Winter 2016

truth truth THE

ABOUT THE

House of Delegates

Legislative Wrap Up Hypertension and Heart Health Winter 2016

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3555 Deer Park Drive, Suite 160 Stockton • 209.546.6100 641 Fulton Ave, Suite 200 Sacramento • 916.414.8282 Nick Salvetti, CFP®, CRPC®

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VOLUME 64, NUMBER 4 • DECEMBER 2016

House of Delegates 2016

{FEATURES}

14 23 30 WINTER 2016

HOUSE OF DELEGATES 2016

{DEPARTMENTS} 38 IN THE NEWS

LEGISLATIVE WRAP UP 2016

58 PUBLIC HEALTH

THE TRUTH ABOUT THE TRUTH

New faces and Announcements Hypertension and Heart Health

61 PRACTICE MANAGEMENT:

Committed to Improving Quality Health Care

65 NEW MEMBERS

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PRESIDENT Kwabena Adubofour, MD PRESIDENT-ELECT Grant Mellor, MD PAST-PRESIDENT John Zeiter, MD SECRETARY-TREASURER George Savage, MD BOARD MEMBERS Raissa Hill, DO, Dan Vongtama, MD, Alvaro Garza, MD, MPH, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Nicole Bojorques

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Kwabena Adubofour, MD, Lisa Richmond MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, MD LEGISLATIVE Jasbir Gill, MD COMMUNITY RELATIONS Joseph Serra, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS James Noonan, Kwabena Adubofour, MD, Alvaro Garza, MD, MPH, Julie Williamson, MPH

PUBLIC HEALTH Alvaro Garza, MD SCHOLARSHIP LOAN FUND Matthew Wetstein, PhD

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

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

SUGGESTIONS, story ideas or completed stories written

James R. Halderman, MD, Roland Hart, MD,

by current San Joaquin Medical Society members

Grant Mellor, MD, Kwabena Adubofour, MD,

are welcome and will be reviewed by the Editorial

Raissa Hill, DO, Ramin Manshadi, MD

Committee.

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: 209-952-5299 Fax: 209-952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM Closed for Lunch between 12pm-1pm

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THE SAN JOAQUIN MEDICAL SOCIETY invites you to a

THURSDAY | DECEMBER 15, 2016 Stockton Golf and Country Club

3800 Country Club Blvd | Stockton, CA 95204

6:00pm Cocktail Reception 7:00pm Dinner Join us for hosted cocktails and hors d’oeuvre reception with a lovely dinner and presentation of the

OUTSTANDING ACHIEVEMENT IN MEDICINE AWARD to Bennet Omalu, MD

Inspiration behind the movie “Concussion”

$45 for physician members and guests $75 per person for non-members Please make your reservation before December 2 by calling the San Joaquin Medical Society at 209-952-5299.

We expect this to be a sold out event, so please don’t delay!

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EXECUTIVE DIRECTOR’S REPORT

TIS THE SEASON! As I sit writing this on November 9, the election season has officially come to a close. Regardless of your position on the presidential election, I am sure we can agree we will not miss the painful, never ending television and radio ads! Additionally, we can relish the fact that, once again, the California Medical Association took on the tough fights and prevailed, winning all of our statewide ballot measure endorsements. Together, we voted to invest in Medi-Cal by voting yes on positions 52, 55 and 56. Proposition 56 will save lives, reduce smoking rates and prevent thousands of children from starting to smoke in the first place.

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. You can see the complete slate of resolutions and recommendations in the Legislative Wrap Up on page 23.

And just like that we move from election season to the holiday season. It’s time for family, food and my favorite - shopping! At SJMS, we are gearing up for our annual Holiday Party on Thursday, December 15 at Stockton Golf & Country Club. This is always a festive evening of great food and fellowship to celebrate a wonderful year. For the first time, we will be giving the Outstanding Achievement in Medicine Award to SJMS member Dr. Bennet Omalu for his groundbreaking and world renowned research in discovering chronic traumatic encephalopathy (CTE) in retired NFL football players.

His discoveries and, subsequent difficult journey, ultimately led him to his position as San Joaquin County’s Chief Medical Examiner and was the inspiration for the movie Concussion. If you have not seen the movie, I would urge you to do so before the party. It is fascinating! I invite you to learn more about Dr. Omalu in this issue’s feature story.

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 am truly grateful.

Happy Holidays,

Lisa Richmond

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Proudly welcoming six new providers to our community

Pablo Castro, MD Family Medicine

Mari Lewis, MD Pediatrics

Sami Moshi, MD Neurology

Rosemary Nunez-Davis, DO Pediatrics

Emmanuel Obanor, DO Gastroenterology

Norman Schmidt, MD Family Medicine

Millsbridge Family Care 209.334.8540

West Pediatric Care 209.333.3135

West Pediatric Care 209.333.3135

Plaza Specialty Care 209.334.8514 Galt Family & Specialty Care 209.745.8080

Tokay Specialty Care 209.334.8570

Millsbridge Family Care 209.334.8540

LodiHealthPhysicians.org WINTER 2016

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We believe in 98.6 degrees.

Being a good doctor is about more than practicing good medicine. It’s about preventing illness. Being proactive.

Taking the time to really listen. And giving our patients the personalized care they deserve. So, to all doctors, we’d like to say thanks. Because of you, a healthier life for everyone is as normal as 98.6.

For more information, visit us online at kp.org/centralvalley

A message from our President > Kwabena O.M. Adubofour, MD, FACP

Doing More With Less Choosing Wisely Choices, choices, choices and in each clinical encounter with our patients we are faced with a myriad of them. My focus with this piece is embedded in a simple but difficult question: How do we begin or end each clinical encounter with a silent question to ourselves about the cost of care? How do we change the entrenched “culture” of not considering the cost of health care and why is this subject taboo in some quarters? As a profession, can we justify the high cost of care associated with some of our decisions that may not benefit patients in the long term?

How about the patient who comes to see you with a printout from “Dr. Google” – has she/he paused to ask if the demands being made may adversely impact health and the financial costs associated with the demands?

Yes, this discussion is really about the business side of medicine and more so a call for all of us to play a more significant role in decreasing the cost of health care by making wise decisions and considering the cost of our interventions in relationship to the benefit to the patient. We do not do so on a routine/daily basis and that is wrong.

ABOUT THE AUTHOR ­ Kwabena O.M. Adubofour, MD, FACP Medical Director, East Main Clinic and Stockton Diabetes Intervention Center and Current President of San Joaquin County Medical Society.

Simply stated, as clinicians, we need to play a more central role in attempting to decrease the cost of healthcare by choosing wisely. Here is why this is important: More than $750 billion of US health care spending annually represents waste, including approximately $200 billion in over-treatment (1) .

Can you imagine what these monies could do for our efforts at disease prevention and chronic disease management as well as the training of more clinicians? We have an urgent stake in this and we need to make palpable efforts at decreasing the cost of healthcare with each patient encounter.

Back in 2012, the American Board of Internal Medicine (ABIM) Foundation launched the “Choosing Wisely” campaign. This laudable initiative targeted low -value care by creating lists of wasteful interventions and disseminating them to physicians as well as patients. One of the original goals of the campaign was to promote conversation about risks and benefits to prevent unnecessary tests and procedures (2).

Translation of the dictates of the choosing wisely campaign to the bedside or to the clinic have been slow and in a recent article published online in JAMA (Aug 2016)

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A message from our President > Kwabena O.M. Adubofour, MD, FACP

Reid and associates reviewed the use of 28 choosing wisely low-value services in 1,468,689 commercially insured adults in 2013 and discovered the following: • 7.8% of patients received low-value care • 1.5% had a triiodothyronine levels checked in hypothyroidism • 1.3% had imaging for nonspecific low back pain • 1.0% had imaging for an uncomplicated headache The total cost of the above was $32.8 million and most certainly just the tip of the proverbial iceberg. What this study and others reveal is that we clinicians need to communicate risks/benefits to our patients in a more effective manner. Dr. Google should not win the day when there is absolutely no evidence to support patients demands and we should hold ourselves accountable as well and not practice low- value care.

The list below details other areas where savings can occur were we to recognize that the practices constituted low value care: 1) In a stable patient not admitted for an electrolyte disorder or blood loss is there a justification for daily blood chemistries and CBC? Let us remember that the unnecessary phlebotomy is not without risks.

2) Should we still give packed RBC’s to a hemodynamically stable patient with anemia but with a hemoglobin of more than 7g/dl? The evidence says NO. 3) Patients are demanding testosterone therapy in the absence of any biochemical evidence of deficiency – do not spend health care dollars treating such patients.

4) Patients with diabetes who are eating in the inpatient or outpatient setting should not be on a so called sliding scale insulin regimen as monotherapy – this is ineffective, is not physiologic and increases the risk of hypoglycemia and unwanted hyperglycemia and yet such patients are routinely managed in this manner in hospitals in this community and across the nation.

5) That patient who threatens to post not so nice comments about you because you did not prescribe antibiotics for a day of URI symptoms of viral etiology does require education and not antibiotics.

6) In the emergency department are we obtaining imaging studies instead of a high-sensitive D-dimer measurement in individuals with low pretest probability of venous thromboembolism? This happens far too often.

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7) In the evaluation of simple syncope do not obtain CT or MRI in the presence of a normal neurologic examination – the yield from the imaging study is extremely low and yet nearly every patient presenting with syncope on a nearly routine basis has a brain imaging study ordered.

The examples are many and as part of the choosing wisely campaign each specialty organization was tasked with providing a list of low-value practices to be avoided or questioned by members of that discipline. I urge you to visit the choosing wisely web page and familiarize yourself with this important issue.

The “Do Something” Culture: The ability to do more with less and the ability to choose wisely should come with an ability to be able to shed the current culture of “one must do something” with every patient encounter. Sometimes all it takes is a discussion of benefits and risks in order to come to a shared decision with the patient to do less or nothing at all.

Doing less or nothing requires work: It demands that we become effective communicators in speaking to our patients, it demands that we become excellent at corralling the evidence in support of our decisions, it demands greater understanding of benefits and risks of clinical decisions, it demands that we shift medicolegal fears to the background, it demands that we practice defensible medicine and not defensive medicine.

It demands that we challenge old ways of doing things constantly and above all it demands that we change the current culture to one that embraces choosing wisely in all clinical encounters.

Your society will continue to work to raise awareness of these issues and will welcome contributions on how as a community of physicians we can lead the change that the choosing wisely initiative calls for.

References: 1) Olsen L, Young P. The Healthcare Imperative: Lowering Costs and Improving Outcomes. Workshop Series Summary.

National Academic Press; Washington, DC, 2010.

2) Wolfson D, Santa J, Slass L. Engaging physicians and consumers in conversation about treatment overuse and waste: a short history of the choosing wisely campaign. Acad Med. 2014;89(7), 990-995.

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MIEC Belongs to Our Policyholders!

Toni Brayer, MD Board of Governors

Over the last 20 years California policyholders have saved an average of 25% on premiums due to our Dividend Program*

Keeping true to our mission MIEC has never lost sight of its original mission, always putting policyholders (doctors like you) first. For over 40 years, MIEC has been steadfast in our protection of California physicians with conscientious Underwriting, excellent Claims California Dividends as % of premiums management and hands-on Loss Prevention ($1m/$3m limits) services; we’ve partnered with policyholders 60% to keep premiums low.

MIEC Average Dividend Added value: n No profit motive and low overhead n Supports organized medicine in Califonria For more information or to apply: n www.miec.com n Call 800.227.4527 n Email questions to underwriting@miec.com * On premiums at $1/3 million limits. Future dividends cannot be guaranteed.

