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FALL 2018
VOLUME 66, NUMBER 3 • SEPTEMBER 2018
{FEATURES}
16 20 24 36 42 54 FALL 2018
{DEPARTMENTS} 46 IN THE NEWS
LIFETIME ACHIEVEMENT AWARD DINNER
ARE YOU READY TO CHECK CURES?
DECISION MEDICINE 2018 NEW FACES, FAMILIAR PLACES WELCOME TO THE NEXT GENERATION OF CMA
New faces and Announcements
56 PRACTICE MANAGEMENT:
Committed to Improving Quality Health Care
58 PUBLIC HEALTH Latent Tuberculosis in San Joaquin County 61 NEW MEMBERS
CMA DEFEATS AB 3087
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PRESIDENT R. Grant Mellor, MD PAST-PRESIDENT Richelle Marsigan, DO SECRETARY-TREASURER Hyma Jasti, MD BOARD MEMBERS Kismet Baldwin, MD, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD, Raghunath Reddy, MD, Kwabena Adubofour, MD
MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso
SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Grant Mellor MD, Lisa Richmond MANAGING EDITOR Lisa Richmond
COMMITTEE CHAIRPERSONS
CREATIVE DIRECTOR Sherry Lavone Design
DECISION MEDICINE Kwabena Adubofour, MD
CONTRIBUTING WRITERS R. Grant Mellor, MD,
CMA AFFAIRS COMMITTEE Larry Frank, MD
James Noonan, Gordon Arakawa, MD, PhD,
PUBLIC HEALTH TBD
Andrew Ochoa
SCHOLARSHIP LOAN FUND Matthew Wetstein, PhD THE SAN JOAQUIN PHYSICIAN MAGAZINE
CMA HOUSE OF DELEGATES REPRESENTATIVES
is produced by the San Joaquin Medical Society
Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Grant Mellor, MD, Kwabena Adubofour, MD, Raissa Hill, DO,
SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.
Ramin Manshadi, MD PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm
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Strong community partnerships lead to happier, healthier people
Celebrate Health
Partnering today for a healthier tomorrow With nearly 350,000 members and growing, Health Plan of San Joaquin continues to build relationships with health care providers to deliver on our mission to improve wellness throughout the communities we serve. NCQA re-accreditation for Health Plan of San Joaquin (HPSJ) The National Committee for Quality Assurance (NCQA) has awarded Health Plan of San Joaquin its three-year re-accreditation in the category of Medicaid HMO. NCQA is one of the most comprehensive evaluations in the health insurance industry.
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Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL
CATARACT SURGERY • GLAUCOMA CARE RETINAL •SERVICES EYELID SURGERY • LASIK • VISION EXAMS •• GLASSES CONTACTS Committed to continuously advancing vision careEXAMS andCARE providing compassionate patient care CATARACT SURGERY • GLAUCOMA RETINAL •SERVICES EYELID SURGERY • LASIK • VISION • •GLASSES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS GLASSES CONTACTS CATARACT SURGERY • GLAUCOMA CARE• RETINAL • EYELID SURGERY • LASIK • VISION EXAMS • •GLASSES •SERVICES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS • GLASSES • CONTACTS Joseph T. Zeiter, M.D.
Joseph John H. T. Zeiter, M.D.
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Richard John C.M. Canzano, Wong, M.D.
John Harold C. Canzano, Hand, M.D. M.D.
Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.
Joseph T. Zeiter, M.D.
Joseph John H. T. Zeiter, M.D.
Richard John H.M.Zeiter, Wong, M.D. M.D.
Richard John C.M. Canzano, Wong, M.D.
John Harold C. Canzano, Hand, M.D. M.D.
Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.
Joseph T. Zeiter, M.D.
Joseph John H. T. Zeiter, M.D.
Richard John H.M.Zeiter, Wong, M.D. M.D.
Richard John C.M. Canzano, Wong, M.D.
John Harold C. Canzano, Hand, M.D. M.D.
Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.
Joseph T. Zeiter, M.D.
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Richard John H.M.Zeiter, Wong, M.D. M.D.
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John Harold C. Canzano, Hand, M.D. M.D.
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eiter, M.D.
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Richard John H. M.Zeiter, Wong,M.D. M.D.
Richard John C. M. Canzano, Wong,M.D. M.D.
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Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.
Judith Prima, O.D. Peter V. A. Hetzner,
Judith Linda A. Hsu, Prima, O.D. O.D.
Steven LindaA.Hsu, Wood, O.D.O.D.
Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.
Robert Dupree,
eiter, M.D.
Joseph John H.T.Zeiter, Zeiter,M.D. M.D.
Richard John H. M.Zeiter, Wong,M.D. M.D.
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John Harold C. Canzano, Hand, M.D. M.D.
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Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.
Judith Prima, O.D. Peter V. A. Hetzner,
Judith Linda A. Hsu, Prima, O.D. O.D.
Steven LindaA.Hsu, Wood, O.D.O.D.
Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.
Robert Dupree,
eiter, M.D.
Joseph John H.T.Zeiter, Zeiter,M.D. M.D.
Richard John H. M.Zeiter, Wong,M.D. M.D.
Richard John C. M. Canzano, Wong,M.D. M.D.
John Harold C. Canzano, Hand, M.D. M.D.
Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.
Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.
Judith Prima, O.D. Peter V. A. Hetzner,
Judith Linda A. Hsu, Prima, O.D. O.D.
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Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.
Robert Dupree,
eiter, M.D.
Joseph John H.T.Zeiter, Zeiter,M.D. M.D.
Richard John H. M.Zeiter, Wong,M.D. M.D.
Richard John C. M. Canzano, Wong,M.D. M.D.
John Harold C. Canzano, Hand, M.D. M.D.
Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.
Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.
Judith Prima, O.D. Peter V. A. Hetzner,
Judith Linda A. Hsu, Prima, O.D. O.D.
Joseph Zeiter, M.D.
John Zeiter, M.D.
Richard Wong, M.D.
John Canzano, M.D.
Joseph Zeiter, Jr. , M.D.
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Peter Hetzner, O.D.
Linda Hsu, O.D.
tzner, O.D.
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Judith LindaA.Hsu, Prima, O.D. O.D.
Steven LindaA.Hsu, Wood, O.D.O.D.
Robert Pedersen, O.D. StevenE. A. Wood, O.D.
Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.
Robert Dupree, O.D.
tzner, O.D.
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Judith LindaA.Hsu, Prima, O.D. O.D.
Steven LindaA.Hsu, Wood, O.D.O.D.
Robert Pedersen, O.D. StevenE. A. Wood, O.D.
Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.
Robert Dupree, O.D.
tzner, O.D.
Peter JudithV.A.Hetzner, Prima, O.D. O.D.
Judith LindaA.Hsu, Prima, O.D. O.D.
Steven LindaA.Hsu, Wood, O.D.O.D.
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tzner, O.D.
Peter JudithV.A.Hetzner, Prima, O.D. O.D.
Judith LindaA.Hsu, Prima, O.D. O.D.
Steven LindaA.Hsu, Wood, O.D.O.D.
Robert Dupree, O.D.
Over 50 years ofE. K.Pedersen, Vision Care Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Over 50 years ofE. K.Pedersen, Vision Care Over 50 years of Vision Care Over 50 years of Vision Care
Over 55 years of Vision Care
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Robert O.D. Robert Devinder E. Pedersen, K.call Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, Steven LindaA.Hsu, Wood, O.D. StevenE.A.Pedersen, Wood, please O.D. To refer AO.D.patient, To refer A patient, please call Robert O.D. Devinder Grewal, O.D. Robertplease Dupree, O.D. Jennifer ToPedersen, refer A patient, callPham, O.D. Ralph Miranda, O.D. To refer A patient, please call
209-461-2170 209-461-2170 209-461-2170 www.zeitereye.com 209-461-2170 www.zeitereye.com www.zeitereye.com 209-466-5566 www.zeitereye.com
Steven Wood, O.D.
STOCKTON • LODI • MANTECA • TRACY • SONORA refer a patient, please call STOCKTON •To LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA
STOCKTON • LODI • MANTECA • TRACY • SONORA
www.zeitereye.com
FALL 2018
Robert Dupree,
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EXECUTIVE DIRECTOR’S REPORT
GOODBYE SUMMER, HELLO FALL When I think of Fall, I think of kids returning to school to start a brand-new school year, with all the excitement and nervous anticipation that comes with it. It is bittersweet for me this year as I have reached the milestone of not only having both kids in high school, but also my daughter, Riley’s first, last day of high school as she is officially a senior. (sniff sniff).
LISA RICHMOND
I love seeing all the sweet photos of the kids on their first day. This year, I was particularly excited to see a different type of back to school photo, White Coat ceremony photos from two of our super star Decision Medicine Alumni (2012), Jazzmin Williams and Oscar Levya. Both graduated from Stanford University and just started their first year at UCSF and Harvard Medical Schools, respectively. This is the dream for our Decision Medicine students! We hope that through their experience in the program, they are inspired and motivated to pursue the long road to medicine and come back to serve our community. For a glimpse into Decision Medicine and the adventures of the 2018 cohort, please see the enclosed article and photo spread. Like our Facebook page to watch our highlight video. SJMS is dedicated to not only growing our own physicians, but also supporting those who come to our community to train. We could not be more excited to introduce you to the new residency program at St. Joseph’s Medical Center in this issue’s feature article. These residents along with those from San Joaquin General Hospital all receive complimentary membership to the San Joaquin Medical Society and the California Medical Association. This dual membership provides them with social, educational and leadership engagement opportunities. The objective for them is to feel connected and eventually to stay to practice in our community.
