ACCMA May/June 2018 Bulletin by ACCMA

ACCMA BULLETIN Serving East Bay physicians since 1860

COVER STORY: ACCMA at 2018 CMA Legislative Advocacy Day (p. 17)

May/June 2018

POLST eRegistry Update (p. 19) ACCMA Now Offering CME (p. 21)

Tackling Health Care Affordability (p. 7) Member Spotlight: Melvin Donaldson, MD (p. 25) CMA Major Issue Report on Mental Health (p. 9)

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

Vol. LXXIV, No. 3

Serving East Bay physicians since 1860

NEWS & COMMENTS

PRESIDENT’S PAGE A Proactive Agenda for Tackling Health Care Affordability

By Thomas Sugarman, MD, ACCMA President 9

CMA HOD Major Issue Report: Mental Health

Edited by ACCMA Staff 17

2018 CMA Legislative Advocacy Day Highlights

By James Hanson, MD 19

POLST eRegistry Now Accepting Fax Forms

By Thomas Sugarman, MD 20

Member Benefit: Group Dental Plan Through Delta Dental

ACCMA Now Offering CME, Looking for CME Committee Members

By Juan Ordonez, MD 23

Sexual Harassment in Today’s Workplace: A Paradigm Shift?

By T. Hensley “Ted” Williams, JD 24

Health and the Climate Connection: What Doctors Need to Know

By Cynthia A. Mahoney, MD 25

Member Spotlight: Melvin Donaldson, MD

The Alliance Prepares for Behavioral Health Treatment Transition

By Scott Coffin, CEO, Alameda Alliance for Health

NEW MEMBERS

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

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ACCMA BULLETIN | May/June 2018

NEWS & COMMENTS

Physician Price Fixing Bill Fails to Advance AB 3087, a harmful government intrusion into the health care market, failed to pass the California Assembly Appropriations Committee by the May 25th deadline; the bill is therefore defeated. The bill would have created a commission of political appointees to set caps on physician rates, hospital fees, and commercial insurance premiums while doing nothing to improve access to care. The California Hospital Association (CHA) estimates that under the bill, approximately 60% of the state’s hospitals may lose money (at least $18 billion annually in revenues) and an estimated 175,000 healthcare workers could lose their jobs. The ACCMA thanks those physicians who took action against this bill. This is a great example of the power of organized medicine; please encourage your nonmember colleagues to join the ACCMA/CMA, who are working hard on your behalf, at www.accma.org/join.

Health Net Rescinds Modifier 25 Change In response to opposition led by the California Medical Association (CMA), Health Net has announced that it will not proceed with implementation of its proposed reduction in modifier 25 and emergency services payments. Additionally, Health Net expressed a commitment to work with CMA and others to implement an educational program to provide data and feedback to physicians, and information on proper coding practices for ED services. CMA met with Health Net and followed up to request rescission of the changes, which would have cut reimbursement of E/M services with modifier 25 by 50 percent and reduced reimbursement for Levels 4 and 5 emergency services to a Level 3 rate if Health Net deemed the diagnosis was nonemergent. For more information, go to https://bit.ly/2lomCvm.

Aetna to Terminate Check Payments Aetna informed contracted physicians on February 1 that the option of receiving payment by check will no longer be available and is asking providers to choose either electric funds transfer (EFT) or virtual credit card (VCC). Previously hardship exemptions had been allowed. If they are not already enrolled in an electronic payment method, physicians will be notified of their specific enrollment deadline for an electronic payment option; if none is chosen, providers will automatically be enrolled in virtual credit card payments. VCC payments are subject to transaction and interchange fees on the receiving end, which can run as high as 5 percent per transaction for physician practices. EFT is similar to direct deposit, and each EFT transaction carries only one fee of about 34 cents. Physicians can enroll in EFT through EnrollHub®, a free multi-payor EFT portal. To read more, go to https://bit.ly/2Gqvjgx.

CMA Seeks Smoother CURES Transition The California Medical Association (CMA) is asking the California Department of Justice to help ensure a smooth implementation of the new CURES requirement. Effective October 2, 2018, physicians must consult CURES, California’s prescription drugmonitoring database, prior to prescribing Schedule II, III or IV controlled substances to a patient for the first time and at least 4

once every four months thereafter if the substance remains part of the patient’s treatment. CMA is suggesting the development of educational materials, user outreach and assistance, and the establishment of a provider workgroup to ensure clinician input into the creation of these tools and resources. The Medical Board of California has posted information on what physicians can do to prepare for compliance at https://bit.ly/2rPBDtK. For further assistance, contact the ACCMA at (510) 654-5383 or accma@accma.org.

Alameda County Health Advisory for Measles The Alameda County Public Health Department (ACPHD) confirmed one case of measles in an unvaccinated patient in Alameda County in March. This case is linked to an unvaccinated traveler who was exposed in Europe and developed measles after returning home. Physicians are requested to consider measles in patients with a rash and fever, regardless of travel history; prepare their facility for the possibility of patients with measles; report and test suspected measles cases immediately, while the patient is still in your office, in consultation with the ACPHD; confirm immunity of health care staff with unknown vaccination status; and vaccinate children and non-immune adults, unless contraindicated, according to national guidelines. To read the health advisory, go to https://bit.ly/2Hm9WBK.

Prior Authorizations Negatively Affect Patient Outcomes A recent American Medical Association (AMA) survey of 1,000 practicing physicians found that payers’ prior authorization requirements delay treatment, have a negative impact on clinical outcomes, and lead patients to abandon treatment. Sixty-four percent reported waiting at least one business day for prior authorization decisions from insurers, and thirty percent said they wait three business days or longer. Every week a medical practice completes an average of 29 prior authorization requirements per physician, which take an average of 14.6 hours to process. The AMA is urging an industry-wide reassessment of prior authorization programs to ensure patients receive timely and medically necessary care and medications and to reduce administrative burdens. Physicians can share their experiences and add their voices to advocacy for reform by going to AMA’s Physicians Grassroots Network.

CMA and ACCMA Opposition to Ballot Measure to Set Dialysis Rates The California Medical Association (CMA) and Alameda-Contra Costa Medical Association (ACCMA) are opposing a ballot initiative to limit what insurance companies can reimburse dialysis centers to provide patient treatments. The proposition, which may be on the November ballot, sets artificially low reimbursement rates that do not cover the actual cost of providing care. The proposition’s definition of “patient care services cost” excludes many necessary costs, such as for physician medical directors and nurse clinical coordinators, regulatory compliance, and others. The quality of and access to care will be endangered as community dialysis clinics may reduce operations or

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NEWS & COMMENTS

even close. To join our fight to keep physician focus on patient care and reimbursement rates that cover the actual cost of care, become a member of the ACCMA/CMA: www.accma. org/join. To read more, go to http://www.cmanet.org/news/ press-detail/?article=california-physicians-oppose-november.

Supplemental Medi-Cal Funding Update Governor Jerry Brown has included $1.3 billion in Proposition 56 tobacco tax funding to provide supplemental payments for Medi-Cal providers in his proposed fiscal year 2018–19 budget. The budget also includes $40 million for graduate medical education (GME), as required by Proposition 56, and $55 million to support psychiatric GME programs in underserved areas. ACCMA/CMA will continue to advocate for physicians’ budget priorities. To support our advocacy for physician rates that cover the actual cost of care, join the ACCMA at www.accma.org/join.

CMA Survey Finds Rampant Health Plan Payment Abuses Two-thirds of physician practices in California, responding to a survey by the California Medical Association (CMA), report routine problems with health plans engaging in unfair payment patterns. These violations include repeated delays in the adjudication and correct reimbursement of provider claims, and attempts to rescind or modify authorizations after service is rendered. A state law passed in 2000 is not being effectively enforced by the Department of Managed Health Care (DMHC). To address this problem, CMA is sponsoring AB 2674, which would require DMHC to investigate provider complaints under the 2000 law and require penalty amounts equal to the amount of underpayment plus interest, at minimum. Physicians are reminded that ACCMA/CMA members have access to our free personal practice management assistance with contracting, billing, and payment problems. Contact the ACCMA at (510) 654-5383 or accma@accma.org.

Rating QPP Performance Measures A recent study published in the New England Journal of Medicine found that about one-third of the MIPS/QPP performance measures for ambulatory general internal medicine used by the Centers for Medicare and Medicaid Services (CMS) were not valid for evaluating the benefits and harms of a medical intervention. Another one-third were determined to be of uncertain validity. CMS aims to base 90% of Medicare fee-forservice payments to physicians on “value” by the end of 2018 by using performance scores, and practices are spending about $40,000 per physician to report on performance-measurement activities. The California Medical Association (CMA) is urging CMS to reduce this administrative burden by lowering the number of EHR measures, expanding the adjustments for complex patients, removing the requirement to report all payer data, and exempting physicians within five years of retirement. To join our fight to keep physician focus on patient care rather than on regulatory compliance, become a member of the ACCMA/CMA: www.accma.org/join. To read the study, go to http://www.nejm. org/doi/full/10.1056/NEJMp1802595.

UPCOMING EVENTS Webinar: Avoiding Embezzlement: Strategies to Protect Your Practice Wednesday, July 11 | 12:30 – 1:30 pm Free (ACCMA members); $49 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

Ethics & Professionalism for Physicians (with CME)

Presented by the Institute for Medical Quality Saturday–Sunday, July 28–29, El Segundo For more information and to apply, go to www. imq.org or call (415) 882-5167.

Ambulatory Accreditation Workshop

Presented by the Institute for Medical Quality Friday, August 24 | 8:30 am – 3:30 pm For more information, go to www.imq.org or call (415) 882-5167.

2018 NEPO Summit

Presented by Physicians for a Healthy California Thursday–Saturday, September 13–15, Pasadena For more information and to register, go to www. phcdocs.org.

