Summer 2010 by San Joaquin Medical Society

Community Medical Centers REVIVES HISTORIC GLEASON HOUSE Summer Issue 2010 SUMMER 2010

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Volume 58, Number 2 • June 2010

{FeATUReS}

18 32 40 52

DR. STANLey cLARK

{DePARTMeNTS}

2010 Lifetime Achievement Recipient

IN THe NeWS New faces and Announcements

DR. RAMIN MANSHADI

cOMMUNITy INTeRNSHIP PROgRAM

MANAgINg PROFeSSIONAL RISK

MeMBeRSHIP BeNeFITS: CMA launches new monthly resource

DIABeTeS ReFeReNce gUIDe

HeALTHcARe HAPPeNINgS IN PIcTUReS

2010 Young Physician Award

TAKINg STReeT MeDIcINe TO THe gLeASON HOUSe cMA STePS UP!

An interview with Elizabeth McNeil

oN THE CoVER: Community Medical Centers CEo Mike Kirkpatrick, Medical Director Thomas Mahoney, MD and Care Link Manager Randy Pinnelli, PA stand in front of the historic gleason House – soon to be the location of their twelfth clinic.

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Helping doctors treat and patients heal. The Advanced Imaging Center at Lodi Memorial Hospital offers Board certified radiologists, comprehensive diagnostic services, and a convenient location for patients.

Lawrence R. Frank, MD President James Halderman, MD President-Elect Robin Wong, MD Past-President George Khoury, MD Secretary-Treasurer Board Members

High Field MRI Breast MRI Digital X-ray (walk-inâ&#x20AC;&#x2122;s welcome)

Shiraz Buhari, MD Thomas McKenzie, MD Javad Jamshidi, MD

Moses Elam, MD John Olowoyeye, MD Raissa Hill, MD Jerry Soung, MD

Trinh Vu, MD Anil K. Sain, MD Kristin M. Bennett, MD

Medical Society Staff Michael Steenburgh Executive Director Debbie Pope Office Coordinator Gena Welch Membership Coordinator

(209) 333-7422 Frank M. Hartwick, M.D. Majid Majidian, M.D. R. Brandon Rankin, M.D. Grant W. Rogero, M.D. Roger P. Vincent, M.D.

Committee Chairpersons MRAC F. Karl Gregorius, MD

Decision Medicine Kwabena Adubofour, MD

Ethics & Patient Relations to be appointed

Communications Morris Senegor, MD

Legislative Patricia Hatton, MD

Community Relations Joseph Serra, MD

Audit & Finance Marvin Primack, MD

Member Benefits Jasbir Gill, MD

Nominating Hosahalli Padmesh, MD

Membership to be appointed

Public Health Karen Furst, MD

Scholarship Loan Fund Eric Chapa, MD

NORCAP Council Sandon Saffier, MD CMA House of Delegates Representatives Shiraz Buhari, MD Patricia Hatton, MD James J. Scillian, MD

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Lawrence R. Frank, MD Francis Isidoro, MD Gabriel K. Tanson, MD Peter Gierke, MD

James R. Halderman, MD Peter Oliver, MD Robin Wong, MD

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When was the last time a doctor came to YOU? Our program offers: • • • • •

Expert evaluation and treatment of patients with NYHA functional class III/IV heart failure and AHA/ACC stages C and D heart failure. Exceptional experience – with nearly 400 transplants and 200 ventricular assist device implantations since our program began. Access to the most current mechanical assist devices available: both short-term systems designed for treatment of cardiogenic shock and others designed for long-term left-and/or right-ventricular support. Urgent outpatient consultations and evaluations of your patients – within 48 hours. We can also accommodate same-day hospital transfers.

An experienced, highly-trained cardiac care team, comprised of Board certified, fellowship trained cardiologists, cardiovascular and thoracic surgeons, physician assistants, nurse coordinators, dieticians, licensed clinical social workers, psychiatrists, financial counselors and rehabilitation specialists.

At California Pacific Medical Center’s Heart Failure and Transplant Program we are committed to work-

ing with referring physicians to provide comprehensive patient care, focused on improved survival and quality of life for patients with advanced heart failure.

We are heart failure cardiologist Ernest Haeusslein, M.D. and cardiothoracic surgeons James Avery, M.D. and Glen Egrie, M.D. We would like to make

an appointment to see you in your office. Why?

We’d like the opportunity to acquaint you with our facilities, staff and advanced therapies, including destination therapy and “bridge to transplant.” We’d also like to review referral indicators to help identify your patients who may benefit from these advanced therapies.

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To schedule our visit to your office – or to refer a patient: 415-600-1051

www.cpmc.org/services/heart

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MeSSAge > executive Director

People Who Make the Difference This issue is really all about great people and their amazing accomplishments on behalf of our community, our medical society and, ultimately, all the people who receive medical help. In our community there is a network of organizations and caregivers that did not appear out of thin air, but was constructed by years of dedicated effort. That network is still being built. Within this Physician Magazine you can read about some of the architects of that health network. During our General Membership Meeting and Dinner on June 27th, we will focus the evening on honoring Dr. Stanley Clark, our 2010 Lifetime Achievement Recipient. Attempting to complete a little research on Dr. Clark, I pulled his bulging membership file and discovered many interesting facts which are featured in our story on page 18. The file also contained a collection of photos chronicling his long career here in Stockton and every photo featured him sporting a different bow tie, which struck me as symbolic of a man who was practical (long ties get in the way), humorous (a bow tie is whimsical), and possessing the dexterity of a fine orthopedic M.D. (bow ties require finesse to tie properly). Turns out that Dr. Clark is all of these things…and a lot more. We are very proud to honor him. For the past two years the executive board has discussed the introduction of a new award meant to honor the stellar work being performed by so many of our younger physicians. Despite the common challenges of establishing their practices and starting and raising a family – many of our younger members find the time and energy to contribute to a wide variety of civic, non-profit, political, philanthropic and even teaching opportunities. For some, their motivation is a strong personal interest in a particular field or project and for others it’s simply a deeply felt sense of purpose to give back. So, for the first time in our 144 year history, we will bestow the new Young Physicians Award as well during our General Membership Dinner. Our first recipient is Dr. Ramin Manshadi who somehow finds the time to contribute his expertise to a wide variety of causes. You will certainly enjoy reading more about him on page 32. The wonderful work Community Medical Centers accomplishes is certainly no secret to our membership, but few may be aware of their Care Link program which is featured on page 40. You may also be surprised at the historical roots of CMC that are revealed in the story. This program is truly a shining light of our medical community and worthy of our support. Lastly, I would like to honor someone who truly provides the “glue” that keeps the medical society together – our Office Coordinator Debbie Pope. When I joined the society 3 years ago, and Gena Welch joined us a year later, Debbie provided us the foundational platform to work from and we’ve grown as a team. Well, Debbie just passed the 10 year milestone with us. She wears many hats and handles them all well. Thanks Debbie for your significant contributions. All the Best!

Moris Senegor, MD Editor Editorial Committee Shiraz Buhari, MD Kwabena Adubofour, MD Robin Wong, MD William West Managing Editor William@sjcms.org Michael Steenburgh Contributing Editor Sherry Roberts Creative Director/Graphic Designer sherry@sjcms.org Contributing Sources California Medical Association Los Angeles County Medical Association San Diego County Medical Society The San Joaquin Physician magazine is published quarterly by the San Joaquin Medical Society Suggestions, story ideas or completed stories written by current San Joaquin Medical Society members are welcome and will be reviewed by the Editorial Committee. Please direct all inquiries and submissions to: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: 209-952-5299 Fax: 209-952-5298 Email Address: gena@sjcms.org Medical Society Office Hours: Monday through Friday 8:00 AM to 5:00 PM

Mike Steenburgh Executive Director

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Introducing...

St. Joseph’s new Patient Pavilion

St. Joseph’s Medical Center’s newly completed patient pavilion is now open. The $117 million, 152,000 square foot addition brings a new level of patient care environment to the community. Modern, spacious, and stunningly beautiful, the Patient Pavilion consists of a Women & Infants Center, an Adult ICU and an Oncology and Medical-Surgical Telemetry unit. The three floors are filled with state-of-the-art equipment and technology and impeccable design to create the perfect healing environment. THE WOMEN & INFANTS CENTER FEATURES: 8 Private Labor & Delivery rooms 6 Private High-Risk rooms 2 Operating rooms specifically for Cesarean Sections 20 Private Postpartum rooms Level III Neonatal Intensive Care Unit, including 20 NICU beds in 8 connecting rooms 2 NICU isolation rooms 1800 N. California Street, Stockton, CA 95204 209.943.2000 | StJosephsCares.org SUMMER 2010

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Message > From The President

Whither Health Care Reform? A controversial piece of legislation that some see more as Medical Insurance Reform.

Health Care reform will take the medical profession to accomplish. Medical care by legislation is a failure, often adding expense and “busy work” with little return in improved health care.

ABOUT THE AUTHORLawrence Frank, MD is the 2009-2010 President of San Joaquin Medical Soceity.

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There is much to like in it. Recognizing the importance of our primary care providers, their Medicare payments will increase without decreasing payment to specialists. Recognizing that having medical insurance doesn’t equal access to care and the paucity of primary care providers, particularly acute in Central California, unused residency slots will be slotted for training primary care providers and general surgeons. The importance of preventive care in reducing health care expenses is recognized; Medicaid will now provide coverage as will Medicare without copays. The devil is in the details: what are “certain preventive services” and will reimbursement meet or exceed the costs (to physicians) to provide same? Many providers would say that MediCal payments (when/if ultimately received) are, um, parsimonious at best. The purpose of this legislation is

to improve health care access and reduce costs to the nation. But will this achieve its goal? How much health care “reform” can either third party payers, government or private, or providers affect? As physicians, the high percentage of our citizens who are illiterate (and thus unable to use printed health information), are obese and at risk of or have diabetes, who are hypertensive and eat a high salt diet, the lack of safe places (read parks) for children to exert themselves with play are worrisome. We are now appalled at children presenting with type 2 Diabetes, some so obese that gastric bypass surgery is now done on children as young as 12 years old. This is exacerbated when school budgets, slashed to the bone, reduce physical education. Those of us whose BMIs are higher than 26 know how difficult it is to lose weight once gained; few are those with the discipline to eat and exercise down to a healthy weight and keep it there. Some restaurants

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now serve such huge portions that I would characterize their serving vessels not as plates but as troughs. Fast food restaurants have doubled the size of their hamburgers and french fried portions even before supersizing.2 In addition to “Big Pharma”, we now must deal with “Big Salt.”1 The Food Industry (Frito-Lay, ConAgra, PepsiCo, etc.) uses salt to make low quality food (some the lowest quality the FDA allows for human consumption) palatable. To significantly reduce salt content, they readily admit they would have to use higher quality and thus, more expensive, foods; of course the increased cost would be passed on to the consumer, a further hardship for the socioeconomically challenged. The food industry argues that reducing caloric intake by 100 calories daily would save more health care costs than reducing salt content, the same industry (including restaurants and fast food dispensers) that has increased serving sizes (see above). Health, a condition, and wellness (a term I used to abjure) is a process; these are dynamic and change as we age. A 12 year old with a BMI of 35 is doomed to a life shortened by illness. The coming decades will see health care costs soar because of this. Treating diabetes, hypertension, cardiac and vascular disease and renal failure is not prevention; it is managing a potentially preventable illness and is expensive. Cleveland Clinic’s CEO said we need to get out of the illness business and into the health

Presented By :

business. This is a daunting challenge and must start very early, as in before birth with readily available prenatal care. Genetic differences among different ethnicities can increase the risk of obesity and/or hypertension. These are exacerbated by the above noted. Cultural differences in food preferences must be addressed. As a medical student in New York City (40 years ago!), it was clear that expecting Puerto Rican patients to readily follow a diabetic diet acceptable to those of northern European descent was futile. The National Kidney Foundation website readily directs viewers to latino-friendly dietary information in Spanish; the American Diabetic Association’s Spanish information is more difficult to tease out. Guidance for Southeast Asians and Pacific Islanders still depends on volunteers within these communities. Finally, education and acculturation over one to two generations will be needed to alter some cultures that see obesity as a sign of wealth and prestige: you can afford lots of food. Socioeconomic factors are also in play. A study by our Public Health Department found fresh fruit and vegetable availability was the lowest in economically depressed parts of Stockton but all manner of processed foods (American “cheese”, tortilla and potato chips, Ding Dongs) were readily available and attractively displayed – this in the agricultural center of California. The weekly Farmers’

Complimentary Dinner / CME Seminar for San Joaquin Medical Society Members with... David Tong, MD

in conjunction with :

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Please call the medical society office at (209) 952-5299 to reserve your seat.

Thursday, September 23rd, 2010

All attendees will receive 1.0 Hour credit of Category 1 CME

Wine & Roses Spa and Resturant

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Cocktail Reception 6:30pm • Dinner Presentation 7:00pm

2505 W. Turner Road • Lodi, California

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Message > From The President Market is held in north Stockton; is there a way to bring the Farmers’ Market to southeast Stockton or can southeast Stockton be brought to the Farmers’ Market just as patrons are brought to the Asparagus Festival by bus? What can be done to make our parks safe enough for our children to play in them without the risk of injury or death from random drive by shootings? Until safety is assured, parents will insist on their children staying home where there major exercise involves thumb muscles only.