MPL Industry Average Dividend

50% 40% 30% 20% 10% 0%

No Profits No Dividends 1 9 9 7

MIEC 6250 Claremont Avenue, Oakland, California 94618 • 800.227.4527 • www.miec.com SJMS_07.06.16 WINTER 2016

—

2 0 1 6

MIEC OwnedSAN byJOAQUIN the policyholders we protect.

PHYSICIAN 11

LIFE

Get Back To It Dameron Hospital’s comprehensive cardiac program provides the community with access to a broad range of advanced cardiac care services including cardiac surgery, a cardiac catheterization lab, peripheral vascular treatment and a cardiac EP lab for treatment of abnormal heart rhythms. In addition, Dameron Hospital is a designated STEMI receiving center for emergency care for heart attacks. Dameron’s highly-skilled cardiologists, cardiac surgeons and nurses combine expert knowledge with advanced technology to care for patients with all levels of advanced cardiac needs.

Excellence in Cardiac Care

209-944-5550 DameronHospital.org Stockton, CA

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The

REMEDY for all your

Financial

NEEDS

As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff !

In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money.

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2016 HOUSE OF DELEGATES CALIFORNIA MEDICAL ASSOCIATION DELEGATES DISCUSS MAJOR ISSUES AND ELECT OFFICERS AT ANNUAL MEETING More than 500 California physicians convened in Sacramento for the 145th Annual Session of the California Medical Association (CMA) House of Delegates, October 15-16, 2016, at the Sacramento Convention Center. This meeting marks the end of the first year of CMA’s new governance reforms and the first time the delegates have reconvened since they approved the reforms at last year’s House of Delegates (HOD).

Under the new system of governance, proposed policies are considered on a quarterly basis, with online testimony throughout the year. The HOD still meets annually, but the delegates now establish broad policy on current major issues affecting members, the association and the practice of medicine. The major issues discussed this year are listed on the following page. >>

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MACRA:

As the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is implemented over the next several years, the CMA will be working hard to ensure it is workable for practicing physicians and improves patient care. The CMA House of Delegates discussed various recommendations to guide CMA’s policy on this issue.

MAINTENANCE OF CERTIFICATION: CMA supports the highest

standards for licensure that are based on education, training, experience and ethical criteria. In a sometimes heated debate, delegates discussed various models and proposals regarding maintenance and recertification of specialty board certification, including alternative approaches.

OPIOIDS:

The issue of opioid-related misuse, abuse and overdose continues to be a major policy issue at the federal, state and regional levels. The delegates discussed various strategies and policies to promote prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose.

PHYSICIAN BURNOUT:

Recognizing that it is the responsibility of the medical community to identify risk factors for and appropriately respond to signs of physician burnout, the CMA House of Delegates explored strategies to preserve the physical and mental well-being of physicians.

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ACA CHANGES:

Beginning in 2017, states can request a five-year renewable exemption on key coverage provisions within the Affordable Care Act, including those related to benefits and subsidies, the exchanges, and the individual and employer mandates. The CMA House of Delegates discussed various recommendations related to a possible Section 1332 waiver for California.

FIVE-YEAR PUBLIC HEALTH PLAN: For many decades, CMA has taken an active role

in championing notable and successful public health policy campaigns that promote healthy practices and behaviors.

Continuing its commitment to public health, the CMA House of Delegates strategies to prevent and treat chronic disease and supports healthy and safe communities, focusing on the following areas: adult and childhood obesity, tobacco use, pain, behavior health disorders, violence and infectious disease.

Before debating the issues, the delegates heard from experts in each major issue area, and for the first time continuing medical education (CME) credit was offered for these educational sessions. Final reports detailing the actions taken by the delegates are posted at www.cmanet.org/hod.

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NEW PRESIDENT OF CMA PROMISES TO RESTORE VALUE TO THE PROFESSION Ruth Haskins, MD, was installed as CMA’s 149th president. In her address to the delegates, she promised that in the face of the big changes taking place in health care and the overarching administrative burdens that have been placed on physicians, she would bring back value to the profession of medicine during her year as president.

“For most of us, being physicians is not something we do’, it is something we ‘are,’ she said. “ We need to be valued for the sacrifices we have made to earn our professional titles. We dedicated years of our lives for our education and training – giving up social events, missing holidays.”

“We need to be valued for what we give up every day as we try our best to remain passionate about our work,” she said. “The responsibility of life and death decisions, compounded by administrative burdens often feels overwhelming.”

“The public needs to know how much we’d rather be touching our patients than stroking our electronic medical record keyboards; how much we’d rather be enjoying family time or exercising than completing charts at home every evening. We need to be valued for the hours of time we spend agonizing over details about our patients’ health and the business of our practice: time we will never be compensated for.”

Dr. Haskins, an ob-gyn practicing in Folsom, has been a member of CMA and the Sierra Sacramento Valley Medical Association for 23 years.

She served on the CMA Board of Trustees from 2013-15 and as chair of the CMA Council on Legislation from 2010-13.

Dr. Haskins is a U.S. Air Force veteran who began active duty while enrolled in the University of Pittsburgh School of Medicine. She completed her residency in Obstetrics and Gynecology at the David Grant USAF Medical Center at Travis Air Force Base before transferring to the Illinois-based Scott Air Force Base Medical Center, where she later became chair of the department of obstetrics and gynecology.

Dr. Haskins progressed to the rank of major in the military and was involved in the readiness campaign for Operation Desert Storm and Desert Shield in the early 1990s. The strength of her loyalty to her country is only matched by her passion for her hometown heroes, the Pittsburgh Steelers. Her fervor for sports and appreciation of great teamwork feeds into her enthusiasm for restoring the joy and value of the practice of medicine.

“California’s physicians are fortunate to have a champion for health care on their side,” said outgoing CMA President Steve Larson, MD, MPH. “Dr. Haskins brings energy and enthusiasm into everything she does, and I know she’ll provide the leadership needed to help tackle the health care challenges facing California.”

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THE PUBLIC NEEDS TO KNOW HOW MUCH WE’D RATHER BE TOUCHING OUR PATIENTS THAN STROKING OUR ELECTRONIC MEDICAL RECORD KEYBOARDS.

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House of Delegates > 2016

2016-2017 EXECUTIVE COMMITTEE Joining Dr. Haskins on the Executive Committee are:

Theodore M. Mazer, MD

Tanya Spirtos, MD

Robert E. Wailes, MD

Lee T. Snook, Jr., M.D

David H. Aizuss, MD

Steven E. Larson, M.D

President-Elect: Theodore M. Mazer, MD, was elected president-elect and will serve in this capacity for one year, taking office as president during next October’s annual meeting. Dr. Mazer is a board-certified otolaryngologist who has been working in a small, solo practice in San Diego for more than 25 years. A CMA member since 1988, Dr. Mazer served on the association’s Board of Trustees from 2002 to 2010, speaker of the house from 2013 to 2016, and has chaired various committees, including those focusing on medical services and access to specialty care.

Speaker of the House: Lee T. Snook, Jr., MD, a Sacramento pain management specialist, was elected Speaker of the House. A CMA member since 1985, Dr. Snook has served as chair of the CMA Worker’s Compensation Technical Advisory Committee and as a member of CMA’s Board of Trustees. Dr. Snook has served as vice speaker of the CMA House of Delegates since 2011.

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Vice Speaker of the House: Tanya Spirtos, MD, a Redwood City obgyn was named Vice Speaker. Dr. Spirtos has been a member of CMA since 1985, serving on the CMA Board of Trustees since 2009 and on the CMA delegation to the American Medical Association.

Chair of the Board: David H. Aizuss, MD, an ophthalmic surgeon from Los Angeles, will be returning as chair of the CMA Board of Trustees, a position he has held since 2014. Dr. Aizuss, a CMA member since 1981, previously served as vice chair of the board from 2011-2014, and is a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons.

Vice Chair of the Board: Robert E. Wailes, MD, a pain specialist and board-certified anesthesiologist from Encinitas, will be returning as vice chair of the Board of Trustees, a position he has held since 2014. Dr. Wailes, a CMA member since 1982, has served

as president of the San Diego County Medical Society and represents the American Academy of Pain Medicine at the American Medical Association.

Immediate Past President: Steven E. Larson, MD, a board certified internist and infectious disease specialist from Riverside, will serve one last year on the Executive Committee as immediate past president. Dr. Larson, a CMA member since 1980, is the current CEO and chairman of the board of Riverside Medical Clinic and is also a delegate to the American Medical Association, serving as vice chair of the Pacific Rim Delegation.

Full bios for the Executive Committee members are available at www.cmanet. org/about/cma-governance.

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This year, Health Plan of San Joaquin awarded 14 students from our community with funding to help them pursue an education in medicine through our Health Careers Scholarship Program.

Working with local high schools and nursing programs, as well as San Joaquin Medical Society’s Decision Medicine Program, our hope is that students will pursue their passion for medicine and become part of the solution for expanding access to health care in the communites we serve.

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Legislative wrap up

Yet Again,We

Rise

The California Medical Association’s 2016 Legislative Wrap-Up

BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT OF GOVERNMENT RELATIONS

The delivery of health care, and its costs, continue to be at the forefront of California politics. Dramatic changes, such as the implementation of the Affordable Care Act, escalating health care premiums, consolidation of health plans, rising drug costs and the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), continue to create uncertainty in the marketplace, causing a relatively new state Legislature to question nearly every aspect of health care delivery in California. The result has been a record number of significant legislative challenges to the core policy beliefs of the California Medical Association (CMA).

“Transition” was the consistent variable in 2016. The year began with a transition of power in the Assembly as thenSpeaker Toni Atkins (D - San Diego) handed over her leadership position to current Speaker Anthony Rendon (D - Lakewood). Chairs of policy committees during Speaker Atkins’s tenure worked quickly to conclude unresolved legislation from 2015, while policy chairs appointed by Speaker Rendon rushed to learn the full breadth of their policy committees’ jurisdictions. During all this time, the special legislative sessions on health care and transportation continued to convene. >>

Legislative Wrap Up > 2016

Great Opportunities Legislative transition is synonymous with opportunity — and these opportunities are both good and bad.

The continuation of the special session on health care gave CMA and the Save Lives Coalition the opportunity to beat Big Tobacco by passing the most expansive package of tobacco reform legislation in the history of the Golden State. We closed loopholes in workplace and school campus smoking laws, brought e-cigarettes under the umbrella of tobacco products, increased licensing fees, and raised the legal purchasing age to 21. But our war against tobacco is not over yet, as we take on the industry again at the ballot box in November to increase the state tax on all tobacco products in order to help fund Medi-Cal. Our public health focus did not end with tobacco.

After the tragic loss of two San Diego medical students to a drunk driver in 2015, CMA pushed for mandatory responsible beverage training for managers, servers and bartenders in establishments that serve alcohol.

We took advantage of the shift in Senate chairmanships to reestablish CMA’s position at the bargaining table on reforms to the workers’ compensation system. Last year, partnering with Senator Richard Pan, MD, CMA sponsored SB 563 to ensure the utilization review program was not providing incentives for denying medically appropriate care. This effort, combined with our continual effort to push for improvements to the system, resulted in our sponsored bill being incorporated into a larger workers’ compensation reform bill, which decreased the

Great Threats Our opponents also have the ability to recognize and take advantage of opportunities, resulting in threats that must either be defeated or neutralized depending on the political realities surrounding the particular issue.

Threats to the profession during this legislative session came in the shape of SB 932 (Hernandez) and SB 1033 (Hill). SB 932 sought to

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usage of prospective utilization review – solidifying the physician’s place in that discussion.

