January 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

See Inside Affordable Healthcare Act New California Health Laws Patient Blood Management

January 2014 • Vol. 36 No. 1

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

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JANUARY 2014 / VITAL SIGNS

Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society January 2014 Vol. 36 – Number 1

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

AFFORDABLE HEALTHCARE ACT: Frequently Asked Questions.....................................................5

SAVE THE DATE: 2014 Yosemite Postgraduate Institute: March 28-30........................................6

CMA EDUCATION SERIES.........................................................................................................9

CALIFORNIA LEGISLATION: New Health Laws...........................................................................10

BLOOD CENTER: Patient Blood Management...........................................................................12

CLASSIFIEDS..........................................................................................................................18 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

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

• President’s Message

• Attention Members! Sign-up for Email Notices

• HIPAA Compliance Seminar: January 16

• Transform Your Front Desk: February 4

• ICD-10 Readiness: February 4 & 5

• Coding ICD-10-CM Workshop: February 5 & 6

• Walk With A Doc

Kern County Medical Society...........................................................................................15

• Membership Recognition

• Membership Recap

Fresno-Madera Medical Society......................................................................................16

• President’s Message

• Physicians Honored With Community Service Awards

• Walk With A Doc

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

Cover Photography: “San Joaquin Valley Fog”

By Newton Seiden, MD 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.

JANUARY 2014 / VITAL SIGNS

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you work to protect your patients.

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SponSored by:

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

UnderwrItten by:

OR SCAN TO LEARN MORE!

New York Life Insurance Company New York, NY 10010 on Policy Form GMR

the Association Services division of Marsh has moved to Mercer, both part of Marsh & McLennan Companies.

65583 (1/14) Copyright 2014 Mercer LLC. All rights reserved.

Mercer Health & benefits Insurance Services LLC • CA Ins. Lic. #0G39709 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com

AFFORDABLE HEALTHCARE ACT

Frequently Asked Questions about California’s Health Benefit Exchange for Physicians and their Staff

In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets and, beginning in 2014, will provide health insurance to much of the nation’s uninsured.

Under the ACA, two-thirds of California’s uninsured may be covered by private insurance through a health insurance exchange purchasing pool.

California’s exchange, Covered California, began enrollment on October 1, 2013 – with coverage beginning on January 1, 2014. The following FAQ for physicians and their office staff provides answers to the most commonly asked questions about exchange eligibility and enrollment.

What is Covered California? Covered California is the new marketplace where Californians can compare and purchase health coverage. Through Covered California, many patients will be eligible for financial assistance to help pay their premiums and even co-pays.

Through Covered California, individuals and small businesses can compare diff erent health insurance companies and learn whether they qualify for premium assistance and tax credits. Californians will also be able to find out if they are eligible for low-cost or no-cost health coverage through Medi-Cal. How will Covered California impact my practice? The impact on physician practices will vary greatly depending on the mix of patients in your practice and the extent to which you contract with Covered California plans. Millions of previously uninsured Californians will now be eligible for health insurance through Covered California and Medi-Cal. Your patients with employer-sponsored coverage are not likely to see significant changes in their coverage. Small and medium sized physician practices with 50 employees or less are also eligible to participate in the Small Business Health Options Program (SHOP). For information, visit www.coveredCA.com.

Which patients can buy coverage through Covered California?

Legal California residents, except for currently incarcerated individuals and legal minors, are eligible to buy insurance through Covered California.

Which patients are eligible for subsidies through Covered California to purchase coverage? Premium assistance is available to individuals and families who meet certain income requirements and do not have access to affordable, adequate health insurance through their employers. Eligibility for premium assistance is based on family income and the number of people in the family. The size of the premium assistance is calculated on a sliding scale, with those who make less money getting more financial assistance. Individuals with incomes up to $45,960 and a family of four with an income up to $94,200 may be eligible for premium assistance.

How will patients’ federal premium subsidies work? Federal premium assistance is only available when enrolled in a health plan through Covered California, and it is paid directly to the health plan in which the patient is enrolled.

Premium assistance will be adjusted at the end of the benefit year based on the patient’s actual income. A patient may be held accountable for any excess subsidies received when filing that year’s taxes. For this reason, patients should immediately report any changes in income to Covered California that may impact the amount of premium assistance,

such as changing jobs, losing a job or receiving EXCHANGE RESOURCES a promotion.

FOR PHYSICIANS Will my Covered The California Medical Associ­ California patient be ation (CMA) has developed several able to continue to re­sources to help educate physicians see me? You will have on the exchange and ensure that to be contracted with a they are aware of important issues Covered California plan related to exchange plan contracting. and your patient will have Among those resources is “CMA’s to select that plan. Each Got You Covered,” a physician’s health insurance plan has guide to Covered California. This a specific list of doctors resource is FREE to members and and hospitals that are provides a comprehensive overview considered in-network of the Affordable Care Act and the providers for covered exchange, key issues to watch and services. Directories of things to consider when deciding doctors and hospitals whether to contract with an exchange will be available at www. plan. This guide and other exchangeCoveredCA.com. related resources are available at Patients should be www.cma net.org/exchange. advised to verify with the Additionally, CMA members and individual plan that a their staff have free one-on-one access particular doctor’s or to CMA’s practice management hospital’s services will be experts through the CMA reimburse­ covered under that plan. ment helpline at 888-401-5911 or Covered California is economicservices@cmanet.org. providing a searchable online directory so that patients can see which health plan networks contain a particular doctor or hospital.

