Central Valley Physicians Winter 2016

Physicians Central Valley

Serving Fresno Madera, Kern and Kings Counties

A Giving Practice VALLEY PHYSICIANS HONORED FOR SERVICE- ORIENTED CAREERS

Fresno Madera Medical Society Elects New Officers CMA Delegates Set Policy at Annual Meeting Can a Solo Practice Survive in Today’s Environment?

Winter 2016

Success.

It’s what California’s finest physicians strive for... and what CAP can help you achieve.

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice, and are committed to supporting you with a range of valuable programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

Protect Your Online Reputation With CAP’s Free Physician’s Action Guide!

The Physician’s Online Reputation Action Guide can help you build a strong and positive reputation.

Learn how to: • Encourage patients to post positive reviews.

• Appropriately respond to negative reviews.

• Optimize social media to establish your credibility.

Request your free electronic or hard copy today!

800-356-5672 | CAPphysicians.com/ReputationPro 2

CENTRAL VALLEY PHYSICIANS

Winter 2016

VOLUME 1, NUMBER 1 • WINTER 2016

Cover Photo by Tomas Ovalle

{FEATURES}

12 28 36 46 50 54 Winter 2016

2015 HOUSE OF DELEGATES A GIVING PRACTICE

Valley physicians honored for service-oriented careers

CMA BENEFITS AND PROTECTS CAN A SOLO PRACTICE SURVIVE in today’s environement?

PHSICIAN SHORTGAGE in Kern County

IN MEMORIAM

Alex Moir, MD, James P. Zettas, MD, Bruce Berg, MD

{DEPARTMENTS} 20 FRESNO MADERA MEDICAL SOCIETY

Elects New Officers

22 IN THE NEWS

New faces and Announcements

34 FRESNO MADERA MEDICAL SOCIETY’S

ANNUAL INSTALLATION AND AWARDS GALA Photo Spread

40 NEW FACES

of Fresno Madera Medical Society

42 PUBLIC HEALTH

A Message from America’s Blood Centers

44 PRACTICE MANAGEMENT:

Committed to Improving Quality Health Care

53 KERN COUNTY MEDICAL SOCIETY

Elects New Officers

CENTRAL VALLEY PHYSICIANS

3

Letter From The Executive Director

HARD WORK AND CHANGE My name is Nicole Butler and I am the new Executive Director of the Fresno Madera Medical Society… well six months new I should say.

NICOLE BUTLER

To give you some background, I have been working in health care industry for the past 15 years mostly in marketing and sales. I have worked for Adventist Health Hospitals in Hanford, Community Medical Centers and most recently was part of launching the first PACE program in Fresno. All of which I thought was challenging, until I got to Fresno Madera Medical Society.

Working for a non-profit organization that was formed 133 years ago is an honor, but also challenging. Fresno Madera Medical Society was organized in 1883 when there were seventeen physicians practicing in Valley, now Fresno and Madera have over 3000 physicians and residents serving the population.

Our goals are simple for 2016, but will require a lot of hard work.

1. Strengthen and build the Medical Society. Currently we have just over 1000 members our goal is to grow by 13% therefore we need to maintain current membership and recruit 130 new members.

2. Provide more benefits to our members. Our focuses this year are increase CME opportunities, improve the well-being of our physicians and host more networking events.

3. Provide resources to practice managers so they can increase efficiency and productivity.

For those members that have supported the medical society for so many years, I want to thank you. And for those physicians that have not been part of the society we will be reaching out to you providing educating on member benefits. We want you to be part of this special group of local physicians who understand the importance and value of working together to create healthy communities through statewide and local advocacy, professional education and networking.

I am very honored and proud to be a part of this health care community and this organization – that for more than 100 years has focused on the important needs and interests of physicians and their patients. I am ready for the challenge and the hard work it will take to be successful.

If you have any questions about becoming a member, accessing services or need assistance, do not hesitate to contact me at (559) 224-4224 ext. 114 or email nbutler@fmms.org.

Thank you,

PRESIDENT Hemant Dhingra, MD PRESIDENT-ELECT Alan Kelton, MD VICE PRESIDENT Trilok Puniani, MD SECRETARY-TREASURER Cesar A. Vazquez, MD PAST-PRESIDENT A.M. Aminian, MD BOARD OF GOVERNORS Christine Almon, MD, Alan Birnbaum, MD, Jennifer Davies, MD, Joseph Duflot, MD, William Ebbeling, MD, Don Gaede, MD, David Hadden, MD, Christina Maser, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Katayoon Shahinfar, MD, Roydon Steinke, MD, Jessica Lee, MD CENTRAL VALLEY PHYSICIANS EDITOR Alan Birnbaum, MD MANAGING EDITORS Nicole Butler and Millie Thao EDITORIAL COMMITTEE Alan Birnbaum, MD - Chair, Don Gaede, MD - Associate Editor, Virgil Airola, MD, Hemant Dhingra, MD, Roydon Steinke, MD, Cesar Vazquez, MD, Nicole Butler, Millie Thao CREATIVE DIRECTOR www.sherrylavonedesign.com CONTRIBUTING WRITERS Alan Birnbaum, MD, Eddie Hughes, Susan Rossmann, MD, PhD, Millie Thao CONTRIBUTING PHOTOGRAPHERS Tomas Ovalle, Derek Martin CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: Central Valley Physicians 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720 Phone: 559-224-4224 • Fax: 559-224-0276 Email Address: nbutler@fmms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9 a.m. to 5 p.m.

Closed from 12 to 1 p.m.

MEDICAL SOCIETY STAFF Executive Director Nicole Butler Director, Communications and Physician Relations Millie Thao CMA HOUSE OF DELEGATES REPRESENTATIVES Hemant Dhingra, MD*, A.M. Aminian, MD, Patrick Golden, MD, Brent Kane, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Roydon Steinke, MD, Toussaint Streat, MD ALTERNATES Alan Kelton, MD*, Naeem Aktar, MD, Praveen Buddiga, MD, William Carveth, MD, Trilok Puniani, MD, Swarnpal Sekhon, MD *Automatic Delegate

Nicole Butler Executive Director Fresno Madera Medical Society

4

CENTRAL VALLEY PHYSICIANS

Winter 2016

January 2016

Y

C  W

A REPORT ON WHAT IT TAKES TO MAKE A HEALTHY COMMUNITY

The One-in-a-Million ER

Table Mountain Rancheria Trauma Center

1 MILLION PATIENTS 2007-2016

LIFE SAVER. SAFETY NET. SAVING GRACE. Shortly before the calendar turned to 2016, the one millionth patient was treated in Community Regional Medical Center’s emergency department. When the Table Mountain Rancheria Trauma Center opened in 2007, its football-field sized emergency department was the largest in California. It quickly became one of the busiest serving an average of 355 patients a day – 17 on average for trauma care.

Community Regional serves as the region’s hub for higher level care, with 25 outlying hospitals transferring 1,074 trauma patients to it last fiscal year. The hospital’s 57 emergency beds are nearly always full, many days requiring another 60 hallway beds to temporarily address the overflow.

Much of the increase in patients results from the expansion of insurance coverage through the Affordable Care Act (ACA) – particularly Medi-Cal. Community Regional, the state’s fourth largest hospital in terms of beds, has more inpatient Medi-Cal discharges than any hospital in California, surpassing even Los Angeles County/USC Medical Center. “Medi-Cal patients are always the highest utilizers of emergency departments,” said Dr. Gene Kallsen, a UCSF clinical professor of emergency medicine.

“There are not enough doctors accepting Medi-Cal.”

In 2013 to expedite treatment, Community Regional’s ER staff began triaging patients in waiting areas. Now, more than 62% of patients start their care here and 56% of those patients can be treated and discharged without using an ER bed. Community Regional also opened a new Prompt Care Clinic with extended hours to care for those with less critical needs. And a patient flow command center was set up to increase the daily capacity to treat patients from an average of 600 to 630.

Level 1 trauma & burn service area includes 2.5 million people in 9 counties

San Francisco

2nd busiest ER in California, caring for 10,000 patients a month

Community Regional sees more critically ill patients than any other California hospital – 25,000 last fiscal year in need of Fresno immediate, critical care Los Angeles

MAKING CARE ACCESSIBLE: CommunityMedical.org/about-us

One Network. One Community.

Clovis Community Medical Center | Community Behavioral Health Center | Community Regional Medical Center | Fresno Heart & Surgical Hospital

Winter 2016 CENTRAL VALLEY PHYSICIANS 5 WHAT HAPPENS WHEN A HOSPITAL NETWORK AND ITS COMMUNITY ARE CONNECTED? FIND OUT AT CommunityMedical.org/about-us

A message from our Editor > Alan M. Birnbaum, MD

Are we going to cook or are we going to measure?

ABOUT THE AUTHOR ­ Alan M. Birnbaum, MD, is Board Certification in Adult Neurology and is with Spruce Multispecialty Group. Dr. Birnbaum is currently Medical Director of the Saint Agnes Medical Center Stroke Program and a Board Member of Fresno Madera Medical Society.

6

CENTRAL VALLEY PHYSICIANS

TAKE FIVE. Consider putting on the famous jazz instrumental by the late Dave Brubeck, “Take Five,” his swinging masterpiece in 5/4 time, to calm your mood for my thoughts below. Then ponder all meanings of the title, including the original directive to relax for a few minutes, but for medical QUALITY, it means giving patients five extra minutes. Consider some approaches and then some BARRIERS. Despite federally designed directives to cut the time physicians spend with patients, TIME means real value to the person and/or family in your exam room. The recently and sadly lost Chief of Family and Community Medicine at UCSF Fresno, Alex Moir, MD, once explained on receiving an award that he never rushed examinations and always tried to get to know his patients. Quoted in the Fresno Bee, Dr. Moir, a member of many professional associations, including the Fresno Madera Medical Society, when receiving the 2012 Physician of the Year Mission award from Adventist Health Central Valley Network, explained: “Whole-person care is important to better establish a relationship with patients. Patients develop a level of trust, which helps me to work with them to treat the real issue instead of just the symptoms.”

For a general medical practice, that extra five minutes may mean the difference between leaving a patient on a sloppy amalgam of ten medications, instead of doing

a medication reconciliation that cuts that mix down to six, decreasing dosing to twice a day, so improving compliance and benefit.

A dispassionate auditor might even find that such cuts cost to the system.

In a surgical practice, an extra five extra minutes often represents a pre-incision “time out,” averting otherwise unseen hazard. Or, that time might allow personally seeing a post-op patient rather than leaving care completely to a physician’s assistant.

Such extra minutes can allow input from a family member, sometimes raising an alternative diagnosis or treatment. How many of us have heard a comment alerting us to a companion having an issue of unappreciated importance? “Oh, I also have that tinnitus thing, just my left ear last six months, goes along with my pulse.” That person needs to have their own doctor order a carotid ultrasound!

Five minutes can be a metaphor.

Sometimes it really means fifteen minutes, the difference between what I have for years scheduled for a typical new patient neurology consultation, and what I was allotted circa 1979 when working per diem for an HMO. These extra minutes, particularly as I explain my conclusions, can elicit extra information that impacts how I finalize details of further studies and management.

Adequate time for visits is the commodity that drives “concierge” practices, whose patients pay out of pocket for a different

Winter 2016

pace and style of medicine. Finally, five minutes more on a schedule can realistically requires a full-time data analyst and compliance officer. I mean that by the last patient of the morning or day, the doctor remains do know individuals who do similar or at least parallel work. To have on or close to schedule. Little irks patients more than waiting not fifteen the talent, training and tenacity to be effective requires a substantial minutes or less for their appointment, but half an hour, an hour, or…two background in healthcare, statistics, and law. A goal for such a person hours. Having an achievable schedule represents an important element would be to at least keep Medicare reimbursements for their group of life quality for a physician. neutral.

Enough for the benefits of that extra five minutes, the core of what I estimate the cost to my smaller group of six partners, one employed I personally consider to be medical QUALITY. We should try to physician and one physician’s assistant as up to $10,000 per provider attain that if we possibly can. As to BARRIERS, consider what the per year. Down the street, the much larger orthopedic group might mother of famed New York Times restaurant and cuisine writer Mimi experience a somewhat lower cost per doctor, the same for the mediumSheraton heard from her aged mother as she began cooking with her to sized primary care group across the street from them. Outsourcing quantitatively capture treasured family recipes. I retrieved Sheraton’s compliance tasks to individuals or firms who specialize in such work 1979 classic, “From My Mother’s Kitchen: Recipes and Reminiscence,” might some mitigate costs, similar to how we must pay for software from a bookshelf where it had been ironically co-existing next to John “maintenance” of our federally-mandated EHR, our Electronic Health Nance’s 2009 book “Why Hospital Should FLY: The Ultimate Flight Record but it is a tax regardless.

Plan to Patient Safety and Quality Care.” I found the quote I recalled as What will happen to practices that find themselves failing federal the first sentence of the Introduction, mother protesting to her daughter, benchmarks, then PENALIZED, causing significant drops in Medicare “Are we going to cook or are we going to measure?” payments? Likely large numbers of them will simply close their doors, Thanks to an insufferable string of federal directives particularly as their physicians seek affiliation with more statistically successful affecting Medicare practice and reimbursements, physicians find organizations, not necessarily in the same area. Such shifts could even themselves today in Beatrice Solomon’s kitchen. When the CMS further aggravate already inadequate physician to patient ratios in “cookbook” for supposed “quality improvement” frustrates and alarms even my organized German-born office manager, Barbara (Blersch) Cordova, who asks ten Allow us to cook more and measure less. Pay doctors questions about these, I consider her query, “Do you really think these programs improve healthcare?” simply and honestly for the care they provide.

The implied answer to her ten questions is…NEIN. As Drop all artificial and intrusive schemes. a parallel decision, shall we remain physicians or become statisticians? Consider the “alphabet soup” of directives as indigestible to practicing physicians as an undercooked matzoh ball in Mrs. Solomon’s chicken soup: underserved areas like our Central Valley. In turn that would make the PQRS – the central arrhythmic heartbeat of the bureaucracy, concept of “Take Five,” to improve the quality of the individual patient“Physicians’ Quality Reporting System,” with us since 2006 physician visit by increasing time spent, impossible to achieve. We would VBPM – “Value-Based Payment Modifier,” differential payments be unable to meet the late Dr. Moir’s goal of “whole person care” with its “based on quality of care as compared to cost of care,” emerging in 2008 “level of trust.”

MIPS – “Merit-Based Incentive Payment System,” adjusting payment Allow us to cook more and measure less. Pay doctors simply and based on “quality, resource use, clinical practice improvement, honestly for the care they provide. Drop all artificial and intrusive meaningful use of certified HER technology,” leading to an escalating schemes. series of adjustments that start at +/- 4% in 2019 to as much as +/- 9% by How and to whom should the practicing physician cry their concern?

2022 That might be in the tenor of newsman Howard Beale played by the APMs – “Alternative Payment Models,” a 2015” Health and Human posthumous Oscar-winning actor Peter Finch in the 1976 movie, Services concept to tie payment levels to “quality or value,” a complex “Network.” In words by the great Paddy Chayefsky, Beale exhorts his scheme that may reward a few physicians able to meet all requirements, viewers to shout out of their windows, progressive implementation over ten years, to encourage ACO’s, “I’m as mad as hell, and I’m not to going to take this anymore!”

“Accountable Care Organizations,” bundled payment models and Angered doctors might write PTAC, the “Physician-Focused Payment “Patient Centered Medical Homes,” all of which emphasize putting Model Technical Advisory Committee,” whose heptathlon of a name smaller groups and even individual doctors at “financial risk.” exemplifies the issue. This committee of eleven in the GAO, the How many of our readers actually understand these four entities and Government Accountability Office, by law oddly cannot have a majority the ominous implications for their practices? I estimate 25% or less (as I of healthcare providers! contact@gao.gov did not!)

SHOUT now, or forever hold your peace.