Webinar: HIPAA Risk Analysis: Practical Tips for Compliance

Friday, September 14 | 12:15 – 1:15 pm Free (ACCMA members); $49 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

Winding Down Your Practice: Strategies for a Successful Retirement

Wednesday, September 19 | 6 – 8 pm (includes spousal fee; dinner served) $99 (ACCMA members); $199 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

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

ACCMA BULLETIN | May/June 2018

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PRESIDENTâ&#x20AC;&#x2122;S PAGE

A Proactive Agenda for Tackling Health Care Affordability By Thomas J. Sugarman, ACCMA President

Thomas Sugarman, MD

his yearâ&#x20AC;&#x2122;s California Medical Association (CMA) House of Delegates meeting in October is entirely dedicated to crafting a proactive strategy to address the vexing issues of health care cost and affordability. With continued attacks on physicians such as AB 3087 coming from Sacramento, it is incumbent on physicians through organized medicine to show effective leadership on this issue and provide real policy alternatives to the status quo and to poorly thought-out approaches that would limit access to care. While AB 3087 is dead for this legislative session, issues of health care affordability and quality remain at the forefront of our patientsâ&#x20AC;&#x2122; mind. Physicians must be bold and creative in developing policy proposals that meaningfully address affordability while expanding access to care and improving equity and quality. In the March 13, 2018 issue of

the Journal of the American Medical Association (JAMA), there is an excellent article by I. Papanicolas, L.R. Woskie, and A.K. Jha that compares U.S. health care costs with 10 other high-income countries.1 Accompanying the article are several editorials. While physician salaries are high in the U.S., there is much less of a disparity when comparing physician salaries to average salaries in the respective country. Moreover, because there are fewer physicians in the U.S., physician salaries are neither a major cost driver nor the cause for the high cost of health care in the U.S. relative to the other 10 wealthy countries. Delegates should review this JAMA issue in preparation for the HOD. Proposals for improving health care affordability, quality, and equity should address the following issues:

Administrative Burdens

Administrative processes and requirements are key cost drivers that divert physician time from patient care and add little value to health care delivery. Administrative costs in the U.S. are 8% of total healthcare spending vs 1-3% in the comparison countries.2 In one of the accompanying editorials, E.J. Emanuel argues that 12.9% of the increased per capita cost of U.S. health care is due to administrative burdens.3 Insurance industry overhead and administrative costs imposed on physicians are major cost drivers that increase prices for health care services and premiums for consumers. High administrative costs incurred by physicians include filing claims, appealing capricious insurer decisions, and

obtaining prior authorization. CMA should strongly consider promoting policies that lower administrative burdens while incentivizing appropriate utilization and discouraging inappropriate utilization.

Pharmaceutical Costs

No discussion of health care costs can exclude the high cost of prescription drugs as a major cost driver for patients. The JAMA article shows that drug costs are more than 50% higher than our closest peer. According to a report from the Commonwealth Fund, per-capita drug spending in the U.S. was in line with that of other industrialized nations during the 1980s and through the mid-1990s.4 During the late-90s, U.S. per-capita drug spending began to pull away from other industrialized nations, and nearly doubled between 2000 and 2009. After a period of relatively flat cost growth, drug spending spiked again beginning in 2014, reaching over $1,000 per-capita in 2015, more than $200 higher than the next highest country. Notably, the U.S. is actually tied with the United Kingdom for the highest share of generic drugs in its pharmaceutical market, yet our overall drug spending is far higher than other industrialized countries. The U.S. also does far less than other industrialized countries to limit out-of-pocket costs for prescription drugs. Fourteen percent of insured patients in the U.S. cited cost as a reason for skipping prescriptions or doses, compared with 2% in the United Kingdom.5 The CMA must advocate for policies that will make a continued on next page ACCMA BULLETIN | May/June 2018

PRESIDENT’S PAGE

(continued from page 7)

meaningful difference for consumers in controlling the cost of prescription drugs.

Social Determinants of Health

The current debate about the cost of health care has been unfortunately narrow and limited to spending within the health care system. A 2013 analysis by E.H. Bradley and L.A. Taylor shows that U.S. net social spending—including health and other social services— is actually in line with that of other industrialized nations, but the share of spending devoted to social services is comparatively low.6 Poverty, homelessness, and food insecurity contribute to increased utilization of safety net health care resources and are associated with worse health outcomes. Many responsibilities that should be borne by the

social safety net are often instead handled by the health care system, which employs case managers and social workers responsible for coordinating social services for patients, further adding costs to the health care system. Unfortunately, a solution currently being proposed in the state legislature, SB 1152, would compel hospitals to provide homeless assistance even to persons without medical issues. With 24% of the population living below the poverty line, the U.S. lags the 10 other wealthiest countries in addressing income disparity.7 Investing in services that keep people healthy and reduce preventable hospital visits should be a key strategy for controlling overall health care costs and improving health outcomes.

Cost Shifting

Cost shifting within the health care

system must also be addressed. While the extent and significance of cost shifting is a highly debatable topic, it is undeniable that in a state where onethird of residents are covered by MediCal, there are consequences when physician reimbursement does not cover the cost of care. A 2006 study published in Health Affairs found that a 1 percent relative decrease in Medicare payments is associated with a 0.17 percent increase in the corresponding price paid by privately insured patients and a 1 percent relative reduction in Medicaid reimbursement is associated with a 0.04 percent increase in private insurance payments.8 The researchers also found that cost shifting from Medicare and Medicaid was responsible for 12.3 percent of price increases from private payers from 1997 to 2001. continued on page 19

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HOD MAJOR ISSUE REPORT

CMA House of Delegates Major Issue Report: Mental Health Edited by ACCMA Staff

The following is an excerpt from the Major Issue Report to the 2017 CMA House of Delegates on Mental Health. The recommendations adopted by the House are at the end of this report. To read the full report, go to https://www.cmanet.org/account/ groups/hod/resolutions/.

ental disorders or illnesses take many different forms and level of acuity, with some rooted in deep levels of anxiety, extreme changes in mood, or reduced ability to focus or behave appropriately. Other disorders involve unwanted, intrusive thoughts and some may result in auditory and visual hallucinations or false beliefs about aspects of reality. Reaching a level that can be formally diagnosed often depends on a reduction in a person’s ability to function because of the disorder. Certain disorders or classes of disorders are more likely to begin during certain life stages and are thus more prevalent in certain age groups. The most common type of mental disorder is anxiety disorder, followed by mood disorders; although anxiety disorders may be more common, mood disorders have the highest proportion of serious cases. Data also shows that persons diagnosed with anxiety or mood disorders are about twice as likely to suffer from a substance use disorder (abuse or dependence) compared with respondents in general; further, about half of individuals with a substance use disorder have a co- occurring mental illness. Lifetime anxiety disorders generally have the earliest age of first

onset, most commonly around age 6, followed by age 11 for behavior disorders (e.g., attention deficit hyperactivity disorder), age 13 for mood disorders and age 15 for substance use disorders. Schizophrenia spectrum 1 and psychotic disorders emerge later in life, usually in early adulthood. Not all mental health issues first experienced during childhood or adolescence continue into adulthood, and not all mental health issues are first experienced before adulthood. Mental disorders can occur once, reoccur intermittently, or be more chronic in nature. As a result, variation in symptoms even within one type of disorder, individual situations and symptoms are extremely common. The prevalence of Californians with mental health illness is a significant issue: nearly 1 in 5 Californians have a mental health need, and among children, nearly 1 in 13 suffers from a mental illness that limits participation in daily activities. Furthermore, given California’s diverse population, the existence of significant disparities for racial and ethnic minorities in accessing high quality, mental health services results in a greater loss to their overall health and productivity.

Mental Health Treatment in California

Beginning in the 1950s and 1960s, the U.S. heavily promoted deinstitutionalization, a movement to close state psychiatric hospitals and deliver mental health services on an outpatient basis in the community. Deinstitutionalization offered the

promise of adequate and accessible community based services that would offer comprehensive service care in the least restrictive setting needed and had a profound effect on the way states approached and funded mental health services. The driving theory behind deinstitutionalization was that it should release persons residing in psychiatric hospitals to communitybased alternative facilities, divert new admissions to these alternative facilities, and develop special services for the care of a noninstitutionalized population with mental illness. The process was aided in California by the passage of the Lanterman-Petris-Short (LPS) Act, which significantly reduced involuntary commitment of individuals with mental illness to state hospitals. To be involuntarily committed or treated under the LPS Act, patients had to meet imminent dangerousness criteria that ended inpatient care for individuals with mental illness who met less rigid “need-for-hospitalization” criteria. Over time deinstitutionalization led to a 95 percent decrease in the number of inpatient and residential psychiatric beds for California state and county mental hospitals. Between 2005 and 2010, the number of available state psychiatric beds in all facilities, including general hospitals, declined an estimated 14 percent on top of the already dramatically reduced bed capacity. As of 2013, California has lost nearly 30 percent of the beds it had in 1995, a drop of almost 2700 beds. continued on next page

ACCMA BULLETIN | May/June 2018

HOD MAJOR ISSUE REPORT

Community-based Mental Health Services. The impact of the deinstitutionalization movement continues to be felt today and has been accompanied by several unintended consequences. First, the Community Mental Health Act of 1963 did not fully fund the community-based system of care for which it was intended to support. While the number of people with mental illness served in community-based settings have increased and some are being treated in alternative care models, funding remains fragmented and access to mental health services is a substantial concern. Other unintended consequences of deinstitutionalization include the severe shortage of psychiatric beds and a fragmented array of community-based services that are unable to meet the needs of a complex patient population with day-to-day needs. This has resulted in a population of patients with mental disorders who are unable to access appropriate care. Many individuals who may previously have been treated in state psychiatric facilities have ended up homeless, in the emergency room, the criminal justice system, and other settings that exacerbate their illness. California’s mental healthcare delivery system has undergone significant changes over the years, but has struggled to meet the needs of a complex patient population, due in large part to chronic underfunding and stigma. Many of the same problems that beset the mental health delivery system several decades ago still exist today, and stand in direct result of specific policy decisions that have been made over the years.

Barriers to Maintaining a Strong Mental Health System

The failure of California’s mental health care delivery system to meet

(continued from page 9)

the high volume of need experienced across the state is the direct result of several systemic barriers that have impeded progress. These issues include: • Lack of awareness and social stigma surrounding mental health issues which prevents individuals from seeking and receiving appropriate behavioral health care. • A mental health financing system that lacks true parity between mental and physical health insurance coverage and creates incentives for fragmented care delivery. • Low reimbursement rates and inadequate insurance coverage exacerbates the shortage of behavioral health providers resulting in poor access and high out-of-pocket costs for patients. • Insufficient infrastructure of specialized behavioral health treatment facilities, such as in-patient psychiatric beds and crisis centers, which forces patients to seek treatment in hospital emergency departments. Failure to provide early assessment and treatment has also contributed to a sharp increase in the incarceration of the mentally ill within California’s criminal justice system, leaving prisons and jails as a primary source of mental health services.