How can a patient apply for Covered California coverage or Medi-Cal? Open enrollment will continue until March 31, 2014, but patients must enroll in a plan by December 15, 2013, for coverage to begin January 1, 2014. In subsequent years, open enrollment will run from October 15 through December 7. Patients can apply for a Covered California health insurance plan online at www.CoveredCA. com or by calling 800-300-1506.

In-person assistance is also available from Certified Enrollment Counselors in many communities. Patients can be directed to their nearest Certified Enrollment Counselor by calling 800-300-1506.

What if I have questions about how my business may be impacted by Covered California or health plan contracting under Covered California? If you have questions related to your business or contracts for providing services to Covered California patients, please refer to the California Medical Association’s (CMA) resource page, “Health Insurance Exchange Resources for Physicians,” at www. cmanet.org/exchange. For further assistance, please contact CMA’s Physician Hotline at 800-786-4262.

How much should patients expect to pay out of pocket for health care services? Patients’ co-pays and deductibles will vary based on the plan that is selected.

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SAVE THE DATE: March 28-30, 2014

2014 Yosemite Postgraduate Institute 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 Brochures to mail January 2014 Information: csrau@fmms.org or 559-224-4224x 118

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JANUARY 2014 / VITAL SIGNS

CMA NEWS Verifying your patients’ eligibility and benefits in 2014 may save your practice thousands of dollars

The beginning of a new year means calendar year deductibles and visit

frequency limitations start over. Remember, with open enrollment there may be changes to patients’ benefit plans, or they may even be insured through a new payor. Physicians are urged at this time of the year to be diligent in verifying patients’ eligibility and benefits to ensure that you will be paid for services rendered.

2014 also brings a host of other challenges that could affect your ability to be paid: • Medicare patients can modify their enrollment choices from October 15, 2013, through December 7, 2013, allowing them to switch between Medicare fee-for-service and Medicare Advantage (MA), or switch from one MA plan to another.

• Under the Affordable Care Act (ACA), California opted to expand Medi-Cal eligibility to childless adults ages 19-64 with incomes up to 138 percent of federal poverty level, effective January 1, 2014.

The state estimates an additional 1.6 million individuals may become eligible for Medi-Cal/Medi-Cal managed care under the ACA expansion.

• In 2013, over 900,000 children transitioned out of the Healthy Families program into Medi-Cal managed care, while another 274,000 transitioned from fee-for-service Medi-Cal into MediCal managed care through the rural expansion project. Many of these enrollees transitioned toward the end of 2013.

• With the ACA requirements on minimum benefit levels that must be offered by plans, approximately 900,000 individuals have received policy cancellation notices from their current health plans. Many of those patients will have different plans and/or benefits effective January 1, 2014.

• Approximately 600,000 patients previously insured through the Low Income Health Program will be transitioned into Medi-Cal managed care plans on January 1, 2014.

• It is estimated that anywhere from 150,000 to 450,000 individuals will enroll in an exchange plan through Covered California in 2014.

And don’t forget that under the ACA, patients receiving premium assistance through federal tax subsidies are given a 90-day grace period in which to pay their portion of the premium. During the first 30 days of the grace period, the plans must pay for services incurred. However, during days 31-90 of the grace period, plans are allowed to suspend the patient’s coverage. If the patient doesn’t true-up by day 90, the plan can terminate the policy, potentially leaving 60 days worth of unpaid claims. While physicians can pursue the patient for the balance incurred during days 31-90 of the grace period, it seems unlikely a patient would be able to pay a doctor’s bill if unable to pay for the plan premium.

This reinforces the importance of verifying patient eligibility– particularly for exchange patients – each time they are seen. If the exchange patient’s eligibility verification states coverage is suspended, the practice can treat the situation as it would any other patient who has had a lapse in coverage. For non-emergency services, patients would have the option to either pay cash to see the physician or not be seen. The grace period issue only applies to exchange enrollees receiving federal tax subsidies; however, information on whether or not they are receiving subsidies will not be noted on their ID cards.

(More information on the grace period issue can be found in CMA’s

exchange toolkit, “CMA’s Got You Covered,” available free to members at www.cmanet.org/exchange.)

Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit.

Taking proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money.

New MICRA brochure available for patients

The California Medical Association (CMA)-led coalition working to

protect California’s landmark Medical Injury Compensation Reform Act (MICRA) has published a patient education brochure to help inform California voters about the ballot initiative being pushed by trial attorneys. The ballot measure would impact access to care for patients, causing community health centers and physician offices across the state to close.

MICRA opponents have already begun collecting signatures in an attempt to place language on the November 2014 ballot. California trial lawyers are attempting to lift MICRA’s cap on speculative, noneconomic damages, presenting ballot language that seeks to more than quadruple the maximum award for non-economic damages to roughly $1.1 million. A change like that would mean increased health care costs for everyone and decreased access to care that many patients count on.

There is no doubt that physicians understand how catastrophic a measure like this would be for access to affordable health care. To win this fight, voters, our patients – those we interact with everyday in our practices – must understand the fact that protecting MICRA goes handin-hand with protecting access to quality health care in California.

The pamphlet, published by “Patients, Providers and Healthcare Insurers to Protect Access and Contain Health Costs,” can be distributed to patients during office visits and will be accompanied by talking points for physicians to ensure that any conversation regarding MICRA is about educating patients on the real impacts the proposed ballot measure would have, if passed.

Sample pamphlets were mailed last month to a select group of CMA members. If you think this information would be of benefit to your patients, contact Yna Shimabukuro at yshimabukuro@cmanet.org or call 916-551-2567 to receive 50 copies for your office.

Online payment portals: Physicians beware

Recently, a number of payors have begun to offer online payment portals that allow patients to pay for physician services via the Internet.

