October 2014

SAN FRANCISCO MEDICINE J O U R NA L O F T H E S A N F R A N C I S C O M E D I CA L S O C I E T Y

POLITICS AND ADVOCACY IN MEDICINE Influencing the Health of Your Patients through Politics

SFMS Voter Guide No on 45 No on 46 Yes on E

SFMS Leadership Election Information

Plus: New POLST Form Enclosed

VOL.87 NO.8 October 2014

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IN THIS ISSUE

SAN FRANCISCO MEDICINE

October 2014 Volume 87, Number 8

Politics and Advocacy in Medicine FEATURE ARTICLES

MONTHLY COLUMNS

7 Oppose Proposition 46

4

9 Oppose Proposition 45

11 President’s Message

Lawrence Cheung, MD, FAAD, FASDS

14 Making a Difference: Influencing My Patients’ Health

through Politics

Shannon Udovic-Constant, MD 15 The Potential of Advocacy: Why Get Involved?

Heyman Oo, MD, MPH

16 Vote “Yes” on Proposition E: The SFMS Champions the

San Francisco Soda Tax

John Maa, MD

17 Taking Action to Make Change: The SFMS Political Action Committee

George Fouras, MD, and Andrew Calman, MD

18 The November Ballot: Current Politics from the Perspective

of a Doctor’s Son

David Chiu

Membership Matters

13 Guest Editorial: A Hungry Child Has No Politics

Lucy Crain, MD 32 Medical Community News 34 Upcoming Events

OF INTEREST 19 POLST: The New Version Is in Effect

Jeff Newman, MD, MPH, and Steve Heilig, MPH

With new POLST form

20 SFMS 2014 Leadership Election Information

27 ACA 411: Tracking Health Reform in California

Voter Reference Guide SFMS and CMA have taken positions on three ballot initiatives. These issues are explained at greater length within this issue. Use this quick reference on election day!

NO on 45 Proposition 45 would grant the State Insurance Commissioner the authority to regulate health plan and insurance company premium rates.

NO on 46

Proposition 46 would quadruple the limit on medical malpractice awards, threaten personal privacy, and require random alcohol and drug testing of physicians.

YES on E

SF’s soda tax initiative would help fund health and nutrition programs and improve access to food by imposing a tax of two cents per ounce on the cost of sugar-sweetened beverages.

Editorial and Advertising Offices: 1003 A O’Reilly Ave. San Francisco, CA 94129 Phone: (415) 561-0850 Web: www.sfms.org

MEMBERSHIP MATTERS Activities and Actions of Interest to SFMS Members

Save the Date: SFMS Career Fair on November 5 Calling all residents, fellows, and employers! SFMS will be hosting its fifth annual Career Fair on November 5 at the CPMC Pacific Campus. The event runs from 5:00 p.m. until 8:00 p.m. and is complimentary to residents and fellows from the four San Francisco-based residency programs. This is an excellent opportunity for physicians looking to practice in the Bay Area to network with representatives from a variety of practice types and settings, and for employers to connect with physician job seekers.

As part of an effort to make participation accessible to all, we are offering a tiered pricing structure for employers; solo/ small group physician member practices can exhibit free of charge. For event details or to inquire about exhibiting, contact the Membership Department at (415) 561-0850 or visit www. sfms.org/Membership/StudentResidents.aspx.

SFMS Spotlights No on 46 at General Meeting

Bright smiles were seen all around by those who attended the September SFMS General Meeting at the Golden Gate Yacht Club, as SFMS President Lawrence Cheung, MD, warmly welcomed eighty local physicians and residents to the annual event. Featured speaker and CMA President Richard Thorp, MD, delivered an informative presentation about the SFMS and CMA legislative advocacy efforts to preserve MICRA and protect access to quality health care and patient privacy. Visit the SFMS Facebook or Flickr pages for more photos from the General Meeting.

Standardized Prior Authorization Form for Prescription Medications Effective October 1

A new law (SB 866) is requiring that all insurers, health plans (and their contracting medical groups/IPAs), and providers use a standardized two-page form when requesting prior authorization for prescription drug benefits.

Additionally, if a health plan or insurer fails to use or accept the prior authorization form, or fails to make a determination within two business days, the prior authorization request is deemed approved. In the past, plans had five business days to make a determination, while practices were often forced to sort through hundreds of different prior authorization forms to locate the one needed. Prescribing physicians must submit (and plans and insurers must accept) the new, standardized two-page 4

form for medications where a prior authorization is required.

However, the standardized form does not apply to requests for authorization of procedures, nor does it expand the list of medications that require prior authorization. For more information on the standardized form, please visit http://bit.ly/Zb9gFK.

New CMS Rule Changes Meaningful Use Timeline

The Centers for Medicare and Medicaid Services (CMS) published a new final rule that will provide eligible professionals participating in the Medicare and Medi-Cal electronic health record (EHR) incentive program an additional year to upgrade their certified electronic health record technology (CEHRT) and revise the meaningful use timeline. The rule went into effect on October 1, 2014.

The final rule will allow eligible professionals to use 2011 Edition CEHRT or a combination of 2011 and the 2014 Edition CEHRT for the 2014 EHR reporting period to demonstrate meaningful use. Eligible professionals who were scheduled to begin Stage 2 in 2014 will not be required to begin Stage 2 until 2015 if they attest that they could not fully implement the 2014 Edition CEHRT due to delays in availability of the 2014 Edition CEHRT for the 2014 reporting period. The final rule will also revise the meaningful use timeline for Stage 3 to begin in 2017 for eligible professionals. CMS, however, emphasizes that beginning in 2015, all providers will be required to report using the 2014 Edition CEHRT to successfully demonstrate meaningful use.

To access more detailed information on the federal EHR incentive program and meaningful use, please visit http://bit. ly/1smlTrZ.

SFMS Member Appointed Newest San Francisco Health Commissioner

David Pating, MD, an SFMS board member and chief of addiction medicine at Kaiser San Francisco, was appointed and sworn in as a member of the San Francisco Health Commission by Mayor Ed Lee. The Health Commission oversees all activities of the health services of the City and County of San Francisco, including the Department of Public Health and San Francisco General Hospital. Dr. Pating’s nomination was strongly endorsed by the SFMS, and he joins SFMS past-President Edward Chow, MD, Commission President.

Pating, an assistant clinical professor in psychiatry at UCSF and vice chair of the California Mental Health Services Oversight and Accountability Commission, has been a guest editor of the SFMS journal San Francisco Medicine and president of the California Society of Addiction Medicine, among many other positions and contributions.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

Hydrocodone Products Reclassified to Schedule II The federal government’s new rules governing hundreds of medicines containing hydrocodone went into effect on October 6, 2014. These drugs have been reclassified as Schedule II substances, in line with oxycodone and morphine.

This reclassification has been applied to all drugs containing both hydrocodone (which by itself was already classified a Schedule II drug) and specified amounts of other substances, such as acetaminophen or aspirin.

Patients taking Schedule II drugs are limited to a 90-day maximum supply of medication and must see a provider to get a refill. (Under the Schedule III classification, a prescription could be refilled five times before the patient had to see a physician.) Generally, physicians will not be allowed to call, fax, or e-mail in a prescription to a pharmacy; instead, patients must present a written prescription. For more details about the reclassification, please visit http://bit.ly/1o1cXmW.

Legislature Passes SB 964 to Require Annual Reports from Insurers on Network Adequacy

The California legislature has passed a bill that will require Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks. The bill also requires DMHC to post annual reviews regarding plan compliance on its website.

SB 964—supported by SFMS and CMA—was signed into law by Governor Brown in late September. With roughly 1.4 million Californians newly enrolled in Covered California products since October 2013, the importance of adequate provider networks has been paramount. New insurance products with narrowed networks have made it exceedingly difficult for both physicians and patients to find out who is in and out of these networks.

Anthem Blue Cross Claims Underpaid Due to System Error

The California Medical Association (CMA) has received physician complaints that Anthem Blue Cross is applying a sequestration cut to their payments, causing some claims to be underpaid. The issue affects claims in which Medicare is the patient’s primary plan and Anthem Blue Cross CalPERS is the supplemental plan. After Medicare processes the claim and forwards on, Anthem’s system appears to be applying, in error, a 2 percent sequestration cut to the amount they would normally pay as a supplemental plan. While the individual amounts are small, they can quickly add up for a practice.

CMA escalated the issue to Anthem and has learned that a system issue is causing the underpayments. Anthem is reporting that it does not anticipate a fix until 2015, but will explore a workaround to prevent this error until the fix is implemented.

CMA has asked Anthem to identify the claims that have been underpaid to date, automatically reprocess affected claims, and continue reprocessing affected claims on a monthly basis until the fix is implemented.

Coming Soon to an Inbox Near You: Membership Renewal

2015 membership renewals are right around the corner! Make sure you continue to receive the benefits of SFMS and CMA by renewing your membership. There are three easy ways to renew your dues again this year: • Mail or fax in your completed renewal.

• Renew online at www.sfms.org with your credit card.

• Enroll in the Easy Pay (quarterly installments) Automatic Dues Renewal Plan by contacting SFMS, (415) 561-0850 or membership@sfms.org.

WWW.SFMS.ORG

October 2014 Volume 87, Number 8 Editor Gordon Fung, MD, PhD Managing Editor Amanda Denz, MA Copy Editor Mary VanClay

EDITORIAL BOARD Editor Gordon Fung, MD, PhD Obituarist Erica Goode, MD, MPH Stephen Askin, MD Erica Goode, MD, MPH Toni Brayer, MD Shieva Khayam-Bashi, MD Linda Hawes Clever, MD Arthur Lyons, MD John Maa, MD Chunbo Cai, MD Payal Bhandari, MD David Pating, MD SFMS OFFICERS President Lawrence Cheung, MD President-Elect Roger S. Eng, MD Secretary Richard A. Podolin, MD Treasurer Man-Kit Leung, MD Immediate Past President Shannon UdovicConstant, MD SFMS STAFF Executive Director and CEO Mary Lou Licwinko, JD, MHSA Associate Executive Director, Public Health and Education Steve Heilig, MPH Associate Executive Director, Membership and Marketing Jessica Kuo, MBA Director of Administration Posi Lyon Membership Assistant Ariel Young BOARD OF DIRECTORS Term: Jan 2014-Dec 2016 William J. Black, MD Benjamin C.K. Lau, MD Ingrid T. Lim, MD Keith E. Loring, MD Ryan Padrez, MD Rachel H.C. Shu, MD Paul J. Turek, MD

Term: Jan 2013-Dec 2015 Charles E. Binkley, MD Gary L. Chan, MD Katherine E. Herz, MD David R. Pating, MD Cynthia A. Point, MD Lisa W. Tang, MD Joseph Woo, MD

Term: Jan 2012-Dec 2014 Andrew F. Calman, MD Steven H. Fugaro, MD Brian Grady, MD John Maa, MD Todd A. May, MD Kimberly L. Newell, MD William T. Prey, MD

CMA Trustee Shannon Udovic-Constant, MD AMA Delegate Robert J. Margolin, MD AMA Alternate Gordon L. Fung, MD

OCTOBER 2014 SAN FRANCISCO MEDICINE

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oppose prop . 46 a costly threat to your personal privacy californians can't afford .

Prop. 46 is Costly for Consumers • Trial lawyers out to profit from medical lawsuits carelessly threw Prop. 46 together without any concern for your pocketbook or your privacy, your health or your health care.

• If they get their way, medical lawsuits and jury awards will skyrocket. Someone will have to pay those costs. And that someone…is you.

Prop. 46 Jeopardizes People’s Access to their Trusted Doctors • If Prop. 46 passes and California’s medical liability cap goes up, you could also lose your trusted doctor. It’s true. Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable.

• Even respected community clinics, including Planned Parenthood, warn that specialists like OB-GYNs will have no choice but to reduce or eliminate vital services, especially for women and families in underserved areas.

Prop. 46 Threatens People’s Personal Privacy • Money isn’t the only thing Prop. 46 will cost you. It could cost you your personal privacy, and the doctors you trust and depend on.

• Prop. 46 forces doctors and pharmacists to use a massive statewide database 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 – none.

• And who controls the database? The government – in an age when government already has too many tools for violating your privacy.

That’s why a diverse and growing coalition of trusted doctors, community health clinics, hospitals, family-planning organizations, educators, local leaders, public safety officials, businesses and working men and women urge Californians to oppose Prop. 46.

Increased costs. Losing your doctor. Threatening your privacy.