JAZZMIN WILLIAMS
Did you know that effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) prior to prescribing Schedule II, III or IV controlled substances? We have included everything you need to know to be prepared on page Finally, please SAVE the DATE for our annual Holiday Party on Thursday, December 13 at 6pm. Invitations to follow later this Fall.
Best Wishes,
Lisa Richmond
OSCAR LEVYA
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THE STANFORD CARDIAC S U R G E RY P R O G R A M AT
Partners in Cardiac Surgery Leaders in Health Care The Stanford Cardiac Surgery Program at Dameron Hospital is expanding its medical team with the addition of Dr. Maria Currie, Stanford Cardiac Surgeon and faculty member. This program builds a strong partnership between Stanford Health Care and Dameron Hospital to provide patients with local access to Stanford’s leading-edge patient care.
DR . ERIC KEYSER , MD
DR . MARIA CURRIE , MD
“Dr. Currie is an outstanding cardiac surgeon and will complement Dr. Keyser’s expertise. We anticipate excellent results from the Dameron team and we are prepared to extend the support they need to make this program as successful as possible.” – Dr. Joseph Woo, MD Cardiothoracic Surgeon and Chairman of Stanford University School of Medicine’s Cardiothoracic Surgery Department
525 West Acacia Street, Stockton, CA 95203 209-944-5550 DameronHospital.org 10
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A message from our President > R. Grant Mellor, MD
Community
ABOUT THE AUTHOR R. Grant Mellor, MD- Pediatrician and Chief of Professional Development, Central Valley Service Area, The Permanente Medical Group and current President of the San Joaquin Medical Society
FALL 2018
Our community had an important anniversary in August: The Community Medical Centers celebrated its 50th year. The San Joaquin Medical Society was involved in the foundation of CMC, which was initially a set of volunteer medical clinics for migrant workers. CMC now consists of 18 neighborhood clinics, and cares for more than 80,000 patients. It remains a notable bright spot in our community! The San Joaquin Medical Society continues to contribute to the local medical community. We had another successful summer of Decision Medicine, the program that exposes underprivileged high-achieving high school students to the medical profession. Decision Medicine has produced a number of medical students so far, and we expect to see many of them return to our community to practice in the coming years. Our newest initiative, Bridge to Medicine, is gaining momentum. BTM is designed for all students, including the sons and daughters of SJMS members, graduates of Decision Medicine, and other highly-qualified students in the community. The program will provide coaching, identification of volunteer opportunities, help with applications, and interview preparation. We recently had a presentation regarding Baccalaureate/MD programs (aka “BS/MD” programs) that was well-attended and will hopefully yield some early med-school acceptances this year. Education remains the big topic for the medical community in the Central Valley. St. Joseph’s Medical Center launched its first two residency programs this Summer: Emergency Medicine and Family Medicine (the
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A message from our President > R. Grant Mellor, MD
latter in conjunction with Community Medical Centers). We can expect still more new residency programs from St. Joseph’s and other local institutions in the near future. Medical Students will be arriving in our hospitals and clinics in ever-greater numbers. Three medical schools in our region (California NorthState University, UC Davis, and Touro University) are planning to send significantly more students to train in Central Valley hospitals and clinics in the next few years. They have recognized that San Joaquin County has vast untapped clinical resources for medical education. Soon we’ll all be used to seeing residents and medical students in our daily work. The question remains: who will build the first medical school in Stockton? Many in our community are working on “pipeline” development of our local students (in addition to our
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efforts above). One notable example is Dr. Amir AssadiRad, Delta College professor, who has written a book entitled “Medical School; the Nuts and Bolts of Getting In.” He has created a speaking circuit at local high schools, drumming up interest in medicine as a career. There are many individuals and groups in our community working to transform our medical teaching infrastructure. The Central Valley will be a great place to prepare for a medical career, complete a residency program, and practice medicine. Enjoy the upcoming beautiful Central Valley fall season. I look forward to seeing you at the December dinner! Kind Regards, Grant
FALL 2018
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Please join us for the Please join us for the
Annual Annual Membership Membership Dinner Dinner honoring our honoring our
2018 Lifetime Achievement Award Recipient 2018 Lifetime Achievement Award Recipient
JeRoLd JeRoLd yecIeS, yecIeS, Md Md young Physician Award Recipient – cyrus Buhari, do young Physician Award Recipient – cyrus Buhari, do S u n d ay, J u n e 1 0 , 2 0 1 8 u n d ay, 6:00pm J u n e 1|0 ,dinner 2 0 1 8 7:00pm cocktail SReception cocktail Reception 6:00pm | dinner 7:00pm S to c k to n G o l f & c o u n t ry c lu b S to c k to n GBoulevard olf & co u n t ry ccalifornia lu b 3800 country club | Stockton, 3800 country club Boulevard | Stockton, california Member Physicians and Spouse/Guest Member Physicians Spouse/Guest non-Members andand Invited Guests – non-Members and Invited Guests –
– $45 per person – $45 person $75 perper person $75 per person
If you would like to attend this event, please call in your reservation If you would like to attend this event, please call in your reservation to the Medical Society: (209) 952-5299 before June 1 to the Medical Society: (209) 952-5299 before June 1
PReMIeR LeveL SPonSoRS PReMIeR LeveL SPonSoRS
Lifetime Achievement & Young Physician A ward D inner SUNDAY, JUNE 10, 2018
JEROLD YECIES, MD CYRUS BUHARI, DO
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Lifetime Achievement & Young Physician
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Controlled Substance Utilization Review and Evaluation System
CURES?
Are you ready to check 20
Starting October 2, all physicians must consult database before prescribing controlled substances BY KATHERINE BOROSKI
Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workf low, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload. >> On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018.
FALL 2018
CMA publishes safe prescribing resources for physicians What Physicians Need to Know
Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient. The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply. Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: • Admitted to a facility for use while on the premises;
The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. The page includes two CMA white papers on opioid prescribing, links to CMA’s health law library resources on the topic, the Medical Board of California’s “Guidelines on Prescribing Controlled Substances for Pain,” a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state’s prescription drug monitoring database. Members can find the page at cmanet.org/safeprescribing.
• In the emergency department of a general acute care hospital,
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so long as the quantity of the controlled substance does not exceed a seven-day supply; •A s part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or •R eceiving hospice care. In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.
CMA Fights for CURES Protections
CMA worked closely with the bill’s author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.
Save the Date: CURES webinar with DOJ on 8/22
CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet. org/events.
For More Information
For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA’s online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page.
Additional Resources:
CURES website: oag.ca.gov/cures CURES FAQ: oag.ca.gov/cures/faqs Medical Board CURES webpage: mbc.ca.gov/cures CMA CURES webpage: cmanet.org/cures CMA Safe Prescribing webpage: cmanet.org/safe-prescribing CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov.
FALL 2018
New report shows California’s progress addressing opioid crisis The American Medical Association (AMA) recently issued a new report documenting how California’s physician leadership is advancing the fight against the opioid crisis. The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid us disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017. “This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders,” said California Medical Association (CMA) President Theodore M. Mazer, M.D. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.” For more details on the report visit end-opioid-epidemic.org. Katherine Boroski is Senior Director of Communications for the California Medical Association.
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GROWING GROWING GROWING OUR OWN DECISION MEDICINE 2018 BY ANDREW OCHOA • PROGRAM FACILITATOR
“YOUR PARENTS DID NOT RAISE YOU IN THE BAY AREA. THEY DID NOT RAISE YOU IN LOS ANGELES. THEY RAISED YOU HERE AND WE NEED YOU TO COME BACK TO SERVE YOUR COMMUNITY.” THESE WERE PERHAPS THE MOST MEMORABLE WORDS GIVEN BY DRS. ADUBOFOUR AND KHOURY AT THE DECISION MEDICINE BANQUET. IT WAS RECENTLY REPORTED THAT THE SAN JOAQUIN COUNTY HAS 25% FEWER PRIMARY CARE PHYSICIANS THAN THE STATE AVERAGE. THE NEED FOR PHYSICIANS IN THE VALLEY IS INCREASING AND ONE WAY TO COMBAT THIS IS TO HELP OUR LOCAL STUDENTS PURSUE MEDICINE. >>
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Since the start of the program in 2001, the San Joaquin Medical Society has taken high achieving students from high schools across the county and provided them a glimpse in to the life of physicians through discussions, lectures and hands-on experience in various hospitals and clinics. Furthermore, it allows the students to experience what it’s like to be a physician in their own community. As an example of the caliber of students who apply, this year we had 152 applicants, interviewed 45 and finally accepted our 24 students with an average GPA of 4.37. They represented 15 high schools from Tracy to Lodi. This elite group of students not only demonstrated academic excellence, they were also involved in a myriad of extracurricular activities and handled themselves extremely well in the interview among a panel of physicians and facilitators, which can be just a little nerveracking. Each year the program kicks off with a ropes course to develop teamwork and rapport within the group. Here they are broken up into teams where they create their own team name, logo, and cheer. Our teams this year were The Blueberry Brainiacs, FDA: Future Doctors of America, The Lifesavers, and Code Blue. It was evident, even on day one, that this group
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HPSJ Health Careers Scholarships Decision Medicine Students Honored During the 2018 Decision Medicine Celebration Banquet, at Stockton Golf and Country Club, HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD, presented $2,500 HSPJ Health Careers Scholarships to DM 2018 graduates Julia Spencer, who will attend University of California, Irvine and hopes to be an OB-GYN, and Maha Shaikh, who will attend University of California, Santa Barbara and plans to be a physician. Each student has their own HPSJ DM program mentor. Health Promotion and Cultural & Linguistics Program Manager Jenny Dominguez is Julia’s mentor. Maha’s mentor is HPSJ Compliance Specialist Syla
would work well together. There was so much encouragement and camaraderie that even those who were too afraid to go up on the ropes course still felt a part of the team.