Physicians should be aware, however, that while these online payment portals typically do not charge setup fees for participating, physicians will be assessed a per transaction fee, similar to the transaction fees associated with credit card or merchant transactions.

Aetna, for example, partnered with Citi to provide an online patient health care payment option called Money² for Health. This online payment tool will allow patients to securely pay for physician services through the Aetna Navigator member website. For physicians who have signed up to participate in Money² for Health, patient payments will be electronically transferred into your designated accounts.

United Healthcare (UHC) has also recently instituted a similar online portal through Instamed. Through the myClaims Manager Please see CMA News on page 8 JANUARY 2014 / VITAL SIGNS

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CMA NEWS Continued from page 7 selection on the www.myuhc.com website, members can now elect to make payments to their medical providers.

Physicians should also be aware that non-participation in these programs does not necessarily prohibit patients from continuing to pay through the portal. For instance, the UHC/Instamed program will still allow patients to make payments to physicians who have chosen to not participate in the program. In lieu of an electronic funds transfer to the physician’s bank account, Instamed will issue a hardcopy check to the physician instead. However, the issuance of the hardcopy check does not alleviate the physician from being required to pay a reduced transaction fee. CMA has inquired further with United about physician options to avoid any transaction fees.

Medical board not behind ‘daily deal’ cease and desist letters

The Medical Board of California recently issued a statement that it did

not author a letter apparently coming from its Discipline Coordination Unit warning physicians to immediately “cease and desist “ from conducting any daily deal marketing arrangements with sites such as Groupon, Living Social and Amazon. A number of California physicians have called the medical board stating that they have received these letters dated November 6, 2013, on the medical board’s masthead.

These letters are fraudulent and were not generated by the medical board. When the medical board receives any complaint regarding a physician – including the use of daily deal marketing or internet-based coupon sites – the complaints are evaluated on a case-by-case basis to determine whether there is a violation of the law.

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Physicians should, however, use caution when using such sites.

While each deal varies, typically the physician agrees to give the coupon company a percentage of the revenue obtained from patients using the coupon (reports suggest as high as 50 percent) in return for the marketing company’s promotion of the practice through various types of coupons or “daily deals.”

Even if patients using such coupons are cash-paying and noninsured, the activity raises significant legal issues for physicians.

Accordingly, physicians should act with extreme caution in this area, after obtaining the advice of an attorney experienced in health care fraud and abuse laws.

For more information, see CMA On-Call document #0104, “Practice Promotion through Third Party Coupons.” On-Call documents are available free to members in CMA’s online health law library at www. cmanet.org/cma-on-call. Nonmembers can purchase documents for $2/page.

CMS launches new online ICD-10 implementation guide

The

Centers for Medicare & Medicaid Services (CMS) recently launched an online ICD-10 implementation guide to help practices of all sizes successfully make the switch to the new ICD-10 coding system, which is used to report medical diagnoses and inpatient procedures.

Physicians and payors must begin using the new code sets by October 1, 2014.

The differences between ICD-9 and ICD-10 are significant.

Physicians and practice management staff need to start educating Please see next page

CMA NEWS Continued from page 8 themselves now about this major change so that they will be able to meet the October 1, 2014, compliance deadline, which is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).

Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services To access the online guide and other CMS resources and tools to help with the ICD10 transition, visit http://cms.gov/Medicare/ Coding/ICD10/ProviderResources.html. To assist physicians in preparing for the transition to ICD-10, CMA has partnered with AAPC to provide CMA members with a complete suite of ICD-10 educational courses at steeply discounted rates.

Need help 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?

• Are your claims denied for timely filing?

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

• 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?

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

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

2014

EDUCATION SERIES CMA Center for Economic Services Webinars At-A-Glance

Most webinars are FREE for CMA members, $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. and are free for CMA members and their staff. See the event calendar for additional details.

JANUARY 15: Avoiding Embezzlement: A Physician’s Guide to Protecting Your Practice: Medical practices suffer from one of the highest embezzlement rates of all industries. It has been estimated that one in six physicians will be the victim of embezzlement at some time during their practice years.

Physicians will learn how to take some relatively simple, yet critical, steps to protect their revenue including how to conduct proper employee reference checks, bonding employees, watching for behavioral signs that may signal stealing, petty cash and accounting control procedures, spot checking techniques, bank account reconciliation, and the importance of reporting theft. This webinar is open to physicians only.

JANUARY 16: Medicare: 2014 New Rules: This webinar will focus on final rules from the Medicare Physician Fee Schedule rules, including PQRS and Value Based Modifier changes that will affect physician practices during 2014 and beyond. This will help you prepare for any continuing or new programs that may negatively impact payments, as well as prepare you for revisions to policies that may impact your billing and reimbursement.

JANUARY 22: Update on Medicare Physician Incentives: What’s New for 2014: Presented by the Centers for Medicare & Medicaid Services (CMS), webinar attendees will understand the background and rationale for CMS incentives and payment adjustments that affect physicians, including the Physician Quality Reporting System (PQRS), the ePrescribing (eRx) Incentive Program, the Electronic Health Record (EHR) Incentive Program, and the new Value Modifier (VM) program; be able to define what actions they need to take to receive each incentive and avoid payment adjustments; and know where to go to obtain further information about CMS quality programs and stay abreast of current and future developments.

This webinar is 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.

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CALIFORNIA LEGISLATION

New Health Laws For 2014 The California Legislature had an active year passing many new laws affecting health care. Below are highlights of the new laws likely to impact physicians in 2014 and beyond.

For more details, see “Significant New California Laws of Interest to Physicians for 2014,” in the California Medical Association’s online resource library at www.cmanet.org/resourcelibrary.