Exactly what happens when trial lawyers play doctor.

No on Prop. 46 Paid for by NO on 46 − Patients, Providers and Healthcare Insurers to Protect Access and Contain Health Costs, with major funding from the Cooperative of American Physicians Independent Expenditure Committee and the California Medical Association Physicians’ Issues Committee.

Oppose Proposition 46 Prevent Increased Health Care Costs and Protect Access to Care – Vote No on 46 Over the last several months, you may have read information about the Medical Injury Compensation Reform Act (MICRA) lawsuit initiative, Prop 46, in the pages of this journal, on sfms.org, and likely from materials from the hundreds of coalition partners who have all pledged to oppose the measure this November.

An Overview of Prop. 46

The measure is complex and contains three separate and distinct pieces that trial-lawyer proponents have thrown together in an effort to mask their real intent—quadrupling noneconomic damages in MICRA, pulling money directly out of the health care delivery system, and putting it into their own pockets. Prop. 46 will:

Quadruple California’s cap on non-economic damages that can be assessed in medical negligence

lawsuits to $1.1 million, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs, dramatically increase your annual medical liability insurance premium, and reduce access to quality health care in California.

Add significant bureaucratic requirements for prescribing controlled substances by requiring

physicians, pharmacists, and veterinarians to check a defunct CURES database before prescribing schedule II or III drugs.

Mandate drug and alcohol testing on physicians. Prop. 46 imposes a “presumption of negligence” im-

mediately upon a positive test or if a physician is unable to take the test within the mandated 12-hour timeframe.

Raising Health Care Costs

We know that trial lawyers out to profit from medical lawsuits drafted Prop. 46 sloppily, and it will result in higher health care costs for everyone. We’ll see money come directly out of the health care delivery system and straight into the pockets of the lawyers who stand to gain most. According to California’s independent, nonpartisan Legislative Analyst’s Office (LAO), Prop.

46 could increase costs for state and local governments by “several hundred million dollars annually.”

State and local governments are hit with higher costs in two ways: They provide health care benefits for current and retired government employees AND they also provide health care services for low-income residents through Medi-Cal and other locally run health care programs such as community clinics and public hospitals.

Higher health care costs for state and local governments would reduce funding available for vital local services like police, fire, social services, parks, and libraries, to name a few. If Prop. 46 passes, everyone will carry the burden of these increased costs.

WWW.SFMS.ORG

According to a study by California’s former legislative analyst, Prop. 46 will increase health care costs across all sectors by $9.9 billion annually, which translates to around $1,000 per year in higher health costs for a family of four. For many families across

the state, that means a tough choice between groceries and health care—one that we can’t afford to let happen.

Threatening Privacy

Prop. 46 includes a provision that could significantly jeopardize the privacy of patients’ personal prescription medical information. The initiative forces doctors and pharmacists to use a massive statewide database, called CURES, which contains a record of every dispensed prescription of a Schedule II, III, or IV substance. 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.

Prop. 46 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.

Another concerning piece of this provision is that the massive ramp-up of this database will significantly put at risk patients’ private medical information. Prop. 46 doesn’t contain any provisions or funding to upgrade the database with increased security standards to protect personal prescription information from government intrusion, hacking, theft, or improper access by nonmedical professionals.

What You Can Do

For the future of medicine in California and patient safety, please get involved in the campaign.

Donate to the campaign. It’s as simple as visiting NoOn46.com and clicking on “contribute.” Every dollar counts, as we need to produce materials to ensure that voters understand the risks associated with Prop. 46.

Order campaign material. We’ve got buttons,

office posters, patient brochures, lab coat cards, and more, all available by contacting SFMS at membership@sfms.org and (415) 561-0850 x200.

Spread the word about No On 46. As physicians, we see dozens of patients daily. Take the time to let them know about the dangers and real intent behind Prop. 46.

OCTOBER 2014 SAN FRANCISCO MEDICINE

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Oppose Proposition 45 The “Other” Trial Lawyer Proposition Puts a State Politician in Charge of Your Patients’ Health Care There is more than one proposition on the California ballot this November that threatens health care providers and patients.

The same groups pushing to change the Medical Injury Compensation Reform Act (MICRA)—Consumer Watchdog and its trial-lawyer allies—are also pushing Proposition 45, which would give the State Insurance Commissioner sweeping new power over health care benefits, rates, and copayments for individuals and small groups.

The San Francisco Medical Society is part of a broad coalition, including the California Medical Association, California Hospital Association, specialty societies, hospitals, health plans, labor, and small businesses, that is opposed to Prop 45.

CMA President Dr. Richard Thorp explained why so many provider groups are against Prop 45: “Prop 45 threatens physicians’ ability to provide the care that patients need by giving a single elected politician—the Insurance Commissioner—vast new power over health care benefits and rates. With recent cuts to the MediCal program, we are already seeing the devastating impact it can have on patient access to care when politicians cut reimbursement rates below the cost of providing care. Additional cuts would result in an even more difficult time for patients who need care the most.”

Beyond these flaws, Prop 45 has a hidden agenda: allowing trial lawyers and the sponsors to file costly new health care lawsuits. They buried a provision in the fine print that allows them to “intervene” in the regulatory process created under the initiative and file lawsuits if they don’t like the results. In doing so, they can pocket millions of dollars in so-called “intervenor fees”— as much as $675/hour. In fact, the proponents have already received more than $11.5 million from a similar provision used in auto and home insurance regulation. Many business groups and taxpayer organizations also oppose Prop 45 because it sets up a costly, duplicative new bureaucracy, when California already has multiple regulators overseeing health care.

Lastly, Prop 45 establishes new and conflicting rules that could interfere with California’s implementation of the Affordable Care Act—providing more uncertainty, delay, and confusion at a time when California providers and patients are already dealing with massive changes to our health care system.

For information or to sign up to oppose Prop 45, visit www.stophighercosts.org.

Join the San Francisco Medical Society and

VOTE NO on Proposition 45.

Just Too Much Power for One Politician.

“Proposition 45 gives one politician, the State Insurance Commissioner, power over health care benefits and treatment options, which can have a significant impact on patient care. Treatment decisions should be made by doctors and patients—not by someone with a political agenda.”

Dr. Man-Kit Leung, Board Member of the San Francisco Medical Society

Nurses, doctors, community health clinics, business, labor and taxpayer groups oppose Proposition 45.

PaId fOr by NO ON 45 – CalIfOrNIaNS agaINST HIgHer HealTH Care COSTS. MaJOr fuNdINg by KaISer fOuNdaTION HealTH PlaN, INC., WellPOINT, INC. aNd blue SHIeld Of CalIfOrNIa WITH a COalITION Of dOCTOrS, NurSeS, HOSPITalS, HealTH PlaNS, aNd CalIfOrNIa eMPlOyerS.

www.NoOn45.org

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The Enright Room at CPMC Pacific Campus 2333 Buchanan St, San Francisco Refreshments and hors d’oeuvres provided by the SFMS

For detailed event information, including a list of confirmed exhibitors, please visit http://www.sfms.org/Membership/StudentResidents.aspx

EVENT OPEN TO ALL UCSF, CPMC, ST. MARY’S, AND KAISER PERMANENTE SF RESIDENTS AND FELLOWS

PRESIDENT’S MESSAGE Lawrence Cheung, MD, FAAD, FASDS

Health and Politics, Both Local and Beyond This issue of the San Francisco Medicine deals with a subject that is very important to me: physician advocacy and politics in medicine.

Indeed, at our strategic retreat last year, we felt that this component is so important and integral to the Society that we specifically included it as one of the four major goals for the Society: “to be a recognized resource and advocate with expertise on medicine and public health issues in our community.”

While this year’s political activity has been dominated by the battle over Proposition 46, the ill-conceived trial lawyer’s attempt to overturn MICRA, we have many other issues to deal with as well. The SFMS is, in many ways, a perfect vehicle for physicians to engage in advocacy because it allows individual physicians to amplify our collective voices to potentially improve the health of the 800,000 souls living in San Francisco.

For those who are interested in physician advocacy but do not know where to start, there are essentially three opportunities: the California Medical Association House of Delegates (CMA HOD), the annual Legislative Day in Sacramento, and the SFMS Political Action Committee (PAC).

I remember my first year as a delegate to the HOD as quite overwhelming. Luckily, Dr. Hugh Vincent served as my mentor and helped me make sense of the process. Essentially, the job of the delegate starts early in the summer, when we help draft our own resolutions and review those submitted to the CMA HOD meeting in October. Usually done over the course of three marathon meetings, we decide as a delegation whether to take a position on each resolution submitted to the HOD. These resolutions are assigned to one of six reference committees (Science/Public Health, Government Health Programs/Health System Reform, CMA Membership/Finance/ Governance, Insurance/Reimbursement, Quality/Ethics/ Medical Practice Issues, and Health Professions/Facilities).

Each reference committee holds a hearing in which testimony for and against the resolution is heard, and the committee then renders an opinion on the resolution. It is then up to the entire House of Delegates to vote on each and every one of the resolutions. I am proud to note that the SFMS delegation has been prolific under the leadership of Dr. Steven Follansbee and will continue to be so under the new leadership of Dr. Gordon Fung. We have traditionally submitted and had the HOD pass many resolutions that have had significant public health impact — on HIV, environmental health, reproductive health, and many other topics. What most members do not know is that anyone can author a resolution and have it submitted to the CMA HOD. Our delegates will help fine-tune the wording and help shepherd it along the way to the CMA. Participation in the annual Legislative Day is open to all members of the Society. Typically held in April, “Leg Day” proWWW.SFMS.ORG

vides us a chance to meet with our own representatives in both the State Senate and Assembly. Typically, the day starts with an address by the California Governor or Lieutenant Governor regarding the state of health in California. This is followed by a briefing on those bills of significance to California physicians that are being considered by either the Senate or the Assembly. Participants are given background information and talking points on each bill ahead of time. As a delegation, we then meet and discuss pertinent bills with our local State Senator or Assemblymember and we ask for either a “yes” or “no” vote on each bill. If you have not participated in our annual Legislative Day, I urge that you consider doing so, because it will give you some perspective about how politics work in Sacramento.

Lastly, I want to focus on the work of our Political Action Committee. The PAC is currently chaired by Dr. George Fouras and works to identify and support candidates who are sympathetic to causes relevant to the health of San Francisco. We meet prior to our general Board of Directors meeting. Every other year, we host a Candidate’s Night during which candidates for each Board of Supervisor District come to our office and explain their vision. When we have identified candidates who are sympathetic to our causes (such as Supervisor David Chiu who, after our discussions, has spoken strongly against Prop 46), we will support the candidate financially and via official endorsement. At times, we will host fund-raising events for our candidates; I recently hosted one at my home for Supervisor Chiu. As the saying goes, “all politics are local,” and we try to remember that—while also striving to be a presence in Sacramento and beyond as well. The bottom line for our work is the health of our patients and community.

See the summary from the 2013 HOD here: http://www. sfms.org/Advocacy/HealthPolicyReport.aspx

OCTOBER 2014 SAN FRANCISCO MEDICINE

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GUEST EDITORIAL Lucy Crain, MD, MPH, FAAP

A Hungry Child Has No Politics Editors’ note: In this issue of our journal, “politics” is the theme and political considerations are everywhere herein. Thus we thought we’d turn this page over to an issue that should be above political consideration—children who do not have enough to eat. Longtime SFMS leader Lucy Crain, MD, pediatrician and activist in the best sense of the word, here shares an important effort to address this failing in our own community.

—Gordon Fung, MD, and Steve Heilig, MPH

One in four San Francisco Bay Area children goes to bed hungry each night due to lack of food.

Who’s Hungry? You Can’t Tell by Looking! is a photo education project designed to promote awareness and provide information about the prevalence of childhood hunger in northern California, aimed at health care professionals and the general public. Envisioned and produced by pediatrician members of California Chapter I of the American Academy of Pediatrics (several of whom are members of SFMS) in collaboration with local photographer Karen Ande, the project encourages screening and referral for hunger/food insecurity in our community.

Working with the Food Security Task Force of SFDPH, the SF Food Bank, the SF School District, and other local community organizations to provide information about access to food and nutrition resources in the San Francisco Bay Area, we have the following goals: promote awareness of the prevalence of child hunger/food insecurity to our membership and the general public; encourage routine screening using the two-item Household Food Security Survey screen (see the end of this article); collaborate with local food banks, public health, school district, and other community-based organizations to improve referral and access to nutrition resources for food-insecure families; influence policy to help find solutions for food insecurity/hunger.

