ACCMA Bulletin Sept/Oct 2022

us

accma@accma.org

MD

Your safety is important to us. We will ensure all county guidelines are being met at the time of the event.SAFETYCOVID-19 …. requests the pleasure of your company The Alameda-Contra Costa Medical Association Join us KEENA TURNER LEGENDARY #58 AND 4-TIME SUPER BOWL CHAMPION FOR THE SAN FRANCISCO 49ERS

visit accma.org/events

for

with

register online.

Friday, November 4, 2022 Reception begins at 6:00 pm 41 Tunnel Road, Berkeley, CA GUEST

Keena Turner will join us to discuss sportsmanship, teamwork, the championship mindset, and what it took to win and sustain dominance during his eleven-year professional football career. Now, Vice President and Senior Advisor to the General Manager, Keena will highlight his “Team of the Decade", the future of today's Niners, and successful leadership tools and qualities.

Please to Contact at or call (510) 654-5383 any questions. the 154th ACCMA Annual Meeting this November. Enjoy a lively reception, formal dinner, and presentation featuring our 2023 ACCMA President, Edmon Soliman, , and a very special guest speaker. SPEAKER

Judith Stanton, MD

Irina Kolomey, MD

Irene Lo, MD

Terry Hill, MD

Bindoo Rellan, MD

By Scott Coffin, CEO, Alameda Alliance for Health

Stephen Post, MD

CMA & AMA REPRESENTATIVES

Ross Pirkle, MD

Irene Lo, MD

Albert Brooks, MD, SecretarySuparnaTreasurerDutta, MD, Immediate Past President

David Lopez, Assoc. Director of Advocacy and Strategic Initiatives

Griffin Rogers, Director, Napa & Solano County Medical Societies

MarkDelegateKogan, MD, CMA Trustee, AMA Alternate-Delegate

Suparna Dutta, MD, CMA Trustee

Kristin Lum, MD

MEMBERSHIP COMMUNICATIONS& COMMITTEE

Richard Rabens, MD

Shakir Hyder, MD

Eric Chen, MD

Suresh Sachdeva, MD

Robert Edelman, MD, President

Jeffrey Klingman, MD

Harshkumar Gohil, MD

Robert Edelman, MD

Ronald Wyatt, MD

Michael McGlynn, MD

ACCMA STAFF

Rollington Ferguson, MD

Lamont Paxton, MD

Alexander Kao, MD

Steven Rosenthal, MD

Thomas Powers, MD

Sonia Sutherland, MD

COVID13 ThemselvesPhysiciansAbortion19UpdatesTherapeuticsLawsandHowCanProtect

ChristineAssociateMaki, Administrative Assistant

New22 Members Classifieds26

James Hanson, MD

Bay16Area Physician Wellness Collaborative ACCMA15 Annual Meeting Addressing23 Food Insecurity with Recipe4Health

News4 & Comments PRESIDENT’S7 PAGE An Honor to Serve By

James Hanson, MD

Edmon Soliman, MD, President Elect

Stephen Larmore, MD

ProgramPhysician15PROGRAMSACCMALeadership EMALA D A CONTRA COSTA MEDICAL AS S O C I INOITA NCORPORATED JAN 1871 1 8 6 0 ACCMA EXECUTIVE COMMITTEE

Mark Kogan, MD, Chair

Katrina Peters, MD

Katrina Peters, MD, CMA Trustee

Jennifer Mullins, Assoc. Director of Education and Events

Alejandra Hinojosa, Communications

COUNCILORS & CMA DELEGATES

Lilia Lizano, MD

Jonathan Savell, MD

Arden Kwan, MD

Terence Lin, MD

Joseph Greaves, Executive Director

Clifford Wong, MD

REDUCE – REUSE – RECYCLE Printed in the U.S.A. with soy inks on paper stock certified by the Forest Stewardship Council. EMALA D A –CONTRA COSTA MEDICAL AS S O C I INOITA NCORPORATED JAN 1871 1 8 6 0 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN Serving East Bay physicians since 1860 September/October 2022 | Vol. LXXVIII, No. 4 ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 3

ACCMA President HOD9ADVOCACYYOUR2022MajorIssue –Physician Workforce November10 General Election Preview Public12 Service Loan ACCMA21ForgivenessClimate Change Policy IN California’s11PRACTICEYOURBigMove on Data Exchange By

Terence Lin, MD

Jeffrey Poage, MD

Mae Lum, Deputy Director

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION 6230 Claremont Avenue, Oakland, CA 94618 Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org Robert Edelman, MD, the California Medical Association

By the Medical Insurance Exchange of California

Patricia L. Austin, MD, AMA

Patricia Austin, MD

Frank Staggers, Jr., MD

4 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN NEWS & COMMENTS

PRIOR AUTHORIZATION REFORM

MEDI-CAL RX UPDATES

Senator Richard Pan, M.D. introduced SB 250 to reduce admin istrative burdens in physician practices so physicians can spend more time dedicated to patient care. ACCMA and CMA sup port SB 250 which will reform the prior authorization process in a comprehensive way. The result will be less clinical time spent on administrative work, increased access to necessary care for patients and a restoration of the physician-patient relationship in medical decision making. SB 250 will be heard soon in the Assembly Appropriations Committee.

The ACEs Aware initiative released a new quarterly data report detailing the number of Adverse Childhood Experience (ACE) screenings conducted for children and adults in California between January 1, 2020 and September 30, 2021. The data show that Medi-Cal clinicians – primarily pediatric, family medi cine, and behavioral health professionals – conducted about 987,500 ACE screenings of more than 793,000 unique Medi-Cal beneficiaries. The report also shows that between December 4, 2019 and May 31, 2022, more than 23,400 individuals have taken the ACEs Aware training, 11,900 of whom are Medi-Cal clinicians who are ACEs Aware-certified and eligible to receive Medi-Cal payment for conducting ACE screenings. Read more at bit.ly/3AWdu8L.

Under SB 137, health plans/insurers must verify the accuracy of their contracting providers’ demographic information every 90 days, as opposed to the 180-day or annual requirement prior to January 2022. Providers who fail to comply with the verification requests risk payment delays and removal from the provider directory. Health plans or insurers may also ter minate a contract with a provider for a pattern or repeated failure to update the required information. Practices should also note that if the practice is: moving, adding or losing providers, changing the practice name/TIN, closing a prac tice or changing specialties, you should inform payors with at least 90 days advance notice to prevent payment issues.

ACCMA has joined CMA and several other health advocacy organizations in supporting Proposition 1, a ballot measure seeking to enshrine an individual’s right to have an abortion, or to use or refuse contraception, in the California Constitution. ACCMA believes medical decisions—including those around abortion or contraception—should be decided by patients in consultation with their health care provider. To learn how to support this initiative or to view a fact sheet directly from the Yes on 1 campaign, visit protectabortionca.com.

KidsVaxGrant 2.0 will help medical practices with 200 phy sicians or fewer serving pediatric populations administer COVID vaccines to their infant and toddler pediatric patients. Administered by Physicians for a Healthy California (PHC), CDPH is investing approximately $10 million to fund the KidsVaxGrant 2.0. Individual practices may be eligible for up to two grant opportunities – awards between $10K-25K. Providers serving pediatric populations that were previously awarded a KidsVaxGrant are eligible to apply for KidsVaxGrant 2.0. The application deadline is October 14. Visit phcdocs.org/ Programs/CalVaxGrant.

Steven M. Thompson Physician Corps Loan Repayment Program and the Licensed Mental Health Services Provider Education Program are accepting applications until 3 pm on October 31, 2022. Check your eligibility or find more informa tion on loan repayment programs by visiting bit.ly/3cA2Jj5.

ACCMA ENDORSES PROP. 1 TO PROTECT ABORTION, CONTRACEPTION RIGHTS

CALIFORNIA’S BIG MOVE ON DATA EXCHANGE

UPDATE PRACTICE DEMOGRAPHIC INFO

APPLY FOR PHYSICIAN LOAN REPAYMENT PROGRAMS

ACES AWARE REPORT

California Legislature unanimously passed CMA-sponsored bill AB 1636 that will ensure physicians who have committed sexual misconduct are prohibited from the ability to petition the medical board for reinstatement. In December 2021, the LA Times reported that the Medical Board of California reinstated 10 of 17 California physicians who previously had their licenses revoked for sexual misconduct. AB 1636 will protect patients and the integrity of the medical profession by ensuring that physicians who commit sexual misconduct are appropriately disciplined. The bill now sits on the governor’s desk awaiting signature. Read more at bit.ly/3AXNtWw.

The Data Exchange Framework, abbreviated “DxF”, will require all actors in the health care system – physicians, hospitals, health plans, skilled nursing facilities, etc. – to make patient data available to all other actors within the bounds of federal and state privacy laws. Once all actors have signed the Single Data Sharing Agreement, practices and others will be contrac tually obligated to share data across the health care system. The date by which practices must comply with this requirement depends on the size of the practice. Now that the Framework has been published, the timeline for implementation is going to move quickly. It will be important for practices to familiarize themselves with the requirements of the Framework and begin their preparations as soon as possible. Please find the full article from CMA on page 11.

FUNDING FOR PROVIDERS SERVING PEDIATRIC POPULATIONS

Effective September 16, Medi-Cal Rx prescribers will be required to submit prior authorizations for new start medica tions in 11 drug classes. DUR Reject Code 88 edits have been turned on as of July 22. Activation of Reject Code 80 has been postponed due to provider feedback. Revised provider alerts and other informing materials are continuously posted to bit. ly/3CDDBma.

LEGISLATURE PASSES AB 1636 TO PROTECT PATIENTS

TO VIEW A FULL LIST OF UPCOMING EVENTS AND TO REGISTER ONLINE, VISIT PATHLMS.COM/MEDICAL-SOCIETY!

ACCMA 154TH ANNUAL MEETING Friday, November 4 | 6:00 to 8:00 pm Claremont Club & Spa, Berkeley, CA

UNITEDHEALTHCARE COMMERCIAL FEE SCHEDULE UPDATE

BAY AREA PHYSICIAN WELLNESS

HELP PROMOTE SCHOOL VACCINATIONS

The National Institute of Health regularly updates their ‘What’s New in the Guidelines’ webpage at bit.ly/3cuOZpF with upto-date information regarding COVID-19 treatment. Alameda County Public Health published a health advisory available at bit.ly/3AZFmZN. Some of the most recent revisions include: consider repeat dosing with Evusheld every six months if patients need ongoing protection, Remdesivir fully approved for treatment of adults and children for in- and out-patients, and limited prescribing of Paxlovid by pharmacists now allowed under EUA. Read the full article on page 13.

Tuesday,COLLABORATIVENovember 15 | 6:00 to 8:00 pm Free | CME Available | Online

Visit the www.ShotsforSchool.org CDPH page for information on immunization laws and required vaccinations for students in California. Families that are having difficulty obtaining required immunizations prior to the start of school can contact their local health department for help in finding a place to get needed immunizations. Additional resources are available in the ‘Don’t Wait – Vaccinate’ toolkit (bit.ly/3TrTPVm) to educate Californians about the importance of staying up-to-date on vaccinations and routine screenings.

