JULY/AUGUST 2015 | VOLUME 21 | NUMBER 4
Page 3 Inside: MCMS Incoming President James Hlavacek, MD Receives The Gavel
SCCMA INCOMING PRESIDENT ELEANOR MARTINEZ, MD RECEIVES THE GAVEL FROM PAST PRESIDENT JAMES CROTTY, MD
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MCMS Incoming President James Hlavacek, MD Receives the Gavel
JULY/AUGUST 2015 | THE BULLETIN | 3
THE SANTA CLARA COUNTY MEDICAL ASSOCIATION OFFICERS President Eleanor Martinez, MD President-Elect Scott Benninghoven, MD Past President James Crotty, MD VP-Community Health Cindy Russell, MD VP-External Affairs Kenneth Blumenfeld, MD VP-Member Services Anh Nguyen, MD VP-Professional Conduct Vanila Singh, MD Secretary Seema Sidhu, MD Treasurer Seham El-Diwany, MD
CHIEF EXECUTIVE OFFICER
COUNCILORS
William C. Parrish, Jr.
El Camino Hospital of Los Gatos: Ryan Basham, MD El Camino Hospital: Vacant Good Samaritan Hospital: David Feldman, MD Kaiser Foundation Hospital - San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Martin Wong, MD O’Connor Hospital: Michael Charney, MD Regional Medical Center: Erica McEnery, MD Saint Louise Regional Hospital: Diane Sanchez, MD Stanford/Lucile Packard Children's Hospital: John Brock-Utne, MD Santa Clara Valley Medical Center: Clifford Wang, MD
CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Tanya Spirtos, MD (District VII)
BULLETIN
THE MONTEREY COUNTY MEDICAL SOCIETY
Editor
OFFICERS
THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
Printed in U.S.A.
Joseph S. Andresen, MD
Managing Editor Pam Jensen
Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/ MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising. Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org © Copyright 2015 by the Santa Clara County Medical Association.
4 | THE BULLETIN | JULY/AUGUST 2015
President James Hlavacek, MD President-Elect Vacant Past-President Jeffrey Keating, MD Secretary Edward Moreno, MD Treasurer Cary Yeh, MD
CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.
DIRECTORS Paul Anderson, MD Valerie Barnes, MD Ronald Fuerstner, MD Gary Gray, DO Steven Harrison, MD David Holley, MD
John Jameson, MD William Khieu, MD Eliot Light, MD James Ramseur, MD Marc Tunzi, MD Craig Walls, MD
BULLETIN THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
700 Empey Way • San Jose, CA 95128 • 408/998-8850 • www.sccma-mcms.org
MEMBER BENEFITS Billing/Collections CME Tracking Discounted Insurance Financial Services Health Information Technology Resources House of Delegates Representation Human Resources Services Legal Services/On-Call Library Legislative Advocacy/MICRA Membership Directory iAPP for
Feature Articles 16 MCMS’s Annual “Physician of the Year” Banquet and Installation 20 SCCMA Award Presentations and Installation 30 SCCMA Awards Banquet Photos 38 CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions
Departments 6 Discount Ticket Program 7 From the Editor’s Desk 8 Message From the SCCMA President
the iPhone
10 Message From the Outgoing SCCMA President
Physicians’ Confidential Line
12 Message From the MCMS President
Practice Management
13 Message From the Outgoing MCMS President
Resources and Education Professional Development Publications Referral Services With
40 Silicon Valley’s Health Trust Extending Availability of Diabetes Education for Seniors 42 Medical Times From the Past
Membership Directory/Website
44 SCCMA Alliance Foundation
Reimbursement Advocacy/
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48 MEDICO News 54 West Nile Virus Activity Increases JULY/AUGUST 2015 | THE BULLETIN | 5
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Outgoing SCCMA and MCMS President’s Drs. James Crotty and Jeffrey Keating have accomplished much. A year ago, Dr. Crotty acknowledged the importance of the SCCMA’s support of physicians in our work in promoting public health. He also called for working together to defeat Proposition 46 and upholding California’s long-standing MICRA law: “We cannot have healthy citizens without enough doctors. We cannot have healthy citizens without compensation commensurate with our training and responsibility level. We cannot have healthy citizens without economic incentives to keep patients healthy, encouraging healthy lifestyles, and decreasing costs.”
Fast-forward a year later! We welcome incoming SCCMA President Dr. Eleanor Martinez and MCMS President Dr. James Hlavacek. Read on as they share their visions for the year ahead.
Editor, The Bulletin
July 1st! We all remember this day and time of year well. It is the change of seasons and changing of the guard for medical students, interns, residents, and graduates entering private practice. It is a time of excitement, anxiety, new challenges, and meeting new responsibilities. It is a time of reflection, admiration, and recognition of our own and other’s accomplishments. It is also a time for the installation of new officers in the Santa Clara County and Monterey County Medical Societies and honoring those who have served over the past year.
EDITOR'S DESK
Physician Editor, The Bulletin
Medical Association, Outstanding Contribution in Medical Education, Outstanding Contribution in Community Service, the Citizen’s Award, a Special Recognition Award; and MCMS’s Physican of the Year Award.
FROM THE
By Joseph Andresen, MD
JOSEPH S. ANDRESEN, MD
A Time for Reflection, Admiration, and Recognition!
Joseph S. Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area.
Dr. Keating, too, emphasized his goal to fight Proposition 46 by increasing physician membership and participation in educating the public. Proposition 46 was soundly defeated and we thank our leaders for their hard work in this important accomplishment. There are many to be recognized: SCCMA’s Benjamin J. Cory, MD Award, Outstanding Achievement in Medicine, Outstanding Contribution to the JULY/AUGUST 2015 | THE BULLETIN | 7
Inaugural Address By Eleanor Martinez, MD President, Santa Clara County Medical Association
President, Santa Clara County Medical Association
ELEANOR MARTINEZ, MD
MESSAGE FROM THE
SCCMA PRESIDENT
The following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 9, 2015.
Eleanor Martinez, MD is the 2015-2016 president of the Santa Clara County Medical Association. She has a solo obstetrics and gynecology practice in Los Gatos.
With a humble heart and tempered excitement about the challenging task that lies before me, I accept the role as the 80th President of the Santa Clara County Medical Association. First of all, I would like to thank all of you for coming tonight and celebrating with our 2015 Awardees. Thank you, Jim Crotty, for giving us the leadership to sail through the past year. I would like to thank several of my colleagues, without whom I would not be involved in this organization. To mention a few, I begin with Dr. Jim Hinsdale who encouraged me to assume the role of councilor representing the Good Samaritan Hospital. From then, many other mentors have pushed me to attend meetings, meet with our State Legislature, take day trips to the Sacramento Capitol, and spend the weekend at the annual CMA House of Delegates meeting. Then there is Dr. Tanya Spirtos whose relentless work in speaking out for our various resolutions during the House of Delegates Annual CMA meeting left me in awe. Her knowledge of the parliamentary procedures and her comments during those meetings continue to encourage us to speak out. Her dedication to the CMA organization is something to be emulated. She continues to work with medical students, proctoring them, and encouraging their involvement in organized medicine. Such will assure us of the future of medicine. Then there are members of the Executive Council, our CEO Bill Parrish who is respected by other County Medical Societies and the SCCMA staff – this organization has the reputation of being one of the strongest County Medical Societies in this state, and that is why I call this task challenging. However, I am assured that I have the support of a good team within this organization. Being involved with SCCMA is likened to playing a ball game. When Dr. Tacker kept repeating to me that we need to keep our eye on the ball; that ball is patient care. This is why we chose the honorable
8 | THE BULLETIN | JULY/AUGUST 2015
profession of healing. I am more familiar with basketball as I love watching that sport. It is a team sport unless one watches Kobe Bryant who loved to hog the ball. The game requires everyone to keep their eye on that ball and working towards winning the game. That is no different than being involved with SCCMA. Each of us in this room has made a decision to be in the healing profession. Each of us has made many sacrifices in our youth to achieve that endpoint. We all had dreams and aspirations that we will take care of the sick, prevent diseases, and enjoy the camaraderie and respect of our fellowmen, our colleagues. We all knew that the road ahead would not be easy, beginning with long nights burning the midnight oil, many days of heartaches, humiliations, and frustrations during our residencies, and finally arriving at the place, which we all freely chose, be it practicing solo, or joining a group. But the proverbial basketball was always the same, unchanging – the care for the patient and their well being. Times have changed – little did we know that the practice of medicine would mean the practice of good business as well. Many of us were not prepared for that. Nowadays, we all are given choices – do we continue to practice solo or do we join a bigger group who would ease our pain in managing our offices. Again, the choices to do so are only ours to make and it is not going to be easy. I would posit that, perhaps, the answer is found in staying focused on the ball – yes, it is true that our reimbursements and our bottom line to staying afloat as a solo practitioner or a small group are being threatened. Imagine being paid less than the cost of a slice of pizza. Yes, we have been threatened by the attempt to reform the MICRA Act of 1975 and yes, we continue to be inundated with bills that infringe on our scope of practice. For most of us, it has removed the joy of practicing medicine for others. It has hastened retirement or moving out of state. Yet, we won overwhelmingly on Proposition 46 despite the prediction that it was in jeopardy. Our patients voted for us. The Vaccination Bill 277 that Senator Dr. Richard Pan and Senator Ben Allen fought so valiantly for passed, and California became only the third state with no religious or
personal belief exemption for vaccination. There are more issues coming down the pipeline: the debates on scope of practice and access to care, funding for more medical schools and residencies to prevent doctor drain to other states, legalization of marijuana, end of life issues, environmental impacts on health, and decreased reimbursements for the dedicated care we render to our patients, to name a few. All of these and more are slowly eroding our morale and threatening our profession. Some issues are challenging with no easy answers. There will be many debates. We cannot afford to lose sight of the ball when debating on these issues. But I believe we all have a genuine concern for the health and well-being of our patients and that will continue. Which leads me to the main message I would pose to all of you. Can we do this separately in our own clinics, small groups or larger groups like Stanford, VMC, PAMF, and Kaiser? I do not think so. That is where organized medicine comes in – that is where our involvement with groups like our local County Medical Society and CMA become crucial. There are many ways we can become involved: giving a day of our time to meet with our State Legislature (and trust me, they do listen now); dropping a line or two to our Senators or Congressmen about bills that impact us and our patients; engaging with teaching our medical students; helping our SCCMA Alliance and Foundation; or being members, as well as recruiting new members, for SCCMA. We can no longer allow outside forces to dictate how we care for our patients. It is only by being united and assertive that we can make a difference in preserving our noble profession. I also believe that those of us who are in the twilight years (or what one would call retirement) are valuable contributors to the Society. Your experiences and wisdom have weight. People listen. We learn from you. So stay involved.
Many of you have asked me why I accepted this position, even asking me if I am crazy – I think I am that and more. But I, like those within SCCMA, CMA, and AMA, are imbued with the calling that we need to be heard; that we need to do something rather than complain about people “running over us.” Yes, it is true that Covered California is not the glorious reform it was touted to be, and yes, it is true that the Affordable Care Act is with its faults, but I have yet to hear a viable alternative or solution from those who oppose it. You and I are paying for the uninsured. I believe health care is a right, not a privilege, but it is a responsibility that should be shared by all – by the doctors, by other health care providers, the hospitals, the insurance industry, the pharmaceutical companies, and lastly the patients. Somehow it seems evident that the burden of the Affordable Care Act is falling only on the shoulders of us, the doctors. I am both motivated and compelled to be a leader of this noble profession – to represent you in the Santa Clara County Medical Association – to be an advocate for our patients. That I know for sure. I, as a solo practitioner, whose passion is rooted in the values of patient care, taught by my father (a physician), am prepared and excited to lead this organization. The challenge is ahead, but as a group, we can prevail. Our goals will be met, but it requires a strong and formidable team to make it happen. As with any team sport, each member plays a vital role. The success of a team is only as strong as the communication and participation of these parts. As your President, I promise my dedication and leadership to this team. As your teammate, I look forward to your support and working towards a successful future. Thank you. JULY/AUGUST 2015 | THE BULLETIN | 9
Outgoing President's Speech By James R. Crotty, MD, MBA
Past-President, Santa Clara County Medical Association
JAMES R. CROTTY, MD, MBA
MESSAGE FROM THE
SCCMA PAST-PRESIDENT
Past-President, Santa Clara County Medical Association
James R. Crotty, MD, MBA, is the 2014-2015 past-president of the Santa Clara County Medical Association. He is a urologist and is currently practicing with The Permanente Medical Group/Kaiser in San Jose.
