, and clinics. Medi-Cal patients rely on this vast network of providers to receive high quality care. Subsequent to the adoption of the Patient Protection and Affordable Care Act of 2009, we have experienced a substantial decline in the number of uninsured residents and major expansion of residents covered by Medi-Cal. Our ability to continue to provide our Medi-Cal patients with timely access to high quality care will be significantly jeopardized by the proposed rule. IMPACT OF PROPOSED CHANGES Physicians, dentists, hospitals and other providers in our community will be impaired in our ability to continue to participate in the Medicaid program, exacerbating existing provider shortages and patient access to care challenges. The rule will disproportionately harm California’s rural and underserved areas where 2/3 of the residents are enrolled in Medi-Cal and there are already serious provider shortages, hospital closures, and patients travelling long distances to receive care. When patients are forced to delay care, their conditions worsen and ultimately become more challenging and costly to treat. The proposed rule will significantly decrease access to care for vulnerable patients by forcing California to cut reimbursement rates even lower – The proposed rule would reverse longstanding policy that is consistent with federal law by inappropriately restricting California’s ability to finance the non-federal share, which would cause major disruptions to health care delivery on our community. There is simply no way to replace all non-federal share funds affected by the proposed rule with only state and local tax revenue. Consequently, the proposed rule would lead to a further reduction in Medi-Cal reimbursement

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

MFAR

(continued)

rates, which are already far below Medicare rates and do not adequately cover the full cost of services. This reduction in overall funding will be compounded by the new restrictions being imposed on supplemental payments. Supplemental payments should be looked at in the context of the overall Medi-Cal reimbursement rate (combined base rate and supplemental rate). In California, and in many states, virtually all providers receive supplemental payments, which are necessary components of reimbursement. Even with supplemental payments, Medi-Cal reimbursement rates are often far below the cost of care. Capping supplemental payments according to an arbitrary formula will only further drive down Medi-Cal reimbursement rates. The consequence of cutting reimbursement rates is that fewer providers will be able to afford to provide care for Medi-Cal patients, making it even more challenging for Medi-Cal patients to receive timely access to quality care. Medi-Cal patients do not have the means or ability to seek out alternatives. The effect of this proposed rule is that care will be delayed, contributing to poorer health outcomes and adding costs to the overall health system. The proposed rule will lead to a reduction in covered benefits, leaving patients without the ability to access critical services â&#x20AC;&#x201C; Because there is simply no realistic way to replace all non-federal share funds affected by the proposed rule with only state and local tax revenue, the proposed rule would likely force California and local managed care plans to significantly reduce covered benefits for children, pregnant women, working adults and the disabled. Patients will no longer be able to access critical health care services, and patient conditions will worsen and ultimately be more challenging and costly to treat. The proposed rule will lead to more overcrowding in emergency departments â&#x20AC;&#x201C; We know that when patients are unable to receive care, they turn to emergency departments to receive routine, non-emergency care because EMTALA requires emergency departments to evaluate all patients who come through the door. Prior to the implementation of the ACA, emergency department overcrowding was attributed to uninsured patients who could not access services in lower cost settings due to lack of coverage. Under the proposed rule, emergency departments will not only be the default provider for uninsured patients, but for the 1/3 of Californians who have Medi-Cal for their insurance. As a result of the proposed rule, we can expect that MediCal patients will find it more challenging to access care in lower acuity, lower cost ambulatory care settings, causing them to turn to the ED as a backup. ED overcrowding has abated in our community since the expansion of Medi-Cal under the ACA, since more patients have coverage under Medi-Cal. The proposed rule will reverse the progress we have made and will lead more patients to seek care in emergency departments. It is unconscionable and deeply irresponsible of CMS to propose a rule that will drive insured patients from lower acuity, lower cost providers into emergency departments for routine non-emergent services. The net effect is to decrease access to emergency medical care for everyone. The proposed rule will lead to the loss of medical services and the creation of more medical deserts in our community â&#x20AC;&#x201C; Despite being located within the San Francisco Bay Area, one of the most affluent regions in the United States, our community has areas that are medically underserved due primarily to inadequate Medi-Cal funding at current levels. In fact, the only community hospital in West Contra Costa County (Doctors Medical Center, San Pablo) had to close its doors several years ago due primarily to its payor mix, which was heavily weighted towards Medi-Cal. Consequently, there is no community hospital or emergency department to serve the working-class communities along the highly congested I- 80 corridor between Vallejo in Solano County and Berkeley in Alameda County. By substantially reducing Medicaid funding for California, the proposed rule would exacerbate financial pressures many safety net providers in our community already feel and would likely lead many providers to close their doors entirely. There are safety net hospitals, clinics and physician practices that are currently operating on very thin margins that simply cannot withstand a dramatic reduction in Medi-Cal funding. The effect of the proposed rule would be to force many of them out of business, not only reducing access to care for Medi-Cal patients, but also putting many people out of work. Estimates suggest that the proposed rule would result in at least 10,000 job losses in our community alone. On behalf of East Bay physicians and the over 500,000 Medi-Cal patients to whom we provide care, we urge CMS to rescind this harmful proposal so that we can continue to meet the needs of our patients by providing access to timely, affordable, quality care. If you have any questions or would like to discuss this matter further, please contact Joseph Greaves, ACCMA Executive Director, at 510-654-5383 or jgreaves@accma.org. Sincerely,