COVID-19 TREATMENT AND PREVENTION GUIDELINES

UHC issued a notice of amendment to 3,500 physicians tied to the UHC 2008 commercial fee schedule advising providers of the transition to a new fee schedule effective October 15. Please be aware that fee schedules will transition automatically and no action is required on your part. If you have any ques tions or would like to confirm if your practice will be affected, please contact UHC’s Network Account Manager at west_phy sician_contracting@uhc.com.

COVID-19 VACCINE COSTS SHIFTS TO INSURERS, PATIENTS

The Annual Meeting is a fun and entertaining evening for the East Bay health care community to connect with one another, enjoy dinner and a fun program, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program. This year’s guest speaker is Keena Turner, fourtime Super Bowl champion for the San Francisco 49ers. Read more on page 15. Go to accma.org/ events to purchase tickets online.

More than 60 Bay Area leaders from physician organizations are convening bimonthly on Zoom to share their experiences on how they are improving physician wellness in their workplaces and to learn from one another in a collaborative roundtable discussion. The November 15 discussion will focus on building a center for physician wellbeing within your organization with self-care support systems, peer support resources, mental health referrals and consultation services, life-needs support mechanisms, and other comprehensive wellbeing resources. Read more on pages 16 and 17. To request an invitation to enroll, visit bit. ly/3PcTd3L.

CA BUDGET SUPPORTS UNIVERSAL HEALTH CARE

HHS will be meeting with drugmakers, pharmacies, and other stakeholders on August 30 to map out how insurance cover age and reimbursements would cover the costs of COVID-19 vaccines, tests, and treatments. As COVID-19 cases drop, the Biden Administration shifts this burden onto insurance and patients. Additional news indicates that HHS is likely to extend the PHE into January 2023, ensuring expanded Medicaid cov erage, telehealth services, and boosted payments to hospitals.

MEDIA TRAINING FOR PHYSICIANS

Governor Gavin Newsom signed the 2022-23 state budget, which continues California’s commitment to achieving universal health care access. The $308-billion budget addresses many of CMA’s key priorities, including a phased-in system to provide full scope Medi-Cal coverage to all income eligible Californians regardless of age or documentation status by January 1, 2024. Visit bit.ly/3CFlFYb for a list of some of the key health care provisions included in the final budget.

UPCOMING EVENTS

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 5 NEWS & COMMENTS

Are you interested in adding your voice in support of Prop. 1 to protect abortion rights in California and/or Prop. 31 to stop the sale of flavored tobacco products? The campaigns in support of the measures are looking for physician volunteers to serve as spokespeople and will be conducting a series of trainings in the coming weeks all over the state (and remotely) where physician volunteers will get message training for media interviews, author op-eds and participate in press conferences and other media events. To sign up, please email svelayas@ cmadocs.org and include your name, title, phone number, email address, and which proposition/training you would like to participate in.

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Wake Up to New Options for Medical Malpractice Coverage

Of course, we cannot look back on this year without think ing about the millions of patients and physicians affected by the Supreme Court’s decision to overturn Roe v. Wade and Planned Parenthood v. Casey. This ruling has already had detrimental effects on access to reproductive health care services and on the physician-patient relationship. ACCMA is proudly support ing Proposition 1 to enshrine in the California Constitution an continued on page 24

An Honor to Serve

It

Fortunately, in May, the CMA reached a negotiated agreement in the form of AB 35 – the MICRA Modernization Act – to keep MICRA intact. MICRA’s $250,000 cap on noneconomic damages, which had remained unchanged since 1975, realistically could not be kept at that level forever, and was MICRA’s primary vulnerabil ity. Under AB 35, the cap on noneconomic damages will increase from $250,000 to $350,000 for non-death cases and $500,000 for wrongful death cases on January 1, 2023, followed by incremen tal increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases. After 10 years, a 2.0% annual inflationary adjustment will apply. This avoided the complete lifting of caps on noneconomic damages. To our benefit, the new law also makes adjustments to periodic payments, keeps limits on attorney contingency fees, and establishes a new statute that ensures protections for benevolent gestures and statements of fault by health care providers. It also preserves many important guard rails of MICRA, including the one-year statute of limitations to file a case, the option of binding arbitration, and allowing other sources of compensation to be considered in award determinations. We also focused on a number of other legislative priorities. We held numerous district meetings with our local elected offi cials, and dozens of members participated in CMA’s 48th Annual Legislative Day in Sacramento. Among the bills we lobbied for was SB 250, a bill introduced by Senator Richard Pan, MD, that would relieve physicians from obtaining prior authorization if at least

has been a tremendous honor to serve as your ACCMA President. Over the past year, we have confronted several chal lenging issues that have required the ACCMA and CMA to once again step up and fight for the prerogatives of our profession and the well-being of our patients.

ACCMA and CMA also continued our advocacy efforts around Medicare payment reform and stopping Medicare pay ment cuts. In a 2022 CMA survey, 72% of California physicians said Medicare FFS payments do not cover their costs of providing care; compounding this, physicians are facing potential payment cuts of more than 8.5% in 2023. To address these looming cuts, ACCMA leaders met with our Congressional representatives in August and urged them to end this annual ritual of pay ment cuts and replace it with a more comprehensive strategy to reform Medicare physician reimbursement for the long term and ensure patient access to Medicare services. You can read more about the meetings between ACCMA physicians and our local Congressmembers on page 10 in this issue.

Another area of focus was physician workforce. ACCMA and CMA lobbied both HHS and our members of Congress to ensure that California physicians were not excluded from federal loan repayment programs due to a loophole that bars physicians who are not directly employed by a hospital system, which is not allowed under California law. CMA also sponsored AB 2132 (Villapudua) to establish a pilot program to provide underrep resented students with financial aid from undergraduate through residency in exchange for working in medically underserved areas. The bill unfortunately did not get much traction this year but will continue to be a focus in the future.

By Robert Edelman, MD, ACCMA President

90% of their prior authorization requests were approved in the prior year. The bill cleared the Senate and was passed out of the Assembly Health Committee, but it unfortunately did not make it through the Assembly before the August deadline. Prior authori zation reform remains a major priority at the state and federal level and efforts will continue next year.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 7 PRESIDENT'S PAGE

Our top priority at the start of 2022 was defeating a major anti-MICRA initiative that had qualified for the November 2022 ballot. Misleadingly titled the Fairness for Injured Patients Act (FIPA), this costly and dangerous initiative would have quin tupled MICRA’s cap on noneconomic damages, and would have eviscerated MICRA by excluding an estimated 90% of malprac tice suits from MICRA protections. We were prepared for an allout, all-hands-on-deck effort to defeat it.

and

WORK

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to calculate

SESSION 2 Phairas President Practice Liability Consultants, LLC, has assisted physicians/groups WRVUs hospitals compensation formulas, and has been an expert witness WRVUs. Mullins,

Work RVUs aim to measure and compensate for a physician’s pr oductivity but fail to account for insurance payor reimbursement rates or collections revenue. Still, WRVUs are increasingly becoming the compensation method of choice for hospital foundations, universities, and medical groups. It is crucial that physicians learn how to calculate WRVUS if joining an organization or being acquired, as well as understand the compensation methodologies, how to negotiate dollars per WRVU, and how to monitor the recordation of WRVUs for accurate compensation.

in cases involving compensation and

at jmullins@accma.org with any questions.

NEGOTIATING RVUS: COMPENSATION AND BONUSES Debra

UNDERSTANDING RVUs

www.practiceconsultants.net SPEAKER: DEBRA PHAIRAS Please contact ACCMA Associate Director of Education and Events, Jennifer

1 CALCULATING RVUS: MEASURING PRODUCTIVITY

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ONAVAILABLEDEMAND bit.ly/3puf7nt SESSION 3 MONITORING RVUS: FORMULAS AND CONTRACTS This series consists of three 20-25 minute segments: MONKEYPOX DIAGNOSIS, TREATMENT, & PREVENTION Available On Demand at bit.ly/3CoGo2u Clinical manifestations of monkeypox Viral ACCMAPublicVaccinationsSignstransmissionandsymptomsandtreatmenthealthmeasuresunderwayhaspartneredwithrepresentatives from Alameda County and Contra Costa County Public Health to offer a 1-hour presentation covering: CME Available Accreditation Statement: ACCMA is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education. Credit Designation Statement: ACCMA designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. PRESENTERS Nicholas Moss, MD, MPH Alameda County Division of Communicable Disease Control and Prevention Ori Tzvieli, MD Contra Costa Health Services

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CALCULATION & COMPENSATION

NEWS & COMMENTS ( continued from page 21)

Some of the policy questions for HOD discussion are:

The full Major Issue report is available at cmadocs.org/hod. If you have any questions or want more information, contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at dlopez@accma.org or (510) 654-5383, ext. 6320.

P hy sic ian s Nurse Voice:PermanentPhysicianPractitionersAssistantsLocumTenensPlacement8009199141or805-641-914 1 FAX: 805 64 1 -91 jnguyen@tracyzweig.com43www.tracyzweig.com Tracy Zweig Associates A RE G IS TR Y & PL AC EMENT F IR M

A 2021 survey done by the California Health Care Foundation of physicians, nurses, nurse practitioners, physicians assistants, and behavioral health specialists in California found that 59% felt burned out, 57% felt overworked, and 50% felt frustrated. A more recent survey by the American Medical Association found that about 20% of physicians said they were likely to leave their current practice within two years, while one-third planned to reduce their work hours within the next 12 months.

Currently California is experiencing a health care provider shortage and it has reached crisis mode. In California, only two regions (the greater Bay Area and the Sacramento area) have enough primary care doctors: between 60 and 80 doctors per 100,000 people. Most regions fall below the 60-doctor bench mark that experts consider adequate, and California’s rural regions fared much worse. In 2030, demand for primary care clinicians in California is projected to exceed supply by 12 to 17%.

• Are there additional ways California might address systemic barriers in the medical education and licensure pathways that created the racial/ethnic disconcordance between California’s population and the medical profession?

• Are there options that relieve pressure on the system in a way that ensures equitable levels of care and training and creates space to build strategies that require a longer runway?

• Does CMA policy adequately address strategies to protect the existing physician workforce?

Further, California’s physician workforce does not reflect the demographics of California’s population. Black and Latinx physi cians are under-represented relative to their shares of California’s population. In terms of language access, Spanish-speaking physi cians are the most under-represented in the physician workforce in California with only 62.1 per 100,000 Spanish speakers. Compare that disparity to the 344.2 physicians who only speak English per 100,000 population that only speaks English. While medical students and residents had more racial and ethnic diversity than practicing physicians, only 4.7% of medical school graduates and 5.1% of residents and fellows were Black, and 7.2% of medical school graduates and 6.1% of residents and fellows were Latinx.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 9 HOD MAJOR ISSUE

HOD Major Issue – Physician Workforce

The Physician Workforce Major Issue would review current CMA policy that is related to workforce and identify if it suf ficiently addresses the needs to protect existing physician work force and grow it in a way that supports increased access to care by a workforce that reflects California’s diverse population.

