2016 July/August

JULY / AUGUST 2016 VOLUME 22 | NUMBER 4

SCCMA Incoming President Scott Benninghoven, MD Receives the Gavel From Past President Eleanor Martinez, MD

INSIDE: MCMS Incoming President Craig Walls, MD

Receives the Gavel

VOLUME 22 | NUMBER 4

JULY / AUGUST 2016

MCMS Incoming President Craig Walls, MD Receives the Gavel From Past President James Hlavacek, MD 2 | THE BULLETIN | JULY / AUGUST 2016

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

Feature Articles

Billing/Collections

12 MCMS’s “Physician of the Year” Banquet and

CME Tracking

Installation

Discounted Insurance

14 MCMS Banquet Photos

Financial Services

16 SCCMA Award Presentations and Installation

Health Information Technology

26 SCCMA Awards Banquet Photos

Resources House of Delegates

36 Zika Presentation by CDPH

Representation Human Resources Services Legal Services/On-Call Library Legislative Advocacy/MICRA Membership Directory APP for the iPhone

Departments 5 Thank You to Our Retiring Physician Editor: Dr. Joseph Andresen 6 Message From the SCCMA President

Physicians’ Confidential Line

7 Message From the MCMS President

Practice Management

8 Message From the Outgoing SCCMA President

Resources and Education Professional Development

38 Medical Times From the Past

Publications

40 MEDICO News

Referral Services With

48 MACRA: What Should I Do Now to Prepare?

Membership Directory/Website Reimbursement Advocacy/ Coding Services

51 When A Practice Becomes Terminal 52 Classified Ads

Verizon Discount JULY / AUGUST 2016 | THE BULLETIN | 3

THE SANTA CLARA COUNTY MEDICAL ASSOCIATION OFFICERS President Scott Benninghoven, MD President-Elect Seham El-Diwany, MD Past President Eleanor Martinez, MD VP-Community Health Cindy Russell, MD VP-External Affairs Kenneth Blumenfeld, MD VP-Member Services Ryan Basham, MD VP-Professional Conduct Vanila Singh, MD Secretary Seema Sidhu, MD Treasurer Anh Nguyen, MD

CHIEF EXECUTIVE OFFICER

COUNCILORS

William C. Parrish, Jr.

El Camino Hospital of Los Gatos: Vacant El Camino Hospital: Vacant Good Samaritan Hospital: Vinit Madhvani, 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: Vacant Stanford Health Care / 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

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

THE MONTEREY COUNTY MEDICAL SOCIETY

Printed in U.S.A.

OFFICERS

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 2016 by the Santa Clara County Medical Association.

4 | THE BULLETIN | JULY / AUGUST 2016

President Craig Walls, MD President-Elect Maximiliano Cuevas, MD Past-President James Hlavacek, MD Secretary Alfred Sadler, MD Treasurer Steven Harrison, MD

CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.

DIRECTORS Valerie Barnes, MD David Holley, MD John Jameson, MD William Khieu, MD Eliot Light, MD

Phillip Miller, MD David Ramos, MD James Ramseur, MD Marc Tunzi, MD Raymond Villalobos, MD

to Our Retiring Physician Editor 10 Years! That’s How Long As of July 2016, Dr. Joseph Andresen has retired as the Physician Editor of The Bulletin. Dr. Andresen has been a long serving Physician Editor for 10 years. During this time he has served our Medical Associations with dedication, commitment, and diligence while bringing to the journal a wealth of knowledge and topics to his editorial columns that have tremendously made an impact on the content of The Bulletin. Dr. Andresen has brought an invaluable depth of knowledge, experience, and commitment to the journal during this time. His work has enhanced the reputation of the journal. It is clear that The Bulletin and the members in which it serves, have benefited enormously under Dr. Andresen’s tenure and we will miss him and his significant contributions.

SCCMA and MCMS would like to extend its sincere appreciation to Dr. Andresen for his contributions and service to the Journal, both as author and physician editor. Thank you for your 10 years of dedication to SCCMA and MCMS, Dr. Andresen! You will be missed. Best wishes for all your future endeavors.

JULY / AUGUST 2016 | THE BULLETIN | 5

President, Santa Clara County Medical Association

SCOTT BENNINGHOVEN, MD

MESSAGE FROM THE

SCCMA PRESIDENT

Opening Remarks

Scott Benninghoven, MD is the 2016-2017 president of the Santa Clara County Medical Association. He has a general surgery practice in the South County and practices at Saint Louise Regional Hospital, Regional Medical Center of San Jose, as well as O’Connor and Good Samaritan Hospitals.

The following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 7, 2016.

I wanted to introduce myself and give you some personal history. I am very proud to be a fifth generation Californian on my father’s side and a fourth generation Californian on my mother’s side, both of whom are here tonight. My father’s great, great grandfather came to San Jose in 1850, as a 19 year-old seeking his fortune in the gold fields, but ultimately ended up in ranching in what is now Milpitas. My mother’s family immigrated to San Francisco from Italy in the 1880’s, becoming successful in the fruit and canning industry.

I am a firmly established bay area resident.

Upon completion of my surgical residency in Southern California I moved to the South County in 1990, Morgan Hill and Gilroy, to begin a general surgery practice with Jim Hinsdale and John Saranto. With that said, I am proud to be the first President of the Santa Clara County Medical Association from South County.

I started in this organization, as most others did, as a member of the Council, representing Saint Louise Regional Hospital. Over the years, I have found physicians in this organization to have the same goal and passion towards the delivery and improvement of patient care both locally and state wide. I have experienced wonderful, thoughtful, and insightful discussions about issues that face physicians. Two weeks ago, I sent out an email requesting opinions that centered around End-of-Life Option, which goes into effect on June 9th. Organizations may decide to “opt out” of participating in this law and when Saint Louise Hospital was deciding to “opt out,” I initially was personally uncomfortable with that decision. However, after having about 20 of my esteemed colleagues “weigh in” and finding out what the law and issues really were, I felt comfortable with the original decision. I hope that my question also stimulated others’ thoughts when facing this discussion at their hospital. We are never alone.

I am also very proud of the hospitals where I practice at Saint Louise Hospital and Regional Medical Center of San Jose, in addition to O’Connor and Good Samaritan Hospitals, their fellow sister hospitals. I would also like to thank my colleagues, friends and family who have continued to support me over the years. I would like to extend a special thanks to my family and friends who are here tonight. Dr. Hinsdale, without whom I would not have come to practice in California. In 26 years, I have never regret-

6 | THE BULLETIN | JULY / AUGUST 2016

ted starting and building a life here. Dr. Saranto: 26 years, I can’t imagine a more compatible partner and friend. Always being there, if I needed advice or assistance, and never asking for much except Wednesdays off to ride your bike. And Dr. Traver: starting a new trauma group with Dr. Kline, thank you for your continued support also. Also the SCCMA Executive Committee and Council, I am looking forward to an enjoyable and instructive year ahead.

Medical Technology has changed drastically and rapidly over my lifetime, fortunately. When I was born with hyperbiluruinemia of Rh incompatibility, the only therapy was a newly developed treatment consisting of a complete blood exchange transfusion. My father took me by car from Alta Bates in Berkeley to San Francisco General where they were trying this new treatment. In the short span of my life, technology has advanced so much that new fields of medicine have developed right here in our backyard. Most recently, surgical technique has become miniaturized and computerized with laparoscopic, arthroscopic, endoscopic, endovascular, and robotic. However, we must remember that technology is a tool to provide better care, not the care itself.

During a discussion on the phone with Dr. Richard Slavin, he mentioned a topic, which is close to my heart, the “team approach” to health care. For better or worse, the current method of practice is becoming a team activity. Dr. Slavin said the physician leader “can’t accomplish anything without a multidisciplinary team of Nurse Practitioners, Physician Assistants, Social Workers, outreach coordinators and skilled staff.” And he is absolutely correct.

In my world of in-patient care, the rate of new therapies are progressing rapidly and becoming more complicated as well. The idea of equalizing the “providers of care” so that EVERYONE has input into that patient’s care does improve care. I also believe that this is a good thing as long as we don’t lose sight of the goal, which is to provide better care to the patient. Despite all specialized input, the physician, however, is ultimately responsible for that patient’s welfare and health. We must never give up that responsibility to “the team.” Dr. Cossman recently wrote an opinion in General Surgery News about this subject, stating: “On rounds, I hear ‘the team thinks this’ or ‘the team wants to do that,’ as if ‘the team’ can think or actually do something.” He is not an advocate of the team approach, to say the least. I believe we can have it both ways if we make a conscious and concerted effort to find a middle

Continued on page 9

President, Monterey County Medical Society

CRAIG A. WALLS, MD

to care for them in their time of need, of suffering, of trauma, of affliction, and at the end of life. Patients do not seek and find succor in their relationship to regulators, insurance companies, the pharmaceutical industry, or hedge fund managers. They need the truth, expertise, honesty, and the love that their doctor, and only their doctor, can give them. Our presence at the bedside is our gift and our responsibility.

So where do doctors sit at the table in 2016? Are we on the plate?

In recent decades, physicians have, too often, relinquished our role of moral leadership in healthcare to other powers and authorities. We mistakenly told ourselves that we were responsible to form the individual relationship with the patient and that someone else should be responsible for the system that we work within. That was our mistake.

Look where surrendering leadership has brought us. Results from the 2014 Physicians Foundation Survey should give us pause: • only 44% of physicians describe their morale and their feelings about the current state of the medical profession as positive.

• fully 69% of physicians believe that their clinical autonomy is sometimes or often limited and their decisions compromised.

When it comes to life and death, and treatment and diagnosis, and scientific honesty versus exploitative hucksterism, pseudoscience and amateurism – MDs and DOs stand at the kitchen door.

We have to get our house in order – starting in the kitchen. Through the trust and respect of our patients, doctors can take back our place as the natural leaders of healthcare in the U.S. That take-back starts in our local medical societies. It starts here, with the Monterey County Medical Society.

As your President, I will work to find ways to increase our membership, the strength of our voice, and the moral authority of our profession in our county and country.

In high school, Sister Mary Stella taught us that “love” means putting the interests of your loved one – your child, your partner, your patient – above your own interests. As physicians, as professionals, we love our patients. That love is the strongest power we have. Let’s use that power to reclaim our kitchen as the chef!

I pledge to work hard on behalf of the doctors and the patients of Monterey County, and I invite the physicians in Monterey County to join me.

MESSAGE FROM THE

The following speech was presented at MCMS’s Physician of the Year and Installation Dinner on June 16, 2016.

Thank you to Dr. Jim Hlavacek for his dedication and hard work. His will be large shoes to fill, and I thank all the members who voted to give me this honor and opportunity as your next President.

Here’s news: Healthcare in America is becoming ever more complex! I do not call what we have in the U.S. a healthcare system, because that word system implies a coordinated and functional organ of healthcare provision. We do not have that, in case you had not noticed. What we have is a patchwork of sometimes competing and sometimes cooperating interests that label themselves, variously, as healthcare.

There are a lot of cooks in our kitchen. Regulators have a big wooden spoon. A multitude of insurers and underwriters have a quiver of silver spoons.

Pharma has a ladle. Wall Street holds the mortgage for our kitchen’s house. The patients do not so much have a spoon as they are the ingredients being stirred.

Where are the doctors in the kitchen? Where should we be?

We should be the chefs.

The truest definition of a “professional” is someone who places the interests of his client above the interests of herself. That ideal sets “professionals” apart from entrepreneurs, employees, consultants, and workers.

Physicians epitomize professionals for American culture, still.

The 2016 Harris Poll surveyed Americans impression of the most prestigious careers and found that physicians are still at the top of that list with 90% of respondents naming doctors.

Our nation of patients look to us – the doctors –

MCMS PRESIDENT

Opening Remarks

Craig A. Walls, MD, is the 2016-2017 president of the Monterey County Medical Society. He is an Emergency Medicine doctor with the California Emergency Physicians Medical Group and is currently practicing with Natividad Medical Center in Monterey.

JULY / AUGUST 2016 | THE BULLETIN | 7

President, Santa Clara County Medical Association

ELEANOR MARTINEZ, MD

SCCMA PRESIDENT

MESSAGE FROM THE OUTGOING

Outgoing President’s Speech

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.

The following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 7, 2016.

Tonight marks the last time I will be addressing all of you as the President of the Santa Clara County Medical Association. I am handing the gavel to Dr. Scott Benninghoven. It is with much anticipation that I do so and with the resolute determination to continue on serving this well respected organization as the past president. With so many years of service to SCCMA, attending the Executive Council meetings, and participating in various committees, as well as being one of our Delegates to the CMA House of Delegates, there is no one better prepared than Dr. Benninghoven. Scott, you have all our support.

I cannot believe that one year has quickly gone by. I equate it to riding the fastest roller coaster. When Dr. Bill Lewis called me sometime in March last year and told me I was nominated to be the President, I was flabbergasted. I never thought that I would be capable to fill the shoes of those before me. Those were big shoes! I asked him to give me the weekend to think about it. I was happy serving on various Committees and being on the Executive Council in various roles through the years, and being a Delegate to CMA. It was comfortable. To be asked to serve as a President of this great organization is an honor, but with it came a tremendous responsibility to represent you all. After seeking counsel from trusted family and friends, as well as colleagues, and not one who shies away from challenges, I accepted (I was also reminded that I was crazy to take on the role!)

