ACCMA November/December 2018 Bulletin by ACCMA

ACCMA BULLETIN Serving East Bay physicians since 1860

November/December 2018

COVER STORY: 2019 ACCMA President Lubna Hasanain, MD: Bringing Physicians Together to Lead (p. 7) CMA 2018 Legislative Summary (p. 9) Report from the 2018 CMA House of Delegates (p. 11) How to Challenge AB 72 Interim Payments (p. 13) Volunteer Spotlight: ACCMA Member Stephanie Santos, MD (p. 17) ACCMA 150th Annual Meeting in Photos (p. 23)

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ACCMA Executive Committee Lubna Hasanain, MD, President Katrina Peters, MD, President-Elect Suparna Dutta, MD, Secretary-Treasurer Thomas Sugarman, MD, Immediate Past President Councilors & CMA Delegates Eric Alexander, MD Eric Chen, MD Megan Durr, MD Robert Edelman, MD Rollington Ferguson, MD James Hanson, MD Shakir Hyder, MD Irina Kolomey, MD Terence Lin, MD Lilia Lizano, MD Abbas Mahdavi, MD Joshua Perlroth, MD Andrew Pienkny, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Edmon Soliman, MD Judith Stanton, MD Michael Stein, MD CMA & AMA Representatives Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, AMA Alternate Delegate (at Large) Ronald Wyatt, Jr., MD, CMA Trustee 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. 6

Serving East Bay physicians since 1860

NEWS & COMMENTS

PRESIDENT’S PAGE

By Lubna Hasanain, MD, ACCMA President 9

CMA 2018 Legislative Summary

By Janus L. Norman, CMA Senior Vice President 11

CMA Outlines Bold Health Care Agenda to Improve Patient Affordability, Access, and Quality

By the California Medical Association 13

AB 72: The Independent Dispute Resolution Process and How to Appeal

By the California Medical Association 15

Introducing the Encore Physicians Program

Volunteer Spotlight: ACCMA Member Stephanie Santos, MD

Providing Longitudinal Primary Care in Rural Haiti: Short-Term Personal Commitment and Long-Term Community Health Gains

By John F. Brown, MD 21

Dan Golenternek, MD, POW Physician

By Lincoln Cushing, Kaiser Permanente archivist and historian 23

ACCMA 150th Annual Meeting in Photos

Choosing to Serve the Most Vulnerable By Scott Coffin, CEO, Alameda Alliance for Health

NEW MEMBERS

COUNCIL REPORTS

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INDEX OF ARTICLES 2018

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November/December 2018

Bringing Physicians Together to Lead

ACCMA Staff Joseph Greaves, Executive Director Jan Jackovic, Director of Operations Griffin Rogers, Director, Napa & Solano County Medical Societies David Lopez, Assoc. Dir. of Advocacy & Policy Mae Lum, Assoc. Dir. of Membership & Comms. Essence Hickman, Operations Coordinator Aimee Robinson, Physician Engagement Coordinator Shana Prince, Education and Events Coordinator

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ACCMA BULLETIN | November/December 2018

NEWS & COMMENTS

West Nile Virus Update The California Department of Public Health (CDPH) has updated the West Nile Virus (WNV) map. As of November 30, 2018, there have been 189 human cases reported in 31 counties, including 3 human cases in Contra Costa County. Among the 189 human cases, there were 8 WNV-related fatalities. For more information and resources, please visit the CDPH website (bit.ly/2zRtWr5), the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/westnile/index.html), or the California West Nile Virus website (westnile.ca.gov).

Help Physicians and Communities Affected by the Wildfires The California wildfires labeled Camp, Woolsey, and Hill have destroyed thousands of homes, structures and medical practices, as well as displaced thousands of Californians. In response, the California Medical Association (CMA) and Physicians for a Healthy California (PHC) have launched a donation page to help impacted physicians and their families. One hundred percent of donations will directly support relief efforts. To donate, please go to www.phcdocs.org/news/wildfires.

CMS Publishes Final 2019 Physician Fee Schedule The Centers for Medicare and Medicaid Services (CMS) has released the final 2019 Medicare payment rule. Two proposed rules that the California Medical Association (CMA) fought against have been postponed or dropped. The proposal to collapse E/M code and payment levels has been postponed for at least two years, and the proposal for multiple service payment reduction has been dropped. The final rule also includes documentation changes that are intended to reduce administrative burdens on physicians; CMA-sponsored California geographic payment increases; new payments for physician services that are not part of an office visit; and expansion of the low-volume threshold exception policy to exempt small practices from MIPS. For more information, go to bit.ly/2Dm6CUH.

Medicare Payment Adjustments in 2017 Performance data released by the Centers for Medicare and Medicaid Services (CMS) for the 2017 Medicare Quality Payment Program (QPP) show that 93 percent of eligible clinicians received a positive payment adjustment for their performance in 2017, and overall 95 percent avoided a negative payment adjustment. The national average score for MIPSeligible clinicians was 74 points. Those participating in MIPS as individuals or groups received an average score of 66 points, and those participating in MIPS through an alternative payment model (APM) received an average score of 88 points. For more details of the 2017 performance data, go to bit.ly/2K4OD6r.

ACA Reduced Disparities in Coverage Rates Findings from the 2017 California Health Interview Survey show that the Affordable Care Act (ACA) narrowed disparities in coverage rates between different racial and ethnic groups. In 2017, there continued to be no statistically significant difference in the nonelderly uninsured rate among white, African American, and Asian/Pacific Islander Californians, which is a major shift since 2013. However, Latinos continued to experience a higher uninsured rate than other groups. Throughout its history, the ACCMA has sought to improve public health and patients’ access to care. To read the full report, go to bit.ly/2SvOvjC.

Public Charge Rule and Health Care Access Experts at a recent webinar hosted by the UCLA Center for Health Policy Research estimated that California would lose $718 million to $1.67 billion in federal funding due to the chilling effect under the public charge rule proposed by the federal government. The researchers project that up to 765,000 Californians would disenroll from either Medi-Cal or CalFresh (SNAP) nutrition assistance. Both the American Medical Association (AMA) and the California Medical Association (CMA) have raised concerns that the proposed policy change would have a chilling effect on families needing to access health care services, which will compromise the public health and ultimately increase health care costs overall. To read how ACCMA members can respond to the proposed rule, turn to page 28.

Opioid Prescription Restrictions at Walmart and CVS Pharmacies In 2018, Walmart (including Sam’s Club) and CVS Caremark implemented dosage and duration corporate policies to restrict opioid prescriptions filled at their pharmacies. Specifically, Walmart restricted initial opioid prescriptions for acute pain to no more than seven days and 50 morphine milligram equivalents (MME), and CVS Caremark restricted initial opioid prescriptions for an acute condition to a seven-day supply and 90 MME, although prescribers may request a prior authorization for higher doses up to 200 MME/day. Physicians have reported being asked for extensive medical documentation such as treatment agreements, tried/failed therapies, and diagnoses codes before an opioid prescription will be filled by the pharmacist. CMA is concerned that the effects of these new corporate policies may intrude upon the physician-patient relationship, compromise patient confidentiality, and create barriers for patients who need access to their medications. If you or your patients have encountered such policies, please contact CMA’s Center for Legal Affairs at (800) 786-4262 or legalinfo@cmadocs.org.

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NEWS & COMMENTS

UHC to Implement Outpatient Advanced Radiology Policy

East Bay Times Op-Ed on East Bay Progress on Opioids

Effective January 1, 2019, UnitedHealthcare (UHC) will require prior authorization for certain advanced imaging procedures when performed in the outpatient hospital setting. The new policy will not apply to procedures performed in a free-standing diagnostic radiology center or office setting. A similar policy was implemented by Anthem Blue Cross in December 2017. For more information, go to bit.ly/2Qy9sNy.

In early December, the East Bay Times published an op-ed by East Bay Safe Prescribing Coalition (EBSPC) cochairs Tom Sugarman, MD and Kathleen Clanon, MD. The op-ed highlighted the progress the coalition has made in curbing the opioid epidemic. It also noted that more work must be done, and increased resources need to be allocated towards treatment and prevention. You can read the op-ed at https://bayareane.ws/2E4gRgJ. EBSPC is co-sponsored by the ACCMA, and brings together the East Bay medical community, consumers, and community leaders to promote safe and appropriate prescribing practices and reduce prescription drug abuse in our community. If you would like to get involved in the EBSPC’s efforts to fight the opioid epidemic, please contact the EBSPC at eastbaysaferx@accma.org.

Deadline to Change Medicare Participation Status for 2019 Physicians have until December 31, 2018 to make changes to their Medicare participation status. As always, physicians have three choices regarding Medicare: (1) be a participating provider, (2) be a non-participating provider, or (3) opt out of Medicare entirely. To change participation status, physicians must send a letter to Noridian, California’s Medicare contractor, postmarked by December 31, 2018. Physicians can learn more about their options by reading “Medicare Participation (and Nonparticipation) Options,” available free to ACCMA/CMA members or $60 for non-members at bit.ly/2BS4hzJ.

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

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

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Thursday, Jan. 17 | 10:00 am – 2:00 pm 6230 Claremont Ave., Oakland CME FREE FOR MEMBERS, LUNCH INCLUDED

Advance Care Planning: Approaches and Lessons from Health Systems and Medical Groups

Thursday, Jan. 24 | 6:00 – 8:00 pm 6230 Claremont Ave., Oakland CME FREE FOR MEMBERS, DINNER INCLUDED To register for events, go to www.accma.org/ events or call the ACCMA at (510) 654-5383.

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ACCMA BULLETIN | November/December 2018

CMA’s Advocacy Secures $1 Billion+ In 2016, and with a $1 million investment, the California Medical Association (CMA) led a coalition to take on Big Tobacco to improve patient access to care through MediCal, which serves one-third of the state’s population. California voters overwhelmingly approved Proposition 56, which added a $2 tax on tobacco products and stipulated that funds should increase access by improving provider payments. California’s 2018-2019 state budget continues to provide over $1 billion annually to improve provider payments so more Medi-Cal patients can access care when they need it most. Other key investments include graduate medical education (GME) funding increases and medical school loan repayments. Since 1856, CMA has worked tirelessly to ensure that health care professionals serving on the frontlines of medicine in our communities have a voice in the development of health care legislation, regulations and policy. JOIN CMA TODAY and support the next generation of physicians and the future of health care policy and business in California.

