Vital Signs February 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

February 2014 • Vol. 36 No. 2

See Inside Affordable Healthcare Act AMA News Western Health Care Leadership Academy

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

800-252-7706 www.CAPphysicians.com

San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior)

by A.M. Best.

We invite you to join the nearly 12,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

2

FEBRUARY 2014 / VITAL SIGNS

Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society February 2014 Vol. 36 – Number 2

Contents CMA NEWS................................................................................................................................7 NEWS

AFFORDABLE HEALTHCARE ACT: Surviving the First Month of Covered California..........................5

CMA EDUCATION SERIES.........................................................................................................6

AMA News..............................................................................................................................9

2014 Yosemite Postgraduate Institute: March 28-30...............................................................11

Western Health Care Leadership Academy..............................................................................12

CLASSIFIEDS..........................................................................................................................19 Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Committee 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 Thelma Yeary

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 Medi­ cal Society, PO Box 28337, Fresno, CA 93729-8337.

Advertising Contact: Display: Annette Paxton, 559-454-9331 apaxton@cvip.net Classified: Carol Rau Yrulegui 559-224-4224, ext. 118 csrau@fmms.org

Fresno-Madera Medical Society......................................................................................13

• General Society Meeting: February 20

• An Evening with the Fresno Philharmonic: February 15, 2014

• Walk With A Doc

• Be Sure to Purchase your 2014 FMMS Pictorial Directory

• Communicable Disease Quarterly Report

Kern County Medical Society...........................................................................................16

• National Kidney Month

• New Member

• Membership Recap

TULARE County Medical SocieTY.......................................................................................17

• Executive Director’s Message

• Attention Members! Sign-up for Email Notices

• Learn About Covered California

• Walk With A Doc

Cover Photography: “ Winter in Chicago”

By Cyndi Ginn Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

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 559-224-4224, ext. 118.

FEBRUARY 2014 / VITAL SIGNS

3

Are you ConFuSed

By wHAt you’re HeArInG ABout tHe AFFordABLe CAre ACt, or Covered CALIFornIA? you’re not ALone

individuals Guaranteed issue coverage, 19 rating territories, new family component rating new For 2014!

Is your plan grandfathered?

Which ACA metal tier do you want? Do you qualify for a subsidy through the Covered California Individual exchange?

Decide to comply with individual mandate or pay the penalty – greater of $95 ($285 per family) or 1% of household income Determine if you want to buy on or off exchange Critical to evaluate provider networks before making a change Evaluate formularies to make sure new insurer covers your medications

sole ProPrietors If you are a sole proprietor or partnership without any non-spouse W2 employees, ACA considers you individuals and no longer eligible for group coverage.

If you have non-spouse employees, provide coverage or obtain other group coverage waivers If no non-spouse employees, determine if subsidy eligible for Covered California Individual plans Decide to comply with individual mandate or pay the penalty – greater of $95 ($285 per family) or 1% of household income Determine if you want to buy on or off exchange Critical to evaluate provider networks before making a change Evaluate formularies to make sure new insurer covers your medications

small GrouPs (2–50) Does ACA require me to offer health insurance or pay a penalty?

Is your plan grandfathered? Does it satisfy ACA metal tier standards? If not grandfathered, does the new plan include the level of benefits you want?

No RAFs, new age bands, 19 rating territories, new family component rating new For 2014!

Determine if eligible for employer tax credit through Covered California SHOP exchange Keep or consider employer provided coverage for employee morale, retention and recruitment strategy If no employee coverage, assist employees with meeting the individual mandate by directing them to Covered California Individual Exchange marketplace Comply with Employer notice requirements of October 1, 2013 for all new hires

SponSored by:

Clear answers to your questions are a CliCk or Phone Call away. www.CountyCMAMemberInsurance.com or 800-842-3761 to speak with a Mercer Client Advisor.

Fresno-Madera Medical Society Kern County Medical Society Tulare County Medical Society

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 65406 (2/14) Copyright 2014 Mercer LLC. All rights reserved.

777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com

AFFORDABLE HEALTHCARE ACT

Surviving the First Month of Covered California On

January 1, 2014, California’s health benefit exchange, Covered California, began providing health coverage to more 400,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect.

To that end, the California Medical Association (CMA) offers the following tips to survive the first month of Covered California: Check your participation status with the various exchange plans through the Covered California provider directory. The search function on the Covered California website (www.CoveredCA. com) allows patients to determine if a particular physician is contracted with any of the participating health plans. Though aimed at patients, physicians can also use the search to determine which plans list them on their exchange provider directories and will also be important as physicians refer patients to other specialists. CMA encourages physicians to review their status with plans offered in their area to determine whether they are showing as participating or non-participating. To access: • Visit www.CoveredCA.com and click on the yellow “Apply Now” button.

• S elect the “Preview Plans” tab at the top of the next screen.

• The user will then be directed to provide some general demographic information and click “See My Results” at the bottom right.

• Click “Preview Plans” again on the next page, then select the “Find your doctor or hospital/clinic or medical group” bar in the middle of the screen •C lick “Find Your Doctor.”

• Enter the physician’s name and location of practice (e.g., city or zip code) and click “Search.” If the desired physician is contracted with a participating Covered California health plan, his or her name should appear in the subsequent provider list.

