April 2015

Official Magazine of FRESNO COUNTY Fresno-Madera Medical Society KERN COUNTY Kern County Medical Society KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Medical Society TULARE COUNTY Tulare County Medical Society

See Inside: CMA Leaders Converge On Capitol Hill To Advocate Medicare Fix New Measures To Combat Vector-Borne Diseases FDA Approves First Biosimilar Medication To Be Sold In US

April 2015 • Vo V Vol. l. 37 No. 4

Vital Signs

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Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society

Contents EDITORIAL.................................................................................................................................5 NEWS

CMA NEWS.............................................................................................................................6

BLOOD CENTER: New Measures To Combat Vector-Borne Diseases............................................8

April 2015 Vol. 37 – Number 4

HEALTHCARE REFORM............................................................................................................9

Editor Alan Birnbaum, MD

Fresno-Madera Medical Society......................................................................................10

CLASSIFIEDS..........................................................................................................................15

• Society Presents Awards at Regional Science Fair

• In Memoriam: Robert J. De Klotz, MD

Fresno-Madera Medical Society Editorial Board Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD

• MEDPARD Database

• Walk WIth A Doc

• President’s Message

Kings Representative TBD

• Order Your Membership Director

• Membership Recap

Managing Editor Carol Rau Yrulegui

Kern Representative John L. Digges, MD Tulare Representative Francine Hipskind Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medi­cal Society, PO Box 28337, Fresno, CA 93729-8337.

Kern County Medical Society...........................................................................................12

TULARE County Medical SocieTY.......................................................................................13

• Honduras Medical Mission

• Calling All Tulare County Medical Society Members

• Upcoming Events

• Just Walk With A Doc

Advertising Contact: Display: Annette Paxton, 559-454-9331 apaxton@cvip.net Classified: Carol Rau Yrulegui 559-224-4224, ext. 118 csrau@fmms.org Vital Signs is published monthly by Fresno-Madera Medical Society.

Editorials and opinion pieces accepted for publication do not necessarily reflect the opinion of the Medical Society. All medical societies require authors to disclose any significant conflicts of interest in the text and/or footnotes of submitted materials.

Questions regarding content should be directed to 559-2244224, ext. 118.

Cover Photograph: “ Table Mountain”

by Don Gaede, MD

Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee APRIL 2015 / VITAL SIGNS

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There has never been a better time to shop the sponsored workers’ compensation plans offered through the Fresno-Madera, Kern and Tulare County Medical Societies/CMA. That’s because workers’ compensation insurance rates in California continue to move upward. The Insurance Commissioner recommended an increase of 6.7% in pure premium rates for 2015 compared to the average premiums charged as of July 20141. Your plan may experience a higher or lower rate increase than recommended by the Department of Insurance.

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By becoming involved with the sponsored plans you will receive valuable protection for your practice and employees while supporting the good work of your Society!

Take control of your workers’ compensation costs. Call 800-842-3761 now for your free, no-obligation quote. Or visit www.CountyCMAMemberInsurance.com for more information and to download an application or premium indication form.

Sponsored by: Fresno-Madera Medical Society Kern County Medical Society Tulare County Medical Society

Scan for more info!

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 Copyright 2015 Mercer LLC. All rights reserved. • 777 South Figueroa Street, Los Angeles, CA 90017 CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com 800-842-3761 • 69907/71369 (4/15)

Source: Workers Compensation Insurance Rating Bureau of California, http://www.wcirb.com/sites/default/files/documents/insurance-commissioners-decision-01012015_1.pdf 1

4 APRIL 2015 / VITAL SIGNS

EDITORIAL Commodities and Care, Competitors and Colleagues Alan M. Birnbaum, MD Editor, Vital Signs

Considering the practice of medicine over the nearly 40 years since I earned my M.D. degree, few changes seem as profound in medical care as what is becoming more of a commodity than a service.

Circa 1975, every fellow physician was a valued colleague. In 2015, however, physicians have become competitors, due to a healthcare business model not even envisioned four decades ago. Does this mercantilization of medical practice really best serve our patients or ourselves as professionals?

Having recently seen several unfortunate developments, we should NOT let local healthcare divide into a dither of dueling duchies. As a medium-sized medical market, it’s better that our several systems in Fresno and Madera counties develop complementary sets of services, rather than directly compete at each point of service.

I do not recall my late mother, Nathalie M. Wolfe, MD, who died in 1975, ever refer to contracts when it came Regardless to her pediatric practice. Today, however, rarely does a physician not sign at least one contract. Most doctors we should are signatory to several, primarily insurance coverage contracts and related financial arrangements with pause when we restricted physician panels. The freedom that patients once enjoyed to select their physicians unencumbered are asked to by participating physician rosters, has vanished. take sides, to Some of the 1975 terms now seem dated or even incomprehensible to younger physicians. “Usual, customary and reasonable,” circa 1975 represented a qualitative consensus on what to charge patients for a given service. make decisions Such has been largely replaced by complex fee schedules, often with discounts from the primary amounts. based on being Beyond that is capitation and demographic data driving estimates as to how much care a group will consume. a competitor, Arguably this evolution to managed care has emerged due to medical care becoming far more costly than rather than it was circa 1975, to the point of being financially burdensome for most families. Greater technology, a wider retaining a choice of drugs, costly specialty drugs and implanted devices, all have raised healthcare’s share of the gross collegial national product to today’s staggering 18 percent.

