Spring 2014 by San Joaquin Medical Society

Community Health

LEADERSHIP COUNCIL

PLUS: Gleason House CMA Governance Reform Spring 2014

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SAN JOAQUIN PHYSICIAN

SPRING 2014

VOLUME 62, NUMBER 1 • FEBRUARY 2014

Gleason House

{FEATURES}

12 16 44

{DEPARTMENTS} 28 MICRA

CALIFORNIA MEDICAL ASSOCIATION Governance Reform

COMMUNITY HEALTH Leadership Council

GLEASON HOUSE

Two Year Anniversary

Trial Lawyers’ Money Grab Threatens to Overturn MICRA

30 CMA PRACTICE RESOURCES 36 IN THE NEWS

New Faces and Announcements

54 PUBLIC HEALTH 67 NEW MEMBERS 69 IN MEMORIAM

Cover Photo by Dale Goff

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SAN JOAQUIN PHYSICIAN

PRESIDENT Thomas McKenzie, MD PRESIDENT-ELECT Ramin Manshadi, MD PAST-PRESIDENT Raissa Hill, DO SECRETARY-TREASURER James J. Scillian, MD BOARD MEMBERS Lawrence R. Frank, MD, Moses Elam, MD, Peter Drummond, DO, Dan Vongtama, MD, Karen Furst, MD, Kwabena Adubofour, MD, Kristin M. Bennett, MD, Clyde Wong, MD, George Savage, MD, Parvinderjit Kaur, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond COMMUNITY PROJECT MANAGER Vanessa Armendariz MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Thomas McKenzie, MD Lisa Richmond, Mike Steenburgh Vanessa Armendariz

COMMITTEE CHAIRPERSONS MRAC F. Karl , Gregorius, MD DECISION MEDICINE Kwabena Adubofour, MD ETHICS & PATIENT RELATIONS to be appointed

MANAGING EDITOR Mike Steenburgh CREATIVE DIRECTOR Sherry Roberts CONTRIBUTING WRITERS Vanessa Armendariz, Lita Wallach, Steven E. Larson, M.D., MPH

LEGISLATIVE Jasbir Gill, MD COMMUNITY RELATIONS Joseph Serra, MD PUBLIC HEALTH Karen Furst, MD

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society

SCHOLARSHIP LOAN FUND Janwyn Funamura, M.D. NORCAP COUNCIL Thomas McKenzie, MD

SUGGESTIONS, story ideas or completed stories written by current San Joaquin Medical Society

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD,

members are welcome and will be reviewed by the Editorial Committee.

James R. Halderman, MD, Patricia Hatton, MD, James J. Scillian, MD, Peter Oliver, MD, Roland Hart, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD,

San Joaquin Physician Magazine

Gabriel K. Tanson, MD, Ramin Manshadi, MD

3031 W. March Lane, Suite 222W

Stockton, CA 95219 Phone: 209-952-5299 Fax: 209-952-5298 Email Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM Closed for Lunch between 12pm-1pm

SAN JOAQUIN PHYSICIAN

SPRING 2014

Sometimes You Just Need a Little Help.

Fifth Annual Golf Tournament Join fellow San Joaquin Medical Society members and invited guests for a relaxing round of golf, a special Cinco de Mayo themed lunch and after golf party. Plus an opportunity to benefit our local The First Tee of San Joaquin program and SJMS’ Decision Medicine Program. Your hosts, Drs. Kwabena Adubofour, George Herron, Prasad Dighe and George Khoury are committed to making this an event to remember!

Sunday May 4th, 2014 • Stockton Golf & Country Club • 4 Person Scramble $175 per golfer - Price includes Green Fees, Golf Cart, Lunch, tee prizes and after golf party! $50 of every entry fee goes to The First Tee of San Joaquin program • Hole Sponsorships benefit SJMS’ Decision Medicine Program

Registration and Range Open 11:00am • Putting Contest Qualifying 11:00am - 12:30pm Buffet Lunch 12:00pm • Shotgun start 1:00pm

To sign up, please call the San Joaquin Medical Society office at 209-952-5299 SPRING 2014

SAN JOAQUIN PHYSICIAN

Letter From The Executive Director

STAFF REPORT

COMMITTED TO OUR COMMUNITY

or 13 years, the Community Health Leadership Council has worked to build partnerships and engage community stakeholders of health, education and business through a leadership steering committee, annual Forums and goal specific workgroups. It has been my pleasure to work with such an esteemed group of individuals on this Council and to attend my first forum in November, the presentation about the Affordable Care Act by keynote speaker Peter V. Lee, Director of Covered California at the University of the Pacific. The feedback from attendees on this topic was overwhelmingly positive. Please read more about this important initiative in this month’s feature article. LISA RICHMOND

In preparation for the story on the 2nd Anniversary of the Gleason House, Vanessa Armendariz, Community Relations Manager and I took a trip down to Community Medical Center’s Gleason House and Gospel Center Rescue Mission’s Respite Care for the homeless. It is amazing to see the evolution of this old house, the vision of a place that would welcome and provide healthcare to an underserved population and the passion of the people who work there. We left truly inspired! You will find more information on Gleason House and the need for respite care on page 44. Spring proves to be a busy time of year as we prepare for the upcoming Decision Medicine application and interview process. We are working to expand our pool of physician mentors who are willing to invite a student in to your practice in July to experience a “day in the life” of a physician. Please let us know if you are interested. For more information on Decision Medicine, please visit www. decisionmedicine.com. Additionally, physician members will be receiving nomination forms for Lifetime Achievement and Young Physician Awardswhich will be given out at our Membership Dinner at Brookside Country Club on Sunday, June 22, 2014. We are fortunate to have so many worthy candidates in San Joaquin County. We look forward to receiving your nominations. Finally, please save the date for the 5th Annual SJMS Golf Tournament benefitting The First Tee of San Joaquin and SJMS’ Decision Medicine program. This year the tournament will be held at the beautiful Stockton Golf and Country Club on Sunday, May 4 at 1pm. Please see enclosed advertisement for all of the exciting details! All the Best,

Lisa Richmond

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SPRING 2014

Param K. Gill, M.D.

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David L. Eibling M.D.

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R. Afiba Arthur, M.D.

Tonja Harris-Stansil, M.D.

Catherine Mathis, M.D.

Kevin E. Rine, M.D.

Jacqualin Miller, D.O.

Linda Bouchard, M.D.

Lynette Bird, R.N., B.S.N.

Philip D. Ross, M.D.

Maria E. Escalona, M.D.

Vicki Patterson-Lambert, R.N.P.C. Denise Morgan, M.S.N. - N.P.

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A message from our President > Thomas McKenzie, MD

One of my favorite bumper stickers....

It’s called thinking............you should try it sometime! One challenge of writing a President’s column is trying to decide what to write and who will read it. How many journals are piling up on your desk every day? Which ones to do you choose to read.. and what is your attention span during your busy day? I know you certainly aren’t taking this magazine home, so I better be concise and succinct.

With the implementation of the new healthcare system, increased regulatory and documentation requirements (I just can’t wait for the excitement of ICD-10), what is our future as physicians? What is the future of our Medical Society? Certainly as in politics, the future is in our physician demographics. Where are the young physicians? It is my perception that young physicians misunderstand the value of the California Medical Association (CM A) and our Medical Society, and are in general disengaged in Society functions. Some call it a generation gap, others believe it is a function of residential work hours prompting many to enjoy life outside of medicine, and just treat their chosen occupation as an 8 to 5 job.

ABOUT THE AUTHOR Dr. Thomas McKenzie is President of the San Joaquin Medical Society and is an Orthopedic Surgeon practicing in Lodi.

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SAN JOAQUIN PHYSICIAN

A message from our President > Thomas McKenzie, MD

There are just too many totally missing in action. What can we as a Medical Society do to engage these young physicians? More than anything else, it is imperative that we show the worth of the Society to them as individuals and physicians. So I’m asking each of you to grab a younger physician and make sure they know their future, and our future, is up to them. Educate them about some of the successful policies that have helped contain health costs and keep access to care a reality – polities like the Medical Injury

us win the campaign – so, visit www.cmanet.org/micra to find out more information about how to join the efforts. Our futures are being decided by the medicalindustrial complex composed of big government, the insurance oligopolies, large pharmaceutical and medical equipment companies, and questionable selfserving metadata studies of big Pharma and large/ prestigious academic medical system complexes. If you don’t have a seat at the table....you may be on the menu. Our thinking and doing is most effective at the local level- with one on Many and medical one interaction with students haven’t been educated about the importance our patients and of , and aren’t aware of the law’s each other. Lead by example. I strongly importance. So what can we do about it? Is ignorance urge you to commit bliss? We have such an opportunity , as resources to the a MICRA ballot initiative will be on November’s ballot. CM A specifically to support the defense of MICR A. Every dollar counts, and we Compensation Reform Act (MICR A). need yours to win this fight. Request financial support Many young physicians and medical students by your hospital medical staff, as are so many other haven’t been educated about the importance of hospital staffs are doing. Our patients and the future of MICR A, and aren’t aware of the law’s importance. So medicine so strongly depend on this – I cannot stress what can we do about it? Is ignorance bliss? We have enough the importance of your financial contribution. such an opportunity right now, as a MICR A ballot I strongly encourage you to forward $100 of your initiative will be on November’s ballot. I challenge money for MICR A defense to the CM A. It is $100 each physician reading this to find a resident, young that will be spent in your best interest. Checks may be physician, medical student, mentee or colleague and mailed the below address: have a conversation about how a change to MICR A like the one being proposed will increase health care CALPAC costs for every Californian and result in decreased 1201 J. Street, Ste 275 access to care for patients that need it most. Sacramento, CA 95814 As stated in my last article, MICR A remains the issue that is not going to go away. Trial lawyers have long tried to increase the cap on MICR A as a way To be concise, our future is the next to line their own pockets, but together as physicians generation. Teach them the lessons we must push back for the benefit of our patients and of history. This is all about MICRA. the future of medicine. Regardless of demographics, practice type, political beliefs..... the preservation of MICR A is a uniting issue for the house of medicine. United We Stand The CM A and our county Society have tools to help

MICRA

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“

young physicians

right now

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CMA > Governance HOD 2013 Reform

By Steven E. Larson, M.D., MPH, Chair of the CMA Governance Technical Advisory Committee

GOVERNANCE

REFORM CMA ENVISIONS A NEW FUTURE FOR ORGANIZED MEDICINE

Change is never easy. But oftentimes is it necessary, and

In a nutshell, the reforms will make CMA more relevant

even invigorating. The California Medical Association

and effective by focusing the association on, and

(CMA) is about to embark on a journey of change that

bolstering its resources to address, the critical issues of

will position our association as a nimble, proactive

universal importance to physicians. By doing so, CMA

organization ready to lead the practice of medicine

will be better able to protect the interests of its physician

into a brave new world. In 2013, the CMA House of

members and, even more importantly, guide the future

Delegates (HOD) approved a plan to reform the way our

of our profession, not only in California but nationwide.

association is governed. Will it be easy? No. Will it be worth it? There is not a doubt in my mind.

12 SPRING SAN2014 JOAQUIN PHYSICIAN

SAN JOAQUIN PHYSICIAN SPRING 2014 12

IN A NUTSHELL

The reforms will make CMA more relevant and effective by focusing the association on, and bolstering its resources to address, the critical issues of universal importance to physicians.

150 YEARS OF TRADITION For 150 plus years, CMA has been guided by the HOD, which meets once a year to set policies and direct resource allocation. This has led to a sometimes unwieldy 581-member HOD, a Board of Trustees numbering more than 50, a seven-member Executive Committee and hundreds of other members serving as alternate delegates and in various capacities on dozens of councils, committees, sections and mode of practice forums. Over the years, there have been several task forces assigned to this subject. It wasn’t until this year, however, that the abstract discussions about “governance reform” began to produce concrete results. These discussions resulted in big questions. Does the HOD foster a reactive culture rather than a proactive one? Does it inhibit CMA’s ability to take quick action in a rapidly evolving health care environment? While these questions were being asked, the HOD was spending most of its time on a growing number of resolutions that struggled to

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be assigned or implemented because of resource limitations. The CMA Board of Trustees, realizing that a floundering governing style prevented the organization from quickly acting on issues of universal import to the membership and their patients, created a committee—the Governance Technical Advisory Committee (GTAC)—to look at this issue. The GTAC confirmed what the executive committee had feared —the association was unable to quickly address universal issues that arose faster than the once-a-year HOD meetings could handle. And, there were other inefficiencies in CMA’s governing bodies and processes. And there was the cost. An independent study commissioned by CMA (an activity-based costing, or “ABC” study) found that CMA governance is far more resource-intensive than previously thought, accounting for almost one-third of CMA’s operating budget—an allocation that commensurately reduces resources available for advocacy and other member services.