The next step was to call Bill Parrish and Jean Cassetta. I needed to know that the key people who helped run this organization would be there to support me.

• To Bill Parrish: Thank you for having the SCCMA and its continued success and high regard close to your heart. The SCCMA is a highly respected medical organization in our state. It is through the hard work and networking of Bill Parrish that we are recognized. He also leads the Monterey County Medical Society.

• To Jean Cassetta: Another thanks – Your effort working for the SCCMA to gain more members needs to be recognized. Your involvement with Young Physicians, Medical Students, and Residents, as well as member benefits increases our visibility in this community. You are the connection to those in the legislature of

8 | THE BULLETIN | JULY / AUGUST 2016

Sacramento, facilitating our town hall meetings, as well as bringing us speakers from CMA to keep us informed of changes that impact us physicians.

• To Pam Jensen: I love how you never lost your cool when I promised to get you my article for The Bulletin at such a date and was late several days later. I always emailed you those articles with the same message – “Please go over it and edit both language and spelling before printing.”

You are a very patient woman. I want all of you to know, it took me several nights to research and put together those articles. I sure hope you took the time to read them. My patients read them in my waiting room. It was better than reading about irrelevant news from tinsel-town.

An example: My article on the End-of-Life issue had triggered some questions from my patients who are now finally acknowledging that “the conversation” needs to happen. It was a timely article now that the Compassionate Bill has been signed into law. Nowadays the question is centered on Opioid Abuse.

• To the rest of the SCCMA support team: Mark Christiansen from BME, Sandie Moore, Leslie Sorensen, Shannon Landers – this organization would not be the best without all of you. I thank you.

While the journey of being a President went too quickly, I have learned many lessons during this time. Yet I have received more than I have given in such a service. First, I have learned to not quickly respond to issues presented without first giving it much thought. Knowing I represent this organization, my deliberation and replies had to be well thought of first. I learned to clarify my answer, making sure that it reflected my own personal opinion and not SCCMA as a whole. It is no wonder that during our discussions on resolutions during the House of Delegation forums, we are always predicating it with “Speaking for myself,” or “speaking on behalf of ....”. An example was the issues regarding universal health care, legalization of marijuana, and endof-life. I have very strong personal opinions on these matters, but I have to be careful that my stand is not misconstrued as representing the SCCMA or CMA, as a whole.

Secondly, being the President of SCCMA, while a very honorable position, demanded time and commitment. Each event that SCCMA and CMA had, I felt, required my presence as your President and

Representative. I cannot admit to having 100% attendance, but I tried, and made most of them, thanks to the support of our Council Members. There were phone calls that needed responses, and emails as well. The 5:30 p.m.

Executive Council Meetings every first Tuesday was, at times, a stressor because clinic tended to spill over beyond 4:30 p.m.

Because of my visibility as the President of SCCMA it was not unusual to be asked about issues in the world of organized medicine. These encounters frequently happened while at lunches with my colleagues.

At times, the concerns about SCCMA and CMA were legitimate. I hope that I have provided light on those concerns. However, it is still a source of frustration for me, as well as for other leaders in organized medicine, that those who complained the loudest were frequently those who either dropped their membership, or are not members. Yet all of us physicians bear the fruits of the hard work and labor of the few who chose to be involved in this organization. An example is the failure of Prop 46. Everyone has not seen an increase in their malpractice premiums. That is how organized medicine helped us physicians.

I am convinced that we need the power of organized medicine to be heard by all and to effect changes in policies in Sacramento. Not all will be able to take time from their practices, but those fees and dues do help propel our cause. After all, we are all in this together – We need to protect our profession from interferences that impact our care of our patients.

Thus, I am appealing to all of us to keep the fire going, keep talking, share the news of what SCCMA and CMA are doing. Let us pass the word along through the power of social media and technology to get our fellow physicians involved. Let us be a voice to champion what SCCMA and CMA is working for, both locally and nationally. Keep them informed of those “HOT TOPICS.” Those calls to our state representatives and elected officials do matter. We also need to engage our patients. I have found that if I talk to them about these current issues, they are interested.

We are a team, and that team needs to move as a whole. A row boat cannot move forward with only one rowing while the rest are just riding along! This is the third lesson I have learned the past months. While I had always believed in the necessity of being involved in organized medicine, it was more than ever honed in me this past months as President.

Our Executive Council meetings were not only very productive, and collegial, but had humor. Our Council speakers were very informative speakers. Some were well attended and some were not. I would have loved to see more of my colleagues during our session on Medicare. The fourth lesson is that I would suggest that SCCMA post those agendas in hospitals in our county. I am hoping it would draw non-members to be our visitors to see what we do.

I have been blessed with this whole experience with the support of my colleagues.

• Past President, Jim Crotty: Your very thoughtful deliberation, especially with regards to financial matters, leave me in awe. I am glad someone has that background in MBA on our team.

• Cindy Russell, VP for Community Health: To be honest with you, I told Dr. Lewis you should be the President and he was honest to tell me that you were asked and you felt that VP for Community Health is the niche that would give you and us the most benefit, and I am glad. How you manage to keep us apprised of environmental issues and chase us to take a stand – simply admirable! Your work demanded time away from your practice, yet you continue to give it your time and commitment. We have benefited from you and your shared knowledge about the impact of chemicals on our health and environment.

• VP of External Affairs, Dr. Ken Blumenfeld: You wore many hats during our Executive meetings, giving us insights on the items of importance at CMA. You were our ears at the CMA Headquarters.

• VP of Member Services, Dr. Anh Nguyen: Like me, you are ascending the ranks and it is a well deserved role.

• VP of Professional Conduct, Vanila Singh: Though there were not many professional misconducts during our term, your input during our Executive and Council meetings were insightful and thought provoking – I do know you were also instrumental in asking Dr. John Brock-Utne to be a Councilor Representative from Stanford. His voice during our Council meetings was well received, and it is our hope that he will be able to convince the Stanford administration about the importance of having their physicians as members of SCCMA. The addition of Stanford physicians would greatly increase our membership, and thus bring on “Power in numbers.” We need more rowers in that boat and not riders.

• Dr. Seema Sidhu, Secretary: another very vocal voice in our Executive Council, and her participation especially in the HOD as Co-Chair is very much appreciated.

• Our Treasurer, Dr. Seham El-Diwany: She pours through those numbers with Mark and Bill, and makes sure that we guard our fiduciary responsibility to our members.

• Lastly, to all Councilors who represent each of their hospitals, Drs. Ryan Basham, David Feldman, Hemali Sudhalkar, Martin Wong, Michael Charney, Erica McEnery, Diane Sanchez, Clifford Wang, and John Brock-Utne: You all are the bridge of SCCMA to your local hospitals. I thank you.

In closing, I thank you for this honor of being among you. You have all been a blessing in my life and this ride was worth it!

Now, we must move onwards with a new Captain. Congratulations Dr. Scott Benninghoven and the new team.

Message From The SCCMA President, Continued From Page 6 ground. I always remember one of my attending’s favorite sayings: “Don’t find yourself at either end of the swinging pendulum.”

Despite all the technology, core measure, goal oriented therapy, and quality metrics, it is the gentle touch and quiet listening that matter most to the patient, because what hasn’t changed is the relationship between the doctor and the

patient. Now, we may be using new technology and provide care through a “team approach,” but medicine is still one human being treating another, with the ultimate goal of making their life better.

Which brings us to the reason why we are here tonight. To honor eight individuals who represent the best of Santa Clara County Medi-

cal Association. I would like to take this time to apologize in advance for compacting the entire award recipients’ lifetime of hard work and accomplishments into a short presentation.

To be continued on page 16, SCCMA Award Presentations.

JULY / AUGUST 2016 | THE BULLETIN | 9

https://shopcf.accesso.com/clients/cedarfair/affiliate/login.php?m=2877&ec=300

USERNAME: cga-sccma PASSWORD: CaGA95054

Adult Admission: $43.99 / $35.00-member price Season Pass: $67.00

www.wildatwork.com

“Not Yet a Member” Sign in with your Email COMPANY NAME: SCCMA/MCMS http://shop.accesso.com/clients/cedarfair/affiliate/login.php?m=4358&ec=600

USERNAME: SCCMA

PASSWORD: 2015fun

Admission: $32.00 / $25.00- member price

https://affiliate.montereybayaquarium.org/default.asp

STORE NAME: SCCMA1001 Adult Admission (18-64): $39.95 / $34.95- member price Student (13-17) $34.99 / $29.95- member price Children (3-12) $29.95 / $19.95- member price

http://shop.accesso.com/clients/accesso18/affiliate/index.php?m=11872

Username: SCCMA CODE: SCCMA1 Adult Admission: $33.99 / $23.99- member price Season Pass: $39.99

https://shop.sixflags.com/clients/sixflags/affiliate/login.php?m=15780&ec=

Username: SantaClaraDK CODE: SixFlags7 General Admission: $64.99 / $38.99- member price Season Pass: $79.99 / $64.99- member price http://www.beachboardwalk.com/gad/

Discount Code: SCCMA2016 Unlimited Rides + 2 Attraction Tickets: $40.95 / $32.95- member price Season Pass: $74.99 Call Leslie at (408) 998-8850 or (831) 455-1008, ext 3008 $18.50 / $15.20- member price Gift Certificates - 1 lb box of candy

Visit our Website at www.sccma-mcms.org All websites, links, and promo codes are case-sensitive

10 | THE BULLETIN | JULY / AUGUST 2016

Legacy Wealth Advisors Managing the reserve investment accounts of the Santa Clara County Medical Association (SCCMA) and the Bureau of Medical Economics (BME) since 2000 1900 The Alameda Suite 510 San Jose, CA 95126 P: (408) 452-7700 F: (408) 452-7470 Email: Info@lwallc.com

Wealth Management

Legacy offers a broad range of wealth management services to SCCMA and MCMS physician members and their families. Such services include: • Financial Planning, Risk Management, Educational & Retirement Planning Projections • Liquidity Management and Cash Flow Analyses • Estate Tax and Charitable Planning • Existing Portfolio Analysis • Design and Implementation of Investment Strategies

Member Savings!

Legacy offers a one-hour complimentary financial planning check-up to Association members (this is a $500 savings). For more information, please call Lawrence Pizzella at (408) 452-7700 or email lawrence@lwallc.com

www.lwallc.com

EXCLUSIVE MEDICAL COLLECTIONS ACCURATE CONSISTENT

FULL TIME

KNOWLEDGEABLE

ATTORNEY ON STAFF

THE BUREAU OF MEDICAL ECONOMICS Competitive pricing with a rate of recovery over twice the national average.

Providing exclusive medical revenue recoveries since 1947.

Knowledgeable collectors and certified medical coders all working to provide maximum recovery while maintaining the physician/patient relationship.

BME is a not-for-profit owned by physicians for physicians founded by SCCMA. No risk as there is No fee unless there is a recovery.

As an SCCMA-MCMS member benefit, you are entitled to a discount of no less than 5%!



Call (408) 998-5811 x 3034 Email karen@bmesc.org

1(888) 543-7497 www.bmesc.org JULY / AUGUST 2016 | THE BULLETIN | 11

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 Thursday evening, June 16, 2016, at the Corral De Tierra Country Club. Approximately 100 members and special guests attended, including Keynote Speakers Ruth Haskins, MD (CMA President-Elect), Lee Snook, MD (Vice Speaker of the CMA House of Delegates) and Assemblymember Luis Alejo and Senator Bill Monning.

James Hlavacek, MD, 2015-2016 MCMS president, was honored as the outgoing president, and Craig Walls, MD, was welcomed as MCMS’s incoming president for 2016-2017. Serving in the current fiscal year with Dr. Walls are: James Hlavacek, MD, as past president; Maximiliano Cuevas, MD, as president-elect; Alfred M. Sadler, Jr., MD, as secretary; and Steven W. Harrison, MD, as treasurer. The MCMS board of directors are Valerie Barnes, MD; David Holley, MD; John Jameson, MD; William Khieu, MD; Eliot Light, MD; Philip Miller, MD; David Ramos, MD; James Ramseur, Jr, MD; Marc Tunzi, MD; and Raymond Villalobos, MD. Award honoree Richard Dauphiné, MD, FACS received an award for “Physician of the Year.” Richard Dauphiné, MD, FACS, is the medical director of the Monterey Sports Medicine Center and a board-certified orthopedic surgeon with 30 years of active surgical experience on the Mon-

Assemblymember Luis Alejo, Dr. Richard Dauphiné (Physician of the Year), and Senator Bill Monning 12 12 | THE THE BULLETIN BULLETIN | JULY/AUGUST JULY / AUGUST2016 2016

Dr. James Hlavacek (Outgoing President), Senator Bill Monning, and Dr. Craig Walls (Incoming President) terey Peninsula.

Dr. Dauphiné received his bachelor’s degree from Yale University and his medical degree from Georgetown University. He served his surgical internship at Boston City Hospital and completed four years of orthopedic surgery specialty training at the Mayo Clinic. He is a fellow of the American Academy of Orthopedic Surgeons and the American College of Surgeons, as well as a member of the American College of Sports Medicine and the Arthroscopic Association of North America.