The following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 9, 2015. SCCMA members, staff, families, and guests, I feel fortunate to have had the opportunity to be the President of the largest County Medical Association in California. Personal thanks for all of the support from my TPMG Urology Department colleagues and from Raj Bhandari our Physician-in-Chief. As my college-age daughter said yesterday, “It’s been a year?” I would like to talk with you about the future, but I must start with the past. One year ago, I talked to this group about the “Troy and Alana Pack Patient Safety Act.” This ballot initiative had garnered enough signatures to be placed on the November, 2014 ballot. Even before this proposition had been numbered, Santa Clara County Medical Association, with the leadership and support of California Medical Association, especially CMA President Richard Thorp, MD and CEO Dustin Corcoran, organized local physician meetings, handing out pocket cards, buttons, and lawn signs. We worked with local and regional union, professional, and teaching organizations. We wrote articles. We met with media. We gathered important editorial and newspaper support. CMA paid for television and radio time. The effort was huge and costly because the consequences were huge. At the voting booths, citizens rejected Prop. 46. What I learned first-hand in the campaign was how deception, distortion, and outright lies seemed to be considered par for the course. For example, the television ad supporting Prop. 46 showed a man at a bar, wearing a white lab coat, with a stethoscope around his neck, downing whiskeys and ignoring a beeper flashing “Emergency.” What I also learned was how physicians could work together to accomplish an aim. I think this is what surprised the trial lawyers and maybe even surprised us. Thanks again to all who contributed to fighting Prop. 46. We hope it will be many years before the trial lawyers attempt to change MICRA again. This is the power and value of membership in SCCMA/CMA. I have become more familiar with the California legislative process, and I have learned why CMA needs to be reactive,
10 | THE BULLETIN | JULY/AUGUST 2015
but also must be proactive. The Santa Clara County Medical Association has been very active this year and I have continued ongoing SCCMA leadership efforts to expand our attention outward to physician concerns in our county and in our state by inviting speakers to our monthly meetings. We have gained membership at Santa Clara Valley Medical Center and with the San Jose Medical Group. CMA and SCCMA became very active when the Ebola epidemic sent shock waves through our health care systems, after the first U.S. case in Dallas. SCCMA worked with CMA and the County Health Officers to establish referral centers and care plans for screening patients. SCCMA continues to support and work with Stanford on outreach to disadvantaged high school students who have an interest in medicine. The program has grown in popularity and reputation. Currently there are 200 applications for 40 slots. SCCMA was involved in the potential sale of O’Connor Hospital to Prime Medical, and what the consequences might be for Santa Clara County physicians. Now for the present: the fact is that SCCMA/ CMA has become a stronger advocate for the concerns of California physicians. Now when a health issue or question surfaces, the first question is, “What does CMA have to say about this?” This is an opportunity. We are lucky to have Bill Parrish as our CEO. We are fortunate to have Mark Christiansen as head of BME. We are blessed to have dedicated staff like Jean, Pam, Sandie, Leslie, Maureen, Shannon, and Marcy. We have a close association with Monterey County Medical Society and also with AlamedaContra Costa Medical Association. We are also lucky to have extraordinary physicians who commit their precious time to SCCMA to be Officers, Councilors, and Delegates. Eleanor will be a great President. CMA is fortunate to have an engaged CEO and a sharp and dedicated staff. There are hundreds of bills submitted by California Assembly and Senate members. Many of these bills are designed to change health care delivery in California. CMA monitors all of these bills. One bill that has gotten widespread media attention is SB 128. The title of this bill is “End of Life Options Act.” This bill, introduced by Senators Lois Wolk and Bill Monning, would allow physician assisted suicide for individuals with an in-
curable terminal illness. This law was written with safeguards in place to ensure that these individuals are competent to make decisions, and that doctors have to agree that the disease is likely to cause death in less than six months. Again, the California Medical Association was asked their opinion. SCCMA invited Senator Monning to talk with members about the bill. CMA has been successful in changing some of our governance so that issues can be discussed and policy adopted on a year-round basis rather than once per year at the House of Delegates meeting. Because of these changes, CMA was able to get input from members via the internet. CMA decided to change existing policy and not be opposed, but neutral, to this legislation. In fact, it is the first and only state medical association not opposed to this patient right. There is a concern that if this bill does not get signed into law there will likely be a ballot initiative at the next election.
CMA presently supports these bills (partial list): • SB 277, introduced by Senator Richard Pan, that would increase immunization rates by eliminating the personal exemption for vaccination. • SB 243, introduced by Senator Hernandez, that would significantly increase Medi-Cal reimbursements. • SB 289, introduced by Senator Mitchell, which would insist that physicians be reimbursed for patient care via telephone or other electronic communication methods. • SB 591, introduced by Senator Richard Pan, MD, which would increase sales tax on tobacco by $2 per pack. Bills that CMA opposes are (partial list): • AB 159, introduced by Ian Calderon, which would allow patients access to investigational drugs outside of the FDA process. Currently, the FDA is trying to address this concern with new policy. • AB 1306, introduced by Autumn Burke, which would delete all physician supervision for nurse midwives. • SB 482, introduced by Richardo Lara, would require physicians to consult a patient’s electronic history in the CURES database prior to prescribing Schedule II and III medications. • SB 622, by Senator Hernandez, would expand the scope of practice for Optometrists. • SB 323, by Senator Hernandez, would expand the scope for Certified Nurse Midwives. CMA and AMA have finally succeeded in eliminating SGR, or the Sustained Growth Rate. This law, signed by President Clinton in 1987, was meant as a control on health care spending. Congress had applied a temporary “doc fix” 21 times. The new law, “Medicare Provider Payment Modernization Act of 2015,” will change physician payments. The future: Now is the opportunity to show that CMA is most interested in the health and well-being of California citizens and residents. If we can demonstrate that we have the interests of our patients foremost, we will continue to have political muscle to influence policy, laws, and regulations that impact physicians. We cannot have healthy citizens without enough doctors. We cannot have healthy citizens without compensation
commensurate with our training and responsibility level. We cannot have healthy citizens without economic incentives to keep patients healthy, encouraging healthy lifestyles, and decreasing costs. Keeping our California population healthy will involve the development of metrics. It is extremely important that California physicians be the drivers for these measures. Questions such as “How healthy are Californians?” is a question that CMA must be able to address. I agree with the Institute for Healthcare Improvement that we have a Triple Aim: to improve the patient care experience, to improve population health, and to decrease per capita costs. What drives CMA political clout is in part being organized and effective, but also the size of our membership. The larger our organization grows, the more weight and importance will be the collective opinion. CMA has over 40,000 members. SCCMA has grown in membership. We have 4,500 members who are in solo practice, small group, large group, very large group, government and academic, residents and students. SCCMA leadership reflects this diversity. I have to comment on return on investment of membership. Membership is not cheap, but when you consider the potential cost increases in medical malpractice insurance that CMA prevented, the potential decreases in Medicare that CMA and AMA helped prevent, the potential and actual increases in Medi-Cal and Medicare reimbursements, and prevention of physician unfriendly insurance company practices, your membership has a huge return on investment. Your $1,000 can return tens of thousands of dollars each year. We must continue to grow membership. If we focus on efforts to improve the health of Californians, Californians will support California physicians. I look forward to my new duties as the SCCMA Past President.
JULY/AUGUST 2015 | THE BULLETIN | 11
Inaugural Address By James M. Hlavacek, MD
President, Monterey County Medical Society
JAMES M. HLAVACEK, MD
MESSAGE FROM THE
MCMS PRESIDENT
President, Monterey County Medical Society
James Hlavacek, MD, is the 2015-2016 president of the Monterey County Medical Society. He is an Anesthesiologist and is currently practicing Chief-of-Staff with Natividad Medical Center, in Monterey, and also practices at George L. Mee Memorial Hospital.
Dear Members of the Medical Society: It is my honor to represent you for the next year. It will be an exciting and challenging year, which I hope will continue to improve how we practice and, ultimately, improve the health of our patients. A little bit about me and my background – I was born in India where my parents were foreign correspondents. My dad was the head of United Press for the region until 1957. Our family moved to Jamaica, Florida, and Nebraska, where I grew up. After college (Nebraska Wesleyan University), Medical School (University of Nebraska), and internship (CreightonSt. Joseph Hospital), it was time to go somewhere else for residency. I did my residency in anesthesiology at St. Elizabeth’s Hospital in Boston. I then added a Fellowship in Cardiac Anesthesia at Hahnemann Hospital in Philadelphia. We then moved back to Boston where my wife Monica, a dentist, did her residency in prosthodontics. We came to Monterey like many other gold seekers, and feel like we did indeed strike it rich here. As I start my 17th year on staff at Natividad Medical Center, where I am currently Chief of Staff, and my 11th year on staff at George L. Mee Memorial Hospital, I am so happy to live in such a wonderful area. The new Level 2 Trauma Center at Natividad Medical Center is a major improvement in the care of our patients. No longer are these patients sent out of the County for treatment. This has added many new doctors, nurses, and other medical specialists to the hospital. Dr. Gary Gray, an MCMS Board Member, Chief Medical Officer and Interim CEO at Natividad and his staff have done a tremendous job in planning and opening the Trauma Center. I joined the Monterey County Medical Society to help represent my fellow doctors in any way I could. Much of what we do is controlled by government regulations. The importance of making sure the laws enable us to care for our patients is so vitally important. Our legislators need information and education from us to make the best informed choices. As members of the Medical Society we engage with the elected representatives on a local, state, and national level to maintain and improve the way we practice and care for our patients. The defeat of Proposition 46 demonstrated how important the California Medical Association is to us
12 | THE BULLETIN | JULY/AUGUST 2015
as doctors, and to all Californians. Had Proposition 46 passed, the damaging effects on our ability to care for patients would have been devastating. Dustin Corcoran, the Chief Executive Officer of CMA and his staff, and all County Medical Societies are to be congratulated for the team effort to defeat this Proposition. The defeat of Proposition 46 brought together many diverse organizations, republicans and democrats, labor, and others in a cooperation rarely seen in Sacramento. It was also extremely expensive. The campaign spent $60 million, with CMA spending above $8 million to defeat Prop. 46. CMA’s contribution was critically important to our success in this matter! SB 277 recently passed the legislature and was signed into law by the governor. This bill, to immunize, with very few exceptions, all school age children, is an important improvement in public health. Senator and Pediatrician Richard Pan, MD, from Sacramento, is to be congratulated on spearheading this bill. Senator Bill Monning (of Carmel) was also a strong advocate in helping get this bill passed. I am amazed to see that Senator Monning now faces a potential recall because of his support of the bill. ICD-10 is coming on October 1st. The potential for disruption and chaos with its implementation is very real. Fortunately, CMA has been engaged with CMS to soften the impact and help ensure that doctors, clinics, and hospitals continue to get paid as the new system is rolled out. The Medical Society is your resource in understanding and using this new and more complicated system of coding. We need more members to help strengthen our position in organized medicine. We are part of District 7, the largest voting block in CMA. Together, we are a potent force advocate for your right to practice. The value we derive as members of the Medical Society makes us all proud to spread the word to our colleagues who are not members. Please help me in getting our fellow doctors to join. The benefits of membership are numerous and far outweigh the cost of joining. I hope to meet many of you during my year as your President. I encourage you to contact me for any help you need. With a powerful team locally, lead by Bill Parrish our Executive Director, and the state California Medical Association in Sacramento, your needs will receive the attention they deserve. Thank you, Jim Hlavacek, MD 831/905-6266
Past-President, Monterey County Medical Society
The following speech was presented at MCMS’s Annual Physician of the Year Banquet and Installation Dinner on June 2, 2015. It was an honor to have been the Monterey County Medical Society President for the 2014-15 term. The highlight of the year for me as President was the successful defeat of Prop. 46. For me, the “No on 46” campaign highlighted how much we need organized medicine. I was impressed by the California Medical Association’s ability to provide logistics, legal advice, and expertise on media relations; I have no doubt that without CMA the Proposition would have passed. In meetings with CMA staff, the MCMS leaders were advised to follow the script of the campaign and not make statements or behave in a way which would be used against us. This highlighted the need to work together to prevail on a strategic level and to follow the advice of the professionals in their respective domains; just as we would have patients follow our advice. Convincing people to join the Society is a continued challenge. In the age of instant messaging and social media, actually meeting in person is becoming anachronistic. Convincing doctors to join and then to actually pay membership fees is an even greater challenge. Of course, the less who join the more the remaining need to contribute. Organized medicine (e.g. MCMS, CMA, and AMA) is the only legal way we are allowed to be heard, and the best way to change policy. If Prop. 46 had passed, the value of the Society would then have been made apparent, but then it would have been, perhaps, too late. The knowledge base seems to be increasing exponentially and just keeping up on the science of medicine is a challenge. On top of that, things are becoming increasingly difficult for us: endless new regulations, maintenance of certification, and ICD10 are examples. Let there be no doubt there are forces at play that will continue to try to erode the autonomy of physicians and disrupt the patient-physician relationship. Being busy physicians, we do not have time to fight and that is why we need organized medicine, to fight for us. I would like to thank the MCMS Directors and Officers for their support. For the last term, Dr. Pa-
JEFFREY KEATING, MD
Past President, Monterey County Medical Society
tricia Ruckle was the Secretary and Dr. Steven Vetter the Treasurer, with the following Directors: Paul Anderson, MD; Valerie Barnes, MD; Ronald Fuerstner, MD; Gary Gray, DO; Steven Harrison, MD; David Holley, MD (Also AMA Trustee); John Jameson, MD; William Khieu, MD; Eliot Light, MD; Edward Moreno, MD; Marc Tunzi, MD; Craig Walls, MD; and Cary Yeh, MD. It was a pleasure to work with Bill Parrish, the CEO, who in addition to: Jean Cassetta (Membership Director), Pam Jensen (Managing Editor of The Bulletin), and Molly Meyers (Membership Coordinator), helped me meet deadlines and made me look good. I, of course, wouldn’t be anything without the support of my beautiful wife, Gina. Dr. Hlavacek, as you all know, is the incoming President. Dr. Hlavacek graduated Undergraduate from the Ludwig Maximillian Universitat in Munich and Nebraska Wesleyan University in Lincoln, Nebraska. After obtaining his MD from the University of Nebraska, he did his residency in Anesthesiology at St. Elizabeth’s Hospital in Boston, with a Fellowship in Cardiac Anesthesia at Hahnemann Hospital in Philadelphia. He is the current Chief-ofStaff at Natividad Medical Center. Dr. Hlavacek has enthusiasm and endless energy, and I know he will be a fine President.
