December 2014

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

Vital Signs

December 2014 • Vol. 36 No. 12

See Inside: No on Prop. 46: A Success!

The Jeopardy Bug Data Breaches in California Up CMS Releases Payment Rules

Greetings for the Holiday Season

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Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society December 2014 Vol. 36 – Number 12 Editor Alan Birnbaum, MD Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Board Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD Kern Representative John L. Digges, MD Tulare Representative Francine Hipskind Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medical Society, PO Box 28337, Fresno, CA 93729-8337.

Contents EDITORIAL ................................................................................................................................5 NEWS HEALTHCARE NEWS ...............................................................................................................6 The Jeopardy! Bug .................................................................................................................9 2015 Post Yosemite Institute ...............................................................................................12 CLASSIFIEDS..........................................................................................................................15 FRESNO-MADERA MEDICAL SOCIETY .....................................................................................11 • President’s Message • Medical Managers Network Forum • Lung Association Volunteer Names Physician Leader of the Year • In Memoriam: Larry E. Nix, MD • No On 46: A look back KERN COUNTY MEDICAL SOCIETY ..........................................................................................13 • Membership News • Save Date: KCMS Installation of Officers: January 16 TULARE COUNTY MEDICAL SOCIETY ......................................................................................14 • President’s Message • Just Walk With A Doc • Renew Your Membership Today! Ask a Nonmember Colleague to Join Today!

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

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

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

Cover Photograph: By Ning Lin, OD, MD

Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee DECEMBER 2014 / VITAL SIGNS

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Member Benefit News: Open enrollment for the Fresno-Madera, Kern and Tulare County Medical Societies-sponsored dental plan has started!

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For more information... Call a Client Advisor at 800-842-3761 for more information.

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

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777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance.service@mercer.com 65460 (11/14) www.CountyCMAMemberInsurance.com • Copyright 2014 Mercer LLC. All rights reserved.

4 DECEMBER 2014 / VITAL SIGNS

EDITORIAL

Beyond Victory for the No on Proposition 46 Coalition Alan M. Birnbaum, MD Editor, Vital Signs

The recent rejection of Proposition 46, which would have gutted MICRA, should remind physicians that key to victory was a coalition of 766 organizations assembled by the California Medical Association. These included not just healthcare but also 42 unions, 50 business organizations, 24 political entities, and 13 educational groups. We must maintain this corps of forces for further common goals. Organized medicine should realize that these allies hardly had protection of physician income as even a subsidiary motive.

California doctors gained these partners due to their interest in maintaining access to care at an affordable price.

The 2014 election increased the power of forces unfriendly to ACA, the Affordable Care Act, or Obamacare as some call it.

Passed in 2010 and progressively implemented, this imperfect legislation represents only a first step to improve access. The nation needs an ACA II, to further refine the original goals of ACA, while purging the system of continuing barriers and inequities.

Individual basis health coverage for now over 7 million Americans, and another 2 million by late 2015, has been achieved at the cost of complexity and often inadequate reimbursement levels. Patients having purchased Exchange plans frequently are unable to secure even primary medical care.

Even those fortunate to have more equitable group health plans find themselves facing costs that discourage seeking care.

The coalition that successfully defeated Proposition 46 should now look to the failings of group health and individual Exchange plans.

Eliminating out of pocket cost for preventative care represented a progressive step. Beyond that all deductibles should be replaced by tiered copayments that reduce as expenses accrue during the year. Perhaps these might start at 40%, decline to 20% then 10% prior to reaching stop loss levels. Maximum out of pocket amounts also need to become more affordable than current amounts, typically $6250 for an individual and double that for a family. Almost no middle income American family can really afford $12,500 annual out of pocket expenses.

As well, payments to medical providers equitably should never fall below Medicare levels. Desirable levels are 10% to 20% above it. Even Medi-Cal reimbursements should not fall greater than 20% below the basic standard. Such would improve access while emptying crowded emergency departments of non-acute patients. We could and should treat chronic disorders at much earlier stages. We want diabetes management to start in outpatient offices or clinics when Hgb-A1c reaches 6.5%, not when an ambulance sirens the patient to a hospital with acute MI or stroke and an A1c of 13%.

Might Congress redress these issues over the next two years? Again such seems improbable in a Congress led by Speaker Boehmer and Majority Leader McConnell. That leaves the California Legislature to assume leadership in this area, on behalf of nearly 40 million citizens of this state, including over 100,000 physicians.

