Winter 2021

Winter 2021

SERVING SAN JOAQUIN,

TUOLUMNE, ALPINE, AMADOR AND CALAVERAS COUNTY PHYSICIANS

Making theRight

CALLS LIFETIME ACHIEVEMENT AWARD RECIPIENT CONNECTS WITH HOMETOWN PATIENTS

Young Physician Award Value of Advocacy 2021 Legislative Wrap Up

WINTER 2021

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WINTER 2021

VOLUME 69, NUMBER 4 • DECEMBER 2021

PICTURED ABOVE: GLEASON HOUSE

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PRESIDENT'S MESSAGE

12 IN THE NEWS

42 YOUNG PHYSICIAN AWARD

21 VALUE OF ADVOCACY

44 GLEASON HOUSE

26 PRACTICE NEWS AND

48 PUBLIC HEALTH UPDATE

RESOURCES

30 MAKING THE RIGHT CALLS

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38 LEGISLATIVE WRAP UP

53 ELECTRONIC PRESCRIBING MANDATE

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PRESIDENT Raghunath Reddy, MD PRESIDENT ELECT Cyrus Buhari, DO TREASURER Nguyen Vo, MD BOARD MEMBERS Hyma Jasti, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Stephen Tsang, MD, Maggie Park, MD, Sujeeth Punnam, MD, John Zeiter, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD

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

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

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD

CONTRIBUTING WRITERS Jo Ann Kirby, Roger Phillips, Raghunath Reddy, MD, Maggie Park, MD, Amy Rhoades, MPH, Cheryl Laughlin

MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

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

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

James R. Halderman, MD, Raissa Hill, DO Richelle Marasigan, DO, Ramin Manshadi, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD, Philip Edington, MD

San Joaquin Physician Magazine

Harpreet Singh, MD

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

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EXECUTIVE DIRECTOR’S REPORT

STRONGER TOGETHER

In October, the CMA House of Delegates formally approved the merger of the Tuolumne County Medical Society with the San Joaquin Medical Society. They are in good company joining the other foothill communities, Alpine, Amador and Calaveras included in the SJMS service area. We are excited to expand and welcome colleagues from Tuolumne and know that we are stronger together as we work on a number very serious issues including defending MICRA again in the November 2022 election and looming Medicare cuts.

In what amounts to a “perfect storm” of payment cuts going into effect on January 1, 2022, physician practices face the following stack of Medicare financial hits:

LISA RICHMOND

• Expiration of the current Medicare 2% sequestration cut wavier given during the COVID-19 PHE.

• Imposition of an inadvertent 4% Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO.

• Expiration of last year’s Congressionally enacted bill to stop the 3.75% payment cuts to the Medicare physician fee schedule. Physicians were facing these cuts due to budget neutrality adjustments in the fee schedule but fortunately, Congress stepped in and stopped the cuts.

• A freeze in annual inflation updates for Medicare physicians.

This would result in a combined 9.75 percent payment cut on January 1! And all of this comes at a time when physician practices are still recovering from the sheer exhaustion and financial instability caused by the COVID-19 public health emergency.

Significantly, 245 Members of Congress, including local Representative Josh Harder, recently signed a letter to House Leadership highlighting the financial uncertainty with the Medicare payment system and urging leaders to pass legislation to stop the physician payment cuts before Jan 1, 2022.

SJMS and CMA urge physicians to continue to ask our Members of Congress to stop these cuts to protect access to care in the San Joaquin valley. Congress is expected to act on this legislation in mid-December.

On a much lighter note, we are so excited to finally celebrate 2020 Lifetime Achievement Award recipient, Dr. Peter Garbeff at our upcoming annual Holiday Party. We know you will enjoy reading more about Dr. Garbeff and Young Physician Award recipient, Dr. Philip Cheng.

We hope that you have a happy and healthy holiday season as we look forward to 2022!

Best Wishes,

Lisa Richmond

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WINTER 2021

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1-877-226-5820 SAN JOAQUIN PHYSICIAN

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Physician Education & Resources St. Joseph’s Medical Center offers a variety of updates and education just for physicians.

We have created one central page where you can get updates on everything from upcoming physician events and news, to CME presentations. To learn more and access session links please visit:

StJosephsCares.org/PhysicianEducation Free CME Opportunities for Physicians

Continuing Medical Education (CME) presentations, including Tuesday Noon Conferences, are listed on the web page with the appropriate meeting links.

CME

CREDITS

Provider Wellness Mixers

Join with your colleagues for a time to connect and decompress. Check out our website to find out when the next mixer will take place.

Community Updates

Find information on upcoming community updates and other hospital events and presentations.

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WINTER 2021

A message from our President > Raghunath Reddy, MD

MICRA Under Attack Again!!!

MICRA opponents are at it again and have succeeded in making it a ballot measure as a proposition (# to assigned in July 2022) that will be on the ballot in the November election. Most of you may recollect the Proposition 46 of 2014 election year wherein we were successful in our campaign to defend MICRA. The trial lawyers are at it again to overthrow MICRA with a new measure named “FIPA” with disastrous consequences for the healthcare industry, physicians, and patients, if they prevail.

Our society has grown since 2014 and there are quite a few new, young physicians who may not be well versed on MICRA and how it has helped in keeping malpractice premiums, health insurance premiums at a manageable level, in addition to umpteen other benefits such as minimizing and/or eliminating frivolous lawsuits. Therefore, I feel it is time to revisit and educate about MICRA and galvanize the physician community to put up a united front to defend it.

MICRA- Medical Injury Compensation Reform Act (MICRA) was the result of a massive campaign in mid-1970’s spearheaded by the CMA, channeling the frustrations of physicians due to spiraling costs of Medical malpractice which were resulting from frivolous lawsuits, excessive jury awards, massive increases in Malpractice premiums threatening the viability of many specialties practices Physicians were left with few choices and none of them acceptable: Raise fees, drop their professional liability insurance coverage, leave the state, or quit practicing medicine.

The CMA campaign was successful in persuading the then Governor Jerry Brown to call for a special session of legislative hearings that resulted in enacting MICRA in Sep 1975.

ABOUT THE AUTHOR Raghunath Reddy, MD is the current president of the San Joaquin Medical Society and practices family medicine at Stockton Primary Care Medical Center

According to Hamm-Frech-Wazzan report published in 2014 and revised in 2019.

(In agreeing to prepare the report, this committee insisted on, and were given, total control of methodology, findings, and conclusions, as well as complete control over the editorial content of the report. Findings and conclusions are the products of objective analysis, and do not necessarily reflect the sponsoring organization’s views.)

In 1975, the California Legislature enacted, and Governor Edmund G. Brown Jr. signed, the Medical Injury Compensation Reform Act, commonly known as “MICRA.” The

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A message from our President > Raghunath Reddy, MD

purpose of MICRA, as its author – Assemblyman Barry Keene – explained, was to address: . . . a persistent problem of enormously escalating medical costs [that have] evolved, in my judgment, into a crisis . . . [that] threatens to degenerate further into a catastrophe of immense proportions to the health care consumer.1 (Mr. Keene’s emphasis) Primary findings and conclusions can be summarized as follows: 1. A cap on non-economic damages reduces health care costs, thereby making health care more affordable.

2. An increase in the cap on non-economic damages would significantly increase the cost of health care in California.

3. An increase in the MICRA cap would raise the annual cost of California’s health care system by $11.4 billion. The increase in costs for the average California resident would be $285, or $1,141 for a family of four.

4. The additional $11.4 billion in health care costs resulting from a higher cap would be borne by three groups of Californians: consumers, workers, and taxpayers.

5. A higher cap on non-economic damages would reduce Californians’ access to quality health care. It would do so primarily in three ways: a. By making health care and health insurance more expensive and less affordable for California residents; b. By reducing the number of health care providers – doctors and hospitals – in California, particularly in rural, minority, and low-income areas; and c. By discouraging doctors from delivering babies and performing high-risk, but potentially lifesaving surgeries, where the risk of a lawsuit is disproportionately high.

6. The MICRA cap has not reduced access to the courts for individuals with meritorious claims.

7. Notwithstanding the MICRA cap, the rate of increase in medical liability damages awards in California far exceeds the rate of inflation. Even with the $250,000 cap on non-economic damages, the average size of paid claims has increased since 1976 at a rate that is more than 2.7 times the rate of inflation.

Other States Have Followed California’s Lead California was the first state to reform its medical liability tort system, and in the intervening years many other states have followed its lead. Currently, 31 states limit the size of noneconomic damages awards.

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The Fairness for Injured Patients Act (FIPA) Effectively Eliminates Caps on Non-Economic Damages The initiative creates a new category of injuries which are indistinguishable from other injuries and not currently recognized under California law. This new “catastrophic injury” category does not include caps on non-economic damages set forth by the Medical Injury Compensation Reform Act (MICRA) and eliminates caps on attorneys’ fees. This measure would essentially eliminate the attorneys’ fee cap on both non-economic and economic damages.