I haven’t even addressed smoking (don’t get me started). Thus, whereas much of the Health Care Reform legislation passed is commendable, actual health care reform cannot be legislated any more than can morality. Civil Rights legislation and Hate Crime laws haven’t changed everyone’s opinions about “the other.” Health Care reform will take the medical profession to accomplish. Medical care by legislation is a failure, often adding expense and “busy work” with little return in improved health care. As physicians and as members of organized medicine, we must lead, educate, persuade, cajole and in all other manners drive the changes. We must, in humility, recognizing that we still don’t know everything, educate and convince our patients not only to improve their own health by appropriate lifestyle changes, but to serve as models for their children and grandchildren. We must start to figure out how to work locally to bring down the barriers to good health – much of which doesn’t depend on going to the doctor’s office. Can we convince local restaurants to reduce portions and can we convince their patrons of the health value of such changes? Can we make neighborhoods and parks safe and enjoyable and encourage our citizens to use them? Tilting at windmills? Perhaps. “Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure... than to rank with those poor spirits who neither enjoy nor suffer much, because they live in a gray twilight that knows not victory nor defeat.” –Theodore Roosevelt. Thank you for the opportunity to serve as your society’s President this past year. I have learned much.

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(209) 957-3888 caring support guidance choices

1. The Hard Sell on Salt, The New York Times, vol CLIX, no. 55,056, p. 1, Sunday, May 30th, 2010. 2. Childhood Obesity and Type 2 Diabetes, K. Adubofour, MD, 21st Annual Diabetes Symposium, Sutter Health, April 2010

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From The Editor < Message

Misfortune VS. Calamity

Thoughts About The Predicament Of “County” Hospital

What I did not realize, and now learned with the predicament of San Joaquin General is that government based institutions and services take their biggest hits late in a recession, because drops in tax revenues are one or two years behind. ABOUT THE AUTHORMoris Senegor, MD serves as the Chairperson of the Publications Committee for the San Joaquin Medical Society and Editor of its flagship publication the San Joaquin Physician.

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The famous Victorian Prime Minister, Benjamin Disraeli, upon being asked the difference between calamity and misfortune quipped about his legendary rival, “if Gladstone fell into the Thames that would be a misfortune, and if anybody pulled him out, that I suppose would be a calamity.” I bet the esteemed members of the San Joaquin Board of Supervisors are privately feeling the same about their biggest problem: San Joaquin General Hospital, currently in the throes of a grand misfortune. They are the rescuers, and the consequences of salvation, to them, may seem worse than those of closure. The latter, now looming in the horizon, is a source of concern in our medical community, doctors and hospitals alike. Many have approached me – I happen to work both at San Joaquin General and other area hospitals – with questions about what I think is happening there, and my prognosis. They usually display fearful attitudes, seeming to anticipate a giant sewage leak into their emergency rooms, OR’s, and practices. Even a limited reduction of services at San Joaquin General such as neurotrauma (what

I provide) is being viewed with fear. Obviously the capacity of area hospitals to absorb displaced patients from San Joaquin General is being questioned by those who staff them. As with any enterprise in trouble, there is abundant finger pointing in various directions to blame for the predicament of San Joaquin General. Included are outside consultants (the Camden Group) who are viewed as strangers out to destroy cherished institutions in our community, and the hospital’s current administration who are viewed as incompetent. Perusal of letters to the Stockton Record Editor reveals a regular stream of writers bearing such accusations. Other culprits include the Board of Supervisors, a political body incapable of acting effectively as a Board of Trustees for the hospital, the San Joaquin Residency programs which are blamed for their inefficiency and cost, dragging down the finances of the hospital, and various employee unions viewed as intransigent, sucking up precious dollars by creating an atmosphere resistant to a lean workforce. Even though I partly practice at San Joaquin General, I am not sufficiently

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Message > From The Editor again. “Hospitals Under the Knife” proclaims a headline (Wall embedded in the inner workings of the hospital to confirm whether Street Journal, March 26, 2010). It turns out that the nation’s largest any of the above is accurate. All I know is that the more a prominent public hospital system, known as New York City’s Health and medical enterprise gets in trouble, the more fingers arise, usually Hospital Corporation is facing a $ 1 billion deficit, and planning to accompanied with loud mouths assigning blame. Other examples lay off 2600 employees including doctors and nurses. This is a giant in my two decades in our community include the financial troubles organization made of 24 provider entities, including 11 hospitals of Omni IPA in the 1990’s, the demise of St. Dominick’s Hospital in 5 boroughs, some well known, such as Bellevue, Harlem and in Manteca, and various past crises that have afflicted Joaquin Bronx. Imagine 11 County Hospitals, all under one umbrella, all General. Over the years I have learned to keep my own fingers in trouble. It seems to dwarf the $20 million deficit hounding our to myself, for I find them necessary in providing me with strokes Board of Supervisors, Mr. Cohen and Mr. Culbertson. Another needed to swim through the turbulent waters of modern medicine. hospital conglomerate in trouble, according to the article, is Miami’s When they point here and there, it is harder to keep afloat. Jackson Hospital System, four public hospitals in Dade County, However I do feel that the main factor responsible for the current, facing a deficit of $ 226 million. In dollar amounts these giants worst crisis of the hospital is the Great Recession of 2007- 2008. certainly eclipse the trouble in our hometown, but then we are small Not being an economist, I previously only knew the general outlines compared to New York and Miami, and ours may very well be as of events in a recession. For instance, stock markets recover early, big as theirs, in proportion to while everyone is down in population size. the dumps. I also knew that The Camden Group unemployment starts late advocates that the hospital’s in a recession and ends late, predicament be remedied long after the recession is either by making it a larger, officially over. What I did more full-service entity not realize, and now learned (including diversified with the predicament of cardiac and oncology San Joaquin General is services currently not that government based available), or shrink it institutions and services to a more primary care take their biggest hits late in and obstetrics oriented a recession, because drops institution. The obvious in tax revenues are one or path is the latter, since two years behind. Thus enlarging the hospital would we now have headlines in require substantial capital, our papers proclaiming currently unavailable. I have disaster in the hospital, met with Mr. Culbertson, accompanied on the same whom I personally consider pages with rosy outlooks - Moris Senegor, MD a well meaning man. I about the general economy. do not think he wants to In the near future some carry a taint in his career of official body will declare that being the one that killed San the Great Recession ended Joaquin General. He sounds optimistic that the hospital can survive some time around the end of 2009 or early 2010. That’s about when in the long term as a shadow of its former self and intends to enact San Joaquin General’s chronic troubles became potentially lethal. this vision. To be sure, as I indicated above, the hospital has been on the Therein lies the dilemma facing the Board of Supervisors. Weary edge of a cliff for years. It has grappled with funding shortages with of past deficits, I am certain they see continued survival of the every small and large past downturn in the State economy. Its hospital as a harbinger of “more of the same”. How long the County residency programs have been chronically on the brink of closure can continue subsidizing the hospital remains a delicate question for until a recent deftly organized rescue. Its specialty staffing has been them. Ongoing financial drain in years to come promises slow and what I call a “leaking boat”: every time administration plugs up a leak ongoing hurt. Closure on the other hand, is a one time, big wallop by filling an important specialty position another seems to open up of political pain, with none afterwards. It is a bit like having a bunch elsewhere. San Joaquin administration has been in a chronic crisis of teeth extracted without anesthesia, but then none are left to cause mode for years. The decision to recruit the Camden Group, in part future trouble. arose out of these old crises. No one expected the perfect financial Would the continuing presence of San Joaquin General in our storm that was to appear while turnaround efforts got under way. community be a “calamity” to our government? This question will Drought in all the coffers supplying the hospital, especially the State haunt the Supervisors in the months to come. with its Medical program, and the County, as of now still the rescuer of last resort, is now bringing the unthinkable to the fore. If you think San Joaquin General is unique in this regard, think

“Drought in all the coffers

supplying the hospital, especially the State with its Medical program, and the County, as of now still the rescuer of last resort, is now bringing the unthinkable to the fore.”

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community > Lifetime Achievement

Lifetime Achievement Award Winner:

Dr. Stanley Clark By William West

The 2010 Lifetime Achievement Award winner is Dr. Stanley Clark, Jr., an orthopaedist known for his wit and energy, his enthusiasm as a team doctor for University of the Pacific and various high schools, and his international medical trips. His beginnings may have foretold his vibrancy and colorful career. For example, the place of his birth was determined by one of the most colorful figures of the early twentieth century, Pancho Villa. “My father was regular army who had run away from home at age 17 and enlisted,” Dr. Clark said. “He went into the medical corps. He was a ward sergeant, headed for dental school, went to Alaska to set up dental clinic, but Pancho Villa started shooting things up and he had to go to Texas. He eventually enrolled in officer candidate school and got his lieutenancy in the medical corps.” The Clark family ended up in San Antonio where Stanley A. Clark, Jr., was born in 1921. The peripatetic lifestyle of the Army brat was just beginning. There were adventures and close calls along the way. When he was two years old and living in Manila, an earthquake in Tokyo was so strong it flipped his grandmother’s rocking chair. In San Diego, he accidentally slammed his Chevy Roadster into a 18

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telephone pole when he was 17-years old. But no crossborder conflict, tectonic slippage, or distracted driving deterred him from a lifetime of medical service in Stockton and around the globe. Berkeley and Stanford Dr. Clark attended the University of California at Berkeley, graduating in 1942. Then he created for himself a Big Game ambivalence by enrolling in Stanford Medical School where he received and M.D. in 1946. He did orthopaedic residency at Fort Miley Veterans Hospital in San Francisco from 1948 to 1950. He served in the military from 1946 to 1948 and his final rank was Captain MC. “I met my wife-to-be, Carolyn in San Francisco,” said Dr. Clark. Carolyn also attended Stanford and earned a nursing degree. “All that I may have achieved would not have been possible without the support and driving energy of my loving wife of 63 years and the protection of our living God, Jesus Christ,” Dr. Clark said. He met Luis Arismendi in medical school in Stanford. Dr. Arismendi was headed to Stockton to join his father in law as a general surgeon. By way of this connection, Dr. Clark came to Stockton and partnered with Dr. Clarence Luckey in June of 1951. At the time there were three orthopedists in town, according to Dr. Clark. When Dr. Clark came to town the population was 90,000 and in the medical society had 90 physicians. Today there are more than 300,000 people in Stockton and its unincorporated suburbs. The medical society counts more than 700 members. Dr. Clark was President of the Medical Society for the 1969-1970 term. “I have many memories of Stan Clark from the 60s and the 70s,” Dr. Henry Zeiter said. “But I remember

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many friends and fans in the S.J. Medical Society’s him mostly from the monthly Medical Society getAuxiliary, she received no compensation for her foster togethers at the Dameron Annex Building on Lincoln care labors. Street. Stan, Dr. Chimiklis, and I were usually the last Carolyn was known as the flower lady for the to leave. We closed all these parties at 11:00 pm. The Auxiliary. At their once a month lunches, she would young members now can’t even imagine what those bring flowers from her own garden. She was and is, monthly meetings were like. Stan was the life of those by all accounts from a number of friends, a warm and parties. He was always happy, smiling, and acidly wonderful lady and a perfect foil for Stan’s humor. sarcastic at times, all in good fun. I have never seen Dr.Clark and Dr. Luckey were team physicians for Stan morose or unfriendly, and he cared for everyone.” the UOP football team during this time. “He always maintained a good sense of humor,” Dr. “UOP put a lot of people into the pro ranks,” Dr. Robert Hermann said via email. “He had a limerick Clark recalled. “Dick for all occasions-although Bass went to the Los none of them can be Angeles Rams after a repeated in mixed 1000-yard-running company.” “All that I may have achieved year. We repaired his “Stan Clark was the knees twice in college. only doctor I knew would not have been possible More recently, people in Stockton who had might remember a bomb shelter at his without the support and driving Mike Merriweather, house!” Dr. Joe Serra who went to the said. “I was in it. It was energy of my loving wife of 63 Vikings. We worked a real underground on his leg as well”. bomb shelter.” In association with It was a very busy years and the protection of our the Orthopaedics time for the young Overseas physician. Typical living God, Jesus Christ.” Organization, Dr. days began early. Clark went to Malawi, He was scrubbed - Dr. Stanley Clark in east Africa, for one and ready for 6:30 month at a time 1989 a.m. surgery, then off through 1991, where to the office to work he practiced orthopaedic through the day until 6:00 surgery and trained Malawians in orthopaedic p.m. Often he would get called back or out to the techniques. Wife Carolyn, an R.N., conducted a survey emergency clinic was a very basic one in downtown of five Presbyterian Hospitals at the behest of the Stockton. Patients were treated there for quite a while. Presbyterian Central Office. In 1993 they traveled to There were no emergency rooms at the hospitals at India for a month to work in the Presbyterian hospital that time in the 1950s. in Miraj, which is located in western central part “My partner and I would go up into the foothills of India. In 1994 they went to St. Lucia in the West to do orthopedic surgery,” Dr. Clark said. “Itinerant Indies, also an Orthopaedic Overseas Organization surgery is frowned upon nowadays, but at that time operation, where they stayed for six weeks. there just weren’t very man orthopedic men around. He served from 1983-to-1986 and 1992-to-1995 We’d travel to San Andreas and Jackson. Ripon had a as Chief of Surgery at St. Joseph’s Hospital (now St. hospital at that time.” Joseph’s Medical Center). “We also spent time out at the County Hospital,” “I had the opportunity to work with him while Dr. Clark said. “We were on staff and conduct grand he served as Chair of the Department of Surgery at rounds. We not only treated patients, we taught the St. Joseph’s and I was Vice President for the Medical residents.” Staff,” Dr. Hermann said. “He very capably managed several difficult situations and was able to deal firmly Carolyn Clark and fairly with a few recalcitrant surgeons’ egos. It was a busy time for Carolyn Clark as well. Stan was a true gentleman and a highly respected Carolyn Clark fostered newborns. At any time of the Orthopaedic Surgeon, both by his patients and the day or night, if she got a call to care for abandoned medical community.” children, she responded. She took care of hundreds of babies before they were adopted. According to her