• Click on the desired physician’s name. Review the information listed in the “specialty designation” and “languages” fields then click the “Add to My Providers List” option.

• Click “Choose a Plan.” The plans in which the chosen physician participates will show a gray checkmark box in the “My Doctors” row within the summary at the lower half of the page. A gray minus-sign box indicates that the physician does participate in the plan.

CMA performed a number of test searches and noted inaccuracies or missing information with some of the information on the Covered CA website. For this reason, CMA also recommends practices check the individual plan websites to confirm their participation status matches that of Covered CA. In most cases, this can be done by clicking “View Directory” on the last page of the Covered CA provider directory.

It’s important that the front office staff have a clear understanding of which plans the practice participates with so they can clearly communicate this information to patients before scheduling.

To find out which plans and products are being offered in your area, download the booklet at: https://www.coveredca.com/coverage-basics/ PDFs/CC-health-plans-booklet-rev3.pdf.

Physicians with questions or concerns about their participation status are encouraged to contact the plan directly.

• I f you show as participating and aren’t sure how/why, ask the plan to provide a copy of the notice they sent to you, including the terms (e.g., reimbursement rates, termination/opt out provision, etc.).

• If you are listed as non-participating and are interested in joining the network, inquire with the plan about how to join the exchange networks.

Who to call: • Anthem Blue Cross Network Relations – 855-238-0095 or networkrelations@Wellpoint.com • Blue Shield of California Provider Services – 800-258-3091 • Chinese Community Health Plan Delegating to Chinese Community Healthcare Association – 415-216-0088, x2806 • Contra Costa Health Services Provider Relations – 925-313-9501 • Health Net of California Provider Services – 800-641-7761 or provider_services@healthnet.com • L.A. Care Health Plan Provider Information Line – 866-522-2736.

• Molina Health Plan Provider Relations – 888-665-4621 • Sharp Health Plan Provider Support Department – 858-499-8330 • Valley Health Plan Provider Relations – 408-885-2221, option #1 • Western Health Advantage Member Services – 888-563-2250 What will Covered CA ID cards look like? All Covered CA ID cards will display the Covered CA logo in addition to the plan name.

What if an exchange patient presents without an ID card?

Coverage for patients who enrolled in an exchange plan by December 23, 2013, is effective on January 1, 2014. Covered California has extended the deadline for patients to submit their first month’s premium to January 15.

Once payment is received, plans have 10 business days to issue patient ID cards. This means patients may present to your office without an ID card.

Until the practice can verify eligibility and benefits, physicians can require patients to pay at the time of service. Once the patient provides the practice with the information on their ID card, the practice can verify eligibility for the date of service, submit a claim to the plan and issue a refund to the patient, if appropriate.

Patients who do not pay their first month’s premium by January 15 are responsible for payment of any services incurred dating back to January 1.

Still have questions? CMA has published a comprehensive exchange toolkit, “CMA’s Got You Covered: A Physician’s Guide to Covered California, the state’s health benefit exchange.” The toolkit along with other exchange resources can be found in CMA’s exchange resource center at www.cmanet.org/exchange.

CMA members and their staff also have FREE access to our reimbursement helpline at 888-401-5911 or economicservices@cmanet. org.

FEBRUARY 2014 / VITAL SIGNS

5

CMA NEWS

2014

EDUCATION SERIES 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

CMA Center for Economic Services Webinars At-A-Glance

Most webinars are FREE for CMA members and their staff, $99 for non-members.

A Webinar Invitation for All Physicians and Their Staff

The California Medical Association (CMA) offers programs to educate physicians and staff on a range of practice management issues. Space is limited, so register soon.

Most webinars are held over the lunch hour, from 12:15 to 1:15 p.m.

Feb. 19: Transitioning your Practice – Retiring, Selling or Buying a Practice – Debra Phairas• 12:15-1:15p.m Considering retirement? Selling or wanting to buy a practice? Making this transition requires planning and sufficient time to accomplish this effectively for your patients, staff and family. California has a high cost of living, which makes it more difficult for physicians to sell, transition, start, or purchase a practice. Learn creative strategies to help you accomplish your goals. This seminar will discuss the options, including: bringing in an associate, recruiting or selling the practice. Included is the latest information on valuation methodology for selling, divorce or estate planning.

Feb. 26: Fraud and Abuse: Dangers & Defenses – DHCS• 12:15-1:15p.m.

Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the importance of documentation, present suggestions for implementing internal controls, and increase awareness of preventive measures to protect your practice from fraud or abuse.

March 5: HIPAA Security Risk Analysis-How to Make Sense of this Requirement – David Ginsberg• 12:15-1:15p.m.

March 26: Physician Practice Options – Self Employment or Group Affiliation – Debra Phairas•12:151:15p.m These webinars are hosted by the California Medical Association. You must register at least one hour prior to the event. 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 Help Line at 800-786-4262.

6

FEBRUARY 2014 / VITAL SIGNS

CMA NEWS Gov. Brown’s proposed budget eliminates retroactive Medi-Cal cuts

Governor Jerry Brown announced that the State of California would not be moving forward with retroactive collection of a 10 percent cut to the Medi-Cal program, a win for physicians and patients in California. The announcement came as part of the governor’s 2014-2015 fiscal year budget proposal.