“The California Medical Association is proud to leverage a $1 million investment for Proposition 56 into a $1 billion annual return on behalf of California’s physicians, medical groups and patients.” – Dustin Corcoran, CEO CMA’S REACH 43,000 Members 37 Component Medical Societies 27 Specialty Societies 200+ Medical Groups

PRESIDENT’S PAGE

Bringing Physicians Together to Lead By Lubna Hasanain, MD, ACCMA President

Lubna Hasanain, MD

e as physicians have put precious years of our lives to learn our art. At the beginning of my medical career, I took care of a scared nineteen-year-old in a maternity ward at the civil hospital of Karachi, which is affiliated with my alma mater Dow Medical University in Pakistan. She was in sepsis, a complication of obstructed labor due to CPD, and had

been brought to the big city from a far-flung rural area. My job as a thirdyear medical student was to take her pulse and BP every few minutes and do tepid sponging. When I came to the US, I learned that this is called “scut work.” I had not been learning a skill but merely doing a job, one that no one else was there to do or wanted to do. But I will never forget that young woman and the valuable lesson that her dark, lifeless eyes taught me: timely access to quality health care prevents tragedies and saves lives. That is why organized medicine is important and why I choose to be involved in the ACCMA. When doctors come together and speak with one voice—whether it’s to advocate for universal access, protest against family separation or pharmaceutical monopolies, or promote the public health—we can improve the health of our patients and our communities. That is what is so special about the ACCMA; we bring physicians together from all walks of life in the East

Bay to advocate for what is important to our profession and to our patients. We put our collective brain power to work solving problems that are impacting our patients and our community—from promoting advance care planning to combatting the opioid epidemic. And the ACCMA helps physicians lead the way, because the last thing we need are more bureaucrats and businessmen making health care decisions for our patients. It is my honor to serve as your ACCMA President over the next year. We have a long and distinguished history of innovation and service to the medical profession, to our patients, and to the East Bay community. This issue of the ACCMA Bulletin is focused on community service and how physicians give back to their community. I look forward to working with all of you along with our able staff at the ACCMA to continue our fine tradition of advocacy for quality health care and supporting physician practices as we embark on the next 150 years.

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 | November/December 2018

THINK ACCMA

FOR FREE CME!

As part of your ACCMA membership, access to CME credits will be available to you each year AT NO COST. That means you can satisfy part of your CME requirements for license renewal FOR FREE, by being a member of the ACCMA. This new complimentary benefit—among many other member benefits—represents ACCMA’s ongoing commitment to supporting East Bay physicians in patient care, professional development, and practice management, and to making your membership save you time and money.

Register for CME-eligible ACCMA seminars and webinars, both live and on-demand, at www.accma.org/events or in the ACCMA Learning Center at learning.accma.org

The ACCMA Learning Center gives you access to a wide range of tools aimed at helping you, your practice and/or your health system provide better care. Log-in instructions for first-time users (members): (1) Enter the Learning Center by going to learning.accma.org. (2) Click "Forgot Password." (3) Use the email address associated with your membership and follow the instructions to create a new password. Nonmembers may also access Learning Center resources by creating a new account. Discounts do not apply. Questions about your account or Learning Center resources may be directed to accma@accma.org

Contact the ACCMA at (510) 654-5383 for more information about our CME program and/or your other member benefits!

CMA 2018 LEGISLATIVE SUMMARY

CMA 2018 Legislative Summary By Janus L. Norman, CMA Senior Vice President

Janus Norman

t has been said that “diligence makes the difference between all-time greats and one-hit wonders.” For over 160 years, the physician leadership of the California Medical Association (CMA) has practiced unmatched devotion to its members and the entirety of the physician community. CMA’s physician leaders care for their individual patients at all hours of the day or night and are stewards of the profession in their limited time off. This investment of sacrificed family and personal time has powered the state’s largest medical association forward. Innovations in the association’s governance structure have increased CMA’s ability to maintain its vaulted position within the Golden State’s political “Game of Thrones.” Success in the legislative process is sometimes difficult to measure. Insiders often refer to published lists of powerful special interest groups or individuals, articles listing interest groups that have spent the most money on lobbying and/or campaign

activities, or the number of mentions an association receives in news articles. If those are the measurements of success, CMA is at the top of the class: staff are consistently included in the Capitol Weekly Top 100; CMA is routinely recognized by news outlets as one of the most effective lobbying organizations in the state; and rarely does an article regarding health care legislation not include a quote from the CMA president. Prominence is significant; it aids in the creation of political capital. But distinction itself is not the goal. Physician leaders want to ensure that CMA improves the health care delivery system by obtaining state budgetary appropriations to increase patient access and protect against ill-conceived legislation that would directly threaten their ability to financially maintain a practice and provide the best care.

Return on Investment

In 2016, CMA, the California Dental Association, the Service Employees International Union (SEIU), and their coalition partners beat the odds. Together, we convinced voters to increase the state’s tobacco tax by $2 in order to invest a majority of the revenue into increasing access to care. CMA contributed $1 million to the statewide Proposition 56 campaign. Now that the tax is being collected and distributed, the physician community sees the impact. The 2018–19 State Budget included: • Over $1 billion in new funding to support supplemental payments for physicians participating in the Medi-Cal program

An expansion of the number of CPT codes that are eligible for those supplemental payments • $190 million for medical student loan repayment • $40 million in new funds for graduate medical education, which will be administered by Physicians for a Healthy California (formerly known as the CMA Foundation) In the 2017–18 legislative session, two detrimental proposals were introduced that would have upended the state’s health care delivery system. SB 562 (Lara, Los Angeles) would have required California to implement an extremely flawed single-payer proposal. AB 3087 (Kalra, San Jose) would have empowered a politically appointed committee to price fix physician services. In both instances, the health care community looked to CMA for leadership and expertise. On a weekly basis, opposition coalitions met at CMA headquarters to execute a substantial grassroots program, earned media strategy, Capitol lobbying strategy, and a digital media campaign. The defeat of SB 562 and AB 3087 once again showcased CMA as an unapologetic leader in health care policy. As a result of defeating both bills, the Legislature now looks to our House of Delegates for a solution to improve access and increase the affordability of health care in California. During the first quarter of the year, the CMA Board of Trustees adopted CMA’s sponsored bill package. The bills focused on: • Improving state oversight and regulation of predatory behavior by health plans (AB 2674 by continued on next page •

ACCMA BULLETIN | November/December 2018

CMA 2018 LEGISLATIVE SUMMARY

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Assemblymember Aguiar-Curry and AB 2427 by Assemblymember Wood) Improving access to medication assisted treatments for individuals fighting opioid addiction (AB 2384 by Assemblymember Arambula) Improving the medical board disciplinary process (AB 505 by Assemblymember Caballero) Increasing transparency and oversight in the pharmaceutical

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supply chain (AB 315 by Assemblymember Wood) • Protecting medical independence for physicians working in county sheriff ’s departments (SB 1303 by Senator Pan) I am pleased to report that all sponsored legislation made it through both houses of the Legislature and were sent to the Governor for consideration. While the fate of each bill will vary, it is important to note this year the Legislature agreed with each of

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

the policy principles of our sponsored legislation. For a full description and status of each measure, visit cmadocs. org/leg-wrap-2018. The call for leadership is once again before us. Guided by our grand history, we must continue to exercise our diligence, provide solutions, and construct the development of the next iteration of California’s health care delivery. Let’s do it again!

CMA HOUSE OF DELEGATES

CMA Outlines Bold Health Care Agenda to Improve Patient Affordability, Access and Quality By the California Medical Association

n October, the California Medical Association (CMA) convened its 147th annual House of Delegates (HOD) meeting in Sacramento. Over 500 California physicians convened to debate on the most critical issues affecting members, the Association, and the practice of medicine. The major focus of HOD was the creation of an initial framework for a bold agenda to increase health care affordability, improve health care delivery, create efficiencies throughout the health care system, and improve health outcomes, which includes addressing social determinants of health and expanding telehealth services. Virtually all of us have directly witnessed the impacts on our patients, but the following statistics bear repeating because they reinforce the critical nature of CMA’s charge: Prescription drugs prices have increased 25 percent since 2012 (Health Care Cost Institute). Health insurance deductibles have more than doubled since 2008, and half of all workers now have a deductible of at least $1,000 for an individual, up from 22 percent in 2009 (Kaiser

Family Foundation). Employer-sponsored insurance premiums have risen from $6,000 in 1999 to more than $18,000 in 2016, and out-of-pocket costs have increased by more than 53 percent between 2006 and 2016 (Economic Policy Institute). The average American spent $10,345 on health care in 2016, yet roughly 41 percent of Americans say they can’t pay a $400 emergency expense without borrowing or selling something (Centers for Medicare and Medicaid Services, Federal Reserve). Thirty-three percent of Americans with health insurance said they or a family member had problems affording care in the last year (Kaiser Family Foundation survey). Twenty-seven percent of our time is spent with patients, while nearly half is spent on electronic health records or other desk work. Spending three hours a day on administrative tasks equals a loss of 2,200 patient visits per physician per year (Annals of Internal Medicine). CMA President David H. Aizuss, MD, put it best: “Health care costs continue to grow, with patients paying

GET INVOLVED Do you want to help establish CMA policies on major issues that affect the practice of medicine? Physicians interested in influencing CMA’s advocacy agenda can serve in the House of Delegates or on one of CMA’s councils and committees. For more information, contact David Lopez, ACCMA Associate Director for Advocacy and Policy, at dlopez@ accma.org or (510) 654-5383.

more and getting less—except for more runarounds, fine print and larger medical bills. This is our current reality and the battle we must fight, because it’s hurting our patients’ ability to access needed care, treatment and medications. No family should have to forego medical care to pay household bills or take on debt, yet that is exactly the situation more Californians are facing. If health care isn’t affordable, then it isn’t accessible, and the California health care system must do better for our patients.” With physicians at the center of health care delivery, CMA has long advocated on behalf of our patients to ensure they are receiving affordable, timely and quality care, and we doubled down on that commitment at HOD. After hearing expert testimony, CMA debated and identified four critical issues that California must address to make health care affordable while improving quality and access: • Reform health care delivery and utilization by making payment and delivery more efficient, as well as expand telehealth. continued on next page

SAVE THE DATE: 2019 HOUSE OF DELEGATES The 2019 House of Delegates will be October 26–27, 2019 in Anaheim, at the Disneyland Hotel.