MESSAGE FROM THE
By Jeffrey Keating, MD
MCMS PAST-PRESIDENT
Outgoing President's Speech
Jeffrey Keating, MD, is the 2014-2015 past-president of the Monterey County Medical Society. He is a Pathologist and is currently practicing with Community Hospital of Monterey Peninsula in Monterey.
JULY/AUGUST 2015 | THE BULLETIN | 13
Wireless Technology and Public Health:
Health and Environmental Hazards in A Wireless World
Are wireless devices making us ill? Join Dr. Joel Moskowitz, Director of the Center for Family and Community Health, U.C. Berkeley School of Public Health, along with other experts to learn about the current scientific research regarding electromagnetic frequencies and their impact on biological systems. We will hear why 200 international scientists recently called for safer wireless radiation standards. Panelists will discuss links to autism, cancer, infertility, effects on wildlife, as well as best practices with cell phone safety and wi-fi precautions. Refreshments served. Saturday, October 10, 2015 9AM - 1PM Mountain View Center for the Performing Arts 500 Castro Street Mountain View, CA 94041 Sponsor: Santa Clara County Medical Alliance Foundation Tickets: $12 each (incl: $2 Facility Use Fee) www.mvcpa.com | 650-903-6000
14 | THE BULLETIN | JULY/AUGUST 2015
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1(888) 543-7497 www.bmesc.org JULY/AUGUST 2015 | THE BULLETIN | 15
MEMBER NEWS & HAPPENINGS
Monterey County Medical Society’s Annual Physician of the Year Banquet and Installation The Monterey County Medical Society held its annual Physician of the Year Banquet and Installation on Tuesday evening, June 2, 2015, at the Bayonet Black Horse Club, Seaside. Approximately 100 members and special guests attended, including Keynote Speaker Luther Cobb, MD (CMA President) and Field Representative for Assemblymember Mark Stone, Taina Vargas-Edmond; Mayor of Del Rey Oaks, Jerry Edelen; and Mayor of Seaside, Ralph Rubio. Jeffrey Keating, MD, 20142015 MCMS president, was honored as the outgoing president, and James Hlavacek, MD, was welcomed as MCMS’s incoming president for 2015-2016. Serving in the current fiscal year with Dr. Hlavacek are: Jeffrey Keating, MD, as past president; Edward Moreno, MD, MPH as secretary; and Cary Yeh, MD, as treasurer. The MCMS board of directors are Paul Anderson, MD; Valerie Barnes, MD; Ronald Fuerstner, MD; Gary Gray, DO; Steven Harrison, MD; David Holley, MD; John Jameson, MD; William Khieu, MD; Eliot Light, MD; James Ramseur, Jr, MD; Marc Tunzi, MD; and Craig Walls, MD. Award honoree Richard L. Murtland, MD, received an award for “Physician of the Year.” He was recognized and honored for his many years of practicing such an ethical and high level of Thoracic Surgery in Monterey County’s small community. 16 | THE BULLETIN | JULY/AUGUST 2015
His training at Chapel Hill in North Carolina was superb under Drs. Harry Peters and Nathan Womach. The Monterey Peninsula was blessed to have such a specialist/teacher in Thoracic Surgery here as early as the late 1950’s. As far back as 1961, the community has observed his professionalism, highest surgical judgment and wisdom, accurate surgical skills, more than conscientious preoperative and postoperative care, willingness to team up in severe trauma cases at any hour, and attending any patient, regardless of ability to pay. A member of the elite Western Thoracic Surgical Society, and deeply grounded in honesty and ethical practice of medicine and surgery, he has looked over (and at age 90 still looks over) the entire Physician Community with a fatherly view of maintaining the highest standards of professional care, as well as similar standards in his personal life. The annual banquet was a great success and a lot of fun! MCMS members, their families, and special guests enjoyed a fantastic meal, camaraderie, and a great program to wrap-up the evening.
Thank You
to our sponsors who have helped make this event possible. P L AT I N U M
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S I LV E R
JULY/AUGUST 2015 | THE BULLETIN | 17
William Lewis, MD; Ben Richards, MD; and Hisashi Kajikuri, MD (Award Presenters) pose with Richard Murtland, MD (Honoree “Physician of the Year”).
MONTEREY COUNTY MEDICAL SOCIETY
2015 “Physician of the Year” and Installation JUNE 2, 2015
Dr. James Hlavacek (Incoming President) and Dr. Jeffrey Keating (Outgoing President). 18 | THE BULLETIN | JULY/AUGUST 2015
Award honoree Richard Murtland, MD, receives his “Physician of the Year” Awards from incoming President James Hlavacek, MD.
Jeffrey Keating, MD (MCMS Outgoing President), and Dick Murtland, MD (Physician of the Year).
CEO William Parrish presents a “Presidential Appreciation Plaque” to outgoing president Dr. Jeffrey Keating. Also, in picture, is incoming president Dr. James Hlavacek.
Mayor of Seaside, Ralph Rubio; Mayor of Del Rey Oaks, Jerry Edelen; and CMA President Luther Cobb, MD.
Dr. Richard Murtland receives his “Physician of the Year” Awards.
Dr. Hlavacek’s wife, Monica, having some fun with her husband / incoming president.
William Parrish, Chief Executive Officer. JULY/AUGUST 2015 | THE BULLETIN | 19
MEMBER NEWS & HAPPENINGS
Santa Clara County Medical Association Award Presentations and Installation The Fairmont Hotel’s Club Regent, in San Jose, provided the setting this year for Santa Clara County Medical Association’s Annual Awards Banquet. James Crotty, MD, 2014-2015 SCCMA President, following his outgoing president’s speech, presented Eleanor Martinez, MD, with the presidential gavel for 2015-2016. Serving in the current fiscal year with Dr. Martinez are: Scott Benninghoven, MD, as President-Elect; Cindy Russell, MD, as Vice President of Community Health; Kenneth Blumenfeld, MD, as Vice President of External Affairs; Anh Nguyen, MD, as Vice President of Member Services; Vanila Singh, MD, as Vice President 20 | THE BULLETIN | JULY/AUGUST 2015
of Professional Conduct; James Crotty, MD, as Past President; Seham El-Diwany, MD, as Treasurer; and Seema Sidhu, MD, as Secretary. The SCCMA Councilors are: Ryan Basham, MD (El Camino Hospital-Los Gatos); Michael Charney, MD (O’Connor Hospital); David Feldman, MD (Good Samaritan Hospital); Erica McEnery, MD (Regional Medical Center); Diane Sanchez, MD (Saint Louise Regional Hospital); Hemali Sudhalkar, MD (Kaiser Foundation Hospital – San Jose); Clifford Wang, MD (Santa Clara Valley Medical Center); and Martin Wong, MD (Kaiser Permanente Hospital-Santa Clara).
Dr. Basham’s wife, Marilyn, and son, Dr. Ryan Basham accept the award.
The evening’s festivities culminated with the recognition of those who have dedicated their lives to furthering the high quality of medical care. Dr. Martinez made the following presentations:
ARTHUR BASHAM, MD
SPECIAL RECOGNITION AWARD: A POSTHUMOUS AWARD This award is given in recognition and appreciation for many years of dedication and service to the physicians of Santa Clara County, their patients, and our community. I would not be where I am today without the influence and men-
torship I received from Dr. Basham. He embodies what SCCMA stands for; a voice of reason in this community. Aside from being a recognized Ophthalmologist receiving accolades such as the 2006 “Outstanding Contribution to the Medical Association” Award, Art was what Jesuits would call “A Man for Others.” For 33 years he took time away from his clinical schedule to educate residents and medical students in Ophthalmology/Neuro Ophthalmology at Stanford as an adjunct Clinical Associate Professor. It was not uncommon to see him bring these students along with him to his operating rooms or clinics. His time was also devoted to clinics at the VA Hospital and Valley Medical Center, but it didn’t end there. He was active internationally, as well, devoting his time and resources to foreign countries in being a visiting professor in Pakistan, Saudi Arabia, Vietnam, and the Philippines. For him, his desire to educate was not bound by any zip code, state line, or international border. He would go wherever his skills and knowledge was most needed, even in the most underserved and remote areas of the world. Rene Ladines, his scrub assist who traveled with him to the Philippines, could not speak more highly of the tremendous impact Dr. Basham had on the people he treated there. Simply put, he brought sight to people even in the most remote and out-of-site parts of the country, all while providing his own equipment and staff with nothing to ask for in return. And before he left, he made sure the country was in good hands by instructing fellow Filipino ophthalmologists on the latest techniques and practices in the field. As a Philippine doctor, I am proud to say his charitable services and medical expertise were valued and deeply appreciated by my people. Those of us who knew him personally, or were even his patients, Continued on page 22 JULY/AUGUST 2015 | THE BULLETIN | 21
SCCMA Award Presentations and Installation, from page 21
knew that he was much more than a great doctor and educator. He was a tremendous colleague and family man as well. He was never short in giving praise or encouragement to those he worked with, and spoke with such pride of his family. I recall him saying that his wife Marilyn has the better job, nowadays, caring for their grandchildren. He said that her days are happy days. And as a proud father, he spoke with nothing but pride and exuberance when speaking of his kids and their accomplishments. I even remember him counting the days until his son Ryan would be joining his practice. It must be such a great reward to be able to operate with your son and go on medical missions as well. Dr. Art Basham was a teacher, mentor, philanthropist, missionary, friend, and family man. He lived a truly full life. He was “A Man for Others.”
SENATOR JERRY HILL CITIZEN’S AWARD
This award is given to an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. 22 | THE BULLETIN | JULY/AUGUST 2015
California Senator Jerry Hill represents the 13th district. He started his career in public service as Mayor of the city of San Mateo, served on the San Mateo County Board of Supervisors, ascending and being elected into, the State Assembly, and then elected as State Senator in November, 2012. His track record depicts him as a committed environmentalist as well as a staunch advocate for the health of his constituents. In the senate, his commitment is evident in his legislation that increases oversights to auto shredders, whose fires are contaminating Redwood City and surrounding communities. As an assemblyman, his legislation saved millions of dollars through increased efficiency, improved gas pipeline safety, cracking down on underage drinking in party buses, and retailers who sell tobacco to minors. A proponent on the use of solar devices, he brought solar jobs into this area. He is chair of the Senate Business, Professions and Economic Development Committee, and chair of the sub-committee on California’s Innovation, Technology and Life Sciences Economy, as well as Electric and Transportation Safety. He has several legislative bills that are of medical relevance. To cite a few: • SB 1311 Establishing Hospital Protocols for Antibiotic Use in Patients. • SB 1249 Auto & Appliance Shredder Waste Regulation, which provides better oversight of the industry to prevent contaminations and explosions, and risks to California communities. • SB 445 Underground Storage Tank Cleanup, to prevent soil and groundwater contamination from petroleum. • AB 1301 Reducing Sales of Tobacco to Minors. • AB 1452 Child Safety Seats. • SB 47 The Children’s Safe Playground and Turf Act of 2015, a bill banning new artificial turf fields made from recycled tires while the state conducts studies for possible link to cancer and health risks, and bills to extend youth tobacco regulations to include “E” cigarettes. During our Annual Legislative Day in Sacramento, the SCCMA constituency made it a point to visit with Senator Hill. He has always made it a priority to meet with us. I have found him to be a genuinely authentic individual and a true gentleman. He instituted a contest “There Oughta Be a Law ... Or Not,” which is open to all constituents of the 13th district, whereby residents can submit their ideas for improving quality of life in their community and California. The winner is selected by Senator Hill, who then works to implement the reform during the legislative session. This has become a public vehicle for the constituents to be engaged in legislation. This level of concern and participation is what he shows us whenever the doctors come for a visit to Sacramento. He lends a listening ear to our concerns about bills impacting the medical profession and the patients we care for. He gives his insights regarding the status of said bills and their potential for success. During our last legislative visit he
gave us an honest opinion on the bill that we were advocating for…the increase in Medi-Cal reimbursement up to Medicare rates. He opined it was a good bill, especially with the lack of physicians to care for the influx of new Covered California enrollees. However, he was realistic and honest that the current state of the California budget would not be able to shoulder the burden to finance this, due to earmarks already in place for the budget surplus. The delegation as a whole considers Senator Hill as a friend in the Capitol. We are pleased to honor him with this award tonight.