Again, one in four San Francisco Bay Area children goes to bed hungry each night due to lack of food. This and families’ lack of money to buy adequate food to feed themselves define food insecurity. Pediatricians know that child hunger contributes to learning and behavior problems and a myriad of growth and developmental issues. We also recognize that parents, especially mothers, routinely go hungry in order to provide food for their children. We might not realize the prevalence of food insecurity or hunger within our own communities and our own patient populations. In fact, you cannot tell by looking whether a child is hungry or food insecure, as Ande’s photographs demonstrate. Photos of children whose consenting parents completed the screening questionnaire were taken at a local health fair and at other city venues last fall and winter. Of the first twenty families who consented to WWW.SFMS.ORG

have their children photographed, ten screened hungry/food insecure. The photographic exhibit was introduced in May by Supervisor John Avalos and continues to hang in his office in City Hall for public viewing before moving to other sites.

San Francisco Mayor Ed Lee established the Food Security Task Force and has pledged to find solutions for ending hunger in our community by 2020. As physicians, we need to acknowledge that you can’t tell just by looking whether a child or adult is hungry. We encourage all pediatric and adult primary health care professionals to routinely screen for food insecurity/hunger using the two questions below, and to refer those screening positive to appropriate community resources.

Awareness of this problem is a crucial first step; doing something about it is the essential next one.

Screening Questions

In 2010, Hager and associates confirmed (Pediatrics 2010; 126:e26-e32) the validity of a two-item screen for food-insecurity risk, having analyzed the USDA survey of 30,098 families, based on the eighteen-item Household Food Security Survey (HFSS). That multisite survey found 23.7 percent of families to be food insecure. Working to develop a more succinct screening instrument applicable to routine use, they found the following two-item screen brief, valid, sensitive, and specific:

(a) Within the past 12 months, we worried whether our food would run out before we got money to buy more. (b) Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.

Lucy Crain, MD, MPH, FAAP, is a developmental-behavioral pediatrician. She served as Clinical Professor of Pediatrics at UCSF from 1988 to 2003 and also founded and directed their Pediatric Disabilities and Down Syndrome Clinic. Since 2004, she has served as a pediatrician in Developmental Medicine at the Mary L Johnson Clinic. She is a well-known advocate of children’s health care and longtime member of the SFMS. OCTOBER 2014 SAN FRANCISCO MEDICINE

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Politics and Advocacy in Medicine

MAKING A DIFFERENCE Influencing My Patients’ Health through Politics Shannon Udovic-Constant, MD I learned a long time ago that, as an individual physician, I directly affect the health and well-being of my own patients, one patient at a time. The power of

organized medicine is that physicians across all specialties can have one voice to address the broader health care issues facing patients and their physicians. This often occurs by influencing health care policy and the political arena.

I caught the advocacy bug early in my physician career. It started with my frustration with my prescription prescribing data being packaged with my AMA masterfile info and then targeted by drug representatives to try to influence me to prescribe more expensive drugs. As patients were struggling to pay higher and higher rates for their health care, this practice that unnecessarily increased health care costs was infuriating to me. Rather than stew about it or just complain to my husband at the dinner table, I drafted a resolution for the CMA House of Delegates to require this practice to continue only if the physician opted in. Unfortunately, the resolution did not pass, but I successfully raised the issue to the attention of many and the AMA started advertising the ways physicians could opt out of their data being shared in this way. Medium success.

My next foray into influencing policy came when my colleague, Dr. Chuck Wibbelsman, asked me to be a cosponsor of a resolution to the CMA that would support allowing adolescents to consent for the prevention of sexually transmitted infections (STIs). This was the natural extension of current confidentiality laws that allow teens to consent for testing and treatment of STIs. For those of us caring for young people, it was frustrating to have a successful way to prevent cervical cancer with the HPV vaccine and not be able to give it to teens, who were often at the highest risk if a parent wasn’t attending visits or was in denial about their teens’ risks. This resolution easily passed and became CMA policy. Then a California legislator wrote the bill to support this, and it passed. This is now California law. Major success.

Next I turned my attention toward the very real problem in my practice of about one-third of my patients being diagnosed as overweight, despite my rabid counseling around healthy eating, avoiding all sugar-sweetened beverages, and increasing exercise. It became necessary to do something different. Taking lessons from the campaign waged at curtailing tobacco-related disease, I began to look at addressing childhood overweight through broader public health efforts. I felt that this was the only way that I could somehow stop the growing numbers of teens in my practice being diagnosed with type II diabetes. I have written legislation to limit marketing to children (see article by Dr. John Maa on page 16). I have lobbied for passage of increased physical education in schools and potable drinking water at all 14

California public schools. There is still a lot of work to be done in this area, but I am seeing some slow progress.

The natural extension of passing policy for the CMA and lobbying for the passage of legislation is to make sure that my elected officials know who I am. This is very helpful when I call and ask for a certain vote. I accomplish this by donating individually to campaigns, being available for press conferences on legislation that has a health angle, and attending legislative days in Sacramento to meet with my legislators. In addition, I give to both the SFMS Political Action Committee and CALPAC, which is CMA’s PAC (of which I also serve on the Executive Committee). Through our PACs, we can give larger dollar amounts to candidates who support issues important to physicians and our patients.

Why do I volunteer so much of my time working to shape health care policy and then working to influence politics? It matters for our profession and for the health of our patients. If we don’t get involved, then others will decide for us. I encourage you to get involved. If you ever find yourself complaining around the dinner table about something that should be a law, then please send a message to me or another SFMS leader, because we can take it to the CMA House of Delegates. In the words of the late Maya Angelou, “Ask for what you want and be prepared to get it.”

Shannon Udovic-Constant is a pediatrician at Kaiser Permanente in San Francisco and an associate clinical professor at UCSF in the Department of Pediatrics. She is the Immediate Past President of the SFMS. Dr. Udovic-Constant is pictured below speaking in support of San Francisco’s Proposition E at city hall.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

Politics and Advocacy in Medicine

THE POTENTIAL OF ADVOCACY Why Get Involved?

Heyman Oo, MD, MPH Within the first few months of my pediatric residency at UCSF, I quickly learned how very easy it is to feel overwhelmed and lost. The sheer magnitude of

medical knowledge to be learned, the pace and volume of work to be accomplished, and the vastly intricate and complex health care system to be navigated makes the day-to-day of residency feel like running around an M.C. Escher painting. For a young physician trainee, advocacy could easily take a backseat to it all, since tackling systemic inefficiencies and injustices would be yet another check box on an already too-long list of check boxes.

Rather than be discouraged by “the system,” however, working to give a voice to patients who cannot speak for themselves can actually be a way to self-empower.

At our public clinics at SFGH, there has been a rise in recently arrived immigrant children and teens coming from Central America. In the news, we heard stories of border protests, crowded detention centers, and the impossibility of immigration reform. In our exam rooms, though, we heard stories about the fear, trauma, and pervasive drug/gang violence that these children confronted on a daily basis in their home countries. It simply did not seem fair to have the experiences and challenges of our patients overshadowed by political agendas, so we worked to make sure that their voices were heard.

In collaboration with other residents and attendings, we reached out to the media with op-ed pieces, perspective pieces, and letter-to-the-editor submissions. As the pediatricians caring for these kids, our goal was to ensure that their stories were heard and that the political discussions taking place about our patients were in the best interest of our patients. By reaching out of our professional silos, we initiated discussions with the school system educating these new students, the mental health workers counseling these victims of trauma, the lawyers providing pro bono legal services to these asylum seekers, and the Mayor’s Office investing resources into all of these various support services for these children.

We know that a child’s health is intricately linked to his or her social environment, so it is crucial to our work as pediatricians to partner with those making polices that shape those environments. Working to ensure that these immigrant children will receive the social services they need to flourish is part of our medical duty. And while I know that advocating for our patients on the local level may not erase their previous traumas or fix the larger societal problems that brought them to us in the first place, making sure their voices are heard can make a difference for their futures.

Advocacy, to me, is synonymous with voice, and being an advocate means being a voice for people and populations who do not normally have the opportunity to be heard. The majorWWW.SFMS.ORG

ity of physicians advocate on a daily basis for their individual patients—whether it be to insurance companies, to hospital administrators, or to family members—trying to ensure that their patients obtain the care they need. It can be challenging to advocate on a larger scale given the demands of modern medical practice, but perhaps it should be viewed as necessary to continually be self-empowered.

Making a difference is why many of my young colleagues and I chose a career in medicine. So, while my day-to-day may continue to feel like running up and down sideways stairs, unsure if I’m making a difference, by giving a voice to my patients through public advocacy I remind myself that it is still possible.

Heyman Oo, MD, is a first-year resident in the UCSF Pediatrics Leadership for the Underserved (PLUS) program and member of the SFMS. She received her MD from UC San Diego School and MPH from the Harvard School of Public Health. She is a recipient of Leonard Tow Humanism in Medicine Award from the Association of American Medical Colleges and a former Benjamin Kean Tropical Medicine Fellow.

OCTOBER 2014 SAN FRANCISCO MEDICINE

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Politics and Advocacy in Medicine

VOTE “YES” ON PROPOSITION E The SFMS Champions the San Francisco Soda Tax John Maa, MD The SFMS has a long history of effectiveness in physician advocacy for the public health of San Francisco. The most

recent success has resulted in the placement of a soda tax on the November 4, 2014, ballot by the SF Board of Supervisors, which seeks to reduce the impact of sugar-sweetened beverages on the incidence of diabetes, obesity, and tooth decay. The soda tax has been renamed Proposition E and will raise the price of soda by 2 pennies per ounce (the price of a 12-ounce soda will increase 24 cents).

In 2011, with the intent to improve school nutrition, SFMS Past President Shannon Udovic-Constant, MD, first championed a CMA resolution titled “Marketing of Unhealthy Food and Beverages to Children,” which would inspire legislative efforts in Sacramento to ban sugary drinks from being sold on middle and high school campuses. In 2014, her pioneering efforts were reflected in Senate Bill 1000, by Bill Mooning, which sought to place a warning label on sodas, and also by the invitation to the SFMS leadership from Supervisors Wiener and Mar to assist with the key steps to move Prop E through City Hall.

The SFMS PAC was one of the earliest financial supporters of the legislation, and in the spring Dr. Udovic Constant secured the endorsement and financial support of the CMA at a Board of Trustees meeting. SFMS President Lawrence Cheung and other SFMS members spoke at multiple City Hall hearings, press events, and editorial meetings on behalf of the soda tax, and Dr. UdovicConstant was featured at the press conference on the steps of City Hall on the day that the Board of Supervisors formally voted to place the soda tax on the November ballot. The SFMS is featured in the SF Voter Information pamphlet for Prop E both in the proponent’s statement as well as the rebuttal to the opposition arguments made by the soda industry.

President Cheung has praised this opportunity for San Francisco to become the first major city in America to actively decrease the consumption of sugar-sweetened beverages and support programs that will improve our city’s health. The revenue from the tax on soda and other sugar-sweetened beverages will be dedicated to fund active recreation and nutrition programs in schools, parks, and recreation centers; food-access initiatives; drinking fountain and water bottle filling stations; and dental health services. Disadvantaged and low-income communities, particularly those most impacted by the diabetes and obesity epidemics, will be prioritized in funding decisions. San Francisco’s Office of Economic Analysis estimates that a soda tax could reduce consumption as much as 31 percent and provide up to $54 million annually to support health, nutrition, and active recreation programs.

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When President Obama raised the idea of a national soda tax in 2009, the beverage industry went into overdrive, spending millions of dollars lobbying Congress to make sure that idea never saw the light of day. After Mexico instituted a sugar and soda tax in January of 2014, national soda consumption fell by 7 percent.

Recently, Connecticut Congresswoman Rosa De Lauro has proposed a national soda tax to revive the dialogue. Extensive scientific evidence has highlighted the hidden dangers of the “liquid sugar” dissolved in soda. First, the high dissolved-sugar content is not obvious to the drinker, who may mistakenly believe that the caloric content is similar to water. Second, the normal signals to the brain that one is full are not activated by liquid sugar, and the stress on the pancreas and liver result in greater weight gain than from consuming solid food with an equal calorie content.