This measure would obliterate existing safeguards for out-ofcontrol medical lawsuits, resulting in skyrocketing healthcare costs and huge windfalls for attorneys who would get paid ahead of the patients, with uncapped fees in this new category.

This initiative was written and promoted by out of state trial attorney, who is also funding the majority of the campaign.

What can we do???

• Educate self and colleagues about MICRA and its benefits.

• Financially support and assist in fundraising campaign • Reach out to hospitals where you work • Talk to family, friends, and patients to vote no FIPA proposition • Talking points, flyers, education materials will be forthcoming from SJMS and CMA Please reach out with questions, ideas, suggestions or to help to SJMS Subcommittee on “Vote No on FIPA” campaign members Drs. Neelesh Bangalore, Sanjeev Goswami, Sujeeth Punnam, Raghunath Reddy.

The CMA is doing an excellent job in fighting to defend MICRA and have already engaged the same team from 2014 that successfully defended MICRA in defeating prop 46. Please also visit the campaign website www.protectmicra.org for MICRA related information.

In closing, I would like to appeal that this is one battle that none of us can take lightly as the consequences if FIPA succeeds are devastating to say the least and will have both immediate and long-term impact on the viability of the practice of medicine, tremendous cost escalation, risk of losing many specialty practices, providers shying away from performing high risk procedures and so on.

Together we can win this!!!

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Finding and fixing from the inside out.

Interventional Radiology offers minimally invasive options.

Today, with minimally invasive techniques, the Interventional Radiology team at St. Joseph’s Medical Center can treat many conditions that once required surgery, using minimally invasive treatments, offering less risk, less pain, and less recovery time for our patients, when compared to open surgery. Whether your patients are suffering from back pain, chronic kidney disease, heart and vascular conditions, cancer or men’s and women’s health issues, interventional radiology treatments are available to address many health concerns.

St. Joseph’s Interventional Radiologists have a wealth of experience and expertise in minimally invasive treatments. Some of those treatments include pulmonary embolism and DVT, radioembolization for liver cancer, cryoablation for kidney cancer and balloon kypohoplasty for vertebral compression fractures. For more information visit, StJosephsCares.org/Interventional-Radiology or call IR scheduling at 209.467.6323.

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In The News

IN THE

NEWS

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

psychoeducation and wellness recommendations to help her patients. She currently accepts Medicare, Cigna, and Optum/ United Healthcare with pending applications for Blue Cross Blue Shield and Aetna.

She is currently accepting patients and can be reached at 213375-8095 or through her website: thejazzydoc.com.

Jasmine Singh, MD Dr. Jasmine Singh, Board Certified psychiatrist, returns to practice in her hometown of Stockton, CA. Dr. Singh completed her residency in psychiatry at the University of California San Francisco in Fresno, CA. While in residency, Dr. Singh was invited to be a medical correspondent on local television. Here she produced and engaged in television segments aimed to spread mental health awareness and information to the masses. Dr. Singh has been featured on CBS, NBC, NPR, various podcasts, in addition to print magazines, newsletters, and even international channels.

A select few of her segments are available to watch on her YouTube channel, “The Jazzy Doc”.

Dr. Singh has now returned to her hometown of Stockton, CA, to open up her own private practice. Dr. Singh provides psychopharmacology services, as well as talk therapy,

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Lodi Memorial’s Advanced Imaging Center Offers the Latest Cancer Screening Technology Adventist Health Lodi Memorial has launched its newly renovated Advanced Imaging Center (AIC) which offers an unrivaled level of service by combining state-of-the-art equipment with well-trained, caring imaging clinicians. The hospital has made significant investments in acquiring some of the most advanced diagnostic screening tools in the county.

• Mammography- The Advanced Imaging Center at Adventist Health Lodi Memorial is now offering 3D Digital Mammography. This includes computer-assisted detection and artificial intelligence enhancement to help radiologists identify subtle tissue abnormalities.

• M RI- The AIC features a wide-bore MRI unit to accommodate larger patients and increase overall patient comfort. The high-tech unit also allows for non-invasive prostate screening and evaluation.

• Computerized Tomography (CT) Scanner- This scanner provides 128-Slice Imaging and contains Smart Dose Technology, providing the highest quality image with the lowest possible radiation dose.

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Lodi Memorial and Dameron Hospital Recognized by HealthGrades for Clinical Excellence According to new research released by Healthgrades, Adventist Health Lodi Memorial received Five-Star ratings for clinical achievements in categories that included: Orthopedics • Five-Star Recipient for Hip Fracture Treatment for 15 Years in a Row (2008 to 2022)

Lodi Memorial’s Advanced Imaging Center

• Ultrasound- The newest addition to the AIC is an Automated Breast Ultrasound Unit. This advanced screening tool is for patients with dense breasts that may otherwise be difficult to evaluate.

For patient scheduling and referrals, call the Imaging Center at 209-339-7505.

New Adventist Health Lodi Memorial Physical Therapy Office Opens at Reynolds Ranch Adventist Health Lodi Memorial is excited to announce the opening of its new rehabilitation services clinic at the Reynolds Ranch Shopping Center in Lodi.

Located at 2600 Reynolds Ranch Parkway, Suite 120, in Lodi, California, the new location operates as a joint partnership with PT Solutions Physical Therapy, which is fully committed to providing an excellent care experience while managing patients’ physical therapy services needs and restoring their health. Conveniently located off of Highway 99 between the Lodi and North Stockton communities, the clinic is staffed by three experienced physical therapists and offers easy access and ample parking.

PT Solutions Physical Therapy is the official provider of Rehabilitation Services at Dameron Hospital and Adventist Health Lodi Memorial in San Joaquin County. PT Solutions is a physical therapist‐owned private practice with over 220 points of service across the United States and is highly regarded by health care systems across the country.

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Critical Care • Five-Star Recipient for Treatment of Pulmonary Embolism in 2022 • Five-Star Recipient for Treatment of Respiratory Failure for 2 Years in a Row (2021 to 2022) Patient Safety • Recipient of the Healthgrades 2021 Patient Safety Excellence Award™ which placed Lodi Memorial among the Top 10% of all hospitals in the Nation for Patient Safety in 2021.

Additionally, Dameron Hospital, which is managed by Adventist Health, received a 2022 Five-Star rating for its clinical performance in Critical Care for ability to effectively manage treatment of diabetic emergencies in 2021.

Every year, Healthgrades evaluates hospital performance at nearly 4,500 hospitals nationwide for 31 of the most common inpatient procedures and conditions.

Introducing Angela Nicolini, DO, Family Medicine Adventist Health is proud to welcome new family medicine provider, Angela Nicolini, DO. Dr. Nicolini is a family medicine physician and a native to San Joaquin County.

Dr. Nicolini received her Doctor of Osteopathic Medicine at Touro University before completing her residency in Family Medicine at San Joaquin General Hospital. Throughout her education and career, she has been consistently communitydriven, working with various health fairs, community clinics, and homeless outreach.

Dr. Nicolini’s desire to care for her community is evident in her personalized approach to patient care. She considers caring for

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In The News

IN THE

NEWS Angela Nicolini, DO your family as important as caring for her own, and she brings a special interest in post-cancer care for patients and families.

Dr. Nicolini is currently accepting new patients at the Adventist Health Trinity Multispecialty Care Office located at 10200 Trinity Parkway in Stockton. For more information, please call 209-958-0808 or visit AdventistHealth.org/ ANicolini.

Introducing Eman Albaddawi, MD, Pulmonology Adventist Health Lodi Memorial is thrilled to welcome Dr. Eman Albaddawi to the AHLM pulmonology team. She joins a skilled team of local providers focused on respiratory health.

Dr. Albaddawi has extensive experience in the world of Internal Medicine and pulmonology. After obtaining her medical degree from Jordan University of Science and Technology, she went on to complete residencies at Jordan University and Mercy Hospital and Medical Center at the University of Illinois at Chicago. From there, Dr. Albaddawi

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

Eman Albaddawi, MD pursued two fellowships at Orlando Regional Medical Center in Pulmonary Medicine and Critical Care medicine, respectively.

Dr. Albaddawi has experience treating COPD, asthma, lung cancer, lung fibrosis, interstitial lung disease and pulmonary hypertension among other medical conditions.

She is currently welcoming new patients at the Adventist Health Pulmonology Office, located at 1231 West Vine Street, Suite 19 in Lodi. For more information, please call 209-3348586 or visit AdventistHealth.org/EAlbaddawi Lodi Memorial Receives Get with The Guidelines® Stroke Gold Plus Quality Achievement Award Adventist Health Lodi Memorial has received the American Heart Association/American Stroke Association’s Get with The Guidelines®-Stroke Gold Plus Quality Achievement Award for 2021.

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This prestigious award recognizes AHLM’s commitment to ensuring stroke patients receive the most appropriate treatments, according to nationally recognized, research-based guidelines.

covered by Medi-Cal Rx. HPSJ Providers are preparing now.

Learn more at hpsj.com/pharmacy-announcements/.

