March 2015

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

See Inside: Legislation Announced to Ban Personal Belief Exemptions $10 Million Reasons to Become A Member Covered California Update ICD-10 Coding Workshop Offered

Vital Signs

March 2015 • Vol. 37 No. 3

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

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Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE! On October 15, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action Guide for Medical Practices has the answers you need to successfully make the transition.

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800-356-5672 CAPphysicians.com/icd10now

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

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

CMA NEWS.............................................................................................................................6

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

March 2015 Vol. 37 – Number 3

Covered California: January 2015 Update...........................................................................8

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

Editor Alan Birnbaum, MD

CLASSIFIEDS..........................................................................................................................15

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

TULARE County Medical SocieTY.......................................................................................10

• California’s Quality Improvement Organization

• TCMS Spring General Meeting: April 9

• Calling All Tulare County Medical Society Members

• Upcoming Events

• Just Walk With A Doc

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

• President’s Message

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

• President’s Message

• In Memoriam: Willilam Owen, MD

• ICD-10-CM Coding Seminar

• Walk WIth A Doc

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

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

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

Cover Photograph: “ Blossom Trail, Fresno County”

by Liz Hudson, Hudson Farms’ Fruit Stand, Sanger, California

Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee MARCH 2015 / VITAL SIGNS

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4 MARCH 2015 / VITAL SIGNS The County Medical Associations & Societies receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

EDITORIAL Get Up, Stand Up, For Your Rights Alan M. Birnbaum, MD Editor, Vital Signs

Absent ACCESS to healthcare, the technical excellence of American medicine means nothing to many California citizens. I believe that physicians in our state, the most populous of 50, remain eager to provide care to all, particularly preventative primary care, which yields health dividends as citizens age, driving down the rate of costly hospitalizations.

Similarly, specialty physicians understand that earlier care, adequately funded, decreases chronic consequence.

Per a January 2015 New England Journal of Medicine article, from the University of Pennsylvania and the Urban Institute, part of the initial phase of the Affordable Care Act, the federally-funded two year Medicaid/MediCal subsidy of primary care up to the Medicare rate, increased care access in 10 states sampled, roughly proportional to the increase over the wholly inadequate base rate.

The Urban Institute calculated that the loss of that subsidy would drop provider reimbursement rates an average of 43 percent. We all understand that California’s impact will be much greater, due to abysmal baseline rates for care. The drop will be approximately 60 percent.. That makes providing care for Medi-Cal patients unfeasible for virtually any private practice physician trying to provide basic care. Reimbursements in California that As Bob Marley, have not been adjusted for the cost of office overhead or the fair value of a physician’s time over two decades, once said, have made Medi-Cal “coverage” a misnomer or even myth for all too many.

“Get up, With the basic rate for a CPT 99213 Medicare office visit around $75, a Medicare/Medi-Cal reimbursement of perhaps $60 allows access. By contrast, $24 or so fails, since the cost of office overhead in our area stand up, approximates $100 an hour. Cost of care equations vary for specialty care, but basic principals persist. It is no for your surprise that well over half of Medi-Cal clients cannot find a doctor.

A critical reason to remain a member of your local medical society and the California Medical Association rights.”

(CMA) , is the CMA’s enlarging involvement in the “We Care for California” coalition for increased MediWe ALL need Cal reimbursements. Not only does this include physicians and dentists, but also hospitals, allied health care workers, first responders, home health care and other providers… and even some health plans: http://www. to STAND UP wecare4ca.org behind The concept enjoys unified editorial support, from the San Francisco Chronicle, the Los Angeles Times, “Care for the San Diego Union Tribune, and The Sacramento Bee. Read at least one of the links to mid-2014 editorials; read them ALL. As our new CMA President, Luther F. Cobb, M.D. , recently wrote: California” “With over 12 million people to be enrolled in Medi-Cal, it is more important than ever to ensure that the program is adequately equipped to handle new patients….California pays some of that nation’s lowest Medicaid reimbursement rates, and in order to properly serve the poorest and most vulnerable patients among us, at a minimum… provider cuts made in 2011 need to be restored.”

In fact that 10 percent per 2011’s AB 97. represents only an initial small step. Nothing less than an approximate DOUBLING of E/M payments would be equitable.