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SUMMER 2010

Please join us for the Premier S PonSor

Annual Membership Dinner honoring our 2010 Lifetime Award Recipent

gold SPonS orS

Silver S PonS or

Dr. Stanley Clark and our 2010 Young Physician Award Recipient, Dr. Ramin Manshadi

SunDAY, June 27, 2010

Stockton Country Club

Cocktail Reception 6:00pm – Dinner 7:00pm

3800 Country Club Boulevard • Stockton, California

Additionally, we will honor the passing of the gavel from President Lawrence Frank, MD to President-elect James Halderman, MD

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bronze S PonS or

Member Physicians and Spouse/Guest $35 per person non-Members and Invited Guests $60 per person Call in your reservation to Gena at the Medical Society: (209) 952-5299

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community > Healthy Families Program

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SUMMER 2010

A Healthy Plan for San Joaquin When it comes to health, many people have a trusted community physician, a neighborhood pharmacist and a favored area hospital. With so much of healthcare being local, why wouldn’t somebody want a local health plan that works closely with these providers in coordinating that care? That was the thinking in 1994 when San Joaquin County decided to develop its own community health plan -- Health Plan of San Joaquin. Now, over 15 years later, HPSJ, as it’s commonly called, has reached a membership of 100,000 area residents through a focus on customer service, quality, and community involvement. Health Plan of San Joaquin was initially launched to serve local families in the State Medi-Cal Program, providing health benefits for low income and vulnerable families. Since its inception, HPSJ has expanded to serve more Central Valley residents. In addition to being the leading health plan among San Joaquin County Medi-Cal participants, HPSJ is now the largest health plan in the area serving children through the State’s Healthy Families Program. In 2009, Health Plan of San Joaquin began offering AIM (Access for Infants and Mothers), a health coverage program for uninsured or underinsured women who are pregnant. “There’s no question that being local has had a positive impact on our success,” said David Hurst, the Health Plan’s vice president of marketing. “For members, the idea of being served by a plan that is highly visible in the community and easily accessible is unique. We’re able to be involved with our members in a more direct way because we’re right here.” Some high touch efforts to work with members include personal case management, face to face customer service, community outreach and a special member advisory committee that provides feedback and suggestions to the Health Plan regarding its programs. Hurst notes that many of HPSJ’s efforts to engage with members are particularly tailored to the community. “We’ve developed health improvement programs that allow us to work with trusted community agencies, schools, churches, non-profits

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and other trusted organizations that serve our clients to promote preventive care, wellness, the importance of health coverage for families,” said Hurst. Beyond customer service, the Health Plan’s commitment to quality extends to the health services members receive. Quality measurements among health plans have placed HPSJ among the highest in the state in areas such as immunizations and well child exams. HPSJ has emphasized preventive care for members by developing an incentive program that rewards members for getting appropriate care with gift cards for adults and movie tickets for kids. HPSJ’s focus on access has resulted in an expansive physician and provider network, including nearly 200 primary care physicians and over 600 area specialists. HPSJ is also the only plan participating in the Medi-Cal and the Healthy Families Programs with relationships with all hospitals in San Joaquin County. Beyond the benefits and services provided to members, the Health Plan also places a priority on investing in community health initiatives. In 2009, the Health Plan provided $150,000 in grants to community-based organizations for their health programs focused on access to healthcare, nutrition and physical activity and other key community needs. HPSJ also launched the Health Careers Scholarship Program, providing funds to graduating high school students that plan to pursue health professions and brings those skills back to San Joaquin County. HPSJ’s success in San Joaquin County and unique model as a community health plan prompted its expansion to Stanislaus County (Healthy Families and AIM) and Merced County (Healthy Families). Health Plan of San Joaquin is headquartered with offices in French Camp, providing easy access for members, providers and the community from all points of region. For information about the Health Plan or coverage programs that may be available for uninsured community residents, call 1-888-936-PLAN.

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Stockton Golf & Country Club tradition • private setting • heritage 3800 W. country club blvd • stockton, ca

Call for special membership pricing (209) 466-4313

State of the art fitness center

Procedures performed at our center currently include:

Swimming Pool and Clubhouse

Clubhouse Amenities: - Grand Ballroom for events - Casual & Formal Dining Rooms - Grill Room overlooks 18th Green - Locker rooms with Spas/Steam Room

• Colonoscopy • Bronchoscopy • Gastroscopy • Biopsy

Conveniently located across the street from Lodi Memorial Hospital 840 S. Fairmont Suite 1 Lodi, CA 95240

The Endoscopy Center of Lodi is a beautiful state of the art facility providing modern outpatient care. The Center is equipped with one fully state licensed operating room and a procedure room.

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(209) 371-8700 www.endoscopyoflodi.com

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Independent But Not Alone.

Steven Wall, M.D. Hill Physicians provider since 2004. Uses Hill inSite, Hill EHR, Ascender and RelayHealth for eClaims processing, electronic health records, practice management, preventive care reminders and secure online communications with patients.

Independence and strength are not mutually exclusive. Practices affiliated with Hill Physicians Medical Group retain independence while enjoying the strength that comes from being part of a large, well-integrated network of physicians. Hill’s advantages include: • Fast, accurate claims payments • Free electronic communication capabilities via RelayHealth • RN case management for complex, time-intensive cases • Deep discounts on EPM and EHR solutions for the federal mandate • Preventive care and disease management reminders for patients • High consumer awareness that attracts patients That’s why 3,500 independent primary care physicians, specialists and healthcare professionals have made Hill Physicians Medical Group one of the country’s leading Independent Physician Associations. Get more for your practice with Hill.

Your health. It’s our mission.

Get more information about Hill Physicians at www.HillPhysicians.com/Providers or contact: San Joaquin area: Paula Friend, regional director, (209) 762-5002, Paula.Friend@hpmg.com Sacramento area: Doug Robertson, regional director, (916) 286-7048, Doug.Robertson@hpmg.com Bay area: Jennifer Willson, regional director, (925) 327-6759, Jennifer.Willson@hpmg.com Hill Physicians’ 3,500 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Health Administrators (San Joaquin), Health Net, PacifiCare and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt-in. SUMMER 2010

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COMMUNITY > news

IN THE

NEWS

Get to Know CMA’s New CEO Dustin Corcoran Golf, shyness, marriage, Bob Dylan and the future of CMA…what do they all have in common? They define CMA’s new CEO, Dustin Corcoran. For the full story, watch CMA’s nine minute video now posted on YouTube. To find it, simply search for Dustin Corcoran or go to www. sjcms.org and the link is on our “About Us” Page.

Hill Physicians Begins Serving San Joaquin Medi-Cal Recipients Hill Physicians Medical Group began providing care to San Joaquin’s Medi-Cal recipients on April 1, 2010. The arrangement also brings the doctors of San Joaquin General Hospital into the Hill Physicians provider network for Medi-Cal enrollees. “We’re very pleased,” says Paula Friend, regional director for Hill

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Providing staff, physicians and patients with relevant & up to date information Physicians in San Joaquin. “Medi-Cal is an important safety net for people and now we and our colleagues at San Joaquin General Hospital can work together to help provide care to people who rely on Medi-Cal in our community.” Combined, there will be 195 primary care doctors and specialists from Hill Physicians’ San Joaquin provider network and San Joaquin General Hospital available to Medi-Cal enrollees through Anthem Blue Cross. Medi-Cal recipients have the option of selecting coverage and providers through Anthem Blue Cross or Health Plan of San Joaquin, the two Medi-Cal managed plans contracted with the State’s Department of Health Care Services. Anthem Blue Cross is transitioning from a direct contracting arrangement in favor of a medical group or independent physician association model, which is expected to place more emphasis on primary care and prevention. Hill Physicians is one of the groups selected by Anthem to provide those services and more than 132 doctors from Hill’s local network chose to participate. Another 63 doctors from San Joaquin General Hospital are joining Hill Physicians Medical Group in order to serve Anthem Blue Cross local Medi-Cal beneficiaries. “I’m glad that a medical group as well-respected as Hill Physicians is caring for Medi-Cal members in our community,” says Dr. Robert Abatecola, a family medicine practitioner with San Joaquin General Hospital. “Some Medi-Cal enrollees have complex medical situations and Hill brings resources in patient education, preventive care and case management that go far beyond what an individual physician can offer.” Hill Physicians Medical Group is nationally recognized for its expertise in managed healthcare, and was awarded “Elite” status by the California Association of Physician Groups in 2009 – its highest designation. Hill Physicians began serving Medi-Cal members in Sacramento in late 2008 and plans to begin doing so in San Francisco later this year. “We’re committed to serving Medi-Cal members, “says David Culberson, director of San Joaquin General Hospital. “Our clinics and community medical centers now can serve more people through this affiliation with Hill Physicians.” San Joaquin General Hospital operates 30 outpatient clinics, many of which recently have been updated, and has developed a Hospital Master Plan that will revamp the hospital campus. Many Medi-Cal beneficiaries will receive letters letting them know that they will become Hill Physicians members through

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news < COMMUNITY Anthem Blue Cross. The change does not impact Medi-Cal enrollees who receive services through Health Plan of San Joaquin. _______________________________________ Dr. Yao Joins Lodi Vine Clinic Neurologist Weiping Yao, MD, joins the Lodi Memorial Community Clinic - Vine in May. This specialty-medicine practice is also home to Frank Huang, MD, an endocrinologist. Dr. Yao graduated from Sun Yat-Sen University of Medical Sciences, in China, in 1983. The Lodi Memorial Community Clinic - Vine is located at 1235 W. Vine St., Ste. 22, in Lodi. Current patients can call for appointments, and new patients are welcomed with a physician’s referral. Most insurances are accepted. Call 334-8520 to schedule an appointment. ________________________

Dr. Peter Tuxen attended the University of Colorado, in Boulder, CO, and completed his residency at San Joaquin General Hospital. Board Certified by the American Board of General Surgery, the American Board of Colon and Rectal Surgery and the Drug Enforcement Agency, Dr. Tuxen is a member of the American College of Surgeons, the American Society of Colon and Rectal Surgeons, the San Joaquin Medical Society, the California Medical Society, the Northwest Society of Colon and Rectal Surgeons, and the Northern California Society of Colon and Rectal Surgeons. Dr. Tuxen has been a member of the medical staff at St. Joseph’s Medical Center since 1977. ________________________

St. Joseph’s Women’s Imaging Center Continues Services in Mobile Mammography Unit On Sunday, March 28, 2010, St. Joseph’s Women’s Imaging Center, located at 2320 N. California Street, Stockton, was Dr. Yao Joins destroyed by a fire. Fortunately, all of Surgeon Peter Tuxen, MD, the patient records were recovered and Joins St. Joseph’s relocated to St Joseph’s Medical Center. Medical Group Continuing their commitment to St. Joseph’s Medical Group of Stockton serving patients and providing the is pleased to welcome surgeon Peter A. highest quality mammography and Tuxen, MD, to their medical group of breast imaging, St. Joseph’s Women’s Family Practitioners, Internal Medicine Imaging Services has been temporarily Specialists, Pediatricians, and General relocated to the St. Joseph’s Mobile Medicine Practitioners. Dr. Tuxen has Mammography Unit (MMU), at 542 joined St. Joseph’s Medical Group, but will remain in his current office located McCloud Ave., adjacent to the hospital. at 1805 N. California Street, Suite 409, St. Joseph’s Mobile Mammography here in Stockton. Unit is a fully accredited and licensed A surgeon in the Stockton area since digital mammography unit that 1977, Dr. Tuxen is a prominent leader routinely travels throughout Northern in his field. Dr. Tuxen is a member of California, serving women who do not the Surgical Committees at St. Joseph’s have access to mammography services. Surgeon Peter Tuxen, MD Medical Center, as well as at Dameron The same technicians and radiologists Hospital, and is also a member of the who perform and read the mammograms Tumor Board and the Surgery Quality Assurance Committee at for the Women’s Imaging Center will continue to provide services St. Joseph’s. He is the Chairman of the Surgery Department and a through the MMU. member of the Tissue and Transfer Committee at Dameron. St. Joseph’s is in the process of developing a new north Stockton During his tenure, Dr. Tuxen has held numerous medical location to re-locate the Women’s Imaging Center in the Fall. For staff committee positions, including a term as President of the questions and/or appointment scheduling information, please call Medical Staff at St. Joseph’s. Dr. Tuxen is a positive role model (209) 466-5028. for colleagues and dedicated to providing top quality care to his _______________________________________ patients. “I connect with my patients on a very personal level,” says Dr. Susan McDonald, MD, Appointed Vice Tuxen. “They share things with me they don’t share with other President of Medical Affairs for St. Joseph’s people because we’re talking about very private and personal Medical Center - Susan McDonald, MD has been aspects of their health. I enjoy getting to know them and using my appointed to Vice President of Medical Affairs (VPMA) for St. 30 years of surgery experience to improve their health.” Joseph’s Medical Center, Stockton. As VPMA, Dr. McDonald