We also turned our eye inward to the health and the future of the profession. Working closely with our colleagues at the California Academy of Family Physicians, the California Primary Care Association and other organizations, we secured a badly-needed investment in our state’s primary care workforce: a $100 million appropriation in the 2016-17 state budget. This appropriation will provide $33 million each year for three years to increase funding for the Song-Brown Program, a competitive grant program that supports primary care residency programs in medically underserved areas.

The budget will set aside some portion of this money exclusively for residency programs at clinic-based Teaching Health Centers, including support for the six existing sites as well as for clinics interested in starting new training programs. We believe this augmentation represents one of the biggest investments in the primary care physician workforce the state has ever undertaken.

Then, with the California American College of Emergency Physicians, we co-sponsored legislation to extend the program that donates certain traffic fines to the Maddy Emergency Medical Services Fund, which provides reimbursement to physicians who treat uninsured patients. Finally, CMA ensured that physicians suffering from substance abuse had a credible, viable health and wellness program to ensure that their patients continue to receive the very best care from those impacted physicians.

put limitations on what may be included in contracts between health care insurers/plans and providers, as well as to implement a new process for approving mergers and acquisitions of health plans and riskbased organizations. Meanwhile, SB 1033 would have required doctors under probation with the Medical Board of California to disclose their probationary status to all patients.

Neither measure made it out of their

House of Origin.

Once again, we protected patients from undertrained practitioners offering treatment outside of their scope of practice.

Nurse practitioners, optometrists, naturopathic doctors and certified nurse midwives — all had their scope expansion efforts decisively defeated.Scope bills on nurse practitioners (SB 323 - Hernandez) and optometrists (SB 622 -

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Hernandez) were not even brought up for a vote in the Legislature this year due to overwhelming pressure and negative perception

of the proposals in the Capitol.

Naturopathic doctors (SB 538 Hueso) and certified nurse midwives (AB 1306 - Burke) were longer

Great Compromises Amid all of these defeats, this year was also a year of great compromises. The majority of the bills we opposed at the start of the year were neutralized through amendments and negotiations during the course of the legislative session.

This year saw the completion of the CURES database negotiations that were begun in 2015. SB 482 (Lara) is a great achievement in mitigating the inevitable tightening of requirements for CURES database use. More work on this issue remains to be done, but much has been achieved through this bill and through building a foundation of cooperation with the Legislature and other stakeholders.

The most contentious negotiation this session was that of AB 72 (Bonta, et. al.), the out-of-network bill signed into law by the Governor. AB 72 is a direct result of our defeat last session of AB 533 (Bonta), which essentially would have extended Medicare rates to all non-participating physicians. CMA defeated AB 533 last year on the last night of session. However, Assemblymember Bonta requested reconsideration, a procedural maneuver that granted him an opportunity to bring up the bill at any point in 2016 for a second vote.

To neutralize the threat of a revote on AB 533, our allies forced Bonta to restart negotiation on out-of-network billing, not only with CMA but also with the legislators as well. Their intervention precipitated the development of the jointly-authored AB 72. The joint authorship of Assemblymembers Wood, Santiago, Maienschein, Gonzalez, Dahle and Bonilla was far more favorable for our association than the prior year’s stakeholder process, which was solely directed by Assemblymember Bonta’s office. The end result is a law that puts to rest the issue

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fights, with both lasting up until the last hours of the legislative session.

Ultimately, however, both bills were defeated by wide margins.

of so-called “surprise billing” in a way that preserves the ability of a physician to continue collecting their usual rate (as long as they obtain the consent of the patient), implements a statutory payment structure that borrows significantly from CMA policy and ensures that the statutory payment structure only applies in a narrow set of circumstances.

While the enactment of AB 72 can never be described as favorable, it did present CMA with the opportunity to rise above the negative political constructs and portrayals of physicians conjured up by the health insurer lobby.

Through our good faith participation in the AB 72 stakeholder process, CMA once again represented the true nature of physicians delivering care in a complex system. We were able to convey that physicians desperately do not want patients to be financially injured by the profit-driven decisions of health insurers to narrow physician networks so that patients are barred from having a substantive opportunity to utilize their in-network benefits.

Yet again, CMA rose to the occasion, transforming an absolute debacle into an advocacy gateway leading to enhanced network adequacy standards and allowing physicians a means to continue collecting their normal rate. Our actions also weakened the narrative weaponry available to health insurers. Surprise billing, or balance billing, was the primary “white hat” issue for health insurers. With the introduction of AB 533, they sought to exchange that “white hat” issue for a substantial financial windfall. With the passage of AB 72, the insurers have lost that issue in a manner that could see the overall physician compensation increase over time and stricter oversight of their networks.

SAN JOAQUIN PHYSICIAN

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Gill Obstetrics & Gynecology

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Just like no two individuals are exactly alike, each woman has unique healthcare needs. For over 60 years, the specialists of Gill Obstetrics & Gynecology have been trusted to provide innovative, personalized care to women in our community. For women with gynecological issues requiring surgery, our team of highly skilled surgeons will help you consider the options just right for you, including single site robotic surgery.

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Legislative Wrap Up > 2016

Change Is Happening The question is whether CMA will continue this trend of rising above a turbulent political environment and marketplace to lead California from uncertainty to clarity.

No longer can organized medicine maintain an overly defensive posture, hoping and working to simply maintain the status quo or to get things back to the way they used to be; such a position is unrealistic and will lead to decisive losses in the near future.

Change is happening, and change will continue to happen. CMA’s charge must be to look into the future and act boldly to shape the world of health care in a way that is most favorable for all physicians and their patients.

CMA’s leadership challenge is not new. The physician leaders and staff that set the course of this organization had the same duty. I submit to you the same call to action as CMA’s former Chief Lobbyist Steve Thompson: “Crisis… is an opportunity for leadership. It’s an

opportunity for the CMA to take the lead in providing solutions to the myriad problems facing health care today.

The challenge ahead is to know what solutions to propose.

But, if CMA does not lead in problem solving, that role will be filled by others who are far less concerned with what the future holds for physicians and patients.”

As we embrace this challenge, we must recognize that sometimes it is impossible to find complete agreement — what might help one physician might be less favorable to another. But we are organized medicine. We cannot allow rifts to seep outside of our House. We cannot give into the temptation to tear down what has been built. Our enemies are waiting and counting on division within the House of Medicine to create fractures so they may exploit the harmful opportunities that would result.

We rise today because we were unified yesterday. We will rise tomorrow, because we reaffirmed our bond today.

For more details of the major bills that CMA followed this year, see www.cal.md/legwrap2016.

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.

ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.

SUBSCRIBE NOW

Sign up now for a free subscription to our e-mail bulletin, at www.cmanet.org/news/cpr

n from the n is nthly bulleti This bulleti e is a free mo nomic Services.

Eco ces (CPR) rove practic ctice Resour ociation’s Center for their office staff imp CMA Pra dical Ass sicians and Me phy nia ifor help CMA Cal to Resources (CPR) Practice to date, sign Aetna to require addition and tools free monthl stay up from al accreditation require- full of tips Californiaility . l Association’s is aSLE Medica RS: Toy bulletin the ments CenterTTE and viab : in order to betatio for Econom ire- surgica paidnfor CMA NEW certain requ efficiency full of tips andANY tools OTH ewsletters.ic Services. This toERhelp l eagues. is gy services physici rg/n In this issuepatholo accredi et.oans and their office staff efficien and collbulletin CPR OR viabilitwww.cman orkersimprov additional certain surgical ire Update 1 SUBSCRIBE TO cy and e practice on two ptions at y. for Anthem Blue Cross 1 to your cow Aetna to requ r to paid subscri SUBSCR bethe issues pending IBE TO CPR OR ANY free this bulletin with for orde ard up in Departm OTHER ts forw ent CMA of Managed Health Care men NEWSLETTERS: To up for free Please D:subscri ices ding stay May 2012

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201 owe As a resu they wereCPR • May 2012 • Page 1 of 5 CPR • May the money providers

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SAN JOAQUIN PHYSICIAN

WINTER 2016

WINTER 2016

SAN JOAQUIN PHYSICIAN

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PHOTO BY DALE GOFF

truth truth THE

ABOUT THE

STORY BY JAMES NOONAN l PHOTOS BY DALE GOFF AND BENNET OMALU, MD

DR. BENNET OMALU HAS DEDICATED HIS LIFE TO THE PURSUIT OF THE TRUTH, BOTH IN SCIENCE AND SOCIETY, LEARNING ALONG THE WAY THAT WHAT IS RIGHT, AND WHAT IS EASY RARELY SHARE A PATH. As children, we’re taught that the distinction between “true” and “false” is a simple one.

Like black or white, good or bad, the difference between the two should be obvious on their face. When one fully commits to this idea of “the truth,” however, things quickly become anything but obvious.

“The truth is inconvenient. The truth may be difficult, but come what may, there will always only be one truth,” says Dr. Bennet Omalu, a man who knows better than most what chasing the truth can cost you.

In Omalu’s life, seeking the truth has always been a driving motivator. It was a quest for truth that led him to the field of medicine. It was a quest for the truth that found him standing toe-to-toe with one of America’s most influential corporations, and it was a quest for the truth that has helped him elevate the work of the San Joaquin County Coroner’s Office to its current position of what he believes to be a national benchmark of excellent. >>

32 SAN JOAQUIN PHYSICIAN PHOTO BY BENNET OMALU, MD

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The Truth About The Truth > Dr. Bennet Omalu

On the day he reflects on such things, Omalu sits, as he undoubtedly has done on many days just like it, in backyard of his rural Sacramento home while his two young children play in the distance. Their laughter echoing through the autumn air, he delves deep into the fruits of his long and eventful career, knowing full well that without his insatiable desire for truth, and the difficulties that came along with it, none of it would have ever come to pass.

“I was doing what I was doing to enhance the lives of others,” he said. “I was simply doing a simple thing that a Christian would do - searching for the truth, asking myself questions and using my faith and my science to discover the answers to those questions.”

By now, Omalu’s professional accolades have been well-documented in the realms of both medicine and pop culture. Those who don’t personally know the man - who came to this county in his twenties chasing the purest, most idyllic, version of the American Dream - could be forgiven for thinking this newfound notoriety might have gone to his head.

The reality could not be more different.

For those unaware of Omalu rise to fame, it began in 2002, when his life trajectory took a dramatic, and unexpected, turn while performing a routine autopsy on the brain of former Pittsburgh Steelers’ center Mike Webster.

Within the preserved tissue, he discovered a degenerative disease that would change his life forever. Shedding light on the new condition - now known as chronic traumatic encephalopathy, or CTE - shook the National Football League to its core, igniting the league’s extremely public efforts to demonize and discredit Omalu and his work.

Through it all, Omalu persevered, continuing to strive toward what he knew to be right.

In 2009, his status as a celebrity in the field of forensic pathology began a gradual bleed into the realm of popular culture, as GQ magazine chronicled Omalu’s struggle on a national stage through their exposé, Game Brain, which would eventually inspire the book and 2015 film, Concussion.

While fame and notoriety have certain come along as a passengers on Omalu’s quest for truth, they are baggage, he says, that was never intended.

“I came to America in search of myself. Just to be myself.

I didn’t come to America to be a champion of anything,” he says. “I just came to have a good and simple life.”

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PHOTO BY BENNET OMALU, MD

The truth is inconvenient.

The truth may be difficult, but come what may, there will always only be one truth.

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The Truth About The Truth > Dr. Bennet Omalu

PHOTO BY DALE GOFF

This county has been good to me. They needed me, but I needed them, too. I was running away. I needed somewhere where I could be left alone, and this county has been nothing but supportive of me.