ALLIED HEALTH PROFESSIONALS

AB 1000 (Wieckowski) – PHYSICAL THERAPISTS: DIRECT ACCESS TO SERVICES (CMA Position: Support/Co-Sponsored) Allows physical therapists to treat patients for 45 days or 12 visits without first seeing a physician. Requires a physical therapist to refer a patient to a physician if the condition is beyond the therapist’s scope of practice or if the patient is not progressing, to disclose to the patient any financial interest he or she has in treating the patient, and with the patient’s authorization, notify the patient’s physician that the physical therapist is treating the patient.

Specifies that professional corporations, including medical corporations, are not limited to employing those licensed professionals that are listed in Corporations Code §13401.5.

CONFIDENTIAL INFORMATION

SB 46 (Corbett) – PERSONAL INFORMATION: PRIVACY Amends existing law that requires notification to individuals whose unencrypted computerized personal information was, or is reasonably believed to have been, acquired by an unauthorized person due to a breach of security of a computerized system or data. Revises certain data elements included within the definition of personal information by adding certain information that would permit access to an online account. Imposes additional requirements on the disclosure of a breach of security of the system or data in situations where the breach involves personal information that would permit access to an online or email account.

DRUG PRESCRIBING AND DISPENSING

AB 635 (Ammiano) – DRUG OVERDOSE TREATMENT: LIABILITY (CMA Position: Support) Authorizes a licensed health care provider, who is permitted by law to prescribe an opioid antagonist and is acting with reasonable care, to prescribe and subsequently dispense or distribute an opioid antagonist for the treatment of an opioid overdose. This is permitted to treat a person at risk of an opioid-related overdose or a specified person in a position to assist a person at risk of an opioid-related overdose. Authorizes these licensed health care providers to issue standing orders for the distribution of an opioid antagonist.

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SB 809 (DeSaulnier) – CONTROLLED SUBSTANCES: REPORTING (CMA Position: Support) Funds the Controlled Substance Utilization Review and Evaluation System (CURES) for the electronic monitoring of the prescribing and dispensing of controlled substances by assessing an annual fee on practitioners authorized to prescribe, order, administer, furnish or dispense controlled substances, non-governmental clinics and non-governmental pharmacies. Establishes the CURES Fund within the State Treasury.

Requires the Medical Board to periodically develop and disseminate education materials relating to the assessment of a patient’s risk of abusing or diverting controlled substances and information related to CURES to physicians and general acute care hospitals. Eliminates notarization requirement for application process and requires health care practitioners and pharmacists to apply to obtain approval to access CURES after January 1, 2016. Requires the Department of Justice in conjunction with the Department of Consumer Affairs and relevant licensing boards to develop a streamlined application and approval process to access CURES and enable health care practitioners and pharmacists with access to CURES to delegate their authority to order reports from CURES.

HEALTH CARE COVERAGE SB 161 (Hernandez, E.) – STOP-LOSS INSURANCE COVERAGE (CMA Position: Support) Prohibits a stop-loss insurer from excluding any employee or dependent on the basis of specified actual or expected health status-related factors.

Establishes regulatory requirements for stop-loss insurance policies for small employers, including requiring a stop-loss insurer to renew all stoploss insurance policies at the option of the small employer and prohibiting setting individual attachment point of $40,000 or greater and an aggregate attachment point of the greater of $5,000 times the total number of group members, 120% of expected claims, or $40,000 for a policy year or providing coverage for an employee or his or her dependents. Exempts small employer stop-loss insurance issued prior to September 1, 2013, from these attachment point requirements.

Please see next page

CALIFORNIA LEGISLATION Continued from page 10

MEDICAL EDUCATION

CA ABX12 (Pan) – HEALTH CARE COVERAGE (CMA Position: Support if Amended) Establishes health insurance market reforms contained in the Affordable Care Act specific to individual purchasers, such as open enrollment, prohibiting insurers from denying coverage based on preexisting conditions, insured claims experience as part of a single risk pool, the use of certain factors in determining individual plan rates, insurance advertising and marketing, small employer enrollment periods and coverage effective date and premium rates, a risk adjustment program, insurance data reporting, and insurer disclosure requirements; and makes conforming changes to small employer health insurance laws resulting from final federal regulations.

AB 1202 (Skinner) – OCCUPATIONAL SAFETY AND HEALTH STANDARDS (CMA Position: Support) Requires the Occupational Safety and Health Standards Board to adopt a standard for the handling of antineoplastic drugs, primarily cancer drugs, in health care facilities regardless of the setting. Requires the standard to be consistent with and not exceed specific recommendations adopted by the National Institute for Occupational Safety and Health for preventing occupational exposures to those drugs in health care settings.

SB 191 (Padilla) – EMERGENCY MEDICAL SERVICES (CMA Position: Co-Sponsored) Extends the operative date to January 1, 2017, of existing law that establishes the Maddy Emergency Medical Services Fund, which authorizes each county to establish an emergency medical services fund for reimbursement of costs related to emergency medical services and funding for pediatric trauma centers, and authorizes county boards of supervisors to elect to levy an additional penalty upon fines, penalties and forfeitures collected for criminal offenses. Makes technical, non- substantive changes to the provisions.

AB 565 (Salas) – CALIFORNIA PHYSICIAN CORPS PROGRAM (CMA Position: Sponsor) Amends the Steven M. Thompson Physician Corps Program to require the guidelines for the selection and placement of program applicants to include criteria that would give priority consideration to program applicants with experience providing health care services to medically underserved populations or in a medically underserved area. Gives priority to applicants who agree to practice in those areas and serve a medically underserved population, and give priority consideration to applicants from rural communities who agree to practice in a physician owned and operated medical practice. Amends the definition of “practice setting” to include a physician owned and operated medical practice setting that provides primary care located in a medically underserved area.