Ka. Dr. Dhanvanthari told the students, “We are proud of the way you purposefully blend hard work, academic excellence and
The first stop on our two-week hospital/clinic tour was St. Joseph’s Medical Center. It was here that the students became CPR certified, toured the hospital, and even watched a couple of operations from the gallery. They were very excited that premier Cardiothoracic Surgeon, Dr. Morrissey happened to be performing open heart surgery, which they were able to observe!
a passion for service. As we continue to support your progress through academia, including mentors from our likewise dedicated health plan staff, we hope that your journey will always bring you back to your Central Valley roots and outstanding health care careers.”
Next came the visit to San Joaquin General Hospital where the students were immersed in various activities. Due to the
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residency programs at SJGH, students are fortunate to interact with many physicians, including residents and interns. One of the favorite activities each year is rounding with residents, which they feel is very “Greys Anatomy. “ While half of the students were at SJGH, the other half were matched with a SJMS physician member for a one on one day of shadowing in their clinic, where they were able to experience the day in the life of a physician. As we picked up each student from their respective offices and ask about their day, they were beaming with excitement from the experience with their mentor. Perhaps the most eye-opening visit was to Channel Medical Center and Gleason House in downtown
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Stockton. Their assemblage of medical professionals dedicated to serve the less fortunate in their community was inspiring. The students viewed first-hand what it meant to provide healthcare to the homeless and underserved, as well as other valuable resources. Finally, the students continued to learn about community service by volunteering at St. Mary’s Dining Hall where they prepared dinner for the evening. UC Davis School of Medicine was the next stop. Students learned from current medical students about their path to medicine including an informative Q & A session and speed networking activity. They toured the medical school and found themselves enjoying the simulation rooms. Later, they walked to Shriners Hospitals for
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Children, where they learned about the wide array of services provided to children. They toured the facility and enjoyed “medical play” with current patients. This is typically where the future pediatricians shine, but with this group of students, they all shined. It is heartwarming to see the joy on both the students and patients faces during this activity! Week two started at Dameron Hospital. Along with an interesting tour of the hospital, the students learned about forensic pathology as well as how to type their own blood. At the beginning of the day each student had their blood drawn and later were given the antibody solution to test for coagulants. The excitement was particularly palpable when one of the students found that she was AB+, a rare occasion. Kaiser Modesto was the last location within the valley and was a memorable day. The students witnessed a simulation of a
Thank You for Your Support! FINANCIAL SPONSORS Health Plan of San Joaquin Community Health Fund Kaiser Permanente
Shriners Hospitals for Children St. Joseph’s Medical Center St. Mary’s Dining Hall UC Davis School of Medicine
COMMUNITY PARTNERS/HOSTS California Pacific Medical Center Community Medical Centers Dameron Hospital Kaiser Permanente HospitalModesto Medtronic San Joaquin General Hospital
PHYSICIAN MENTORS Bhagya Nakka, MD Chunhui Fang, MD Cyrus Buhari, DO Diego Ferro, MD Gentry Vu, MD George Khoury, MD Greg Bensch, MD
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Jerold Yecies, MD Joey Zeiter, MD John Canzano, MD Kwabena Adubofour, MD Linda Sakimura, MD Patricia Hatton, MD Prasad Dighe, MD Raissa Hill, DO Rodney DeGuzman, MD San Tso, DO Sunny Philip, MD Thomas McKenzie, MD Travers McLoughlin, MD
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hazardous emergency, toured the facility, and participated in a birthing simulation. Some of the students loved the intensity of both simulations (budding ER & OB/Gyns) while others preferred the pathology lab scene, which was a lot more relaxed. Ultimately, they all enjoyed the Case Study activity, where they worked in small groups with a physician to diagnose a patient with a “mystery disease.” The program culminated at California Pacific Medical Center in San Francisco, where the highlight was dissecting a pig heart with the help of cardiologists, fellows and residents. The students were so engaged in the dissection and did everything from identifying all the cardiac anatomy to probing the arteries and veins. After leaving CPMC, we headed to Pier 39 for a fun, Forrest Gump themed dinner at Bubba Gumps.
The most important thing we hope to provide to the students is encouragement and inspiration. Each year, they will encounter someone or hear something during the program that they can relate to and that has often has turned in to a mentor opportunity. During this long road to medicine, they often experience self- doubt and need someone remind them that they CAN do this, that anything is possible with hard work. Last year when asked for his advice, one of our young physicians said very simply “it’s a long road, it’s hard, you will fail, you will fall down, but pick yourself up and keep going because it’s worth it in the end”. This is the message we hope they will carry with them on their journey.
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2018
DM Students Solman Aniss
Manteca High School
Maggie Baird
Kayla Rafanan
Alondra Camarena
Betelhem Randolph
Cecila Crawford
Darren Saadat
Fatima Gutierrez
Elizabeth Pham
Nadine Koochou
Jazmin Segura
Yuvleen Kaur
Julia Tang
Ria Kotecha
Chalyn Valdez
Alondra Manzo
La Rissa Vasquez
Bear Creek Highschool
Health Careers Academy High School
During the recent celebration banquet, Tatum Halligan presented 2017 DM Alumni, Heidi Solis with a $2500 scholarship in memory of her father, Rick Halligan. Heidi will be studying Biological Science at California State University Sacramento this Fall and plans to become a physician. Rick Halligan was a Diagnostic Imaging Supervisor at San Joaquin General Hospital. He was the DM program coordinator for SJGH and one of the most passionate volunteers.
Stockton Collegiate International Schools
Benjamin Holt College Preparatory Academy
Millennium High School
SJMS Presents 2nd Annual Rick Halligan Memorial Scholarship
Jazmin Parra-Santos
Tracy High School
Millennium High School
Sierra High School
Edison Highschool
Joanna Mendoza
Health Careers Academy
Duc Nguyen
Cesar Chavez High School
Lincoln High School
Tracy High School
Stockton Early College Academy
Franklin High School
Manteca High School
Lodi High School
Stockton Collegiate International School
Britney Wong
Lincoln High School
Bear Creek High School
Diana Villicana
Aspire Benjamin Holt College Prep Academy
Lolita Mondragon “Rick will always be remembered for
Franklin High School
his incredible sense of humor and
Modupe Osikomaiya
enthusiasm for his profession and our Decision Medicine students� said Lisa
Stockon Early College Academy
Richmond, Executive Director of the San Joaquin Medical Society.
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Familiar Places St. Joseph ’s Medical Center is a Stock ton institution , having ser ved the communit y for more than a centur y. This summer, the hospital injects some new blood in the area’s physician communit y, with the launch of two new residency programs .
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“ FOR SE VER AL YE ARS , WE HAD B EEN E VALUATING WH E TH ER OR NOT WE COU LD START A RESIDENCY PROG R AM H ERE AT ST. JOSEPH ’ S .” -DO N WI LE Y
For more than 100 years, St. Joseph’s Medical Center has served the Stockton area, yet patients at the storied hospital may have recently noticed some fresh, new faces walking the halls. In July, members of the hospital’s inaugural class of medical residents arrived on scene, representing a major milestone for a program that hopes to help provide a home-grown physician workforce for California’s Central Valley. In all, 15 residents spread over two programs - nine in Emergency Medicine and six in Family Practice -- are the result of years of work by SJMC staff and physician leadership, and something that nearly all agree is perfectly suited for a community that has been served by more than a century by St. Joseph’s. “For several years, we had been evaluating whether or not
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we could start a residency program here at St. Joseph’s,” said Don Wiley, chief executive officer for SJMC. “We knew that our community needed more opportunities for training, and believed that our facility could be a perfect fit for that need.” Kenneth Scott Whitlow, DO, FAAEM, director of academic affairs and the programs’ designated institutional official, echoed these statements, nothing that St. Joseph’s had been involved in the training of surgical residents from San Joaquin General Hospital. “Even then, it seemed that a move toward graduate medical education was possible,” he said. The roots of today’s program were set down in earnest in 2015, when St. Joseph’s launched a program to allow local medical students to complete required training clerkship at St. Joseph’s, representing the hospital’s first foray into
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constructing and overseeing its own training programs. making their way to California to practice. It was then, Whitlow recalls that the wheels of today’s At the same time, one of the most widely acknowledged program were set in motion. strategies for combating physician shortages, and one of the “Around one year after that medical student program key recommendations of the study referenced above, is to started, the discussions expanded to include the possibility educate and train physicians in the communities where they of building a residency program for primary care specialties are most needed. at St. Joseph’s to help alleviate the physician shortage in the “One of the major recommendations to solve the problem area,” he said. over time is to develop more residency training opportunities California’s physician shortage has been well in the Central Valley, as well as bringing medical school documented within the medical education communities, and perhaps no area of the “ON E OF TH E MA JOR RECOM M EN DATIONS state has been as adversely impacted by the TO SOLVE TH E PROB LEM OVER TIM E IS shortage as communities with the Central TO DE VELOP MORE RESIDENCY TR AINING Valley. OPPORTU NITIES IN TH E CENTR AL VALLE Y, According to a recent study by the University of California, San Francisco’s AS WELL AS B RINGING M EDICAL SCHOOL Health Force Center, communities in the TR AINING H ERE .” Central Valley are experiencing alarmingly - K EN N E TH SCOT T WH ITLOW, DO, FA AEM low ratios of primary care clinicians to residents. The problem is only getting worse, with the study suggesting that, by 2030, the Central Valley’s training here,” Whitlow said. “We hope to be a significant ratio will be somewhere around 70 clinicians to 100,000 tool in helping achieve these goals for our region. The residents. These figures are more than 50 percent lower than data has been fairly consistent for many years that resident the rest of California, and the study points out that less than physicians tend to stay within 50 or so miles of where they half those clinicians are expected to be physicians. complete their terminal residency training. Around 40 to To make matters worse, the same study suggests that 50 percent remain and practice within those areas. We are more physicians are currently leaving the state than are working very hard to continue that trend here at SJMC to do
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our part to help solve our health care access issues.” When it comes to the question of access, however, underserved communities aren’t the only ones jockeying for position in the medical residency equation. Every March, as the national Match Day draws near, fourth year medical students experience the fiercely competitive process of matching with their desired residency program. For traditionally desirable locations, such as California, there are sometimes hundreds, if not thousands of applicants for only a dozen or so available slots, something that Wiley notes was mirrored in the St. Joseph’s inaugural run at attracting residents. “We saw somewhere between three hundred and four hundred applicants for our emergency medicine program, alone,” Wiley said. “The demand was incredible.”