Across the country larger systems of care probably will be able to meet some or all of these federal directives. To meet the dictates of such

Winter 2016

CENTRAL VALLEY PHYSICIANS

7

FRESNO MADERA MEDICAL SOCIETY MEMBERS ENJOY: Vast CMA Resources: • Contract Analysis

“My membership provides me a voice in Sacramento and Washington DC.” Thomas McKenzie, MD Member Since 1991

• Reimbursement Hotline • Legal Hotline • Legislative Hotline • HIPPA Compliance • Free Monthly Webinars on various topics • Extensive Online Resources including over 200 letters, agreements, forms, etc.

• Plus – Free Legal Advice with CMA ON-CALL Documents

Fresno Madera Medical Society Resources: • Online Prescriber’s Letter subscription • DocBookMD phone app • Annual Directory • Free CME Seminars • Cost Saving Benefits • Quarterly Publication • Website/Online Resources • Insurance Savings • Alliance Membership • Annual Social Events • Patient Referrals • Office Manager Forum and Practice Resources

Your membership investment supports our advocacy efforts on your behalf in Sacramento and Washington DC.

For more information about membership please contact us (559) 224-4224 • www.fmms.org CENTRAL VALLEY PHYSICIANS Winter 2016 1040 E. Herndon Ave., Suite 101 • Fresno, CA 93720

8

A message from our President > Hemant Dhingra, MD

President’s Message

ABOUT THE AUTHOR ­ Hemant Dhingra, MD, nephrologist, is President and CEO of The Nephrology Medical Group, Inc. Dr. Dhingra is President of Fresno Madera Medical Society and an Assistant Clinical Professor of Medicine at UCSF Fresno.

Winter 2016

First I would like to express my gratitude as well. As a society, we are trying to to all of you who gave me the opportunity use social media, improved website and to become the President of Fresno Madera print media to improve our reach in the Medical Society. I am deeply honored to community and change the perception serve our community. I am confident that regarding our role in health community. with your help and the guidance of the My commitment to enhance executive board we will be able to advance membership remains strong. We will the goals of our society. be coming to your offices, practices and Through my years on the board and hospitals to meet with you and make this past year as president-elect, I have you aware of membership benefits. gained a deep appreciation My plans for this year are lofty and ambitious of the vision, contributions but I am very optimistic that with the help of and diligence membership and committed board we will be of the past presidents of able to accomplish them. our society.

My years as a member and later on as a committee Our board is very committed towards member taught me that FMMS is not this goal and we are actively engaged in just a society but a community composed developing new membership benefits. We of volunteers and friends with common are collaborating with CMA and will be interests. using all the resources at our disposal. I Vital Signs magazine had served the encourage all members to visit FMMS and membership as its monthly publication for CMA websites to become familiar with the long time. As change is perpetual and with programs and benefits available. My plans changing needs we have tried to revamp for this year are lofty and ambitious but I the look and content of the magazine. am very optimistic that with the help of This will now be a quarterly publication membership and increased membership with more content. I am really thankful to and a committed board. I wish you all a very Dr. Birnbaum and his committee for the happy and prosperous New Year. hard work. I will be communicating with membership via my monthly newsletter CENTRAL VALLEY PHYSICIANS

9

N O R C A L

G R OU P

OF

COMPANIES

GUIDE GUARD ADVOCATE

MEDICAL PROFESSIONAL LIABILITY INSURANCE

PHYSICIANS DESERVE Offering top-tier educational resources essential to reducing risk, providing versatile coverage solutions to safeguard your practice and serving as a staunch advocate on behalf of the medical community.

Talk to an agent/broker about NORCAL Mutual today. Š 2015 NORCAL Mutual Insurance Company. nm0607

NORCALMUTUAL.COM | 844.4NORCAL

NORCAL MUTUAL RISK MANAGEMENT INSIGHT

5 Tips To Help Lower Medical Texting Risk The following risk management tips may help physicians protect patients’ confidentiality while adopting texting as a practice communication tool.

01

Do not electronically transmit highly sensitive ePHI (e.g., information about mental health, HIV, substance abuse or minors).

02

Install password protection, encryption, auto-lock and remote wiping programs to prevent data breaches.

03

Double check your recipient and review content of texts for misleading abbreviations and autocorrect errors before sending.

04

Assume that any individual nearby can view texts.

05

Ensure that you have cyber liability insurance coverage for potential exposures.

The risk of violating healthcare privacy laws (HIPAA and HITECH) through texting is a serious concern for all healthcare providers and entities. Every effort should be made to comply with these laws. Setting up a texting protocol may require guidance by business or legal advisors, as well as risk management experts.

For the full report visit textrisk.norcalmutual.com.

Copyright Š2015 NORCAL Mutual Insurance Company. All rights reserved.

2015 House of

Delegates California Medical Association

delegates set policy and

elect officers at annual meeting More than 500 California physicians, residents and medical students convened in Anaheim October 16-18, 2015, for the California Medical Association’s (CMA) annual House of Delegates (HOD). On the following pages are highlights of the actions taken at this year’s meeting. >> STORY BY ELIZABETH ZIMA l PHOTOGRAPHY BY JEFF WALTERS

12

CENTRAL VALLEY PHYSICIANS

Winter 2016

2015 This year saw an expanded “virtual” reference committee process, with all reference committee testimony conducted online. The reference committee members met via conference call in advance of HOD to develop recommendations that were presented to the House for f loor debate. This was the final year that the HOD will meet in its current format, with the new governance reforms approved at last year’s meeting taking effect at the close of the 2015 meeting.

(For more details on the new governance process, see page 19.)

The House also installed a new president, Riverside infectious disease specialist Steven E. Larson, M.D., M.P.H., and Folsom OB/GYN Ruth Haskins, M.D., was tapped as president-elect.

THE FULL 2015-2016 CMA EXECUTIVE COMMITTEE INCLUDES: • President Steven E. Larson, M.D., M.P.H., Riverside • President-Elect Ruth Haskins, M.D., Folsom • Speaker of the House of Delegates Theodore M. Mazer, M.D., San Diego • Vice-Speaker of the House of Delegates Lee T. Snook, Jr., M.D., Sacramento • Chair of the Board of Trustees David Aizuss, M.D., Los Angeles • Vice-Chair of the Board of Trustees Robert E. Wailes, M.D., Encinitas • Immediate Past President Luther F. Cobb, M.D., Eureka

Winter 2016

CENTRAL VALLEY PHYSICIANS

13

Reports and Resolutions Below are a sampling of the resolutions adopted as policy.

(The full actions of the HOD are available for members only at www.cmanet.org/hod. Click on “Annual Meeting Resolutions” then on the “Documents” tab.)

TOBACCO (RES. 107-15): CMA reinforced its long-established

stance against tobacco use, with the passage of a resolution that strongly objects to pro-tobacco efforts by the U.S. Chamber of Commerce in other parts of the world. CMA calls on the Chamber to immediately halt all advocacy efforts on behalf of tobacco companies and urges all conscientious companies that are members of the Chamber to either take similar action or quit their membership to protest such anti-health efforts.

PUBLIC HEALTH FUNDING (RES. 112-15): The delegates voted

unanimously to urge the State of California to restore public health funding. The resolution calls on CMA to work with state health and legislative officials, through the state budget process, to develop a plan to repair California’s public health infrastructure and funding for vital prevention services.

BIOMEDICAL CAREERS (RES. 609-15): The delegates directed

CMA to support pipeline programs targeting underrepresented minority and disadvantaged students, to help increase ethnic minority physicians in medically underserved areas.

IMPLICIT BIAS TRAINING (RES. 610-15): Acknowledging

their impact on patient care, the delegates urged CMA to support studies of the impact on patient care of “implicit bias” – defined as the positive or negative perceptions, feelings and stereotypes that impact our comprehension and behaviors in an unconscious way. The resolution also called on CMA to support the inclusion of implicit bias training in medical school curriculums and continuing medical education programs.

HSA LIMITS (RES. 411-15): The delegates passed a resolution

directing the association to support increasing the dollar amounts eligible for tax-free deposit into a health savings account (HSA) to cover a greater proportion of an enrollee’s potential out-of-pocket costs in a high-deductible health plan.

14

CENTRAL VALLEY PHYSICIANS

Winter 2016

House of Delegates > CMA

HOSPITAL AFFILIATION REQUIREMENTS (RES. 402-15): The delegates passed a resolution opposing

the health plan practice of requiring physicians to maintain a hospital affiliation in order to contract with the plan. Many physicians, for a variety of reasons, no longer physically practice in a hospital setting. As such, requiring physicians to have hospital privileges at an in-network facility in order to contract with a health plan unfairly penalizes physicians.

ADMINISTRATIVE BURDENS (RES. 404-15): In

an effort to reduce the administrative burdens on physicians, the delegates passed a resolution that supports a requirement that each health plan provide a single comprehensive information resource (telephone or online) that can address all inquiries related to benefit eligibility, provider plan participation and service per-certification.

POWDERED ALCOHOL (RES. 104-15): The

delegates passed a resolution directing CMA to encourage an established health research entity to evaluate powdered alcohol products for potential health and societal impacts. The resolution also calls on CMA to advocate for the development of regulatory controls for powdered alcohol products similar to those for liquid alcohol products. This resolution was referred for national action.

MEDICAL LOAN FOR UNDOCUMENTED MEDICAL STUDENTS (RES. 602-15): The resolution directs

CMA to work with the state to create and fund a loan program for undocumented medical students, including public service loan forgiveness for this loan program.

WHEN IS A CHILD’S BRUISE FROM AN ACCIDENT OR SOMETHING MORE? Do You Know What, When & How to Report?

Take this complimentary online course and: 

Learn essential signs that should be reported



Earn continuing education credits



Share with your colleagues.

Pre-register for this free course at: http://www.imq.org/education/caprrc.aspx

Winter 2016

CENTRAL VALLEY PHYSICIANS

15

CMA ELECTS SACRAMENTO OB/ GYN RUTH HASKINS, M.D., AS 2015-16 PRESIDENT-ELECT

Awards and Elections CMA INSTALLS RIVERSIDE INFECTIOUS DISEASE SPECIALIST AS 2015-16 PRESIDENT

Riverside infectious disease specialist Steven E. Larson, M.D., M.P.H., was installed as CMA’s 2015-16 president.

“It is an enormous honor to serve the 40,000 plus members of CMA as their president,” said Dr. Larson, speaking to the more than 500 delegates in attendance. “As we face some of the most rapidly changing times in health care that this country has ever seen, I look forward to working with the county medical societies and my colleagues across the state in unifying together as one voice to tackle whatever obstacles lie ahead.”

Dr. Larson practices in both Riverside and San Bernardino counties. He is currently the Chief Executive Officer and Chairman of the Board of Riverside Medical Clinic and serves as a clinical professor of biomedical sciences at the University of California, Riverside, School of Medicine.

Dr. Larson earned his medical degree from the Medical College of Wisconsin and completed his residency in internal medicine and a fellowship in infectious diseases. He earned a Masters in Public Health from Loma Linda University and is board certified in both internal medicine and infectious diseases.

In addition to his experience with CMA, Dr. Larson also serves as a delegate to the American Medical Association, is a member of the Medical Group Management Association, the Infectious Disease Society of America, Southern California Infectious Disease Society and the American College of Physicians.

“California will be faced with many exciting changes to health care in the coming year, including a ballot measure to increase the state’s tobacco tax, which will help to save lives and reduce teen smoking,” said Dr. Larson. “With a vested interest in public health and a commitment to serve my colleagues and my patients, I’m looking forward to what the year will bring.”

16

CENTRAL VALLEY PHYSICIANS

Sacramento OB/GYN Ruth Haskins, M.D., was selected as the association’s president-elect. She will serve in this capacity for one year and will be installed as president at the conclusion of next year’s HOD. “I am thrilled to have been elected to become CMA president and cannot wait to positively contribute to ensure this wonderful organization, and the doctors it represents, continues to move closer to achieving its full potential,” said Dr. Haskins.

As one of her main goals, Dr. Haskins plans during her term to encourage the active participation of all CMA members by optimizing the year-round process of policy-making.

“I encourage all physicians to incorporate health advocacy as an integral part of the practice of medicine,” said Dr. Haskins. “I encourage doctors to look at health advocacy as an outlet for enhancing their passion for practicing medicine by the empowerment gained by speaking out in the political arena.”

Dr. Haskins attended the University of Pittsburgh School of Medicine. She was selected in 1980 for a Health Professions Scholarship Program position and while in medical school began active duty in the U.S. Air Force (USAF) with the rank of Second Lieutenant. Upon graduation, she reported to the David Grant USAF Medical Center at Travis Air Force Base, for training in Obstetrics and Gynecology, at the rank of Captain.

Dr. Haskins completed her four-year

Winter 2016

House of Delegates > CMA

IMPERIAL VALLEY PHYSICIAN RECEIVES CMA’S 2015 “COUNTRY DOCTOR” AWARD

residency and was transferred to Scott Air Force Base Medical Center in Illinois. She was promoted to Major in 1991, and was involved in the military’s readiness campaign during Desert Storm and Desert Shield. In 1992 she was appointed Chairman of the Department of Obstetrics and Gynecology at Scott Air Force Base.

From 1997 through 2008, Dr. Haskins was an Associate Professor at the University of California, Davis. There, she initiated a course in legislative advocacy that grew into an annual lobby day for OB/GYN residents, which just celebrated its 10th anniversary.

Today, Dr. Haskins has a very busy solo practice in the Sacramento area. She has been a member of CMA and the Sierra Sacramento Valley Medical Society for 22 years, serving as CMA trustee from 2013 to 2015 and as chair of the CMA Council on Legislation from 2010 to 2013. She has also been an active delegate representing the voice of the American College of Obstetricians and Gynecologists in the House of Delegates for over 20 years.

“Now I look forward to being the voice for all doctors and an advocate for all patients of California,” she said.

Winter 2016

George Carr Fareed, M.D., was awarded CMA’s Frederick K.M. Plessner Memorial Award, which honors the California physician who best exemplifies the ethics and practice of a rural country practitioner.

Dr. Fareed has been described by patients as an empathetic doctor and has become a friend to many patients. Before he moved to the Imperial Valley in 1991, he had a distinguished history as a clinical researcher, worked as the team doctor for the U.S. tennis team and established three HIV specialty care clinics for underserved patients in the Imperial Valley, which borders Mexico.

From 1970 until 1991, Dr. Fareed was a successful clinical researcher as an assistant professor of medicine at Harvard Medical School and then an associate professor at the University of California, Los Angeles Geffen School of Medicine. He continues there today as an adjunct associate professor. After his years in academic research, he moved into public and private biotech work as the director of cancer biotherapy at INGENER, director of new product development for XOMA Corp. and as president of Advanced Antigens, Inc. He developed processes that led to three U.S. patents in the biotech field.

After two decades spent in research, he decided that he wanted to use to put his clinical skills into action and headed out to the Imperial Valley to establish his practice in the town of Brawley. He started by establishing three HIV clinics through a partnership with Clinicas De Salud Del Pueblo, because there was little treatment available in the area for those with the infection. These clinics were the first in the area to serve patients on both sides of the border.

Dr. Fareed has an active interest in sports medicine and was able to put this interest into practice as the team physician for the U.S. Davis Cup tennis team, working with such tennis greats as Michael Chang, Jim Courier, Andre Agassi, John McEnroe and Pete Sampras from 1991 to 2003.

CENTRAL VALLEY PHYSICIANS

17

House of Delegates > CMA

SACRAMENTO PHYSICIAN RECEIVES CMA’S INAUGURAL COMPASSIONATE SERVICE AWARD

Sacramento ophthalmologist Barbara Arnold, M.D., was awarded the first annual Compassionate Service Award, which honors the California physician who best illustrates the association’s commitment to community and charity care.

In addition to being a skilled and compassionate physician, Dr. Arnold is a gifted artist who teaches art classes through the Crocker Art Museum for visually impaired and legally blind individuals. Since the program’s inception in 2012, her efforts have helped

Other News

ANNUAL GALA RAISES IN EXCESS OF $60,000 FOR PUBLIC HEALTH PROGRAMS

The CMA Foundation hosted the 19th Annual President’s Reception and Awards Gala at Disney’s Grand Californian Hotel and Spa in Anaheim during CMA’s annual House of Delegates meeting. The event raised in excess of $60,000, including $32,500 for medical student grants— thanks to the generosity of our sponsors and donors.