Katrina Peters, MD, MPH President

ACCMA BULLETIN | MARCH/APRIL 2020

NEW MEMBERS

NEW & RETURNING MEMBERS Alta Bates Med Ctr/ Sutter East Bay Medical Group Alejo Santa Cruz, MD Family Medicine East Bay Newborn Specialists, Inc. Jayalakshmi Ravindran, MD, FAAP, MS Pediatrics Palo Alto Foundation Med Group Rajesh Shinghal, MD Urology The Permanente Medical Group Maria Alvarado-Garcia, MD Internal Medicine Anne-Francelle Lucero Ardina, MD Pediatrics Zachary Paul Bailowitz, MD Physical Medicine and Rehabilitation Marina Nabil Bissada, DO Family Medicine Melissa Christine Blankenbeckler, MD Pediatrics Lena Braginsky, MD Obstetrics and Gynecology Giye Choe, MD Thoracic Surgery Adrianna St Rose Dâ&#x20AC;&#x2122;mello, MD Internal Medicine Jason Smith Day, MD Emergency Medicine Mansooreh Eghtesad, MD Pathology Nassrene Yousef Elmadhun, MD Thoracic Surgery Scott David Everett, MD Family Medicine Austin Jacob Fain, DO Family Medicine Nazia Farah, DO Family Medicine Farrah H. Fong, DO Family Medicine Ann Katherine Froderberg Gallagher, MD Pediatrics Sonali Ladha Ghosh, MD Family Medicine Erin Lee Habecker, MD Psychiatry Kristina Kostenkova Heller, DO Internal Medicine Ngu Wah Hlaing, MD Internal Medicine Katherine Huang, MD Obstetrics and Gynecology