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CMA > Governance Reform

THE GOVERNANCE TAC REPORT The full report of the CMA Governance Technical Advisory Committee, as amended by the House of Delegates at its October 2013 meeting in Anaheim, is available for download on the California Medical Association website. To access the report, available to members only, visit www.cmanet.org/hod and click on the “documents” tab. The report begins on page 12 of the “Actions of the 2013 House of Delegates” document.

The GTAC began its discussion of how to bring relevance, democracy and costeffectiveness to governing the association. It became clear to us that the rank and file members want more advocacy, while the delegates and trustees are heavily invested in leadership.

TACKLING THE BIG ISSUES

A proposal to reform CMA’s governing structure, put before the 2013 CMA HOD by the GTAC this past October, proposed that instead of a diffuse focus on many issues, the HOD take on a limited number of big issues—the most important, most pressing matters facing physicians and the practice of medicine. CMA’s long-standing traditions of

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democratic participation and representative governance would continue; the difference, as envisioned by the GTAC, is that specific issues that are of concern to a narrow spectrum of the membership would no longer command HOD’s limited time. Rather, the democratically elected Board of Trustees would act on those issues, as it already does on the increasing number of matters referred to the board for action by a House that is aware of its policy-making constraints. The HOD would continue to set policy on major issues, and its decisions would be informed through a year-round process not constrained by 15-minute limits on debate of recommendations developed in a rushed overnight exercise, as is currently the case. More focused expertise would be brought to bear in a more careful development of

recommendations for action. Policy on other issues would realize the same benefits of a more careful and expert deliberative process throughout the year. We would like to improve the discussion at the House of Delegates to deal with the big issues of the day and to utilize the valuable resources of our delegates for the collective development and direction of important policy matters. We believe this proposal has real potential for a robust discussion around issues that will impact all physicians. The reforms would also open the discussion to individual members who could continue to bring forth their ideas and proposals through a year-round resolution process provided for in the CMA bylaws. Such proposals would be studied, with recommendations acted on by the board. A year-round dialog about timely issues should result in well-thought out policy pieces that could be brought to the floor during HOD.

CHARTING A COURSE FOR THE NEXT 150 YEARS

This year’s discussion and debate at HOD on governance reform has set the stage for the GTAC to make proposals to modify the bylaws to begin the changes needed to set CMA’s course for the next 150 years. I am optimistic that this will result in an improvement for our entire organization. It will make CMA more effective in reaching the average member and give them a direct voice in policy, bringing broader input into our more difficult decisions. Dr. Larson, a Riverside physician, has served as Chairman of CMA’s Board of Trustees since 2011. He is also the Chair of CMA’s Governance Technical Advisory Committee.

SAN JOAQUIN PHYSICIAN

E-Communication: The Potential and the Pitfalls

March 8, 2014 Breakfast– 8:00 am, Presentation – 8:30-10:30 a.m. CME - 2 AMA PRA Category 1 Credits™ Stockton Golf and Country Club

To register please call the medical society at 209.952.5299 Educational Objectives

By reviewing different modes of electronic communication (including text messaging, email, and social media) and their impact on patient care and privacy, this presentation will support your ability to: • Apply risk management strategies to minimize risks associated with the use of e-Communication • Increase awareness of risks associated with use of e-Communication • Ensure patient privacy is protected

Faculty

Jane Mock Risk Management Specialist NORCAL Mutual Insurance Company

CME Information and Disclosure

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of NORCAL Mutual Insurance Company and San Joaquin County Medical Society. NORCAL Mutual Insurance Company is accredited by the ACCME to provide continuing medical education for physicians. NORCAL Mutual Insurance Company designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The faculty member—Jane Mock—has no relevant financial relationships to disclose. Planners from NORCAL include Jo Townson (CME Manager) and Kirsten Padgett (Regional Risk Management Manager)—both of whom have no relevant financial interests to disclose. The planner from SJCMS is Lisa Richmond, who has no relevant financial interests to disclose.

Community Health > Leadership Council

Community Health Leadership Council

By Lita Wallach

Not all diseases can be cured. But, many can be medically managed to help lessen patients’ symptoms so they can enjoy normal lives. On a broader scale, not all of what ails an entire community can be cured. But, strides are happening to improve health access, education and a healthy environment in the San Joaquin Valley. It is a holistic pursuit to improve the quality of healthcare so that community residents can enjoy healthy living. At the helm of this effort is a diverse set of leaders who collaborate on healthcare improvements and they abide by a motto of “We can always do better.” The Community Health Leadership Council strategizes on issues and presents timely, educational and provocative forums to community leaders in the San Joaquin community. That is the opinion of forum participants who recently heard a presentation about the Affordable Care Act by keynote speaker Peter V. Lee, Director of Covered California

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at the most recent forum at the University of the Pacific. For thirteen years, the Community Health Leadership Council has met and convened annual forums, called Community Health Forum. It has brought notable speakers to Stockton and has provided a platform for stimulating conversation. Annual forum topics range from health care reform, physician recruitment and retention, healthcare workforce shortages, chronic disease, community health and the economics of health. “Community Health Forum has become a brand name in the Central Valley,” said Patricia Hatton, MD, OBGYN. “I’ve been attending the Forum since the beginning. It’s always been engaging and informative.” “The Forum gives you a heads up of what the future holds, especially regarding healthcare delivery issues and how that affects our community,” said Lawrence Frank, MD, FACP, San Joaquin General Hospital. “Instead of second or third hand information, the Community Health Forum provides speakers who are directly involved in the issues. I appreciate getting a first-hand exchange of information. For example, Ken Shachmut, the Vice President of Safeway Corporation spoke about their corporate business plan and the rising cost of employee health care. I also appreciated the perspective from Dr. Pallavicini (Provost, University of the Pacific) when she spoke about how we can improve the recruitment of young people into the medical field. That was very helpful because it raised our awareness about ways to advise young people about their chances of getting into college or medical school.” While the Community Health Forum has earned a reputation as a must attend strategic forum, the

decision-makers who host the annual event are credited for their leadership in the community. A sixteen-member Council is comprised of those who represent health, education and business organizations throughout San Joaquin County and the Central Valley. That includes a member of the San Joaquin County Board of Supervisors, County Health Care and Public Health Services Directors, University of the Pacific President, San Joaquin Delta Community College President , Business Council CEO, San Joaquin General Hospital CEO, Hospital Council Vice President, Superintendent of Schools, Health Plan of San Joaquin CEO, The Permanente Medical Group PhysicianIn-Chief, Eberhardt School of Business Health Care Management Chair and Professor of Economics, Thomas J. Long School of Pharmacy and Health Sciences Faculty, San Joaquin Medical Society Executive Director and Health Care and Education Consultant. “People probably see us as the entity that puts on an annual conference. What they might not realize is that we meet monthly to keep each other informed about important health concerns throughout the community,” said Ken Cohen, Director, San Joaquin County Health Care Services. “We’re more of a Think Tank or a Health Trust for San Joaquin County. The Forum is important, but there’s much more to our charter. Council members share perspectives about complex issues that affect the health of this community. Most importantly, we listen to each other and build valuable relationships. We never want to lose sight of what’s most important and that includes the patients who we serve, the students who we support and our focus on improving the health status of the community,” said Cohen.

The Council believes in building relationships. In The Promise and Pitfalls of Shared Leadership, it notes that “leadership is as much an institution as it is an individual trait.” Council members have institutional commitments of their own, but that commitment extends beyond organizational responsibility. They have developed a bond based on principles of leadership and have built a culture of trust in each other. “Over the years, this concept has developed into very nice relationships,” said Ken Cohen. “This is unique to us. We’ve brought business, education, health care and government together in an informal setting to brainstorm and collaborate about ways to improve the health of the community.”

Principles of Leadership

In 2001, the Council agreed to a set of principles. These time-tested fundamentals include: Community Health Leadership Council Principles: • Build trust • Offer a forum where open dialogue and collaboration is encouraged • Create an environment where meaningful issues are discussed • Recognize issues that are the “common enemy” and seek solutions for the benefit of all • Create a forum that does not duplicate other community efforts “The communication that we experience through the Council is powerful,” said Pamela Eibeck, PhD, President of the University of the Pacific. “It’s truly a privilege to participate with a group of community

[1] Shared Leadership: Reframing the How’s and Whys of Leadership, Craig L. Pearce and Jay a. Conger, page 250, 2003.

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Community Health > Leadership Council

leaders who are committed to the overall health of the San Joaquin community. There’s a willingness to share insights and we examine community health from a holistic viewpoint.” “The biggest value is the convenience of networking with other community leaders from different sectors,” said William Mitchell, Director of San Joaquin County Public Health Services. “A good example is having all of us in one room talking to one another. It’s a good opportunity to share theories about what we’re trying to achieve in Public Health Services, especially when you have leaders like Dr. Eibeck of the University of the Pacific, Dr. Kathy Hart of San Joaquin Delta Community College, Dr. Elam from

are issues that don’t necessarily go away, but the Forum gives us the opportunity to address and make sense out of them,” said Dr. Hatton. Healthcare workforce shortages, including physicians, nurses and more have been a major focus of the Council since it first met in 2001. As the community’s diversity and population grew, complex workforce issues continued to evolve. The Council has helped local leaders to examine some of the issues at various levels. For example, San Joaquin Delta Community College has historically depended upon area hospitals to satisfy its clinical training requirements for their Nursing and Psychiatric Technician programs. It has long-established relationships with hospital staff and has successfully placed its students at clinical sites The Community Health Leadership Council strategizes on issues and presents throughout the timely, educational and provocative forums to community leaders in the San years. But, in Joaquin community. That is the opinion of forum participants who recently heard a more recent times, a changing presentation about the Affordable Care Act by keynote speaker Peter V. Lee, Director economic of Covered California at the most recent forum at the University of the Pacific. landscape brought an inf lux of other public Kaiser Permanente, Brian Jensen of the Hospital Council and private educational training programs and that meant and others all in the same room. For example, we discuss greater opportunities for students who wanted to pursue how social and environmental determinants of health are a healthcare career. It also brought some competition for shared issues that require our focus, plus the importance of clinical training site space at hospitals and San Joaquin Delta the involvement of others in the community. Public health Community College had to maneuver for hospital staff issues are interconnected with education and economic attention. development. The Council provides that important link for “I had just become president at Delta College when I all of us to improve the health and economic vitality of the joined the Council,” said Kathy Hart, PhD, President of San community,” said Mitchell. “We’ve formed solid relationships Joaquin Delta Community College. “I quickly learned just which makes it easy to pick up the phone and call each other.” how much the Council could help us with our issue. Council members helped to arrange a meeting with various hospital nursing directors and within a short time, we were able to solve many of the clinical training issues quite effectively. A similar example is true with the prison hospital. I’m grateful “The Community Health Leadership Council has always that I could rely on Ken Cohen, the Director of Health Care provided a platform for significant stakeholders who are Services to sort through issues related to the training of involved in community health to come together to work Psychiatric Technicians. Together, Ken and I met with the on improving the quality of health in the community,” said California Health Care Facility leadership and we expressed Patricia Hatton, M.D. “The most recent annual Forum our concerns about the increasing demand for Psychiatric had the head of Covered California, Peter Lee. The Forum Technicians in our community. The County needed to brings together physicians, state legislative representative and retain its Psychiatric Technicians and I needed to train them. local politicians, colleges and business leaders. I remember Being able to reach out to Ken was a tremendous help in the very first Forum in early 2000s where we separated into solving a complex issue. I have trusted peers in this Council workgroups and decided what we wanted to accomplish. It and that is invaluable.” started with healthcare workforce issues, physician and nurse shortages, chronic disease and rising healthcare costs. These

Problem Solving

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TH 17 ANNUAL

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Community Health > Leadership Council

Quotes “Health care from a business perspective is a priority.” - Ron Addington, CEO/President, Business Council, Inc.

“We’re more than an annual forum. We’re a leadership group.” - Ken Vogel, Supervisor, District 4, San Joaquin County Board of Supervisors

“Everybody involved in the Council is looking at the holistic picture rather than just advocating for their particular discipline.” - Dr. Pamela Eibeck, President, University of the Pacific

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Healthcare Workforce:

Council members worked together to support a Healthcare Careers Pathways initiative that brought K-12, community college and university students together with area hospitals. The key was to introduce students to healthcare careers and bring health, education and business together to support the concept. “The HEAL program (Health Education and Leadership) was a project that I introduced to the Council and their response was fantastic,” said Mick Founts, EdD, Superintendent of Schools, San Joaquin County Office of Education. “When you have the right leadership around a table, you’ll get the support you need. This program worked because each of the area hospitals adopted a grade level and provided hands-on learning about healthcare careers.” “We launched the Healthcare Careers Pathways to prepare young people for careers in healthcare. It was an experiential three-month series of field trips and we brought 600 eighth grade students to seven area hospitals. Students scrubbed in and performed mock surgeries in the operating room,” said Lita Wallach, President of Wallach and Associates and Director of Community Health Leadership Council. “Some of these students continued on to the Health Careers Academy, a Stockton Unified School District charter high school and others participated in the San Joaquin Medical Society’s Decision Medicine Program.” Student involvement is important to the Council. Each year at the annual Forum, students from the University of the Pacific’s Eberhart School of Business and Thomas

J. Long School of Pharmacy and Health Sciences help plan the event and participate in group dialogue. “It’s important that my graduate students in the Health Management MBA program network with members of the health, education and business community,” said Peter Hilsenrath, PhD, Joseph M. Long Chair in Healthcare Management and Professor of Economics, Eberhardt School of Business and Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific. “Students are exposed to the concerns of local hospitals and become more aware of what’s going on in the community. It’s a good way to foster community service and learn about critical health care issues at the same time.”

