June 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: Covered California Has $363M in Grants Remaining for FY 2014-15 Coding Corner MICRA: What is All the Fuss About & the Ballot Initiative’s Other Part

June 2014 • Vol. 36 No. 6

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

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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 June 2014 Vol. 36 – Number 6

Contents CMA NEWS................................................................................................................................5 NEWS

HEALTHCARE NEWS................................................................................................................6

CMA NEWS: What Physicians Need to Know About the Anthem Exchange Addendum...................9

CODING CORNER: What Do We Do Now? ICD-10.......................................................................9

Introducing Covered California Provider Educators...................................................................10

Want More Than $1,000,000?...............................................................................................10

CLASSIFIEDS..........................................................................................................................19 Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD

Fresno-Madera Medical Society......................................................................................11

• President’s Message

• Legislative Meeting with Assemblyman Jim Patterson: June 6

• Walk with a Doc

• Medical Managers Forum: June 12

Kern County Medical Society...........................................................................................13

• First Kern County Conference on Aging: An Interdisciplinary Approach to Geriatric Care: June 21

• Membership News

Kern Representative John L. Digges, MD

TULARE County Medical SocieTY.......................................................................................14 • MICRA: What’s All the Fuss About?

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

• Walk With A Doc

Cover Photograph: “ Jellyfish, Monterey Bay Aquarium”

By Robert M. Bernstein, 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.

JUNE 2014 / VITAL SIGNS

3

d

How Successful Is Your Practice?

Let physician members know your practice is available for referrals Use Vital Signs to advertise your practice at special rates offered to member physicians. contact: Annette Paxton Vital Signs Advertising Representative (559) 454-9331

d

4 JUNE 2014 / VITAL SIGNS

CMA NEWS Physicians who wish to opt out of Blue Cross exchange network must do so by end of June

Physicians who do not want to participate in Anthem Blue Cross’s individual/exchange network have until June 30, 2014, to opt out.

Anthem Blue Cross recently notified over 11,000 practices that are currently participating in its individual/exchange network of a contract addendum that will become effective July 1, 2014. The amendment only applies to physicians who are currently participating in the Anthem Blue Cross individual/exchange network.

According to the notice, which was mailed on March 31, the addendum contains new regulatory requirements. While many provisions are requirements of Covered California, the California Medical Association (CMA) has concerns with certain provisions that appear to be beyond the scope of regulatory requirements.

One provision of significant concern is language in section 12 that removes a participating physician’s ability to opt out of the individual/ exchange product without affecting the underlying Prudent Buyer contract, as is allowed currently. Effective July 1, the only option for physicians who wish to opt out of the individual/exchange product is to terminate the underlying Prudent Buyer PPO agreement.

Physicians do have the right to opt out of the Anthem exchange product without affecting the underlying Prudent Buyer PPO contract if Anthem receives notice before the effective date of the addendum, July 1, 2014. The notice must be received by Anthem by June 30.

If you do not wish to participate in the individual/exchange product, you can opt out by providing 90 days written notice, which should be sent via certified mail with return receipt, to: Anthem Blue Cross Prudent Buyer Plan Contract Processing Attn: Individual/Exchange Contract Processing Mail Station 8A P.O. Box 4330 Woodland Hills, CA, 91365-4330 Please cc CMA on any opt-out notices submitted to Anthem at California Medical Association, Center for Economic Services, 1201 J Street, STE 200, Sacramento, CA 95814.

Physicians are reminded that even if they opt out, their PPO patients may still have some out of network benefits. Patients with EPO products will likely not have any out of network benefits However, be aware that Blue Cross and Blue Shield refuse to honor assignment of benefits and will send any out of network payments to the patient. Therefore, it is recommended that physicians collect payment at the time of service for Blue Cross or Blue Shield patients they see out of network.

Physicians who decide to opt out are also encouraged to notify affected patients. CMA has prepared a sample letter that physicians can use to notify patients of their decision.

Contact: CMA reimbursement helpline, 888-401-5911 or economicservices@cmanet.org.