Honored at the event were new CMA President Steven E. Larson, M.D.; the 2015 Robert D. Sparks, M.D., Leadership Achievement Award winner, San Diego physician David Folsom, M.D.; and the 2015 Adarsh Mahal, M.D., award winner, San Francisco physician Michael LeNoir, M.D. After a cocktail reception and dinner, guests were treated to the music of the band Power Mix, a 17-piece orchestra with a full horn section, three strings and eight lead vocalists. The band covered old favorite dance hits from yesterday and today.

18

CENTRAL VALLEY PHYSICIANS

visually impaired individuals develop creative and meaningful hobbies with rewards far beyond the students’ hopes and expectations. Currently, there is a waiting list for Dr. Arnold’s classes. Many of her students come from out of the Sacramento area, some travelling with their guide dogs via Amtrak to take her classes.

Dr. Arnold has been teaching ophthalmology to residents at the University of California Davis Eye Center for more than 20 years. She is an Emeritus Chair in the UC Davis Department of Ophthalmology and was the department chair for 26 years.

Among the big ticket items auctioned off were an evening of good food and political insight with CMA’s CEO, Dustin Corcoran – also known as the defender of MICRA and the destroyer of Proposition 46; a chance to see golf ’s most talented players at Augusta Masters Golf Tournament in Georgia; and a San Francisco 49er weekend package featuring Club Level seats in the new Levi’s Stadium to watch the team play.

To view more photos from the event, visit CMA’s Flickr page at www.flickr.com/californiamedicalassociation.

CALPAC FUNDRAISING RECORD SHATTERED AT HOUSE OF DELEGATES

CMA’s Political Action Committee, CALPAC, shattered all previous fundraising records in the history of the PAC by raising roughly $173,000 during CMA’s annual meeting.

In a record-setting show of support for CALPAC, CMA members bested last year’s mark of $119,000 while also exceeding the $140,000 goal established at the opening of the House of Delegates meeting.

The donations collected over the weekend, as well as all contributions made to CALPAC, will be used to support candidates who share medicine’s agenda and priorities and will work to affect policies beneficial to the House of Medicine.

For more information about CALPAC, visit www.calpac.org.

Winter 2016

2010

2011

2012

2013

2014

New governance rules go into effect for CMA

WITH THE CLOSE OF THE CMA’S 144TH HOUSE OF DELEGATES (HOD) ON OCTOBER 17, NEW GOVERNANCE REFORMS TAKE EFFECT. THESE REFORMS WILL ALLOW CMA TO BE MORE NIMBLE AND EFFECTIVE IN MAKING DECISIONS ON CRITICAL ISSUES THAT ARE IMPORTANT TO PHYSICIANS.

In 2013, CMA’s Governance Technical Assistance Committee (GTAC) recommended, and the HOD adopted, a proposal to create a more modern, efficient system of governance and enable more focused and effective advocacy programs.

In 2014, HOD approved updates to CMA’s bylaws that enabled these changes.

CMA’s long-standing traditions of democratic participation and representative governance will continue, but HOD will focus on the most pressing matters facing physicians and the practice of medicine. A new HOD structure will focus on a limited number of current major issues—the most important matters facing physicians and the practice of medicine each year, while the Board of Trustees will assume responsibility for policy-making on all other matters.

The new bylaws will also

Winter 2016

accommodate the submission of resolutions from individuals throughout the year, rather than just once a year, allowing CMA to react quickly—via its democraticallyelected Board of Trustees—to critical issues in real time. Any CMA member may author a resolution and have it submitted to the Board of Trustees using the year-round process. This approach preserves the ability of individual members to participate in and inf luence CMA policy-making in a more timely way, rather than waiting for a once-a-year opportunity at HOD, which had been CMA’s tradition.

In 1856, CMA was established with a mission very similar to the one followed today—promoting 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. The new governance

structure will allow the membership to maintain its position as a nimble, proactive organization ready to lead the practice of medicine for another 150 years.

In 2016, HOD will become a two-day meeting, during which delegates will discuss and vote on the most important issues facing CMA members and the practice of medicine, including any items that the Board refers to the House.

Delegates will also elect officers, receive annual reports on the actions of the standing councils and committees during the previous year, and attend educational sessions on key issues.

CMA would like to thank those members who participated in this three-year process, particularly the GTAC members who worked so hard on this proposal and the trustees and delegates who debated the issues.

CENTRAL VALLEY PHYSICIANS

19

FMMS > Elects New Officers

FMMS NEWS

FRESNO MADERA MEDICAL SOCIETY

ELECTS NEW OFFICERS Photos by Derek Martin

O OFFICERS: PRESIDENT: Hemant Dhingra, MD Nephrology, The Nephrology Medical Group, Inc. PRESIDENT-ELECT: Alan Kelton, MD Internal Medicine, Central California Faculty Medical Group VICE PRESIDENT: Trilok Puniani, MD Neurology, Kaiser Permanente Fresno Madera Medical Society announced the appointment of new officers for 2016.

The Board of Governors and the following new officers started their term beginning January 1.

“It is a trying time for the medical community, but we are fortunate have leaders who are passionate and committed to improving the wellbeing of our local physicians,” said Nicole Butler, executive director at Fresno Madera Medical Society.

Incoming president Hemant Dhingra, MD, nephrologist at The Nephrology Medical Group, Inc., has practiced medicine in Fresno since 2007. Dr. Dhingra has been a rising leader within the Medical Society, having previous experience serving in all of the officer positions as President-Elect, Vice President and Secretary/Treasurer. He also supports and serves in various leadership roles of other local organizations.

20

CENTRAL VALLEY PHYSICIANS

SECRETARY/TREASURER: Cesar Vazquez, MD Pediatrics, Cesar Vazquez, MD, Inc. IMMEDIATE PAST PRESIDENT: A.M. Aminian, MD Allergy, Allergy Institute

Winter 2016

Fresno Madera Medical Society and California Medical Association (CMA) strive to protect physicians. This past year, they prevented a 21 percent cut in Medicare reimbursement by winning a 12-year fight to end the Sustainable Growth Rate (SGR). A one-year grace period for ICD-10 implementation was provided to continue to prepare physicians and their office staff for the upcoming changes. More than $10 million in unpaid claims were recovered for physicians in medical societies across the state. SB277 was passed to increase immunization rates, a plan brought forward by CMA Member and California State Senator Richard Pan, MD. “In 2016, the medical community can expect more legislative threats to the practice of medicine in California, economic shifts in service reimbursement, and further changes to provider networks. Fortunately, we are ready – armed with new officers, who will work hard to support our local physicians wholeheartedly,” Butler said.

Winter 2016

This year the Medical Society will bring more educational symposiums for physicians, debut its new magazine Central Valley Physicians, provide training for physician managers and staff, and will continue be a resource for physicians throughout the region.

About the Medical Society: Established in 1883, the Fresno Madera Medical Society is credited as being Fresno County’s oldest professional organization. The Medial Society represents 1,000 physicians in the twocounty area advocating for the profession and health of the community. Members of the Medical Society are also members of California Medical Association (CMA), the largest health care advocacy organization in California. Together, the organizations work to protect physicians from legal, legislative and regulatory intrusions so that they can focus on what’s really important to them – their patients.

B BOARD OF GOVERNORS: Christine Almon, MD Alan Birnbaum, MD Jennifer Davies, MD Joseph Duflot, MD William Ebbeling, MD Don Gaede, MD David Hadden, MD Christina Maser, MD Ranjit Rajpal, MD Oscar Sablan, MD Katayoon Shahinfar, MD Roydon Steinke, MD Jessica Lee, MD (Resident Board Member) CMA Trustee: Virgil Airola, MD

CENTRAL VALLEY PHYSICIANS

21

In The News

IN THE

NEWS

Providing physicians, office staff and healthcare executives with relevant and up-to-date information

• FRESNO • Northwest Medical Group moves to new Palm location In November 2015, Northwest Medical Group moved to its new location on Palm Avenue between Herndon and Alluvial avenues.

Internal medicine and administration were first to move, followed shortly by urgent care, family practice, pediatrics and pharmacy. All phone numbers remain the same. For more information, visit www. northwestmed.net.

New Saint Agnes Urgent Care opens in northwest Fresno In December 2015, Saint Agnes Urgent Care opened in northwest Fresno, on the corner of Herndon and Milburn avenues.

Saint Agnes Urgent Care is the first of many services that will be offered by Saint Agnes and Saint Agnes Medical Providers (SAMP) in the building formerly known as Northwest Medical Group. Starting in January, the building officially open as Saint Agnes Wellness Center.

Services will include primary care, internal medicine, OB/GYN, occupational health and the Saint Agnes satellite laboratory, which has

New Saint Agnes Urgent Care been operating at this location for nearly 20 years.

“This is an exciting venture for Saint Agnes and we’re thrilled about the opportunity to expand our presence to meet the needs of northwest Fresno residents,” said Nancy Hollingsworth, Saint Agnes Medical Center president and CEO. For more information, visit www. saintagnesmedicalproviders.com/urgent-care.

HAVE SOMETHING TO SHARE? We welcome submissions to our In the News section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to nbutler@fmms.org one month prior to publication (March 1 for the Spring issue, June 1 for the Summer issue, September 1 for the Fall issue, and December 1 for the Winter issue).

22

CENTRAL VALLEY PHYSICIANS

Winter 2016

Community Medical Centers partners with Adventist Health Community Medical Centers and Adventist Health announced a joint venture – creating a new managed-care network for central San Joaquin Valley’s underserved. The goal is to improve access to higher-level care for MediCal patients in rural areas and expand access to primary care closer to where patients live in Fresno, Kings, Madera and Tulare counties.

“The collaborative venture will deliver more comprehensive, efficient, lower-cost and high-quality healthcare to a population in need,” said Tim Joslin, CEO of Community Medical Centers. “Clearly we’re building on the strengths of both organizations.”

This new partnership between Community and Adventist Health could eventually relieve pressure on local emergency rooms and provide better follow-up care after hospitalizations for Medi-Cal patients who live in small, rural communities, helping to reduce healthcare costs for all.

Subject to approval by the California Department of Managed Health Care, Adventist Health and Community will build upon the managed Medi-Cal Adventist Health Plan that begins in Kings County on January 1. The two will remain independent organizations, but the joint-venture health plan will be equally financed, jointly owned and operated collaboratively. Within the next two years, it’s estimated the new plan could deliver coordinated, clinically integrated care to as many as 200,000 people in four counties. For more information, visit www. communitymedical.org/news-events.

Local Physician, Joaquin Arambula Runs for California State Assembly Emergency department physician, Joaquin Arambula, MD, is running in a special election for California State Assembly District 31 – a position vacated early by Henry T. Perea.

“I am running for Assembly to make our community a healthier place to live, work and raise a family,” said Dr. Arambula. “I want to be a strong voice for everyone in the Valley. I will go to Sacramento to fight for access to quality health care, public education and our fair share of water.”

Winter 2016

Dr. Arambula and opponent Clint Olivier were already set to run in the November general election for a two-year term starting January 2017. Since Perea decided to vacate office early, the special election on April 5 will elect an individual to complete the current term ending this December. The individual with more than 50% of votes will be immediately sworn in to take office. The

Joaquin Arambula, MD November election will continue to take place for the 2017-18 term.

The 31st Assembly District incorporates most of Fresno County and includes Coalinga, Firebaugh, Fowler, Huron, Kerman, Kingsburg, Mendota, Orange Cove, Parlier, Reedley, Sanger, Selma and parts of Fresno.

Dr. Arambula is endorsed by the California Medical Association. He has been a member of the Fresno Madera Medical Society since 2003. Since 2007, Dr. Arambula has served in a senior position with California Emergency Physicians at Adventist-Selma and was appointed Medical Director in early 2013. He also serves as a mentor for the UCSF Fresno Doctor’s Academy, helping to encourage local students interested in healthcare.

Dr. Arambula is a Central Valley native and is the son of Juan Arambula, former school board member, Fresno County Supervisor and California Assembly member. He and his wife Elizabeth live in Kingsburg with their three young daughters.

UCSF-Fresno selected for national professional development program The UCSF-Fresno Medical Education Program has been chosen as one of nine medical institutions for a program to help build faculty teams that will work together to improve patient care.

The Fresno faculty will be participate in Professionals Accelerating Clinical and Education Redesign (PACER), a new, national professional development program.

PACER is a three-year program that is funded by the Josiah Macy Jr. Foundation with matching funding from the Boards of Family Medicine, Internal Medicine and Pediatrics and the Accreditation Council for Graduate Medical Education. The project is implemented and evaluated by educational researchers in the department of family medicine at Oregon Health & Science University.

The program will help build a “more seamless system” of care for patients at the Deran Koligian Ambulatory Care Center at Community Regional Medical Center, said Dr. Serena Yang, associate clinical professor of pediatrics and leader of the UCSF-Fresno PACER program.

Internal medicine, family medicine and pediatrics will be the core, where patients first access medical care, Yang said. But pharmacists, nurses, mental health therapists and sub-specialists will work as a team with the primary care practitioners. The team also will take advantage of electronic medical records to communicate, Yang said. And the grant will allow for faculty members to educate future doctors of the importance of the team approach to medicine, she said.

Smittcamp $1 million gift will help expand neurosciences services Community Medical Centers has received a $1 million gift from Robert E. Smittcamp and the Smittcamp Family Foundation to expand neuroscience services for the San Joaquin Valley. The gift is meant to help expand a vital service line not available elsewhere in the region.

“I understand the critical need for stroke, head trauma and spine care in our region,

CENTRAL VALLEY PHYSICIANS

23

In The News

IN THE

NEWS and the terrific neuroscience program they’re building at Community Regional Medical Center needs to keep growing,” said Bob Smittcamp, chairman and CEO of Lyons Magnus, Co., Inc. in Fresno.

Community Regional in downtown Fresno provides the only Level 1 Trauma Center between Los Angeles and Stockton, and a significant number of trauma cases involve brain and spine injuries.

Neuroscience experts on site perform life-saving work around-theclock.

But not all neuroscience cases are caused by traumatic injuries.

Community’s neuroscience program also cares for patients suffering from strokes, brain tumors, spine disorders, and neurological diseases such as Parkinson’s disease, ALS and epilepsy.

Katie Zenovich, Community’s vice president for corporate development, said the Smittcamp gift is the largest single donation ever directed to the medical center’s neurosciences program.

“I’m impressed with Mr. Smittcamp’s leadership and his sincere commitment to help us create a comprehensive, world-class neuroscience center for the region,” said Tim Joslin, Community Medical Centers CEO. For fiscal 2015, Community Regional Medical Center in Downtown Fresno averaged nearly 100 stroke patients a month, with about 48 percent over the age of 65. The facility saw a total of more than 2,400 neurology cases. Since 2013, Community Regional has done more than a third of all the brain surgeries in a seven county area.

DHL Worldwide Co-Founder Gifts $1-Million to Establish Center on Aging at UCSF Fresno UCSF Fresno Medical Education Program and the Larry L. Hillblom Foundation announced the establishment of the Larry L. Hillblom Center on Aging at UCSF Fresno.

The Center on Aging at UCSF Fresno is made possible by a $1 million gift from the Larry L. Hillblom Foundation. This unique care facility will be the first of its kind in the central Valley. With the number of senior citizens growing, the demand for physicians who understand the needs and care for the aging population will be high.

The number of Californians aged 65 or older is expected to increase from 4.6 million in 2012 to more than 8.6 million in 2030, according to a report by the Public Policy Institute of California.

24

CENTRAL VALLEY PHYSICIANS

Providing physicians, office staff and healthcare executives with relevant and up-to-date information

Grant A. Anderson and Terry C. Hillblom, brothers of the late Larry L. Hillblom of the Larry L. Hillblom Foundation’s board, presented a check to UCSF Fresno in early December.