We now see a move to provide a more livable minimum wages in larger metropolitan areas. Exemplar is just-passed Proposition J in San Francisco, a Minimum Wage Ordinance, with its five step increments through mid-2018. Could not our state legislature similarly mandate more reasonable levels and limitations for healthcare plans? Do we really need Bronze, Silver, Gold and Platinum levels? Might not two alloys of care suffice? Beyond that recent pharmacy cost spikes even for generic drugs scream for an effective consumer response.

The coalition that successfully defeated Proposition 46 should now look to the failings of group health and individual Exchange plans. We must work legislatively towards a system that will cure access anxiety and immunize California families from crippling costs. As physicians, we have a responsibility to medically treat our patients. Yet to achieve that statewide we and our lay allies must politically treat our flawed system.

Author may be reached at Siriusguy @aol.com.

DECEMBER 2014 / VITAL SIGNS

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physicians in California are working to expand their scope of practice and have their services reimbursed by insurance plans sold through Covered California, HealthyCal reports (Flynn, HealthyCal, 11/3).

In January 2005, California became the 13th state to license naturopathic doctors (California Healthline, 1/20/05). According to NIH, naturopathy is listed as a specialty under “complementary and alternative medicine.” It includes services such as: • Acupuncture; • Chiropractic care; and • Meditation (HealthyCal, 11/3).

The field also encourages a healthy diet, exercise and avoidance of drugs (California Healthline, 1/20/05).

Naturopaths receive four years of training and are qualified to provide check-ups, wellwoman exams and other services, according to HealthyCal. However, their services often are not covered or reimbursed by health insurance.

Dhurga Reddy, chair of the California Naturopathic Doctors Association’s insurance committee, said naturopathic physicians can prescribe medication only under a supervising medical physician.

Naturopathic physicians are urging lawmakers to adopt state legislation that would add four services to their scope of practice, including: • Directing allied health professionals, such as nurse practitioners; • Performing joint manipulation consistent with their training; • Performing minor in-office procedures that are consistent with their training, such as removing moles for biopsy; and • Prescribing certain medication without supervision.

They also are calling for their services to be included in coverage sold through Covered California. However, some physicians and regulators say naturopathic doctors lack sufficient training to provide primary care that is equivalent to that provided by traditional physicians, HealthyCal reports.

Yvonne Choong – senior director of the California Medical Association’s Center for Medical and Regulatory Policy – said physicians and naturopathic doctors are taught different material in school. She added that unlike naturopaths, most physicians also complete three to seven years in a residency program (HealthyCal, 11/3).

Please see Healthcare News on page 7

HEALTHCARE NEWS Continued from page 6

Data breaches in California increase 600 percent

The second annual report on financial data breaches in California was

released by the California Attorney General and showed that the number of reported data breaches in 2013 was up 28 percent from the previous year, and the total number of records breached increased by more than 600 percent, from 2.5 million in 2012 to 18.5 million in 2013.

Breaches in the health care sector made up 15 percent of the total, with 1.5 million records compromised.

The majority of health care breaches resulted from physical theft – accounting for 70 percent, compared with 19 percent in other industry sectors. Data breaches by malware and hacking only made up 9 percent of health care losses.

Fifty-five percent of health care breaches involved the theft of Social Security numbers, but the most common type of data breach is health information, which was compromised in 75 percent of health care data breaches, according to the report.

Over the study period there were 31 data breaches in health care, 24 resulting from stolen hardware, five from lost media and two from stolen documents. The stolen hardware was taken from the workplace, an employee car and an employee home, and included 16 laptops and eight desktops.

The report said that the “strategic use of encryption” should be used by those in health care to protect medical and financial information on laptops, portable devices and desktop computers.

The report also cites a recent study by the Ponemon Institute, which found that criminal attacks targeting the health care system are growing.

Overall, the report found that there were a total of 298 breaches reported in the state in 2012 and 2013, including 167 last year (Attorney General report, October 2014).

Health Plans, Providers Increasingly Partner on Narrow Network Plans

Insurers and providers increasingly are entering into partnerships to offer

health plans with narrow provider networks, Modern Healthcare reports.