CMA has secured funding for GME through Proposition 56, the tobacco tax passed in 2016, and helped secure additional new funds for GME slots by aligning the tax on e-cigarettes and vaping products to other tobacco products. Yet, despite increased residency slots, there is likely to be an ongoing shortage in primary care and psychiatry for a decade.

The 2022 CMA House of Delegates meeting, to be held in Los Angeles from October 22 to 23, will discuss three major issues, two that are actionable (Physician Workforce and Health Care Reform) and one for information (Mental Health).

Medicare Payment Reform. We urge Congress to enact Medicare payment reform to provide stability for physicians and patients. In 2023, physicians are facing more than 8.5% payment cuts. Medicare physician payments already lag nearly 40% behind inflation and the costs to operate a medical practice. Since 2001, Medicare hospital and nursing home payments increased 60%, inflation increased by 40%, yet physician payments increased only 7%. In many California communities, there are no primary care physicians accepting new Medicare patients. California patients are facing access to care challenges and California is projected to have the largest physi cian shortages in the nation over the next decade. Congress must reverse this trend to help patients get the care they need.

District (AD) 20 encompasses the following cities: Ashland, Castro Valley, Cherryland, Fairview, Fremont, Hayward, Pleasanton, San Lorenzo, Sunol, and Union City. Liz Ortega and Shawn Kumagai are the two candidates who will appear on the ballot. CALPAC has endorsed Shawn Kumagai.

Prior Authorization. We continue to fight for medical deci sions to be made by trained medical professionals, instead of lay entities more concerned with the corporate bottom line than the quality of patient care. This is why we are supporting HR 3173, S 3018, and HR 7995 to streamline prior authorization

10 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN NOVEMBER

Proposition 31: Referendum on 2020 Law that Would Prohibit the Retail Sale of Certain Flavored Tobacco Products. Opponents of Proposition 31 seek to overturn Senate Bill 793 (SB 793), which was signed into law on August 28, 2020. SB 793 was designed to ban the sale of flavored tobacco products and tobacco product flavor enhancers, with exceptions for hookah tobacco, loose leaf tobacco, and premium cigars. Retailers would be fined $250 for each sale violating the law. The California Coalition for Fairness is campaigning for the veto referendum to repeal SB 793. Through December 31, 2021, the campaign had received $21.16 million, including $10.33 million from R.J. Reynolds Tobacco Co. and $9.83 million from Philip Morris USA.

The

2022 General Election is scheduled for November 8. Below you will find information regarding key races, state propositions, and ACCMA advocacy on federal legislation.

NovemberELECTIONS General Election Preview

KEY RACES

Proposition 1: Constitutional Right to Reproductive Freedom. This measure would amend the California Constitution to prohibit the state from denying or interfering with an individual’s reproductive freedom in their most intimate decisions, which includes their fundamental right to choose to have an abortion and their funda mental right to choose or refuse contraceptives.

Over the course of the 2022 Congress legislative recess, ACCMA members met with Congressmembers to discuss Medicare pay ment reform, prior authorization, and the Inflation Reduction Act. We want to thank Congressmembers Eric Swalwell, Mark DeSaulnier, Mike Thompson, and Jerry McNerney for meeting with our members to discuss these priorities.

Alameda County BOS District 3 encompasses the following cities: Alameda and San Leandro; a portion of the city of Oakland, including the Chinatown, San Antonio, Fruitvale and Melrose areas; the unincorporated communities of San Lorenzo and Hayward Acres; and a portion of the unincorporated community of Ashland. Rebecca Kaplan and Lena Tam are the two candi dates who will appear on the ballot. The Alameda-Contra Costa Physicians Committee (ACCPAC) has endorsed both Rebecca Kaplan and Lena Tam.

Senate District (SD) 10 encompasses cities in both Alameda and Santa Clara counties. Lily Mei and Aisha Wahab are the two candidates who will appear on the ballot. The California Medical Association Political Action Committee (CALPAC) has endorsed Lily Mei.Assembly

Proposition 29: Requires On-Site Licensed Medical Professional at Kidney Dialysis Clinics and Establishes Other State Requirements. SEIU-UHW is back a third time with another dialysis proposition. The new proposition is nearly identical to Proposition 23, which 63% of voters overwhelmingly rejected in 2020. This initiative would arbitrarily require a physician, nurse practitioner or physi cian assistant to be always onsite at dialysis clinics. This measure

ACCMA LEGISLATIVE MEETINGS

continued on page 21

KEY STATE PROPOSITIONS

Contra Costa County BOS District 4 encompasses the fol lowing cities: Walnut Creek, Concord, Pleasant Hill, San Miguel, and Clayton. Ken Carlson and Debora Allen are the two can didates who will appear on the ballot. ACCPAC has endorsed Debora Allen.

would move doctors and other providers away from patient care into administrative roles. Please note that ACCMA opposed the two prior initiatives and has also opposed this initiative. This lat est proposition will again jeopardize access to care, worsen our health care provider shortage, and increase health care costs for all Californians.

Probably every physician practice has had the frustrating experi ence of trying to deliver the best possible care to a patient, only to be hampered by the inability to access relevant health informa tion. Important pieces of a patient’s history, such as prescriptions, chronic conditions, or previous diagnoses may be trapped in data silos held in a million different places, inaccessible to the patient or the physician at the point of care. Myriad studies of the health care system have shown that lack of health information at the point of care often leads to duplication, waste, and delay.

By the California Medical Association

With a combination of mandates, a new governing board, and publicly funded assistance, the California Data Exchange Framework (DxF) is set to pull health information exchange into the 21st Century.

state is not building a “Statewide HIE.” When the law that cre ated the framework was being written, CMA’s position was that physicians should have the flexibility to choose the technology that works best for their practice. Based on CMA’s advocacy, the law prohibits the state from forcing physicians into one system. Instead, the Framework is intended to be “technology agnostic,” meaning that practices are free to choose the method of data exchange that works best for them. This could include a local health information organization, a national data sharing network, or other data sharing technology.

Despite the widespread adoption of electronic health records (EHRs) across the state, this problem persists. A combination of technology challenges, competitive forces, and some legal uncertainty has kept data locked away from both patients and physicians. Starting in 2020, the federal government began work ing to address this problem through the 21st Century Cures Act Final Rule, often known as the “Information Blocking Rule.” This rule clarified in federal regulation that patients have the right to access their own medical information through the technology of their choosing. For the first time, physicians, hospitals, and health plans must make that information available. This rule started the country down the path of widespread and seamless data exchange.

California’s Big Move on Data Exchange

Now, the California Medical Association (CMA), is working with the State of California to build on the federal regulations to accelerate and expand data exchange efforts here in the state. After a year of legislative negotiations, State Budget appropriations, and stakeholder meetings, the California Health and Human Services Agency (CHHS) published the Data Exchange Framework on July 5.The Data Exchange Framework, or DxF, will require all actors in the health care system – physicians, hospitals, health plans, skilled nursing facilities, etc. – to make patient data available to all other actors within the bounds of federal and state privacy laws. It will do this by requiring all those actors to sign the Single Data Sharing Agreement (described below). Once they have signed the agreement, practices and others will be contractually obligated to share data across the health care system.

Now that the Framework has been published, the timeline for implementation is going to move quickly. It will be important for practices to familiarize themselves with the requirements of the Framework and begin their preparations as soon as possible. To help practices prepare, this article will give a high-level overview of the Framework, describe some things practices can do to prepare, and point them to some helpful resources CMA is developing.

THE DATA EXCHANGE FRAMEWORK

2 Single Data Sharing Agreement: To govern the Framework, the state has created the Single Data Sharing Agreement (DSA). This document is a contract that all practices are required by law to execute by January 31, 2023. The intent of the DSA is to act as a contract between physician practices, hospitals, health plans, etc., that they will make data available to each other upon request. The DSA lays out the parameters of how that data exchange should happen, predominantly via accompanying Policies and Procedures that describe what data elements need to be exchanged, privacy and security standards, and permitted uses of health data. The DSA also

Importantly, the Data Exchange Framework does not require practices to utilize any particular data-sharing technology. The

The Data Exchange Framework consists of four major 1components: Data Sharing Requirement: As described above, the Framework includes a legal requirement that physician practices and other health care entities make data available to other sig natories of the Data Sharing Agreement. The date by which practices must comply with this requirement depends on the size of the practice. In general, practices of more than 25 phy sicians will need to be engaged in data exchange by January 31, 2024. Practices smaller than 25 physicians will have 2 additional years, until January 31, 2026.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 11 DATA EXCHANGE FRAMEWORK continued on page 18

Public Service Loan Forgiveness

We support the proposal submitted by the California Medical Association, the California Hospital Association, the Texas Medical Association and the Texas Hospital Association that requires an additional written certification from an authorized official of the public service organization (hospital, clinic) certifying that the physician works full time (30 hours/week) in the private non-profit facility, is authorized through the clinical privileges credentialling process, but is not able to be employed by the facility because of state law. This is an additional standard for California and Texas physicians who are prohibited from being directly hired and paid by the facility. continued on page 26

12 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN PUBLIC SERVICE LOAN FORGIVENESS

California and Texas, state law allows public non-profit hospitals to employ physicians but prohibits private non-profit hospitals from employing physicians. As a result, many California and Texas physicians have been excluded from the program. Below please find a letter that ACCMA sent to the Education Secretary Miguel Cardona.

and CMA have been advocating to fix the fed eral public service loan forgiveness (PSLF) program to allow California and Texas physicians working in private non-profit hospitals/clinics to receive loan forgiveness. The US Department of Education required all physicians to be directly employed by non-profit hospitals/clinics in order to obtain loan forgiveness. In

and Texas physicians should have equal access to this national loan forgiveness program like our colleagues in all other 48 states. We can meet all the PSLF standards, except we are not able to be employed by private non-profit institu tions under our state laws.

Qualifiedrelationship.California

I am writing on behalf of the Alameda-Contra Costa Medical Association – representing 5,000 physician members – to urge the U.S. Department of Education to provide student loan forgiveness under the federal Public Service Loan Forgiveness (PSLF) program to California and Texas physicians who meet all requirements of the PSLF program and who would otherwise qualify for PSLF except that they are not directly employed by private non-profit hospitals due to state laws, which are critically important and protect against corporate, non-physician entities employing physicians and making medical decisions. This cor porate bar on the practice of medicine is a critically important law that protects and preserves the independence of physicians’ professional judgment in the care of their patients and ensures that external forces cannot interfere with the physician-patient

August 8, 2022

While state laws in California and Texas do allow public non-profit hospitals and clinics to directly employ physicians, private non-profit institutions – including community hospitals, children’s hospitals, rural hospitals and district hospitals – are prohib ited from directly employing physicians. Therefore, since the inception of the PSLF program, California and Texas physicians who are otherwise qualified to receive loan forgiveness have been inadvertently excluded from a national program in which our similarly situated physician colleagues in all other states can participate.