To receive the Gold Quality Achievement award, AHLM had to receive 85 percent or higher adherence to all Get with The Guidelines-Stroke achievement indicators for at least 24 consecutive months. The Gold Plus Quality Achievement is an even more advanced level of recognition, acknowledging the hospital’s consistent compliance with quality measures.

AHLM earned further recognition for Target: Stroke Honor Roll Elite, which means 75 percent or more of acute ischemic stroke patients who were treated with IV tPA, received thrombolytic therapy within 60 minutes.

“It is always an honor to be recognized for outstanding patient care” said Lodi Memorial Chief Medical Officer Eric Cornwell, MD. “This award is a reflection of the hard work and dedication of our stroke team, who is committed to providing advanced stroke treatments to our patients as quickly and effectively as possible.”

Spina Bifida Has Become a Condition of Adults Over the past few decades, individuals with spina bifida have been living longer and longer. Moreover, they tend to have less disabilities than they once did too. The story of this overlooked medical development is featured in a recent issue of the Provider Post, the quarterly newsletter of Shriners Hospitals for Children — Northern California.

The article describes how the population of people born with spina bifida has been getting older, to the point where there are now more adults with spina bifida than children, and how society’s acceptance of people with disabilities has evolved with this improved prognosis.

To read more, go to https://shriners.foleon.com/providerpost/summer-edition/welcome.

Rx Transition: From HPSJ to Medi-Cal Effective January 1, 2022 Health Plan of San Joaquin pharmacy benefits will be transitioned to and administered

by Medi-Cal Rx. After this date, ALL outpatient drugs will be

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Health Plan of San Joaquin (HPSJ) contributes to the California Health Care Foundation spotlight on enhanced roles for community health workers and promotores in Medi-Cal plans As part of its statewide “Advancing California’s Community Health Worker (CHW) & Promotor Workforce in MediCal” project, the California Health Care Foundation (CHCF) hosted a virtual October 14 event and introduced their newly launched online resource center for managed care plans looking to integrate CHWs and promotores into their programs. HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD, who participated in standing up this CHCF project along with HPSJ CEO Michael Schrader, was one of four featured speakers for the October web event.

For more about the new online resource center, go to https:// tinyurl.com/56keb75z. Read a report about the CHCF initiative and view the October event at https://tinyurl. com/3tjzx39p.

Health Plan of San Joaquin (HPS) launches COVID-19 vaccination incentive program and member outreach strategy: Ask. Learn.

Decide.

HPSJ has launched a fourth COVID-19 campaign, targeting young adults in communities of color. These groups experience greater disparities in vaccinations for many

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In The News

IN THE

NEWS reasons, including personal choice, misinformation, historical references, religion, and social influence. HPSJ’s goal, working with providers and partners throughout the community, is to increase COVID-19 vaccinations among HPSJ members to 73% by March 2022, with a direct and targeted approach.

Ask. Learn. Decide. is a no-pressure campaign that aims to: • Build trust by encouraging people to seek information on their own terms, probe, and uncover the facts • Empower people by addressing the topics that are of most concern and making the information readily available and easy to access • Encourage communities of color to make their own decisions about receiving the vaccine Using member vaccination data to identify “hot spots” in the community, HPSJ is now reaching out to members who are hesitant to receive the vaccine, aiming to address their specific questions and concerns.

As a component of our Vaccination Incentive Program, Health Plan of San Joaquin (HPSJ) is administering incentives to HPSJ members. These members are eligible to receive an incentive when they complete their first or second dose of the COVID-91 vaccination. Providers who are administering vaccinations will be required to provide an attestation signed by the patient. Medi-Cal Beneficiaries who decide to receive their vaccine from community-based vaccination sites will also be required to sign an attestation to request their incentive.

Upon validation of the attestation, HPSJ will mail a $50 gift card to the address provided by the Medi-Cal Beneficiary.

Do you have an event coming up? We can support your efforts in communicating with your patients. Contact us at 209.942.6300.

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

If your practice is not providing vaccinations to patients, please direct them to www.hpsj.com/decide for a community vaccination and testing calendar.

Do your HPSJ patients need transportation to test or vaccination sites? They can call HPSJ at 888.936.PLAN (7526), TTY/TDD 711 to set up transportation to/from their vaccine appointment.

St. Joseph’s Nationally Recognized with an ‘A’ For the Fall 2021 Leapfrog Hospital Safety Grade St. Joseph’s Medical Center was awarded an ‘A’ grade in the fall 2021 Leapfrog Hospital Safety Grade, a national distinction recognizing St. Joseph’s achievements protecting patients from harm and providing safer health care. This is St. Joseph’s fifth consecutive ‘A’ grade.

“We are honored to once again earn this recognition by The Leapfrog Group. This is truly a testament to our incredible team, whose dedication to safety and quality I see demonstrated in the hospital every day,” stated Don Wiley, president, and CEO of St. Joseph’s Medical Center. “This fifth consecutive ‘A’ grade illustrates our commitment to always providing the highest quality care to our community.”

The Leapfrog Group is an independent national watchdog organization committed to health care quality and safety. The Safety Grade is a letter grade assigned to all general hospitals across the country and updated every six months, assessing how well the hospital prevents medical errors and other harms to patients.

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St. Joseph’s awarded Gold Seal of Approval for Total Joint Replacement for Knee and Hip from The Joint Commission St. Joseph’s Medical Center has earned The Joint Commission’s Gold Seal of Approval® for Joint Replacement for Hip and Knee Certification by demonstrating continuous compliance with its performance standards. The Gold Seal is a symbol of quality that reflects a health care organization’s commitment to providing safe and quality patient care.

The certification recognizes health care organizations that provide clinical programs across the continuum of care for knee and hip joint replacements. The certification evaluates how organizations use clinical outcomes and performance measures to identify opportunities to improve care, as well as to educate and prepare patients and their caregivers for discharge.

St. Joseph’s underwent a rigorous, onsite review and during the visit, a team of Joint Commission reviewers evaluated compliance with related certification standards. Joint Commission standards are developed in consultation with health care experts and providers, measurement experts and patients. The reviewers also conducted onsite observations and interviews.

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“This certification recognizes health care organizations committed to fostering continuous quality improvement in patient safety and quality of care,” says Mark Pelletier, RN, MS, chief operating officer, Accreditation and Certification Operations, and chief nursing executive, The Joint Commission. “We commend St. Joseph’s for using certification to reduce variation in its clinical processes and to strengthen its program structure and management framework for knee and hip replacement patients.”

Physician Education & Resources at Your Fingertips St. Joseph’s has launched a one-stop webpage for physicians looking to find the latest information. Physicians can find information about free CME opportunities, Quarterly Provider Wellness Mixers and community updates. To learn more and access the information, please visit StJosephsCares. org/PhysicianEducation.

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IN THE

NEWS Kaiser Permanente Expands Access to Mental Health Services for Central Valley Students Kaiser Permanente Central Valley is partnering with four local organizations to provide additional mental health support to students in San Joaquin and Stanislaus counties.

The COVID-19 pandemic was especially challenging for children who were isolated from their friends, school activities and social networks. Many are still struggling to cope with the difficulties they and their families faced. Kaiser Permanente is committed to supporting the mental and emotional health of children by developing resources and creating partnerships in our communities.

More than $400,000 in grants from Kaiser Permanente will help the following community-based organizations in San Joaquin County, as well as two others in Stanislaus County, improve access to mental health programs, promote health equity for at-risk students, support in-person and virtual mentoring services, increase social and emotional learning skills, and more: • Delta Health Care: An organization focused on promoting community health and wellness and providing services that support individuals and families of San Joaquin County.

A $150,000 grant will help provide mental health services,

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

referrals, and support for adolescents and teens attending high schools within Stockton Unified School District.

• Sow a Seed: Committed to empowering youth and their families with the education, programs, and resources necessary to overcome social and emotional challenges, Sow-A-Seed has received $100,000 to improve youth access to mental health services. The grant will promote health equity for at-risk youth by integrating in-person and virtual mentoring and mental health services into school and community center settings.

“These local organizations have a shared goal of meeting the many health care needs of our diverse communities,” says Darryl Curry, Interim Vice President and Area Manager for Kaiser Permanente Central Valley. “The need for mental health services is only increasing, especially among our youth.

We are proud to support the dedicated efforts of our trusted community partners as we work together to remove barriers and provide the best care for those in need.”

This year Kaiser Permanente has awarded more than $2.2 million to local organizations across the Central Valley in support of a wide range of programs and services focused on improving the health, safety, and access to care in underserved communities. These community grants are a part of Kaiser Permanente’s ongoing commitment to improving the total health of the communities we serve.

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The Pediatric Orthopedic Program Parents and providers choose care at Shriners Hospitals for Children — Northern California for children with a wide range of musculoskeletal conditions.