1. Social Stigma Related to Mental Disorders

Historically, individuals with mental disorders have been perceived negatively by society, and the stigma associated with mental disorders manifests in the form of fear, bias, distrust, avoidance, anger, and/or embarrassment. Stigma can be a barrier in encouraging people to seek treatment; to address the issue of stigma, there needs to be a change in society’s perception of mental disorders through

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greater availability of effective treatment options, provider attitude toward recovery for individuals with mental disorders, and public awareness that mental disorders are not only common but treatable. Determining the actual prevalence of mental disorders in the population is difficult, because many cases may not be diagnosed due to concerns about being stigmatized.

2. Financing of Behavioral Health Treatment and Services

California has a complex financing and delivery structure for mental health services and treatment, comprised of a confusing array of federal, state and local funding streams. Much of this is due to policies implemented over the last several decades that have resulted in a decentralized mental health service delivery system. Medicare, Medicaid and funds provided by California’s Mental Health Service Act each have specific and often conflicting rules regarding how funds may be utilized. Care for the SMI population has historically been realigned to counties, either directly through county operated programs, or increasingly, through contracted nonprofit providers. Associated funding was provided in 1991 realignment, as well as the public safety realignment of 2011. But those funds were and are inadequate to meet the needs of the public mental health system. As California’s mental health care landscape continues to evolve, one of the most significant areas where change and innovation is starting to occur is within the local county health care delivery systems. There is a shift towards providing more integrated, better coordinated care between primary and specialty care that emphasizes value. Since 1986, the share of U.S. spending on inpatient and

HOD MAJOR ISSUE REPORT

residential treatment has decreased significantly, while spending on outpatient treatment and prescription drugs has increased dramatically. In California, funding primarily flows through the county systems that administer about 90 percent of the revenue dedicated to public mental health services in the state. This reflects a historical reliance upon public facilities and programs in the provision and coverage of mental health services, in large part due to a lack of coverage through private insurance. This will likely continue to increase given California’s expansion of MediCal eligibility in 2014 and continued implementation and enforcement of federal health care reform. Distribution and Source of Funding. In 2009, the United States spent $147 billion on mental health treatment, of which 60 percent was attributed to public sources, such as Medicaid, Medicare, state and local governments and federal grants. In California, public spending on mental health services for Fiscal Year 2012–13 was estimated to be $7.76 billion, of which $3.34 billion was for MediCal alone. The major public funding sources reflect an array of different funding streams that are used by California counties often in a complementary fashion to meet each beneficiary’s unique needs, while maximizing federal Medicaid reimbursement. Federal Funding: The largest funding source for California’s public mental health services is federal Medicaid reimbursement, at roughly one-third of all funds. This funding is used to reimburse counties for medically necessary services provided to Medi- Cal Specialty Mental Health beneficiaries through a federal match to state spending, which in California is generally set at 50 percent. SAMHSA also administers block grants as an additional

source of federal mental health funding in California. SAMHSA also provides a minimum level of funding for substance use treatment, primarily for Narcotic Treatment Programs, to counties. A brand new Medi-Cal waiver for Substance Use DisorderOrganized 1 Delivery System (SUDODS) was an attempt to restructure service to create a full continuum of care and was made optional for counties; however, additional funding was not allocated. State Funding: There are several dedicated revenue sources that provide state funding for the delivery of California’s public mental health services. They include: • Sales tax and vehicle license fees: A portion of the state’s revenues from sales tax and vehicle license fees are appropriated to California’s 58 counties for administration of mental health services, which was estimated to be $1.94 billion in FY 2012-13. • Proposition 63: The Mental Health Services Act (MHSA), passed by voters in 2004, provides personal income tax revenues (surcharge on incomes above $1 million) to counties to expand services to people of all ages with serious mental health issues and build upon evidence-based, effective

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service models. The MHSA addresses a broad continuum of prevention, early intervention, and service needs as well as providing funding for infrastructure, technology, and training for the community mental health system. Approximately $1.83 billion was deposited during FY 2016-17 to be distributed to counties, and reflects about one-quarter of public funds. 1991 Realignment: Dedicated sales tax revenues distributed to counties to provide: emergency evaluation and treatment for persons who are a danger to self/others or gravely disabled; long-term nursing care; state hospital care; hospitalization in skilled nursing facilities licensed as Institutions for Mental Disease. Most services funded by this source are not permitted to be funded by other sources. 2011 Realignment: Dedicated sales tax revenues distributed to counties to provide medically necessary services to Medi-Cal Specialty Mental Health beneficiaries, including Early and Periodic Screening, Diagnosis and Treatment mental health services to children and adolescents. continued on next page

PROPOSITION 63 AUDIT Recently, a state auditor’s report found that California counties were putting Prop 63 dollars in reserves, rather than spending them on badly needed mental health service and that the State Department of Health Care Services was conducting insufficient oversight of counties’ use of Prop 63 dollars. Alameda County was one of the counties audited for this report. Though the State Auditor found that Alameda County was not holding excess reserves, they did recommend that the County strengthen its monitoring of Prop 63 spending to ensure that it is spending Prop 63 dollars appropriately.

ACCMA BULLETIN | May/June 2018

HOD MAJOR ISSUE REPORT

Of concern are provisions in the 2017-2018 State Budget that diverts $110 million in Mental Health Realignment Account growth funds over five years to defray the costs of county resumption of responsibility for In-Home Supportive Services. Mental health services are often the first cut, and the last restored in meeting state and county fiscal obligations. Lack of Parity Between Mental and Physical Health Care. Despite the mental health parity laws and efforts by state regulators, evidence suggests that some state exchange health plans are not in compliance. One report indicates that while information provided through plans’ “explanation of benefits” might show that there aren’t limits on mental health coverage, limitations including treatment caps and other barriers may exist. DMHC implemented a mandate that insurers under its supervision prove their compliance with the federal mental health parity law, however, a 2015 review indicated that none of the 26 managed care insurers were able to demonstrate full compliance. More specifically, a lack of parity affects the following: Provider Panels: Although patients face similar problems accessing specialists in other fields, psychiatric care stands out as an area where wait times for an initial appointment are consistently long, violating statutory standards. Low fees offered providers by insurance carriers contribute to the shortage of providers. Data collected from other states by the American Psychiatric Association strongly suggests that fees for the same billing codes are unjustifiably lower for psychiatrists than for other types of physicians. A review of California’s billing codes for Medi-Cal do not indicate that fee-for-service payments for psychiatrists are adjusted downward. However, there is insufficient

(continued from page 11)

data to determine if psychiatrists are compensated at parity with providers in other specialties in Medicare and by commercial payors. Parity among providers will continue to be an issue that needs to be monitored. Inpatient Unit Payment Rates: Informal surveys by the California Psychiatric Association have confirmed that daily inpatient bed rates paid by carriers are significantly lower for psychiatric care than for medical care, perhaps half of what would be paid for a comparable medicalsurgical bed. General hospitals with psychiatric units are often unable to afford to expand their units, because they are losing money on psychiatric admissions. This is rarely the case for beds on medical-surgical units. In the worst cases, psychiatric units that run at near 100 percent occupancy and are vital to communities are closed for financial reasons. For example, in 2011, Cedars Sinai in Los Angeles had to close its inpatient and outpatient psychiatric services due to hospital finances. Lack of Parity for Substance Use Programs: Despite the legal requirements for coverage at parity level for substance use disorders, enforcement is lacking, and the provision of services is very uneven. While the ACA requires parity for addiction treatment services, many health plans vary

widely in their coverage. Still many plans utilize prior authorization, reauthorization, dosage and/or duration limits, and place annual or lifetime medication limits as a means of reducing expenditures but which thereby restrict access to these services. A 2015 review of bronze-level plans offered by Covered California indicated that none of the plans offered an acceptable level of coverage for the treatment of opioid use disorder.

3. Utilization and Delivery of Behavioral Health Treatment and Services

Survey data indicates there are significant gaps in the use of mental health services and treatment in the U.S., with unmet need experienced across all categories of mental illness, regardless of acuity. Among adults with any mental illness and a serious mental illness, about 67 percent and 35 percent, respectively, did not receive any mental health services or treatment within the past year. For the 8.1 million adults with co-occurring AMI and a substance use disorder, approximately half of this population did not receive either mental health or substance use treatment at a specialty facility in the past year. Further, among the 2.3 million adults who had co-occurring SMI and a substance use disorder in the past

MAT REIMBURSEMENT RATES One of the biggest barriers to accessing treatment for patients with Opioid Use Disorder, especially for patients on Medi-Cal, is inadequate reimbursement that does not cover the cost of care. To address the growing need for Medication-Assisted Treatment (MAT) for Opioid Use Disorder, the California Medical Association is sponsoring AB 2384 (Arambula). This bill would increase reimbursement for MAT and remove barriers to treatment such as prior authorization for patients with a diagnosis for Opioid Use Disorder.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