Aging community members will benefit from a multi-disciplinary team approach to health care in one centralized location. The donation will allow for further medical care, medical education and research aimed at addressing the health needs of a quickly growing and underserved population.

The Larry L. Hillblom Foundation was established in 1996. By virtue of Mr. Hillblom’s will, substantially all of the Foundation’s funding supports medical research within the State of California, with particular attention to research programs conducted by the University of California.

Central Valley Colon and Rectal Surgical Associates, Welcome A New Surgeon Central Valley Colon and Rectal Surgical Associates, office of John Garry, MD, and William Carveth, MD, welcome a new surgeon to their practice. Phuong H. Nguyen, MD, comes to Fresno after spending the last two years in private practice in Charlotte, North Carolina. Dr. Nguyen holds board certifications through the American Board of Surgery in both General Surgery and Colon and Rectal

Winter 2016

Phuong H. Nguyen, MD

Surgery. He gained medical experience serving in medical missions abroad and has presented his surgical research across the US and Europe. He is fully trained in advanced laparoscopic and daVinci robotic surgical techniques for: colon and rectal cancer, anal cancer, diverticular disease, inflammatory bowel disease (Chron’s disease and ulcerative colitis), benign and malignant polyps of the colon and rectum, Familial Adenomatous Polyposis (FAP), Hereditary Non Polyposis Colon Cancer

• KERN • Kern Medical Center Becomes Kern Medical Kern Medical, formerly Kern Medical Center, today announced its new name. Kern Medical, the community’s only trauma center, explained the change is a subtle but significant alteration that better represents its comprehensive model of care.

Kern Medical will continue its role as Bakersfield’s academic training hospital and its affiliation with UCLA’s David Geffen School of Medicine. But it now expands to the west side of Bakersfield with new Stockdale and Truxtun clinics, both of which provide a full suite of care including endocrinology, rheumatology, internal medicine, pulmonology, neurology, orthopedics, ophthalmology, ENT, and other surgical and medical specialties.

“The name Kern Medical is representative of our evolution,” said Russell Judd, CEO of Kern Medical. “As we improve access to care, we also expand our geographic footprint. That means moving beyond our main campus and offering more points of care.”

The name change is coupled with a new contemporary logo, with bright and inviting colors, which can be seen on Kern Medical’s new website. Today, Kern Medical also launched fresh advertising, including TV and radio commercials, print advertising, outdoor billboards and signage in and around the Kern Medical campus.

Kern Medical provides care to a significant percentage of Kern County residents and offers several important specialty services that are difficult to access, such as care

Winter 2016

(HNPCC), rectal prolapse, anorectal diseases (hemorrhoids, anorectal fistulas, anal fissures) and screening colonoscopies. Dr. Nguyen completed his fellowship training in Colon and Rectal Surgery at Indiana University School of Medicine in Indianapolis, Indiana, general surgery residency at Carolinas Medical Center in Charlotte, North Carolina completed medical school at Florida State University College of Medicine in Tallahassee, Florida, and. To reach Dr. Nguyen, call 559-440-0283.

CONTINUING

MEDICAL

EDUCATION March 18-20, 2016

65TH ANNUAL POSTGRADUATE INSTITUTE YOSEMITE NATIONAL PARK, CALIFORNIA For more information, 559-224-4224

Saturday, April 2, 2016 8 a.m. to Noon

FRONTIERS IN HEPATOLOGY AND GASTROENTEROLOGY SYMPOSIUM H. MARCUS RADIN CONFERENCE CENTER, CLOVIS COMMUNITY MEDICAL CENTER For more information, 559-324-4002

Saturday, May 7, 2016 8 a.m. to Noon

NEPHROLOGY SYMPOSIUM CLOVIS VETERANS MEMORIAL For more information, 559-224-4224

May 18-20, 2016

HIGH SIERRA WILDERNESS & TRAVEL MEDICINE CONFERENCE PINES RESORT AT BASS LAKE For more information, 415-476-4251

CENTRAL VALLEY PHYSICIANS

25

In The News

IN THE

NEWS

Providing physicians, office staff and healthcare executives with relevant and up-to-date information

San Joaquin Community Hospital announces new CNO

for high risk pregnancy, HIV care, and endocrinology.

“Kern Medical has been and will continue to be a leading player in the Kern County health care landscape. Our objective is to provide the best in care to all in need,” said Judd. “With continued investment in access to quality care through new services and more locations, we will achieve that goal.”

Susan Herman DNP, MSN, RN, NEA-BC, CENP officially started her new role as the Chief Nursing Officer at SJCH. Based on the credentials after her name, it’s easy to see that SJCH is lucky to have her.

With nearly 20 years of experience in

Tracy Zweig Associates INC.

A

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners ~ Physician Assistants

Locum Tenens ~ Permanent Placement Voice: 800-9 1 9 -9141 o r 8 0 5 -6 4 1 -9 1 4 1 FAX: 8 0 5 -641 -9 1 4 3

tzweig@tracyzwe i g. com www.tracyzw e i g. com

26

CENTRAL VALLEY PHYSICIANS

health care, Dr. Herman has served in a variety of roles in both inpatient and outpatient areas. Most recently, she served at Stanford University Medical Center’s Lucile Packard Children’s Hospital. The non-profit 308-bed hospital has been named one of America’s Best Children’s Hospitals by U.S. News and World Report.

As part of her role, Dr. Herman oversaw the Magnet Program, developed by the American Nurses Credentialing Center to recognize healthcare organizations for nursing excellence.

In her new role at SJCH, she brings a passion to develop nurses at all levels of the organization.

“My doctoral work centered on transformational leadership – I’m excited to meet our staff and serve as a role model for the future nurse leaders of our hospital,” Dr. Herman said. “My commitment is to work with our teams to create a shared vision for the future of nursing at SJCH. We’ll develop new processes, create professional standards and build a deep commitment to our mission that will help us take patient care to the next level.”

Dr. Herman is also involved in a number of professional associations, including serving as the 2015 president for the Association of California Nurse Leaders and on the Board of Trustees for the California Hospital Association. She has also worked in the areas of cancer, orthopedics and recruiting; bringing a wealth of all-around knowledge

Winter 2016

to SJCH. In her spare time, she is an avid gardener and enjoys spending time with her family.

Development of northeast medical plaza opens first phase

Grp *FP t Medical NorthwesHerndon #105 4770 W. 93722 : 2 71-6 329 Fresn o / FAX ’73 e 271-6300 Med Irvin UC C ol

*ORS First # 103 7235 N. 93720 4 32-8518 Fresn o / F AX: 432-2600 S ch ’81 US C Med

, Adriana PADILLA

FP Fresno 4005 N. 93726 Fresn o ’89 222-9394 CA Irvine Univ of

, Marta OBLER

*P Fresn o 7300 N. 720 93 Fresno 4 448-483S alvador ’84 Univ of

O’LA UGH

BH AN, PADM ANA -*ON

LIN , Thom

, Jam OSBO RNE

e L. IOS , Jorg PALAC

*AN . S hepherd 5874 E 9 Clovis 9361 5 orres, 930-126 Martin de P Univ S an Peru ’94

es G ., Jr.

EM don 2755 Hern 1 Clovis 9361 324-4 040 S ch ’86 US C Med

H NESSY

O’SH AUG Michael

A.

ciates *IM-*HEM C are Asso Cancer Fir 1791 E. 93720 1225 Fresn o 22 / FA X: 326326-12 Med C ol ’66 Madrasu

as J.

*PM e 2841 Tular 21 937 35-3 698 Fresno / FA X: 4 n Univ ’85 435-3696 Washingto George

I, Louis PARDIN

IM-C D . Warner #102 1095 E 9 3720 5062 Fresno 0 / FAX : 432432-152 U Med ’54 Creighton

,

#23 3 *OBG Fresno 155 N. 9370 1 654 1 Fresno 8 / FA X: 499499-654 Med S ch Dartmouthpshire ’88 New Ham

, Steven PARKS S -TRS -TS

Paul OSTO YA, *OBG . Warner #101

1095 E 93 710 4 35-403 5 X: Fresno 67 / FA ’81 435-35 nian Univ Ja gello

O. , William OWEN

*IM-C D H erndon 1379 E. 93720 4 35-48 27 Fresn o / FA X: ch ’56 435-2630 ern U Med S Northwest

y 2009

ical S ociet dera Med

*GS -*CC Surgery Dept of no Flr 1 2823 Fres 1 719 9372 Fresn o X: 4 59-3 70 / FA 459-37 ’70 U of Neb

Z, Rabia PARVEE M

ciates *IM-O N-HE C are Asso Canc er . Fir 1791 E 93720 1225 Fresno / F AX: 326- ’82 326-1222 C ol Pakistan Dow Med 61

Directory

Fresn o–Ma

CMA

WEB SERIES February 24, 2016

HIPAA COMPLIANCE: KEY RISKS ALL PHYSICIANS SHOULD KNOW

12:15 - 1:15 p.m.

Please join us and CMA’s HIPAA advisor, David Ginsberg, for his annual HIPAA Compliance Update. This webinar will summarize recent federal enforcement and what this means for every medical practice. We will also discuss the top HIPAA privacy and security gaps and risks, along with simple steps to comply.

March 9, 2016

CLOSING A MEDICAL PRACTICE

12:15 - 1:15 p.m.

This webinar will cover some of the major practical and legal issues that may arise when closing a medical practice, and will assist physicians who are retiring or otherwise leaving their practices and/or families or estates of deceased physicians. Issues that will be addressed in this webinar will include people and agencies to notify when a physician practice closes, medical records retention and other issues, and considerations when selling a medical practice.

Winter 2016

H. , Douglas OWYANG R.

, Michael OBERTO

MEMBERS

(continued on page 32)

You can still order your 2016 edition of the Fresno-Madera Medical Society Pictorial Directory.

ACTIVE

A five building, 15 acre medical campus has opened its first phase in Bakersfield, CA. The 8700 square feet Ambulatory Susan Herman Surgical Center is the first suite to be completed, and opened for patients in December 2015.

The 65,000-square-foot building is the, the first to open in the Ambulatory Surgical Center for Bakersfield Specialist Surgical Center. The suite is about 8700 square feet with two surgical suites and a procedure room. The largest operating room is over 650 square feet. The next to be completed will be the Imaging

ORDER YOUR 2016 PHYSICIAN PICTORIAL DIRECTORY

Physician members of FMMS will automatically receive a complimentary copy of the directory. Additional directories can be purchased for the following rates:

Physician Member Non-Member

$20 $30

Directories will be delivered or mailed directly to the physician’s address as shown in the membership data base.

Hospitals, governmental agencies, businesses and individuals do NOT qualify for the member rate.

Sales tax and shipping are included in the price.

To purchase or for additional information, please call 559-224-4224 ext. 110.

CENTRAL VALLEY PHYSICIANS

27

Central Valley Physicians > Lifetime Achievement Award

Giving

PRA TICE VALLEY PHYSICIANS HONORED FOR SERVICE-ORIENTED CAREERS

Story By l Eddie Hughes • Photography By l Tomas Ovalle

Two longtime Central Valley physicians were honored for decades of serving the community — from providing lifesaving surgical procedures to volunteering to help those in need.

Dr. Fitzalbert Marius and Dr. David Hodge each accepted a Physician Community Service Lifetime Achievement Award, presented in November by the Fresno Madera Medical Society.

“The Lifetime Achievement Award for community service is one of our most prestigious honors for physicians and Dr. Marius and Dr. Hodge were obvious choices,” said Dr. Hermant Dhingra, president of the Fresno Madera Medical Society.

“The work these men have done and continue to do in our community shows their passion for making a difference through their time and talents.”

The Fresno Madera Medical Society, founded in 1883, is credited with being Fresno County’s oldest professional

28

CENTRAL VALLEY PHYSICIANS

Winter 2016

Winter 2016

CENTRAL VALLEY PHYSICIANS

29

Central Valley Physicians > Lifetime Achievement Award

organization and formed the structure of organized medicine in the area. The Society represents more than 1,000 physicians in the two-county area, advocating for the health of the community.

Dr. Marius and Dr. Hodge agree it’s not the awards for their service that bring gratification — it’s seeing the impact their work has on people.

DR. FITZALBERT MARIUS At 93 years old, Dr. Fitzalbert Marius remains active in the community, from speaking and teaching at church to sharing his art and historical insight to AfricanAmerican history. A list of his community service, talks, publications, committees and art exhibits spans more than 20 pages.

Some of Dr. Marius’ most recent talks included topics like “How to Get the Most out of the Bible” at Fresno School of Missions and “Blacks Must Consist, Resist and Persist” during Black History Month at Edison High School.

“It is absolutely foundational that a person in the field of medicine be involved in the community,” Dr. Marius says, “for that is basically what medicine is all about — assisting in bringing people in your community close to an intended perfect mental, physical and psychological state.”

30

CENTRAL VALLEY PHYSICIANS

Dr. Marius was born in Colon, Panama, in 1922 to West Indian parents. When he was 3 years old, his family, including five brothers and a sister, immigrated to New York City. As early as age 7, he apprenticed as a tailor before discovering a love for art in high school, when one of his teachers was Harlem Renaissance poet Countee Cullen.

Dr. Marius enlisted in the Army during his sophomore year at Lincoln University and served from 1942 to 1946.

After discharge, he graduated cum laude from Lincoln in 1948. He worked as a tailor while studying clothing design at New York Central School of Industrial Arts until 1950, when his classmates urged him to apply to medical school.

Though his main interest was art, he was accepted to Howard Medical School in Washington D.C. and graduated in 1954, before moving to California for a general surgery residency at Fresno County General Hospital.

Dr. Marius has remained in the area since, working with heart surgery teams at Saint Agnes Medical Center and Fresno Heart and Surgical Hospital as recently as 2013.

As a surgeon, his schedule was busy and his time was in high demand, but he prioritized community service for more than six decades of his career.

Winter 2016

“I was reared in a family that taught and had a tradition of productivity and sharing,” Dr. Marius said. “After I truly became a Christian in 1967, my personality, along with my faith, kept me motivated to be a sharer of what I possessed physically, metaphysically and spiritually.”

Those family values of service are what led to Dr. Marius receiving the Lifetime Achievement Award.

“Although as a human being I appreciated that someone recognized that I had served my community,” Dr. Marius said, “my main [motivation] was not the receiving of honor, kudos or recognition, but the fact that my service was having an effect upon the people of the community.”

DR. DAVID HODGE

Hodge. He said correcting conditions which provide an infant a full life is what interested him in medicine.

“I decided to pursue a career in pediatric surgery because it was rewarding to correct an abnormality which if uncorrected is incompatible with life.”

A native of Hutchinson, Kansas, Dr. Hodge recalls being intrigued by medicine as a youth when he cut his finger one summer and needed stitches. He went on to study at Northwestern University before attending medical school at Kansas University.

Dr. Hodge has also gone on a Rotary Club trip to Rwanda to deliver wheelchairs to disabled people, and traveled to Armenia to provide care to children and education for other physicians.

“I feel physicians need to be involved in community activities so they can better understand the community in which they live and practice,” Dr. Hodge said.

“It is very humbling to be honored by your peers. What I do, I do because I love doing it and not to gain any recognition for myself.”

Dr. David Hodge has 36 years of pediatric surgery experience in the Fresno area and has practiced at Valley Children’s Hospital for the past 10 years. And that’s only where his impact on the community — and beyond — begins.

A member of the Fresno Rotary Club, Dr. Hodge is also founder of Project Nino, a voluntary clinical outreach program in Mexico created in response to the 1985 Mexico City UCSF Fresno Department of Internal Medicine presents earthquake that killed more than Air Pollution & Climate Change Symposium 10,000 people and injured 30,000.

For the past 30 years, Dr. Hodge has led a team of physicians and educators providing health care to families in Mexico who otherwise would have limited access.

