Winter 2018

HOUSE OF

DELEGATES Legislative Wrap Up Opioid Advocacy AB 72 WINTER 2018

Winter 2018 SAN JOAQUIN PHYSICIAN

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VOLUME 66, NUMBER 4 • DECEMBER 2018

{FEATURES}

16 28 32 42

LEGISLATIVE WRAP UP OPIOID ADVOCACY HOUSE OF DELEGATES AB 72 INDEPENDENT DISPUTE RESOLUTION

{DEPARTMENTS} 46 IN THE NEWS

New faces and Announcements

54 PRACTICE MANAGEMENT:

Committed to Improving Quality Health Care

56 PUBLIC HEALTH

Sexually Transmitted Diseases in San Joaquin County

62 NEW MEMBERS

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PRESIDENT R. Grant Mellor, MD PAST-PRESIDENT Richelle Marsigan, DO SECRETARY-TREASURER Hyma Jasti, MD BOARD MEMBERS Kismet Baldwin, MD, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD, Raghunath Reddy, MD, Kwabena Adubofour, MD, John Zeiter, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Maria Rodriguez-Cook

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Grant Mellor MD, Lisa Richmond MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, MD

CONTRIBUTING WRITERS R. Grant Mellor, MD, Kismet Baldwin, MD

CMA AFFAIRS COMMITTEE Larry Frank, MD PUBLIC HEALTH COMMITTEE Kismet Baldwin, MD SCHOLARSHIP LOAN FUND Matthew Wetstein, PhD

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

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

James R. Halderman, MD, Grant Mellor, MD, Raissa Hill, DO, Ramin Manshadi, MD,

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD, Philip Edington, MD,

San Joaquin Physician Magazine

Steven Kmucha, MD

3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

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Partnering today for a healthier tomorrow With nearly 350,00 members, Health Plan of San Joaquin continues to build relationships with health care providers, resource agencies, and local businesses to deliver on our mission to improve wellness throughout the communities we serve.

Strong community partnerships lead to happier, healthier people.

888.936.PLAN (7526) TTY/TDD 711 | www.hpsj.com WINTER 2018

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MILLENIALS TO BOOMERS - DRYTOEYE MILLENIALS ALL GENERATIONS: MILLENIALS BOOMERS - DRYTOEYE MILLENIALS BOOMERS DRYTOEYE DRY -EYE BOOMERS - DRY EYE

SENIORS - CATARACTS & FADING VISION SENIORS - CATARACTS SENIORS - CATARACTS & FADING VISION SENIORS: SENIORS - CATARACTS & FADING VISION & CATARACTS FADING VISION

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Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL

CATARACT SURGERY • GLAUCOMA CARE RETINAL •SERVICES EYELID SURGERY • LASIK • VISION EXAMS •• GLASSES CONTACTS Committed to continuously advancing vision careEXAMS andCARE providing compassionate patient care CATARACT SURGERY • GLAUCOMA RETINAL •SERVICES EYELID SURGERY • LASIK • VISION • •GLASSES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS GLASSES CONTACTS CATARACT SURGERY • GLAUCOMA CARE• RETINAL • EYELID SURGERY • LASIK • VISION EXAMS • •GLASSES •SERVICES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS • GLASSES • CONTACTS Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Joseph Zeiter, M.D.

John Zeiter, M.D.

Richard Wong, M.D.

John Canzano, M.D.

Joseph Zeiter, Jr. , M.D.

Michael Mequio, M.D.

Peter Hetzner, O.D.

Linda Hsu, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Pedersen, O.D. StevenE. A. Wood, O.D.

Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Pedersen, O.D. StevenE. A. Wood, O.D.

Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Dupree, O.D.

Over 50 years ofE. K.Pedersen, Vision Care Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Over 50 years ofE. K.Pedersen, Vision Care Over 50 years of Vision Care Over 50 years of Vision Care

Over 55 years of Vision Care

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Robert O.D. Robert Devinder E. Pedersen, K.call Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, Steven LindaA.Hsu, Wood, O.D. StevenE.A.Pedersen, Wood, please O.D. To refer AO.D.patient, To refer A patient, please call Robert O.D. Devinder Grewal, O.D. Robertplease Dupree, O.D. Jennifer ToPedersen, refer A patient, callPham, O.D. Ralph Miranda, O.D. To refer A patient, please call

209-461-2170 209-461-2170 209-461-2170 www.zeitereye.com 209-461-2170 www.zeitereye.com www.zeitereye.com 209-466-5566 www.zeitereye.com

Steven Wood, O.D.

STOCKTON • LODI • MANTECA • TRACY • SONORA refer a patient, please call STOCKTON •To LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA

STOCKTON • LODI • MANTECA • TRACY • SONORA

www.zeitereye.com

WINTER 2018

Robert Dupree,

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EXECUTIVE DIRECTOR’S REPORT

NEW LOOK FOR THE NEW YEAR

If you haven’t already, I am guessing you will notice something different about SJMS. We have rebranded with a new logo and launched our new mobile friendly website! Given that the California Medical Association’s family includes 37 medical societies, a political action committee and foundation, it was important to demonstrate a cohesive and consistent brand across all communication channels, affiliates and platforms. Therefore, shortly after CMA’s launch, we followed suit. After a couple of lively conversations about accent color (who knew we’d have so many opinions?), the Board selected green. We hope you like it too! While we will continue to tweak and improve the website in next couple of months, we know you will enjoy the new functionality and design.

LISA RICHMOND

We often talk about advocacy as one of the intangible, yet most important, member benefits of joining SJMS/CMA. Each year a group of seven dedicated SJMS Delegates participate in the legislative process as they meet with hundreds of their peers from throughout California at the annual CMA House of Delegates Conference. They pour through the countless resolutions and make recommendations based on their experience and expertise. It’s been said that “if you don’t have a seat at the table, you are on the menu,” so we would like to invite you to the table! We are recruiting passionate leaders, who are interested in influencing policy and legislation, to serve as Alternate Delegates. Please call our office for more information. We invite you to read about this year’s top issues and hot topics in the HOD and Legislative Wrap Up articles.

As mentioned above, the new website will be much more interactive and allow us to streamline our processes. Therefore, we are getting an early start on our call for nominations for the 2019 Young Physician and Lifetime Achievement Award. In addition to mailing the nomination forms to all members later in December, this year you can choose to nominate your deserving candidate online. You will find the link with criteria for each award on our homepage at www.sjcms.org under “featured”.

The holiday season is a time to reflect on the past year, hopes for the coming year, and simply take some time to rest and rejuvenate. I wish you all much laughter, joy, good cheer and time with those who matter most. Thank you for the privilege of leading the society for another year. I hope to see you at our annual Holiday Party on Thursday, December 13. See enclosed ad for more details!

Happy Holidays,

Lisa Richmond 8

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THE STANFORD CARDIAC S U R G E RY P R O G R A M AT

Partners in Cardiac Surgery Leaders in Health Care The Stanford Cardiac Surgery Program at Dameron Hospital is expanding its medical team with the addition of Dr. Maria Currie, Stanford Cardiac Surgeon and faculty member. This program builds a strong partnership between Stanford Health Care and Dameron Hospital to provide patients with local access to Stanford’s leading-edge patient care.

DR . ERIC KEYSER , MD

DR . MARIA CURRIE , MD

“Dr. Currie is an outstanding cardiac surgeon and will complement Dr. Keyser’s expertise.

We anticipate excellent results from the Dameron team and we are prepared to extend the support they need to make this program as successful as possible.”

– Dr. Joseph Woo, MD Cardiothoracic Surgeon and Chairman of Stanford University School of Medicine’s Cardiothoracic Surgery Department

525 West Acacia Street, Stockton, CA 95203 209-944-5550 DameronHospital.org 10

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A message from our President > R. Grant Mellor, MD

A Doctor's Reminder

ABOUT THE AUTHOR ­ R. Grant Mellor, MD- Pediatrician and Chief of Professional Development, Central Valley Service Area, The Permanente Medical Group and current President of the San Joaquin Medical Society

WINTER 2018

One of my favorite movies is “The Doctor,” in which William Hurt plays a surgeon whose professional life is changed after he develops cancer and becomes a surgical patient. Following his patient-care epiphany, he initiates a program wherein all new surgical residents are admitted to the hospital as a patient, so to experience care from their perspective.

I had my own (much less serious) change-in-perspective experience recently. I found myself lying on an ER gurney (rather than standing next to it), being inside of the CT donut (rather than sending someone to it) and feeling rather worried while awaiting the doctor’s verdict (rather than delivering it). I was surprised by the degree of anxiety the experience provoked, and the great comfort I found in having a physician who listened and seemed to care. A week later I was delighted to be back at work, on my accustomed side of the exam table. I found myself listening a bit more carefully, empathizing a bit more, and realizing anew what an important and impactful job I had.

Another source of inspiration has come recently from the student essays I have been reading and critiquing, as part of our new “Bridge to Medicine” mentoring program. We’re working with a handful of gifted high school students who have (in our view) a good shot at gaining admission to the various Baccalaureate/MD programs around the country. Students who are accepted are given provisional guarantee of admission (pending successful completion of coursework and MCAT), which vastly reduces the stress, time and cost of applying to medical school. We have identified 20 programs across the nation that seem to be worth applying to. Each application includes some variant of the question “Why do you want to be a doctor?”

Reading these essays helps me remember why I wanted to be a doctor too – to help people, to relieve suffering, to prevent disease, to be there for patients in need. Like I was last month, and like all will be some day.

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Sometimes You Just Need a Little Help.

EXCI

RAFFTING PRIZ LE E S

Tenth Annual Golf Tournament Join fellow San Joaquin Medical Society members and invited guests for a relaxing round of golf, BBQ lunch, dinner and after golf party. Exciting and generously donated raffle prizes you don’t want to miss. Plus an opportunity to benefit our local The First Tee of San Joaquin and SJMS’ Decision Medicine programs. Your hosts, Drs. Kwabena Adubofour, George Herron, Prasad Dighe and George Khoury are committed to making this an event to remember!

Sunday April 28, 2019 • Brookside Country Club • 4 Person Scramble $175 per golfer - Price includes green fees, golf cart, lunch, after golf dinner and party! See registration form for details. $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 WINTER 2018

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By Janus L. Norman, CMA Senior Vice President, Centers for Government Relations and Political Operations It has been said that “diligence makes the difference between all-time greats and one-hit wonders.” For over 160 years, the physician leadership of the California Medical Association (CMA) has practiced unmatched devotion to its members and the entirety of the physician community. CMA’s physician leaders care for their individual patients at all hours of the day or night and are stewards of the profession in their limited time off. This investment of sacrificed family and personal time has powered the state’s largest medical association forward.

Innovations in the association’s governance structure have increased CMA’s ability to maintain its vaulted position within the Golden State’s political “Game of Thrones.”

Success in the legislative process is sometimes difficult to measure. Insiders often refer to published lists of powerful special interest groups or individuals, articles listing interest groups that have spent the most money on lobbying and/or campaign activities, or the number of mentions an association receives in news articles. If those are the measurements of success, CMA is at the top of the class: staff are consistently included in the Capitol Weekly Top 100; CMA is routinely recognized by news outlets as one of the most effective lobbying organizations in the state; and rarely does an article regarding health care legislation not include a quote from the CMA president.

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Prominence is significant; it aids in the creation of political capitol. But distinction itself is not the goal. Physician leaders want to ensure CMA improves the health care delivery system by obtaining state budgetary appropriations to increase patient access and protect against ill-conceived legislation that would directly threaten their ability to financially maintain a practice and provide the best care.

“The 2018–2019 State Budget included over $1 billion in new funding to support supplemental payments for physicians participating in the Medi-Cal program.”

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cmadocs.org | Page 1

RETURN ON INVESTMENT In 2016, CMA, the California Dental Association, the Service Employees International Union (SEIU) and their coalition partners beat the odds. Together, we convinced voters to increase the state’s tobacco tax by $2 in order to invest a majority of the revenue into increasing access to care. CMA contributed $1 million to the statewide Proposition 56 campaign. Now that the tax is being collected and distributed, the physician community sees the impact.

The 2018-2019 State Budget included:

• • • •

Over $1 billion in new funding to support supplemental payments for physicians participating in the Medi-Cal program

An expansion of the number of CPT codes that are eligible for those supplemental payments $190 million for medical student loan repayment

$40 million in new funds for graduate medical education, which will be administered by Physicians for a Healthy California (formerly known as the CMA Foundation)

In the 2017-2018 legislative session, two detrimental proposals were introduced that would have upended the state’s health care delivery system. SB 562 (Lara, Los Angeles) would have required California to implement an extremely flawed single-payer proposal. AB 3087 (Kalra, San Jose) would have empowered a politically-appointed committee to price fix physician services. In both instances, the health care community looked to CMA for leadership and expertise.

“[...] the Legislature now looks to our House of Delegates for a solution to improve access and increase the affordability of health care in California.”