Unfortunately, the budget does not stop the 10 percent cuts moving forward. Although elimination of the retroactive cut is a huge step in the right direction, an additional 10 percent cut going forward will only cement California in the position of having the lowest Medicaid rates in the nation.

CMA is part of an unprecedented coalition that will continue working to stop the cuts. The coalition, called “We Care for California,” includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers. CMA and the We Care for California coalition will continue to push for full restoration of the cuts moving forward.

In March of 2011, the California Legislature passed and Governor Jerry Brown signed AB 97, which included a 10 percent reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers. The cuts were enjoined for two years while the matter was being argued in a CMA-filed lawsuit.

Despite earlier rulings in CMA’s favor, a three judge panel of the 9th Circuit Court of Appeals cleared the way for implementation of these rate reductions.

CMA requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied.

Obama signs Medicare SGR Reform Act of 2013, stopping pay cut for 3 months

President Obama signed into law the Pathway for Medicare SGR Reform Act of 2013, preventing a scheduled 24 percent Medicare physician payment cut from taking effect on January 1, 2014.

The new law stops the cuts called for under the sustainable growth rate (SGR) for three months and instead provides a 0.5 percent update through March 31, 2014. The three months gives Congress time to finalize the Medicare payment reform legislation.

The Centers for Medicare and Medicaid Services is currently revising the 2014 Medicare Physician Fee Schedule to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November. The new law also extends the exceptions process for outpatient therapy caps through March 31, 2014.

Contact: Elizabeth McNeil, 800-786-4262 or emcneil@cmanet.org.

Making sense of Medicare payment changes

With the new 2014 fee schedule, the temporary halt to the sustainable

growth rate (SGR) cut and an interim .5 percent payment increase, Medicare physicians are understandably confused about what impact these changes will have on their practices. Below is a quick summary of the various Medicare payment changes facing physicians in 2014: 2014 Fee Schedule: While the 2014 Medicare fee schedule contains a 3.7 percent conversion factor increase, the overall fee schedule is budget neutral due to myriad relative value unit (RVU) changes. These changes will impact providers differently depending on their specialty, codes billed and geographic region. The revised 2014 fee schedule is available from California’s Medicare contractor, Noridian.

Sequestration: There is no additional sequestration cut for 2014.

However, the 2 percent sequestration cut that took effect in April 2013 is still in effect. That cut is expected to remain in place until Congress adopts

an alternative deficit reduction framework. As it was last year, the cut will be applied to all fee-for-service (Part A and Part B) claims after determining coinsurance, any applicable deductible and any applicable Medicare secondary payment adjustments. The cut will also be applied to Medicare Advantage plans.

E-Prescribing Penalty: Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013 Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule.

How will these changes affect me?

It is important that physicians understand how a fee schedule can affect their practice’s bottom line so that they can make informed decisions about participation. The CMA has developed a simple worksheet to help physicians analyze the impact fee schedule changes may have on their practices based on commonly billed CPT codes. CMA’s Financial Impact Worksheet is available free to members in CMA’s online resource library.

Contact: Michele Kelly, 213-226-0338 or mkelly@cmanet.org.

Medical board will collect CURES fees beginning April 1

The Medical Board of California announced it will soon begin collecting an additional $6 per year on physician license applications and renewals to fund the Controlled Substance Utilization Review and Evaluation System (CURES). The fees, authorized by SB 809, provide funding for ongoing maintenance and staffing of CURES. Physicians can expect to see an additional $12 ($6 per year) added to their licensing fees beginning April 1, 2014.

CURES is an online database that allows authorized users, including physicians, pharmacists, law enforcement and regulatory boards, to access information about a patient’s controlled substance prescription history. The new law will provide roughly $1.5 million annually to maintain the database.

The bill builds on funding provided through the 2013 budget to upgrade the system. With proper funding, maintenance and privacy safeguards, CURES has potential to benefit the public and physicians, assisting physicians in making informed prescribing decisions and helping to control drug diversion in the state.

The new fees will be assessed on physicians and other licensees authorized to prescribe, order, administer, furnish or dispense controlled substances, including dentists, pharmacists, veterinarians, nurses, physician assistants and veterinarians.

Contact: Alecia Sanchez, 916-551-2878 or asanchez@cmanet.org.

CMA fights to protect patient privacy in CURES prescription database

The California Medical Association (CMA) has filed an amicus brief with the California Court of Appeal in Alwin Lewis, M.D. v. Superior Court of the State of California, asking the court to give meaningful privacy protection to patient data collected in the Controlled Substance and Utilization Review and Evaluation Systems (CURES) database.

In this case, a Medical Board of California investigator testified that the board routinely obtains confidential prescribing records from CURES for all patients of physicians subject to medical board investigations, even where the complaint is unrelated to the patients or the physician’s prescribing practices.

CMA believes that the current laws governing CURES and the manner in which patient prescription drug data is disclosed are inconsistent with the Please see CMA News on page 8 FEBRUARY 2014 / VITAL SIGNS

7

CMA NEWS Continued from page 7 broad scheme of federal and state laws protecting the confidentiality and privacy of patient medical information.