HOD MAJOR ISSUE REPORT

year, about 1 in 3 adults did not receive either type of care in the past year. Additionally, about 1 in 5 people say they or a family member had to forego needed mental health services because they couldn’t afford the cost, their insurance wouldn’t cover it, they were afraid or embarrassed, or they didn’t know where to go. Adolescents are especially vulnerable to gaps in treatment services, which makes early intervention and prevention a priority for this population. Although many disorders can be treated, almost half of adolescents with mental health issues do not receive any mental health services. Medi-Cal Mental Health Delivery System. Largely due to the Affordable Care Act expansions, Medi-Cal enrollment increased significantly from about 7.8 million in 2013 to about 13.5 million in 2016 – nearly 5.7 million new enrollees. Under state law, counties are required to deliver mental health services to individuals with and without Medi-Cal, either through county-owned and operated facilities or through outside contracts with hospitals, clinics, community-based organizations and private health care providers. For Medi-Cal enrollees, there are two primary systems of care that serve both the mild to moderate population and the seriously mentally ill. This includes a specialty mental health system that is administered by the counties for Medi-Cal members with significant impairment and provides rehabilitative and acute inpatient care. For Medi-Cal members with mild to moderate mental health conditions, outpatient mental health services are covered by the Medi-Cal managed care plan or state fee-for-service system. Counties must also have memoranda of understanding (MOU) with local Medi-Cal managed care

plans to facilitate the coordination of services for shared beneficiaries. Medi-Cal Specialty Mental Health System: County mental health plans (MHPs), which are the county mental health departments throughout the state, are responsible for authorization and payment of specialty mental health services for Medi-Cal members who may have serious mental health needs. They perform this function under the state’s Specialty Mental Health Services (SMHS) Consolidated Medicaid Waiver, and services include inpatient/post-stabilization, targeted case management, and recovery-focused rehabilitative services (e.g., crisis services). These services are often described as “carved out” because they are not provided by the Medi-Cal managed care plans, but are provided by counties instead because of their specialized nature. Medi-Cal members are eligible to receive “carved out” specialty mental health services from the counties if they meet the medical necessity criteria in state regulations. This includes having received a covered diagnosis, demonstrating specified impairments and meeting specific intervention criteria, but the medical necessity criteria can vary depending upon what the determination is for (i.e., inpatient, outpatient, or outpatient for beneficiaries under age 21). This flexible interpretation of medical necessity across counties can lead to differences in coverage across the state; under state law, counties are not required to provide Medi-Cal mental health services for individuals who don’t meet the county’s medical necessity criteria. Essentially, even individuals covered under Medi-Cal may be barred from care if their symptoms or mental health needs do not qualify them as sufficiently functionally impaired or disabled.

(continued)

Children’s Specialty Mental Health Services: Medi-Cal covers approximately 90 percent of children with SED served by counties. Youth with SED and their families almost always need coordination of services received from the school, child welfare agency, juvenile justice system, and other community organizations. Thus, under the children’s system of care in the California Welfare and Institutions Code, counties are required to coordinate a child’s mental health care with these other entities. This is done in coordination with the federal mandate associated with Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. The federal EPSDT program requires states to provide Medi-Cal members under age 21 with medically necessary mental health services, including services that may not otherwise be included in the state’s Medicaid program. California counties are responsible for administering the EPSDT program, which includes services such as individual, group and/or family therapy, crisis counseling, case management, special day programs, medication, and substance use disorder services, among other benefits. The program is aimed at correcting or improving conditions that could be more expensive to treat later in life.

4. Facilities Shortage

With alarming frequency, patients with acute psychiatric illness in need of hospitalization are unable to obtain needed inpatient care because of the unavailability of beds. In California. there are approximately 6,000 inpatient psychiatric beds in 140 hospitals supporting a population of more than 36 million people. Often, overcrowded emergency rooms have become a place of continued on next page

ACCMA BULLETIN | May/June 2018

MENTAL HEALTH

(continued from page 13)

last resort for psychiatric patients. Psychiatric boarding, defined as psychiatric patients’ waiting in hallways or other emergency room areas for inpatient beds, is a serious problem nationwide. Boarding consumes scarce emergency room resources and prolongs the amount of time that all patients must spend waiting for services. It is often the result of an inability to gain timely access to community-based care. These patients are typically released as soon as risk of harm to self or others has decreased but before proper treatment and discharge planning can be implemented – so that sicker psychiatric patients can take their places in the emergency department hallways. Crisis residential programs have been proposed as an alternative to reduce unnecessary stays in psychiatric hospitals, reduce the number and expense of emergency room visits, and divert inappropriate incarcerations while producing similar outcomes to those of institutionalized care.

Final Adopted Recommendations

RECOMMENDATION 1: That CMA develop a strategic and implementation plan for advancing CMA’s mental health delivery priorities. The plan shall include, but not be limited to

actions as follows: 1) Support legislative and regulatory measures to: a) Advance the integration of mental and physical health care specifically integrating mental health professionals into the primary care setting. b) Amend the Lanterman-PetrisShort Act to expand the definition of “grave disability” to include individuals with mental health disorders who are unable to care for their own health and safety due to their mental illness. c) Protect the confidentiality and privacy rights of patients receiving care for psychiatric and substance use disorder conditions, while allowing appropriate data-sharing among clinical professionals caring for the same patients and information sharing with family in defined situations when essential for patient care. d) Support innovative alternatives in crisis care, such as Psychiatric Emergency Services and Crisis Residential Programs. e) Work with the California Department of Corrections and Rehabilitation (CDCR) and local government agencies that oversee jails to support the diversion of individuals with mental illnesses

2) a)

ACCMA ACTION ON JOHN GEORGE HOSPITAL In 2016, after facing instances of serious over-crowding, John George Psychiatric Hospital in San Leandro, part of Alameda Health System, contemplated placing a hard cap on the number of patients they could see in their Emergency Room and refusing transfers from community hospitals after this cap has been reached. ACCMA advocacy and leadership led Alameda Health System to adopt a more flexible policy that would better serve the community and help patients experiencing mental distress get the right care in the right place.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

c) d)

away from correctional facilities and toward appropriate treatment settings. CDCR and local agencies should ensure follow-up community treatment and establish insurance eligibility for individuals who are being released from jail or prison with mental health or substance use disorders. Target mental health service outreach and access to evidencebased treatment for particularly vulnerable populations including individuals with substance use disorder and/or dual diagnosis, LGBT individuals, foster youth, the homeless, etc. Develop and maintain a real-time database of available inpatient psychiatric beds at licensed psychiatric facilities to allow for timely and appropriately disposition of patients requiring inpatient care. Continue to expand and support the behavioral health workforce, including: Training and expanding financial incentives, including loan repayment programs, for behavioral health providers who demonstrate a 21 commitment to practice in underserved areas and communities. Support voluntary education and training opportunities for primary care and other medical providers to provide behavioral health services, while seeking to reduce the systemic administrative and financial barriers that have impacted their ability to deliver mental health services in the primary care setting (see 3b). Support crisis intervention training programs for law enforcement and other first responders. Creating more training opportunities within public educational institutions, such as the University

MENTAL HEALTH

of California and California State University systems, for mental health clinicians at all levels (e.g., Master’s level professionals including Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, Licensed Professional Clinical Counselor, Psychologists, NPs, PAs, MDs). 3) Facilitate streamlined financing and payments for mental health services through: a) Support for measures that would expand funding and the number of available adult and pediatric beds for inpatient psychiatric care, including hospital rehabilitation, acute crisis stabilization settings and residential care. This includes increasing the Medi-Cal budget for mental health, thus facilitating increased inpatient and residential bed availability, and outpatient services. b) Reducing the administrative and financial barriers which have impacted the mental health service delivery in outpatient medical care settings (e.g., allowing simultaneous billing for the management of chronic physical conditions and management of psychiatric and mental health conditions, and ensuring physicians have adequate time to treat patients in a more holistic manner and address both their physical

and mental health care needs). c) Legislative and regulatory measures that facilitate streamlined payment and greater flexibility for counties to use Mental Health Services Act (MHSA) and federal Medicaid funding, allowing their use for needed services, such as innovative programs and supported housing for homeless mentally ill patients and expanding the use of Assisted Outpatient Treatment (Laura’s Law) for individuals lacking capacity to understand their need for treatment. State government should maintain oversight over countyadministered programs and ensure that all counties follow standardized rule for provision of services when mental health patients present across county lines (e.g., when one county’s resident who needs mental health care is seen in an 22 emergency department located in another county). d) Increase regulatory assessments of whether health plans (including county and other government mental health delivery programs) are providing parity care for mental health and substance use disorders and meeting regulatory access standards, and assisting health plans to come into compliance with parity laws and access standards when they are found

(continued)

to be deficient. Penalties can be considered if assessment shows that plans demonstrate a willful pattern of non-compliance with current laws and standards. e) Promote integrated care for mental health and substance use disorders in Medi-Cal rather than the current bifurcated system that fragments care. 4) Support further research and evaluation of mental health delivery models, including but not limited to: a) Creating a comprehensive data infrastructure to better measure mental health outcomes on a state/population level. b) Developing universally accepted quality measures for mental health care. c) Funding and creating greater access to medical research opportunities that further the cause of mental health, including during residency training and throughout continuing medical education. 5) Support actions to reduce social stigma surrounding mental health issues by: a) Promoting public awareness of the prevalence and treatability of mental health issues. b) Addressing providers’ understanding and approach toward recovery for individuals with mental disorders.

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

ACCMA BULLETIN | May/June 2018

Thank You Physician Members!

We Defeated AB 3087 In May 2018, the California Medical Association (CMA) announced the resounding defeat of Assembly Bill 3087 (Kalra) – dangerous legislation that would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. Thousands of physician members contacted their legislators because AB 3087 would have: ∙ Decimated California’s health care delivery system.

∙ Disrupted care and limited choice for millions of California patients.

∙ Caused 175,000 health care workers to lose their jobs.

∙ Forced hospitals to close and pushed health care providers into early retirement.

∙ Caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

"I want to thank each of you for your support and dedication to CMA. We could not have dealt this bill such a resounding defeat without the united voices of our physician members. Together, we stand taller and stronger." – CMA President Theodore M. Mazer, M.D.

Join the Fight to Protect Medicine

Your voice is key to our success. All you need is the desire to make an impact, and CMA will give you the rest. Join CMA's Physician Advocate Program today! Learn more at cmadocs.org.

2018 CMA LEGISLATIVE ADVOCACY DAY

2018 CMA Legislative Advocacy Day Highlights By James Hanson, MD, Chair, ACCMA Legislative Committee

James Hanson, MD

n April 18, 2018, over 40 ACCMA members joined over 500 physicians, medical students, residents, and CMA Alliance members from throughout California in Sacramento for the 44th Annual California Medical Association (CMA) Legislative Advocacy Day. Over the course of the day, physicians heard from key legislative leaders and CMA’s legislative advocates, and met with members of the State Legislature who represent the East Bay to discuss pending legislation that would dramatically impact the practice of medicine in California.