“Medicine in this community as An educational program designed to provide current clinical updates been good to me, and I have always on air pollution and climate change to physicians, surgeons, mid-level felt it is my responsibility to give providers and nurses in our region. back to the community and others Saturday, April 23, 2016 - 7:30 am - 2 pm who are in need of help,” Dr. Hodge UCSF Fresno Center Auditorium said. “Helping others and seeing 155 N. Fresno Street, Fresno, CA 93701 (Corner of Divisadero & Fresno) how grateful they are for the help, however small, leaves one with an CME: 5.5 (Applied For) indescribable feeling.”

Early Registration by March 4: $25 After March 4th, Registration: $50 For many Valley families, that indescribable feeling is one they For more information call feel when their loved ones receive 559-499-6421 or email msozinho@fresno.ucsf.edu. lifesaving treatment. And that ability to help children is what drives Dr.

Winter 2016

CENTRAL VALLEY PHYSICIANS

31

In The News (continued on page 27)

UCSF Fresno Department of Internal Medicine Presents:

2ND ANNUAL

MEDICAL

UPDATE March 11-12, 2016 UCSF Fresno Center Auditorium 155 North Fresno St. Fresno, CA 93701

(Corner of Divisadero & Fresno)

An educational program designed for internists, family practitioners, primary care physicians, and nurse practitioners who work in the primary care field.

CME: 11.25 (Applied For) Early Registration Fee: $200 (By February 12, 2016) After Feb. 12th, Registration Fee: $249 Register online at: www.fresno.ucsf.edu/ conferences/update2016

For more information: Call 559-499-6421 or email msozinho@fresno.ucsf.edu

32

CENTRAL VALLEY PHYSICIANS

Center operated by Kern Radiology, followed by a Cancer Center. There are still leasing opportunities within the first building and on the campus

Calling all physicians and health professionals!

Rio Bravo Medical Campus

The American Lung Association in California will host a meeting for physicians and health professionals to learn about opportunities to support our lung health mission in the Valley. The meeting will be held Thursday, Feb. 24 at Mercy Hospital Bakersfield in Clerou Room from 5:30 to 7:00 pm and is co-hosted by the Kern County Medical Society. To RSVP, please contact Maria Jaime at 661-282-3306 or email Maria.Jaime@lung.org.

• CLASSIFIEDS • FOR LEASE/RENT

Medical office space, 1331 square feet. Many new exterior improvements.

1046 and 1060 E. Shields Ave. Contact Shannon Mar, 559-999-6165 or smar@guarantee.com.

FOR LEASE/RENT

Medical office space, 1302 square feet. Adjacent to Saint Agnes, remodeled, covered parking, available April 1, 2016.

559-905-1041.

HELP SAVE SOME BABIES

As Medical Director of Helping Hands Pregnancy Center you can join our free pro-life Christian clinic and make all the difference in the world for those unborn.

Contact Jill at 559-642-7985.

Family Retreat and Investment Opportunity This is the HISTORIC 127ac 3 FALLS RANCH owned by the same family for over 100 years is nestled in the Sierra’s about 1 hour from Bakersfield or Visalia.

A Quiet and Beautiful Place for You and those you love to Escape and Enjoy each other. The only sounds are of the peaceful forest and the nearby creek that flows through the property.

The spacious four bedroom Mountain Home features an incredible sun deck where one can view the creek and the magnificent surrounding forest. BUT THAT’S NOT ALL – The area is extremely popular and small parcels are seldom available. This property lends itself nicely to that possibility of being divided and sold into smaller parcels.

There is much to consider in the purchase of such a unique property. The Beauty, the Convenience, the Tranquil Atmosphere, and the Potential.... YOU MUST SEE IT FOR YOURSELF.

CALL TO INVESTIGATE & SEE BOB CLERICO REAL ESTATE

661-204-9539

Winter 2016

WEDNESDAY

MARCH 2, 2016

6–8pm Appetizers & Refreshments

ELEPHANT LOUNGE Hosted by Dr. Hemant Dhingra, M.D. Supported by FMMS Political Action Committee

80 W Shaw, Clovis (@Villa)

HERO CHAMPION ADVOCATE

$1000 $500 $250

Bring your family and friends to support Joaquin, A Trusted Voice for the Valley!

Paid for by Dr. Joaquin Arambula for Assembly 2016 Special Election, FPPC # 1381864

RSVP: (559) 264-3131 or arambula4assembly@gmail.com

Can’t join us? YOU CAN STILL HELP! Donate to: Joaquin Arambula for Assembly, PO Box 4469, Fresno, CA 93744-4469 | JoaquinArambula.com Contributions are not tax deductable. Contributions are limited to $4,200 per election per person, and may be accepted from individuals, businesses, unions, corporations, PACs and political parties. Small contributor committees may give up to $8,500 per election. Contributions from foreign nationals or donors under the age of 18 are prohibited, and we cannot accept contributions which have been reimbursed by another person unless you inform us of the true source of the contribution. By law we must ask for the following information from you in order to accept your contribution: your name, street address, occupation and employer. We cannot accept cash, cashier’s checks or money orders of $100 or more.

Winter 2016

CENTRAL VALLEY PHYSICIANS

33

Gala Dr. and Mrs. Alan Kelton

Drs. Alan Birnbaum, Shamsuddin Khwaja, Ernest Pope, Peter Birnbaum and guests

Gala FRESNO MADERA MEDICAL SOCIET Y

Drs. A.M. Aminian and Roy Steinke congratulate Carol Yrulegui on her retirement from FMMS

Fresno Madera Medical Society’s annual Installation and Awards Gala was attended by more than 200 physicians and guests. The event took place Friday, November 13, at Fort Washington Country Club.

Lifetime Achievement Awards were honored to Drs. David Hodge and Fitzalbert Marius for their remarkable work, extraordinary leadership and community service.

Drs. Jean Linder, Herberto Boro, Roy Smith, John Monteleone and guests

New 2016 officers were announced during the installation ceremony – President: Dr. Hemant Dhingra, PresidentElect: Dr. Alan Kelton, Vice President: Dr. Trilok Puniani, Secretary/Treasurer: Dr. Cesar Vazquez, and Immediate Past-President: Dr. A.M. Aminian.

Also recognized were physicians who have been dedicated members of the Fresno Madera Medical Society for 40 or more years. Carol Yrulegui was thanked for her 23 years of service and congratulated on her retirement. The silent auction, coordinated by the Fresno Madera Medical Society Alliance, helped raise funds for the Scholarship Foundation, which has been provided grants for medical students from Fresno and Madera counties since 1962.

Drs. A.M. Aminian, Fitzalbert Marius and Denard Fobbs

34

CENTRAL VALLEY PHYSICIAN

Save the Date 2016 Installation and Awards Gala: Friday, November 18

WINTER 2016

a

FRESNO MADERA MEDICAL SOCIETY

>

GALA 2016

Drs. Willis Chang, Thaung Aung, William Holmes, Amie Holmes, Hector Ramos and guest

Drs. A.M. Aminian, David Hodge, Krishna Rajani and Robert Kezirian

Dr. and Mrs. Dominic Dizon and Dr. and Mrs. Alan Kelton

Dr. Hemant Dhingra

WINTER 2016

Dr. and Mrs. Peter Birnbaum

Berj Apkarian

Dr. Alex Sherriffs, Dr. Denard Fobbs and Pamela Freeman-Fobbs

CENTRAL VALLEY PHYSICIAN

35

T H E C A LI FOR N I A M EDIC A L A SSOCI AT ION

POWERFULLY BENEFITS AND PROTECTS T H E COM M U N IT Y It is difficult to imagine, but the 2015 legislative year was even more challenging than the 2014 legislative year, which included the diversion of staff resources to defeat Proposition 46. With a third of legislators (40 out of 120) serving freshman terms, the California Medical Association’s (CMA) Government Relations staff spent a considerable amount of time during the first quarter educating new legislators and their staff about the mission and policies of CMA. Through our educational efforts, we successfully stopped the introduction of a number of harmful legislative proposals and shifted focus to the passage of CMA’s sponsored bill package.

C M A’ S 2 01 5 L E G I S L A T I V E W R A P U P

BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT

SCHOOL VACCINES

A majority of our resources this year went to the passage of SB 277 (Pan and Allen), our sponsored bill eliminating the personal belief exemption (PBE) for school vaccination requirements. We faced relentlessly vocal opposition from anti-vaccine activists, who were supported by the California Chiropractic Association and the newly founded Public Health Council. As it moved through the Legislature, SB 277 had four hearings in various committees, each of which was flooded by protesters.

Our strategy to overcome this deluge was to counteract on the same grassroots level from which we were attacked. CMA engaged with school districts, county boards of supervisors and all levels of local government to strengthen support for the bill. Through these and our more traditional lobbying efforts, we were able to see the bill passed out of the Legislature and sent to the Governor’s desk. Although the Governor had 12 days to pass or veto the measure, he chose to sign SB 277 into law less than 24 hours after he received it. In his signing message, he wrote, “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.”

36

CENTRAL VALLEY PHYSICIANS

Winter 2016

Legislative Wrap Up > CMA

SB 277 also garnered tremendous support in the press and from the physician community at large.

All through the year, this bill made state and even national headlines. The New York Times, often regarded as the national “newspaper of record,” even editorialized in support of the bill. After SB 277 became law, Senator Richard Pan, M.D., was lauded

by TIME magazine as a “hero of vaccine history,” while the Journal of the American Medical Association pointed to SB 277 as a potential catalyst and model for stricter vaccine requirements across the nation. The New England Journal of Medicine chronicled the entire SB 277 story, describing a sea change in the national politics of vaccination. We continue to regularly field calls from allies across the country who are seeking to learn more about what we accomplished and how we did it.

Unfortunately, our time to celebrate the hard-won victory was not long, as we quickly had to turn our attention to new attacks: a referendum to overturn the new law and a recall effort against Dr. Pan for his authorship of it. Through CMA’s political action committee, CALPAC, we will continue to work to defend Dr. Pan and his important law from this spurious attack.

relating to certified nurse midwives (CNMs).

Negotiations with the CNMs were productive and in time we were able to reach an agreement, moving CMA to a neutral position. Ultimately, however, this bill, too, died in committee.

PHYSICIAN AID-IN-DYING

Another fruitful negotiation centered on SB 128 (Wolk and Monning), the physician aid-in-dying bill. This controversial measure demanded a lot of attention from CMA. We began the year with a longstanding House of Delegates-established policy of opposition to this subject. It soon became clear, though, that this was no longer the overwhelming stance of the membership that it once was. CMA’s

“Our strategy to overcome this deluge was to counteract on the same grassroots level from which we were attacked.”

SCOPE OF PR ACTICE

Throughout the year, CMA dedicated a vast amount of resources to the successful defeat of several scope-of-practice expansion attempts that were before the Legislature. These measures were: SB 323 (Hernandez), for nurse practitioners; SB 538 (Block), for naturopathic doctors; and SB 622 (Hernandez), for optometrists. Each of the bills claimed to expand the scope of practice for allied health professionals as a means of ameliorating California’s access to care crisis, but, in reality, posed a danger to patients.

Through diligent lobbying and with the engagement of our physician members calling and writing their legislators, CMA convinced lawmakers of that truth.

Each bill was successfully killed in either a policy or fiscal committee, sending an unequivocal rejection of scope expansions as an answer to access to care issues.

Year after year, these expansions are rejected by the Legislature, demonstrating that the physician voice still holds sway at the Capitol.

Scope of practice fights generally play out similarly, except, this year, for one unique experience. An amicable solution was reached on AB 1306 (Burke),

Winter 2016

physician leaders began a conversation with our physician members so that we could update our official policy to reflect the new, nuanced views of our members. CMA became the first medical association in the nation to move from opposition to neutrality on physician aid-in-dying. Having received permission from our Council on Legislation and from our Board of Trustees to engage with the bill’s proponents in hopes of reaching solutions, CMA’s lobbyists, in conjunction with CMA’s Center for Legal Affairs, entered exhaustive negotiations. Although CMA had become neutral on the concept of physician aid-indying, there were still concerns to be addressed about the bill’s language. Through countless meetings, a final comprehensive solution was reached and CMA officially became neutral on the bill. The crucial amendments that were secured to reach that agreement included the strongest statutory immunity protections for physicians, voluntary participation protections and mental health evaluations. After SB 128 failed in the Assembly Health Committee, its cause was revived through a bill, ABX2 15 (Eggman), in the special session on health care called by the Governor. This bill ultimately retained our negotiated amendments and our neutrality, and was passed by the Legislature on its last day in session. On October 5, the Governor signed the bill into law.

CENTRAL VALLEY PHYSICIANS

37

Legislative Wrap Up > CMA

WORKERS COMP

The physician aid-in-dying bill was far from our only instance of exhaustive negotiations this year. CMA also took part in extensive discussions regarding AB 1124 (Perea), a bill that would require the Division of Workers’ Compensation to establish a prescription formulary. After several months of diligent negotiations, we reached an agreement with the author’s office that moved our position to neutral. Through negotiations on this bill, CMA solidified its standing as a full stakeholder in workers’ compensation.

will allow the Department of Justice to roll out its automated registration process and protect doctors from being disciplined by the Medical Board of California during the system roll-out.

In two days, the bill was heard in Senate Business and Professions Committee, on the Senate Floor and on the Assembly Floor. AB 679, as amended on September 10, passed the Legislature without receiving a single “no” vote. The measure also included an urgency clause, meaning the bill goes into effect as soon as it is signed by the Governor.

“SURPRISE” BILLING

CUR ES

In the final days of the session, while almost all eyes were watching the major political fights, CMA staff went to work with Assemblymember Travis Allen to extend the Controlled Substance Utilization Review and Evaluation System (CURES) registration deadline for all prescribers and furnishers. On Thursday, September 10, CMA and Assemblymember Allen gutted and amended AB 679 to extend the deadline from January 1, 2016, to July 1, 2016. This extension

Our other focus in the final days was the completion of a year-long fight. AB 533, introduced by the Chair of the Assembly Health Committee, Rob Bonta, initially seemed like a matter of negotiation. We had a good relationship with the author, and we shared his goal of addressing the “surprise billing” problem.

Instead, over the course of the year, those negotiations became increasingly hostile until they finally deteriorated to an all-out war.

Going into the last week of the legislative session, AB

Please join us to learn more about

Lung Health Programs and Resources in the Valley Hosted by American Lung Association in California & Kern County Medical Society WHEN: WHERE:

Wednesday, Feb. 24 • 5:30 to 7 pm Mercy Hospital Downtown, Clerou Room, 2215 Truxtun Ave. Bakersfield, CA 93301

Come join us to learn more about American Lung Association lung health programs and resources in Central Valley and opportunities for health professionals to improve lung health.

The American Lung Association in California invites you for a dinner presentation about our programs and resources for asthma, COPD, lung cancer, smoking cessation, air quality and research. Join our team of dedicated medical experts to learn more about ways improve lung health and fight lung disease.

RSVP - Maria.Jaime@lung.org or call 661-282-3306 by Feb. 19.

38

CENTRAL VALLEY PHYSICIANS

Winter 2016

533 would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. The bill would have required noncontracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. In addition, the bill would have implemented barriers for PPO patients seeking to access their out-of-network benefits.

Overnight, the bill became essentially a health plansponsored bill, with the strong support of consumer groups and organized labor.

With myriad resources, the health plans spent tens of thousands of dollars hiring contract lobbying firms to lobby in favor of AB 533. The California Federation of Labor, the California Firefighters and most of organized labor, who were misinformed about the full contents of the bill, also lent their political muscle to the passage of bill, for they believed it would protect patients from exorbitant, unexpected bills. Finally,

the California Chamber of Commerce and consumer groups, led by Health Access, also spent their political resources in favor of the bill.

In order to defeat AB 533, it was all hands on deck at CMA and we called upon our Legislative Key Contacts, CMA officers and medical executives, asking them to call their legislators on the last night of session to ask them to vote no on AB 533. CMA was also able to call upon the specialty societies and two of our closest allies to stand in opposition: the California Dental Association and the California Podiatric Medical Association.

After countless hours of lobbying and passionate debate in the halls and on the floors of the State Capitol, CMA and our allies defeated the measure on the floor of the State Assembly. This CMA victory was the final act taken by the Legislature in 2015, solidifying this year as one of the most challenging and one of the most successful.