With more than 6,900 video-documented operative arthroscopies of the knee and shoulder, Dr. Dauphiné’s experience and surgical expertise are unparalleled on the Central Coast.

Actively involved in medical education, Dr. Dauphiné is an Associate Professor of the University of California, San Francisco Medical School and has been a preceptor for the University of California, Davis Medical School Allied Health Professions Section. He is currently a Clinical Investigator for Conformis, studying long term results of their partial knee replacements.

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.

GOLD

S I LV E R

B RO N Z E

JULY / AUGUST 2016 | THE BULLETIN | 13

Dr. Richard Dauphiné celebrates his special honor of “Physician of the Year” with his family.

MONTEREY COUNTY MEDICAL SOCIETY

2016 “Physician of the Year” and Installation JUNE 16, 2016

Dr. James Hlavacek (Outgoing President) poses with his lovely family and Assemblymember Luis Alejo.

Dr. Dauphiné’s friends help him celebrate his special honor and award for “Physician of the Year.”

Dr. Dauphiné’s friends enjoying the lovely venue.

Physician of the Year, Dr. Richard Dauphiné and Dr. Valerie Barnes (MCMS Director).

Photos: Jean Cassetta

Dr. James Hlavacek (Outgoing President) and his beautiful family.

Dr. Richard Dauphiné enjoys the beautiful venue, posing with his wife, Judge Susan Dauphiné.

MEMBER NEWS & HAPPENINGS Dr. Eleanor Martinez receives an appreciation plaque from Dr. Scott Benninghoven for her outstanding leadership as President for 2015-16

Santa Clara County Medical Association Award Presentations and Installation The Fairmont Hotel’s Club Regent, in San Jose, provided the setting for Santa Clara County Medical Association’s Annual Awards Banquet and Installation. Over 200 members and guests were in attendance this year.

Eleanor Martinez, MD, 2015-2016 SCCMA President, following her outgoing president’s speech, presented Scott Benninghoven, MD, with the 16 | THE BULLETIN | JULY/AUGUST JULY / AUGUST2016 2016

presidential gavel for 2016-2017. Serving in the current fiscal year with Dr. Benninghoven are: Seham El-Diwany, MD, as President-Elect; Cindy Russell, MD, as Vice President of Community Health; Kenneth Blumenfeld, MD, as Vice President of External Affairs; Ryan Basham, MD, as Vice President of Member Services; Vanila Singh, MD, as Vice President of Professional Conduct; Eleanor Martinez,

The evening’s festivities culminated with the recognition of those who have dedicated their lives to furthering the high quality of medical care.

Dr. Benninghoven made the following presentations:

JANICE BREMIS 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.

Janice Bremis is one of the two outstanding recipients we have this year for the “Citizen’s Award.”

Janice is the Executive Director for the Eating Disorders Resource Center (EDRC), which she co-founded in 2008. The Resource Center enables thousands of people through support groups at local hospitals and a call-line, to obtain the help they need.

As a leader, and passionate about the fight against all types of eating disorders, she has shared her own personal struggles with anorexia.

This openness has drawn numerous volunteers, physicians, and medical experts to this organization.

In addition to educating patients about their eating disorders, the EDRC has coordinated and delivered numerous education presentations to health care professionals at hospitals, community centers, county clinics, and non-profit organizations. The center also distributes cards outlining the diagnostic criteria for eating disorders. This material has

Scott Benninghoven, MD, 2016-17 SCCMA President

MD, as Past President; Anh T. Nguyen, MD, as Treasurer; and Seema Sidhu, MD, as Secretary.

The SCCMA Councilors are: Michael Charney, MD (O’Connor Hospital); Vinit Madhvani, 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).

Continued on page 18 JULY/AUGUST 2016 | THE BULLETIN | 17

given hospitals and health care providers tools for early recognition and intervention.

Janice quickly recognized the financial strain this disease has had on the clients. This often limits their access to care and resources available to combat their eating disorder. Therefore, she spearheaded efforts and worked closely with the Santa Clara Mental Health Department to ensure clients with eating disorders get what they need and have access to care.

She has also been working very closely with the American Psychological Association to establish diagnostic criteria for eating disorders. This will allow patients to have the insurance coverage necessary to have ongoing treatment.

Janice feels that the signs of an eating disorder often go unnoticed by the ED and Primary Care Physician. Her goal is to educate providers about the missed signs and symptoms of this devastating disease. In doing so, this will allow patients to “overcome the embarrassment and come forward to receive the care they need.”

It is with great pleasure that I present Janice Bremis with the “Citizen’s Award.”

ROBIN RIDDLE 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.

Robin Riddle is the second of the two outstanding recipients we have this year for the “Citizen’s Award.”

Dr. Richard Adrouny, who came to know and respect her while dealing with his wife’s Progressive Supranuclear Palsy in 2010, nominated Robin. Dr. Adrouny wrote, “Without Robin’s visionary outreach to the

18 | THE BULLETIN | JULY/AUGUST 2016

rest of us, I am sure our individual journeys would have been much harder than it already was.”

Robin Riddle is the founder and CEO of the non-profit Brain Support Network, which is focused on the needs of families dealing with four neurodegenerative disorders collectively known as Atypical Parkinsonian Disorders. The four disorders: Progressive Supranuclear Palsy, Multiple System Atrophy, Corticalbasal Syndrome Degeneration, and Dementia with Lewy bodies, are often not able to be delineated initially and are most often lumped into the overall category of Atypical Parkinsonian Disorders. As more symptoms appear, the initial diagnosis can be refined into one of these four diagnoses.

Common to all these disorders is that they have no cure and virtually no treatment yet.

Robin’s personal journey with neurodegenerative disorders began with her father Larry who was diagnosed with Progressive Supranuclear Palsy in 2004. Along with three other caregivers, she formed the San Francisco Bay Area PSP Support Group. This became the Brain Support Network in 2005 with the expansion to include Multiple System Atrophy, Corticalbasal Syndrome Degeneration, and Dementia with Lewy bodies.

Robin’s father’s brain was donated to Mayo Clinic in Jacksonville, Florida in 2007. Using his brain tissue, a scientist from the Mayo Clinic, and others, published in Nature Genetics a landmark study, which identified three new genes, linked to this devastating disorder.

Her book of work included personally assisting 150 other families through the brain donation process. At present, post mortem brain tissue analysis is the only way to confirm the diagnosis. In 2012, this work was turned over to the Brain Support Network. Of the nearly 300 families who have donated their loved one’s brain, half have received a confirmatory diagnosis that was different from the clinical diagnosis. This important work provides closure to families, as well as supports the ongoing research and clinical accuracy of these related disorders.

Robin’s work and care cannot be done alone. She has built a team and a network of employees, caregivers, volunteers, and providers to support patients and families with these devastating disorders that have no cure.

It is with great pleasure that I present Robin Riddle with the “Citizen’s Award.”

RICHARD J. SLAVIN, MD

ROBERT D. BURNETT, MD LEGACY AWARD

This award is given to a physician member of the Medical Association who has demonstrated extraordinary visionary leadership, tireless effort, selfless long-term commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exalted goals of the medical profession.

Dr. Richard Slavin is this year’s recipient of the prestigious “Robert D. Burnett, MD Legacy Award.”

Dr. Slavin initially was the Chairman of the Board of Directors at Sunnyvale Medical Clinic. After stepping down from the board and a brief absence from the clinic, it came to his attention that the clinic was having financial difficulties for which he offered some sound advice. He was then invited to work with the administration to implement a whole new way of running the clinic. Upon working with this administration, he found great respect and admiration for these individuals. This turned his path to administration and leadership. Over the span of his career, he has been the CEO of Camino Healthcare, and CEO of the Palo Alto Medical Foundation. He has also been on the Board of the Integrated Health Care Association for 18 years. In addition, he has been on the Board of the Markkula Center for applied ethics at Santa Clara University.

His education began at the University of California, Berkeley. He attended medical school at the Washington University, followed by his surgical training at Stanford University Medical School. His emergence as a leader began in the U.S. Air Force as Chief of Surgery at Offutt Air Force Base in Omaha, Nebraska. He then returned to California and started his surgical practice at Sunnyvale Medical Clinic. He has practiced General, Vascular, and Thoracic Surgery at El Camino Hospital for over 30 years.

His colleagues note that he has demonstrated leadership by example, and the model of the servant leader. Dr.

Slavin championed the goals of quality, service, and affordability long before most of us knew what this meant in today’s health care model. He led Sunnyvale Medical Clinic from 35 physicians to 150. Then lead the team to join Palo Alto Medical Foundation, becoming the third CEO of that organization. PAMF now has over 1,500 physicians who care for over one million patients in six counties.

This award has only been given out four times, with the first recipient being Dr. Burnett himself. The nominating committee felt that Dr. Slavin personified all this award stands for.

It is with great pleasure that I present Dr. Richard Slavin with the “Robert D. Burnett, MD Legacy Award.”

RAJ BHANDARI, MD

BENJAMIN CORY, MD AWARD This award is for a physician member of the Medical Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.

Dr. Raj Bhandari is this year’s recipient of the “Benjamin Cory, MD Award.”

Dr. Bhandari, Physician-in-Chief and Chief of Staff for The Permanente Medical Group in San Jose, was nominated by his peers for amazing leadership. He has fostered a multi-disciplinary, highly collegial environment that actively promotes cross-specialty collaboration.

Dr. Bhandari was born in a small farm town in Northwest India.

After graduating from The Armed Forces Medical College in India, he

Continued on page 20 JULY/AUGUST 2016 | THE BULLETIN | 19

chose to forgo the option for military medicine to pursue a post-graduate education in the United States. He completed a Neurology Residency at Ohio State University, followed by two years of a Neurology Fellowship at Stanford University. He has been at Kaiser Permanente San Jose since 1983. His area of special interest in Neurology is chemodenervation for neurological disorders.

Dr. Bhandari was selected as a California Healthcare Foundation Fellow from 2005-2007 where health care professionals gain the experiences, competencies, and skills necessary for effective leadership. He promotes patient safety and quality, as demonstrated by the opening of the first multi-bed simulation center at a Kaiser campus. Their physician and nurses train for real medical or emergent situations.

Dr. Bhandari looks beyond the Medical Center and into the Community, making a real difference by donating his time and talent to outside organizations who promote health. He has worked to extend health care beyond the hospital to Cisco employees and their families via LifeConnections Health Center. He has also worked with the Children’s Discovery Museum to promote healthy diet and living. He is also on the Medical Advisory Board for SOMAS Mayfair and serves on the Santa Clara County INSPIRE Leadership Group, overseeing a federal grant for obesity prevention and smoking cessation in the county. He uses his influence to make systemic changes to programs that create healthy communities.

It is with great pleasure that I present Dr. Raj Bhandari with the “Benjamin Cory, MD Award.”

DANIEL I. JACOBS, MD

OUTSTANDING ACHIEVEMENT IN MEDICINE AWARD This award is for a physician member of the Medical Association who, during his medical career, has made unique contributions to the betterment of patient care, for which he has received widespread recognition. Consideration shall be given to research and/or the development of procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine.

Dr. Daniel Jacobs is this year’s recipient of the award for “Outstanding Achievement in Medicine.”

Dr. Jacobs has been treating patients in plastic and reconstructive surgery at Kaiser San Jose since 2000. He has developed a medical device for patient controlled tissue expansion and is a pioneer in breast reconstruction techniques.

He is Chief of General Surgery, Vascular Surgery and Plastic Surgery, and a leader in this Department and specialty. Dr. Jacobs recognized the morbidity associated with placement of breast prosthesis under the pectorals major muscle and the intense pain for women under-going mastectomy for breast cancer. In 2011, he began placing the expander in the pre-pectoral location. This procedure required new and innovative materials and techniques to achieve the desired outcomes. Dr. Jacobs and his team have been able to reconstruct hundreds of mastectomy defects using this technique. He is currently still studying the technique and once longterm outcomes are available, it is believed that this series will represent the largest experience with this innovative technique. The early success has 20 | THE BULLETIN | JULY/AUGUST 2016

been encouraging and the technique has been adopted at academic centers nationwide on a limited basis.

In addition, Dr. Jacobs is involved in designing medical devices to improve surgical outcomes. He is the inventor of the AirXpander, which is an innovative device allowing for patient-controlled expansion without repeated office visits and percutaneous expansion procedures associated with traditional breast reconstruction.

Dr. Jim Romano, who was a faculty member while Dr. Jacobs was a resident at USC, would like to say a few words about Dr. Jacobs.

It is with great pleasure that I present Dr. Daniel Jacobs with the award for “Outstanding Achievement in Medicine.”

DANNY L. SAM, MD

OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION This award is for a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activities over and above the membership at-large.

Dr. Danny Sam is this year’s recipient of the award for “Outstanding Contribution in Medical Education.”

Dr. Sam’s nomination says it all. This nomination started with “his career dedicated not only to excellent patient care, but also to making sure that there will be excellent well-trained physicians for generations to come.”

Dr. Sam’s career at Kaiser Permanente began in 1989, and since then, he has held a variety of leadership roles where he has mentored numerous

physicians and residents. Initially, he served as the Director of Internal Medicine Residency; however, due to his leadership and commitment to fostering Medical Education he was promoted to the Director of Graduate Medical Education. In this role, he leads the large Internal Medical Residency Program and coordinates the three other Residency Programs.