Dear Secretary Cardona,

ACCMA

Evusheld is a combination monoclonal antibody that can only be used in high-risk patients who:

RECOMMENDATIONS FOR CLINICIANS PRESCRIBING MONOCLONAL ANTIBODIES AND REMDESIVIR

TREATMENT GUIDELINES

The FDA has authorized a change in dosing for Evusheld. Consider repeat dosing every 6 months (300 mg tixagevimab and 300 mg cilgavimab) if patients need ongoing protection. For individuals with a history of severe hypersensitivity reaction to a COVID-19 vaccine, consider consultation with an allergistimmunologist prior to Evusheld administration.

COVID THERAPEUTICS

UCSF (bit.ly/3Rc6N7O): Contact OPHoutreachBAMfax@ucsf.edu or (415) 514-7328. For UCSFaffiliated practices only.

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 13

• Long-term Care Facility Residents: Specialty Pharmacy associated with LTCF

Alameda County Public Health Department and Contra Costa County Health Services continue to provide infor mation to assist you in identifying and providing COVID-19 treatment and pre-exposure prophylaxis to your eligible high-risk patients. Effective treatment is available and should be offered to all high-risk patients for outpatients with mild to moderate COVID-19 if they meet criteria for treatment based on EUAs. Most information presented here applies to both counties.

• Forcovid-19-test-to-treat-locator-dhhs.hub.arcgis.comclinicalquestionsabout treatment with COVID-19 outpatient therapeutic products, contact Arnie Spanjers, MD, Alameda County Public Health Department, at arnie.spanjers@ acgov.org

The Alameda County PHD recommends that clinicians with patients who meet the inclusion criteria for the use of outpatient MAB therapy or Remdesivir contact the following entities, or other participating medical systems, for information on treatment availability. Treatment should be coordinated in advance of send ing a patient for therapy.

AND

COVID Therapeutics Updates

PRE-EXPOSURE PROPHYLAXIS

The guidelines for Therapeutic Management of Nonhospitalized Adults With COVID-19 (bit.ly/3wzr2Em) and Prevention of SARS-CoV-2 Infection (bit.ly/3wBPF3k) have been frequently updated due to changes in prevalence and susceptibilities of cur rent COVID-19 subvariants. With the increased availability of most products, all eligible patients can and should be offered treat ment. The NIH Panel currently recommends one of the following •(bit.ly/3QW2wpk):

• If timely appointments in Alameda County are not available for your patients, you can contact the hospitals below: Stanford Medical Center, Palo Alto (shc.is/3QTXuJS):

The Alameda County PHD recommends two therapeutic locator websites to identify sources of therapeutics and “test to treat” sites:

Contact DL-SHC-Pharmacy-COVID@stanfordhealth care.org or (650) 391-8503.

• Alternative Therapies (for use only when neither of the preferred therapies are available, feasible to use, or clinically appropriate – in alphabetical order):

Preferred Therapies (listed in order of preference): Paxlovid (nirmatrelvir 300 mg plus ritonavir 100mg ) orally twice daily for 5 days Remdesivir IV daily for 3 days

The

B ebtelovimab 175 mg, administered as a single IV Linfusionagevrio (Molnupiravir) 800 mg orally twice daily for 5 days

• Cannot be vaccinated due to a history of severe adverse reac tion to a COVID-19 vaccine component.

Total Infusion: totalinfusion.com/make-a-referral (Monoclonal antibodies only)

• covid-19-therapeutics-locator-dhhs.hub.arcgis.com

• Do not have COVID-19 and have not had a recent exposure;

• Have moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medica tions or treatments, and may not mount an adequate immune response to COVID-19 vaccination, OR

Providers who do not currently receive Evusheld through the HHS Health Partner Portal distribution process can order small, limited quantities (1-3 patient courses) through AstraZeneca. Call the AstraZeneca Evusheld HelpLine for Providers at 1-833-EVUSHLD or visit the product website (evusheld.com) for more information.

• Outpatients: Physician referral through the patient’s health plan

A program of the Bay Area Medical Societies

The ACCMA has transitioned this program to a full scholarship opportunity available to all members.

CONTINUING MEDICAL EDUCATION

Accreditation Statement: The ACCMA is accredited by the California Medical Association (CMA) to provide continuing medical education Credit Designation Statement: ACCMA designates this live activity for a maximum of 24 hour(s) of AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Enhance your leadership effectiveness

To participate, complete the online scholarship application at https://bit.ly/3JZlkkW no later than Friday, November 18.

Learn from nationally recognized experts

Today’s dynamic health care environment requires physicians to be effective leaders to ensure organizational and individual success. The Physician Leadership Program addresses the fact that physicians are, and should be, placed in roles with organizational responsibility, but have limited formal opportunities to learn the concepts, skills, and tools of leadership. This program allows physicians to build upon their clinical leadership experience by honing skills like communicating a vision, motivating colleagues, negotiating with payers, and collaborating across silos in order to build organizations, compete for resources, lead change, influence policy and overcome challenges.

PROGRAM DATES  January 21, 2023Oakland  January 31, 2023  February 21, 2023  March 14, 2023  March 28, 2023  April 8, 2023 - Oakland For additional information, please contact Jennifer Mullins, ACCMA Associate Director of Education & Events, at jmullins@accma.org, or (510) 654-5383.

ACCPAC

The Physician Leadership Program kicks off in January 2023 with an in-person session in Oakland, followed by four 2-hour virtual sessions led by nationally recognized faculty. Concluding the program, we will reconvene in Oakland for one final in-person session. In addition to these plenary sessions, Dr. Worthen will offer a oneon-one consultation for each participant to focus on their personal leadership goals. The program is sequenced and scheduled to accommodate busy physicians. Participants will gain practical skills and insights directly applicable to their practice opportunities and challenges. Participants can earn a certificate of completion and up to 24 hours of category 1 CME credit.

Expand your network with local colleagues

Earn a Certificate of Completion and up to 24 hours of CME Credit

We are inviting all interested participants to apply for a scholarship to attend the program at no cost at bit.ly/3JZlkkW. Applications are due by November 18. Following our review, participants in the 2023 cohort will be notified by December 15. For more information, see flyer on opposite page or contact Jenn Mullins, Associate Director of Education and Events at jmullins@ accma.org or (510) 654-5383 x6305.

Physician Leadership Program

We are excited that this year’s keynote speaker is Keena Turner, legendary #58, and 4-time Super Bowl champion for the San Francisco 49ers. He will join us to discuss sportsmanship,

Hilary Worthen, MD, and nationally recognized faculty. Also new in 2023 are one-on-one consultations with Doctor Worthen for each participant to focus on their personal leadership goals. A final in-person convening in Oakland will conclude the program.

ACCMA is now accepting sponsorships from medical staffs, practice groups, hospitals, and health care advocates who would like to support or attend this year’s event. The Sponsor level includes a table for 10 and acknowledgment in the ACCMA Bulletin, which is sent to about 5,200 physicians. A substantial por tion of your sponsorship is tax deductible. Please contact Jennifer Mullins, ACCMA Associate Director of Education and Events, at jmullins@accma.org or (510) 654-5383 to reserve your table today. You can also contact her for individual tickets or purchase tickets online by going to www.accma.org/events. We look for ward to seeing you on November 4!

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 15 PHYSICIAN LEADERSHIP PROGRAM

ACCMA Annual Meeting

We are excited to announce that the program will be offered as a full scholarship opportunity to ACCMA participants. Physicians seeking to enhance their leadership skills, learn from nationally recognized faculty, network with other Bay Area physicians, and become part of a physician leadership alumni group should apply now.

Join the ACCMA at www.accma.org/membership/join-now

teamwork, the championship mindset, and what it took to win and sustain dominance during his 11-year professional football career. Now, as Vice President and Senior Advisor to the General Manager of the 49ers, Keena is a pillar in the community and supports several organizations focusing on our community’s youth.

The sixth iteration of the regional Physician Leadership Program will begin in January 2023. The program was first developed by physician leaders from the ACCMA in collabora tion with faculty from the UC Berkeley School of Public Health and Haas School of Business. Each cohort has experienced a dif ferent variation of the curriculum to reflect the current climate in healthcare.Thissuccessful program allows physicians to build upon their clinical leadership experience by honing skills such as com municating a vision, motivating colleagues, negotiating with pay ers, and collaborating across silos in order to build organizations, compete for resources, lead change, influence policy, and over come

Over the decades, the Annual Meeting has served as a fun and entertaining evening during which the East Bay health care community can connect with one another, enjoy dinner and a fun program, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program. This year’s program is packed with an engaging guest speaker, highlights of local physician accomplishments, and poster presentations from previous student scholarship winners.

will be celebrating its history, the achievements of East Bay physicians, and the installation of its 2023 officers— while also raising funds for medical student scholarships—during our Annual Meeting on Friday, November 4 from 6 to 9 p.m. at the Claremont Club & Spa in Berkeley.

Thechallenges.2023program will be the first to be offered in a hybrid format over a four-month period. Kicking off with an all-day, in-person Saturday session in Oakland, followed by four 2-hour virtual sessions, the Physician Leadership Program is led by

ACCMA

Join a roundtable of your colleagues – more than 60 leaders from medical groups, hospital medical staffs, residency programs, and other physician organizations – to learn and share how to apply the organizational culture and practice changes that reduce physician burnout and drive professional fulfillment. Here's how the Bay Area Physician Wellness Collaborative can support your wellness efforts:

Join a roundtable of your colleagues – more than 60 leaders from medical groups, hospital medical staffs, residency programs, and other physician organizations – to learn and share how to apply the organizational culture and practice changes that reduce physician burnout and drive professional fulfillment. Here's how the Bay Area Physician Wellness Collaborative can support your wellness efforts:

To request an invitation to enroll, visit https://bit.ly/3PcTd3L

If you have any questions or would like more information, please contact Mae Lum, ACCMA Deputy Director, at (510) 654-5383 or mlum@accma.org.

We invite you to join our efforts to restore joy to the practice of medicine, together.

Do you want to improve physician health and professional satisfaction in your organization but don't know where to start or what step to take next?

Collaborate with other wellness leaders on a highly structured roadmap to make substantive changes that can fundamentally change the practice environment in your Refineorganization.andcustomize initiatives that will have the greatest impact on improving physician wellness for the least amount of time and cost – no matter your practice size or resource limitation.

Do you want to improve physician health and professional satisfaction in your organization but don't know where to start or what step to take next?

To request an invitation to enroll, visit https://bit.ly/3PcTd3L

We invite you to join our efforts to restore joy to the practice of medicine, together.

If you have any questions or would like more information, please contact Mae Lum, ACCMA Deputy Director, at (510) 654-5383 or mlum@accma.org.

Receive expert guidance and resources from Program Director Paul DeChant, MD. In addition to bimonthly meetings, virtual office hours will be held every other month.

Collaborate with other wellness leaders on a highly structured roadmap to make substantive changes that can fundamentally change the practice environment in your Refineorganization.andcustomize initiatives that will have the greatest impact on improving physician wellness for the least amount of time and cost – no matter your practice size or resource limitation. Receive expert guidance and resources from Program Director Paul DeChant, MD. In addition to bimonthly meetings, virtual office hours will be held every other month.