In turn, that has created administrative mechanisms to curtail costs. But as one can see, with far less than relationship the intended results. Management costs themselves create one cost increment. Beyond that as last month’s to other Vital Signs Editorial discussed, certain pricing mechanisms, especially very high deductibles, more often physicians in benefit insurance corporations more than actual patients. Yes, let us use the term PATIENT, not “health care our community. consumer” or other business gibberish.

Concurrently, we have seen amalgamation of physicians into hospital-affiliated groups. Pursuant to that, we see specific competition for patient populations, prominent marketing to employer groups, and related advertising to individual policy subscribers who are now better able to purchase coverage, albeit with Exchange plan access barriers generated by punitively poor practitioner payments.

Regardless we should pause when we are asked to take sides, to make decisions based on being a competitor, rather than retaining a collegial relationship to other physicians in our community. Our patients are not merchandise to be bought and sold. We should not become sales people for a particular medical brand. While we may have a primary allegiance, we should not let such become absolute and divisive.

As the Fresno Madera Medical Society recreates its evolving role within our two counties, one of its charges should be to promote professional collegiality, to avoid having patients become commodities, and to keep our roles as business competitors’ subsidiary. Led by our 2015 President Dr. Al Aminian, there is no other local organization with that vision and responsibility.

While I spend time advising the administration of one particular local health system, a challenging and rewarding privilege, concurrently, I understand that I must also help promote a joint vision for health care in Central California with improved access and more acceptable cost restraints. Personally I am proud to be part of an April 3 stroke care CME event at St. Agnes that will include physicians from both of our two major systems, who have met to coordinate care in an area with evolving and improving interventions. The band Canned Heat sang: Let’s work together Now, now people Because together we will stand Every boy, every girl and man Change that rocking last line to “every doctor, nurse and man” and you will understand my vision for unifying health care in our Central Valley.

Author may be reached at Siriusguy @aol.com.

APRIL 2015 / VITAL SIGNS

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6 APRIL 2015 / VITAL SIGNS

CMA leaders converge on Capitol Hill to advocate for Medicare fix

In February, 25 California Medical Association (CMA) physician leaders were in Washington, D.C., as part of the American Medical Association’s Legislative Week to urge Congress to enact the bipartisan, bicameral legislation that would repeal the Medicare sustainable growth rate (SGR) and institute a new payment system.

The group also asked Congress to reauthorize the State Children’s Health Insurance Program, formerly known as Healthy Families, which is set to expire September 2015.

Medicare SGR Last year, both houses of Congress were very close to a permanent repeal of the badly broken SGR formula. For the first time in a decade, House and Senate Committees had adopted a bipartisan, bicameral payment system to replace the SGR. Unfortunately, they were unable to agree on how to pay for it, ultimately passing a patch to stop the SGR-triggered payment cuts for the 17th time in 10 years.

Congressional leaders have agreed to carry the bipartisan bill forward in the new Congress and leave it intact. However, there remains strong disagreement on how to pay for the bill, despite the House and Senate leadership’s stated commitment to enact the bill this year.

Fortunately, there is a growing chorus of conservative thinkers, such as the Wall Street Journal, Americans for Tax Reform and the Galen Institute, who have all told Congress that the projected SGR cuts are “phony” – lawmakers having never implemented the SGR over the last decade, instead adopting short-term patches year after year to stop the cuts – and therefore, the repeal itself does not need to be offset with corresponding funding. If Congress accepts this policy, they will only need to find an additional $30 billion to pass the bill.

Luther Cobb, M.D., CMA president, told Congress that half of California physicians are over the age of 55 and nearing retirement. Passage of Medicare payment reforms would bring the stability and resources necessary to physicians to keep them in practice. He also said that requiring financial offsets for the SGR is akin to a “payday loan” and a waste of federal resources. The cumulative cost of the patches now total more than the entire repeal legislation will cost. On behalf of CMA, Dr. Cobb urged Congress to move quickly to protect California’s seniors and military families.

Continued on next page

CMA NEWS Continued from page 6

Physician groups urge CMS to create contingency plans for ICD-10 transition

The

California Medical Association (CMA), American Medical Association (AMA), and 98 other state and specialty societies urged the Centers for Medicare and Medicaid Services (CMS) to put contingency plans in place for the October transition from ICD-9 to ICD-10 to avoid possible failures that could result in significant disruptions for physicians and Medicare patients. Now that CMS and the chairmen of the three Congressional health committees have announced they will not support a further delay in the implementation of ICD-10, organized medicine has turned its attention to CMS to institute protections for physicians.