Dr. Sam is also an Assistant Clinical Professor of Medicine at Stanford University School of Medicine.

Dr. Sam is a mature leader with boundless energy and fabulous people skills. The 22 peer physicians and former residents who nominated him for this award exemplified this. There are many positive comments on his teaching skills and they continue to reflect on his advocacy for residents and his desire to develop physicians who truly care about their patients.

However, Dr. Sam’s work has not been easy. In 2004, he inherited a program with major issues that threatened the ACGME accreditation. He never waivered when he had to tackle tough issues, such as resident morale, and the relationship between Hospital Based Specialist and the Resident Program Directors. He conquered these tough issues and was able to rebuild the Residency Program from the ground up.

When asked about his principles that allowed him to achieve these goals and turn around the residency program, he replied, “You have to meet each issue directly and immediately. It is best to address issues or conflict personally and as soon as recognized.”

His contributions to graduate medical education have exceeded all reasonable standards. That is why he was nominated by 22 individuals to receive

this award.

It is with great pleasure that I present Dr. Danny Sam with the award for “Outstanding Contribution in Medical Education.”

LYNN B. ROSENSTOCK, 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 above that expected of the membership at-large.

Dr. Lynn Rosenstock is this year’s recipient of the award for “Outstanding Contribution to the Medical Association.”

Before Dr. Rosenstock came to us at the Medical Association, her education began at Washington State University, followed by Medical School at Washington University, St. Louis. She did an internship at University of Virginia and a Residency in General Surgery at New York University, Bellevue. She then got smart and went into anesthesia, completing her Anesthesia Residency at Columbia University in 1969. She then joined the Anesthesia Faculty at Stanford University Hospital in 1970. That move was certainly a good thing for us.

She joined the 11-physician Associated Anesthesia Medical Group in 1975, where she later became President of the Group. Events at that time really tried her leadership skills. The independent physicians in

Continued on page 22 JULY JULY/AUGUST / AUGUST 2016 | THE BULLETIN | 21

Palo Alto were practicing at Stanford University Hospital, which repeatedly tried to move the independent physicians out of the University Hospital. It was a continuous challenge to maintain their access to the Hospital.

Dr. Rosenstock joined the Medical Association and has been an active member for 31 years. In addition to being President of the Association in 2001-2002, she has served on the Council representing Stanford University Hospital, the Executive Committee as Vice-President, Membership Committee, and Nominating Committee. She told me that “I started as a Councilor to SCCMA, then was on some committees and then I was President.” Her time with SCCMA was much more than that. Everyone I interviewed commented on her outstanding leadership qualities, both as a member of SCCMA’s Delegation to the House of Delegates, and as President.

Mr. Parrish wrote, “She was very active as President, drafting letters to Legislators, representing and speaking at multiple meetings and events, and excelled at leading Council Meetings. She was liked, and more importantly respected by leadership, members and staff, setting the bar for all Presidents to come.”

Dr. Rosenstock’s passion has been Women in Medicine. She was the second female President in the first 125 years of the Association. Times have changed since then, but Dr. Rosenstock has been a leader in that change, mentoring women in medicine to become leaders in their fields.

She has been the Chair of Women Physicians’ Committee and continues to meet with and mentor women physicians.

It is with great pleasure and respect that I present Dr. Lynn Rosenstock with the award for “Outstanding Contribution to the Medical Association.”

PAUL M. JACKSON, 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 atlarge.

Paul M. Jackson, MD is honored as the recipient of this year’s award for “Outstanding Contribution in Community Service.”

Dr. Richard Mahrer nominated him because he felt that Dr. Jackson was responsible for “breaking the difficult racial barriers and was responsible for other well trained doctors of diverse racial ethnicity to practice in our city.”

Dr. Jackson was raised in Mansfield, Ohio. He was influenced to go into medicine by Dr. Harold Mills, the black family physician in his hometown.

He began working in Dr. Mills office at the age of 15 and made house calls with him during high school.

That early experience inspired him and other men of his community to go on to college and then pursue a medical career.

Dr. Jackson completed college, medical school, and an internal medicine residency in the state of Ohio. He then went on to serve in the United States Army during the Korean War. There, he worked in the MASH hospital.

22 | THE BULLETIN | JULY/AUGUST JULY / AUGUST2016 2016

Upon returning to Cleveland, he worked in Metropolitan General Hospital as Chief Resident in Internal Medicine, followed by a year of Gastroenterology.

In 1962, he came to “San Jose, California and met with other black physicians in the area and decided to practice in the area and at a hospital that had no other black physicians.” He then went on to start a solo practice in Internal Medicine and Cardiovascular Disease. At that time, in order to supplement his income, he had to work at Goodwill Industries and for the County as a jail physician. Other local physicians would not share call with Dr. Jackson with the exception of Dr. Mahrer.

During the sixties, he was active in the NAACP serving as Vice-President and banquet chairman for three years. In that role, he said that he was privileged to meet with such individuals as Julian Bond, Sol Alinsky, Louis Lomax, Harry Edwards, and Willie Brown.

Dr. Jackson’s skill as an outstanding internist, and his sense of humor were gradually noticed by the other physicians. He was elected chairman of the Department of Medicine at O’Connor Hospital. Then, in 1979, he was elected President of the medical staff. He co-founded the treadmill clinic and pacemaker clinic at O’Connor Hospital.

Dr. Jackson believes that one of the most rewarding parts of his medical career was serving on the Minority Admission Committee at Stanford Medical School from 1971-1979. He felt this allowed him to give back and influence other future physicians.

He received the Vincentian Award, the most prestigious recognition from O’Connor Hospital. This award is given to the physician who most personifies the values of excellence. At his retirement, he was granted honorary membership to the medical staff for 50 years of service.

Dr. Mahrer summed up his nomination with: “Paul is a pioneer in race relations, a wonderful man, and a brilliant doctor.”

It is with great pleasure that I present Dr. Paul M. Jackson with the award for “Outstanding Contribution to the Community.”

Sa

Lynn B.

Jan

JULY / AUGUST 2016 | THE BULLETIN | 23

HealthMed Realty is a Full-Service Commercial Real Estate Firm specializing in Medical & Dental Real Estate. Put our experience on your side and we will save you time and money. Call us today! (408) 217-6000 44,649 SF FoR SALE »» CALL FoR PRICE

2,948 SF FoR SALE »» CALL FoR PRICE

393 Blossom Hill Rd, San Jose

15195 National Ave #207, Los Gatos

This stable Class-A asset is one of only a few multi-tenant medical office buildings in the Silicon Valley of this size and scale. It is 90% leased to a synergetic group of healthcare tenants offering crucial medical services to the community, including primary care, dialysis, physician specialties, oral care and ophthalmology.

Convenient access to Hwys 85, 87 & 101. Land size: ±88,000 SF.

Beautiful high-end built-out medical condo with 2 private garage stalls. 6 exam rooms, procedure room, lab area, 2 private offices, library, 2 nurses’ work stations, a large storage room in basement area and a lounge with access to balcony. Minutes away from Good Samaritan Hospital. Convenient access to Hwys 17 & 85.

Call to tour!

4,800 SF FoR SALE »» CALL FoR PRICE

2,233 SF FoR SALE »» CALL FoR PRICE

1835 Park Ave, San Jose Owner user opportunity! Rare single-story medical/dental building in Rose Garden area. ±4,000 SF plus ±800 SF of basement. Ideal space for medical/dental use. Other possible uses: law offices or professional offices. ±1 mile from O’Connor Hospital. Minutes away from downtown San Jose. Easy access to Hwys 280, 880 & 87.

105 N. Bascom Ave, San Jose Newer condo in a medical building. Second floor end unit.

Close to O’Connor Hospital. Great access to Hwys 880 & 280.

Call to tour!

Do you have an office EMERGENCY? Call us at (408) 217-6000 24 | THE BULLETIN | JULY / AUGUST 2016

scan me to see our latest availabilities

1,317-2,034 SF AVAILABLE

2,190 SF AVAILABLE

1,232 SF AVAILABLE

1,100-2,200 SF AVAILABLE

15899 Los Gatos Almaden Rd, Los Gatos

15215 National Ave, Los Gatos

2516 Samaritan Dr, San Jose

10601 S. De Anza Blvd, Cupertino

2-story medical office building.

Close to Good Samaritan Hospital and Mission Oaks Hospital. Elevator served. EZ access to Hwys 85 & 17.

Newly remodeled medical suite.

7 exam rooms, 3-4 private offices, storage area. Near Good Samaritan Hospital. EZ access to Hwys 85 & 17.

Efficient medical suite with exterior entrance. Across from Good Samaritan Hospital. Easy access to Hwys 85 & 17. TI dollars available.

Park-like setting with mixed used tenants including retail, office, medical & dental. High traffic area with easy access to Hwys 280 & 85.

2,607 SF AVAILABLE

1,314 SF AVAILABLE

1,000-2,980 SF AVAILABLE

482 SF AVAILABLE

14601 S. Bascom Ave, Los Gatos

401 Warren St, Redwood City

877 W. Fremont Ave, Sunnyvale

1555 Sunnyvale Saratoga Rd, Sunnyvale

Medical/office suite. Immediate access to Hwys 17 at Lark Ave & Hwy 85 at Los Gatos Blvd. Close to Good Samaritan Hospital.

Ready to go! Corner ground floor fully plumbed dental suite with abundant natural light. Reserved parking available.

Foothill Medical-Dental Center is a 6 plus acre medical project in the heart of Sunnyvale. Medical & plumbed (dental) suites available.

Medical/dental space located on the border of Sunnyvale/Cupertino.

One mile from Apple HQ. EZ access to Hwy 280. TI’s available.

1,605 SF AVAILABLE

700 SF AVAILABLE

1,486-2,208 SF AVAILABLE

1,075-4,370 SF AVAILABLE

2242 Camden Ave, San Jose

1795 Park Ave, San Jose

2060 Aborn Rd, San Jose

2930 Aborn Square Rd, San Jose

Fully plumbed dental suite in Rose Garden area. Flexible terms. Good freeway access. Great satellite office or start up location.

Great location & high traffic area.

Ground floor plumbed dental suite and second floor office space available. Elevator served.

2,000 SF AVAILABLE

820 SF AVAILABLE

BRAND NEW exteriors, lobby & full ADA upgrades! Close to Good Samaritan Hospital & Los Gatos.

Easy access to Hwys 880 & 17.

645-1,721 SF AVAILABLE

Neighborhood shopping center with wide array of retail tenants anchored by Ross Dress For Less.

High traffic area. EZ access to 101.

YouR PRoPERtY

YOUR PROPERTY COULD BE LISTED HERE

393 Blossom Hill Rd, San Jose

470 E. Calaveras Blvd, Milpitas

2080 S. Bascom Ave, Campbell

Your Property Address

Modern medical suites in a premier Class A medical office building. TI available for qualified tenants. Easy access to Hwys 85, 87, and 101.

Medical/dental space available at Calaveras Park Professional Center.

High traffic area with convenient access to Hwys 680 & 880.

Small unit perfect for office or retail. Located on heavily trafficked Bascom Ave, directly adjacent to Pruneyard Shopping Center.

Looking to lease your property or buy an investment property? Need to find the right space? Contact us today! We can help you.

690 Saratoga Ave | Suite 200 | San Jose, CA 95129 408-217-6000 T | 408- 457-8803 F www.HealthMedRealty.com Lic. 01902032

JULY / AUGUST 2016 | THE BULLETIN | 25

Congratulations to all Award Ho

Awardees (Left to Right): Dr. Daniel Jacobs (Outstanding Achievement in Medicine); Dr. Raj Bh Dr. Paul Jackson (Outstanding Contribution in Community Service); Robin Riddle (Citizen’s A Education); and Dr. Lynn Rosenstock (Outstanding Contribution to the Medical Association).

26 | THE BULLETIN | JULY / AUGUST 2016

onorees this year!

handari (Benjamin Cory, MD Award); Dr. Richard Slavin (Robert D. Burnett, MD Legacy Award); Award); Janice Bremis (Citizen’s Award); Dr. Danny Sam (Outstanding Contribution in Medical JULY / AUGUST 2016 | THE BULLETIN | 27

SCCMA Equals Extraordinary Le

SCCMA Past Presidents and President pose for a memorable photo at th

Left to Right: Dr. Scott Benninghoven (Current President) and Past Presidents Drs. John Sh Martinez, Martin Fishman, Tanya Spirtos (also CMA Trustee), Sameer Awsare, Jim Hinsdale (also 28 | THE BULLETIN | JULY / AUGUST 2016

eadership

he 2016 Awards Banquet.

hinn, Tom Dailey (also CMA Trustee), Tony Nespole, Lynn Rosenstock (also Awardee), Eleanor o CMA Past President and Current AMA Trustee), Jim Crotty, John Longwell, and William Lewis.

JULY / AUGUST 2016 | THE BULLETIN | 29

Photos: Brandon Vaccaro Studio

Scott Benninghoven, MD accepts the gavel as SCCMA’s 2016-2017 President.

