February 2015

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

See Inside: Insurance Commission Issues Emergency Regulation Message from CMA President Several Affordable Health Care Acts Take Effect Save the Date: Yosemite Postgraduate Institute

Vital Signs

February 2015 • Vol. 37 No. 2

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

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

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

LETTER TO THE EDITOR...........................................................................................................6

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

February 2015 Vol. 37 – Number 2

LETTER FROM CMA PRESIDENT...............................................................................................7

2015 Post Yosemite Institute..................................................................................................6

Editor Alan Birnbaum, MD

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

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.

CLASSIFIEDS..........................................................................................................................15 Fresno-Madera Medical Society......................................................................................10

• Medical Managers Network Forum

• In Memoriam: Clarence Hodge, MD; Ellsworth Miller, MD; Dale Kirkegaard, MD

• ICD-10-CM Coding Seminar

• Walk WIth A Doc

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

• Metro Record Storage and Shredding Offer

• Membership News

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

• Medical Reserve Corps

• Calling All Tulare County Medical Society Members

• Upcoming Events

• Just Walk With A Doc

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

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

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

Cover Photograph: “ Jokulsarlon, Ice Lagoon at Sunset” South Iceland, Nov. 1, 2014

by Joseph B. Hawkins, Jr. MD Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee FEBRUARY 2015 / VITAL SIGNS

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Group

Dental Long Term Disability Level Term Life Employment Long Term Care Business Owners Policy Group Professional Liability Workers’ Compensation Acc

Health Insurance

4 FEBRUARY 2015 / VITAL SIGNS

Are you aware that small groups can change their health insurance at any time throughout the year?

Mercer provides a wide range of health insurance options and guidance to members of the Fresno-Madera, Kern County and Tulare County Medical Societies.

We connect you with the top group insurance carriers and help you choose the coverage that best fits your needs and budget. We offer flexibility and value so you can provide quality health, dental, life and disability plans to your employees.

Small Group (2 to 50 employees) coverage is available for all business forms that include at least one non-spouse W-2 employee in addition to the owner(s). Tax form verification of your status as a small group is required. We can help you to determine whether your business structure and enrollment will qualify for small group coverage if you are not sure.

Plus, members who purchase their group health insurance through Mercer, the Societies’ sponsored insurance program broker and administrator, are eligible to receive Mercer Select H&B KnowHow. Developed by Mercer, a leader in human resource consulting, outsourcing and investments, Mercer Select H&B KnowHow is a tool that helps provide employers with important human resources information such as the latest health and benefit requirements for California, and it provides the forms needed for compliance.

For more information, contact a Mercer Client Advisor at 800-842-3761, or visit www.CountyCMAMemberInsurance.com.

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

69900 (2/15) Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 Copyright 2015 Mercer LLC. All rights reserved. • 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com

EDITORIAL

Charlie Teaches the Cost and Value of Free Speech Alan M. Birnbaum, MD Editor, Vital Signs

That we live as free citizens in a free society has everything to do with not just freedom of speech and press, but freedom

from fear when we express ourselves. Absent unrestricted public expression we become serfs or even slaves. Consider two points of courage nearly 400 years apart.