ACCMA BULLETIN | November/December 2018

CMA HOUSE OF DELEGATES

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that all modes of medical practices are financially vibrant. • Ensure patients have access to necessary treatment and medications by addressing pharmaceutical costs. In the coming months, CMA will develop targeted, pragmatic and workable solutions, as well as continue to work with our members, health care stakeholders, and policymakers

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Expand patient choice and affordability by increasing competition throughout health care with market-based solutions. Maximize physicians’ time spent with patients by reducing administrative burdens and eliminating duplicative tasks that add unnecessary costs without improving health outcomes. CMA also remains committed to ensuring

to ensure patients can access quality care in an affordable and timely manner. As a physician-led organization, CMA’s collective strength is derived from the dedication and passion of its membership. We thank the HOD delegates, and we thank you for your continued commitment to patients and the profession.

THANK YOU Thank you to the following members for representing the ACCMA District IX Delegation at the CMA HOD meeting: Robert Benjamin, MD Albert Brooks, MD Arthur Chen, MD Eric Chen, MD Suparna Dutta, MD Robert Edelman, MD Russ Granich, MD Lubna Hasanain, MD Arden Kwan, MD Kristen Lum, MD Abbas Mahdavi, MD Katrina Peters, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Edmon Soliman, MD Frank Staggers, Jr., MD Michael Stein, MD Thomas Sugarman, MD (Chair) Brad Volpi, MD Renee Wachtel, MD Clifford Wong, MD Ronald Wyatt, MD Sijie Zheng, MD

Thank you also to the following ACCMA members who represented other delegations: Basil Alwattar, MD, Specialty Delegation Patricia Austin, MD, Solo & Small Group Practice Forum Randy Bergen, MD, Very Large Group Practice Forum Lonnie Bristow, MD, FACP, Past Presidents Patricia Castaneda-Davis, MD, Very Large Group Practice Forum Michael Cedars, MD, Specialty Delegation Christopher Chen, MD, EMOS Jacques Corriveau, MD, FAAP, Specialty Delegation Joy Garg, MD, Very Large Group Practice Forum Andre Gay, MD, Specialty Delegation Kirk Hahn, MD, Very Large Group Practice Forum Walter Keller, MD, Very Large Group Practice Forum Terry Hill, MD, Administrative Practice Forum James Hinsdale, MD, Past Presidents Linda Kim, MD, Very Large Group Practice Forum Jeffrey Klingman, MD, CMA Board of Trustees Mark Kogan, MD, CMA Board of Trustees Roman Kownacki, MD, MPH, Very Large Group Practice Forum Jessie Liu, MD, Resident and Fellow Delegation Janet Lord, MD, Specialty Delegation Anmol Mahal, MD, Past Presidents Candace Markley, MD, Resident and Fellow Delegation Myngoc Nguyen, MD, Specialty Delegation Russell Nord, MD, Specialty Delegation Elaine Ong, MD, Very Large Group Practice Forum Rahul Parikh, MD, Very Large Group Practice Forum Mitesh Patel, MD, Specialty Delegation Katrina Saba, MD, Very Large Group Practice Forum Simpson So, MD, CMA Board of Trustees Yen Truong, MD, MPH, Specialty Delegation Steven Una, MD, Solo & Small Group Practice Forum Ashby Wolfe, MD, MPH, Specialty Delegation

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CHALLENGING AB 72 INTERIM PAYMENTS

AB 72: The Independent Dispute Resolution Process and How to Appeal By the California Medical Association

new California law took effect last year that changed the way that non-contracted physicians bill and are paid for providing non-emergency care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. This out-of-network billing and payment law (AB 72) was designed to reduce unexpected medical bills when patients go to an innetwork facility but receive care from an out-of-network doctor. While patients with out-of-network benefits can consent to treatment from out-of-network providers, absent a valid consent form, health plans and insurers are required to reimburse out-of-network physicians at an interim payment rate. Without a signed consent, patients are only responsible for their in-network cost sharing. The interim rate is the greater of the plan/insurer’s average contracted rate (ACR) or 125 percent of the Medicare fee-for-service rate for the same or similar services in the general geographic region in which the services were rendered, unless otherwise agreed to by the noncontracting provider and the payor. (By January 1, 2019, both regulators will have adopted a standardized methodology that all payors are required to use to compute the average contracted rate.)

Can I Challenge the Interim Payment?

The law does include a mechanism for physicians to challenge the payment amount if they are dissatisfied—the independent dispute resolution process (IDRP). Payors are required to

participate in the IDRP once a physician begins the process. The first step is to determine whether you are eligible for IDRP. This step is important as there are fees involved, which are split equally with between the payor and the physician. To be eligible for IDRP, a physician must first appeal in writing to the payor for additional payment. If the physician is not successful in resolving the dispute through the payor’s internal appeal process, the physician may then file an IDRP through the appropriate regulator—either the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI), depending on the product type. Claims are only eligible for the IDRP for 365 days from the date of the payor’s written response to the appeal. If a physician attempted the appeal process but the payor was nonresponsive, the 365-day limit to file IDRP will begin after 45 business days have passed from the date of receipt of the physician’s appeal. Instances where physicians have had patients sign written consent forms for the use of outof-network benefits are not eligible for IDRP. The IDRP process for both regulators is web- and email-based and conducted through the regulators’ portals, with no parallel paper process. Physicians may bundle up to 50 claims in a single IDRP application. These claims must all be for services provided by the same physician, for the same payor (health plan, insurer, or delegated entity), and for the same or similar services. While DMHC does not define same or similar services, CDI defines them as those that

fall within the same subheading in the CPT or HCPCS manual. Each application will need to include a copy of the original claim form, corresponding explanation of benefits, and a copy of the determination letter from the payor or the physician dispute resolution, if applicable. CDI also requires an IDRP request form with a final offer indicated, an IDRP request claim information spreadsheet when submitting bundled claims, copies of all correspondence between the provider and insurer, both sides of the patient’s ID card, and the assignment of benefits, if applicable. For both regulators, a copy of the appeal to the payor is also recommended. While not required, it is encouraged that each IDRP application submitted include a narrative summary justification. This should explain the physician’s billed charges or final offer for all claims at issue, including the physician’s training, qualifications, length in practice, the fees usually charged by the physician, other economic aspects relevant to the physician’s practice, any unusual circumstances, and other relevant factors. Physicians should also include supporting documentation as the independent review organization conducting the IDRP will base its decision on the information submitted when rendering a decision. Supporting documentation may be a citation referenced in the narrative summary justification or include a provider directory report demonstrating network adequacy concerns, continued on next page

ACCMA BULLETIN | November/December 2018

CHALLENGING AB 72 INTERIM PAYMENTS

timely access enforcement actions and appropriate reimbursement amounts from other payors. There is no page limit for either the narrative summary justification or the supporting documentation. The DMHC and CDI’s IDRP processes have many differences including arbitration types. DMHC uses traditional arbitration, meaning the arbiter can select any reimbursement amount he/she determines is appropriate. CDI uses baseball-style arbitration, meaning the arbiter will select one of the two parties’ final offers and no other amount. In both cases, prior to remitting IDRP fees, the parties may agree to a settlement of the claim(s). In all cases of IDRP, the arbiter’s decision is binding on both parties. Payors are required to implement the decision obtained through the IDRP. If dissatisfied, either party may pursue any right, remedy, or penalty established under any other applicable law. Physicians are encouraged to utilize IDRP, as regulators are required to consider information from the IDRP when establishing methodology for determining average contracted rates,

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which in turn will likely impact payor contracting practices going forward. For more information on IDRP eligibility, identifying the regulator, the submission processes and what to include in the narrative summary justification and/or the supporting documentation, the California Medical Association (CMA) has created an IDRP guide, “A Physician’s Guide to the AB 72 Independent Dispute

Resolution Process.” This and many other valuable resources on navigating the out-of-network billing and payment law can be found in CMA’s AB 72 Resource Center: cmadocs. org/out-of-network-billing. Practices with additional questions or concerns can contact CMA’s Reimbursement Helpline at (800) 786-4262 or economicservices@cmadocs.org.

AB 72 RESOURCES CMA has developed a number of resources to help physicians navigate this new law. These are all available free to members at cmadocs.org/ out-of-network-billing. • • • • • • • •

FAQ: A Physician’s Guide to AB 72: Questions and Answers A Physician’s Guide to the AB 72 Independent Dispute Resolution Process Instructions and Sample Form for Obtaining Patient Consent Under California’s New Law Sample Payor Appeal Letter for Interim Payments Billing Requirements and Payment for Out-of-Network Services at In-Network Facilities AB 72 Payment Monitoring Workbook Health Law Library Document #7508: Non-Contracting Physicians Balance Billing Toolkit

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ENCORE PHYSICIANS PROGRAM

Introducing the Encore Physicians Program

he practice of medicine is a calling. It brings joy and fulfillment. The decision to retire, balancing financial stability with a desire for freedom, is never easy. The pressures of practice in today’s health care environment lead many physicians to retire earlier than our mentors. That escape is initially elating but for some retirees, providing their medical expertise in new arenas may become a way to restore the satisfaction that medicine once brought them. A new program, The Encore Physicians Program, provides an opportunity for retired physicians to practice part-time, caring for patients who most need their assistance, in community health centers. Community health centers serve everyone regardless of ability to pay or insurance status. Born during the social rights movements of the sixties, these clinics provide culturally sensitive care to an underserved population. And they have been growing. Between 2001 and 2017, patients being served by community health centers in the United States increased by 164%, or 17 million patients. This increase was driven by multiple factors, including a