Fromgroupaspectsexperiencemanagementyearswithphysicianexperiencedexecutivemorethan25ofclinicalandinallofmedicalleadership.2009–2014,

March 7, 2023: Get Rid of Stupid Stuff (GROSS) – Reclaim up to 3 hours a day by getting rid of poorly designed, unnecessary, or burdensome work, and identifying administrative tasks that a non-physician team member can handle.

areas of focus will be covered in the following sample roadmap:

Personal Resilience – individual skills, behaviors, and attitudes

Efficiency of Practice – workplace systems, processes, and practices

September 13, 2022: Wellness Leader – Q&A with guest speaker Gaurava Agarwal, MD, CWO at Northwestern Medicine, on the variety of forms that a wellness leader role can take depending on the size, nature, and resources of the organization.

Culture of Wellness – organizational work environment, values, and behaviors

These3.2.1.

hepatients.served

WELLNESS COLLABORATIVE

Dr. Paul DeChant is an

November 14, 2023: Organizational Compacts – Examine how organizational values guide the vision and mission statements for physician organizations, and how compacts can support a clinical environment for physician success and quality care for

January 10, 2023: Peer Support/Burnout Coaching – Examine different options for providing evidence-based support for physicians, reviewing how each approach provides unique value based on the needs of the individual and organization.

May 9, 2023: Diagnostic Assessments – Explore the variety of wellness and burnout surveys available to help an organization choose the right survey for its needs.

November 15, 2022: Center/Committee for Physician Wellbeing – Build self-care support systems, peer support resources, mental health referrals and consultation services, life-needs support mechanisms, and other comprehensive wellbeing resources.

July 11, 2023: EHR Optimization – Consider approaches to optimizing the EHR, including innovations that significantly reduce documentation burden and in-basket overwhelm.

September 12, 2023: Daily Huddles – Reimagine the daily huddle process and how it specifically addresses key drivers of burnout; provide a guide to get started or to improve a huddle process that is currently in place.

as CEO of Sutter Gould Medical Foundation. He led a management system and culture transformation based on the theme of “Returning Joy to Patient Care,” which achieved the highest levels of provider and patient satisfaction in Sutter Health, improved physician satisfaction from the 45th to 87th percentile, and was recognized as the highest rated in overall care among 170 California medical groups two years in a row.

The Bay Area Physician Wellness Collaborative is led by Dr. Paul DeChant, a nationally recognized physician wellness expert with a background in practice redesign and organizational change. Following the Stanford Model for Professional Fulfillment, the three areas of focus for driving organization-wide progress are:

18 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN DATA EXCHANGE FRAMEWORK ( continued from page 11)

lays out practices’ responsibility to comply with the HHS Data Exchange Board (see below).

ACCMA members can place a classified ad for four months online and in two issues of the ACCMA Bulletin at NO CHARGE.

January 31, 2024 Most health care providers must imple ment the Data Exchange Framework

3 HHS Data Exchange Board: The State has proposed to cre ate a 5-to-7-member governing body that will oversee data exchange in California. This board will be charged with over seeing and updating the Data Sharing Agreement, ensuring compliance with the DxF, and qualifying health information organizations. The details about this board will be included in a legislative proposal that will be introduced next year.

January 31, 2026

ACCMA AND CMA RESOURCES

Small and safety net practices (see above) must implement the Data Exchange Framework

January 31, 2023

DATEREQUIREMENT

are required to execute (sign) the Data Sharing Agreement in just a little over four months from the writing of this article. The state has not yet announced how that process will take place, so please watch for further announcements from CMA or the State of California. In addition, it is important for physicians to know that they must sign the agreement by January 31, 2023, even if their practice is small enough to be in the cohort that does not have to comply until 2026.

Finally, be sure to work with your EHR vendor, especially if you work with a smaller, specialty system. These systems can require custom interfaces to onboard to an HIO, which can be both time-consuming and costly. On the plus side, some EHRs connect through a national data sharing network, allowing you to comply without adding a new vendor. Either way, it helps to include your EHR vendor early and often.

• CMA Fact Sheet for physician members (bit.ly/3RkgbXb) summarizes the requirements and components of the DxF and includes FAQs that will be updated regularly.

• Call the ACCMA at (510) 654-5383 or the CMA Member Helpline at (800) 786-4262.

A general timeline for the Data Exchange Framework is listed

With these new requirements being phased in over the next four years, practices will want to get started on building their game plan for compliance as soon as possible. If you participate in a

4 Technical Assistance for Small and Safety Net Practices: The 2022-23 State Budget included $50 million for provid ing technical assistance to small practices and other safety net providers. As of the writing of this article, there are no addi tional details to share. CMA is in actively engaged in ensuring that the funding will reach physician practices quickly and efficiently, to help them prepare for the DxF. For more details on these components, CMA members can access the CMA DxF Fact Sheet on the CMA website (see below).

WHAT PRACTICES CAN DO NOW

• Online briefing on the Data Exchange Framework (recorded June 28, 2022): youtube.com/c/CMAdocs.

To place a classified ad, go to www. accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383.

medical group or an IPA, a good place to start is by contacting that entity to inquire about their plans for compliance with the Data Exchange Framework. If you get access to an EHR system or population health platform through the group or IPA, and they already engage in data exchange, an individual practice may not need to sign their own DSA. The organization will sign the Data Sharing Agreement on your behalf, and data exchange will be handled at that level.

All health and human services organiza tions (including physician practices) must execute the Data Sharing Agreement

below:Practices

For more independent practices, now is a good time to familiarize yourself with the health information organizations (HIOs) that serve your community. Members of the California Association of Health Information Exchange (ca-hie.org/about/ members) represent the largest and most well-established HIOs in the state. They have already signed an agreement to work together. As more entities become aware of the requirements of the DxF, lead times to sign up with an HIO may become longer; it will help to approach them soon.

TIMELINE

2091: Protection of medical privacy to prevent patients from being compelled to testify or provide information in an out of state investigation or action related to abortion

AB 2626: Prohibition on medical and nursing board suspension/revocation of a license solely for performing an abortion

In its statement, HHS clarified that abortion is one of the required stabilizing treatments under EMTALA and confirmed that EMTALA requirements preempt any state laws banning abortions – even if there are no exceptions for emergency care, or if emergency care is more narrowly defined under state law. On August 2, the U.S. Department of Justice filed a lawsuit challenging Idaho’s SB 1385, arguing that the prohibition of abortions except for life-saving treatment would violate EMTALA’s requirement to perform abortions in other emergency situations. Importantly, HHS has also issued guidance on HIPAA and disclosures of information relating to reproductive health care (bit.ly/3RidlBE).

Following is a partial summary of abortion laws in California. For a summary of laws specific to minors and parental notifica tion and/or consent, please see “Parental Involvement in Minor Abortions” at bit.ly/2HsVlE1.

include:AB

Under EMTALA, an “emergency medical condition” is defined as “medical conditions with acute symptoms of sufficient severity that, in the absence of immediate medical attention, could place the health of a person (including pregnant patients) in seri ous jeopardy, or result in a serious impairment or dysfunction of bodily functions or any bodily organ. Further, an emergency medical condition exists if the patient may not have enough time for a safe transfer to another facility, or if the transfer might pose a threat to the safety of the person.”

• Pending bills in the state legislature related to abortion

CALIFORNIA ABORTION LAWS

TELEMEDICINE AND PATIENTS SEEKING OUT-OF-STATE CARE

• In November 2022, California voters will decide whether to enshrine the right to abortion and contraception in the state

• On June 24, Governor Gavin Newsom signed AB 1666 into law. This law declares other states’ laws allowing civil actions arising from abortions to be contrary to California public policy, thus preventing the application of case law or the enforcement of out-of-state judgments within California.

FEDERAL GOVERNMENT RESPONSE AND EMTALA

Abortion Laws and How Physicians Can Protect Themselves

• California joined Oregon and Washington in the Multi-State Commitment to Reproductive Freedom, which includes, among other pledges, a refusal of “extradition of individu als for criminal prosecution for receiving legal reproductive healthcare services in our states.”

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 19 DOBBS DECISION

The recent decision by the U.S. Supreme Court in the case of Dobbs v. Jackson Women’s Health Organization held that the Constitution of the United States does not confer a right to abortion, effectively remitting abortion rights and restrictions to the state level. In this article, we lay out the state abortion laws in California, including changes resulting from the Dobbs decision; explore the ripple effects of the decision; and provide physicians with guidance to protect themselves.

The Biden Administration has taken steps to preserve access to care in the wake of the Dobbs decision. Most notably, on July 8, President Biden issued an Executive Order protecting access to reproductive healthcare services and subsequently, HHS issued a statement reaffirming physician requirements under Emergency Medical Treatment and Active Labor Act (EMTALA).

Questions have arisen around how disparate state laws will be continued on page 20

By the Medical Insurance Exchange of California (MIEC)

Note: MIEC recognizes that the language used to describe abortionrelated care is politically and culturally sensitive. In this article, we have striven to use clinically accepted terminology and directly quoted statu tory language where applicable.

Abortion is legal in California up to the point of fetal viability, and it may be performed past that point in cases where the mother’s life or health is endangered.

Constitution (Proposition 1).

AB 2223: Removing requirement for coroner to investi gate fetal deaths after 20 weeks gestation

navigated when patients travel to other states to receive repro ductive or abortion-related care, or when a physician licensed in multiple states prescribes medication for purposes of abortion via telemedicine.Somestates

At this point, there is much that is still unclear; the legal landscape around abortion is still changing both at the federal and state level, and clinical guidance is still being developed. Therefore, it is important for physicians to follow ongoing changes, look to the most authoritative sources for guidance, and know how and when to ask for assistance in specific situations. MIEC recommends the following.

Emergency medical conditions involving pregnant patients may include, but are not limited to: ectopic pregnancy, complications of pregnancy loss, or emergent hyperten sive disorders, such as preeclampsia with severe features.

HOW CAN PHYSICIANS PROTECT THEMSELVES?

Stabilizing treatment could include medical and/or surgical interventions (e.g., methotrexate therapy, dilation and curet tage (D&C), removal of one or both fallopian tubes, antihypertensive therapy, etc.).

20 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN DOBBS DECISION ( continued from page 19)

are seeking not only to prohibit abortion within state jurisdictions, but also to prohibit citizens from obtaining outof-state abortions. For example, Missouri advanced a proposal to allow private citizens to sue Missouri residents who undergo an abortion outside the state, as well as their providers and anyone else who assists them in seeking an abortion. Similarly, Texas has enacted a six-week ban on abortion with a private right of action enabling individuals to sue abortion providers and others. This has caused concerns amongst physicians in states where abortion is still legal, in terms of their legal liabilities.

Keep up to date with developments in state and federal law. Physicians practicing in states currently allowing abortion should continue their current practice, while remaining vigilant of any

Regardless of the specific clinical guidance or state-specific laws around abortion, physicians should always carefully docu ment patient care including history and exam findings, informed consent, and indications for treatment. Good documentation will greatly facilitate the defense of any claim by providing evidence of medical decision-making.