In November 1734 the British colonial governor William Cosby had his sheriff arrest John Peter Zenger, the publisher of The New York Weekly Journal, whose pieces written as “Cato” had criticized attitudes and actions of this petty despot. While a grand jury refused to indict Zenger, Cosby’s attorney general Richard Bradley filed libel charges in August 1735, alleging that the Weekly Journal had printed “divers scandalous, virulent, false and seditious reflections.” Ultimately his lawyers so eloquently convinced a jury of Zenger’s innocence that they returned a not guilty verdict in 10 minutes, accepting the argument they made that truth was an absolute legal defense Charlie Hebdo against libel. Seventy years later a further case involving a small paper called The Wasp and its publisher Harry reserves and Croswell bolstered that principle, leading to legislation directly establishing this axiom. It passed in 1804 by the New York Legislature, then further accepted across the United States. preserves Freedom to express political opinion in our country very much rests upon these two cases. Our country the right to has thrived due to the freedoms of speech and press founded in the First Amendment to our Constitution. ridicule that After World War II, the United Nations’ 1948 Universal Declaration of Human Rights globally expanded that principle: “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold which lacks opinion without interference and impart information and ideas through any media regardless of frontiers.” logic, hinders That as a physician and citizen I can currently voice disapproval of my Fresno County Board of Supervisors’ human values poorly-considered merger of the County Coroner with the Sheriff’s Office, finds protection from principles and precedents as above. I do not fear that Sheriff Margaret Mims, whom I and many others criticize for accepting, and revokes condoning and promoting a merged Sheriff’s-Coroner office, will send a deputy to arrest me as did Governor rights of Crosby 380 years ago, on grounds I have seditiously libeled her. human In today’s political climate of delicate and unstable balance between individual rights and police protection, distance should separate law enforcement and an medically-trained independent Coroner. This critical existence. principle has been powerfully voiced by recently retired County Coroner and pathologist Dr. David Hadden, whom we continue to value as a member of our Medical Society.

Yet while on one hand we value our rights as American citizens, nearly four centuries later we face graver threats to expression that lurch violently across our world. We have North Korea’s arrogant hacking of Sony Pictures for daring to produce the satirical movie “The Interview,” and more tragically, three madmen defamed their own peaceful prophet, by first slaughtering 13 then another four French citizens in the Charlie Hebdo tragedy. This French satirical weekly lampoons and intentionally offends those who would chain belief to a rigid orthodoxy.

Charlie Hebdo reserves and preserves the right to ridicule that which lacks logic, hinders human values and revokes rights of human existence. After January’s murders France immediately understood the value of the publication. The French have joined spontaneous and organized Unity Marches to illustrate their support, nearly four million joining the latter on the Sunday following the deaths. Their signs read, “Je Suis Charlie…I Am Charlie”. We ALL must be Charlie, wielding the pencil as the symbol of unchained expression, even in this digital age, by spoken word, written page and yes, even cartoon. Even more importantly they will buy and read the three million copies of the next issue of Charlie Hebdo, the ultimate rebuttal of intimidation by terror by those who lack all understanding of Salaam…

Shalom… PEACE. Ask yourself. Do you have the courage to speak out against what is inadvisable, what is clearly wrong, what is immoral, what is horrific, what is heinous? Will you take personal risk to preserve the foundation of democracy, peaceful freedom of expression?

Answer now. Answer loudly: Nous Sommes Charlie… WE ARE CHARLIE! Author may be reached at Siriusguy @aol.com.

FEBRUARY 2015 / VITAL SIGNS

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LETTER TO THE EDITOR

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 Brochures will be mailed January 2015

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

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Dear Editor,

I enjoyed reading your editorial in January’s Vital Signs. I especially liked your statement: “For each procedure ordered, all of us need to ask what question the test would answer, as well as if the result will truly impact care.”

You’re right: Americans do not have limitless amounts of money to spend on their healthcare.

The more money that is spent on medical tests, the less money will be available to pay us physicians.

Compared to tests and procedures, I believe that money spent on physicians brings much more bang for the buck. But that is true only if we help our patients make wise choices. Our mantra should be: eliminate the wasteful, and preserve the useful.

The ABIM Foundation, through its Choosing Wisely initiative, is doing an invaluable service to help physicians and patients toward this goal. The goals of Choosing Wisely is to promote conversations between providers and patients by helping patients choose care that is: 1) supported by evidence, 2) not duplicative of other tests and procedures already performed, 3) free from harm, and 4) truly necessary.

More than 70 specialty societies have signed on, and each has submitted a list of 5 tests or procedures that doctors and patients should question.

For example, the American Association of Neurolgical Surgeons (in agreement with you) states: “Don’t obtain imaging of the spine in patients with non-specific acute low back pain and without red flags.”

The American College of Cardiology recommends against annual stress cardiac imaging as part of a routine follow-up in asymptomatic patients (They explain that such testing may lead to unnecessary invasive procedures and excess radiation exposure without any proven impact on patients’ outcomes).