Physicians in the Community Health Center Network

growth in the poverty and uninsured rates, and more recently by the expansion of the Affordable Care Act. In 2015, 63% of individuals seen at community health centers in California held Medi-Cal insurance. Although the community health centers have expanded in California, staffing shortages are a constant issue. The backbone of the clinics is primary care physicians, who are in short supply nationally due to many factors, including the burden of medical school debts and the minimal number of training programs for primary care physicians. These factors may lead to a preference for lucrative specialty training. Furthermore, community health centers have difficulty attracting physicians due to lower salaries and heightened patient complexity, which are often due to social determinants of health. The California Health Care Foundation has explored several strategies to improve medical care to the underserved. Kaiser Northern California Community Benefits has also been working with the regional health center consortium on ways

to address the staffing shortages. Kaiser Community Benefits hired Melissa Schoen, Principal at Schoen Consulting with 25 years in the healthcare industry, to explore the demand and opportunity to utilize retired physicians to address the issue. Initial research showed that there was a potential supply of retired physicians interested in working in health centers but they were not sure how to get started. Retired physicians who were working in health centers had learned about the need through personal connections, word of mouth, or previous volunteering. A retired physician who was interviewed said, “Although we get a lot of information on how to prepare financially for retirement, there isn’t a lot of information on how to prepare socially.” Additionally, health centers expressed interest in utilizing retired physicians, given their experience and potential for providing support and mentorship for the provider staff. There seemed to be potential for a program to harness the energy and experience of retired physicians to support health centers’ workforce challenges, so Melissa reviewed other models of utilizing volunteers or fellows that could be leveraged to support retired physicians in serving the underserved. From the beginning, the alignment with Encore.org and their program, Encore Fellowships, was clear. Encore’s mission is to tap the talent of people 50 years and older as a force for social good. Encore Fellowships have matched over 1,700 retired business professionals in paid, high-impact assignments with non-profit organizations that can benefit from their continued on next page

ACCMA BULLETIN | November/December 2018

ENCORE PHYSICIANS PROGRAM

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for the Contra Costa Health Plan, experience and skills to expand their wished to work more directly with the capacity. With Encore Fellowship’s community health centers: “Melissa effective program, success in matching and I had several conversations about and a sustainable business model that direct patient care versus leading the could potentially work with matchEncore Program. Given my recently ing retired physicians and health cenretired status, I believe I can have a ters, Melissa reached out to Encore. greater impact through the Encore org about the possibility of workPhysicians Program with a plan to ing together on this new program work at a clinic once the Program is for retired physicians, and they were self-sufficient.” immediately interested in exploring a With Kaiser Permanente potential new way to use their model. Northern California Community “I have been working with Benefits Program providing a grant Encore.org to develop this pilot in for the administration of the program, the Alameda Health Consortium, Encore Fellowships will test a model a sister agency to the Community of placing retired physicians into cliniHealth Center Network. They work to cal roles. Doctor Bourne will provide provide advocacy, programmatic and outreach to retiring and retired physimanaged care services, respectively, to cians, match them with the right clineight federally qualified health centers ic, and assure a successful onboardin Alameda and surrounding counties. ing. The pilot program is through We believe that this partnership can the Alameda Health Consortium, with be an effective way to address health clinics in Alameda and Contra Costa center physician workforce challenges Counties. and support increasing access to high Physicians commit 15 hours per quality care for the most vulnerable week for one year with a $50,000 stipopulations,” explains Melissa. pend paid by the clinic. The health Laura Miller, MD, Chief Medical centers will hire and credential physiOfficer for the Community Health cians, and provide robust malpracCenter Network and an ACCMA tice insurance assigned to Federally member, said, “We are excited to be Qualified Clinics. Clinic duties and part of the pilot to explore how retired schedules will be determined by each physicians can support health cenphysician and clinic medical director. ters to provide much needed care to “The program makes so much our communities. Our health center sense to me. When I talked to newly patients and providers alike will benretired physicians, most were elated efit from the skills of retired phyfor six months. They appreciated the sicians. Kaiser Northern California stress relief with the end of patient Community Benefits has funded the responsibility, and relaxpilot implementation to ation from limited schedtest the concept and proules. But I found that a gram model.” void developed in sevThe leader of the eral retirees as they tried pilot program is Gerry to keep busy,” explains Bourne, MD, who retired Doctor Bourne. from Kaiser Vallejo after He continues, “They approximately 25 years. missed that sense of purHe is dedicated to propose that patient care viding care for the underprovides…the smiles, the served and while working Gerry Bourne, MD 16

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

nods, the ‘Thanks, Doc, I feel so much better,’ that we pass off as nothing. We all went into medicine with a hope to ease suffering, let alone cure disease, but that desire can erode and doctors suffer burnout. But after a few months of ‘self-care,’ many retirees are motivated to return to patient care. Some choose programs in exotic lands, some via telehealth but others wish to care directly for the immense population of underserved in our own communities.” Doctors find the work rewarding. “Working at a community health center a couple of days a week has been perfect for me. It allows me plenty of free time, yet I can continue to practice high-quality primary care medicine in a supportive and very appreciative environment,” says Doctor Steve Rich, former Chief of Medicine at Kaiser Santa Rosa and a 34-year member of the Sonoma County Medical Association. As one of the physicians currently working at a community health center, “I am fully engaged and have a continued sense of purpose. It has been a very nice transition out of my much busier career at The Permanente Medical Group.” Working closely with the Alameda Health Consortium, Doctor Bourne and the community health centers will onboard and follow up closely to ensure that any concerns are addressed promptly. The pilot program will be evaluated by Engage R&D, supported by funds from the California Health Care Foundation. Engage R&D will review and determine the program effectiveness and sustainability, and how processes can be improved to support staffing community health centers with retired physicians. Doctor Bourne can be contacted at gbourne.encore@ gmail.com and interested physicians can learn more at https://encore.org/ encore-physicians-program/.

OPERATION ACCESS

Volunteer Spotlight: ACCMA Member Stephanie Santos, MD

n November 2018, ACCMA member Stephanie Santos, MD, was chosen as the recipient of the Volunteer of the Year Award from the East Bay Leadership Council for her work as an Operation Access volunteer. Operation Access (OA) coordinates donated surgical and specialty care for uninsured and low-income members of the Bay Area community through the work of medical volunteers. Dr. Santos, a gastroenterologist at Kaiser Permanente in Oakland and Richmond, stands out within the OA network of volunteers because aside from her direct service, she fulfills an important role as a catalyst, advocate, and leader.

ACCMA member Stephanie Santos, MD, receiving Volunteer of the Year Award from the East Bay Leadership Council

Helping to grow the impact of the program, Dr. Santos has recruited five other specialists and collaborated with

a nurse lead to bring Kaiser Richmond’s gastroenterology department into OA’s network of volunteers in 2017. The teams primarily provide donated colonoscopies, a procedure done to detect and prevent colorectal cancer, the second leading cancer killer in the US. As a result of Dr. Santos’s leadership, both Kaiser Permanente locations in Oakland and Richmond participate in two to three volunteer events per year, making it possible to provide twelve to fourteen crucial colorectal cancer screenings for people at above average risk for colon cancer at each event. Dr. Santos plays a large role in the coordination of these events, reviewing each case and triaging according to the needs of the patients. The Director of the departments at both hospital locations also volunteers with the program and supports Dr. Santos in her efforts to expand the screenings provided through OA’s partnership with Kaiser Permanente. Together, their passion and drive led to the identification of the opportunity to involve nurse practitioners and physician assistants in providing sigmoidoscopies, another colorectal cancer screening that does not need to be performed by a gastroenterologist. By providing this additional procedure and involving more medical professionals, OA can reach more people and coordinate more interventions for people in need. Since she began volunteering in January 2013, Dr. Santos has provided 57 GI screenings to people who would otherwise have no access to specialty

care procedures. Her advocacy for expansion of services and the volunteer network has extended the reach of the program and helped prevent the development of colorectal cancer for many individuals. Upon receiving the award, she acknowledged that the recognition was not only for her, but also for the entire staff of nurses and medical assistants who help make it possible for both sites to serve so many patients. She stated that she could not have had this success without them and therefore the award belonged to the teams at both hospitals. Dr. Santos’s passion for serving the underserved is inspiring. When asked what motivates her to volunteer, she responded, “My work with OA is not anything close to work; it’s giving back to the community at large. I enjoy partnering closely with an organization that is a safety net for the wonderful patients who otherwise would not get the medical care they need, but to which they should have access. It just seemed like a nobrainer; I feel my team has a special skill and if it is a skill that we can give and provide for other people, it seems like a simple thing to do. Health care is a right, not a privilege. Volunteering for OA helps to bring to heart the fundamental reason why we go into medicine.” If you’re interested in learning more about Operation Access, please visit their website at www.operationaccess.org or contact Angelica Gutierrez at angelica@operationaccess.org.

ACCMA BULLETIN | November/December 2018

GLOBAL HEALTH TEAMS

Providing Longitudinal Primary Care in Rural Haiti Short-Term Personal Commitment and Long-Term Community Health Gains By John F. Brown, MD

t the start of my medical career, I embraced a dilemma that many providers face: a love of helping patients in need combined with a desire for proper work-life balance to allow for a long, happy, and productive medical practice. After many opportunities and experiences during my medical school and residency training, I found what I believe to be a wonderful opportunity for service with Global Health Teams that allows me to maintain my medical practice, family, and community commitments.

John F. Brown, MD volunteering for Global Health Teams in Leon, Haiti

Global Health Teams (GHT, formerly known as the Seattle-King County Disaster Team) began going to Leon, Haiti 20 years ago. Initially, this was to help their team members develop skills in responding to

a domestic disaster. Their experience in Haiti transformed their directive. The group decided to continue going back to Leon to set down roots in a clinic and serve the Haitian people with large clinics each February, June, and October. Over the years, GHT has expanded its reach to two other locations in southwestern Haiti: Abricots and Castillon. Clinics are also offered in those locations in April and October. Located in the mountains of southwestern Haiti, Leon is a beautiful place with unfortunate circumstances. It is no more than a dirt road in the middle of the forest, about an hour’s drive from the nearest city, Jérémie. Most of the inhabitants of the region are subsistence farmers. Natural disasters like Hurricane Matthew in 2016 devastated the region. Access to basic services is sparse and availability of medical care is limited. Serving a catchment area of about 30,000 people, the Leon clinic functions all year round with a staff of nurses, pharmacists, and public health workers. The GHT medical teams— consisting of physicians, nurse practitioners, physician assistants, nurses, laboratorians, paramedics, and Emergency Medical Technicians— augment the local staff, providing primary care and public health services. The aims of the program are based on a long-term commitment to community health and collaboration with local health resources. On an individual basis, patient care is provided at a primary-care level with 4 to 5

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

treatment stations, allowing practitioners to deal with chronic disease management and acute emergencies such as minor to moderate trauma and episodes of infectious disease. The patients range in age from neonates to the elderly, and medical issues from childbirth to palliative care are tackled by team members ranging in experience from first-time global health providers to experienced members with 10 or more missions under their belt. Professional interpreters who have ties with the local community are paired with providers while they are working at the clinic. Physician clinical judgment is supported by strong laboratory services and ultrasound capability. Acute curative “office-based” procedures are performed, such as incision and drainage of abscesses; simple fracture reductions and immobilization; and wound care. The clinic is a basic facility, with patient exam spaces, a small resuscitation area, pharmacy, and a solar power electric system for basic lighting and ventilation. On a community basis, there is an emphasis on providing a high standard of primary care, comparable to what practitioners are used to in the United States, in this more austere environment. The team works together, and shares expertise between providers and the community clinic staff. The overall goals of care are developed in conjunction with the community health committee. Local sources for medication and medical supplies are continued on next page