As a leader in orthopedic care, our programs include: » Hand and upper extremity

» Pediatric orthopedic surgery

• Hand differences

• Hip, knee and foot disorders

• Post-traumatic deformities

• Growth modulation

» Multi-disciplinary neuromuscular • Cerebral palsy • Brachial plexus injury • Spina bifida

Together with UC Davis Children’s Hospital

• Limb lengthening • Skeletal dysplasias • Musculoskeletal tumors » Spine surgery

• Rehabilitation

• Scoliosis

- Traumatic brain injury - Spinal cord injury

• Complex spine deformities » Sports medicine and joint preservation

To Refer a Patient WINTER 2021

Call: (916) 453-2191 Fax: (916) 453-2395 Email: referrals.ncal@shrinenet.org SAN JOAQUIN PHYSICIAN Online Referral Form: www.shrinerschildrens.org/referandtransfer

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Passion and Purpose Make CMA the Most Effective Advocacy Organization The California Medical Association (CMA) proudly advocates on behalf of its nearly 50,000 members for pragmatic and forward-looking policies that keep patients healthy and communities thriving.

The 2021 legislative session has once again demonstrated CMA’s ability to develop and enact health policy that reflects the needs of physician practices, while the COVID-19 pandemic has reinforced why CMA must continue to champion sound, science-based policies, legislation and regulations.

For 165 years, CMA has been honored to represent physicians to ensure the medical community is well-equipped to address any challenge that stands in the way of their ability to deliver timely, accessible and affordable health care to all Californians.

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The Value of Advocacy - 2021 Edition | 1

Reducing Costly Administrative Burdens In this legislative session, CMA blocked attempts to add costly administrative burdens in physician practices, so physicians can dedicate more time to patient care. This included:

Defeating attempts to add over $2 billion in unfunded staffing costs at a time when physician practices were already struggling financially due to the public health emergency +

Saving physicians approximately $40 million over two years by defeating attempts to increase Medical Board of California licensing fees by nearly 50%

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Ensuring physicians retain valuable patient care time by: ٙ Defeating legislation that would have required physicians to provide written and oral disclosure to every patient of all payments received by all drug and/or device manufacturers, as well as notifying patients of the existence of the Open Payments database where that information is housed ٙ Preventing new burdensome and duplicative reporting requirements that would have required physicians to submit weekly reports to the California Department of Public Health (CDPH) on any patient with a respiratory disease even though this information is already being submitted through the Confidential Morbidity Report

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Saving physicians from costly new annual disclosure requirements by defeating legislation that would have required updated recordkeeping software and additional staff to ensure compliance

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Defeating legislation that would have wasted time and money on unnecessary testing by creating new obligations for physicians in emergency departments

Helping Physicians Navigate the Pandemic Throughout the public health emergency, CMA has advocated for programs and policies to support physician practices as they navigate the hardships of the COVID-19 pandemic. This included:

Distributing $100+ million worth of PPE at no cost to more than 8,000 physician practices across the state to ensure they can safely serve the patients of California +

Successfully advocating for reduced administrative burdens related to licensure renewal and continuing medical education (CME) requirements during the pandemic

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Advocating for policies to ensure practices could both implement and be reimbursed for telehealth so physicians could continue providing care safely to their patients

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Advocating for and administering the CalVaxGrant program, which provided $40 million to health care providers to encourage participation in the COVID-19 vaccination program.

Applicants enrolled to become vaccine providers, including physician practices with 200 or fewer physicians, were eligible for grants of up to $55,000.

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The Value of Advocacy - 2021 Edition | 2

Protecting the Financial Health of Physician Practices Over the past year, CMA has made it a top priority to ensure the financial health of physician practices. We accomplished this by:

Making permanent $1.2 billion in tobacco tax funding to increase Medi-Cal reimbursements for eligible services +

Extending telehealth payment parity to require health insurers to cover services provided via telehealth—including audio-only services—in the same way they would an in-person encounter for all plan-provider contracts. This requirement applies to Medi-Cal managed care to ensure that Medi-Cal providers have the same economic benefit as commercial providers.

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Defeating attempts to change the timeframe during which patients may consent to be charged for medical services, while allowing for consent to be given electronically

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Securing physician reimbursement for adverse childhood experiences (ACEs) screenings from commercial plans, in addition to Medi-Cal

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Providing more than $150 million in state tax relief for physician practices by bringing full conformity between California state tax code and federal law with regard to Paycheck Protection Program (PPP) loans, making forgiven PPP loans state tax-deductible and delivering tax relief to businesses hit hardest by the pandemic

+

Restoring the full deductibility of state and local taxes for federal tax purposes for entities organized as LLCs, Partnerships and S-Corporations. The 2017 Federal Tax Cut and Jobs Act had placed a cap of $10,000 on the amount of state and local taxes that an individual could deduct on their federal taxes. This policy negatively affected physician practices as their state and local taxes paid were often higher than this cap.

Increasing Health Care Coverage Increasing access to quality health care for all Californians has remained a top priority for CMA. This year we continued the fight by:

Preventing health plans from steering patients away from their own community doctors for telehealth visits, helping physicians maintain a stable patient load and provide better integrated care +

Securing additional eligibility for Medi-Cal in several ways in the 2021-2022 state budget: ٙ Extending coverage to all children under 5, eliminating the risk of these patients sliding into and out of coverage while a physician is managing their care ٙ Expanding eligibility for full-scope coverage to individuals 50 and older, regardless of documentation status ٙ Restructuring the eligibility determination to focus on income rather than assets, thus widening the pool of Californians with access to health care coverage

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+

Protecting patients from delays or treatment interruptions by creating a more transparent and standardized process in step therapy protocols ٙ Requiring prior authorization or step therapy exception requests to be deemed approved if a health plan or insurer fails to act within a specified timeframe

Physician Workforce CMA is committed to ensuring California is training and recruiting enough physicians to meet current and future demand. This year, we:

Increased state investment in physician recruitment incentives and programs, including $30 million for physician loan repayment +

Simplified the process of obtaining a California medical license for out-of-state physicians, while still maintaining current licensing and professional standards

+

Expanded the definition of CME-qualifying activities to include practice management content, as these topics assist physicians in carrying out their professional responsibilities more effectively and efficiently, and results in better services to patients

Call (800) 786-4262 or visit cmadocs.org to learn more.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare.

For the time being, we will be offering Zoom Meetings until we can get back to meeting in person.

This monthly forum is normally held on the second Wednesday of each month. Registration is required!

If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org for the Zoom call info!

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December 8th, 2021: 11:00AM to 1:00PM

" Medicare Changes:2022 and Beyond” This 60-minute virtual (online) training provides your practice with updates on Policy, Payment and Quality Provisions for Medicare under the Physician Fee Schedule (PFS) for CY 2022 and beyond.

Subjects highlighted in this workshop: • • • • •

Telehealth during COVID- PHE Evaluation and Management (E/M) Visits Quality Payment Program (MACRA) Year 6 Compliance with the MAC Other Medicare Part B issues

Your billing staff will walk away with the resources to decrease denials and maximize reimbursement.

Cheryl Bradley is an Associate Director in CMA’s Center for Economic Services.

She has over 25 years’ experience in the Medicare Program and has held a variety of responsibilities including Education and Training Specialist, Medical Review Analyst, and has worked with providers in virtually all specialties across all the CA Medicare contractors. Cheryl is a known educator speaking at conferences, state associations, and for numerous organizations. She provides problem solving assistance to CMA member physicians on a number of Medicare issues.

She is great at using humor to help providers navigate this difficult healthcare program.

January 12th, 2022: 11:30AM to 1:30PM

“Certified OSHA Staff Training”

Federal OSHA regulation Title 29, Part 19101030 requires that all employees who have potential for exposure to blood and bloodborne pathogens (BBP) must receive training before

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they begin suchg work and must be retrained annually. If the practice is organized as a PA, LLP or LLC OSHA considers doctors to be employees and they must also receive training.

A certificate of course completion will be given to each attendee. While the certificate documents safety training required by CalOSHA regulations, It must also be supported by the employer’s in-office, site- specific Exposure Control Plan.

Carrie Champness, RN, BSN Safety Compliance Specialist- Carrie has been an OSHA compliance specialist for over 35 years and provides up-to-date information about changes and practice requirements to meet all OSHA mandates.

CMA PRACTICE RESOURCES $55,000 in Practice Suppor t CalVaxGrant Available through December 17th As Califor nia continues its efforts to vaccinate all eligible residents against COVID-19, the state is offering providers up to $55,000 to support vaccination efforts. To be eligible for the CalVaxGrant, organizations must: • B e one of the following types of medical provider (routine or non-routine vaccinator):

• M edical practice* with no more than 200 physicians

• * Medical group/private practice, Federally Qualified Health Centers (FQHC), Rural Health Clinic (RHC), community health center, migrant or refugee health center, STD/HIV clinic health center, tribal health center, Indian Health Service (IHS) or urgent care

• I ndependent pharmacy organization

• S tudent vaccine clinic, which includes student health centers, university

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health centers and K-12 schools

• H ome health agency

• Skilled nursing facility • Be enrolled in myCAvax

• N eed help with the myCAVax application? Email myCAvaxInfo@ cdph.ca.gov for one-on-one application support • E xpend or plan to expend award on allowable expenses, which includes staffing and training (most common expenses), technology, infrastructure, supplies/ equipment and administrative overhead

• H ave not received money from the State Innovation Fund

Ensure your practice information is up-to-date with contracted payors Every practice understands the importance of collecting up-to-date demographic information from patients, including changes to a patient’s address, phone number, insurance, and eligibility and benefits. Ensuring that these items are up to date guarantees that the practice can quickly communicate with the patient about test results or other medical issues, as well as schedule and confirm appointments. Accurate patient insurance, eligibility and benefits information also helps to prevent unnecessary denials or delays in payment, and goes a long way toward ultimately saving time and money for the practice.