FOR MORE DETAILS ON THE MAJOR BILLS THAT CMA FOLLOWED THIS YEAR, VISIT HTTP://CAL.M.D./LEG-WRAP-2015.

Medical Group Management Association and the Fresno Madera Medical Society present

Identify Your Practice Potential Managing the Missed Opportunities Speaker: Irv Barnett of Moss Adams Wednesday, March 16, 2016 5:30 pm - social 6 pm - dinner and presentation Fort Washington Golf & County Club 10272 N. Millbrook Ave. • Fresno, CA 93730 Physicians and Mid-State MGMA Members: FREE Non-Members: $30 RSVP: 559-288-2265 or joanneh@omniwomenshealth.com Cash or check payable at the door, credit card payment at www.camgma.com

Winter 2016

CENTRAL VALLEY PHYSICIANS

39

F

FRESNO MADERA MEDICAL SOCIETY

NEW FACES

NEW FACES OF

Fresno Madera Medical Society FMMS

Fresno Madera Medical Society remains your partner in medicine.

To reach the Medical Society, call 559-224-4224.

In the past few months there have been several staffing changes at Fresno Madera Medical Society. In December 2015, Carol Yrulegui retired after 23 years of dedicated service. In addition, there are a couple of faces new to the organization.

Nicole Butler joined as Executive Director in June 2015. In her role, she manages staff, strategic planning, budget and the overall organization. Butler comes to the Medical Society with more than 20 years of experience in sales, marketing and business development.

She has previous experience with health plans, Community Medical Centers, and Adventist Health in Hanford.

In October 2015, Millie Thao joined Fresno Madera Medical Society as Director of Communications and Physician Relations. She oversees the Society’s membership, publications and CME activities.

She has more than 10 years of experience in healthcare. Most recently, she was the physician liaison at Saint Agnes Medical Center and previously the physician liaison at Community Regional Medical Center. She has a background in mass communications and journalism, public

relations and marketing. Currently, she serves as President of the local Mid-State chapter of Medical Group Management Association (MGMA) and also has past legislative experience in Washington D.C. Becky Gentry continues to work parttime as the office assistant – updating the physician database and helping to coordinate Walk with a Doc. Fresno Madera Medical Society continues to be a resource for physicians by providing valuable benefits to its members. In 2016, there will be more opportunities for members to network with other physicians and local experts, to become more involved with healthcare legislation, and to help improve the wellbeing of local physicians throughout the Valley. The Medical Society will offer more continuing medical education and will run a monthly education series for office managers, with topics such as new HIPAA regulations, HR training, marketing and social media, and much more.

Walk with a Doc Take a Step Towards Better Health Walk with a Doc is a FREE walking program for anyone who is interested in taking steps to improve their heart health.

Each walk is hosted by a friendly, local physician. In addition to numerous health benefits received just by walking, you will also get the chance to talk with a doc.

FRESNO

2016 SCHEDULE

Where: San Joaquin River Parkway & Trust 11605 Old Friant Rd Fresno, CA 93730 When: 3rd Saturday Time: 8:30 am Dates for Fresno February 20 March 19 April 16 May 21 June 18 July 16 August 20 September 17 October 15 November 19 December 17

MADERA Where: Lions Town & Country Park- Pavilion 2300 Howard Rd Madera, CA 93637 When: 1st Saturday Time: 8:30 am Dates for Madera February 6 March 5 April 2 May 7 June 4 July 2 August 6 September 3 October 1 November 5 December 3

Join us for Walk with a Doc

For more information or questions, please call (559) 224-4224 or visit www.fmms.org.

Public Health

Update

DONATE BLOOD You can give life to your community by donating at either a Central California Blood Center near you or by stopping by one of the many mobile blood drives held every day around the Central Valley. By donating you help to ensure an adequate supply of blood is available for your family, friends and neighbors when they need it.

Central California Blood Center Administrative Offices and Jenny Eller Donor Center 4343 W. Herndon Avenue Fresno, CA 93722 (559) 389-LIFE(5433) Fresno Donor Center 1196 E. Shaw Ave, Suite 102 Fresno, CA 93710 (559) 389-5500

Expecting the Unexpected

North Fresno Donor Center 1010 E. Perrin Fresno, CA 93720 (559) 389-5600

(Note: Dr. Rossmann wrote these comments shortly after the recent terrorist attacks in Paris; Central California Blood Center in Fresno is a member of America’s Blood Centers.)

A Message from America’s Blood Centers (ABC) President Susan Rossmann, MD, PhD

Last week, the Advisory Committee on Blood and Tissue Safety and Availability (ACBTSA), which reports to the Undersecretary for Health of the Department of Health and Human Services, met to discuss the sustainability of the U.S. blood supply. Among the concerns was the worry that a shrinking blood inventory and collection system, appropriate to the reduced level of routine red cell blood use, would not be able to provide appropriate surge capacity.

Later that same week, the terrorist attacks in Paris provided all-too-real and graphic examples of why we need a robust blood reserve. As far as I have been able to determine from news reports and the statements of the French blood agency, all the urgent needs were met from current blood inventories.

42

CENTRAL VALLEY PHYSICIANS

Winter 2016

the connection between his gift and the recipient. When the potential recipient is bloody and smeared across the TV screen, this connection is not hard to make; in ordinary circumstances the connection may be less clear.

We know that it is the blood already on the shelf, in the hospitals, or even carried on ambulances, that saves lives first, in the most urgent situations. As a country, we need to make sure that we have this reserve always available, and that we also have the capacity to collect and process blood more quickly should the need arise. We can see that our donors will be ready. It is an important part of the work of the ACBTSA subcommittee and all of us to make sure we as blood centers are ready as well.

Almost simultaneously, it The French collection agencies seems, many, many people came immediately scheduled collections to spontaneously to donate blood at later days. Our specialized collection collection centers across France, programs based on blood type and as shown in this CNN clip. The specific hospital needs are efficient number of those presenting to donate and successful only as long as we was estimated at 10,000, and onecontinue to allow that donor to feel fifth were new donors. Fadila Benayache, a young woman who was donating, told CNN, “I was just thinking …

Assisted Living • Memory Care What can I do?”

We have had large-scale public blood collection programs only since W WII, less than 75 years. Yet a substantial number of the public has adopted blood donation as a way to give back. In the face of terrorist attacks, such as those that occurred last week in Paris and in the U.S. on 9/11, Resident focused care that you will be proud to recommend. donation offers some people a way to feel they are helping Personalized care plan • Incontinence Program in the face of a seemingly helpless situation. The Medication management including injections • Purposeful activity programs instinct to help others is a Nurse on-site 7 days a week • Diabetic Wellness Program very strong one, and we must make sure our programs 5605 N Gates Ave • Fresno, CA 93722 continue to support that sensibility in ordinary 559-682-3114 circumstances through oakmontoffresno.com ordinary everyday blood RCFE #107206882 TOURS AVAILABLE DAILY! donations.

Premier Senior Living

Winter 2016

CENTRAL VALLEY PHYSICIANS

43

Office Manager’s Forum Free to FMMS/CMA Members!

THE OFFICE MANAGER’S FORUM EMPOWERS PHYSICIANS AND THEIR MEDICAL STAFF WITH VALUABLE TOOLS VIA EXPERT LED EDUCATIONAL SESSIONS FROM INDUSTRY PROFESSIONALS WHO ARE COMMITTED TO DELIVERING QUALITY HEALTH CARE. For more than 130 years, the Fresno Madera Medical Society (FMMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. FMMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice. Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the last Wednesday of each month from Noon to 1:30 p.m. at the Fresno Madera Medical Society and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($20 thereafter). Registration required.

For more information, contact Millie Thao, Director of Communications and Physician Relations, 559-224-4224 Ext. 112 or milliethao@fmms.org.

Fresno-Madera MEDICAL

SOCIETY

New Members

FEBRUARY 24, 2016

Noon to 1:30 p.m.

LEGAL UPDATES: KEEPING YOUR PRACTICE COMPLIANT IN 2016 Nathan W. Powell, Dowling Aaron Incorporated Nathan’s practice focuses on business transactions, entity formation, healthcare, and employment law. He counsels clients on healthcare related issues, including but not limited to, consent, privacy, Anti-Kickback, Stark, HIPAA, and related matters. Nathan also assists physicians and other healthcare providers in structuring their business transactions and relationships in compliance with the complex federal and state regulatory framework.

MARCH 30, 2016

Noon to 1:30 p.m.

MEDICARE CHANGES: 2016 AND BEYOND Chery Bradley, Associate Director CMA Center for Economic Services In her capacity as Associate Director of CMA’s Center for Economic Services, Cheryl provides policy support and analysis for CMA member physicians on issues regarding Medicare. Cheryl has over 20 years’ experience in the Medicare Program, having worked as an Educator and Training Specialist, Medical Review Analyst, and as a Customer Service Representative across all of the CA Medicare contractors including Noridian Healthcare Solutions most recently. Cheryl has provided problem-solving assistance and presented before physicians, specialty organizations, insurance billers, and other healthcare professionals in CA, Hawaii and Nevada.

APRIL 27, 2016

Noon to 1:30 p.m.

GETTING PAID: A PHYSICIANS GUIDE TO TAKING CHARGE OF ACCOUNTS RECEIVABLE Mark Lane, Associate Director CMA Center for Economic Services 18 years of experience allowed him to understand the needs and positions of both Physicians and Payors, making him an ideal candidate to educate providers on overcoming the ever changing challenges of the healthcare landscape.

ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.

from the is thly bulletin This bulletin is a free mon nomic Services. practice Eco ces (CPR) staff improve tice Resour ciation’s Center for their office CMA Prac Medical Asso help physicians and California CMA Practice to , sign

May 2012

May 2012

In this issue:

Resources (CPR) is to date Aetna to require addition and tools a free monthl stay up from Toy bulletin al accreditation require- full of tips Californiaility .

Medical Association’sNEW the ments in order to be SLETTERS: and viab ire- surgical paidnfor CMA Center for certain requ letters.ic Services. This eagues. efficiency full of tips andANY tools OTH ewsEconom toERhelp pathology services physicia is t.ornsg/n accreditatio and their office staffrs and collbulletin efficienc CPR OR viability orke improve practice additional certain surgical www.cmane ire Update 1 SUBSCRIBE TO y and on two ptions at . for Anthem Blue Cross 1 to your cow Aetna to requ r to subscri SUBSCR be paid issues pending IBE TO CPR OR ANY this bulletin with ardOTHER up for free forw CMA se ments in orde ices the Department of Managed Health NEWSLE up for free Plea tions TTERS: To stay up D:subscrip 1 serv Meet Your CMA s issues pending Care to date, sign at www.cmanet.org EAD THE WOR pathology Center for Economic 1 Cros SPR /newsle tters.

Blue SPREAD THE WORD: Anthem : Markaged lth Care Services Please forward this two Advocate bulletin to your coworke Man LaneHea Update on of ent 2 artm rs and colleagues.

CMA Advocacy at Work Services with the Dep 2 for Economic 2 Center Urgent CMA survey response requeste Aetna to require additi Meet Your d 2 onal accreditation requir 3 Mark Lane practices perin order to be paid for 1, 2012, emen Advocate: Aetna erroneou ts orak sly terminates providers from 3 Californi ctive August both Clinical Lab certain surgic a network y at Wor altopatho be ns that, effe CMA Advocac vices logy ser-the Col3 requested Docume fied physicia ing will be required accredit ed with Document, Docume s from noti respnt,onse ey ntly surv Aetna a recerecently notified y test Urgent United Healthca inates providernt Aetn 3 3 certified and physicia ns(CL termre announces extensio that,IA) ffice patholog effective usly forming ts in-o August neo ing in-office with the men 1, 2012,con n of HIPAA form practice sistent Amendgy testing will s perAetna erro5010 enforcem t patholo 3 ge isClinical toryImp rovemen Improve (CAP). be required tochan network ent be both as an ment ia ists P the Amendm forn 4 tory olog CA nt Laboraents that Cali s What’s a COHS? (CLIA) certified Path ume ion of lege ofAm ericann Patholo and America recognit Aetna claim ument, Doc ed with the ology testS)accredit ns, (CAP). of HIPAA lege of nt, Doc physiciagists tophysicia DocumeSave In aa lette the Date unces extension Services (CM pital anatomic path Col4 4 letterr to icaid In Aetna re anno -hos claimsforthat e &ns,Med lthca non Centers 4 icar the Hea change for Act ed Med Medicar is now consiste tion Unit to avoid the 2013 e-presc e &nMedicai nt with the 4 ters for implemend Services (CMS) recognit organiza Cen ribing penapprove atioorganiza altyrcement ddaccredit s withas the edit ion ation cern of accr 5010 enfo CAP ificacon an tion for non-hos 45 approve voiced ing.

S? forgydual cert nizaPayor patholo a COH ciation haspital anatomic need Updates

: In this issue

ements tion requir al accredita pathology seruire addition gical Aetna to req paid for certain sur be to er in ord vices

What’s Health plan provider ibing pen 5 newslett Save the Date ers escr 2013 e-pr 55 avoid the Act now to 5 alty 5 CMA ates Payor Updresources ers slett new When youprov seeider this icon, that means th plan there Heal are addition al resources available free to Californ ia Medical Association (CMA) membe rs at the CMA website To access any of . these visitns http://www.cmanet.org/resources,mea ces., that

ourcesicon CMA ressee this

s availresource When you Assoadditional

are ia Medical CMA website. there al-Leg Medic to Californ Librar able free A)almem bersyat the s, visit (Form resource erly(CM CMA ciation these ll) any ofOn-Ca . ess

the

test- orga ing.

The California nia Medical Asso d Aetna to explain editation Califor Medical Associat roved accr ialty society ion has voiced concern tation The has aske of this policy andasked P as an apps with cy has spec en- A thea implem poliand and Aetna e CA tion explain tion. n of this Althoug theifica tatio need may recogniztoCLI h CMS cert for ices.certifica mayS recogniz Further- , CM aCAPa as an Aapprove ing servdual ough CM tion,tion CMS . Alth ire eboth does not srequire ation CAP -accredit aorganiza not requ ology testd accredit both a CLIA path the in doe certifica S accreditation obta ffice tion CM and accredit a specialty society ns to tion, to perform orm in-o in-office physicia patholoity CAP, the to perf gyof expressededit testing ng toCMA ations with services.ordi obtaining Further, theofabil accr concern thewith ability process of physicia Aetna. Acc ally, the tion prior to the concernsimposed the CAP accreditaimposed byns tos.obtain expressed deadline Addition tion process day ng the deadline by Aetna. to CAP, takes r to ely 90Accordi approxim thes.accredita-is working closepractice ately tion prio for 90mat roxi days. Additio ly app A a seconda s cost nally, CM take ry proc the process e, obtainin accredit essation can be very can be very g r state and tion a s.on this issuofseve for practice othe In addition editation costlywith Aetn ral accr to their ry contact nda tact on this with A) and r conAetna a seco ly with the issue,(AM to thei Americaition CMA is working ciation Associat details. close- Gaul, senior In addn Medicalan ion Asso (AMA) and specialty medical Medical furtherother for several societies stateTam Am.eric Stay tuneds.for andmy tuneddetails. the Stay contact further Practice ly swith with question societie letter can s about ut the the ns medical letter abocan network manage contact specialty 4. Gaul, seniormlane@cmanet.org Tammy r at Aetna questio5-6604.

-660 at (215)77 tices with Contact: CMA Prac a at (215)775 (888) 401-5911 or reimbur sement at Aetn , help ager line, line (888) man 401-591 help 1 or mlane@cmanet.o network bursement rg CMA reim

In this acc ion, you will org/ Topublicat references to cmanet.find “medical-legal” docume http://www.