At the same time, workers comp “reform,” per SB863 from September 2012, has resulted in two-thirds of industrial treating physicians often unable to get authorization for reasonable and routine care, compounded by well over half of physicians finding bills for this complicated group of patients downcoded, any appeal costly and problematic.

Even Medicare, for many doctors the least problematic payor, now via the PQRS, the Physician Quality Reporting System and other fine print programs, will for many deduct 1.5 percent more from claims submitted for care that had been of entirely adequate quality. Finally, the 10 percent to even 40 percent reduction in E/M payments by some large carriers providing Covered California Exchange plans has undermined access for families who must purchase health coverage on an individual basis.

Do I sound like a broken record since I became Editor? If the system has been broken, its sounds will repeat and squeak and growl and howl. As Bob Marley, himself a tragic young victim of inadequate healthcare, once sang, “Get up, stand up, for your rights.” We ALL need to STAND UP behind “Care for California” and parallel programs, to achieve physician equity and optimal patient care ACCESS. Author may be reached at Siriusguy @aol.com.

MARCH 2015 / VITAL SIGNS

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CMA NEWS

2015 Yosemite Postgraduate Institute March 27-29, 2015 Yosemite National Park

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

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

6 MARCH 2015 / VITAL SIGNS

Legislation announced to ban personal belief exemptions for school vaccinations

With the number of California measles cases growing, Sacramento pediatrician and State Senator

Richard Pan, MD, has announced his intention to introduce legislation to repeal personal belief exemptions for school vaccinations. Cosponsoring the repeal with Dr. Pan is Sen. Ben Allen, D-Redondo Beach.

In 2012, Dr. Pan also authored California Medical Association-sponsored AB 2109, which requires a parent or guardian seeking a personal belief exemption from school immunization to first obtain a document signed by a licensed health care practitioner. Since the bill took effect in 2014, the number of parents in California who filed personal belief exemption forms to exempt their kindergarteners from vaccinations has dropped by 20 percent, with 2.5 percent of kindergarten children opting out this school year, down from 3.1 percent last year. In some communities, however, as many as 10 percent of parents continue to file personal belief exemptions.

The bill would still allow exemptions for children who cannot be vaccinated for medical reasons. It would also require that parents be notified of the vaccination rates at their children’s schools.

CMS announces it will work to reduce meaningful use reporting burden

After repeated calls for changes from the American Medical Association (AMA), the California

Medical Association (CMA) and other physician groups nationwide, the Centers for Medicare and Medicaid Services (CMS) announced that it would address the meaningful use issues raised by providers and make changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program to “reduce the reporting burden, while supporting the long term goals of the program.” CMS said it would issue new rules governing the program this spring.

Beginning January 1, 2015, Medicare physicians who have not successfully attested to meaningful use of an EHR system may incur payment penalties.

Continued on next page

CMA NEWS Continued from page 6 Last fall, CMS made a stunning announcement that while 78 percent of physicians are using an EHR, more than 50 percent of eligible physicians will face penalties under the meaningful use program in 2015. Moreover, only of half of eligible physicians participated in the Physician Quality Reporting System (PQRS) program in 2013. By 2017, physicians could face up to 11 percent in combined payment penalties from these and other Medicare penalty programs. (For more details about the various Medicare incentive and penalty programs, see “Medicare Incentive and Penalty Programs: What physicians need to know,” available free to members in CMA’s online resource library.)

In a recent letter to CMS, AMA said that the meaningful use program, which was originally “intended to increase physician use of technology to improve patient care,” was hindering physician participation by setting a strict set of one-size-fits-all requirements that forced physicians to purchase expensive EHR systems with frustratingly poor usability that resulted in interfering with patient care.

AMA and CMA have called on CMS to make the meaningful use program more practical and flexible to ensure the intended improvements in patient care and practice efficiencies. The reforms include the consolidation and alignment of the quality and meaningful use programs; requiring interoperability and the exchange of information in a meaningful format and the simplification of the certification process; a reduction in penalties and reinstatement incentive payments; allowing physicians to meet no more than 10 required measures; and expanding the options for specialists.