According to Gerald Kominski, director of the UCLA Center for Health Policy Research, the trend mostly is the result of the Affordable Care Act. He said, “If you’re competing on price and you can’t vary copayment structure or deductibles, the only thing you can do is try and keep your networks as affordable as possible.”

In addition, other reasons cited by stakeholders for narrow network partnerships include: • Providing a network patients can trust; • Removing patients’ financial barriers to care; • Incentivizing the proper patient behavior; and • Enhancing data analytics by combining providers’ data with that from insurers.

Modern Healthcare listed several examples of recent provider-insurer narrow network partnerships: • California-based Anthem Blue Cross and seven health systems in the Los Angeles area, which announced the formation of a joint venture HMO in September in an effort to increase competition with narrow network plans such as Kaiser Permanente; • M innesota-based Mayo Clinic and Medica, which will offer a narrow network health plan for 2015, available on Minnesota’s insurance

exchange and through the off-exchange individual market; and isconsin-based health system Aspirus and insurer Arise Health Plan •W – both not-for-profits – which this week announced a health plan for individuals and companies with fewer than 50 employees.

The Aspirus/Arise plan will provide enrollees with discounted innetwork rates at Apirus’ six hospitals and doctors employed by or who contract with the health system (Herman, Modern Healthcare, 10/16).

CMS releases Payment Rules

CMS has released close to 3,000 pages of regulations that finalized payment rules for different Medicare providers and services for 2015, The Hill reports.

Among other rules, CMS created new payments for chronic care management programs, launched efforts to streamline payments for individuals’ hospital care and expanded the agency’s Physician Compare website. CMS Administrator Marilyn Tavenner said the “rules are a part of a broader strategy driving greater value in health care.”

Rules on Physician Compare Website, Open Payments System CMS said the rules expanding the Physician Compare website would significantly bolster “the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures” (Viebeck, The Hill, 10/31).

Separately, the rules also eliminate a reporting exemption under the Sunshine Act that excluded payments to physicians associated with accredited continuing medical education from the payments that have to be shared on the Open Payments System. CMS said the rule would now require group purchasing organizations and affected manufacturers to report compensation given to physician speakers at continuing education events in most cases.

The rules also broaden quality performance penalties for all physicians and include additional quality criteria for the Medicare Shared Savings Program. Specifically, Medicare physician payments beginning in 2015 will be adjusted based on quality performance measures and penalties will no longer apply solely to larger physician practices.

Meanwhile, the accountable care organizations taking part in the Medicare Shared Savings Program will be subject to 33 adjusted quality requirements, including: • Measures for patient stewardship resources; • Readmissions to 30-day, all-cause skilled nursing facilities; and • Unplanned, all-cause admissions for individuals with diabetes, heart failure and more than one chronic condition (Evans, Modern Healthcare, 10/31).

CMS also finalized rules that, beginning in January, will: • Establish new quality and performance care standards for patients undergoing dialysis treatments; • Require Medicare to use competitive bidding rates to purchase durable medical equipment (Young , CQ HealthBeat, 10/31); • A llow physicians bill Medicare $40.39 per month for each patient with more than one chronic condition to improve care quality (Morgan, Reuters, 10/31); • E xpand coverage for telehealth physician visits by requiring Medicare to reimburse physicians for wellness and behavioral health visits (Evans, Modern Healthcare, 10/31); and Eliminate a “narrative” requirement that requires physicians to • submit written descriptions explaining why home health services are necessary (Young, CQ HealthBeat, 10/31).

Please see Healthcare News on page 15 DECEMBER 2014 / VITAL SIGNS

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Don’t miss the opportunity to attend the 2015 winter cme symposium in Whistler, BC, Canada

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February 25-28, 2015 • Wednesday – Saturday 2015 Winter Symposium Scheduled Speakers Stay tuned for more speakers to come.

David Holloway, MD, CPE, FAAFP

Chen-Tan “CT” Lin MD, FACP

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“Giving Patients Access: Improving Both Patients & Physicians Lives.”

Chief Medical Officer, Bend Memorial Clinic

CMIO, Colorado Health

Neil E. Romanoff, M.D., MPH, FACP

Vice President for Medical Affairs Associate Chief Medical Officer, Medical Staff Affairs Chief Patient Safety Officer “Delivering the Safest Care: What Will Go Wrong Next?”

Town Hall Meeting

Blair Childs

Senior Vice President of Public Affairs for Premier, Inc “Updates from Washington D.C.: Issues Affecting Health Care & Physicians.”