After one learns that ten packets of sugar are dissolved in the average 12-ounce soda, the intelligence, courage, and vision of our SF Supervisors to sponsor the soda tax and assist the citizens of San Francisco in improving their own health becomes clear. The campaign is also a testament to the key role that SFMS can play in physician advocacy and government to promote the health of San Francisco. Please encourage your family, friends, and colleagues to vote “Yes on E.” For more information or to contribute to this public health campaign, please visit www.sfms.org/ForPatients/ SFSodaTax.aspx.

John Maa, MD, is chair of the University of California Office of the President Tobacco Related Disease Research Program and is on the medical staff at Marin General Hospital. Dr. Maa is also an Assistant Professor of Surgery and Associate Director of the Surgery Clerkship for the UCSF. He earned his medical degree at Harvard Medical School, completed residency training at UCSF, and served as a captain in the medical corps of the U.S. Army for nine years. He is currently on the SFMS board of directors as well as the editorial board for San Francisco Medicine.

Photo: SFMS President, Lawrence Cheung, MD, speaks out in support of Prop. E.

TAXING SODA: A DISSENTING VIEW The SFMS has a strong “support” position on Proposition E, the soda tax, for reasons described here by Dr. Maa. We have had one member, cardiologist Michel Accad, MD, voice opposition to our position. His editorial “Prohibition Then and Now” is available at http://bit.ly/1rFsKx2.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

Politics and Advocacy in Medicine

TAKING ACTION TO MAKE CHANGE The SFMS Political Action Committee George Fouras, MD, and Andrew Calman, MD The SFMS PAC is dedicated to advocating for policies and candidates who support the goals and ideals of the SFMS and its physician community. SFMS

PAC has its own set of bylaws and board of directors. Members of the Board include SFMS Board members as well as other interested SFMS members. Any member of the SFMS is welcome to participate and to attend our meetings, which usually precede the general SFMS Board meeting. We are able to sustain our activities from donations that we receive from the SFMS membership.

Our Mission

The SFMS PAC exists to advocate for political candidates who share our beliefs regarding issues of public health, along with support for propositions and other legislative issues that support the overall mission and ideals of the SFMS.

and office holders, as well as to enjoy conversation over a glass of wine with your colleagues in a relaxing atmosphere. Finally, if you have a passion for politics or policy, you are encouraged to come to our PAC Board meetings and consider joining the Board. We are always looking for new ideas and energy!

George Fouras, MD, is an adolescent psychiatrist who works specifically with children in foster care. He is a longtime member and past president of the SFMS and serves as chair of the SFMS PAC. Andrew Calman, MD, practices ophthalmology at CPMC-St. Luke’s and teaches at CPMC and UCSF. He is past president of the California Eye Physicians and Surgeons and served for many years on the California Medicare Carrier Advisory Committee, as well as the National Health Policy Committee of the American Academy of Ophthalmology. He is past chair of the SFMS PAC.

Past Projects

A few of our recent activities have been the support of Proposition A (the SFGH rebuild) and of the statewide anti-tobacco initiative. In addition, we have supported the election of Richard Pan, MD, to the State Assembly and the election of Gavin Newsom, both for his second term as mayor of San Francisco and in his campaign for lieutenant governor.

Tracy Zweig Associates INC.

A

REGISTRY

&

PLACEMENT

FIRM

Current Projects

Our projects this year represent a broad range of issues.

We are planning a major outlay of funding, as many of our supported candidates are in hotly contested races. We are once again supporting the election of Richard Pan, MD, to the State Senate. Dr. Pan is a practicing pediatrician in the Davis area and one of only a handful of physicians who have been elected to the State Legislature. We are also supporting David Chiu, who comes from a medical family and is in a tight race against David Campos for the State Assembly seat being vacated by Tom Ammiano. Campos is being supported by trial attorneys, who are also promoting Proposition 46. We have provided support against Proposition 46, which is an attempt to increase the cap on noneconomic damages as part of MICRA, in addition to mandating drug testing for physicians.

Get Involved!

The most crucial way for members to become involved is to donate to the PAC. It is only through donations that we are able to do the work that we do. If you have more time, are interested in meeting potential candidates, or have a candidate or cause that you would like to support, you can attend a fund-raiser.

These provide a great opportunity to get to know candidates WWW.SFMS.ORG

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Voice: 800-919-9141 or 805-641-9141 FAX: 805-641-9143 tzweig@tracyzweig.com www.tracyzweig.com

OCTOBER 2014 SAN FRANCISCO MEDICINE

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Politics and Advocacy in Medicine

THE NOVEMBER BALLOT Current Politics from the Perspective of a Doctor’s Son David Chiu, President, San Francisco Board of Supervisors It was an honor to be invited by San Francisco Medicine to contribute an article on public policy topics of concern for physicians, particularly those on San Francisco’s November ballot. My immigrant mother’s dream

has always been to see her oldest son’s name published in a medical journal, although I suspect this is not exactly what she had in mind.

Life after Pre-Med

I come from a family of healers. My grandfather sold herbs— traditional Chinese medicines, not the San Francisco variety—in Taiwan. After growing up during the difficult years of World War II, his son—my father—immigrated to the United States to study Western medicine and become a physician. My brother became an acupuncturist and a professor of Eastern medicine, and a dozen of my aunts, uncles, and cousins are physicians throughout the United States. My parents hoped that I too would follow in the family tradition. I went to Harvard intending to become a doctor. However, after completing an undergraduate thesis on national health care political trends, I decided to go to law school and get a master’s degree in public policy.

After moving to San Francisco almost twenty years ago, I worked as a civil rights lawyer for an organization that had successfully fought the denial of health care to undocumented immigrants.

In 2008, I decided to run for the San Francisco Board of Supervisors.

During the past six years as the president of the Board of Supervisors, it has been important for me to bring diverse stakeholders together to diagnose problems, evaluate options, and seek to cure the ills challenging our city. On those many occasions when the worlds of medicine and politics collided, I have been grateful for insights from my physician friends and advisors, particularly from the San Francisco Medical Society. I worked closely with SFMS leaders to oppose continued drastic state government cuts to Medi-Cal, and I have been proud to work to backfill federal cuts to HIV/AIDS programs, allocate more resources to our city’s public health budgets, establish language access services for immigrant patients seeking treatment, advocate for San Francisco to be the first hepatitis B-free city in the country, and craft agreements to seismically retrofit the CPMC Cathedral Hill Hospital, St. Luke’s Hospital, and Chinese Hospital.

Big Soda: Making San Francisco Less Affordable

On the November ballot, there are two measures that could have an enormous impact on health care in the City of St. Francis.

The first is local Proposition E, which would levy a 2-cents-perounce tax on sugar-sweetened beverages and for which I am a cosponsor. I want to thank the SFMS and the medical community for its strong advocacy, as many medical experts have explained that a decline in soda consumption due to a sugary beverage tax would represent a major step forward in the fight against the epidemics of 18

diabetes and obesity.

Less attention has been paid to what Prop E will mean in the long term for health care affordability in San Francisco. For months, the $300-billion-per-year soda industry has bombarded voters with campaign materials that play on the fears of San Franciscans concerned about our city’s affordability crisis. Big Soda has been saying the tax is regressive and will raise grocery costs for the most needy in our city. These scare tactics just don’t hold up: The real issue of affordability is not about the cost of a 12-ounce can of cola but the impact of health care costs associated with sugary beverage consumption. Public health studies anticipate that a small increase in the price of sweetened, high-calorie drinks would lead consumers to avoid these products and substitute more nutritious, lower-priced choices. In addition to decreased consumption of sugary beverages, passing Prop E will create tens of millions of dollars of new revenues for nutrition, after-school, healthy foods, oral health, chronic disease, recreation and park, and physical education programs for our most vulnerable residents.

Protecting Access to Care

Also on the November ballot, the passage of state Proposition 46 could mean a profound increase in health care costs in San Francisco and throughout California. Among other things, Prop 46 would quadruple the Medical Injury Compensation Reform Act’s (MICRA) $250,000 cap on malpractice claims. Raising the MICRA ceiling for medical injury claims would result in higher malpractice insurance rates for medical professionals.

In the recent aftermath of the Affordable Care Act, the creation of the Covered California exchange, and great uncertainty over future health care costs, now is not the time to change MICRA. For me, as a former trial attorney, this issue is not about doctors versus lawyers. The reason community clinics, Planned Parenthood, women’s organizations, children’s groups, and many labor unions oppose Prop 46 is that the measure’s passage would result in skyrocketing health care costs, limiting care for those communities that are most in need. The state’s nonpartisan Legislative Analyst’s Office warns that raising MICRA’s cap would increase the health care costs of state and local governments by several hundreds of millions of dollars each year, resulting in severe cuts to vital community health programs, and translating to $1,000 in additional health costs each year for a family of four.

I hope you will join me in making sure that your colleagues, families, and friends understand what is at stake in the November 4 election and vote No on 46 and Yes on E. Editor’s Note: Supervisor David Chiu is also on the November ballot, as a candidate to represent the 17th Assembly District, San Francisco’s eastern neighborhoods. His opponent, Supervisor David Campos, is being supported by trial attorneys who advocate for Prop 46.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

POLST: New Version Is in Effect Jeff Newman, MD, MPH, and Steve Heilig, MPH

“When it came time for my family to discuss end-of-life care issues for my father, the POLST framework was invaluable. It greatly facilitated early and useful dialogue and allowed us to come to a very comfortable consensus despite a long-standing history of disagreement over his earlier long-term care issues.”

—Keith Loring, MD, FACEP, emergency physician and SFMS board member

Our San Francisco POLST Coalition, based at the SFMS, is pleased to provide the newly revised California POLST form and some talking points for physicians outlining key changes to the form. The revision

and resources were developed by a multispecialty, statewide group of physicians practicing in many settings.

We agree that the changes will expedite shared decision making by patients (and designated decision makers) with their physicians and encourage discussion of goals of care treatment options with family members and other clinicians who know the patients well.

While EMS, ED, and hospital experience with POLST documents have increased, we are still concerned that the documents are frequently not available when needed. R&D on POLST registries is underway. In the interim, we recommend that POLST be considered a high priority for data exchange within and among the various provider systems in San Francisco; this would require better incorporation into electronic medical record systems. Such efforts are underway but seem to be difficult.

SFMS is also participating in a citywide task force to improve advance care planning, including POLST, throughout San Francisco. We will report on this initiative in future issues of San Francisco Medicine.

2014 Physician Orders for Life-Sustaining Treatment (POLST) Key Talking Points for Health Care Providers Effective Date • California’s revised Physician Orders for Life-Sustaining Treatment (POLST) form went into effect on October 1, 2014.

• Previous versions of POLST will still be honored after the 2014 form goes into effect.

Instructions

• Begin using the revised POLST form on October 1, 2014, and discard old blank forms.

• It is ideal to complete a 2014 version of POLST—and void older versions of the form—when a patient’s POLST is updated with changes to its contents.

WWW.SFMS.ORG

Key Changes to the Form • In order to be consistent with Section A, treatment choices for Sections B and C have been switched in their order, and each section begins with the most aggressive and invasive treatment choices.

• In Section B, the choice of “Limited Additional Interventions” has been renamed “Selective Treatment,” and the choice of “Comfort Measures Only” has been renamed “ComfortFocused Treatment.”

• Goal statements have been added for each treatment choice in Section B. These descriptions help patients understand the goals of care within each option and aim to promote quality conversations with a patient and/or legally recognized decision maker. The goal statements are as follows: • Full Treatment: Primary goal of prolonging life by all medically effective means.

• Selective Treatment: Goal of treating medical conditions while avoiding burdensome measures.

• Comfort-Focused Treatment: Primary goal of maximizing comfort.

• In Section B, the Full Treatment option features a box that can be marked to indicate “Trial Period of Full Treatment.” This option is beneficial for patients who want to try short-term ventilatory support but do not want prolonged life support.

• “Address” was clarified and now reads as “Mailing Address.”

• The new “Office Use Only” box is in place for internal use only.

Reminders

• POLST is a voluntary form.

• Previously completed POLST forms remain valid.

• It is recommended that POLST be copied on pink paper to help ensure that the document stands out and is followed.

However, POLST on any color paper is valid.

• Copies and faxes of POLST are valid.

• Whenever possible, ensure that the Advance Directive and POLST form are consistent with each other.

Jeff Newman, MD, is adjunct professor, Institute for Health & Aging, UCSF, and a former SFMS board member.

Steve Heilig is with the SFMS and the clinical ethics program at CPMC and is coeditor of the Cambridge Quarterly of Healthcare Ethics.