Drs. Seema Sidhu (Secretary) and Seham El-Diwany (President Elect)

SANTA CLARA COUNTY MEDICAL ASSOCIATION

2016 Annual Awards Banquet and Installation JUNE 7, 2016

William Parrish (SCCMA’s CEO) and his wife Luanne 30 | THE BULLETIN | JULY / AUGUST 2016

Past Presidents Drs. Tony Nespole and Martin Fishman

Dr. Paul Jackson enjoys his special evening with family and friends.

A special thank you to the Palo Alto Medical Foundation for their Gold level sponsorship!

SCCMA-BME staff: Mark Christiansen, Karen Jorgenson, Jean Cassetta, Shannon Landers, William Parrish (CEO), Paul Moore, Sandie Moore, Leslie Sorensen, and Pam Jensen.

Our two Awardees for the “Citizens Award,� Robin Riddle and Janice Bremis celebrate their special evening with friends and colleagues.

Dr. Danny Sam (Award Honoree) poses with his family JULY / AUGUST 2016 | THE BULLETIN | 31

Award Honoree Dr. Raj Bhandari and his family.

Drs. Seham El-Diwany (President Elect), Eleanor Martinez (Outgoing President), Kenneth Blumenfeld (VP –External Affairs), and Cindy Russell (VP – Community Health)

Award honoree Dr. Danny Sam celebrates his special honor with family and friends. A special thank you to Kaiser for your very generous sponsorship!

Richard Slavin, MD (Award Honoree) celebrates his special evening with family and friends.

Award Honoree Dr. Raj Bhandari poses with SCCMA’s CEO William Parrish

SCCMA honors three Awardees from Kaiser this year: Drs. Danny Sam, Raj Bhandari, and Daniel Jacobs.

Dr. Lynn Rosenstock (Award Honoree) and her husband Norman

William Parrish (CEO) and Dr. Sameer Awsare (Past President)

Dr. Lynn Rosenstock (Award Honoree) celebrates her special evening with her family and friends.

Dr. Paul Jackson enjoys his special evening with family and friends.

(Head table) L to R: Dr. Kenneth Blumenfeld (VP – External Affairs) and his wife Ellen, Bonnie and Dr. James Hinsdale (Past SCCMA and CMA President), William Parrish (CEO) and his wife Luanne; In back: Dr. Sameer Awsare (Past President), Dr. Eleanor Martinez (Outgoing President), Dr. Scott Benninghoven (Incoming President) and his wife Pamela JULY / AUGUST 2016 | THE BULLETIN | 33

(L to R) Ed and Julie Ryu (Sponsors from Legacy Wealth Advisors); In Back: Dr. Arthur Chen (ACCMA President) and Linda and Donald Waters (ACCMA CEO); Dr. Erica McEnery (Councilor for RMC) and her husband John, Dr. Cindy Russell (VP – Community Health), and Sheila and Chris Foley (Sponsors from Standard Business Machines)

Dr. Raj Bhandari (Award Honoree) poses with his family and fellow physicians/colleagues from Kaiser.

34 | THE BULLETIN | JULY / AUGUST 2016

Dr. Scott Benninghoven (Incoming President) and his wife Pamela

Dr. Daniel Jacobs (Award Honoree) enjoys his special evening with family and friends.

Dr. Richard Slavin (Award Honoree) and his wife Sally

Dr. Raj Bhandari celebrates his special honor and evening with his family and friends. A special thank you to Kaiser for your very generous sponsorship!

Dr. Paul Jackson (Award Honoree) poses with his family.

Dr. Erica McEnery (Councilor for RMC) and her husband John.

JULY / AUGUST 2016 | THE BULLETIN | 35

PUBLIC HEALTH NEWS

Zika Presentation

By CDPH Minutes from meeting on May 5, 2016

By Donald Baird, MD Reprinted with permission of the Humboldt-Del Norte County Medical Society (North Coast Physician, June 2016 issue)

ZIKA VIRUS BASICS

• A mosquito-borne flavivirus similar to dengue, yellow fever and West Nile viruses.

• Prior to 2007, not a lot of widespread infection; sporadic cases in Africa and Asia.

• Yap Island outbreak in 2007. 185 cases.

• Now 52 countries have had infections.

• Geographic range has been expanding, including Africa, India and much of SE Asia.

• Estimated 1.5 million cases in Brazil have been suspected since January 2016.

• Zika may have become introduced during the 2014 Brazilian World Cup soccer event.

36 | THE BULLETIN | JULY / AUGUST 2016

• Aedes aegypti is the primary vector in the Brazilian outbreak.

• 264 cases this year in Mexico, with most being from southern states, particularly Oaxaca and Chiapas. None from tourist areas in the north like Baja and Cancun.

• There have been 426 travel-associated Zika cases in the U.S. Eight have been from sexual transmission.

• 43 cases of travel-associated Zika in CA from 13 counties.

• Potential for local transmission is low due to patchy mosquito distribution in CA, use of screens and air conditioning, better water management, and some mosquito control programs.

CLINICAL ASPECTS OF ZIKA

• Virus can replicate in semen and is present in high amounts. One case had detectable virus in his semen at 62 days.

• MSM transmission has been reported.

• Oral, vaginal, and anal sex have been implicated in cases.

• In CA, we have one case of sexual transmission.

• Not known if asymptomatic men or women can sexually transmit Zika. To date, all sexual transmission has occurred with individuals who had actual symptoms.

• Zika transmission via blood transfusion has been documented in Brazil.

• Reviewed signs and symptoms – rash, fever, arthritis, conjunctivitis are most common.

• Dengue, chikungunya, and malaria may be similar in presentation.

Can also consider other things like rubella, measles, parvovirus, acute HIV infection, leptospirosis, rickettsia, and syphilis.

• Management – limited. No antiviral treatment available.

Supportive care – rest, fluids, acetaminophen. Avoid aspirin and ibuprofen.

• Gullain-Barre Syndrome – 1-2 cases/100,000 per year worldwide is the baseline rate. Zika-associated GBS may be 24/100,000 cases.

• Other concerns include: coma, stroke, and meningitis, but this is based on a very small case number.

• First U.S./Territory death related to Zika has happened in Puerto Rico.

ZIKA AND MICROCEPHALY

• In the U.S., microcephaly is seen in 2-12/10,000 live births, when not factoring in Zika.

• In one study, pregnant women with Zika were shown to have a significant link with cranial abnormalities and growth retardation.

The study found that infection during anytime of pregnancy was problematic. Earlier, it was assumed that early term infection was worse, but this has not been the case. There is a risk during the entire pregnancy. Why? A study showed that Zika had a preference for cells (cortical neural progenitors) that are involved in brain development.

• Only two cases of perinatal transmission. Both infants developed rash and thrombocytopenia, but both recovered without any sequalae.

•

•

• • •

didn’t have PCR testing available as we do now.

Viral load can be quite low during acute illness.

Thus, most detections by PCR are in the first few days of infections.

After VRDL started doing all testing, 91% of patients tested are female; 84% were on asymptomatic women. About 20% of symptomatic cases tested were pregnant.

Findings from VRDL: 1,972 patients tested. Now 43 cases are labconfirmed for Zika.

Urine-based testing has been encouraging and they need to consider this for future testing.

Commercial labs are bringing Zika testing on board.

PUBLIC HEALTH SURVEILLANCE

• Suspect Dengue, Chikungunya, and Zika are reportable to Local Health Departments (LHDs). LHD reports to State. They report to CDC. • Can report through CalREDIE or using Zika case report forms.

• CDC and CDPH working to report birth defects through a pregnancy registry.

• Aedes are container breeders, which is problematic.

• Aedes eggs can withstand desiccation for several months – problematic.

• Prevention: ȧȧ No vaccine ȧȧ Avoid being bitten ȧȧ Wear long sleeved shirts and pants ȧȧ Use air conditioner and screens ȧȧ Sleep under a mosquito bed net ȧȧ Empty standing water from containers • Guidance for those seeking to get pregnant: ȧȧ Postpone travel and avoid mosquito bites ȧȧ Breast feeding still recommended ȧȧ Prevent sexual transmission from male partners: consistent and correct use of condoms or abstinence ȧȧ Delay conception for eight weeks after exposure to Zika

LAB TESTING

• Who to test: those with symptoms that occur within two weeks of exposure, asymptomatic pregnant women 2-12 weeks after exposure, infants with microcephaly or calcifications after maternal exposure, sexual partners of case-associated with no travel history , GBS after potential Zika virus exposure.

• Prior to 2007, there were only 14 confirmed human cases, but they JULY / AUGUST 2016 | THE BULLETIN | 37

Opodeldoc a once ubiquitous natural home remedy, now forgotton

By Elizabeth Ahrens-Kley Leon P. Fox Medical History Committee Opodeldoc is first mentioned as being invented by the celebrated but controversial alchemist medic, Theophrastus Bombastus von Hohen­heim (b. 1493), known as Paracelsus.

Botanist, chemist, and professionally trained physician, Paracelsus gained a following across Europe as a defiant reformer in the field of medicine. He travelled widely to study alternative healing and herbology, taught in German instead of Latin, and stressed the power of natural healing. This medic is also known as one of the early “fathers” of toxicology and introduced medical chemistry into mainstream medicine.

By the turn of the nineteenth century, Opodeldoc was an all-purpose palliative found in households across Europe (it is said that Goethe wegen seiner Steifgkeit “des Opodeldoks 38 | THE BULLETIN | JULY / AUGUST 2016

bedürftig” ist), and had also found widespread popularity on the American east coast. Pioneer physician Dr. Benjamin Cory carefully packed Opodeldoc in his trunk of medicines when he left Ohio and drove his ox team west in 1847.

Most of Dr. Cory’s medications were of the allopathic sort, as any combination of purgatives (laxatives and emetics), bloodletting, and poultices for blistering was the mainstream treatment to fight disease. So what was Opodeldoc?

Paracelsus’s oppodeltoch was likely inspired from botanicals learned from the different countries he visited during his years of being an itinerant scholar medic. It was a type of plaster or balm possibly concocted from terebinth (distilled resin from the Pistacia tree) or another wood, combined with half a dozen other ingredients comprising different medicinal oils (wormwood, rosemary, thyme). Terebinth is used as a source for turpentine, which in medicinal form applied to the skin enhances blood flow to treat nerve pain, joint pain, it is also antiseptic and anti-inflammatory. In the eighteenth and early nineteenth centuries, the spelling was revised to opodeldoc and the recipe officially changed to a type of soap liniment, which was incorporated into patented medicines. The most famous brand was Dr. Steer’s Opodeldoc, made from Castile soap in alcohol, with camphor, marjoram and rosemary oils, plus his special ingredient, ammonia.

Being relatively easy to make, manufacturers vied to convince customers of the supremacy of their product. However, “Mrs. Beeton’s Book of Household Management,” published in 1861, considered it a necessity in all households and provided a simple home recipe:

OPODELDOC

This lotion being a valuable application for sprains, lumbago, weakness of joints, & etc., and it being difficult to procure either pure or freshly made, we give a recipe for its preparation. Dissolve 1 oz. of camphor in a pint of rectified spirits of wine; then dissolve 4 oz. of hard white Spanish soap, scraped thin, in 4 oz. of oil of rosemary, and mix them together.

Thus, it is no surprise that Dr. Cory packed a supply of this liniment in his wagon for the emigration west. Within months after starting his practice in San Jose, California, gold was discovered and the doctor joined the exodus to the gold country; his Opodeldoc was surely a godsend to miners who spent their days and nights out in the cold, digging and panning for gold! Although some grandmothers today may remember this all-around household palliative, it no longer exists and has been largely forgotten.

Dr. Cory’s original hand-written list of medicines packed for his journey west; possibly, he carried a large supply of Opodeldoc (Box F)

Leon P. Fox Medical History Committee The Leon P. Fox Medical History Committee meets bi-monthly, the first Monday at noon (lunch provided). The purpose of the committee is to identify, collect, and preserve archival material, memorabilia, and artifacts representing the medical history of Santa Clara County. A guest speaker gives a historical presentation at each of the meetings, which is then transcribed for SCCMA’s Medical History archives.

If you are interested in joining this committee, please contact Pam Jensen at SCCMA at (408) 998-8850 or pjensen@sccma.org.

JULY / AUGUST 2016 | THE BULLETIN | 39

CMA Alert, July 11, 2016 issue

Tobacco tax initiative qualifies for November ballot as Prop. 56 The California Healthcare, Research and Prevention Tobacco Tax Act of 2016 has officially qualified for the November ballot as Proposition 56.

The California Secretary of State confirmed that the measure qualified, after a random sampling of the 1 million signatures submitted by Save Lives California showed that the campaign had more than the 585,407 signatures necessary to earn a spot on the ballot.

Reaching 1 million signatures is a tremendous achievement for the coalition and a testament to its strength. But the road to November won’t be easy. Big Tobacco has the financial means to lead a tough campaign of its own against us.

Prop. 56 – supported by a broad alliance of physicians, health care advocates, educators and others – would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack. The majority of the money from the initiative’s user fee on cigarettes and other tobacco products, including e-cigarettes containing nicotine, will be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products.