SUMMER 2010

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COMMUNITY > news

IN THE

(MRI) system. The high resolution, three-dimensional images produced by the MRI let physicians view the body’s organs and tissues at many different angles painlessly and quickly without using radiation. The $2 million MRI system from General Electric is the best in its class

NEWS will work closely with the entire medical staff to advance clinical and patient safety strategies and directly oversees the facility’s medical directors and medical staff office. Dr. McDonald has been a member of St. Joseph’s medical staff for almost three years as an Anesthesiologist with Stockton Anesthesia Medical Group, Inc. (SAMGI). In addition to her full time position as the VPMA, Dr. McDonald will continue to provide anesthesia in a limited capacity. During her tenure on the medical staff at St. Joseph’s, Dr. McDonald served as the Chairperson of the Anesthesia Quality Committee, the IRB, and championed efforts such as the medical center’s procedural sedation policy, exsanguinations protocol, and the implementation of the OB epidural program. Prior to SAMGI, Dr. McDonald worked at Virginia Mason Medical Center in Seattle, Washington, for 11 years. Dr. McDonald received her medical education at the University of Pennsylvania and is Board Certified, Diplomate Status, in Anesthesiology. ________________________ Sutter Tracy’s New High-Tech MRI Helps Doctors Get the Full Picture Detecting tumors, blood clots, weak blood vessels and other problems inside the body is faster and easier than ever with Sutter Tracy Community Hospital’s new stateof-the-art magnetic resonance imaging

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Susan McDonald, MD, and the only MRI in the area equipped with a separate, more comfortable table dedicated to breast MRI. The new MRI is the latest addition to Sutter Tracy’s line of high tech services, which includes digital X-ray and mammography, advanced computed tomography (CT), and stereotactic breast biopsy. “MRI technology has advanced tremendously over the past few years producing higher resolution images in less time. With this new MRI, we can make faster, more accurate diagnoses which will lead to better treatments and outcomes for patients,” said T. Tejpal Singh, medical director for Sutter Tracy Imaging Services. “The new MRI can image the breast, which we couldn’t do with our old MRI so we had to refer those patients to facilities

outside of Tracy. Now our patients can receive the care they need close to home. The new unit also produces much improved images of abdominal organs and blood vessels.” Women at high risk of developing breast cancer are among those to benefit most from the new MRI, added Dr. Singh. While mammography is still the screening tool of choice for most women, research shows that MRI is better at detecting breast cancer than mammography alone in certain women at high risk for breast cancer – i.e. those with a strong family history of breast cancer or a genetic mutation that predisposes them to the disease. Sutter Tracy’s new MRI is also equipped with computer-aided detection (CAD), a system of hardware and software applied to breast MRI images. The system works like an “additional pair of eyes” and helps radiologists to more quickly and accurately determine the size and location of cancers found on breast MRI. The top-of-the-line MRI is capable of many other advanced applications as well, including magnetic resonance angiography (MRA). MRA provides a non-invasive alternative for diagnosing damaged blood vessels in the brain following a stroke or circulatory problems in the legs, arms and organs such as the kidney. The new MRI isn’t the only change patients will notice. Sutter Tracy moved their MRI suite to a new larger building closer to the hospital to provide greater convenience for patients and their loved ones. Unlike the previous location, the new MRI suite has its own beautifully decorated waiting area and private changing room. “We put a lot of effort into improving the patient’s experience as well as upgrading our equipment,” said David Bowlsby, Sutter Tracy Imaging Services manager. “The larger space, big windows

SUMMER 2010

SAN JOAQUIN PHYSICIAN

COMMUNITY > news and special touches make visiting the MRI suite much more pleasant and comfortable for everyone involved. It’s all part of Sutter Tracy’s effort provide the community with the best health care services possible.” ________________________ A Message from SJ Public Health PHS needs a volunteer Obstetrician to participate on the Fetal-Infant Mortality Review (FIMR) Team. The Team reviews deaths of infants <1 year old, with particular attention to deaths occurring among African-Americans. The Obstetrician would greatly benefit the Team by providing information on risk factors related to adverse fetal outcomes as well as medical background on prenatal care, labor, and delivery. Meetings occur every other even month (except December) at St. Joseph’s Cancer Center. Lunch is provided. Next two meetings: June 24 and August 26 from 12:00-1:30 PM. PHS also needs a volunteer Pediatrician to participate on the Child Death Review Team. The Team reviews deaths of children <18 years old. The Pediatrician would play a vital role on this Team by providing medical information on child development, childhood diseases, and injuries. Meetings are held on the 3rd Thursday of every month at the Sheriff’s Office in French Camp. Each Team Member receives cases to review 1-2 weeks in advance of a meeting. If a Member is unable to attend a certain meeting, s/he only has to let the coordinator know. Interested physicians can contact Dr. Wendi Dick, Assistant Health Officer, at (209) 4683859 or WJDick@SJCPHS.org ________________________ St. Joseph’s Medical Center Receives National Award for Environmental Excellence St. Joseph’s Medical Center has

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received the highest environmental achievement award presented by Practice Greenhealth, a national membership organization for health care facilities committed to environmentally responsible operations. St. Joseph’s was named a member of the Environmental Leadership Circle, Practice Greenhealth’s most prestigious award. These competitive awards are given within the healthcare sector to institutions for outstanding programs to reduce the facility’s environmental footprint. “All of our members are committed to improving health care’s environmental performance, but there is an illustrious group of facilities setting the highest standards,” said Practice Greenhealth Executive Director Bob Jarboe. “They are the best of the best, the recipients of our top award. St. Joseph’s Medical Center has introduced extensive environmental strategies into health care and is committed to achieving further improvements.”

The Environmental Leadership Circle recognizes healthcare facilities that exemplify environmental excellence and are setting the highest standards for environmental practices in health care. Award winners are chosen by the Practice Greenhealth award review team from the top Partner for Change applicants. To be considered, facilities must meet the criteria for the mercury-free award, recycle at least 25 percent of their total waste stream, have implemented numerous other innovative pollution prevention programs, and are leaders in their community. This is the fifth consecutive year that St. Joseph’s Medical Center has attained the Environmental Leadership Status. St. Joseph’s has been part of the Environmental Leadership Circle since its inception in 2007. Each year, the hospital strives to achieve the highest level possible of environmental awareness and conservation integration. The many recycling programs ongoing

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at St. Joseph’s include green waste, batteries, cans, bott les, wood pallets, hospital products such as blue wrap and shrink wrap, baby bott les and energy efficient laundry washers. “We take pride in being an environmental leader within the health industry and are dedicated to continuously striving to improve our environmental performance,” said John Kendle, St. Joseph’s Director of Operations, Support and Services. “The Environmental Leadership Circle is only going to get more crowded as more health care facilities make a commitment to reduce the health and environmental impacts associated with health delivery.” St. Joseph’s Medical Center has also implemented the use of 100% postconsumer waste recycled paper for the entire hospital, reusable isolation gowns, reusable sharps containers, and initiated onsite vermicomposting for wet kitchen scraps. St. Joseph’s has also begun a partnership with MedShare, which acts as a recycling and distribution center for surplus medical supplies and equipment. They redistribute donated product to healthcare facilities in our community and in economically developing countries that have litt le or no medical resources. ________________________ cMA Alert: New Physician Signage Regulations Take effect June 27 California physicians will soon be required to inform their patients that they are licensed by the Medical Board of California, and to provide patients with the board’s contact information. Despite CMA objections, the Office of Administrative Law recently approved these regulations, which are intended to let consumers know where to go for information on or with complaints about California medical doctors. CMA believes these regulations are an unnecessary administrative burden as state law already requires physicians to post their medical license or wear

SUMMER 2010

a name tag indicating their licensing status. The new regulations, which take effect June 27, 2010, require physicians to provide this notice by one of three methods: 1. Prominently posting a sign in an area of their offices that is conspicuous to patients, in at least 48-point type in Arial font. 2. Including the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s fi le, stating the patient understands the physician is licensed and regulated by the board. 3. Including the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative; the notice must be placed immediately above the patient’s signature line in at least 14-point type. Regardless of which method you choose, the notice must read as follows: “NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322, www.mbc.

ca.gov.” According to the medical board, physicians, not facilities, are responsible for compliance with this regulation. In group sett ings, only one sign must be posted (should that option be chosen), but it must be posted in a location where it can be seen by all patients. Although CMA strongly supports patient access to information about a physician’s education, training, and other qualifications, we believe that it would be more useful to provide patients with specific information about the education and training of their physicians. To that end, CMA is cosponsoring a “truth in advertising” bill along with the California Society of Plastic Surgeons. Our bill would require all health care practitioners to display their educational degree, license type and status, and board certification on either their nametag or in their offices, to help patients better understand the credentials of a health care practitioner prior to receiving treatment.

San Joaquin Medical Society members can

call our office to request a FRee laminated sign for your office. you may also visit our website to download a PDF sign, sample letters and additional information on this important topic.

SAN JOAQUIN PHYSICIAN

Young Physician Award Winner:

Dr. Ramin Manshadi By William West

SAN JOAQUIN PHYSICIAN

SUMMER 2010

r. Ramin Manshadi is School of Pharmacy. Heart abnormalities could be detected the first recipient of “I try to balance my private practice through a physical examination that the Young Physician with teaching and also the American includes standardized medical history Award from the San College of Cardiology’s California questions and an electrocardiogram Joaquin Medical chapter,” said Dr. Manshadi. “I think each (EKG). The EKG should be given by a Society. The fortyactivity helps me to be a better doctor and cardiologist or internist. An abnormal four-year-old interventional cardiologist take better care of my patients.” reading could signal a problem that would was chosen because he of his dedication He has a special interest in Sudden require follow-up. to high standards of patient care and Cardiac Death in athletes. On the “I believe genuine interest in people innovative techniques, his engagement bookshelves in his Pacific Avenue office is the key to all these things that I in professional organizations, and his are photos of Dr. Manshadi with former do,” Dr. Manshadi said. “If you are community involvement. 49er quarterback, Joe Montana and more a businessman physician than An example of patient care and with Sacramento Kings general manager truly interested in helping people, the innovation is the case of the Stockton Geoff Petrie. He has worked to increase involvements in groups won’t work. One woman who now lives must be more altruistically because a heart pump motivated.” circulates her blood. Dr. Manshadi has When the then 59-yearoffered free clinics for I believe genuine interest in people old woman experienced the uninsured. He has is the key to all these things that I acute heart failure after provided full Thanksgiving suffering from chronic meals for eight families. do,” Dr. Manshadi said. “If you are heart failure, her blood Dr. Manshadi was more a businessman physician than pressure plummeted born in Israel and his toward zero. She was in family moved to the truly interested in helping people, cardiogenic shock. She United States in 1978 the involvements in groups won’t was past Class 4 heart from Iran , thankfully failure. missing the 1979 Iranian work. One must be more altruistically Dr. Manshadi referred fundamentalist revolution. motivated. -Dr. Manshadi her to the Heart Failure/ He is a Baha’i, a faith not Transplant Program at well-regarded by the California Pacific Medical Iranian government. His Center in San Francisco , a faith is a guiding light in his hospital authorized to use an experimental awareness of the symptoms that may professional and personal life. heart pump that is small enough to be indicate increased risk for SCD in athletes. The doctor earned a B.S .in Physiology, portable. The machine is known as a In collaboration with Dameron Hospital, University of California , Davis ; a M.S. left ventricular assist device or LVAD. he has donated defibs to all the high in Physiology, University of Health Because Dr. Manshadi pushed hard on schools in Stockton . He has helped find Sciences/ Chicago Medical School, 1991; behalf of his patient, he found a way for donors for defibrillators in local schools a M.D., University of Illinois at Chicago her to survive. and his goal is to place them in every Health Sciences Center Another example is a nearly 80-yearschool in California . He is certified with the American old man who received a defibrillator He just completed an agreement with Board of Interventional Cardiology, pacemaker implant that wirelessly the St. Joseph ’s Foundation to partner American Board of Nuclear Cardiology, transmits heart function data to an in the defibrillator effort. Also, he just American Board of Internal Medicine, and internet site that Dr. Manshadi can finished a PSA video with the Sacramento the American Board of Cardiology monitor. The man lives in the foothills and Kings Coaches and players that is found He has been a national speaker for this data stream enables Dr. Manshadi at the HYPERLINK “http://Kings.com” pharmaceutical companies including to get critical feedback, especially when \t “_blank” Kings.com website. Pfizer, GlaxoSmithKline, and Merck. the patient has an episode of distress. SCD is a condition in which the heart Manshadi was voted Top The technology, which at the time it was stops abruptly without warning. This is Interventional Cardiologist 2007 implanted by Dr. Manshadi was the first usually caused by ventricular fibrillation, by Castle Connelly ; America’s Top in this area, allows correlation of heart which is an abnormality in the heart’s Cardiologist 2006-2007 by the function data to symptoms. electrical system and will result in death if Consumers Research Council, and Future In addition to a busy private practice, not treated immediately. Leader Award by American College of he finds the time and energy to serve as “Most SCD is caused by hidden heart Cardiology California Chapter. an Associate Clinical Professor at UC problems that are not recognized by Davis and a Clinical Professor at the UOP coaches or staff,” Dr. Manshadi said.