Accountability

San Joaquin County Health Care Services has long recognized the value of building trusted relationships among community leaders. “Thirteen years ago when we created the Council, we were looking for an opportunity to convene hospital and health care leaders for many reasons,” said Margaret Szczepaniak, Assistant Director, San Joaquin County Health Care Services. “The County seemed like the logical neutral convener of the Community Health Leadership Council. We continue to manage and fund this effort because collaboration and communication are priorities for us. This effort is more important now than ever. We are in an era where the quality of health care can depend on the sharing of accurate information. This is especially important as we move forward with the Affordable Care Act. The methodologies for

SPRING 2014

improving safety and sharing patient care information through electronic health records is as important as leaders sharing key strategies on addressing health disparities, improving quality and access to care, and preparing a future healthcare workforce,” said Szczepaniak. “That’s a large part of the value of this group.” “We’re more than an annual forum. We’re a leadership group,” said Ken Vogel, San Joaquin County Board of Supervisors. “San Joaquin County has a mandated responsibility for health care in this community and that’s an important reason we’re involved. We provide the neutral ground to nurture this type of leadership discussion and we work together to find solutions,” said Vogel. “I think the Community Health Forum has become a reliable source of information where community leaders can learn more about what ails us,” said Moses Elam M. D., Physician-In-Chief, The Permanente Medical Group. “We secure high quality and prominent keynote speakers who know how to drive home key points of critical health care issues.” The roster of keynote speakers includes, Peter V. Lee, Director, Covered California, Robert Pearl, M.D., Executive Director and CEO of The Permanente Medical Group, Edward O’Neil, MPA, PhD, FAAN, The Center, University of California, San Francisco, Ken Shachmut, Senior Vice President of Safeway Corporation, Lisa Jing, Cisco Global Health Engagement to name a few. “The question we face after hearing provocative presentations, is what do we do now? That’s where our Community Health Leadership Council comes in.”

Community Conversations:

Community Health Leadership Council recently added an element called “Community Conversations.” These are in addition to the annual forum and are designed as topical

meetings that occur throughout the year. These meetings provide opportunities to engage community leaders in small, intimate settings. “We were aware that there had been lingering questions about the new prison health facility from several members in our community,” said Ken Cohen. “We decided that our

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Community Health > Leadership Council

Quotes “Instead of second or third hand information, the Community Health Forum provides speakers who are directly involved in the issues.” - Dr. Lawrence Frank, MD, FACP, San Joaquin General Hospital

“I’ve been attending the forum since the beginning. It’s always been engaging and informative.” - Dr. Patricia Hatton, MD, OBGYN

“I think physicians find this valuable.” - Lisa Richmond, Executive Director, San Joaquin Medical Society

SAN JOAQUIN PHYSICIAN

Council was in a good position to identify current critical issues and convene small, shirt-sleeve sessions on various topics. We held our first “Community Conversations” session and invited the correctional health care leaders from the California Health Care Facility at Stockton to share information with us in a casual format. This first meeting was successful and participants requested that we follow up with a tour of the prison. With the approval and guidance of prison facility staff, we facilitated that too,” said Cohen.

Media Reports on Council’s Issues:

When the media reports on the issues that the Council addresses each year, the headlines range from hopeful to threatening:

Talking together is a healthy beginning “An entrepreneurial effort is adding a new twist to community health mobilization in San Joaquin County. A small group of health leaders is working to solve serious issues that affect the health and lives of county residents. The Community Health Forum consists of health-care leaders who collaborate to identify and solve problems requiring communitywide solutions.” (The Record, Opinion Page, 11/12/05)

Forum Focuses on Health Solutions

“Leaders of San Joaquin County’s largest health-care providers have been coming together regularly since 2001 to address and find solutions to the area’s pressing health need.” (The Record, 11/16/05)

Media headlines:

• Group trying to cure what ails county medical care • Finding the right medicine • Health study ranks S.J. in U.S. bottom 10 • Dire need for doctors • Valley lags in health professionals • Growing crisis in ER care • Sick at the core • Health workers in short supply • Nurse shortage nears crisis level • Community Health Forum and Healthcare Career Pathways • Wanted: A new health care system • Health Care shift will stress system Kaiser leaders says key in future will be prevention • Strategy and tactics emerge from CHF workshop • Community Health Forum: Is inequality making us sick? • Quality, Service, Cost: Pick any two

Sticking Together for Community Health: You cannot have it all. That has been the underlying theme of four of the annual Forum’s keynote speakers. Dr. Robert Pearl, Executive Director and CEO of The Permanente Medical

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Group stressed that people have learned to accept compromise when dealing with businesses, such as accepting lower quality to save a “few bucks.” (Health Care Shift Will Stress System Kaiser Leader Says Key in Future Will Be Prevention by Joe Goldeen, 11/12/11, The Record). When Dr. Pearl spoke to the participants of the 2011 Community Health Forum, he wasn’t optimistic. “This Valley is going to have tremendous impact from health care reform. In 2014 there will be 15 to 20 percent more insured, and it will stress the system tremendously,” said Dr. Pearl. “If all we do is take care of chronic disease, we won’t have enough resources. We want to prevent diabetes, not treat diabetes.” So, what kind of impact can the Council have on San Joaquin County when community health assessments rank us at or near the bottom of all counties in California? That’s a question that Council members grapple with regularly and some hold direct responsibility to help solve that crisis in their daily jobs. “This is not just a job for me,” said Amy Shin, CEO, Health Plan of San Joaquin. “We can see greater improvement because we work together to solve some of our critical issues. This is a personal mission because I can relate to so many people who suffer from lack of health access and health insurance. For most of my life, my family was uninsured. The communication and brainstorming that we do in the Council contribute to improving accountability. Health care needs to be more culturally and linguistically available in our community. I’m here to help make that happen. The Council is where I can share that kind of commitment.” This is the kind of message that is gaining momentum in the business world. The Business Council (San Joaquin County) participates in the Community Health Leadership Council and is

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represented by their CEO/President, Ron Addington. “The Business Council has added health care to our set of core issues,” said Ron Addington. “Health care from a business perspective is a priority. As time goes on, there’s an impetus for companies to look at health care as their core competence. Companies today are incentivizing their employees to

achieve improved health outcomes, such as providing memberships in health clubs and promoting smoking cessation and weight loss programs and physical activity. All that impacts employees’ health and the company’s bottom line.” “Because the health care needs of county residents are so diverse, it’s important that health care leaders meet

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Community Health > Leadership Council

regularly to prioritize the issues. I’m happy to participate in this effort,” said David Culberson, CEO of San Joaquin General Hospital.

One of a Kind

The Council is described as unique, reliable, local and trusted. “I work in fifteen counties and this is the only model I’ve seen like this,” said Brian Jensen, Vice President, Hospital Council of Northern and Central California. “Of course, there are many other collaboratives, such as clinics, hospitals, county mental health and community based organizations, but mostly they are concerned with operational issues. The Community Health Leadership Council leaders get together to gain different perspectives and step back to view issues from a higher vantage point.” The Council is a think tank that also produces tangible outcomes. “From a physician’s perspective, the Council does a good job of providing timely information such as the Affordable Care Act and technicalities related to Covered California,” said Dr. Hatton. “I’d also like to see them address the issue of electronic medical records. Physicians are spending so much of their efforts trying to convert to electronic medical records because it’s a mandate. The Council’s support on this topic would be beneficial.” “The most valuable thing we do is identify key initiatives that need to be addressed,” said Joseph Woelfel, BS, MS, PhD, RPh, FASCP, Thomas J. Long School of Pharmacy and Health Sciences at the University of the Pacific. “At a recent Forum, we presented information about the Community Needs Assessment

SPRING 2014

for San Joaquin County. We are concerned about the data in the assessment, including incidents of asthma and chronic obstructive pulmonary disease and other problems that are associated with air quality in San Joaquin County.

Issues and Forum Topics on the Horizon: • Affordable Care Act – Year One: A Look Back and a Look Forward

“The Council’s mission is to build trust among health, education and business leaders and to support actions and forums that promote community engagement. If we don’t do this, then who will? That’s the question we often ask ourselves.” - Lita Wallach Through San Joaquin County Public Health Services, area hospitals, San Joaquin Medical Society, Community Health Leadership Council and American Lung Association for example, community physicians and providers can work together to address these community health issues. We can also help to educate the business community and from that perspective, we can work towards a healthier environment.” “Having notable keynote speakers such as Peter Lee is important for our physicians,” said Lisa Richmond, Executive Director, San Joaquin County Medical Society. “Covered California and other key topics are in line with our mission of educating our physicians and their patients. I think physicians find this valuable.”

What’s Next?

“The Council’s mission is to build trust among health, education and business leaders and to support actions and forums that promote community engagement, said Lita Wallach. If we don’t do this, then who will? That’s the question we often ask ourselves.”

• Community Health Assessment • Health Information Exchange • Healthcare Workforce Development • Evolving Partnerships For more information, contact Lita Wallach, Director, Community Health Leadership Council

CHLC Members Ron Addington CEO/President Business Council, Inc. Kenneth B. Cohen Director San Joaquin County Health Care Services David Culberson, CEO San Joaquin General Hospital Pamela A. Eibeck PhD President University of the Pacific Moses D. Elam, MD Physician-in-Chief The Permanente Medical Group, Inc.

SAN JOAQUIN PHYSICIAN

Community Health > Leadership Council

Mick Founts, EdD Superintendent of Schools San Joaquin County Kathy Hart, PhD President - Superintendent San Joaquin Delta Community College

Peter Hilsenrath, PhD Joseph M. Long Chair in Healthcare Management and Professor of Economics, Eberhardt School of Business and Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific

You Have a Choice Choose Quality

Brian Jensen, VP Hospital Council of Northern and Central California William Mitchell, MPH Director San Joaquin County Public Health Services Lisa Richmond Executive Director San Joaquin Medical Society Amy Shin, CEO Health Plan of San Joaquin Margaret Szczepaniak Assistant Director San Joaquin County Health Care Services

(209) 957-3888 www.hospicesj.org James Saffier, MD On-Site Medical Director Hospice & Palliative Care Internal Medicine

Ken Vogel San Joaquin County Board of Supervisors, District 4 Chair, Community Health Leadership Council Lita Wallach, President Wallach and Associates Director, Community Health Leadership Council Joseph Woelfel, BS, MS, PhD, RPh, FASCP Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific

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Protect Access to Quality Health Care and Patient Privacy OPPOSE THE MICRA MEASURE Here’s why a broad coalition of doctors, community health clinics, hospitals, local governments, public safety, business and labor opposes the proposed November ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals:

YOU MAY BE AWARE OF A TRIAL ATTORNEY-SPONSORED BALLOT MEASURE THAT WOULD UNDERMINE THE PROTECTIONS AFFORDED TO PATIENTS ACROSS CALIFORNIA AS PART OF THE MEDICAL INJURY COMPENSATION REFORM ACT (MICRA).

THIS NOVEMBER, these trial attorneys will ask voters to weigh

THE CALIFORNIA MEDICAL ASSOCIATION (CMA) has joined a

in on “The Troy and Alana Pack Patient Safety Act,” which

broad coalition of doctors, community health clinics, hospitals,

would make it easier and more profitable for lawyers to sue

local governments, public safety, business and labor to oppose

doctors and hospitals. This measure, according to California’s

the proposed November ballot proposition. Visit www.cmanet.

independent Legislative Analyst, could increase state and local

org/micra for more information about what CMA is doing in this

government malpractice and health care costs by “hundreds

fight and how to get involved.

of millions of dollars annually,” ultimately placing the burden of this additional cost on all of us. AS IT STANDS NOW, county and state hospitals have to pay medical malpractice awards out of the budgets they receive from

Community health care clinics, like Planned Parenthood, say this measure will raise insurance costs that will cause specialists, like OB/GYN’s to reduce or eliminate services to their patients.

taxpayers. If medical malpractice awards increase, government costs will increase too. Somebody has to pay, and that will be taxpayers through higher taxes and California citizens through higher health care costs.

NOT ONLY WOULD THIS MEASURE COST patients across the state, it’s a misleading measure intended to fool voters.

ADDITIONALLY, this measure would vastly increase the number

Written by trial attorneys, the measure makes it easier and

of lawsuits filed in California. That’s why the independent

more profitable for lawyers to sue doctors and hospitals —

Legislative Analyst says that county and state hospitals will see

even if that means higher health costs for the rest of us. Our

costs of tens of millions of dollars that taxpayers will have to

health laws should protect access to care and control costs for

pay.

everyone, not increase lawsuits and payouts for lawyers.