With proper funding, maintenance and privacy safeguards, CURES has potential to benefit the public and physicians, assisting physicians in making informed prescribing decisions and helping to control drug diversion in the state.

Recent CMA-supported legislation will provide a consistent funding source and the means for a significant technological upgrade of the system that currently contains over 100 million entries of controlled substances dispensed to patients in California.

Contact: CMA Center for Legal Affairs, 800786-4262 or legalinfo@cmanet.org.

Problems getting paid?

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

Reimbursement Help Line 888-401-5911 or economicservices@cmanet.org.

When to call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing, and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help.

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

• Are you not being paid according to your contract?

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

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

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

•A re your claims denied for timely filing?

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

• Have you done everything you can to resolve an issue with a payor, including appealing, and have been unsuccessful in getting the payor to resolve the issue?

8

FEBRUARY 2014 / VITAL SIGNS

AMA NEWS From the American Medical Association

U.S., Canadian med ed leaders formalize reciprocal accreditation

In a landmark agreement signed Dec. 12, 2013, the accrediting bodies of U.S. and Canadian medical schools took an important step in advancing their commitment to shared quality standards in medical education.

Building on more than 50 years of close work between the Liaison Committee on Medical Education (LCME) and the Committee on Accreditation of Canadian Medical Schools (CACMS), the agreement formalizes their partnership to ensure medical school graduates in the United States and Canada meet their respective countries’ standards and are prepared for the next phase of their medical training.

The agreement was signed by the four organizations that sponsor these accrediting bodies: the AMA, the American Association of Medical Colleges (AAMC), the Canadian Medical Association and the Association of Faculties of Medicine of Canada.

Under the new agreement, the policies and processes of the LCME and CACMS will be modified to reflect six principles of accreditation, as well as components that are specific to U.S. and Canadian medical program accreditation. The understanding also calls for regular review of the principles to ensure they are addressing future medical education needs in both countries.

U.S. programs will continue to be LCME-accredited, while Canadian medical education programs will continue to receive both LCME and CACMS accreditation. The agreement allows Canadian programs the flexibility to address the differences in some aspects of medical education programs in order to meet unique national demands.

50 years of anti-smoking efforts save 8 million lives

January 2014 marks the 50th anniversary of the seminal 1964 U.S. Surgeon

General’s Report on Smoking and Health, a new study in the Journal of the American Medical Association (JAMA) has found that public health efforts have cut smoking rates in half since then, saving 8 million lives.

The AMA’s work to improve public health around smoking goes back to an official acknowledgement of the harms of smoking made the same year as the surgeon general’s first report, continuing with a “war on smoking” launched in 1972 and numerous other efforts across the decades.

We’re proud of our work to help end tobacco use.

1972

AMA launches war on smoking

1964

AMA acknowledges health hazars of smoking

1985

AMA supports s law prohibiting smoking on public transportation

1996 AMA’s efforts help halt cigarette advertising to minors

2011

AMA creates dramatic mass transit ads to drive quitting

Most recently, the AMA was among the signatories of a letter to President Barack Obama in honor of the smoking report’s 50th anniversary.

The letter calls for federal actions that could “ultimately eliminate the death and disease caused by tobacco,” including robust smoking prevention campaigns, enforcement of health plan requirements to cover tobacco cessation treatment and FDA authority to regulate manufacturing, marketing and sales of tobacco products.

Since 1964, adult smoking rates in the United States have gone from 42.4 percent down to 20.6 percent as of 2009, according to data from the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.

Tobacco use is a major risk factor for two of the nation’s most prevalent and troubling conditions – type 2 diabetes and heart disease.

Medi-Cal Incentives to Quit Smoking (MIQS) Tools for Provider Action California Smokers Helpline Launches Free, Web-Based Referral Service

The California Smokers’ Helpline – www.nobutts.org – just made it easier for health professionals to refer their patients who smoke to the Helpline for free, evidence-based, tobacco cessation services in multiple languages.

Health professionals can now register online for the Helpline’s new free, web-based referral service. Once approved, it’s easy and convenient to refer patients who want to quit smoking with the Helpline’s online referral service – just select the provider name from the drop-down menu, enter the patient’s name, date of birth, phone number and preferred language, obtain patient consent, and click save!

Free Nicotine Patches and Gift Card Incentive for Medi-Cal Members Who Want to Quit Smoking

Quitting smoking just got easier for Medi-Cal members! For a limited time through December 2015, the Medi-Cal Incentives to Quit Smoking (MIQS) Project is offering additional incentives to eligible Medi-Cal members age 18 and older who want to quit smoking or using other tobacco.

These incentives include free nicotine patches and a $20 gift card bonus for members who call the California Smokers’ Helpline at 1-800-NO BUTTS and enroll in Helpline counseling.

The nicotine patches and the gift card are mailed directly to the member’s home.

To be eligible for the $20 gift card bonus when calling the Helpline, members must: 1) Ask for the gift card; 2) Have a valid Medi-Cal Beneficiary Identification Card number; and 3) Complete the first counseling session.

FEBRUARY 2014 / VITAL SIGNS

9

BETTER NOW We guarantee ICD-10 and Meaningful Use. So patients can be guaranteed your undivided attention.