“Sadly, we see tobacco’s deadly and costly toll every day in our hospitals and clinics. Cancer and other tobacco-related diseases kill more people than car accidents, murder, suicide, alcohol, illegal drugs and AIDS combined,” said Steven Larson, MD, MPH, president of the California Medical Association (CMA). “The heart of this initiative is simple: Taxing tobacco saves lives by getting people to quit or never start smoking. The only people who will pay are those who smoke. If you don’t smoke, you don’t pay.”

California taxpayers pay $3.5 billion annually to treat cancer and other tobacco-related diseases through Medi-Cal. A user fee on cigarettes is a matter of fairness – it shifts the fiscal burden to smokers for these medical programs, smoking prevention and research.

The Prop. 56 tobacco tax will also prevent a new generation of kids from taking up a deadly, addictive habit. Despite years of progress in education and research about the dangers of tobacco, nearly 17,000 California kids get hooked on smoking every year; one-third of them will eventually die from tobacco-related illnesses.

40 | THE BULLETIN | JULY / AUGUST 2016

Last month, the California Hospita l Association (CHA) contributed $9 million to Save Lives California, giving a boost to a campaign expected to be outspent by tobacco companies.

Prop. 56 – The California Healthcare, Research and Prevention Tobacco Tax Act of 2016 – is backed by Save Lives California, a coalition of health advocates and others that includes CMA, the American Cancer Society Cancer Action Network, American Lung Association in California, American Heart Association, California Dental Association, CHA, SEIU California, Blue Shield of California and philanthropist Tom Steyer.

If you haven’t already, be sure to add your name to the growing list of Save Lives California supporters. It’s easy – all you have to do is go to http://cal.md/Yeson56 and enter your email address and zip code. By doing so, you can be among the first to say “I’m in” to fight for a $2 tobacco tax increase in California.

For more information on the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, go to http://www.yeson56.com.

CMA Alert, July 11, 2016 issue

CMA urges CMS to fix MACRA administrative burdens The California Medical Association CMA) submitted comprehensive comments to the Centers for Medicare and Medicaid Services (CMS) outlining constructive improvements for the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA).

“CMA is extremely concerned that the proposed rule does not go nearly far enough to fix the outlandish administrative burdens in the Medicare program as required by MACRA,” CMA wrote in a letter to acting CMS administrator Andrew Slavitt . “In several instances, the MACRA merit-based incentive payment system (MIPS) rule is more complex than the existing programs. And the promising Alternative Payment Model (APM) track has been all but amputated.”

The MACRA law clearly mandated CMS to simplify and reduce the burdensome reporting programs as well as incentivize innovative new payment models led by physicians. CMA outlined the most serious areas of concern with the proposed rule, including: • The accommodations for solo, small and rural practices are inadequate.

• The MIPS reporting programs continue to be unnecessarily burdensome and complex, particularly the electronic health record (EHR) Advancing Care Information category.

• There is no accountability for EHR vendor compliance and interoperability.

• The MIPS Resource Use category will continue to discourage physicians from treating high-risk, vulnerable patients.

• The Advanced APMs are limited and the financial risk requirements severely inhibit the expansion of innovative APMs. • The performance reporting period starts too soon—January 1, 2017.

CMA’s MACRA Technical Advisory Committee developed over 40 practical recommendations to simplify and improve the implementation of MACRA. In addressing the issue of participation for small practice and solo practice physicians, CMA suggested that the initial reporting period be moved back one year to January 1, 2018, and that CMS significantly expand the permanent MIPS low-volume exemption for small practice physicians and physicians located in health professional shortage areas.

CMA also suggested that there should be a phase-in pathway to help

small and rural practices transition to MIPS, as well as safe harbors for small practices until virtual group reporting systems can be established.

CMA also recommended that Medicare-Medicaid dual-eligible patients be excluded from the scoring system so physicians are not penalized for treating these complex patients.

In addressing the regulatory burdens of MIPS reporting programs, CMA recommended improvements to four reporting programs (quality, EHR advancing care information, resource use and the clinical improvement activities) that include reducing the scoring complexity of these programs. While CMS reduced nearly half of the quality measures, CMA is urging that more measures be eliminated, particularly the irrelevant EHR Meaningful Use Stage 3 measures, and that physicians should be given partial credit for any measures that are met, rather than an all-or-nothing approach. CMA also placed great emphasis on CMS holding EHR vendors more accountable for compliance and interoperability.

Finally, CMA urged CMS to provide more opportunities for physician-led payment models with reduced financial risk requirements and to extend the deadlines for physicians to participate in the Comprehensive Primary Care Medical Home models with private payors.

JULY / AUGUST 2016 | THE BULLETIN | 41

Public Health Threat of Flavored Tobacco Products

The public health threat to youth and minority populations from smoking is climbing because of tobacco companies’ development and predatory marketing of new products such as candy and fruit flavored e-cigarettes, according to recent California Medical Association (CMA) findings.

Despite decades of policies and education about tobacco’s deadly toll, new products that appeal to young people and are falsely thought to be healthier have led to an uptick in those starting smoking and in continued use among established smokers, CMA found in a new white paper titled “Flavored and Mentholated Tobacco Products: Enticing a New Generation of Users.”

“This is more of the predatory targeting of youth, LGBT people, and communities of color that we have seen for years from tobacco companies,” said Darin Latimore, MD, vice-chair of CMA’s Council on Legislation. “They are using sweet-flavored products to hook a new generation of smokers to keep their industry alive and well, despite the fact that they are peddling products that lead to death and disease.”

Evidence shows that populations disproportionately targeted by tobacco company marketing tactics are particularly vulnerable to sweet flavors and menthol, and are largely driving this increased uptake and sustained use of flavored tobacco products.

The paper, based on numerous published studies, states that tobacco use remains the chief risk factor for the leading causes of death in California.

“A foundation of this strategy is the use of candy and fruit flavors and cooling additives in tobacco products that are intended to attract and retain users by masking the naturally harsh taste of tobacco,” CMA wrote. “Contrary to popular beliefs, flavorings do not reduce the health impacts and risks associated with tobacco use, and are not safer than non-flavored tobacco products.

Tobacco companies have introduced flavored products that share the same flavors, names, packaging and logos as popular candy brands like Jolly Rancher, Kool-Aid and Life Savers. Characteristic of Big Tobacco’s longtime predatory practices, bright packaging and product placement at the register, near candy, and often at children’s eyelevel, increases tobacco flavored products’ visibility to kids. Flavored and menthol tobacco products are “starter” products that establish daily habits and increase addiction to tobacco products, make it harder to quit, and increase use of multiple tobacco products concurrently.

There are now over 460 brands of e-cigarettes and more than 7,700 unique e-cigarette flavors available for purchase online, including a wide range of child-friendly candy and fruit-flavors that are not permitted in cigarettes, such as Wrigley’s, Atomic Fireball, Tutti Frutti and Cap N’ Crunch.

Teen e-cigarette use tripled between 2013 and 2014 and now exceeds youth use of traditional cigarettes. Approximately 2 million high school students and 450,000 middle school students currently use e-cigarettes, according to a Centers for Disease Control and Prevention (CDC) survey.

In California, 63% of smokers start by the age of 18, and 97% start by age 26.

The paper was prepared by CMA and reviewed by its Council on Science and Public Health, a panel of physician experts, with input from subject matter researchers. It was approved by the CMA Board of Trustees on April 21, 2016.

CMA publishes MACRA resource center On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the health care financing system in the most significant and far-reaching way since the program’s inception in 1965.

To help physicians understand the MACRA payment reforms, and what they can do now to start preparing for the transition, the Califor42 | THE BULLETIN | JULY / AUGUST 2016

nia Medical Association (CMA) has published a MACRA resource center.

There you will find an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, the American Medical Association and the Centers for Medicare and Medicaid Services.

View the resource center at www.cmanet. org/macra.

To learn more about MACRA and what physicians can do now to prepare, register for CMA’s July 13 webinar, MACRA: What Is CMA Doing to Improve It? What Steps Can You Take to Prepare Now? If you can’t make the live webinar, it will be archived immediately following the presentation and available for on-demand viewing in CMA’s online resource library.

CMA Alert, July 11, 2016 issue

CMA applauds HHS plans to prevent opioid overdoses and improve access to addiction treatment The Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services (HHS), has issued a final rule that will expand access to buprenorphine, one of three medications currently approved by the Food and Drug Administration for medication-assisted treatment of opioid use disorder. The new rule increases the limit on the number of patients that qualified physicians can treat with buprenorphine from 100 to 275, increasing access to live-saving addiction treatment services.

The California Medical Association CMA) supports the administration in its efforts to increase access to much-needed medication-assisted treatment for opioid use disorders, and submitted comments supporting the rule.

Across the country, many people suffering from opioid use disorder are unable to access medication-assisted treatment for their condition due to a lack of nearby physicians with waivers to prescribe buprenorphine.

With more than 2.2 million people nationwide last year who met the diagnostic criteria for an opioid use disorder, increasing appropriate access to life-saving addiction treatment services is one component of a balanced approach to addressing rising opioid-related morbidity and mortality rates. Treatment of opioid use disorder with opioid maintenance therapies has been shown to be cost effective, safe and successful when used appropriately.

Despite the known effectiveness of this treatment, physicians have been slow to prescribe buprenorphine due to many possible barriers and concerns, including third-party reimbursement and documentation, stigma, lack of adequate training and education, and a lack of community behavioral supports.

“Medication-assisted treatment is proven effective, but for too long, too many patients have lacked access to this treatment,” said American Medical Association (AMA) President Andrew W. Gurman, MD. “[The] final rule is an important step that nearly triples the number of patients practitioners may treat with a waiver, but more must be done to leverage trained physicians to close the treatment gap.”

In another proposed rule, the Center for Medicare and Medicaid Services (CMS) is proposing to remove the hospital patient satisfaction survey questions related to pain management from the Medicare hospital payment scoring calculation. Under the proposed rule, hospitals could continue to use the questions to survey patients about their pain management experience, but the questions would not impact hospital payments. CMA supported 2016 federal legislation to delink the pain survey from hospital payments and welcomes this significant proactive regulatory action from CMS. Additionally, HHS announced that it is launching more than a dozen new scientific studies on opioid use and pain management to help fill knowledge gaps and inform efforts to prevent and treat opioid use disorders. HHS is also seeking input from the medical profession and other health care stakeholders to improve the effectiveness and reach of prescriber education programs on opioid analgesics.

The White House in February announced plans to spend $1.1 billion to alleviate opioid abuse, but Congress has yet to make the needed appropriations. Congress has passed more than 25 new bills aimed at supporting opioid prevention and treatment strategies, and while they are being deliberated by a House-Senate Conference Committee, none of these bills comes close to providing the $1.1 billion investment advocated by President Obama.

CMA and AMA are supporting most of the legislative package and will continue to work with the conference committee and the administration to further refine the proposals, as well as promote additional funding for opioid prevention and treatment.

To access CMA materials on safe prescribing, go to http://www.cmanet.org/safe-prescribing.

CMA Alert, July 11, 2016 issue

CMA Q3 council reports now available for comment The California Medical Association CMA) has posted its third-quarter council reports online, part of the year-round (quarterly) policymaking process instituted at the close of the 2015 House of Delegates.

In May 2016, the third-quarter resolutions were opened for online testimony. At the close of the comment period, the testimony received was used to inform CMA’s various councils, which then met and developed recommendations that

will go before the Board of Trustees in July.

These council reports are now available online and open for further comment and discussion until July 25, just prior to the board meeting. If you have any feedback that you think would be critical for the board to consider, now is your opportunity to make your voice heard.

To view the reports and/or to make a comment, go to https://www.cmanet.org/hod. You will need to log-in with your CMA web account.

Submit a resolution for consideration If you have a resolution you would like to submit for future consideration, please e-mail it to resolutions@cmanet.org. The resolution submission deadline for the 4th Quarter has passed, but we encourage you to submit for the 1st Quarter of the next resolution year. Please read the guidelines before submitting a resolution. Resolutions that do not follow the guidelines will be rejected.

JULY / AUGUST 2016 | THE BULLETIN | 43

CMA Alert, July 11, 2016 issue

Noridian reports low response rate for Medicare part B revalidations Noridian, Medicare’s administrative contractor for California, reports that only 19% of physicians have responded to the most recent Medicare Part B revalidation notices. Noridian is in the process of deactivating Medicare billing privileges for physicians who received a revalidation notice from Noridian but did not turn in a completed application to the Centers for Medicare and Medicaid Services (CMS) prior to the most recent deadline of May 31.

If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for your Medicare billing privileges. Noridian will not apply a retroactive effective date and no payments will be made for the period of deactivation.

If a revalidation application is received but incomplete, Noridian will

contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges.

If your revalidation application is approved, no further action is needed.

If you do not know when you are up for revalidation, you can look up your revalidation date through the CMS look-up tool (http://cal.md/ CMSlookup). Those due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see “TBD” in the due date field.

For more information on the revalidation process, go to http://cal. md/noridianrevalidation or contact Noridian by calling 855/609-9960.

CMA Alert, July 11, 2016 issue

Ballot measure to provide new funding for Medi-Cal qualifies for November ballot The ballot initiative to maintain the taxes on the wealthiest Californians to prevent billions in cuts to education and other vital services has officially qualified for the November 2016 ballot. The California Secretary of State announced that the initiative could move forward as enough valid signatures were submitted and verified. This measure will generate an average of $8 billion per year, and provide up to $2 billion annually to improve access to health care for low-income children and their families.