The Society of General Internal Medicine says there in no indication for daily home glucose testing in patients with type 2 diabetes not on insulin.

I urge everyone to visit www.choosingwisely.org and check out the lists.

– Don H. Gaede, MD, Fresno

CMA NEWS Insurance commissioner issues emergency regulation requiring health insurers to have sufficient networks

California Insurance Commissioner Dave Jones issued an emergency

regulation that establishes stronger requirements for health insurers to create and maintain sufficient medical provider networks to provide timely access to medical care.

The California Medical Association (CMA) has performed an initial review of the proposed regulations, and they appear to be a significant step forward for the state towards ensuring that provider directories are accurate and that networks are adequate. The regulations are consistent with a number of CMA recommendations made over the past year, such as requiring that insurers have clear, publicly available criteria over who is included in a network and that insurers demonstrate comprehensive quality assurance programs in many areas related to directories and networks.

The emergency regulations strengthen current rules and regulations and add new medical provider network requirements that require insurers to, among other things, include an adequate number of primary care physicians accepting new patients, an adequate number of primary care physicians with admitting privileges at network hospitals, build a network capable of the treatment of mental health and substance use disorders, adhere to appointment waiting time standards, and require network facilities to inform patients if an out-of-network provider will participate in nonemergency procedure or care, before the care is provided, so that the patient has an opportunity to decline the provider’s participation.

These regulations would only apply to plans regulated by the Department of Insurance, not plans regulated by the Department of Managed Health Care or in the Medi-Cal program.

Once the emergency regulations are noticed publicly by the Office of Administrative Law, the public will have five calendar days to submit comments. If approved, the regulations will be effective for 180 days, at which time they can be readopted on an emergency basis for another 90 days or go through the regular rulemaking process.

Governor’s January budget proposal leaves state’s woeful Medi-Cal reimbursement rates untouched

Gov. Jerry Brown unveiled a $164.7 billion budget proposal for the 2015-

2016 fiscal year. Unfortunately, the budget proposal contains no increases to Medi-Cal provider reimbursement rates.

According to the administration’s estimates, enrollment in Medi-Cal is expected to reach 12.2 million enrollees this year, representing about 32 percent of the state’s population. This is dramatic increase, up from 7.9 million enrollees in 2013.

“While the physicians of California applaud the extension of the program to offer health care coverage to more patients, it remains disappointing that an increase to California’s woefully inadequate Medi-Cal provider reimbursement rates was not included,” said CMA President Luther F. Cobb, MD. California’s Medi-Cal rates often do not even come close to the cost of providing care. Medi-Cal physicians are currently paid roughly $16 for a regular, primary care visit. For many practices, this is simply unsustainable.

This issue is compounded by the fact that the Affordable Care Act’s (ACA) bump in Medi-Cal reimbursement rates for primary care physicians ended, resulting in, on average, a 60 percent decrease in reimbursement Please see CMA News on page 9

Dear Colleagues:

Although 2014 will long be remembered as the year that all modes of practice and specialties of the House of Medicine came together in a group effort to defeat Proposition 46, it is imperative that we maintain the momentum we have gained as we confront the issues of the coming year and beyond.

Following such a historic year, I would like to take a moment to reflect on what we have accomplished and what we can look forward to Luther F. Cobb, MD CMA President over the next 12 months.

I have, for over three decades, been a firm believer in the institution of organized medicine and the good that we can accomplish with unified action. As the President of the Humboldt-Del Norte Medical Society and Chair of the Council on Legislation, and in my time as Vice Speaker and Speaker of the House of Delegates, I have seen you all accomplish remarkable feats together. Whether it has been determining our stance on the sweeping changes of health system reform; combating unwarranted extensions of allied health professionals’ scope of practice; fighting for access to care; working to ensure the practice of medicine is dedicated to patient welfare rather than the insurance bottom line; redefining Medicare geographic payments, and on and on; we have been able to get all this done because we work together for the benefit of all.

Our political power was evidenced this November when we handed the trial attorneys’ Proposition 46 an unprecedented two for one electoral defeat, in conjunction with an unparalleled coalition across all party and advocacy lines. We distributed over three million lab coat cards, hundreds of thousands of patient brochures, posters and yard signs all over the state, mostly because of the ground game we mobilized.