John Kulin, M.D. On the network since 2009

YOUR 2014 SUCCESS: GUARANTEED

In a year of massive change, athenahealth wants to help your practice stay independent Two fast-approaching initiatives—the ICD-10 transition and Stage 2 of the Meaningful Use program—are hitting the calendar at the same time. And both can cause administrative chaos and financial strain for practices.

At athenahealth, we don’t believe government mandates—or any change—should take focus away from patients.

So, as part of our continued dedication to caregivers, we guarantee your success as you face these programs.

It’s an assurance no traditional vendor could even attempt. But with our proven combination of cloud-based software, network intelligence and back-office services, we are uniquely poised to come through for our clients.

ICD-10 Guarantee athenahealth guarantees we will be ready for ICD-10 by the October 1, 2014 deadline or you don’t pay for our services until we are.

Additionally, any new clients who experience significant interruption in cash flow may be eligible to receive a cash loan from us.†

Meaningful Use If you participate in the Meaningful Use program—Stage 1 or Stage 2—athenahealth guarantees your Medicare incentive check.

And our track record speaks for itself, with 96% of our participating providers attesting in 2012.††

TO LEARN MORE VISIT: athenahealth.com/fresnoprint † This Guarantee covers ICD-10-CM codes and does not cover the ICD-10-PCS code set. Eligibility for the cash advance is limited to independent practices that (i) are live on athenahealth’s athenaOne services, or on our athenaCollector, athenaCommunicator and athenaClinicals services, by June 30, 2014; (ii) have an overall average days in accounts receivable (DAR) of more than 60 days in regard to transactions occurring on or after October 1, 2014; (iii) have Client-responsible DAR of seven days or less for such month; and (iv) are not in breach of the athenahealth Master Services Agreement; provided, however, that the total aggregate amount of cash advances made by athenahealth to its clients will not exceed $50 million dollars in the aggregate and cash advances made to each practice will be capped based on the number of MDs and mid-level providers in such practice. Additional terms and conditions apply; please see your sales representative for more information. †† If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act reimbursement payments only. Additional terms, conditions, and limitations apply.

10

FEBRUARY 2014 / VITAL SIGNS

2014 Yosemite Postgraduate Institute March 28-30, 2014 Yosemite National Park

Topics include: •Opioid Use and Misuse •Health and Wellness •Cardiology •Sports Brain Injuries • Rheumatology Tests & Diseases • HRT in Males and Females Osteoporosis

For Information and brochure: csrau@fmms.org or 559-224-4224x 118 or visit: www.fmms.org

REGISTER TODAY!

FEBRUARY 2014 / VITAL SIGNS

11

Health Care LEADERSHIP ACADEMY L Western

APRIL 11-13, 2014 • SAN DIEGO, CA

The 17th Annual Western Health Care Leadership Academy (formerly the California Health Care Leadership Academy) continues its mission of providing information and tools needed to succeed in today's rapidly changing health care environment. Hear from the experts and leaders of change, and attend a comprehensive slate of practice management seminars and workshops to position your practice for success.

Topics will include: Leadership Development: Choose from a slate of leadership development workshops to enhance your leadership skills and position yourself as a health care leader during times of change.

ACA Implementation: With insurance industry reforms in place and health benefit exchanges across the country now open for business, a slate of experts will discuss the dynamics of the new marketplace – including concerns about network adequacy and the positives and perils of exchange plan contracting.

Practice Management: Position your medical practice for success in the post-reform health care landscape with a slate of practice management workshops.

ICD-10 Transition: The October 1, 2014, transition to ICD-10 will take strategic planning and considerable preparation. Breakout sessions will help physicians understand and prepare for this major coding change.

Detailed agenda will be posted soon at: westernleadershipacademy.com

12

FEBRUARY 2014 / VITAL SIGNS

KEYNOTE ADDRESS BY FORMER SECRETARY OF STATE HILLARY RODHAM CLINTON Presented by:

Fresno-Madera MAKE YOUR RESERVATION!

Fresno-Madera Medical Society presents

Just Walk!

Walk with a Doc ‘Walk with a Doc’ strives to encourage healthy physical activity in people of all ages and reverse the consequences of a sedentary lifestyle.

WHO CAN ATTEND: Participation is open to anyone interested in taking steps to improve their health.

GRAB A FRIEND AND HEAD TO THE PARKS ON SATURDAY MORNINGS

FRESNO

Woodward Regional Park Sunset View Shelter Registration 8:45am Walk Event 9:00am-10:00am February 22, 2014 March 22, 2014 April 26, 2014

UPDATE ON ORGANIZED MEDICINE: What Physician Practices Need to Know featuring

Richard E. Thorp, MD President, California Medical Association Attend to find out what organized medicine is doing to help you, including: • The fight to preserve MICRA • Stopping reimbursement cuts • Assistance with ACA implementation Thursday, February 20, 2014 • 6pm TorNinos’ Banquet Hall 5080 N. Blackstone Ave (just north of Shaw Ave.) FMMS members: No charge Non-FMMS Physician Member/guest: $25 Information: 224-4224, ext 118 or csrau@fmms.org

MADERA

Town & Country Park Pavilion Area Registration 8:15am Walk Event 8:30am-9:30am February 1, 2014 March 1, 2014 April 5, 2014 FURTHER INFORMATION Fresno-Madera Medical Society (559) 224-4224, ext. 110 or at www.fmms.org/receptionist@fmms.org

Find us on Facebook: Fresno-Madera Medical Society

http://www.facebook.com/pages/Fresno-MaderaMedical-Society/107731015917068

Be sure to purchase our FMMS Pictorial Directory

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 Ujagger-Singh Dhillon, MD William Ebbeling, MD Anna Marie Gonzalez, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Alan Kelton, MC Constantine Michas, MD Trilok Puniani, MD Khalid Rauf, 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

$20 FMMS Members $30 Non-FMMS member

CMA Trustee District VI Virgil Airola, MD

Directories can be purchased and picked up at the FMMS office at: 1040 E. Herndon Ave. Suite 101, Monday-Thursday 8am-4:30pm Friday by appointment only.