a sheer manpower perspective. There are also significant benefits in the areas of recruitment and retention, as physicians hoping for teaching opportunities tend to gravitate toward hospitals with residency program. “Programs like these just make sense for St. Joseph’s,” Wiley said. “They’re good for our community, they are good economically and they’re good from a standpoint of recruiting the best and brightest physicians to serve our patients.” Other benefits, however, are less clear in the immediate term, but will likely have lasting benefits for the community in the years to come. “Programs such as these have the ability to help change the community itself. They allow more professionals and their families move to an area, and remain for longer “IT’S TAKEN MORE THAN THREE YEARS OF VERY periods of time,” Whitlow HARD WORK TO GET US TO THIS POINT. WE said. “These families add to EXPECT ANOTHER FOUR YEARS OF THIS TYPE the tax base, they shop and OF WORKLOAD TO FINISH BUILDING WHAT OUR support local businesses, PROGRAM WILL FINALLY LOOK LIKE BY 2023. and their presence can have a ripple effect. The advances AFTER THAT, THE WORK CONTINUES, JUST IN A in healthcare and education DIFFERENT WAY.” help bring more business - K EN N E TH SCOT T WH ITLOW, DO, FA AEM development to an area, and most importantly provide a Figures such as these are evidence of claim long pipeline of physicians to care for our growing community in advocated for within the ranks of organized medicine -perpetuity.” California simply does not fund enough residency slots. While the program is still in its early days, this notion of While programs such as those at St. Joseph’s are helping “the pipeline” is already beginning to factor into discussions. address this program at the local level, the California In the coming years, St. Joseph’s hopes to bring similar Medical Association is working to help address the problem programs online in the areas of OB/GYN and Internal in Sacramento. In 2017, CMA fought to restore more than Medicine. If both programs were to develop, as planned, $40 million per year in funds to expand for graduate medical St. Joseph’s Medical Center could, one day, play host to education (GME) slots, as well as reallocate $33 million back 79 residents across four, three-year programs. For those into the Song-Brown Workforce training program. who have led the hospital through the process thus far, the Those involved in the recent program launch at St. prospect is an exciting one, but one that they all recognize Joseph’s would be among the first to recognize that added, or will require a great deal of effort. new, residency slots have a variety of ancillary benefits for the “It’s taken more than three years of very hard work to get institutions that provide them. us to this point. We expect another four years of this type of “The benefits to St. Joseph’s are, really, just starting as our workload to finish building what our program will finally first residents are now getting highly involved in patient care,” look like by 2023,” Whitlow said. Whitlow said, noting that the hospital is seeing increased “After that, the work continues,” he said. “Just in a resources that can be dedicated to primary care clinics from different way.”
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•• SAN JOA
QU IN
BEST W2I0N1N8ER OA QU
INE •• AZ AG M
W•IN N JER • SAN
IN
Gill OB/GYN thanks you for entrusting us with your healthcare needs. It is our great privilege to bring new life in the world and share in your happiness. We have cared for the women of this community for over 65 years and look forward to becoming the first to welcome the next generation in your family and in our area.
EXPERIENCE MATTERS With 65 years of experience and roots dating back to 1953, Gill Obstetrics PRENATAL & POSTPARTUM CARE • HIGH RISK PREGNANCY • GYNECOLOGY • ENDOMETRIOSIS has a rich history of servingINCONTINENCE generations of women• OVARIAN throughout CYSTIC San DISORDER • LAPAROSCOPY • HYSTEROSCOPY URINARY DIAGNOSIS & TREATMENT OF CERVICAL, UTERINE, OVARIAN CANCERS • ROBOTIC SURGERY Joaquin County. We offer clinical expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that we put out patients needs first. After all...each woman needs are unique and you deserve special care!
Gill OB/GYN thanks you for entrusting us with your healthcare needs. It is our great privilege to bring new life in the world and share in your happiness. We have cared for the women of this community for over 65 years and look forward to becoming the first to welcome the next generation in your family and in our area. FALL 2018
SAN JOAQUIN PHYSICIAN
Gail Joseph, M.D.
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••
2018
ZINE
With 65 years of experience and roots dating back to 1953, Gill Obstetrics has a rich history of serving generations of women throughout San Joaquin County. We offer clinical expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that we put out patients needs first. After all...each woman needs are unique and you deserve special care!
GA
EXPERIENCE MATTERS
MA
BEST
WELCOME TO THE NEXT GENERATION OF CMA Since 1856, the California Medical Association (CMA) has supported physicians and the practice of medicine to keep the Golden State healthy and thriving. CMA’s success is rooted in our ability to effectively connect, communicate and engage with members. Because together, we are stronger.
“Diverse organizations like CMA need a bold brand and modern website to reinforce our mission through impactful design, messaging and imagery,” said CMA Vice President of Strategic Communications Laura Braden Quigley. “Our website was last updated in 2011, and our brand family had been untouched since the early 1990s. Given that CMA’s family includes 37 county medical societies, a political action committee, a foundation and other partners, it is critically important to demonstrate a cohesive and consistent brand across all communications channels, affiliates and platforms.” CMA’s website functionality, design and content strategy was reimagined with a focus on membership recruitment and engagement. Enhanced features of the new website include:
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One Login: We’ve simplified the login process so you don’t
have to keep track of multiple usernames and passwords. The joint CMA/county login means that your county medical society login now grants access to your CMA account.
My CMA: From public health to Medi-Cal, choose your preferences for custom content and personalized alerts. Mobile Responsive Design: CMA’s new site is optimized for mobile devices, so you can stay engaged from your phone or tablet. Search: The new and improved search function returns more relevant results, making it easier for you to find what you need. Grassroots Action Center: The Grassroots Action Center is the new hub for all of CMA’s advocacy efforts. Make your voice heard, join the Physician Advocate program, receive training from CMA experts and more!
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For additional information and resources: Customize Your Website Content: cmadocs.org/my-cma Website How-to Webinar and Usage Guide: cmadocs.org/cma-next-generation Contact the CMA Communications Team: communications@cmadocs.org.
Policymaking: Submit and
comment on resolutions through CMA’s year-round policymaking process.
Discussion Forums: With
improved features, we’ve made it much easier and faster to connect with physician colleagues.
Legislative Hot List: Receive real-time updates on health care legislation impacting your patients and medical practice. Newsroom: In addition to press releases and breaking news, CMA now has media training and other resources available, just for members. You can also join our Social Media Ambassador program or become a Media Surrogate! Join CMA: We have streamlined the
application process so it is fully integrated with our membership database. Join or renew today and immediately get full access to your “My CMA” dashboard and valuable member benefits.
“CMA’s brand and website serve as powerful recruitment and engagement tools to keep California’s physicians at the forefront of an ever-changing health care landscape,” said CMA President Theodore M. Mazer, M.D. “It also sends a bold message to physicians that we continue to be ready to embrace tomorrow’s challenges and opportunities. Much has changed since 1856, but CMA’s mission remains constant: to promote the science and art of medicine, protect public health, and better the medical profession.”
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Change your Bookmarks: CMAdocs.org In addition to the new website, CMA is also moving to a new URL that is easier to remember and more representative of who we are: CMAdocs.org. We have also moved to @CMAdocs on Facebook, Twitter, YouTube, Instagram and LinkedIn. CMA’s emails have been updated to email@cmadocs.org, and the staff directory remains the same: the f irst letter of the f irst name and last name (e.g.: dcorcoran@cmadocs.org).