MEDI-CAL

PUBLIC HEALTH

SB 94 (Senate Budget and Fiscal Review Committee) – MEDI-CAL: MANAGED CARE: LONG-TERM SERVICES AND SUPPORTS (CMA Position: Oppose) Amends existing law regarding the Coordinated Care Initiative (CCI) and separates CCI provisions to allow the mandatory enrollment of MediCal and Medicare beneficiaries (dual eligibles) into Medi-Cal managed care, the integration of long-term supports and services into managed care plans, and the commencement of the In-Home Supportive Services Statewide Public Authority, to proceed separately from the CCI Duals Demonstration Project (now called Cal MediConnect).

SB 494 (Monning) – HEALTH CARE PROVIDERS (CMA Position: Support ) Increases the number of beneficiaries assigned to the panel of a fulltime equivalent primary care physician under a Medi-Cal managed care plan. Requires a health service plan to ensure that there is at least one full-time primary care physician for every 2,000 enrollees. Authorizes the assignment of up to an additional 1,000 enrollees to the primary care physician for every full-time non-physician medical practitioner supervised by that physician. Requires the Medi- Cal program to evaluate the location, hours, and language capabilities of practitioners and adds non-physician medical practitioners (physician assistant or a nurse practitioner) to the definition of a primary care provider.

PROFESSIONAL LICENSING AND DISCIPLINE AB 1288 (Perez, V.) – STATE MEDICAL BOARDS: LICENSING: APPLICATION PROCESSING (CMA Position: Sponsor) Requires the State Medical Board and the Osteopathic Medical Board of California to develop a process to give priority review status to the application of an applicant who can demonstrate that he or she intends to practice in a medically underserved area or serve in a medical underserved population.

SB 304 (Lieu) – HEALING ARTS: BOARDS This bill is the sunset extension bill for the Medical Board containing statutory and technical changes to provisions relating to Medical Board review by appropriate legislative committees, issuance of a license to a physician and surgeon who has acquired any part of his or her education from an unrecognized medical school who has held licensure in another state or Canada, reporting an electronic address to the Board, licensed midwives, adverse event reporting, fines for failure to provide health care records by a facility, and Medical Board investigations.

AB 446 (Mitchell) – HIV TESTING (CMA Position: Support) Requires a medical care provider or a person administering a HIV test to provide a patient with information about risk reduction strategies and information regarding test results. Requires oral or written informed consent as specified for the HIV test except when a person independently requests an HIV test from an HIV counseling and testing site and requires the person administering the test to document the person’s independent request for the test. Exempts clinical laboratories from the informed consent requirements. Requires an HIV test to be offered to any patient having blood drawn at a primary care clinic and consents to the test. Authorizes disclosure of HIV test results by secure Internet website posting.

These are just a sampling of the new laws impacting health care in 2014 and beyond. For a complete list, see “Significant New California Laws of Interest to Physicians for 2014,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.

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BLOOD CENTER Patient Blood Management Coordinators and Transfusion Safety Officers:

A Pathway to Better Care Submitted by Patrick Sadler, MD, Central California Blood Center

Many professionals in transfusion medicine and blood banking have heard about patient blood management coordinators, or PBMCs, and transfusion safety officers, or TSOs; however, few understand the work that these individuals do. These professional roles are evolving and no consensus has been reached on job titles, descriptions or responsibilities.

Here is one possible approach – that PBMCs focus on blood conservation strategies or alternatives to transfusions while TSOs are concerned with safe, evidence-based transfusion practices. This article will illustrate PBMC and TSO activities through a case study envisioned by the authors.

CASE: A 65-year-old man presented to his surgeon for revision knee replacement. He took a significant amount of aspirin for pain control, which contributed to frequent peptic ulcers and anemia. The surgeon completed educational offerings provided by the PBMC and TSO addressing the risks and benefits of avoiding transfusion as well as those of transfusion therapy, so the surgeon attempted to identify risk factors for transfusion, such as pre-existing anemia and bleeding history. The surgeon recognized that the patient’s stomach ulcers could increase the likelihood of anemia. The surgeon completed educational offerings provided by the PBMC and TSO addressing the risks and benefits of avoiding transfusion as well as those of transfusion therapy, so the surgeon attempted to identify risk factors for transfusion, such as pre-existing anemia and bleeding history. The surgeon recognized that the patient’s stomach ulcers could increase the likelihood of anemia.

ACTION: The surgeon ordered a complete blood count, which revealed that the patient was moderately anemic with a hemoglobin level of 9.8 g/dL. The PBMC – whose clinical role included a heavy focus on anemia management – recommended that the patient be enrolled in a preoperative anemia management program and evaluated by a physician.

These actions took place, and the patient presented for surgery three weeks later with a hemoglobin level of 12.1 g/dL after receiving parenteral iron for iron deficiency anemia.

In preparation for the operation, the PBMC reviewed blood conservation strategies with the surgeon. The surgeon considered using perioperative blood recovery techniques but declined based on the patient’s hemoglobin level, the fact the procedure was planned, and the lack of a significant bleeding history.

Unfortunately, the surgery resulted in a 30 percent blood loss, which was more than anticipated. The patient remained hemodynamically stable. The PBMC and TSO assisted the surgeon and anesthesiologist in collecting laboratory values that offered a clear picture of the patient’s bleeding status.