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

CDC encourages antiviral treatment for influenza

With a poorly matched influenza vaccine and influenza activity high across much of the country, the Centers for Disease Control and Prevention (CDC) is urging physicians to prescribe antiviral drugs to patients who are very ill with flu-like symptoms, particularly those over age 65 and those at high risk of complications from the virus.

Because antivirals are most effective if administered in the first 48 hours, the CDC urges that they be prescribed for high risk patients with flulike symptoms, even before ordering tests to confirm the virus.

Physicians are also encouraged to continue vaccinating patients against the flu, even though early reports indicate the vaccine is not well matched to this year’s strain.

Medical board approves amendment to regulation allowing PAs to conduct surgery without immediate physician supervision The Medical Board of California approved an amendment to California administrative law that would allow physicians assistants (PA) to perform surgery without the immediate physical presence of a supervising physician.

Existing law permits PAs to act as first or second assistant in surgery under the supervision of a physician. In 2011, a concern was raised by a PA licensee to the Physician Assistant Board that the current regulation did not reflect current medical community standards and that the law was unclear on the degree of physician supervision required of a PA as an assistant in surgery.

The final regulation, which goes into effect on April 1, 2015, clarifies that a PA may perform surgical procedures, without the physical presence of the supervising physician in the operating room if the physician is “immediately available” to the PA. The medical board defines “immediately available” as “able to return to the patient without delay, upon the request of the PA or to address any situation requiring the supervising physician’s services.”

For more information on physician assistants, see CMA On-Call document #3007, “Physician Assistants.” This document, as well as the rest of the California Medical Association’s (CMA) online health law library, is available free to members in CMA’s online resource library. Nonmembers can purchase documents for $2 per page.

Contact: Yvonne Choong, 916-551-2884 or ychoong@cmanet.org.

ICD-10 transition guide now available; new resource webpage available

With eight months until the transition to ICD-10, will your practice be ready be October 1, 2015?

To help physicians prepare for the transition, the California Medical Association (CMA) has published a new resource, “ICD-10 Transition Guide – What physicians need to know,” which includes an ICD-10 transition preparation checklist.

CMA has also created an ICD-10 transition webpage, www.cmanet. org/icd10, that includes important news articles and other ICD-10 transition information. CMA will also be hosting a number of live training events to assist physicians with the transition, with details announced soon.

Featured member benefit Mobile Physician Websites: Over 80 percent of internet users search for health info and services. Mayaco Marketing & Internet provides you with the best in a mobile-friendly web design. California Medical Association (CMA) members save up to $1,000 on unique website packages. Don’t miss your chance to grow your practice with a dynamic website! To check out the great features Mayaco Marketing & Internet offers, visit www. mayaco.com/physicians.

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

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

$10 million reasons to be a CMA member

The

California Medical Association’s (CMA) Center for Economic Services (CES) has now recouped $10 million from payors on behalf of CMA member physicians. These monies, recovered over the last five years, represent actual physician reimbursements that would have likely gone unpaid without the intervention of the CES team.

Founded in 1999, CES provides CMA members with one-onone assistance for billing, contracting and payment problems that may arise. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials by payors to assisting with contract analysis during negotiations.

Assistance from CES can range from education on how to increase a practice’s efficiency to direct intervention with payors or regulators. This support is reserved exclusively for CMA members.

CES also provides physicians and their staff with access to CMA Practice Resources, a monthly bulletin offering tips for improving practice efficiency and viability. To sign up for a free subscription, visit the CMA website at www.cmanet.org/newsletters.

For practice management tools, newsletters and other online assistance, visit www.cmanet.

MARCH 2015 / VITAL SIGNS

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COVERED CALIFORNIA 2015 Update

Over 1.1 million consumers enrolled in health

Is your new patient an undercover police officer?

Remember that nice patient who asked for pain medicine a couple of months ago?

The entire visit may have been recorded in HD quality video.

The Medical Board uses undercover police officers who pose as new patients. Some carry incredibly small cameras. Some have legitimate medical conditions. Their acting skills are good enough to fool you.

When the Medical Board demands an explanation, any explanation, seek help immediately. The attorneys at Baker, Manock & Jensen have helped many physicians whose care is being investigated by the Medical Board. 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

insurance during Covered California’s first enrollment period which began October 1, 2013 and ended April 15, 2014. This enrollment surpassed the state’s 2014 enrollment goal of 816,000. Now, with the conclusion of the second enrollment period, Covered California is expected to surpass its goal again.