Contact: Medical Association’s nts. The California (CMA) online medical library contains over -legal 4,500 pages of medical legal, regulatory, and reimbursement informatMedical-legal docume ion. nts are free to membe to es and can be found renc DMHC claims audit in CMA’s online will find refers ia library, http://www.cma Health ion, you resource Asl previously reported The Californ ical-lega net.org/ Managed with nts. -library. resource this publicat , on ume NonmemIn 2012 artment of bers e med can l-leg al” doc Care (DMHC) ordered Jan. 12,aud purchas claims, it the Departm ent of2Manage e medical the Dep A) onlin dica -legal ments for “me Anthem d Health s provider docu- medical’s (CM msBlue Cross 12, 201 $2 per page. interest, reproces Association . , ontoJan. dating DMHC clai pages of s providerss to reproces

ces

al Library Medical-Leg A On-Call) CM (Formerly

ing with

nd Update on two Anthe ss issues pe m Blue Blue Cro pendingCa the Department of Mana o AnCross themissues with re tw ged Health Update on ged Health ManaCare ent of the Departm

0 tion back to 2007. reported Medical s over 4,50 bursement informa The order is As previously ry contain

e Anthem Blu

Cro claims, with

s health plan

bers based on 2008 DMHC red reim libra largest HC) orde audits CMA Center free to mem in California. These e (DM latory, and the seven above the threshl, regu 200of7.the sevenHC Econom largest its of plans Car audits foundngviolation legafor umentsesare e resource audhealth ic Servic back tos of doc 1201 J Street, DM old allowed under claim payments ical-legal #200, A’s onlin 2008paymen rest, dati ary.

claim ts aboveofthe Med Sacramento, Californ inte ia law at d on in CM95814 resource-libr economicservices@cman seven r isallbase health plans. be found CA net.

As a result, DMHCThe orde d violations healthreshorg/ uth plans. and can et.org • 916/551 cma -2061 assessed adminis audits foun legal doc n ww. ://w medicallibrary, http purchase bers can e.

Nonmem $2 per pag ments for

s to pay

plan seve providers the money Thesetrative fines,law at allthe required required the onstrate ifornia. plans Calwere pays, ifornia ivetofine inthey owed and trat mandat ed ssed plans dem that plans under Cal adminis demonstrate dated that of 5 old allowed • Page 1 DMHC asse d and man

ic Services for Economento, CA 95814 1 CMA Center Sacram -206 et, #200, • 916/551

2012 owe As a result, they wereCPR • May 2012 • Page 1 of 5 CPR • May the money providers

1201 J Stre rvices@cmanet.org economicse

CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA’s Center for Economic Services.

This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.

SUBSCRIBE NOW

Sign up now for a free subscription to our e-mail bulletin, at www.cmanet.org/news/cpr

If there are additional topics that would like us to cover please contact Millie Thao at 559-224-4224 Ext. 112 or milliethao@fmms.org.

FUTURE TOPICS INCLUDE: Anatomy of Managed Care Contracting Marketing 101: Advertising, PR, Social Media

Solo Practice > Facing Challenges

Story By Millie Thao

Can a solo practice

SURVIVE in today’s environment?

In today’s world of medicine, there is an ever growing laundry list of new regulations mandated for physicians – from ICD-10 to PQRS, new HIPPA rules and more. It is increasing apparent that trends show solo and small practices are combining with larger organizations that can help take on the burdens packaged with practicing medicine. But, is that the key to success? For some it may be enticing, but others have chosen to dare another route.

His first day as a solo practitioner started with one employee who brought with her a pencil and some paper. Their first business decision: order a fax machine. Cardiothoracic surgeon Shamsuddin Khwaja, MD, and his practice have come a long way since then. Five years later, his lobby is full of thankful patients and his practice is thriving.

Solo practice physicians, once common throughout the country, are now a vanishing breed. Of the 2,711 physician search assignments Merritt Hawkins represented in 2011-12, less than one percent offered a solo practice, down from 22 percent in 2004. The most recent data available from the AMA Physician Master File indicates 13 percent of all physicians are in solo practice today (The Physicians Foundation by Merritt Hawkins, 2012).

In any new endeavor, there are both challenges and rewards. For a physician, the decision to go solo should not be made without weighing out

the odds. Pediatrician Cesar Vazquez, MD, was faced with this life-changing choice and decided to venture out on his own, opening his practice four months ago.

“It is a complicated, but rewarding process,” said Dr. Vazquez. “I have gained a lot along the way, but am still learning and facing new challenges every day.”

All risk is taken on by the solitary physician, including financial risk.

Start-up businesses face an immense amount of overhead cost, and solo physicians have no assistance with shared expenses. This includes combating reimbursement issues, purchasing malpractice and liability insurance, and providing workers comp and health insurance for the physician, physician’s family and employees. Medical office space, computers, printers, phones, IT support, electronic medical records, staff, medical equipment and supplies are all costs that also add up. There are also taxes, payroll deductions and retirement plans to consider Solo practitioners are also challenged with coverage. In group practices, physicians are able to have their patients seen by other physicians within the group; therefore, they are without fear of losing their patients.

There is no such benefit for solo practitioners.

An increasing number of regulatory mandates from the government has also made practicing medicine more difficult.

So what is the reward? Being in charge of the care provided.

“I enjoy being able to spend quality time with my patients,” said Dr. Vazquez. “Not having a quota to meet, means less pressure to see a certain

amount of patients per day – which results in better quality of care.”

The ability and freedom to build a practice is undoubtedly gratifying. “I take pride in knowing that everything here was built through my own hard work,” said Dr. Khwaja. “It is a privilege to care for my patients in a manner that I envisioned and created.”

Drs. Khwaja and Vazquez have found there is no true recipe for success. However, from their separate

Internet, everything is transparent.

“On Healthgrades, patients rate physicians based on ten questions, and five of those questions have nothing to do with the physician’s ability to practice medicine. They are based solely on the people who run the office – on wait times, office cleanliness, appointment availability, etc. If you don’t hire people who have the same vision as you, you will certainly see those effects in your practice,” said Dr. Khwaja.

“Not having a quota to meet, means less pressure to see a certain amount of patients per day – which results in better quality of care.”

Winter 2016

experiences, they have learned through research, practice, and sometimes trial and error. They have both come a long way from their start and have offered the following survival tips for anyone who is braving their paths and going solo.

Hire a consultant or find a mentor.

There are people out there who have expert knowledge or who have experience traveling this road. Use them to your advantage. There are several legal and HR regulations that you may not be aware of, so make sure to do your research.

Be open-minded and creative.

Sometimes things don’t turn out as planned. Be prepared to change your course until you find what works for you.

Hire the right people. In Dr. Khwaja’s experience, he has found it essential to surround himself with people who share the same ideas and beliefs towards patient care and with people who can be supportive of him and his endeavors. In the age of the

Network. Even if it means going out of your comfort zone, meet other physicians and market yourself, because it will pay off in the end. It is important for the growth of your practice to develop a referral base.

Focus forward. Dr. Khwaja says, “It’s like looking out of your car.

Look through the windshield at what is coming up directly in the future ahead of you. But the rear view mirror is there, so you don’t forget where you’ve come from.”

Be resilient. Never give up.

Remember, the best things do not come easy.

Lastly, make your bed every morning. According to Dr. Vazquez, “there will be days where everything goes upside down and you feel like nothing was accomplished. But when you go home at night, and your bed is made, you will at least know you’ve accomplished one good thing! It is humbling and it will make you thankful to have a place to lay your head at night.”

CENTRAL VALLEY PHYSICIANS

47

WEBINARS

EDUCATION •

SEMINARS

•

PODCASTS

•

AND MORE

DID YOU KNOW? CMA offers free webinars to its members Through its robust webinar series, CMA gives physicians and their staff the opportunity to watch live presentations on important topics of interest and interact with practice management, legal and financial experts, to name a few, from the comfort of their homes or offices. The webinars are free to CMA members and members’ staff and provide the timely information needed to help run a successful medical practice. What’s more, all webinars are available on-demand immediately following the live airing, providing an ever-growing resource library accessible at any time.

FEBRUARY

10

CMA Physician Governance - How to Get Involved in CMA’s Newly Reformed Governance Structure February 10, 2016 | 12:15pm - 01:15pm | Members Only

An educational session designed to explain CMA’s structure of physician governance and how members can get involved in the organization – especially in light of recent changes and improvements to the process. See how your voice can impact the future of the practice of medicine in California. Ideal for members who are interested in getting involved (or more involved) in organized medicine.

FEBRUARY

24

HIPAA Compliance: Key Risks All Physicians Should Know February 24, 2016 | 12:15pm - 01:15pm

Please join CMA’s HIPAA advisor, David Ginsberg, for his annual HIPAA compliance update. This webinar will summarize recent federal enforcement and what this means for every medical practice. We will also discuss the top HIPAA privacy and security gaps and risks, along with simple steps to comply.

Closing a Medical Practice MARCH

9

March 9, 2016 | 12:15pm - 01:15pm This webinar will cover some of the major practical and legal issues that may arise when closing a medical practice, and will assist physicians who are retiring or otherwise leaving their practices and/ or families or estates of deceased physicians. Issues that will be addressed in this webinar will include people and agencies to notify when a physician practice closes, medical records retention and other issues, and considerations when selling a medical practice.

PRESENTER: Theodore M. Mazer, M.D., is a board-certified otolaryngologist who has been working in a small, solo practice in San Diego for more than 25 years. He is currently serving as the California Medical Association’s Speaker of the House.

PRESENTER: David Ginsberg is Co-Founder and President of PrivaPlan Associates, Inc., a leading provider of HIPAA privacy, security and breach notification services, consulting and products for the health care and business associate industry. He has more than 30 years of experience in the health care industry.

PRESENTER: Lisa Matsubara is Legal Counsel in the Center for Legal Affairs at the California Medical Association. She also manages CMA’s legal educational resources, including the California Physician’s Legal Handbook and the legal information help line.

REGISTER ONLINE TODAY! WWW.CMANET.ORG/EVENTS *Webinars are free for CMA members and their staff ($99 for non-members).

48

CENTRAL VALLEY PHYSICIANS

Winter 2016

CMA Legislative Advocacy Day Webinar Training MARCH

23 MEMBERS ONLY

March 23, 2016 | 7:00pm - 8:00pm

CMA will host its 42nd annual Legislative Advocacy Day on Wednesday, April 13, at the Sheraton Grand in Sacramento. Attendees will also go to the Capitol to meet with legislators on health care issues. More than 400 physicians, medical students and CMA Alliance members will be coming to Sacramento to act as champions for medicine and their patients by lobbying their legislative leaders.

In preparation for Legislative Advocacy Day, CMA’s Center for Government Relations will host a special webinar. This webinar will review in detail CMA’s list of bills to be lobbied and effective advocacy tips, as well as covering other relevant program information.

APRIL

6

MACRA Implementation: A Review of the CMS Proposed Rule April 6, 2016 | 12:15pm - 01:15pm

This webinar will review the details of the proposed rule around the new Medicare Merit-Based Incentive Payment System (MIPS) implementation. We’ll also discuss any new details available regarding the Alternative Personnel Management System (APMS), and review the next steps toward implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

APRIL

20

How to Reduce Overhead Expenses and Increase Profitability April 20, 2016 | 12:15pm - 01:15pm

There are only three ways to realize increased net income: raise fees, increase productivity or decrease overhead. With managed care contracting difficulty, increased fees are difficult to achieve. The doctor/ group may already be working at maximum capacity so this may not be an option. In California, practices have higher overhead costs than national norms. The only way to assure profitability is to control and reduce overhead expenses. This webinar will provide information on how to do just that in a way that works for your practice.

MAY

4

Contract Renegotiations: How to Get Past “No” with a Payor May 4, 2016 | 12:15pm - 01:15pm

When submitting a request to renegotiate, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. However, many practices fail to present a business case, which often results in a quick reply from the payor indicating that they are not in a position to renegotiate at this time. This webinar will cover steps practices can take to build their best business case and identify the uniqueness of their practice to prevent the “auto-reply” and present a thoughtful renegotiation request.

PRESENTER: Janus Norman is CMA’s Senior Vice President for Government Relations and Political Operations, and serves as CMA’s chief lobbyist. Prior to joining CMA, he served as Legislative Advocate for the American Federation of State, County and Municipal Employees (AFSCME).

PRESENTER: Ashby Wolfe, M.D., MPP, MPH is a boardcertified family physician who currently serves as Chief Medical Officer for California, Arizona, Nevada, Hawaii and the Pacific Territories for the Centers for Medicare and Medicaid Services (CMS).

PRESENTER: Debra Phairas is President of Practice & Liability Consultants, LLC, a nationally recognized firm specializing in practice management and malpractice prevention. Her background includes medical clinic administration and loss prevention management for NORCAL Mutual, a physician malpractice insurance carrier in Northern California.

PRESENTER: Kristine Marck is an Associate Director in CMA’s Center for Economic Services. With over 20 year of experience in the health care industry, she offers a unique perspective as well as a balance of working for and with physicians and a drive to assist them in difficult times.

SIGNING UP FOR WEBINARS IS AS EASY AS 1, 2, 3…

(1) Go to www.cmanet.org/events, (2) Select the webinar you would like to join and (3) Register to attend. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Member Help Line at (800) 786-4262.

Winter 2016

CENTRAL VALLEY PHYSICIANS

49

PHYSICIAN SHORTAGE in Kern County The Rio Bravo Family Medicine Residency program will enroll its third class of six resident physicians this July with the hope that these family physicians will stay to practice in Bakersfield and surrounding Kern County.

They will make a critical impact in Kern County, where for every 100,000 people, there are only 49 primary care physicians (PCPs). To put that in perspective, the Council on Graduate Medical Education, which informs Congress on physician workforce issues, recommends, at minimum, 60 PCPs and ideally 80, to serve the basic health needs of a population of that size. Outside the Bakersfield metro area, the density of physicians is abysmal. Nearly the entire county earns the federal designation of Primary Medical Care Health Professional Shortage Area, with approximately 29 PCPs for every 100,000 people.

Furthermore, over 32 percent of California’s practicing PCPs are age 60 or older, hastening the need to cultivate the next generation of physicians. These numbers confirm what those working here already know: we are facing a dire primary care physician shortage and the limited access to care creates and exacerbates health disparities.

In 2015, Kern ranked 51 on negative health outcomes and 55 on negative health factors out of California’s 57 counties. The metrics, which include rates of adult smoking, obesity, STIs, teen pregnancy, and preventable hospital stays, are exactly the areas where primary care physicians can intervene.

50

CENTRAL VALLEY PHYSICIANS

The Clinica Sierra Vista based Rio Bravo program is taking on this ambitious challenge by recruiting homegrown medical graduates to not only provide essential care to patients now, but become the physicians we require to address these health issues over the coming years. The Rio Bravo program began in 2014 as a Teaching Health Center on the heels of the closure of the Kern Medical Center’s Family Medicine residency program, making it the only family medicine training program in the county. It received its primary funding through a federal grant. This year, through sustained advocacy, that funding was extended for another two years. But the grant’s future remains tenuous, while other critical sources of residency funding have already dried up. A three year $21 million grant from the California Endowment to the Song-Brown program, the only state funding source available to residency programs, ends this year. The federal Primary Care Residency Expansion program, which awarded more than $18 million in grants to California to create new primary care resident positions, ended in 2015. These funding deficits leave programs in the Valley and across the state vulnerable to contraction and closure at a time when the need to grow our primary care

Winter 2016

Kern County > Physician Shortage

physician workforce is at its greatest.

A state investment into the Song-Brown program this year will make the difference to protect Rio Bravo and similar programs.

The Song-Brown program focuses on primary care residency programs located in areas of unmet need and rewards them for delivering quality care to the state’s most vulnerable populations, providing culturally competent education to their residents, and recruiting underrepresented minorities into their programs. This existing

state infrastructure recognizes the needs of Californians, and particularly of our patients in the Valley. Past investment in this program has been extremely successful in generating physicians who train and stay in the community.

I urge you to lend your voice to this campaign to support our primary care physician workforce by sharing your stories about the need for primary care physicians here in Kern County with your elected officials.