JOHN SHERCK, MD
BENJAMIN J. CORY, MD AWARD This award is given to a physician member of the Association who is a true pioneer in their field, with an exceptional reputation and the drive to continually push themselves further. A doctor who displays all of these qualities and more is Dr. John Sherck. A colleague of his wrote that Santa Clara Valley Medical Center is a level one trauma center due to the great efforts of John. In serving as the Director of SCVMC’s Trauma Center until 2014, and now as the Vice Chair of the Department of Surgery, Dr. Sherck has transformed that facility into something truly remarkable. Along with memberships in many professional and specialty organizations, Dr. Sherck has published and presented many papers in his field of expertise. He is a reviewer in the World Journal of Emergency Surgery, as well as the Journal of Trauma. He has also been on the Board of Directors of the California Institute for Medical Research since 2007, as well as being on the Advisory Board for Northern California Traumatic Brain Injury Model System. He has even received an award from Mayor Chuck Reed for his dedication and commitment to keeping San Jose safe, and the list goes on and on from his various other impactful activities. It is also important to note the impact he has had as a teacher and mentor. Dr. Sherck has taught and mentored hundreds of residents and junior faculty. So much so that he was awarded the “Henry Kaiser Award for Excellence” in clinical teaching. His colleague Dr. Greg Adams recalled an event that depicts why he was so deserving of such an award: In 1990, Dr. Adams was an intern and Dr. Sherck was his attending. It was his first open cholecystectomy with common biliary tract surgery. He was guided to do this difficult operation, step by step, by a very patient mentor. Not once did Dr. Sherck take over the case. Time was not of the essence, teaching was. This experience had such an effect on Dr. Adams that he remembers it like it was yesterday. In his own words, “Dr. Sherck makes the people around him work hard for him and with him.” Others who have worked with him agree with this description. A
fellow colleague of his noted, she could not even recall him ever getting angry, even when the work was getting too overwhelming working in a busy County Medical Center. He was simply inspiring and ultimately focused on caring for his patients. Another described him as a humble man who must get up every morning with one mantra, “To take care of people as they would want to be.” He was always available to anyone in need, whether for the patient or his colleague. Dr Sherck believes that a system would only work best if everyone works with the same goal. That is why the Santa Clara Valley Medical Center is a reputable trauma center. Lastly, I wanted to close with a story Dr. Adams wanted me to share describing yet another side of Dr. Sherck: While operating one day, everyone noticed that instruments were falling to the floor from the surgical field. In Dr. Sherck’s serious tone of voice, he ordered the circulating nurse to “ Please turn down the gravity knob.” The nurse frantically looked around the room for this “gravity knob.” After nearly turning the room upside down it occurred to this poor nurse that she had been fooled and she quickly turned to see the smirks on the faces of her team. This man also has a very dry sense of humor and wit about him. An epitome of excellence, compassion, enthusiasm, and humor, it is an honor to present the Benjamin J. Cory, MD Award to Dr. John Sherck. Continued on page 24 JULY/AUGUST 2015 | THE BULLETIN | 23
SCCMA Award Presentations and Installation, from page 23 STEPHEN WANG, MD
OUTSTANDING ACHIEVEMENT IN MEDICINE AWARD The Award for Outstanding Achievement in Medicine is an Award given to a physician who has made a unique contribution to the betterment of patient care, which results in widespread recognition. In describing this recipient, a colleague wrote, “Clinical risk surfaces with the application of a new technology. Many physicians use the technology for patient care, but it takes a person with vision to recognize the risk and have the determination to do something about it.” As an Interventional Radiologist at the Kaiser Permanente Santa Clara Medical Center, Doctor Wang was involved in establishing a dedicated IVC filter clinic in Kaiser. The goals of this clinic were the following: 1. to use the safest retrievable filter for the patient, 2. to eliminate unnecessary IVC filter placement, and 3. to improve the rates of IVC filter retrieval. As a result of his continued dedication, exceptional results were achieved from this clinic in realizing its goals, including a 20% reduction in unnecessary filter replacements, thus, reducing unnecessary risks to patients. His work was carried further
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by developing the IVC filter formulary, a Kaiser Permanente national filter registry, and an EMR application for IVC filter care coordination tool. This work brought recognition to Dr. Wang and as a result he was invited to lecture on this work at the American College of Physicians meeting. Dr. Wang continues to be involved in research and clinical applications related to IVC filters in interventional cardiology. He is a recognized outstanding consultant for peer reviews and serves as a valuable resource on a global scale for IVC filter related issues, including device choices and recommendations, as well as the associated complications with filter use. In speaking with Dr. Wang, I wanted to know what made him interested in the field of IVC filters. From his responses I could sense the enthusiasm and passion in his voice. Our conversations even extended beyond IVC filters, as we discussed other topics relating to life as a doctor faced with management issues in ethics, conflicts of interest, resources, finances, and other dilemmas. At the end of this phone call I could understand why his peers nominated him for this award. Dr. Wang’s IVC story began when he started noting that there were many patients who developed blood clots when IVC filters were used. Initially, he thought it was specific to only one particular device, but as he explored deeper into the issue he found the problem was in the IVC filters as a whole. With his engineering and medical background, coupled with his kinship with his college roommate, the pair uncovered a flaw in the design of the IVC filter. The research was done at the Lawrence Livermore Laboratory and the publications of this data are forthcoming. This research all took place on his days off and was uncompensated. It was only fueled by his burning desire to get to the root cause of this complication, and his conviction that the patients could be better served. Through his perseverance and determination, it became very clear to Dr. Stephen Wang that insertions of IVC filters should not be taken lightly. His findings became a springboard for forums on studying the emerging technology around IVC filter devices. Ultimately, it has led to the creation of the IVC filter clinics here
JAMES WOLFE, MD
OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION
in San Jose and his model is being utilized in numerous other clinics across the country. In 2010, his work was published in the Journal of Vascular and Interventional Radiology and was the featured article selected for CME credit. The article entitled “Toward an Optimal Position for Inferior Vena Cava Filters: Computational Modeling of the Impact of Renal Vein Inflow With Celect and TrapEase Filters” received the Outstanding Publication of the Year Award from the Lawrence Livermore National Laboratory. He continues to do research on this subject and there are many more publications that are forthcoming. He admits the road he took in addressing the issue and risks of IVC filter use was not an easy one, but his conviction to “do no harm” guided him through the various obstacles he encountered. Dr. Stephen Wang never wavered from his vision. As was said earlier, “Many physicians use the technology for patient care, but it takes a person with vision to recognize the risk and do something about it.” With great admiration and respect for all his work, his colleagues and the SCCMA present the “Outstanding Achievement in Medicine Award” to Dr. Stephen Wang.
This award is given to a physician member of the Association who has exhibited a sustained interest and participation in medical education activities, which is exemplary and above that expected of the membership at-large. When Dr. James Hinsdale nominated Dr. Wolfe for this award and wrote why he should be given this “long overdue recognition,” the nominating committee could not agree more. His CV speaks of a very accomplished and respected individual. It depicts his true passions over the years – patient care and dedication to teaching. He continues to conduct clinical research, publish papers, and remain involved in pharmacodiagnostics. It is an honor to recognize a colleague who, in turn, pays tribute to his fellow colleagues – his mentors and previous partners in private practice: Dr. Alvin Jacobs, the founder of the field of pediatric dermatology, who received the same award from this Association in 1991; and Dr. Minoru Yamate, who was recognized for his outstanding contribution in community services. Both of these men reinforced Dr. Wolfe’s dedication to teaching. Dr. James Wolfe has provided the following insights regarding the future of volunteer physicians contributing to medical education: “Beyond physicians’ daily important contributions to the health of their patients, their skill set also allows them to volunteer their time in many meaningful ways, such as working in a medical clinic serving low income patients or traveling to emerging countries to perform much needed surgeries. For me, and potentially for so many others, teaching physicians in practice, house-staff, fellows, and medical students, both in a lecture hall setting and in a patient care environment, has been extremely rewarding. Physicians in private practice and in large Health Care Systems (HCS) can serve as invaluable resources for clinical teaching. They can provide a unique perspective filled with nuances in patient-centered education. It is also important to recognize that volunteer teaching is not a unidirectional experience. Both preparing to teach and receiving input from students on medical subjects outside the sphere of the volunteer teacher’s specialty contribute to making the teacher a better clinician. In addition, a “teaching patient” with limited financial resources and insurance coverage, who is often seen in county and university clinics and hospital wards, and who might otherwise be excluded from seeing the volunteer teacher, derives tremendous benefit from such teacher-student education. However, volunteer teaching takes time away from the physician’s focus on daily clinical practice; this may lead to a decrease in revenue for the private practice or the HCS where the physician is employed and ultimately may impact the clinical volunteer’s income. This may not be acceptable to the physician’s employer or to the physician who, given the current economic climate, may be under the financial pressure of increasing living expenses and the burden of escalating post-training loan payback responsibilities. Moreover, increasing direct competition between large HCS’s, foundations, physicians in solo or group private Continued on page 26 JULY/AUGUST 2015 | THE BULLETIN | 25
SCCMA Award Presentations and Installation, from page 25
practice, and university medical systems may potentially interfere with or preclude a physician’s quest to volunteer time to teach, often at a “competitor’s” location. These barriers to volunteer teaching should be addressed by our medical community and its leaders, and solutions should be sought. It is my hope that the SCCMA will strive to restore volunteer teaching as a valued priority. The physician who provides care for a patient benefits that patient, but the physician who volunteers their time to teach physicians or soon-to-be physicians how to improve the quality of their care, benefits not only the patient they are seeing together, but a future generation of patients that the enlightened trainee will see over a lifetime.” It is with pride and high regard that Dr. James Wolfe is recognized with the award for “Outstanding Contribution in Medical Education.”
J. RONALD TACKER, PHD, MD
OUTSTANDING CONTRIBUTION TO THE MEDICAL ASSOCIATION This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more activities of the Association over and beyond that expected of the mem26 | THE BULLETIN | JULY/AUGUST 2015
bership at-large. After receiving his PhD in Medical Microbiology and his Doctor of Medicine in 1975, Dr. J. Ronald Tacker has been involved in the science of medicine in various capacities. He finished his urological residency at the University of Oklahoma, and then a urological fellowship from Stanford University School of Medicine. For 23 years he was a consultant both at Stanford University School of Medicine and Santa Clara Valley Medical Center Spinal Cord Injury Unit. He was the Clinical Professor of Urology at Stanford University School of Medicine from 1990-2003. During these times he was also involved in organized medicine, contributing his time on various committees as well as being a Delegate to CMA, a member of the SCCMA Executive Council, and becoming the President of the Santa Clara County Medical Association from 1995-1996. All throughout, he was a tireless supporter of the SCCMA. Thinking he had accomplished all he set out for as a doctor, he retired. He admits that he and his wife had planned to tour the entire USA in a motorhome. They did that, but he couldn’t help but feel a sense of emptiness within him. Something seemed unfinished. In his own words, Dr. Tacker “flunked the course on retirement.” He reinvented himself in a different state and began working towards being a primary care physician. Since 2003, he has volunteered as a physician in various clinics – Medicine of the Olympics, Dungeness Valley Health, and Wellness Clinic to mention a few. Aside from providing his free services to these organizations, he became a physician for Kitsap Medical Group, an internal medicine group specializing in adult primary care and long term care. It is in this capacity in which he feels most whole again by providing care to those in need. When I called him to tell him that he was going to receive this award, his first response was “I am humbled. I love what I do, both when I was there in San Jose, and now here in Washington State.” His high praises for the SCCMA as an organization flowed throughout the telephone conversation. He highlighted that the SCCMA is an outstanding medical society. He could not forget the tireless effort of everyone in keeping cigarettes away from youths, and educating legislature in this regard. When asked what was his lowest point during his presidency at SCCMA, he lamented that he failed to get the Stanford medical community more involved in organized medicine. I reassured him that beginning with his endeavor, the Stanford medical students are now an integral part of our organization and, hopefully, more of their physicians would join SCCMA as well. He was very pleased. He
believes that the future of medicine depends on the vigorous and passionate involvement of younger physicians. He believes that all physicians should always keep their “eye on the ball,” and that ball is patient care. Politicians need to constantly be reminded of that, and he believes that is where the medical association comes in. “An organization like the SCCMA, composed of the physicians, should not lose sight of that ball – we are the patient advocates.” Even if Dr. Tacker has moved away, he continues to have an influence on us. We can all learn that it is never too late to reinvent oneself. And it is for this reason, and for all of his tireless efforts, Dr. Ron Tacker deserves the award for “Outstanding Contribution to the Medical Association.”