Ms. Barbara Spurrier

Co-Founder & Administrative Director Center for Innovation, Mayo Clinic “Health Care Innovation Strategies: Innovations to Deliver Safer More Efficient Care - Mayo Clinic Experience.”

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Jeopardy! host Alex Trebek and Dr. Linda Fraley

The Jeopardy! Bug: My Experience as a Contestant Linda Fraley, MD, Retired, Fresno Pediatrician

Jeopardy! Runs in families. I know that from watching the show for the past 30 years and from my own family. You will see parents of junior players and children of past winners as contestants.

Jeopardy! initially ran from 1964-74 with host Art Fleming, when my grandmother and I would watched it. I was busy with medical school and residency when it was on hiatus for 10 years, but was right back watching when the Alex Trebek era started in 1984. The longest-winning champion Ken Jennings definitely revived Jeopardy! for the Millennials. While I enjoyed rooting for Ken, champion Brad Rutter became my all-time favorite player, and why not? He has won the most money.

Over the years, I have made several attempts to get on the show. My first was in 1987. I drove from Fresno to Burbank and waited outside the studio in a long line before being ushered inside. We were given a 50 question written test. I think I got about 30 questions right. I was sent home and would wait another 17 years to try again.

The current process for hopeful contestants is to first complete an online and timed 50-question test that is given in January of each year. You do this with interactive adobe-type set ups, and you realize for the first time, the importance to remember the category.

My first online test was in 2004, but I was not called back for the next step – an in-person test. I was prompted to re-enter the fray by my mother’s diagnosis of breast cancer. I watched the show every night during my visits with her in Santa Rosa, so I was determined to get on for her to see me.

I remember buying my first World Almanac and Shakespeare for Dummies and actually studied some. My other Jeopardy! books would expand to include atlases, musical compilations and Leonard Maltin’s Movie compendium (not the best use of time). The spheres of knowledge a contestant should know are bodies of water, American presidents, Shakespeare’s heroines and the Bible. Fortunately, I already had knowledge of medicine and biology and authors. Novels are my best category.

In 2006, I was finally chosen for the in-person test. You fill out information and conflict of interest forms, etc., take another 50-question written test (just in case you had help with the online) and finally are given a practice test with buzzers and questions put up on a screen in front of you.

This information is kept on file for 18 months, during which time you may be called back as a contestant for the show. During this 18-month period, you are not eligible to retake the January online test. (My husband and I began doing tests on alternate years). I was not called back to be a contestant.

When my mother died in October 2007, the task became a memorial to her. In January 2008, I retook the on-line test and in March, I was called for another in-person test, but again – did not get chosen to be a contestant.

In 2010, I was called back for the in-person test, but in 2012 was not.

Finally, in June of 2013, I was called for the in-person test. I had a great time at the auditions where, this time, they had a category in poetry and authors. Still, no word from Jeopardy! until February of this year (2014) when they called to say I was chosen to be a contestant. Jubilation ensued.

More paperwork came for me to fill out – “Five Interesting Facts” “What is your dream job?” “How would you use your winnings”, “Have you had a terrible job interview” etc.

I ended up in the studio twice. My first was in March. At the time, I was living in Southern California, a “local,” and was warned I could be bumped for people who had flown in. It was a great disappointment for my family and friends who came with me to sit through five tapings and not see me go on.

I had a great time, though, meeting crew members and other contestants like Ben-Her whose four other brothers had Ben names, an astrophysicist who said the taping wasn’t even his most exciting event of the week as his group at the Jet Propulsion Lab was being honored for gleaning supportive data for the “big bang” theory (the data since deemed suspect). I met the current three-day champ, a steampunk-loving librarian. We were all cheerfully competitive, and I was delighted to go home to study more.

Finally, my taping was scheduled for July 30. After a five-day cram session, I flew to Los Angeles from Santa Rosa (where I now live). I was challenging a two-day winner, an attorney from New York, and a fellow contestant, a petite dynamo also from New York who was a social media person for Bride’s magazine.

A crew member came up to me during the first commercial break and told me I was ringing in too soon and was being locked out, thus a poor showing on that first segment. You can read the questions faster than Alex speaks them, but you have to wait until he finishes before you can ring in.