For more information on POLST, including forms, see: http://bit.ly/POLST2014

OCTOBER 2014 SAN FRANCISCO MEDICINE

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SLATE OF CANDIDATES SFMS 2014 Election Pursuant to the San Francisco Medical Society Bylaws Article X Section 2-Nominations, the Nominations Committee renders in writing the following slate of candidates for the 2014 SFMS election. This slate was read at the September 8, 2014, General Meeting, at which time the SFMS President called for additional nominations from the floor.

2015 Officers | Term 2015

For SFMS President-Elect Richard A. Podolin, MD, FACC For SFMS Secretary Kimberly L. Newell, MD For SFMS Treasurer Man-Kit Leung, MD (Incumbent Treasurer) For SFMS Editor Gordon L. Fung, MD, PhD, FACC, FACP (Incumbent Editor)

SFMS Board of Directors

Term: 2015-2017 Seven candidates to be elected to the SFMS Board of Directors.

Steven H. Fugaro, MD (Incumbent Director) Brian Grady, MD (Incumbent Director) John Maa, MD (Incumbent Director) Todd A. May, MD (Incumbent Director) Stephanie Oltmann, MD William T. Prey, MD (Incumbent Director) Michael C. Schrader, MD, PhD, FACP Kory D. Stotesbery, DO

SFMS Young Physicians Section (YPS) Alternate Delegate to the CMA House

Term: 2015-2016 Four candidates to be elected to the SFMS Nominations Committee.

Konstantin Bukov, MD Meghan D. Gould, MD Ingrid T. Lim, MD, FACEP, FAAEM Ray Oshtory, MD, MBA

Term: 2015-2016 The candidates receiving the highest number of votes will serve as Delegates; the rest will be Alternate Delegates or on the wait list. The President-Elect automatically becomes one of the Delegates according to the SFMS Bylaws.

Lawrence Cheung, MD, FAAD, FASDS (Incumbent Delegate) Mihal L. Emberton, MD, MPH, MS (Incumbent Alternate) Steven H. Fugaro, MD (Incumbent Alternate) Gordon L. Fung, MD, PhD, FACC, FACP (Incumbent Delegate and Delegation Chair) Pratima Gupta, MD Jerry Y. Jew, MD, MBA Victor Kwok, MD Robert J. Margolin, MD (Incumbent Alternate) Adi J. Price, MD Kory D. Stotesbery, DO Andrea M. Wagner, MD (Incumbent Alternate) Amy E. Whittle, MD

SFMS Nominations Committee

SFMS Solo/Small Group Practice Forum and Alternate Term: 2015-2016 The candidate with the highest number of votes will be recommended to the California Medical Association (CMA) as the Delegate; the candidate with next highest number of votes will be recommended to CMA as the Alternate Delegate.

Payal N. Bhandari, MD (Incumbent Alternate) Eric Tabas, MD (Incumbent Delegate)

Term: 2014-2015 One candidate to be elected as YPS alternate delegate.

Shoshana R. Ungerleider, MD

District VIII (SFMS) CMA Trustee

Term: October, 2015-October, 2018 One candidate to be elected as CMA Trustee.

Shannon Udovic-Constant, MD, FAAP (Incumbent Trustee)

SFMS Delegation to the CMA House of Delegates

NOTES 2014 President-Elect Roger S. Eng, MD, automatically succeeds to the office of President.

2014 President Lawrence Cheung, MD, automatically succeeds to the office of Immediate Past President.

Member voting will take place ONLINE ONLY from October 20 to November 10.

Your e-ballot must be cast by 5 p.m. on Monday, November 10, 2014.

In order to place your vote, we must have your e-mail address in our database. Please provide us with your e-mail address if we don’t already have it. Paper ballots will NO LONGER be mailed. Please look for a special e-mail from SFMS on October 20 with detailed information regarding the online voting process, as well as the link to the online ballot. If you are unsure about whether or not we have your e-mail address, please e-mail membership@sfms.org.

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SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

CANDIDATE BIOGRAPHIES President-Elect

Secretary

MAN-KIT LEUNG, MD

KIMBERLY L. NEWELL, MD

RICHARD A. PODOLIN, MD, FACC

Cardiology

Treasurer

Incumbent Treasurer

Pediatrics

Otolaryngology

Current Job Positions and Hospital and Teaching Affiliations

Pediatrician, Kaiser Permanente; Assistant Clinical Professor, UCSF

Private practice in small group; affiliations with Chinese Hospital, St. Francis Memorial Hospital, CPMC, St. Mary’s Medical Center; Adjunct Clinical Instructor, Stanford University School of Medicine Department of Otolaryngology – Head & Neck Surgery

SFMS: Secretary 2014, Board of Directors 2009-13, Executive Committee 2012-14, Nominations Committee 2009, Alternate Delegate to CMA House 2014. Additionally, for many years served as delegate to the CMA from the California Chapter of the American College of Cardiology.

SFMS: Board of Directors 2012-14, Executive Committee 2014, Nominations Committee 2010-11

SFMS: Treasurer; Secretary, Board of Directors, Executive Committee, PAC (former Vice Chair), Nominations Committee, Chinese Hospital liaison to SFMS; CMA: Alternate Delegate to HOD, CMA At-Large Delegate to COL

Served as Chairman of the Quality Committee at St. Mary’s Medical Center for four years, and then as Chief of Staff for four years. I have been President of the San Francisco Heart Association and a District Councilor for the California Chapter of the American College of Cardiology. I’m currently serving as ViceChairman of the Community Board of St. Mary’s Medical Center and Board Chairman of the St. Mary’s Medical Center Foundation.

Why Are You Interested in Serving?

Having trained at UCSF, worked in the community at SFGH and at several private practice offices, and now being in practice at Kaiser San Francisco, I have had experience with a range of medical settings and care delivery systems in this city. I have held several local and regional leadership positions at Kaiser Permanente, including Emerging Leaders Program, Physician Health and Wellness Lead, Department Technology Lead, Innovation Group Lead, and CME Coordinator.

In this period of fundamental change in our health care system, physicians need to align to advocate for their profession, their patients, and their community. The strength of the SFMS and the CMA will directly affect the viability of medical practice and the vitality of health care in San Francisco.

More than ever in these turbulent times, physicians must work to shape how medicine evolves so we can continue to take exemplary care of our patients and attain professional satisfaction. I would be honored to help lead this group of committed physician leaders for the benefit of the entire community.

In private practice with one partner (Remo Morelli, MD) and affiliated with St. Mary’s Medical Center.

SFMS/CMA Committees or Offices

Additional Relevant Experience

WWW.SFMS.ORG

In this position, I hope to strengthen our financial stability so that we can continue to champion causes for and protect the welfare of physicians and patients, especially throughout this period of health care reform.

OCTOBER 2014 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES Board of Directors

Editor

STEVEN H. FUGARO, MD

GORDON FUNG, MD, PHD, FACC, FACP

BRIAN GRADY, MD Incumbent Director

Incumbent Director

Incumbent Editor

Also Candidate for AMA Delegation

Cardiology

Also Candidate for CMA Delegation

Internal Medicine

Urology

Current Job Positions and Hospital and Teaching Affiliations

Clinical Professor of Medicine, UCSF Medical Center; Director of Cardiac Services at UCSF Medical Center at Mount Zion; Director of Asian Heart & Vascular Center; Director of Electrocardiography Laboratory at MoffittLong Hospital

Private practice in Primary Care Internal Medicine in San Francisco; Medical Staff at University of California San Francisco; Medical Staff, California Pacific Medical Center

Urologist, Golden Gate Urology; active medical staff member at CPMC and CPMC/St. Luke’s, St. Mary’s Medical Center, St. Francis Memorial Hospital, and Seton Medical Center

SFMS: Editor 2010 to present, Past President; CMA: Delegate since 2000, Member of Council of Scientific Affairs 2004-present, IMQ Surveyor since 1994

SFMS: Board of Directors (former President), Membership Committee, Co-chair of Medical Review Advisory Committee, Finance Committee, Alternate Delegate to CMA House; CMA: Committee on Legislation, Professional Liability Committee

Liaison from St. Luke’s Medical Staff to the SFMS; member of the SFMS Board of Directors

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

Communications, education, and learning are the jobs of the editor. Over the past two years I have learned much more about the topics and issues facing the clinicians in practice in the community as well as academics. Working with the SFMS staff, Editorial Board, and Executive Committee and keeping the communication channels open with the membership and other interested parties that interface with SFMS through San Francisco Medicine has been one of the highlights of my involvement with SFMS. In a sense, San Francisco Medicine, our award-winning journal, is one of the oldest still-viable forms of social media used by the physician community serving San Francisco Bay Area. I truly cherish my time on the board and look forward to serving as your editor for 2013.

22

I have been actively involved in organized medicine for more than seventeen years, including being Past President of SFMS. Since that time I have been a member of the SF Tobacco Free Coalition and have worked actively on tobacco control measures at the city and state levels.

Currently serving as the Chief of Surgery Department, St. Luke’s; former president of the CMA Resident Physician’s Section; delegate to the AMA HOD and CMA HOD, Resident and Student

Why Are You Interested in Serving?

The SFMS plays a critical role as the public voice of all physicians in San Francisco. SFMS has had a notable history of successfully advocating for health and medical issues important to all the physicians and citizens of San Francisco. This year has been a prime example, with the extraordinary leadership exhibited by the Board in opposing the MICRA ballot measure in November.

With the rapid changes occurring in medicine in our community, it’s very important for physicians to work together to share information, resources, and experiences. I would be honored to represent my colleagues by serving the SFMS to help in this process.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

TODD A. MAY, MD

JOHN MAA, MD Incumbent Director

STEPHANIE OLTMANN, MD

Incumbent Director

General Surgery

Family Medicine

Family Medicine

Current Job Positions and Hospital and Teaching Affiliations

Chair, University of California Office of the President Tobacco Related Disease Research Program. Medical Staff, Marin General Hospital. Selected as a (415) Top Doctor by Marin Magazine and as a San Francisco SuperDoctor in both 2012 and 2013

Chief Medical Officer, San Francisco General Hospital; Primary Care Physician, Family Health Center, SFGH; Hospitalist Attending Physician, SFGH; Professor, Family & Community Medicine, University of California, San Francisco

Primary Care Physician at Dignity Health Foundation Group, St. Mary’s Medical Center, and USF Student Health Center

SFMS: Board of Directors 2012-2014; Executive Committee 2014/2012; AMA 1991; CMA Specialty Section Delegate-Northern California Chapter of the American College of Surgeons (ACS); David Perlman Award for Excellence in Medical Journalism by the San Francisco Medical Society in 2013; San Francisco Medicine Magazine Editorial Board 2012 to present

SFMS: Board of Directors 2014, SFGH Liaison to the SFMS Board of Directors during term as Chief of the Medical Staff at SFGH 2009-11

Young Physician Section Delegate to CMA House of Delegates 2014, Alternate Delegate to CMA House 2013

Immediate Past President, ACS Northern California Chapter; Board of Directors (ex officio) and Western States Affiliate Taskforce Member, American Heart Association; recipient of the 2013 ACS Arthur Ellenberger Award for Excellence in State Advocacy; nominated for the White House “Champion of Change for Prevention and Public Health” by US HHS in 2013; named one of “Top 20 People Making a Difference in Healthcare in America,” 2009; Past President, American Heart Association, San Mateo Division 2004-05; David Perlman Award for Excellence in Medical Journalism by the San Francisco Medical Society in 2013

I have been closely involved with clinical operations at SFGH for the last 18 years, in both primary care and inpatient services. I have assumed substantial leadership roles at the SFGH campus. I am a member of the San Francisco Department of Public Health Integrated Steering Committee, which guides DPH clinical and public health functions.

Co-Chief and Chief in family medicine residency program at North Shore – LIJ Health System, Glen Cove, NY; Resident Delegate to the Congress of Delegates for the NY State Academy of Family Physicians during second and third years of residency

As a Board member, I will seek to empower physicians to advocate effectively in City Hall and Sacramento on important public health issues to strengthen the future of medicine across California. A key strategy for success is to reduce student indebtedness and make medical training more affordable for future trainees.

This is a dynamic time in health care, requiring enhanced communication and relationships among city hospitals and medical groups. San Francisco General Hospital’s participation with SFMS historically has been lower than that of other hospitals—this is a timely opportunity to increase SFGH representation and involvement with SFMS.