AB 3087

Our sole focus for this year’s Legislative Day was the defeat of AB 3087, a dangerous and radical legislation introduced by Assemblymember Ash Kalra of San Jose, that would create a state commission to fix prices that can be paid by commercial health plans for health care services in California. This

bill is nothing if not an assault on physicians and the practice of medicine in California, and that was the message we carried to our meetings with East Bay legislators. The issue of high health care costs is concerning to all Californians; however, ACCMA members educated our legislators on why this is the exact wrong approach to take to address the issue. ACCMA members explained that because Medi-Cal and Medicare do not compensate for the full cost of care provided, for those in private practice commercial payors are critical to remaining in practice and providing care to California patients every day. The impacts of AB 3087 would be felt especially in areas of the state that already suffer from poor access to care due to the state’s chronic underinvestment in access to health care. For years, physicians from across California have descended on Sacramento annually for Legislative Advocacy Day to implore the state to increase reimbursement in the MediCal program and improve access to care for our state’s low-income residents. Now, after passing Proposition 56 and finally seeing some increased investment in access to care, politicians are threatening the solvency of physician practices across California by threatening to fix prices for health care services paid by commercial payors. The ACCMA delegation again included residents in training with the Kaiser Oakland Pediatric Residency Program. To some residents in their final year or entering their final year of residency, the potential impacts of

Top: ACCMA members meet with Sen. Wieckowski’s staff; Bottom: ACCMA members meet with Assemb. Bill Quirk

AB 3087 are all too real. Many of them are carrying hundreds of thousands of dollars in debt and are being heavily recruited to practice medicine in other states with lower taxes, lower costs of living, and higher Medicaid reimbursement rates. Creating a state commission to dictate from Sacramento how much they can be paid for treating commercial patients would just make it that much harder for them to practice in California. Physicians have continued on page 22 ACCMA BULLETIN | May/June 2018

POLST EREGISTRY UPDATE

POLST eRegistry Now Accepting Fax Forms By Thomas Sugarman, MD

Thomas Sugarman, MD

hysicians, skilled nursing facilities, hospices, and community clinics in Contra Costa County can now submit their patients’ POLST (Physician Orders for Life-Sustaining Treatment) forms to the community’s online POLST registry via fax, helping to honor end-of-life choices across the continuum of care. The fax option is the newest tool

PRESIDENT’S PAGE

and signed forms directly to the eRegistry. The fax number should be available anytime, and all registered users will be contacted with the fax number when it comes online. If you need any help, project team members are available to assist you. ACCMA is proud to lead this community-wide effort to ensure that patient end-of-life treatment preferences are known and honored, but we need your help—the success of this project is contingent on broad participation from the Contra Costa medical community. If the pilot project succeeds in demonstrating the implementation and use of an electronic POLST eRegistry, it would inform state lawmakers in creating and financing statewide electronic access to POLST to make them available to health care professionals when they are needed, across care settings. If you need assistance or have questions, please contact Griffin Rogers, ACCMA’s director of programs, at grogers@accma.org or (510) 654-5383.

(continued from page 8)

The ACCMA knows all too well the impact that low reimbursement in public programs has on hospitals’ ability to remain open and continue caring for our communities. We were deeply involved in the ultimately unsuccessful efforts to save Doctors Medical Center from closure. Doctors Medical Center, located in the low-income West Contra Costa County community of San Pablo, served almost exclusively Medicare and Medi-Cal patients, and ultimately could not remain open in

to submit POLST forms under the California POLST eRegistry Pilot Project, a state-authorized project privately funded by the California Health Care Foundation (CHCF) to test a centralized, electronic registry of POLST forms. The goal of the pilot project is to inform and support the development of statewide electronic access to POLST. Once in the eRegistry, faxed forms will be available within 24 hours to first responders and emergency physicians at participating hospitals. As the local pilot site administrator of the project, the Alameda-Contra Costa Medical Association (ACCMA) is asking all physicians to fax their POLST forms to the eRegistry immediately. Doing so will help populate the database and ensure that more emergency providers will be able to locate a patient’s POLST form when querying the system. Getting started is simple. After a physician, NP, or PA registers online at registry.vyncahealth.com, medical office staff can begin faxing completed

this health care environment. Other safety net hospitals in our community struggle from year to year to make up the Medicare and Medi-Cal shortfall and continue serving patients. If Medi-Cal and Medicare truly covered the cost of care, hospitals that treat patients covered by these programs would not be struggling to keep their doors open.

Focus on High Value Care

According to the data analysis by E.J.

Emanuel, one of the cost drivers is high margin–high cost procedures such as MRI/CT imaging, some joint replacements, cesarean sections, coronary bypass.9 The U.S. has relatively high utilization for many of these procedures. Physicians must lead the way to ensure that we maximize the value of our country’s health care dollar. If high utilization leads to better outcomes, then we must find a way to deliver those services equitably. On continued on page 26 ACCMA BULLETIN | May/June 2018

MEMBER BENEFIT: DELTA DENTAL

Member Benefit: Group Dental Plan through Delta Dental

discounted Delta Dental group dental insurance plan is one of the many benefits of ACCMA membership. It is part of the Health Care Employees/Employer Dental and Medical Trust, which is a Taft-Hartley Multi-Employer Trust Fund started over 40 years ago as a multiemployer, collectively bargained plan between hospital workers and their union. The trust was created to provide competitive medical and dental plans for employers that were unable to obtain affordable pricing from insurance carriers on an individual basis due to their group size or industry. The Health Care Trust now has over 200 employer groups from hospitals, cities, counties, and nonprofit health care organizations, and nearly 25,000 participants. The increased enrollment has resulted in competitive premiums throughout the trust fundâ&#x20AC;&#x2122;s history. The administrators of the Trust negotiate benefits and renewals with Delta Dental, and currently has an administrative staff of 20 employees. They assist ACCMA members with billing, eligibility, and claims assistance. Their experienced staff includes English-, Spanish-, and Russianspeaking benefit coordinators, and has over 25 years of experience working with insurance carriers.

Better Benefits Promote Staff Recruitment and Retention

Not only does offering dental insurance reap benefits in better overall health for your employees, it is also a key component in providing competitive compensation packages and also 20

allows employers to attract and retain the best employees. The Health Care Trust offers a variety of affordable dental plan options. The dental plans include annual maximums ranging from $500.00 to no annual maximum. They also offer affordable dental HMO plans that have no annual maximums or deductibles. Delta Dental plans emphasize preventative care and are easy to use. They also offer access to the most extensive network of dentists in the country; four out of

five dentists nationwide are contracted Delta Dental dentists. The program is designed to maximize the benefits offered to ACCMA members, and the ACCMA receives no income from it. To find out how to access discounted Delta Dental group plans as an ACCMA member benefit, contact Dublin Insurance Services at (925) 803-1880 or benefits@dublinsure.com with your questions regarding your employee benefit plan options.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CME PROVIDER ACCREDITATION

ACCMA Now Offering CME, Looking for CME Committee Members Most programs will offer free CME to ACCMA members By Juan Ordonez, MD, CME Committee Chair

Juan Ordonez, MD

he Alameda-Contra Costa Medical Association (ACCMA) is now able to provide continuing medical education (CME) credit to physicians after being awarded an initial two-year accreditation by the Institute

of Medical Quality, a subsidiary of the California Medical Association, in April. ACCMA develops numerous educational activities each year that could potentially offer CME credits, particularly on the topics of physician leadership, physician wellness, endof-life care, safe prescribing, and protecting patient information. Of those determined to be CME-eligible, most are anticipated to be free to ACCMA physicians, potentially saving members hundreds of dollars each year by averting other often costly CME activities. CME may also be offered at certain ACCMA committee meetings, should they include a CME-eligible educational component—an additional bonus to committee participation. To help provide guidance for ACCMA’s new CME program, the organization is looking for additional members to serve on its recently

formed CME Committee. The committee will meet quarterly over the lunch hour and provide leadership, coordination, and direction for relevant CME functions identified by ACCMA or its committees, including reviewing potential CME activities, ensuring they adhere to guidelines and conducting evaluations. No past experience with CME is required— committee members will be oriented to the CME process by ACCMA staff and other committee members. A callin option will also be available at each meeting for those who cannot attend in person. If you would like to serve on the ACCMA CME Committee or know someone who would, please contact Griffin Rogers, ACCMA’s director of programs, at grogers@accma.org or (510) 654-5383.

CODING CORNER: Reporting E/M Services with Time as the Controlling Factor Occasionally, a health care provider’s discussions with a patient about his or her medical condition(s) may consume a greater portion of the provider/patient encounter than the time devoted to performing a relevant history, exam and medical decision-making (MDM). In such cases, CPT® guidelines allow you to consider time as “the key or controlling factor to qualify for a particular level of evaluation and management (E/M) services.” When using time to determine a proper E/M service level, you must be careful to follow four conditions:

•

The E/M service to be reported must have a “reference time.” • Counseling or coordination of care must dominate the encounter. • For outpatient visits, time must be face-to-face. • The extent of the counseling and/or coordination of care must be documented in the medical record. For more information, go to http://www.cmanet. org/cpr/cpr-archives/2018/june-2018#coding.

ACCMA BULLETIN | May/June 2018

2018 CMA LEGISLATIVE ADVOCACY DAY

also sounded the alarm on California’s physician shortage for years, imploring the legislature to invest in Graduate Medical Education (GME) to train more residents and bring more physicians to California. [Editor’s note: Physician workforce will be the topic of the July/August 2018 issue of the ACCMA Bulletin.] Due to heavy pressure from organized labor, AB 3087 passed out of the Assembly Health Committee. Fortunately the bill failed in the Assembly Appropriations Committee at the end of May.

Guest Speakers

CMA President Ted Mazer, MD, opened the program by greeting attendees and getting physicians fired up to take on AB 3087. CMA Vice President of Government Relations Janus Norman provided an advocacy overview of CMA’s message on AB 3087, why it would harm access to care, and how to refute the arguments made by the supporters of AB 3087.

(continued from page 17)

Left: CMA Senior VP Janus Norman; Right: ACCMA members meet with Sen. Skinner’s staff

Mr. Norman also gave physicians an insider’s view of the legislative fight that was about to ensue over AB 3087, speculating that due to the strong political muscle behind the bill, it is likely that AB 3087 will make it at least to the Assembly floor. The afternoon political panel featured Assembly Health Committee Chair Jim Wood, DDS, as well as State Senator Richard Pan, MD and Assemblymember Joaquin Arambula,

MD. These three legislative champions were crucial in leading the State Senate and Assembly to reject Governor Brown’s initial fiscal 2017–18 budget that did not include Proposition 56 funding to support a Medi-Cal rate increase for providers. They discussed the importance of investing in California’s health care system to improve access to care and the continued work that needs to be done to support access to care in California.