SUSAN KUTNER, MD
OUTSTANDING CONTRIBUTION IN COMMUNITY SERVICE This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large. Dr. Susan Kutner is a Breast Surgeon practicing in the Department of Surgery at Kaiser Hospital in San Jose. She held the position of Chief of the Department of Surgery at Kaiser Santa Teresa Hospital from 19962001. Following her surgery residency at Kaiser Foundation Hospital in San Francisco in 1983, Dr. Kutner made a decision to focus on issues of women’s health with a specific interest in breast cancer. Early on, she recognized the impact of being given a diagnosis of breast cancer on a woman’s journey. She viewed the lives of her patients as stories about courage. From these encounters she saw the need for developing advocacy groups in the community to assist these women. She knew that by starting the community in early awareness and education about the reality of breast cancer, one can have a significant impact in early diagnosis and institution of treatment. Dr. Kutner is involved with the Center for Disease Control Advisory Committee on Young Women and Breast Cancer. This committee is charged with providing educational support and research development for early diagnosis of breast cancer in younger women, especially African American women. One of her colleagues spoke of how Dr. Kutner made it her mission to make the Department of Surgery in Kaiser San Jose recognize the importance of establishing a subspecialty division centered on breast surgery. She was described as a trailblazer in the era when a female general surgeon was in the minority. She was relentless in her desire to set up this subspecialty. Her involvement in professional activities centered on breast cancer, care of women with the disease, and early
detection, as well as education of young women. This led to being a climber and team doctor for the Breast Cancer Fund, Climb Against the Odds. The mountains she and her team traversed included Mt. Fuji in 2000, Mt. Shasta in 2003 and 2006, and Mt. Rainier in 2005. She continues as a member of the Board of Directors for the Breast Cancer Fund. Dr. Susan Kutner is a true advocate for women with breast cancer. As an educator, she believes that with vigorous early and persistent education, aside from family history, lifestyle choices, environment, exercise, and diet, a true impact can be made on the prevention of breast cancer. In speaking with Dr. Kutner, one cannot help but be drawn to her dedication to help eradicate this disease through research and educational resources. As her fellow general surgeon stated, this is her mission, and she has gained the respect of her peers in the pursuit of that endeavor. Kofi Annan, a Nobel Peace Prize recipient said, “There is no tool for development more effective than the empowerment of women.” In recognition for her devotion to the empowerment of women, especially the young, the Santa Clara County Medical Association, with much admiration and respect, presents Dr. Susan Kutner with the “Outstanding Contribution in Community Service” Award.”
JULY/AUGUST 2015 | THE BULLETIN | 27
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28 | THE BULLETIN | JULY/AUGUST 2015
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Drs. Jim Crotty (Outgoing President), Eleanor Martinez (Incoming President), and Sameer Awsare (Past President).
Past President John Longwell, MD, celebrates his special evening with his family Helen Wang, RN, and Leo Wang.
SANTA CLARA COUNTY MEDICAL ASSOCIATION
2015 Annual Awards Banquet and Installation JUNE 9, 2015
Award Honoree John Sherck, MD celebrates his special evening with family and friends. 30 | THE BULLETIN | JULY/AUGUST 2015
Susan Kutner, MD (Award Honoree); Lana Johnson; Frank Staggers, Jr, MD (ACCMA President); Parn Kokotaylo; Linda Waters; Donald Waters (ACCMA CEO); Pamela Dudley; and Scott Benninghoven, MD (President Elect). Award honoree Dr. James Wolfe poses with his son Brad and daughter Lauren.
Dr. Jim Crotty delivers his Outgoing President's speech.
Dr. Susan Kutner (Award Honoree) poses with Dr. Maria Herenyiova.
A special thank you to Kaiser San Jose for your sponsorship! L to R: Dr. Heidi Olander, Dr. Josipa Bubalo, Irene Chavez (Senior VP/Area Manger), Dr. Timothy Tsang, Dr. Maria Herenyiova, Dr. David Hensley, and Dr. Seham El-Diwany (SCCMA Treasurer).
Drs. Eleanor Martinez (Incoming President), Jim Crotty (Outgoing President), and Seham El-Diwany (Treasurer). JULY/AUGUST 2015 | THE BULLETIN | 31
Linda Tacker, Dr. J. Ronald Tacker (Award Honoree), and William Parrish (CEO).
Dr. Cindy Russell, Dr. Gloria Wu, and Dr. Jane Weston. In back: Julian Goduci (CEO, EnviroMerica – Bronze Level Sponsor, thank you!), and Dr. Jack Silveira.
Marilyn Basham, Dr. Elizabeth Basham, and Anne Chalmers.
Award Honoree James Wolfe, MD celebrates his special honor with his family and friends. 32 | THE BULLETIN | JULY/AUGUST 2015
SCCMA’s incoming President Eleanor Martinez, MD celebrates her installation and special evening with her family and friends.
Dr. Timothy Tsang, Linda Tacker, Dr. J. Ronald Tacker (Award Honoree), and Dr. John Shinn (Past President).
Past Presidents Drs. Martin Fishman, Thomas Dailey, J. Ronald Tacker (also Award Honoree), and Sameer Awsare.
Dr. Olivia Jee, Dr. Jennifer Tran, Dr. Arbella Malik, Dr. Daljeet Rai, Chris Wilder (Executive Director, VMC Foundation – Silver Level Sponsor, thank you!), and Dr. Andrew Nevitt.
(Head table) L to R: Sameer Awsare, MD (Past President), Martin Fishman, MD (Past President), Barbara Fishman, William Parrish (CEO), Luanne Parrish, James Crotty, MD (SCCMA Outgoing President), Jenny Crotty, J. Ronald Tacker, MD (Past President and Award Honoree), and Linda Tacker.
Outgoing President James Crotty, MD, and his wife Jenny.
Past President Thomas Dailey, MD, and his wife Rosemary, and Past President Martin Fishman, MD, and his wife Barbara.
Marilyn Basham, and Drs. Ryan and Elizabeth Basham celebrate this special evening in honor of their husband/ father’s “Special Recognition – Posthumous Award.”
Incoming President Dr. Eleanor Martinez poses with her sons David and Michael. JULY/AUGUST 2015 | THE BULLETIN | 33
Dr. Arthur Basham’s (Posthumous Award Honoree) family and friends celebrate in honor of his “Special Recognition Award.”
Dr. Frank Staggers, Jr. (ACCMA President) wins the drawing for the iPad Air 2, which was generously donated by Chris Foley, Standard Business Machines.
Kim Fang, Dr. David Campen, Dr. Christine Chang, Dr. Robert Buechel and his wife Joan, Dr. Erica McEnery and her husband John; and in the back are Dustin Shaver and Steven Chandler from NORCAL (Gold Level Sponsor-Thank You!).
SCCMA-BME Staff: Leslie Sorensen, Sandie Moore, Paul Moore, Mark Christiansen (General Manager, BME), Pam Jensen, William Parrish (CEO, SCCMA and BME), Shannon Landers, and Jean Cassetta.
Award Honoree Dr. John Sherck poses with his family. 34 | THE BULLETIN | JULY/AUGUST 2015
CEO William Parrish presents a Fitbit as a thank you gift to outgoing president Dr. Jim Crotty, receiving a happy response!
Senator Jerry Hill presents his acceptance speech for “Citizen’s Award.”
Eleanor Martinez, MD accepts the gavel as SCCMA’s 2015-2016 President.
Dr. James Wolfe (Award Honoree) and Dr. John Shinn (Past President).
Dr. Scott Benninghoven (President-Elect) and his wife Pamela pose with Dr. Erica McEnery (Councilor for RMC) and her husband John.
SCCMA CEO William Parrish and his wife Luanne.
A special thank you to Santa Clara County IPA (SCCIPA) for their Gold level sponsorship of the Awards Banquet.
Dr. David Adamson and his wife Rosemary; Ed Ryu and his wife Julie (Legacy Wealth AdvisorsSponsors, Thank You!); Dr. Mary Kilkenny; Dr. Linda Teagle; Dr. Kim Dang; and Dr. Angela Pollard. JULY/AUGUST 2015 | THE BULLETIN | 35
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CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions CMA PUBLISHES With implementation of the ICD-10 code set just around the corner, many physicians have been understandably wary about the transition and the potential for payment disruptions and claims processing errors that could interfere with patient care. Fortunately, the California Medical Association (CMA) – working closely with the American Medical Association (AMA) and other medical associations – has secured provisions that will ease this transition, particularly for physicians in practices with limited resources. Thanks to CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently announced that it will provide a one-year grace period during which it will allow for flexibility in the Medicare claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. The ICD-10 implementation date of October 1, 2015, has not changed.
ICD-10 TRANSITION GUIDE CMA has published the “ICD-10 Transition Guide” to help practices of all sizes successfully make the switch to the new ICD-10 coding system. The guide will answer frequently asked questions and includes CMA’s “ICD-10 Transition Preparation Checklist” to
THE CHANGES ANNOUNCED INCLUDE:
help ensure the transition is
CLAIM DENIALS: Medicare review contractors will not deny claims based solely on the
a smooth one. The guide is
specificity of the ICD-10 diagnosis code as long as a valid code from the right family of
free to members-only at
codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10
www.cmanet.org/icd10.
coding mistakes during the grace period. QUALITY REPORTING: Physicians also will not be penalized under the quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, again as long as a code from the correct family of codes is used.
ICD-10
ICD-10 What
ADVANCE PAYMENTS: If Medicare contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, advance payment may be available to keep resources flowing to physician practices. ICD-10 COMMUNICATION CENTER: CMS will set up a communication center to monitor the implementation of ICD-10 in an effort to quickly identify and resolve issues related to the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive
Transi
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and triage physician and provider issues. For the latest ICD-10 news and updates, see CMA’s ICD-10 resource page at www.cmanet.org/icd10. 38 | THE | JULY/AUGUST 2015 42 BULLETIN SAN JOAQUIN PHYSICIAN
FALL 2015
2015 ICD-10-CM Code Set Boot Camps DISCOUNTED
ICD-10 EDUCATION AND TRAINING FOR MEMBERS
Recognizing that health care providers need help with the transition, CMA, AMA and CMS are also working to make sure physicians and other providers are ready for the October 1, 2015, transition to the new ICD-10 code sets. CMA, in partnership with its local county medical societies and the California Medical Group Management
Association, is offering two-day ICD-10 code set seminars around the state. The two-day boot camps include 16 hours of intensive general ICD-10 code set training, along with hands-on coding exercises. To view the available dates and locations, visit CMA’s ICD-10 event calendar at www.cmanet.org/aapc-icd10. In addition to the two-day code set boot camps, CMA has negotiated deep discounts on other ICD-10 training courses through AAPC. For details, visit www.cmanet.org/aapc.
Sav eu
2015 ICD-10-CM Code Set Boot Camps p to
CMS and AMA will also be offering webinars, educational articles and national provider calls to help physicians and other health care providers prepare for the transition. For more information, see CMS’s ICD-10 provider page at www.cal.md/cms-icd10 and AMA’s ICD-10 web page at www.cal.md/AMAICD10.
$40
0!
Learn to code for ICD-10-Clinical Modification (ICD-10-CM) and prepare for the ICD-10 Proficiency Assessment. Training is led by a certified AAPC instructor and is provided onsite in a classroom format. Conducted over two days, attendees will receive 16 hours of intensive general ICD-10 code set training along with hands-on coding exercises.
WHAT’S INCLUDED:
TRAINING FOCUSES ON:
• 16 CEUs
• ICD-10 format and structure
• AAPC ICD-10-CM Code Set Course Manual
• Complete in-depth ICD-10 guidelines
• AAPC ICD-10-CM Code Set Draft Book
• Nuances found in the new coding system, with coding tips
• AAPC Online ICD-10-CM Proficiency Assessment (Required for current AAPC CPCs to maintain their credential)
• Access to AAPC’s Online ICD-10-CM Assessment Training Course through December 31, 2015
PRICING: • $399 for CMA members & members’ staff • $499 for CA-MGMA members • $599 for non-members
LOCATION/DATES
*Comparable AAPC ICD-10 Boot Camp Costs $799
Santa Maria . . . . . June 8-9
San Jose . . June 30-July 1
Sacramento . . . .July 15-16
Modesto . . . . August 12-13
Fresno . . . . . . . June 15-16
Redlands . . . . . . . .July 7-8
Roseville . . . . . August 4-5
Redding . . . . August 24-25
Napa. . . . . . . . . June 18-19
Los Angeles . . . . . .July 8-9
Stockton. . . . August 10-11
Eureka . . . . . August 26-27
Irvine . . . . . . . . June 23-24
Santa Rosa. . . . .July 13-14
San Diego . . . . June 25-26
Torrance . . . . . . .July 14-15
(French Camp)
*Dates and locations subject to change. Please check www.cmanet.org/AAPC-ICD10 for updated information and new boot camps being added.