GLOBAL HEALTH TEAMS

utilized whenever possible. The clinic formulary is based on the World Health Organization Essential Medicine List. Short education modules are often presented in the evenings after clinic, many based on research done on local health conditions by GHT. Local medical resources are utilized when available and appropriate for more complex care. This includes referrals for surgeries, HIV patient management, high-risk pregnancy care, and certain specialty services such as breast cancer evaluation. Public health messaging on prenatal care, childhood development, HIV prevention, and basic infectious disease treatment are provided to patients at the time of their visit. Haiti is the poorest country in the Western Hemisphere and has some of the worst health indicators, with short lifespan, high maternal/child mortality, injury disability, infectious disease, and nutrition-related morbidity being the norm. Recent setbacks, such as a 2015 health care worker strike and Hurricane Matthew in 2016, have diminished gains from investment in health care by multiple non-governmental organizations. We have seen improvement in the management of community health problems with our intervention, such as improving Hemoglobin A1c values, and better tracking and control of hypertension and its complications. Living conditions for team members are reasonable for an austere rural setting. The team lives in a rectory, with three to four team members sharing large rooms with beds and indoor bathrooms with running (cold) water. Food safety is paramount, with teamprovided potable water and hot meals prepared by the rectory staff. Teams are composed of varying specialties but always include a team emergency physician and team emergency medical supplies. Medical evacuation

insurance, in-country transportation, and lodging are provided for team members through GHT. The team members pay for their individual participation costs, and may do so by fundraising using the Global Health Teams webpage, if desired. In 2019, there are many opportunities for participation. The team missions have become available to Emergency Medicine Residents through a partnership with the UCSF/ Zuckerberg San Francisco General Hospital Department of Emergency Medicine Residency Program Global Health Interest Group. Information and pictures about the volunteer experience, a video walkthrough of the Leon clinic, and dates of upcoming trips are available at www.globalhealthteam.org.

(continued)

Recruiting is in progress for all 2019 teams. If you would like more information, please contact the Global Health Teams Project Director, Lori Van Slyke, at lori@globalhealthteam. org, or go to www.globalhealthteam. org. My experience working on the teams since 2004 has been remarkably positive. I have made many lifelong friends, both among the community of Leon and my fellow team members from all over the United States and Canada. Moreover, I have had a chance to step out of my ordinary practice and continue my lifelong journey of medical learning. The last baby I delivered, the last fracture I reduced using ultrasound, the last cholera patient I treated, and the last hug I received from a grateful family member have all been continued on page 30

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

ACCMA BULLETIN | November/December 2018

NEW MEMBERS

NEW & RETURNING MEMBERS Alameda Alliance for Health 1240 S. Loop Road, Alameda Sanjay Anil Bhatt, MD Emergency Medicine Alameda InPatient Medical 2070 Clinton Avenue, Alameda Samra Rashid, DO Internal Medicine Marina Wellness Primary Care 947 Marina Village Parkway, Alameda Josephine Nwannekaego Agbowo, MD Family Medicine The Permanente Medical Group 4501 Sand Creek Road, Antioch Shobha Neerkaje Bhat, MD Family Medicine Asieh Kazem Haghighi, MD Occupational Medicine Duong Lam-ba Le, MD Cardiovascular Disease Jessica Lauren Weinstein, MD Neurology Rui-Tao Zhang, MD Hospitalist The Permanente Medical Group 39400 Paseo Padre Parkway, Fremont Laurence Earl Cook, MD Orthopaedic Surgery The Permanente Medical Group 200 Muir Road, Martinez Bree Zimmerman, MD Dermatology The Permanente Medical Group 3600 Broadway, Oakland Samantha Wei-Lin Coffino, MD Pediatrics Margaret Christine Ford, MD Internal Medicine

The Permanente Medical Group 901 Nevin Avenue, Richmond Daniel Russell Hans, DO Family Medicine Nancy T. Nguyen, MD Obstetrics and Gynecology The Permanente Medical Group 2500 Merced Street, San Leandro Gurraj S. Bedi, DO Family Medicine Michael H. Hwang, MD Emergency Medicine Gordon Yang Wu, MD Emergency Medicine The Permanente Medical Group 2300 Camino Ramon, San Ramon Lindsey Patricia Goosherst, DO Family Medicine The Permanente Medical Group 3553 Whipple Road, Union City Meron Haile, MD Ophthalmology The Permanente Medical Group 3555 Whipple Road, Union City Seema Panduranga Kini, MD Dermatology Aman Deep Singh, MD Psychiatry

The Permanente Medical Group 710 S. Broadway, Walnut Creek Emily Fanya Stein, MD Psychiatry The Permanente Medical Group 1515 Newell Avenue, Walnut Creek Mohan Rama Bhat, MD Internal Medicine Karl Fehskens Russ, MD Pediatrics Tri-City Health Center 2449 Plumleigh Drive, Fremont Harsha Ramchandani, MD Internal Medicine

NEW RESIDENT MEMBERS Alameda Health System-EM Residency Esteban Cubillos-Torres, MD Drusia Colleen Dickson, MD Kaitlen Shanna Howell, MD Charisma Kaushik, MD Gi Xiang Lee, MD Amy Liang, MD Michael Altaf Mian, MD Nana Yaa Yeboah Misa, MD Justin E Moore, MD

Qianglong David Zeng, MD Psychiatry

Anthony Chase Palisch, MD, MS

Hao Zhang, MD Obstetrics and Gynecology

Kadia E Wormley, MD

The Permanente Medical Group 1425 S. Main Street, Walnut Creek Armen Hratch Khararjian, MD Pathology Pardis Poorzand, MD Hospitalist

Shane Deus Petrites, MD

UCSF East Bay Surgery Clifton Roy Ewbank, MD

NEW STUDENT MEMBER

Rachel Siemons, MS UCB-UCSF Joint Medical Program

Tyler J. Smith, DO Emergency Medicine

Rose He Fu, MD General Surgery The Permanente Medical Group 3801 Howe Street, Oakland Ali Asghar Torbati, MD Internal Medicine The Permanente Medical Group 7601 Stoneridge Drive, Pleasanton Nivia Magdalena Acosta, MD Obstetrics and Gynecology David Syngyu Lee, MD Dermatology

HOW TO LOG INTO CMA’S NEW WEBSITE The ACCMA and CMA websites now share a single sign-on. If you’re an ACCMA/CMA member, that means you can log into the CMA website with your ACCMA website username and password. In most cases, your username will be your email address or your medical license number. If you do not know your ACCMA login credentials, simply use the username and/or password retrieval. If you have any problems accessing your account, please contact the ACCMA at (510) 654-5383. PLEASE NOTE: Changing your password on the CMA website changes your password on the ACCMA website, and vice versa.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

DAN GOLENTERNEK, MD

Dan Golenternek, MD, POW Physician By Lincoln Cushing, Kaiser Permanente archivist and historian

hen we think of Army veterans, we usually think of infantry soldiers who fought on the front lines. But the armed forces also include health care professionals whose medical service exemplifies the highest levels of sacrifice and bravery. Dan Golenternek, MD, endured World War II in just such a manner that serves as a shining example. The first reveal of his sacrifice emerged when we learned he was a prisoner of war in a short report from the Oakland (Kaiser) Permanente Foundation Hospital in the December 1945 issue of the Alameda-Contra Costa Medical Association Bulletin: “Coffee consumption in the staff dining room rose sharply in October with a daily contingent of colleagues back from the wars to tell their stories and catch up on gossip from the home front. Major Dan Golenternek has gained back 90 pounds of the somewhat more which he lost during three and a half years in Japanese prison camps…” Such weight loss is alarming. What happened? Dr. Golenternek, who’d been training at L.A. County Hospital before enlisting in the Army, was captured by the Japanese Army in April 1942 and imprisoned in the Philippines soon after he’d gone to the South Pacific. Later he was one of two U.S. Medical Corps physicians at the Sendai #6-B prisoner-of-war slave labor camp working at the Mitsubishi Mining Company copper mine in Hanawa, Japan. At liberation, it held 546 POWs: 495 Americans, 50 British, and 1 Australian. The other physician was John Lamy, with a rank of First Lieutenant.

The Sendai camp was established on September 8, 1944 and liberated a year later. It was filled with prisoners (including survivors of the infamous Bataan Death March) shipped from the Philippines to Japan on the “hell ship” Noto Maru. The Noto Maru sailed from Manila on August 27, 1944, transporting 1,035 American POWs to Port Moji, Japan. Dr. Golenternek was one of them. Army Air Corps Technical Sergeant James T. Murphy, who survived the Sendai camp, recounted the horrific conditions and Dr. Golenternek’s role: “Dr. Golenternek was not given any medicines or medical facilities in his required job of keeping the slave-laborers—the American POWs—fit enough to walk the two miles to and from the mine daily, in their inadequate clothing and shoes, and to perform their 12-hour shifts … By hook and by crook, by sheer innovation … he managed to keep the sickest POWs from going to the mine. He created medical facilities and methods to treat wounds where there were none. He even convinced the Japanese to increase our food rations. All his methods had curative effects, and during that year of 1944–1945, only eight POWs were lost.” Another POW physician, Harry Levitt, MD, recounted earlier experiences with Dr. Golenternek at Bilibid and Rokuroshi Camps in the Philippines: “In Bilibid, Dr. Golenternek was called to care for the Japanese commander, who had an indolent ulcer on his leg that didn’t heal despite three surgical attempts by Japanese doctors. The commander told Dr. Golenternek to operate and cure the ulcer or he would be executed.