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As an immigrant from Nigeria, Omalu found himself infatuated with the very ideals that have drawn people to the shores of this nation for centuries - honesty, integrity and a fair shake for those willing to work for it. For him, these notions were largely foreign ones, and their unfamiliar nature was part of what made them so appealing.

“I came from a country that most consider to be one of the most corrupt in the world,” he said. “Seeing this, I knew that corruption doesn’t help anyone, including the ones being corrupted.”

It’s ironic, in a sense, that Omalu’s unyielding desire to strive toward these ideals would ultimately be what exposed to him the fact that his new country was far from immune to such corruption. This revelation, and their resulting fallout, would also yield him the life he so thoroughly enjoys today.

Shortly after publishing his findings on CTE, the NFL began working to discredit Omalu’s research, a crusade so intense that it eventually forced him to uproot from his home in Pittsburg, Pennsylvania and flee to a little-known corner of California known as the San Joaquin County.

While traumatic at the time, the experience has shaped Omalu’s life forever.

“The transition was extremely difficult. That was a very dark time in my life,” he said. “In a way, running away actually helped. As a man of faith, I believe that difficulties actually create opportunity.”

Today, with his career established and research widely accepted for the monumental discovery that it is, it would be easy to look back at those dark days and write them off as simply “formative years” of struggle through which one needed to simply grit and endure. Omalu remembers them differently, however, noting that the offer to work in San Joaquin County came as something of a safe harbor in a sea of turmoil.

“This county has been good to me. They needed me, but I needed them, too,” he said. “I was running away. I needed somewhere where I could be left alone, and this county has been nothing but supportive of me” Given the global attention that has recently been brought to both Omalu and his work, many observers wondered how long it would be before he left his now familiar harbor and set sails for bigger seas.

Those asking such questions, he said, don’t fully understand the bond he shares with the place he now calls home.

“Many people thought I might leave the county, and my

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PHOTO BY BENNET OMALU, MD

question is ‘why?’” he says, explaining that his connection to San Joaquin County, and the people with which he works, has trumped even the most appealing offers from elsewhere. “I wouldn’t call it loyalty, but I’d say I feel a sense of family with these people for all they have done for me.”

In 2013, Omalu’s declining the chief investigator on deaths in Washington D.C. garnered headlines throughout the region. He admits that any given county employee turning down such a position wouldn’t likely generate such headlines. He also admits that the Washington D.C. position was far from the first suitor to come knocking. It also would almost certainly not be the last.

Through all of it, he had made up his mind to stay put; right here in the safe harbor he sailed into back in 2007.

Asked why, he speaks with the highest regard for the work produced by the San Joaquin County SheriffCoroner’s Office, noting that even the most established and esteemed positions that have come knocking at his door would be hard pressed to duplicate the work being done right here in the Central Valley. The credit, he says, is far from his alone, with the county sheriff, the Board of

WINTER 2016

Supervisors and his colleagues at the offices deserving just as much as he does.

“The quality of work coming out of the Coroner’s office can compete with any office on the face of the earth,” he said. “It’s second to none.”

In addition to his work, Omalu knows he has other reasons why the Central Valley will remain his home.

On the lawn of his backyard, his daughter, Ashley, and his son, Mark, are playing a game of kick soccer. Their happiness, as well as that of his wife Prema, are now Omalu’s top priority. Reflecting on his accomplishments, he speaks as highly of his role of a husband and a father he does of the groundbreaking research he continues to do on the human brain, noting that, in many ways, the two are inseparably linked.

“Today, it’s so much more,” he said. “It’s no longer just about football players and their families. It’s about the truth. It’s about little kids and their families. It’s a celebration of who we are, of the humanity of mankind.”

Dr. Omalu’s latest book “The Truth Doesn’t Have a Side,” is slated to be released in August.

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Fortunately, there’s the Manteca Wound Center.

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In The News

IN THE

NEWS

Julio Narvaez, MD

Dr. Narvaez Returns from Volunteer Mission to Indonesia

Dr. Julio Narvaez of Delta Eye Medical Group has recently returned from a volunteer mission to the Island of Alor, Indonesia, where he led an eye team to help the blind and needy who have no easy access to medical care. The team evaluated 750 patients and operated on almost 50 individuals, most for severely blinding diseases. The care given resulted in a greatly improved quality of life not only for the individuals, but also for the families burdened with

Mobile App Developed by Shriners Hospital Cerebral Palsy Experts Wins National Award

HipScreen, a mobile application developed by pediatric orthopaedic surgeons at Shriners Hospitals for Children — Northern California, has put early detection of hip disorders

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

Mission to Indonesia

the care of a visually disabled member. The services were well received and appreciated by the community to the extent that the mayor of the island hosted the entire eye team for a formal dinner in the official mayor residence.

Since returning from this mission, Dr. Narvaez published an article in the prestigious peer reviewed Journal of Cataract and Refractive Surgery, describing a new surgical technique which was found to be useful to other eye surgeons.

in children with cerebral palsy in the hands of physicians and parents worldwide.

One in three children with cerebral palsy is at risk for hip development problems. A regular schedule of examinations

WINTER 2016

and x-rays — a hip surveillance program — can preserve a child’s function and greatly reduce pain. HipScreen promotes early detection by guiding users through the Vedant Kulkarni, MD surveillance process with educational materials and assessment tools.

The American Academy of Cerebral Palsy and Developmental Medicine honored HipScreen with its Fred P. Sage Award on September 24, 2016 at its annual meeting in Hollywood, Florida. The Sage award recognizes outstanding clinical research and educational material presented in an electronic format.

Dr. Vedant Kulkarni, who led the development of HipScreen, accepted the Sage award. Dr. Kulkarni is devoted to treating children with all types of pediatric orthopaedic conditions and injuries. He has a special interest in neuromuscular disorders such as cerebral palsy and is part of the Cerebral Palsy Center of Excellence at the Northern California Shriners Hospital, where he worked with the program director Dr. Jon R. Davids to develop HipScreen.

To learn more about the innovative HipScreen application, go to www.hipscreen.org, where the app can be downloaded for Apple iOS devices. It soon will be available for the Android platform.

Dr. Michelle James Shares Best Practices at Annual Meeting of the American Society for Surgery of the Hand

Dr. Michelle James, Chief of Orthopaedics at Shriners Hospitals for Children — Northern California, shared best practices in pediatric hand and upper extremity care at the 2016 meeting of the American Society for Surgery of the Hand (ASSH). The annual meeting of the 3,800 member organization took place September 29 through

WINTER 2016

October 1 in Austin, Texas.

Dr. James presented three lectures and coauthored two research studies presented at the meeting. “The ASSH Annual Michelle James, MD Meeting attracts hand surgeons from all over the world. It is an honor and privilege to present our research results and my congenital hand surgery experience to the other members of this professional association.”

Dr. James delivered two instructional lectures on congenital hand surgery: 1) Opposition Transfers for Thumb Hypoplasia; and 2) Index Dorsal Rotation Flaps for Arthrogryposis. The purpose of these lectures was to provide details and outcomes of two recently developed operations to improve prehension for children with thumb anomalies, and she was invited to present her 27 year experience with surgical treatment of the forearm in radial longitudinal deficiency at a symposium entitled “What I Have Learned in Congenital Hand Surgery” A noted pediatric hand surgeon, Dr. James has served as a mentor for many pre-medical and medical students and orthopaedic surgery residents. She serves on the Board of Directors of the American Board of Orthopedic Surgeons and is Deputy Editor for Hand, Upper Extremity, and Topics in Training for the Journal of Bone and Joint Surgery.

San Joaquin General Pediatric Physician Mamta Jain Receives Honor From the Family Resource Center

Pediatric physician and Pediatric Department Chairperson at San Joaquin General Hospital Mamta Jain, MD is a 2016 honoree of the San Joaquin Family Resource Center’s ABC Award. The Action on Behalf of Children (ABC) Awards are presented in special

SAN JOAQUIN PHYSICIAN

39

In The News

IN THE

NEWS recognition to those in San Joaquin County who have shown above and beyond dedication to the well-being of local children.

Dr. Jain was recognized for the hard work Mamta Jain, MD and professional dedication she performed as a SJGH Pediatric physician and department head.

Dr. Jain received her medical training at Lady Hardinge Medical College, and her pediatric residencies at LHMC & Kalaroati-Saran Children’s Hospital, and the Lincoln & Mental Health Center- University of Illinois. Dr. Jain has worked for several years in the pediatric department of San Joaquin General, as well as, San Joaquin County Clinics and has a wealth of professional experience in all phases of adolescent medical care.

The Family Resource & Referral Center provides advocacy, information, training, and direct services to enhance childcare, child development and family wellbeing in San Joaquin County. The Center promotes community awareness about the needs of children, families of children, and participates in building community coalitions to develop solutions for those needs. The Center’s staff works with parents, care providers, businesses, and community leaders to promote quality services for children and their families. Through

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its professional staff, the Center is a clearinghouse for information on child care services, parenting, nutrition, and child safety. It administers child care and nutritional resources and conducts workshops in effective practices of child rearing, child care, and child safety.

San Joaquin General Emergency Nurse Kelleher Receives A Plaque For Her Founding of the Emergency Nurses Association.

The California State Chapter of the Emergency Nurses Association came to San Joaquin General Hospital to honor its co-founder Judith C. Kelleher MSN RN FAEN. Nurse Kelleher was trained at the San Joaquin General Hospital School of Nursing.

The Emergency Nurses Association began in 1970 when two experienced nurses, Judith Kelleher (West Coast) and Anita Dore RN (East Coast), joined ranks and began the organization called Emergency Department Nurses Association – EDNA. The title was later shortened to Emergency Nurses Association – ENA. Today the well-respected organization has 42,000 members representing all fifty states plus 404 members from all six continents.

The organization Judith Kelleher, MSN RN FAEN

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provides education and guidance for nurse professionals who make a career choice to provide emergency department medical care. The organization is a guiding light to emergency healthcare organizations and performs much needed education to hospitals worldwide in how to professionally operate a modern state-of- the-art emergency department.

At the ceremony October 10th Janet Williams, The California State ENA President, said: “The California ENA has chosen to place a plaque in the Emergency Department of San Joaquin General Hospital in Stockton, CA. Judy is a graduate of the San Joaquin General Hospital School of Nursing. It is therefore fitting to place this distinguished plaque here in tribute to San Joaquin General Hospital Emergency Services and Nurse Kelleher. Judy, on behalf of all members and Emergency Department nurses everywhere, we thank you for your work and your dedication.”

San Joaquin General Hospital Nurse Jackie Bagatta Recognized by the CA State Senate

San Joaquin General Hospital’s Deputy Director of Nursing Jackie Bagatta was recognized by both the San Joaquin Chapter of the March of Dimes, as well as receiving an award from the California State Senate for her dedication toward the prevention of birth defects, premature birth and infant mortality. She was awarded for her compassionate care and was recognized for providing lasting, positive impact on babies and families in San Joaquin Jackie Bagatta County.

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Paul K. Zielgele Joins Lodi Health as New Chief Financial Officer

Paul Ziegele comes to Lodi Health from Adventist Health System in Altamonte Springs, Florida. He served Paul Ziegele most recently as the Interim Vice President and Chief Financial Officer for Murray Medical Center in Chatsworth, Georgia, a recent acquisition for the health system.

For more than 20 years, Ziegele has worked for Adventist Health System in the finance arena. During that time he was instrumental in lowering costs, preserving jobs, creating annual gains and being responsible for the financial reporting and staff management at several acute care hospitals.