Serving on the Board is a privilege and a great opportunity to advocate for the physician community in San Francisco. In a time of significant changes in health care and of rapidly evolving technology, I am looking forward to engaging in the process of health care reform and policy.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

WWW.SFMS.ORG

OCTOBER 2014 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES Board of Directors MICHAEL C. SCHRADER, MD

WILLIAM T. PREY, MD

KORY D. STOTESBERY, DO

Incumbent Director

Also Candidate for CMA Delegation

General Psychiatry and Sleep Medicine

Internal Medicine

Child Psychiatry

Current Job Positions and Hospital and Teaching Affiliations

Solo practice for twenty-seven years; Active Staff at California Pacific Medical Center; Adjunct Professor at Argosy University in Alameda, California

Private practice, internal medicine; Fellow, American College of Physicians; Associate Clinical Professor of Medicine, UCSF Volunteer Clinical Faculty; Instructor, Inpatient Medicine CPMC 2000-11; Instructor, UCSF Foundations of Patient Care Preceptor 1998-present; Instructor, UCSF Longitudinal Care Experience 2012-present

Seneca Family of Agencies and Private Practice in San Francisco and Walnut Creek

None

None

I trained to be a physician-scientist but decided my passion was clinical medicine. I have always participated in teaching the next generation of physicians. I am president of an independent physician office, a small business.

I have experience in clinical practice quality and served previously on the Subcommittee on Congestive Heart Failure Outcomes and the Atrial Fibrillation Clinical Pathway Committee at UCSF/Mt. Zion.

For the past year I have been a member of the Executive Board for the Northern California Regional Organization of Child and Adolescent Psychiatry. I began as a delegate to our national assembly of child psychiatrists working to improve the organization’s structure as well as advocating for transparent and ethical research publication. I also started the Early Career Psychiatrist Committee to organize events focused on improving our involvement in advocacy in the Bay Area, as well as increasing our network with all fields of medicine.

Medicine is currently experiencing disruptive innovation with increasing influence of political agendas and technology—and profit-driven medicine. Doctors are being manipulated by insurers, misguided regulations, and corporate medicine.

As an early-career physician and a psychiatrist, I hope to bring valuable perspectives to the SFMS Board of Directors. Mental health, particularly for youth, has become an important topic in our society. I am excited about the prospect of representing those interests and assisting SFMS to be a leader in this front.

SFMS/CMA Committees or Offices

SFMS: Board of Directors 2014/2011-12; CMA: Alternate Representative in the late 1980s Additional Relevant Experience

I have had several administration positions during my years of practice, including being the Acting Medical Director of the St. Mary’s Hospital Sleep Disorder Center, Psychiatric Director of the Children’s Hospital Eating Disorders Center, and Medical Director/Chief of Staff of the Ross Psychiatric Hospital. These experiences have taught me the importance of teamwork, focused goals, and creative problem solving.

Why Are You Interested in Serving?

I have learned a great deal about the local politics and complex realities that organized medicine has to face in the Bay Area during my tenure on the board. The Board’s evolving positions on topics such as e-cigarettes, Laura’s Law, and access to mental health treatment are of particular interest.

24

Physician shortage. Regulatory pressure. Demands for quality. These problems should be acted on by physicians to benefit patients.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

SFMS Nominations Committee

Family Medicine

INGRID T. LIM, MD, FACEP, FAAEM

MEGHAN D. GOULD, MD

KONSTANTIN BUKOV, MD

Emergency Medicine

Primary Care

Current Job Positions and Hospital and Teaching Affiliations

Primary care physician, private practice with privileges at St. Mary’s, Saint Francis, and CPMC

Primary care pediatrician at Golden Gate Pediatrics, newborn rounding privileges at CPMC, Moonlighter at SFGH Pediatric Urgent Care, Clinical Instructor at UCSF, Pediatric Preceptor for second-year medical students

Senior Emergency Physician, the Permanente Medical Group, Kaiser Permanente, San Francisco Medical Center; President, Professional Staff, Kaiser San Francisco (elected office); Chief, Continuing Medical Education, Kaiser San Francisco; Residency Site Director, UCSFSFGH Emergency Medicine Residency Program; Assistant Clinical Professor, Emergency Medicine, UCSF

None

Kaiser Permanente San Francisco Medical Center Liaison to the SFMS Board 2013-present, SFMS Board Director 2014-16

Lobbied for the California Health Insurance Reliability Act (SB 840) in Sacramento, 2006, as a member of AMSA; involved in Primary Care Progress at UCSF (2012-14), a community of student, resident, and physician colleagues collaborating to revitalize primary care practice

From 2009-10, I served as the President of the California Chapter of American Academy of Emergency Medicine (CAL-AAEM), after being on the Board of Directors for three years. Our organization was committed to the principles that every individual should have unencumbered access to quality emergency care, that the practice of emergency medicine is best conducted by a board-certified emergency physician, and that fair and equitable practices should be the standard.

I joined SFMS for the opportunity to address medical and health issues in our local community. As a member of the Nominations Committee, I can use my connections to SFGH, UCSF, CPMC, and private practice to recruit and engage with new members to advance the Society’s mission.

We’re at a pivotal crossroads with health care in this country. No matter what practice setting we work in, physicians must have a voice at the legislative table, or someone else will determine how we practice medicine and care for our patients. I want to be part of this.

SFMS/CMA Committees or Offices

None

Additional Relevant Experience

I’ve served on the Credentialing Committee for Theda Care Physicians, Shawano, WI, from 2009-11.

Why Are You Interested in Serving?

I would be very excited to serve on the Nominations Committee to help bring in new leaders with new ideas for the San Francisco medical community.

WWW.SFMS.ORG

OCTOBER 2014 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES SFMS Nominations Committee

SFMS Solo/Small Group Practice Forum Delegate and Alternate PAYAL N. BHANDARI, MD

RAY OSHTORY, MD, MBA

ERIC TABAS, MD

Incumbent Alternate

Orthopedic Spine Surgery

Family Medicine

Obstetrics and Gynecology

Current Job Positions and Hospital and Teaching Affiliations

Founder and solo physician of Advanced Health, Medical Director of Skyline Community College, Hospital affiliation with California Pacific Medical Center

Solo Practice; Active: CPMC, Saint Mary’s, Saint Francis; Courtesy: Davies, Mount Zion, UCSF; Associate Clinical Professor of Obstetrics/Gynecology, UCSF

Editorial board of the SFMS Journal and guest contributor

SFMS: Solo/Small Group Practice Forum Delegate 2006–present, Treasurer 2000, Director 1994–99, SFMS Finance/Investment 1999–2014 (Chair 2000), SFMS Services, Inc., Board 1997–2001 (Secretary/Treasurer 1999), Executive Committee 1998–2000

I am co-program director for this year’s Northern California Orthopedic Society Annual Meeting. I currently serve as co-chairman of the Spine Products Committee and am a member of the New Technology Committee at CPMC. I have served on the Capital and Budget Committee and on the nominations committee for the Chairman of the Department of Orthopedics at St. Luke’s and plan to serve on both again this year.

By being one of the founding senior physicians of the first patient-centered medical home in San Francisco, I have learned how to build a large corporation focused on population management while better understanding the direct impact of managed care on providers and patients. I have returned to private practice to work directly for patients and provide comprehensive, personalized care where accessibility and transparency are the backbone.

I have been in solo practice for twenty-nine years. I have been active in our professional groups in an effort to advance policies and legislation for all doctors. I presently serve as Treasurer of the SSGPF and serve on the Executive Committee of the SSGPF.

A society is only as strong as its leadership.

Today, more than ever before, doctors need charismatic and influential leaders to fight for the needs of our patients and colleagues.

I would be honored to help recruit these leaders to continue the Society’s tradition of advocacy and service.

As a solo family doctor in private practice, I feel the daily negative impact of declining insurance reimbursement and increasing medical cost on the evolution of today’s medical landscape. I would be honored to help make a positive difference for providers and patients by helping shape health care policy.

As a delegate of SFMS, I can help shape the issues pertinent to our members. SFMS is the only organization that is accessible to all San Francisco physicians. It provides us with a community beyond our individual situations.

SFMS is the voice of medicine for doctors, patients, politics, and the media, and I am proud to represent those physicians at CMA.

Solo private practice; privileges at CPMC, St. Luke’s, and St. Francis hospitals

SFMS/CMA Committees or Offices

None

Additional Relevant Experience

Why Are You Interested in Serving?

26

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

ACA 411: Tracking Health Reform in California SFMS Young Physicians Section Alternate Delegate to CMA House

Sandra R. Hernández, MD

For District VIII (SFMS) California Medical Association (CMA) Trustee

CEO, California Health Care Foundation

SHANNON UDOVICCONSTANT, MD, FAAP

SHOSHANA R. UNGERLEIDER, MD

Incumbent Trustee

Hospitalist/Internal Medicine

Pediatrics

Current Job Job Positions Positions and and Hospital Hospital and and Teaching Teaching Affiliations Affiliations Current

I live in San Francisco and work as an internal medicine hospitalist at John Muir Medical Center in Walnut Creek, California.

SFMS/CMA Committees or Offices

None

SFMS/CMA Committees or Offices

Additional Relevant Experience Additional Relevant Experience

In medical school at Oregon Health and Science University, I served as Vice President of the American Medical Student Association chapter. I also served on the Student Health Advisory Committee Member at the University of Oregon.

Why Are You Interested In Serving?

Why Are You Interested in Serving?

This position will allow me to learn more about health care policy and how the CMA advocates for patients, physicians, and the best practice of medicine in California. I have a personal passion for issues surrounding graduate medical education and end-of-life care of patients.

Kaiser Permanente Pediatrician; Associate Clinical Professor, UCSF Department of Pediatrics; Short-Term Director from San Francisco to the Permanente Medical Group (TPMG) Board SFMS: Immediate Past President 2014, President 2013, President-Elect 2012, Treasurer, 2011, Board of Directors 2007–10 (Executive 2007–present, Bylaws 2007), SFMS PAC Board 2006–14 (Chair 2009–10, Secretary/ Treasurer 2007–08); CMA: Trustee Oct. 2012-Oct. 2015, CMA House of Delegates 2010–13 (Alternate, 2008–09), CALPAC Board 2011–present, CMA Young Physician Section Executive Committee, At-Large Member 2003–05, CMA Council on Legislation member 2010–present I serve on four medical boards: CMA, SFMS, TPMG, and ex officio to the American Academy of Pediatrics, California. I have extensive experience in health care policy and advocacy as co-chair for the AAP-CA State Government Affairs Committee, as a delegate to the CMA House, and a member of the CALPAC Board. I am a direct and effective communicator, also skilled at developing coalitions with other physicians.

I am proud to be from the SFMS, with its history of bringing forward important policies that have shaped CMA. I want to continue to serve SFMS for the CMA to be what San Francisco’s physicians want it to be. I will work to preserve the profession of medicine so that it is a career that I would want my children to pursue.

Candidate bios continued on following page . . .

WWW.SFMS.ORG

“If you don’t know where you are going, any road will take you there.”—Lewis Carroll

In the spirit of knowing where we are going, the California HealthCare Foundation has launched a new, interactive data tool to track the impact of the Affordable Care Act (ACA) in California. This is far from an academic exercise, because everyone involved with implementing the law expects twists and turns as it unfolds in the real world, along with the need to thoughtfully adjust as the ACA evolves.

The need for reliable public data is clear.

Here in California, generations of low-income residents and members of racial and ethnic minorities have felt the effects of limited access to medical care. When lawmakers passed the ACA, this was one of the many serious problems in our health care system that they were trying to fix. Now that California has persuaded millions of people to enroll in ACA health plans, we will need to see whether the promise of care turns into a reality. Our data tool, which we call ACA 411, aims to do just that, along with answering numerous other burning questions on whether coverage, affordability, and access to care are improving.

We launch this interactive tool with what we know today about these issues, and periodically, when new data are available, we will update it. ACA 411 offers a wide range of indicators—including many broken down by demographics and regions. The data are presented through a smartly designed interface that will be easy to use and grow more valuable over time. Users will find numbers on such meaningful topics as family spending on care, people who delay or forgo care, reasons for lack of insurance, local uncompensated hospital care, families with high health cost burdens, and dozens of others. Taken together, these numbers will reveal how California is faring under the biggest change in the American health care system since Medicare and Medicaid were created in the 1960s.

ACA 411 is a project in keeping with California HealthCare Foundation’s mission to bring data and dispassionate analysis to the intense and often contentious world of health care policy. By providing facts and data as they emerge, CHCF will inform the policy conversation about how best to improve health care for all Californians. A lot rides on the success of that discussion.