As noted above, California has committed to providing legal protection for physicians providing care and patients coming to this state for care. Other care providers have taken a different approach. Planned Parenthood of Montana has ceased providing medication abortions to patients traveling from out of state due to concerns that patients taking the medication in their home state will be violating state law.

future changes in the law. However, physicians who practice in multiple states, either in person or through telehealth, should be aware of and compliant with the laws in each state in which patients are located at the time of treatment. Furthermore, physi cians treating patients who travel from out-of-state should con sider potential legal liabilities across state lines.

The most recent formal guidance was published by CMS on July 11; this updated guidance addresses how EMTALA applies to pregnant patients (go.cms.gov/3R2stDS). With regards to spe cific conditions and treatments, CMS states the following:

In 2021 the FDA authorized the medications Mifepristone and misoprostol to be prescribed via telemedicine and mailed to the patient for the termination of pregnancies of less than 10 weeks gestation. Currently, nineteen states (not including AK, CA, HI, or ID) have laws in place restricting access to such medications by mail. A Louisiana law makes “delivering, dispensing, distributing, or providing” an “abortion-inducing drug” to a pregnant person in Louisiana a crime punishable by fines and imprisonment, raising questions on how such a law will be enforced if the prescribing provider resides outside of the state. The U.S. Attorney General issued a statement advising that states cannot ban mifepristone based on disagreement with the federal government on its safety and efficacy (bit.ly/3Kow0cQ).

The American Academy of Emergency Physicians also released a statement in response to the Dobbs decision (bit. ly/3coYQNT) and is seeking to provide guidance to physicians providing emergency care (bit.ly/3CKhJ8u).

Follow available clinical guidance. MIEC recommends that physicians remain vigilant of and continue follow any formal guid ance offered through the government and/or professional orga nizations. The American College of Obstetrics and Gynecology (ACOG) has issued multiple statements since the Dobbs decision (bit.ly/3ctvgXt), but there has been little clinically specific guidance offered, most notably around the issue of how physicians should balance life-saving care with state prohibitions on abortion. On July 13, ACOG issued a statement on the clarification of EMTALA protections (bit.ly/3Ku7SG2), in which it acknowledged that the clarification of EMTALA protections should reassure physicians that they will be protected when providing evidence-based emer gency medical care, without fear of state bans on abortion.

Contact MIEC for assistance. MIEC is committed to protect ing its members in this rapidly changing legal environment. Physicians who are concerned about specific situations and their associated liability risk, or who are concerned about a potential claim arising from providing reproductive health services to a particular patient, should contact MIEC for assistance.

• Preparing our healthcare system to manage the health conse quences of extreme heat, powerful storms and floods, yearround wildfires, droughts, and other climate-related events, especially those which result in population disruption and population displacement

Note

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 21 CLIMATE CHANGE POLICY

NOVEMBER ELECTIONS (continued from page 10) requirements so that patients are ensured timely access to the evidence-based, quality health care they need.

Inflation Reduction Act. We support the Inflation Reduction Act that was signed by President Biden. The legislation includes important and historic changes for our patients. It will reduce Medicare’s unsustainably high prescription drugs costs, ensure continued availability of affordable health care coverage for mil lions of Californians under the Affordable Care Act (ACA), and address the devastating impact of climate change on public health.

• Treating climate change as a public health emergency

According to the World Health Organization, “Climate change is already impacting health in a myriad of ways, including by leading to death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods, the disrup tion of food systems, increases in zoonoses and food-, water- and vector-borne diseases, and mental health issues. Furthermore, cli mate change is undermining many of the social determinants for good health, such as livelihoods, equality and access to health care and social support structures. These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvan taged, including women, children, ethnic minorities, low-income communities, migrants or displaced persons, older populations, and those with underlying health conditions.”1

• Eliminating racial and economic disparities among com munities bearing disproportionate environmental costs, like more lead, particulate air pollution, ozone smog and other health hazards in the places people live, work and play

Questions/comments may be directed to the ACCMA at accma@accma.org or (510) 654-5383.

1 World Health Organization, October 30, 2021: room/fact-sheets/detail/climate-change-and-healthhttps://www.who.int/news-

• Ensuring fair employment and economic opportunities for workers and communities adversely impacted by climate change and the transition to a low-carbon economy

Climate change is one of the greatest public health threats we are facing in the 21st century and is already having a significant nega tive impact on the public health and wellbeing of patients in our own community. As a professional association of physicians, the ACCMA is principally focused on policy aspects of climate change that directly impact the health of our patients and community and about which our members have expertise. In broad terms, the ACCMA believes the following climate change-related policy inter ventions will improve the health of our patients and community:

• Ensuring safe and healthy air quality

• Supporting the development of healthy communities by investing in safe walking, bicycling and street infrastructure and providing safe and affordable public transit options

• Transitioning to clean, safe, and renewable energy; and energy efficiency and reducing anthropogenic greenhouse emissions

ACCMA Climate Change Policy

The Alameda-Contra Costa Medical Association (ACCMA) represents over 5,400 East Bay physicians, medical students, and physicians in training, who are responsible for providing medical care to and supporting the wellbeing of the residents of Alameda County and Contra Costa County. The mission of the ACCMA is to promote the science and art of medicine, the care and well-being of patients, the protection of the public health, and the betterment of the medical profession.

• Implementing policies at the practice-level to mitigate cli mate change, implement environmentally sustainable and energy-efficient practices, and prepare for the impacts of climate change on patient health and clinical operations

• Funding for climate change research to understand, adapt to, and mitigate the human health effects of climate change

If you have any questions or want more information, please contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives at dlopez@accma.org or (510) 654-5383, ext. 6320.

The ACCMA Council adopted the following policy at its May meeting to guide ACCMA advocacy on climate change.

• Creating healthy, sustainable, and resilient food systems

• Providing access to safe and affordable drinking water and a sustainable water supply

Margarita Berrios, MD Maria Bhaijee, MD

Audrey Arzamendi, MD Alex Aslan, MD

WELCOME, BROWN & TOLAND PHYSICIANS!

Manasi Bapat, MD

Rodolfo Cadang, MD

Susan Fang, MD

Joseph Brandel, MD

Adrianna Browne, MD John Bry, MD

Barbara Benzwi, MD David Berke, MD

Maria Escalada, MD

Dionisio Fernandes, MD James Feusner, MD Carl Fieser, Jr., MD Mark Finch, MD Charles Fiske, MD Timothy Fitzer, MD Laravic Flores, MD Rachel Fogel, MD Karen Fong, MD Lloyd Ford, MD Zuzana Foster, MD

Lucille Andersen, MD Jennifer Anderson, MD

Amar Anand, MD

Gerald Collins, MD Christian Conderman, MD Patricia Conolly, MD Christina Corey, MD Mario Corona, MD

Mandeep Chadha, MD Less Chafen, MD Dev Chahal, MD Harvind Chahal, MD

Farinaz Farrahi, MD Aamir Faruqui, MD Naseem Fatima, MD Vahid Feiz, MD

Jeffrey Burack, MD Benjamin Busfield, MD Olivia Butt, MD

Emily Hunter-Adamson, MD Said Ibrahimi, MD

Robert Amster, MD

Kenneth Caldwell, MD John Call, MD

Faye Yu, MD, General Surgery, TPMG San Leandro

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Pacita Aducayen, MD

Daniel Abelson, MD

Jennifer An, MD

Gregory Barme, MD Sherilyn Baughman, MD Eric Bava, MD Barbara Beach, MD Gary Bean, MD

Jose Arias Vera, MD

Claudia Iota-Herbei, MD Joshua Jacobs, MD Sanjeev Jain, MD Amir Jamali, MD Akbar Jamall, MD Babak Jamasbi, MD Adrian James, MD Benjamin Jarrahi, MD Kirk Jensen, MD

Julia Bley, MD

Philip Chyu, MD Juliana Cinque, MD Rebecca Citron, MD Ronald Cohen, MD Susie Cohn, MD

Sarbjit Hundal, MD

Michael O’Neal, MD, Emergency Medicine, TPMG Walnut Creek

Clarisse Cadang, MD

Michael Faer, MD

Edward Van Becker, MD David Bell, MD

Jeffrey Bortz, MD

Jenna Brimmer, MD

Shilpi Anand, MD

Marina Bulatov, MD

22 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Lisa Arcilla, MD

Chika Akera, MD

Barbara Botelho, MD

Brad Buchman, MD, Family Practice, UC Health

Kendell Cannon, MD

Premjit Chahal, MD Elaine Cham, MD Clayton Chan, MD Mark Chan, MD Sue Chan, MD Anita Chang, MD David Chang, MD Gwendolen Chang, MD Heidi Chang, MD Kimberly Chang, MD Kenneth Chao, MD Paul Chard, MD

Mehrnoosh Almassi, MD

John Bokelman, MD

Anupama Ganga, MD Karna Gendo, MD Barsam Gharagozlou, MD Hussain Gilani, MD Katherine Gilbert, MD Carol Glann, MD Erica Glenn, MD Carla Golden, MD Mona Goldfine, MD Michael Goldrich, MD Esha Gollapalle, MD Merry Gong, MD Julie Goo, MD

Linda Gordon, MD Karen Graham, MD Douglas Grant, MD David Green, MD Trinh Green, MD Robert Greenberg, MD Robert Greene, MD

Hina Ahmad, MD

Navjeet Boparai, MD

Melody Brewer, MD

Tammy Chen, MD William Chen, MD Xiaochuan Chen, MD Xiaoshuang Chen, MD Christi Cheng, MD Huilan Cheng, MD Joseph Cheng, MD Paul Cheng, MD Susan Cheng, MD Suraj Cherry, MD Ka Cheung, MD Brian Chin, MD Catherine Chin, MD Douglas Chin, MD Jonathan Chin, MD Cynthia Chiu, MD Harneet Chopra, MD Tina Chou, MD

Audreyandra Imansjah, DO, Family Practice, San Ramon

Haseeb Al-Mufti, MD

Kelly Pfeifer, MD, Family Practice

Chew May Cheah, MD, General Medicine, TPMG Richmond

Anne Foster, MD, ObstetricsGynecology, UC Health

Norman Banks, MD

Rajiv Ahuja, MD

Amitabh Bharadwaj, MD

Alok Bhattacharyya, MD

Suzanne Bodor, MD

Michael Ajuria, MD

Kasra Amirdelfan, MD

Henry Chen, MD Jeff Chen, MD Ji Jill Chen, MD Kwan Chen, MD,FACC,MPH Steven Chen, MD