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SUMMER 2010

SAN JOAQUIN PHYSICIAN

Community Service > internship program

Re-Launch of Community Internship Program Popular program led by Dr. Joe Serra sets dates in September Quick Facts! Program Dates: Orientation Meeting – Monday, September 13 6:00pm Stockton Golf and Country Club Shadowing Days – Tuesday- Thursday, September 14 – 16 Participants choose 2-3 half day sessions Dinner Presentation – Thursday, September 16 6:30pm Stockton Golf and Country Club Application Process: Further information and Application is available online at www.sjcms. org or call our office to request material be mailed at 952-5299 Participation is limited for this unique program.

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In today’s health care environment of spiraling costs, confusion, criticism, litigation, and misunderstanding, health professionals must respond to medical consumers’ concerns by establishing ongoing and open communications. These communications must flow both ways if we are to resolve conflicts and devise constructive methods of containing costs without sacrificing patient care. Our Mini-Internship Program is an effort to achieve these ends by exposing the humane concerns of physicians through firsthand experience for interns. It also gives physicians input from a broad spectrum of community representatives as well which many find helpful in running their practice. It is for these reasons, that the medical society, through the persistence of Dr. Joe Serra who serves as the Community Relations Chair, is re-launching this popular program and already has several interested community leaders committed to participate. Interns will once again be invited from business, politics, media, labor, clergy, education, law, and the insurance industry, patient advocacy, or social service agencies, legislative, judicial, and regulatory organizations as in the past. This first program will take place during the week of September 13 – 17, 2010 with participants spending half a day in each one-on-one placement with physicians, rotating through a minimum of two assignments during the three-day project with the option of adding additional half days with other physician(s) to include more assignments. Interns are encouraged to ask questions and comment freely during their visits with physicians. In 2011, we plan to expand the program to twice a year to include as many people as possible in these small group experiences. Participating physicians represent the gamut of medical fields, from primary care (family and internal medicine,

SUMMER 2010

pediatrics and obstetrics/gynecology), through emergency One of the outcomes of the last session held in 2004 medicine, surgery, and a host of specialties. was an entertaining article in The Stockton Record written As with past schedules, the program consists of a by participant/writer Gilbert as she covered her time reception at the Society offices to give the participants and with Orthopedic Surgeon Dr. Mikaelian and Radiologist the physicians an opportunity to get to know one another. Dr. Khoury and how it related to her profession. In a The next two or three days provides participants one-onthank you note to Dr. Serra she wrote, “I feel honored one experiences to observe to have been asked and side by side activities of can’t tell you how much the physicians as they see I value the experience.” “This program was very interesting patients, conduct surgery She went on to write and amply demonstrated to me or other procedures. that “It was a fascinating, how hard physicians work and how The last activity includes mesmerizing experience to a dinner with all of the see Dr. Mikaelian perform concerned they are with each patient. participants and physicians arthroscopic surgery. I will I was fortunate to spend time with Drs. to share their experiences never forget the images and Fram Buhari and Dhiren Nanavati who and discuss the outcome. process that I witnessed. were both excellent and informative. I Every year this joint And after looking at highly recommend this program!” dinner includes a robust film with Dr. Khoury, I discussion of the value of understand why my doctor - Max Freeman, Attorney the experiences and how has never bothered to it will help participants actually show me my own in their role to share their MRI films. These doctors positive experiences through were wonderful teachers, kind, their individual profession. Physicians also shared patient, thorough, and I learned a lot.” She wrapped the perceptions they had gained of how valuable the up her note by writing, “This Program was a wonderful experiences seemed to be to them and the participants experience, and I appreciate all you did to make it possible.” with whom they interacted.

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risk management > medical records

Managing Professional Risk Making Changes to a Medical Record: Corrections vs. Alterations By Mary-Lynn Ryan, Risk Management, NORCAL Mutual Insurance Company and the NORCAL Group

Appropriate, consistent and accurate medical record documentation promotes quality patient care by providing a comprehensive patient history and facilitating continuity of care among different members of the healthcare team. The medical record is also the best evidence of care provided, should that care ever be questioned in medical liability litigation. Physicians can preserve the medical record’s effectiveness as a patient care tool and as a defense tool by resisting the temptation to inappropriately change the record. Whereas appropriately executed corrections are a relatively benign aspect of documentation, medical record alterations can cast doubt on the physician’s credibility and make an otherwise defensible case one that has to be settled. Defining Alterations: When a physician receives notice of a lawsuit and goes back to the medical record to “clarify” certain points for the purpose of aiding the defense of the claim, it is an alteration. Medical record alterations are considered a deliberate misrepresentation of facts. When an alteration is discovered during medical liability litigation it seriously impacts 38

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the ability to defend the claim. Additionally, many medical liability policies exclude coverage for claims in which the medical record was altered, which means the physician may end up paying for a judgment and defense costs out of pocket. Defining Corrections: When a physician changes a patient’s medical record during the normal course of treatment, before the issue of a claim or lawsuit arises, it is a correction. Corrections are acceptable, provided the changes are made appropriately. Tips for Appropriate Medical Record Correction Develop a medical records correction policy that incorporates the following recommendations: Mark the original (erroneous) entry through with a single line. Do not obscure the entry with correction fluid or ink. Do not attempt to write the intended number or word on top of the erroneous one(s) (i.e., “write over”). Sign, date and time the new (correct) entry.

SUMMER 2010

Never “back date” an entry to the medical record. If appropriate, direct the reader’s attention from the original, erroneous entry to the corrected entry, especially if it is not readily apparent that the subsequent entry is a correction. After a corrected entry has been added, never physically remove or erase an erroneous entry from the patient’s chart. The earlier (erroneous) entry may have been relied upon by other members of the healthcare team. To physically remove it would therefore falsely represent the integrity of the record. Develop policies and procedures that address making an addendum (or late entry). Write a note as an addendum if there is a need to write an entry in the record that is not contemporaneous with the finding or treatment being described. Place this addendum entry chronologically in the record, based on when it is being entered in the record. At the beginning of the addendum, explain to what the addendum refers. Sign, date and time the addendum entry. Electronic Health Records Users of electronic health record (EHR) systems should not be able to make changes to a computerized record indiscriminately or anonymously. When medical practices select an EHR system, they should ensure that once information is entered it cannot be removed. Although many software vendors claim that information cannot be removed or altered, practices should perform due diligence to confirm vendors’ security claims. In a properly functioning EHR system, any changes to the medical record must be made as addendums and dated appropriately so that later they cannot be construed as alterations. Conclusion

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Physicians should never place themselves in the position of having to defend a medical record alteration. There is almost always a price to pay, and the price can be high. Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL Mutual insureds. To learn more, visit www.norcalmutual.com/cme.

SUMMER 2010

SAN JOAQUIN PHYSICIAN

TAKING STREET MEDICINE TO

THE GLEASON

HOUSE

In the early 1960s, S.J. Medical Society members Dr. Robert Browne and Dr. Virgil Gianelli voluntarily provided health care to those who had noneâ&#x20AC;&#x201D;migrant farm workers and their families. Their pioneering outreach spawned a wave of other medical and dental volunteers. Within a decade that volunteerism led to Community Medical Centers with eleven clinics. Today, CMC provides Care Link, a group who visit farms, shelters, and homeless on the streets. Care Link / CMC will open their twelfth clinic in the former home of a Stockton legend: Edna Gleason.

By William West l Pictured: Randy Pinelli and Angie Carlos tend to a street person.

SAN JOAQUIN PHYSICIAN

SUMMER 2010

SAN JOAQUIN PHYSICIAN

cOVeR STORy > gleason house

Community Medical Centers ﬁrst trailer provided care in remote places and at jobsites – circa 1967. Edna Gleason, born in 1886 in Stockton, fed the hungry Community Medical Centers began in the 1960’s as a and homeless from the backyard of her house on South San volunteer effort of the San Joaquin Medical Society to help Joaquin Street. In the basement she kept powdered milk that migrant farm workers. The volunteer doctors drove to the fields the needy could access through a small door in the back of the to offer medical care, food, and clothing. house. She kept a separate bank Dr. Robert Browne, a family account for cash assistance to practitioner, and Dr. Virgil Gianelli the impoverished. Soon, her began the outreach to migrant “The number of patients we serve has historic house will be the home worker campsites. They worked continued to grow at a steady rate with to a medical clinic for the needy from the trunks of their cars. This marked increases over the past ﬁve of today. became the local Migrant Farm The Gleason House Medical Workers program and eventually years—more recently in response to Clinic is a collaborative effort the CMC. Both doctors were persons who have lost their employment of the Care Link - Community Stockton natives. Medical Centers’ “Health Care “Gianelli never forgot his roots,” and insurance,” Mike Kirkpatrick for the Homeless” program said Browne, according to a press and the Gospel Center Rescue release from the Mission (GCRM). SJMS in 2004 when Dr. Browne “Through their clinics, distributed throughout the county, received the Lifetime Achievement Award. “He grew up on Community Medical Centers provide much needed primary Wilson Way and he was really dedicated to taking care of care access to the growing underserved population in our disadvantaged people. In those days, there were no clinics for community,” said Dr. Dale Bishop, the Medical Director of the migrant farm workers. Most of them lived in tents in Linden. Health Plan of San Joaquin. “The Gleason House program, in We used to go to the tents, sometimes churches. We even set particular, targets care to those with the greatest needs and most up a clinic at the Linden Fire Department.” challenging access issues in this population.” In 1967, with federal and state funding, the SJMS developed

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SUMMER 2010

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Mrs.

Gleason, who was the first woman on the Stockton city council, was a self-taught pharmacist who passed the state-licensing exam and then had to fight licensing board to be certified. Reportedly, a month after she received the license, her husband (a pharmacist) died. She eventually owned several pharmacies in Stockton. She served as president of the California Pharmaceutical Association in 1933 and 1934. Though she died childless in 1963, there are still those who remember her. “Griselda Olivas, who is with the Care Van at St. Joseph’s, grew up next door to Mrs. Gleason and still remembers her,” said Angie Carlos, an outreach worker for Care Link, while standing inside the Gleason House during a recent tour. “Griselda was just a little kid and would sneak into Mrs. Gleason beautiful backyard. It was lush. She got in trouble one day for sneaking in.” “The more you learn about the Gleason House and Edna Gleason, the more you start to feel the cohesion of the whole community,” said Randy Pinelli, Homeless Health Care Services Director. “For example, the UOP pharmacy school was advised at its inception by Edna Gleason.” Gleason Park, not far from her house, was dedicated to her in 1975.

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two clinical facilities and a mobile clinic. Now, CMC has eleven clinics in San Joaquin, Solano, and Yolo counties. Sometime in 2010 the renovated Gleason House is scheduled to open as the CMC’s twelfth medical clinic for the homeless and impoverished. “The Gleason House Homeless Clinic has been a work in process,” Mike Kirkpatrick, CEO of Community Medical Centers said. “We first began to seek funding to develop it over eight years ago. Requests were denied by the Bureau of Primary Health Care for three years in a row and we then began to look at special congressional appropriations. Three years later we were successful in obtaining some funds to begin the renovation project, but were short the total needed.” As part of the American Recovery and Reinvestment Act, additional funding was obtained but not enough to cover all the renovation costs. “Since then,” Mr. Kirkpatrick said, “we have partnered with the Gospel Rescue Mission to apply for Community Development Block Grant funds, which were recently approved by the City of Stockton and the County—so almost a decade of perseverance has finally made the project feasible.” “Services will be targeted to homeless individuals and families in the Stockton area who are housed in shelters or living under bridges,” Mr. Kirkpatrick said, “This is much the way we started our clinic program in 1965 when we served Migrant Farm Workers along the ditch banks and in the orchards near Linden.” CMC serves over 69,000 individuals each year with primary medical care including Family Practice, Pediatrics, Internal Medicine, and OB/GYN physicians—about 35 Full time physicians, 10 midlevel practitioners (who work for the organization), and 2.5 FTE OB/GYNs under contract through San Joaquin County. The total employee group is 365. “We offer evening, Saturday, and holiday hours at most locations, in addition to our regular daytime hours,” Mr. Kirkpatrick said. “Physicians are on call for after-hours coverage and in-patient care is coordinated in San Joaquin County with San Joaquin General. Of our patient population, 60% are Medi-Cal, 30% are uninsured who pay for services discounted on a sliding fee scale, and the remainder include some State and local contracts, Medicare, and private insurance. Over 70% of our service activity occurs in San Joaquin County.” The largest segments of CMC’s patient population are children and adults to age 30. Second largest is 30 to 60 years old and about 5% over 60. Ninety percent of patients are below 200% of federal poverty guidelines. “The number of patients we serve has continued to grow at a steady rate with marked increases over the past ﬁve years—more recently in response to persons who have lost their employment and insurance,” Mr. Kirkpatrick said. Community Medical Centers is appreciative of the community support it has received over the years,” Mr. Kirkpatrick said, “and thanks the physician members of the San Joaquin Medical Society and our hospitals for the cooperative partnerships we have developed to assure a strong safety-net is available to the uninsured and underinsured populations.”