Such a victory would never have been possible if not for the dedication we all had to one another and to the future of the practice of medicine.

It is indeed a great honor to follow in the footsteps of Richard Thorp, MD, who as last year’s president led an incomparable team effort to victory, not only with Proposition 46, but also the other battles and challenges we faced.

So what does that mean for the year ahead?

Already, the California Medical Association (CMA) has been involved in a public launch to increase the tobacco tax in California. We currently stand 47th in the nation in that regard. A broad coalition of public health advocates will be working all across the state. This action may end up being a legislative effort, or perhaps a ballot initiative, but we will be pressing forward this year. We know that as millions of citizens are signing up for health insurance coverage, it is more important than ever to ensure that they have real access to quality medical care, not just a card promising care without the infrastructure to deliver. To that end, CMA has been working with partners to educate physicians and patients about their choices.

Many other issues are sure to arrive in the coming year; they always do. As a group, united, we can accomplish great things, as we have already proven.

I look forward to working with you all in the exciting new year.

Luther F. Cobb, MD CMA President FEBRUARY 2015 / VITAL SIGNS

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CMA NEWS Continued from page 7 rates overnight. Many primary care physicians that were able to take on new Medi-Cal patients with the ACA’s primary care rate increase will no longer be able to do so, despite the increase in patients and demand for care.

“CMA and our stakeholder partners will look toward reforms that will result in real access to care so that health reform is more than an empty promise of an insurance card,” said Dr. Cobb.

Contact: Eduardo Martinez, Associate Director, Government Relations, emartinez@cmanet.org.

CMA creates new resource summarizing Medicare incentive and penalty programs

Over the past few years, Congress has created a number of programs that

call for payment incentives and reductions (referred to as “adjustments” by the Centers for Medicare and Medicaid Services) that impact physicians and their practices. At their inception, most of these programs offered an incentive to participate. However, most of the programs are entering their penalty phases, with complex and potentially conflicting requirements and implementation processes.

To help physicians understand how these programs will affect their practices, the California Medical Association (CMA) has created a new resource, “Medicare Incentive and Penalty Programs: What physicians need to know.” The resource is available free to CMA members in the resource library at www.cmanet.org/resource-library.

Featured member benefit Controlled Substance Prescriptions: CMA members save 15% on tamper-resistant prescription pads and EHR printer paper with Rx Security.

Contact: CMA member help center, 800-786-4262 or memberservice@cmanet.org.

Mark your calendars now for the 41st annual CMA Legislative Advocacy Day

The event (formerly known as the Legislative Leadership Conference) will

take place on April 14, 2015, at the Sheraton Grand Hotel in Sacramento, just three blocks from the State Capitol and across the street from CMA headquarters.

This is a unique event for California physicians and is free of charge to all CMA members. Plan to join more than 400 physicians, medical students and CMA Alliance members who will be coming to Sacramento to lobby their legislative leaders as champions for medicine and their patients.

Prior to the conference members will receive webinar training on legislation and policy affecting the practice of medicine.

Contact: Yna Shimabukuro, 916-444-5532 or yshimabukuro@ 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.

HEALTHCARE REFORM Several Affordable Care Act Provisions To Take Effect in 2015

Several provisions of the Affordable Care Act are expiring or taking effect for the first time in 2015, which could pose challenges, The Hill reports.

Employer Mandate Kicks In; Some Stakeholders Pressing for Changes The ACA’s employer mandate, after being delayed twice, goes into effect for large companies this year (Ferris, The Hill, 1/1).

The employer mandate requires businesses with more than 50 full-time employees working 30 hours or more per week to provide affordable health insurance coverage to workers or face fines.

Under a timeline released by the Department of Treasury and Internal Revenue Service in February, mid-sized businesses that employ 50 to 99 full-time workers will have another year to provide health insurance coverage to employees. These employers will not face fines for failing to provide coverage to workers until 2016, according to the final rule.