“I’m excited to have Paul join our executive team,” Daniel Wolcott, Chief Executive Officer of Lodi Health said. “He brings a deep experience in financial leadership and has had a couple of opportunities to assist hospitals as they became part of a larger health system. This includes the financial leadership during an electronic health record conversion similar to Project Genesis.”

“It’s a great facility with opportunities to grow,” Ziegele said of Lodi Memorial Hospital. “The affiliation with Adventist Health secures that future. My whole career, I’ve bought into the mission of Adventist Health.”

Ziegele and his wife Lisa have two daughters, and they are excited to make the transition to Lodi from their current home in Dade City, Florida.

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In The News

IN THE

NEWS Emmanuel N. Obanor, DO, Pharm.D, joins Lodi Health

Emmanuel N. Obanor, DO, Pharm.D, has joined Lodi Health as a gastroenterologist and is practicing at medical offices in both Lodi and Galt.

“I started in the area, now it’s time to give back to the area,” Dr. Obanor said.

Obanor earned his Doctor of Pharmacy degree through University of the Pacific and then moved on to Pomona to earn his Doctor of Osteopathic Medicine degree from the College of Osteopathic Medicine.

Dr. Obanor comes to Lodi Health by way of Sacramento, where he provided Emanuel Obanor, DO, PharmD urgent care services and was a gastroenterology consultant. He earned his gastroenterology fellowship through Garden City Hospital in Garden City, Mich.

It was a concern for family that interested Dr. Obanor in pursuing a career in medicine. “I had a family member in Nigeria who could not get into a hospital due to money

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and distance,” Dr. Obanor said. “Taking care of patients, making them happy and free of pain is what drives me.”

Dr. Obanor practices at Lodi Health Plaza Specialty Care, 999 S. Fairmont Ave., Ste. 125, Lodi and Galt Family and Specialty Care, 387 Civic Dr., Galt.

Norman D. Schmidt, MD, joins Lodi Health as family practitioner

Norman D. Schmidt, MD, has joined Lodi Health as one of Lodi Health’s newest doctors practicing at Millsbridge Family Care. He comes to the organization after having a solo family practice for 24 years.

“The positive feedback from my patients is wonderful,” Dr. Schmidt said. “The positive interactions with patients and the end result of improved health are always satisfying, and are what make me love what I do.”

Dr. Schmidt, a native Lodian, completed his residency at San Joaquin General Hospital in Stockton. He completed a threeyear family practice residency, then served as the chief resident. In 1992

Norman Schmidt, MD

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he set up his solo family practice in Turlock, Calif., which he recently closed to practice with Lodi Health.

Dr. Schmidt graduated with his Doctorate of Medicine from Washington University School of Medicine in St. Louis, Mo. During his second and third years, he did postgraduate research in immunopathology of pancreatic islet transplantation. Previous to that he earned his bachelor of science in biochemistry from the University of California, Davis.

Dr. Schmidt practices at Lodi Health Physicians Millsbridge Family Care, 1901 W. Kettleman Lane in Lodi.

more than 1,000 physicians and numerous stakeholders.

He led key efforts of the organization’s Medicare Shared Savings Program and Cigna Collaborative Care initiative, improving patient outcomes across a number of areas. He holds a master of business administration from University of Central Florida and a bachelor’s degree from Southern Adventist University.

He and his wife, Cara, are active in their community through service and healthful-living projects and are looking forward to enjoying activities in Lodi and the surrounding area.

Lodi Health welcomes new pediatrician Mari Lewis, MD

Lodi Health names Kevin Attride AVP of Population Health

Lodi Health announced that Kevin Attride has joined the organization as Assistant Vice President of Population Health. Attride will facilitate strong partnerships with health care providers, wellness resources, and community stakeholders to improve health status and outcomes in the community.

“I’m excited to join the team at Lodi Health to build on the best practices already in place and collaborate Kevin Attride with physicians, leaders and stakeholders to extend care beyond the hospital’s walls,” Attride said. “The mission of Lodi Health demands that we look for ways to improve the existing health care structure through enhanced coordination and integrating all aspects of care delivery: physical, social, mental and spiritual.”

Attride was most recently director of network analytics and physician engagement for AMITA Health in the Chicago area. He helped develop the population health model for

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Mari Lewis, MD

Mari Lewis, MD, has joined Lodi Health and is seeing patients at Lodi Health Physicians West Pediatric Care.

Dr. Lewis was only 14 years old when she decided to pursue a career as a pediatrician. She was deeply impacted after seeing the care a younger family member received during a severe illness. “Seeing those doctors who were able to care for her and our whole family inspired me to do the same,” she said.

Dr. Lewis is a graduate of the University of Mississippi Medical Center, where she also completed her Pediatrics training. During her residency, Dr. Lewis worked in highintensity environments, including pediatric and neonatal intensive care units, a level-one pediatric emergency department, as well as inpatient wards and outpatient clinical settings.

For Dr. Lewis, the best part of what she does is watching her patients through the years, from their first baby

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http://www.imq.org/education/caprrc.aspx WINTER 2016

In The News

checkups, to starting kindergarten, then seeing them through the teen years into high school. “Getting to watch my patients grow is such a special experience,” Dr. Lewis said.

Brooke McCollough, Lodi Health’s Executive Director of Quality and Physician Services. “He is truly someone his colleagues and patients believe in.”

Though she spent most of her life in Mississippi, she came to Lodi by way of her husband, a Seattle native she met in medical school, who always hoped to return to the West coast. “I enjoy working in Lodi because the friendliness of its people reminds me of the town where I grew up,” she said.

As chief of staff, Dr. McLoughlin has been an integral part of leading Lodi Health’s medical staff through hospital transitions. Not only is he guiding the medical staff through the integration of a new electronic health records system, Dr. McLoughlin successfully lead the team through a hospital affiliation – all while retaining the support of both community and hospital physicians.

Dr. Mari Lewis practices at Lodi Health Physicians West Pediatric Care, located at 2415 W. Vine St., Suite 100, in Lodi. Call 209.333.3135 to schedule an appointment.

When he is not providing excellent care and guidance, Dr. McLoughlin spends time with his wife, Cindy, and their three children, Tristan, Liam and Julia.

Dr. Travers McLoughlin Awarded 2016 Physician of the Year Mission Award

Lodi Health’s Dr. Travers McLoughlin, MD, was awarded the 2016 Physician of Travers McLoughlin, MD the Year Mission Award at the Adventist Health Physician Leadership Symposium on Oct. 10. The organization annually selects a winner from each of its hospital/clinic systems. Those selected meet criteria focused on the provision of total health care with an emphasis on wellness, spiritual health and quality care with compassion.

As Lodi Health’s chief of staff and as a radiation oncologist, Dr. McLoughlin is an exemplary leader and human being, who is known for his compassionate care and hard work.

Since joining the Lodi community in 2005, he has made an indelible impact on those he has worked with and treated.

“He is a compassionate, skilled physician who is greatly admired as a leader, health care provider and friend,” said

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Lodi Health Dietitian Andrea Chapin named fellow by Academy of Nutrition and Dietetics

Lodi Health dietitian Andrea Chapin has been named a fellow of the Academy of Nutrition and Dietetics. The designation recognizes academy members who have distinguished themselves among their colleagues, as well as in their communities, by their service to the dietetics profession and by optimizing the nation’s health through food and nutrition.

“I am honored to be recognized as a fellow of the academy,” Chapin said. “I truly enjoy the opportunities I have to help patients in the hospital, our local youth, and the general community improve their lives through nutrition and wellness.”

A fellow signifies that a member has lived up to the academy’s values of customer focus, integrity, innovation and social responsibility.

As a dietitian,

Andrea Chapin

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In The News

IN THE

NEWS Chapin goes above and beyond. She is passionate about nutrition and spends her own time teaching children and adults how to live healthy lives. She has gone to Mexico with Flying Samaritans to work at a free clinic and offer nutritional counseling. She is a mentor and preceptor for Sac State’s dietetic interns. She also leads presentations on nutrition topics to Leadership Lodi, Lodi Middle School’s career day, the Turkey Trot and Liberty High School’s health day.

Lodi Health Successfully Launches New Electronic Health Records System

Lodi Health officially launched “Project Genesis,” the conversion to an integrated electronic health record (EHR) across the healthcare system, including the hospital, medical practices and outpatient service locations. In the fall of 2015, when planning for this project began, the conversion was titled Project Genesis, a named determined through a voting process in which employees participated.

Project Genesis, the system-wide EHR launch, allows doctors and medical staff to view a patient’s health history in one place. Records are now streamlined and accessible through the Adventist Health enterprise, ensuring consistency and improving coordination of care. The new system advances patient safety and the level of care Lodi Health provides by allowing physicians and nurses to share medical results, tests and notes through the hospital units, ambulatory services and between care settings.

The new EHR is part of Lodi Health’s affiliation with Adventist Health, and the conversion was made possible

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through a $7.7 million investment by Adventist Health.

Project Genesis has been a massive undertaking, with nearly 1,400 Lodi Health employees from various units working with technology and care specialists since October 2015 to build and test the customized EHR platform. Certified trainers led every clinical staff member through courses to prepare them for the conversion in the way they document the care they deliver. Training was scheduled in 11 rooms, six days a week, 15 hours a day for seven weeks. The organization installed more than 2,800 pieces of equipment ranging from computers, printers and scanners to switches and surge protectors. Staff worked around the clock, with “superusers” on all floors and in a designated command center to assure a smooth and successful transition.

New MRI Services Expand Patient Imaging Options at Dameron Hospital

Dameron Hospital recently added MRI services to expand its existing imaging capabilities for San Joaquin residents.

This new on-campus service utilizes a mobile MRI coach, provided by Alliance, and features a stateof-the-art General Electric 1.5T MRI unit that provides superior orthopedic image quality and advanced neurological and vascular imaging Dameron MRI capabilities.

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“Our new MRI service is supported by highly experienced MRI technologists and radiologists who will help us provide referring physicians with timely results,” said Michael Glasberg, SVP and Chief Operating Officer. “We’re focused on providing convenient access for patients and an efficient patient referral process for physicians to ensure we create a positive experience for everyone involved. It’s another way we are differentiating ourselves as a hospital and healthcare service provider in the community.”

The mobile unit will ensure patients and physicians get access to this important diagnostic tool now, as Dameron prepares for a permanent MRI facility being constructed over the next 12-18 months.

Dameron Hospital Awarded Five-Star Ratings for Total Knee Replacements and Back Surgeries from Healthgrades

Dameron Hospital recently received five-star recognition for its quality performance and orthopedic excellence in total knee replacements for 2017 and back surgeries (without spinal fusion) in 2016 from Healthgrades, the leading online resource that helps consumers search, compare and connect with physicians and hospitals.

“Receiving a Healthgrades 5-Star rating for two of our orthopedic surgical services is an indication of how well our physicians and the Dameron Hospital nursing and support staff are working together as a team in the best interest of our patients,” said Dameron Hospital Vice President of Medical Affairs and Chief Medical Officer Brad Reinke, MD. “All of our health professionals communicate with each other to ensure that everyone understands their role in the patient care plan to support the healing process.”

This award-winning care was recognized on the Healthgrades Report to the Nation, backing up Dameron’s continuing commitment to provide the best orthopedic care for residents of Stockton and the surrounding communities in San Joaquin County.

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Devin Zarkowsky, MD, joins Dameron Hospital as dedicated ED General Surgeon

Devin Zarkowsky, MD, has joined Dameron Hospital as its Emergency Department’s new General Surgeon. Dr. Zarkowsky is board-certified with the American Board of Surgery, and is currently a part of Dameron’s Surgicalist Program which provides dedicated onsite surgical specialists to treat patients with emergent and/ or urgent care needs. This model Devin Zarkowsky, MD not only allows Dr. Zarkowsky to devote all his time to Dameron’s ED without having to worry about an outside practice, but it also benefits the patients of Dameron Hospital with more comprehensive decision-making, consistent patient care plans and faster discharges.