WINTER 2009

CARE LINK

FACTS: In 2001 Care Link â&#x20AC;&#x201C; CMCâ&#x20AC;&#x2122;s Health Care for the Homeless Program received $250,000 in Federal support and began providing services with an initial goal of providing care for 1,000 homeless individuals annually. Since its inception Care Link has consistently provided no-cost health care for more than 1,500 homeless individuals annually (with a single year high of over 1,700 users) and provided nearly 5,000 patient encounters per year. In 2007 CMC served 7707 migrant and seasonal farm workers, 1823 homeless and 179 HIV/ AIDS patients (2007 UDS Report). Within the county the problem of homelessness is most acute in the Stockton area. A 1989 study by Mendelson and Associates found that there were 3,000 homeless persons in San Joaquin County with 90 percent in the Stockton area. Since this report was prepared over 16 years ago, the number has undoubtedly grown. CMC counted approximately 1823 homeless persons among its user population in 2007, including those served at homeless shelters, and at various street outreach efforts.

WINTER fALL 2009 2009

SAN JOAQUIN PHYSICIAN

Membership > Benefits

yOUR OFFIce MANAgeR ADVOcATe

HAS THe ANSWeRS cMA LAUNcHeS NeW MONTHLy ReSOURce FOR PRAcTIce MANAgeRS The maiden issue of CMA Practice Resources (CPR) was launched this past April and now is available on a monthly basis. Our normal Q & A section features material from the May CPR Bulletin so you can see the quality of material provided in this new resource. The free monthly e-mail bulletin from the reimbursement experts in CMA’s Center for Economic Services is full of tips and tools to help physicians and their staff improve practice efficiency and viability. If you or your staff would like to subscribe, you can do so at http://www. cmanet.org/news/cpr or go to our own website at www.sjcms.org and you will find the subscription links there as well (There is also a pdf subscription form attached, if you would prefer to print/fax.) If you have any questions or comments, contact San Joaquin Medical Society’s Gena Welch, Membership Coordinator at (209) 952-5299 or for specific questions about the CMA’s new CPR Bulletin, contact Aileen Wetzel, at (916) 551-2037 or awetzel@cmanet.org.

geNA WeLcH MeMBeRSHIP cOORDINATOR (209) 952-5299 gena@sjcms.org

BRIeFLy NOTeD REPoRT UNfAIR PAYMENT PRACTICES CMA fights Blue Shield Policy on Consultations CMA Has New Consultation Code guide Calculating Interest on Claims Medicare Payment Cuts

OFFICE MANAGERS FORUM: Join Gena Welch each month at Valley Brew for a lively seminar attended by dozens of other ofﬁce managers who enjoy a complimentary lunch and some great networking as well. For more info or next month’s topic, call Gena at 952-5299 to be added to our guest list. Every second Wednesday from 11:00 - 1:00

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SUMMER 2010

RePORT UNFAIR PAyMeNT PRAcTIceS CMA is fighting on your behalf to curb abusive practices by third party payors. Our goal is to not only enact meaningful laws, but to make sure that these laws are enforced by state regulators. Unfair payment practices include, but are not limited to: Improper denial or delay in payment of a claim Failure to acknowledge receipt of a claim Underpayment Dispute resolution difficulties Untimely requests for refunds Unilateral contract amendments Note: Physicians should first appeal all unfair payment practices through the payor’s Provider Dispute Resolution (PDR) process and allow at least 45 working days for the dispute to be resolved. If the plan fails to resolve the issue, physicians should file a formal complaint with the appropriate regulator. TAKe AcTION Step 1 – Identify the regulator. The Department of Managed Health Care (DMHC) regulates HMOs, as well as Anthem Blue Cross PPO and Blue Shield PPO. For a full list of health plans regulated by DMHC, see http://wpso.dmhc.ca.gov/hpsearch/ viewall.aspx. The California Department of Insurance (DOI) regulates most PPOs. For a list of insurers regulated by DOI, see http://insurance. ca.gov/0100-consumers/hcpcarriers.cfm. For information on filing a complaint against self-insured ERISA plans, see CMA On-Call #1022, “ERISA Plans.” For workers’ compensation plans, see #1929, “Treating Physicians: Payment for Treatment.” Step 2 – Prepare your complaint. Gather documentation, including copies of your claims, EOBs, appeals, and any responses received from the payor. Step 3 – File your complaint. Complaints about DMHC regulated health plans must be filed through the agency’s online portal, http://www.dmhc.ca.gov/ providers/clm/clm_comp.aspx. To submit a complaint about a DOI regulated insurer, download and complete a Health Care Provider Request for Assistance (HCPRA) for each affected claim. (http://www.insurance.ca.gov/0100-consumers/upload/ RFAHPRFA.pdf) Step 4 – Notify CMA.Members are encouraged to send CMA a copy of their complaint to help with our advocacy efforts. (CMA, Attn: Economic Services, 1201 J Street, Ste 200, Sacramento CA 95814 or fax 916/551-2027.) TIP: Encourage your patients to also report unfair practices to the appropriate regulator.

SUMMER 2010

CMA RESOURCES: CMA On-Call documents #1051, “Physician Complaints About Managed Care Plans,” and #1049, “Patient Complaints About Managed Care Plans,” #0122, “ERISA Plans,” and #1929, “Treating Physicians: Payment for Treatment.” Need assistance filing a formal complaint? CMA’s reimbursement specialists can help. Call CMA’s reimbursement help line at 888/401-5911 or e-mail economicservices@cmanet.org. cMA ADVOcAcy ReSULTS IN ReVISeD BLUe SHIeLD POLIcy ON FReQUeNcy OF cONSULTATIONS The staff at Plastic Surgery Associates in Redding recently contacted CMA after receiving a notice from Blue Shield about a change to their payment policy on consultation codes. Specifically, Blue Shield announced it would reimburse for only one consultation code within a 12 month period when performed by the same physician or another physician of the same specialty within the same practice. CMA learned that Blue Shield’s edits only review the first 3 digits of the ICD-9 code. Thus, subsequent claims submitted within a 12 month period by the same practice with the same first three digits of the ICD-9 code would automatically be denied per the new policy, even if the claim was for subsequent consultative services on a separate or different part of the body. For example, if a patient was referred for a consultation on a suspicious mole on her neck, the physician would bill a consultation code. But if the patient was referred back for another consultation for a suspicious mole on a different part of the body, the first 3 digits in the diagnosis code could be the same. For example, 173.4 is

SAN JOAQUIN PHYSICIAN

Membership > Benefits

Upcoming Office Managers Forums June 9 – Health Plan of San Joaquin Here about the latest developments from HPSJ Gerri Casillas Nunez, Supervisor State Sponsored Programs Linda Reynolds, Provider Services Manager

July 14 – Taking Charge: Evaluating Relationships and Preparing for Negotiations – A Focus on Payor Contracting Aileen Wetzel Associate Director, Center for Economic Services California Medical Association

August 11 – Minimizing the Financial Hit! Making every dollar count in this difficult economic period. Irv Barnett, Sr. Manager Healthcare Moss Adams, LLP

September 8 – Top Ten HR Topics! What you may not know about employment but should. Melissa Irwin, SPHR Senior Consultant TPO HR Management OMF meets every second Wednesday of the month at Valley Brew Restaurant 11:00am – 1:00pm

malignant neoplasm of the skin on the scalp and neck, 173.7 is lower limb, 173.0 is the lip, etc. Blue Shield’s system would inappropriately deny the second visit based on only the first three digits of the ICD-9 code. To address this issue, Blue Shield has extended the edits to the first four digits of the ICD-9 code. The updated policy will be implemented in Blue Shield’s May release, scheduled for May 25, 2010. TIP: Health plans and insurers are required to fully disclose complete fee schedules and payment rules to contracting physicians (28 C.C.R. §1300.71(o), Business & Professions Code §511.4, Insurance Code §10133.6.) Best Practice: Obtain and review the payment policies for each contracted payor to ensure that your practice can administratively comply with each policy. CMA RESOURCES: CMA On-Call document #1070, “Managed Care Contractual Protections.” Is a contracted payor not reimbursing claims according to their own payment policies? Members are urged to contact CMA’s Center for Economic Services at 888/401-5911 or economicservices@ cmanet.org. Which Laws Apply? Throughout this bulletin, CMA On-Call documents, and other CMA resources, you will see various laws referenced. Knox-Keene plans include licensed HMOs and their contracting medical groups/IPAs, Anthem Blue Cross of California PPO and Blue Shield of California PPO. These plans are governed by the Health & Safety Code and are regulated by the Department of Managed Health Care. PPOs and other insurers, including Blue Cross and Blue Shield life and health PPOs, are governed by the Insurance Code and are regulated by the Department of Insurance. Self funded ERISA plans and Medicare are governed by federal law and workers’ compensation plans must adhere to the Labor Code. CMA Publishes Consultation Code Billing Guides As you are aware, Medicare is no longer recognizing inpatient and outpatient consultation codes. Effective January 1, 2010, physicians must instead bill using E&M codes from the Office and Other Outpatient Services, Initial Hospital Care, and Initial Nursing Facility sections of the 2010 CPT.

CMA has published a Medicare consultation code billing guide to provide some clarity on this understandably confusing and complex issue. CMA has also published a Managed Care Consultation Code Quick Reference Guide, which details which major payors in California will be changing their own payment policies as a result of this change. CMA RESOURCE: CMA’s consultation code billing guides are available to members-only at www.cmanet.org/ces. If you have any additional questions about these new rules, call CMA’s reimbursement help line, 888/401- 5911 or e-mail economicservices@cmanet.org. CMA Advocacy at Work “We wanted to take this time to express our gratitude to CMA and their staff on all the help and hand holding that was readily available to us through our stressful times. Because of CMA we were able to clear up our A/R’s from an HMO product line that refused to pay our doctors for the services rendered to our patients. CMA staff stuck by us through mounds of paperwork to get us paid for what was rightfully owed to our doctors. Thank you so much. It is such a relief knowing that CMA and their wonderful staff are available to assist us through any questions and concerns.” – Jane Kim, Office Manager for CMA Members Drs. David A. Thompson and Lance J. Lee Ask the Expert: Interest Calculations Question: If a payor does not pay my claim within the statutory timeframe, how do I calculate interest due? Answer: Interest is calculated beginning with the first calendar day after the 30 or 45 working day period has elapsed. Example: Contracted rate is $325.84. Determine the interest rate. In this example it is a PPO claim, so interest is 10 percent per year. Determine amount not paid – in this example it is $325.84 Multiply amount not paid by the interest percent per annum: $325.84 x .10 = $32.58/year. Divide interest due in a year by 365 days to get the daily interest due: $32.58/365 days = $.089/ day. Determine the number of days the payment is late. Remember, the clock starts ticking from the 31st (or 46th) working day from the day the payor received a clean claim. Multiply the daily interest due by the number of days the payment is late to get the interest due $.089 x 237 days = $21.09.

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Membership > Benefits Remember – if the issue is with a Knox-Keene plan that fails to automatically include interest due on a claim, they must pay a $10.00 per claim penalty in addition to the interest due. Ask the Expert: Payor Solvency Question: One of my contracted payors has stopped paying claims. I am concerned that the payor may be experiencing financial difficulty. What should I do? Answer: One of the symptoms that a health plan, IPA or other payor is having financial difficulties is a failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory timeframes but does not release the checks in a timely manner. If you are experiencing repeated payment delays you should investigate the financial health of the payor.

CMA RESOURCE: To help CMA members monitor the financial health of their contracted payors, CMA has put together a Payor Solvency Checklist, which includes helpful information as well as options available to the practice. MeDIcARe PAyMeNT cUTS STOPPeD – FOR NOW On April 16, the President signed H.R. 4851, the Continuing Extension Act of 2010, retroactively reversing the 21.3 percent Medicare physician payment cut that took effect on April 1 and extending 2009 payment rates through the end of May. The Centers for Medicare and Medicaid Services (CMS) had instructed contractors to hold physician claims for 10 business days to minimize administrative complications and cash flow disruptions and allow Congress time to retroactively stop the cut before physician payments were affected. California’s Medicare contractor, Palmetto, informed CMA that it did not pay any claims under the reduced fee schedule and that claims are being released for April dates of service. Claims will be processed one to two days at a time, starting with the oldest claims, until all claims that exceed the 14-day payment floor hold are released.

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PROBLeMS geTTINg PAID? CMA’s Center for Economic Services (CES) provides direct reimbursement assistance to CMA physician members and their office staff. Reimbursement Help Line 888/4015911 One-on-one educational and reimbursement assistance to physician members and their staff Practice Empowerment Tools and resources to empower physician practices Seminars and toolkits for physicians and their staff Experienced Staff Staffed by practice management experts with a combined experience of over 125 years in medical practice operations To access our reimbursement advocates, your physician must be a CMA member. For membership information, contact CMA Member Services at 800/7864CMA (4262) or memberservice@ cmanet.org.

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SUMMER 2010

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SAN JOAQUIN PHYSICIAN FALL 2009

Denise Morgan, M.S.N. - N.P.