It is equally important that physicians ensure their practice demographic information is up to date with any contracted payors.

• R eason #1 – Up-to-date practice information such as specialty, address, tax identification number (TIN), practice name, and complete list of physicians in the practice (along with their national provider identification numbers) ensures that payments and other vital contractual notices are received by the practice.

• R eason #2 – Providing updated, accurate practice information to payors ensures that your information is displayed correctly to patients looking for a physician through payors’ provider directories. It also helps

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reduce the potential for delayed or denied payments.

• R eason #3 – It will likely keep your practice compliant with your contracts.

Most payors have language in their contracts that requires physicians to notify the payor in writing of any changes in their practice.

To ensure that your information is accurate, practices are encouraged to review their information with each contracted payor on an annual basis, at minimum. However, if a practice is moving, adding or losing providers, changing the practice name and/or TIN, closing a practice or changing specialties, it’s important to inform the payor ahead of time.

Information that should be reviewed includes, but is not limited to: • Practice name • Practice TIN • Practice and physician NPIs • Specialty • Practice physical address • Practice phone number • Pay-to address • P hysician or lead administrator email address (if available) • Practice fax number • W hether the practice is open/closed to new patients • L anguages spoken (if published) • P roducts for which the practice is contracted • P roviders included in the contract • P roviders leaving/joining practice • H ospital privileges The Califor nia Medical Association (CMA) has queried the major payors on their processes for updating provider demographic information and compiled their responses into a new resource for physicians, “Updating Provider Demographic Information with Payors,” which is available free to CMA members.

Practices should be aware that updates to provider demographics may take up to 90 days to complete – so submitting an update to the payor as soon as information changes is extremely important.

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San Joaquin Medical Society Member Only Benefits • Complimentary Dark Web Compromise Credential Report ✓ Over 11 billion accounts have been compromised – Has yours?

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Making theRight

CALLS LIFETIME ACHIEVEMENT AWARD RECIPIENT CONNECTS WITH HOMETOWN PATIENTS

BY JO ANN KIRBY

From his office at Sutter Gould in Stockton, Dr. Peter Garbeff, M.D., can look out and spot his elementary school in the Parkwoods neighborhood where he grew up after moving here with his family from the Midwest as a young boy.

Some of those Midwestern traits of altruism, a strong work ethic and modest integrity stuck with him and are evident in the way the urologist cares for his patients. “I think his best quality is his sense of patient care,” Dr. Kurt Roemer, who has been in practice with Dr. Garbeff for more than several decades. “He’s the only person I know who still takes two or three hours a day to make patient calls. Because of that, of course, his patients love him. I think he’s a very compassionate, giving person and that really that speaks volumes in his relationships with all his patients.”

Growing up in Stockton, Dr. Garbeff attended Lincoln High School where he excelled in academics. Dr. Roemer recalls being at a Lincoln High basketball function for the team his son coaches and seeing an old yearbook photo of Dr. Garbeff on display. “I took a picture and shared it with him. >>

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A family friend sealed his fate in the best possible way. When he was contemplating his path, Dr. Fred Wilcox, a Stockton OB/GYN who he considers a mentor, asked him what he was going to do and advised him to consider urology because he had a friend who was head of urology at the famed Mayo Clinic. “When someone opens a door, you walk through it,” Dr. Garbeff said of the once-in-a-lifetime opportunity. “That’s something I always tell my kids.”

When my son orders Lincoln swag I make sure I get something for Peter,” Dr. Roemer said.

His roots here give him an advantage with many of his patients who feel like they know him. But his devotion to them is what really wins them over.

In nominating Dr. Garbeff for the San Joaquin Medical Society’s Lifetime Achievement Award, Dr. Joseph Serra noted that the urologist is dedicated to his patients, taking the time to report lab results the same day. Not only is he popular with patients but he is always available to assist colleagues with projects and concerns, Dr. Serra said.

The doctor truly enjoys his work, calling urology an innovative field that is changing by leaps and bounds. He didn’t set out with his sights on the medical field. Attending University of California at Davis, he was initially bent on majoring in economics. “Well, I was bored to death and everyone else in my dorm was going to be a doctor, so I said, ‘why not,’’’ he recalls.

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After graduating from UC Davis in 1977 with a Bachelor of Science degree in biological sciences, he went on to finish medical school at University of Southern California. He then took advantage of that connection that Dr. Wilcox presented him, going on to serve both his internship and residency at the Mayo Clinic. He then worked as a chief resident in urology there before coming home to California to begin his practice.

Dr. Roemer said Garbeff ’s solid character and compassion stand out. “He was very helpful to me when my first year of practice with a partner didn’t work out so well,” Dr. Roemer said. “He let me work in his office without even charging me rent. I’ve always been so impressed by his generosity.”

He also is a proud father. He has three children of his own and two stepchildren with his wife Loretta along with multiple grandchildren and a great grandchild. His lifetime achievement award will give his daughter a great excuse to come out from Chicago for the party to join her younger brothers in attendance, something that brought tears to his eyes when it was announced. “It came as a big surprise,” he said, of the moment Lisa Richmond, executive director of SJMS, and her colleague came by his office to announce the award. “I had tears in my eyes,” he said with a chuckle. “And they said, ‘oh you have tears in eyes’, and I said yeah it’s another party and I don’t like parties.”

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That’s no surprise, given his calm demeanor and dedication to his work.

As he reflects on his career, he says it’s been hectic at times. Taking care of patients day in and day out doesn’t leave much time for contemplation but one thing does stick out. “The thank yous I get back from people really mean a lot,” he said. And the San Joaquin Medical Society’s big thank you in acknowledging his commitment to the medical community means a lot, as well.

Nominated in 2020, the celebration has been put off due to the Covid-19 pandemic. But it is finally time for the humble doctor to shine in the spotlight for a moment. But then, it will be back to the office.

The pandemic presented a few obstacles to practicing medicine but he was able to navigate it so that his patients weren’t impacted beyond some surgeries being put on the back burner.

As the pandemic dragged on Dr. Garbeff learned he wasn’t a huge fan of

“I have no plans to retire, as long my brain keeps working and I have the motivation, I’ll be here.” telehealth practices. He prefers to communicate with patients the old-fashioned way, by picking up the phone or checking in with his patients in person. And he doesn’t plan on retiring any time soon. He’s as busy as ever, mentally triaging who is sickest and needs to see him first on any given day.

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“I’ll keep on working,” he said. Even on the weekends, an ideal day off has him arriving at the office around 6 a.m. and working until 10 a.m. It’s not much different from a regular weekday when he is the first person in the office. “I have no plans to retire, as long my brain keeps working and I have the motivation, I’ll be here,” he said.

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Advanced Interventional Radiology Procedures in Central Valley The interventional radiology (IR) team at Doctors Hospital of Manteca diagnoses and treats medical conditions using X-rays, ultrasound and computerized tomography (CT) in largely an outpatient setting. If your patient needs a minimally invasive image-guided alternative to open surgery, we offer the following core interventional procedures: Arterial study for angioplasty, stent, grafts and thrombolysis

Placing and removing inferior vena cava (IVC) filters

Biopsies

Thoracentesis

DVT/PE thrombectomy, thrombolysis

Urinary tract obstruction or stone management

Dialysis vascular access and maintenance of fistula, AV declot Embolization (uterine fibroid embolization, varicocele, for pelvic congestion and for aneurysms) Epidurals, pain block and myelogram Gastrostomy tube placement

Varicose vein treatment Vascular access (ports and lines) Venous thrombolysis, thrombectomy and recanalization Vertebral augmentation for compression fractures (kyphoplasty and vertebroplasty)

Paracentesis

To refer a patient, please call 855-476-4445 or visit DoctorsManteca.com WINTER 2021

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WINTER 2021

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Entering 2021, hope abounded that the pandemic would dissipate, allowing to life to return to normal. But the collective longing for normalcy would go unmet. The California State Legislature continued to operate under public health protocols that limited in-person contact and relied upon non-traditional approaches to advocacy. As veteran legislators began settling back into their Capitol offices, 18 new elected legislators were sworn into the Legislature: twelve Democrats and six Republicans. With these additions, the Democrats increased their existing supermajorities in both the Senate and the Assembly.

Implementing lessons learned from the prior year on how to better navigate the Capitol’s hybrid-working approach and prohibition on in-person meetings, the California Medical Association (CMA) took an aggressive approach to the year. Specifically, CMA sponsored and cosponsored a larger number of bills than standard practice, entered a greater number of partnerships and coalitions, and maintained an aggressive posture throughout the year, despite calls from legislative leadership to decrease the number of bills under consideration.