Lab results reported that the patient’s hemoglobin dropped to 6.9 g/dL and the team determined that the bleeding was controlled. The physicians decided to transfuse two red blood cell, or RBC, units. Upon receiving the order, blood laboratory personnel reviewed the clinical indications for transfusion and, in consultation with the TSO and a review of the hospital’s transfusion criteria, issued only one RBC unit.

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During the RBC order placement, the anesthesiologist decided to order washed and irradiated blood components, not knowing the indications for modified blood components. Upon receiving the order, the laboratory personnel contacted the TSO, who had a quick conversation with the anesthesiologist about indications for component modifications. The professionals finally determined that the patient required no product modifications, as adding these components “just in case” could delay delivery to the bedside. The TSO was present at the transfusion, acting as the second verifier at the time of administration. The TSO was available to educate the health care team on the recognition of any signs or symptoms of a transfusion reaction as well as what necessary actions to take if a reaction were to occur.

RESULTS: As a result of efforts of the PBMC and TSO in collaboration and consultation with the patient care team, the patient received one RBC unit, which increased his hemoglobin to 7.8 g/dL and resulted in no transfusion reactions noted. Moreover, the health care team developed a clearer understanding of preoperative anemia management; the correct blood components indicated for transfusion; the signs and symptoms of transfusion reactions; and the actions to take should incidents occur.

This case illustrates the overlapping pretransfusion, transfusion, and posttransfusion responsibilities. In some situations, it may be possible to combine the PBMC and TSO role. With institutions striving to implement PBM programs and provide clinical resources, cut spending and increase efficiencies, the evolving roles of these two positions require careful consideration.

Melanie M. Jorgenson, RN, BSN, is a transfusion safety officer at Puget Sound Blood Center in Seattle; Justin Kreuter, MD, is the associate medical director of the Tissue Typing Laboratory at Mayo Clinic in Rochester, Minn.; and Joseph Thomas, RN, BSN, is a senior transfusion safety nurse consultant at Strategic Healthcare Group in Indianapolis.

SOURCE: ‘Patient Blood Management Coordinators and Transfusion Safety Officers: A Pathway to Better Care’, by By Melanie M. Jorgenson, RN, BSN; Justin Kreuter, MD; and Joseph Thomas, RN, BSN (AABB Contributing Writers). AABB News, September 2013

Tulare Thomas Gray, MD, FACEP

President’s Message May You Live In Interesting Times

As the year comes to a close, change is expected. Two years ago, Steve Beargeon asked me to consider serving as

the President of the Tulare County Medical Society. I thought it an honor to be nominated and an opportunity to learn from the master Executive Director of the Society. While all good things come to an end,unfortunately, this good thing has to end as I become President. Steve has announced his retirement as the Executive Director after serving for 23 years. During that time he has mentored numerous members as officers, Board members, and CMA delegates. Under his guidance, TCMS has become one of the most robust Societies in the State. Membership has grown substantially. The benefits the Society offers to physician members and staffs has grown to include staff education, physician communication, billing education, and CME. Fortunately, Steve’s legacy will continue. He groomed his successor. Fran Hipskind, the Provider Relations manager, was wisely approved by the Board to assume the Executive Director position. The officers and Board look forward to working with Fran to meet the challenges of the coming year.

On January 1, another phase of the Affordable Care Act (ACA) takes effect in California. It is not news that Congress passed the historic legislation in 2010 and its stepped implementation continued this year with the opening of the statewide health exchanges. Covered California has been operating more smoothly than the federal health insurance exchange website. While the ACA is a flawed attempt to correct the national disgrace of disproportionate health care access, it makes very positive changes for millions of the underserved. The country and its physicians are waiting with bated breath to see how registration progresses and if it will make provision of care to the newly insured fiscally possible in the current model of health care delivery.

Then some things never seem to change. Once again, Congress has to override the Sustainable Growth Rate as it has done yearly since 2003 to prevent a 24.4% decrease in Medicare payments to physicians. Of course the best solution to this decade long dilemma is repeal of the SGR and substitute it with a workable solution that will secure patients access to medical care. Although the cost of providing care has risen by 25% since 2001, the reimbursement from Medicare has remained flat. Nonetheless, most physicians continue to see Medicare patients in their practices despite rising overhead. Physician patience with this legislative foot-dragging is commendable. However, the situation could be worse. MICRA could be changed.

For the Nth time since it became law in 1975, trial lawyers are in assault mode. This time, rather than challenging the constitutionality of the law or using the legislative process to alter the MICRA protections, they are using the ballot initiative process. Currently signatures are being gathered for the “patient safety” proposition that requires mandatory drug testing of physicians and hides the disembowelment of MICRA. In November 2014 this proposition will likely be on the general ballot. Loss of MICRA protections may result in tripling of malpractice premiums.

Subtract that from Medicare’s flat rates for the last twelve years and continued Medicare participation becomes very unattractive.

And the future. Business is brisk in the Emergency Departments. We serve as the vanguard for seeing sociopathic trends in society. Beware of the Knockout Game. Youths in small groups strike without warning at older adults.

The object is to knock their victim unconscious with a single or several hits to the face and head. Their associates sometimes record this violence in the few seconds it takes and subsequently post it on the web. It may have already occurred in our area. Stupid, senseless and dangerous. Yes. Exercise caution when alone in public places and be wary of groups of teenage men. Threats to our daily lives do not just come from laws and the lawyers who make them.

Happy Holidays and let us continue to work for the welfare of our families and patients in 2014!