SAN JOAQUIN PHYSICIAN

SPRING 2014

MICRA > Protect Access

YOU’LL HEAR A LOT OF RHETORIC

patients. Finding doctors to deliver

OVER 1,000 GROUPS have joined

from the proponents of the measure

children in rural areas and community

together in support of MICRA and in

but really, this is another example of

clinics is already difficult and reducing

opposition to this dangerous, costly

special interest legislation trying to

services will make a bad situation worse.

measure. Be part of the effort to protect

fool the voters into thinking this about

patients by visiting

something that it’s not. The authors

www.cmanet.org/micra today!

of this proposal purposely threw in non- MICRA provisions, like drug testing doctors, to disguise the real intent, which is to increase the limits on medical malpractice awards so that trial lawyers make even more money. The main proponent of the measure was recently quoted in the LA Times, saying, “The drug rules are in the initiative because they poll well, and the backers figure that’s the way to get the public to support the measure. ‘It’s the ultimate

S ERVI NG C ENTR AL VALLEY FAM ILIES S INC E 19 96 Over 200,000 members in San Joaquin and Stanislaus Counties experience improved access to health care through Health Plan of San Joaquin.

sweetener.’” THIS MEASURE also requires a government database with personal information on patients’ prescription drug history. Hackers have already managed to access personal information from millions of Target customers and even the Pentagon, and another big database will only make our information more vulnerable. PHYSICIANS TAKE AN OATH to protect patients – and this dangerous initiative would put patients at risk of losing access to quality medical care. COMMUNITY HEALTH CARE CLINICS, like Planned Parenthood, say this measure will raise insurance costs that will cause specialists, like OB/GYN’s to reduce or eliminate services to their

SPRING 2014

1-888-936-PLAN hpsj.com

SAN JOAQUIN PHYSICIAN

CPR > CMA Practice Resources

CPR As of January 15, Covered California reports that more than 625,000 individuals have enrolled in exchange plans. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and

their staff know what to expect.

SURVIVING THE

MONTH OF COVERED CALIFORNIA To help answer some of the more common questions we’ve received thus far, the California Medical Association (CMA) has created a second tip sheet for physicians, “Surviving the Second Month of Covered California.” For more information on Covered California, visit CMA’s exchange resource center at www.cmanet.org/exchange. In the resource center you will also find other exchange resources, including CMA’s “ Surviving the First Month of

Covered California” tip sheet and a comprehensive exchange toolkit, “CMA’s Got You Covered: A Physician’s Guide to Covered California, the state’s health benefit exchange.” CMA members and their staff also have FREE access to CMA’s reimbursement helpline at (888) 401-5911 or economicservices@cmanet.org.

FEBRUARY 2014 CPR 30

SAN JOAQUIN PHYSICIAN

SPRING 2014

CMA develops simple tool to identify physician participation status in exchange plans

On January 1, 2014, Covered California began providing health coverage to more 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted. Even if you did not intentionally contract with any exchange plans, the California Medical Association (CMA) urges physicians to check their participation status. It is very possible that physicians may have been unknowingly opted into an exchange plan network due to the way that major insurance plans have structured their provider agreements. If you’ve attempted to look up your exchange plan participation status on the Covered California website, you know that it’s not a straightforward process. Because it is critical that physicians know what plans they are contracted with, CMA has created a quick and easy tool to look up your exchange plan participation status in just a few clicks. The tool, available to members only, requires simply your first and last name and middle initial and it will tell you which plans list you as a contracting physician (as of September 2013, the most recent data released by Covered California). To access the tool, visit www.cmanet.org/exchange-lookup.

SPRING 2014

Please note: You will be required to login with a physician member account. If you have not already activated your web account, visit www.cmanet.org/activate. If you need assistance activating your account, contact CMA’s member service center at (800) 7864262 or memberservice@cmanet.org. For more information on Covered California, visit CMA’s exchange resource center at www.cmanet.org/exchange. Physician members and their staff also have free access to CMA’s practice management experts at (888) 401-5911 or economicservices@cmanet.org.

Important new brochure available for patients

California’s trial attorneys recently launched an all-out assault on California’s historic tort reform law – the Medical Injury Compensation Reform Act (MICRA) – which since 1975 has helped keep malpractice premiums in check and ensure that California’s patients have access to affordable health care. MICRA opponents have already begun collecting signatures in an attempt to place language on the November 2014 ballot. California trial lawyers are attempting to lift MICRA’s cap on speculative, non-economic damages, presenting ballot language that seeks to more than quadruple the maximum award for non-economic damages from the current $250,000 to roughly $1.1 million. A change like that would mean increased health care costs for everyone, and decreased access to care that so many patients count on. If successful, the trial attorneys’ efforts will cause malpractice rates to skyrocket, and recreate the same conditions that threatened to throw California’s health care system into crisis during the early 1970s.

There is no doubt that physicians understand how catastrophic a measure like this would be for access to affordable health care. It immediately and dramatically impacts access to care for patients, causing physician offices and community health centers across the state to close. To win this fight, voters, our patients – those we interact with every day in our practices – must understand the fact that protecting MICRA goes hand-in-hand with protecting access to quality health care in California. The California Medical Association (CMA) is leading a coalition working to protect MICRA. The coalition, “Patients, Providers and Healthcare Insurers to Protect Access and Contain Health Costs,” recently published a patient education brochure to help inform California voters about the ballot initiative being pushed by trial attorneys. The pamphlet is available in both English and Spanish and can be distributed to patients during office visits and will be accompanied by talking points to ensure that any conversation regarding MICRA is about educating patients on the real impacts the proposed ballot measure would have if passed. If your physician thinks this information would be of benefit to your patients, contact Yna Shimabukuro at yshimabukuro@ cmanet.org or call (916) 551-2567 to receive 50 copies for your office. CMA has also scheduled a series of MICRA webinars for physicians and their practice staff, so you can help your patients, friends, family and colleagues understand what’s at stake and why they should stand with CMA in opposition to the trial lawyers’ greed fueled initiative. The first webinar, MICRA: Where We Are Today, is scheduled for February 13. For more information or to register, visit www.cmanet.org/events.

SAN JOAQUIN PHYSICIAN

CPR > CMA Practice Resources

CPR Duals demonstration project announces additional delays

Anthem Blue Cross to move eligibility, benefits and claim status inquiry functions to Availity Web Portal in March

Anthem Blue Cross has advised that effective March 14, 2014, patient eligibility, benefits and claim status inquiry functions will transition from its ProviderAccess portal to the Availity web portal. As of that date, practices will only be able to access this information via the Availity web portal. While BlueCard eligibility, benefits and claim status functions will also transition to Availity, the BlueCard Advisor function that allows practices to determine which Blues plan to send the claim to will continue to be available on the ProviderAccess portal. In order to access information on the Availity web portal, practices must first register and sign the Availity Organizational Access Agreement. To register for the Availity web portal, visit www.availity.com/providers/ registration-details. Anthem Blue Cross is also offering free 30-minute webinars on the ProviderAccess functionality shutdown and Availity registration process. The webinars will take place on the following Wednesdays, 10 to 10:30 a.m. February 12 February 19 March 12 No prior registration is required. Practices interested in attending should visit the Provider Network Education page on the Anthem Blue Cross website or click here on the date of the webinar to join. Practices with questions on the Availity site or registration can call Availity at (800) AVAILITY (282-4548). Availity is also offering a series of provider workshops and webinars, from new user training to specific modules on various portal functionality. To view the full schedule, visit www.rsvpbook.com/AvailityWest.

The California Department of Health Care Services (DHCS) recently announced two additional delays for the Cal MediConnect project for dual eligibles. DHCS delayed passive enrollment for dual eligibles in Santa Clara for a second time in two months, moving it from July to now no sooner than December 1, 2014. This is an addition to last December’s notice of delays for Alameda, Santa Clara and Los Angeles. Implementation in Orange County has also been delayed indefinitely, following an audit of CalOptima – which is the county’s only MediCal managed care plan – by the Centers for Medicare and Medicaid Services. The audit uncovered a number of serious issues that must be resolved before the duals transition can move forward in Orange County. Previously, Orange County was scheduled to begin passive enrollment on April 1, 2014. The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s lowincome seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state’s dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino and Santa Clara. There remains no change to the implementation dates for the remaining four counties: Riverside, San Bernardino, Sand Diego and San Mateo. These counties will begin passively enrolling patients in managed care plans beginning April 1, 2014. Alameda, Santa Clara and Los Angeles will all begin with a voluntary enrollment period on April 1, 2014. During the voluntary period, patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will vary by county and by plan. Alameda will begin passive enrollment no earlier than July 1, 2014. Los Angeles will begin passive enrollment no earlier than July 1, 2014, for Health Net, and December 1, 2014, for LA Care. Santa Clara will now begin passive enrollment no early than December 1, 2014. DHCS will be notifying affected patients 90, 60 and 30 days prior to their passive enrollment date. The California Medical Association (CMA) has also learned patients’ prior notification letters will be sent out in blue

FEBRUARY 2014 CPR

envelopes. We’ve provided you a link to the 90-day notification so practices can familiarize themselves with its contents should patients have questions regarding the transition. The 60- and 30-day notices have yet to be finalized but CMA will provide links once they are released. DHCS has received federal funding for a Cal MediConnect Ombudsman division to field concerns specific to this project. DHCS is still in the proposal phase while searching for a partner vendor. We will provide additional information once it becomes available. For more information, visit www.cmanet. org/duals and www.calduals.org.

Did you know you can request reconsideration if you’re getting dinged with a 2% Medicare eRx penalty?

Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013 Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule. The Centers for Medicare and Medicaid Services (CMS) has notified physicians and group practices that did not meet the requirements and will be subject to the 2014 payment adjustment. Some practices have reported that their meaningful use attestation was not taken into consideration as an exemption. If this has impacted your practice, you must request a review. If you believe this determination to be in error, CMS has implemented an informal review process through which reconsideration can be requested. Informal

review requests will be accepted through February 28, 2014, and can be submitted via email only to eRxInformalReview@cms. hhs.gov. CMS will make an informal review decision within 90 days of the original request. Please note that the informal review decision will be final, and there will be no further review or appeal. For complete instructions on how to submit an informal review request, see CMS’s “2014 eRx Payment Adjustment Informal Review Made Simple.” Questions about the eRx Incentive Program can be directed to the CMS QualityNet Help Desk at (866) 288-8912 (TTY 877-7156222) or qnetsupport@sdps.org.

CMS updates EFT authorization agreement

The Office of Management and Budget recently approved changes to the CMS 588, Electronic Funds Transfer (EFT) Authorization Agreement. The revised EFT agreement is available on the CMS Forms List. As of January 1, 2014, new EFT authorization agreements submitted must be on the new form. Submissions on the old forms will be returned to the applicant.

Noridian sends out another wave of Medicare revalidation requests

As called for under the Affordable Care Act (ACA), Medicare Administrative Contractors (MACs) have been requiring physicians to revalidate their Medicare enrollments. Between now and March 23, 2015, MACs will continue reaching out to physicians, notifying them of the need to revalidate. The most recent round of revalidations requests went out by December 30, 2013.

The revalidation requirement is necessitated by new screening criteria called for under the ACA. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the Medicare program. The level of risk will determine the degree of screening to be performed when processing the enrollment application. Physicians who receive a request for revalidation must respond to that request within 60 days or face the possibility of being deactivated. Do not do anything until you get a letter instructing you to revalidate. (This is very important to ensure an orderly enrollment process.) Physicians who are making changes (moving, closing practice, etc.) should continue to submit their changes as usual. For providers in PECOS – the revalidation letter will be sent to the special payments and correspondence addresses simultaneously. If these are the same, it will also be mailed to the primary practice address. For providers NOT in PECOS – revalidation letters were sent earlier this year to the special payments or primary practice address. If you are not in PECOS and have not already received a letter, contact Noridian for guidance. To find out whether you have been mailed a revalidation notice go to the revalidation page on the Centers for Medicare and Medicaid Services website. If you are listed, and have not received the request, contact Noridian at (855) 609-9960. Contact: CMA reimbursement help line, (888) 401-5911 or mkelly@cmanet.org.