By the end of the first quarter of 2021, CMA had already provided approximately $250 million in state tax relief to the physicians of California.

The aggressive positioning of the association allowed CMA to take advantage of abnormalities in the legislative process. For example, during his presentation of the January 10 budget proposal, Governor Newsom called for the Legislature to take early action on specific items designed to either re-open K-12 public schools or boost the economy. This break from the traditional state budget process allowed CMA to lead a multi-industry coalition effort to enact the largest state tax rebate in the history of California, through CMA-sponsored AB 80 (BURKE).

This bill provided full state tax conformity with federal tax rules regarding the deductibility of forgiven Paycheck Protection Program loans for physician practices. Thus, by the end of the first quarter of 2021, CMA had already provided approximately $250 million in state tax relief to the physicians of California.

during the pandemic have not been recovered. Affordable housing, homelessness and school re-opening remained the top overarching policy areas California’s legislative leadership and the Governor sought to address.

CMA was able to utilize the budget process to make significant progress towards achieving interoperability within the health care delivery system.

Specifically, the 2021-22 State Budget establishes the California Data Exchange Framework, which puts California on a path toward making all electronic health data available at the point of care for every patient.

Although pandemic response was also a top priority, it was not among the highest profile matters at the beginning of traditional budget deliberations. However, the COVID-19 pandemic clearly identified rampant inequalities in health care. Whether it was testing, access to physician practices or availability of hospital beds, the case was clear that too many areas of the state did not have sufficient access to health care.

CMA refused to concede the point. Though pandemic response was only a portion of what the state needed to address through budgetary allocations, CMA persisted and worked to achieve many victories including: •

EXTENDING THE TELEHEALTH FLEXIBILITIES and expansions from the COVID-19 public health emergency, including payment parity for telehealth (including audio-only) in Medi-Cal, for an additional year. This will provide $179 million in reimbursements for these services and ensure patients continue to have access to care via telehealth.

•

MAKING PERMANENT THE PROPOSITION 56 TOBACCO TAX FUNDING, ensuring certainty of $1.2 billion in total funds ($413.9 million in general funds) annually to continue the Medi-Cal supplemental payments. This will increase practice stability for Medi-Cal practitioners and access to care for Medi-Cal beneficiaries.

•

EXPANDING ELIGIBILITY FOR FULL-SCOPE COVERAGE to individuals 50 and older, regardless of documentation status.

With an early victory on state tax conformity, CMA was well positioned for the traditional state budget.

Despite programs and efforts to mitigate the economic impacts of the pandemic, many Californians still face severe hardships. Over 4 million Californians remain unemployed and approximately half of the jobs lost

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•

EXTENDING COVERAGE TO ALL CHILDREN UNDER 5, eliminating the risk of these patients sliding into and out of coverage while a physician is managing their care.

•

SECURING $50 MILLION, ONE-TIME IN GME FUNDING to support startup costs for new residency programs.

•

PROVIDING GRANTS OF UP TO $50K TO PHYSICIAN PRACTICES to incentivize participation in the state’s vaccine network for a total of $37 million in one-time support for the community vaccination rollout effort.

•

FIXING THE STATE AND LOCAL TAX (SALT) DEDUCTION CAP. For an individual with a $200k per year total combined (business and wage) income, this change amounts to an estimated $3,900 per year total tax reduction for those who choose to pursue this option.

In addition to these victories, CMA was able to utilize the budget process to make significant progress towards achieving interoperability within the health care delivery system. Specifically, the 2021-22 State Budget establishes the California Data Exchange Framework, which puts California on a path toward making all electronic health data available at the point of care for every patient. Under the framework, the State of California will develop a standard data sharing agreement through which all physicians, hospitals and health plans will exchange health care data. The state will also work with CMA and others to develop a program of technical assistance to support small and safety net practices.

With the main budget bill enacted, CMA turned its attention to the passage of the association’s remaining sponsored bills and priority bills of interest. Below are summaries of outcomes in particular issue areas.

SCOPE OF PRACTICE A primary focus of CMA’s Government Relations team was to ensure that the singular occurrence of the passing of a major scope bill did not turn into a harmful pattern.

Despite many attempts, CMA was able to stop bills that sought to further erode important patient protections.

Most notably, AB 1328 (IRWIN) if enacted, would have increased pharmacists’ scope by authorizing them to order and interpret all CLIA-approved tests, as opposed to only monitoring and managing the efficacy and toxicity of drug therapies. In partnership with the American College of Obstetricians and Gynecologists, CMA was successful in defeating this legislation. In addition, AB 407 (SALAS) would have allowed optometrists to treat more severe eye diseases with the use of pharmaceutical agents and therapeutic pharmaceutical agents without increased

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education and training. Recognizing the detrimental impact this bill would have, CMA teamed up with the California Academy of Eye Physicians and Surgeons and successfully limited the optometrists’ expansion to include treatable areas, such as the front of the eye, eyelids and adjacent tissue, as well as shortened the list of approved drugs for the conditions they may treat.

ADMINISTRATIVE BURDENS CMA-sponsored SB 510, authored by Senator Richard Pan, M.D., requires the health plans and insurers to cover COVID-19 testing and vaccinations during the pandemic without barriers like patient cost-sharing or prior authorizations. At a time when health inequities have been laid bare in the health care system, SB 510 ensures that all Californians, regardless of race, income or geographic region are able to receive vaccination and testing, which will remain necessary until the conclusion of the pandemic. This bill implements valuable lessons learned over the course of the pandemic, setting up a framework in preparation for future public health crises.

Protecting practices from future sudden dramatic cost increases is necessary to increase the resiliency of physician practices during significant public health crises.

CMA also sponsored SB 242 by Senator Josh Newman, which requires health care plans and insurers to reimburse provider costs related to the procurement of critical safety supplies, such as personal protective equipment. These increased costs have impacted physician practices of all sizes. Protecting practices from future sudden dramatic cost increases is necessary to increase the resiliency of physician practices during significant public health crises.

The passage of SB 242 will ensure health plans meet their obligation to protect provider networks and ensure access to care for all Californians.

TELEHEALTH

AB 457 by Miguel Santiago ensures that patients are notified of their rights to have a telehealth visit with their own physician. It would further guarantee that, when patients do access services through a third-party corporate telehealth provider, they receive high quality, integrated care including the sharing of medical records.

Essentially, AB 457 stops health insurers from steering patients away from their treating physicians to third-party,

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direct to consumer companies utilizing a “next doc up” model of care. Thus, it ensures that patients have the right to turn to their treating physicians to continue receiving coordinated, fully integrated care.

MENTAL HEALTH COVERAGE The COVID-19 pandemic has increased the spotlight on the importance of identifying and treating mental health conditions across the board. CMA-sponsored SB 428, authored by Melissa Hurtado, requires commercial health care service plan contracts or health insurance policies to provide coverage for adverse childhood experiences (ACEs) screenings. This bill makes commercial plan coverage consistent with the screening coverage currently provided for Medi-Cal beneficiaries to assist the California Surgeon General’s goal of providing universal screening for all Californians.

FIGHT ON! Though the pandemic persists and the changing dynamics of state legislature continue to create chaos, the voice of the physician community is breaking through. The accomplishments, achievements and acclaim of this year showcased CMA’s ability to move forward an agenda to protect physician practices, increase access to care and build a prosperous future for the medical profession.

Our fight is not finished. Next year, we will continue to push for additional relief from onerous administrative burdens, to protect physician autonomy and to preserve an economic environment that allows physician practices to keep their doors open to the communities they serve.

In unity,

IMPROVING PUBLIC HEALTH, INCREASING ACCESS TO CARE CMA has worked tirelessly for decades to decrease the harmful impacts of tobacco. With the successful passage of Proposition 56 in 2016, the state increased the taxation on traditional cigarettes, but inadvertently created a financial incentive for traditional smokers to switch to vaping products that where taxed at a lower level.

Authored by Senator Ann Caballero, SB 395 imposes a 12.5% tax on e-cigarettes to reduce their use and generate revenue for important health care workforce initiatives.

Most significantly, the majority of the ongoing funding— an estimated $30 MILLION each year—will be used to support the Medi-Cal Loan Repayment Programs for Physicians and Dentists.

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Janus L. Norman CMA Senior Vice President Centers for Government Relations and Political Operations For more details on the major bills that CMA followed this year, visit cmadocs.org/legwrap2021. Subscribe to CMA’s free biweekly Newswire and stay informed on CMA’s legislative efforts and other issues critical to the practice of medicine at cmadocs.org/subscribe.

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Philip Cheng, MD Receives 2020 Young Physician Award A transformative doctor whose work secured efforts to care for sick children locally, instead of sending them out of the area for treatment, is being honored for his efforts

In early Spring 2020, Dr. Philip Cheng was selected by the nominating committee as the Young Physician Award recipient before the pandemic required that the festivities be postponed. He grew up in Stockton, attending local schools before going away to college at University of California, Riverside. Later he attended medical school at Virginia Commonwealth University and trained at University of California San Francisco, Fresno campus before completing his Fellowship in Neonatal-Perinatal Medicine at University of California, San Diego, where he was Chief Fellow.