Covered California’s second enrollment period, which opened November 15, 2014 has now been extended to April 15, 2015. During the second enrollment period, Covered California officials announced that more than 354,000 new enrollees signed up for a health plan. As of February 2, 2015, 4,798 Fresno County consumers enrolled in health coverage, while 913 new Madera County consumers enrolled. Of the 1.1 million who enrolled last year statewide, about 92 percent (or 944,000) of individuals renewed their plan as of February 2, 2015.

During the second enrollment period, Covered California began offering six new health plans statewide. In Fresno, Madera, and Kings counties, in particular, four plans were available to enrollees. These included: Anthem Blue Cross PPO, Blue Shield of California PPO, Kaiser Permanente HMO, and Anthem Blue Cross HMO. Premium assistance was available to those with a household income between 138 percent and 400 percent of the federal poverty level (FPL). Only enrollees who selected a Silver Metal level plan were eligible for cost-sharing subsidies.

Since September 2013, the California Medical Association (CMA) Foundation has served as a partner in Covered California’s Outreach and Education Program. The CMA Foundation has provided over 1.6 million outreach and education contacts to health care providers in almost every county in California. Over 2,500 events, including medical staff presentations, radio shows, physician seminars, and one-onone practice visits have been held throughout the state.

To ensure that you and your staff are up to date on the changes impacting your practice, join us for a local presentation or schedule an inoffice meeting to address your specific inquiries or to ask questions. For more information, please contact the Provider Educator in your area: For Northern and Central California, contact Fonda Winslow at fwinslow@thecmafoundation. org or call 559-644-5888.

HEALTHCARE REFORM Emergency regulation requiring health insurers to have sufficient medical providers goes into effect immediately

Patients have been surprised by huge bills from out-of-network doctors who were included in their treatment without notice or consent of the patient. This emergency regulation is one of the first in the nation to address these surprise bills.

The emergency regulation strengthens and adds new medical provider network requirements, including requiring health insurers to: • Include an adequate number of primary care physicians accepting new patients to accommodate recent and ongoing anticipated enrollment growth; • Include an adequate number of primary care providers and specialists with admitting and practice privileges at network hospitals; • Consider the frequency and type of treatment needed to provide mental health and substance use disorder care when creating the provider network; • Adhere to and monitor new appointment wait time standards; • Prevent “surprise” bills by requiring medical facilities to inform patients that an out-of-network medical provider will participate in the non-emergency procedure or care, before the care is provided, so that the patient can decline the participation of the out-of-network provider if they so choose; • Report information about the networks and changes to the networks to the Department of Insurance on an ongoing basis; • Provide accurate provider network directories to the Department and make them available both to policyholders and the public, so that those shopping for health insurance have this information as well; • Make arrangements to provide out-of-network care at in-network prices when there are insufficient in-network care providers.

HHS ANNOUNCES PLAN TO MOVE TOWARD ALTERNATIVE PAYMENT MODELS

Last month, HHS announced it will seek to make 30% of Medicare payments for hospitals and physicians through alternate payment models like accountable care organizations and bundled payments by 2016, the Wall Street Journal reports.

Medicare, which paid $362 billion to providers caring for more than 50 million U.S. residents in 2014, began to tie payments to performance as part of the Affordable Care Act. About 20% of payments made by the insurance program are now made through alternate payment models (Radnofsky/ Beck, Wall Street Journal, 1/26).

Writing in the New England Journal of Medicine, HHS Secretary Sylvia Mathews Burwell outlined the major goals for the Medicare system in the coming years. Along with the alternative payment models goal for 2016, Burwell also wrote that HHS will seek to have 50% of Medicare payments through alternate payment models by the end of 2018.

Further, she wrote that HHS will seek to have 85% of Medicare hospital fee-for-service payments tied to quality or value – through programs such as the Hospital Value-Based Purchasing Program or the Hospital Readmissions Reduction Program – by the end of 2016. That percentage would increase to 90% by the end of 2018 (Demko, Modern Healthcare, 1/26).

To facilitate the transition away from fee-for-service care, Burwell announced the formation of a Health Care Payment Learning and Action Network (O’Donnell, USA Today, 1/26).