On a weekly basis, opposition coalitions met at CMA headquarters to execute a substantial grassroots program, earned media strategy, Capitol lobbying strategy and a digital media campaign. The defeat of SB 562 and AB 3087 once again showcased CMA as an unapologetic leader in health care policy. As a result of defeating both bills, the Legislature now looks to our House of Delegates for a solution to improve access and increase the affordability of health care in California.

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During the first quarter of the year, the CMA Board of Trustees adopted CMA’s sponsored bill package. The bills focused on:

•

• • • •

Improving state oversight and regulation of predatory behavior by health plans (AB 2674 by Assemblymember Aguiar-Curry and AB 2427 by Assemblymember Wood)

Improving access to medication assisted treatments for individuals fighting opioid addiction (AB 2384 by Assemblymember Arambula) Improving the medical board disciplinary process (AB 505 by Assemblymember Caballero)

Increasing transparency and oversight in the pharmaceutical supply chain (AB 315 by Assemblymember Wood)

Protecting medical independence for physicians working in county sheriff’s departments (SB 1303 by Senator Pan)

“[...] all sponsored legislation made it through both houses of the Legislature and were sent to the Governor for consideration.”

I am pleased to report that all sponsored legislation made it through both houses of the Legislature and were sent to the Governor for consideration. While the fate of each bill will vary, it is important to note this year the Legislature agreed with each of the policy principles of our sponsored legislation. A full description and status of each measure is provided on the following pages.

The call for leadership is once again before us. Guided by our grand history, we must continue to exercise our diligence, provide solutions and construct the development of the next iteration of California’s health care delivery.

Let’s do it again!

In Unity,

Janus L. Norman CMA Senior Vice President Centers for Government Relations and Political Operations

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cmadocs.org | Page 2

CMA SPONSORED LEGISLATION AB 315 (WOOD) PHARMACY BENEFIT MANAGEMENT This bill requires pharmacy benefit managers (PBM) to register with the Department of Managed Health Care (DMHC), to exercise good faith and fair dealing, to inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable costsharing amount for the prescription drug, if the customer pays the retail price, to submit the claim to the health plan or health insurer in the same manner as if the customer had purchased the prescription drug by paying the cost-sharing amount, requires the payment to apply to the deductible and the maximum out-of-pocket limit in the same manner as if the enrollee had purchased the prescription drug by paying the cost-sharing amount. The bill also requires DMHC to convene a task force on PBM reporting to determine what information related to pharmaceutical costs it should require to be reported by health care service plans or their contracted PBMs. The bill also establishes a pilot project in Riverside and Sonoma counties to assess the impact of health plan and PBM prohibitions that prohibit the dispensing of particular quantities of prescription drugs by network retail pharmacies.

Status: Signed by the Governor (Chapter 905, Statutes of 2018).

AB 505 (CABALLERO) MEDICAL BOARD OF CALIFORNIA: ADJUDICATION: EXPERT TESTIMONY Current law prohibits the use of expert testimony in matters brought by the Medical Board of California unless specified information is exchanged with counsel for the other party and requires the exchange of the information to be completed 30 calendar days prior to the commencement date of the hearing or as specified. This bill would authorize the administrative law judge to extend the time for the exchange of information, upon a motion based on a showing of good cause, for a period not to exceed 100 calendar days, and at least 30 days before the hearing date.

Status: Signed by the Governor (Chapter 469, Statutes of 2018).

AB 1976 (LIMÓN) EMPLOYMENT: LACTATION ACCOMMODATION This bill extends the lactation accommodation protections within the federal Affordable Care Act (ACA) to all working mothers in California. Before this bill, California law only required employers to provide a lactation space for nursing mothers outside of a toilet stall. The ACA required employers with 50 or more employees to provide

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a nursing mother a lactation space outside of a bathroom.

With certain exemptions, AB 1976 requires all employers to provide a nursing mother with a place to express milk outside of a bathroom; thereby ensuring that a mother employed by an employer with less than 50 employees has a sanitary space to breastfeed upon returning to work.

Status: Signed by the Governor (Chapter 940, Statutes of 2018).

AB 2384 (ARAMBULA) MEDICATIONASSISTED TREATMENT This bill would require a health care service plan that provides prescription drug benefits to cover, at a minimum, at least one of each of the specified medicationassisted treatment and overdose reversal prescription drugs approved by the United States Food and Drug Administration for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider. Prohibits the specified covered drugs from being subject to step therapy, prior authorization or other similar plan requirements.

Status: Vetoed by the Governor.

AB 2427 (WOOD) MEDI-CAL: ANTICOMPETITIVE CONDUCT This bill would require the Department of Health Care Services to include a contract provision in any extension, renewal, or awarding of a new contract to a for-profit Medi-Cal Managed Care company if the Attorney General determines that the for-profit health plan or insurer engaged or engages in anticompetitive conduct or practices, as defined, or if the department determines that the for-profit health plan or insurer has a pattern or practice of not complying with the medical loss ratio. AB 2427 would ensure that for-profit companies are not gauging the MediCal system by putting profits before patients.

Status: Vetoed by the Governor.

AB 2674 (AGUIAR-CURRY) HEALTH CARE SERVICE PLANS: DISCIPLINARY ACTIONS Would require the Department of Managed Health Care to review complaints filed by a provider who believes a plan is engaging in an unfair payment pattern, conduct an audit and an enforcement action pursuant to existing regulations, and if a final determination is made that a plan’s practice constitutes a “demonstrable and unjust payment pattern” or “unfair payment pattern,” assess and require the plan to pay an administrative penalty in an amount not less than the amount owed plus interest and to pay the provider what the provider is owed plus interest.

Status: Signed by the Governor (Chapter 303, Statutes of 2018).

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SB 1303 (PAN) CORONER: COUNTY OFFICE OF THE MEDICAL EXAMINER This bill would require that counties with a population for 500,000 or more, excluding charter counties, either replace the Sheriff-Coroner’s office with a Medical Examiner’s office or institute a policy where investigations involving conflicts of interest must be referred to a county with the Medical Examiner model. In a Medical Examiner model, a physician determines the type and manner (accident, homicide, natural causes, etc.) of death. In a SheriffCoroner model, a physician determines the type of death but the elected Sheriff, who has no medical training, retains the right to determine manner of death. Recent examples out of San Joaquin County have demonstrated the downside to the Sheriff-Coroner model. On April 25, the San Joaquin County Board of Supervisors, in a unanimous 5-0 vote, eliminated the office of the Sheriff-Coroner and adopted a Medical Examiner model. This was the main focus of SB 1303 and the pressure from this legislation clearly influenced the county’s decision.

Status: Vetoed by the Governor.

SUCCESSFULLY NEGOTIATED BILLS AB 1092 (COOLEY) HEALTH CARE SERVICE PLANS: VISION CARE SERVICES: PROVIDER CLAIMS: FRAUD This bill would specify that a specialized health care service plan that undertakes solely to arrange for the provision of vision care services may use a statistically reliable method to investigate suspected fraud and to recover overpayments made as a result of fraud for optometric services only. The author accepted CMA’s amendments to exclude all medical services from application of the bill. The bill would require the health care service plan’s statistically reliable method, and how the plan intends to utilize that method to determine recovery of overpayments for optometric services made as a result of fraud, to be submitted to, and approved by, the Department of Managed Health Care as elements of the plan’s antifraud plan.

Status: Signed by the Governor (Chapter 525, Statutes of 2018).

AB 1560 (FRIEDMAN) NURSE PRACTITIONERS: CERTIFIED NURSEMIDWIVES: PHYSICIAN ASSISTANTS: PHYSICIAN AND SURGEON SUPERVISION The Physician Assistance Practice Act authorizes a physician assistant licensed by the Physician Assistant Board to be eligible for employment or supervision by any physician and surgeon who is not subject to a disciplinary

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condition imposed by the Medical Board of California prohibiting that employment or supervision. The act prohibits a physician and surgeon from supervising more than four physician assistants at any one time. This bill would prohibit a physician and surgeon from supervising more than 12 nurse practitioners, certified nurse-midwives and physician assistants at any one time, as specified.

Status: Failed on the Senate Inactive File.

AB 1751 (LOW) CONTROLLED SUBSTANCES: CURES DATABASE This bill would authorize the Department of Justice (DOJ) to enter into an agreement with an entity operating an interstate data share hub for the purposes of participating in interjurisdictional information sharing between prescription drug monitoring programs across state lines. CMA worked with the author to ensure that any agreements or sharing of Controlled Substance Utilization Review and Evaluation System (CURES) information will not occur until DOJ has promulgated and approved regulations that detail who can access CURES data, to what extent and for what purposes it can be accessed, and what penalties are in place for any unauthorized use of the information contained within the database.

Status: Signed by the Governor (Chapter 478, Statutes of 2018).

AB 1753 (LOW) CONTROLLED SUBSTANCES: CURES DATABASE Current law requires prescription forms for controlled substance prescriptions be obtained from security printers approved by the DOJ. This bill would authorize the DOJ to reduce or limit the number of approved printers to three.

The bill would require prescription forms for controlled substance prescriptions to have a uniquely serialized number, in a manner prescribed by the DOJ, and would require a printer to submit specified information to the DOJ for all prescription forms delivered.

Status: Signed by the Governor (Chapter 479, Statutes of 2018).

AB 1787 (SALAS) REPORTING: VALLEY FEVER Would require the state Department of Public Health, when it receives a report of a case of coccidioidomycosis after the reporting deadline for a specified year, to include the case in its data collection for the next year and attribute it to the year of diagnosis in future data reporting. This bill would require the department to collect data on coccidioidomycosis cases

by April 15 of each year.

Status: Signed by the Governor (Chapter 229, Statutes of 2018).

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AB 1790 (SALAS) VALLEY FEVER EDUCATION, EARLY DIAGNOSIS, AND TREATMENT ACT This bill would require the state Department of Public Health and the California Conference of Local Health Officers, by July 1, 2019, to make available protocols and guidelines—developed by the National Institutes of Health, the federal Centers for Disease Control and Prevention, and other appropriate professional health care organizations— for educating physicians and other health care providers regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance and treatment.

Status: Signed by the Governor (Chapter 338, Statutes of 2018).

AB 1801 (NAZARIAN) NEWBORNS: CYTOMEGALOVIRUS PUBLIC EDUCATION AND TESTING This bill would, until January 1, 2023, require the state Department of Health Care Services to establish a commission on Cytomegalovirus (CMV) Public Education and Testing. The bill would require the commission to examine research and data regarding congenital CMV and develop recommendations.

Status: Vetoed by the Governor.

AB 1880 (FONG) VALLEY FEVER REPORTING Current law requires the state Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. This bill would require the department to collect data on coccidioidomycosis cases on or before April 1 each year, as specified.

Status: Failed in the Assembly Health Committee.

AB 1881 (FONG) VALLEY FEVER TESTING This bill would require the department to develop standardized methodology for coccidioidomycosis tests to ensure comparable sensitivity and specificity among laboratories.

Status: Failed in the Assembly Health Committee.

AB 1998 (RODRIGUEZ) OPIOIDS: SAFE PRESCRIBING POLICY This bill would require, by July 1, 2019, every health care practitioner who prescribes, orders, administers or furnishes opioids classified as Schedule II and Schedule III to adopt, review and periodically update a safe opioid prescribing

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policy. The bill would prohibit the safe opioid prescribing policy from placing a limitation on the prescription, ordering, administration or furnishing of opioids to patients with prescribed conditions.

Status: Failed in the Senate Appropriations Committee.

AB 2193 (MAIENSCHEIN) MATERNAL MENTAL HEALTH This bill would require, by July 1, 2019, a licensed health care practitioner who provides prenatal or postpartum care for a patient, or pediatric care for an infant, to offer to screen a mother for maternal mental health conditions.

The bill would require a licensed health care practitioner to appropriately screen for maternal mental health conditions during pregnancy and the postpartum period if the mother agrees to be screened.

Status: Signed by the Governor (Chapter 755, Statutes of 2018).

AB 2342 (BURKE) BREAST AND OVARIAN CANCER SUSCEPTIBILITY SCREENING This bill would require health care service plans, health insurers, and the state Department of Health Care Services to cover breast and ovarian cancer susceptibility screening as recommended by the United States Preventive Services Task Force.

Status: Vetoed by the Governor.

AB 2423 (HOLDEN) PHYSICAL THERAPISTS: DIRECT ACCESS TO SERVICES: PLAN OF CARE APPROVAL The federal Individuals with Disabilities Education Act is a law that is implemented by states and public agencies to ensure early intervention, special education and related services to eligible infants, toddlers, children and youth with disabilities. Its purpose is to ensure that all children with disabilities have available to them a public education that emphasizes special education and other services designed to meet their unique needs and to prepare them for further education and independent living. AB 2423 exempts physical therapy services that are part of an Individualized Education Program or Individualized Family Service Plan from the direct access limitation that prevents physical therapists from continuing treatment beyond 45 calendar days or 12 visits without receiving a physician’s signed approval of the physical therapist’s plan of care; thereby removing a barrier to federal compliance for California school districts.