CMA, AMA and the other groups are asking CMS to conduct end-toend testing in all modes of practice for a larger sample of physicians and to publicly release the results. Moreover, the groups are asking CMS to provide advance payments to physicians in the event that claims are delayed.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” said AMA President Robert M. Wah, MD. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”

CMA is separately urging CMS to delay implementation if the results from the end-to-end testing is not successful for at least 95 percent of physician claims. The group said it is concerned the “administration is underestimating the impact the transition to ICD-10 will have on the regulatory tsunami that is already burdening physicians and threatening access to quality care.”

Bill to eliminate the use of tobacco products at California baseball venues introduced in Assembly

A bill (AB 768) that would eliminate the use of all tobacco products –

including smokeless tobacco – at all baseball venues in California in an effort to protect the health of players and to set an effective example for children was introduced last week by Assemblymember Tony Thurmond (D-Richmond). A similar local measure was also introduced in San Francisco by Supervisor Mark Farrell.

Even as cigarette use continues to show a steady decline among youth, smokeless tobacco use has remained troublingly steady. According to the Centers for Disease Control and Prevention, in 2013, 14.7 percent of high school boys (and 8.8 percent of all high school students) reported current use of smokeless tobacco products. Each year, roughly 535,000 kids ages 12-17 use smokeless tobacco for the first time.

Last June, Hall of Famer Tony Gwynn died at age 54 after a long battle with salivary gland cancer, which he attributed to his longtime use of chewing tobacco. Two months later, pitching great Curt Schilling, only 47, announced his treatment for oral cancer that he said was “without a doubt, unquestionably” caused by 30 years of chewing tobacco.

The Tobacco-Free Baseball Act will apply to baseball games at all levels, including the major and minor leagues, all interscholastic and intermural play, and organized leagues for youth or adults. It will cover the players, the fans, and anyone in the venue during a baseball game or related activity.

Smoking is already prohibited at Major League Baseball parks; this legislation would simply expand the ban to include all tobacco.

Smokeless tobacco companies spent about $450 million on marketing in 2011 (the most recent year available) – more than three times the amount they spent in 1998.

While CMA has yet to take an official position on the bill, the legislation is in line with longstanding policy to reduce access to tobacco products.

Open Payments database available for physician review in April

The Centers for Medicare and Medicaid Service (CMS) announced that

it will make the Open Payments database available to physicians for their review of payments made to them by drug and medical device companies.

The Open Payments database is a part of the Physician Payments Sunshine Act, a provision of the Affordable Care Act. Last year’s inaugural launch of the Open Payments program was plagued with data inaccuracies and a less-than-user-friendly registration and review process. This year, medical device and drug manufacturers will have until March 31 to submit 2014 financial data. According to CMS, the 2014 payment data and updates to 2013 data will be published in June.

If you haven’t already registered for the Open Payments portal, do it now so you will have access to review and dispute any incorrect data this spring. Physicians should be aware that there is a two-step registration process for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Portal, a step many physicians may have already completed as the gateway enables access to a number of other CMS programs. Step two is to register in CMS’ Open Payments system.

Health Law Library

The California Medical Association’s (CMA) online health law library

contains over 4,500 pages of medical-legal, regulatory, and reimbursement information.

ON-CALL documents are free to members and can be found in CMA’s online resource library. Nonmembers can purchase medical-legal documents for $2 per page

Problems getting paid?

The

California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff.

Reimbursement Help Line (888-401-5911) or economicservices@ cmanet.org When to call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing, and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help.

• Are your claims not being paid in a timely manner?

• Are you not being paid according to your contract?

• A re your claims being denied after obtaining prior authorization or verifying eligibility?

• A re you receiving unreasonable requests for medical records or untimely requests for refunds?

• A re you having difficulty obtaining fee schedules and/or payment rules?

• Are your claims denied for timely filing?

• Have you been presented with a managed care contract and you’re not sure if the terms are consistent with California law?

APRIL 2015 / VITAL SIGNS

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BLOOD CENTER New Measures To Combat Vector-Borne Diseases Transfusion, Transmitted Babesiosis: New Screening Assays Move Closer To Approval Patrick Sadler, MD Central California Blood Center

According to the most recent data collected by the Food and Drug Administration, transfusion-transmitted babesiosis leads the causes of infectious mortality in transfusion recipients, accounting for 21 percent of the deaths.1 Although potential donors are asked about a history of the disease, this approach does not catch all infected individuals because they can be asymptomatic at the time of donation. In addition, FDA-licensed tests for donor screening that could reduce the risk of transmission are not available.