This is reiterated prior to taping. This, I think is part of what makes us love Jeopardy! When we watch at home, we call out the answers before anyone else does, and it makes us feel smart.

It was over before I knew it! I loved the answers I did give. They were about things I’ve known for decades like Marlon Brando, National Geographic and Henry Clay and included two of the $2000 questions.

Please see Jeopardy on page 10 DECEMBER 2014 / VITAL SIGNS

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Jeopardy Continued from page 9

You said what

to the Medical Board’s investigator?

Physicians often come to us after they have been interviewed by a Medical Board investigator or after they have already provided a written description of their care.

Did you know that a Medical Board investigator is a sworn peace officer, with a gun, and a badge, and the power to arrest you?

When the Medical Board demands an explanation, seek help immediately. The attorneys at Baker, Manock & Jensen have helped many physicians through the maze that is a Medical Board investigation. We would be honored to help you.

George L. Strasser 5260 North Palm Avenue Fresno, CA 93704 559 432-5400 gstrasser@bakermanock.com www.bakermanock.com

10 DECEMBER 2014 / VITAL SIGNS

The ones I missed stayed with me, too. I’ve never seen high-fructose corn syrup as HFCS. I was late on toting up presidents to get to Madison. Beluga should have been mine as well as Leatherstocking Tales and Mark Twain. The one that really hurts is the one my son and husband in the audience kept murmuring afterwards.

“Maracana.” It’s the name of the stadium where the World Cup Final is played. Two weeks before my taping. I had watched the game. But none of us answered, so it could have been the difference.

I went all out in the Final. Even if I had it right, another contestant still would have prevailed.

At first I felt I was on the “boulevard of broken dreams,” but I’ve since cowgirled-up and realized how much fun I had. On the night of the telecast – October 6, 2014 – we had a party and watched the show with friends and family.

Dr. Fraley and her husband, Geron Nichols, MD, both retired Fresno physicians, live in Santa Rosa, CA. Dr. Fraley can be reached at jgnicholsmd@hotmail.com.

Fresno-Madera PRAHALAD JAJODIA, MD

President’s Message ORGANIZED MEDICINE AND THE CALIFORNIA MEDICAL ASSOCIATION

After serving on the FMMS Board of Governors for several years – and as this year’s FMMS president – one fact has become self-evident. Organized medicine cannot be totally effective on its own. Dr. Birnbaum’s editorial this month touches on this fact. The No On 46 campaign was overwhelmingly successful because of the backing of a huge coalition of non-medical organizations.

This year’s sought-out change to MICRA was one of the most contentious and high-stakes ballot fights in California history , and we rose to the occasion. As the California Medical Association (CMA) points out, an increase in the MICRA cap on non-economic damages has been rejected 10 times in court, 5 times in the Legislature and now overwhelmingly by voters.

This campaign energized the whole medical community. I thank each and every one of you who put a sign in front of your offices and homes and who set out campaign literature for patients to see.

We must use this unity moving forward and showcase to our colleagues the value that the CMA and FMMS brings to our great profession and for future issues that threaten our profession.

The power of our group lies not just with our FMMS Board of Governors and CMA Delegates, but with our individual members. If you get a call asking to serve on a FMMS committee, please consider it. We promise not to waste your time.

It has been a great honor to serve as your president this year.

m u r o f k r o netw

of the

LUNCH & LEARN for Fresno-Madera Medical Society Members’ Medical Staff

Update of Controlled Substances: Rescheduling of Hydrocodone Combination Products Presented by:

Vinnie Valderos

Agent, Fresno Office, Drug Enforcement Administration, Dept. of Justice Discussion to include: • Determination to Transfer Hydrocodone to Schedule II • Legal Authority • Background • Clarification of Affected Drugs and Substances

JANUARY 22, 2015 • 12 to 1pm Fresno-Madera Medical Society offices 1040 E. Herndon Ave. #101 BROWN-BAG LUNCH: Beverages & dessert provided No charge to attend; due to space limitations, no more than two (2) people per office may attend.

Must RSVP by Wednesday, January 21 to: Doreen Chaparro at dchaparro@fmms.org or 559-224-4224x 112.