The ACCMA wishes to acknowledge and thank members who participated in the CMA Legislative Leadership Conference in Sacramento: Myles Abbott, MD Basil Besh, MD Kevin Booth, MD Eric Chen, MD Joel Chiu, MD Jacques Corriveau, MD Suparna Dutta, MD Lubna Hasanain, MD Terry Hill, MD Mark Kogan, MD Evelyn Li, MD Terence Lin, MD Kristen Lum, MD F. Michael Melewicz, MD Myngoc Nguyen, MD Roman Kownacki, MD Jeffrey Klingman, MD

Katrina Peters, MD, MPH Jeffrey Poage, MD Thomas Powers, MD Katrina Saba, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Ryan Shanahan, MD Simpson So, MD Edmon Soliman, MD Frank Staggers, Jr. MD Michael Stein, MD Thomas Sugarman, MD Kurt Wharton, MD Clifford Wong, MD Ronald Wyatt, MD Robyn Young, MD, FACP

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Kaiser Pediatric Residency Program Elizabeth Hayes, MD (Faculty) Christine Yeh, MD (Faculty) Rebecca Dang, MD James Hall, MD Ted Handler, MD Anqi Li, MD Menglu Li, MD Kara Mesznik, MD Eva Padilla, MD Ryan Palapaz, MD Deepika Parmar, MD Ruby Patel, MD

SEXUAL HARASSMENT PREVENTION

Sexual Harassment in Today’s Workplace: A Paradigm Shift? By T. Hensley “Ted” Williams, JD

T. Hensley “Ted” Williams, JD

t seems like every time you listen to or read the news, some highranking executive, sports icon, or celebrity has been accused of sexual harassment. This is particularly painful for those of us within the management ranks of business and industry because we know that this affects not only the alleged victim and the accused harasser but also employee morale, customer relations, the company image, and potential profits. Additionally, increasing numbers of victims of harassment are stepping forward and demanding that harassment be acknowledged and obliterated. Today, there is absolutely no excuse for sexual harassment within society and the workplace. Workplace sexual harassment, put simply, is “conduct on the basis of sex, that affects a term or condition of employment.” If this unwanted conduct affects and/

or impacts a term or condition of employment, it is inappropriate, possibly leading to discipline or termination and, in many cases, it is illegal. Examples include unwanted touching, sexual remarks and innuendos, graphic pictures and videos, requests or threats for sexual favors in order to retain continued employment or get more pay or a promotion, etc. When an employee brings harassment to the attention of a manager or supervisor, it must be investigated as soon as possible to determine if a workplace violation has occurred. It cannot be overlooked, ignored, or put aside. It must be dealt with in a manner that protects the alleged aggrieved as well as the alleged violator. The “investigation,” must be timely, thorough, professional, and confidential as much as possible. The principals and any witnesses must be interviewed. A conclusion must be made on the facts, including appropriate discipline, if required. There should be a well-articulated and published harassment policy and procedure in place that includes an easy-to-follow understandable stepby-step complaint and resolution procedure. Annual management and staff training should have been conducted. This allows management to consistently administer and manage its harassment policy in a fair and equitable modality. If these critical components are not already in place, management should take the necessary steps to make them a reality. The most effective harassment

prevention strategy is constant and consistent management and staff training regarding the organizational, operational, and legal impacts of workplace harassment. It should not be assumed that new as well as veteran staff are aware that harassment is not acceptable in the workplace and that there are penalties up to and including termination. It is management’s responsibility to make this fact irrefutably clear to its entire workforce, vendors, and customers. Harassment in the workplace is a dangerous, destructive distraction that takes the focus off workforce performance, productivity, and company profits. Ted Williams serves many Californiabased medical groups and healthcare professionals and is the principal consultant and trainer for The Williams Group. He provides workplace/workforce consulting and training services for more than 21 industries, including: executive coaching, investigations, organizational system audits, workplace diversity, wage and salary compensation program design, succession planning, and affirmative action program planning. He also designs and delivers on-site and web-casted workplace/ workforce training workshops and webinars, and has been a keynote and session speaker for national, regional, and local annual conventions. He can be reached at ted@the-williams-group. com or at (515) 274-6899.

ACCMA BULLETIN | May/June 2018

PERSPECTIVE

Health and the Climate Connection: What Doctors Need to Know By Cynthia A. Mahoney, MD

Cynthia A. Mahoney, MD

The ACCMA Public Health Committee heard a presentation by Doctor Mahoney on the health impacts of climate change on February 27. This article expresses the opinion of the author and does not reflect ACCMA policy.

ealth has been called the human face of climate change. Recognizing the reality and the urgency of climate change, the American Medical Association (AMA) has affirmed the necessity for a physician role in protecting public health. The flames of climate change are literally licking at the health sectors’ heels (see accompanying photo). Ironically, overwhelming smoke from that Sonoma fire prompted a health advisory for many miles, forcing cancellation of my scheduled talk (CM) on Health Impacts of Climate Change at Contra Costa College in San Pablo.

Climate change is here and now. All Americans are at risk—with children, the elderly, the poor, the chronically ill, and many people of color most vulnerable. Heat itself is most deadly, accompanied by drought, crop failures, worsening air pollution, and allergens. Extreme weather, megastorms, floods, and wildfires cause trauma and displacement. Escalating mental health impacts include posttraumatic stress disorder (PTSD), depression, anxiety, and violence. We are creating an environment more favorable to microbes than people, with rising food, water, and vectorborne diseases such as Zika and Lyme. Water shortages, food insecurity, and rising seas threaten national security with conflict and mass migration. Extreme events across the US in 2017 harmed thousands of people and cost $350 billion in damages at just 1ºC of warming. Scientists now predict 4ºC (7ºF) in our children’s lifetimes, reducing our beautiful green planet to a roasted world that will cripple our civilization. Millions of lives are at stake. The good news is that we have solutions that will make us healthier now, but we have less than a decade to put them in place to avoid catastrophic, potentially irreversible tipping points. We can choose to decarbonize the economy as quickly as possible, by eliminating greenhouse gas emissions of CO2, methane, and HFCs, and sequestering carbon. Carbon pricing is the best tool to accelerate the rapid transition to clean energy, like IV insulin for a hyperglycemic crisis.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

The prestigious Lancet Commission on Health and Climate Change has called strong and sustained carbon pricing “the most powerful strategic instrument to inoculate human health against … climate change.” In addition to climate change, pollution exacts a tremendous toll on our health—the “hidden health costs” of fossil fuels. Ozone and particulates (PM2.5) contribute to our epidemic of childhood asthma, respiratory disease, and cancer. Even more alarming, the American Heart Association (AHA) now recognizes particulates as a major contributor to heart attacks and strokes, with 200,000 premature deaths in the US each year and nearly the same number of non-fatal events. PM2.5 are linked to reproductive and developmental disorders, cognitive and behavioral problems in children, diabetes and even dementia. Cleaning the air we breathe now creates healthier communities with health benefits valued at $500 billion every year in the US. The Medical Society Consortium, representing over half the physicians in the US, calls on us as trusted messengers to be educators and advocates for our patients and the public. Critical to that role is prevention—to advocate for policies that will avoid the worst of climate change. What role can the ACCMA play? See part 2 of this article in the September/October 2018 issue of the ACCMA Bulletin. Doctor Cynthia Mahoney is a 19-year member of the ACCMA.

MEMBER SPOTLIGHT

Member Spotlight: Melvin S. Donaldson, MD, ACCMA’s Longest-Serving Active Member

“I

planned on being a physi cian when I was nine. And I never changed from that.” Doctor Melvin S. Donaldson started practicing medicine in 1952, when Dwight D. Eisenhower was President and gasoline was 29 cents per gallon, and has worked full-time since then. Sixty-five years later, Doctor Donaldson is the longest-serving active ACCMA member. His love of working with military veterans for the last five years is what keeps him going to his office five days a week. He grew up in Burlingame, and began studying at Stanford University in 1940, where he was in the ROTC in a horse-drawn artillery unit and played the tuba in the Stanford Band. He graduated from the Stanford University School of Medicine in 1947 and served as a physician at the Mare Island Naval Hospital in Vallejo for two years. After he completed his residency in family practice at the University of Colorado in Denver in 1952, where he received a MS degree,

Melvin S. Donaldson, MD

he joined the primary care practice of Doctor Stanley R. Truman, who was ACCMA President in 1968. Doctor Donaldson has been in solo general practice since Doctor Truman retired in 1977 and has always practiced in Oakland. He served on the Board of Directors of Health Ventures, Inc., a medical group at the Merritt Peralta Medical Center, and was also the last staff president at Peralta and chair of the Family Practice department at Merritt and Highland Hospitals. He was the last family physician with major surgical privileges at all East Bay hospitals, until he ceased performing surgery at the age of 65. He can remember making house calls in East and West Oakland in the middle of the night, putting on coat and tie, to treat patients for heart attacks and deliver one of more than 1,000 babies over his career. Doctor Donaldson partnered with Doctor Arthur Stanten (an ACCMA member for 55 years) to open an imaging center in Antioch. He decided last year to focus exclusively on screening military veterans for their benefits because of the great need for such examinations in Northern California. His medical expertise extends beyond the human body. While he was a physician on staff at the Alta Bates Summit Medical Center, he was also a research associate for the Steinhart Aquarium and the Department of Aquatic Biology at the California Academy of Sciences from 1970 to 1980. In his herpetology studies, Doctor Donaldson discovered that metronidazole, a relatively new drug 4 used for the treatment of amoebic

dysentery in humans, also worked to cure dysentery in snakes and other reptiles, although the exact mode of introduction and spread of the disease could not be discovered. The resulting paper, “Epizootic of Fatal Amebiasis Among Exhibited Snakes,” of which he is the lead author, was published in the American Journal of Veterinary Research in 1975. He also studied the cyanide collecting of reef fishes at the Academy. Doctor Donaldson served as Chair of the ACCMA Adoptions (later named Family Life) Committee from 1963 to 1983, which discussed ethical issues, proposed guidelines, and made recommendations regarding the role of physicians in adoptions. He was also Chair of the Abortion Ad Hoc Committee from 1970 to 1972, and served on the Continuing Medical Education Committee from 1962 to 1972. He and his wife Nance (they have been married for 52 years) are extensively engaged in the community. They were recognized as Philanthropists of the Year by the Alta Bates Summit Foundation in 2001, and funded a laboratory at the California Academy of Sciences. Their collection of contemporary Navajo rugs is on loan and will eventually be donated to the California Academy of Sciences. They also support Native American arts and crafts education to ensure that future generations will develop skills in moccasin making, silversmithing, and rug weaving. His hobbies include dye-transfer photographs; many of his pictures were displayed in the cardiology wing continued on page 30 ACCMA BULLETIN | May/June 2018