CPR > CMA Practice Resources

CPR DHCS pays over $100 million to primary care physicians in initial retroactive Medi-Cal rate increase payment

The Department of Health Care Services (DHCS) has now made several retroactive interim payments to primary care physicians who have attested to their eligibility for the rate increases called for under the Affordable Care Act (ACA). These primary care payment increases have been put in place by the federal government in an effort to recruit more primary care physicians to treat low-income patients who will be newly eligible for health coverage in 2014. Although under the ACA the rate increases took effect on January 1, 2013, DHCS had been waiting for approval of its rate increase implementation plan from the Centers for Medicare and Medicaid Services (CMS). Approval was granted in late October, with the increases retroactive to January 1, 2013. These payments, totaling over $100 million, are an estimate of what DHCS believed is owed to physicians for fee-for-service Medi-Cal claims retroactive to January 1. The payments did not, however, include claim level detail. DHCS is also making weekly lump sum payments, in addition to regular Medi-Cal payments, to primary care physicians enrolled in fee-for-service Medi-Cal who have attested. The weekly interim payments represent estimated increase amounts due until DHCS’s computer systems can be updated to begin processing individual claims at the new rates, which could be as late as July 2014. Going forward, DHCS will make retroactive fee-forservice Medi-Cal claims payments on a monthly basis to physicians who have newly attested the previous month. When DHCS updates its computer systems and begins paying claims at the new rates, it will issue a final settlement, which will reflect a “true up” of

payment owed but not reimbursed, or possibly a refund request if overpaid. This final settlement will include claim level detail for the entire amount paid as part of this increase. Attest today! The increased payments are not automatic. To qualify for the increased payments, providers must first attest to their eligibility. The attestation form is available on the Medi-Cal website. Physicians are required to complete the attestation online (paper copies will not be accepted). As of early January, DHCS reports that approximately 15,000 eligible providers have completed the attestation process. (For more information on the specialists and subspecialists that qualify, click here or see the CMS Q&A.) The increase also applies to services provided by physicians to Medi-Cal managed care patients; however, funding to the Medi-Cal managed care plans for the increase was not expected until the end of January. It is unclear exactly when each plan will make the retroactive payments or implement the increase once the federal funds are received. The California Medical Association (CMA) encourages practices to track all of the estimated lump sum payments received from DHCS, identified with RAD code 1801 (1801 A/R ACA interim payment). This upfront step should ease the reconciliation of those affected accounts once DHCS releases the claim level detail. The rate increase applies to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461 and 90471 – 90474. More information on the primary care rate increase can also be found in CMA’s MediCal Primary Care Physician Rate Increase FAQs.

SAVE THE DATE: Former Secretary of State Hillary Rodham Clinton will headline the 2014 Leadership Academy

The 17th annual Western Health Care Leadership Academy is thrilled to welcome keynote speaker Hillary Rodham Clinton, Former Secretary of State and Former U.S. Senator from New York. This year’s Academy (formerly the California Health Care Leadership Academy), is scheduled for April 11-13, 2014, at the San Diego Convention Center. Top thinkers and doers will share strategies and resources for accelerating the shift to a more integrated, high performing, and sustainable health care system. The conference will examine the most significant challenges facing health care today and present proven models and innovative approaches to transform your organization’s care delivery and business practices. Topics will include leadership development, ACA implementation, practice management and the ICD-10 transition. Visit www.westernleadershipacademy.com for more details.

UMVS offering TRICARE provider training webinars

United Military & Veterans Services (UMVS) will be offering twice weekly provider training webinars on TRICARE related topics. These 90-minute webinars, scheduled every Tuesday and Thursday through March 6, 2014, will provide information on TRICARE website enhancements, newly implemented referral and authorization features on the UHCMilitaryWest. com portal and information on the fax-back feature for referral and authorization requests. Advance registration is required for these webinars. For more information or to register, visit www. UnitedHealthcareOnline.com (click on “Tools and Resources” then on “Training and Education”).

The Coding Corner: Quick tips for easy “add-on” coding CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek. Mr. Verhovshek is the managing editor for AAPC, a training and credentialing association for the business side of health care.

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Throughout the CPT® codebook, you will find designated “add on” codes. Add-on codes are identified throughout the CPT® manual by a “+,” and their descriptors will contain a variation of the phrase “report in addition to code for primary procedure.” You also can find a complete list of add-on codes in Appendix D of the CPT® codebook. Three simple tips can help you to apply add-on codes appropriately. 1. Add-on codes describe procedures or services that are always provided “in addition to” other, related services or procedures. Add-on codes cannot stand alone as separately reportable services. A persistent problem with add-on codes is identifying which code(s) may be reported as primary with a particular add-on. CPT® sometimes provides explicit instruction as to which codes may be primary with a particular add-on code (e.g., “Use 64148 in conjunction with 36147”) – but not always. But, the CMS Manual System provides a handy reference to allow you to identify quickly if your add-on/ primary code pair is allowable. CMS Transmittal 2636 (CR 7501, Jan. 16, 2013) classifies add-on codes as one of three types: Type I – This type of add-on code has a limited number of identifiable primary procedure codes. Type II – These add-on codes do not have a specific list of primary procedure codes. CMS encourages claims processing contractors to develop their own lists of primary procedure codes for this type of add-on codes. Type III – The third type of add-on code has some, but not all, specific primary procedure codes identified in the CPT® manual. CMS advises claims processing contractors that the primary procedure codes in the CPT® manual are not exclusive, and encourages contractors to develop their own lists of additional primary procedure codes.

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The transmittal lists each add-on CPT® code, identifying it as either a Type I, Type II or Type III. For those add-ons identified as Type I, the transmittal lists the acceptable primary procedure codes. Note that the code pairings in the transmittal are based on Medicare – rather than AMA – guidelines. In almost all cases, CMS instructions match those in the CPT® manual, but there are exceptions. For example, CPT® allows separate reporting for use of an operating microscope (+69990) with many dozens of codes from throughout the CPT® manual (including Category III codes); whereas, CMS allows 69990 with relatively few codes from the 6xxxx-series. For the small number of Type II and Type III codes, you’ll have to rely on your individual payer for guidance – but at least you’ll be able to identify those codes quickly. 2. Add-on codes have no global period assigned. They are instead “included” in the global surgical fee for the primary procedure. 3. Add-on codes are “modifier 51 exempt” and therefore are to be paid at full fee schedule value. Their assigned value accounts for the “additional” nature of the procedure. Bonus Tip: Periodically check your explanation of benefits carefully for claims with add-on codes to be sure the payer is reimbursing you the entire fee schedule rate for the billed procedures or services. If you find a payer reducing the fees for your add-on codes, appeal the claims.

CMA Advocacy at Work

“CMA reimbursement advocates are able to get the answers when we can’t get them ourselves. They have been of great assistance to our practice! Thank you CMA for all that you do.” Gina Reader, Office Manager Mark E. Reader, D.O. Member since 2006 Tulare County

PAYOR UPDATES

BLUE SHIELD: Blue Shield recently announced new and updated formulary and medication coverage policies, effective December 17, 2013. For more information, download the Fourth Quarter 2013 Formulary and Medication Coverage Policy Summary at the Blue Shield website, www.blueshieldca.com. MEDICARE REMINDERS: If you are submitting an application as a new provider to Medicare, or requesting changes to your existing enrollment, you may submit your 855 paper application or make the changes in the Internet-based PECOS system 60 days prior to the expected start date. UNITED HEALTHCARE: Effective April 23, 2014, United Healthcare will apply an enhanced level of HIPAA edits to professional (837p) and institutional (837i) claims submitted electronically to most United Healthcare payer IDs. These edits will include validation of code sets (such as diagnosis, procedure, modifier and national drug codes) at a pre-adjudication level. Because the new edits will be applied on a pre-adjudication basis, an increase in the number of claim rejections may occur. It is important to check all of your electronic claim submission reports to verify claims transmission has been completed and that claims have not been rejected by your clearinghouse or United Healthcare. Effective April 1, 2014, UHC Medicare Advantage health plans will now require prior authorization for Intensity Modulated Radiation Therapy (IMRT), Sterotaxic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) when performed in an outpatient setting. Providers seeking additional details about the requirements should visit UnitedHealthcareOnline.com/Clinical Resources.

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In The News

IN THE

NEWS

Providing staff, physicians and patients with relevant & up to date information

One Of the World’s Smallest Babies Born at San Joaquin General Hospital

On Tuesday, January 22, 2014 baby girl Amiracle Brown, will finally be discharged home to her family. Born 15 weeks early, with a birth weight of 297grams, which is slightly less than 10 and a half ounces, Amiracle is among the smallest birth-weight infants to have survived in the recorded medical archives worldwide and perhaps the second smallest infant to ever survive in California. Born at San Joaquin General Hospital on May 9, 2013, Amiracle has survived against tremendous odds. Dr. Jeffrey Lindenberg, Director of the intensive care nursery, credits her remarkable early life story to the outstanding staff at SJGH, as well as to the unfaltering optimism and love of her mother and father. Dr. Lindenberg emphasizes that Amiracle remains an infant with special needs, but based on her truly amazing first 8 months of life, this exceptional infant’s future might continue to exceed all expectations. When asked to comment upon their experiences at SJGH, Ms. Felicia Brown, the mother, said: “We are so blessed to have Amirical come home to us. We never gave up hope with the Hospital’s staff and just knew she would be coming home to us. She is a miracle!” San Joaquin General Hospital, home of the first intensive care nursery in the county, has provided care for nearly ten thousand of our county’s most vulnerable newborns, since its designation as a level III intensive care unit in 1985. The NICU continues to be a facility of pride in our community.

Dr. Simran Sethi

Dr. Simran Sethi joins Lodi Health Physicians Millsbridge Family Care

Lodi Health is happy to welcome internal medicine physician Simran Sethi, MD, to its medical practices. Dr. Sethi attended medical school at Medical College of Wisconsin in Milwaukee. She completed her residency in the radiology department at the University Hospitals Case

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Medical Center in Cleveland. For two years, Dr. Sethi practiced medicine at Santa Clara Valley Medical Center in San Jose. Dr. Sethi is fluent in Urdu. She practices at Lodi Health Physicians Millsbridge Family Care, located at 1901 W. Kettleman Ln. in Lodi. New patients and most insurances are accepted. Call 334.8540 for appointments. Dr. Abishai Rumano joins Lodi Health Physicians West Occupational Medicine

Lodi Health recently welcomed physician Abishai Rumano, MD, to Lodi Health Physicians West Occupational Dr. Abishai Medicine. Dr. Rumano attended medical school at the University of Colorado Medical Centre, Denver, and completed hisinternship and residency at University of California, Davis. Dr. Rumano has been a physician for three decades, starting as a staff physician and medical director at Mountain Lake Medical Group and with the Republic of Zimbabwe Ministry of Health. He will be joining Dr. Buckman at the Lodi Health Physicians West Occupational Medicine, located at 2415 W. Vine St. in Lodi. Employers and interested patients may call 339.7441 for information. Dignity Health Medical Group Stockton welcomes new general surgeon, Dr. DeAndrea Sims

Dignity Health Medical Group Stockton, 1901 N. California St, Stockton, is pleased to introduce its new general surgeon, DeAndrea Sims, MD. Dr. Sims is certified in General Surgery by the American Board of Surgery. Dr. Sims comes to Dignity Health Medical Group Stockton from her residency in general surgery at San Joaquin General Hospital in French Camp, CA. She received her medical education at the Howard University College of Medicine in Washington, D.C. Dr. Sims is committed to treat each patient with individualized care. “Through discussion and understanding

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we are able to accomplish the best outcome and treatment together,” explained Dr. Sims. Her clinical interests include colorectal, breast, and laparoscopic surgery. Dr. Sims is a member of the American Medical Dr. DeAndrea Sims Association, American College of Surgeons, American Society of Breast Surgeons, and the Association of Women Surgeons. For more information on Dignity Health Medical Group Stockton, visit www.StocktonMedicalGroup.com. Dignity Health Medical Group Stockton welcomes new family medicine physician, Dr. Nicole Knotts

Dignity Health Medical Group Stockton, 3132 W. March Ln., Stockton, is pleased to introduce its new Dr. Nicole Knotts family medicine physician, Nicole Knotts, MD. . Before joining Dignity Health, Dr. Knotts completed her residency in family medicine at Arrowhead Regional Medical Center in Rialto, CA. Dr. Knotts received her medical education from Ross University School of Medicine in Commonwealth of Dominica, West Indies. Dr. Knotts is a member of the American Academy of Family Physicians. For more information on Dignity Health Medical Group Stockton, visit www.StocktonMedicalGroup.com

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In The News

IN THE

NEWS Dignity Health Medical Group Stockton welcomes new Family Nurse Practitioner, Denise Gontiz, FNPC

Dignity Health Medical Group Stockton, 3132 W. March Ln, Stockton is pleased to introduce Denise Gontiz, FNPC it’s new board certified family nurse practitioner, Denise Gontiz, FNP-C. Gontiz received her medical education from Sonoma State University, and is a member of the California Association of Nurse Practitioners and the American Association of Nurse Practitioners. Her clinical interests include diet and nutrition, bariatric surgery follow-up, and women’s health. Gontiz provides individualized care with a focus on holistic care to treat the mind, body and soul. “I look forward to partnering with my patients for all of their healthcare needs,” expressed Gontiz. For more information on Dignity Health Medical Group Stockton, visit www.StocktonMedicalGroup.com St. Joseph’s Medical Center announces 2014 Medical Staff Officers

Michael A. Herrera, DO, has been appointed St. Joseph’s Chief of Staff for 2014. In this position, he is responsible for leading the medical staff, which meets to review patient care and safety issues and set policy for the medical care provided at the medical center. Dr. Herrera completed his residency in emergency medicine at University of California, Davis Medical Center, and is board certified in emergency medicine.