Post Office Box 28337 Fresno, CA 93729-8337 1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: www.fmms.org Officers Prahalad Jajodia, MD President A.M. Aminian, MD President-Elect Hemant Dhingra, MD Vice President Ahmad Emami, MD Secretary/Treasurer Ranjit Rajpal, MD Past President Board of Governors Alan Birnbaum, MD S.P. Dhillon, MD William Ebbeling, MD Anna Marie Gonzalez, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Alan Kelton, MD Trilok Puniani, MD Khalid Rauf, MD George Saul, MD Roydon Steinke, MD CMA Delegates FMMS President Don Gaede, MD Michael Gen, MD Brent Kane, MD Brent Lanier, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD Praveen Buddiga, MD Surinder P. Dhillon, MD Trilok Puniani, MD Oscar Sablan, MD CMA Trustee District VI Virgil Airola, MD Staff Sandi Palumbo Executive Director

DECEMBER 2014 / VITAL SIGNS

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Fresno-Madera Lung Association Volunteer Named Physician Leader of the Year Fresno-Madera

Medical Society member Praveen Buddiga, MD, a volunteer physician of the American Lung Association in California, was honored September 19, 2014, as the Physician Leader of the Year by the Network for Ethnic Physician Organizations at their annual Leadership Summit in Riverside, Calif.

Dr. Buddiga was recognized for his outstanding leadership to support ethnic health care professionals, eliminate healthcare disparities, to reduce air pollution, and create healthier communities with greater options for walking, biking and other clean air options.

Of East Indian/Asian origin, Dr. Buddiga

has helped develop a network of clinics that offer Allergy, Asthma, Immunology and Sinus services in underserved areas of the Central Valley to help address the lack of health care.

Dr. Buddiga is also a Delegate for the California Medical Association representing the Fresno-Madera Medical Society and is an active Board member on the Environmental Justice Advisory Group (EJAG) of the San Joaquin Valley Air Pollution Control District.

Congratulations Dr. Buddiga!

2015 YOSEMITE POSTGRADUATE INSTITUTE March 27-29, 2015 Yosemite National Park

Topics include: n Depression n ADHD n Migraines n Epilepsy n Autoimmune Diseases n Wound Care n Cholesterol Guidelines n Atrial Fibrillation n Genetic Testing n HIV n ICD-10

NO ON 46

Dr. Sergio Ilic participated in a “No on 46” press conference at the Fresno Chamber of Commerce prior to the election.

Brochures will be mailed January 2015

LARRY E. NIX, MD 45-year member

Larry Nix, MD, an obstetrician/gynecologist passed away on November 7, 2014, at the age of 77.

Dr. Nix was born in Eureka, CA in 1937. He received his medical degree from USC in 1962 and completed his internship and residency training at Fresno County General Hospital in 1967. After serving as a Major in the US Army for the following two years, he opened his private OB-GYN practice in Fresno in 1969.

While a member of the Fresno-Madera Medical Society (FMMS), Dr. Nix served on many of its committees, including FMMS president in 1978 andwas a delegate to the California Medical Association. At the time of his death, Dr. Nix was still practicing part time with the Central Valley Women’s Health Associates.

He is survived by his wife, four children, seven grandchildren, and one great-grandchild.

12 DECEMBER 2014 / VITAL SIGNS

Information: csrau@fmms.org or 559-224-4224x 118.

Kern

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

Kings SAVE THE DATE! Friday, January 16, 2015: KCMS Installation of Officers The Bell Tower

Membership News MEET THE NEW KCMS MEMBERS: The following physicians’ names, etc. are being published in accordance with KCMS Bylaws. Board Certification will be listed only if the physician has been certified by a Specialty Board recognized by the American Board of Medical Specialists as approved by the AMA. Pradip K. Rustagi, MD (Oncology/Hematology/Internal Medicine) Comprehensive Blood & Cancer Center 6501 Truxtun Ave., 93309-0633 661-322-2206 / FAX: 661-322-7027 Pradip.rustagi@gmail.com Medical Degree: Ohio State U 1977; Internship/Residency: Ohio State U 1977-1980; Fellowship: Duke University, NC 1980-1982; Board Certified: Oncology/Hematology/IM Darshan R. Shah, MD (Plastic Surgery) Beautologie Medical Group 4850 Commerce Dr., 93309-0415 661-327-3800 / FAX: 661-451-5001 drshah@drshah.com Medical Degree: U of Missouri 1995; Internship/Residency: KMC 1995-2000; Residency: Mayo Clinic, MN 2000-2002; Board Certified: Plastic Surgery