Staff Sandi Palumbo Executive Director

Call 559-224-4224x118 or csrau@fmms.org FEBRUARY 2014 / VITAL SIGNS

13

Fresno-Madera

14

FEBRUARY 2014 / VITAL SIGNS

Fresno-Madera

Communicable Diseases Quarterly Report Quarter 4:

October 1 - December 31, 2013

Department of Public Health www.fcdph.org 2012 Cases Sexually Transmitted Diseases

2013 Cases

*5 Year Average

4th QTR

YTD

4th QTR

YTD

10

90

11

62

88

1,543

6,201

1,392

6,043

5,873

444

1,532

398

1,716

982

HIV

35

111

12

77

118

Syphilis-Total

2

15

3

65

29

AIDS Chlamydia Gonococcal Infection

Vaccine Preventable Diseases Hepatitis A

0

5

0

4

4

Hepatitis B (Acute)

0

2

0

4

6

Hepatitis B (Chronic)

36

199

69

188

212

Meningitis

1

18

1

16

27

Mumps

1

1

0

3

1

Pertussis

3

16

15

33

136

Points of Interest: Fresno County observed a spike in Pertussis activity in the fourth quarter of 2013. Patients that were reported were mostly under the age of 1 years old. The cases either did not qualify for the vaccine due to age restrictions or got sick a few days following vaccination. For the later condition the vaccine did not have sufficient time to develop immunity in the patient to protect him or her.

The Tdap vaccine is effective at preventing pertussis if people received booster shots at recommended intervals. It is recommended that people who cohabit with infants and children receive booster shots of Tdap.

This preventative action will assist in protecting the infants and children of the household from contracting pertussis. Please visit the URL below for more information:

h p://www.cdc.gov/pertussis/vaccines.html

Reportable Diseases in Fresno County: Food Borne Diseases Campylobacteriosis

82

382

71

410

272

Shiga Toxigenic E. Coli

4

6

0

5

9

Giardia

1

11

4

18

19

Salmonellosis

38

150

24

197

151

Shigellosis

3

21

5

24

50

Food Borne Outbreaks

0

1

0

2

2

A selection of Reportable Diseases appears in this Quarterly Report. Includes data on cases that are not closed.

Reportable disease information is compiled by numbers of cases.

In the tables to the left, numbers of cases for each disease are listed for the current and previous year and corresponding quarter. Fresno County case counts along with a five year average are presented in the table to the left.

The five year average range is 2008-2012.

Vector Borne & Zoonotic Diseases

Color Code:

Lyme Disease

0

5

0

2

3

Malaria

1

4

0

1

2

= Cases are lower than the five year average

West Nile Virus

7

29

1

7

13

= Cases are comparable to the five year average

1,165

236

987

1,410

Selected Communicable Diseases Hepatitis C (Chronic)

231

Red

Legionellosis

3

6

2

4

5

Tuberculosis

8

34

4

34

55

= Cases are higher than the five year average

*Five year averages are year to date figures.

Helpful links for disease rates, Centers for Disease Control and Prevention (CDC) www.cdc.gov/datastatistics; California Department of Public Health (CDPH) www.cdph.ca.gov/data/statistics ; Fresno County Department of Public Health www.fcdph.org/statistics Definitions:

•

Communicable disease – a disease which can be transmitted directly or indirectly by a living organism or by a non-living object or substance.

Examples include: from an infected person to another person who is susceptible; from an object (sheets, clothing, telephone handset, drinking glass) that may harbor germs to a susceptible person.

•

Reportable disease – in compliance with federal and state health code, certain diseases must be reported when a confirmed diagnosis is made on a secured and standardized form. Visit http://wwwn.cdc.gov/nndss/document/2012_Case%20Definitions.pdf for more information.

Developed November 9, 2012

FEBRUARY 2014 / VITAL SIGNS

15

Kern Kings National Kidney FoundationTM 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 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

This Black History Month, Take Time to Talk with Your Family About Health History:

More than 26 million Americans have kidney disease. 1 in 3 adults are at risk for getting it, and most don’t know it. Kidney disease can be found and treated early to prevent more serious health complications.

Due to high rates of diabetes, high blood pressure and heart disease, African Americans have an increased risk of developing kidney failure.

African Americans need to be aware of these risk factors and visit their doctor or clinic regularly to check their blood sugar, blood pressure, urine protein and kidney function.

Want to find out more or get involved?