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CMA ADVOCACY > Health Reform

CMA Steps up Where AMA Can’t: An Interview With CMA’s Vice President for Federal Government Relations Reprinted from San Diego County Medical Society

NOTE FROM SDCMS: Carefully note the references to CMA vs. AMA in Elizabeth McNeil’s comments and the ways CMA is better able to address California-specific issues than is AMA, especially due to the different constituent members. Elizabeth and CMA have been at the forefront of educating federal legislators and White House aides in the truth behind the Dartmouth Atlas studies and the inappropriate use of the studies by rural states to reallocate funds away from California. Without CMA’s efforts on this front, we stood to lose much more in coming years! San Diego Physician: Tell us how you got started at CMA. Elizabeth McNeil: I actually started my career on Capitol Hill working as a legislative assistant to several members of Congress. After I left Washington, DC — almost 20 years ago now — I came to California and have been working for CMA ever since. For years CMA had been doing some federal lobbying, but not to the extent that it needed to. We realized that, because of our unique circumstances here in California and the enormous impact federal issues have on our doctors and how they practice medicine, we differed from a lot of the other states and from AMA on different issues. SDP: Can you give us an example? McNeil: There are some issues where AMA can’t help California’s doctors — when we have, for example, geographic

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fights between the states, which was the central theme this year. The president and his budget staff focused in on the Dartmouth studies that show wide disparities in Medicare spending across the country. For instance, in Los Angeles and Miami-Dade, Florida, we spend four times as much as other regions to provide the same care to senior patients. Many analysts believe it is inefficient delivery of care, and they have used the Dartmouth studies as a way to curb runaway healthcare costs. The Midwest and Northwest rural states that spend less than California operationalized it into legislation. The rural state proposal would have rewarded the states that spend less than the national average, and doctors in California, for example, who spend above the national average, would have had their reimbursements cut significantly. So that was the proposal put before Congress in an environment of cost containment and no new Medicare revenue. We spent our entire year fighting this fight, and AMA couldn’t enter the fray because they have states who are winners and states who are losers, and they couldn’t get in the middle of it. CMA had to be engaged in Washington, DC, ensuring that the bills were amended to account for California’s socioeconomic differences (income, racial and ethnic diversity, insurance status), health status differences, and our geographic differences in practice costs. As we know from numerous studies, including MedPAC, if researchers account for these other factors, the geographic variation in spending between states goes way down. Had the other states prevailed, we would have had up to 22 percent in payment cuts in California.

SUMMER 2010

SDP: What would you say to physicians who are angry with AMA right now with respect to health reform? McNeil: It’s easy to stand on the outside and criticize AMA on healthcare reform, saying they should have gotten more for the docs. A lot of physicians are upset that AMA didn’t stand up and fight for the right to privately contract, for example. Private contracting is an uphill battle with Congress. It’s an issue that will take several years and a lot of work to take hold. I think AMA did the right thing in supporting expansion of coverage to the uninsured and all of the reforms on the for-profit insurance industry, which has been a part of CMA’s agenda for decades. Could AMA have done more to leverage Congress and their support for getting more on the physician payment side? Yes, they could have, and that’s what’s frustrating and lacking in this bill — that’s the unfinished business of health reform [see page 36]. However, physicians also need to understand that the health reform bill was more about reigning in escalating healthcare costs than it was about covering the uninsured. It was a tough environment. There was enormous pressure to contain costs in the Medicare program. Compared to the other providers — health plans, hospitals, pharma, nursing homes, and home health — physicians did not receive deep payment cuts. However, other than primary care, we were not given appropriate updates, and physicians are rightfully angry and frustrated. The Medicare SGR needs to be eliminated. That’s a huge start to getting us on the path of stable updates. But the incentives in our payment systems need to be completely realigned. CMA physicians did an incredible job of educating our congressional delegation, particularly those House Democratic leaders that included $450 billion in physician payment fixes in the House bill to provide coverage and access to doctors. I think AMA was right in their support of the House bill, but, unfortunately, we ended up with the Senate bill, which wasn’t nearly as good for doctors. I think we all should have been stronger in our opposition to the Senate bill. CMA tried to be very outspoken about the Senate bill. But AMA has a lot of commitments from the White House, the House leadership, and, to some extent, the Senate leadership, to address the physician payment issues, to stop the 21 percent SGR cut and repeal the SGR payment formula, and to weaken the impact of the independent Medicare board on physicians. CMA is working on these issues as well as including the California GPCI fix in the SGR bill this year. We expect a bill by June. I think our CMA leadership did a better job of nuancing our position on what we supported and what we didn’t. We were very strong in our opposition to the Senate bill. I think we did a better job of pointing out to our physician members where we had problems and what we wanted fixed. AMA did some important things for physicians, but they didn’t do

SUMMER 2010

SAN JOAQUIN PHYSICIAN

cMA ADVOcAcy > Health Reform a good job of involving the grassroots. CMA and San Diego have fantastic physician advocates who have been most effective. However, I think we have no idea the wrath that would have fallen upon physicians from the public and from Congress if physicians once again were standing in the way of low-income people who need health insurance. I think it’s something that we had to play very carefully. Medicine wanted to be relevant to the conversation and a partner at the table in the negotiations. If we had said hell no like the insurance industry finally did, we would have been left out of the room like they were, and you saw how the Obama Administration went after them with full force. I think if medicine had come out with a single oppose position, it would have been very harmful to our future success in achieving our legislative goals and on implementation of reform. And there are good things in this bill for physicians. So you have to be firm about what you oppose, but you also have to let Congress know that you want to be part of the solution. Whether it’s legislative or clinical, physicians are always looking for the solutions, rather than being part of the problem. SDP: Any last words? McNeil: This bill is a mixed bag for doctors. It’s great that we’ve covered a lot of uninsured patients and that we’re

going to reform the insurance industry. The primary care investments are significant. The fact that we’ve covered 80 percent of Californians is no small feat to be overlooked — we have to keep our perspective on that. It isn’t the way I would have done it. It isn’t the way most physicians would have done it. But I think we all need to move forward at this point and focus on improving it. There are a lot of important battles to be fought on SGR and reform implementation, and physicians have got to stay united. They’ve got to stay engaged in this battle; it’s probably more important than ever to speak out about access to doctors. And the implementation … boy, the devil’s in the details on this. It’s going to be an enormous amount of work, and that’s really where this bill will be won or lost for the doctors and the patients. I urge physicians not to get discouraged. Half of our doctors support this bill and the other half are very discouraged. For those who are discouraged, I encourage you to remain engaged, to stay in the fight because there’s still a lot to be gained here. The unfinished business agenda is important. We have to explore new payment and delivery models, realign incentives, and let physicians practice medicine. And as physicians, whether we agree or disagree, we will only prevail if we fight together — AMA, states, counties, and specialties.

A LOCAL HEALTH PLAN FOR LOCAL PEOPLE... Health Plan of San Joaquin is your community health plan – created by local people for local people. That means decisions about our programs and services are made right here at home by people who know and understand San Joaquin’s community health needs. It also means the personal doctors, pharmacists and area hospitals you trust can access our medical leadership to discuss your individual needs as a patient and assure you’re getting the best treatment for you. Long time community physicians David Eibling, M.D. (Associate Medical Director) and Dale Bishop, M.D. (Medical Director) bring nearly 50 years of community health leadership in guiding Health Plan of San Joaquin.

SAN JOAQUIN PHYSICIAN

Call Health Plan of San Joaquin today to find out why a local health plan can make a difference for your family.

1-888-936-PLAN (7526) www.hpsj.com 1-888-936SUMMER 2010

Membership < MeDIcAL SOcIeTy

19 NEW

MEMBERS IN THE PAST 60 DAYS!

...and even more on the way. Tawanda Adeshina, MD Family Practice Kaiser Permanente 7373 West Lane Stockton, CA 95210 Office: (209) 476-2080 Meharry Medical College: 2002

Ramesh Dharawat Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6624 Shivaji University Miraj Medical College: 1977

Usman Ali Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6624 Fiji Medical School: 1978

Daniel Dietrich, MD Radiology Valley MRI & Family Medical Imaging Center 546 E Pine Street Stockton, CA 95204 Office: (209) 467-1000 Uniformed Services University of Health Sciences: 1998

Mehrdad Amirhamzeh, MD Pathology 1805 N California, Ste 407 Stockton, CA 95204 Office: (209)408-8338 Medical College of Wisconsin: 1990 Sanjeev Bansal, MD Family Medicine Sutter Gould Medical Foundation 2545 W Hammer Lane Stockton, CA 95209 Office: (209)956-1552 Government Medical College: 1999

SUMMER 2010

Jon Eck, MD Occupational Medicine 3663 E Arch Road, Ste 400 Stockton, CA 9515 Office: (209)943-2202 St Louis University School of Medicine: 1988 Eric Larson, MD Family Medicine Kaiser Permanente 7373 West Lane Stockton, CA 95210 Office: (209)476-2181 University of California School of Medicine – Davis: 2001

Colleen Lennard-Love Otolaryngology Sutter Gould Medical Foundation 2545 W Hammer Lane Stockton, CA 95209 Office: (209)830-4062 Hahnemann University School of Medicine: 1995 Linath Lim, MD Internal Medicine Sutter Gould Medical Foundation 2505 W Hammer Lane Stockton, CA 95209 Medical College of Pennsylvania: 1993 Arturo Macasinag Radiology Sutter Gould Medical Foundation 2505 W Hammer Lane Stockton, CA 95209 Office: (209)524-1211 University of Santo Tomas: 1971 Jeffrey McDavit, MD Pathology St Joseph’s Medical Center 1800 N California Street Stockton, CA 95204 Office: (209)461-5340 University of Southern California School of Medicine: 2003 Susan McDonald, MD Anesthesiology St Joseph’s Medical Center 1800 N California Street Stockton, CA 95204 Office: (209)467-6552 University of Pennsylvania School of Medicine: 1995 John Newman, MD Family Medicine Kaiser Permanente

7373 West Lane Stockton, CA 95210 Meharry Medical College: 1976 Ma Padero, MD Internal Medicine Kaiser Permanente 1721 W Yosemite Avenue Manteca, CA 95337 Office: (209)824-5088 Xavier University: 1987 Charles Stillman, DO Radiology Valley MRI & Family Medical Imaging Center 546 E Pine Street Stockton, CA 95204 Office: (209)467-1000 Kirkville College of Osteopathic Medicine: 1995 Priya Swamy, DO Internal Medicine Sutter Gould Medical Foundation 2505 W Hammer Lane Stockton, CA 95209 Office: (209)549-3370 Touro University College of Osteopathic Medicine: 2006 Leila Yasrebi, MD Pediatrics Kaiser Permanente 7373 West Lane Stockton, CA 95209 Office: (209)476-5725 Ross University School of Medicine: 2000 You-Tan Yeh, MD Internal Medicine Sutter Gould Medical Foundation 2505 W Hammer Lane Stockton, CA 95209 Office: (209)549-3370 Medical College of Wisconsin: 2006

SAN JOAQUIN PHYSICIAN

â&#x20AC;&#x153;The (Diabetes Collaborative) training sessions helped our practice become more aware of diabetes as a health issue, recognize diabetes care deficiencies in our practice, and make changes to improve.â&#x20AC;? Carlos E. Meza, MD 56

SAN JOAQUIN PHYSICIAN

SUMMER 2010

diabetes guide < practice resources

Diabetes and Cardiovascular Disease: New Comprehensive Reference Guide for Clinicians By Carol A. Lee, Esq., President and CEO, CMA Foundation

The California Medical Association (CMA) Foundation will soon release the 2009/2010 Diabetes and Cardiovascular Disease Reference Guide. The Guide aims to support clinicians’ management of diabetes-related, cardiovascular complications. The idea for this guide was in part generated from clinicians in San Joaquin County who participated in the CMA Foundation’s Advancing Practice Excellence in Diabetes pilot project. Diabetes and Cardiovascular Disease Reference Guide Contents The Guide will be updated annually and include: Guidelines supporting the screening and diagnosis of type 2 diabetes, dyslipidemia and hypertension. Approaches to the clinical management of type 2 diabetes and its related cardiovascular complications. Strategies for preventing and more effectively managing type 2 diabetes complications. Strategies for effective communications with patients. Educational resources for physicians, other health care professionals and patients with diabetes. Developing the Diabetes and Cardiovascular Disease Reference Guide In late 2009, several participating physicians in the CMA Foundation’s Advancing Practice Excellence in Diabetes projects’

SUMMER 2010

Quality Collaborative expressed the need for resources that better linked diabetes with cardiovascular disease. They shared with Foundation staff that during visits with their diabetic patients, they actively discussed hypertension, high cholesterol and other issues related to cardiovascular disease. Many felt overwhelmed by the daunting task of addressing diabetes and its cardiovascular complications. The CMA Foundation took action and convened an expert panel of physicians and other health care professionals to develop this comprehensive Guide. More than 30 experts engaged in developing the Guide, including representatives from the: American College of Cardiology, American Association of Clinical Endocrinologists, National Medical Association, American College of Physicians, California Department of Healthcare Services, California Diabetes Program, California Diabetes Coalition and representatives from a number of health plans and other provider organizations. Diabetes & Cardiovascular Disease Prevalence: Nationally & Locally Nearly half of all adults in the US have one chronic condition associated with an increased risk of cardiovascular disease. According to the Centers for Disease Control and Prevention, 45% of individuals 20 years of age and older have hypercholesterolemia, hypertension, or diabetes. In fact, the major complication of diabetes and the leading cause of death among

SAN JOAQUIN PHYSICIAN

practice resources > Diabetes Guide patients with diabetes is cardiovascular disease. San Joaquin County ranks 48th out of 58 counties for the percent of county residents 18 and older with diabetes, as reported by the California Diabetes Program. This translates to 9.2% of residents diagnosed with diabetes compared to 7% of statewide. 65.2% have been diagnosed with high blood pressure, much higher than the state average of 61.5%, designating San Joaquin County as 35th out of 58 counties statewide. The impact of diabetes is especially visible among San Joaquin County’s Latino and African American population. Among those diagnosed with diabetes, 63.6% of Whites and 66.2% of Latinos were reported to have high blood pressure and 32.5% of Whites, 48.7% of African Americans reported having high cholesterol.

improvement project, Advancing Practice Excellence in Diabetes, to improve the quality of diabetes care provided in solo and small group practices in California. The overarching goals were to 1) decrease the prevalence of type 2 diabetes; and 2) reduce the racial and ethnic health disparities associated with type 2 diabetes. San Joaquin County was one of three geographic regions selected for participation due to its diverse patient and physician population, including a strong presence of Southeast Asian patients. Six practices from this region participated in the pilot and were comprised primarily of solo physicians with four to seven medical and front office staff. The Health Plan of San Joaquin and the San Joaquin Medical Society were strong partners in this pilot.