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 Officers Jeffrey W. Csiszar, MD President Vacant President-Elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President Board of Directors Bradley Beard, MD James E. Dean, MD Thomas S. Enloe, Jr., MD Ying-Chien Lee, MD Uriel Limjoco, MD Michael MacLein, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

Sujie Tang, MD (Hematology/Oncology) Comprehensive Blood & Cancer Center 6501 Truxtun Ave., 93309-0633 661-322-2206 / FAX: 661-322-7027 Medical Degree: Shandong Med. U, China 1994; Internship/ Residency: Texas Tech 2005-2008; Fellowship: USC 2009-2012; Board Certified: Internal Medicine/Oncology Don V.A. Zapanta, MD (Family Medicine/Pediatrics) 1619 Cecil Ave., Ste. B, Delano, 93215-1515 661-721-9001 / FAX: 661-721-1516 zapanta@pacbell.net Medical Degree: U of St. Tomas 1973; Residency: Martin L. King Hosp. Program 1979-1981

November 2014 Membership Recap Active ...................................................... 248 Resident Active Members ..............15 Active/65+/1-20hr ................................4 Active/Hship/1/2Hship ...................0 Government Employed ......................4 Multiple Memberships .......................1 Retired .......................................................6 2 Total...................................................... 334

New Members (Pending Dues) .......................................2 New Members (App Pending) ......0 Total Members .............................335

DECEMBER 2014 / VITAL SIGNS

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Tulare THOMAS GRAY, MD, FACEP

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org

President’s Message

Thank you for your efforts to educate your patients, families and friends in the successful effort to defeat Proposition 46. The battle was won but the war will likely continue. Now that our focus on self-preservation is over (for the time being) it is time to move on with our real business: taking care of patients and maintaining population health. How can we (collectively) best work toward this?

The reimbursement pie is not growing as rapidly as the demand for service in our business. All payers (at last count 126 government, 246 commercial / indemnity for the last year for my practice) expect more for less. All patients expect prompt service and to be made well. It is our responsibility to reconcile these disparate ends. It is no secret that we spend 17+% of GDP on healthcare in the United States. That is 1.5-2X other OECD (Organization of Economic Cooperation and Development) countries. Administrative costs are exorbitant (2-5X in the U.S. v. other OECD countries) and hospital costs are high (1.2-2X despite having 0.5X fewer beds per capita). Outpatient and ambulatory care costs also far exceed other countries (1.8-3.5X). ‘But this …’ and ‘but that …’ will come to mind as excuses for these excesses. The facts are nonetheless the facts.

What can/should we, as individual practitioners and TCMS members, do to address quality and access to care?

Our practice milieu is unique. We are, for the most part, independent practitioners. Not to ignore EMTALA, PHI, ICD 10, ACA, CMS, NQMs, CQMs, PQRS, HIQRs, CPOE, EBM and so on, we like to think we have some control over our destinies and those of our patients.

Three behaviors can result in simplification, economy and improved care: (1) communicate; (2) avoid duplication; and (3) Share information including the plan for patient management.

If our records were accessible by other physicians who may be in contact with the patient (PMD, clinics, urgent care, ED, hospitalist, consultants), it could save a lot of time + effort = expense for all and be much better for our patients. The Central Valley Health Information Exchange can help those things happen. (See Vital Signs, October 2014.)

The HIE will give full access to patient data for participants. It will allow ordering of lab and radiologic testing, a secure email capability for sharing Protected Health Information to other physicians or providers and open a secure portal to allow selected information to be viewed by patients. Healthcare organizations in our four county area are working toward implementation. Several organizations are already exchanging data and Tulare County hospitals are in the process of testing data exchange. The promise is decreased redundancy; better communication among all parties, better outcomes for patients, decreased cost and it meets the ‘meaningful use’ requirement for 2015.

What could go wrong? Interfacing medical data in the digital universe has not been straightforward. But that cannot be an excuse for resisting the progress we must continue to make for our practices and our patients. So let us ensure that the Tulare County Medical Society will support the CVHIE and other innovations that can help improve community health with the cooperation and vigor we shared in our fight against Proposition 46 and with a similarly successful outcome.

Welcome Dr. Manga, the incoming President, and the new members of the Board and give them your support in leading us forward in 2015.

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

Renew Your MembershipToday; Urge Nonmember Colleagues to Join!