Status: Signed by the Governor (Chapter 761, Statutes of 2018).

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AB 2487 (MCCARTY) PHYSICIANS AND SURGEONS: CONTINUING EDUCATION: OPIATE-DEPENDENT PATIENT TREATMENT AND MANAGEMENT This bill allows a physician who seeks to prescribe medically assisted treatment pharmaceuticals to fulfill their annual continuing education requirement by completing the DATA-Waivered Physician course along with four additional credit hours on treating substance use disorders.

Status: Signed by the Governor (Chapter 301, Statutes of 2018).

AB 2682 (BURKE) NURSE-MIDWIVES: NATUROPATHIC DOCTORS: ALTERNATIVE BIRTH CENTERS Current law authorizes the Board of Registered Nursing to appoint a committee of qualified physicians and nurses to develop standards for educational requirements, ratios of nurse midwives to supervising physicians, and associated matters. This bill would delete those provisions and would instead require the board to appoint a committee of physicians, surgeons and nurses to make recommendations to the board on all matters relating to midwifery practice, including, but not limited to, education and appropriate standards of care.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

AB 2760 (WOOD) PRESCRIPTION DRUGS: PRESCRIBERS: NALOXONE HYDROCHLORIDE AND OTHER FDAAPPROVED DRUGS This bill would require a prescriber to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another drug to the patient and specified others.

Status: Signed by the Governor (Chapter 324, Statutes of 2018).

SB 1003 (ROTH) RESPIRATORY THERAPY This bill would prohibit any state agency, except for the Respiratory Care Board of California, from defining or interpreting respiratory care for those licensed pursuant to these provisions, or from developing standardized procedures or protocols, unless authorized by these provisions or specifically required by state or federal statute. The bill would also authorize the board to adopt regulations to define, interpret or identify basic respiratory tasks and services, intermediate respiratory tasks, services

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and procedures that require formal training, and advanced respiratory tasks, services, and procedures that require advanced training.

Status: Signed by the Governor (Chapter 180, Statutes of 2018).

SB 1034 (MITCHELL) HEALTH CARE: MAMMOGRAMS Current law requires, until January 1, 2019, a health facility at which a mammography examination is performed to include a prescribed notice on breast density in the summary of the written report that is sent to a patient, if specified circumstances apply. This bill would extend the operation of that provision until January 1, 2025.

Status: Signed by the Governor (Chapter 332, Statutes of 2018).

SB 1121 (DODD) CALIFORNIA CONSUMER PRIVACY ACT OF 2018 This bill amends the recently enacted California Consumer Privacy Act of 2018, AB 375 (Chau), which beginning January 1, 2020, provides consumers with certain rights over their personal information collected by businesses.

The changes it makes include properly exempting medical providers from AB 375 provisions. Specifically, those amendments exclude: 1) providers governed by the Confidentiality of Medical Information Act (CMIA), Health Insurance Portability and Accountability Act of 1996 (HIPAA) covered providers and entities; 2) information that is collected and treated as private medical information and; 3) information collected pursuant to clinical trials from application of AB 375.

Status: Signed by the Governor (Chapter 735, Statutes of 2018).

SB 1152 (HERNANDEZ) HOSPITAL PATIENT DISCHARGE PROCESS: HOMELESS PATIENTS Current law requires each hospital to have a written discharge planning policy and process that requires that the appropriate arrangements for posthospital care are made prior to discharge for those patients likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning. This bill would require each hospital to include a written homeless patient discharge planning policy and process within the hospital discharge policy as well as provide non-medically necessary care in the hospital’s emergency department.

Status: Signed by the Governor (Chapter 981, Statutes of 2018).

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SB 1254 (STONE) HOSPITAL PHARMACIES: MEDICATION PROFILES OR LISTS FOR HIGH-RISK PATIENTS This bill would require a pharmacist at a hospital pharmacy to obtain an accurate medication profile or list for each high-risk patient upon admission of the patient under specified circumstances. The bill would authorize an intern pharmacist or a pharmacy technician to perform the task of obtaining an accurate medication profile or list for a high-risk patient if certain conditions are satisfied. The bill would require the hospital to establish criteria regarding who is a high-risk patient for purposes of the bill’s provisions and determine a timeframe for completion of the medication profile or list, based on the populations served by the hospital.

Status: Signed by the Governor (Chapter 697, Statutes of 2018).

SB 1264 (STONE) MEDI-CAL: HYPERTENSION MEDICATION MANAGEMENT SERVICES This bill would include hypertension medication management services as a covered pharmacist service under the Medi-Cal program.

Status: Failed in the Assembly Appropriations Committee.

SB 1336 (MORRELL) PUBLIC HEALTH: END OF LIFE OPTION ACT Existing law requires the state Department of Public Health to create a report with information collected from attending physician follow-up forms and to post that report to its website. This bill would require the report described above to further include the areas of practice of each physician who wrote a prescription for an aid-in-dying drug, the motivating reason or reasons behind a patient’s decision to request the aid-in-dying drug, and the number of patients who received a mental health specialist assessment prior to receiving the aid-in-dying drug. The bill would require the Medical Board of California to make any necessary changes to the applicable forms to conform with these requirements.

at least one hour of sexual harassment training to all nonsupervisory employees by January 1, 2020, and once every two years thereafter.

Status: Signed by the Governor (Chapter 956, Statutes of 2018)

SB 1448 (HILL) HEALING ARTS LICENSEES: PROBATION STATUS: DISCLOSURE This bill would, on and after July 1, 2019, require the California Board of Podiatric Medicine, the Naturopathic Medicine Committee, the State Board of Chiropractic Examiners and the Acupuncture Board to require a licensee to provide a separate disclosure to a patient or a patient’s guardian or health care surrogate before the patient’s first visit if the licensee is on probation pursuant to a probationary order made on and after July 1, 2019. The bill, on and after July 1, 2019, would require the Medical Board of California and the Osteopathic Medical Board of California to require a licensee to provide a separate disclosure to a patient or a patient’s guardian or health care surrogate before the patient’s first visit if the licensee is on probation pursuant to a probationary order made on and after July 1, 2019, under specified circumstances.

Status: Signed by the Governor (Chapter 570, Statutes of 2018).

SCR 110 (WIENER) SEX CHARACTERISTICS This resolution makes various legislative declarations regarding intersex individuals and calls upon stakeholders in the health professions to protect intersex children from nonconsensual medically unnecessary surgeries and to enact procedures that would delay interventions to determine gender assignment until an individual can participate in the decision.

Status: Signed by the Governor (Chapter 225, Statutes of 2018).

Status: Failed in the Senate Health Committee.

SB 1343 (MITCHELL) EMPLOYERS: SEXUAL HARASSMENT TRAINING: REQUIREMENTS This bill would require an employer who employs five or more employees, including temporary or seasonal employees, to provide at least two hours of sexual harassment training to all supervisory employees and

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OPPOSED LEGISLATION AB 221 (GRAY) WORKERS’ COMPENSATION: LIABILITY FOR PAYMENT Current law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury. This bill would provide that for claims of occupational disease or cumulative injury filed on or after January 1, 2018, the employee and the employer would have no liability for payment for medical treatment unless one or more of certain conditions are satisfied, including that the treatment was authorized by the employer.

Status: Failed in the Assembly Insurance Committee.

AB 1110 (BURKE) PUPIL HEALTH: EYE AND VISION EXAMINATIONS Would require, during the kindergarten year or upon first enrollment or entry at an elementary school, a pupil’s eyes and vision to be examined by a physician, optometrist or ophthalmologist, unless the pupil’s parent or guardian submits a written waiver to the school. The bill would require, in a pupil’s kindergarten year or upon first enrollment or entry at an elementary school that is not a charter school, the pupil’s vision to be appraised in accordance with the above-specified provisions only if the pupil’s parent or guardian fails to provide the results of the eye and vision examination.

Status: Failed in the Assembly Appropriations Committee.

AB 1612 (BURKE) NURSING: CERTIFIED NURSE-MIDWIVES: SUPERVISION Would repeal the requirement that a certified nurse-midwife be under the supervision of a licensed physician and surgeon. The bill would authorize a certified nurse-midwife to consult, refer or transfer care to a physician and surgeon as indicated by the health status of the patient and the resources and medical personnel available in the setting of care. The bill would provide that a certified nurse-midwife practices within a variety of settings, including the home setting. The bill would specify that nurse-midwifery care emphasizes informed consent, preventive care, and early detection and referral of complications.

Status: Failed in the Assembly Appropriation Committee.

AB 1795 (GIPSON) EMERGENCY MEDICAL SERVICES: COMMUNITY CARE FACILITIES This bill would authorize a local emergency medical services agency to submit, as part of its emergency medical services plan, a plan to transport specified patients who meet triage criteria to a behavioral health facility or a sobering center. The bill would make conforming changes to the definition of advanced life support to include prehospital emergency care provided during transport to a behavioral health facility or a sobering center. The bill would authorize a city, county, or city and county to designate, and contract with, a sobering center to receive patients, and would establish standards that apply to sobering centers, as specified.

Status: Failed in the Assembly Appropriations Committee.

AB 2078 (DALY) SEX OFFENSES: PROFESSIONAL SERVICES This bill would expand the crime of sexual battery to apply to a person who performs professional services that entail having access to another person’s body and who touches an intimate part of that person’s body while performing those services, and the touching was against the person’s will and for the purpose of sexual arousal, sexual gratification or sexual abuse. The bill would expand the definitions of each of the crimes of rape, sodomy, oral copulation and sexual penetration to include any of those crimes performed against a victim’s will by a professional whose services entail having access to the victim’s body, if the conduct is performed by the professional while performing those services. Because this bill significantly broadens the situations in which allegations of sexual battery can be made, the potential exists for physicians to be swept up in this change should a patient withdraw consent during a routine exam or procedure.

Status: Failed in the Senate Appropriations Committee.

AB 2668 (ALLEN) PUPIL IMMUNIZATIONS: PUPILS NOT IMMUNIZED This bill would delete private institutions, including private elementary and secondary schools, child care centers, day nurseries, nursery schools, family day care homes, and development centers, from certain immunization requirements, thereby allowing pupils who do not meet those immunization requirements to enroll in those institutions.

Status: Failed in the Assembly Health Committee.

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AB 2741 (BURKE) PRESCRIPTION DRUGS: OPIOID MEDICATIONS: MINORS This bill sets a five-day cap on the supply of a schedule II opioid that may be prescribed to a minor, except in very limited circumstances. It also requires signed informed consent from a minor’s parent or guardian before being prescribed a schedule II opioid. The consequences of a violation of these provisions would be unprofessional conduct and could subject a prescriber to action against their license.

Status: Failed in the Senate Business, Professions, and Economic Development Committee.

AB 2789 (WOOD) HEALTH CARE PRACTITIONERS: PRESCRIPTIONS: ELECTRONIC DATA TRANSMISSION Current law provides for the regulation of health care practitioners and requires prescription drugs to be ordered and dispensed in accordance with the Pharmacy Law. The Pharmacy Law provides that a prescription is an oral, written, or electronic data transmission order and requires electronic data transmission prescriptions to be transmitted and processed in accordance with specified requirements.

This bill, on and after January 1, 2022, would require health care practitioners authorized to issue prescriptions to have the capability to transmit electronic data transmission prescriptions, and would require pharmacies to have the capability to receive those transmissions.

Status: Signed by the Governor (Chapter 438, Statutes of 2018).

AB 3087 (KALRA) CALIFORNIA HEALTH CARE COST, QUALITY, AND EQUITY COMMISSION This bill would create the California Health Care Cost, Quality, and Equity Commission, an independent state agency, to control in-state health care costs and set the amounts accepted as payment by health plans, hospitals, physicians, physician groups, and other health care providers, among other things.

Status: Failed in the Assembly Appropriations Committee.

SB 538 (MONNING) HOSPITAL CONTRACTS This bill would prohibit contracts between hospitals and contracting agents or health care service plans from containing certain provisions, including setting payment rates or other terms for nonparticipating affiliates of the hospital, requiring the contracting agent or plan to keep the contract’s payment rates secret from any payor that is

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or may become financially responsible for the payment, and requiring the contracting agent or plan to submit to arbitration, or any other alternative dispute resolution program, any claims or causes of action that arise under state or federal antitrust laws after those claims or causes of action arise, except as provided. The latest amendment requires health plans and health insurers to be responsible for including and disclosing relevant terms of the provider contract with the third-party payor. The bill would make any prohibited contract provision void and unenforceable.

Status: Failed in the Assembly Health Committee.

SB 562 (LARA) THE HEALTHY CALIFORNIA ACT This bill, the Healthy California Act, would create the Healthy California program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

Status: Failed in the Assembly.