Visit www.kidney.org or call 800-622-9010 Awareness • Treatment • Prevention

New Member The following physicians’ names, etc. are being published in compliance with the KCMS Constitution & 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 American Medical Association.

Albert McBride, MD (Urology) Highgrove Medical Group 2701 Chester Ave. Ste.201, 93301-2016 661/716-1070 FAX: 716-1075 albertmcbride@msn.com Medical School: G. Washington U, DC 1963 Internship: D.C. General Hospital 1963-64 Residency: G. Washington Univ. Med. Center, DC 1964-68; Board Certified Urology: 1972

CMA Delegates Jennifer Abraham, MD John Digges, MD Lawrence N. Cosner, Jr., MD CMA Alternate Delegate Joseph H. Chang, MD CMA YPS Representive Joseph H. Chang, MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

16

FEBRUARY 2014 / VITAL SIGNS

Membership Recap JANUARY 2014 Active...................................................................................................................................................... 265 Resident Active Members................................................................................................................ 2 Active/65+/1-20hr............................................................................................................................... 4 Active/Hship/1/2Hship.................................................................................................................. 0 Government Employed..................................................................................................................... 4 Multiple Memberships...................................................................................................................... 1 Retired.......................................................................................................................................................61 Total.......................................................................................................................................................337 New Members (Pending Dues).................................................................................................... 1 New Members (App Pending)..................................................................................................... 0 Total Members............................................................................................................................ 338

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

Tulare FRAN HIPSKIND

Executive Director’s Message CHANGES

As I stepped into the role as your Tulare County Medical Society Executive Director in January, it was with a sense

of gratitude to the steady leadership and years of service to Steve Beargeon. While titles may have changed, I commit to continue the unwavering service you have become accustomed to. I look forward with much anticipation and excitement at what lies ahead for you as a member. Your membership and participation are what drives and motivates us to offer worthwhile programs and services all while advocating to protect the physician–patient relationship.

By now we have seen the first month of the Affordable Care Act come and go. Feedback reviews have been mixed from both physicians and patients. Early in January we shared a “Surviving the First Month of Covered California” tip sheet that was prepared by the California Medical Association (CMA). It answered pointed questions in reference to physician participation status and how to identify what patients are participating. To further assist in understanding logistical questions and procedures with Covered California, the CMA Foundation has placed Michelle Garcia to work with the Tulare County Medical Society Members and office staff. Ms. Garcia has designated days that she can come to your office to answer your specific questions. If you would like to know more or to schedule a time to have her come and visit, please call our office and we will put you in touch with her.

Looking to other changes slated for 2014, we hope that you will take advantage of our ICD-10 learning opportunities. We have been able to secure a very capable ICD-10 educator to do the training for physician members and coding staff. We have February dates scheduled and we will do a repeat of the courses in August of 2014 in case you missed out. I also highly encourage you to keep abreast of what your specific specialty society is offering in coding education. I also know that local hospital efforts are being planned to work with staff physicians in acclimating them to the new coding procedures and documentation.

Medical Injury Compensation Act (MICRA). To borrow from the movie “The Godfather” I paraphrase: “No more meetings, no more discussions… it’s all out war – we go to the mattresses….”

At the time of this writing Consumer Watchdog, the organization fronting the MICRA repeal and mostly supported by trial attorneys, has heavily concentrated on the unfortunate case of Miss Jahi McMath. She is the young California girl who was recently declared brain dead following sleep apnea surgery. They are using this case as a fundraising tool to qualify the initiative to overturn MICRA and the malpractice limit (SFgate.com, 1/8/14). From this we can surmise their tactics cannot be underestimated. The stakes are high in this and fighting will not come cheap. If you have not already contributed to CALPAC, you may pay later with your malpractice premiums increase.

It is hard to imagine those rates potentially doubling or tripling. CMA has written brochures that can be distributed to your patients to educate them on MICRA and what an overturn of the law means to them. If you wish to contribute to CALPAC or to obtain the brochures, please contact the TCMS office at 559-734-0393.

Remember this is the month of St. Valentine! Remember those you love and say it to them!

Fran Hipskind may be reached via email at: fran@tkfmc.org.

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

ATTENTION: Tulare County Medical Society Members!

If you would like to be placed on the email list please send us your preferred e-mail address so that we can cut down on the snail mail notices, please e-mail it to Fran@tkfmc.org or you can fax it to 559-334-0090.

Add me to the email list: Name: Email FEBRUARY 2014 / VITAL SIGNS

17

Tulare Dr. Ravi Kumar hosts a Tulare

Interested in Learning About Covered California?

Michelle Garcia, California Medical Association Foundation educator for Covered California Health Plans, is available by appointment on Wednesday’s in Tulare County. She will come to your office or meet at the TCMS office.

If you would like additional information, please call or email: Tulare County Medical Society office – 559-734-0393; Michelle Garcia, 559-644-5888, mgarcia@thecmafoundation.org.

• Know which health plans you are contracted with Covered CA. If you don’t know, come find out!

• Understand the cost-sharing responsibilities that patients will have to pay and the differences established by the “Metal Tiers” in Covered CA Health Plans • Be knowledgeable about the newly-required ten essential health benefits every Qualified Health Plan now covers • Small Business Health Options Programs (SHOP): does your practice qualify for tax credits by providing health insurance to your employees?