According to Bloomberg, the new goals represent a “major shift” for providers and more than double the reach of alternate payment models that

federal health officials say have saved millions (Wayne, Bloomberg, 1/26).

However, some experts say it remains unclear whether the new payment models will succeed in efforts to reduce cost and improve care. A RAND Corporation study funded by HHS last year concluded that “[w]e still know very little about how best to design and implement [value-based payment] programs to achieve stated goals and what constitutes a successful program” (Millman, “Wonkblog,” Washington Post, 1/26).

CALIF. HEALTH GROUPS JOIN PLEDGE TO MOVE TO VALUE-BASED AGREEMENTS Last month, a group of some of the largest health care systems and insurers – including two from California – announced a commitment to transition from fee-for-service payments to value-based agreements by 2020, the New York Times reports (Abelson, New York Times, 1/28).

The private coalition, known as the Health Care Transformation Task Force, was proposed by Richard Gilfillan, CEO of Trinity Health and the former head of the Center for Medicare and Medicaid Innovation. It aims to reach a consensus on the most-effective payment models for hospitals, private insurers, and federal payers to eliminate the need for multiple arrangements for each private payer and Medicare (New York Times, 1/28).

The task force has 28 members so far. Sixteen of the participants are provider organizations, including: • Advocate Health Care • OSF Healthcare • A scension • Partners Healthcare • Dignity Health • Trinity Health The four insurers participating in the task force are: Aetna; Blue Cross Blue Shield of Massachusetts; Blue Shield of California; and Health Care Service Corporation (Rappleye, Becker’s Hospital CFO, 1/28).

The coalition says it is committed to moving 75% of its contracts into alternate payment models by 2020.

PRICES FOR KNEE, HIP REPLACEMENT SURGERIES VARY ACROSS CALIF., U.S. Prices for hip and knee replacement surgeries – the fastest-growing medical

procedures in the U.S. – can vary by tens of thousands of dollars within California and other states, according to a report released Wednesday by the BlueCross BlueShield Association, the Washington Post’s “Wonkblog”.

However, the costs varied greatly within the same markets, which researchers described as a “seemingly random” pattern (Morgan, Reuters, 1/21).

Prices for knee replacement surgery ranged from: • $18,179 to $36,388 in Orange County; • $19,581 to $19,724 in Fresno; • $20,868 to $33,924 in Los Angeles-Long Beach; • $22,795 to $28,222 in Riverside-San Bernardino; and • $37,662 to $43,133 in San Diego.

Meanwhile, prices for hip replacement surgery ranged from: • $17,260 to $46,447 in Los Angeles-Long Beach; • $18,531 to $19,970 in Fresno; • $19,214 to $23,718 in Riverside-San Bernardino; • $19,607 to $28,657 in Orange County; and • $23,696 to $47,386 in San Diego.

According to “Wonkblog,” the gap in prices can be attributed to several factors, including: a hospital’s mix of privately and publicly insured patients; competition within markets; location; and how much no-cost care a hospital provides (“Wonkblog,” Washington Post, 1/21).

The study examined knee and hip replacement surgery costs in five markets within California.

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

9

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

Eligible physician practices in California can receive no-cost assistance from Health Services Advisory Group (HSAG), the state’s Medicare Quality Improvement Organization (QIO) to meet the requirements of Meaningful Use (MU), Physician Quality Reporting System (PQRS) and value-based purchasing. In addition, HSAG provides physicians evidencebased best practice training on cardiac and diabetes care with the goal of advancing and enhancing the quality of care Medicare beneficiaries receive from their health providers.

Diabetes Assistance • Receive no-cost assistance to identify Medicare patients who are pre-diabetic and refer them to a local diabetes prevention program.

• Learn best practices to improve diabetes care.

• Become a DSME trainer in your local area through no-cost DSME trainings from HSAG. • Increase the number of community residents trained in DSME, broadening public knowledge.

As California’s QIO, HSAG is committed to driving rapid, large-scale change that puts beneficiaries, families, and caregivers first and contributes to better patient care, better population health, and lower costs through improvement. This work is grounded in foundational principles that align with the four goals of the Centers for Medicare & Medicaid Services’s (CMS’s) Cardiac Assistance Quality Strategy platform: eliminate disparities, strengthen • Receivetechnical assistance to identify infrastructure and data systems, enable local innovation, and at-risk patients for cardiovascular disease to proactively manage your hyperfoster learning organizations. tensive patient panel.