How to Login to CMA’s New Website CMA and the county websites now share a single signon. If you're a CMA member, that means you can login with your county website username and password. In most cases, your username will be your email address or your medical license number. PLEASE NOTE: Changing your password on the CMA website changes your password on the county website, and vice versa. Member Physicians: All CMA members already have a website account, and you can login with your county website username and password. If you do not know your county login credentials, use the password reset to retrieve them. Nonmembers: To determine whether you already have a record in our database, visit the “register” page and enter your email (you do not need to enter any additional information at that time). If your email is in our system, you will see a note to that effect, then you can use the password reset feature to access your login information. SAN JOAQUIN PHYSICIAN
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Have You Visited the Improved cmadocs.org? My CMA
Choose your preferences for custom content and personalized alerts.
Grassroots Action Center The new hub for all of CMA’s advocacy efforts.
Simplified joint CMA/county login process so you don’t have to keep track of multiple usernames and passwords.
Mobile Responsive Design Optimized for mobile devices, so you can stay engaged from your phone or tablet.
Newsroom
In addition to press releases and breaking news, you can also join our Social Media Ambassador program or become a Media Surrogate.
Legislative Tracker
Real-time updates on legislation impacting the practice of medicine.
One Login
Join CMA
Streamlined application process that is fully integrated with our membership database.
Search
Returns more relevant results, making it easier for you to find what you need.
Discussion Forums Easier and faster to connect with physician colleagues.
Policymaking
Submit and comment on resolutions through CMA’s year-round policymaking process.
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Learn more about CMA’s next generation at cmadocs.org FALL 2018
CURES Duty-to-Consult Mandate Takes Effect October 2 Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – before prescribing Schedule II, III or IV controlled substances.
When Must I Consult CURES?
Physicians must consult the database before prescribing controlled substances to a patient for the first time and at least once every four months thereafter.
Save the Date:
Free CURES webinar with the California Department of Justice on 8/22. Register at cmadocs.org/events.
For More Information CMA CURES webpage: cmadocs.org/cures CURES website: oag.ca.gov/cures Summer FALL 2018 2018
CENTRAL COAST PHYSICIANS SAN JOAQUIN PHYSICIAN 11 45
In The News
IN THE
NEWS
Providing staff, physicians, and patients with relevant & up to date information
St. Joseph’s Earns Top Rating for Open Heart Surgery St. Joseph’s Medical Center has earned a distinguished threestar rating from The Society of Thoracic Surgeons (STS) for its patient care and outcomes in isolated coronary artery bypass grafting (CABG) procedures, the most frequently performed open heart surgery. The three-star rating, which denotes the highest category of quality, places St. Joseph’s among the elite for heart bypass surgery in the United States and Canada.
care delivery and helps provide patients and their families with meaningful information to help them make informed decisions about health care.”
“We are so proud to be recognized as one of the top hospitals for heart surgery in our nation,” said Don Wiley, president and CEO of St. Joseph’s Medical Center. “We have a long legacy of bringing the best in heart care to our community and this award truly reflects our team’s deep commitment to cardiac excellence.”
St. Joseph’s Receives Get With The Guidelines - Stroke Gold Plus Quality Achievement Award St. Joseph’s Medical Center has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.
Historically, only about 10% of participants in the nation receive the three-star rating for isolated CABG surgery. This latest analysis of data for CABG surgery covers a 1-year period, from January 2017 to December 2017, and includes 206 CABG procedures performed at St. Joseph’s. The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada. “The Society of Thoracic Surgeons congratulates STS National Database participants who have received threestar ratings,” said David M. Shahian, MD, Chair of the STS Council on Quality, Research, and Patient Safety. “Participation in the Database and public reporting demonstrates a commitment to quality improvement in health
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Database participants are made up of the best-of-the-best cardiac surgery programs in North America, who want to benchmark their outcomes against like-minded hospitals. St. Joseph’s Medical Center has participated in STS public
“St. Joseph’s is dedicated to continually bringing the highest quality of care to stroke patients in our community,” said Don Wiley, Hospital President and CEO. “We’re so proud to have received this award from the American Heart Association, recognizing our adherence to evidenced-based guidelines for treating stroke, which translates into better results for our patients.” St. Joseph’s earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date,
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evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions. Additionally, St. Joseph’s received the association’s Target: StrokeSM Honor Roll Elite Plus award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. St. Joseph’s Receives Platinum Performance Award from American College of Cardiology’s Action Registry St. Joseph’s Medical Center has received the American College of Cardiology’s ACTION Registry Platinum Performance Achievement Award for 2018. St. Joseph’s is one of only 203 hospitals nationwide to receive the honor. The award recognizes St. Joseph’s commitment and success in implementing a higher standard of care for heart attack patients and signifies that St. Joseph’s has reached an aggressive goal of treating these patients to standard levels of care as outlined by the American College of Cardiology/American Heart Association clinical guidelines and recommendations.
reaccreditation in the category of Medicaid HMO. NCQA is one of the most comprehensive evaluations in the health insurance industry. HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD, said: “Health Plans accredited by NCQA demonstrate their ongoing commitment to delivering high-quality care. NCQA is very member focused and this reaccreditation reaffirms the company wide dedication to serve our members and the community.” For members of Health Plan of San Joaquin, who mostly are working families and children, as well as seniors and persons with disabilities, this means – • NCQA has reaffirmed that HPSJ aligns with its Quality standards to increasingly deliver better service, having greater and greater positive impacts on members’ health. • H PSJ’s diverse membership can rely on their memberfriendly, very easy to read communications and the strong member advocacy from their case management team. • NCQA recognized that HPSJ deploys tech-supported processes to improve the member experience – and that HPSJ will continue to explore and add such technologies, as they benefit members and support the HPSJ provider network. • Members are choosing quality by choosing HPSJ, their local, home-grown health plan.
To receive the ACTION Registry Platinum Performance Achievement Award, St. Joseph’s has demonstrated sustained achievement in the ACTION Registry for eight consecutive quarters and has performed at the top level of standards for specific performance measures. Full participation in the registry engages hospitals in a robust quality improvement process using data to drive improvements in adherence to guideline recommendations and overall quality of care provided to heart attack patients. NCQA Reaccreditation for Health Plan of San Joaquin The National Committee for Quality Assurance (NCQA) has awarded Health Plan of San Joaquin its three-year
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Health Plan of San Joaquin announces its 2018 Health Careers Scholarships (HCS) and Mentors - will increase scholarship support level for next HCS HPSJ continues to encourage future Central Valley doctors, nurses and pharmacists and support up to seven local schools and programs, including San Joaquin Medical Society’s DECISION MEDICINE. To date, over 170 scholarships have been awarded to deserving students in San Joaquin and Stanislaus Counties! Each HCS scholar receives $2,500, is
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In The News
IN THE
NEWS assigned an HPSJ mentor, and is eligible to later apply for a $1,000 continuing education grant. During the next round of scholarships (2018-2019) the student Health Careers Scholarship award will be increased by $500 to $3,000. HealthReach 27/7 nurse and doctor advice line from Health Plan of San Joaquin Health Plan of San Joaquin has put out a reminder to its network to direct HPSJ patients to HealthReach, their free 24 hours a day, 7 days a week advice nurse line, so members can get assistance when their provider is not available. In addition to being able to speak with a registered nurse about any health problem, the nurse triages the member’s call, provides advice, and when appropriate refers the member for a telephone consult with a physician. • The physician can provide appropriate recommendations and prescriptions for simple conditions. • This is an added service for the HPSJ member, and they are able to get care in their home. • If the HPSJ member needs a higher level of care and needs to be seen, the physician will advise them to seek that needed level of care. • Conditions that physicians could diagnose and treat through a telephone consult may include: cold and flu, or rashes and infections such as sinusitis and conjunctivitis. They will provide prescriptions if needed. The primary care provider will receive a summary of the telephone consult with a physician.
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Providing staff, physicians, and patients with relevant & up to date information
This is another way HPSJ ensures patients always get the care they deserve when they need it most. At the same time, they are able to support the HPSJ provider network. Call HealthReach at 800.655.8294. Adventist Health Lodi Memorial Welcomes Pediatrician, Indu Lal, MD Adventist Health Lodi Memorial is proud to welcome Indu Lal, MD, board certified pediatrician. A graduate of Moti Lal Nehru Medical Indu Lal, MD College in Allahabad, India, Dr. Lal completed her residency with the Waterbury Department of Regional Pediatrics at the University of Connecticut in Waterbury, Conn. An advocate of providing total health care for children, Dr. Lal also received additional training in integrative medicine at Harvard Medical School with a certification in acupuncture. After leading a successful 40-year private pediatric practice, Dr. Lal’s passion for practicing medicine led her to return from retirement and join Adventist Health. “My passion is caring for children, and I am always so honored when parents allow me to be a part of their children’s wellbeing. Adventist Health has a vision for health care that is closely
FALL 2018
aligned with my own, and a culture that reflects my personal values,” she said. In her free time, Dr. Lal enjoys spending time with family, watching basketball games, cooking Indian cuisine, practicing yoga, reading and gardening. Dr. Lal is now accepting new patients. She practices at Pediatric Care, 2415 W. Vine Street, Suite 100, in Lodi. For an appointment, please call 209-333-3135.
own medical career,” Jawid said. “I found a similar focus and mission with Adventist Health, having worked with representatives from Loma Linda University in Afghanistan during medical school.” A sports enthusiast, Dr. Jawid plays soccer and also enjoys basketball and football. He loves spending time with his family and traveling. He speaks English, French, Farsi and Urdu.