For more information contact: Abhinaya Narayanan Manager, Workforce Development California Academy of Family Physicians anarayanan@familydocs.org To contact Senator Jean Fuller about this issue in Kern County call 661-323-0443

THE PROBLEM:

THE SOLUTION:

1) More than $40 MILLION that funds the training of California primary care physicians is expiring: A three-year, $21 million California Endowment grant supporting the Song-Brown Health Care Workforce Training Program expires in 2016.1 In 2014, the Legislature appropriated a one-time $4 million infusion into SongBrown to help meet the demand for primary care physicians in areas of unmet need, but that funding was not renewed.

The federal Primary Care Residency Expansion program, which awarded more than $18 million in grants to California to create new primary care resident positions,2 ended in 2015.3 Each year in California, only 368 slots are available to the thousands of medical students seeking to train in family medicine. If the funding described above is not replaced, 158 OF THOSE SLOTS WILL BE LOST, creating a terrible deficit of primary care physicians in California’s underserved communities.

Increase funding for the Song-Brown program through a state budget appropriation and create a robust and consistent funding source to stem the loss of primary care physicians.

The Song-Brown Program provides an existing state infrastructure to support an increase in the number of primary care providers serving California’s underserved populations. Programs that receive SongBrown funding must have a proven record of training health care professionals who care for underserved populations in underserved areas and expanding the ethnic diversity of the health care workforce. By investing in Song-Brown, California will realize an immediate return on investment as each primary care resident provides an average of 600 ADDITIONAL PATIENT VISITS PER PHYSICIAN PER YEAR DURING TRAINING ALONE. Our long-term workforce also would grow significantly as the vast majority of physicians who train in a region stay there to practice. California leads all fifty states in the percentage of residency program graduates who stay in the state in which they trained.12 Nearly 70 percent of medical residents who train in California practice here after graduation.

2) California faces a long-standing shortage of primary care physicians at a time when demand for their services has never been greater: Only 36 percent of California’s active patient care physicians practice primary care;4 23 of California’s 58 counties fall below the minimum required primary care physician to population ratio.5 California needs an estimated additional 8,243 primary care physicians by 2030 to prevent projected shortages in the state (about 412 new primary care physicians per year).6 More than 32 percent of California’s practicing primary care physicians are age 60 or older – only four other states have a larger percentage of soon-to-retire physicians.7 3) Californians face daunting access to care issues because of increased health plan enrollment and inadequate physician networks: Approximately 4.7 million people have gained health insurance since 2013 (1.3 million through Covered California;8 nearly 3.4 million through Medi-Cal9), placing immense strain on our primary care workforce.

Recent audits by the California State Auditor10 and the Department of Managed Health Care (DMHC)11 found California lacking in accurate and adequate physician networks.

Winter 2016

Contact: Jodi Hicks Phone: 916-662-1725 CAFP Legislative Advocate Email: jhicks@lawpolicy.com Why invest in primary care training?

The value of primary care physicians is welldocumented. Primary care reduces hospitalization

CENTRAL VALLEY PHYSICIANS

51

Kern County > Physician Shortage

CALIFORNIA’S PROJECTED PRIMARY CARE PHYSICIAN NEED

rates and costs while improving quality. States with higher ratios of primary care physicians to population have better health outcomes, including decreased mortality from cancer, heart disease and stroke.

An increase of one primary care physician per 10,000 people in a state is associated with a rise in that state’s quality rank by more than 10 places and a reduction in overall spending of $684 per Medicare patient.13 Does California have a sufficient primary care physician workforce?

Forty percent of California’s counties fail to meet the recommended primary care physicians to patient ratio. Many other counties barely meet the recommended number of primary care physicians and now likely face a shortage as the number of insured individuals has grown from Medi-Cal expansion and Covered California enrollment. The Inland Empire, Central Coast, San Joaquin Valley and the Northern and Sierra regions are areas of particular concern.

52

CENTRAL VALLEY PHYSICIANS

How many primary care physicians do we need?

The Council on Graduate Medical Education, the group authorized

by Congress to assess workforce needs and make recommendations, recently reported that AT MINIMUM, 40 percent of the U.S. physician workforce should be primary care. California is well under this minimum recommendation at 36 percent practicing primary care physicians. Our state barely creates enough new physicians to replace those we lose to retirement or other reasons. Since one-third of California’s physicians are nearing retirement age and millions of our state’s residents are entering our health care system under the Affordable Care Act, California’s demand for primary care physicians is even more pronounced. To respond to the health needs of our aging and growing population, by 2030 we will need 8,243 more primary care physicians.

Winter 2016

KCMS > Elects New Officers

KCMS NEWS

KERN COUNTY MEDICAL SOCIETY

ELECTS NEW OFFICERS Kern County Medical Society announced the appointment of new officers for 2016.

The Board of Directors and the following new officers started their term beginning January 1.

The Kern County Medical Society (KCMS) has undergone many changes in recent months. These changes have strengthened KCMS and allow it to better serve our local physicians. Our leadership is dedicated to meet the needs of our physicians in a rapidly changing environment.

O OFFICERS:

PRESIDENT: Vipul R. Dev, MD Plastic Surgery/Pediatric Surgery/Hand Surgery, California Institute of Cosmetic and Reconstructive Surgery

The 2016 KCMS President, Vipul Dev, MD, has been a member of KCMS since 2005 and has served as a board member and KCMS/CMA Delegate since 2013. Dr. Dev is motivated to continue to move KCMS towards positive change and growth in 2016.

KCMS and the California Medical Association (CMA) are the unifying voice of physicians. When health reform decisions are being made at the state and federal levels, we are at the table to represent California doctors. One more voice strengthens our representation and advocacy efforts to create and maintain a physician-led, patient-centered health care system in California.

PRESIDENT-ELECT: William J. Farr, MD Family Medicine, Farr Medical Group

About the Medical Society: The Kern County Medical Society (KCMS) was founded in 1897 as a professional association of physicians practicing in Kern County who are dedicated to addressing local health issues of concern to their patients and their profession. We are a component society of the California Medical Association (CMA) representing over 30,000 physicians in California.

B Alberto Acevedo, MD

Darshan R. Shah, MD

Michelle S. Quiogue, MD –

Franco A. Felizarta, MD

Edward W. Taylor, MD

Immediate Past-President

Betsy Matkovic, MD

Eric A. Peck, MD

Mark L. Nystrom, MD

Kristopher L. Lyon, MD

Winter 2016

SECRETARY: Eric J. Boren, MD Internal Medicine/Allergy, Kern Allergy Medical Group Inc.

TREASURER: Bradford A. Anderson, MD Pain Management/Rehabilitation

CENTRAL VALLEY PHYSICIANS

53

In Memoriam

In Memoriam Alex Moir, MD • James P. Zettas, MD • Bruce Berg, MD

ALEX MOIR, MD December 12, 1962 – December 19, 2015

Dr. Alex Moir, chief of the department of family and community medicine at UCSF Fresno, died Dec. 19 in a skiing accident while on vacation with his family. He was 53.

His death was announced in a Facebook post by UCSF Fresno Family & Community Medicine. “It is with great sadness that I write to let you know that our colleague and friend, Alex Moir, MD, Chief of Family and Community Medicine died on Saturday in a ski accident while on a vacation with his family in Canada. Alex has spent his entire career at UCSF Fresno since graduating from medical school tirelessly providing care to the patients in our region. Alex has been an outstanding physician, teacher, mentor and leader, and he will be greatly missed,” said Michael Peterson, MD, Interim Associate Dean and Chief of Medicine at UCSF Fresno. “Our thoughts, prayers and deepest sympathies go out to his family, friends and colleagues.”

Dr. Moir received a bachelor’s degree from the University of California, Santa Barbara, and completed his medical degree at the University of Miami, according to his biography on the UCSF Fresno website. He completed his residency in family and community medicine at UCSF Fresno and joined the faculty after graduation. Dr. Moir advocated for rural and small-community family medicine, as well as health care for Latinos and other underserved communities. He also taught and practiced rural medicine in Selma at the Adventist Medical Center.

He was recognized in 2012 by the Adventist Health Central

54

CENTRAL VALLEY PHYSICIANS

Valley Network with a Physician of the Year Mission Award for his commitment to providing physical, mental and spiritual care to his patients.

In a statement when he received the award, Dr. Moir said he never rushed exams and took time to get to know patients.

“Whole-person care is important to better establish a relationship with patients,” he said. “Patients develop a level of trust, which helps me to work with them to treat the real issue instead of just the symptoms.”

He was a member of the American Academy of Family Medicine, the Society of Teachers of Family Medicine, the American Medical Association, the California Medical Association and the Fresno Madera Medical Society.

He was also a member of the San Joaquin River Parkway Conservation Trust, a nonprofit focused on developing parks and protecting wetlands.

Dr. Ruth Avila, a family physician at Fresno State, said she knew Dr. Moir while she was an intern at Valley Medical Center and he was in his third year of residency.

“There are a lot of unique, quirky people you train with, and some of them can be a little cutthroat,” she said, “but he was just so humble and so easygoing.”

Dr. John Zweifler, chief medical officer of Adventist Health, knew Dr. Moir for more than 25 years and remembers him best for his commitment to social justice and his caring for others.

As a mentor, faculty member, doctor and friend, Dr. Moir was compassionate to all who knew him and a very effective physician, Zweifler said.

The incredible outpouring of emotion from the community in response to news of his death shows that Dr. Moir left an indelible impression on everyone, Zweifler said.

“It’s a huge loss,” he said. “The only positive is to emulate how he was with others so that the world can be a better place.”

Fresno Madera Medical Society Member for 20 years

Winter 2016

JAMES P. ZETTAS, MD March 14, 1926 January 6, 2016

Dr. James P. Zettas, a retired orthopaedic surgeon, passed away January 6, 2016, in Sequim, Washington. Born March 14, 1926 the son of the late Gust and Lillian Zettas. He grew up in Chicago with his brother Paul.

He graduated from the University of Illinois Medical School in 1955, completing his residency in Orthopaedic surgery at Cook County Hospital in Illinois and Boston Children’s Hospital. He was certified for membership in the American Academy of Orthopaedic Surgeons.

Before opening his own private Orthopaedic practice in Naperville, Illinois, he served as a Lieutenant at the U.S. Naval Air Station in Patuxent River, Maryland. James and his wife Patricia moved to California where he became the Chief of Orthopaedic Surgery at the Fresno County Hospital. The challenges there remained the highlight of his medical career. Later, his brother Dr. Paul Zettas, joined him at Fresno County Hospital where they worked together until opening their own private practice.

James and Patricia moved to Sequim, Washington in 1991 to semi-retire. There he joined the Orthopaedic practice of a former classmate and friend. James dedicated his working life to medicine. He valued each of his patients and was genuinely interested in their well-being.

Outside of medicine, he enjoyed a variety of interests. He was passionate about music, excelled playing the organ, and his Yamaha Clavinova. He read extensively which bolstered his ability to speed through daily crossword puzzles. Always looking for new challenges, he kept up with the times and early on became proficient at the computer. Having played football in high school and college, he had a lifelong love for the game. He also enjoyed the outdoors and was an avid gardener, boasting about his dandelion free lawns! Always making people laugh, a number one priority.

James will be remembered for his keen sense of humor and quick wit. Wherever he was, laughter followed. He was known for his big heart and was always a generous person. He enjoyed traveling and maintaining strong friendships and family bonds.

Growing up the son of Greek immigrants, he was aware of and always maintained a proud sense of his Greek heritage. His ability to speak Greek, learned at home as a young child, gave him great pleasure. James is survived by his devoted and beloved wife Patricia; his brother Paul Zettas MD and wife Jenny, of Santa Barbara; Nieces, Carol Weill (Michael) of Palatine IL, Pamela Perlman (Ed) of Greenwich CT, and Christine Di Filippo (Jim) of Colleyville TX. His brother-in-laws Bill Chymiy of Orland ME, and Jim Chymiy (Ava) of Memphis TN. James was loved by many and will be truly missed by all. His was a life well lived in every sense.

Fresno Madera Medical Society Member for 10 years

Winter 2016

BRUCE BERG, MD September 5, 1919 - January 10, 2016

Family surrounded Dr. Bruce M. Berg as he peacefully passed away on January 10, 2016. He is survived by Rita, his beloved wife of 43 years. After their marriage in Honolulu, HI, the two began sharing a life and love for traveling, tennis, and hosting gourmet dinner parties for family, friends and the community. One of their greatest enjoyments came from raising their four children, ten grandchildren, and five great-grandchildren. Bruce, better known by his family as Papa, developed a passion for medicine at an early age as he was inspired by his uncle, Dr. Ralph Mendelson, a former private physician to two Kings of Siam.

After graduating high school at the age of 16, Bruce began his professional journey in medicine. He received his Bachelor of Science Degree from Stanford University in 1940. During this time, he served as a member of the Varsity Boxing Team, earning the title of Pacific Coast Intercollegiate Featherweight Champion in 1939. In 1944, Bruce’s lifelong passion became a reality when he graduated from Stanford Medical School. As a young and eager new doctor, Bruce began his medical career serving not only his patients, but also his country.

From 1944 to 1946, Dr. Berg served as a Lieutenant in the United States Navy, Sixth Marine Division.

As officer in charge of a combat medical unit, he served at Guadalcanal and Okinawa. Even though Dr. Berg was dedicated to the service of his country, his oath as a physician and his strength of character led him to care for all who were wounded on the battlefield, whether they were friend or foe. His professional and personal integrity did not go unnoticed, as Dr. Berg was the recipient of a widely publicized letter written by Dr. Kosaburo Iyesaka, a Japanese physician. The letter was addressed to “My generous and kind Dr. Bruce Berg,” and its content contained the recognition over the defeat of Japan and expressed surprise at the kind treatment given to civilian Okinawans by American forces. After completing his two year residency at the San Francisco Veterans Hospital, Dr. Berg began his work in private practice of Internal Medicine in Fresno, CA, eventually becoming an esteemed cardiologist in the Central Valley. Throughout his many years serving as a physician, Dr. Berg earned many achievements and accolades. He served as a past President of Fresno County Heart Association, a former President of the St. Agnes Medical Staff and twice Chief of the Department of Medicine at St. Agnes Hospital. He was also an elected Fellow of the American College of Cardiology and the American College of Angiology. In 1975, Dr. Berg became one of the founding directors of Norcal Mutual Insurance Company.

Upon his retirement at Norcal in 1992, he was credited for his professionalism, enthusiasm, and dedication towards building an extremely successful and service oriented organization. Bruce had many loves outside his passion for medicine. He was known for his distinguished palate for fine wine and food, his quick wit and knee slap sense of humor, love of exotic cars, flying planes, and weekly tennis games. During his down time, Bruce was an avid sports fan of the San Francisco Giants, Stanford’s athletic programs, and tennis. At this time, the family would like to extend a special thank you to our aunt Judy for ensuring Bruce maintained his dapper appearance by providing his monthly in home spa treatments. His wife Rita would also like to thank Peter Holmes; attorney’s, Paul Hager and Jeff Reich; and Dr. John Slater, for their faithful Tuesday night visits over the past several years. In addition, she would also like to thank attorney, Pat Turner, for being Bruce’s loya lunch companion every Wednesday. Finally, our most sincere appreciation to Larry Swearingen for the respect and dignity he demonstrated while caring for “Doc” these past three years.

Fresno Madera Medical Society Member for 53 years

CENTRAL VALLEY PHYSICIANS

55

Fresno Madera Medical Society 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

Hilton San Francisco Union Square

May 13 - 15, 2016

San Francisco, CA

Physicians, nurses, medical practice managers and all other health care industry professionals—Join us in the heart of San Francisco to prepare for changes affecting your profession, your practice and your economic future.

Health care power players will share strategies and resources for accelerating the shift to a more integrated, high performing and sustainable health care system. Speakers include Dr. Atul Gawande, distinguished surgeon, teacher and writer – named one of TIME magazine’s 100 most influential thinkers; Karl Rove, former Deputy Chief of Staff and Senior Advisor to President George W. Bush; and Donna Brazile, Al Gore campaign manager and Democratic National Committee Vice Chair.

800.795.2262 www.westernleadershipacademy.com