Thanh-an Nguyen Huynh, DO Internal Medicine

Stephen Thomas Sewell, MD Internal Medicine

Kathryn Ellen Keaty, MD Obstetrics and Gynecology

Sophie Helene Shabel, MD Obstetrics and Gynecology

Anam Boaz Khan, MD Internal Medicine

Abigail Lauren Shatkin-Margolis, MD Obstetrics and Gynecology

Rukhsana A Khan, MD Psychiatry

Katherine Louise Shea, MD Anesthesiology

Neera Khattar, MD Emergency Medicine

Brady Alan Sieber, MD Plastic Surgery

Virginia Huynh Kim, MD Radiology

Razan Taha, MD Family Medicine

Kevin Douglas Kirschman, MD Obstetrics and Gynecology

Kathrine Colleen Taylor, MD Obstetrics and Gynecology

Andrea Mary Konkoly, MD Internal Medicine

Michele Julie Wong, MD Family Medicine

Pushpa Krishnasami, MD Occupational Medicine

Vincent Woon-Cheuk Wong, DO Internal Medicine

Nicole Rose Lederman, MD Psychiatry

Lauren Kazuko Yokomizo, MD Internal Medicine

Christian Alexander Lee Rodriguez, MD Internal Medicine Nancy Lee, MD Anesthesiology Nicole Nakyung Lee, MD Radiology Denise Y. Lu, DO Family Medicine Vikram Singh Mahal, MD Emergency Medicine Shilpa Mathew, MD, JD Obstetrics and Gynecology Lauren Beverly Moneta, MD Head and Neck Surgery Roshan Fatemeh Najafi, MD Family Medicine Shefali Nath, MD Internal Medicine Thuc-Quyen Tran Nguyen, MD Hospice and Palliative Medicine Anabel Ortiz, MD Hospitalist Kirtan Ajay Patel, MD Internal Medicine Kenneth J Perry, MD Emergency Medicine Gabriel Mario Poliboy, MD Pediatrics Pamela Bettina Polynice, DO Emergency Medicine Benjamin Micah Raber, MD General Surgery Adolfo Romero-Duran, MD Family Medicine Nikharika Saw, MD Anesthesiology

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Pittsburg Health Clinic Gupta Etwaru, MD Ophthalmology Planned Parenthood of Northern California Sara Lynne Kennedy, MD, MPH Obstetrics and Gynecology Sutter East Bay Medical Group Adedotun Ademijulo Adewusi, MD Internal Medicine Susan Lyla Adham, MD Pediatrics Arzou Diane Ahsan, MD Obstetrics and Gynecology Maria Ait Rais, MD Internal Medicine Melissa Marie Amorn, MD Otorhinolaryngology Donald Linell Anderson, MD Anesthesiology Altaf Hussain Ansari, MD Emergency Medicine Matthew William Arnold, MD Neurology Irmeen Musharraf Ashraf, MD Family Medicine Marina Mihaela Atala, MD Internal Medicine Jennifer L Ault, DO Neurology Lilian Nadir Babvani, MD Internal Medicine Jyothi Bachwani, MD Internal Medicine

NEW MEMBERS

(continued)