Babesia microti – a malaria-like parasite that infects red blood cells – is responsible for most babesiosis in the United States. It is transmitted by the bite of infected ticks, specifically Ixodes scapularis, typically in the nymphal stage. Blood centers in areas where B. microti-infected ticks are endemic – primarily the Northeast and upper Midwest – have taken steps to test donor samples using investigational assays. The results from their initial studies, published in “Transfusion,” demonstrate the efficacy of these screening tests and suggest that widespread donor screening in blood centers may be feasible.2,3 Carolyn Young, MD, vice president and chief medical officer of Rhode Island Blood Center in Providence, R.I., and lead investigator on a prospective study, estimates her center has tested 10,000 units since July 2010. Notably, no cases of transfusion-transmitted babesiosis have been reported from units tested as a part of the study.4 Medical and research directors are already thinking ahead to a time when FDA-licensed tests exist. “The hard question is what population to implement testing for,” said Beth Shaz, M.D., medical director of New York Blood Center. A July AABB Association Bulletin on babesiosis also identified this question as an issue for further consideration.5 CHIKUNGUNYA VIRUS – TAKING ACTION IN RESPONSE TO AN OUTBREAK IN THE CARIBBEAN Another vector-borne infectious agent, chikungunya virus, made headlines in December 2013 following the outbreak in the Caribbean and again in July 2014 when Florida health officials announced the first chikungunya cases acquired in the U.S. Infected Aedes aegypti and A. albopictus mosquitoes transmit the virus when they bite people.

Transfusion transmission of the virus has not been observed; however, experts warn of a theoretical risk.

To reduce this risk, a June 2014 AABB Association Bulletin on chikungunya virus encouraged blood collectors to inform donors to contact blood centers if they experience post-donation symptoms and have recently traveled to the Caribbean. 6 Another option is to defer donors for the duration of the virus’s incubation period – 14 to 28 days – if they have traveled to areas where epidemics are occurring.

However, blood centers do not know how many donors would be deferred under such a policy. “If we can avoid compromising the adequacy of the blood supply, then a travel deferral is a simple step to take,” said Louis Katz, MD, chairman of the AABB Transfusion Transmitted Diseases, or TTD, Committee. To better understand the effect of this type of deferral, the committee announced its plan to assess donor travel patterns during 8 APRIL 2015 / VITAL SIGNS

summer and winter in the June Association Bulletin. The committee has now devised and distributed the “Donor Survey of Travel to the Americas and Caribbean” to blood centers nationwide. “We focused on travel to the Caribbean and Latin America because we think U.S. residents travel to these areas more frequently than other areas where outbreaks have occurred,” said Steven Kleinman, MD, senior medical advisor of AABB. Kleinman also serves on the TTD committee.

The committee distributed more than 100,000 anonymous surveys, which asked donors to provide their zip code of residence and travel history for the previous 14 to 28 days. Katz and Kleinman expect analysis of these responses will provide a better idea of donors’ travel patterns, but are not certain whether they will lead to a recommendation for travel-related deferrals. “Ultimately, we will take results from the survey and combine them with other information on the epidemic and then make a decision on any deferral,” said Kleinman. In any case, the committee plans to disseminate the information to the broader blood bank community.

Katz and Kleinman also cautioned that the current study surveyed travel patterns of donors during August and September 2014. The committee anticipates doing a second survey during the winter months when donors may be more likely to visit these popular destinations. “We are being precautionary,” said Katz. “We want to know what the effect on the donor pool would be if we had to respond to an outbreak.”

Kleinman also is looking ahead to how the data may be used in the future. Travel patterns are a concern for dengue, another mosquitoborne virus. “Because the survey asks about regions where both viruses are endemic, the results could help with deferrals for exposure to dengue virus,” said Kleinman.

References: 1. Food and Drug Administration. Fatalities reported to FDA following blood collection and transfusion: Annual summary for fiscal year 2013. http://www.fda.gov/Biologics BloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ ucm391574.htm. Accessed August 20, 2014.

2. L evin AE, Williamson PC, Erwin JL, et al. Determination of Babesia microti seroprevalence in blood donor populations using and investigational enzyme immunoassay. Transfusion doi: 10.1111/trf.12763.

3. Moritz ED, Winton CS, Johnson ST, et al. Investigational screening for Babesia microti in a large repository of blood donor samples from nonendemic and endemic areas of the United States. Transfusion doi: 10.1111/trf.12693.

4. Young C, Anjulika C, Berardi V, et al. Preventing transfusion-transmitted babesiosis: preliminary experience of the first laboratory-based blood donor screening program.

Transfusion 2012; 52:1523-29.

5. AABB. Association Bulletin #14-05. Babesiosis. July 18, 2014.

6. AABB. Association Bulletin #14-03. Chikungunya Virus. June 6, 2014.

(Source: ‘New Measures to Combat Vector-Borne Diseases’, by Katherine Bricceno, Ph.D., AABB News, October 2014) NSFUSION-

HEALTHCARE REFORM OFFICIALS REVOKE BLUE SHIELD OF CALIFORNIA’S TAX-EXEMPT STATUS

CMS UNVEILS ‘NEXT GENERATION’ ACO MODEL FOR PATIENTS, PROVIDERS

The California Franchise Tax Board has stripped the not-for-profit Blue

Last month, CMS unveiled the Next Generation Accountable Care Organization Model, which it hopes will provide an attractive alternative payment model for providers wary of existing models, MedPage Today reports.

Patrick Conway, CMS CMO and deputy administrator for innovation and quality, said CMS, after launching its Medicare Shared Savings and Pioneer ACO programs, “started to hear from stakeholders that [said], ‘You really need a next-generation model’” (Frieden, MedPage Today, 3/10).