Over the next five years, HSAG will build on this platform • Access cardiovascular educational to accomplish these major goals in California. For doctors, sessions, designed for providers to this means sharing best practices and tracking progress to help highlight evidence-based best practices that improve cardiac care.

Medicare beneficiaries prevent heart attacks and strokes. It also • Apply your quality improvement knowlmeans increasing opportunities for patients to receive diabetes edge towards the Million Hearts® goal self-management education (DSME) classes, while expanding of preventing one million hearts and the ranks of DSME educators in the community. As part of strokes by 2017.

HSAG’s assistance, providers will gain support to integrate PQRS and MU Assistance • Learn how to harness EHR technology electronic health record (EHR) technology that advances quality for chronic disease management and care into their practices, while earning CMS payment incentives. preventive services.

Moreover, physicians will be able to participate in HSAG• Earn CMS incentive payments by receivsponsored webinars, teleconferences, community collaboratives, ing provider-directed training to produce quality measure reports from your EHR. learning and action networks, and other virtual and face-to-face • Obtain assistance to help enroll pagatherings that drive improvement and bring evidence-based tients into your EHR portal. practices, knowledge, and tools to their practices. For example, • Gain technical assistance to boost paHSAG willoffer at no-cost, EHR technical assistance toproviders tient and family engagement. who identify and refer patients with diabetes or who are prediabetic to a DSME program – a proactive means to prevent avoidable hospitalizations and adverse drug events.

For more information about how HSAG can assist your practice, please email Debashish Mittra, Director Physician Office Quality, at dmittra@hsag.com or call 818.265.4690.

This material was prepared by Health Services Advisory Group, the Quality Improvement Organization for California under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

Publication No. CA-11SOW-XC-12162014-01

SAVE THE DATE FOR TCMS

Wine Social

May 8, 2015 at Chinese Cultural Center

10 MARCH 2015 / VITAL SIGNS

Physician Benefits of Working with HSAG on Chronic Disease Care

Tulare General Membership Meeting “Physician Labeling for the Betterment of our Profession” Peter Bretan, MD April 9, 2015 • 6pm • Visalia Country Club Dr. Bretan is a practicing urologist and renal transplant surgeon in Novato, CA. He was a past president with the Marin County Medical Society and remains active as a Board of Trustee for the California Medical Association. Additionally, Dr. Bretan is a retired Captain in the U.S. Public Health Services Reserves in which he served over 25 years and was deployed to New Orleans after Hurricane Katrina. He will share life experiences that led him to start Lifeplant International (www.lifeplant.org), a charitable organization that promotes disaster readiness, organ donation, and early disease screening worldwide. Dr. Bretan has been recognized for his work and in 2014 was the recipient of the American Medical Association’s Benjamin Rush Award for Citizenship and Community Service.

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

May 6, 2015 • 12:00-3:00pm • Golden West High School • Redwood High School May 20, 2015 • 12:00-3:00pm • Mt. Whitney High School • El Diamante High School For more information, or to volunteer for this meaningful project, please contact: Thelma Yeary, TCMS at 559-627-2262 or thelma@ tkfmc.org.

Notices will be mailed directly to TCMS members but if you have any questions, please do not hesitate to call the Tulare County Medical Society office at 559-627-2262.

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

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

MARCH 2015 / VITAL SIGNS

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Kern Kings Michelle S. Quiogue, MD

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

President’s Message Thank you for trusting me with the office of KCMS President this year. As

I surveyed the faces in attendance at the Officers’ Installation Dinner on January 16th, I was reminded of what an honor and privilege it is to be called to this noble profession where the resilience and fragility of humanity is our daily work.

Since moving to Bakersfield over 10 years ago, I have often witnessed, contributed to and benefitted from the generosity of physician colleagues.

I believe the role of the medical society is to strengthen the connections and relationships that bind us together and to recognize our physician philanthropists who are working to support our community beyond the confines of the exam room. This year we in the KCMS will work to strengthen our community by increasing the frequency and variety of medical society events. Each month there will be an opportunity to get together, experience community and build new relationships. Be sure your dues are paid up and read our emails so you don’t miss out.