Sonia Louise Badheka, DO Obstetrics and Gynecology

Leif Robert Hass, MD Family Medicine

Susan Nguyen, MD Internal Medicine

Tamika Elecia Bailey, MD Internal Medicine

Lenny C Husen, MD Internal Medicine

Rohini Erika Noronha, MD Internal Medicine

Chhavi Bajaj, MD Internal Medicine

Risa Kagan, MD Obstetrics and Gynecology

Jennifer Madeline Owen, MD Family Medicine

Sumbella Farhan Baqai, MD Internal Medicine

Brian Randall Kaye, MD Rheumatology

Tianli Pan, MD Internal Medicine

Mohsin Sultan Barra, MD Internal Medicine

Fatma Shabbirali Khakoo, MD Hospitalist

Kavita Subhash Patankar, MD Internal Medicine

Rajesh Behl, MD Medical Oncology

Dmitry M Khvatsky, MD Internal Medicine

Charu Puri, MD Internal Medicine

Felix Ralph Berberich, MD Pediatrics

Oleg Igor Krijanovsky, MD Medical Oncology

Sindhu Radhakrishnan, MD Internal Medicine

Michele Diahann Bergman, MD Obstetrics and Gynecology

Benedikt Wilhelm Kurz, MD Pediatrics

Bernice Maria Rodrigues, MD Family Medicine

Nina Rachel Birnbaum, MD Family Medicine

Rita Ophelia Kwan-Feinberg, MD General Surgery

Reina M Rodriguez, MD Family Medicine

Naomi Bitow, MD Family Medicine

Yolanda Chuck-Yan Lau, MD Pediatrics

Phillip Leon Ross, MD Urology

Jeeven Kaur Brah, MD Internal Medicine

Elizabeth Mary Mahler, MD Internal Medicine

Alfort Briones Santos, MD Family Medicine

Amit Chadha, MD Internal Medicine

Janice E Manjuck, MD Critical Care Medicine

Peter Andrew Schneider, MD, FACS Urology

Sharon Hsi-Jan Chan, MD Internal Medicine

Gaurav Mathur, MD Hospice and Palliative Medicine

Virginia Kathleen Scialanca, MD Internal Medicine

Lisa Jane Chandler, MD Internal Medicine

Tun Tun Maung, MD Internal Medicine

Sabine M Steegers, MD Internal Medicine

Joseph T Chao, MD Dermatology

Adrienne Laura Mcgrael-Souders, MD Family Medicine

Mac Lincoln Sterling, MD Internal Medicine

Patricio Martin Chavez, MD Emergency medicine

Maria Fatima Militante-miller, DO Internal Medicine

Khin Myat Thu, MD Internal Medicine

Paul Tinpo Cheung, MD Internal Medicine

Mary Lynn Miller, MD Internal Medicine

Prathibha Venkataswamy, MD Hospitalist

Nalurporn Chokrungvaranon, MD Endocrinology, Diabetes and Metabolism

Daniel Mark Montes, MD Family Medicine

Andrew Bard Wallach, MD Family Medicine

Alan Robert Cohen, MD Internal Medicine

Lloyd Conrad Morrissey, MD Internal Medicine

Grant Woei Wang, MD Family Medicine

David Eric Collins, MD Neurology

William Michael Mundy, MD Family Medicine

Serena Donchi Way, MD Pediatrics

Joanna Anat Cooper, MD Sleep Medicine

Kalpna Rachel Munzni, MD Internal Medicine

Laura Lyn Wedderburn, MD Internal Medicine

James Vincent Felt, MD Internal Medicine Jill Diane Foley, MD Obstetrics and Gynecology Arash Foroutani, MD Internal Medicine Anna C Frick, MD Obstetrics and Gynecology Martin J Garcia, MD Internal Medicine Ramakrishna Prasad Gollapudi, MD Gastroenterology Manjula Vinodh Gunawardane, MD Internal Medicine

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

ACCMA BULLETIN | MARCH/APRIL 2020

2020 ACCMA COUNCIL

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

Practice & Liability CONSULTANTS Put Your ACCMA Membership to Work! Go to www.accma.org/ MemberBenefits, or call ACCMA at (510) 654-5383 for help.

Health Care Practice Management In a special arrangement with Practice & Liability Consultants, ACCMA members may purchase the following practice management kit at a reduced price: â&#x20AC;¢ Office StaffPersonnel Policies an d Procedures Manual

Practice consulting services available. Debra Phairas 461 Second Street, Suite 229 San Francisco, CA 94107 (415) 764-4800 Fax (415) 764-4802 www.practiceconsultants.net

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

ALAMEDA ALLIANCE

Addressing COVID-19 in Our Community By Scott Coffin, CEO, Alameda Alliance for Health

lameda Alliance for Health (the Alliance) is honored to serve nearly 245,000 children and adults in Alameda County. In this edition, you will learn more about the Alliance’s efforts to reduce the administrative burden and improve cash flow for our contracted providers during the COVID-19 pandemic. You will also learn about how we are working to ensure that some of our most vulnerable members, including older adults and people with chronic health conditions continue to receive the care they need, as well as what Alameda County and our social safety net partners are doing to prepare for a potential surge in cases. THE ALLIANCE’S EFFORTS TO ADDRESS COVID-19 IMPACTS Since we first learned about the novel coronavirus earlier this year, there have now been over 1.5 million cases reported in 213 countries and territories throughout the world. As we continue to see the virus spread throughout our various communities, we are working hard to ensure that our provider partners have the resources they need to provide care for our members while reducing the continued spread of COVID-19. Prior to the Department of Health Care Services’ (DHCS) guidance on alternative modalities, the Alliance made a decision to cover medical visits conducted via telephone for all of our contracted providers and delegates. We understood that provider offices were receiving increased requests for telephonic appointments as a result of the growing concern over the COVID-19 pandemic. In an effort to support our provider partners in delivering care to Alliance members, we approved the use of an interim procedural (CPT) code which allowed for telephonic appointments to be billed at the same rate as an in-person visit. Since then, the Alliance has implemented the DHCS issued guidance about covering telephonic and telehealth appointments. As we continued to hear from our providers requesting assistance with navigating the policy changes that directly impact their practice, we tailored our educational materials to help clarify these questions. Additionally, in order to accommodate providers, many who have moved their staff to a remote work setting, we are working to encourage the use of our Provider Portal that now