Meanwhile, businesses that employ 100 or more full-time workers will be subject to the mandate starting this year. However, the final rule gives these employers more time to ramp up coverage. To avoid fines, large employers only need to offer coverage to 70% of workers in 2015, rather than 95%. They will need to start offering coverage to 95% of workers in 2016 (California Healthline, 11/12/14).

First Tax Season for Individual Mandate Fines, Subsidy Corrections This year’s tax season also will be the first in which individuals could face financial penalties for not having health coverage under the ACA’s individual mandate, according to The Hill.

Under the individual mandate, most U.S. residents are required to purchase coverage or face penalties of at least $95 for an adult or 1% of an individual’s income, whichever is higher.

According to The Hill, the IRS could face challenges enforcing the mandate as a result of recent budget cuts (The Hill, 1/1). The agency since 2010 has had its funding decrease by nearly $1 billion and its number of fulltime employees cut by 13,000. Tax preparers expect the individual mandate to be only “lightly enforced” in 2015, according to the Wall Street Journal.

The enforcement of the mandate largely will rely on consumers to answer honestly about whether they have coverage, although the IRS has said that it could use its regular enforcement mechanisms, such as requesting additional documentation or conducting audits. According to the Journal, the IRS, CMS and other federal agencies in January will reach out to U.S. residents via emails, telephone calls and text messages to explain what they should expect during this year’s tax season.

Other 2015 Challenges Other potential challenges to the ACA and other health programs this year include: • Addressing the scheduled expiration of funding for the Children’s Health Insurance Program, which was reauthorized under the ACA, in September 2015; • Cuts in Medicare funding faced by providers for failing to demonstrate meaningful use of electronic health records (The Hill, 1/1); • K ing v. Burwell, a Supreme Court case challenging federal subsidies given to U.S. residents to purchase coverage through the federal exchange (Kenen, Politico, 12/31/14); and • The end of a temporary increase in Medicaid reimbursements for primary care physicians, which could affect access to care (The Hill, 1/1).

Please see Healthcare Reform on page 15 FEBRUARY 2015 / VITAL SIGNS

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Fresno-Madera

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

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m u r o f k r o netw

of the

LUNCH & LEARN

FEBRUARY 22, 2015 • 12 to 1pm 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

Fresno-Madera Medical Society offices 1040 E. Herndon Suite #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

Clarence H. Hodge, MD 52-year member Clarence Hodge, MD, a retired anesthesiologist, passed away on November 16, 2014, at the age of 87.

Dr. Hodge was born in Riverside, CA in 1937. He received his medical degree from George Washington Univ. in 1957 and completed his internship and residency training at Fresno County General Hospital and UCLA. After practicing for a year in Merced, Dr. Hodge moved to Fresno and practiced with the Fresno Anesthesia Group and Saint Agnes Medical Center. He retired in 1988.

Dr. Hodge is survived by his wife, two children, three grandchildren, and one great-grandchild.

Ellsworth L. Miller, MD 43-year member Ellsworth Miller, MD, a retired internist, passed away on December 11, 2014, at the age of 98.

Dr. Miller was born in Riverside, CA in 1916. He received his medical degree from USC in 1944 and completed his residency training at Letterman General Hos-pital in San Francisco. He then served in the U.S. Army for 30 years, achieving the rank of colonel. His positions included Chief, Intelligence; Senior Medical Representative to the Canadian Forces Medical Service and Director of Medical Services in Germany.

After retiring from the army in 1970, Dr. Miller came to Fresno and worked as a medical consultant with the Fresno County Health Department and the California State Health Department.

Dr. Miller is survived by three children, two grandchildren and one great-grandchild.

Dale Duane Kirkegaard, MD 54-year member Dale Kirkegaard, MD, a retired general surgeon, passed away on December 24, 2014 at the age of 88.

Dr. Kirkegaard was born in South Dakota in 1926. He received his medical degree from the University of Iowa College of Medicine in 1950 and completed his residency training at the Veterans Adm. Hospital in Iowa City after serving for two years in Korea with the U.S. Army. He moved to Fresno in 1957 and practiced as the Staff Surgeon at the V. A. hospital. He retired in 1997.