NEW MEMBERS

NEW & RETURNING REGULAR MEMBERS Bay Imaging Consultants 2125 Oak Grove Rd., #200, Walnut Creek Aseem Om Rawal, MD Radiology

Epic Care 3300 Webster St., #710, Oakland Dawud Lankford, MD Urology Epic Care 106 La Casa Via, #200, Walnut Creek Christian N. Kirman, MD Plastic Surgery

Bhupinder Bhandari, MD 3755 Beacon Ave., Fremont

Epic Care 1844 San Miguel Dr., #310, Walnut Creek

Gautam Pareek, MD Internal Medicine Epic Care 911 San Ramon Valley Blvd., #100, Danville Marianne M. Borden, MD Pediatrics

Eileen H. Benway, MD Pediatrics Marian R. Birdsall, MD Pediatrics John Muir Urgent Care Center 1450 Treat Blvd., #160, Walnut Creek

Andrew L. Nash, MD Pediatrics

Shiv Sudhakar, MD Infectious Disease

Pittsburg-Antioch Medical Group 2220 Gladstone Dr., #3, Pittsburg John W. Gallo, DO Internal Medicine Kourosh Moazemi, MD Internal Medicine Mostafa Shalaby, MD Internal Medicine Sutter East Bay Medical Group 350 Hawthorne Ave., #2316, Oakland Manjula V. Gunawardane, MD Hospitalist Vituity/John Muir Medical Center 3901 Lone Tree Way, Antioch Janet H. Young, MD Emergency Medicine Vituity/John Muir BHOC 4080 Port Chicago Hwy., Concord Ameek S. Mundi, DO Psychiatry Vituity/St. Rose Hospital 27200 Calaroga Ave., Hayward

PRESIDENT’S PAGE

(continued from page 19)

the other hand, if there are some lowvalue procedures with high utilization, we must decrease the number of those procedures.

Summary

These are some of the central issues we look forward to tackling this October with our colleagues from around California at the CMA House of Delegates meeting. We would love to hear from ACCMA members about what you believe are solutions to improving the California and U.S. health care system. Unless and until physicians lead the way at developing a better health care system, our patients and our practices will suffer from others making poorly thought-out decisions. You can share your thoughts with me at president@accma.org.

References 1. Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA 2018; 319(10):1024–1039. doi:10.1001/ jama.2018.1150 2. Ibid. 3. Emanuel EJ. The Real Cost of the US Health Care System. JAMA 2018; 319(10):983–985. doi:10.1001/ jama.2018.1151 4. Sarnak DO, Squires D, Kuzmak G, Bishop S. Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier? The Commonwealth Fund, October 2017. 5. Ibid. 6. Bradley EH and Taylor LA. The American Health Care Paradox: Why Spending More Is Getting Us Less. New York: Public Affairs, 2013. 7. Papanicolas et al., op. cit. 8. Zwanziger J and Bamezai A. Evidence of Cost Shifting in California Hospitals. Health Affairs 2006; 25(1):197–203. doi:10.1377/ hlthaff.25.1.197 9. Emanuel, op. cit.

Yi-Ling Kao, MD Emergency Medicine Scott L. Zeller, MD Emergency Medicine Vituity/Sutter Delta Medical Center 3901 Lone Tree Way, Antioch Melody J. Glenn, MD Emergency Medicine Alicia M. Kurtz, MD Emergency Medicine Rochelle C. Rock, MD Emergency Medicine Vituity/Washington Hospital 2500 Mowry Ave., Fremont Aaron E. Barry, MD Anesthesiology Walnut Creek–Danville Oral Surgery 1855 San Miguel Dr., #25, Walnut Creek Carrie A. Baldwin, MD, DMD Oral and Maxillofacial Surgery

NEW STUDENT MEMBER Joshua Neff, MS UCB-UCSF Joint Medical Program

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

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

ALAMEDA ALLIANCE

The Alliance Prepares for Behavioral Health Treatment Transition By Scott Coffin, CEO, Alameda Alliance for Health

Scott Coffin

lameda Alliance for Health (the Alliance) is proud to serve over 269,000 low-income children and adults in Alameda County. Here you will learn about the work the Alliance has been doing to prepare for the Behavioral Health Treatment (BHT) transition for Medi-Cal members under the age of 21. You will also learn about California’s Proposition 56 and the supplemental payment program that will provide directed payments to providers for rending specified services in managed care.

BHT Services Under Medi-Cal

According to the Centers for Disease Control and Prevention (CDC), the prevalence of autism spectrum disorder (ASD) among children in the United States continues to rise. Among 11 states that the CDC monitored in 2014, 1 in 59 children aged 8 years were deemed to have ASD, up from 1

in 68 children in 2012. Medi-Cal health plans throughout California, such as the Alliance, have been developing benefit programs to manage ASD using behavioral health treatment services since federal mandates deemed these services medically necessary in 2014. BHT services develop or restore the functioning of an individual with ASD by teaching skills through the use of behavioral observation and reinforcement, or through prompting to teach each step of a targeted behavior. At the Alliance, the process of building an effective BHT program has been a priority that required extensive education to help newly diagnosed members and their families understand what BHT benefits are (such as Applied Behavioral Analysis), what provider types are delivering services (board certified behavior analysts and paraprofessionals), and how we can help link eligible children to these services.

New Benefit Expansion

Beginning July 1, 2018, the California Department of Health Care Services will expand the eligible population for BHT services to all Medi-Cal members under the age of 21 who receive a recommendation from a physician or psychologist, regardless of diagnosis. Today, the Alliance coordinates care for over 400 BHT members, giving us the experience and foundation necessary to expand this program. Alliance members already receiving BHT services from their local regional center will also have these benefits

transitioned to our health plan on July 1. In Alameda County, once the BHT benefit expands to individuals without ASD, the Alliance will assume full responsibility for covering BHT for all our members under the age of 21.

The Alliance Approach

Although BHT services are expanding to a broader population, the Alliance’s overarching BHT program goals remain the same: to ensure that all eligible members get timely access to the medically necessary services they need. Likewise, the clinical goals of the Alliance’s BHT program will remain focused on increasing skills and reducing maladaptive behaviors for our members, primarily through one-on-one Applied Behavior Analysis (ABA). At its core, ABA is structured to address behaviors, improve social interactions and develop skill building. ABA principles and techniques can foster basic skills such as looking, listening, and imitating, as well as complex skills such as reading, conversing, and understanding another person’s perspective. Additional service components such as parent training can also help ensure that progress is sustained between ABA sessions.

Moving Forward

Currently the Alliance is holding regular meetings with local regional centers and BHT providers leading up to July 1 to ensure that each transitioning member is covered by their current continued on page 29 ACCMA BULLETIN | May/June 2018

COUNCIL REPORTS

MARCH 8, 2018 The meeting was called to order by Doctor Thomas Sugarman, President. Doctor Sugarman introduced the guest speaker, Antonio Villaraigosa, California Gubernatorial Candidate for the June 2018 Primary Election. The invitation to Mr. Villaraigosa to speak before the Council was intended to be informational to give ACCMA members an opportunity to meet him and hear his views on health care matters. The Council approved the minutes of the February 8, 2018 Council meeting, and the appointment of Doctor Terry Hill as Alternate Councilor-A representing District 10. Doctor Sugarman noted that the Council has three Alternate Councilor positions to fill in districts 3, 4, and 5. Doctor Sugarman announced that the Nominating Committee would be meeting in June and asked Councilors to nominate members to fill the open positions. Mr. Greaves presented a recommendation from the Physicians Advisory Committee to begin the development of a wellness program by pursuing funding that has been made available by the Medical Insurance Exchange of California (MIEC). The Council approved the committee recommendation. Mr. Draper presented the recommended positions from the Public Health, Child Welfare, and Medical Services committees on House of Delegates Quarter 2 resolutions. The Council approved the recommendations. Doctor Sugarman and Mr. Greaves spoke to the Council on the petitions being circulated in the cities of Emeryville, Livermore, and Redwood City to place on the ballot an Accountable and Affordable Health Care Initiative. The Council approved taking a position in opposition to these initiatives if they are approved for the ballot. Doctor Kogan provided the AMA Delegates report. The AMA had lobbied heavily against the Anthem modifier 25 payment reduction policy and Anthem has rescinded this policy implementation. He also reported that the CMA Board of Trustees had not met since the last Council meeting.

Doctor Sugarman reminded the Council that CMA Legislative Day was scheduled for April 18, 2018. He requested that Council members submit ideas for House of Delegates major issue topics on or before April 17. Mr. Greaves discussed the CMAsponsored legislation, SB 1303, which would require counties with populations more than 500,000 to replace the office of the coroner with an office of the medical examiner. Doctor Sugarman briefly discussed the CMA communication applauding the California Department of Insurance and the Department of Managed Health Care’s investigation into Aetna’s coverage denials. Ms. Lum provided a brief report on membership retention and recruitment activities. She stated that letters had been sent to those members who had not yet renewed, which informed them that their memberships had terminated. Doctor Hasanain provided a report on the Human Trafficking Symposium hosted by the ACCMA on March 1. The event was an overwhelming success with over 90 registered attendees. Mr. Rogers announced that National Healthcare Decisions Day is scheduled for April 16. The ACCMA’s East Bay Conversation Project will be hosting tables at three local health care facilities throughout the week. He also said the Berkeley Physicians Leadership Program begins on March 24. So far 27 physicians have registered for the program. Doctor Sugarman encouraged Council members to attend the candidate interviews for Assembly District 15, which covers North Alameda County and West Contra Costa County. Interviews will be conducted the morning of March 10. There being no further business, the meeting was adjourned.