SB 1156 (LEYVA) HEALTH CARE SERVICE PLANS AND HEALTH INSURANCE: 3RDPARTY PAYMENTS SB 1156 establishes requirements for any entity making third-party premium payments if that entity is a provider that receives a direct or indirect financial benefit from the third-party payments, or if that entity receives the majority of if funding from one or financially interested health care provider. SB 1156 links Medicare reimbursement rates to private sector payors’ fee schedules. This is a rate setting bill because it would mandate that providers who treat patients that receive charitable premium assistance to temporarily maintain commercial insurance for their family, receive Medicare reimbursement rates while allowing the health care service plan or health insurer to continue to collect the full cost of the private market based monthly insurance premium.

Status: Vetoed by the Governor.

SB 1229 (STONE) PHARMACISTS: OPIOID MEDICATIONS: CONSULTATION This bill would require a pharmacist to provide oral consultation to a patient or the patient’s agent before dispensing any opioid medication in accordance with regulations adopted by the California State Board of Pharmacy. The bill would prohibit the pharmacist from dispensing the medication if the patient or the patient’s agent declines the consultation.

Status: Failed in the Senate Business, Professions, and Economic Development Committee.

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SB 1238 (ROTH) PATIENT RECORDS: MAINTENANCE AND STORAGE This bill would require certain health care providers at the time of creation of a patient record to provide a statement to the patient, or the patient’s representative, that sets forth the patient’s rights and the intended retention period for the records. The bill would require certain health care providers that plan to destroy patient records to notify the patient at least 60 days before a patient’s records are to be destroyed.

Status: Failed in the Assembly Appropriations Committee.

SB 1240 (STONE) PRESCRIPTION DRUGS: CURES DATABASE This bill would require a prescription, if in writing or transmitted electronically, to include an International Statistical Classification of Diseases, 10th revision (ICD-10) code or a legible clear notice of the condition or purpose for which the drug is being prescribed, unless the patient requests this information to be omitted and would require a prescription transmitted orally to include either an ICD-10 code of a description of the condition or purpose for which the drug is being prescribed.

SB 1322 (STONE) MEDI-CAL: COMPREHENSIVE MEDICATION MANAGEMENT This bill would provide that comprehensive medication management services are a covered benefit under the MediCal program, and would require those services to include, among other things, the development and implementation of a written medication treatment plan that is designed to resolve documented medication therapy problems and to prevent future medication therapy problems.

Status: Failed in the Senate Health Committee.

SB 1325 (MOORLACH) PEACEFUL AND NATURAL DIGNITY ACT: THE RIGHT OF SELF-QUARANTINE Current law sets forth various civil rights of individuals and provides a civil cause of action for a violation of those rights. This bill would recognize the right of selfquarantine, and would establish a civil cause of action for violation of that right.

Status: Failed in the Senate Health Committee.

Status: Failed in the Senate Business, Professions, and Economic Development Committee.

SB 1285 (STONE) HEALTH CARE COVERAGE: ADVANCED PRACTICE PHARMACIST This bill would require coverage for services provided by an advanced practice pharmacist performed within the scope of his or her practice, including comprehensive medication management services in a health care service plan contract and health insurance policy, and, to the extent that federal financial participation is available, in a MediCal managed care plan.

Status: Failed in the Senate Health Committee.

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CMA’s Advocacy Secures $1 Billion+ In 2016, and with a $1 million investment, the California Medical Association (CMA) led a coalition to take on Big Tobacco to improve patient access to care through MediCal, which serves one-third of the state’s population.

California voters overwhelmingly approved Proposition 56, which added a $2 tax on tobacco products and stipulated that funds should increase access by improving provider payments.

California’s 2018-2019 state budget continues to provide over $1 billion annually to improve provider payments so more Medi-Cal patients can access care when they need it most. Other key investments include graduate medical education (GME) funding increases and medical school loan repayments.

Since 1856, CMA has worked tirelessly to ensure that health care professionals serving on the frontlines of medicine in our communities have a voice in the development of health care legislation, regulations and policy.

JOIN CMA TODAY and support the next generation of physicians and the future of health care policy and business in California.

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“The California Medical Association is proud to leverage a $1 million investment for Proposition 56 into a $1 billion annual return on behalf of California’s physicians, medical groups and patients.”

– Dustin Corcoran, CEO CMA’S REACH 43,000 Members 37 Component Medical Societies 27 Specialty Societies 200+ Medical Groups

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Opioid Advocacy

Update

"Over the last few years, the changing landscape surrounding prescribing opioids has been dizzying as payors, legislators, pharmacies and medical boards seek ways to be proactive in addressing the opioid epidemic – sometimes ignoring the actual realities of medical practice and creating barriers to good care."

By Theodore M. Mazer, M.D.

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From the beginning of the opioid epidemic, the California Medical Association (CMA) has been one of the most engaged and determined stakeholders working to strike a balance between patient access to necessary medicine and preventing and addressing abuse.

CMA has been a leader in advocating for increased funding, access and availability of preventive services, opioid-use disorder treatment programs and non-opioid therapies, including mental health services and medication-assisted treatment (MAT). We have successfully worked to stop legislation that interferes with the practice of medicine and creates barriers to care, such as government-mandated dosage and duration limits.

Over the last few years, the changing landscape surrounding prescribing opioids has been dizzying as payors, legislators, pharmacies and medical boards seek ways to be proactive in addressing the opioid epidemic – sometimes ignoring the actual realities of medical practice and creating barriers to good care. And as you’re aware, California physicians have been engaged in the debate since the beginning, on behalf of our patients and profession.

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CMA released a white paper, “Opioid Analgesics in California: Relieving Pain, Preventing Misuse, Finding Balance” in 2013. Developed through CMA’s Council on Science and Public Health, it has been the cornerstone of our work to educate physician colleagues, guide the medical board and policymakers, and help health care stakeholders navigate the evolving science related to opioids. At its core is the premise that care must be evidence-based and reflect the individual needs of the patient – ultimately, allowing physicians to make proper care decisions.

CMA’s emphasis on these principles has remained constant, including advocacy on opioid-related activities in 2018, which include:

concerns, monitor the board’s process to determine whether disciplinary actions are based on the appropriate standard of care, and if the process used to identify physicians subject to these inquiries needs additional transparency or modification.

Physicians who are under review may contact CMA (800-7864262, CMAdocs.org) for information about the disciplinary process and their legal rights.

Access to Medication-Assisted Treatment and Overdose Reversal Medications: To help reduce the rates of overdose and stigma associated with opioid-use disorder, CMA sponsored AB 2384 (Arambula), which would have removed barriers to coverage of MAT services and naloxone to ensure that people who face addiction have better access to treatment. Governor Jerry Brown vetoed AB 2384, claiming a need for utilization controls and barriers to patient access of life-saving treatments. In response, CMA issued a statement

Controlled Substance Utilization Review and Evaluation System (CURES): CMA has been working with the state for years to ensure adequate educational and technical support for physicians who will have to check CURES as part of their prescribing workflow, "At the federal level, CMA successfully fought back against starting on October 2, 2018.

CMA has advocated for legislation that would have required one-size-fits-all medicine sustained user outreach and by mandating prescription drug dosage and duration limits." educational efforts by the state that provide clarity of this new law, as well as prioritize the clinician perspective on an ongoing basis expressing disappointment and concern, while reiterating our following implementation. We will continue to engage as intention to work with the next governor to make this issue a the new requirement to consult CURES is implemented priority in 2019. and work with stakeholders to ensure CURES has adequate The federal opioid bill continues to push treatment in the support. right direction by providing grants to improve access to MAT and codifying the ability for physicians to prescribe MAT for Ensuring Fair Enforcement: The Medical Board of California up to 275 patients, which is critical since the current caps are is examining deaths associated with the use of prescription far too limiting and leave many patients on waiting lists for opioids and is reviewing whether the care and treatment years. provided by physicians to those individuals met the standard of care. As part of a “routine” review, the board sent letters Individual Patient Care: At the federal level, CMA to physicians who were identified as prescribing opioids successfully fought back against legislation that would have in a manner that, after physician review, merited further required one-size-fits-all medicine by mandating prescription investigation, and requested that those physicians submit drug dosage and duration limits. additional information including a summary of the care California legislators also sought to statutorily limit provided, the patient’s medical records, and any additional dosages and durations of opioid pain relievers through AB materials that would be pertinent to the board’s investigation.

2741 (Burke) and AB 1998 (Rodriguez), using arbitrary and CMA has raised concerns about the board’s process and minimal amounts. Both bills were defeated earlier this year. will continue to work with the board to address physician

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allow physicians to prescribe MAT drugs, like buprenorphine, outside of an opioid treatment center.

After CMA-led negotiations with the author, the bill was amended to allow physicians who seek to prescribe MAT to fulfill their annual continuing education requirement by completing the DATA-Waivered Physician course along with four additional credit hours on treating substance use disorders. Successful advocacy prevented additional and mandatory continuing education.

The road has been long and hard-fought, and California’s comprehensive approach has focused on safe prescribing, naloxone distribution, public education campaigns, local opioid safety coalitions "From 2013-2017, California experienced over a 24 percent and increasing access to treatment, including MAT. decrease in opioid prescriptions, and is only one of five states This approach has produced promising results. with a multi-year decrease in prescription opioid overdoses."

From 2013-2017, California experienced over a 24 percent decrease in opioid prescriptions, and is only one of five states fentanyl. It also expands the number of Institute for Mental with a multi-year decrease in prescription opioid overdoses.

Diseases inpatient Medi-Cal beds available for opioid California is now tied for the lowest per capita opioid substance abuse disorder treatment and enhances Medi-Cal prescription rate in the country, while opioid prescribing has patient access to non-opioid options. Medicare coverage decreased for the fifth year in a row. for treatment has been expanded, with new Medicare More work remains, as the drugs responsible for these payment and delivery demonstration projects approved for overdose deaths are changing and have been spurred by illicit comprehensive management of opioid-use disorder. fentanyl. CMA will continue to work with policymakers, Unfortunately, the bill package also includes a mandate elected officials and health care stakeholders to ensure your for physicians to e-prescribe controlled substances for voice – and your patients’ voices – are heard.

Medicare patients after January 1, 2021. However, it includes I want to thank our physician members for their dedication many exceptions, and it directs the Centers for Medicare to finding a balance between prescribing controlled substances and Medicaid Services to implement additional exceptions. safely and effectively to relieve pain, while simultaneously In a major win, the Drug Enforcement Administration reducing the risk of prescription medication misuse, addiction (DEA) has been mandated to update its antiquated and and overdose. burdensome process for e-prescribing. While more than 90 Federal Funding and the Congressional Opioid Crisis Response: Earlier this year, Congress approved $10 billion in new funding for states to address opioid-related education, prevention, treatment and law enforcement issues. The House and Senate reached an agreement on the “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act,” and they will send it to President Donald Trump soon. It is a comprehensive package of more than 300 bills that, among other things, provides grants to states to address prevention and treatment, as well as stop the flow of illicit drugs, such as

percent of physicians e-prescribe, only 21 percent e-prescribe controlled substances, largely due to the DEA’s burdensome requirements. The state mandate takes effect in 2022.

Physician Education on Safe Prescribing and Treatment: Governor Brown recently signed AB 2487 (McCarty), which originally mandated all California physicians to take an eight-hour course required to qualify for a federal waiver to the Drug and Addiction Treatment Act of 2000 in order to

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Theodore M. Mazer, M.D., is a board-certified otolaryngologist who has been working in a small, solo practice in San Diego for more than 25 years. He is the immediate past president of the California Medical Association.

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2018 HOUSE OF DELEGATES

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2018 HOUSE OF

DELEGATES CMA OUTLINES BOLD HEALTH CARE AGENDA TO IMPROVE PATIENT AFFORDABILITY, ACCESS AND QUALITY Dear Physician Colleagues, In October, the California Medical Association (CMA) convened its 147th annual House of Delegates (HOD) meeting in Sacramento. Over 500 California physicians convened to debate on the most critical issues affecting members, the Association and the practice of medicine.

The major focus of HOD was the creation of an initial framework for a bold agenda to increase health care affordability, improve health care delivery, create efficiencies throughout the health care system, and improve health outcomes, which includes addressing social determinants of health and expanding telehealth services. >>

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Virtually all of us have directly witnessed the impacts on our patients, but the following statistics bear repeating because they reinforce the critical nature of CMA’s charge: Prescription drugs prices have increased 25 percent since 2012 (Health Care Cost Institute).

Health insurance deductibles have more than doubled since 2008, and half of all workers now have a deductible of at least $1,000 for an individual, up from 22 percent in 2009 (Kaiser Family Foundation).

Employer-sponsored insurance premiums have risen from $6,000 in 1999 to more than $18,000 in 2016, and out-ofpocket costs have increased by more than 53 percent between 2006 and 2016 (Economic Policy Institute).

The average American spent $10,345 on health care in 2016, yet roughly 41 percent of Americans say they can’t pay a $400 emergency expense without borrowing or selling something (Centers for Medicare and Medicaid Services, Federal Reserve).

Thirty-three percent of Americans with health insurance said they or a family member had problems affording care in the last year (Kaiser Family Foundation survey).