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 JANUARY 2014 / VITAL SIGNS

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Tulare HIPAA Compliance Seminar The Tulare County Medical Society in joint venture with Dowling Aaron Incorporated would like

to extend an invitation to attend the HIPPA Compliance presentation to better prepare you in the workplace. This presentation will review the relevant previously existing HIPAA rules, the key new requirements and penalties, significant California law that will apply instead of HIPAA, and the latest relevant “horror story” examples of OCR enforcement. Providers will learn how the new rules impact their practices, and what providers can do to seek to minimize the risk of a costly violation.

When: Thursday, January 16th, 2014 Where: Visalia County Club Time: 6-6:30pm Social/6:30pm Dinner Cost: TCMS Member/Guest are FREE RSVP’s needed by January 9, 2014.

To register for this event or for more information, please contact Dana Ramos at 559-627-2262 or by e-mail at dramos@tkfmc.org.

REMINDER: Sign up ASAP! Classes are filling up fast!

Dr. Ravi Kumar hosts a Tulare

Transform Your Front Desk Front desk staff training is critical to maintaining effective and compliant practice operations.

Yesterday’s receptionist is obsolete in today’s regulatory intensive world. This 3 hour course will focus on gathering accurate patient information, addressing challenging patient behavior, handling privacy related issues, making appropriate scheduling decisions…and much more.

When: February 4, 2014 Time: 9am-2pm OR 1pm-4pm (please specify morning or afternoon course when registering) Where: Visalia Convention Center Cost: $49 (per person) to TCMS/FMC physician members and staff For more information, or to sign up, please contact Dana Ramos at 559-734-0393 or via e-mail at dramos@tkfmc.org.

ICD-10-CM Readiness for Providers Attend this two-evening session especially for all clinicians. ICD-10 impacts all third-party billing.

Transition steps and training must begin now. Practices ill-prepared to take on the new coding system next year will suffer lost reimbursement. Each evening session will focus on your role in providing correct information to your coding and reimbursement staff. The first evening will go over ICD-10 documentation and implementation. The second evening will include a series of ICD-10 case studies.

When: February 4 & 5, 2014 Where: Visalia Convention Center Time: 6-8pm (dinner will be provided) Cost: FREE to TCMS physician members

Coding ICD-10-CM Workshop: Advanced

This

two-day program is designed for outpatient coding and reimbursement professionals to strengthen and apply knowledge in real-world coding situations. Participants will complete coding exercises and strengthen knowledge through a series of challenging case studies to illustrate the use of diagnostic and procedural coding for ICD-10. The first day will cover chapter-specific guidelines and exercises. Day two participants will work collaboratively to cover case studies.

When: February 5 & 6, 2014 Where: Visalia Convention Center Time: 9am- 4pm Cost: $100 (per person) to TCMS/FMC physician members and staff

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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

Kern Kings PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581

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 Ronald L. Morton, 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 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

Col. Ceferina Ruiz and Capt. Elsa P. Ang, MC, USNR

Member Recognition

Elsa P. Ang, MD, Captain Elsa Penaranda Ang, MC, USNR (Ret), was elected as the first female Filipino President of the Filipino American Military Officers (FAMOS) at their membership meeting held November 17, 2013 at the Coronado Cays Yacht Club. The official Inauguration will be in April, 2014.

FAMOS was established in April, 1990 by Filipino Commissioned Military Officers of the United States of America Armed Forces in San Diego County. The goal of the founders is to harness the visions of the FAMOS into a united front.

Congratulations Dr. Ang!

Membership Recap

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

December 2013 Active.......................................................................................................................................................255 Resident Active Members................................................................................................................ 2 Active/65+/1-20hr............................................................................................................................... 4 Active/Hship/1/2Hship.................................................................................................................. 0 Government Employed..................................................................................................................... 4 Multiple Memberships...................................................................................................................... 1 Retired...................................................................................................................................................... 60 Total...................................................................................................................................................... 326 New Members (Pending Dues).................................................................................................... 1 New Members (App Pending)..................................................................................................... 0 Total Members.............................................................................................................................327

Kern Medical Society’s Installation of Officers January 11, 2014 The Mark Restaurant For reservation and information call 661-325-9025.

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Fresno-Madera PRAHALAD JAJODIA, MD

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 Prahalad Jajodia, MD Brent Kane, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD Praveen Buddiga, MD Surinder P. Dhillon, MD Trilok Puniani, MD Oscar Sablan, MD CMA Trustee District VI Virgil Airola, MD Staff Sandi Palumbo Executive Director

President’s Message Distinguished Colleagues and Friends:

I am deeply humbled and honored to be given the opportunity to serve as the president of the Fresno-Madera Medical Society (FMMS) for 2014. I would like to express my sincere thanks and gratitude to all the Society members for entrusing me with this role. I assume this position with great repsonsiblility and assure all of you that I will do my best to work for the advancement and betterment of FMMS members and the communities we serve.

My goals for the coming year will be to: 1. Make our FMMS financially stronger by increasing memberships 2.

Increase membership benefits and save thousands of dollars in office supplies, car buying, EMR and various insurances for our members.

3.

Encourage various groups of doctors to become members, such as: a. Indian, Pakistani and Latinos doctors’ groups. b. Radiology groups c. Hospitalist groups d. Anesthesiology groups e. Academia groups 4.

A rrange financial educational seminars for our members so that they can avoid costly financial mistakes 5.

Arrange CME programs in various specialties.

6.

Make general membership meetings more social by arranging more wine tasting dinners and golf tournaments, etc.

7. Increase our accessibility to our members and non-members via our web site and Facebook 8.

A rrange EMR training programs, ACLS/BLS programs and coding and billing programs at the Medical Society office 9.

Continue our successful “Walk with a Doc” program which was started in October, 2012 10. Sponsor a school nutrition program and a tobacco-free week As the incoming president, I encourage all of you to donate your time, talent and expertise in the coming year to make our Society stronger than ever. It is with profound gratitude and humility that I express my thanks to all of you from the bottom of my heart.