Dr. Kirkegaard is survived by his wife, two children, four grandchildren and one great-grandchild.

Fresno-Madera ICD-10-CM Coding Workshop Wednesday, March 25, 2015

9:00am to 4:00pm • 8:30am registration (Continental breakfast and lunch provided) Bella Pasta Restaurant 7033 N. Cedar Avenue., Fresno, CA This workshop is designed to provide the knowledge and skills required of medical personnel, staff and coders to successfully assign diagnostic codes that will ensure medical necessity on insurance claims.

The vastly expanded code set is presented using a systematic, easy to manage approach with hands-on coding exercises.

This comprehensive training on the use of the new diagnostic manual will also enable attendees to focus on specialty coding. Bring your own ICD10-CM manual or may use one of the instructor’s manuals.

• • • • • •

Included in the seminar: Medical necessity ICD-10 Certification Coding rules & guidelines Tables in the Alpha Index Chapter specific coding guidelines Hands-on coding exercises Presented by:

Lisa Phillips, CPC, CPC-I AAPC Certified ICD-10 Instructor

Registration Fee:

FMMS member physicians or office staff $125

Non-member physicians or office staff $225

Please make the following reservation _____ # at $125 – FMMS Physicians or Office Staff _____ # at $225 – Non-FMMS Physicians or Office Staff Name of Registrants____________________________________________________________ Name of Physician Employer_____________________________________________________ Office Phone______________________________ Cell__________________________________ Email Address___________________________________________________________________ Payment: Check for $__________ MAKE CHECK payable to FMMS Credit Card Payment:

o

VISA or

o

MasterCard AmoUnt $_____________________

Name on card ___________________________________________________________________ Credit Card #____________________________________________________________________ Expiration Date___________________________

Zip Code of Billing Address_________

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

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

• Spend more time with your family and friends?

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

FRESNO: FEBRUARY 21 MARCH 21

San Joaquin River Parkway 11605 Old Friant Rd. Registration 8:45am Walk Event 9am-10am

MADERA: FEBRUARY 7 MARCH 7

Town & Country Park Pavilion Area Registration 8:15am Walk Event 8:30am-9:30am Ready to Volunteer?

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

Signature_______________________________________________________________________

RSVP by Monday, March 23, 2015 Fax registration to: 559-224-0276 Information: 559-224-4224, ext. 112 or dchaparro@fmms.org Mailing Address: FMMS, PO Box 28337, Fresno, CA 93729-8337

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

FEBRUARY 2015 / VITAL SIGNS

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

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SAVE THE DATE: Friday, February 20, 2015

In today’s world, offices that shred their own documents and don’t destroy electronic information properly, open themselves to major threats of HIPAA non-compliance and increase their liability risks. Outsourcing shredding keeps sensitive materials away from curious employees, avoids accidental confidentiality breaches, provides standardization and uniformity of destruction policies, is more cost effective and meets the requirements of HIPAA’s Privacy and Security Rules.

As part of Metro Record Storage & Shredding’s mission to help the community safeguard confidential material and meet legal document destruction requirements, they are offering a “Free Shred Day” for medical facilities on Friday, February 20, 2015 from 1-5pm at Metro’s office; 2929 16th Street, Bakersfield (just west of Mercy Hospital, near Oak Street). You are invited to bring up to five (5) standard-sized boxes of documents, two (2) hard drives and unlimited X-rays (unjacketed) to be shredded for FREE. Call Metro at 661-322-2929 for more information or visit www. metrorecord.com.