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Considering a commercial loan? Abdul Raif Jawid, MD
Adventist Health Lodi Memorial is Proud to Welcome Internist, Abdul Raif Jawid, MD. Dr. Jawid is a graduate of Kabul Medical University in Kabul, Afghanistan, and completed his residency in internal medicine with Alameda Health System in Oakland, Calif. He is board certified in internal medicine.
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Dr. Jawid was inspired to pursue a career in medicine by his mother, a nurse practitioner. “My mother was always dedicated to helping people and making a difference, and I have carried this passion for service into my
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Investing In Business Relationships.
www.cvcb.com • (800) 298-1775 Proudly serving the San Joaquin Valley and Greater Sacramento
SAN JOAQUIN PHYSICIAN
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In The News
IN THE
NEWS Dr. Jawid practices at Millsbridge Family Medicine, 1901 W. Kettleman Lane, Suite 200, in Lodi. For an appointment, please call (209) 334-8540. Adventist Health Lodi Memorial is Proud to Welcome Sital Singh, MD, Gastroenterologist/Hepatologist. Dr. Singh is a graduate of Creighton University School of Medicine in Omaha, Neb. He completed both his internal medicine residency and fellowship in gastroenterology and hepatology at the University of California, Davis Medical Center in Sacramento. Growing up in the greaterSacramento area, Dr. Singh is excited about the opportunity to care for his hometown community. Sital Singh, MD “I love the community in the Sacramento area, and have always envisioned myself practicing here. My inspiration is to provide a personalized approach to medicine, and I found that with Adventist Health Lodi Memorial,” he said.
A life-long Sacramento Kings fan, Dr. Singh enjoys watching games with his family and playing basketball in his free time.
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Providing staff, physicians, and patients with relevant & up to date information
As a gastroenterologist/hepatologist, Dr. Singh will provide comprehensive care for the digestive system for ages 18 and older, addressing conditions such as acid reflux (GERD), Barrett’s disease, Crohn’s disease, peptic ulcers, hiatal hernias, swallowing disorders, diverticulosis and diverticulitis, and celiac disease, as well as screenings for colon cancer. Dr. Singh practices at Adventist Health Physician Network Medical Office - Gastroenterology, 999 S. Fairmont Avenue, Suite 125, in Lodi. For an appointment, please call (209) 334-8514. Adventist Health Lodi Memorial Proudly Welcomes Highly Respected Urology Group Adventist Health Lodi Memorial is proud to welcome urologists, N. Erick Albert, MD, Nancy Little, MD, and Ayad Khourdaji, MD. Well-known in the local community, Dr. Albert and Dr. Little bring their extensive experience in urological care to Adventist Health Lodi Memorial, where they have been joined in practice by Dr. Khourdaji. Dr. Albert is board certified in urology with more than forty years of experience in providing exceptional care. A graduate of the University of Illinois College of Medicine, in Chicago, IL, Dr. Albert completed his general surgery internship and residency at the University of California at Los Angeles. He
N. Erick Albert, MD
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completed his urology residency at Yale New Haven Hospital in New Haven, CT. Dr. Albert also proudly served as a major in the Army Medical Corps at Carl R. Darnell Army Medical Center in Ft. Hood, TX, after which he was awarded an Army Commendation Medal for his service. Dr. Little is board certified in urology and is a graduate of the Thomas Jefferson University Sidney Kimmel Medical College in Philadelphia, PA. She completed her residency at Duke University Medical Center in Durham, NC, and completed a fellowship in urodynamics and urologic Nancy Little, MD surgery at the David Geffen School of Medicine at UCLA in Los Angeles, CA. Dr. Little holds an additional subspecialty board certification in Female Pelvic Medicine and Reconstructive Surgery and has practiced in the Lodi area for more than 25 years. Dr. Khourdaji is a graduate of Wayne State University Medical School in Detroit, MI. He completed both his general surgery internship and urology residency with Beaumont Health System in Royal Oak, MI. Dr. Khourdaji also completed a fellowship in andrology and Ayad Khourdaji, MD infertility with the University of Virginia Health System in Charlottesville, VA. His passion for medicine led him to complete a degree in biomedical engineering prior to attending medical school. Drs. Albert, Little and Khourdaji look forward to continuing to provide compassionate, patient-focused care for all male and female urinary tract health concerns; including men’s reproductive health and andrology, erectile dysfunction, benign prostatic hyperplasia, kidney stones and incontinence. They specialize in male and female reconstruction procedures, including male urethral reconstruction, Botox injections for women with overactive bladder concerns, as well as the sling procedure for female stress incontinence.
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The three physicians will continue to practice in the longestablished office location of Dr. Albert and Dr. Little, as part of Adventist Health Physicians Network. The office is located at 830 S. Ham Lane, Suite 26, in Lodi. For an appointment, please call (209) 368-6661. Eric Cornwell, MD, joins Dameron Hospital as Medical Director for Surgical Services Eric Cornwell, MD, has joined Dameron Hospital as its new Medical Director for Surgical Services. Dr. Cornwell brings with him years of experience to Dameron, including general Eric Cornwell, MD surgery, women’s health, and urology. He is a graduate of Dartmouth Medical School in Hanover, New Hampshire, where he obtained his medical degree and Bachelor of Science degree in Biology. He completed his internship and residency at U.C. Davis Medical Center. Dr. Cornwell is board certified with the American Board of Surgery and holds a fellowship with the American College of Surgeons. Apart from being a general surgeon, Dr. Cornwell has also held positions as Assistant-Physician-In-Chief of Physician Human Resources, Assistant-Physician-In-Chief of Surgical Services, Chief of Surgery, Chief of Women’s Health, Chief of Urology, and a Diversity Facilitator. When he’s not at Dameron, Dr. Cornwell enjoys training dogs and horses, ranching, painting, and poetry.
HAVE SOMETHING TO SHARE? Send your files to lisa@sjcms.org one month prior to publication (February 1st for the Fall issue, May 1st for the Fall issue, August 1st for the Fall issue and November 1st for the Fall issue).
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In The News
IN THE
NEWS Tony Ha, MD, joins Dameron Hospital as Medical Director for Radiology Tony Ha, MD, has joined Dameron Hospital as its new Medical Director of Radiology. Part of Central Valley Imaging Medical Associates, Inc., Dr. Ha is Board Certified in Diagnostic Tony Ha, MD Radiology and is Board Eligible for certification in Vascular and Interventional Radiology. He is a Millennium Scholar graduate from the University of California San Diego, where he earned Bachelor’s Degrees in Biochemistry and Psychology. After completing a year of research at the University of California Davis, he returned to UCSD where he received his Medical Degree. Dr. Ha’s training continued with a Surgical Internship and Radiology Residency at Harbor-UCLA Medical Center, where he served as Chief Radiology Resident. Dr. Ha currently holds memberships with the American Medical Association, the American College of Radiology, the American Roentgen Ray Society, and the Los Angeles Radiological Society. When he’s not at Dameron, Dr. Ha likes to volunteer for Disaster Healthcare Volunteers of California. When he’s not at Dameron, Dr. Ha enjoys dogs, hiking, and cooking. Brian Sakamoto, MD, joins Dameron Hospital as Assistant Medical Director for Radiology
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Providing staff, physicians, and patients with relevant & up to date information
Brian Sakamoto, MD, has joined Dameron Hospital as its new Assistant Medical Director of Radiology. Part of Central Valley Imaging Medical Associates, Inc., Dr. Sakamoto is Board Certified in Diagnostic Radiology. He is a graduate from the Saint Louis University School of Medicine, where he Brian Sakamoto, MD earned his Medical Degree and Bachelor Degree in Biology. He served as a Radiology Body Imaging Fellow at Stanford Hospital and Clinics, and completed his internship and residency at Arrowhead Regional Medical Center and Saint Louis University Hospital, respectively. Dr. Sakamoto currently holds memberships with the Radiological Society of North America and the American College of Radiology. He is also a veteran of the U.S. Air Force as a major under the 375th Medical Group from Scott Air Force Base. When he’s not at Dameron, Dr. Sakamoto enjoys volunteering, hiking, camping, rafting, fishing, and baseball. New Cardiothoracic Surgeon Joins Stanford Cardiac Surgery Program at Dameron The Stanford Cardiac Surgery Program at Dameron Hospital is now staffed by two experienced cardiothoracic surgeons. Stanford Cardiothoracic Surgeon Maria Currie, MD, has established her full-time practice at Dameron Hospital effective July 1, 2018.
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She has been practicing at the Stanford University School of Medicine’s Department of Cardiothoracic Surgery since July 2017 and specializes in cardiothoracic transplants at Stanford. In addition to her experience with cardiothoracic transplants, Dr. Currie has also done extensive work in the area of augmented reality and visualization systems to enhance minimally invasive cardiac surgery procedures.
using the most advanced medical techniques available and I believe that the cardiac surgery program at Dameron aligns perfectly with this objective,” said Dr. Currie. “I’m excited about joining the team and becoming a part of the local community.”
Dr. Currie’s personal interests include spending time with family, enjoying good food and reading.