“Doctors and other health care providers across the state are supporting this initiative because it will provide critical funds to improve access to health care for low-income children and their families,” said California Medical Association CMA) President-Elect Ruth Haskins, MD. “This initiative will help our state provide the care vulnerable kids need to stay healthy and thrive.”

The California Children’s Education and Health Care Protection Act of 2016 – now known as Proposition 55 – will temporarily extend for 12 years current tax rates on the wealthiest Californians – singles earning more 44 | THE BULLETIN | JULY / AUGUST 2016

than $250,000 and couples earning more than $500,000 a year. The measure will direct funds specifically to K-12 public education and community colleges, while also allocating funds to health care for low-income children and their families. The measure contains strict accountability requirements.

Budget forecasts show that unless California extends these taxes on the wealthy, in the first year alone our public schools will lose nearly $4 billion and our state budget will face

a deficit of more than $4 billion. A recent Public Policy Institute of California survey found that 64% of California voters support extending the income tax rates on the wealthiest individuals and couples to spare education and other vital services from a repeat round of devastating budget cuts.

CMA is part of the broad and diverse coalition of teachers, physicians, school employees, parents, working families, community organizations and business groups supporting this ballot initiative. The coalition includes CMA, the Association of California School Administrators, California Federation of Teachers, California Hospital Association, California School Employees Association, California Teachers Association, Service Employees International Union California State Council, SEIU 1000 and numerous others.

CMA is urging physicians to add their names in support of the California Children’s Education and Health Care Protection Act today to give our kids the quality schools and health care they deserve. To do so, go to http://cal.md/ Yeson55.

CMA Alert, June 27, 2016 issue

State budget includes $100 million to expand GME On June 15, the California legislature passed a $170.9 billion budget that includes historic support for and expansion of primary care graduate medical education (GME) in medically underserved areas.

Under this budget agreement, the state will spend $100 million over three years ($33 million each year) to fund the Song-Brown Program, an existing grant program housed within the Office of Statewide Health Planning and Development that supports primary care residency programs in medically underserved areas.

“A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said California Medical Association (CMA) President Steven Larson, MD, MPH. “The legislature’s move to restore and stabilize funding for these programs is an important first step toward reversing the state’s shortage of primary care physicians, particularly in the underserved communities that need it the most.”

CMA led a coalition of health care groups—including the California Academy of Family Physicians, American College of Physicians, Osteopathic Physicians and Surgeons of California, California Primary Care Association, California Hospital Association, California Children’s Hospitals Association and Planned Parenthood Affiliates of California—to secure this important funding for primary care residency programs.

GME is the hands-on training phase of physician education that is mandatory in order for physicians to obtain their license for independent practice. During this clinical training, residents also provide needed care for one out of every five hospitalized patients, including our seniors, veterans and patients in underserved communities.

This additional funding is critically important, as the United States as a whole—and California in particular—is facing a severe shortage of doctors, which is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement. It is projected that by 2025 we will have up to 90,000 fewer physicians than the country needs.

After several rounds of negotiations with the Governor’s administration, the $100 million will be spent in the following categories: • $62 million in new funding to be spent over six years to help support existing primary care residencies (family medicine, pediatrics, internal medicine, OB/GYN).

• $10 million in new funding to be spent over six years to support the creation of new primary care physician residency programs at facilities without existing programs.

• $10 million in new funding spent over six years to fund new primary care residency slots at existing residency programs.

• $17 million in new funding to be spent over six years to support existing Teaching Health Center primary care residencies.

• $1 million to fund the State Loan Repayment Program, a federally funded (state administered) provider incentive program (different than the Steve Thompson Program) that clinics use to recruit providers to medically underserved areas.

CMA and the American Medical Association (AMA) are also actively advocating for additional GME funding at the federal level. Medicare currently provides the bulk of the GME funding nationwide, about $9.5 billion annually. Unfortunately, this figure hasn’t changed in nearly 20 years. Inadequate funding for residency programs means that hundreds of graduating medical students don’t find a residency slot to continue their training.

AMA also adopted policy at its annual meeting aimed at ensuring there is sufficient funding for medical residency positions across the U.S. The new policy also calls for transparency in the actual costs of residency programs and how GME funding is distributed to address physician shortages in undersupplied specialties.

CMA Alert, June 27, 2016 issue

FAQ: What can I do about negative patient reviews online?

Physicians may find themselves the subject of comments and reviews posted on health care-related consumer review websites. While studies have shown that most online reviews of physicians are positive, these websites can be a concern for physicians because inappropriate negative comments can damage physicians’ reputations and affect their practice.

California Medical Association CMA) OnCall document #0401, “Online Consumer Review and Rating Sites,” discusses how physicians can manage and respond to comments about

themselves and their practices on consumer review websites.

While physicians may want to respond to online reviews by patients, it is important to remember that such responses may violate a patient’s confidentiality as well as federal and state privacy laws. The On-Call document discusses how physicians can address negative online comments and provides guidance for physicians faced with comments that are clearly false, inappropriate or inflammatory.

The document also provides helpful tips for

physicians to monitor and control their online presence and possible legal remedies.

Physicians should also review CMA OnCall document #4100, “HIPAA Overview and Enforcement,” which provides a general overview of their obligations surrounding patients’ protected health information under the Health Insurance Portability and Accountability Act (HIPAA). CMA On-Call documents are available free to members in CMA’s online health law library at www.cmanet.org/cma-on-call.

JULY / AUGUST 2016 | THE BULLETIN | 45

CMA Alert, June 27, 2016 issue

AMA declares gun violence a public health crisis, vows to push Congress for action The American Medical Association (AMA) responded to the worst mass shooting in the nation’s history by declaring gun violence a public health crisis with more than 6,000 deaths already recorded in 2016.

With physician members from across the nation meeting in Chicago, the AMA House of Delegates pledged to actively lobby Congress to overturn legislation that for 20 years has prohibited the Centers for Disease Control and Prevention (CDC) from researching gun violence.

“Even as America faces a crisis unrivaled in any other developed country, Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries,” said AMA Past President Steven J. Stack, MD. “An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”

AMA also voted to expand its existing policy on gun safety to support waiting periods and background checks for all firearm purchasers. The previous policy supported waiting periods and background checks for handgun purchasers only. The vote builds on extensive, longstanding AMA policy on gun safety.

“The shooting in Orlando is a horrific reminder of the public health crisis of gun violence rippling across the United States. Mass killers have used AR-15s, rifles and handguns and today we strengthened our policy on background checks and waiting periods to cover them all with the goal of keeping lethal weapons out of the hands of dangerous people,” said Dr. Stack.

The California legislature also voted to establish and fund a firearms violence research institute within the University of California. This bill was strongly supported by the California Medical Association (CMA).

CMA has long advocated for reasonable and responsible gun control legislation that makes our communities and hospitals safer.

“Physicians are too often firsthand witnesses to the physical and psychological damage gun violence inflicts on our communities and as a result, uniquely understand the importance of keeping ammunition out of the hands of criminals,” said CMA President Steven E. Larson, MD, MPH. As of 2016, there were no federal laws banning semiautomatic assault weapons, military-style .50 caliber rifles, handguns or large-capacity ammunition magazines, which can increase the potential lethality of a given 46 | THE BULLETIN | JULY / AUGUST 2016

firearm. There was a federal prohibition on assault weapons and highcapacity magazines between 1994 and 2004, but Congress allowed these restrictions to expire and has since refused to address the issue.

In January, President Obama issued a package of executive actions designed to decrease gun violence, notably a measure to require dealers selling firearms at gun shows or online to obtain federal licenses and, in turn, conduct background checks of prospective buyers. He also proposed new funding to hire hundreds more federal law enforcement agents, and budgeting $500 million to expand access to mental health care. Suicides, many by individuals with undiagnosed mental illness, account for about 60% of gun deaths.

In Congress, four democratic Senators (Dianne Feinstein of California, Bill Nelson of Florida, Richard Blumenthal of Connecticut and Chuck Schumer of New York) are expected to call for immediate passage of a bill to prevent people on terror watch lists and suspected terrorists from buying firearms or explosives. Federal agents had interviewed the Orlando gunman twice in recent years when he was suspected of terrorism.

Last December, Congressional democrats attempted to pass this legislation but were blocked by republicans, who said the government could mistakenly place innocent people on watch lists.

The California legislature has not been idle on this issue. Last month, the California state legislature began hearing legislative proposals for gun control bills that include a ban on assault weapons, reporting procedures for lost and stolen guns, the creation of a database of ammunition owners, placing serial numbers on firearms, funding for gun control research, classifying parts of guns as guns themselves, a ban on buying more than one firearm per month, and expanding who can request a gun violence restraining order. In May, the state legislature also passed bills that would tighten gun restrictions in the state.

California Lt. Gov. Gavin Newsom also announced that his gun control initiative has received over 600,000 signatures and will be included on the ballot in the fall. Newsom’s measure would require ammunition sellers to be licensed like firearms dealers and establish a process to seize guns from people prohibited from owning them because of their criminal records. It also would mandate lost or stolen guns be reported to law enforcement and require the state Justice Department to notify federal authorities when someone is added to the database of prohibited firearm owners.

CMA Alert, June 13, 2016 issue

CMA publishes new resources on California’s mandatory school vaccination requirement Beginning July 1, 2016, all California schoolchildren will be required to have the appropriate vaccinations prior to enrolling in a public or private elementary school or child care center, unless the child has a medical exemption. The new law (SB 277) removes the personal belief exemption from the vaccine requirement. The new rules do not, however, apply to children participating in home-based private schools or independent study programs not requiring classroom-based instruction.

The California Medical Association CMA) has created new resources and updated existing resources to aid physicians and the public in complying with the new requirement. These resources, available free to members in CMA’s health law library, include information on when children must be vaccinated, which vaccinations are required, and what information physicians must provide to parents or guardians regarding the risks, ben-

efits and adverse reactions to a specific vaccine. The resources also discuss the disclosure of immunization information and reporting of adverse reactions to public health departments.

The available documents include: • CMA On-Call document #3211, “Vaccine Administration” • CMA On-Call document #3114, “Vaccine Administration: Mandated Information” • CMA On-Call document #3603, “Vaccines, Drugs and Devises: Reporting Adverse Events” • CMA On-Call document #4252, “Disclosure of Immunization Information” On-Call documents are free to members in CMA’s online health law library at www.cmanet.org/cma-on-call.

CMA Alert, June 13, 2016 issue

California Cancer Registry publishes materials to help inform patients about cancer reporting The California Cancer Registry (CCR) has published free materials to help physicians better inform patients about the registry and cancer reporting. A patient information brochure and poster are now available to physicians to distribute to cancer patients at the time of their diagnosis.

CCR, a program of the California Department of Public Health’s Chronic Disease Surveillance and Research Branch, is California’s statewide population-based cancer surveillance system and is recognized as one of the leading

cancer registries in the world. Since 1988, the registry has collected information about almost all cancers diagnosed in California; the only exceptions are basal and squamous cell carcinoma of the skin and carcinoma in situ of the cervix.

This information furthers our understanding of cancer and is used to develop strategies and policies for its prevention, treatment and control.

At the time of a patient cancer diagnosis, physicians are required to inform patients that their data will be reported to the registry. The regulations stipulate that physicians will inform

patients that cancer has been designated a reportable disease and that the clinician will report the diagnosis as required by law.

To obtain copies of the brochure and poster, visit http://www.ccrcal.org. Questions can be directed to the California Cancer Registry at 916/731-2500. The California Medical Association (CMA) also offers a resource document, On-Call document #3662, “Requirements for Reporting Cancer and Parkinson’s Disease Cases,” available free to members in CMA’s health law library.

CMA Alert, July 11, 2016 issue

Have you gotten an information request from BetterDoctor?

The California Medical Association (CMA) has received several inquiries over the past few weeks from practices concerned about the validity of requests for information from a company called BetterDoctor.

As you may know, a new law took effect July 1 that requires payors to ensure that their physician directories are accurate and up-to-date. BetterDoctor is a vendor working on behalf of a number of plans on a pilot project to ensure the accuracy of their physician directories as required under the new law. Practices are encouraged to respond to the information requests, as the law also requires physicians do their part to keep their information up-to-date.

Eight California plans have contracted with BetterDoctor to confirm provider directory information. The eight plans included in the pilot are Anthem Blue Cross, Blue Shield of California, Health Net of California, Humana, LA Care, Molina Healthcare, SCAN and Western Health Advantage. There may also be other pilot programs taking place on behalf of other payors that utilize other vendors as well.

For more information about physicians’ obligations under SB 137, see CMA’s new resource, “What Physicians Need to Know to Avoid Penalties Under the New Provider Directory Accuracy Law,” available at http:// www.cmanet.org/resource-library.

JULY / AUGUST 2016 | THE BULLETIN | 47

MACRA: What Should I Do Now to Prepare?