includes access to electronic RA’s (remittance advice statements). The Provider Portal is a tool that can be used to obtain services electronically and serves as a resource to assist providers in reconciling billing and payments, submitting requests for authorization electronically, and obtaining claim status. The Alliance continues to find ways to ease the administrative burden that our providers are experiencing related to the COVID19 situation, including changes in our Pharmacy Department. As of mid-March, the Alliance’s Pharmacy Department turned on our enhanced disaster program which allows for coverage of a 90-day supply for most prescriptions and over the counter medications. ‘Refill Too Soon’ overrides are also available in order to provide early refills to members as the ongoing COVID-19 situation evolves. Additionally, we are temporarily waiving fees from Walgreens and CVS pharmacies that offer home delivery, as well as waiving prior authorizations for step therapy and quantity limits in the event of a drug shortage. Our members over 65 years old as well as those with chronic health conditions are among the most vulnerable groups and at higher risk for severe illness from COVID-19. In order to safely reach this group, the Alliance began a call campaign in April that included automated calls to nearly 60,000 members, offering valuable information on what to do if they suspect they have COVID-19 symptoms, how to protect themselves and others from spreading the virus, and how to access the Alliance’s Member Services Department. In addition, we are launching the second phase of this campaign in partnership with our providers to personally contact members by phone to identify what types of services and resources they may need (addressing social isolation, food insecurities, and addressing flu symptoms). As the situation with COVID-19 evolves, we will continue to find ways to reach out to our most vulnerable members to ensure that they have access to resources and the care they need. ALAMEDA COUNTY’S COVID-19 RESPONSE Our Alameda County partners continue efforts to prevent and contain the spread of COVID-19 in our community. In continued on page 33 ACCMA BULLETIN | MARCH/APRIL 2020

COUNCIL REPORTS

JANUARY 9, 2020

The meeting was called to order by Doctor Katrina Peters, President. ACCMA Executive Director, Joseph Greaves welcomed new members of the Council and provided an orientation to the roles and responsibilities of ACCMA Councilors. Doctors Shakir Hyder and Edmond Soliman were nominated for the Councilor-at-Large position. The Councilor-at-Large will be selected at the February Council meeting. The 2020 ACCMA Council meeting schedule was approved as amended to change the November Council meeting to November 3, 2020. All other Council meetings remain as scheduled. Mr. Greaves discussed the suspension of the Professional Liability Committee meetings due to legal concerns. ACCMA is working with the Medical Insurance Exchange of California (MIEC) to evaluate other programs that could take the place of the committees. Other committee changes were also briefly discussed. Doctor Sugarman presented the ACCMA Emergency Committee recommendations regarding the “Until Help Arrives” program that aims to educate and provide training to the general public about compression-only CPR, controlling bleeds, assessing scene safety, etc. A one-hour online course is available to instruct physicians to provide training to the public. The Council approved the recommendations that the ACCMA facilitate training by encouraging both doctors and medical students to take the course; buying training equipment to lend to training sessions; maintaining a volunteer trainer list; and soliciting funding for the training equipment from community groups. The Council reviewed a request from Alameda County Supervisor Wilma Chan to endorse a proposal to expand the CalAIM “In Lieu of Services” (ILOS) Meals/Medically Tailored Meals program to include a broader risk group, including medically frail patients. After discussion, the Council requested that the ACCMA Public Health Committee review this program proposal and provide the Council with their recommendation. Doctor Dutta provided the AMA Delegates report. She stated that there was no new business to report and tabled a full report to the February Council meeting. Doctor Wyatt provided the CMA Board of Trustees (BOT) report. The upcoming BOT retreat will discuss the strategic plan and physician wellbeing. He also reported that CMA is on its way to becoming the largest state medical society in the nation. Mr. Greaves announced to the Council that there were leadership opportunities at the CMA. Any Councilor who is interested in pursuing these opportunities can contact him. Mr. Lopez reported that the HOD Q1 reports were available for review. He also reminded the Council of CMA Legislative Day on April 14, 2020. ACCMA will be providing a bus to transport members to Sacramento and CMA will be providing breakfast and lunch. Mr. Greaves reported that a new MICRA initiative is ramping up for the November 2020 election and has qualified for gathering signatures. This initiative will focus on increasing the 32