Twenty-seven percent of our time is spent with patients, while nearly half is spent on electronic health records or other desk work. Spending three hours a day on administrative tasks equals a loss of 2,200 patient visits per physician per year. (Annals of Internal Medicine) CMA President David H. Aizuss, M.D., put it best: “Health care costs continue to grow, with patients paying more and getting less – except for more runarounds, fine print and larger medical bills. This is our current reality and the battle we must fight, because it’s hurting our patients’ ability to access needed care, treatment and medications. No family should have to forego medical care to pay household bills or take on debt, yet that is exactly the situation more Californians are facing.

If health care isn’t affordable, then it isn’t accessible, and the California health care system must do better for our patients.”

After hearing expert testimony, CMA debated and identified four critical issues that California must address to make health care affordable while improving quality and access: Reform health care delivery and utilization by making payment and delivery more efficient, as well as expand telehealth.

Expand patient choice and affordability by increasing competition throughout health care with market-based solutions.

Maximize physicians’ time spent with patients by reducing administrative burdens and eliminating duplicative tasks that add unnecessary costs without improving health outcomes.

CMA also remains committed to ensuring that all modes of medical practices are financially vibrant.

Ensure patients have access to necessary treatment and medications by addressing pharmaceutical costs.

In the coming months, CMA will develop targeted, pragmatic and workable solutions, as well as continue to work with our members, health care stakeholders and policymakers to ensure patients can access quality care in an affordable and timely manner.

As a physician-led organization, CMA’s collective strength is derived from the dedication and passion of its membership.

We thank the HOD delegates, and we thank you for your continued commitment to patients and the profession.

On the following pages you will find more highlights from this year’s House of Delegates.

HOD

With physicians at the center of health care delivery, CMA has long advocated on behalf of our patients to ensure they are receiving affordable, timely and quality care, and we doubled

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down on that commitment at HOD.

Sincerely,

Lee T. Snook, Jr., M.D., CMA Speaker of the House Tanya W. Spirtos, M.D., CMA Vice-Speaker of the House

LOS ANGELES OPHTHALMOLOGIST INSTALLED AS 151ST PRESIDENT OF CMA CMA installed Los Angeles ophthalmologist David H. Aizuss, M.D., as its 151st president during the organization’s annual House of Delegates meeting in Sacramento.

In his address to the delegates, Dr. Aizuss said that physician

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satisfaction and practice sustainability would be among his top priorities in the upcoming year.

of ophthalmology at the David Geffen School of Medicine at UCLA.

“The presence of third parties in clinical decision-making is corrosive to our relationship with patients,” said Dr. Aizuss. “We must protect both our patients and professional prerogatives, independence and authority.”

He received his medical degree from Northwestern University Medical School and completed his residency and fellowship in ophthalmology at the Jules Stein Eye Institute in Los Angeles.

Dr. Aizuss also noted that heavy administrative demands and emerging payment systems have forced physicians to spend increasing amounts of time on computer work at the expense of patient care, leading to physician dissatisfaction and burnout.

“CMA recognizes the urgent need for additional programming to mitigate physician burnout…Good care includes caring for us, the physicians,” said Dr. Aizuss.

Dr. Aizuss officially took over from Immediate Past President Theodore M. Mazer, M.D., at the end of HOD, and will serve a term of one year..

“Our CMA brand has strength, effectiveness, power and influence,” said Dr. Aizuss. “My goal as your president is to be an effective spokesman and to communicate your concerns, desires, needs and hopes for a professionally satisfying medical practice and effective patient care.”

Dr. Aizuss has been a CMA and Los Angeles County Medical Association (LACMA) member for 37 years. He has been a member of the CMA Board of Trustees since 2010—serving as vice-chair and chair of the board before being named presidentelect at last year’s HOD. Dr. Aizuss has also represented the physicians of California as a delegate to the American Medical Association (AMA), and is currently serving on the AMA Council on Legislation. Dr. Aizuss is a former president of LACMA and the California Academy of Eye Physicians and Surgeons.

Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He is a medical staff member at Tarzana Hospital and West Hills Hospital in Los Angeles County, and serves as an assistant clinical professor

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UROLOGIST AND TRANSPLANT SURGEON NAMED CMA PRESIDENT-ELECT Urologist and kidney transplant surgeon Peter N. Bretan, Jr., M.D., was elected by the CMA House of Delegates as the association’s new president-elect. He assumed office at the close of this year’s meeting and will serve as on the CMA Executive Committee as president-elect for one year. Dr. Bretan will be installed as president at the close of the 2019 House of Delegates. He will be the first Filipino-American physician to serve as CMA president.

Dr. Bretan practices in Marin, Sonoma and Santa Cruz counties. He has served as a CMA trustee and delegate, and is a three-time county medical society president. He is the current president of the California Urological Association and serves as an adjunct clinical professor at Touro University, where he has taught classes in health care policy for the past 15 years.

Dr. Bretan is also the founder and CEO of Life Plant International, a charitable organization that promotes disaster preparedness, organ donation and early disease screening worldwide. He has provided care around the world on medical missions.

“My greatest motivation is in service to give back to society for my good fortune. I grew up as a child farm laborer, and I know what it is to be without adequate health care,” said Dr. Bretan.

Dr. Bretan earned his B.S. in physiology from UC Berkeley and his medical degree from the UC San Francisco, where he completed residencies in general surgery and urology, as well as a fellowship in radiology. He also completed a fellowship at The Cleveland Clinic Foundation in transplantation and renovascular surgery.

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THE FULL 2018-2019 CMA EXECUTIVE COMMITTEE INCLUDES: PRESIDENT: DAVID H. AIZUSS, M.D., LOS ANGELES PRESIDENT-ELECT: PETER N. BRETAN, JR., M.D., WATSONVILLE CHAIR OF THE BOARD: ROBERT E. WAILES, M.D., OCEANSIDE/ENCINITAS VICE-CHAIR OF THE BOARD: SHANNON L. UDOVIC-CONSTANT, M.D., SAN FRANCISCO SPEAKER OF THE HOUSE: LEE T. SNOOK, JR., M.D., SACRAMENTO VICE-SPEAKER OF THE HOUSE: TANYA W. SPIRTOS, M.D., REDWOOD CITY IMMEDIATE PAST PRESIDENT: THEODORE M. MAZER, M.D., SAN DIEGO

MODESTO FAMILY PHYSICIAN RECEIVES CMA’S PRESTIGIOUS “COUNTRY DOCTOR” AWARD Modesto family physician Silvia Diego, M.D., was honored at the 2018 CMA House of Delegates with the association’s most prestigious award, the Frederick K.M. Plessner Memorial Award.

The award honors a California physician who best exemplifies the ethics and practice of a rural country practitioner.

clinics in response to the wave of Medi-Cal enrollments through the Affordable Care Act. Dr. Diego stood her ground, insisting that doing so meant they would have to compromise the quality of the care they were known in the community for providing.

Ultimately, Dr. Diego and Golden Valley Health Centers parted ways after irreconcilable differences over these new policies, which she believed would undermine care for low-income and indigent patients.

The daughter of farmworker parents, Dr. Diego grew up in the small town of San Joaquin in western Fresno County. She was the first in her family to graduate from college, and went on to get her medical degree from Stanford University School of Medicine—one of the top medical schools in the nation.

Now in private practice at Family First Medical Care, Dr. Diego has maintained her commitment to providing patients with the very best care—with a focus on those most in need. Even though it’s a financial challenge for the practice, 50 percent of her patients are on either Medi-Cal or government-assistance programs.

After graduating from medical school in 1994, Dr. Diego completed her residency in family medicine at the Stanislaus Medical Center in Modesto, and has remained in Stanislaus County ever since, with a mission of providing care to the poor and uninsured.

HOD

“I am really very passionate about taking care of my patients— about helping them get the very best health care that they can,” said Dr. Diego. “What is really important, is to care for your patients with compassion and respect.”

Dr. Diego practiced for 18 years at the nonprofit Golden Valley Health Centers, where for eight years she served as chief medical officer. In that role she oversaw care for 20 primary care clinics and more than 100,000 patients.

Dr. Diego selflessly stood up for her patients when a new management policy sought to increase patient numbers at

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Dr. Diego has been a member of CMA and the Stanislaus Medical Society (SMS) for more than two decades. She is a past president of SMS and is currently a member of the CMA House of Delegates. This year, she was the first female physician named as Stanislaus Physician of the Year.

Learn more about Dr. Diego in our video profile at youtube.com/cmadocs.

FRESNO EMERGENCY PHYSICIAN RECEIVES CMA’S COMPASSIONATE SERVICE AWARD Fresno emergency physician Kenny Banh, M.D., was selected as the 2018 recipient of the CMA Compassionate Service Award, which honors a CMA member physician who best illustrates the association’s commitment to community and charity care.

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Dr. Bahn was honored for his role in creating the first medical student-run mobile health clinic in the Central Valley, with the ultimate goals of training the next generation of San Joaquin Valley physicians, increasing the diversity of the medical profession, and providing a significant and positive impact to the valley for those who do not have the normal access to care.

working with the LGBT community to provide a safe, supportive environment at every stage of the coming out or transition process. Another clinic provides health care and screenings services to the homeless population in the Central Valley, offering them what is often their only access to health care.

California’s Central Valley has one of the highest underserved populations in the state, with one of the lowest ratio of physicians to population. Dr. Bahn’s hope for the mobile clinic was to reach some of those patients who are overlooked or do not have a way to access care on their own—all while giving medical students (and soon undergraduates) hands-on experience to learn first-hand about the challenges and rewards of patient care and community medicine.

“The reason I felt Dr. Banh deserved this award is because he did all off this on his own!” said Nicole Butler, executive director of the Fresno Madera Medical Society. During his own downtime he worked on applying for grants, reaching out for donations and coordinating with the communities involved on how to make the clinics happen. “The overall concept is modeled after the UC Davis student-run clinics, but if it wasn’t for Dr. Banh’s passion to care for his community, this program would have never been developed here.”

Today, his mobile clinic concept has come to reality, providing 100 percent free services to its patients. The clinics focus on several areas, including pediatric school outreach in rural areas, LGBT communities, undocumented and homeless communities.

The first clinic Dr. Bahn developed was for gender health,

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Dr. Bahn is board-certified in Emergency Medicine. He earned his medical degree at Drexel University College of Medicine and completed his residency in emergency medicine at UCSF Fresno. He has stayed in the area where he was trained and has been practicing and giving back ever since.

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2018 HOUSE OF DELEGATES

OC PSYCHIATRIST RECEIVES CMA’S NYE AWARD FOR PHYSICIAN HEALTH AND WELLBEING Orange County psychiatrist Nicolaas-John Van Nieuwenhuysen, M.D., was awarded CMA’s 2018 Gary S. Nye Award for Physician Health and Well-Being. This annual award honors a CMA member who has made significant contributions toward improving physician health and wellness.

Apple Valley pediatrician Damodara Rajasekhar, M.D., was named the 2018 recipient of CMA’s Dev A. GnanaDev, M.D., Membership Award, which recognizes a special or unique effort toward membership recruitment.

Dr. Van Nieuwenhuysen is being honored for his commitment to and passion for helping his fellow physicians find success, happiness and well-being in pursuit of their noble profession. He has served as chair of the Orange County Medical Association (OCMA) Physician Wellness Program for more than seven years, growing the program into one of the most established and successful county-medical-society-based wellness programs in the state. In that role, he organizes free workshops and seminars addressing a number of wellness topics to help physicians address stress, life-work balance and healthy lifestyles. To date, nearly 2,000 physicians and health care professionals in Orange County have participated in the program.

“[Dr. Rajasekhar was] the vital spark that reignited the flame, creating an alliance between one of the largest and most wellrespected statewide academic medical groups with the most dominant representation of organized medicine in California,” said Eric R. Hansen, D.O., past president of the San Bernardino County Medical Society (SBCMS), who nominated Dr. Rajasekhar for the award.

Dr. Rajasekhar is a solo pediatrician in Apple Valley, where he provides primary care for children of all ages, from infants to teenagers. He also provides neonatal ICU care at Victor Valley Global Medical Center in Victorville. He has been a member of CMA and SBCMS for 19 years.

“More than a dozen physicians have told us they have used the tips and skills learned in our workshops to make positive changes in their professional and personal lives,” said OCMA Executive Director Jim Petersen. “One physician told us that as a result of our program on resilience and self-compassion, she was motivated to take six months off from her practice to refocus and reprioritize her life. She told us that she was on the verge of quitting medicine, but those six months helped her find the joy in medicine she had been missing for years.”

Dr. Rajasekhar received his medical degree from the University of Madras in India. After completing his residency in pediatrics from the University of Connecticut Medical Center, he also completed a fellowship in neonatal-perinatal medicine from the University of Massachusetts Medical Center. He is board-certified in both pediatrics and neonatal-perinatal medicine. After completing his fellowship in Massachusetts, he worked in Kentucky for two years before starting a solo pediatric practice in California in 1996.