View the tool online:

www.chcf.org/aca-411

OCTOBER 2014 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES Delegates to the California Medical Association House of Delegates MIHAL L. EMBERTON, MD, MPH, MS

LAWRENCE CHEUNG, MD, FAAD, FASDS

STEVEN H. FUGARO, MD Incumbent Alternate

Incumbent Alternate

Incumbent Delegate

Also Candidate for Board of Directors

Dermatology

Family Medicine

Internal Medicine

Current Job Positions and Hospital and Teaching Affiliations

Adult and Family Medicine Senior Physician, the Permanente Medical Group; Clinical Teaching Faculty, UCSF

Private practice in Primary Care Internal Medicine in San Francisco; Medical Staff ,University of California San Francisco; Medical Staff, California Pacific Medical Center

SFMS: President 2014, President-Elect, Treasurer, Secretary, Board of Directors, Political Action Committee, Membership Committee; CMA: House of Delegates with participation in HOD Reference Committee A (Science and Public Health)

Alternate Delegate to CMA House 2013-14

SFMS: Board of Directors (former President), Membership Committee, Co-chair of Medical Review Advisory Committee, Finance Committee, Alternate Delegate to CMA House; CMA: Committee on Legislation, Professional Liability Committee

I have been very active at the both the local (SFMS) and state levels (CMA). I feel that having actively participated in multiple SFMS and CMA committees has given me a perspective on how to continue to steer SFMS in a positive direction.

When my wife was denied health coverage in 2008 by my employer, despite my Public Policy MPH, it took six weeks of emotional collaboration with multiple stakeholders, both in the hospital and community, before we were finally granted spousal benefits. This experience has stimulated my passion for social justice and also prompted my participation on multiple LGBTQ and Diversity Committees, where I continue to refine leadership and advocacy skills.

I have been actively involved in organized medicine for more than seventeen years, including being Past President of SFMS. Since that time I have been a member of the SF Tobacco Free Coalition and have worked actively on tobacco control measures at the city and state levels.

I would like to continue to improve the practice of medicine and the delivery of care from the policy side, where changes can improve the overall health of Californians as well as the lives of physicians. It is an honor to represent my SF colleagues in the House of Delegates.

The CMA plays a critical role as the public voice of all physicians in California. The SFMS delegation has had a particularly notable history of successfully advocating for issues important to the physicians and citizens of San Francisco. The CMA HOD is the foremost gathering of physicians in California who have an interest in optimizing the profession of medicine through political advocacy.

Solo private practice with volunteer teaching responsibility at UCSF

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

SFMS was an invaluable organization for me when I started my solo practice seven years ago and continues to be a resource for me today. The Society serves as my only local advocate and the CMA serves as my only state advocate in matters of public health, patient safety, and physician advocacy. With the looming changes occurring in the profession of medicine, I feel that it is not just a privilege but a duty to make the Society a relevant organization for future San Francisco physicians.

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SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

PRATIMA GUPTA, MD

GORDON L. FUNG, MD, PHD, FACC, FACP

JERRY Y. JEW, MD, MBA

Incumbent Delegate and Delegation Chair

Also Candidate for Editor

Cardiology

Obstetrics and Gynecology

Family Practice

CurrentJob JobPositions Positionsand andHospital Hospitaland andTeaching TeachingAffiliations Affiliations Current

Clinical Professor of Medicine, UCSF Medical Center; Director of Cardiac Services at UCSF Medical Center at Mount Zion; Director of Asian Heart & Vascular Center; Director of Electrocardiography Laboratory at Moffitt-Long Hospital

Kaiser Permanente Senior Physician, Volunteer Assistant Professor at UCSF, Medical Director St. James Infirmary (free clinic in SF for sex workers and transgender individuals)

Associate Medical Director at North East Medical Services (NEMS), a nonprofit community health center operating ten clinics throughout the San Francisco Bay Area; Medical staff with Chinese Hospital.

SFMS: Editor 2010 to present, Past President; CMA: Delegate since 2000, Member of Council of Scientific Affairs 2004-present, IMQ Surveyor since 1994

None

None

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

I ask for your support to represent you at the California Medical Association House of Delegates. San Francisco is a unique community that has a finely honed process to make a significant impact in health policy at the local, state, and national levels. Your delegation over the years has demonstrated success in developing and supporting resolutions that have impacted key areas of our practice, from environmental health issues to public health issues with healthy lifestyle and neighborhoods to streamlining the way for patients to get their prescriptions. No one person can have the expertise required in all these areas. So the collaborative/team effort to bring these issues to the CMA and many to the AMA requires all members of the delegation to pitch in. I look forward to working with this team of delegates to bring San Francisco’s expertise and issues to the state.

WWW.SFMS.ORG

American College of OB/Gyn Legislative Committee member, Board of Directors of California Family Health Council, Member of SF Mayor’s Anti-Human Trafficking Taskforce, former member of Board of Directors for Physicians for Reproductive Choice and Health

Why Are You Interested in Serving?

Medical care and service extends beyond the doors of my clinic. Physician advocacy is an important part of my medical philosophy, as I consistently use my voice as a physician to fight to ensure reproductive rights for all men and women in the U.S. and abroad.

I am part of the California HealthCare Foundation Leadership Program, working with health care leaders to improve health care across California. I actively partake in various committees, both within my organization and externally—championing clinical quality improvements, work flow efficiencies, and team-based approaches to clinical care. I am an active member of the Practice Improvement Project Advisory Board for SFHP and serve as a clinical ambassador to SFGH in improving communication and work flows between our respective organizations.

The importance around educating and galvanizing our colleagues and community has never been more paramount, given the changes with ACA Healthcare Reform and new attacks on MICRA and physician autonomy. With my dynamic background, I aspire to empower physicians to build a better medical community in San Francisco and beyond.

OCTOBER 2014 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES Delegates to the California Medical Association House of Delegates ADI J. PRICE, MD

ROBERT J. MARGOLIN, MD

VICTOR KWOK, MD

Incumbent Alternate

Internal Medicine/Geriatric Medicine

Internal Medicine and Geriatrics

Radiology

Current Job Positions and Hospital and Teaching Affiliations

Health Sciences Assistant Professor of Medicine, University of California San Francisco

SFMS/CMA Committees or Offices

None

Additional Relevant Experience

Former member of Pacific Medical Administrative Group in Honolulu, HI, and member of committee that reviewed nursing home policies; Co-champion of Physician Self Coding Initiative at UCSF Primary Care

Primary Care Practice in Internal Medicine; Chief, Division of Internal Medicine at CPMC; Vice Chief of Staff of the Medical Staff at CPMC; Board of Directors, Medical Insurance Exchange of California; Associate Clinical Professor, UCSF

First-year Radiology resident at UCSF; Completed medical school training at University of California, San Diego, and intern year at Kaiser Foundation Hospital, San Francisco.

AMA: Alternate Delegate to the House of Delegates; CMA: Board of Trustees, Chair of the Audit Committee, Vice Chair of CALPAC; SFMS: Past President, Past Chair of the Delegation

None

I have spent much of the past twenty years in leadership roles in our medical society and the CMA.

During medical school I was the student representative to the San Diego County Medical Society. I was a voting member of the board, and I attended the annual SDCMS retreat, where I participated in numerous information sessions and political/lobbying workshops. I am a former co-president of the UCSD Politics in Medicine club, and a former teaching assistant for the Politics in Medicine class. I organized events that addressed issues such as MICRA, MediCal reimbursement, and scope of practice with speakers such as former CMA presidents Robert Hertzka and James Hay. As student representative to the SDCMS, I participated in interviews of local candidates regarding health care issues and traveled to Sacramento on a lobbying trip.

I have greatly enjoyed my role as your CMA delegate for the past eighteen years. I believe I have the experience, perspective, energy, and desire to continue to advocate for physicians and their patients and thus ask that you elect me to serve as your CMA delegate.

I want to be your representative to the CMA House of Delegates because when physicians speak with one voice, we have the power to affect millions of lives for the better. I want to be a part of that process.

Why Are You Interested in Serving?

To be an advocate for the physicians of SF and to ensure that issues that affect us are not neglected. I am suited for this position because of my strong interest in medical current events, my respect for the opinions of our society members, and my determination to achieve results.

30

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

KORY D. STOTESBERY, DO

ANDREA M. WAGNER, MD

AMY E. WHITTLE, MD

Incumbent Alternate

Also Candidate for Board of Directors

Child Psychiatry

Emergency Medicine

Pediatrics

WhyAffiliations Are You Interested In Serving?

Current Job Positions and Hospital and Teaching

Child Psychiatrist at Seneca Family of Agencies and Private Practice in San Francisco and Walnut Creek

Director of Outside Hospital & Emergency Operations and EPRP for Northern CA; Staff Physician, Emergency Medicine, Kaiser Foundation Hospital, San Francisco

Assistant Clinical Professor of Pediatrics, University of California, San Francisco; Medical Director, San Francisco MedicalLegal Partnership, San Francisco General Hospital; Course Director, Physician in Community & Behavior and Development rotations, UCSF Pediatric Residency

Alternate Delegate to CMA House 2012-14

SFMS Nominations Committee 2014-15

Board of Directors, California Chapter of the American College of Emergency Medicine, June 2006–June 2012; Counselor, American College of Emergency Physicians, 2006-14; Committee Member, Government Affairs Committee California ACEP, 2006-14

I have served as State Governmental Affairs Committee Representative for Chapter 1 of the California American Academy of Pediatrics since 2011. This committee determines advocacy priorities and then reviews state legislation relevant to these areas and determines AAP advocacy strategies. I am also co-chair of the Chapter 1 AAP-CA Advocacy Committee, which coordinates advocacy around pediatric health policy issues at the local, state, and national levels.

I would like to continue in my role in the SFMS delegation to the CMA House of Delegates. We play a critical role for our Medical Society in crafting and promoting policy resolutions. Thank you for your support.

My prior experience in advocacy led me to become interested in serving as a delegate to the CMA House of Delegates. My past experience in evaluating legislation and policy will serve me well in the task of reviewing resolutions and helping to form the SFMS positions.

SFMS/CMA Committees or Offices

None Additional Relevant Experience

I have served as the Northern California delegate to the national assembly for the American Academy of Child and Adolescent Psychiatry for the past two delegations. As a representative, I have helped propose action statements to promote ethical publication of research, establish official recommendations for homeschooling, and explore ways to reorganize the organization to promote efficient advocacy and transparency. I also organized a well-attended advocacy day in Sacramento for child psychiatrists.

Why Are You Interested in Serving?

There are many hurdles the mental health field needs to overcome to be able to provide people with the care that our community needs. Being a delegate with SFMS would allow me the opportunity to work toward making those changes and to learn how to be a more effective advocate.

WWW.SFMS.ORG

OCTOBER 2014 SAN FRANCISCO MEDICINE

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MEDICAL COMMUNITY NEWS CPMC

Edward Eisler, MD

We are pleased to announce that Dr. Richard Hongo has accepted the position of associate program director of the CPMC cardiology fellowship training program. Dr. Hongo is a key member of our electrophysiology team and has been instrumental in bringing state-of-the-art electrophysiology to CPMC. The CPMC cardiology fellowship training program was started by Dr. Arthur Selzer in 1959. The fellowship program currently has nine fellows and has trained close to 200 cardiologists, many of whom formed the nucleus of Bay Area and California cardiology or have achieved prominence in our field. Congratulations to Dr. Lorry Frankel, who has been reappointed chair of the Department of Pediatrics for a second five-year term.

A growing body of research suggests that nonpsychotropic cannabinoid compounds, found in the cannabis plant, are effective antitumor agents in multiple preclinical models of aggressive cancers. California Pacific Medical Center Research Institute (CPMCRI) scientists Sean McAllister (PhD) and Pierre Desprez (PhD) previously discovered that the cannabinoid, cannabidiol (CBD), inhibits breast cancer metastasis—and more recent research suggests a role in treating the most common and aggressive form of brain cancer, glioblastoma multiforme. Glioblastoma multiforme is the most common and severe form of brain cancer. Each year in the U.S., 15,000 people are diagnosed with the illness. Because of the promising preclinical trial data, the U.S. Food and Drug Administration (FDA) has granted orphan drug designation to CBD for the treatment of glioblastoma. The approval significantly advances development of the compound and moves the research one step further toward phase 2 and 3 clinical trials to test the drug in human patients with the disease. Orphan drug approval of the compound represents the first time in the U.S. that a cannabinoid compound has been recognized by the FDA as a potential potent anticancer agent in treating this aggressive form of brain cancer.