He is a graduate of Albany Medical College in Albany, New York, and served his residency at Tri Health/Good Samaritan Hospital in Cincinnati, Ohio; John Hopkins Hospital in Baltimore, Maryland; and DartmouthHitchcock Medical Center in Lebanon, New Hampshire.

When he’s not performing surgeries at Dameron, Dr. Zarkowsky enjoys hiking with his wife and dog, jogging and visiting new restaurants in the Central Valley and Bay Area.

Dignity Health Medical Group Welcomes Tonya Fuller, MD, Neurology

Dignity Health Medical Group Stockton is proud to welcome Tonya Fuller, MD, neurology, to its growing team of specialists. Dr. Fuller is a graduate of the University of Michigan Medical School and completed her internship, residency, and fellowship at the University of Illinois.

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IN THE

NEWS “I treat everyone as if they were my own family.

I believe that physicians and patients make medical treatment decisions as a team,” said Dr. Fuller. Her special clinical interests Tonya Fuller, MD include stroke, epilepsy, and peripheral nervous system disorders. She is certified in adult neurology and electrodiagnostic medicine. Dr. Fuller is accepting new patients and most health insurances including Hill Physicians andMedcore.

Punzalan. Her special clinical interests include Hepatitis B, Hepatitis C, Fatty Liver Disease, women’s health, and functional disorders. Dr. Punzalan is accepting new Carmi Punzalan, MD patients and most health insurances including Hill Physicians and Medcore.

Dignity Health Medical Group Stockton is affiliated with Dignity Health St. Joseph’s Medical Center in Stockton.

St. Joseph’s Medical Center was once again voted the Best Hospital by The Record’s readers in the Best of San Joaquin 2016 poll. In addition, this year St. Joseph’s was also voted Best Emergency Room and Best Labor and Delivery Services. St. Joseph’s Behavioral Health Center was also voted Best Mental Health Services in San Joaquin County.

Carmi Punzalan, MD, Gastroenterology, Joins Dignity Health Medical Group

Dignity Health Medical Group Stockton is proud to welcome Carmi Punzalan, MD, gastroenterology and hepatology, to its growing team of specialists. Dr. Punzalan is board certified in gastroenterology and internal medicine, and board eligible in hepatology.

“I believe exceptional care is based on patient involvement and communication. While treating and managing gastrointestinal and liver disease, I strive to focus on patient’s overall wellness and quality of life,” said Dr.

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St. Joseph’s Voted the Best of San Joaquin

by The Record’s Readers

St. Joseph’s To Host Annual Cancer Symposium

St. Joseph’s Cancer Institute will be holding the 19th Annual Professional Cancer Care Symposium, on Saturday, February 25, 2017. This year’s conference, titled “Lung Cancer: Clear the Air” will provide participants with an opportunity to gain insight from expert speakers

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about advocacy efforts, screening and current treatment options for lung cancer. There will also be information on cancer survivorship and the issues that may arise from cancer and its treatment. Physicians, pharmacists, nurses and others involved in cancer care or those wishing to expand their knowledge in this area are encouraged to attend this one-day symposium. Continuing education credits will be offered at all levels. The goal is to provide knowledge to those caring for people dealing with lung cancer and increased awareness about issues that may arise post diagnosis and treatment. This symposium is provided

by St. Joseph’s Institute in conjunction with the American Cancer Society.

The conference will take place in the O’Connor Woods Conference Room, on Saturday, February 25, 2017 beginning at 8:00 am and ending with lunch at 1:30 pm.

Cost is $49 to attend. For more information or to register, call 209.467.6331.

the Nation for Patient Safety 2016 and Top 10% in the Nation for Patient Safety 2 years in a row (2015-2016), 5 star for hip fracture treatment for 7 years in a row, and 5 star for carotid surgery for 6 years in a row.

Brian Price, Market Development Representative, at St. Joseph’s Medical Center in Stockton, California was recently awarded the Dignity Health Outstanding Achievement Brian Price Award for 2016 amongst his peers at their National Sales Meeting in San Diego, CA.

Insights in Cardiovascular Care Symposium

St. Joseph’s Heart & Vascular Institute will be hosting the “Insights in Cardiovascular Care” symposium, on Saturday, February 4, 2017 at Brookside Country Club in Stockton. Presenters from the American College of Cardiology, UC Davis, and others with discuss carotid artery disease, advanced heart failure, transcatheter aortic valve replacement (TAVR), and other advancements in cardiovascular technologies. Physicians, nurses, and other health practitioners are encouraged to attend this oneday symposium. The conference hours are 8 a.m. to 2:30 p.m. Cost is free to physicians and includes 5 continuing medical education credits. For more information or to register, call 209.467.6331.

St. Josephs’ Recognized by Healthgrades for Patient Safety

For the second year in a row, St. Joseph’s Medical Center has received the Patient Safety Excellence Award™ from Healthgrades, which recognizes hospitals for how well they prevent infections, medical errors, and other complications based on 14 serious, potentially preventable adverse events. Additionally, St. Joseph’s was rated the Top 5% in

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Doctors Hospital of Manteca Receives 4 Performance Excellence Awards for Its Success in Preventing Hospital-Acquired Conditions

Doctors Hospital of Manteca has been named a 2016 Performance Excellence Award winner by The Collaborative Alliance for Nursing Outcomes (CALNOC) for its exemplary work in reducing hospitalacquired conditions.

Doctors Hospital was recognized for its success in four categories: preventing hospital-acquired pressure ulcers and preventing the hospital-acquired infections CatheterAssociated Urinary Tract Infections (CAUTI) in the critical care unit and Central line-Associated Blood Stream Infections (CLABSI) in the critical care unit and the hospital as a whole. CALNOC is the nation’s first registry dedicated to nursing sensitive measures at the unit level.

It is a self-sustaining non-profit public benefit corporation with over 15 years’ experience in advancing the safety and quality of patient care.

“This recognition is a strong affirmation not only of the

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NEWS strength and professionalism of our dedicated nursing and medical staff but also of our overall commitment to patient safety and high-quality standards of care,” said Ikenna Mmeje, CEO of Doctors Hospital of Manteca. “Reducing and preventing hospital-acquired conditions has been and will continue to be a major focus of our clinical team.”

Doctors Hospital of Manteca and other winners of the 2016 Performance Excellence Awards were honored at CALNOC’s 20th Anniversary Conference on October 23-25 in Monterey, Calif.

Joaquin General. On average each year we celebrate a cumulative 6,000 to 8,000 hours of service. Thank you volunteers!

SJGH to Host Annual Volunteer Recognition Dinner

Health Plan of San Joaquin (HPSJ) announced that Satish Kabra, MD, has joined the organization as a medical director.

Board certified in internal medicine, he previously worked at Brown & Toland Physicians in San Francisco as a medical director, and at St. Joseph’s Medical Center in Stockton as a hospitalist.

On December 20 at the Health Plan of San Joaquin Community Room, the SJGH Auxiliary will host its Annual Recognition Dinner. At this event all volunteers are thanked and recognized for their many hours of service to SJGH over the past year. Pins, Certificates, and other goodies are presented in recognition and appreciation for the dedication and commitment of all volunteers to the session of San

San Joaquin Hospital is all ways in need of volunteers. If you are interesting in volunteering please contact Lillianna Carmona, Volunteer Coordinator at (209) 468-6041 or lcarmona@sjgh.org Health Plan of San Joaquin Adds Second Medical Director to its Health Care Team

Dr. Kabra said, “As a physician, I am passionate about solving America’s healthcare problems with effective leadership. “As

HAVE SOMETHING TO SHARE? We welcome submissions to our In-the-News Section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions.

Send your files to lisa@sjcms.org one month prior to publication (February 1st for the Spring issue, May 1st for the Winter issue, August 1st for the Winter issue and November 1st for the Winter issue).

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an area resident, I have seen the impact of limited access to quality health care for underserved communities and I’m committed to helping Health Plan of San Joaquin in its continuing efforts to improve this access.”

Director of Innovation & Strategy now in place at Health Plan of San Joaquin (HPSJ)

Satish Kabra, MD

“HPSJ has seen exponential growth during the past years of Medi-Cal expansion under the Affordable Care Act. With Dr. Kabra’s strategic and tactical experiences improving processes for complex health care organizations, and his attention to bettering measurable outcomes for patients, he is a strong addition to our medical leadership team,” said HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD. Video Now Available Online at the HPSJ. com Provider Portal – Optimizing Transgender Health Training

In September, Health Plan of San Joaquin (HPSJ) held special transgender health training for all area medical providers. The four-hour session featured top medical specialists as well as patients on their own transgender journey.

Reflecting the care team approach that has become the goal for modern transgender medicine, attendees included local physicians, registered nurses, nurse practitioners and behavioral health professionals, as well as from HPSJ medical staff. Attendees received CME and CEU professional credits.

For those unable to be there in person, the session was videotaped. HPSJ network providers are invited to view the video, presented in four segments, inside the HPSJ secure portal (DRE).

Transgender hormone therapies and surgery are covered benefits for HPSJ’s Medi-Cal members.

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Geeta Chawla, MBA/MPH, joined HPSJ as its first director Geeta Chawla, MBA/MPH of innovation and strategy.

With over 15 years of senior leadership experience in strategy, and product and management innovation for the healthcare sector, her recent experiences include being senior innovation manager within Blue Shield of California’s Health Innovation Technology Group (San Francisco) and business strategy manager at Kaiser Permanente (Oakland).

“I have been proud to lead teams of talented, dedicated professional as we helped move 21st century health care in California toward better outcomes for more and more people,” said Ms. Chawla. “I have long been aware of HPSJ’s leadership in creating innovative services, programs and technology that can bring measurable value to consumers, as well as providers,” she said. “Beyond this quest for excellence, HPSJ’s unique, decades-long collaboration with community organizations, and its handson relations with members and healthcare providers, made the opportunity to join this team irresistible,” she added.

Most Behavioral Health Services Coming InHouse at Health Plan of San Joaquin (HPSJ)

In order to better serve patients, and support practitioners in its network, HPSJ has made the strategic decision to more directly work with behavioral health service providers.

So that their members currently receiving behavioral health services can continue to receive timely, appropriate and coordinated care, HPSJ has been initiating direct contracts with many of the behavioral health providers practicing locally. This transition will be in place by Jan. 1, 2017.

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IN THE

NEWS Telemedicine and autism services will remain with Beacon Health Strategies, HPSJ’s behavioral health partner.

Beacon will also continue to perform initial screenings.

Providers and members will still call the behavioral health phone number located on the back of the HPSJ member ID card.

– one of eight awarded by CHCF throughout California – that will launch in 2017 and progress into 2018. As the implementation phase gears up, it is known that provider education regarding pain management will be an important factor, along with support from San Joaquin County Behavioral Health Services.

For members currently receiving behavioral health services, HPSJ believes this direction will result in better coordination of medical and behavioral health care services, and better outcomes for those served.

Opioid overuse continues to be a long-standing, major problem, both nationally and in California. According to the CDC (Centers for Disease Control and Prevention), 14,000 Americans died in 2014 as a result of prescription opioid overdose. In 2015, HPSJ implemented several safety measures to help prevent overuse and promote appropriate use of opioid medications among its members.