Dr. Cheng returned to Stockton to practice alongside his father, Shyh-Fang Cheng, MD at St. Joseph’s Medical Center (SJMC), where he has been the Chair of the pediatrics department and medical director of the Neonatal Intensive Care Unit. In 2018, he was the recipient of the “Champion of Quality” award at SJMC, where he was instrumental in bringing the most up-to-date technology and treatment protocols to the NICU. Additionally, he spearheaded the start of a pediatric hospitalist program at SJMC, which has been key in preventing the transfer of sick children from our county to the Bay Area. According to one of the nominating physicians, Dr. Kwabena Adubofour, “Dr. Cheng continues to foster excellence in the management of sick kids.”

When asked about the best part of working in the community in which he grew up, Dr. Cheng said, “coming to work was truly rewarding as I felt that not only was I helping the babies get better, but I was making a direct impact on the future of the Stockton community.”

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During his time back in Stockton, Dr. Cheng joined SJMS’ Decision Medicine committee and was the keynote speaker at the celebration banquet for the class of 2017. He has served on the SJMS Board of Directors for the past two years.

In April 2020, Dr. Cheng married his “better half ” Enny and the two are proudly raising Milo, the goldendoodle. Recently, they made the difficult decision to move back to Fresno to pursue an opportunity at Community Regional Medical Center.

His last day was December 1. Although he is not able to attend the awards dinner, the San Joaquin Medical Society would like to thank him for his service on the board and recognize his contributions in elevating the level of care for the babies and children of our community.

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Gleason House marks

10 years

as a medical home

for Stockton’s homeless

BY ROGER PHILLIPS

Windows were broken. The flooring sloped.

Randy Pinnelli has not-so-fond memories of the first time he set foot in the decaying downtown home that once belonged to pioneering Stockton pharmacist and City Councilwoman Edna Gleason.

“There were leaks in the roof and pigeons in the attic,” Pinnelli recalls of the home on the grounds of the Gospel Center Rescue Mission. A contractor assessing the house said it would be cheaper to tear it down and start from scratch.

It was 2002, and Pinnelli, director of Community Medical Centers’ 1-year-old CareLink Healthcare for the Homeless Program, was touring the house with Bill Brown, then the CEO of the Rescue Mission.

“We’d love to have you here at the Mission,” Brown told Pinnelli.

Pinnelli was intrigued. The location and the vision of what a refurbished Gleason House could be seemed tailor-made for a clinic devoted to caring for the homeless. Once then-CMC CEO Mike Kirkpatrick toured the battered house, a 30-year lease was agreed upon. The rent was $1 a year.

It would take nearly a decade to find the funding for the massive refurbishment that enabled Gleason House to open its doors as a medical clinic. It has proven to be worth the wait. >>

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“Now, our homeless population had a home to come to,” Medical Receptionist Lettie Berber says. “That was very exciting.”

November marks the 10th anniversary of Gleason House’s opening. Pinnelli and Berber are two of five original Gleason House staff members still with CMC. The others are Social Worker/Case Manager Vikki Cardona, Medical Assistant Jeffrey Palacio-Cortez, and Receptionist Kelly Rillamas-Ente.

There’s a sense of kinship among them. They are the ones who watched their workplace become a neighborhood landmark on San Joaquin Street south of the Crosstown Freeway. Each feels a bond with the light blue shingled two-story former home of Edna Gleason.

“It doesn’t look like a typical community clinic from the outside,” Palacio-Cortez says. “It gives a homey feel to it.”

After 10 years, Gleason House remains the place for homeless residents to go when they need medical care provided by CMC staff.

But CareLink staffing grew over the past decade to the point where the homeless outreach unit recently moved to roomier office space a few blocks away. The new space serves as the launching pad for CareLink staff before they head out for mobile clinics serving the homeless in the county’s encampments and sloughs.

“But in our hearts, Gleason House is our forever home,” Rillamas-Ente says.

Cardona sees a symbolic link between the once-battered house on South San Joaquin Street and the patients served within its now-sturdy walls.

“It’s a metaphor for how our patients are: We see them first, broken, with different ailments physically and mentally,” Cardona says. “And then we come alongside and partner with them, and we’re able to see some transformation in certain parts of their life that they’re ready to transform. It’s kind of like the house.”

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

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

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We Help You Get Paid CMA’s reimbursement experts have recouped $33 million from payors on behalf of member physicians in the past 12 years.

COVID-19 We know that many physician practices are struggling financially in the wake of the COVID-19 pandemic. That’s why CMA continues to work closely with state and federal leaders to ensure that physicians are included in COVID-19 relief programs. CMA has also ensured that there is payment parity between in-person and telehealth services, including telephonic visits, and will continue to fight for physicians’ ability to use telehealth services while not being undercut by out-of-state teledoc companies. Telehealth services have proven to be a critical tool for physicians so they can safely provide care to those who need it during the COVID-19 public health emergency.

PRACTICE MANAGEMENT ASSISTANCE CMA’s practice management experts provide free assistance to members and their staff on reimbursement, contracting and practice management related issues.

DIRECT PAYOR INTERVENTION CMA has recouped $33 million from payors on behalf of CMA member physicians in the past 12 years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.

EDUCATION CMA offers timely, high-quality education programs for physicians and their staff. From interactive in-person seminars to live and on-demand webinars, CMA provides the information needed to help run a successful medical practice.

PRACTICE MANAGEMENT NEWSLETTER CMA Practice Resources—known as CPR—is a monthly email bulletin that includes tips and tools to help physicians and their office staff improve practice efficiency and viability.

PAYOR CONTRACT ANALYSIS CMA members have free access to objective written analyses of major health plan contracts designed to help physicians understand their rights and options when contracting with a third-party payor, as well as which contract provisions are prohibited by California law.

“The value that CMA brings to physician practices cannot be understated. Membership is not a cost to my practice – it is an investment. I couldn’t run my practice without it.”

–Tom McKenzie, M.D., member since 1991

NEED HELP? Contact CMA’s Reimbursement Help Line at (888) 401-5911 or economicservices@cmadocs.org

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Rev. 12.1.2020

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Public Health

Update

Vaccine Hesitancy: Help Us Reach Our Shared Goal

BY DR. MAGGIE PARK, PUBLIC HEALTH OFFICER; AMY RHOADES, MPH AND CHERYL LAUGHLIN As we approach the end of 2021, we are also heading toward nearly a 70% vaccination rate here in San Joaquin County among eligible residents, ages 12 or older, with at least one dose of the COVID-19 vaccine. Compare this to the state’s overall rate of just over 80% of eligible California residents fully or partially vaccinated and we can all appreciate the progress so far but the need to push those vaccination numbers higher.

Throughout the vaccine rollout, San Joaquin County regularly lagged in vaccination rates compared to the state, particularly among certain zip codes and demographics.

This chart shows vaccination data by race/ethnicity over the past year. Latinx and Black populations show the lowest vaccination rates and highest numbers of COVID-19 cases and deaths throughout the pandemic. Helping these underserved groups is even more vital as we focus on the final push toward higher vaccination rates in the county.

Community Partnerships Make a Difference

Source of data: California Department of Public Health

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San Joaquin County Public Health Services (PHS) values our partnerships with a wide range of community- and faith-based organizations, who are vital connectors in our county. Throughout this pandemic, we have all rallied to make vaccines available and to get messaging and services to hard-to-reach areas.

For example, PHS works with community partners

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to mobilize a COVID-19 vaccination van throughout the county. These organizations have helped us to reduce barriers by pointing us to areas where transportation can be limited and transmission rates are often elevated.

But even with this support, vaccine rates throughout the county dropped considerably since last April. Those who were eager to be vaccinated waned, and those who had doubts were not yet convinced. We were at a bit of an impasse to move vaccination rates forward.

That’s when our community- and faith-based partners provided further insights into various groups and the common concerns.

Overall, the issue of trust weaves into all the conversations with vaccine-hesitant individuals in this county. Many of our unvaccinated populations do not trust the government or do not want government dictating what to do. Others simply seek a nonjudgmental space to talk through questions regarding the vaccine. As health care providers, you can provide thoughtful, factual answers to any questions they have.

Vaccine Concerns and Helpful Answers for Your Patients The first vaccine-hesitant group—those who are pregnant or breast feeding—often don’t realize being pregnant puts them at a higher risk for becoming severely ill from COVID-19.

According to the CDC, only 31% of pregnant women have been vaccinated against COVID-19. At the same time, they also report pregnant women with COVID-19 symptoms are twice as likely to be admitted into intensive care with a 70% higher likelihood of dying. This group is at an increased risk for preterm birth, stillbirth, and admission into the ICU for a newborn

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also infected with COVID-19. Let patients who are pregnant know benefits of vaccination outweigh the risks, for them and their unborn child.

Hand-in-hand with pregnancy concerns is another common misconception—COVID-19 vaccinations cause fertility issues.