cap on non-economic damages. CMA will be conducting testing in the field to develop messaging on this initiative. Mr. Lopez reported that the federal “Surprise Billing” legislation did not make it into the year-end House package but would likely be brought back in 2020. ACCMA will be speaking with local legislators on this issue. The Council discussed recent interviews that were held with candidates for District 1 Supervisor for Alameda County: Senator Bob Wieckowski, who will be termed out of the State Senate after his current term; Melissa Hernandez, current city council member for the city of Dublin; and Vinnie Bacon, current member of the Fremont city council. The Council recommended that the ACCPAC board support Ms. Hernandez in the March election. Mr. Greaves provided an update on the Centers for Medicare and Medicaid (CMS) proposed rule on Medicaid financing. The Council approved sending a letter to the US Department of Health and Human Services in opposition to this rule and requested that the letter focus specifically on the impact to Alameda and Contra Costa counties should this rule be enacted. Mr. Greaves discussed the changes to ACCMA Committees for 2020. The changes are as follows: • Professional Liability Committees A and B will be sunsetted due to legal concerns by the Medical Insurance Exchange of California (MIEC). • The Bioethics and Information Technology Committees will be sunsetted and reformed as ad hoc committees as issues on these topics arise. • The Litigation Stress Committee will become a subcommittee of the Advisory Committee on Physician Wellbeing. • The Public Health, Mental Health, and Pediatric Health Committees will merge into a new committee to be known as Community Health Committee. Ms. Lum provided the ACCMA membership report. She requested that Councilors encourage their colleagues to renew for 2020, and presented a talking points memo with tips for speaking with non-renewed and potential members. There being no further business, the meeting was adjourned.

FEBRUARY 13, 2020

The meeting was called to order by Doctor Katrina Peters, President. Ashley McClure, MD, a primary care physician who works at Kaiser Permanente Medical Center in Oakland, spoke to the Council on the climate change crisis impacts on health care, and proposed that this should be a major issue at the 2020 House of Delegates (HOD). Mr. Greaves stated that the Council will consider the climate change crisis as a possible major issue for the 2020 HOD. The Council approved the following appointments: Edmon Soliman, MD – Councilor-at-Large; Colin Mansfield, MD – District 3 – Alternate Councilor-C; Albert Brooks, MD – District 5 – Councilor-D; Jeffrey Stuart, MD – District 5 Alternate Councilor-B; and Renee Fogelberg, MD – District