For practitioners, the change will include these advantages: Most clean claims will be paid within 30 business days of submission Electronic claims processing will be available Electronic funds transfer will occur with electronic remittance advice (RA) for claims payment HPSJ’s focus, and 20-year experience in administering government programs, will contribute to enhanced compliance in an ever-more complicated healthcare landscape California Health Care Foundation awards second Opioid Grant –This Time for Implementation

A collaboration of Health Plan of San Joaquin (HPSJ), San Joaquin General Hospital (SJGH) and Community Medical Centers (CMC) has again been awarded an opioid-related grant from the California Health Care Foundation (CHCF). With successful conclusion by the local partnership of the planning phase, this second HPSJled collaboration has received an implementation grant

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First African-American Health Empowerment Luncheon for San Joaquin County

SJMS President Dr. Kwabena O.M. Adubofour, MD, FACP, was the featured speaker for this special October event held to raise awareness of the health and healthcare disparities experienced by African-Americans in San Joaquin County, and to spotlight prevention and strategies that can improve the health and well-being of all area African-American families and communities.

Held at the French Camp headquarters of Health Plan of San Joaquin (HPSJ), luncheon co-partners were the AfricanAmerican Chamber, Healings in Motion, Public Health Advocates and HPSJ. With a full house for the event,

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HPSJ Policy & Planning Analyst Michael Nguyen noted: We learned… about health and healthcare disparities facing AfricanAmericans in our community.

We shared… our thoughts in our table discussions about barriers and solutions to a healthier community, which informed future advocacy work. (We also shared a delicious, healthful meal.)

We discovered… resources to engage our communities on nutrition and physical activity, as well as how to make the most of the health care system.

We connected… with local leaders, health advocates, and resources to create positive change.

Scrubs for Health Careers Academy

Health Plan of San Joaquin (HPSJ) is supporting our next generation of professionals. They have donated 166 sets of scrubs to each freshman member of the Health Careers Academy (HCA) high school class of 2020.

Lakshmi Dhanvanthari (a member of the HCA Advisory Board) suggested that HPSJ step forward to provide this practical level of support and encouragement. At a presentation held during the opening of the fall term, each student was thrilled to come to the stage – graduation style – to be presented with their own scrubs, each with the HCA and HPSJ logos on the top, and in the school’s signature purple color.

This is the third incoming class — and the largest ever — for the Stockton Unified District charter school. Each student received a set of scrubs.

Launch of Special Program for HPSJ members with COPD Steps to Breathing Easier

HPSJ’s Medical Management department is teaming up with network providers to support members through a newly enhanced Disease Management program. All HPSJ patients diagnosed with COPD (chronic obstructive pulmonary disease) will receive help to manage

Knowing HCA students are required to wear scrubs as their school uniform, HPSJ Chief Medical Officer Dr. Team COPD

their COPD-related chronic conditions and get access to vital services such as transportation and in-home support.

Five New Physicians join Gill Obstetrics & Gynecology Medical Group, Inc.

Alecia N. Russell, DO

Alecia N. Russell, DO

Gill Obstetrics & Gynecology is pleased to announce the association of Dr. Alecia Russell. She was born and raised in Michigan. She knew she wanted to be a doctor from a very young age and set forth to pursue her dream. She attended college at Michigan State University and graduated with honors. She received a Bachelor of Science in Psychology.

She then went on to also attend medical school at Michigan State.

Go Green! She moved to the Detroit area to complete her residency at St. John Providence Health System in Obstetrics and Gynecology. She served as the chief resident during her final year. During residency she met her husband, Dr. David Russell and they were married in 2015. Together they moved to California to pursue their dream of a career in Women’s Health Care. She enjoys preventative medicine as well as minimally invasive surgery.

Geeta Chawla, MBA/MPH

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IN THE

NEWS David J. Russell, DO

David J. Russell, DO

Gill Obstetrics & Gynecology is pleased to announce the association of Dr. David Russell. He grew up in Cambridge Springs, a small town located in Northwestern Pennsylvania. He may have come from a small town but always had very big dreams. He went to Gannon University where he pursued a Bachelor of Science in Biology.

He graduated Magna cum laude in 2008. He then was accepted and completed his Doctorate at Philadelphia College of Osteopathic Medicine. He moved to Michigan to complete his residency in Obstetrics and Gynecology, where he served as the chief resident. His intern year he met his future wife, Dr. Alecia Russell. They are now in California

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Kimberley E. Fillmore, MD

to serve the women of San Joaquin County and provide them access to excellent health care along with the rest of the Gill Obstetrics and Gynecology group. He specializes in laparoscopic surgery and obstetrics.

Kimberley E. Fillmore, MD

Gill Obstetrics & Gynecology is pleased to announce the association of Dr. Kimberley Fillmore. She grew up in the San Francisco Bay Area.

She attended college at Point Loma College in San Diego. She has a master’s degree in organic chemistry from Texas A&M University. She obtained her medical degree from Oral Roberts University. Residency was completed at the University of Kansas Truman Medical Center in Kansas City. She is board

Gail R. Joseph, MD

certified. Her special areas of interest include high risk obstetrics, management of abnormal paps, and the minilaparotomy for benign gyn surgery. She lives in Stockton with her husband, daughter, and son. Her hobbies are crochet, quilting, playing the piano and embroidery.

Gail R. Joseph, MD

Gill Obstetrics & Gynecology is pleased to announce the association of Dr. Gail Joseph. She spent much of her formative years on the Caribbean island of Antigua where she was born. She knew from a young age that her calling was to women’s health and to address disparities in healthcare. After high school she emigrated to the Bronx, New York where she attended

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Herbert H. Lehman College of the City University of New York. She spent her summers working with the Albert Einstein-Lehman Partnership for Access to Medicine, a group which worked to ensure minority students a path to study medicine.

She eventually went on to attend the University of Pittsburgh where she earned her MD in 2011. She completed her residency training in Obstetrics and Gynecology in Florida where she was trained to perform gynecologic surgeries on the DaVinci Robotic System. All the while her focus has remained on providing access to quality medical care in disadvantaged populations.

Of her many passions, performing minimally invasive surgery, treating abnormal bleeding and managing uterine fibroids stand out.

graduate from University of New Jersey- Robert Wood JohnsonRutgers and Residency Ob/Gyn at Bronx Lebanon Medical Center , Albert Einstein Medical School Affiliate in NYC. Dr. Ortiz is most passionate in regards to serving the Community in Obstetrics

and Gynecology, especially the underserved Latino Community.

Specifically health issues such as obesity, postmenopausal and adolescent health.

A Professional Law Corporation

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Our firm devotes its practice to civil litigation with decades of experience representing healthcare professionals in:

Ofelia G. Ortiz, MD

Ofelia G. Ortiz, MD

Gill Obstetrics & Gynecology is pleased to announce the association of Dr. Ofelia Ortiz. She was raised in NYC, originally from Ecuador, S.A. She is bilingual in both Spanish and English. Undergraduate and Masters’ Public Health, Community Health Education from Hunter College, City University of N.Y. A

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• MEDICAL MALPRACTICE ACTIONS • MEDICAL BOARD INVESTIGATIONS • HOSPITAL CREDENTIALING

PROCEEDINGS • PERSONAL INJURY LITIGATION

2509 West March Lane, Suite 200 Stockton, California 95207 Phone (209) 473-8732 Fax (209) 957-9165

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M M E E N N T T O O R R S S

N N E E E E D D E E D D !!

HELP GUIDE A YOUNG PERSON TO FIND HELP GUIDE A YOUNG PERSON TO FIND THEIR PASSION FOR A HEALTH CAREER THEIR PASSION FOR A HEALTH CAREER REQUIREMENTS REQUIREMENTS • An interest in youth development • An interest in youth development • A passion about your career • A passion about your career • Sincere desire to support the personal and • Sincere desire to support the personal professional goals of another person and professional goals of another person • Excellent communication and interpersonal • Excellent communication and interpersonal skills skills • Openness to learning • Openness to learning

The next Mentor Orientation will be held on The next Mentor Orientation will be held on Tuesday, December 6, 2016 at 4:30pm at Tuesday, December 6, 2016 at 4:30pm at Health Careers Academy, Rm 23, University Park Health Careers Academy, Rm 23, University Park 931 E. Magnolia Avenue, Stockton 931 E. Magnolia Avenue, Stockton Please call (209) 933-7360 x8667 or email Please call (209) 933-7360 x8667 or email MaxineAreida@stocktonusd.net to reserve MaxineAreida@stocktonusd.net to reserve a spot or for alternative training dates a spot or for alternative training dates

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• Sensitivity to people of different backgrounds • Sensitivity to people of different backgrounds • A year’s commitment of student contact of • A commitment at year’s least twice a monthof student contact of at least twice a month • Attend a 90 minute Mentor Orientation • Attend a 90 minute Mentor Orientation • Complete a Mentor Interest Form • Complete a Mentor Interest Form • Pass a background check, including finger • Pass a background check, including finger printing printing

HEALTH HEALTH CAREERS CAREERS ACADEMY ACADEMY HIGH SCHOOL HIGH SCHOOL

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Public Health

Update

Addressing Hypertension and Heart Health: from Clinic to Community Julie Williamson, MPH, and Alvaro Garza, MD, MPH

Hypertension affects one in three United States (U.S.) adults and poses a unique challenge to our healthcare system. While the overall prevalence has not changed since 1999 (about 30%), the death rate from hypertension has increased by 17%, with the actual number of deaths increasing by 44%. Of the 70 million adults nationwide with hypertension, nearly half do not have it under control, and nearly 20% are unaware they have the condition. California’s death rate from hypertension, 129 per 100,000 population, exceeds that of the nation at 112; San Joaquin County’s mortality rate is higher still, at 157.

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To address this major public health issue, national and regional health initiatives, including Healthy People 2020, the Million Hearts Initiative, and the Community Preventive Services Task Force, have sought to increase public awareness of the benefits of improving blood pressure control. In spite of significant increases in patients with controlled hypertension (31% in 1999, and 55% by 2014), as well as increases in patient awareness of their disease (69% in 1999, and 81% in 2014), projections show that, by 2030, the prevalence of hypertension will increase 7% from 2013 estimates.

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Figure

Modifiable Factors Contribute to Hypertension Policies Policies & & Programs Programs

Social & Economic Factors (40%)

Health Outcomes Health Outcomes

Health Health Factors Factors

Clinical Care Access & Quality (20%)

Health Behaviors (30%)

Morbidity (Quality of Life)

Physical Environment (10%)

Parks for exercise

Mortality (Length of Life)

Hypertension

Education

Salt use

Medical

Economic Security

Sugar Use

Mental

Heart disease

Housing Security

Physical Activity

Dental

Stroke

Unhealthy food

Stress

Renal Disease

The main health outcomes are death and disease. Death can be a measure of length of life and disease can be a measure of quality of life. Many factors drive those outcomes. Social and economic factors account for about 40%, health behavior factors for about 30%, clinical care factors for about 20%, and physical environment factors for about 10% of a community's health. Therefore, outcomes reflect past health factors and present health factors impact or drive future health outcomes. Finally, policies shape health factors.

County Health Rankings model © 2010 UWPHI;

The risk factors most commonly identified as contributing to hypertension focus on lifestyle factors such as salt intake, unhealthy diet, stress, tobacco use, alcohol consumption, and physical inactivity. Best practices for patient care emphasize detection of undiagnosed hypertension among adults, promotion of blood pressure self-monitoring, and a team-based care approach that includes education and referrals to lifestyle change programs when patients show early warning signs of the disease. In San Joaquin County, the Lifetime of Wellness program recently produced a guide, “Identifying Patients with

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1nov2016

Undiagnosed Hypertension to Improve Population Health”, to support early detection and treatment of high blood pressure using health information technology. The Million Hearts Campaign (http://millionhearts. hhs.gov), sponsored by the U.S. Department of Health and Human Services, offers best practice resources for clinicians and patients. Increasingly health plans, including those in San Joaquin County, are covering the purchase of blood pressure monitors to enlist patients in self-management of their condition. The American Heart Association (www.heart.org) offers many resources for patients

on healthy living, including dietary guidelines and helpful tools that reveal the many hidden ways that salt is added to typical diets.