Local Level Intervention: Advancing Practice Excellence in Diabetes In 2006, the CMA Foundation began the first phase of its diabetes

Some key practice and clinical improvements from the San Joaquin pilot are highlighted below.

Practice-Level Improvements Systems Changes

Activity

1. Prepared and Proactive Team

1. Daily huddles between office managers and physicians to map out the day’s schedule 2. Regular monthly staff meetings to improve overall communication 3. Patient outreach and follow up care led by medical assistant to ensure comprehensive care 4. In-chart reminders (e.g. pre-filled lab slips, printed visit planners) to support the physician in completing all necessary care measures

2. Delivery System Design

5. Use of linguistically and culturally appropriate patient education materials to improve patient knowledge

3. Decision Support

6. Adoption of a combined diabetes and cardiovascular disease visit flow sheet

4. Registry Use

7. Adoption of an electronic registry for point of care and population management

Clinical Improvements Indicator

May 2007

December 2008

1. HbA1c screening (at least once per year)

70%

92%

2. HbA1c at goal (<7%)

21%

40%

3. LDL screening (at least once per year)

70%

90%

4. LDL at goal (<=100 mg/dL)

34%

50%

5. HDL screening (at least once per year)

75%

91%

6. HDL at goal (>35 mg/dL)

50%

73%

7. Cholesterol screening (at least once per year)

70%

90%

8. Cholesterol at goal (200 mg/dL)

46%

65%

SAN JOAQUIN PHYSICIAN

SUMMER 2010

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practice resources > Diabetes Guide Looking Ahead The CMA Foundation is moving forward with broadening the Advancing Practice Excellence in Diabetes project to a multiyear, statewide quality improvement project. The project will continue to address the diabetes and cardiovascular disease link, address healthcare disparities, and target solo and small group practices. The project will initiate work in the areas of patient self

management and medication adherence, while also partnering with Medi-Cal Managed Care Plans to provide local level, quality improvement support to practices. With a focus on achieving quality standards and providing training opportunities for clinicians and their staff, the project will help solo and small group practices prepare for health care reform changes on the horizon. The CMA Foundation will continue to engage the support of clinician champions in San Joaquin County to support this statewide project.

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The CMA Foundationâ&#x20AC;&#x2122;s Diabetes and Cardiovascular Disease Reference Guide will soon be available on the Advancing Practice Excellence in Diabetes Project section ofwww. thecmafoundation.org.Â For more information on the Guide or to see how you can participate in our next phase of the Advancing Practice Excellence in Diabetes project, please contact Senely Navarrete, MPH, Project Director, at (916) 779-6638 or snavarrete@ thecmafoundation.org.

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Community Service > Off the Charts

Health Plan of San Joaquin Honors Local Health career’s Scholarship Awardess Health Plan of San Joaquin is honoring graduating high school seniors who received academic scholarships from the Health Careers Scholarship Program. Thirteen local high school students from San Joaquin County were awarded scholarships for $2,500 and $1,000 totaling nearly $30,000 in awards. Health Plan of San Joaquin’s Health Careers Scholarship Program was established to provide scholarships to students based upon their interest in pursuing a career in the healthcare industry. The 2010 cycle is the second academic year that the scholarships were awarded, and over 30 applications were received. ”There are many and varied opportunities for students seeking health careers in San Joaquin County. Regionally, we are experiencing both a high burden of illness and shortages of medical professionals, particularly primary care physicians, medical technologists, therapists, and nurses. Health Plan’s academic scholarships are a positive strategy to encourage the next generation of talented local students to consider careers in health and medicine,” said Dale Bishop, M.D., medical director for Health Plan of San Joaquin. He said the goal for establishing this scholarship program was to create a channel that can bring talented

students back to join the health-care workforce in San Joaquin County. Jonathan Parra, a Cesar Chavez High School senior who received a $2,500 award, said “this scholarship has encouraged me to continue my education and forwards my interest to return to San Joaquin as a medical professional. I see a need for bilingual doctors in the San Joaquin area to connect with patients directly and fulfill their needs." Parra will be studying pre-med health sciences at the University of California, Davis. The Health Careers Scholarship that Parra received from Health Plan will help him buy books and study materials and will assist with his tuition. More than 30 applications were received from students who have shown promise and interest in pursuing higher education in the health-care industry. Those who received $2,500 include:

Brandon Chan, Bear Creek High School James Cwick, Ripon High School Harbir Dhillon, Lodi High School Derek Leale, Tokay High School Lisa Lim, Cesar Chavez High School Jonathan Parra, Cesar Chavez High School Priyank Patel, Lodi High School Vanessa Sanchez, East Union High School Kor Vang, Bear Creek High School Samuel Walker, Tokay High School

SAN JOAQUIN PHYSICIAN

Dianna Zavala, Lodi High School Those who received $1,000 include: Kaylee Blankenship, Lodi High School Berenice Carlon, Merrill F. West High School Many of the scholarship recipients are firstgeneration college students. The majority will be attending colleges in California, including University of the Pacific, University of California campuses, and Stanford University.

SUMMER 2010

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SAN JOAQUIN PHYSICIAN

San Joaquin Medical Society and CMA Members Enjoy: Vast CMA Resources: Serving the counties of San Joaquin, Calaveras, Alpine, and Amador

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

• • • • • • •

Contract Analysis Reimbursement Hotline Legal Hotline Legislative Hotline HIPPA Compliance Seminars and Conferences Extensive Online Resources including over 200 letters, agreements, forms, etc. • Plus – Free Legal Advice with CMA ON-CALL Documents!

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

Annual Directory CMA Member Seminars Cost Saving Benefits Quarterly Publication Website/Online Resources Insurance Savings Alliance Membership Annual Social Events Patient Referrals Office Manager Forum and Practice Resources

Federal, State, and Local Advocacy: Your Dues are an Investment which Supports our Efforts in Protecting Your Rights. If we don’t Fight for You ... Who Will?

Phone: (209) 952-5299

www.sjcms.org

SAN JOAQUIN PHYSICIAN

SUMMER 2010

San Joaquin Medical Society & Health Plan of San Joaquin

Present: The EHR Best Practice Series™

Learn Best Practices for Selecting, Implementing, and Optimizing an Electronic Health Record (EHR) System With the introduction of the HITECH Stimulus Act, 2010 is the year to fully adopt an EHR system. How do you plan for a successful EHR implementation? What level of “Meaningful Use” deployment is required to receive incentives? There are more than 250 EHR vendors in the market, how do you determine which EHR product meets Stimulus requirements and is the best fit for your practice and budget? Maxwell IT, the producer of the EHR Best Practice Series™ is a nationally recognized EHR consulting company that provides education, self-help resources and vendor analysis through state medical associations. The seminars are designed to be vendorneutral in content and are free or discounted for members and staff.

Basic Course Schedule

March 30, 2010 | 6:00pm – 8:30pm September 21, 2010 | 6:00pm – 8:30pm Cost: Free for all physicians and office staff. Light snacks & beverages will be available during seminar.

Health Plan San Joaquin • Community Room 7751 South Manthey Road • French Camp, CA 95231

Best Practices for EHR Selection & Implementation TOPICS WILL INCLUDE:

EHR101 - Lessons Learned from a Practice Implementation

• Provide a real-life perspective of what it takes to implement an EHR • Discuss short and long-term benefits (ROI) and change management issues • Provide an overview of an EHR system applied to the daily routine of a physician and administrator

Best Practices for Selection and Implementation

• Present an overview of recommended selection criteria and methodology to identify potential vendors • Learn to build a five year budget model that calculates all direct and indirect costs associated with purchase, as well as cost savings • Learn how to effectively compare vendors

Workshop / Selection Handbook

• Experience EHR technology first hand • Speak to experts directly about your specific requirements and experiences • Network with other physicians and administrators beginning the same process • Attendees will receive an EHR Selection Handbook - a planning kit to help kick-start your path to a successful EHR selection and implementation

Supported & Conducted by:

We Support You.

Sponsors: DISCLAIMER: Maxwell IT Company – the lead host of the EHR Best Practice Series™ - would like to thank the sponsors, medical associations and regional hospitals participating to make the events possible. This is a vendor-neutral education program. All supporting medical associations, participating hospitals, and Maxwell IT Company are not affiliated with the participating sponsors, nor do they endorse any specific medical record system or related product or service in conjunction with these programs. © 2010 Maxwell IT Company. All rights reserved. EHR Best Practice Series is a trademark of Maxwell IT Company. SUMMER 2010

SAN JOAQUIN PHYSICIAN

SPRINg 2010

H E A LT H C A R E H A P P E N I N G S

South Wing Dedication May 8, 2010

Top Photo: Key players in designing and building the South Wing on the second floor balcony of the new South Wing. Right photo above: Joe Harrington, president and CEO, Lodi Memorial Hospital; Cecil Dillon, chair, Lodi Memorial Hospital Association Board of Directors; Param Gill, MD, board member, Lodi Memorial Hospital Association Board of Directors; Joe Handel, president, Lodi Memorial Hospital Foundation Board of Directors. Left photo: A view of the health fair in the new Healing Garden from the second floor of the South Wing.

CMA Legislative Day at the Capital - Drs. Jim Scillian, Pat Hatton, President Lawrence Frank, Executive Director Mike Steenburgh and Alliance members Jeanne Siu and Nancy Schneider met with Assemblyman Bill Berryhill in addition to other key representatives.

SPRINg 2010

SJMS Alliance Installation Lunch - Mary Bock was installed as the 2010-2011 Alliance President by California Alliance Past President Debbi Ricks of Santa CLara. SJMS Alliance Past President Jeanne Siu was also reconized.

SAN JOAQUIN PHYSICIAN

H E A LT H C A R E H A P P E N I N G S

Patient Pavilion Opening March 19, 2010

Top left photo: Ribbon Cutting hosted by the Stockton Chamber of Commerce. Top right photo: David Jensen, MD, and Jim Acosta enjoy the event. Second row, right photo: St. Josephâ&#x20AC;&#x2122;s Medical Center CEO Don Wiley addresses the standing room only crowd. Bottom left photo: The hospitals new elevated and sweeping corridor is seen above the large crowd that attended the festivities.

SAN JOAQUIN PHYSICIAN

Bottom right photo: Alisa Kamigaki, Mas Kamigaki, MD, and Florence Kamigaki are pictured in the new spacious lobby of the Patients Pavilion.

SUMMER 2010

H E A LT H C A R E H A P P E N I N G S

Community Center for the Blind Annual Health & Wellness Fair April 10, 2010

Top left photo: all attendees to the fair were invited to have their names translated into braille as a keepsake. Center left photo: The entire event was cosponsored by the Stockton Lions Club. SJMS member and Lions member, Dr. Eric Chapa provided free health screenings as well. Second row, right photo: Kaplan students provided help all day with various tasks including blood pressure checks and even handing out fresh fruit donated by the Food Bank. Bottom left photo: St. Josephâ&#x20AC;&#x2122;s Medical Centers Care Van provided excellent resources to those attending. Bottom right photo: Attendees enjoyed meeting Blind Center staff members.

SUMMER 2010

HEALTHCARE HAPPENINGS is now a regular feature in San Joaquin Physician Magazine and requests your photo submissions for publication consideration. All photos must be submitted as JPG files electronically and contain appropriate captions. Email your submissions to submissions@sjcms.org

SAN JOAQUIN PHYSICIAN

Rita Stolp Vice President Pacific State Bank 1889 W. March Lane Stockton, CA

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Physician Locator Handy Buyer’s Guide Daily CMA Updates Member Benefits & Discounts

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Hundreds of Useful Links Office Resources Dozens of Webinar Links Monthly Event Calendar Tons of Patient Resources

• Physician Magazine Archive • and much more!

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SUMMER 2010

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