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10 – Alternate Councilor-E. Vacancies remain for Alternate Councilor in District 6 and Alternate-Councilor-B in District 12. Doctor Kogan spoke to the Council on the new antiMICRA initiative, which is now gathering signatures for the November 2020 ballot and proposes to increase the cap on non-economic damages from $250K to $1.2M for inflation, with annual increases tied to inflation. CMA plans to fight this ballot measure and is currently requesting that County Medical Societies participate in fundraising efforts. The Council voted to formally oppose the anti-MICRA initiative. Mr. Lopez discussed the Community Health Care Committee recommendation to support expanding medically supportive food and nutrition services in the Medi-Cal program, as requested by Alameda County Supervisor Wilma Chan. The Committee discussed the Food as Medicine Pilot program, the funding sources, the medically tailored meals and prepared boxes, and evaluation methods to determine the success of the program. The Council approved the Committee recommendation to support the program. Doctor Kogan provided the AMA Delegates report and announced that the CMA is calling for nominations for the AMA Delegation. Council members interested in being nominated should contact ACCMA staff. Doctor Klingman provided a report from the CMA Board of Trustees meeting. Mr. Lopez discussed the Q2 HOD resolutions that will be posted on February 13. There are 14 resolutions to review and a conference call meeting to discuss these resolutions is scheduled for February 19. Mr. Lopez discussed California legislative bills AB 890 - Nurse Practitioner Scope Expansion and SB 201- Intersex Autonomy. AB 890 is currently in the Senate Rules Committee and CMA expects the bill to be heard in the Senate over the summer. SB 201 did not pass the Business, Professions, and Economic Development Committee. A letter from the ACCMA to the Centers for Medicare and Medicaid Services regarding the Medicaid Fiscal Accountability Regulation (MFAR) was provided for information. Mr. Greaves stated that the letter goes into detail on the local impact of the proposed changes. Doctor Peters made an appeal to ACCMA Councilors to consider contributing to the ACCMA political action committee ACCPAC. This PAC contributes to local county and state legislators who support the interests of patients and physicians. With the anti-MICRA initiative likely to be on the November 2020 ballot, it is a crucial year to develop relationships with legislators to promote health care issues. Doctor Peters provided a report on the ACCMA committee changes for 2020. The changes represent an effort toward more robust committees and participation. Ms. Lum gave a report on the ACCMA Physician Leadership Program Part 2. She stated that the third cohort has been completed. The next cohort will include intermediate-level courses. Ms. Lum provided updates on the East Bay Clinician Wellness Consortium (EBCWC) and ACCMA Physician Wellness Program. ACCMA will host the 4th EBCWC roundtable on Clinician Wellness, Burnout and Retention on March 26. This

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gathering of wellness champions will collectively address physician burnout. ACCMA is organizing physician engagement groups to be led by trained facilitators and is seeking physician volunteers to lead these discussion groups. Ms. Lum announced to the Council that a seminar for Medication Assisted Treatment (MAT) waiver eligibility training is scheduled for March 26 and the seminar offers free CME for ACCMA members. There being no further business, the meeting was adjourned.

ALAMEDA ALLIANCE (continued from page 31)

partnership with the California Department of Social Services (CSDSS) and Abode Services, the county has worked to secure two hotels with nearly 400 rooms that provide isolation housing for people experiencing homelessness that are affected by COVID-19. Individuals that have tested positive, as well as those who are considered at high risk of contracting the virus, such as older adults and those with chronic health conditions, are among those that will be prioritized to be housed at these hotels. Wraparound support will be provided by Abode Services, while county agencies will offer medical screening and support as well as transportation resources for the sites. Additionally, the county’s Encampment Response Team is providing hand-washing stations in locations throughout Alameda County identified as best places to reach unsheltered individuals to help prevent the spread of the virus. The Alameda County Public Health Department continues to support healthcare facilities as they prepare for a surge in patients, reduction in staff or limited supplies. As our partners at Alameda County continue to work on ways to deal with this pandemic, these efforts will help flatten the curve and preserve hospital capacity in the event of a surge in COVID-19 cases. To stay up to date with the latest information from Alameda County’s Public Health Department, please visit http://www.acphd.org/2019ncov.aspx. 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 nearly 245,000 low-income children and adults through the National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care programs. ACCMA BULLETIN | MARCH/APRIL 2020

CLASSIFIEDS

The medical office of Ahmed Sadiq, MD has moved to a new location as of February 1, 2020. The office is now located at 2333 Mowry Ave, #300, Fremont, CA 94538. The contact number for the new office is 510-796-0222. (PC – Jan/Feb – March/April)