According to Modern Healthcare, the new model uses a combination of fee-for-service and capitation (Evans, Modern Healthcare, 3/10). It creates four payment systems and two risk tracks for its participants, including one with almost full risk (Williams, Healthcare Dive, 3/10).

In a blog post for CMS, Conway wrote that the Next Generation ACO Model “sets more predictable financial targets.” He explained, “To support increased risk, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients” (Conway, CMS blog post, 3/10).

In a significant departure from existing ACO options, patients under the new model will be able to voluntarily sign up to participate in the ACOs. In exchange, they will pay reduced or no copayments for certain services, such as primary care visits (Modern Healthcare, 3/10). Participation in the ACO does not limit patients’ choice of providers, according to Conway.

CMS will accept applications for the Next Generation ACO Model in two rounds that conclude on June 1, 2015, and June 1, 2016, respectively.

To be eligible, provider groups must serve at least 10,000 Medicare beneficiaries. Conway predicted that Pioneer ACOs and Medicare Advantage providers might be interested in the new model (MedPage Today, 3/10).

The program is slated to launch in January 2016 and expand the following year to reach between 15 and 20 ACOs, Conway said (Modern Healthcare, 3/10).

Shield of California of its tax-exempt status, the Los Angeles Times reports.

According to the Times, the tax-exempt status revocation comes as Blue Shield has faced criticism over its: • Executive pay; • Rate hikes; and • $4.2 billion surplus.

According to the Times, Blue Shield’s surplus at the end of 2014 was four times as much as what the Blue Cross and Blue Shield Association requires insurers to stockpile to cover future claim Advocates also have criticized Blue Shield for failing to serve Medi-Cal beneficiaries.

In addition, critics have raised concerns about Blue Shield’s lack of transparency. For example, the insurer’s 2012 filings did not list any executive employees by name.

Michael Johnson, former public policy director at Blue Shield, said that the insurer has been “shortchanging the public” for years. Johnson said that he plans to launch a campaign to convert the insurer into a for-profit company and force it to return billions of dollars to the public.

Blue Shield said it would protest the decision.

FDA APPROVES FIRST BIOSIMILAR MEDICATION TO BE SOLD IN U.S.

Last month, FDA approved Zarxio, Novartis AG’s version of Amgen’s biologic drug Neupogen, making it the first biosimilar medication approved by the agency, the Wall Street Journal reports (Rockoff/Loftus, Wall Street Journal, 3/6).

According to the Washington Post’s “Wonkblog,” Novartis is already selling the biosimilar in more than 40 countries (Millman, “Wonkblog,” Washington Post, 3/6).

Biologics are developed from living cells, which makes the drugs both costly to develop and impossible for generic drugmakers to manufacture exact replicas. However, generic drugmakers can develop less-costly versions of the drugs, called biosimilars, that are close enough to biologics to function in the same manner.

Overall, FDA said Zarxio and Neupogen have “no clinically meaningful differences” (“Wonkblog,” Washington Post, 3/6).

FDA said it soon would release official guidance on naming biosimilars, as well as on interchangeability. According to “Wonkblog,” such guidance could affect the uptake of biosimilars, since pharmacies could automatically substitute a product deemed interchangeable for the brand name biologic (“Wonkblog,” Washington Post, 3/6).

Despite FDA approval, it could be weeks until the treatment is available in the U.S., the Journal reports.

AAMC PROJECTS PHYSICIAN SHORTAGE OF BETWEEN 46K TO 90K BY 2025

The U.S. could face a shortage of between 46,000 and 90,000 physicians by

2025, according to a new report from the Association of American Medical Colleges, Modern Healthcare reports (Robeznieks, Modern Healthcare, 3/3).

The researchers said that a third or more of the physicians currently practicing could retire within 10 years. Further, they noted that the younger physicians replacing the older ones tend to work fewer hours. Meanwhile, the number of people over age 65 is expected to increase by 46% by 2025, according to AAMC Chief Health Care Officer Janis Orlowski (Modern Healthcare, 3/3).

According to the report, the greatest shortfall by percentage will be among surgeons, particularly among those specializing in diseases common among older people, such as cancer and chronic illnesses (“To Your Health,” Washington Post, 3/3). Overall, the number of specialists will fall short of demand by between 28,200 and 63,700 physicians by 2025.

In addition, the report authors expect that the demand for primary care physicians will exceed supply by about 12,500 to 31,100, CQ HealthBeat reports (CQ HealthBeat, 3/3).

APRIL 2015 / VITAL SIGNS

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Fresno-Madera Medical Society Presents Awards at Regional Science Fair The 62nd Annual Central California Regional Science, Mathematics & Engineering Fair was held in March at the Post Office Box 28337 Fresno, CA 93729-8337 1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: www.fmms.org Officers A.M. Aminian, MD President Hemant Dhingra, MD President-Elect Ahmad Emami, MD Vice President Alan Kelton, MD Secretary/Treasurer Prahalad Jajodia, MD Past President

Fresno County Fairgrounds. The event provides an educational experience and stimulates young people’s interest in science, mathematics, computer, technology and engineering. It also provides for public recognition for their work. In addition to the regular panel of judges for the entire event, independent judges who represent government, professional and service organizations also judge and present awards within their specific areas.