At first, Golenternek was reluctant to aid the enemy, but reconsidered after realizing his own death was imminent. The ulcer did heal. A reward of extra food, antibiotics, and vitamins was secretly provided for the POWs, because the appearance of unyielding brutality had to be maintained by the commander.” After the war and brief service at the Permanente Hospital in Oakland, Dr. Golenternek returned to Los Angeles to complete his training in obstetrics and gynecology. He never spoke about his wartime experiences and died in 2004. He was a member of the Los Angeles County Medical Association for 47 years. This article was originally published on Kaiser Permanente’s A History of Total Health blog on November 8, 2018: https://k-p.li/2POS4n

Dr. Golenternek at liberation, 9/14/1945 Photo courtesy National Archives and Records Administration

ACCMA BULLETIN | November/December 2018

The ACCMA grATefUlly ACknowledges oUr evenT sPonsors

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

150TH ANNUAL MEETING

ACCMA 2018 Annual Meeting in Photos

he Alameda-Contra Costa Medical Association (ACCMA) held its 150th Annual Meeting at the Claremont Hotel in Berkeley on Friday, November 2nd. For those members who were unable to join us, the commemorative video honoring ACCMA history can be viewed at https://youtu.be/tZfAb686gcI. Over 250 ACCMA members, their families, and distinguished guests attended this year’s meeting. Highlights

included the installation of the 2019 ACCMA officers: Lubna Hasanain, MD (President), Katrina Peters, MD (President-Elect), Suparna Dutta, MD (Secretary-Treasurer)— and recognition of Doctor Thomas Sugarman’s tremendous leadership as ACCMA President in 2018. The event also featured guest entertainer Dan St. Paul. All proceeds from the ACCMA Annual Meeting benefit the ACCMA

Medical Student Scholarship Program, which supports summer research by medical students in the UC Berkeley/ UCSF Joint Medical Program (JMP) who are engaged in community-based health projects. The ACCMA extends its appreciation to everyone who was able to make this year’s festivities such a success. We hope you can join us for next year’s event on Friday, November 8, 2019. Save the date!

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ACCMA BULLETIN | November/December 2018

150TH ANNUAL MEETING

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ALAMEDA ALLIANCE

Choosing to Serve the Most Vulnerable By Scott Coffin, CEO, Alameda Alliance for Health

Scott Coffin

lameda Alliance for Health (the Alliance) is proud to serve nearly 270,000 low-income children and adults in Alameda County. In this article, you will learn about the Alliance’s commitment to serving Alameda County’s most vulnerable residents. You will also learn why we oppose the federal government’s proposed change to the public charge rule that would negatively impact millions of immigrant families throughout the United States.

Our Commitment to Serving Low-Income Families

Most physicians agree that giving back to the community and serving the underserved is a cornerstone of modern medical ethics. At the Alliance, our mission is to improve the quality of life of our members and people throughout our diverse community by collaborating with our provider partners in delivering high-quality, accessible, and affordable health care

services to Alameda County residents. That is why we are proud to engage with a network of physicians who have chosen to serve low-income children and adults who often face significant challenges that negatively impact their health and well-being. Since the passage of the Affordable Care Act, California has insured more people than any other state in the nation. Medi-Cal now covers nearly 14 million people, or 1 out of every 3 residents in California. In Alameda County, one quarter of the 1.6 million residents are covered through MediCal. Despite the increased number of residents who now have health coverage, the population that our physicians serve is impacted by poverty and related social determinants of health. Access to affordable housing, healthy food, public safety, and other factors present unique challenges to ensuring positive health outcomes for our members and their families. This means that our physicians must work overtime to understand the larger socio-economic factors impacting patients, as well as collaborate with partners throughout the county to achieve better health outcomes for our members. Additionally, the shortage of physicians—particularly in primary care—has put additional pressure on our providers. In 2015, California physicians were less likely to accept new Medi-Cal patients than patients with Medicare or private health insurance. Despite this, our network of physicians have made a commitment to work with underserved communities as a tradition of service.

Given the many challenges that our physicians face every day to deliver high-quality services, we are grateful to them for choosing to serve Alameda County’s most vulnerable children, adults, and families.

Public Charge

On October 10, the Trump administration formally announced a proposed regulation that would broaden the public charge rule that has been a part of federal immigration law for decades. A person who is likely to become dependent on the government as their main source of support is considered a “public charge” and may not be able to become a legal permanent resident of the United States. Under the current policy, the only government benefits taken into account when determining who is likely to become a “public charge” are cash assistance and long-term institutional care. The administration proposal expands these benefits to include Medicaid, the Low-Income Subsidy available under Medicare Part D, and federal public housing such as Section 8. The federal government’s changes to the public charge rule would discourage benefit use among many immigrants, including the use of programs such as Medi-Cal, and could jeopardize access to health care services for millions of legal immigrants in Alameda County and the United States. As a participant of the safety net system, the Alliance is dedicated to the health, safety and well-being of children, families, and all Alameda County residents, and opposes the continued on page 28

ACCMA BULLETIN | November/December 2018

COUNCIL REPORTS

JUNE 14, 2018 The meeting was called to order by Doctor Thomas Sugarman, President. Doctor Sugarman introduced the guest speaker, Peter Bretan, MD, 2018 candidate for CMA President-Elect. Doctor Bretan is a transplant surgeon and urologist. His campaign advocates establishing a CMA fellowship in health care policy, a stronger focus on communications at the CMA level, and proactively leading the development of an affordable health care system model for all. Doctor Sugarman introduced the two newest Alternate Councilors that were appointed to the Council: Doctor Gautum Pareek is a gastroenterologist practicing in Fremont and Doctor Katrina Saba is a pediatrician practicing in Oakland. Doctor Sugarman announced that the ACCMA is soliciting nominations of qualified ACCMA members to serve on the Alameda County Adult Inmate Medical Services (AIMS) Panel. Mr. Greaves noted that the panel was created in 1988 by the Alameda County Board of Supervisors to provide independent quality review of health care services provided by private contractors in the County jail. The County has contracted with IMQ to serve as the quality review consultant to the panel. Doctor Drager presented the ACCMA Finance Committee recommendations to the Council. The Committee recommended approval of no dues increase in ACCMA membership dues for the 2019 membership year and the proposed fiscal year 2018–19 budget. The Council approved the Finance Committee recommendations. Doctor Sugarman announced that the Council will be in recess for the months of July and August. The Council approved granting to the Executive Committee the authority to approve new members and member reinstatements during the recess. Mr. Draper discussed the proposed HOD Resolution of the Public Charge Rule submitted by the Medical Student Section and reviewed by the ACCMA Public Health Committee. This resolution asks the CMA to establish as policy its opposition to Federal and state

legislation denying or restricting legal immigrants Medicaid and immunizations. The Council approved support of this resolution with the amendment to include a statement of support from the AMA if the AMA passes a similar resolution on the public charge rule. Doctor Austin provided the AMA Delegates report. The AMA Annual Meeting of the House of Delegates was held in Chicago June 9–13, 2018. Topics discussed during the meeting included human rights in prisons, drug prices, delaying surgery for ambiguous genitalia, gun control, physician-assisted suicide, and opposition to the criminalization of self-induced abortions. Doctor Austin announced that she was elected Vice-Chair of the AMA Constitution and Bylaws Committee. Doctor So provided a brief report from the CMA Board of Trustees. He stated that there had been no meeting since April and the Board was scheduled to meet again in July. Doctor Wharton reported on the Committee of Delegation Chairs (CDC) report on the major issues for 2018. The major topic selected for discussion at the HOD is health care cost and affordability, which has been broken into four parts to address utilization through improved care delivery, the problem of increasing pharmaceutical costs, reducing administrative burdens on physician practices, and enhancing competitiveness of the health care market. Doctor Sugarman announced that the meeting to review the next major issues report was scheduled for September 20, 2018. Mr. Draper requested that those Councilors who wish to attend the 2018 House of Delegates provide their RSVPs by June 30, 2018. Doctor Ordóñez provided the report from the ACCMA Continuing Medical Education Committee. The Committee reviewed and adopted program policies incorporating suggestions from IMQ, the accrediting agency. The ACCMA has been accredited as a CME provider for two years after which a review will be conducted. The Council had a discussion regarding Maintenance of Certification (MOC) requirements and the possibility that some CME courses

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

may satisfy MOC requirements. Doctor Brooks offered the use of facilities at Washington Hospital for CME course training. Mr. Rogers announced plans to hold a raffle at the ACCMA Annual Meeting to help raise money for the ACCMA Community Health Foundation’s Medical Student Scholarship Fund. Doctor Sugarman provided an update on California Assembly bill AB 3087, a bill which would create the California Health Care Cost, Quality, and Equity Commission, an independent state agency, to control in-state health care costs and set the amounts accepted as payment by health plans, hospitals, physicians, physician groups, and other health care providers. Mr. Draper provided a brief recap of the recent district meetings with local area legislators. He stated that the focus of the meetings was to discuss AB3087 and other healthcare issues. The Legislative Committee members met with most legislators in ACCMA-area districts. Mr. Greaves provided an update on Children’s Hospital of Oakland (CHO) and the conflict between staff and the administration. Leadership for the two hospitals will be holding town hall meetings to discuss physician concerns. The ACCMA contacted the hospital leadership and offered assistance for these meetings if needed, but hospital administration declined. Ms. Lum provided a report on membership. She stated that membership numbers were down by 74 members which leaves 97% of the membership totals from end of 2017. Mr. Rogers announced that the ACCMA webinar in July, “Avoiding Embezzlement: Strategies to Protect Your Practice,” is being offered free of charge to ACCMA members. There being no further business, the meeting was adjourned.