Douglas Abeles, MD

William Chow, DO George Chu, MD Taylor Chung, MD

Joshua Au, MD Michael Austin, MD

Susan Ferguson, MD

Jeanie Ahn, MD

Iryna Falkenstein, MD Sassan Falsafi, MD Ming Fang, MD

NEW & RETURNING MEMBERS ASSOCIATION BULLETIN continued on page 24

Daniel Brinton, MD Adam Brooks, MD Candida Brown, MD

David Bradshaw, MD

Christopher Walker, MD, Internal Medicine, TPMG Oakland

Sarah Rahman, MD, Internal Medicine, Alameda Health System

Michael Brown, MD

Ernest Bloom, MD

Navjot Grewal, DO Suneet Grewal, MD Emily Guh, MD Tanya Gupta, MD Erin Gutierrez, MD Jaimish Gwalani, MD Fadi Haddad, MD Joanna Halkias, MD Michael Hall, MD Ali Hamraz, MD James Han, DO Sarah Handelsman, MD Ted Handler, MD Nadine Hanna, MD Claire Hargrove, MD Steven Harrison, MD Stephen Hart, MD Jacquelyn Haskell, MD Maurine Heard, MD Michael Hebrard, MD Robert Heidersbach, MD Ileana Helms, MD Juliana Herbert, MD Lisa Higa, MD Viet Huy Ho, MD Victorina Hoffmann, MD Melanie Hom, MD Eitan Homa, MD Kenneth Honsik, MD Kelly Hood, MD Brian Hopkins, MD Carolyn Hoppe, MD Rupert Horoupian, MD Mehra Hosseini, MD James Howard, MD Kenneth Hsiao, MD Kun Huang, MD Rong Huang, MD Xiaoguang Huang, MD Floyd Huen, MD Michelle Huffaker, MD Thomas Hui, MD Melvin Huie, MD

Christina Chavez-Johnson, MD Varun Chawla, MD Qi Che, BenjaminMDChen, MD

Brazell Carter, MD Kimberly Ceci, MD

Magdalen Edmunds, MD Kasra Eliasieh, MD Robert Elliott, MD Selena Ellis, MD Ronald Elson, MD Louis Enrique, MD Jose Enz, MD Robert Eppley, MD Mark Escajeda, MD

Anurag Agrawal, MD

Patricia Francis, MD Jonathan Frank, MD Linda Frankel, MD Orrin Franko, MD Ingrid Freeny, MD Lily Friedman, MD Yaron Friedman, MD Jessica Furer, MD Sangeeta Gambhir, MD Renu Gandhe, MD

Josephine Agbowo, MD

Clemens Esche, MD Alex Espinoza, MD Thomas Eusterbrock, MD Tracy Evans-Ramsey, MD Uchechukwu Ezeh, MD

Anastasia Coutinho, MD Beth Cowan, MD Kevin Critchlow, MD Joel Crockett, MD James Crook, Jr., MD Natalie Cvijanovich, MD Katherine D’harlingue, MD Leonardo Dacanay, MD Frances Dalton, MD Juliana Damon, MD Minh-Ngoc Dang, MD Bay Dang-Vu, MD Earl Darby, MD Neesha Dave, DO Alyson Davidson, MD Sally Davis, MD Sharon De Edwards, MD Lilia De Jesus, MD Darrow De Luca, MD Jennifer De Niro, MD Michael Deboisblanc, MD Jordan Deschamps-Braly, MD Christin Destefano, MD Barbara Devane, DO Deepak Dhawan, MD Rafael Diaz Flores, MD Ole Dierks, MD Clement Donahue, MD Rakesh Donthineni, MD Warren Dotz, MD Robert Doud, MD T. Eric Drasin, MD Kathryn Drinkard, MD Golde Dudell, MD Kimberly Duir, MD David Durand, MD Benjamin Durant, MD John Edelen, MD

Alameda

Addressing Food Insecurity with Recipe4Health

Earlier this year, the Alliance introduced six Community Supports services, including housing transition and tenancy services, recuperative care, asthma remediation, and medically tailored meals/food. These services, while not medical in nature, are major factors in social determinants of health that are helping our members avoid hospital stays, reduce visits to the emergency department, and improve their overall well-being.

We know that lack of access to healthy foods are associ ated with poor health, leading to higher health care costs. A study funded by U.S. Health & Human Services found that unhealthy eating habits cost the U.S. health care system about $50 billion per year; these costs are associated with heart disease, stroke, and type 2 diabetes. As a safety net provider, our mission is to improve the health and well-being of our members by collaborat ing with our provider and community partners to deliver high-quality and accessible services, and the Recipe4Health program does just that.

• Have chronic condition(s), such as but not limited to diabe tes, cardiovascular disorders, congestive heart failure, stroke, chronic lung disorders, human immunodeficiency virus (HIV), cancer, gestational diabetes or other high-risk peri natal conditions and chronic or disabling mental/behavioral health disorders.

Alliance for Health (the Alliance) is proud to serve over 320,000 children and adults in Alameda County. In this article, you will read about the newest Community Support service that the Alliance is offering to eligible members, and which will address food insecurity while improving the physical and behavioral health of our most vulnerable residents.

are filled by Dig Deep Farms – a social enterprise founded in 2010 by the Deputy Sheriffs’ Activities League and the Alameda County Sheriff’s Office – and local urban farm that creates green economy jobs for justice-involved individuals.

By Scott Coffin, Alliance CEO

Through this important partnership, we hope to address poor health outcomes that are associated with food insecurity that our members face on a regular basis, to support the needs of our most complex and vulnerable patients, assist with the management of chronic health conditions, and reduce hospitalizations.

Patients who qualify for this service must meet at least one of the following criteria to be eligible:

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 23 ALAMEDA ALLIANCE continued on page 24

• Have intensive care coordination needs.

During the past year, the Alliance has worked diligently to meet the requirements needed to implement major components of the Department of Health Care Services’ (DHCS) CalAIM initiative. We are proud to have successfully launched new enhanced care management and community supports services, and the transition of major organ transplants into Alameda County’s Medi-Cal managed care program. These essential services, along with other CalAIM initiatives, are helping improve the health outcomes of our members, particularly those with the most complex health care needs.

• Is being discharged from the hospital or a skilled nursing facility or at high risk of hospitalization or nursing facility placement.

Since 2020, the Alliance has financially invested in the Recipe4Health program and partnered to help launch and expand Food as Medicine efforts at local clinics throughout Alameda County. Through this partnership, thousands of patients

Beginning in September, the Alliance launched the Recipe4Health program, as part of our medically tailored meals/ food program. Recipe4Health is a ‘food as medicine’ program administered by the Alameda County Health Care Services Agency (HCSA) as part of the ALL IN program. Recipe4Health aims to address social drivers of health among residents by pre scribing patients’ nutrient-dense produce and connecting them to local support groups that brings members together and includes physical activities, healthy food demonstrations, stress reduction, and social connection over the course of several months.

Through our partnership with the Alameda County, eligible Alliance members will have access to food prescriptions, which includes up to twelve weeks of a wide selection of healthy vegeta ble alternatives. We are proud to note that the food prescriptions

Samali Kasozilubega, MD

Neil Kamdar, MD

Amy Kane, MD

Oliver Khakmahd, MD

Matthew Johnson, DO

Do-Eun Lee, MD

Dorothy Khong, MD

Derek Jue, MD

Kate Kasberger, MD

Jagmohan Khaira, MD

Young Min Kang, MD

Hamidreza Khonsari, MD

Nadine Kindy-Baillot, MD

Ashutosh Lal, MD

Lily Kao, MD

Rao Kosaraju, MD

Alexander Kopelnik, MD

Michael Kassels, DO

Nisreen Kothari, MD

Chi Keung Lee, MD

Gail Kang, MD

Elaine Lee, MD

Sharon Jones, MD

Kerry Kay, MD

Jennifer Levy, MD

Tsung Tsuan Li, MD

Esther Li-Bland, MD Sai-Woon Liang, MD

Speaking of the upcoming November election, our Legislative Committee was also busy this year interviewing candidates for local office and sharing our impressions with CALPAC and ACCPAC, our political action committees that provide financial support to physician-friendly candidates. In our area, CALPAC is supporting Lily Mei for Senate District 10 and Shawn Kumagai for Assembly District 20, and ACCPAC is dually supporting Rebecca Kaplan and Lena Tam for Alameda County Board of Supervisors District 3 and Debra Allen for Contra Costa Board of Supervisors District 2.

Christopher Lee, MD Diane Lee, MD

ABOUT ALAMEDA ALLIANCE FOR HEALTH

throughout Alameda County have been screened for food insecu rity and have been offered healthy food interventions in combi nation with group behavioral support that have led to improved health outcomes. The integration of Recipe4Health into the Alliance’s Community Supports medically tailored meals/ food program will address the nutritional needs of the Alameda County community while reducing barriers associated with food insecurity. If you have any questions about this medically support ive meals/food service, please contact the Alliance’s Community Supports Team at CSDept@alamedaalliance.org.

Barry Kerman, MD

involved in over the past year in its efforts to empower and orga nize physicians to lead and improve the practice of medicine so as to better patients’ lives and the community’s health. ACCMA is a remarkable organization, and I have been honored and extremely proud to serve as your President. I would like to thank you, our members, for your continued to support of ACCMA and CMA. I would also like to thank the scores of members who take time out of their busy lives to serve on the ACCMA Council, the District IX Delegation, and on our many committees for your many con tributions to the betterment of medicine. Finally, I would like to congratulate our incoming President, Doctor Edmon Soliman. Having worked with Edmon, I am confident that he will do a great job, and I wish him and the other officers the best of luck in the coming year.

Lisa Kalar, MD

Maggie Lam, MD Arthur Lande, MD

24 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETINASSOCIATION BULLETIN ALAMEDA ALLIANCE ( continued from page 23)

Richard Kamrath, MD

Dawud Lankford, MD

Nicole Learned, MD

PRESIDENT'S PAGE (continued from page 7)

Kristina Kramer, MD Jennifer Krasnoff, MD

Ruben Kalra, MD

Olivia Lang, MD

Jenny Jew, MD

Kanwar Kelley, MD

James Kong, MD

Valerie Jerdee, MD

Deepika Kancherla, MD

Brian Kellert, DO

Sara Johnson, MD

Anna Khananian, MD

Kenneth Kim, MD

Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 310,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products.

individual’s right to reproductive freedom and to use and refuse contraception. Page 19 in this issue provides guidance to physi cians on protecting themselves against out-of-state abortion laws.