FMMS thanks this year’s judges – UCSF-Fresno Residents: Drs. Benji Huang, Rachel Manalo, K. Kiran Reddy and Satjit Sanghera.

This year’s winners and their projects are: Junior Division • 1st Place: Sarah Sumner: Fairmont Elementary; Title: Will Spices Increase or Decrease an Organism’s Heart Rate?

• 2nd Place: Andrew Cardoso: Quail Lake Environmental Charter; Title: Determining the Most Effective Way to Clean a Pacifier Senior Division: • 1st Place: Onkar Sandu: Clovis North High School; Title: A Novel Sensor for the Detection of Heart Disease • 2nd Place: Titus Patton: Sanger High School; Title: Antimicrobial Properties of Stingray Mucus Congratulations to all!

Board of Governors Alan Birnbaum, MD William Ebbeling, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Trilok Puniani, MD Ranjit Rajpal, MD George Saul, MD Roydon Steinke, MD Connor Telles, MD Cesar Vazquez, MD CMA Delegates FMMS President Don Gaede, MD Brent Kane, MD Brent Lanier, MD Andre Minuth, MD Ranjit Rajpal, MD Oscar Sablan, MD Roydon Steinke, MD Toussaint Streat, MD

Resident Doctors Rachel Manalo and Satjit Sanghera read over one of the science projects.

CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD Praveen Buddiga, MD Surinder P. Dhillon, MD Trilok Puniani, MD CMA Trustee District VI Virgil Airola, MD Staff Carol S. Yrulegui Interim Executive Director Doreen Chaparro Physician Liasion

10 APRIL 2015 / VITAL SIGNS

Doctors H. Kiran Reddy, Satjit Sanghere and Rachel Manalo judging at this year’s Regional Science Fair.

Fresno-Madera

In Memoriam Robert J. De Klotz, MD 50-year member

Robert De Klotz, MD, a retired urologist, passed away March 1, 2015 at the age of 86.

Dr. De Klotz was born in Twin Falls, ID in 1928. He received his medical degree from the University of Kansas in 1959 and completed his internship and residency training at Good Samaritan Hospital in Portland, OR and Presbyterian Medical Center in San Francisco. He began his practice in Fresno in 1964 and retired in 1997. He served as historian for the American Urological Association and was instrumental in the formation of its urological antiquities collection. In addition he was instrumental in forming the Fresno-Madera Medical Society’s Historical Library, including a donation of his collection of leather bound medical books.

Dr. DeKlotz is survived by his two children and four grandchildren.

COMING IN JUNE 2015

ICD-10 Code Set Training Seminar Intensive 2-day, ICD-10 code set training designed specifically for coding staff.

This onsite training course is approved for 16 CEUs through AAPC. Dates to be determined Call 559-224-4224 x 112 for further information.

This walking program is risk free and requires no preparation. Physicians just need to: SPEND A SATURDAY MORNING: • Presenting a 2-3-minute talk on the health benefits of walking from the perspective of your specialty • Leading a 45-50 minute walk around San Joaquin River Parkway in Fresno or Town & County Park in Madera • Answering potential questions from the walkers Encourage patients to take steps to improve their health Fresno-Madera Medical Society Physicians: Looking for ways to: • Add more physical activity to your lifestyle?

• Be a role model and inspiration to your patients and your community?

• Spend more time with your family and friends?

Consider volunteering ONE HOUR every month or two in the FresnoMadera Medical Society’s: WALK WITH A DOC Program

MADERA: APRIL 4

Town & Country Park Pavilion Area Registration 7:15am Walk Event 7:30am-8:30am Ready to Volunteer?

Call the FMMS office: 559-224-4224x110 or email: receptionist@fmms.org

FRESNO: APRIL 18 Stress Awareness/Public Health

San Joaquin River Parkway New Location: Meet at the San Joaquin River Parkway River Center 11605 Old Friant Rd. Registration 7:15am Walk Event 9am-10am

Find us on Facebook: Fresno-Madera Medical Society www.facebook.com/pages/Fresno-MaderaMedical Society/107731015917068

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Kern Michelle S. Quiogue, MD

2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org Officers Michelle S. Quiogue, MD President Vipul R. Dev, MD President-Elect Eric J. Boren, MD Secretary Bradford A. Anderson, MD Treasurer Alpha J. Anders, MD Past President Board of Directors Alberto Acevedo, MD William J. Farr, MD Susan S. Hyun, MD Kristopher L. Lyon, MD Betsy Matkovic, MD Mark L. Nystrom, MD Eric A. Peck, MD Edward W. Taylor, III, MD Linda P. Veneman, MD CMA Delegates Jennifer Abraham, MD Lawrence N. Cosner, Jr., MD Vipul Dev, MD John Digges, MD CMA Alternate Delegate Sarah Assem, MD CMA YPS Delegate Cyrus R. Moon, MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

President’s Message As a KCMS-CMA member, you have one of the most talented staffs in the industry looking after your interests in Sacramento and Washington, D.C. But the benefits of membership don’t stop there.