SEPTEMBER 13, 2018 The meeting was called to order by Doctor Lubna Hasanain, President-Elect. Doctor Hasanain introduced guest speaker Kenneth Blumenfeld, MD, 2018 candidate for CMA-President Elect. His

COUNCIL REPORTS

practice is with the Palo Alto Medical Group and he is currently the President of the Santa Clara County Medical Association. He spoke about opioids, the underserved, physician wellness programs, the need for more diversity in membership, and creating more residency programs in the state. If elected, he will promote the value of membership to attract more physicians to the organization. Doctor Hasanain introduced guest speaker Theodore Mazer, MD, CMA President. Doctor Mazer reported on his advocacy for universal access to care and stated that physicians need to be included in the discussion on policies for universal care and single payer solutions. He also spoke about requiring the Department of Managed Health Care to listen to physician complaints and to take action, all the bills sponsored by the CMA that are on the governor’s desk, advocating for physician autonomy in hospitals, and maintenance of certification. The council approved the minutes of the June 14, 2018 Council meeting and the minutes of the August 30, 2018 Executive Committee meeting. Doctor Hasanain announced that the ACCMA is soliciting nominations of qualified ACCMA members to serve on the Alameda Adult Inmate Medical Services (AIMS) Panel and is looking for an additional 2–3 members. Doctor Thomas Powers submitted his name as a nominee for the panel. Doctor Drager discussed the recommended policy from the Finance Committee for managing ACCMA shortterm investments. The Council approved the new policy on the management of short-term investments. The Council approved a recommendation from the Executive Committee to participate in an educational initiative being led by the California Academy of Family Physicians (CAFP) to increase the awareness of California physicians to the health issues created by today’s immigration policy environment. A small grant will be awarded to the ACCMA for participating in this program. The Council approved recommen-

dation from the ACCMA Emergency Committee to encourage local hospitals to support expanding access to Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) in hospital emergency departments, as part of our efforts to address the opioid epidemic through the East Bay Safe Prescribing Coalition. Doctor Kogan provided the AMA Delegates report. He noted that on October 16 the ACCMA was hosting a reception for AMA President-Elect Patrice Harris, MD. The next meeting of the AMA will be held in November. The AMA is opposing the merger between CVS and Aetna due to concerns that the proposed merger will result in reduced competition in the insurance market, which would not be in the best interests of physicians or patients. Doctor So provided the CMA Trustees report. He commented that Doctor Mazer had provided an excellent update on current CMA activities. Doctor Klingman urged Council members to review the CMA House of Delegates major issue report on affordability that has been posted on the CMA website page for the House of Delegates. Mr. Lopez updated the Council on the preparations for the upcoming CMA House of Delegates (HOD). He announced that the major issues report was available for review and that on September 20, there will be a District IX meeting to discuss the major issues report. Mr. Lopez also reviewed the tentative schedule and logistics for the HOD. Mr. Greaves discussed the outcome of the Public Charge Resolution and the decision by the CMA to add the resolution to the Reaffirmation Calendar and be presented directly to the Board of Trustees. Mr. Lopez discussed the efforts to oppose the Livermore Measure U ballot measure. The ACCMA has joined local health care providers to form Protect Livermore No on U coalition. He discussed ways to become involved by participating and engaging in media trainings, walking precincts and talking to neighbors, displaying and distributing campaign materials, among other activities. There is a similar measure,

(continued)

Measure F in Santa Clara. He stated that the CMA is also involved in opposing these measures that are being considered in other Bay Area cities. The Council requested that information about Livermore Measure U be circulated to all members. Doctor Hasanain reminded the Council that the ACCMA Annual Meeting is being held on Friday, November 2, 2018 at the Claremont Resort. This year a raffle will be held to raise funds for the ACCMA Medical Student Scholarship fund. Mr. Lopez reminded the Council of the upcoming CURES deadline on October 2, 2018. There are new requirements in the regulation and the ACCMA and the CMA have provided a webinars to review these new requirements. There was concern expressed about how to best inform members about critical regulatory deadlines to ensure timely compliance. The Council asked ACCMA staff to investigate more effective mechanisms for communications with members. Mr. Rogers provided an update on the POLST eRegistry project. He stated that the project was nearing an end and is still soliciting feedback on the eRegistry process. The project is still accepting POLST forms via fax and practices in Contra Costa County are encouraged to participate. Ms. Lum presented a membership update. ACCMA is at 98.5% membership for 2018 as compared to 2017 membership numbers. The ACCMA has been meeting with medium-sized groups to encourage membership for the entire practice. Mr. Rogers announced upcoming ACCMA-sponsored events. The Frank E. Staggers, Sr. Hypertension Project Forum is scheduled for September 25 and its guest speaker will be Tony Iton, MD. The East Bay Conversation Project’s Advance Care Planning Summit for Advocates will be on October 11. The ACCMA is hosting a reception for AMA President-Elect, Patrice Harris, MD, on October 16. Mr. Rogers also announced the seminars and webinars that are scheduled for September and October. There being no further business, the meeting was adjourned.

ACCMA BULLETIN | November/December 2018

ALAMEDA ALLIANCE

(continued from page 25)

expansion of the public charge rule. On November 9, the Alliance Board of Governors passed a resolution opposing the government’s proposed changes to the public charge rule that would negatively impact immigrant families in Alameda County and throughout the United States. The Alliance is committed to providing access to care for those who need it and to ensuring that our members and communities

are not left behind.

About Alameda Alliance for Health

Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was

created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to nearly 270,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care programs.

HOW ACCMA MEMBERS CAN RESPOND TO PROPOSED PUBLIC CHARGE REGULATION Both the American Medical Association (AMA) and the California Medical Association (CMA) have raised concerns that the Administration’s proposed policy change in determining if an immigrant to the US constitutes a public charge would have a chilling effect on families needing to access health care services, which will compromise the public health and ultimately increase health care costs overall. If enacted, these changes would reduce participation in Medi-Cal and other federal assistance programs by immigrant families. AMA and CMA policy supports everyone’s access, regardless of immigration status, to medically necessary, affordable, and quality health care. ACCMA members were encouraged to submit public comments in opposition to the proposed regulations (due by December 10) and to attend an Alameda County Town Hall meeting on November 8. The ACCMA is also participating in “Promoting Open

Conversations about the Health Consequences of Immigration Policies,” a project supported by a consortium of medical societies led by the California Academy of Family Physicians (CAFP) that is developing educational resources for physicians regarding immigration policy changes and their impact on patients. As part of this project, CAFP has produced a new fact sheet outlining physicians’ rights and responsibilities. Members are encouraged to review this information before responding to enforcement actions by immigration officials and interactions with law enforcement. Please go to https://bit.ly/2Q43d0i to access the fact sheet. If you have any questions or want more information, please contact David Lopez, ACCMA Associate Director of Advocacy and Policy at dlopez@ accma.org or 510-654-5383.

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

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CLASSIFIEDS

POSITIONS AVAILABLE – 1

MEDICAL OFFICE MANAGER IN OAKLAND: Small group dermatology practice looking to hire a full-time Medical Office Manager, who will be responsible for managing daily operations of a 5-physician practice with 2 office locations and overseeing all office staff (approximately 15–20 front desk employees, medical assistants, and billers). Responsibilities include: • Human Resources: Manage hiring/firing/employee reviews for office staff • Scheduling: Oversee physician and office staff schedule • Accounting: Daily practice accounting, monthly/yearly budgeting, month-end reporting and reconciliation • Liaison for Ancillary Services: Banking, accounting, payroll, insurance, pension, etc. • Customer Service: Seek ways to improve patient experience, handle patient complaints • Maintain Daily Operations: See that supplies are kept stocked, repairs/ maintenance for office and equipment as needed, licenses and certifications are kept up to date • Billing: Oversee operations of Billing Office Supervisor We are looking for someone with medical office management experience, or an educational background in healthcare administration looking to start a career. Dermatology or general healthcare knowledge relating to OSHA, HIPPA, healthcare law/malpractice a plus. Applicants must have experience with accounting and be detail oriented. Strong customer service skills and managerial experience required. Competitive salary + benefits. To apply, go to https:// bit.ly/2zAdN8p. (1 – Nov/Dec – Jan/Feb)

PRACTICE CLOSURE - PC

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

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

California Medical Association Political Action Committee

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

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

OFFICE FOR RENT – 3

NORTH OAKLAND MEDICAL OFFICE SPACE: Three exam rooms and an office consultation room available Mondays, Wednesdays, and Fridays at 80 Grand Ave., Suite 810, Oakland. $600 per day. Contact Elena DeLeon at edeleon@ ebplasticsurgery.com or (510) 451-6950. (3 – Nov/Dec – Jan/Feb)

Please visit www.calpac.org for more information

ACCMA BULLETIN | November/December 2018

INDEX OF ARTICLES 2018

ACCMA 2018 ACCMA Council ACCMA Annual Meeting, in Photos ACCMA Is Working for You and Your Patients ACCMA Now Offering CME, Looking for CME Committee Members By Juan Ordonez, MD Celebrating the 150th ACCMA Annual Meeting Council Reports Nov 2017 Jan 2018 Feb 2018 Mar 2018 May 2018 June 2018 Sept 2018 Registration Open for 2018 Berkeley Physician Leadership Program By Ronald W. Wyatt, Jr., MD Welcome New ACCMA Members! ADVANCE CARE PLANNING POLST eRegistry Pilot Project Needs Physicians’ Support POLST eRegistry Now Accepting Fax Forms ADVOCACY 2018 CMA Legislative Advocacy Day Highlights By James Hanson, MD ACCMA Action on John George Hospital Importance of Medical Staff Self-Governance Make Your Voice Heard! Medical Staff Prevails in Legal Battle Over Medical Staff Self-Governance By the California Medical Association November Election Issues of Concern to Physicians Physicians Launch New Coalition to Protect Access to Care ALAMEDA ALLIANCE UPDATE By Scott Coffin, CEO, Alameda Alliance for Health Alameda Alliance for Health Continues to Make Headway into 2018 Alliance Efforts to Address the Big White Pill in the Room Choosing to Serve the Most Vulnerable Improving Measures for Treating Diabetes Patients Telehealth Increases Access to Care The Alliance Prepares for Behavioral Health Treatment Transition

Mar/Apr 30 Nov/Dec 23 Sept/Oct 18 May/Jun 21 Sept/Oct 11 Jan/Feb Mar/Apr Mar/Apr May/Jun May/Jun Nov/Dec Nov/Dec