Throughout the clinical trials, there were people who became pregnant after being fully vaccinated. Share with patients that no evidence shows the COVID-19 vaccine causes fertility problems in men or women. There is currently no evidence that ANY vaccines, including COVID-19 vaccines, cause fertility issues.

Many residents also believe—the virus that causes COVID-19 is in the vaccine. Remind individuals that the virus that causes COVID-19 is not in the vaccine, so it is impossible to get COVID-19 from the vaccination. Another concern—side effects from the vaccine or general uncertainty about what to expect. Be open and honest about the potential side effects, which include a sore arm at the site of injection, body aches, chills, fatigue, or fever. Side effects typically only last about 24 hours and are normal. These are all signs the immune system is building protection to the virus.

Others continue to question the speed of vaccine development—mentioning inadequate data exists on potential long-term side effects and safety. In truth, the COVID vaccine research is built on decades of scientific studies and moved quickly because of advanced technology already underway.

Technology and available funding helped expedite the COVID-19 vaccine. Additionally, mRNA vaccines have been studied for decades and shown to be safe for use in humans.

All three vaccines have undergone extensive clinical trials

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and approval by the FDA and included people from varying demographics.

Some individuals feel the vaccine is not effective—noting that fully vaccinated people can still be infected with COVID-19.

These people can benefit from learning that a fully vaccinated person is less likely to become severely ill, hospitalized, or even die from COVID-19 infection. And while people who have already had COVID-19 feel they have sufficient antibodies to protect against another infection, it is unknown how long or how much protection someone may have. The safest and most effective way to ensure everyone is protected against the virus is to be fully vaccinated.

Finally, when it comes to youngsters aged 12-17, all of these reasons for hesitancy are coupled with the fear of interfering with children’s growth and development. If you are providing vaccinations, this is another issue to discuss with each child’s caregivers. Assure them that every vaccine goes through rigorous, three-stage clinical development to ensure safety.

And before being administered locally, those findings are reviewed and approved by four safety-focused organizations—

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the Centers for Disease Control (CDC), Food and Drug Administration (FDA), Western States Scientific Safety Review Workgroup, and California Department of Public Health.

Your shared knowledge can help break down hesitations to vaccinations.

Getting Our Community to Immunity COVID-19 vaccination guidance and eligibility change often, so it is important to stay current for yourself, staff, and patients by referring to local testing and vaccination information at www.SJReady.org. The best way to address common myths and concerns is to keep communication open and spread accurate information. For more details on the COVID-19 vaccine, visit covid19.ca.gov/vaccines/.

As with any vaccine, there will always be individuals who are resistant. We acknowledge that even with all the data and facts, someone may still not want the vaccine. It is still important to have these conversations with your patients. Health care providers continue to be a trusted source for individuals and families. Together, we can spread facts and increase vaccination rates in San Joaquin County and help end the pandemic.

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World-class technology The art of a confident diagnosis Advanced Imaging Center 1031 S. Fairmont Ave., Lodi 209-334-8580

Imaging services with a personal touch The Advanced Imaging Center at Adventist Health recently renovated the entire facility to ensure that your patient’s diagnostic imaging experience is as welcoming and enjoyable as possible. We provide an unrivaled level of service by combining state-of-the-art equipment with well-trained, innovative, knowledgeable and caring imaging clinicians.

Exceptional radiologists The radiologists at Adventist Health bring years of training and clinical expertise to our imaging services, assuring you a level of expertise that allows for a precise reading and interpretation of diagnostic tests.

We’ve invested in the latest technology so your patients can get advanced imaging services they need, without leaving our community.

• 128-slice CT Scanner • MRI • 3D Mammography

• Digital Radiography • DEXA (bone densitometry) • Ultrasound

To schedule imaging procedures for your patients, please call 209-339-7505 or fax an order to 209-339-7412.

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CALIFORNIA’S ELECTRONIC PRESCRIBING MANDATE Are you ready for California’s electronic prescribing mandate?

Beginning on January 1, 2022 – less than three months from today – almost all prescriptions written in California must be transmitted electronically. Physicians who have not yet implemented electronic prescribing in their practices should begin the process now.

The electronic prescribing mandate was contained in a law passed by the California State Legislature in 2018. The bill (AB 2789) had a three-year delayed implementation to allow physicians and other prescribers the opportunity to select and implement an electronic prescribing platform. But the delay ends at the end of this year.

The law is partially based on the Medicare electronic prescribing for controlled substances (EPCS) requirement, which is also set to take effect on January 1st. The Centers for Medicare and Medicaid Services (CMS) has proposed in the 2022 Medicare Physician Fee Schedule to delay

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implementation of the EPCS requirement for an additional year, to January 1, 2023, but that does not have any direct effect on the state requirement. Much of the language of the requirement was copied straight from the federal regulations.

Unlike the Medicare requirement, however, the state mandate applies to almost all prescriptions, not just those for controlled substances. In that respect, the state mandate is much broader than the Medicare one and will affect many more physicians.

The California Medical Association (CMA) opposed AB 2789 when it was being debated in the legislature and offered the author possible amendments that would have created some accommodations in the law. But the proposed amendments were rejected, as the Legislature saw AB 2789 as just an extension of the Medicare requirement. Understanding the Electronic Prescribing Mandate >>

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As physicians approach coming into compliance with the electronic prescribing mandate, it is important to understand a few major facets of the law. CMA has based the following on conversations with many physicians over the past few months.

EXCEPTIONS

The following types of prescriptions are exempt from the electronic prescribing mandate: • Controlled substances prescriptions for use by a patient who has a terminal illness.

• E-prescribing is not available due to a temporary technological or electrical failure.

• The prescribing physician is issuing a prescription to be dispensed by a pharmacy located outside California.

• The prescription is issued in a hospital emergency department or urgent care clinic and either the patient resides outside California, the patient resides outside the geographic area of the hospital, the patient is homeless or indigent and does not have a preferred pharmacy the prescription is issued at a time when a patient’s regular or preferred pharmacy is likely to be closed.

• The prescription is issued by a veterinarian.

• The prescription is for eyeglasses or contact lenses.

• The prescribing physician and the dispenser are the same entity.

• The prescription is issued by a prescribing physician under circumstances whereby the physician reasonably determines that it would be impractical for the patient to obtain controlled substances from an e-prescription in a timely manner, and the delay would adversely impact the patient’s medical condition.

• The prescription that is issued includes elements not covered by the latest version of the National Council for Prescription Drug Programs’ SCRIPT standard.

If a physician believes that one of the above exceptions apply, they must document it in the patient record within 72 hours of filing the prescription.

PRACTICE EXEMPTIONS

While some specific prescriptions are exempted from the electronic prescribing mandate, there are no exemptions in the law for physician practices. CMA receives many questions from physicians about hardship exemptions, considerations for retired (or semi-retired physicians), low volume prescribers, physicians in safety net settings, and rural physicians. All of the above are subject to the law, and there is no provision in the law

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for a practice to request an exemption.

ENFORCEMENT

Physicians who fail to comply with the law will be referred to the Medical Board of California. The Medical Board has published several physician communications outlining the requirements of the law but has not proposed any specific enforcement actions they might take.

An enforcement action by the Medical Board under this law would be triggered by a complaint. The most likely scenario is that a physician is referred to the Medical Board by either a patient or a pharmacist.

Importantly, the law does not create private right of action.

That is, physicians cannot be sued for failing to comply with the law.

PRODUCT SELECTION AND IMPLEMENTATION

For physicians who have an electronic health record (EHR) system, implementing electronic prescribing may be as simple as turning on an embedded electronic prescribing module.

Any EHR that is certified by the Office of the National Coordinator for Health IT (ONC) must have the capability to transmit prescriptions, including controlled substances, electronically. Physicians with an EHR should contact their vendor for more information.

For paper-based practices, selecting the right technology platform will be a little more complicated. A stand-alone electronic prescribing system (that is, not tied to an EHR) will likely be much cheaper and easier to implement than a complete EHR system. Most paper-based practices will likely look to one of these systems.

While CMA does not endorse any particular electronic prescribing system, there are a few recommendations for physicians who are in the market.

First and foremost, if the practice does any prescribing of controlled substances, the system must have the ability to do EPCS and query the CURES database. Not all commercially available systems can do both of these, so practices should ask perspective vendors before investing in a system.

Also, practices should strongly consider electronic prescribing systems that are connected to the SureScripts network. SureScripts is the largest electronic prescribing network in the country. Vendors on their certified product list will give physicians and patients the largest number of pharmacies from which to choose.

CMA members are also always welcome to call the CMA Member Helpline at (800) 786-4262 to request one-on-one assistance.

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Strong community partnerships lead to happier, healthier people.

HPSJ has partnered with safety-net and traditional providers for over 25 years to create access to quality healthcare for low-income children, families and individuals- some of the most vulnerable residents of our community.

Whether your practice was there from the start, or has recently joined us, we want to extend a sincere thank you for sharing our mission of improved wellness through meaningful partnerships and collaboration.

Community • Partnership • Wellness

www.hpsj.com | 888.936.PLAN (7526)

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

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

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