Aimed at meeting both your professional and personal needs, CMA’s extensive network of benefit partners makes it so that your membership can easily pay for itself. Members receive deep discounts on everything from magazines to office supplies to insurance products. Members can offset the price of their annual dues when using membership services and discounts.

Union Bank provides members with a variety of discounted financial services, including payroll processing, fraud reduction, business credit and treasury management solutions. As an already established leader in the health care market, Union Bank’s staff is uniquely positioned to assist you and your practice. Find out more at www. unionbank.com/CMA. Website Development: Mayaco Design and Marketing offers members discounted website development services for their practices. Contact Mayaco at (209) 957-8629 or www.mayaco.com for information.

DocBookMD: Members are eligible for a free download of the DocBookMD smart phone app which allows you to securely send HIPAA-compliant messages directly from your iPad, iPhone and Android devices. Find out more at www.docbookmd.com.

Office Supplies: Save up to 80% on office supplies and equipment from Staples, Inc. Visit www.cmanet.org/ benefits to access the member-only discount link.

Car Rentals: CMA members save up to 25% on car rentals for business or personal travel from Avis and Hertz.

Wells Fargo Advisors: Members are entitled to one-on-one financial consultations, professional investment advice and several more discounted services from Wells Fargo’s team of financial experts. Learn more about these services and special CMA member benefits at www.cmanet.org/wells or call (855) 225-4363.

Medical School Debt Management: GL Advisor is a financial advisory firm that specializes in helping physicians effectively manage medical school debt and other financial matters. Members receive a $50 discount on 12 months of service. Get your coupon code at www.gladvisor.com/cma.

In addition to these benefits, the entire spectrum of member services is at your fingertips.

Obtain one-on-one assistance to identify, prevent and fight unfair payment practices.

Access valuable professional resources, including more than 5,200 pages of legal information related to the practice of medicine, for free by visiting CMA’s Health Law Library at www.cmanet.org/cma-on-call .

Get the latest tools for negotiating contracts, billing issues and more by utilizing on-demand webinars at www. cmanet.org/webinars.

For more information about any of these member benefits, visit www.cmanet.org/benefits.

BENefits at your fingertips Activate your CMA web account today at www.cmanet.org CMA staff ready to serve you by calling (800) 786-4262

2015 KCMS MEMBERSHIP DIRECTORY

The

2015 KCMS Membership Directory is here!

Additional copies may be obtained by using the Order Form on page 7 or call the KCMS Office, (661) 325-9025

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March 2015 Membership Recap

Active....................................................................................................256 Resident Active Members...........................................................14 Active/65+/1-20hr.............................................................................4 Active/Hship/1/2Hship................................................................0 Government Employed...................................................................4 Multiple Memberships....................................................................1 Retired....................................................................................................63 Total....................................................................................................342 New Members (Pending Dues)..................................................1 New Members (App Pending)...................................................0 Total Members..........................................................................343

Kings

Tulare

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org

Officers Jeffrey W. Csiszar, MD President Vacant President-Elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President Board of Directors Bradley Beard, MD Jacqueline G. DeCastro, MD Thomas S. Enloe, Jr., MD Michael MacLean, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

Honduras Medical Mission Steve Carstens, DO, MS, FACEP Clinical Faculty, Department of Emergency Medicine Kaweah Delta District Hospital and Member, Sequoia Deanery of the San Joaquin Valley

Have you ever thought about working with a humanitarian medical mission?

If so, you might be interested in joining the Sequoia Deanery ecumenical medical mission group to Honduras June 28 through July 7. The group will be hosting its 16th trip this summer when they visit the highland community of San Miguel de Matazanalez.

The group has served over 6,000 patients over the last 1-1/2 decades with eleven providers. Last year we saw approximately 450 patients during the five days of clinic operation. Our goal is to provide access to medical and dental care that patients in remote areas might not otherwise have. Furthermore, as we continue to grow, we are looking at ways to integrate with the local health agencies to identify and maintain necessary treatments for those patients with chronic illnesses.

We have found that the most successful team members must have the ability to have a passion for serving the underserved as well as the ability to Please see Honduras on page 14

Officers Monica Manga, MD, ABIM President Virinder Bhardwaj, MD President-Elect Raman Verma, MD Secretary/Treasurer Thomas Gray, MD Past President Board of Directors Anil K. Patel, MD Jerry Jacobson, MD Pradeep Kamboj, MD Matthew Kirkman, MD Christopher Rodarte, MD Antonio Sanchez, MD CMA Delegates Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates Robert Allen, MD James Foxe, MD Mark Tetz, MD Sixth District CMA Trustee Ralph Kingsford, MD Staff Francine Hipskind Executive Director Thelma Yeary Membership Dana Ramos Administrative Assistant Lydia Garcia Administrative Assistant

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Tulare Tulare County Medical Society Upcoming Events

Calling All Tulare County Medical Society Members

SPRING GENERAL MEETING

VISALIA UNIFIED HIGH SCHOOLS NEED YOU!