Some examples of possible events we will be working on are the Walk with a Doc program, line dancing at Buck Owens Crystal Palace, Night at the BMOA, First Friday at The Mark. There will be a mix of family events and adult only events, and we look forward to partnering with our KCMS Alliance leadership to reach all members of our KCMS family. I welcome your suggestions for other community building events. This is your medical society; make it into what you believe a medical society should be.

While we can’t hope to control the ocean nor the weather, we are certainly all in the same boat and we are more resilient when we build each other up. Physicians in crisis, treading water or drifting in uncharted water are not alone. Each of us are both helpers and in need of help. Whenever you start to forget this, whenever you think you have to carry the weight of the world solely on your shoulders try saying my three magic words. Look into the eyes of the next colleague you run into at your office and repeat these words: “Dude, Me Too!” I look forward to your participation, your input and to seeing you this year at KCMS events.

Doctors are everyday heroes They are also human

The Physicians’ and Dentists’ Confidential Assistance Line is here

to help This 24-hour phone service is free, provides completely confidential doctor-to-doctor assistance, and will not result in any form of disciplinary action or referral to any disciplinary body. The goal is to help, not to discipline.

Asking for help is one of the most difficult and heroic things you can do: 650-756-7787 (Northern California) 213-383-2691 (Southern California) For more information or to download a copy of the brochure, visit http://www.cmanet.org/resources/confidential-assistance

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

Fresno-Madera A.M. AMINIAN, MD

President’s Message fmms board building a strong foundation

The New Year just three months old, started with many visions, hopes, and goals for our organization, and as

anticipated, no measurable success comes without its challenges.

Indeed, we have faced these challenges head on through the collaborative teamwork of our Board and its members.

Not only will we overcome our current challenges, we will achieve our goals to strengthen our organization. and make it a voice for the medical community.

To achieve our mission, I’m fortunate to have the support of one of the strongest Boards that we could possibly have and one that is determined to move us forward as a community. Our Board members are dedicated individuals who, in spite of their own busy schedules, have offered the medical community their time, expertise, and connections to stabilize our efforts. We have divided the Board responsibilities to address two categories: the reorganization of FMMS (to make it as strong as it is expected to be) and our goals through strategic task forces.

As part of our reorganization, we understand that strong leadership at the staff level is essential to executing the Board’s will. Currently, we are in the process of recruiting a new Executive Director, revising our current policies, as well as creating new ones. The Board is creating strategies to strengthen our financial position long-term while expanding our public relation opportunities. We are very fortunate that CMA is extending their expertise to ensure this all happens flawlessly. Although we have lost some of our resources, we are seeking new venues to garner increased financial support in a way that is sustainable long-term.

Moving our vision forward provided me with an opportunity to create several task forces comprised of Board members tasked with helping me move our organization in the right direction and to showcase our value to our members. We envision this year we will do a better job of making every physician in our area aware of the benefits of FMMS and CMA memberships. Such prominent benefits include protecting ourselves from intrusions into our medical missions (e.g. the failed Prop 46); and help with transitions to ICD 10, insurance contracting, and practice management, amongst others. It’s essential we increase our membership base, but we must provide the value to do so, and that is what we are planning to accomplish.

Patient advocacy continues to be a high priority. Creating better access to care and specialist treatment, enhanced insurance coverage, and improved drug coverage is very important. The task force is working on developing a plan and recommendation to move this agenda forward. The quality of life of our physician members is another priority.

This is a prerequisite for having a stronger physician community. Your Board is taking the necessary steps to develop a strategy that addresses those concerns.

As many doctors plan for retirement, it is our duty to guide our medical students, residents, and newly-starting physicians towards our path of goals and missions. Again, the task force is working on strategy.

One year, in actuality, is a short amount of time. My presidency is not enough to accomplish every single one these goals to the fullest extent. That being said, it is my greatest hope and intent that the present Board will build the foundation for all of these goals, so that we will once again be the strong FMMS we were in the past. We have to remember these are not easy tasks, but they are within reach. We need physician volunteer members for their ideas and participation to attain our goals as an organization. As we move forward, I will keep you updated, but in the meantime, if you would like to be involved, please don’t hesitate to contact me directly.