Rachel Kreps-Falk, MD Michael Krosin, MD Calvin Kuan, MD Michael Kubalik, MD Pradeep Kumar, MD Steven Kurtzman, MD Regis Kwo, MD Eric Lai, MD

Scott S. Lee, MD Erica Leigh, MD Shanti Leon Guerrero, MD Craig Leong, MD Dimitry Lerner, MD Jessica Leung, MD

Man Kong Leung, MD

Stephen Kahn, MD

These are just some of the many activities ACCMA has been

Teresa Kim, MD

Sabiha Karakas-Rothey, MD

Edward Kim, MD

Hon-Wai Lam, MD

Varujan Keledjian, MD

Julia Lam, MD

George Lee, MD Jennifer Lee, MD Christine Lee, MD Mark Lee, MD Peter Lee, MD Scott E. Lee, MD

Ilisten Jones, MD

Elmer Jumig, MD

Melissa Liebowitz, MD Kenneth Lien, MD Suzy Lim, MD David Lin, MD Eduardo Lin, MD Eugene Lit, MD Vanessa Litman, MD Ben Littlejohn, III, MD

Jaspreet Kaur, MD

NEW MEMBERS (continued from page 22)

Toral Kamdar, MD

Leena Kamat, MD

Brian Keyashian, MD

Bamidele Kammen, MD

Ramandeep Kaur, MD

Jesse Jung, MD

Xaviera Ortiz Soto, MD Fernando Otero, MD Eric Padua, MD

John Zink, MD

Nathalie Michaud, MD Christopher Michel, MD Katrina Michel, MD Jennifer Michlitsch, MD Nick Mickas, MD

Jeffrey Wherry, MD

Silvia Villagomez, MD Deepa Vincent, MD Bhupinder Virk, MD Maryna Vityuk, MD Christina Vo, MD Cuong Tat Vu, MD Van Thuc Vu, MD Sanya Wadhwa, MD Alexander Wai, MD Kristin Walker, MD Mark Walters, MD

Ann Nguyen-Traxler, MD

Michael Maiman, MD

Sarah Postma, MD

Michael Wang, MD Xingyue Wang, MD Henry Watson, MD Louis Weckstein, MD

Terry Maher, MD

Iqbal Omarali, MD

Suzanne Nguyen, MD Thi Nguyen, MD

Brad Zwahlen, MD

Rock Liu, MD

Padmavathi Madathanapalli, KalyaniMD

Leanne Marcotrigiano, MD Andres Marin, MD

Michael Nickas, MD

Andrew Pienkny, MD

Maganti, MD

Lawrence Weil, MD

Patricia O’Connor, MD

Kristelle Lusby, MD Hnoukaj Lyfoung, MD Daveena Ma, MD

Serena Wu, MD

Denise Yun, MD

Jennifer Miller, MD Terina Miller, MD Andrew Min, MD

Rajiv Nagesetty, MD

Joel Piser, MD

Jaleh Niazi, MD

ACCMA BULLETIN | SEPTEMBER/OCTOBER 2022 25 NEW MEMBERS ( continued from page 24)

Enoch Nam, MD

Golaun Odabaei, MD

Robin Winokur, MD Phillip Wolfe, MD Rosa Won, MD Bryan Wong, MD

Veena Manjunath, MD

Jeffrey Mann, MD

Stephen Wells, MD Christopher Welty, MD Kathryn Welty, MD

Susan Lo, MD Timothy Lo, MD

Janice Moyer, MD

Meghan Woods, MD Samuel Woods, MD Sara Anna Woolf, MD Sarah Woon, MD William Workman, MD Danny Wu, MD David Wu, MD Monte Wu, MD

Hien Nguyen, MD Mychi Nguyen, MD

Julie O’Melveny, MD

John Peterson, MD An Tan Pham, MD

Rose Ochieng, MD

Dominika Motas, MD Rex Moulton-Barrett, MD

Abid Majid, MD

William Littman, MD

Stuart Mansfield, MD Michael Marchiano, MD

Michael Park, MD

Kalamaoka’aina Niheu, MD Michael O’Connor, MD

Tracy Phillips, MD Matthew Piazza, MD Courtney Pickering, MD

Gregg Pottorff, MD

Charles Preston, MD

Tracy White, MD

Danielle Williams, MD Sean Williams, MD Sharon Williams, MD Steven Williams, MD

Burton Presberg, MD

Robert Yan, MD Yan Yan, MD

Sourjya Misra, MD

Ariel Zodhiates, MD

Kenneth Zuckerman, MD

Htay Win, MD

Jay Zimmerman, MD

Rafik Zarifa, MD

Anthony Padula, MD Maria Pagtalunan, MD Jianqiu Pan, MD Shu Pan, MD

Kenneth Martin, MD Sean Martin, MD Joseph Marzouk, MD Patricia Maska, MD Jason Massa, DO Alison Matsunaga, MD Helen Matthews, MD Peter Mazolewski, MD Collins Mbanugo, MD

Mindy Plotkin, DO Louis Pollack, MD

Jennifer Parma, DO Bijal Patel, MD Chirag Patel, MD Swati Patel, MD Vikas Patel, MD

Lisa Montang, MD

Elaine Pico, MD

Cynthia Mullen, MD

Emily O’Rourke, MD

John Pyun, MD Paige Radell, MD Jeana Radosevich, MD Robert Raphael, MD Hamid Rassai, MD Katherine Rausa, MD Fiona Redwood, MD Margaret Renik, MD Brian Reyes, MD Kimberly Reynosa, MD William Rhoads, MD Philip Rich, MD Joshua Richards, MD Denise Ricker, MD Jenny Riley, MD Rahul Rishi, MD Daniel Robbins, MD Ronald Robinson, MD Geoffrey Rodriguez, MD Soraya Rofagha, MD Chad Roghair, MD Denise Romero, MD Joseph Rose, MD

Brian McGuinness, MD Oscar McKinley, MD Eugene McMillan, MD Barbara McQuinn, MD David Mead, MD

Clark Neuwelt, MD

Brendan Morley, MD Ellen Morrissey, MD

Lynne Rosen, MD Shawn Rosen, MD

Erin Simms, MD Deborah Simon-Weisberg, MD Sylvia Singer, HaramandeepMDSingh, MD Navdeep Singh, MD Jorge Siopack, MD Daniel Sisti, MD Andrew Smith, MD Grace Sohn, MD Charles Som, DO Helen Song, DO Rebecca Spies, MD Donald Stanford, MD Tara Starr, MD Maria Steelman, MD Andrew Stein, MD Claudell Stephens, Jr., MD Duane Stephens, MD Jeffrey Stern, MD Neil Stollman, MD Michaela Straznicka, MD Charles Strotz, MD Fannie Su, MD Wendy Su, MD Nicole Suleiman, MD Shannon Sullivan-Cramer, MD Peter Sun, MD Michael Sung, MD Vikram Suri, MD Kala Swamynathan, MD Walter Sweeney, II, MD Susan Sykes, MD Natsuko Takakuwa, MD Lloyd Takao, MD Alisa Takeda, DO Vikram Talwar, MD Matthew Tamplen, MD Lorena Tan, MD George Tanaka, MD Michele Tang, MD Jaime Tannenbaum, MD Willam Tanner, MD Gerald Tarder, MD Alexander Tauras, MD Jennifer Taylor, MD Scott Taylor, MD Shine-Nee Teng, MD Allyson Tevrizian, MD Rene Thomas, MD Arthur Ting, MD William Ting, MD Kevin Tomfohrde, DO An Tran, MD Thuy-An Tran, MD Jeffrey Traynor, MD Yogesh Trehan, MD Clark Tsai, MD Wilson Tsai, MD Jessica Tsuei, MD Cynthia Tsui, MD Nanci Tucker, MD Anna Usowicz, MD Usha Vallamdas, MD Poornima Vanguri, MD Juan Vargas, MD Madhavi Vemulapalli, MD

Shreyas Makwana, MD

Jason Moy, MD

Lisa Yee, MD

Camilla McCalmont, MD Thomas McBride, MD Rebecca McEntee, MD

Yuyang John Mei, MD Kanwal Merchant, MD Stephen Merjavy, MD Maxwell Merkow, MD

John Mouratoff, MD

Luisa Munoz Del Romeral, MD Anjali Murthy, MD San-San Myint, MD Frederick Nachtwey, MD

Varinder Phangureh, MD

Nancy Mozelsio, MD

Timothy Wei, MD

C. Charles Wen, MD,MBA

Philip Yee, MD

Lynne Neumayr, MD

Anne Yu, MD

Rebecca Yu, MD

Navin Mallavaram, MD

Vivienne Newman, MD Christina Ng, MD

Xiao Yang, MD Xin Yang, MD

Nicole Yee, MD

Mark Zeme, MD

Sammuel Wong, DO Peter Wong, MD

Subhendu Narayan, MD

Kris Yogam, MD

Howard Rosenfeld, MD Michael Rosenfield, DO Andrew Ross, MD Kevin Roth, MD Robert Rovner, MD Aimee Rowe, MD Frederick Rowe, MD Richard Rowe, MD Jon Rowland, MD Anabel Ruiz, MD Daniel Rust, MD Iraj Sabahi, MD Gopal Sachdeva, MD John Francis Safanda, MD Elizabeth Salsburg, MD Peter Sam, MD Amarjit Sandhu, MD Nancy Sandoval, MD Vincent Sansone, MD Sebastian Sasu, MD Ronald Sato, MD Gail Savarese, MD Gregory Schaner, MD Timothy Schmidt, MD Janine Senior, MD Armen Serebrakian, MD Todd Severin, MD Payal Shah, MD Rakhee Shah, MD Saurin Shah, MD Selina Shah, MD Shaily Shah, MD Swapnil Shah, MD Amita Sharma, MD Padmaja Sharma, MD Rishi Sharma, MD Salim Shelby, MD Madhu Shetti, MD Angelina Shigeura, MD Yshay Shlesinger, MD Lori Shore, MD

Li Zhu, MD

Omoniyi Omotoso, MD Roy Orden, MD

Daniel Oberlin, MD Gonzalo Obnial, MD Lilia Oceguera, MD

Yuriria Lobato, MD Matthew Lodewick, MD Evelyn Loo, MD Benjamin Loos, MD Eugene Lowry, MD Peter Lunny, MD

Wendy Patton, MD

Margaret Payne, MD David Perlada, MD Cornelia Pessoa, MD

Liana Vesga, MD Elliott Vichinsky, MD

Jamal Zaka, MD

Arzhang Zereshki, MD

Jeffrey Mark, MD Ken Marriner, MD

26 ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

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Robert Edelman, MD ACCMA President

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Such PSLF loan forgiveness would help many physicians who train in California and Texas to be able to remain and serve our substantial communities of vulnerable, minority and marginalized patients. It would also help low-income minority students afford medical school and return to their underserved communities to practice and serve in non-profit hospitals and clinics. PSLF equity in California and Texas would ensure racial equity in education and health care equity in underserved areas. With medical student loan debt averaging $200,000 in addition to undergraduate debt, the PSLF program is essential to encour age more students to become physicians and address the physician workforce shortages that are harming patient access to timely care. California and Texas are projected to have the largest physician shortages over the next decade due to a significant increase in our populations, an increase in elderly and sicker patients, and an aging physician workforce nearing retirement. Exclusion from PSLF will exacerbate our physician shortages and patient access to care challenges as physicians will choose to practice in other states where they can access the PSLF program.

Primary Care Physician Wanted. Premise Health, the nation’s leader in employer-based healthcare, has an opening for a physician to provide primary care 30 hours per week in our out patient clinic in Oakland; this is a benefited position. Premise Health is the world’s leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest

• Great compensation and benefit plan

• Bottom line is measured by the quality of patient care

• Practice in a supportive, collaborative environment

• Less paperwork and administration time

We urge the Department to adopt the alternative proposal for California and Texas that maintains the integrity of our state laws, while being consistent with the PSLF statute and program standards.

What makes this opportunity unique:

PUBLIC SERVICE LOAN FORGIVENESS (continued from page 12)

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

For more information, please contact Jeff Ligon, Physician Recruiter, at (615) 468-6233 or jeff.ligon@premisehealth.com.

• A collaborative approach with a focus on each individual patient

• Practice evidence-based medicine where you are not paid for production

• A work-life balance that is not just promised

Thank you for your consideration.

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Medical Malpractice coverage for individuals, groups and facilities. Acupuncture, Psychiatry, and other specialty coverages available.

Alameda-Contra Costa Medical Association 6230 Claremont Avenue P.O. Box 22895