CMA’s Legislative Advocacy • Bill to improve network integrity and strengthen physicians’ contracting rights passes out of Health Committee by vote of 17 to 1

The CMA-sponsored bill, AB 2400 (Ridley-Thomas), will prohibit contracts issued, amended or renewed by health service plans and health insurers after January 1, 2015, from including provisions that terminate provider contracts if they exercise their right to negotiate or refuse a material change

to the contract. The bill would also prohibit contracts that are amended or renewed after that date from containing provisions that require participation in unspecified current and future products or product networks, unless the plan discloses the reimbursement rate, method of payment and any other contract terms that are materially different from those of the underlying agreement. Lastly, the bill would require health plans and insurers to provide 90 days advance notice of a material contract change, up from the 45 day advance notice currently required under state law.

CMA recently surveyed California physicians specifically about their experience contracting with Covered California plans. The survey, completed by more than 2,300 physician practices in just two days, found that 80 percent of respondents were, at some point, confused about their participation status in a Covered California plan. The survey results suggest that health plan contracting practices, such as all products clauses and silent amendments, are the primary contributors to the current state of network confusion by patients and providers in California. Survey respondents also report that the confusion has led to patient access issues, loss of patients and has negatively impacted patient care in their practice.

Contact: Juan Thomas, 916-444-5532 or jthomas@cmanet.org.

• Patient access bills clear committee hurdle

Three CMA-sponsored bills to increase access to care in the state – AB

1805, 1759 and 2548 – have cleared their first legislative hurdle. Each bill seeks to address the issue of access to care in a different way: AB 1805, authored by Assemblymember Nancy Skinner, seeks to restore the 10 percent Medi-Cal cut made back in 2011.

AB 1759, authored by Assemblymember Richard Pan, M.D., would extend through 2015 and indefinitely the reimbursement increase for certain Medi-Cal primary care providers, currently mandated by the ACA, but set to expire on December 31, 2014.

AB 2458, authored by Assemblymember Susan Bonilla, would allocate $25 million in general fund dollars for one year and another $2.8 million every year for three years from the California Health Data and Planning Fund, to establish 300 new residency spots in California.

The bills now head the Assembly Committee on Appropriations.

Contact: CMA Center for Government Relations, 916-444-5532 or memberservice@cmanet.org.

• CMA defeats bill that would have eliminated in-office exception to self-referral law

The CMA successfully quashed a bill (SB 1215, Hernandez) that would

have eliminated the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy and physical therapy. The bill died in the Senate Business and Professions Committee after receiving just one vote (from the bill’s author). This bill would have been a major blow to the integrated care model, resulting in increased costs as these services would of been driven toward the more expensive hospital setting and inhibit the development of practices that integrate and coordinate care.

Contact: Stuart Thompson, (916) 444-5532 or sthompson@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.

JUNE 2014 / VITAL SIGNS

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HEALTHCARE NEWS California Agencies Prioritized Exchange Over Medi-Cal

California officials prioritized the state’s insurance exchange under the Affordable Care Act over the law’s expansion of Medi-Cal, leading to a backlog of applications for the low-income health program, HealthyCal reports.

By April 15, about 1.4 million California residents had enrolled in a plan through the exchange. Meanwhile, about 1.9 million residents enrolled in Medi-Cal as of March 31.

According to HealthyCal, Covered California and the state Department of Health Care Services are “playing catch-up” on Medi-Cal enrollment after choosing to focus on exchange enrollment ahead of Jan. 1, the kick-off date for both the exchange and Medi-Cal expansion.

A computer program designed to confirm Medi-Cal eligibility was supposed to launch on Oct. 1, 2013, but it was not available until Jan. 21, 2014. In addition, the computer program had several glitches after it was launched, and it was missing features that were included in the exchange’s enrollment program. According to HealthyCal, many of the issues with the program have not yet been corrected.

The state now faces a backlog of 900,000 Medi-Cal applications.

State officials said the decision to prioritize the exchange over Medi-Cal expansion was made to comply with ACA deadlines.

CMS Releases Final Rule To Ease, Reduce Medicare Regulations

CMS has issued a final rule that cuts down or reins in unnecessary, obsolete or overly burdensome Medicare regulations for hospitals and other providers, Modern Healthcare reports.

The new regulation stems from an executive order that President Obama issued in 2012, which tasked federal agencies to take steps to eliminate outdated and rigid regulations. In February 2013, CMS – in a proposed rule that received more than 400 comments – highlighted specific regulations that it planned to eliminate in response to the executive order.

Agency officials said that under the final rule, health care providers would save an estimated $660 million annually and about $3.2 billion over five years.