Save the date

General Society Meeting Thursday, February 20, 2014 featuring

CMA President Richard Thorp, MD “Update on Organized Medicine” Information: csrau@fmms.org

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Fresno-Madera Physicians Honored With Community Service Awards FMMS president-elect installed

The

Fresno-Madera Medical Society held its 4th Annual Installation and Awards Banquet on November 6, 2013, at Roger Rocka’s Music Hall. A grand time was felt by all who attended the festivities, which included honoring the 2013 Community Service Award recipients, recognizing FMMS’ outgoing president Ranjit Rajpal MD and installing FMMS’ 2014 President Prahalad Jajodia, MD. The presentations were followed by the featured performance of Shrek the Musical.

Fresno-Madera Medical Society Ranjit Rajpal, MD (left) swears in 2014 FMMS President Dr. Prahalad Jajodia.

Kenneth Jue, MD – LIFETIME ACHIEVEMENT AWARD During his active and retirement years, Dr. Jue set precedence and served as an example of dedication to patients and the community by his devoted involvement in both professional and civic activities.

Dr. Jue came to Fresno in 1965 as the first Pediatric Cardiologist, and along with Drs. Tom Eliason, Byron Evans and Roger Larson, developed the Cardiology program and Cath Lab at Valley Children’s Hospital.

With a career spamming over 45 years, Dr. Jue served the children of California’s Central Valley not only Paul Francis, MD (left) presents award to through his private practice but through his teaching Kenneth Jue, MD. and training.

He helped forge an agreement with UCSF to partner with Valley Children’s to provide Pediatric Cardiothoracic Surgical services in Fresno to spare the need for families to travel out of the area for care.

At the time of Dr. Jue’s retirement in 2011, the hospital’s cardiology program grew under his guidance to include eight pediatric cardiologists.

The exemplary care Dr. Jue has showed toward his patients and his joy of teaching, which has inspired generations of trainees and colleagues – has earned him this recognition.

Alex Sherriffs, MD – SPECIAL PROJECT AWARD Dr. Sherriffs’ propensity for teaching is evident not only by his numerous teaching awards, but with his ongoing desire to keep the medical and lay communities and policy makers educated on the harmful effects of poor air quality. He, along with the late Dr. Lee Snyder, first brought to Medical Society’s attention in 2003, the need to get involved in this public health issue.

Representing the Fresno-Madera Medical Society, he and Dr. Synder sought out, applied for and received the first $75,000 grant to support this program, Don Gaede, MD, (right) presents award to including the hiring of a person to carry out duties set Alex Sherriffs, MD.. forth by the Medical Society’s air quality subcommittee.

His effective communication and teaching skills have been key factors in his successes with his many presentations and testimonies for both the private and public sectors These efforts have culminated in Dr. Sherriffs’ appointments to the California Air Resources Board and the San Joaquin Valley Air Pollution Control District in 2013 and 2011. He has gonebeyond the call of duty to serve on a volunteer, non-compensated basis, to two highly public and politicallycharged positions, using his medical knowledge and experience in elevating the importance of health concerns to both Boards when they set policy for attaining healthier air quality.

Congratulations Drs. Jue and Sherriffs!

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 January 25, 2014 February 22, 2014 March 22, 2014

MADERA

Town & Country Park Pavilion Area Registration 8:15am Walk Event 8:30am-9:30am January 4, 2014 February 1, 2014 March 1, 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

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Fresno-Madera

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JANUARY 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

FRESNO

FOR LEASE / RENT

ANNOUNCEMENTS

Small professional office, approx. 600 sf at 2520 H St. Bakersfield, next to San Joaquin Hospital. Call 661-900-5646 or 661-324-1090.

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

PHYSICIAN WANTED

FOR LEASE / RENT

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.

Office space at Cedar/Alluvial. 3,075 sf. Call 559-287-3279 Medical Office space for lease: 1,512 sf. 4-5 exam rms. Ready to occupy. Mid town area of Fresno. Call agent, 559-281-2000or email: jeffdavis@pacbell.net.

PHYSICIAN WANTED 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 Avecinia Wellness Center is hiring board certified FP/IM physicians for its integrative medical practice. Visit www.avecinia.com and email questions/cvs to aamer@awcmgmt.com.

Full or part time Public Health physician with Fresno County Depart. of Public Health. Contact David Pomaville at 559-445-3200.

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

Disability Insurance Available to Physicians As a physician, you probably know better than

anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

That’s why the Societies’ sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company: • Benefits not tied to a practice, giving you more flexibility with potential career changes • Benefit payments that are 100% TAX-FREE – when you pay premiums yourself • High monthly benefits up to $10,000 • Protection in your medical specialty for the first 10 years of disability With this critical protection, you’ll have one less thing to worry about until your return.

Learn more about this valuable plan today!

Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at 800-842-3761.

Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010; Under Group Policy No. G-29322-0 on Policy Form GMRFACE/29322-0.; 66761 (1/14) Copyright 2014 Mercer LLC. All rights reserved. CA Ins. Lic. #0G39709 • Mercer Health & Benefits Insurance Services LLC; 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance.service@mercer.com; www.

CountyCMAMemberInsurance.com.

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.

JANUARY 2014 / 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 Medical society and the Kern, Kings and tulare county Medical societies

NORCAL Mutual is owned and directed by its physicianpolicyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. Contact your broker or call 877-453-4486 today. Visit norcalmutual.com/start for a premium estimate.

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

N o r c A l m u t u A l .c o m