Dr. Van Nieuwenhuysen has used his professional contacts and passion for the program to recruit experts nationwide to present and facilitate workshops on topics ranging from healthy eating, yoga, mindfulness, resilience, life-work balance, and developing and maintaining positive personal and professional relationships.

Dr. Rajasekhar was sworn in as president of SBCMS in June, and he is currently a member of the CMA Board of Trustees, representing the Organized Medical Staff Section (OMSS).

Prior to that, he was an OMSS board member for 10 years and served as the chair of OMSS. He is also currently the treasurer for CMA’s political action committee (CALPAC). Dr. Rajasekhar was named “Fundraiser of the Year” by CMA in 2017 after accomplishing the monumental feat of raising $100,000 for CALPAC—which allowed CMA to aggressively support the hospital medical staff at Tulare Regional Medical Center in its successful lawsuit against the hospital.

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Dr. Van Nieuwenhuysen has begun work this year to take the program to the next level. Along with the committee and staff from OCMA, Dr. Van Nieuwenhuysen is researching community physician wellness programs around the country to identify additional programs to support physician wellness in Orange County, including interactive screening programs, one-on-one counseling, toll-free hotlines and physician support groups.

SAN BERNARDINO PEDIATRICIAN HONORED WITH CMA MEMBERSHIP AWARD

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In 2018, Dr. Rajasekhar played a major role in continuing CMA’s partnership with Loma Linda University Medical Center, leading to membership renewal for 440 Loma Linda physicians.

SAN JOSE SURGEON RECEIVES CMA’S SPEAKER’S RECOGNITION AWARD Phillip M. Lippe, M.D., was chosen to receive the 2018 Gary F. Krieger Speaker’s Recognition Award. The recipient of this award is hand-selected by the current CMA Speaker of the House for

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2018 HOUSE OF DELEGATES

remarkable contributions to CMA and its House of Delegates.

The award was presented at CMA’s annual House of Delegates meeting in Sacramento.

“The recipient of this year’s Krieger Award is a man whose dedication and service has been profound,” said Lee T. Snook, Jr., M.D., Speaker of the CMA House of Delegates. “[Dr. Lippe] continues to contribute his unique and heralded expertise with a drive towards excellence. His contributions cannot be understated, underestimated, nor undervalued.”

Dr. Lippe has been a member of CMA for 54 years, and a member of the House of Delegates for 41 years. He has served on many committees and councils, as well as on the Board of Trustees.

Dr. Lippe has been instrumental in strengthening CMA’s many scientific inquiries and positions. He was the moving force behind CMA’s landmark white paper on opioids, which greatly influenced the Medical Board of California’s November 2014

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Opioid Treatment Guidelines.

He also initiated the American Medical Association’s first Pain Summit and founded the Pain and Palliative Medicine Specialty Council.

To view photos of this year’s HOD, visit flickr.com/californiamedicalassociation.

GET INVOLVED Do you want to help establish CMA policies on major issues that affect the practice of medicine? Physicians interested in influencing CMA’s advocacy agenda can serve in the House of Delegates or on one of CMA’s councils and committees. For more information, contact your local county medical society.

Save the Date: 2019 House of Delegates The 2019 House of Delegates will be October 26-27, 2019 in Anaheim, at the Disneyland Hotel.

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2018 President's Gala

The California Medical Association's

AB 72:

The independent dispute resolution process and how to appeal

BY JULI REAVIS

A new California law took effect last year that changed the way that non-contracted physicians bill and are paid for providing non-emergency care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. This out-of-network billing and payment law (AB 72) was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.

While patients with out-of-network benefits can consent to treatment from out-ofnetwork providers, absent a valid consent form, health plans and insurers are required to reimburse out-of-network physicians at an interim payment rate. Without a signed consent, patients are only responsible for their in-network cost sharing.

The interim rate is the greater of the plan/insurer’s average contracted rate (ACR) or 125 percent of the Medicare fee-for-service rate for the same or similar services in the general geographic region in which the services were rendered, unless otherwise agreed to by the noncontracting provider and the payor. (By January 1, 2019, both regulators will have adopted a standardized methodology that all payors are required to use to compute the average contracted rate.) >>

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CAN I CHALLENGE THE INTERIM PAYMENT? The law does include a mechanism for physicians to challenge the payment amount if they are dissatisfied—the independent dispute resolution process (IDRP). Payors are required to participate in the IDRP once a physician begins the process.

The first step is to determine whether you are eligible for IDRP. This step is important as there are fees involved, which are split equally with between the payor and the physician.

To be eligible for IDRP a physician must first appeal in writing to the payor for additional payment.

If the physician is not successful in resolving the dispute through the payor’s internal appeal process, the physician may then file an IDRP through the appropriate regulator – either the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI), depending on the product type. Claims are only eligible for the IDRP for 365-days from the date of the payor’s written response to the appeal. If a physician attempted the appeal process but the payor was non-responsive, the 365-day limit to file IDRP will begin after 45 business days have passed from the date of receipt of the physician’s appeal. Instances where physicians have had patients sign written consent forms for the use of out-of-network benefits are not eligible for IDRP. The IDRP process for both regulators is web and emailbased and conducted through the regulators’ portals, with no parallel paper process.

Physicians may bundle up to 50 claims in a single IDRP application. These claims must all be for services provided by the same physician, for the same payor (health plan, insurer, or delegated entity), and for the same or similar services. While DMHC does not define same or similar services, CDI defines them as those that fall within the same subheading in the CPT or HCPCS manual.

Each application will need to include a copy of the original claim form, corresponding explanation of benefits and a copy of the determination letter from the payor or the physician

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dispute resolution, if applicable. CDI also requires an IDRP request form with a final offer indicated, an IDRP request claim information spreadsheet when submitting bundled claims, copies of all correspondence between the provider and insurer, both sides of the patient’s ID card, and the assignment of benefits, if applicable. For both regulators, a copy of the appeal to the payor is also recommended.

While not required, it is encouraged that each IDRP application submitted include a narrative summary

To be eligible for IDRP a physician must first appeal in writing to the payor for additional payment.

justification. This should explain the physician’s billed charges or final offer for all claims at issue, including the physician’s training, qualifications, length in practice, the fees usually charged by the physician, other economic aspects relevant to the physician’s practice, any unusual circumstances and other relevant factors.

Physicians should also include supporting documentation as the independent review organization conducting the IDRP will base its decision on the information submitted when rendering a decision. Supporting documentation may be a citation referenced in the narrative summary justification or include a provider directory report demonstrating network adequacy concerns, timely access enforcement actions and appropriate reimbursement amounts from other payors. There is no page limit for either the narrative summary justification or the supporting documentation.

The DMHC and CDI’s IDRP processes have many

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differences including arbitration types. DMHC uses traditional arbitration, meaning the arbiter can select any reimbursement amount he/she determines is appropriate. CDI uses baseball style arbitration, meaning the arbiter will select one of two the parties’ final offers and no other amount. In both cases, prior to remitting IDRP fees, the parties may agree to a settlement of the claim(s). In all cases of IDRP, the arbiter’s decision is binding on both parties. Payors are required to implement the decision obtained through the IDRP. If dissatisfied, either party may pursue any right, remedy or penalty established under any other applicable law.

Physicians are encouraged to utilize IDRP, as regulators are required to consider information from the IDRP when establishing methodology for determining average contracted rates, which in turn will likely impact payor contracting

practices going forward.

For more information on IDRP eligibility, identifying the regulator, the submission processes and what to include in the narrative summary justification and/or the supporting documentation, the California Medical Association (CMA) has created an IDRP guide, “A Physician’s Guide to the AB 72 Independent Dispute Resolution Process.” This and many other valuable resources on navigating the out-of-network billing and payment law can be found in CMA’s AB 72 Resource Center: cmadocs.org/out-of-network-billing.

Practices with additional questions or concerns can contact CMA’s Reimbursement Helpline at (800) 786-4262 or economicservices@cmadocs.org.

AB 72 RESOURCES

CMA has developed a number of resources to help physicians navigate this new law.

These are all available free to members at cmadocs.org/out-of-network-billing.

• FAQ: A Physician’s Guide to AB 72: Questions and Answers • A Physician’s Guide to the AB 72 Independent Dispute Resolution Process • Instructions and Sample Form for Obtaining Patient Consent Under California’s New Law • Sample Payor Appeal Letter for Interim Payments • Billing Requirements and Payment for Out-of-Network Services at In-Network Facilities • AB 72 Payment Monitoring Workbook • Health Law Library Document #7508: Non-Contracting Physicians • Balance Billing Toolkit Juli Reavis is Associate Director in CMA’s Center for Economic Services.

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In The News

IN THE

NEWS Gill Medical Group and the Gill Aesthetic Institute are excited to announce Ruby Gill MD as its new Medical Director, as well as the opening of our new private practice in Family Medicine and Aesthetic Medicine Dr. Ruby Gill is board certified in Family Medicine. She completed her internship at the University of Arizona, Tucson, and completed residency at the UC Irvine Affiliate Presbyterian Intercommunity Hospital.

She loves being at the front lines of patient care, solving problems and discovering diagnoses while helping patients transition through their medical ailments to the appropriate specialists.

She is an avid reader who practices evidencebased medicine and takes part in frequent international conferences.

In addition, Dr. Ruby Gill has a true passion Ruby Gill MD for Aesthetic Medicine and has seen firsthand the invaluable confidence it adds to lives of her patients. With this in mind, Dr. Ruby Gill has spent years doing additional training with aesthetic luminaries to help treat patients and their varied cosmetic concerns. Her aesthetic focus is on noninvasive natural looking outcomes resulting in patients who value aging well.

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

After finishing her medical training in Southern California, she spent time working in the Bay Area before recently transplanting to the Lodi Region. She enjoys spending time with her family, baking, yoga, and hiking. She looks forward to building a relationship with the community.

Dr. Gill is now accepting new patients. She practices at the Gill Medical Group and the Gill Aesthetic Institute, 999 S. Fairmont Ave. Suite 235, in Lodi. For an appointment, please call 209-334-0799 and visit gillmed.com.

Great News! One-Year Extension for Supplemental Payments from Proposition 56 Tobacco Tax Funds Health Plan of San Joaquin (HPSJ) has been briefing their providers about the latest details related to Proposition 56.

The Department of Health Care Services (DHCS) proposal for a one-year extension to the supplemental payments for certain physician services using Proposition 56 Tobacco Tax Funds has been approved for the 2018-19 State Fiscal Year. The supplemental payments are fixed amounts to be paid per claim.

Preventative codes have been added and the rates for most of the existing codes under Prop 56 have been increased.

Managed Care Plans (MCP) are not expected to receive the additional funding for several months. However, Health Plan of San Joaquin (HPSJ) will start paying the updated supplemental amounts soon. Once this process begins, HPSJ providers will start receiving the additional amounts through the regular reimbursement process.

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by the ACAP Scholarship Program Selection Committee. The award, for $5,000, is sent directly to the higher education institution of the awardee’s choice where they are to be applied to tuition costs.

HCA Scrubs

Fresh Sets of SCRUBS – Starting on the road to their health careers Health Plan of San Joaquin (HPSJ) continues to have the honor of supporting our next generation of health care professionals, most recently again donating a set of scrubs ($30 per set) to each of the 137 members of the Health Careers Academy (Stockton) class of 2022.

“Thank you to Health Plan of San Joaquin for the scrubs. Health Careers Academy appreciates the support for our school and students.

The donation of scrubs gives our students a sense of connectivity to the health career industry and helps to create a professional culture on our campus.”

- Health Careers Academy Principal Aaron Mata Central Valley’s Danielle Parks wins nationwide competition for 2018 ACAP Scholarship – More support for future health care workforce The Association for Community Affiliated Plans (ACAP) named Danielle Parks, a nursing student at Modesto Junior College, as the winner of its eighth annual national Scholarship Essay Contest.

ACAP established the scholarship in 2011 to provide crucial, timely financial assistance to an enrollee or an enrollee’s family member of an ACAP health plan seeking higher education to pursue a career in health care or social services. Submissions come from throughout the ACAP nationwide network of Safety Net Health Plans which collectively serve more than 21 million enrollees.

The recipient is selected

Danielle Parks is a member of Health Plan of San Joaquin (HPSJ) in California. Her winning essays detailed a personal story of how her HPSJ doctors quickly helped diagnose and treat a medical issue found during a routine check-up. A single mom working hard to support her family while continuing her health care education, Danielle wrote about the immense support and partnership she felt from her doctors and nurses, emphasizing the top-notch treatment she received.

The mounting shortage of health care providers is especially acute in the Central Valley. Danielle, in her submission, also detailed her plans to become a nurse practitioner and serve her home community. Stanislaus County is considered medically underserved and part of an ethnically diverse region. The ACAP scholarship will provide $5,000 to help further her studies as she finishes her nursing studies at Modesto Junior College and goes on to the Bachelor of Science Nursing (BSN) program at California State University, Stanislaus.