The Stanford Cardiac Surgery Program at Dameron Hospital is comprised of surgeons who are full-time faculty members from the Stanford University School of Medicine’s Cardiothoracic Surgery Department and full-time members of Dameron’s Medical Staff. Their offices are in Stockton at Dameron Hospital. Prior to joining Stanford’s Cardiothoracic Surgery Department in 2017, Dr. Currie was practicing for Michael R. MoRdaunt PeteR J. Kelly RichaRd J. SoRdello, JR. StePhanie Roundy loRi a. Reihl cuRtiS e. JiMeRSon JaMil R. GhannaM
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nine years in Ontario, Canada with Western University’s Cardiac Surgery Residency Program and the Royal College of Physicians and Surgeons of Canada’s Clinical Investigator Program. In addition, she earned a PhD in Biomedical Engineering from Western University in London, Ontario, Canada.
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CMA defeats dangerous rate setting proposal AB 3087 would have decimated California’s health care delivery system BY KATHERINE BOROSKI
In late May, the California Medical Association (CMA) killed a reckless legislative proposal that would have put a new government bureaucracy in charge of health care. Assembly Bill 3087 (Kalra) would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. By unilaterally setting the price for all medical services, the bill would have essentially eliminated the commercial health care market in California. Due in large part to staunch opposition led by CMA, the bill died in the Assembly Appropriations Committee. “No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said CMA President Theodore M. Mazer, M.D. “Had this bill passed, it would have reversed the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.” Since passage of the ACA, the state’s uninsured rate has dropped to an all-time low of 7.1 percent.
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A Groundswell of Physician Opposition Key to the bill’s demise was a groundswell of physician opposition. Through CMA’s Grassroots Action Center, thousands of physician members contacted their legislators because AB 3087 would have: • Decimated California’s health care delivery system. • Disrupted care and limited choice for millions of California patients. • Caused 175,000 health care workers to lose their jobs. • Forced hospitals to close and pushed health care providers into early retirement • Caused a “brain drain” of talented medical students and residents f leeing California for more ideal working conditions.
The Wrong Answer to a Real Problem This poorly conceived legislation would have done nothing to solve the fundamental problems of the health care payment system. “Simply setting physician rates without addressing the rising cost of providing care will do nothing to address health care spending,” said San Francisco pediatrician Shannon Udovic-Constant, M.D., vice chair of the CMA Board of Trustees. “AB 3087 would have driven a lot of physicians out of our state, and it doesn’t address the underlying reasons around rising health care costs in our state.” This dangerous rate setting proposal would have also moved California away from value-based care and universal access, backwards to an antiquated fee-for-service model that discourages contracting and stif les innovation. Instead of addressing the underlying issues, this bill would have forced hospitals to close, pushed health care providers into early retirement and caused a “brain drain” of talented medical students and residents f leeing California for more ideal working conditions.
Medicare Should Not Be a Benchmark for Costs AB 3087 would have required the commission to cap prices for commercial payments for all services to Medicare rates, which is a fundamentally f lawed approach that does not address coverage and benefits or the costs to provide care. Medicare was created to reimburse medical services for an age-specific population based on federal budgetary and regulatory constraints. Medicare rates do not keep up with inf lation or the cost of running a practice. Adjusted for inf lation in practice costs, Medicare physician pay has declined 19 percent from 2001 to 2017, or by 1.3 percent per year on average. Medicare rates are not intended to represent the fair
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market value of health care services. Rather, they f luctuate based on variables unrelated to the services provided, such as the federal budget.
AB 3087 Did Not Address Medi-Cal Rates Medi-Cal is the largest Medicaid program in the nation, with 13.5 million people—about one-third of the state’s population— enrolled in the program. And yet, California still pays among the lowest reimbursement rates of all 50 states, creating a serious access issue for patients. California’s Medi-Cal rates don’t come close to covering the cost of providing care—meaning that physicians lose money for every Medi-Cal patient they serve. Due to low Medi-Cal rates, physicians must make up revenue through their commercial contracts to keep their doors open. Because the AB 3087 proposal did nothing to address California’s sub-standard Medi-Cal rates, hospitals and health care providers would have continued to be underpaid by these governmental programs, putting them in an untenable situation.
AB 3087 Would Have Driven California’s Physicians Out AB 3087 also ignored the recommendations from the University of California, San Francisco’s report—commissioned by the Assembly—to achieve universal access to health care, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas. Currently, six of nine California regions are facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030—a 32 percent increase. “AB 3087 would have caused an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” said Dr. Mazer. “When I look at the economics of my own practice, it’s enough to tell me that I could not survive that environment and continue to see Medi-Cal patients. And probably at this stage of my career, it would drive me out of practice earlier that I might otherwise.” The bill also operated on the false premise that the cost of professional services—in other words, what physicians and hospitals charge for their services—is what’s behind the increase in health care spending in California. Data shows, however, that the price of prescription drugs and
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practice manager Free to SJMS/CMA Members!
resources
The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care. For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice. Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support. The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required. For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership Coordinator, at Jessica@SJCMS.org or call (209) 952-5299.
SEPTEMBER 12TH , 2018
to assess staff needs, hire the “superstar” employee, and motivate your team to succeed.
"HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)"
Debra Phairas- is president of Practice & Liability Consultants, a nationally recognized firm specializing in practice management and malpractice prevention.
11:00AM TO 1:00PM
This 2-hour course covers the following topics: • W hat is cyber security and privacy requirements for medical facilities?
NOVEMBER 14TH 2018:
• Ransomware, malware, email security, and encryption
“HERE TO HELP YOUR PRACTICE SUCCEED”
11:00AM TO 1:00PM
• W hat is the most prevalent cause of beach: how medical facilities are targeted and manipulated? • W hat are the steps you must take to become HIPAA compliant (and not what your IT guy told you)? • How to select the right IT company for your business? • W hat is a HIPAA Breach and what must you do if it happens to you? • W hat is "HIPAA Omnibus Rule" and what does it require? • W hat is the "Privacy Rule" and how do we implement it? • W hat is the "Security Rule" and how do we implement it? • What is considered Protected Health Information in all its forms? • W hat is HIPAA's "Minimum Necessary Provisions" (45 CFR 164.502(b)) • W ho are considered "Business Associates" (45 CFR 164.501) and what are your requirements?
As the health care landscape becomes increasingly complex for providers and practices, Health Plan of San Joaquin partners in numerous ways. The major public, not-forprofit, managed care plan serving San Joaquin and Stanislaus counties, HPSJ affords access to quality care for almost 350,000 members who are mostly working families and children, as well as seniors and persons with disabilities. In San Joaquin County alone, there are over 218,000 HPSJ members representing 91 percent of market share for MediCal enrolled patients. Here, in one place over lunch, a team of HPSJ experts will present clear information and answer the kinds of questions important to PCPs, specialists, practice managers, and staff. From how we support making productive, authentic patient engagement, to new tools for crossing the finish line to HEDIS incentives, here’s just a taste of the program menu. Please join us. Culture & Linguistics, from HPSJ support services, to Cultural Competency Attestation, and Interpretive Services & Sign Language
Julian Goduci- CEO- Enviromerica~ EnviroMerica, Inc. has provided health care facilities with Regulatory Compliance, and Regulated Medical Waste services for over 16 years. They specialize in compliance with OSHA, HIPAA, and requirements for DHHS, OCR, EPA, DTSC, Medical and Dental Boards, and Insurance companies.
From your Provider Services Representative, a tool kit that includes expanded, 24/7 transportation
OCTOBER 10TH, 2018:
DECEMBER 12TH, 2018:
“HOW TO HIRE EXCELLENT MEDICAL OFFICE STAFF: HIRE FOR ATTITUDE. TRAIN FOR APTITUDE”
“2019 MEDICARE CHANGES”
11:00AM TO 1:00PM
The medical office is a multidisciplinary “team sport” in which all positions are important and interdependent with one another. In this presentation, you will learn how
Claims Updates, including claims processing turn-arounds Helping you manage your patients’ best possible health: From Health Navigators, Social Workers, Care Management Options, and health educators HEDIS, what you need to know now and how we’re creating new tools after talking with many throughout our HPSJ provider network
11:00AM TO 1:00PM
Join us for our annual Medicare Update workshop for physicians and office staff. This 2 hour seminar will cover relevant information about current, future and proposed changes for the coming year! Cheryl Bradley~ Associate Director, CMA Center for Economic Services
Public Health
Update
Latent Tuberculosis in San Joaquin County:
A Call to Arms By Gordon Arakawa, MD, PhD.Â
Tuberculosis (TB) is an infectious airborne disease caused by the mycobacterium M. tuberculosis. The mycobacteria are spread from an infected person to another when the infected person coughs or sneezes with the release of tiny droplets into the air. >>
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The war began long ago. Scientists believe strains of M. tuberculosis began infecting humans as long as 15, 000 years ago. The ancient Egyptians and Greeks describe lesions in the body consistent with TB. A century ago, TB was considered “The Captain of all these men of Death.” At one point, TB was responsible for killing one out of every seven persons in the US and Europe. During the early to middle 20th century, the mortality rate began to decline with the isolation of the mycobacterium, development of a test indicating infection and creation of antibiotics to treat TB. In fact, the CDC announced a goal of eliminating TB in the US by 2010, citing a possible end to the war. And then, in the late 1980’s, several factors arose causing TB to once again become a public health problem. According to the CDC, the resurgence of active TB cases in the US was fueled by: the HIV/AIDS epidemic, increased immigration from countries where TB disease was prevalent, increased TB transmission in congregate settings such as prisons and homeless shelters, and the emergence of multi-drug-resistant TB. The battle continues.