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St. Joseph’s Medical Center President & CEO Donald Wiley, Dr. Purushattama Sagireddy, Dr. Todd Primack

Officers for 2014 include Prasad Dighe, M.D., past Chief of Staff, Raghunath Reddy, M.D., chief of staff-elect; Alvin Cacho, M.D., secretary; Kristen Bennett, M.D., member at large to the Executive Committee; and Purushottama Sagireddy, M.D., member at large to the Executive Committee. Department chairs are Thomas Monachino, M.D., Anesthesia; George Charos, M.D., Cardiovascular; Frank Callcott, M.D., Diagnostic Imaging and Radiology; Benjamin Wiederhold, M.D., Emergency Medicine; Sanjeev Goswami, M.D., St. Joseph’s Medical Center President & CEO Donald Wiley, Dr. Vincent Pennisi

Medicine and Family Practice; Kevin Rine, M.D., Obstetrics and Gynecology; Jeffrey McDavit, M.D., Pathology; Surinder Raron, M.D., Pediatrics; and Alan Kawaguchi, M.D., Surgery.

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In The News

IN THE

NEWS St. Joseph’s Honors 2013 Physician Champions

Lisa Folberg “Lisa’s development of working relationships between CMA and California’s regulatory agencies, production of physician education materials on a myriad of issues and initiation of writing and managing grants for the organization has been integral to the success of CMA,” says CMA CEO Dustin Corcoran. “Her expertise makes her the natural fit to lead the CMA Foundation.”

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St. Joseph’s Medical Staff recognized Drs. Vincent Pennisi, Purushattama Sagireddy, and Todd Primack with Physician Champion awards, a peer recognition program which honors physicians who pursue and demonstrate excellence in two categories: Quality and Community. Drs. Purushattama Sagireddy and Todd Primack were honored as Physician Champions for Quality. Dr. Primack is involved with a number of initiatives at St. Joseph’s and in the community to improve patient experience and efficiency of care. Dr. Sagireddy was instrumental in refining St. Joseph’s new electronic medical records system for physician use and improving patient care. Dr. Vincent Pennisi was honored as the Physician Champion for Community, for the countless hours he dedicates to volunteering at St. Mary’s Clinic caring for the underserved. Lisa Folberg takes the helm at CMA Foundation

Lisa Folberg first became interested in public health when she volunteered for the AIDS Hotline in San Francisco in the 1980s. Years later she spent a year in Colombia, South America, developing a public health program for at-risk youth through a World Health Organization/

UCSF collaborating project. “This experience was life-changing,” says Folberg. It further galvanized her purpose in life, which was to help form meaningful public health policy that will benefit people who need it the most. She went on to get a masters degree in public policy at Georgetown University, Washington, D.C. It will come as no surprise, then, to find that Folberg was a natural choice for the job of executive director of the California Medical Association (CMA) Foundation, the public health arm of the CMA that has a 50-year history of developing renowned public health programs that have received national acclaim. “With health care delivery changing more rapidly than ever before, the CMA Foundation is at the helm of public policy discussions, education and awareness campaigns that will benefit physicians and their patients across the state,” says David Holley, M.D., Chair of the CMA Foundation Board of Directors. “Lisa’s expertise and leadership will prove invaluable as we embark on existing projects and on new endeavors.” “I was excited to accept the position,” says Folberg. “There is so much potential for the Foundation to be an important part of California’s changing health care climate.”

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In The News

IN THE

NEWS JOB OPENING Disability Determination Services (DDS) of the California Dept. of Social Services (CDSS) will have fulltime and part-time openings for physicians and psychiatrists at the Stockton Branch. Medical and Psychiatric Consultants will work on a team making the disability determinations. The Medical Consultant/ Psychiatric Consultant reviews all the relevant evidence in the case record and evaluates the medical/ psychiatric issues and impairments. For further information go to www. cdss.ca.gov and put Medical Consultant or Psychiatric Consultant in the search engine or call Ms. Letiticia Earl at 209 472-2036

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As for continuing the 50-year legacy of the Foundation, Folberg is looking forward to building on the work of Carol Lee, former executive director of the Foundation who retired in August. “Carol gave the Foundation a solid reputation throughout the state and now I am looking for what comes next.” What comes next, says Folberg, is taking an honest look at where the need is in health care after the Affordable Care Act and trying to fill those needs. “We are going to be thinking creatively about what the Foundation could do in the current health care climate and we will be developing projects that will take us well beyond where the organization is today.” Folberg came to CMA in 2005 as a lobbyist. She quickly got hooked on the work and the mission of the organization. “I loved lobbying for CMA,” she said. “I felt that what we were fighting for what was important and that of all the voices out there lobbying, we were one of the strongest voices for the patient.” She became Associate Director of Government Relations during the period when then Governor Arnold Schwarzenegger tried to begin health reform in California. “Unfortunately, we didn’t see state based reform, but then the Affordable Care Act was passed. There

has been no more exciting time period to be in health policy, and the CMA has been at the center of implementation,” she said. Folberg lobbied for the association on issues relating to MediCal, budget, public health, managed care and rural health. In her role as lobbyist, she also organized the Alliance for Patient Care, a group of more than 60 health care stakeholder organizations aimed at increasing access to care for California’s neediest patients. Since 2009, Folberg has served as Vice President of CMA’s Center for Medical and Regulatory Policy Department, which focuses on internal policy development and regulatory advocacy. In addition to managing the day to day operations of the center, she also took the lead on issues of health system reform and financing and health information technology. Prior to joining CMA, Folberg worked in the California Legislative Analyst’s Office as a senior fiscal and policy analyst where she examined the Governor’s proposed budget, researched and wrote reports and testified before the legislature on health and social services policy issues. Before this, she was a graduate fellow working for the Center on Budget and Policy Priorities and for California Congressman Pete Stark.

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In The News

“Lisa’s development of working relationships between CMA and California’s regulatory agencies, production of physician education materials on a myriad of issues and initiation of writing and managing grants for the organization has been integral to the success of CMA,” says CMA CEO Dustin Corcoran. “Her expertise makes her the natural fit to lead the CMA Foundation.” Delta Heart and Medical Clinic Physicians Join Gould Medical Group

Dr. Olowoyeye

Dr. Punnam

Dr. Olowoyeye and Dr. Punnam, testing, holter monitoring, and post intervention, pacemaker and Internal formerly of Delta Heart and Medical procedure management. They also cardiac device implantation and vein Group, began their Gould Medical provide in patient services including ablation. Their nine staff members have Group practices on January 31, 2014. invasive and interventional coronary all made the transition to become Sutter GMG provides care for patients at over procedures, peripheral vascular Gould Medical Foundation employees. 20 Sutter Gould Medical Foundation care centers. “The opportunity for us to begin offering cardiology services in San Joaquin County is exciting,” said Paul DeChant, M.D., Sutter Helping Families Cherish Life Gould Medical Foundation AseraCare Hospice® provides quality, compassionate care when you need it most. chief executive officer. Our family-centered, holistic approach ensures that the needs and wishes of our “Adding two respected patients and their families are met when faced with life-limiting illness. cardiologists, and their dedicated staff, helps add to Our services include: • Physician managed care our broad range of services • Admissions 24 hours a day, seven days a week in Stockton, which includes • End-of-life decision making assistance • Special veterans recognition primary care, urgent care, and surgical and specialty Rated above average by CalQualityCare.org services.” AseraCare Hospice–Stockton Dr. Olowoyeye and Dr. 2529 W. March Lane, Ste. 101 Punnam will continue to Stockton, CA 95207 see Stockton area residents 209-474-8349 www.AseraCare.com at their 1801 East March For more information, contact us today. Lane offices in Stockton. They offer a full range of outpatient cardiology This facility welcomes all persons in need of its services and does not discriminate on the basis of age, disability, race, color, national origin, ancestry, services including religion, gender, sexual orientation or source of payment. AHS-10269-13 echocardiogram, stress

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Gleason House > Renovated

The

Gleason House Proudly Celebrates I t s Year

Story by Vanessa Armendariz

Anniversary

In the 2010 summer issue of the San Joaquin Physician Magazine, there was a great story about the Community Medical Centers and its many different medical clinics and initiatives. At the time, the Gleason House was undergoing renovations to be the CMCâ&#x20AC;&#x2122;s twelfth medical clinic for the low-income and homeless population. >>

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SJMS > Scholarship Loan Fund

Address: 423 S. San Joaquin St., Stockton, CA 95203 SPRING 2014

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Gleason House > Renovated

On November 15, 2013, community partners from San Joaquin County gathered to celebrate the 2 year anniversary of the Gleason House. From the outside, the Gleason House looks like an ordinary home. However, when you step through the doors, it transforms into a common medical office.

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The Gleason House was owned by Edna Gleason, a Stockton native and self-taught pharmacist. Her achievements include being the first woman licensed to own her own pharmacy in California and the first woman to be elected President of the California Pharmaceutical Association. She was a true humanitarian and philanthropist- always striving to improve her community. Due to its remarkable history, CMC decided to renovate the house rather than build a completely new center. It took eight years to secure the funding for the renovation, but it was definitely worth the wait! On November 15, 2013, community partners from San Joaquin County gathered to celebrate the 2 year anniversary of the Gleason House. From the outside, the Gleason House looks like an ordinary home. However, when you step through the doors, it transforms into a common medical office. There are three treatment rooms whose walls are graced by photos of the Gleason House throughout its renovation. This serves to remind everyone not only about the history associated with the building, but also the hard work that was put into it. Randy Pinnelli, P.A. and Care Link Program Director explained that when doing the renovation, they wanted it to look “homey” so their patients would feel comfortable. The entire house has hard-wood floors and everything inside is new. Randy explained that the contractors became very passionate about the project. They used the finest craftsmanship and materials, even donating remnant supplies like the beautiful Italian tile in the patient bathrooms. Both the front and back of the house are equipped with a wheelchair lift for disabled patients. Furthermore, Care Link and the Gleason House are transitioning to electronic health records. This process is much more efficient for outreach workers when they are out on the streets seeing patients as they can access patient medical records quickly using a wireless connection and their laptops. The initial goal of CMC’s Health Care

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for the Homeless Program was to provide care for 1,000 individuals annually. Last year, the Gleason House and Care Link surpassed that goal and treated 2,500 patients, accounting for 8,000 medical visits! While these accomplishments are something to be proud of, Gleason House and Care Link are expanding their goals even wider.

New Year, New Goals: The Respite Center With the Gleason House up and running, CMC has their eyes set on even larger goals. One of the problems that the physicians and staff have noticed when working with the homeless population is that they have a high re-admittance rate into hospitals. Many of the homeless do not get the proper medical attention that they need because they cannot afford it or they fear going to the doctor. Randy Pinnelli recounted numerous incidents where he claimed that his patients’ outcome would have been better if they had been cared for in a respite center after their surgery as opposed to being released from the hospital to the streets. One of the most common treatments that the outreach workers provide for patients is wound care. These wounds include animal and insect bites, diabetic ulcers, abscesses and more. Although they effectively treat the wound, there is a high incidence of reinfection because the patient lacks the resources to keep their wounds clean. Similarly, when a homeless patient

“One of the most common treatments that the outreach workers provide for patients is wound care. These wounds include animal and insect bites, diabetic ulcers, abscesses and more.” is admitted to the hospital and treated for their ailment, they are released with nowhere to go. Normally, a recovering patient would have a safe place to go to and family and friends to take care of them. In the case of the homeless, they are forced to go back to their living situation prior to the hospital stay, which can be detrimental to their health. Because they do not have a suitable environment for recovery, many of these patients are readmitted to the hospital within weeks, driving up healthcare costs. As an initial attempt to help provide respite for the homeless, Randy Pinnelli and Bill Brown, Executive Director of the Gospel Center Rescue Mission (GCRM) joined forces. The mission of GCRM is to “minister to the needs of the homeless and poor population in Stockton and the San Joaquin County. They fulfill their mission by providing food, clothing, shelter, education, counseling, substance abuse treatment, spiritual support and follow-up assistance.” With the help of a small grant from St. Joseph’s Medical Center, GCRM was able to equip 2 semi-private rooms with two hospital beds in each. Primary medical care was provided through the CMC’s Care Link program, which provides medical outreach weekly at shelters, under bridges, and parks, as well as at the Channel Medical Clinic. With Gleason House open, patients in the respite rooms can now get treatment there. Gleason House is conveniently located on the same campus as the GCRM. Patients that

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Rebecca Goldsmith, R.N. and Respite Coordinator are recuperating in the respite beds can literally walk a few feet across the courtyard to the back of the medical clinic. The rooms serve as a transitioning shelter rather than a medical facility. With grant funds from Health Plan of San Joaquin and Kaiser Permanente, they were able to hire two part time respite aids and a part-time Respite Coordinator that

Part of what we want to do is the preventive care, not just the after-care. could help assist the respite clients daily with cleaning, laundry, and more. Just recently the GCRM purchased a building that is directly behind the GCRM campus. This new building will be a respite center with 15 beds. Since there are more men than women in need of respite care, the new center will be allocated for the men and the eight beds currently at GCRM will be reserved for women. Rebecca Goldsmith is a Registered Nurse and serves as the Respite Coordinator. Before becoming an RN, she was a committed volunteer at the Mission. She has a true passion towards helping the homeless population. In 2013 Rebecca (also a singer songwriter) recorded “Moving Forward to Rescue the Homeless” a benefit CD for the Gospel Mission. After working with both the Respite and Gleason house patients, she

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realized, “part of what we want to do is the preventive care, not just the after-care.” A large part of preventive care is focusing on the overall health of the patient, not just their current ailment. It is important to educate the homeless on nutrition and fitness because it can dictate their overall health. In response to this idea and with funding from Kaiser Permanente, the GCRM hired a health educator from CMC who will be implementing the “Commit to be Fit” program. This will focus on nutrition, exercise, and one-on-one counseling with each client. This will be particularly important for patients suffering from diabetes, high blood pressure, and obesity. Furthermore, the chef at the mission has agreed to post diagrams of standard food portions to help educate patents about healthy eating. Along these lines, CMC is helping to plan a community garden. Most of the food donated to the Mission consists of foods that are high in carbohydrates. It is often difficult to provide fresh fruits and vegetables. Patients will now be educated on nutrition and healthy eating, so it is imperative that healthy foods be available to them. Maintaining a garden requires hard work, therefore allowing patients a sense of purpose while keeping them active and busy. Tending to a garden can even help with emotional and physical therapy, which can expedite the healing process.