“Beyond her work ethic and accomplishments, Danielle inspires us with her history of giving back to our community,” said Health Plan of San Joaquin CEO Amy Shin. “We also know her very well as one of HPSJ’s 2018 Health Careers Scholars. We look forward to her future success as a nurse practitioner in our community, especially those who need help navigating the healthcare system and being engaged in their healthcare. This ACAP scholarship, as well as the recognition and affirmation it brings, is well-deserved.”

Two new web supports for local practices from Health Plan of San Joaquin Local health care providers are invited to bookmark these features from Health Plan of San Joaquin (HPSJ) at www.hpsj.com/providers: Pharmacy Announcements – Important notices from the California Department of Health Care Services (DHCS), FDA, and HPSJ’s Pharmacy Department. These announcements contain clinically important, drug-specific therapy educational materials and updates.

Claims Corner – A newsletter with news, best practices and resources for efficient and timely billings.

Danielle Parks & Amy Shin

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In The News

IN THE

NEWS

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

property on March Lane, it was a perfect fit at the perfect time.”

“With a larger reception area, centralized nursing stations and specialized areas for testing and treatment, our new Center gives us the ability to deliver timely care and service to a greater number of patients every day,” said Emily Selles, Dameron Hospital Occupational Medicine Manager. “We look forward to partnering with employers in controlling their worker’s comp costs and keeping their employees on the job.”

Dameron Medical Plaza

Dameron Hospital Occupational Medicine’s new March Lane location The Dameron Hospital Occupational Medicine Center is now located on the third floor of the Dameron Medical Plaza at 2021 West March Lane in Stockton.

Dameron’s Occupational Medicine program helps employers create a safe and effective work environment by providing convenient worksite wellness services, testing services, medical examinations and treatment of work-related injuries that are all designed to keep their employees healthy and productive.

“We’re very pleased to announce the opening of our new Occupational Medicine Center at the Dameron Medical Plaza,” said Lorraine Auerbach, Dameron Hospital President and CEO. “Our program has been so successful that it outgrew its original location on Acacia Street and we needed to find a new facility that gives us options for expansion in the future.

When the opportunity came up to acquire this centrally located

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Dameron’s Occupational Medicine Program meets the American College of Occupational and Environmental Medicine (ACOEM) guidelines and can be reached at 209461-3196.

St. Joseph’s Orthopedic and Spine Unit Debuts World Tour St. Joseph’s is excited to feature a new global photo tour on the walls of its dedicated Orthopedics and Spine Unit. The new photo tour, which features scenic scenes from around the world, is meant to encourage mobility among patients recovering from orthopedic surgery. Every 25 feet throughout the unit new destinations can be visited. Patients can enjoy scenic views of destinations near and far including the Statue of Liberty, ancient Mayan Ruins, the Eiffel Tower and more.

To learn more about St. Joseph’s advanced orthopedic services, please call 209.939.4517 or visit StJosephsCares.org/Ortho.

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Nominations for this award took place in June 2018 and voting took place from late July through August 11.

TAVR Team

St. Joseph’s TAVR Team Completes 100th Procedure The transcather aortic valve replacement (TAVR) team at St. Joseph’s Heart & Vascular Institute is proud to have reached a major milestone, recently completing their 100th TAVR procedure, bringing new hope and changing the lives of 100 patients who were suffering from severe aortic valve stenosis.

St. Joseph’s is one of a select group of providers and the only hospital in San Joaquin County to offer TAVR, a minimally invasive procedure that treats aortic stenosis without requiring open chest surgery. TAVR uses a catheter to replace the heart valve instead of opening up the chest and completely removing the diseased valve. The valve used during TAVR is inserted within the diseased aortic valve.

Patients are evaluated by a multidisciplinary team at St. Joseph’s Valve Clinic, which specializes in treating patients with various stages of heart disease, from advanced procedures including TAVR, to disease management. Once a patient is referred to St. Joseph’s Valve Clinic a team of experienced physicians and staff develop a personalized plan of care.

To learn more about St. Joseph’s TAVR program, visit StJosephsCares.org/TAVR. St. Joseph’s Voted Best of San Joaquin by The Record’s Readers St. Joseph’s Medical Center was once again voted Best Hospital by The Record’s readers in the Best of San Joaquin 2018 poll. St. Joseph’s is honored to have consistently received this recognition since the recognition program’s inception. St. Joseph’s Emergency Department was also voted the Best ER. In addition, St. Joseph’s Behavioral Health Center, which offers a wealth of inpatient and outpatient mental health services, was voted Best Mental Health Services in San Joaquin County.

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St. Joseph's Voted Best of San Joaquin

Dignity Health Welcomes New Endocrinologist, Dr. Tarandeep Kaur Dignity Health Medical Group of Stockton is proud to welcome Taurandeep Kaur, MD, endocrinology, to its team of specialists.

“I strive to provide my patients with quality and the most efficient care by being a patients’ advocate and placing their interests first which helps in chronic disease management,” said Dr. Kaur. “I believe in treating the patient and not the disease. My goal is to serve the community by combining my medical skills and passion for patient care.”

Dr. Kaur is board certified in Internal Medicine and completed a fellowship in endocrinology at the Tarandeep Kaur, MD University of Kansas Medical Center. Her special clinical interests include adrenal gland, pituitary and thyroid disorders, as well as metabolic bone disease, diabetes, transgender medicine and hypogonadism.

Dr. Kaur is accepting new patients and most health insurances including Hill Physicians and Medcore. To learn more about Dr. Kaur, please call 209.546.5200 or visit Dignity Health Medical Foundation.org/Stockton.

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In The News

IN THE

NEWS

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

San Joaquin General Hospital and Clinics Gives To The Community Its 3rd Annual Health Fair Saturday, October 20, 2018 San Joaquin County Clinics and San Joaquin General Hospital held their annual community health fair. The event was held at the San Joaquin County Clinics’ main clinic parking lot in French Camp on the campus of SJ General Hospital. This is a yearly event of San Joaquin General Hospital and San Joaquin County Clinics on behalf of the general health of San Joaquin County residents. Spanish and other language medical professionals provided communication with the many diversified communities in our County.

San Joaquin County Clinics partnered with nearby nursing schools to conduct free health screenings, provider review of findings, and provide free flu shots (while supply last). The SJCC Family Medicine and Healthy Beginnings Clinics were also available to see patients who need to see a physician provider the same-day from the screening areas. Car seat checks were also offered by trained San Joaquin General technicians.

The general population attending was low-income families, “at risk” children, youth and adults, and uninsured individuals. San Joaquin County Clinic’s participation is a key factor among other community health fairs in SJ County during October. The goal is to help educate healthy living and provide health care accessibility for the entire County.

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Denish Vyas, MD

San Joaquin General Hospital Physicians Participate in National Cancer Research and Treatment Triple negative breast cancer is one of the serious forms of cancer and finding a cure is an ongoing worldwide effort. This form of cancer is most commonly seen in females under the age of 50 and more common with African American women.

Triple negative cancer represents about 15% of all breast cancer forms.

Presenting positive research findings at a national conference in Boston Massachusetts were San Joaquin General Hospital’s General Surgery Department team of Denish Vyas, MD and Hospital medical staff Professor Lakshmi Chaturvedi, PhD. Their collective findings were focused on new drugs that might change the survival rate of women suffering from this form of cancer.

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The triple negative cancer drug findings of Vyas and Chaturvedi’s were a collective of 8 years of research on the subject. Their work is based on a new group of Irreversible Proteasome Inhibitors. The new drug is being investigated as a breakthrough by university medical schools in multiple breast cancer cases after reading the work of the San Joaquin General Hospital medical team.

“Finding a possible cure for this type of breast cancer and even ways to improve positive outcomes for triple negative cases is a great side benefit of our surgical residency program. Our goal for surgical residents at SJGH is to have a world view of medical discoveries and prepare themselves to be national surgical leaders”, said Denish Vyas, MD Chair of the Hospital’s General Surgical Residency Program. “We have an obligation to our residents to be at the forefront of medical research as it applies to services we deliver here in San Joaquin County.”

The research from the San Joaquin General team was studied and put to test by over 10 medical students from various universities studying new cancer treatments. Some of the medical schools included: University of Michigan medical school, Texas Tech University, Loyola University and the NYU Medical School among others.

It is a positive sign that many nationally respected medical universities, including the University of Michigan, have taken this new research presented by the SJGH medical residency staff as a positive step forward in finding a tangible cure for triple negative breast cancer.

Adventist Health Lodi Memorial Names Medical Officer Adventist Health Lodi Memorial announced today that Dr. Patricia Iris, M.D., has been appointed medical officer and will serve on the hospital’s executive team. Dr. Iris brings with her 15 years of experience in hospital administration and clinical practice transformation.

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In The News

IN THE

NEWS

Patricia Iris, MD

and quality.

As medical officer, Dr. Iris will serve as a liaison between Adventist Health Lodi Memorial’s 400 physicians and hospital and system administration, reporting to hospital president Daniel Wolcott. She also will oversee numerous hospital initiatives focusing on patient care

Dr. Iris most recently served as chief clinical innovation officer with Navvis Healthcare in Honolulu, where she led specialty physicians, physician organizations and health care systems in developing quality improvement strategies around safety and patient-and-family engagement.

Dr. Iris’ experience in public health, population health quality and safety led her to Lodi.

“I love Adventist Health is because they’re known for quality. I’m very passionate about quality and patient safety,” Dr. Iris said. “I am looking forward to working with Lodi’s doctors and getting to know and be a part of the executive team, as well as the Lodi community.”

Dr. Iris earned her bachelor’s degree from Texas A&M University, medical degree from Texas A&M University Health Sciences Center and Master of Public Health at the University of Washington. She completed a pediatric residency program at University of Arizona Health Sciences Center in Tucson.

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

Adventist Health Lodi Memorial Welcomes James Nozaki, MD Adventist Health Lodi Memorial is proud to welcome board certified family medicine physician, James Nozaki, MD. Dr. Nozaki received his medical degree from Loma Linda University School of Medicine in Loma Linda, Calif.

He completed his residency in family practice with Riverside University Health System in Moreno Valley, Calif. With 20 years of experience in family medicine practice, Dr. Nozaki is James Nozaki, MD passionate about serving communities both home and abroad as a medical missionary with the General Conference of the Seventh-day Adventist Church.

“I believe very strongly in a personal approach to medicine,” he says. “I want to develop long-lasting and meaningful relationships with my patients; so they know I am there as both a resource and support for their overall wellness.”

In his free time, Dr. Nozaki enjoys spending time outdoors hiking and swimming with his wife and two children.

Dr. Nozaki practices at Millsbridge Family Medicine, 1901 W. Kettleman Lane, Suite 200, in Lodi. For an appointment, please call (209) 334-8540.

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Adventist Health Lodi Memorial Welcomes Melissa Huynh, FNP-C, PA-C Adventist Health Lodi Memorial is proud to welcome board certified family nurse practitioner and physician assistant, Melissa Huynh, FNP-C, PA-C, specializing in family medicine.

welcomed in January of this year.

Mrs. Huynh practices at Millsbridge Family Medicine, 1901 W. Kettleman Ln., Suite 200, in Lodi. For an appointment, please call (209) 334-8540.

Mrs. Huynh completed her Bachelor of Science in Nursing at California State University, Fullerton, in Fullerton, CA. She completed a physician assistant and nurse practitioner dual track degree program at The Betty Irene Moore School of Nursing at the University of California,

Michael R. MoRdaunt PeteR J. Kelly RichaRd J. SoRdello, JR. StePhanie Roundy

Melissa Huynh, FNP-C, PA-C

Davis, in Sacramento, CA. A Sacramento native, Mrs. Huynh is looking forward to providing compassionate care to the families in the Lodi community as part of Adventist Health.

“I love creating a patient-focused environment,” she says. “My role as a family nurse practitioner allows me to build meaningful relationships with my patients, as I get to know them more on an ongoing basis.”

In her free time, Mrs. Huynh enjoys spending time with her husband and baby girl, whom they

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practice manager Free to SJMS/CMA Members!

resources

The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice.

Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership Coordinator, at Jessica@SJCMS.org or call (209) 952-5299.

DECEMBER 12TH, 2018: 11:00AM TO 1:00PM

“2019 MEDICARE CHANGES” Join us for our annual Medicare Update workshop for physicians and office staff.

This 2 hour seminar will cover relevant information about current, future and proposed changes for the coming year!

ARE YOU READING CPR? CPR contains the latest practice management news, and tips on reimbursement and contracting related issues.

Cheryl Bradley~ Associate Director, CMA Center for Economic Services

JANUARY 9TH, 2019: 11:00AM TO 1:00PM

“HOW TO HIRE EXCELLENT MEDICAL OFFICE STAFF- HIRE FOR ATTITUDE. TRAIN FOR APTITUDE.” The Medical Office is a multi-disciplinary “team sport” in which all positions are important and interdependent with one another. During this presentation, you will learn how to assess staff needs, hire the “superstar” employee, and motivate your team to succeed.

Debra Phairas~ President of Practice & Liability Consultants, a nationally recognized firm specializing in practice management and malpractice prevention.

CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.

SUBSCRIBE NOW Sign up now for a free subscription at www.cmadocs.org/subscribe

FEBRUARY 13TH, 2019: 11:00AM TO 1:00PM

“TBD”

Public Health

Update

Sexually Transmitted Diseases: A Long Time Public Health Adversary

Sexually transmitted diseases have been a public health issue for centuries. According to the Centers for Disease Control (CDC), the United States is currently experiencing a record increase in the transmission of syphilis, congenital syphilis, chlamydia and gonorrhea. California, and more specifically San Joaquin County is also experiencing increases in STD’s as reported by the California Department of Public Health (CDPH). There does not appear to be one defining reason for the continued increase in STDs in the nation, state or county; many factors play a role. Changes in sexual behavior, increased awareness of the symptoms, the prevalent use of

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social networking dating sites, and an overall angst about discussing sexual health contribute to the problem. High rates of STDs are linked to social determinants of health including: socioeconomic status, discrimination, and access to comprehensive, quality health care. Changes in diagnostic, screening and reporting practices, as well as decreases in overall public health funding contribute to the burden of sexually transmitted diseases in San Joaquin County. STD’s are a public health issue which require a multi-faceted and multidisciplinary collaborative approach to achieve results based solutions.

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The Facts Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Untreated infection can lead to long term health problems, including brain disease. Syphilis increases both transmission and acquisition of HIV. Tests and treatment are available. Syphilis first became widely recognized and reported in the late 1490s, when a virtual epidemic swept through Europe. In 2000 and 2001, the U.S. reported a national rate of primary and secondary (P&S) syphilis at 2.1 cases per 100,000 population, the lowest rate since reporting began in 1941, however the P&S syphilis rate has increased annually since 2000–2001. Nationally, men having sex with men (MSM) account for the majority of P&S syphilis cases however the rate of females with P&S syphilis increased 21.1% from 2016.

California data shows similar trends. In 2017, there was a 21% increase in the rate of early syphilis from 2016; the highest number since 1987. Female cases increased over 600% from 2012. San Joaquin County differs in that females ages 15-44 (women of childbearing age) have highest rate of P&S syphilis in the county, not MSM. Every year since 2014, San Joaquin County has reported the highest number of cases on record for the county. In 2017, San Joaquin County logged the 2nd highest rate of primary and secondary syphilis in California; a 44% increase from the previous year. Nationally, statewide and countywide the rate of reported syphilis cases is higher in African Americans than any other population.

Congenital Syphilis

Congenital syphilis is an infection transmitted from mother to child during pregnancy or delivery. Congenital syphilis can cause severe illness in babies including premature birth, low

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birth weight, birth defects, blindness, and hearing loss. It can also lead to stillbirth and infant death. Tests and treatment for pregnant women are readily available. In California, 2017 was the 5th consecutive year for an increasing number of infants born with congenital syphilis; an increase of 32% over 2016, which includes 30 stillbirths. Congenital syphilis burden of this magnitude was last observed in 1995. The number of congenital syphilis cases in San Joaquin County remained steady from 2016-2017, but remain the 6th highest congenital syphilis rate in California, including 3 stillbirths. The resurgence of congenital syphilis points to missed opportunities for prevention.

The recommended regimen for adults with primary and secondary syphilis is Benzathine penicillin G 2.4 million units IM in a single dose. Patients with late latent and tertiary syphilis should receive Benzathine penicillin G 2.4 million units IM once a week for 3 weeks. The only acceptable alternatives for the treatment of latent syphilis are doxycycline (100 mg orally twice daily) or tetracycline (500 mg orally four times daily), each for 28 days. Pregnant women who are allergic to penicillin should be desensitized and treated with penicillin. Treatment of congenital syphilis depends on the likelihood of the infant having congenital syphilis based on the maternal status (serum quantitative non treponemal serologic titer, adequate treatment, time of treatment completion to delivery) and infant status (physical exam findings, serum quantitative non treponemal serologic titer and laboratory evaluation). The decision is to not treat, treat with Benzathine penicillin G 50,000 units/ kg/dose IM in a single dose or Aqueous crystalline penicillin G 100,000–150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days.

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resistance, making successful treatment of gonorrhea more difficult. Currently the single recommended regimen for gonorrhea treatment is dual therapy with Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin 1g orally in a single dose.

If a person’s symptoms continue for more than a few days after receiving treatment, reevaluation is recommended.

Gonorrhea & Chlamydia

Chlamydia and gonorrhea are the most commonly reported sexually transmitted bacterial infections. These infections often cause no symptoms. Tests and treatment are available.

If not treated, chlamydia and gonorrhea can lead to serious reproductive health problems such as pelvic inflammatory disease and infertility.

Gonorrhea was named by the Greek physician Galen and is thought to have been known to the ancient Chinese and Egyptians. Gonorrhea is a very common infectious disease and is the second most commonly reported notifiable disease in the United States. Any sexually active person can be infected with gonorrhea; in the U.S, the highest reported rates of infection are among sexually active teenagers, young adults and African Americans. As with syphilis, epidemiologic and biologic studies have provided evidence that gonococcal infections facilitate the transmission of HIV infection. During 2016-2017, gonorrhea rates increased in 47 states and the District of Columbia.

From 2016-2017, California experienced a 16% increase in the rate of reported gonorrhea and the highest number of gonorrhea cases reported since 1988. Gonorrhea rates among males were two times higher than among females; 33% of cases were among people under age 25. The most affected group in San Joaquin County were males ages 25-29. San Joaquin County reported a 20% increase in the number of cases and ranked 11th highest rate in California.

The CDC recommends yearly gonorrhea screening for all sexually active women younger than 25 years and older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection. Persons with gonorrhea should also be tested for other STDs. Gonorrhea is among CDC’s top three urgent threats for developing drug

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Chlamydia, caused by with the bacteria Chlamydia trachomatis, is the most common notifiable disease in the United States. Chlamydia trachomatis was first discovered in 1907 by Stanislaus von Prowazek in Berlin. It is among the most prevalent of all STDs, and since 1994, has comprised the largest proportion of all STDs reported to CDC. Studies reveal a high prevalence of chlamydial infections in the US, particularly among young women. As with other inflammatory STDs, chlamydial infection could facilitate the transmission of HIV infection. During 2016–2017, the rate of chlamydia increased 6.9%. The rates of reported cases of chlamydia were highest among adolescents and young adults aged 15–24 years during 2013–2017. In 2017, the rate of chlamydia in California, increased 9% from 2016. This was the highest number of chlamydia cases reported since 1990. Chlamydia rates among females were 60% higher than among males; 54% of cases were among people under age 25. San Joaquin County experienced a 5% increase in cases from 2016; females ages 20-24 were most affected. San Joaquin County reports the 15th highest rate of chlamydia in California with African Americans representing the highest rates of any demographic in the county.

Because of the large burden of disease and risks associated with infection, CDC recommends annual chlamydia screening for all sexually active women younger than age 25 years and women ≥25 years at increased risk for infection (e.g., women with new or multiple sex partners). The infection can be treated effectively by antibiotics, such as azithromycin or doxycycline, but it is often asymptomatic, especially in women. Re-infection by the same partner is an important issue in prevention: partner notification rates can be improved and risks of re-infection reduced by providing index cases with Expedited Partner Therapy (EPT).

Treating persons infected with C. trachomatis prevents adverse reproductive health complications and continued sexual transmission, while treating sex partners can prevent reinfection and infection of other partners. Treating pregnant women usually prevents transmission of C. trachomatis to neonates during birth. Chlamydia treatment should be provided promptly for all persons testing positive for infection. Recommended treatment regimens are: Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days.

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CMA’s Center for Economic Services is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice.

CALIFORNIA MEDICAL ASSOCIATION

Assistance ranges from coaching and education to direct intervention with payors or regulators.

Public Health Initiatives

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should incorporate sexual history into routine assessments.

Fresno Madera Medical Because many Society STDs do not have symptoms, screening for San Joaquin County Public Health Services (SJCPHS) is

asymptomatic infection is a cornerstone of STD prevention. diligently working to address the rise of sexually transmitted In 2016, San Joaquin County Public Health Services advised diseasesCMA in themembers county through a multi-faceted approach of can call on CMA’s practice management experts for one-on-one help with payment, billing that all pregnant women be screened for syphilis, using a non March 24 26, 2017 providerand detailing, community education and outreach, case contracting issues.

If you answer “yes” to any of the-following questions, it might be time to call for help.

I’VE RECOVERED treponemal serology test, three times during pregnancy; many review and a media campaign to increase awareness. Complete $know all of the partner’s risk factors making it women do not and comprehensive reviews of each congenital syphilis case are In the past nine years, CMA’s Center for difficult to accurately assess patient risk. Screening and treating performed to identify opportunities for improvement. Public • Are your claims being denied after obtaining prior • Do you have questions about the new law on payment from my payorscongenital using syphilis, therefore it women with syphilis can prevent Economic Services has recovered health nurses meet with physicians to review current diagnosis over authorization?

(Assembly Bill 72)? and billing for out of network services CMA’s Center for during pregnancy for all and treatment guidelines, provide education and resources. $15.5 million from payors on behalf of is best practice to repeat syphilis testing Economic Services women. When testing for STD’s, test for chlamydia, gonorrhea, In an effort provide the county’s homeless •CMA Dotoyou have outreach questionstoabout Covered California?

• Do you need help with Medicare-related issues? members. and syphilis and treat any positives immediately and provide population, SJCPHS has gone into the community to test and CMA’s Center for Economic Services is staffed by partner therapy. with For guidance, review treat for•practice syphilis directly.

Joaquin County Publicmanner?

Health Are your claims San not being paid in a timely • expedited Have you been presented a managed care the CDC or management experts with a combined CDPH diagnosis andnot treatment guidelines for STDs or contact contract and you’re sure if the terms are Servicesexperience would like toofbuild these efforts through increased overon 125 years in medical practice San Joaquin County Public Health Services.

Collaboration is •operations.

Are you being paid according to your contract? consistent with California law? collaboration withnot allOur San Joaquin County providers. goal is to empower physician the key to improving the health of all who live, work, and play in practices by providing resources and guidance to • Are you receiving untimely requests for refunds or is a • Have you done everything you can to resolve an issue San Joaquin County. improve the success of your practice.

The Ask payor recouping money from your check without with a payor, but have hit a brick wall?

To fully achieve the goal of decreasing STD’s in San Joaquin ranges coaching andrequest? education to first notifying you infrom writing of a refund If you have any questions, please call the STD/HIV department County,Assistance providers and public health must collaborate to raise Registration is now open - Call (559) 224-4224 118 for direct intervention with payors or regulators. within Public Healthext.

Services at 209-468-3845 or awareness and assure best practices are implemented for more information or visit www.FMMS.org 209-468-3820. screening, diagnosing, and treatment. Health care providers Access to CMA’s reimbursement experts is a FREE, members-only benefit. help?

Call 786-4262 or email economicservices@cmanet.org.

CMANeed members can call on (800) CMA’s practice management experts for one-on-one help with payment, billing

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and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

• Do you have questions about the new law on payment and billing for out of network services (Assembly Bill 72)?

• Are your claims being denied after obtaining prior authorization?

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In Memoriam

In Memoriam HARVEY I. GOODMAN, MDÂ 1937 - 2018

Harvey I. Goodman MD. passed away unexpectedly on October 18, 2018, at the age of 81 in San Francisco, CA. Harvey is survived by his wife of 58 years, Cynthia Goodman; his children, Lauri Goodman Mills (Brad), Daniel Goodman (Leslie); his brother, John Goodman (Sandy); his grandchildren, Anthony, Lillyan, Brandon; and many great-grandchildren, special honorary grandchildren, nieces, and nephews, cousins, and cherished friends. Harvey placed family above all else. He was a father and a grandfather figure to many.

Traveling the world brought him great joy as did cooking special meals for his family and friends, taking long walks, and sharing good conversations in which his sharp, quick wit was always present. Harvey was an anesthesiologist and medical consultant in Stockton, CA for many decades and a member of the San Joaquin Medical Society for 40 years.

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17 NEW

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Ruby Gill, M.D.

Harsimran Basra, M.D.

999 S Fairmont Ave, Ste. 235 Lodi, CA (209) 334-0799 Ross University School of Medicine

2505 Hammer Ln Stockton, CA (209) 955-7700 Baba Farid University of Health Sciences

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Puneet Grewal, M.D. Cardiology

415 E Harding Way Ste D Stockton, CA (209) 944-5755 Government Medical College

Owais Khawaja, M.D. Cardiology

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Patricia Kennel, M.D. OB/GYN

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Joshua Anderson, M.D. Family Medicine

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Stockton, CA (209) 735-4176 University of Miami

Bryson Nicholson, M.D. General Surgery

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Stockton, CA (209) 647-3950 Howard University College of Medicine

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Marissa Olegario-Nebel, M.D. Family Medicine

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Ryan Callery, M.D. OB/GYN

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