••• Health Awareness Days for December • International AIDS Awareness Month: www.aids2014.org • International Volunteer Day: December 5 14 DECEMBER 2014 / VITAL SIGNS

As a Tulare County Medical Society member you get access to the following benefits locally as well as the rich benefits through the California Medical Association: DocBook MD: HIPAA-compliant smartphone and iPad app allowing doctors to communicate, collaborate and coordinate patient care information.

Norcal Physician liability Insurance – Competitive Medical Malpractice Insurance Rates Marsh Group Insurance – Health, dental, longterm disability, worker’s compensation and life insurance products offered Phone or touch screen tablet reimbursement – Every two years, you are entitled to be reimbursed a percentage of your costs for one of these items.

Epocrates – Most widely used mobile drug and online clinical reference. $30 annual subscription Audio Digest – Huge discounts on Gold Standard Audio CME. One year subscription = $25, two year subscription = $50 UpTo Date – Current, comprehensive, evidence based information in a clinically sound deliver format.

One year subscription, $224.50; three year subscription - $549.50 2015 Coding Book Discounts – CPT, ICD-9, ICD-10, HCPCS and Medicare RBRVS available through our designated vendor For more information, please email info@tkfmc.org or call 559-627-2262.

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

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

FRESNO ANNOUNCEMENTS Dr. Paul James Nugent earned in May 2014 his Masters in Public Health at UC Berkeley & will use this knowledge to deliver innovative care to spine & orthopedic patients, focusing on elaborating “up stream” negative social determinants effecting physicians’ health.

University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Call 559-3200580.

PHYSICIAN WANTED .

Hospitalist physician needed in Fresno. Send resume/CV to Community Hospitalist Medical Group, 1180 E. Shaw, Fresno, CA 93710.

Spruce Multispecialty Group of Fresno, committed to the private practice of medicine, is recruiting a BE/BC IM, Rheumatology or Pulmonary specialist. Contact Rathin at 559-289-9518 or tharathin@gmail.com.

TULARE FOR RENT / SALE

FOR RENT / SALE .

Medical Office, 2,000 sf; Professional Building on Saint Agnes Medical Center campus, North side, 1313 E. Herndon. Call 559-696-0816.

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Class ‘A’ Medical Space • Visalia • 8,190 sf, all/part, available for lease/purchase. Across the street from Kaweah Delta Hospital. Call 559804-7419 or 804-7421. See ad on page 6 for pictures/details.

Healthcare News

for end-of-life care counseling, AP/Modern Healthcare reports. The potential payment changes would take effect in 2016 and would apply to voluntary end-of-life care counseling (AP/Modern Healthcare, 11/1).

Continued from page 7 CMS also announced in the regulations that it will consider whether to reimburse providers

Gar McIndoe (661) 631-3808 David Williams (661) 631-3816 Jason Alexander (661) 631-3818

MEDICAL OFFICES FOR LEASE 1902 B Street – 2,030 sf 8327 Brimhall – 1,629 sf 8327 Brimhall – 2,288 sf Leased 223 China Grade Loop – 8,497 sf Crown Pointe Phase II – 2,000-9,277 sf Leased 3115 Latte Lane – 5,637 sf Escrow 1150 Lerdo Hwy – 1,766 to 3,793 sf 9300 Stockdale Hwy – 16,618 sf 9300 Stockdale Hwy – 5,754 sf 9900 Stockdale Hwy – 2,085 sf Leased 2019 21st Street – 2,856 sf 9300 Stockdale – Surgery Center Available 4100 Truxtun Ave - 6,613 sf 3941 San Dimas Street – 3,959 sf 2731 H Street – 1,375 sf FOR SALE 3015 Calloway – 1,465-10,318 sf Sold 4939 Calloway #103 – 1,827 sf Escrow 223 China Grade Loop – 8,497 sf Crown Pointe Phase II – 2,000-9,277 sf Sold

Tulare County Medical Society presents

Join us at the next Walk With A Doc to take a step toward a healthier you!

All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness.

TULARE: Del Lago Park Saturday, December 13, 2014 8:00am to 9:00am VISALIA: Riverway Sports Park Saturday, December 13, 2014 8:00am to 9:00am Anyone can attend!

For more information, please contact Tulare County Medical Society at (559) 627-2262

DECEMBER 2014 / VITAL SIGNS

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VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337

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