The new rule: Eliminates a requirement that physicians travel to rural or federally qualified health clinics at least once every two weeks, which CMS said is in recognition of physicians’ use of telemedicine in remote areas; Permits registered dieticians and qualified nutritionists to prescribe diets for patients without a physician’s prior approval; Gives more flexibility to ambulatory surgical care facilities that have to meet supervision requirements for radiological services; Allows nuclear medicine technicians in hospitals to prepare radiopharmaceuticals without the constant supervision of a doctor or pharmacist; and Eliminates a repetitive data submission requirement and survey process for transplant facilities (Dickson, Modern Healthcare, 5/7).

CHA, Union Reach Deal Over Hospital Pricing, Executive Pay

The California Hospital Association has reached an agreement with the

Service Employees International Union-United Healthcare Workers West to end a push for two ballot initiatives targeting hospital pricing and 6 JUNE 2014 / VITAL SIGNS

executive pay, Modern Healthcare reports (Evans, Modern Healthcare, 5/6).

In November 2013, SEIU-UHW filed two proposed ballot initiatives with the state Attorney General’s Office in an effort to engage the state’s hospital industry in a public debate over rising costs and high executive salaries. The filing included: The Fair Healthcare Pricing Act, which would have banned hospitals from charging more than 25% above the actual cost of care; and The Charitable Hospital Executive Compensation Act, which would have barred not-for-profit hospital executives from collecting annual salaries greater than $450,000.

As part of the agreement, SEIU-UHW has agreed to drop the two ballot initiatives. In addition, CHA and most of the state’s 430 hospitals will implement a new “code of conduct” to ban negative campaigning between CHA and SEIU-UHW and make it easier for workers to join unions (Terhune, Los Angeles Times, 5/6).

The agreement also calls for the two organizations to jointly fund a $100 million campaign aimed at increasing Medi-Cal payments and reforming the program. Medi-Cal is California’s Medicaid program.

Dave Regan, president of SEIU-UHW, said the groups would jointly pursue a Medi-Cal ballot initiative in 2016 if the campaign is unsuccessful (Modern Healthcare, 5/6).

CHA CEO C. Duane Dauner said, “If we moved forward with the initiative war, it would have been a major catastrophe for both organizations.”

Regan agreed, saying, “Rather than take $100 million and fight each other where the prospects of success are totally unclear and up in the air, we will take a huge amount of resources and attack the problem together” (Los Angeles Times, 5/6).

Dauner defended some hospitals’ decisions not to participate in the agreement, noting that CHA intends to watch the terms of the agreement “play out over the next several years” (Modern Healthcare, 5/6).

Dauner added that both groups “will undertake the task of making sure that we fundamentally reform California’s Medi-Cal program over the coming two years” (Aliferis, “State of Health,” KQED, 5/6).

Meanwhile, critics of the agreement said it does little to address current problems.

Nelson Lichtenstein – director of UC-Santa Barbara’s Center for the Study of Work, Labor and Democracy – said, “This doesn’t sound like a breakthrough agreement,” adding, “SEIU has done this numerous times in the past, and it tends to fall apart.”

Sal Rosselli, president of the National Union of Healthcare Workers, in a statement said, “This agreement will undermine the rights of workers and will eliminate the union’s watchdog role on behalf of patients” (Los Angeles Times, 5/6).

Covered CalifORNIA Has $363M in Grants Remaining for FY 2014-15

After Covered California’s first open enrollment period drew to a close, the exchange has about $363 million in federal grant funds left over to support the insurance marketplace over the next fiscal year, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 4/18).

Officials have predicted that the exchange will be self-sustaining by 2015, when the Affordable Care Act will stop providing federal grants to state health exchanges.

However, exchange budget statements have not included a definitive plan for how Covered California will continue funding its operations at Please see next page

HEALTHCARE NEWS Continued from page 6 that time, and California law prohibits using the state’s general fund to pay for the exchange (California Healthline, 2/10).

During FY 2013-2014, several exchange operations ended up costing more than expected, including: The online enrollment program, which cost nearly $113 million more than expected; Administrative costs, which were more than $2.1 million more than expected (Sacramento Business Journal, 4/18); Enrollment activities, which cost about $2 million more than expected, largely because of more spending on marketing and delayed spending on community grants; and The Small Business Health Options Program, which cost nearly $860,000 more than expected (Covered California report, 4/17).

However, other parts of the exchange were less costly than predicted, including: • Service center operations, which cost more than $26 million less than expected, largely because of less hiring than predicted; and • Plan management and evaluation, which cost nearly $2.5 million less than expected.