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Gleason House > Renovated

How Can The Hospitals Benefit From a Respite Center? Although CMC and the Mission have purchased the building for the respite center, they are still trying to secure funding to renovate the inside, build the garden, and for regular maintenance. Randy Pinnelli explained, “Healthcare for the Homeless Programs around the country have developed respite programs for homeless patients because otherwise, hospitals are stuck holding on to these patients rather than unsafely discharging them to the streets. Even if they send them to the shelter, the next day homeless patients are back on the streets.” Studies have shown that “homeless patients discharged to a medical respite program experienced 50% fewer hospital readmissions at 90 days and 12 months of being discharged compared to patients discharged to their own care.”1 Reducing the amount of readmissions to the hospital would save both the hospital and the patient’s money. For example, the average hospital adjusted expenses per inpatient stay in San Francisco hospitals were $2,279 whereas the cost per day to stay in a medical respite program was only $180.2 3 In 50

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Sacramento, CA, a study involving 119 patients demonstrated annual cost avoidance for hospitals partnering with medical respite programs was $1.07 million.4 Therefore, there is sufficient data that shows the benefit of local hospitals partnering with medical respite centers to not only alleviate costs and free up much needed hospital beds, but to increase the health and well-being of homeless patients. In working with this population for over 20 years, Randy has witnessed many success stories that he loves to share. One of his favorites includes that of “John”, an IV drug user who underwent a fasciotomy to treat an infection in his leg. Randy encountered this patient quite often during wound dressing changes before the procedure. He feared that “John” would go back to his old habits once released to the streets.

available through GCRM, the patient was able to casually talk with other recovering drug users who were part of the addiction treatment program. After 5 weeks in respite care, “John” decided to enroll and graduate from the six month program. He is now 3 years drug free, he is established with a regular medical provider and will be moving into an apartment in the near future!

What Can You Do To Help? The services that CMC and the GCRM offer the homeless population are immeasurable. They have great ideas for new programs and initiatives, but are always seeking more help. The Gleason House is currently serving more than 20 patients a day, but the demand is still greater than what they can meet. Although monetary, food, and clothing donations are appreciated, they also are always in need of passionate volunteers. Volunteers over 16 years of age can help with clerical as well as other basic office help. Volunteer health professionals, including physicians, physicians assistants, and nurses can assist in various capacities at the Gleason House, the respite center, and Care Link.

[Our patients] don’t always dress the best or smell the best but probably one of the greatest things we can offer is to always treat them with respect and care for them like we would expect our family members and ourselves to be. Although he was informed about the rehab addiction treatment program at GCRM, the patient was not interested in participating at the time. He was however, worried about the large gaping wound in his leg. The respite program provided a clean, environment where he could heal and get his pain under control. Since the respite center is on the same campus as the transition housing

Randy sums it up beautifully by saying, “ [Our patients] don’t always dress the best or smell the best but probably one of the greatest things we can offer is to always treat them with respect and care for them like we would expect our family members and ourselves to be.” If you are interested in donating or volunteering, please call (209) 954-7702.

SPRING 2014

Lodi Memorial Hospital Acute Physical Rehabilitation 23 years of specialized, inpatient rehabilitation services for stroke, brain-injury, spinal-cord-injury, multiple-trauma patients and patients with other neurological conditions

The county’s only acute, inpatient physical-rehabilitation program, featuring:  

 

  

Emphasis on regaining independence for safe transition home Coordinated physical, occupational, speech and recreational-therapy sessions, three hours per day State-of-the-art technology for neurologic training Dedicated 24-hour care by rehabilitation-trained, experienced nurses Daily physician visits Outdoor areas for functional activities Private rooms and room-service meals

Our 2013 outcomes Functional Independent Measurement Length of stay Discharge to community

Lodi Memorial Hospital Acute Physical Rehabilitation Ramnik Clair, MD, Medical Director 209/712-7905 Tel 209/333-3082 Fax 975 S. Fairmont Ave., Lodi, CA 95240 SPRING 2014

Lodi Memorial

Nation

32.4 12 87.1%

28.7 15.9 73.7%

www.lodihealth.org SAN JOAQUIN PHYSICIAN

2014

CMA EDUCATION The California Medical Association offers timely, high-quality education programs for physicians and physician office staff. what people are saying

Webinars offer an expanded knowledge base of important and difficult topics

Personal Belief Exemptions to Required Immunizations: A New Role for Physicians CMA, California Immunization Coalition and American Academy of Pediatrics - CA • 12:15-1:15p.m

FEB 20

Learn how a new law to increase childhood vaccination could impact your practice. As of this year, parents who want to exempt their child from one or more required immunizations because of their personal beliefs must provide to the school or child care facility with a statement signed and dated by a health care practitioner and parent indicating that the practitioner has provided, and the parent has received, information about the benefits and risks of immunizations and the risks of vaccine-preventable diseases. The webinar will cover the background behind the law, the new requirements, and how it is expected to work in practice.

Fraud and Abuse: Dangers & Defenses

FEB 26

DHCS • 12:15-1:15p.m.

Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the importance of documentation, present suggestions for implementing internal controls, and increase awareness of preventive measures to protect your practice from fraud or abuse.

HIPAA Security Risk Analysis-How to Make Sense of this Requirement David Ginsberg • 12:15-1:15p.m.

MARCH 5

Conducting a HIPAA Security Risk Analysis is a requirement of the HIPAA Security Rule. It is also a CORE Meaningful Use (Stage 1 and 2) measure to earn EHR incentives and avoid Medicare penalties! This webinar reviews what is required to properly fulfill this compliance obligation and at the same time secure your patient’s health information. Failure to conduct a Risk Analysis or conducting an insufficient one are among the most common deficiencies found during compliance investigations!

Stage 2 Meaningful Use-the 2014 Edition-what you need to know!

APRIL 30 52

David Ginsberg • 12:15-1:15p.m.

Many changes are in order for the 2014 edition (Stage 2) of Meaningful Use. This informative webinar will assist you in understanding these changes and how they impact your workflows and use of electronic health records (EHR). June 18: Power of the Pen (Prescribing)

SAN JOAQUIN PHYSICIAN

SPRING 2014

Power of the Pen (Prescribing)

JUNE 18

DHCS • 12:15-1:15p.m.

Presented by Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the importance of documentation, understand the physician’s role in prescribing, ordering and referring, and increase awareness of fraud and abuse in prescribing and referring.

Recipe for Financial Success: Key Steps To Increase Your Next Income

JULY 16

Debra Phairas • 12:15-1:15p.m

Physicians and office managers need business management skills, particularly in the financial area. This workshop will teach critical skills in analyzing the practice profit/loss statement, accounts receivable ratios and staffing patterns and how to access specialty comparison norms. At least one source of comparison data specific to your medical specialty will be given to each participant.

What to Expect from Medi-Cal Audit

JULY 30

DHCS • 12:15-1:15p.m.

Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the role of utilization oversight and claims monitoring, increase understanding of the audit process and possible outcomes, and understand common problems and methods to improve documentation.

HIPAA Update-Are You Compliant with the Final Omnibus Rule? David Ginsberg• 12:15-1:15p.m.

SEPT 10

The Final HIPAA Rule went into effect in 2013. There are so many changes to HIPAA Privacy, Security, Breach and Enforcement that this rule is referenced as an “Omnibus Rule”. Many changes have profound impact on medical practice workflow. Changes are also relevant if you use an electronic health record. This webinar provides an overview of the HIPAA changes and key steps medical practices can take to comply with HIPAA. HIPAA enforcement penalties can be severe for medical practices who are not compliant!

Managing Difficult Employees and Reducing Conflict in the Practice Debra Phairas• 12:15-1:15p.m

SEPT 17

Very few medical or business schools teach hands-on human resources management skills and techniques. This information-packed workshop will teach you the secrets of how to lead, coach and manage difficult employees; set practice values; and reduce conflict in the practice. You will learn how to: • Adopt the strategies, techniques and approaches used by “superstar leaders” to lead, manage and motivate the workers in your practice. • Set the three values that employees must perform to obtain a raise or risk termination. • Retain your star performers while weeding out your non-performers. • How to avoid the most common mistake by adhering to the chain of command. • How to implement basic conflict resolution skills.

ALL WEBINARS ARE FREE TO MEMBERS AND THEIR STAFF, $99 FOR NON-MEMBERS FOR MORE INFORMATION VISIT WWW.CMANET.ORG/WEBINARS OR CONTACT PRISCILLA AMBROCIO AT PAMBROCIO@CMANET.ORG SPRING 2014

SAN JOAQUIN PHYSICIAN

Public Health

Update

ELECTRONIC CIGARETTE From Wikipedia, the free encyclopedia

Different types of electronic cigarettes

E-cigarettes E-merging as Significant Trend in Nicotine Use Background and Significance Smoking remains the leading cause of preventable death in the United States. The social, economic, and health consequences associated with tobacco use are numerous and significant. The Centers for Disease Control and Prevention (CDC) estimates that smoking causes more than $193 billion per year in health-related costs, including medical

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costs and the cost of lost productivity. In 2008, it was estimated that smoking was attributable to over $18 billion in health care costs in California alone. It is significant to note that rates of smoking and tobacco use are higher in San Joaquin County as compared to the statewide rate for California (18% vs. 14%). Public views have shifted dramatically since the Surgeon Generalâ&#x20AC;&#x2122;s Report on Smoking and Health was published 50

An electronic cigarette (e-cig or e-cigarette), electronic vaping device, personal vaporizer (PV), digital vapor device or electronic nicotine delivery system (ENDS) (not to be confused with smokeless cigarettes) is a battery or USB powered device which simulates tobacco smoking. It generally uses a heating element known as an atomizer, that vaporizes a liquid solution. Some solutions contain a mixture of nicotine and flavorings, while others release a flavored vapor without nicotine. Many are designed to simulate smoking implements, such as cigarettes or cigars, in their use and/or appearance, while others are considerably different in appearance. [1][2][3] The benefits and risks of electronic cigarette use are uncertain.[4][5] They may carry a risk of developing nicotine addiction, and their regulation is the subject of ongoing debate.

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years ago. Although great strides have been made in the fight against smoking and tobacco use, particularly surrounding the prevalence of associated chronic diseases, high rates prevail. Unfortunately, early studies indicate that emerging new products like e-cigarettes could be a catalyst to renormalize smoking and other forms of nicotine use.

E-cigarettes Electronic cigarettes (e-cigarettes) are smokeless battery-operated devices, that, when heated, allow the user to inhale a vaporized liquid nicotine solution while simulating the act of smoking. Originally developed in China, e-cigarettes were introduced to the U.S. in 2006 and have become a multibillion-dollar industry, with a wide array of brands and flavors. As they contain no tobacco, e-cigarettes are not subject to U.S. tobacco laws, and thus, there is no age restriction as to who can purchase the devices. The CDC reported that 1.8 million teens used e-cigarettes in 2012, a 50% increase from 2011. This is particularly concerning since the long-term health risks are unknown. Public health advocates are also worried that e-cigarettes are a possible gateway to nicotine addiction – the amounts and types of ingredients in the vapor are unknown, and little is known about safety regarding second-hand exposure. Although not regulated by the agency because they are classified as a drug delivery device, the Federal Drug Administration

SPRING 2014

Top: Evidence also shows that early initiation of ART can reduced risk for transmission of HIV to uninfected sexual partners, thereby reducing the incidence of new infections in the community.