REGISTER: CALL (800) 786-4262 OR VISIT WWW.CMANET.ORG/AAPC-ICD10 INFORMATION: CALL JULI REAVIS AT (916) 551-2046 OR EMAIL JREAVIS@CMANET.ORG
For more information about CMA, please visit: www.cmanet.org
SIGN UP FOR ICD-10
For more information about these and other CMA member discounted course offerings from AAPC, please visit: www.cmanet.org/AAPC
NEWS ALERTS The CMA website allows registered users to create custom content alerts on the topics that are of interest to you. Once signed up, you will be notified any time there is new content posted in one of your areas, including ICD-10 issues. To sign up, go to www.cmanet.org and visit your account dashboard, click on “My Alerts,” then select “ICD-10.”
JULY/AUGUST 2015 | THE BULLETIN | 39 For more information about CMA, please visit www.cmanet.org or call 800.786.4262 SAN JOAQUIN PHYSICIAN 43
FALL 2015
Silicon Valley’s Health Trust Extending Availability of Diabetes Education for Seniors The Health Trust has rolled out an accredited Diabetes Self-Management Program (DSMP) specifically for Santa Clara County’s senior population. Certified as an accredited program with the American Association of Diabetes Educators (AADE), the Health Trust has demonstrated commitment to the field of diabetes education. The Health Trust also incorporates additional services such as Medical Nutrition Therapy (MNT) and individual diabetes educational sessions with a Registered Dietician to their suite of diabetes prevention and management services currently offered throughout Santa Clara County. The Health Trust is building on the success of the comprehensive Diabetes Self-Management Education Program that was developed by Stanford University Patient Education Center. This program has been offered for several years. This peer-lead program will now be complemented by the addition of licensed and Registered Dieticians. This suite of services is rounded out by evidence-based, peer-lead “Healthy Eating” programs developed by the USDA. Accreditation with the AADE ensures that each Diabetes education program meets the National Standards for Diabetes Self-Management Education and Support. Recognizing the many barriers faced by both the physician and the patient to help mitigate adverse health events caused by diabetes is a priority of the Health Trust to not only spread awareness, but to increase utilization of their DSMP. According to the 2013 Santa Clara County Health Needs Assessment report within the county, nearly 8% of Santa Clara County residents have diabetes. Age-wise, over 30,000 seniors over 65 years old have diabetes. Most recent data in the United States also show that only 26% of diagnosed diabetics met with a diabetes educator and only 1.5% of Medicare beneficiaries received Diabetes Self-Management education and support. “We developed these additional service lines in response to the overwhelming need in our community. Seniors in particular need quality selfmanagement resources such as Medical Nutrition Therapy and peer-lead Diabetes Self-Management groups,” says Paul Hepfer, Vice President of Programs for the Health Trust. “We will begin this first year with a focus on community members with Diabetes who are covered by Medicare and then expand out to other groups as we are able.” 40 | THE BULLETIN | JULY/AUGUST 2015
The Health Trust is striving to close this gap by approaching diabetes education within the empowerment philosophy, incorporating interactive teaching strategies designed to involve patients in problem solving and addressing their cultural and psychosocial needs. Diabetes education has been shown to be effective for improving metabolic and psychosocial outcomes and is an essential first step for self-management and empowerment. The DSMP incorporates ten hours within 12 months to provide individuals with necessary skills (including the skill to self-administer injectable drugs) and knowledge to participate in the management of his or her condition. Additionally, the client will be provided with MNT intervention with a Registered Dietician, who will help counsel the client on behavioral and lifestyle changes required to impact long-term eating habits and health. Program eligibility for a Medicare beneficiary who has had any of the following medical conditions within the 12-month period preceding the orders for training include: • New onset Diabetes. • Poor Glycemic control (HbAIC 9.5 within 90 days of training) • Change in treatment from no medication to medication or from oral medication to insulin. • High risk based on one of the following documented acute episodes of severe hypo or hyperglycemia within the past year necessitating third party assistance for an emergency room visit or hospitalization. • High risk based on some of the following documented complications: pre-proliferative or pro-proliferative retinopathy or prior laser treatment of the eye; kidney complications related to diabetes. As a non-profit foundation, the Health Trust provides culturally appropriate interventions to promote the health and wellness in Silicon Valley. DSMP classes will be offered at its main site, 1400 Parkmoor Avenue, Suite #230, San Jose, CA 95126, and at various other locations throughout Santa Clara County. If your patient has Diabetes, is covered by Medicare and would like to learn more about how to obtain these services, please contact Jessica Arline at 408/961-9858 or jessicaa@healthtrust.org.
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42 | THE BULLETIN | JULY/AUGUST 2015
Medical Challenges on the California Trail ~ Part 2 ~ By Michael A. Shea, MD Leon P. Fox Medical History Committee PART 1 OF THIS ARTICLE WAS PRINTED IN THE MAY/ JUNE 2015 BULLETIN ISSUE The California Trail has distinct geographical areas. The first part of the Trail covers the Plains and follows the Platte River. It reaches the Rocky Mountains at South Pass. This is where Cholera decreased and fevers such as Rocky Mountain Spotted Fever began. Rocky Mountain Spotted Fever is caused by Rickettsia, a rod-shaped parasitic organism carried by ticks. It presents with fever, chills, joint pain, and a macular rash. It did cause some deaths, but much less than Cholera. Quinine, if available, was helpful in reducing the fever. However, true to the times, there is one account of a doctor treating with Calamel (a laxative). Other infectious diseases that probably appeared at this time include Typhoid Fever, Malaria, and Colorado Tick Fever (viral in origin). The latter was characterized by an interval second attack of fever, lasting two to three days.
Accidents and trauma were common occurrences along the California Trail. Wounds by gunshot and arrows, broken bones, and lacerations were all part of the scene. Fractures were treated by simple immobilizing methods. Wounds would be closed by needle and cat-gut sutures. Amputations were performed, on occasion, under hazardous conditions. Anesthesia and asepsis were not part of the operation at this time. Results were poor and patients died mainly from infection.
The average emigrant completed the California Trail in five or six months. This allowed just enough time in some to develop symptoms of scurvy. Scurvy is a disease caused by the lack of Vitamin C in the diet.
Starvation did take some lives. Prominent in the history books is the Donner Party story where 40 out of 87 died before they were rescued from their snow bound Sierra site.
Three months without Vitamin C will lower blood levels to zero. Four to five months without the vitamin will cause symptoms of scurvy, such as fatigue, weakness, hemorrhage around hair follicles, bleeding and swollen gums, anemia, and joint hemorrhages. Beyond five months, edema, oliguria, neuropathy, intra-cerebral hemorrhage, and death. Mortality on the Trail was low, but morbidity was significant. The use of vegetables and fruits containing Vitamin C to treat scurvy had been discovered and forgotten dating back to the seventeenth century.
One of the great stories of the California Trail occurred in 1849. In August of that year, people in California were alarmed when informed that thousands of emigrants were still far back on the trail; women and children among them.
In addition to fruits and vegetables (which some of the pioneers brought with them), fresh meat and raw milk contain Vitamin C. Animals manufacture their own Vitamin C. So, with good numbers of hunters on the trip, many pioneers had adequate Vitamin C with fresh meat such as buffalo. Ironically, there is a good supply of the vitamin in Prickly Pear Cactus, which is found in the Nevada Desert, where the Trail made its way across Nevada.
General Persifor F. Smith, head of the military government in California, realized the emergency and appropriated $100,000 as a relief fund. Major Rucker was put in charge and directed food and supplies to meet all the three major passes through the Sierra. Many hundreds of emigrants were saved by the valiant efforts of the rescuers. They distributed food, supplies, and mules to people suffering from scurvy, starvation, and the bitter cold. The crisis was averted. So ends the story of one of the World’s most historic migrations. The emigrants ultimately met the challenges, medical and otherwise. California began with a hardy stock indeed! JULY/AUGUST 2015 | THE BULLETIN | 43
Santa Clara County Medical Association Alliance Foundation By Suzanne Jackson President Strongly allied with the “family” of organized medicine, the SCCMA Alliance Foundation continues to serve Santa Clara County with its multifaceted volunteer philanthropic services. We are proud of our members who give of their time to achieve the good deeds we seek to accomplish.
Our Alliance strives to raise funds to support our grants and scholarships. Membership dues is only one such avenue for us. A simple and effective vehicle for generating philanthropic funds for our Foundation is smile.Amazon.com. This is a website operated by Amazon that donates 0.5% of eligible purchases to the charitable organizations (such as our SCCMA Alliance Foundation) selected by customers who have registered with Amazon Smile. It’s as simple as that! That money is sent directly to our Foundation bank account on a quarterly basis. Slowly, but surely, we have begun to generate money to help fund our charitable functions. So, the next time you go online shopping, type in smile.amazon.com and select “SCCMAA Foundation.” If you so choose, from that point on any time you access www.smile.amazon.com the Alliance Foundation will be remembered. Please inform your family and friends of this easy method to enhance the philanthropic efforts of your Alliance Foundation. This year’s Foundation grant was awarded to PPI Prevention Partnership International and Celebrating Families. This money will underwrite the publication of instructional books on early childhood hands-on caring, a requisite for a healthy mental and physical upbringing for children in at-risk families. Our Foundation
44 | THE BULLETIN | JULY/AUGUST 2015
shall continue to support those agencies and organizations that promote good health and healthy lifestyles in our community. We are beaming with pride that Donna Spagna, a past Alliance Member-of-the Year recipient, recently received the most prestigious award granted at the Junior League Volunteer Recognition Luncheon. Donna helps cancer patients Donna Spagna through one of their most difficult side effects of chemotherapy – loss of hair. There were 12 other local recipients recognized in the volunteer category, but Donna received the top award. Congratulations, Donna, on this acknowledgement of your tireless and selfless commitment to cancer patients, as well as your volunteer work with Cancer CAREpoint. In closing, we remind you that your membership in our Alliance provides a venue for us to connect with others who experience and understand the unique challenges of medical practice, medical marriages, and medical families, and then provides support where and when needed. A couple resources that we offer are the Physician Family Blog and the Physician Family Magazine, both available free-of-charge online. Also, check out our SCCMAA Facebook page (SCCMA Alliance and Foundation), as well as the CMA Facebook page (CMA Alliance), for upcoming events and membership news. And do remember, now your dues for the SCCMA Alliance are fully tax deductible!!!
SCCMAA Foundation Membership Application Please fill in the following information Name ___________________________________________________________________ Spouse/Partner: ___________________________________________________________ Address: _________________________________________________________________ City/Zip: _________________________________________________________________ Contact Phone: ___________________________________________________________ Email: ___________________________________________________________________
Membership Type/ CMAA and Local Dues* Regular Member- $80
____________
Sustaining (retired, widow(er) - $45
____________
MD-in-Training, spouse/partner - $15
____________
Family/Friends of Medicine - $60
____________
*Dues are Tax Deductible under 501c3 (EIN 27-1977428) AMAA Dues- $50 (recommended) Total
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____My check payable to SCCMAA Foundation is enclosed ____ Please charge my credit card
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Please return this application and payment to: SCCMA Alliance Foundation 700 Empey Way San Jose CA, 95128 408-998-8850 | 408-289-1064 (fax)
JULY/AUGUST 2015 | THE BULLETIN | 45
Classifieds OFFICE SPACE FOR RENT/LEASE OFFICE FOR LEASE/SUBLEASE O’Connor Hospital area with office lease/ sublease. Please contact Dr. Maggie Chau at 408/799-7842 for details.
MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA Medical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500–4,000 sq. ft. Call Rick at 408/2280454.
MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Timeshare also available. Call Betty at 408/8482525.
MEDICAL OFFICE SPACE TO SHARE • SUNNYVALE Convenient location. One large private office plus one exam room, shared waiting room and front office. Newly built, total 1,280 sq. ft. Available now. Please call 408/438-1593.
MEDICAL OFFICE FOR RENT Medical office next to El Camino Hospital. Three exam, reception area rooms, one office. Available soon. Call 650/948-2961.
MEDICAL/DENTAL/PROFESSIONAL OFFICE SUITE • SALINAS Second story of professional building across from Salinas Valley Memorial Hospital. Private balcony. Freshly painted and carpeted, ready for occupancy. 1,235 sq. ft. at $0.729/ sq. ft. Rent is $900/month. Contact Steven Gordon at 831/757-5246.
MEDICAL OFFICE FOR LEASE • SALINAS 262-A San Jose Street, Salinas, CA 93901. Located directly across the street from Salinas Valley Memorial Hospital – the space available is 1,531 sq. ft. first floor and 775 46 | THE BULLETIN | JULY/AUGUST 2015
sq. ft. second floor. Nice bright reception area, four exam rooms, physician’s office, staff kitchen area, and offices for billing staff and/or management, and room for storage. For information, please call and ask to speak to the Office Manager at 831/7578124.
MEDICAL OFFICE SPACE TO SHARE • CAMPBELL Convenient location. 5+ exam rooms M-F. In-office digital x-ray. Two large private offices, shared waiting room and front office. Total office size 3,000 sq. ft. Available now. Call 408/376-3305 or marlene@svspine. com.