• O verall, the exchange’s operating expenses were about 16% higher than expected for FY 2013-2014 (Sacramento Business Journal, 4/18).

According to a report presented during an exchange board meeting, Covered California plans to move into a “sustainability” phase by the end of FY 2014-2015.

At that time, the exchange will transition from relying on federal funding to being sustained by an administrative fee that insurers pay for each policy sold on the exchange (Covered California report, 4/17). The fee is $13.95 per policy in 2014 and will increase or decrease in 2015 depending on the number of individuals who purchase plans (California Healthline, 2/10).

The FY 2014-2015 preliminary budget, including enrollment and revenue estimates, will be considered by the exchange board in May and June. Currently, the preliminary budget “assumes the $363 million in remaining federal grant funding can be used to continue to support establishment activities into 2015,” the report states (Covered California report, 4/17).

You said what

to the Medical Board’s investigator?

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

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

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

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

JUNE 2014 / VITAL SIGNS

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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 * The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days’ advance written notice.

The County Medical Associations and Societies/NORCAP/CMA receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

CODING CORNER

What Do We Do Now? ICD-10 The “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Jennifer Della’Zanna, AAPC ICD-10 trainer and a member of AHIMA and the Association for Healthcare Documentation Integrity.

For those of us in the health information management field, “March madness” had a very different meaning. Watching the Senate vote on HR 4302, otherwise known as the “doc fix” bill, we bit our nails as the vote The key to climbed toward the 60 required votes to pass it. Most people in the country ICD-10 is were unaware of the little piece slipped mastery of the in at the last minute that would delay ICD-10 for at least another year, and guidelines… most news reports didn’t mention it Any staff either. Whether you heaved a sigh of relief or shook your head in disbelief at educated in yet another postponement of the new the new code code set, you are probably wondering what to do now. set should If you are among the majority pull 10-15 of practices that were on track for preparation of the transition on coded charts October 1, 2014, don’t despair. Any a month and training is not wasted. Staff who have received training in the new code set recode them know that many of the differences using ICD-10. between ICD-9 and ICD-10 are a few new concepts that are easily mastered and a new alphanumeric structure to the codes. The key to ICD-10 is mastery of the guidelines, and these have not changed much more than we are used to them changing from year to year. Some simple tasks will keep coders active in using ICD-10, and with practice they will be better prepared next year for the change than they would have been this year. These same tasks can also help a practice that might have been behind schedule for the original implementation date to catch up.

Dual Coding “Dual coding charts” means to code them in both ICD-9 and ICD-10, and it serves two purposes. It keeps coders in practice and helps to highlight areas ripe for provider documentation education. Any staff educated in the new code set should pull 10-15 coded charts a month and recode them using ICD-10. After the coding exercise, discrepancies in documentation

will be apparent. Instances of non-specific coding should be inspected for improved documentation opportunities. Of course, you don’t have to wait until ICD-10 implementation to include increased documentation on a patient’s chart. Make the changes now and repeat the exercise every couple of months to see if the documentation improvements make a difference in the ability to more accurately code the charts in ICD-10.

Staff Training There is no better way to learn a new skill than to teach it to another person. Staff who have received training should be encouraged to pass on their knowledge to other staff members. Already-trained staff members are also prime candidates to keep the office on track for the new implementation date. Keeping up to date on any new changes within the field, creating an implementation timeline and making sure the practice hits the milestones on time will give the entire office a sense of progress and organization that will make the goals easier to achieve. As the new implementation date arrives, look again for more opportunities for formal training of new staff, as well as any opportunities for refresher courses and continuing education for those who have already been trained.

Physician Education Physician staff members should take the opportunity to become familiar with the similarities and differences within the codes frequently used within the practice – in small bites. Absorbing the steps needed to properly document conditions within the specialty will take care of the majority of work needed for physician documentation improvement.

Unusual cases can be dealt with as they arise, but taking care of everyday codes will make the new code set seem less frightening and, by the time implementation gets here, there will be fewer things to learn. Keep in mind, we’re not talking about paragraphs of more documentation – sometimes it only requires a few tweaks to current wording.

Vendor Communication Talk with your electronic health record and practice management software vendors – and keep those lines of communication open. Make sure they are on track with preparations for implementation on their end.

Ask the vendor to come out and educate your staff about changes they’ll be making and how they may affect current office procedures. Make sure you can schedule end-to-end testing as the implementation date nears.