Contact Dr. Aminian at president@fmms.org.

In Memoriam William O. Owen, MD 41-year member

William (Bill) Owen, MD, a recently retired internist and cardiologist, passed away on February 5, 2015 at the age of

83. Dr. Owen was born in Illinois in 1931. He received his medical degree from Northwestern University in 1956 and completed his internship and residency training at Philadelphia General and Chicago Wesley Memorial hospitals.

He began his practice in Fresno in 1962 with the Fresno Medical Group and also became a member of the early team of cardiac surgeons in the area. He fully retired from private practice in 2014. Dr. Owen is survived by his wife, four children, and ten grandchildren.

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

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

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

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

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

• • • • • •

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

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

Registration Fee:

FMMS member physicians or office staff $125

Non-member physicians or office staff $225

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

o

VISA or

o

MasterCard AmoUnt $_____________________

Name on card ___________________________________________________________________ Credit Card #____________________________________________________________________ Expiration Date___________________________

Zip Code of Billing Address_________

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

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

• Spend more time with your family and friends?

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

FRESNO: MARCH 21

San Joaquin River Parkway New Location: Meet at the San Joaquin River Parkway River Center 11605 Old Friant Rd. Registration 8:45am Walk Event 9am-10am

MADERA: MARCH 7

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

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

Signature_______________________________________________________________________

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

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

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CLASSIFIEDS Healthcare Reform Continued from page 9

Affordable Care Act Guidance on Coverage of Tobacco-Cessation Treatment

A group health plan or health insurance issuer will be considered to be in compliant with the ACA’s requirement to cover tobacco-use counseling and interventions if it covers the following, without cost sharing or prior authorization: 1. screening of all patients for tobacco use; and 2. for enrollees who use tobacco products, at least two tobacco-cessation attempts per year, with coverage of each quit attempt including • Four tobacco-cessation counseling session, each at least 10 minutes long (including telephone, group and individual counseling) and • Any FDA-approved tobacco-cessation medications (whether prescription or over-thecounter) for a 90-day treatment regimen when prescribed by a health care provider • To date, the FDA has approved seven smoking-cessation medications; five nicotine medication (patch, gum, lozenge, nasal spray and inhaler) and two non-nicotine pills (bupropion and varenicline).

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

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

FRESNO ANNOUNCEMENT .

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

FOR LEASE / RENT / SALE .

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

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

PHYSICIAN WANTED .

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

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

Busy Fresno area imaging center seeks in-house radiologist to read studies and oversee contrast studies. Retired radiologists welcome. Contact Ed at 559-765-7988 Hospitalist physician needed in Fresno. Send resume/CV to Community Hospitalist Medical Group, 1180 E. Shaw, Fresno, CA 93710.

TULARE .

FOR LEASE / RENT / SALE

Class ‘A’ Medical Space • Visalia • 1,760 sf, all/ part available for lease. Across the street from Kaweah Delta Hospital. Call 559-804-7419 or 804-7421. See ad on page 11 for pitures/details.

Prime location medical offices, across the street from Visalia Medical Clinic. 2,200 sf. 5601 W. Hillsdale Ave. Visalia. Call 559-786-0512 Office space in prime medical location at 220 S. Akers St., Visalia. Perfect for primary care or allergy specialist to open practice in vacated allergist office.

KERN FOR SALE 1880s Victorian office building, corner lot next to Cancer Center & San Joaquin Hosp. 1,200 sf, off-street parking; wheel chair ramp; lobby; secretarial area; 3 offices; conference rm.; kitchen; basement; alarm; storage building. $450,000 OBO, 1402 26th St. Bakersfield. Call Don 661327-2367 or Mike 661-747-4553.

BAKERSFIELD FOR LEASE

Crown Pointe Phase III 2,000 to 20,000 sf 1150 Lerdo Hwy 1,766 to 3,793 sf 9330 Stockdale Hwy 5,754 sf 2019 21st Street 2,856 sf 3941 San Dimas Street 3,959 sf 2731 H Street 1,375 sf 513 W. Columbus Street 2,550 sf 2501 H Street 2,602 sf FOR SALE 513 W. Columbus St 2,550 sf

MARCH 2015 / VITAL SIGNS

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

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

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

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

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