28 22 23 28 28 26 26

Jan/Feb 15 Jan/Feb Mar/Apr May/Jun Jul/Aug Sept/Oct Nov/Dec

24 26 26 22 28 20

Jan/Feb 17 May/Jun 19

May/Jun 17 May/Jun 14 Sept/Oct 16 Mar/Apr 8 Sept/Oct 15 Sept/Oct 13 Jan/Feb 10

Jan/Feb Mar/Apr Nov/Dec Sept/Oct Jul/Aug

25 27 25 27 27

May/Jun 27

CALIFORNIA MEDICAL ASSOCIATION CMA 2018 Legislative Summary Nov/Dec 9 CMA Federal Update Mar/Apr 20 CMA House of Delegates Major Issue Report: Mental Health May/Jun 9 CMA House of Delegates Major Issue Report: Physician Workforce Jul/Aug 9 CMA House of Delegates Major Issue Report: Single Payer and the Public Option Jan/Feb 9 CMA Outlines Bold Health Care Agenda Nov/Dec 11 California Physicians Boost the State’s Economy Jan/Feb 18 Change Your Bookmarks: cmadocs.org Jul/Aug 17 How to Log into CMA’s New Website Jul/Aug 19 Not Getting Our Fair Share Jul/Aug 11 Welcome to the Next Generation of CMA Jul/Aug 17 COMMUNITY SERVICE Introducing the Encore Physicians Program Nov/Dec 15 Providing Longitudinal Primary Care in Rural Haiti Nov/Dec 18 Volunteer Spotlight: ACCMA Member Stephanie Santos, MD Nov/Dec 17 HEALTH CARE REFORM AND LAWS ACA Impact on California End of Life Option Act Reinstated Temporarily New Health Laws for 2018 IN MEMORIAM Hershenhouse, Samuel B., MD Kieran, James, MD Lueders, Harold (Hal) W., MD McDonnell, Terence J., MD Shreyer, Eugene (Gene) S., MD Sommer, Stephen J., MD MEDICARE UPDATES Medicare Payment News for 2018 By Mary Jean Sage, The Sage Associates MISCELLANEOUS Dan Golenternek, MD, POW Physician Member Spotlight: Melvin S. Donaldson, MD, ACCMA’s Longest-Serving Active Member

Jan/Feb 13 Jul/Aug 21 Jan/Feb 21

Sept/Oct Sept/Oct Jul/Aug Jan/Feb Jul/Aug Jul/Aug

30 30 29 29 29 29

Jan/Feb 15

Perspective: Addressing the Climate Crisis – Calling on Physicians to Act, Part II By Lee Balance, MD and Cynthia Mahoney, MD Perspective: Health and the Climate Connection – What Doctors Need to Know, Part 1 By Cynthia Mahoney, MD Perspective: Health Care Rainbow By David J. Anderson, MD Proposition 63 Audit

Sept/Oct 17

NEWS AND COMMENTS ACA Reduced Disparities in Coverage Rates ACCMA Member Irene Lo, MD, Recognized by Diablo Magazine Aetna to Terminate Check Payments Alameda County Health Advisory for Measles Anthem Delays and Reduces Modifier 25 Payment Cut Anthem is Fined for Failure to Resolve Consumer Grievances Anthem Required to Publish Effective Dates for Clinical Policies Blue Shield Corrects System for AB 72 Claims California Regulators to Investigate Aetna’s Coverage Decisions CDPH Clinical Advisory on Influenza Testing and Treatment CDPH Revises Guidelines on Parkinson’s Reporting Requirements CDPH Updates Zika Testing Guidelines Check Your 2019 MIPS Payment Adjustment Calculation CMA and ACCMA Opposition to Ballot Measure to Set Dialysis Rates CMA Seeks Smoother CURES Transition CMA Survey Finds Rampant Health Plan Payment Abuses CMS Finalizes 2018 Medicare Fee Schedule CMS Proposes New 2019 Medicare Fees & QPP Rules CMS Publishes Final 2019 Physician Fee Schedule Confirmed Flu Cases in California Deadline to Change Medicare Participation Status for 2019 Defining Medical Necessity for Children in Medi-Cal Delay in Implementation of CURES 2.0 Database DHCS to Increase Medi-Cal Payments Early Success for State Drug Pricing Transparency Law East Bay Times Op-Ed on East Bay Progress on Opioids Expanded Emergency Health Services Have You Received Your Supplemental Medi-Cal Payments? Health Net Rescinds Modifier 25 Change Help Oakland Shoo the Flu Help Physicians and Communities Affected by the Wildfires HNFS Takes Over TRICARE Beneficiaries Latest Alameda County Guidance on Hepatitis A Lead Testing of Drinking Water in Alameda County Schools Livermore Measure U Threatens Access to Care Local Hospitals Hit with Federal Safety Penalties Local Opioid Overdose Deaths Fell in 2017 Major Changes in the 2018 CPT Codebook Majority of US Medical Students are Women MBC Reviewing Physician Prescribing History Medi-Cal ACA Rate Adjustments Update Medi-Cal Managed Care Providers Are Required to Enroll Medicare Payment Adjustments in 2017 Member Help with Covered California Changes in 2018 National Guideline Clearinghouse Goes Down New Anthem Policy on Sedation During Cataract Surgery New ICD-10 Codes to Report Human Trafficking New Medi-Cal Provider Enrollment System is Live New Medical Board App for Patients New Parkinson’s Reporting Requirements New State Budget Further Improves Medi-Cal Provider Reimbursement New Tools to Help Understand HIPAA Guidelines Online Drug Take-Back Database Opioid Prescription Restrictions at Walmart and CVS Pharmacies Patient Right to Know Act Effective in July 2019 Physician Price Fixing Bill Fails to Advance Prior Authorizations Negatively Affect Patient Outcomes Projected State Shortage of Mental Health Professionals Public Charge Rule and Health Care Access Public Health Advisory for Cyclosporiasis Rating QPP Performance Measures Recent Health Care Deals Move Away from Hospital Care “Shoo the Flu” Program Update State Disability and Paid Family Leave Changes Supplemental Medi-Cal Funding Update Sutter Health & Aetna Joint Health Plan Begins in 2019 UHC Reimbursement for After-Hours and Weekend Care UHC Releases Latest Premium Designation Physician Results UHC to Implement Outpatient Advanced Radiology Policy Warn Patients About New Medicare Scam West Nile Virus Update What to Do if You Have Non-Compliant Prescription Pads What to Do if Your Medicare Patient Doesn’t Have Their New Card

May/Jun 24 Mar/Apr 21 May/Jun 11

Nov/Dec 4 Sept/Oct May/Jun May/Jun Jan/Feb Jan/Feb

4 4 4 4 4

Jul/Aug 18 Jul/Aug 5 Mar/Apr 4 Jan/Feb 4 Jul/Aug 5 Mar/Apr 4 Jul/Aug 18 May/Jun 4 May/Jun 4 May/Jun 5 Jan/Feb 4 Jul/Aug 18 Nov/Dec 4 Sept/Oct 5 Nov/Dec 5 Sept/Oct 5 Mar/Apr 4 Mar/Apr 4 Jul/Aug 18 Nov/Dec 5 Sept/Oct 5 Sept/Oct 4 May/Jun 4 Sept/Oct 4 Nov/Dec 4 Jan/Feb 4 Mar/Apr 4 Mar/Apr 5 Sept/Oct 4 Jan/Feb 5 Jul/Aug 4 Jan/Feb 5 Jan/Feb 5 Mar/Apr 4 Mar/Apr 5 Jul/Aug 18 Nov/Dec 4 Jan/Feb 4 Jul/Aug 4 Mar/Apr 5 Sept/Oct 4 Sept/Oct 4 Jul/Aug 5 Mar/Apr 5 Jul/Aug 4 Jan/Feb 5 Sept/Oct 4 Nov/Dec 4 Sept/Oct 4 May/Jun 4 May/Jun 4 Jul/Aug 18 Nov/Dec 4 Jul/Aug 4 May/Jun 5 Jan/Feb 5 Mar/Apr 4 Jan/Feb 4 May/Jun 5 Sept/Oct 4 Jul/Aug 18 Jul/Aug 4 Nov/Dec 5 Mar/Apr 5 Nov/Dec 4 Jan/Feb 4 Jul/Aug 4

Nov/Dec 21 May/Jun 25

PRESIDENT’S PAGE Thomas Sugarman, MD A Proactive Agenda for Tackling Health Care Affordability

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

May/Jun 7

Full Court Press Underway to Defeat AB 3087 – Call Your Legislator Today! Giving Voice to the Needs of Our Patients Livermore Initiative Would Cripple Access to Care POLST eRegistry Pilot Needs Community-wide Support

Mar/Apr Sept/Oct July/Aug Jan/Feb

Lubna Hasanain, MD Bringing Physicians Together to Lead

Nov/Dec 7

PRACTICE RESOURCES AB 72: The Independent Dispute Resolution Process Nov/Dec Coding Corner: CPT Reporting for Preventive Medicine Services Sept/Oct By John Verhovshek Coding Corner: NCCI Policy Manual Updates Jul/Aug By John Verhovshek Coding Corner: Reporting E/M Services with Time as the Controlling Factor May/Jun By John Verhovshek Health Insurance Counseling and Advocacy Program (HICAP) Mar/Apr By Ruth Atkin, MSW How to Pay Off Student Loans Sept/Oct By Molly Carapiet Member Benefit: Group Dental Plan through Delta Dental May/Jun Sexual Harassment in Today’s Workplace: A Paradigm Shift? May/Jun By T. Hensley “Ted” Williams, JD Three Steps to Cut Your Practice’s Accounts Receivable Balance in Half Sept/Oct By Jesse Meddaugh PUBLIC HEALTH ACCMA Human Trafficking Training Alameda County HCV Eradication Effort Gains Momentum By Kathleen Clanon, MD April 28 is National Prescription Drug Take Back Day Save the Date for Hypertension Sunday 2018 SAFE PRESCRIBING Are You Ready to Check CURES? Contra Costa County Fights the Opioid Epidemic By Thomas Sugarman, MD Co-Prescribing Naloxone to Prevent Opioid Overdose CURES Update By the California Medical Association East Bay Emergency Physicians Expanding Access to Treatment Expanding Access to Treatment to Address the Opioid Epidemic Facing the Opioid Epidemic By Andrea A. Firth Local Coalitions Help Drive Progress in California’s Opioid Epidemic By Kelly Pfeifer, MD MAT Reimbursement Rates Medical Insurance Exchange of California Launches Safe Prescribing Incentive Program By Tom Sugarman, MD

7 7 7 7

13 25 23

21 23 23 20 23

Mar/Apr 25 Mar/Apr 19 Mar/Apr 11 Jan/Feb 15

Jul/Aug 15 Mar/Apr 9 Mar/Apr 14 Mar/Apr 11

Mar/Apr 16 Mar/Apr 13 Mar/Apr 15

Mar/Apr 17 May/Jun 12 Sept/Oct 9

GLOBAL HEALTH TEAMS (continued from page 19)

a part of my Haiti experience. I plan to help this effort and this community for as long as I can. Doctor Brown is an Emergency Physician at Zuckerberg San Francisco General Hospital and the Medical Director of the San Francisco EMS Agency. He is the 2016 winner of the Humanitarian of the Year Award from the California Chapter of the American College of Emergency Physicians.

The ACCMA recommends contacting your professional liability carrier in advance of volunteering to provide medical care overseas.

Helping People in Our Community Since 1996

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