Remember that the new implementation date will change vendor plans as well. By the time ICD-10 implementation takes place (at least another year), new guidance on meaningful use will certainly arise. While vendors may have been on track to be ready for implementation in 2014, by the time final implementation occurs, even more improvements to their systems may be mandated. A little understanding on everybody’s part can go a long way toward a smooth transition.

JUNE 2014 / VITAL SIGNS

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Introducing Covered California Provider Educators The California Medical Association (CMA) and the CMA Foundation have been awarded a grant

from Covered California, the state’s new health benefit exchange. The purpose of the grant is to help medical professionals and their health care teams learn more about Covered California and to help their patients learn more about the new coverage options and financial assistance available through Covered California.

Fresno/Kern Area FONDA WINSLOW, Covered California Provider Educator Fonda Winslow is serving as the Provider Educator for Fresno and Kern Counties. She has worked in private post-secondary education for more than eight years, working with diverse adult populations. Her experience includes managing the academic affairs of a private university, including the development and implementation of institutional effectiveness plans, curriculum development and faculty training. She received her Master’s degree in Adult Education and Training from the University of Phoenix. To contact Winslow, please call, 559644-5888 or email: fwinslow@thecmafoundation.org.

California Statewide Director KENA BURKE, Covered California Project Director Kena Burke is the Director of the Covered CA Project for the California Medical Association Foundation. She has been involved health care policy and access issues for more than 15 years and has extensive experience in grant writing and management, program planning and implementation, strategic planning, public policy advocacy and fiscal policy. Burke has a Master’s degree in Public Policy from Cal Poly State University. To contact Burke, please call, 916-779-6630 or email: kburke@thecmafoundation.org.

Questions: Contact Vanessa Saetern, 916.779.6631 or vsaetern@thecmafoundation.org.

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Fresno-Madera PRAHALAD JAJODIA, MD

President’s Message The MICRA Ballot Initiative’s Other Part

My counter colleague’s (Dr. Kingston) article for Tulare covers the importance of preserving MICRA.

The newly-qualified MICRA ballot initiative also forces doctors and pharmacists to use a massive statewide database known as the Controlled Utilization Review and Evaluation System, or CURES. Besides the fact that CURES is underfunded and understaffed, this ballot measure will force the CURES database to respond to tens of millions of inquiries each year– something the database simply cannot do in its current form or functionality.

Most concerning, the massive ramp up of this database will significantly put patients’ private medical information at risk. The ballot measure contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from government intrusion, hacking, theft or improper access by non-medical professionals.

The initiative is bad for patients, taxpayers and health care as a whole, and there has never been a greater need for physicians to band together and fight for our patients.

As you can see, this initiative is fraught with problems and would prove detrimental to California’s health care system. I’m asking each of you to join the effort to defeat this costly threat to our state, and in doing so, protecting access to care and preventing higher costs for all California. Together, I’m sure we will be victorious.

As we forge ahead to Election Day, it is more important than ever to make sure we are speaking as a unified, coordinated voice. If you haven’t done so already, please visit CMA’s website at www.cmanet.org/micra for the latest information, handouts and to sign up as a campaign coordinator in your area. Please also visit the campaign website at www.stophigherhealthcarecosts.com to sign up to become an official opponent of this badly flawed measure. From the website you can: • Sign up to add your name to the growing list of individuals and groups opposed to the MICRA ballot measure.

• Get important facts, downloads and information that will help you spread the word about this costly measure Be part of our outreach team. If you have direct patient contact, become part of our outreach team. Visit CMA’s MICRA resource page to sign up as a campaign coordinator here.

Participate in message/media training. The campaign is also looking for physicians interested in taking on a more public role speaking to community groups about why this ballot measure should be defeated. Contact Molly Weedn at mweedn@cmanet.org for more information.