OFFICE SPACE TO SHARE • LOS GATOS Located adjacent to El Camino Hospital Los Gatos. Beautiful large office. In-house x-ray, 3 exam rooms available on a daily basis and 7 available 2 days/week. Procedure room. Large open reception area with lovely waiting room. One physician consultation office available. Patient and staff restrooms. Lovely break area with refrigerator, dishwasher, microwave, and adjacent patio. Hi-speed internet, outside and inside storage areas. Ample parking. Cost of sublease proportionate to usage. Call 408/378-7240.
EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an in-
dependent contractor relationship. Please contact Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@allianceoccmed.com for additional information.
INTERNAL MEDICINE PHYSICIAN NEEDED We are looking for an internal medicine physician for our multi-specialty group. Please email your CV to kaajhealthcare@gmail. com.
MEDICAL PROVIDER - (PA) OR (NP) NEEDED FOR OUR BUSY OFFICE (MOUNTAIN VIEW) Are you looking to be a part of a community based medical office? Our busy Primary Care private practice is looking for a motivated and energetic Physician Assistant for full-time or part-time position in our Mountain View office, conveniently located next to El Camino Hospital. The candidate must be able to work well in a team, have handson experience with clinical procedures and possess excellent bedside manners. You must be willing to grow professionally under direct supervision of our Board Certified Internal Medicine physician and to gain experience in administering a variety of clinical, integrative medicine and cosmetic procedures. We offer a highly competitive salary, full benefits, vacation and paid personal days. Our doctors and staff enjoy and promote a very friendly work atmosphere. We
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Well-established concierge medicine practice in Santa Cruz, CA seeks Board Certified Family Medicine or Internal Medicine physician to provide periodic/weekend, outpatient, and inpatient coverage. This flexible, part-time position can expand into a position in the practice with own panel of patients. For more information, please contact: Grace Laurencin, MD (mgl@laurencinpp.com).
PRIMARY CARE PHYSICIAN FOR NONPROFIT CLINIC Catholic Charities of Santa Clara County is looking for a Primary Care Physician as a Supervising Physician for a Physician Assistant, Nurse Practioner and medical interns on Thursdays. Clients include homeless, mental health and seniors. Contact jobs@catholiccharitiesscc.org.
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FOR SALE FAMILY PRACTICE FOR SALE Family Practice for Sale. East San Francisco Bay, CA. Multi-location, multi-discipline practice for the Asian community’s established residents and newcomers. Revenue over $1 million. The languages spoken by physicians and staff include Cantonese, Mandarin, Punjabi, and Spanish; buyer doctor must be fluent in at least one Chinese dialect. The office also performs sleep studies. EMR in place. High profit margin, and seller will stay to train buyer in proprietary systems. Independent appraisal available. Offered at only $682,000. Real estate also available. Contact Practice Consultants at info@PracticeConsultants.com or 800/5766935. www.PracticeConsultants.com.
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CMA Alert, July 13, 2015 issue
Governor Jerry Brown signs vaccination bill Ending months of long debates both in and out of the state Capitol, Gov. Jerry Brown on June 30 signed into law a sweeping vaccination bill that eliminates the personal belief exemption from school immunization requirements. Senate Bill 277, which would require vaccinations of children entering public and private school, passed through multiple legislative committees, the Assembly Floor once, and the Senate Floor twice before it was sent to the desk of Gov. Brown. The bill was there less than 24 hours before the governor gave it his signature. “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases,” Gov. Brown wrote in his signing message. “While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.” A large coalition of the bill’s supporters, which includes physicians, educators, parents and community leaders, met at William Land Elementary School in Sacramento just moments after SB 277 was signed to thank Gov. Brown and the legislators who backed the bill. The bill’s authors, California Medical Association (CMA) member and Senator Richard Pan, MD, and Senator Ben Allen, were also in attendance. “Gov. Brown, I want to thank you — all of us want to thank you — for listening to the science and the people of California who want our state and communities to be safe and healthy,” Dr. Pan said. Dr. Pan, a pediatrician, said he authored the bill because he’s seen “the devastation of vaccine preventable diseases” first-hand. SB 277 was proposed in the wake of a recent wave of outbreaks of vaccine-preventable diseases in California. There have been at least 136 confirmed cases of measles across more than a dozen counties since December. Nearly 20% of those cases resulted in hospitalization. Senator Allen explained how higher immunization rates protect the state from further outbreaks. “We’re protected by two things,” Senator Allen said. “We’re protected by the fact that we are vaccinated ourselves, but we’re also protected by the fact that the rest of us are vaccinated. This is the whole concept of community immunity. So for those people who can’t get vaccinated, they rely entirely upon the vaccination of everybody else preventing a dangerous communicable disease outbreak.” Dr. Pan said he was cautiously optimistic that Gov. Brown would sign 48 | THE BULLETIN | JULY/AUGUST 2015
the bill and that immediately after hearing the news he was “certainly very excited.” “I was happy that we’re heading back to a safer California and a healthier California,” Dr. Pan said. The new law, which takes effect July 1, 2016, will make California one of three states in the nation that does not offer a personal belief or religious exemption for required vaccinations. Under the measure, vaccinations will be required of children first entering school, or when they enter seventh grade, unless they have a physician-approved medical exemption. Personal belief exemptions obtained prior to January 1, 2016, however, will remain valid until the exempted child enters kindergarten or seventh grade. Children who home-school or utilize independent study are excepted from the requirements. CMA Past President Richard Thorp, MD, thanked Senators Pan and Allen for their work on the highly scrutinized bill and its successful passage into law. “SB 277 is based in fact and science and will help increase community immunity across the state,” he said in a statement. “This is sound public health and we hope Governor Brown’s swift signature on the bill shows how important it is for California. We applaud his fast action to keep Californians safe.”
CMA Alert, July 27, 2015 issue
Bills to expand nurse practitioners’, optometrists’ scope of practice stall in Assembly committee A bill that would have allowed nurse practitioners (NP) to practice independently and prescribe drugs without physician oversight is finished, at least for the year. Senate Bill 323 was voted down 8-4 on June 30 in the Assembly Business and Professions (B&P) Committee. The committee agreed to take it up again on July 14, but the bill was pulled from the hearing by its author, Senator Ed Hernandez (D-Azusa). The California Medical Association (CMA) and the California Academy of Family Physicians led the fight against SB 323. Senator Hernandez also pulled a separate scope of practice bill, SB 622, that would have allowed optometrists to perform an array of supplementary procedures with little additional training. That measure would have permitted optometrists to perform scalpel surgeries, laser surgeries, and intraocular injections. It was pulled on July 14 for the second time this month, ending its run in this year’s legislative session. CMA partnered with the California Academy of Eye Physicians and Surgeons along with a robust coalition, including local county medical societies, to warn lawmakers and the public about the dangers of this bill. “It’s clear that members of the committee saw the potential dangers of SB 622,” said CMA President Luther F. Cobb, MD. CMA strongly believes that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state. Allowing practitioners to perform procedures they simply aren’t trained to do can only lead to unpredictable outcomes, higher costs, and greater
fragmentation of care. Lowering certification standards and oversight puts the safety and health of patients at risk. This was the case a few years ago when eight veterans suffered “significant” vision loss, and another 23 suffered progressive vision loss, after optometrists at the Palo Alto Veterans Affairs Health Care System ignored requirements to refer glaucoma patients so their treatment could be monitored by ophthalmologists. During the June 30 hearing, former CMA President Paul Phinney, MD, told the committee that in addition to the association’s concerns about allied health professionals performing procedures for which they are not adequately trained, there is nothing in SB 323 that would augment the productivity of the state’s NPs. About half of nurse practitioners in California do not practice primary care, he said, while the remainder practice in “large, integrated health care delivery systems.” “I worked in one of those health care delivery systems for almost 30 years, and I can tell you that the nurse practitioners in those systems are already very busy,” Dr. Phinney said. “There’s nothing in SB 323 that will augment the productivity of NPs in those systems, which represent a large percent of the remainder of NPs in our state that do primary care.” Assemblymember Jim Wood (D-Healdsburg) called SB 323 a “tough bill” and said he had concerns regarding oversight — particularly whether nurse practitioners would be overseen by an entity other than the Medical Board of California, which oversees physicians. “To have oversight from different entities that are overseeing the practice of medicine is
problematic to me,” Assemblymember Wood said. Much debate also revolved around an amendment suggested by the B&P Committee — and refused by Hernandez — that would have applied the corporate bar on the practice of medicine to nurse practitioners — a provision of law that prevents lay corporate entities from interfering with the independent medical judgment of physicians. Organizations voicing their opposition to SB 323 at the hearing included the California Academy of Eye Physicians and Surgeons, the Medical Board of California, California Psychiatric Association, California Orthopaedic Association, California Society of Dermatology and Dermatologic Surgery, and the California Society of Anesthesiologists, in addition to CMA. “Today was a good day for the health of Californians,” Dr. Cobb said in response to the vote. “We commend the Assembly for rejecting SB 323, which would have significantly compromised patient safety.” JULY/AUGUST 2015 | THE BULLETIN | 49
CMA Alert, July 27, 2015 issue
(CMA Alert, July 27, 2015 issue)
Special session on Medi-Cal financing underway in the Capitol
Six tobacco bills to be taken up during special session on health
In June, Gov. Jerry Brown convened a special legislative session on “health care financing.” Specifically, legislators will be working to come up with new funding for developmental disability services, in-home supportive services and the Medi-Cal program, which is facing a shortfall of at least $1.1 billion through the loss of the managed care organization (MCO) tax. Since 2005, the state has taxed MCOs and used the money to cover the costs of provider reimbursement. However, last summer federal officials informed California that its MCO tax structure was not compliant with new federal requirements. The loss of the MCO tax and the federal matching funds would mean the loss of over $2 billion for the Medi-Cal program. The budget that Brown introduced in January proposed a new MCO tax that would conform to the new federal requirements, but health plans objected to the new tax and the legislature failed to adopt the proposal. The special session will look at sources of funding, from another MCO tax to alternative sources. Legislators will also tackle other issues, including: • How to restore cuts made to Medi-Cal provider reimbursement rates. • How to finance the Medi-Cal program when the state must begin paying in 2017 for 10% of Medi-Cal enrollees who are “newly eligible” under the Affordable Care Act. • How to pay for a court-ordered restoration of a 7% cut in In-Home Supportive Service rates. The special sessions began in June with informational hearings, but the hard work isn’t expected to begin until late August after the summer recess. The California Medical Association (CMA) continues to work with its legislative allies and coalitions to push the issue of reimbursement rates and patient access over the finish line. Medi-Cal currently covers just under one-third of the population of the state of California—about 12.3 million people. Since cuts were made to Medi-Cal in 2011, California has ranked among the bottom three states in the nation for Medicaid reimbursements. Low reimbursement rates have forced many of California’s providers to stop seeing Medi-Cal patients. As a result, more than half of Medi-Cal patients report difficulty finding a doctor. CMA is committed to ensuring that Medi-Cal is not a broken promise of access to care for millions of Californians. 50 | THE BULLETIN | JULY/AUGUST 2015
Six bills aimed at saving lives and reducing the cost of tobacco-related diseases on California’s health system will be taken up during the Legislature’s second special session to address health care — a meeting ordered by Gov. Jerry Brown. Some of the bills being proposed are the same as those introduced in the Capitol earlier this year, including bills to add e-cigarettes to the existing tobacco products definition and to increase the age of sale for tobacco products to 21. Other bills introduced would allow local jurisdictions to tax tobacco products and require all schools in the state to be tobacco-free. The Save Lives California coalition, which includes the California Medical Association (CMA), American Heart Association (AHA), the American Cancer Society and several other health organizations, applauded Senate and Assembly Democrats for announcing the introduction of these bills to fight tobacco use — the No. 1 cause of preventable death in the state. CMA President Luther F. Cobb, MD, said the bills symbolize a “tremendous step forward for a healthier California” and that they will help to curb tobacco use in California’s youth. That statement was echoed by Laphonza Butler, president of SEIU California and SEIU United Long-Term Care Workers (ULTCW), organizations that are also part of the Save Lives coalition. “These bills save lives by stopping young people from picking up cigarettes, and by strengthening our health care system, which must deal with the damage caused by smoking-related diseases in our communities,” Butler said. “The Save Lives coalition is proud to work with legislative leaders to reduce the toll smoking takes on Californians’ health.” Three out of every four kids who try cigarettes continue to smoke as adults, and half of those smokers will die from tobacco-related illnesses, according to American Cancer Society Action Network Vice President Jim Knox. “This is an opportunity California can’t afford to miss,” said Kirk Knowlton, MD, AHA Western States Affiliate board president. “Smoking contributes directly to heart disease and stroke, the No. 1 and No. 5 leading causes of death for Californians. The passage of this package of bills will have an immediate, life-saving impact by reducing the No. 1 preventable cause of premature death and disability.” To learn more about the coalition and see a full list of supporters, visit www.savelivescalifornia.com.