In addition to treating hypertension, it can be prevented.

Preventing new cases from occurring and preventing hypertension from progressing to heart disease, stroke, or kidney failure – requires looking beyond the individual to address factors that most influence population health. The Figure illustrates some of the major factors that influence population health, with examples specific to hypertension. Notably, health care accounts for about 20% of a community’s health, behaviors

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for 30%, physical environment for 10%, and social-economic conditions for 40%.

Until recently, the healthcare community has placed the burden on individuals to address the risk factors for hypertension. For people who live in low-income communities, this poses a significant challenge. Under-resourced communities are more frequently saturated with unhealthy food retailers, have poorer quality schools and housing, and fewer employment opportunities that offer hope for economic advancement. Safety concerns prevent people from walking or biking or being physically active. Lack of access to parks or open space, or to grocery stores (“food deserts�) all contribute to increasing the risk for hypertension.

The evidence continues to grow that shows strong causal relationships between socialeconomic community conditions and unequal and inequitable health outcomes. Nationwide, the prevalence of hypertension among

non-Latino Blacks (41%) is nearly double that of non-Latino whites (24%) and Latino adults (25%).

Death rates from hypertension reveal even greater disparities, with rates for Black males at 51 per 100,000, Black females at 38, compared to white males at 17, and white females at 14.

Changing the social conditions that influence hypertension requires collaboration among many partners.

As respected and influential leaders, healthcare providers are increasingly working with organizations and coalitions that advocate for change.

Among the successful policies and programs being advanced are: rezoning to allow farmers markets and community gardens to be established in urban neighborhoods; joint use of school facilities for community recreation; food labeling policies that highlight the amount of salt and sugar in a product; worksite wellness policies that replace unhealthy vending choices with healthier options that limit salt and sugar additives; and school meal

policies that increase nutritional content of food offered in schools.

Refresh San Joaquin is a countywide initiative designed to improve the health of residents by increasing access to fresh, healthy local produce and replacing unhealthy food, beverage, and tobacco ads with signage for healthier food in small food markets.

Health care providers can help to reverse this epidemic first by instituting best practices in the clinic setting. We must also support changes to those social factors that have the greatest contribution to reducing hypertension, such as improving access to healthy food, supporting economic opportunities for under-resourced neighborhoods, improving education through our public schools, and influencing business and work practices to support healthy eating and physical activity. Advocating together, we can transform communities so that the healthy choice is the easy choice for everyone, everywhere, every day.

For information on the Lifetime of Wellness program in San Joaquin County, contact (209) 463-7309. Additional resources at: https://www.cdph.ca.gov/programs/cdcb/Pages/ResourcesforPartnersandLocalHealthDepartments.aspx

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practice management 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 e-mail Jessica Peluso, SJMS Membership Coordinator, at Jessica@SJCMS.org or call 209-952-5299.

San Joaquin Medical Society and CMA Members Enjoy: Vast CMA Resources:

Serving the counties of San Joaquin, Calaveras, Alpine, and Amador

“My Membership provides me a Voice in Sacramento and Washington DC.” Thomas McKenzie, MD

• • • • • • •

Contract Analysis Reimbursement Hotline Legal Hotline Legislative Hotline HIPAA Compliance Free Monthly Webinars on various topics Extensive Online Resources including over 200 letters, agreements, forms, etc.

• Plus – Free Legal Advice with CMA ON-CALL Documents

San Joaquin Medical Society Resources: • • • • • • • • • • •

DocBookMD phone app Annual Directory Free CME Seminars Cost Saving Benefits Quarterly Publication Website/Online Resources Insurance Savings Alliance Membership Annual Social Events Patient Referrals Office Manager Forum and Practice Resources

Your Membership Investment supports our Advocacy efforts on your behalf in Sacramento and Washington DC

Phone: (209) 952-5299

www.sjcms.org

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CMA/San Joaquin Medical Society sponsored Health Insurance Program

Is your health insurance open enrollment soon?

Are your rates going up?

Want to shop?

Whether you are an individual policyholder or a member of a group health plan, it’s time to think about your health coverage for 2017. The open enrollment period for individual and family plans starts on November 1, 2016. Many practices have open enrollment periods for small groups on December 1 or January 1.

Did you know that you can get the right insurance though the CMA/San Joaquin Medical Society sponsored Health Insurance program with Mercer? If you are covering yourself, or if you’re responsible for providing coverage for your family or employees, working with Mercer online or in person with a licensed agent, can get you the benefits you need, utilizing the physicians you want to see, at a price that fits your budget.

Working with the largest insurers in California, Mercer can help you determine what’s best for you.

Call today at 800-842-3761 or visit www.CountyCMAMemberInsurance.com.

Sponsored by:

Administered by:

Scan for more info

Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709

75528 (11/16) • Copyright 2016 Mercer LLC. All rights reserved. 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com

eMR implementation can be hard.

let us make it easy.

CROWN ENTERPRISES IS A LOCAL FULL SERVICE INFORMATION TECHNOLOGY COMPANY SPECIALIZING IN PROVIDING MEDICAL PRACTICES:

• Certified EMR/PM software selection • Reaching Meaningful Use for Federal Stimulus Money Funding • Hardware Installation and Repair • Business Continuity & Disaster Recovery • HIPPA/HiTech Regulatory Compliance • Network and Systems Security • Local Affordable Flat Fee IT Support

We guide our clients through every critical step and our process ensures improved operational efficiencies, quality of care, and increased practice profits.

Call us today for a complimentary consultation at (209) 390-4670 64

SAN JOAQUIN PHYSICIAN

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New Members

13 NEW

SJMS MEMBERS THIS FALL!

...and even more on the way.

Alaud Din, MD

Khaldoon Khirfan, MD

Thuy-Lien Le MD

2545 W Hammer Ln Stockton, CA 95209 (209) 954-4040 Khyber Medical School, Pakistan

7373 West Lane Stockton, CA 95210 (209) 476-3300 Jordan Univ. of Science and Technology

2185 W Grant Line Road Tracy, CA 95377 (209) 839-3200 Ross University School of Medicine

Jacob McDowell, MD

Aye Soe, M.D

Mitesh Lal MD

2505 W Hammer Ln Stockton, CA 95209 (209) 833-2367 St. Georges University

7373 West Lane Stockton, CA 95210 (209) 476-2000 University of Medicine 1, Yangon, Myanmar

7373 West Lane Stockton, CA 95210 Ross University School of Medicine

Preetika Kataria, MD

7373 West Lane Stockton, CA 95210 Creighton University

Family Medicine

Hospitalist

Olubunmi Ajosw-Popoola, MD Otolaryngology

7373 West Lane Stockton, CA 95210 (209) 476-3300 Harvard Medical School

Rama Balaji, MD Psychiatry

7373 West Lane Stockton, CA 95210 Tininelveli Medical College

Gastroenterology

Internal Medicine

Anesthesiology

7373 West Lane Stockton, CA 95210 Kasturba Medical College, Mangalore India

Gitika Gupta, MD Internal Medicine

1721 W Yosemite Ave Manteca, CA 95337 Stanley Medical College

Family Medicine

Family Medicine

Christianne Bishop, MD Family Medicine

Jeshenna Watkins, MD OB/GYN

7373 West Lane Stockton, CA 95210 (209) 476-3300 University of TN Health Science Center

David Konczal, MD Psychiatry

1789 W Yosemite Ave Manteca, CA 95337 University of Chicago

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WEBINARS

EDUCATION •

SEMINARS

•

PODCASTS

•

AND MORE

DID YOU KNOW? CMA offers free webinars to its members Through its robust webinar series, the California Medical Association (CMA) gives physicians and their staff the opportunity to watch live presentations on important topics of interest and learn from industry experts from the comfort of their homes or offices. The webinars are free to CMA members and members’ staff and provide the timely information needed to help run a successful medical practice. What’s more, all webinars are available on-demand immediately following the live airing, providing an ever-growing resource library accessible at any time.

MACRA: The Final Rule and How to Get Ready December 7, 2016 | 12:15pm - 1:15pm

DEC

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This webinar will review the most important requirements in the final Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rule and where to find additional resources to ensure you’re prepared. This webinar will also cover CMA’s advocacy and future efforts to continue to push Congress and the Centers for Medicare and Medicaid Services to reduce the Medicare reporting burdens.

Preventing Burnout: Individual and Organizational Intervention

JAN

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January 11, 2017 | 12:15pm - 1:15pm

Physician burnout not only affects physicians, but can potentially have a negative impact on other staff, the organization or practice, and patients under their care on a daily basis. By recognizing and responding to burnout, physicians and their institutions will be able to reduce sources of stress and intervene with tips and tools that support professional wellbeing. This webinar will cover different evidence-based individual and organizational strategies available to implement into daily practice.

Medicare Changes: 2017 and Beyond January 25, 2017 | 12:15pm - 1:15pm

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This webinar will focus on changes to the Medicare program in the upcoming year, including MACRA, the 2017 Medicare physician fee schedule, annual updates and other changes. We will review existing programs, such as the Physician Quality Reporting System (PQRS) and the Value Based Modifier system, that may negatively impact payments through 2018, as well as provide tips on how to navigate and prepare for MACRA implementation, which begins in 2017. We will also provide you with education resources that will help you understand what the final rule for 2017 means for your practice.

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PRESENTER: Elizabeth McNeil is the Vice President for Federal Government Relations at the California Medical Association, overseeing all federal legislative and regulatory matters. She has been with CMA for more than 20 years.

PRESENTER: Karen Miotto, M.D. is a Clinical Professor in the Department of Psychiatry and Behavioral Sciences at UCLA, and Director of UCLA Addiction Medicine Service. She is the Chair of the Board of California Public Protection & Physician Health (CPPPH), and Chair of the California Society of Addiction Medicine Committee on Physician Wellbeing. She has also chaired the UCLA Medical Staff Health Program for the past 10 years.

PRESENTER: Cheryl Bradley is an Associate Director in CMA’s Center for Economic Services, where she provides one-onone support to CMA member physicians on Medicare issues.

Cheryl has over 20 years of experience in the Medicare program.

REGISTER ONLINE TODAY! WWW.CMANET.ORG/EVENTSWINTER 2016

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*Webinars are free for CMA members and their staff ($99 for non-members).

STOCKTON MRI & Molecular Imaging Medical Center, Inc. 2320 N. California Street • Stockton, CA 95204 PHONE 209-466-2000 • Fax 209-466-2600 w w w. s to c k to n m r i . co m

The Most Advanced and Comprehensive Medical Imaging Center in San Joaquin County Just Got Better with the Addition of the Central Valley’s only 128 Multislice CT Scanner with Lowest Radiation Dose Imaging Services Include: • The first PET-CT since 2003 • Full service of Nuclear Medicine • Most advanced G. E. High Field MRI (1.5 Tesla) • Full service of Digital Radiography and Fluoroscopy • New GE Logic 9e 3D & 4D Ultrasound Unit • 128 Slice Siemens CT Scanner

All Board Certified Radiologists with fellowship: Javad Jamshidi, MD Francis Isidoro, MD Brian Morrow, MD

The Fastest 128 Multislice High Resolution CT in community practice:

Siemens Somatom Definition AS+ (128) WINTER 2016

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

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