(FDA) is concerned about the safety of these products and how they are marketed as a smoking cessation device to the public. In 2009, the FDA conducted an analysis of two leading brands of e-cigarettes and found traces of known carcinogens and other toxic chemicals, including diethylene glycol, an ingredient found in anti-freeze.

Widely sold online, e-cigarettes are marketed in ways that appeal to youth. Manufacturers are using the same tactics that were used by big tobacco companies in the 50’s, 60’s, and 70’s, including celebrity endorsements, cartoon characters, and sport sponsorships. The City of Stockton is already home to a handful of “vape or juice shops,” which are stores specializing in e-cigarettes and

SAN JOAQUIN PHYSICIAN

Public Health

Update

related accessories. Customers can choose from a wide variety of fruity and candy flavors, such as blueberry waffle, captain crunch, chocolate, and cherry.

Current Policies in Place Recently, several entities have chosen to regulate the use of e-cigarettes. All University of California campuses now ban e-cigarettes anywhere on their premises. The cities of Los Angeles and Carlsbad have both passed strict ordinances that add e-cigarettes to the list of tobacco products where use is prohibited.

Physician’s Role Physicians are in an ideal role to assist and support cessation efforts with their patients. This should be an easier task now that the Affordable Care Act, with its focus on the importance of prevention, includes smoking cessation in the menu of services to be provided by health insurance plans under Covered California. Use of e-cigarettes should be addressed in discussions on tobacco cessation. It is important to note, however, that some medical organizations see e-cigarettes as a positive alternative to traditional cigarettes which can be used as a nicotine replacement product, playing a role in harm reduction for

SAN JOAQUIN PHYSICIAN

those who are trying to stop smoking or are unable to stop smoking. The biggest concern is use of e-cigarettes by children as a gateway drug to cigarette smoking.

STOPP Coalition The San Joaquin County (SJC) Smoking and Tobacco Outreach/ Prevention Program (STOPP), founded in 1991, is facilitated by SJC Public Health Services. The STOPP Coalition consists of a group of diverse community partners working together to make the county a smokeand tobacco-free environment. The STOPP Coalition meets every third Wednesday of the month at SJC Public Health Services to discuss existing and emerging issues that could be addressed through policy and environmental change (e.g., raising awareness of the potential harms of e-cigarettes and encouraging increased regulation of their use in public places). In addition, the Coalition maintains a comprehensive smoking cessation resource list, including referrals to telephone counseling and other community resources.

how to get involved, contact the SJC STOPP Public Health Educator at (209) 468-2415.

References Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;57(45):1226–8 American Lung Association. (2013). The American Lung Association State of Tobacco Control 2013. New York, NY: Hard Copy Printing. U.S. Food and Drug Administration. (2013, April 25). Electronic Cigarettes (e-Cigarettes). Retrieved January 6, 2014, from U.S. Food and Drug Administration website: http://www.fda.gov/ newsevents/publichealthfocus/ucm172906.htm U.S. Food and Drug Administration. (2009, July 22). Summary of results: Laboratory analysis of electronic cigarettes conducted by FDA. Retrieved January 6, 2014, from U.S. Food and Drug Administration website: http://www.fda.gov/ newsevents/publichealthfocus/ucm173146.htm Centers for Disease Control and Prevention. (2013, September). Morbidity and Mortality Weekly Report: Notes from the field: Electronic cigarette use among middle and high school students — United States, 2011–2012. Washington, DC.

STOPP is currently building additional community partnerships to broaden the reach of its campaign. To learn more about the STOPP Coalition and

SPRING 2014

SAN JOAQUIN PHYSICIAN

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.

SAN JOAQUIN PHYSICIAN

SPRING 2014

MARCH 12TH, 2014:

“HOW DO PATIENTS USE THE INTERNET AND SMARTPHONES TO FIND PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS AND SERVICES” 11:00AM to 1:00PM

Over 80% of the people online use the Internet to find physicians and healthcare professionals. You will be learning tips on how to reduce staff calls and improve being found online. Basics also of having a website that can be used on smartphones. Steve Morales, Mayaco Marketing & Internet; “At MAYACO we design websites that work for YOU and your clients. Each one is completely custom with a design and functionality that fit your needs and those of your customers.”

APRIL 9TH, 2014:

“MICROSOFT XP’S “END-OF-LIFE,” BACKUP STRATEGIES AND DATE RECOVERY PROCESS” 11:00AM to 1:00PM

Many of you are familiar with Crown Enterprises who we partner with to give members a discount on IT Support and much more. They will discuss Microsoft XP’s “End-of-Life” and why is it a concern for their Business, as well as Backup Strategies and Data Recovery Processes as it relates to required practices and procedures. Also, plan on plenty of Q&A! Tyler Solt & Mark Williams, Crown Enterprises

MAY 14TH, 2014:

“TRANSITIONING YOUR DASHBOARD TO A SCOREBOARD” 11:00AM to 1:00PM

A dashboard is a toolset developed to provide practices with the relevant and timely information they need to inform daily decisions. It provides these tools in a user friendly format, designed to offer the user a quick and easy way to access information at a specific point in time. A scoreboard, on the other hand, turns data into an actionable management tool, to improve overall patient care team performance and identifies the metrics that can drive success. Applicable to

practices of all sizes, this will simplify the process of ata-glance review of key performance indicators and the ability to monitor practice health. Amy Germann, MBA, FACMPE HEALTH CARE CONSULTING MANAGER Amy has more than 20 years of experience helping physicians, hospitals and ambulatory surgery centers with performance, business development, strategic planning and effective governance.

JUNE 11TH, 2014:

“HEALTH HUB OF SAN JOAQUIN” 11:00AM to 12:30PM

Recognizing a need for people with diabetes to have easier access

to self-management classes, the San Joaquin Medical Society has developed a helpful website, www.HealthHubSJ. com. The Health Hub houses all of the free diabetes education classes, nutrition classes, diabetes prevention and diabetes treatment programs that are available in the San Joaquin County. It provides a comprehensive, yet user-friendly website that can be accessed by physicians, nurses, and medical assistants who are looking for local resources to refer patients to. Vanessa Armendariz serves as the Community Project Manager at the San Joaquin Medical Society, managing our new “Health Hub” website and coordinating several other grant-funded projects relating to diabetes and other chronic diseases.

ARE YOU READING CPR?

CPR contains the latest in Practice Management Resources, Updates and Information.

www.cmanet.org/news/cpr SPRING SPRING 2014 2014

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SAN JOAQUIN PHYSICIAN

SPRING 2014

PRACTICE MANAGEMENT

MANAGING PROFESSIONAL RISK

Tips for

Lowering NORCAL Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL Mutual insureds. To learn more, visit www. norcalmutual. com/cme.

SPRING 2014

Ambulatory-Care

Risks Risk Management, PMSLIC Insurance Company and the NORCAL Group

AMBULATORY-CARE RISKS

Among the factors that influence the safety of ambulatory care and the liability risk levels of office-based physicians, three of the main ones are: The level of communication with other healthcare providers about patientsâ&#x20AC;&#x2122; care; the effectiveness of office follow-up processes; and the attention given to documentation of telephone calls. The following tips may help physicians and office staff members increase patient safety and lower liability exposure related to these factors. >>

Karen D. Davis, MA, CPHRM

SAN JOAQUIN PHYSICIAN

Norcal > Lowering Risk

Communication with Other Healthcare Providers

When you refer a patient to another physician, have some mechanism in place to determine whether your referral recommendation has been carried out and the patient has been seen by the recommended consultant (or another physician of the patient’s choice). Communicate in writing with the consultant about the requested consultation.

An effective way to convey significant details to another physician is to prepare a “fact sheet” with the patient’s clinical information and your impression. After your patient is seen by a consultant, you and the consultant should establish who is responsible for which aspects of the patient’s care and who will order further testing and consultations if necessary. If there is a question about what you or the consultant will do, you should take the time to communicate physicianto-physician and to document the understanding you reach in your discussion. Effectiveness of Follow-up Processes

Systematically monitor compliance with appointments. Establish a process whereby a designated staff member reviews all no-show appointments to determine which patients must be called and rescheduled. Document no-shows, along with the steps taken to contact the patient and reschedule the visit. When a patient is advised to undergo a test, three areas of concern require follow-up:

Has the patient complied with the recommendation? Have test results been

SAN JOAQUIN PHYSICIAN

received and reviewed by the ordering physician? Has the patient been notified about the results? An appropriate followup system provides answers to these questions. Patients should not be solely responsible for making appointments for tests, to see consultants or for calling the office to obtain results.

You should assist patients in making appointments in order to be assured that the appointment has been made. It is also prudent to notify all patients of all test results (rather than just reporting abnormal results). Such a policy helps close each testing loop and reduces the possibility of patient information “falling through the cracks.” Your follow-up system for tests should not only confirm receipt of test results but also ensure that you review the results.

The review should be timely. A test result should never be filed until you (as the ordering physician) have personally reviewed, dated, and initialed it. Without such a method, a positive result can be accidentally misplaced or filed away before you review it or the patient is notified. If the patient later alleges that harm occurred as a result of a delay in diagnosis and treatment, the mishandled test result may well be viewed as concrete evidence of negligence. Documentation of Telephone Calls

Generally, the types of telephone calls from patients that should be documented include: clinical questions and what advice was given, calls for prescriptions or renewals, after-hours calls, and calls to an oncall physician. Calls to patients that should be documented include: calls to share test results, calls to contact no-show patients, calls to give patients

instructions or to advise about further access to care, and unsuccessful attempts to contact patients. Telephone contacts should be documented in the appropriate medical record.

If your office simply keeps a call log, information about a specific call can be difficult to retrieve. The facts surrounding a call are not readily available if they are recorded in a call log; thus, using a log can be detrimental if a malpractice claim is filed and your office must produce information about the patient’s interactions with the practice. You should have a system for documenting all after-hours phone calls.

You can use telephone call forms or a tape recorder or dictation machine to record patient name, time of and reason for the call, and your advice or action. When the call is from a patient, the information should be added to the patient’s chart as soon as possible. Giving clinical or medical advice over the telephone without timely, face-to-face follow-up increases your liability exposure.

Prescribing over the phone is also risky, as it requires you to assess the patient sight unseen. You should not prescribe for a patient unknown to you without seeing the patient. It is also prudent to have established parameters as to when prescriptions will be renewed by phone. Consider developing the preceding suggestions as policy and including them in a policy manual.

Make sure all employees review your policy and consider asking them to sign off yearly that they have been advised of the policy and understand it.

SPRING 2014

“ We listen to policyholders. We provide solid advice and offer real-time solutions to real-time problems.” Loss Prevention Senior Representative Kathy Kenady

Service and Value MIEC takes pride in both. For nearly 40 years, MIEC has been steadfast in our protection of California physicians. With conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services, we’ve partnered with policyholders to keep premiums low. Added value: n

No profit motive and low overhead

17.5 million in dividends* distributed in 2014

For more information or to apply: n

www.miec.com

Call 800.227.4527

Email questions to

Average Dividend as % of Premiums Past five Years

40% 35% 30% 25%

38.6%

20% 15% 10% 5% 0%

MIEC

6.66%

Med Mal Insurance (PIAA)

underwriting@miec.com * (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

MIEC 6250 Claremont Avenue, Oakland, California 94618 • 800-227-4527 • www.miec.com SJMS_01.24.14

SPRING 2014

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In Memoriam

In Memoriam Dr. August C. Armanini Jr.

Dr. Armanini loved to play chess, was a member of the Stockton Astronomical Society and enjoyed playing tennis into his 80’s.

DR. AUGUST C. ARMANINI JR. Feb. 1, 1921 - Jan. 6, 2014

Dr. August C. (Gus) Armanini Jr., pathologist at St. Joseph’s Hospital of Stockton, California for thirty-two years passed away on January 6, 2014 at the age of 92. He was born in Mountain View, CA to the son of Italian immigrant August C. Armanini and San Francisco born Catherine (Piaggio) Armanini who along with his four siblings, Lawrence, Albert, George, and Julia were all in the medical field. Dr. Armanini graduated from Stanford Medical School. He served as commanding officer at the First Medical Field Laboratory of the 8th Army in Korea. In 1954 he and St. Joseph’s started the pathology department. Always a lover of computers, in 1974 Dr. Armanini sought to improve the delivery of health care. With a small group of physicians he began the Computer Information Committee, whose purpose was to provide a communications link between hospital departments. Additionally, he served as Medical Director for the Delta Blood Bank for many years. Dr. Armanini loved to play chess, was a member of the Stockton Astronomical Society and enjoyed playing tennis into his 80’s. Gus is survived by his wife Pearl, two sons Dan (partner Tom Grof) John and granddaughter. Donations may be made to the Hospice of San Joaquin.

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San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568

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Permit No. 60 Stockton, CA

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NORCAL Mutual is owned and directed by its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. For more information contact a NORCAL Mutual broker.

norcalmutual.com 877.453.4486