January 2015 Membership Recap Active...............................................................................................................................................2 4 8 Resident Active Members......................................................................................................14 Active/65+/1-20hr........................................................................................................................4 Active/Hship/1/2Hship...........................................................................................................0 Government Employed..............................................................................................................4 Multiple Memberships...............................................................................................................1 Retired...............................................................................................................................................6 3 Total...............................................................................................................................................334 New Members (Pending Dues)...............................................................................................................................2 New Members (App Pending)..............................................................................................0 Total Members.....................................................................................................................336

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 Jacqueline G. DeCastro, MD Thomas S. Enloe, Jr., MD Michael MacLean, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

Tulare Medical Reserve Corps Seeks Physician Volunteers

The idea for a national volunteer corps emerged out of the tragic events of the 9/11 terrorist attacks in New York City

and Washington, DC. Thousands of medical and public health professionals, eager to volunteer in support of emergency response activities, found that there was no organized approach to channel their efforts. Local emergency responder agencies were overwhelmed and did not have a way to properly identify or manage these spontaneous volunteers. Many highly skilled people, including physicians, nurses and paramedics were turned away. The desire of medical professionals to lend a hand that day and in the months that followed revealed the need for a network to provide the infrastructure to recruit, organize and train individuals who wanted to volunteer their time and skills to strengthen and benefit their community.

The Medical Reserve Corps (MRC) came directly out of this need. In the 2002 State of the Union Address, President Bush asked all Americans to volunteer for their community, and by July 2002, Health and Human Services Secretary, Tommy G. Thompson, officially launched the MRC. The MRC offered a standardized system to recruit, train, track and notify medical professionals to serve in the event of another man-made or natural disaster and to strengthen local public health preparedness. Congress allocated funds to establish the MRC Program Office (now Division of Civilian Volunteer-Medical Reserve Corps) in the Office of the U.S. Surgeon General to initiate an MRC demonstration project and to provide national technical assistance to local MRC units around the country. Since the MRC began, over 990 units have formed across the nation and in every state. Over 220,000 individuals have signed up to volunteer. Local leaders nationwide also have worked diligently and creatively to establish the needed foundation of community support and planning for their units to function effectively when called upon to respond to a disaster.

In 2011, The Tulare County Department of Public Health received approval from the Board of Supervisors to start the Tulare Medical Reserve Corps. After two years of work on developing the unit, program Coordinator Steve Chambers, determined that there needed to be two more units to provide a more local approach to recruiting, training and exercises. In 2013, the Porterville MRC and the Visalia MRC Units started. Today, there are a total of 145 registered members in the three units. The Porterville Unit meets every second Tuesday of the month at the Sierra View Medical Center from 6-8pm. Visalia MRC meets every third Thursday at the Red Cross office on Main Street from 6-8 PM. Tulare is currently looking for a new home location to host our monthly meetings.

You might ask “why should I join the Medical Reserve Corps?” Porterville MRC member, Dr. Garaung Pandya, a General Surgeon and former President of the Tulare Medical Society, says “When a disaster strikes, knowing what to do, where to go and who to contact will increase your likelihood of surviving the catastrophe. Moreover, as a registered volunteer member of the MRC, your medical training can provide valuable and much needed support to the County Public Health response efforts. I encourage you to join the MRC Unit in your area. It is a most rewarding experience for all who participate.”

Every month, the MRC Units hold training classes on emergency preparedness and disaster response. The classes are free to MRC members and refreshments are provided. For more information about an MRC Unit in your community, contract Steve Chambers, M.Sc., at schambers@tularehhsa.org, or call 559-624-8496.

Calling All Tulare County Medical Society Members

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org Officers Monica Manga, MD, ABIM President Virinder Bhardwaj, MD President-Elect Raman Verma, MD Secretary/Treasurer Thomas Gray, MD Past President Board of Directors Anil K. Patel, MD Jerry Jacobson, MD Pradeep Kamboj, MD Matthew Kirkman, MD Christopher Rodarte, MD Antonio Sanchez, MD CMA Delegates Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates Robert Allen, MD James Foxe, MD Mark Tetz, MD Sixth District CMA Trustee Ralph Kingsford, MD Staff Francine Hipskind Executive Director Thelma Yeary Membership Dana Ramos Administrative Assistant Lydia Garcia Administrative Assistant

VISALIA UNIFIED HIGH SCHOOLS NEED YOU! Here’s your chance to volunteer for a great cause!

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

For more information, or to volunteer for this meaningful project, please contact: Thelma Yeary, TCMS at 559627-2262 or thelma@tkfmc.org.