OFFICE FOR RENT - 3

Alameda Medical Office Sublet/Share Available Long established, friendly, high profile medical office suite in Alameda is available for share starting approximately April 1. Ground floor access, 1690sf, very ADA-accessible (no stairs or steps) has 24 hour access and is in a 4 suite building which also contains Quest Laboratory. This suite has been an Ob/ Gyn office for 40+ years and is adjacent to SouthShore Mall, 2 blocks from Alameda Hospital, furnished with very economical rent. Current longtime cotenant Chiropractic physician is retiring. The prospective cotenant has full use of office suite and his/her “half of suite” includes own consultation room with 2 adjacent exam rooms. Please contact Richard Kochenburger, MD: Text/Call (510) 220-1834; E-mail rkoch7@aol.com for further information. (3 – Jan/Feb – March/April)

EQUIPMENT FOR SALE - 7

Practice Close Sale Burdick EKG machine with rolling stand, Electrocautery and hyfercator, Ear wash apparatus with connector to faucet, Healthometer weight scale and height checker, 4 executive chairs and 10 waiting room chairs, minor surgery instruments, oxygen tank with mask and connectors, audiometer, Lighted vision checker with plates, mayo stand, stat kit, etc. Please call for info and appointment: (925) 820-2882. (7 - March/April - May/June)

PRACTICE FOR SALE - 10

Cosmetic Surgery & Aesthetic Dermatology Practice For Sale – San Ramon Valley, CA. Multidisciplinary practice including cosmetic surgery, cosmetic dermatology, laser treatments,

injectables, and other cosmetic procedures. Revenue $2.8 million, almost all private pay, on 40 doctor hours. Located on campus of regional hospital complex; 2 suites include a total of 9 exam rooms. High percentage of patient referrals. Third-party appraisal available. Offered at $1,271,000. Contact Medical Practices USA for more information. 925-820-6758. Email: gary@medicalpracticesusa.com | www.MedicalPracticesUSA. com (10 - March/April) Internal Medicine Practice For Sale – Fresno, CA. Revenue $1.4 million on 70 MD hours/week. Perfect for two doctors to take over. This practice is part of a five-doctor group that includes a lab, Cardiac Ultrasound, Nuclear Cardiology Stress Testing, Gastroenterology Specialty Services, and Bone Densitometry. Offered at $493,000. Contact Medical Practices USA for more information. 925-820-6758. Email: gary@medicalpracticesusa. com | www.MedicalPracticesUSA.com (10 - March/April) Internal Medicine Practice For Sale – Northern California Wine Country, CA. Concierge medical practice with revenues averaging $600,000 seeing 8 - 10 patients per day. Seller’s net income is near the 90-percentile for IM. Long established in the area, moved to newly renovated 1440 sq. ft. location in 2015; great proximity to hospital. EMR in place. Photos and third-party appraisal available. Offered at only $350,000. Contact Medical Practices USA for more information. 925-820-6758. Email: gary@medicalpracticesusa.com | www. MedicalPracticesUSA.com (10 - March/April) Plastic Surgery Practice For Sale – Modesto, CA. Revenue $1.4 million on 4 doctor days. Cosmetic (breast, body, facial, hair transplant, stem cell) and otolaryngology services in accredited surgical suite that is included in the transaction. High referral rate from both patients and other doctors. Thirdparty appraisal available. Photos available. Offered at only $519,000. Contact Medical Practices USA for more information. 925-820-6758. Email: gary@medicalpracticesusa.com | www. MedicalPracticesUSA.com (10 - March/April)

IN MEMORIAM MARTIN A SPELLMAN, MD (1933 – 2020), passed away on February 10, 2020. Dr. Spellman graduated from Stanford University and Stanford Medical School in 1957 before working as a radiologist at Washington Hospital in Fremont for over 30 years. Dr. Spellman taught at Stanford Medical School in the 1980s, taking trips to Ghana, Cuba, The

Azores, and Panama to help train local doctors. Dr. Spellman enjoyed traveling the world with his wife, Sherill, and their family. Dr. Spellman is survived by his brother, Michael Spellman, his daughter, Shannon Spellman, his sons, Patrick and Peter Spellman, as well as six grandchildren. Dr. Spellman was an ACCMA member for 44 years.

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COUNCIL REPORTS

Helping People in Our Community Since 1996

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