MAY 10, 2018 The meeting was called to order by Doctor Thomas Sugarman, President. Doctor Sugarman introduced the guest speaker, James J. Strebig, MD, 2018 candidate for CMA PresidentElect. He is currently a trustee on the CMA Board of Trustees and is the

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

current CALPAC chair. The Council approved the minutes of the March 8, 2018 Council meeting, and the appointments of Doctor Gautam Pareek as Alternate Councilor-A representing District 5 and Doctor Katrina Saba as Alternate Councilor-C, District 10. Doctor Sugarman noted that the Council has two remaining vacancies to fill for alternate councilor positions in Districts 3 and 4. The Council also approved the appointments and reappointments of the 2018 Nominating Committee, and the re-nominations of members currently serving on CMA Councils and Subcommittees. Doctor Sugarman announced that the recently formed ACCMA Continuing Medical Education (CME) Committee is looking for members. This committee will meet on a quarterly basis and provide oversight for the ACCMA’s new CME program activities. The Council discussed and approved the 2018 ACCMA Executive Retreat Recommendations. Doctor Sugarman presented the report and recommendations from the Membership & Communications Committee. The recommendations from the Committee included strategies for improved engagement with members, equitable paths for all members for dues discounts, and a new monthly dues option. After discussion, the Council approved the full committee recommendations. Doctor Sugarman discussed the request from the CMA to join in opposition to the November ballot proposition that would impose arbitrary limits on what insurance companies reimburse dialysis clinics to provide patient care. The Council approved the action to support the CMA position to oppose the ballot initiative. Mr. Greaves reported on the Memorandum of Understanding (MOU) between the Alameda County Health Services Agency and the ACCMA for the ACCMA to coordinate and facilitate the Adult Inmate Medical Services Panel (AIMS) by recruiting physicians and conducting peer review of the medical programs serving adults incarcerated in Alameda County jail facilities. The continued on next page

ALAMEDA ALLIANCE

provider and treatment plan. We are also developing the necessary program modifications to serve a broader population of members and taking steps to implement the program by July 1. In order to prepare Alliance members for the regional center transition, we will be reaching out to affected members to confirm they are aware of the administrative change in their coverage and that there will be no disruption in their current treatment plans. Transitions such as these can appear convoluted, so proactive outreach efforts will ensure that Alliance members are aware and ready each step of the way. As the Alliance’s BHT program expands over the coming months, we will continue to focus on member outreach and stakeholder collaboration. The Alliance remains committed to developing an effective BHT program that not only provides coverage, but also offers high-quality services that

COUNCIL REPORTS

Supplemental Payments from Proposition 56

In November 2016, California voters passed Proposition 56 which increased the tax rate on cigarettes and other tobacco products by $2. The Department of Health Care Services developed a supplemental payment program that requires managed care plans, such as the Alliance, to make directed payments to individual providers rendering qualifying services. The Alliance received Proposition 56 funds at the end of April and instructions on how funds should be distributed earlier this month. Providers who rendered qualifying services between July 1, 2017 and June 30, 2018 are eligible to receive directed payments. The Alliance is currently in the process of scheduling payments to providers who have already rendered eligible services and will ensure that future payments are made within 90

days of receiving a clean claim or accepted encounter. For more information on qualifying services, please visit the Department of Health Care Services website at www.dhcs.ca.gov.

About Alameda Alliance for Health

The 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 more than 269,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care programs.

(continued from page 28)

ACCMA’s general counsel has reviewed the agreement and has determined there are no issues. After brief discussion, the Council approved the ACCMA signing the MOU with Alameda County. Doctor Dutta provided a brief AMA delegates report. She stated there were no current issues to discuss and that the next AMA annual meeting would be held in June. There was no CMA Trustee report. Doctor Sugarman asked for Councilors who had not yet provided an RSVP response for the 2018 CMA House of Delegates (HOD) to do so by June 30, 2018. Doctor Sugarman announced that the CMA Committee of Delegation Chairs had met and have selected the cost and affordability of health care as the sole major issue to be discussed at the HOD.

are much needed by our members.

(continued from page 27)

Doctor Sugarman reported on efforts by the ACCMA to contact local legislators to encourage opposition to AB 3087 (Kalra), which would establish an unelected commission of nine individuals to set physician and hospital rates for commercial health care services in California. Mr. Draper announced that several meetings with local legislators had been scheduled during the next couple of weeks to discuss opposition to AB 3087 and other legislative issues. Doctor Sugarman reported that there was a good turnout for the CMA Legislative Day in Sacramento. Over 60 physicians, residents and medical students from the ACCMA attended the event. Mr. Rogers provided an update on the POLST eRegistry project. He stated that the fax option for POLST forms would be ready in June. He encouraged

Councilors in Contra Costa County to participate in the pilot project. He continues to reach out to skilled nursing facilities and community clinics to encourage more participation in the program. Mr. Draper provided an update on the East Bay Safe Prescribing Coalition Naloxone Education Program. A training session will be held at the ACCMA on May 15 and will offer CME/CPE credit. Doctor Sugarman reported on the news that Contra Costa County plans to join a consortium of more than 25 California counties and other municipalities across the country to initiate litigation against drug manufacturers and distributors responsible for the opioid epidemic that has destroyed lives across the country and in Contra Costa County. The Council discussed this action by the county and approved ACCMA sending a continued on next page

ACCMA BULLETIN | May/June 2018

CLASSIFIEDS

POSITION AVAILABLE – 1

PHYSICIAN IN EAST BAY: Epic Care is seeking an Internal Medicine or Family Practice physician to join our busy primary care practice in the East Bay. This is an outpatient-only clinic. Full-time or part-time options are available. Please send CV and inquiries to hr@epic-care. com with your contact information. (1 – May/June – July/Aug)

OFFICE FOR RENT – 3

CASTRO VALLEY MEDICAL OFFICE SPACE AVAILABLE: 2,400 s.f. newly renovated office space on Lake Chabot Road directly across from Eden Hospital. Location ideal for many uses. Original design as two medical office suites but has been combined now into one large unit, or willing to divide into 1,000 s.f. and 1,400 s.f. office suites again, each with separate entrances and utilities. Ground-level single-story building with three suites. Ample off-street parking, seven exam rooms (three/four, six with sinks), very large reception area, and front office workspace. Break room and lab areas. Each unit has a private

office. Tons of storage, windows, and natural light in all rooms. Two private courtyards. Owner occupies third suite. $6500/mo. ($2700/$3800, if divided), plus PG&E (separately metered) and garbage. Simple lease. Call (510) 914-3928 or stop by 20100 Lake Chabot Road. (3 – May/Jun – Jul/Aug) PRIME PILL HILL MEDICAL/ SURGICAL OFFICE SPACE AVAILABLE: Well-appointed 940 sq. ft. office opposite Summit Hospital, beautiful view, available for sublease. Currently set up for minor office procedures, available fully equipped and furnished, or not, as desired. The office comes with a shared waiting room and two parking places. For further information, contact Rod Perry, MD at (510) 419-0211. (3 – May/Jun – Jul/Aug)

PRACTICES FOR SALE – 10

INTERNAL MEDICINE/GENERAL PRACTICE: In a terrific building close to freeway access in the Pleasanton area. The doctor was practicing in Pleasanton for about 20 years. For more information,

COUNCIL REPORTS

MEMBER SPOTLIGHT

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letter thanking the Contra Costa Board of Supervisors for joining this lawsuit to address this problem. Ms. Lum provided an update on membership recruitment and retention activities. She thanked the Council for retaining 18 non-renewed members since the last Council meeting. She encouraged Councilors to look at the list of the remaining non-renewed members to urge them to renew their membership. Mr. Rogers announced the upcoming online webinars scheduled in May and June: “How to Hire Excellent Medical Office Staff” and “Managing Your Online Presence and How to Win Against Negative Reviews” are being offered free of charge to ACCMA members. There being no further business, the meeting was adjourned.

of Merritt Hospital and are currently hung in his office waiting room. Doctor Donaldson also collects Kachinas, carved figures representing ancestral spirits in Pueblo Indian mythology. He has a few of them on display in his private office. During the 1989 Loma Prieta earthquake, all the figures fell off the shelf onto the floor and none of them were damaged in any way. He credits the Kachina spirit with the miracle, as well as watching over him all these years. Doctor Donaldson plans to retire in four years, when he is 100 years young. The ACCMA thanks and appreciates Doctor Donaldson for being an active member for 65 years!

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

contact Debra Phairas at (415) 7644800 or dphairas@practiceconsultants. net. (10 – Mar/Apr – May/Jun) IN CONTRA COSTA COUNTY: This is a 2,500 sq. ft. esthetic skin care and phlebology practice that grossed over $1.4 million in 2017, a long-established practice that sees up to 185 patients/ month. Three exam rooms and two fully equipped surgery rooms are included in the modern, high-end office. The office features a very dedicated staff, including esthetic RNs and an LVN, all of whom are able to stay on board through a sale. Please contact Venus Gutierrez at (888) 277-6633 for more information. (10 – May/Jun – July/Aug) INTERNAL MEDICINE OFFICE IN PLEASANTON: An Internal Medicine/ General Practice in a terrific building close to freeway access in the Pleasanton area is for sale. The doctor was practicing in Pleasanton for about 20 years. For further information, contact Debra Phairas at (415) 764-4800 or dphairas@practiceconsultants.net. (10 – Mar/Apr – May/ Jun)

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

A L A M E D A

C O U N T Y

Helping People in Our Community Since 1996

www.alamedaalliance.org

Alameda-Contra Costa Medical Association 6230 Claremont Avenue P.O. Box 22895 Oakland, California 94609-5895 ADDRESS SERVICE REQUESTED

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MIEC just announced $13 Million in dividends.* As a member-owned exchange, MIEC provides policyholders with medical professional liability insurance with a vastly superior dividend policy. Our mission is to deliver innovative and costeffective medical professional liability protection and patient safety services for physicians and other healthcare professionals. MIEC has never lost sight of the medical associations who support our policyholders, and continues to provide the service and support they deserve. To learn more about becoming an MIEC policyholder, or to apply, visit miec.com or call 800.227.4527. *On premiums at $1/3 million limits. Future dividends are not guaranteed.

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