CMA Alert, July 27, 2015 issue
House passes bill to increase funding for medical research and speed FDA approvals Last week, the U.S. House of Representatives voted overwhelmingly (344-77) to pass a bill known as the “21st Century Cures Act,” which would boost federal funding for medical research and speed up Food and Drug Administration (FDA) approvals for many new drugs and medical devices. The bill, HR 6, will give $8.75 billion to the National Institutes of Health (NIH) for research and another $550 million to the FDA over the next five years. A scaled-down bill has been introduced in the U.S. Senate and there are hopes that it will pass by the end of the year. The bill will remove barriers to increased research collaboration, modernize the clinical trial process (including patient registries), provide incentives for the development of drugs for rare diseases, create an Innovation Research Fund, and assist the biomedical infrastructure to help the future development of drugs and devices. It would be funded by selling oil from the nation’s strategic petroleum reserves. One goal of the bill is to speed up the FDA approval process. Drug companies have long complained the FDA approval process is too rigorous and too slow, preventing them from bringing some less-profitable drugs to market. Critics of the bill say the FDA currently has strict safety standards for drug approval and this bill will loosen those standards. One of the direct results of the bill would be to allow more flexibility in clinical trials in the development of new antibiotics. Legislators are
convinced that the reliance on old drugs and the lack of new drugs have created a plague of untreatable “superbugs.” The bill would also change the FDA approval process for medical devices, redefining the evidence that can be submitted for consideration to include patient medical histories and articles published in peer-reviewed journals. The measure has generally drawn praise from the medical community and patient groups. However, it has drawn criticism from some consumer advocates that say FDA approval changes would threaten to lower safety standards. The California Medical Association (CMA) has been closely following this bill and will continue to work with the American Medical Association and Members of Congress as the bill moves forward. In addition to the main provisions discussed above, there are a number of other health care related provisions in this bill. A provision of particular concern is one that would allow Medicare Part D plans to create barriers for physicians when prescribing controlled substances to patients. CMA also worked to insert a provision that requires Medicare to provide comparable cost information to seniors for the same services depending on the site of service. CMA has been critical of the fact that Medicare pays as much as three times more for the same service when it is delivered in the hospital versus a physician’s office.
CMA Alert, July 27, 2015 issue
Sugar-sweetened drinks responsible for 25,000 U.S. deaths each year Research published in the American Heart Association’s journal, Circulation, concluded that sugary beverages cause the deaths of 25,000 Americans each year through their contributions to obesity, diabetes, cardiovascular disease, and cancer. Globally, sugary drinks contribute to 180,000 deaths each year, with the highest death rate in Mexico. The U.S. ranked second. The study’s authors examined beverage consumption through national dietary surveys gathered by 51 countries from 1980 to 2010. After estimating how sugar-sweetened beverages contribute toward obesity, and how obesity contributes toward various diseases, the researchers were able to conclude how many deaths from those diseases were due to sugary drinks. “This is not complicated,” Dariush Mozaffarian, MD, senior author of the research, told the Los Angeles Times. “There are no health benefits from sugar-sweetened beverages, and the potential
impact of reducing consumption is saving tens of thousands of deaths each year.” Dr. Mozaffarian also serves as dean of Tuft University’s Friedman School of Nutrition Science and Policy. The study on sugary beverages did not examine the effects on children consuming these beverages, but study coauthor Gitanjali Singh predicts dire consequences for the next generation if consumption rates continue at the current rate.
#BeatTheSweet The California Medical Association (CMA) Foundation’s #BeatTheSweet project is engaging physicians across the state to educate their patients about sugary drinks and how they increase the prospect of developing diabetes. The CMA Foundation and the Network of Ethnic Physician Organizations (NEPO) are both sponsoring the campaign with funding from the California Endowment. As part of the campaign, physicians can re-
quest a poster for their offices that shows a large can of soda with the lettering “Type 2 Diabetes” and “Did you know that one junk drink a day can increase your risk of Type 2 diabetes by 25%?” Physicians are encouraged to place the poster in their waiting rooms where patients can see it to help open a dialog on the topic of sugary drinks and their effects on health. Physicians are also asked to take pictures of themselves engaged in conversations with their patients and post them to social media, like Twitter or Facebook, with the hashtags #BeatTheSweet and/or #SugarlessPour. These hashtags will allow the Foundation to find your post. The CMA Foundation will repost photos with these hashtags to its Facebook page. To get your free poster, contact Liza Kirkland at lkirkland@thecmafoundation.org or 916/7796643.
JULY/AUGUST 2015 | THE BULLETIN | 51
CMA Alert, June 29, 2015 issue
Highlights from AMA’s 2015 House of Delegates The American Medical Association’s (AMA) House of Delegates tackled a diverse set of resolutions this year that are of interest to California physicians, including medical-only exemptions from school vaccination requirements, electronic health record (EHR) meaningful use, ICD10 implementation, Medicaid rates, and opioid abuse. Given the high level of interest in California’s Senate Bill 277 (Pan), which would eliminate the personal belief exemption for school vaccination requirements in California, AMA adopted a policy calling for immunization for all, and only allowing exemptions where medical reasons contraindicate vaccination. Several other vaccine-related resolutions were also passed, including supporting parents who want to help educate and encourage their peers to vaccinate [based on a California Medical Association (CMA) resolution adopted during the House of Delegates]; disseminating materials about the effectiveness of vaccines to states; encouraging states to eliminate philosophical and religious exemptions from state immunization requirements; and recommending that states have an “established decision mechanism that involves public health physicians to determine which vaccines will be mandatory for admission to schools.” AMA also adopted several Medicare-related resolutions on controversial issues. The AMA House overwhelmingly supported a two-year grace period from penalties and recovery audit contractor audits during the ICD-10 implementation, and to make advance payments available if claims are delayed. Resolution 211 calls upon AMA to work with the Centers for Medicare and Medicaid Services (CMS) to give physicians partial credit for accomplishing objectives in the EHR Meaningful Use program, to engage with EHR vendors to reduce the negative effects on physicians, and for AMA to develop a model EHR vendor contract that protects physicians in the event of downtime due to vendor error and other technical problems. The AMA HOD also adopted substitute Resolution 103 on the Medicare three-day stay rule. It asks AMA to continue to urge Congress to eliminate the three-day hospital inpatient requirement for Medicare coverage of post-hospital skilled nursing facility services, and to continue to advocate as long as the three-day stay remains in effect, that patient time spent in hospital observation care or in the emergency room count toward the three-day stay requirement. AMA also renewed its commitment to expand funding sources for graduate medical education, to increase the number of residency slots and to study the reasons medical students fail to match to residency slots (and to assist those medical students). There were several resolutions calling for sweeping reforms of the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) process. The resolutions direct AMA to request that ABMS to develop fiduciary standards for its members boards and to provide full transparency related to the costs of preparing, administering, scoring and reporting MOC exams. It also seeks to ensure MOC “doesn’t lead to unintentional economic hardships.” There were numerous resolutions on the rising costs of generic medications. Substitute Resolution 106 asks AMA to work with federal agencies to address the high and escalating costs of generic prescription drugs and to support legislation to ensure fair pricing of generic medications and 52 | THE BULLETIN | JULY/AUGUST 2015
price transparency. AMA also supported additional steps to address opioid abuse through a series of resolutions calling for increased reliance on prescribing data through modernized prescription drug monitoring programs and sharing data across state lines; more education; better coverage of addiction treatment; and an increased focus on physician-led, comprehensive, multidisciplinary pain management services. The California delegation presented a number of important resolutions as well. The following are summaries of some of the California resolutions that the AMA House of Delegates adopted as policy. Interest on Medicare Overpayments and Underpayments (Res. 404): That AMA support amending federal Medicare law to require that interest on both overpayments and underpayments to providers attaches upon notice of the error to the appropriate party in either instance. Reimbursement for End-of-Life Counseling (Res. 402): That AMA advocate for public and private health care insurers to be required to cover counseling for end-of-life care planning as an accepted and integral part of good medical care. Survivorship Care Plans (Res. 503): That AMA supports the voluntary use of survivorship care plans for cancer survivors when appropriate and also support reimbursement for physicians who prepare them. Study the Impact of the Affordable Care Act (ACA) Medicaid Expansion (Res. 116): Asks that AMA use all available data to study the issues surrounding the ACA expansion of Medicaid to tens of millions of low-income adults to evaluate access, quality of care, adequacy of provider reimbursement and the impact of the ACA on the health care system as a whole. Electronic Cigarettes (Res. 101): Asks that AMA support a ban on the advertising of electronic cigarettes; hold a position that e-cigarettes should be regulated at the federal, state and local level, consistent with other tobacco products; support education of the public on the known and potential health impacts of electronic cigarettes; and support the taxation of electronic cigarettes to fund research into these products. The following additional California resolutions were reaffirmed by the AMA as existing policy. • Res. 109: Medicare Coverage of Physician Administration of Medications Procured by Patients • Res. 205: Doctor Hospital Ownership • Res. 410: Mental Health Crisis Interventions • Res. 411: Homeless Veterans • Res. 509: Long Acting Reversible Contraception and Teen Pregnancy In other California news from AMA, Jim Hinsdale, MD, former CMA President, was re-elected to the AMA Council on Medical Services and Carol Berkowitz, M.D., was re-elected to the Council on Medical Education.
CMA Alert, July 27, 2015 issue
CMA Alert, July 27, 2015 issue
CMS releases proposed Senate panel pushes 2015 Medicare physician fee HHS to delay stage 3 schedule meaningful use The Centers for Medicare and Medicaid Services (CMS) recently released the 2016 proposed Medicare physician payment rule. The rule reflects the 0.5% increase in payment as of July 1, 2015, and the additional 0.5% increase in payment on January 1, 2016, recently adopted by Congress. Overall, Medicare will pay physicians nearly $700 million more in 2016 than they will have paid in 2015. Most notable in the payment rule is CMS’ proposal to pay for advance care planning and end-of-life counseling. The fee schedule would establish two new codes to cover early conversations between patients and their physician about care options. These codes were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC). The codes include discussion before an illness progresses and during the course of treatment so patients can make decisions about appropriate treatment for their personal situation. One code would cover the first 30 minutes and the other would cover additional 30-minute blocks of time. AMA and the California Medical Association (CMA) have been pushing CMS to cover such services. CMS is seeking comments on the 2019 implementation of the new Medicare payment systems recently adopted by Congress as part of the permanent repeal of the sustainable growth rate (SGR) formula. The agency also noted its strong support for promoting primary care services and is soliciting comments on potential coverage of collaborative care services and an expansion of the Comprehensive Primary Care initiative. The proposal also includes an expansion of payment for telehealth services mainly for in-home treatments for end-stage renal disease. There are numerous changes to the relative values of services – many recommended by the AMA RUC. Most notably, payment for gastroenterology services will be reduced 5%, with colon and rectal surgery reduced by 1%. Organized medicine is fighting many of these changes. Other notable provisions of the rule include: • Myriad changes to the Accountable Care Organization Shared-Savings program, the Physician Quality Reporting System (PQRS) and the value-based payment modifier, which will soon apply to all physicians who bill under a tax identification number. • CMS will no longer require physicians who opt out of the Medicare program to notify Medicare on an annual basis. • New appropriate use criteria for advanced diagnostic imaging mainly based on recommendations from the related specialty societies. • Some new exceptions to physician self-referral laws. The overall payment impact by specialty can be found on page 711 of the rule. Please note that these payments do not account for adjustments made by PQRS, the value-based payment modifier or meaningful use. CMS is also updating the Geographic Adjustment Factors for all localities nationwide. California will see increases of 0.1% to 0.3%. Please note that starting in 2017, California localities will move to Metropolitan Statistical Areas due to the CMA-sponsored geographic practice cost index legislation, with there will be larger payment increases to the urban counties currently within the “Rest of California” locality. AMA and CMA are carefully analyzing the multitude of changes to the physician payment system and will be submitting extensive comments.
The Senate Health, Education, Labor and Pensions Committee is asking the U.S. Department of Health and Human Services (HHS) to delay the stage 3 meaningful use rules, its chairman, Lamar Alexander (R-Tenn.) said during a news conference recently. The Centers for Medicare and Medicaid Services (CMS) issued proposed rules for stage 3 in March 2015. What’s concerning providers is that this stage differs from the others in the degree to which a medical provider, to fulfill its requirements, must depend on other providers to document electronically that they have fulfilled the requirements. According to a July 20 policy analysis by the Brookings Institution’s Center for Technology Innovation, this means that if providers do not send electronic summaries, the medical provider who was supposed to receive them will fail to comply with the rulemaking. “This leads to a situation in which even tech-savvy providers will not be able to fulfill the requirements of the third stage of the meaningful use program, regardless of their intentions and efforts,” according to the Brookings analysis. The California Medical Association was among a number of organizations who have been pushing for a delay in the implementation of stage 3. As of now, CMS expects to begin enforcing stage 3 requirements in 2017.
CMA Alert, July 27, 2015 issue
Updated payor profiles now available The California Medical Association’s (CMA) Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, United Healthcare, Medicare/Noridian, and Medi-Cal. Each profile includes key information on health plan market penetration, a description of the plan’s dispute resolution process, and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge at http:// www.cmanet.org/ces.
JULY/AUGUST 2015 | THE BULLETIN | 53
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