• How to direct your uninsured patients to resources so that they can meet the requirements of the Affordable Care Act.

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.

Dates: Saturday, January 25, 2014 and February 22, 2014 Beginning at 8:00AM Location: Del Lago Park, Tulare, CA Who can attend: ANYONE For more information, please contact Roberta Hurtado at (559) 685-4607

18

FEBRUARY 2014 / VITAL SIGNS

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.

KERN FOR LEASE Small professional office, approx. 600 sf at 2520 H St. Bakersfield, next to San Joaquin Hospital.

Call 661-900-5646 or 661-324-1090.

FRESNO ANNOUNCEMENTS 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 Full or part time physician for Family Medicine office in Fresno. Good salary. Optional ownership in the future. Call Krystyna at 559-970-9191.

Full or Part time physician wanted for local occupational medicine clinic to perform physicals on new hires. Call Su Rosenthal at 559-287-0172 or Su@PalmMedical.com Full or part time public health physician with Fresno County Depart. of Public Health. Contact David Pomaville at 559-445-3200.

Part time physician for weight loss clinics in Bakersfield. Possible buy-in. Established practice with potential. Fax CV to 805-644-7943 or email: swhitcomb@pro-weight-control.com

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

MEDICAL OFFICES FOR LEASE 2323 16th St. – 1,194 rsf.

2323 16th St. – 1,712 rsf.

2323 16th St. – 2,568 rsf.

8327 Brimhall – 1,629 rsf.

8327 Brimhall – 2,288 rsf.

Crown Pointe Phase II – 2,000-9,277 rsf.

3115 Latte Lane – 5,637 rsf.

3115 Latte Lane – 2,660-2,925 rsf.

9300 Stockdale Hwy. – 3,743 sf.

9330 Stockdale Hwy. – 5,754 rsf.

9900 Stockdale Hwy. – 2,085 sf.

SUB-LEASE 4100 Truxtun Ave. – Can Be Split Medical Records & Offices Sprinklered – 4,764 rsf.

Adm. & Billing – 6,613 rsf.

FOR SALE 2019 21st Street – 2,856 sf.

2204 Q Street – 4,600 sf.

3015 Calloway – 1,465-10,318 sf.

Crown Pointe Phase II – 2,000-9,277 rsf.

Dear Doctor and Staff:

Location, Location, Location!

1382 E. Alluvial Avenue, Fresno is what N-5 LLC has to offer to you and your practice. We picked our location, because it will remain a positive area indefinitely. Further north is the San Joaquin River and office space is limited.

We are ideally located!

FIVE REASONS TO CALL US TODAY: 1. It takes approximately 10-12 months + to build out an office to actual occupancy. If you are concerned about your current lease we would provide free rent to you so you could complete your lease as signed for.

2. We have a team at Henderson Architectural and Target Contractors who can get the job done on time and on budget.

3. We could offer Free Rent for an extended period of time as determined on the amount you put into lease hold improvements.

4. You would have the possibility of owning your own suite.

5. Parking is 6 stalls/1,000 sq. ft.

Your area of town is good, but north of Herndon Avenue is truly the most ideal area of the greater Fresno/Clovis area.

You may have many more questions, and we would be happy to meet with you and answer them. We would love the opportunity to discuss options available to you.

With Warmest Regards,

N-5 LLC (559) 259-3077

George Kisling, Dennis Nishimine, Lindsay Takeda www.1382EAlluvial.com

1/3 pg six times-a-year FACULTY PHYSICIAN(S) – FAMILY MEDICINE $280/ad KERN AND FRESNO COUNTIES

MAYBE IT’S TIME TO PURSUE A NEW CAREER

Board Certified Family Practice Physicians to serve as faculty for the Sierra Vista Family Practice and Rio Bravo residency programs.

Full and part-time positions available providing teaching and instruction to residents. Make a difference in the lives of new physicians and join the faculty! Competitive salary and benefits.

Positions available in Kern and Fresno counties.

PHYSICIAN(S)– FAMILY MEDICINE – FRESNO COUNTY Provide comprehensive medical services to an established patient population, in one or more of several satellite clinics in the Fresno area.

The position requires an MD, or DO degree or equivalent and completion of residency training in Family Medicine. Board Certification or Board Eligibility in Family Medicine as evidence of completion of the training requirement is acceptable. Valid California medical license also required.

DEPUTY CHIEF MEDICAL OFFICER – FRESNO COUNTY The Deputy Chief Medical Officer (DCMO) is responsible for the overall patient functioning of the medical program of the clinic and satellites, including the day-to-day management, planning and supervision of medical staff activities. The DCMO also assures an efficient system in which quality care is guaranteed to all patients.

The DCMO should be a health care provider (MD/DO) licensed to practice in the State of California. The DCMO should have a strong community health/public health orientation, be experienced in patient care management, and have at least two years of experience in an administrative capacity.

Interested applicants may contact Clinica Sierra Vista at (661) 979-0812.

FEBRUARY 2014 / VITAL SIGNS

19

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

PRSRT STD U.S. Postage PAID Fresno, CA Permit No. 30

HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

NORCAL Mutual is owned and directed by its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. Visit norcalmutual.com, call 877-453-4486, or contact your broker.

A N o r c A l G r o u p c o m pA N y