May 20, 2015 • 12:00-3:00pm May 6, 2015 • 12:00-3:00pm Schools on this date: Schools on this date: • Golden West High School • Mt. Whitney High School • Redwood High School • El Diamante High School FEBRUARY 2015 / VITAL SIGNS

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Tulare

Visalia Medical Clinic welcomes...

Tulare County Medical Society Upcoming Events CODING & REIMBURSEMENT UPDATE 2015

• Internal medicine internship and residency, USC

Thursday, March 5, 2015 • 9am to 12pm or 1 to 4pm This is a comprehensive review of all the most important coding and reimbursement changes for 2015.

• Fellowship in cardiology, Georgia Regents University

ICD-10 CODING WORKSHOP

• Board certified, American Board of Internal Medicine

Friday, March 5, 2015 • 9am to 4pm This class will prepare you for the ICD-10 conversion.

CARDIOLOGIST

Ashkan Attaran, MD • University of Cincinnati School of Medicine

GENERAL SURGEON

Ammon Rasmussen, MD • Ohio State University College of Medicine • Internship and residency, Mount Carmel General Surgery Program, Ohio • Board certified, American Board of Surgery

If you have any questions, please feel free to call the Tulare County Medical Society office at 559-734-0393 and ask to speak to Dana Ramos.

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

Now accepting referrals

Visalia Medical Clinic

VMChealth.com • 5400 W. Hillsdale • 739-2000

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

ANYONE CAN ATTEND! For more information, please contact Tulare County Medical Society at (559) 627-2262 TULARE: Del Lago Park Saturday, Febuary 21, 2015 Topic: HEALTHY HEART Registration: 8:00am Walk Time: 8:30am VISALIA: Blain Park, 3101 S. Court St. Saturday, February 14, 2015 8:00 to 9:00 am

14 FEBRUARY 2015 / VITAL SIGNS

HEALTHCARE REFORM

CLASSIFIEDS

Continued from page 9 FDA Clears 41 New Drugs in 2014; Approval Rate Hits 18-Year High The number of U.S. drug approvals in 2014 reached the highest level since 1996, primarily driven by cancer drugs and treatments for rare diseases, Reuters reports.

Specifically, FDA approved 41 new medicines in 2014, up from 27 in 2013. According to Reuters, treatments for rare diseases comprised almost 40% of FDA’s 2014 approvals. However, insurers and governments have started to push back against the high costs of some of these new drugs, such as AbbVie’s new hepatitis C treatment.

Drug approval “highlights” include Merck’s Keytruda and Bristol-Myers Squibb’s Opdivo, novel cancer treatments that provide long-lasting treatment with fewer side effects. Analysts have suggested that such drugs mark the start of a wave of immunotherapies that could yield more than $30 billion annually in sales.

According to Reuters, the surge in new approvals helped biotech initial public offerings hit record highs last year. The Nasdaq Biotechnology Index rose by 34%, while the S&P 500 Health Care Index rose by 23% (Hirschler, Reuters, 1/1).

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

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

FRESNO .

ANNOUNCEMENT

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

FOR LEASE / RENT / SALE .

Medical start-up space available. Located in an established dental office. Rent negotiable; up to 5 rooms to choose from. Call Stephanie at 559229-6249.

Medical Office, 2000 sf; Professional Building on Saint Agnes Medical Center campus, north side, 1313 E. Herndon. Call 559-696-0816.

PHYSICIAN WANTED .

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

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

Hospitalist 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.

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PHYSICIAN WANTED

Part time physician for Fresno area radiology facility to oversee contrast studies, 2 days per week, 4-7 hrs. per day. Retired physicians welcome.

Contact Ed at 559-765-7988

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TULARE FOR LEASE / RENT / SALE

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

Class ‘A’ Medical Space • Visalia • 4975 sf, all/ part available for lease. Across the street from Kaweah Delta Hospital. Call 559-804-7419 or 804-7421. See ad on page 14 for pictures/details.

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

KERN

FEBRUARY 2015 / VITAL SIGNS

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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.

Proud to be endorsed by the Fresno-Madera, Kern, Kings and Tulare Counties Medical Societies

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