32

SFVAMC

Diana Nicoll, MD, PhD, MPA

In 2010, VA primary care clinics across America implemented the patient-centered medical home called Patient-Aligned Care Teams. At the San Francisco VA Medical Center (SFVAMC), we embraced this model wholeheartedly, with dramatic results. The transformation effort was supported by a Center of Excellence in Primary Care Education (COEPCE) grant to teach interprofessional trainees to deliver team-based patientcentered care. This momentum for advancing patient-centered care has continued, and it’s within this context that we have chosen our new associate chief of staff for Education, Rebecca Shunk, MD. Dr. Shunk, in her role as COEPCE co-director, has personally witnessed the dramatic transformation that results with renewed emphasis on patient-centered care and interprofessional collaboration. In this role she has had the opportunity to reach out to many disciplines and bring them together to teach teambased care to a diverse group of trainees and staff. The result is a primary care clinic where all levels of staff and trainees are collaborating, regardless of prior professional silos.

In the daily morning quality-improvement huddle you can see licensed vocational nurses lead the nurse manager and senior physicians in quality improvement. Registered nurses lead our faculty and trainees in daily preclinic huddles. We all find it inspiring to watch traditionally subordinate team members lead teams of highly educated providers and improving the care of our Veterans. The SFVAMC primary care and clinic staff and trainees have embraced patient-centered team-based care and the flattened hierarchy it brings, and we have no plans to return to the old ways of doing things.

In her new position, Dr. Shunk plans to use this experience to reach out to all clinical and nonclinical staff in the hospital to build bridges between disciplines, resulting in the same kind of interprofessional collaboration seen in our primary care clinics.

Kaiser Permanente Maria Ansari, MD

This fall, there are two propositions on the ballot that could have a dramatic impact on health care costs: Prop. 45, Approval of Healthcare Insurance Rate Change (Rate Regulation), and Prop. 46, Drug and Alcohol Testing of Doctors, Medical Malpractice Lawsuits Cap (MICRA). Both could substantially increase health care costs. Kaiser Permanente is opposed to both.

Prop. 45 would give one politician, the California Insurance Commissioner, the power to approve proposed rates of health plan and health insurance small group and individual products. Rates would include anything that affects charges, including benefits, premiums, base rates, discounts, copayments, deductibles, and any other out-of-pocket costs.

If passed, Prop. 45 would create another expensive state bureaucracy, ultimately paid for with higher health insurance premiums.

Meanwhile, special interest groups, along with lawyers, will benefit from fees generated as they work on blocking any proposed rate increases. This proposition will result in special interest regulation of health care rates without the input of the medical community.

As discussed in last month’s publication, Prop. 46 will quadruple the cap for noneconomic damages in medical malpractice lawsuits from $250,000 to $1.1 million. This is an attempt by trial attorneys to overturn California’s historic tort reform law. MICRA has helped to keep down health care costs and ensure affordable health care for Californians.

The state’s legislative analyst estimates the fiscal impact to range from “tens of millions of dollars to several hundred million dollars annually.”

The proposition also requires a prescription drug database and drug testing for physicians, which are political ploys by the trial lawyers to confuse voters about the real intent of Prop. 46.

Kaiser Permanente is committed to providing quality and affordable health care and opposes Props. 45 and 46.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

Saint Francis Robert Harvey, MD

Minimally invasive surgical techniques have revolutionized many fields of medicine, including knee replacement surgery. Dignity Health Saint Francis Memorial Hospital is proud to be the only hospital-based facility in San Francisco to offer the NavioPFS™ partial knee replacement surgery at our Total Joint Center. This procedure uses handheld robotic technology in tandem with the surgeon’s skilled hands—combining planning and navigation platforms to present the surgeon a virtual cutting guide with detailed visualization and an intelligent handheld instrument.

The partial knee replacement surgery performed at our Total Joint Center allows for a less invasive incision, so patients benefit from a rapid recovery and less postoperative pain. Additional patient benefits include more consistent results, accurately placed implants, and the preservation of knee ligaments, healthy cartilage, and bone. According to patient surveys, eight out of nine patients who received the partial knee replacement surgery would recommend this procedure to a friend or family member.

At Saint Francis, partial knee replacement surgery is delivered by three expert surgeons: Victor Prieto, MD; Dominic Tse, MD; and John Velyvis, MD. Together, they offer more than fifty-five years of experience providing the best possible care for orthopedic injuries and disorders. This is complimented by additional, specially trained podiatric surgeons, nurses, and therapists, who help provide comprehensive care to patients seeking minimally invasive surgery. The program also includes an aggressive rehabilitation program, occupational and physical therapy, instruction on joint protection, energy conservation techniques and the use of assistive devices, and education to prepare patients and caregivers alike for the recovery process.

Saint Francis Memorial Hospital is committed to delivering innovative care to our patients, and we are proud to help patients from San Francisco and beyond get back to their healthy, active lifestyles.

WWW.SFMS.ORG

St. Mary’s

Sutter Pacific

Robert Weber, MD

Bill Black, MD, PhD

In August, Dignity Health St. Mary’s Medical Center earned three-year national accreditation with commendation from the Commission on Cancer (CoC) of the American College of Surgeons. To earn voluntary CoC accreditation, a cancer program must meet or exceed thirtyfour CoC quality care standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patient-centered care.

This accreditation is a testament to the caliber of our cancer program and to St. Mary’s overall commitment to providing high-quality care to patients. St. Mary’s takes a multidisciplinary approach, treating cancer as a complex group of diseases that requires consultation among surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists, and other cancer specialists, resulting in improved patient care. The changing landscape of health care demands that we, as physicians, provide expert and personalized care with an emphasis on convenience for the patient. That’s why an important member of our Cancer Team is Oncology Nurse Navigator Cheri Goudy, who answers patients’ questions, assists with appointment scheduling, and facilitates insurance programs and other needs that may ease the treatment process. The CoC accreditation signals to cancer patients that by choosing St. Mary’s, they are gaining access to comprehensive, state-of-the-art cancer care. I am proud of the fact that the leaders, physicians, and staff at St. Mary’s are heavily invested in the Cancer Center’s projects, programs, quality initiatives, and day-to-day patient care. Their contributions and dedication to the program helped us achieve this milestone. A special thank-you to Laura Fullem-Chavis, St. Mary’s senior director of oncology, research, and women’s health services, for her hard work and direction, and to the St. Mary’s Cancer Committee for their active participation during the accreditation process.

This accreditation with multiple commendations represents a true team effort and ensures that St. Mary’s is able to provide exemplary and compassionate care to cancer patients.

Around the turn of the century, when I was first working with a Sutter Health team on Internet- based care for patients, we got wind of some legislation related to health care and the Internet that was just about to hit the governor’s desk. The bill had been penned by an enthusiastic but nonmedical young staffer of a well-intentioned but nonmedical state legislator who believed the legislation would protect patients’ confidentiality. Surely a noble intent.

Unfortunately, the legislation was proscriptive in ways that could actually have helped patients but ignored related aspects of a patient’s medical information that could have proved damaging if publicized. When we approached the governor’s office in a last-ditch effort to stop it, we discovered that signing this bill was part of a larger political deal that could not be stopped. Our own local legislator recommended that a better strategy would be to let the flawed bill become law and then, over the next several years, work through amendments to reshape the law into something both practical and protective for patients. This episode, along with subsequent such experiences, shed light on the very messy sausage- making that creates our laws. It highlighted how health care-related legislation can be crafted by well-intentioned but uninformed politicians or their staff, without significant input or advice from medical experts. Involvement in the political process is a critical public duty of physicians. We are positioned to understand the subtle nuances surrounding medical issues and patient care. It is incumbent on each of us to work both individually and collectively to help shape the health care debate and to provide expertise. We must remain committed to participation in organized medicine through the San Francisco Medical Society and California Medical Association. We also must volunteer our individual voices on issues in which we possess subspecialty knowledge. Change may only happen incrementally, but advocacy helps inform our politicians and benefits our patients in a variety of ways, including promoting general health and protecting access.

OCTOBER 2014 SAN FRANCISCO MEDICINE

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UPCOMING EVENTS 10/22 Webinar: Analyzing/Negotiating PPO Contracts 12:30 p.m. to 1:45 p.m. | SFMS has teamed up with ACCMA to offer a webinar on PPO contracts. Learn from a successful PPO contracting expert about analyzing present contract rates and strategies for successful renegotiation. The training is free for SFMS members and $199 for nonmembers. For more information on this seminar, please contact Dennis Scott at (510) 6545383 or dscott@accma.org.

10/30: IMQ 2014 Medical Staff Conference

Embassy Suites Waterfront Hotel | Join other medical staff leaders in a one-day learning opportunity that will teach practices for credentialing and privileging no-/low-volume practitioners and telemedicine and allied health professionals, as well as other common challenges. Gain insights about the legal, regulatory, and human aspects of dealing with colleagues who are aging, disruptive, or impaired. Learn how to better use quality measures to make decisions. In one day, attendees will gain insights into how to successfully lead a medical staff and, in doing so, comply with key accreditation, licensure, and legal requirements. Contact Julie Hopkins at jhopkins@imq.org for more info or visit http://bit.ly/1CPfESm to register.

11/4: St. Mary’s Medical Center Progressive Dinner

For more information or to RSVP, please contact Lydia Lee at (415) 750-5868 or Lydia.Lee@dignityhealth.org.

11/5: SFMS Career Fair for Residents/Fellows/ Physician Members

5:00 p.m. to 8:00 p.m. in the Enright Room at CPMC Pacific Campus | SFMS will host its fifth annual Career Fair at the Enright Room at CPMC Pacific Campus. The event is complimentary to residents and fellows from the four San Francisco-based residency programs. This is an excellent opportunity for physicians looking to practice in the Bay Area to network with representatives from a variety of practice types and settings, and for employers to connect with physician job seekers.

For event details or to inquire about exhibiting, contact the Membership Department at (415) 561-0850 extension 200 or membership@sfms.org.

11/19 Webinar: Marketing Your Practice in the Internet Era

12:30 p.m. to 1:45 p.m. | SFMS and ACCMA have partnered up to offer a webinar on effective online marketing strategies for your practice. Learn the tools you will need to use to attract new patients to your practice, retain existing ones, and create and maintain a positive online reputation. The training is free for SFMS members and at $199 for nonmembers. For more information on this seminar, please contact Dennis Scott at (510) 654-5383 or dscott@accma.org.

Save the date! 1/30: SFMS Annual Gala

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January 30, 6:30 p.m. to 9:00 p.m. | Asian Art Museum Gala tickets go on sale November 2015. Stay tuned for details.

SAN FRANCISCO MEDICINE OCTOBER 2014 WWW.SFMS.ORG

A financial safety net for you—

and the ones you love

10- and 20-year level term life No matter where you are in life, SFMS Group Level Term Life Insurance benefits can be an affordable solution to help meet your family’s financial protection needs.

Mercer and SFMS leveraged the buying power of your fellow members to secure dependable and affordable life insurance benefits at competitive premiums from ReliaStar Life Insurance Company, a member of the Voya family of companies.

With quality life insurance benefits extended at competitive rates, you’ll rest easy knowing you’ve provided coverage for your loved ones through the Group 10-Year and 20-Year Level Term Life Plans.

As a member, you can conveniently help protect your family’s financial future with the Group 10-Year and 20-Year Level Term Life Plan.

It features: • Benefits up to $1,000,000 • Rates designed to be level for 10 or 20 full years* • Benefit amounts that never change provided premiums are paid when due

See for Yourself: Get more information about your Group 10-Year and 20-Year Level Term Life Plans, including eligibility, benefits, premium rates, exclusions and limitations, and termination provisions by visiting www.CountyCMAMemberInsurance.com or by calling 800-842-3761.

Sponsored by:

Underwritten by: ReliaStar Life Insurance Company, a member of the Voya family of companies.

67142 (10/14) Copyright 2014 Mercer LLC. All rights reserved.

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

Our cancer experts shed light.

You’re never in the dark.

CPMC brings nationally-recognized cancer experts to our community, including our programs for melanoma led by Dr. Mohammed Kashani-Sabet and gynecologic oncology by Dr. John Chan. We take pride in providing timely access to our expert physicians, and personal follow-up with a patient’s primary or referring physicians means you’re always informed. Comprehensive cancer care at Sutter Health’s CPMC. It’s another way we plus you.

cpmc.org/cancer