FRESNO-MADERA MEDICAL SOCIEY PRESENTS

Legislative Meeting With Assemblymember Jim Patterson Friday, June 6, 2014 • 7:30 am FMMS offices: 1040 E. Herndon #101 Take this opportunity to discuss with Assemblymember Patterson issues and bills of importance to physicians, including: • Need to preserve MICRA • Restoration of the Medi-Cal provider rate cut • Telephonic and electronic patient management

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

Open to all to attend

JUNE 2014 / VITAL SIGNS

11

Fresno-Madera

Fresno-Madera Medical Society

LUNCH & LEARN featuring

CAL/OSHA UPDATE 2013 Most Frequently Cited Cal-OSHA Standards presented by:

Eugene Glendenning

Area Manager Fresno Consultation Area Office

Thursday, June 12, 2014 Noon to 1pm Fresno-Madera Medical Society offices 1040 E. Herndon Ave. #101

Brown-Bag Luncheon Beverages provided For: Fresno-Madera Medical Society Members’ Medical Staff

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 Fresno-Madera Medical Society’s:

WALK WITH A DOC Program This walking program is risk free and requires no preparation. Physicians just need to: SPEND A SATURDAY MORNING: • Presenting a 2-3-minute presentation on the health benefits of walking from the perspective of your specialty • Leading a 45-50 minute walk around Woodward Park in Fresno or Town & County Park in Madera •A nswering potential questions from the walkers Encourage patients to take steps to improve their health

FRESNO

Woodward Regional Park Sunset View Shelter Registration 7:15am Walk Event 7:30am-8:30am

June 28 & July 26 MADERA

Town & Country Park Pavilion Area Registration 7:15am Walk Event 7:30am-8:30am

June 7 & July 12 Ready to Volunteer?

For a schedule of dates and times: Call the FMMS office: 559-224-4224x110 or send email to receptionist@fmms.org

RSVP by June 11: Doreen Chaparro dchaparro@fmms.org 559-224-4224x 112 Find us on Facebook: Fresno-Madera Medical Society

www.facebook.com/pages/Fresno-Madera-Medical Society/107731015917068

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Kern Kings THE FIRST KERN COUNTY CONFERENCE ON AGING:

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

An Interdisciplinary Approach to Geriatric Care Saturday, June 21, 2014 • 8:30am-3:00pm California State University, Bakersfield Student Union Multipurpose Room Keynote Speaker: David B. Reuben, MD Chief of Geriatric Medicine, UCLA Director, Multicampus Program in Geriatric Medicine and Gerontology (MPGMG) Registration online available at http://geronet.ucla.edu/kccoa/ For more information, contact Sarita Love 661-868-3297

2014 KCMS Membership Directory Available

Copies of the 2014 KCMS Membership Directory are available at the

KCMS Office. The cost is $10 for members and $40 for non-members. If you need additional copies, call the KCMS Office and place your order. Orders for 1-5 can be mailed – all others must be picked up. All orders must be paid for in advance or at time of pickup.

Supply is limited, so place your order now!

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

May 2014 Membership Recap Active.........................................................248 Resident Active Members...................2 Active/65+/1-20hr..................................4 Active/Hship/1/2Hship.....................0 Government Employed........................4 Multiple Memberships.........................1

Retired.........................................................62 Total.........................................................321 New Members (Pending Dues).........................................0 New Members (App Pending)........0 Total Members...............................321

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Tulare MICRA – What’s All the Fuss About?

Ralph Kingsford, MD CMA, Board of Trustees 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

I recently ran into a colleague in the hospital, who asked me what the big fuss was about MICRA. I was surprised that he didn’t realize the positive impact it has had on his career, and I took the opportunity to tell him about it, what it means to all physicians in California, and why we need to be united and steadfast in our defense of it. It is now under threat by the upcoming “Troy and Alana Pack Patient Safety Act” measure, placed by the trial attorney front group,Consumer Watchdog on the November ballot. I would like to take this opportunity to help you, too, understand MICRA and its importance in our lives and careers as physicians.

Many physicians today are unaware of the importance MICRA has played in keeping health care costs down and access a reality – especially in areas like ours. So, what exactly is MICRA? MICRA, which stands for “Medical Injury Compensation Reform Act,” was passed and signed into law in 1975 by Governor Edmund J. Brown Jr., yes the very same Jerry Brown, our current Governor.