Thursday, April 9, 2015 • 6pm Speaker: Peter N. Bretan, MD, founder of LifePlant.org If you have any questions, please feel free to call the Tulare County Medical Society office at 559-734-0393 and ask to speak to Dana Ramos.

You may also email her at DRamos@tkfmc.org .

SAVE THE DATE FOR TCMS

Wine Social

May 8, 2015 Chinese Cultural Center

Join us at the next Walk With A Doc to take a step toward a healthier you! All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness.

ANYONE CAN ATTEND! For more information, please contact Tulare County Medical Society at (559) 627-2262 TULARE: Del Lago Park Saturday, April 18, 2015 Topic: CARDIO Registration: 8:00am Walk Time: 8:30am VISALIA: Blain Park, 3101 S. Court St. Saturday, April 11, 2015 8:00 to 9:00 am

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Once again the Tulare County Medical Society is assisting the high schools in the Visalia Unified School District to provide annual sports physicals for athletes. In the past many of you have graciously agreed to participate in the event and we would like to ask you to do so again. We have scheduled two days of physicals with two high schools each day.

May 6, 2015 • 12:00-3:00pm • Golden West High School • Redwood High School May 20, 2015 • 12:00-3:00pm • Mt. Whitney High School • El Diamante High School For more information, or to volunteer for this meaningful project, please contact: Thelma Yeary, TCMS at 559-627-2262 or thelma@tkfmc.org.

Honduras Continued from page 9 work collaboratively with the group as a whole. We have had and continue to work as a coalition of family practice and emergency physicians as well as pediatricians and dentists. Certainly the ability to speak Spanish will be helpful although we do have translators available.

Furthermore, families are welcome as we have had some sixteen teenagers over the years accompany us on our trips and work side by side with the providers. These youth have had some life-changing experiences and some have even gone on in the medical field and others have pursued degrees in Spanish.

Logistically, the trip costs roughly $1,000 per person. Some costs are covered by the mission itself.

An important caveat: we are completely self-funded and all monies come from fund-raising activities such as raffles, rummage sales, etc. We ask that group members both participate in our planning sessions as well as help out with raising money (this has really not been a problem when our members see the benefits). Our port of departure is LAX, travel through El Salvador, and the point of entry is San Pedro Sula.

While we work really hard when the clinic is up and running, a duration of about five days, we also traditionally try to plan for a two to three day R and R at the end of the trip. This is a completely optional component of the mission. Past trips have included the Mayan ruins at Copan, Pico Bonito, Panama, Guatemala, and Lake Titicaca and Machu Picchu (Lima, Peru trip).

At this point we are looking for two providers (preferably primary care; physician assistants or nurse practitioners), dentists, and veterinarians. Please contact either myself at (559) 799-1702 or Sue Nyberg at (559) 733-8244 if you would like further information. Thanks!

CLASSIFIEDS

d

How Successful Is Your Practice?

Let physician members know your practice is available for referrals Use Vital Signs to advertise your practice at special rates offered to member physicians. contact: Annette Paxton Vital Signs Advertising Representative (559) 454-9331

­­Members: 3 months/3 lines* free; thereafter $20 for 30 words.

Non-Members: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30. *Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

FRESNO ANNOUNCEMENT

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University Psychiatry Associates: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC, M-F 8am-5pm. Call 559-320-0580.

PHYSICIAN WANTED .

On-site urologist seeking FM/IM physician to collaborate wellness programs and referral resources in addition to sexual health/urology practice.

Office space available to share in N/E Fresno at 7005 N. Milburn. Call Shelby at 559-277-3963.

Hospitalist: In-Patient MD in hospital to coordinate patient care btwn specialists. Requires a MD or foreign equivalent plus 36-month residency in IM. Must be Board Eligible/Board Certified in IM. Send resume to Community Hospitalist Medical Group, 1180 E. Shaw Ave. Fresno, CA 93710

Place your next classified here!

Vital Signs has over 1,300 monthly readers.

Reach physicans just like YOU with your need or want.

TULARE .

FOR LEASE / RENT / SALE

Prime location medical offices, across the street from Visalia Medical Clinic. 2200 sf. 5601 W. Hillsdale Ave., Visalia. Call 559-786-0512.

Office space in prime medical location at 220 S. Akers St., Visalia. Perfect for primary care or allergy specialist to open practice in vacated allergist office. Call Shelby at 559-277-3963.

KERN FOR SALE 1880s Victorian office building, corner lot next to Cancer Center & San Joaquin Hosp. 1200 sf, off-street parking; wheel chair ramp; lobby; secretarial area; 3 offices; conference rm; kitchen; basement; alarm; storage building. $450,000 OBO, 1402 26th St. Bakersfield. Call Don 661327-2367 or Mike 661-747-4553.

Well established, turnkey medical weight loss clinic. Over 300 active patients and thousands to build from. Cash business with bariatric computer system. Finance with ProMed Financial. Contact Susan at wtloss4sale@yahoo.com.

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