Tuberculosis: the disease
TB is best described by two related conditions. The first condition is TB infection which can result from an individual being exposed to a person with active disease. A large majority of these infected individuals develop latent TB infection (LTBI). In LTBI, TB mycobacteria are present in the body but their growth is inhibited by the host’s immune system. LTBI patients are not infectious. In the second condition, active TB, mycobacteria break through the host’s defenses, rapidly multiply and spread throughout the lungs and body. If the spread of mycobacteria involves the lungs, the patient develops pulmonary TB. A patient with pulmonary TB is infectious and is also usually symptomatic. If TB spreads beyond the lungs (e.g. lymph nodes, bone, meninges, etc.), the patient develops extra-pulmonary disease. It should be noted that patients may develop both pulmonary and extra-pulmonary disease at the same time.
Addressing LTBI
LTBI patients are at risk for developing active TB depending on their immune status. For an otherwise healthy LTBI
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patient the lifetime risk to develop active TB is 5-10%. An HIV patient has a 5-10% yearly risk to develop active TB. Fortunately, this risk of progression to active disease can be curtailed by use of medication therapy. This is imperative since CDC estimates that there are an estimated 43,000 cases of LTBI in San Joaquin County. Over the past 5 years, the CDC and California Department of Public Health (CDPH) have urged local health departments to reduce the risk of TB disease by addressing the LTBI burden. Several studies have examined the effect of decreasing the LTBI burden upon TB incidence rates in the US. The results of one such study are shown in Figure 1. The graph shows marked decreases in TB incidence rates as the LTBI burden is halved or decreased by a factor of four. A salient interpretation is that active TB arises from a “pool” of LTBI. If one reduces the size of the LTBI pool, then active TB will be reduced. A path to victory is clearly marked. Reducing the LTBI burden is a two-step process. The first step involves identifying those individuals with LTBI. The second step involves treating those LTBI patients with appropriate medication therapy. Thus, the battle against TB can be won by actively identifying and treating LTBI individuals before they have a chance develop active TB.
LTBI Identification
Since LTBI patients are not sick, de novo identification of such patients can be difficult. Thus, individuals who are at risk for LTBI infection must be identified. Individuals at risk include those exposed to a person with active TB, especially children under the age of six, individuals born in or report travel to foreign countries where TB is prevalent, IV drug users, the homeless, and persons living in congregate settings. Once an at-risk individual is identified, that individual should undergo confirmatory testing for LTBI via a Tuberculin skin test (TST) or an Interferon Gamma Release Assay (IGRA) test. The TST is placed intradermally along the forearm. Diagnostic reading of the TST takes place 48-72 hours after placement. The IGRA involves a blood test and is thought to be more sensitive and specific than the TST.
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practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice.
CALIFORNIA MEDICAL ASSOCIATION
Assistance ranges from coaching and education to direct intervention with payors or regulators.
TB case, who are now active TB cases. In each instance, the LTBITROUBLE Treatment Fresno Madera Medical Society GETTING PAID? LTBI patient did not start or did not complete the full course Of course, not all at-risk individuals will test positive for of medication therapy. And now, ofInstitute course, each of these new 66th Annual Yosemite Postgraduate LTBI. However, those that do should be urged to undergo
CMA CAN HELP!
CMA members can call on CMA’s practice management experts one-on-one helpfor with payment, billing active cases serve as a nidus a new population of LTBI medication therapy for LTBI. There exist three options for 24 March 26, for 2017 and contracting issues. If you answer “yes” to any of the-following it might be time to call for help. I’VE RECOVERED contacts. questions, medication therapy: Isoniazid (INH) once daily for 9 months, $ Rifampin (RIF) once daily for 4 months and a combination of The San Joaquin County Public Health Services is taking an In the past nine years, CMA’s Center for Isoniazid/Rifapentin (3-HP) once WEEKLY months. At • Are your claims being denied after obtaining prior • Do you have questions about the new for law3on payment from my the payors active role in promoting idea ofusing “Think LTBI” in order to Economic Services has recovered over this point in time, both the CDC and California Department authorization? and billing for out of network services (Assembly Bill 72)? CMA’s Center forit is you, the clinicians in reduce the burden of TB. However, from payors behalf of Public$15.5 Health million (CDPH) recommend the 3-HPon regimen for of Economic Services hospitals, emergency communityissues? medical offices, and •CMA Do youages have questions • Do you need help withrooms, Medicare-related members. all individuals, two and up. about Covered California? urgent care centers who stand at the front lines in this war. CMA’s Center for Economic Services is staffed by Pleaseyou remain identify and test thosecare at risk for LTBI, and • Are your claims not being paid in a timely manner? • Have been alert, presented with a managed practice experts with combined Some might denymanagement there is a TB war here in SanaJoaquin contract andwith you’re not sure ifthen the terms arebe defeated once and treat those LTBI. Only can TB of over why 125 years medical practice County.•experience One may question LTBI in patients must be Are you not Our being paidisaccording to your contract? consistent operations. goal to empower physician for all. with California law? identified and treated, claiming “Conversion to active TB does practices by providing resources and guidance to not REALLY happen here...” As matter of fact, San Joaquin •improve Are you receiving untimely requests for refunds or is a • Have you done everything you can to resolve an issue the success of ayour practice. (For more information on reporting, testing or treating TB and moneyrecently from your check without with a payor, but have hit a brick wall? County payor Publicrecouping Health Services identified several LTBI, please call San Joaquin County Public Health Services, Assistance coaching andrequest? education to first notifying you infrom writing of a refund LTBI patients, each ranges previously identified as contact to an active Registration is now open - Call (559) 224-4224 ext.at118 TB Control Program, 209for 468-3838). direct intervention with payors or regulators.
70,000
more information or visit www.FMMS.org
Access to CMA’s reimbursement experts is a FREE, members-only benefit. help? Call 786-4262 or email economicservices@cmanet.org. CMANeed members can call on (800) CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.
• Do you have questions about the new law on payment and billing for out of network services (Assembly Bill 72)?
• Are your claims being denied after obtaining prior authorization?
• Do you have questions about Covered California?
• Do you need help with Medicare-related issues?
• Are your claims not being paid in a timely manner?
• Have you been presented with a managed care contract and you’re not sure if the terms are
• Are you not being paid according to your contract? • Are you receiving untimely requests for refunds or is a payor recouping money from your check without
consistent with California law? • Have you done everything you can to resolve an issue with a payor, but have hit a brick wall?
first notifying you in writing of a refund request?
Access to CMA’s reimbursement experts is a FREE, members-only benefit. Need help? Call (800) 786-4262 or email economicservices@cmanet.org.
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New Members
6 NEW
SJMS MEMBERS THIS SUMMER!
...and even more on the way.
George Newton, M.D.
Gordon Arkawa, M.D.
General Surgery
Nuclear Medicine
7373 West Lane Stockton, CA 95210 Northeastern Ohio University College of Medicine
1601 E Hazelton Ave Stockton, CA 95205 Boston University School of Medicine
Qingru Wang, M.D.
Harpreet Singh, M.D.
Pediatrics
Internal Medicine
7373 West Lane Stockton, CA 95210 West China University of Medical Science
2505 W Hammer Lane Stockton, CA 95209 (209) 954-3370 Government Medical College, Amritsar
Shin Lee, M.D. Anesthesiology 7373 West Lane Stockton, CA 95210 University of Cincinnati College of Medicine
FALL 2018
Rajvir Singh, M.D. Family Medicine 1335 S Fairmont Ave. Lodi, CA 95240 (209) 366-2007 St. George’s Medical School
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Saving Medical Groups Millions
Thanks to a new CMA-sponsored law, California medical groups will save millions in workers’ comp premiums. As of July 1, 2018, physician owners of professional corporations will be able to exempt themselves from workers’ compensation coverage—regardless of percentage of ownership—resulting in significant premium savings.
The Problem
In 2016, the legislature changed the definition of “employee,” requiring owners with less than a 15% ownership to have workers’ comp coverage. Because of this law, some medical groups were forced to pay drastically increased premiums for coverage they neither needed nor wanted.
The CMA Solution
CMA sponsored a law to once again allow appropriate coverage exemptions for owners, which will save individual medical groups hundreds to hundreds of thousands of dollars in workers’ comp premiums.
Learn more about SB 189 and how it affects your medical group at cmadocs.org/sb189. 62 SAN JOAQUIN PHYSICIAN
FALL 2018
SPEAK MI CULTURA
INNOVATIVE MEDICAL SOLUTIONS IN A MULTICULTURAL WORLD
JRivera Associates envisions a world in which healthcare disparity no longer exists. We are passionate about the power of language and how it transforms and saves lives, delivers trust and keeps people well. We are a team dedicated to providing physicians and their practices with the tools and technology to inform, empower and embrace communication to those who need it most...your patients. Medical Interpretation and Translation | Over 47 languages to support your patients
JRIVERA ASSOCIATES 139 S. GUILD AVENUE FALL 2018 LODI, CA 95240
P: 209-405-0951 E: SERVICES@JRIVA.COM W: WWW.JRIVA.COM
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