Under MICRA, patients can be compensated for unlimited damages for lost wages and lifetime earning potential, unlimited damages for past and future Many medical costs, and unlimited punitive damages. The speculative, non-economic physicians damages are capped at $250,000. Over the years since MICRA passed, the trial today are lawyers have undertaken several legislative attempts to overturn it. Thanks to unaware the unrelenting work of the California Medical Association (CMA) and a broad coalition of groups, these efforts have been thwarted. of the In less than six months, these trial lawyers will ask voters to weigh in on “The importance Troy and Alana Pack Patient Safety Act,” an initiative that was carelessly thrown MICRA has together without any concern for taxpayer pocketbooks, privacy, patients or played in health care. If trial lawyers get their way, our state will be saddled with a costly keeping threat to privacy that California simply cannot afford. health care If this measure is approved by voters, malpractice lawsuits and payouts will skyrocket, adding “hundreds of millions of dollars” in new costs to state and costs down local governments, according to an impartial analysis conducted by the state’s and access Legislative Analyst. Someone will have to pay, and that someone is providers, a reality – taxpayers and consumers. especially CMA and our local medical society have joined a campaign coalition to in areas like oppose the measure, because it will be costly for consumers and taxpayers, ourS. endanger patient access to quality health care and jeopardize the privacy of our personal health information. This group, “Patients, Providers and Healthcare Insurers to Protect Access and Contain Health Costs” is a diverse and growing coalition of trusted doctors, community health clinics, hospitals, family-planning organizations, local leaders, public safety officials, businesses and working men and women formed to oppose this costly, dangerous ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals.

This measure would also have devastating effects on access to care for patients everywhere, but especially in rural and already underserved areas. Community health care clinics like the Central Valley Health Network are already warning that this measure will cause specialists like OB/GYNs to reduce or eliminate services to their patients. This measure could also cause doctors to leave the state, meaning thousands of Californians could lose access to their trusted doctors.

Over the next few months, you’ll hear a lot of rhetoric from the proponents of the measure but really, this is another example of special interest politics trying to fool the voters into thinking this about something that it’s not.

The authors of this proposal purposely threw non – MICRA provisions, like drug testing doctors, to disguise the real intent, which is to increase the limits on medical malpractice awards so that trial lawyers make even more money.

The main supporter admitted that the drug testing provision was added not because it’s good policy, but because of good politics, telling the LA Times that “it’s the ultimate sweetener.”

This proposal also forces doctors and pharmacists to use a massive statewide database known as the Controlled Utilization Review and Evaluation System, or CURES, filled with Californians’ personal medical prescription information – a mandate government will find impossible to implement and a database with no increased security standards to protect your personal prescription information from hacking and theft.

Please see next page

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Tulare MICRA Continued from page 14 Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands this ballot measure will place on it. This ballot measure will force the CURES database to respond to tens of millions of inquiries each year– something the database simply cannot do in its current form or functionality. A nonfunctioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients.

So, what can we do? We must all strive to educate ourselves and our colleagues, as well as our patients, to the dangers that lurk with passage of this Measure. I would encourage each of you to keep abreast with the developments as they occur. Donate to the CALPAC today to help defeat the Measure: (https://my.cmanet. o r g /C a l PA C/c g i - b i n /m e m b e r d l l . d l l / OpenPage?wrp=donations_NL.htm).

Go online to the CMA website and sign the MICRA Commitment Card: (http://www. cmanet.org/issues-and-advocacy/cmas-topissues/micra/join-the-fight/).

In conclusion, I hope I have been able to give you some insight into the importance of preserving MICRA, so that all California physicians, both current and future, may continue to practice in our Golden State and ensure that patients have real access to affordable health care. In Benjamin Franklin’s words, “By failing to prepare, you are preparing to fail.” We cannot fail.

Author can be reached at rkingsford@ vmchealth.com.

We share important information with TCMS current members.

Email us at:

info@tkfmc.org

Tulare County Medical Society presents

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

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

FRESNO ANNOUNCEMENTS Fresno Gastroenterology welcomes boardcertified physicians Dr. Paul Hanchett and Dr. Vivek Mittal. Referrals appreciated. Call 559323-8200 or Fax: referral to 559-323-9200.

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

FOR LEASE Office space at Chestnut/Herndon. Build to suit.

1,200 sf. Call 559-287-3279.

Medical office. 1,000sf, up to 2,500 sf at NE corner First/Herndon & NW corner First/Bullard; starting at $1 psf++ by owner. Call 559-824-9966 or 559-930-4297.

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

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

TULARE Del Lago Park, Tulare, CA Saturday, June 28, 2014 8:00am to 9:00am VISALIA Riverway Sports Park, Visalia, CA Saturday, June 14, 2014 8:00am to 9:00am Who can attend: ANYONE For more information, please contact Tulare County Medical Society at (559) 627-2262

to be added to the list.

JUNE 2014 / VITAL SIGNS

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

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