A checklist for physician practices Wondering where to start? There are some critical first steps that physicians should take to prepare for MACRA implementation. The most important step is to get educated about MACRA. Some specific actions to consider include: Learn the basics of MACRA – Under the MACRA proposed rule, there will be two main pathways for physician reimbursement, the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). For an overview on the two pathways, download AMA’s MACRA Action Kit (see page 5), which also includes a checklist (see page 2). Also, watch the California Medical Association (CMA) webinar titled, “What Is MACRA? What Is CMA Doing to Improve It? What Steps Can You Take to Prepare Now?” and the Centers for Medicare & Medicaid Services (CMS) webinar, “MACRA and the Quality Payment Program: An Update on the Recent Proposed Rule.” The webinars will allow you to view at your own pace and will give you the basics of MACRA. Remember that this is a proposed rule and is not final – CMS issued its proposed rule on April 27, 2016, and received many comments from interested stakeholders, including CMA. The final rule is expected this fall. CMA encourages practices to get ready, but to remember that the details are subject to change. To read CMA’s comprehensive comments to CMS outlining constructive improvements to MACRA, visit www. cmanet.org/macra. There you will also find a link to AMA’s extensive comments.

Determine whether you are exempt from MIPS participation – The proposed rule exempts practices from MIPS if they have a low volume of Medicare patients. This threshold is defined as $10,000 or less in Medicare billed charges and 100 or fewer Medicare patients annually. Physicians in their first year of Medicare participation are also exempt.

Determine whether your practice meets the requirements for small, HPSA, or non-patient facing physician accommodations and exceptions – The proposed rule provides accommodations and additional flexibility for various practice sizes and configurations. See the CMS Small Practices Fact Sheet for more information.

Participate in PQRS for 2016 – Whether your practice ends up participating in MIPS or APMs, there will be a quality reporting component. If you haven’t yet successfully participated in CMS’s Physician Quality Reporting System (PQRS), try again in 2016. CMS has created a 2016 PQRS Implementation Guide that includes a beginner reporter toolkit to help get you started. You’ll gain familiarity with the reporting process and will have access to view your PQRS feedback reports, which can help to guide practice improvements under MACRA.

For more information: CMA’s reimbursement help line, (888) 401-5911 or economicservices@cmanet.org. (Rev. 07/27/16) 48 | THE BULLETIN | JULY / AUGUST 2016

Page 1 of 3

Review QRUR reports to identify where improvements can be made – CMS publishes a mid-year and annual Quality and Resource Use Report (QRUR) to help practices understand their cost and quality assessments under the Value Modifier and quality under PQRS. To access your practice’s QRUR report, visit the CMS Enterprise Portal. One person from the practice will need to obtain an Enterprise Identity Management System (EIDM) account. For more information on setting up an EIDM account, visit the CMS website.

Review proposed measures and determine how you will report – Decide which measures will work for your practice and how you will report the data to CMS. For more information on the proposed individual quality measures for MIPS, see Tables A – G on pages 28,399 – 28,569 of the proposed rule.

Under MIPS there are four reporting categories that allow for different reporting mechanisms: through claims, electronic health records, clinical registry, qualified clinical data registry or the group practice (25+ physicians) reporting option web interface. For more information on reporting mechanisms, see CMS’s “The Merit-Based Incentive Payment System (MIPS)” slide deck (begins on slide 43).

Consider participating in a qualified clinical data registry – If you are not already participating in a qualified clinical data registry, contact your specialty society about participating in theirs. Data registries are a method of reporting that can assist reporting in three of the four MIPS categories.

Evaluate EHR and vendor readiness – Is your EHR considered certified EHR technology (CEHRT)? – Make sure your EHR is certified. To see which EHR systems are CEHRT, see the CMS website.

Talk with your EHR vendor about how its product supports transition to MIPS – Find out whether your vendor will meet Medicare MIPS quality reporting requirements or new payment model adoption. Are there any costs associated with needed updates? Ask about timelines for MACRA readiness and interoperability. Document the conversations.

Review CMS’s list of CPIA – Determine which clinical practice improvement activities (CPIA) your practice is already doing and what adjustments need to be made to complete additional activities by 2017. For a list of high weight CPIA categories, see Table 23 on pages 28,263 - 28,265 of the proposed rule. For a complete list of proposed CPIA, see Table H on pages 28,570 - 28,586 of the proposed rule.

Consider ways your practice can report at least one unique patient for each Advancing Care Information (ACI) measure – ACI will replace the EHR incentive program. Practices should ensure they can report at least one unique patient (or answer “yes”) for each measure of the base score’s six objectives. Ideas (for 2017) include:

For more information: CMA’s reimbursement help line, (888) 401-5911 or economicservices@cmanet.org. (Rev. 12/02/15)

Page 2 of 3

JULY / AUGUST 2016 | THE BULLETIN | 49

•

Reach out to existing patients to encourage use of the patient portal.

•

If your EHR allows you to send a secured message through your patient portal to all of your patients at once, you might consider sending an appointment reminder to all of your patients in 2017.

•

For a complete list of the proposed ACI categories, see Table 6 on pages 28,222 – 28,226 of the proposed rule (with additional information in Section II.E.5.g.7).

Conduct a security risk analysis in early 2017 – Failure to do so will result in a score of zero for the ACI category. The risk analysis should comply with the HIPAA Security Rule requirements. For more information on conducting a HIPAA security risk analysis CMA members have free access to our on-demand webinar, “HIPAA Security Risk Analysis: How to Make Sense of this Requirement” available on our website at www.cmanet.org/ webinars. Additional information can be found in CMA On-Call Document #4102, “HIPAA Security Rule,” also free to CMA members in the online health law library at www.cmanet.org/cma-on-call. The American Medical Association (AMA) website also has resources to help with this step at www.ama-assn.org/go/hipaa.

View AMA’s STEPS Forward Practice Transformation Series learning module – To help practices make the shift to value-based care, AMA has created the STEPS Forward learning module. The module includes five steps to prepare a practice for value-based health care, answers to common questions and case vignettes describing how physicians can create value-based practices.

Confirm whether you are a participant in any of the advanced APMs already approved by CMS – For a list of the CMS-approved advanced APMs in the proposed rule, see Table 32 on page 28,312.

Stay up-to-date on MACRA related news.

• Sign up to receive CMS MACRA email updates.

•

Sign up to receive Medicare news directly from CMA through content update alerts. By doing so, you will be notified anytime a new story about MACRA is posted to our website.

To do so, just activate your web account (if you haven’t already done so) and sign up for custom content alerts on the topics that are of interest to you. You will then be notified any time there is new content posted in one of your interest areas. To do so, 1) Click on “My Account,” 2) In the left sidebar, click on “My Alerts,” 3) Under New Content Alerts, click “Alert Settings,” 4) Type “Medicare” in the search box and hit enter. You can adjust the frequency and format that you receive alerts via the account dashboard. For more information, see www.cmanet.org/custom-content.

Check CMA’s MACRA Resource Center at www.cmanet.org/macra for updates!

For additional information on steps you can take now to prepare, see the AMA MACRA checklist (pages 2-3).

For more information: CMA’s reimbursement help line, (888) 401-5911 or economicservices@cmanet.org. (Rev. 12/02/15) 50 | THE BULLETIN | JULY / AUGUST 2016

Page 3 of 3

When A Practice Becomes Terminal

By Richard A. Mahrer, MD SCCMA Member Since 1955 Is there a hospice for this problem? My practice prognosis is less than six months, at which time my medical entity will have died a natural death after a lifetime of only 62 years.

So one could not say the deceasement was premature! Retirement as a sole internist, if health was not a factor, never seemed to be a laudable option for me. I enjoyed – even loved – nearly all of my patients and my antiqued office is a veritable medical museum and even served as a second home.

I’ve never had a medical partner and have never moved from the current premises where thousands have spent much time (there were never short visits) and many hundreds were seen on house calls and, of course, in hospitals as well as convalescent homes, and some even survived my attempts at healing.

Not that there were problems and frustrations, but there also were rewards (not financial) – satisfaction of face-to-face doctor-patient relationships, which meant getting to really know people who had faith in their doctor. Listening is often more effective than expensive medication – at least it was in the pre-computer era, which

I never dared to enter. Time with patients, daily availability, and promptly returning telephone calls – yes, I mean using that old fashioned instrument – are the sine qua non of an enjoyable medical practice.

But now I am nearly 91 years and one can query: Am I more terminal than my practice?

What new patients would want to come to this office looking for a primary care doctor for the next 35 years? The internet kindly lists my age, which makes me sad, but also I understand all too well that the excitement of seeing new patients is obviously unreasonable.

So the visits are greatly diminished, some days now, zero. Yet, I still have some patients who have passed through these portals for over five decades and they don’t know how, or are unwilling to find a younger and questionably better doctor – and I certainly hesitate to tell them! I have phone calls from patients, pharmacies, and insurance companies, so I still come to my office every day accompanied by my faithful little dog, Suzie-Q, and she still watches the front door hoping a patient will come to see her master. My faithful wife, Nancy, who all the patients dearly love, has not been feeling well lately, but tries to come in at least two half days per week (which currently, is sufficient) and do things I can’t do.

Sometimes, I sit at my desk and recall many of the patients who once came to the office, and the many interesting and tragic events their lives encompassed. I have been proud to have played a role – good or bad – in their medical care. I am happy that I practiced over the decades, which was accurately termed the “Golden Age” of medicine, and know the young doctors of today are immersed in a new and sometimes frustrating medical milieu which, thankfully, I am loath to enter and which, hopefully, promises a better health future for all. Incidentally, these notes originally were written by pen (at least I have given up the quill!), but are now being accurately transcribed by my daughter who did work in my office for several years, but is now out of state.

I have learned and forgotten many things over the years, but I know a warm office décor, a friendly nurse, a lovable little dog, and a doctor with a sense of humor have contributed to the satisfaction of helping other lives to be a little more bearable. And so, if the practice and the practitioner are entering the terminal phase, which obviously is inevitable, and although there are always regrets, there is also pride in being able to have served this long in the profession I love.

JULY / AUGUST 2016 | THE BULLETIN | 51

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

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.

MEDICAL OFFICE SPACE TO SUBLET • MTN VIEW

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 408/228-0454.

Mountain View Medical Office space to sublet. 1,100 sq. ft. Available three days a week. In large medical complex, behind El Camino Hospital. Basement storage, utilities included. Large treatment rooms, small lab space, bathroom, private office, etc. Call Dr. Klein. Cell 650/269-1030.

MEDICAL SUITES • GILROY

FOR LEASE/SALE

First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also available. Call Betty at 408/848-2525.

2,946 sq. ft. well designated office near Good Samaritan Hospital. Upstairs from Los Gatos Surgery Center. Six large exam rooms, two small exam rooms, two consultation rooms, one large lab, one large billing office, three bathrooms, and lunch room. Call 408/356-5027.

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 SPACE TO SHARE • CAMPBELL Convenient location. 5+ exam rooms

smile.amazon.com A great way to support your Alliance When you shop at AmazonSmile, Amazon donates 0.5% of the purchase price to Santa Clara Medical Association Alliance Foundation Inc. Bookmark the link http://smile.amazon.com/ ch/27-1977428 and support us every time you shop.

52 | THE BULLETIN | JULY / AUGUST 2016

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 independent contractor relationship. Please contact Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@ allianceoccmed.com for additional infor-

mation.

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.

FOR SALE FOR LEASE/SALE 2,946 sq. ft. well designated office near Good Samaritan Hospital. Upstairs from Los Gatos Surgery Center. Six large exam rooms, two small exam rooms, two consultation rooms, one large lab, one large billing office, three bathrooms, and lunch room. Call 408/356-5027.

MEDICAL WEIGHT LOSS PRACTICE / RETIREMENT SALE Proven, highly recognized, and profitable established weight loss practice in beautiful Marin County. Current six figures, room for expansion. Work-life balance, time freedom, financial security, relationship-driven practice. I am 100% committed in assisting the new owner with all the support necessary to ensure a smooth transition. Please contact me for more information or to schedule a visit.

Gail Altschuler, MD at 415/309-6258 or drgail@marinweightloss.com.

METRO MEDICAL BILLING, INC.

• • • • • •

Full Service Billing 25 years in business Bookkeeping ClinixMIS web based software Training and Consulting Client References

Contact Lynn (408) 448-9210 lynn@metromedicalbilling.com Visit our Website: metromedicalbilling.com

Diabetes Self-Management Program Do your patients struggle with Diabetes? Are they Medicare Part B beneficiaries?

The Health Trust, accredited by the American Association of Diabetes Educators, offers a suite of evidenced based Diabetes management services that can help.

Call 408-961-9858 or email diabetesED@healthtrust.org, to learn more.

The Health Trust is licensed by Stanford University to deliver these workshops in multiple languages.

• 1:1 Medical Nutrition Therapy session w/ a Registered Dietitian (Medicare Part B beneficiaries only) • 6 week peer led workshop series covering the AADE 7 Self-Carebehaviors

Tracy Zweig Associates INC.

A

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners ~ Physician Assistants

Locum Tenens ~ Permanent Placement V oic e : 8 0 0 -919-9141 or 805-641-9141 FA X : 805-641-9143

t z w ei g@ tracyzw ei g. com w w w. tracyzw ei g. com JULY / AUGUST 2016 | THE BULLETIN | 53

Do you know What, When and How to Report Child Abuse?

FREE ONLINE COURSE! Course developed by the Child Abuse Prevention Center 





Approved for 1.25 AMA PRA Category 1 Credits™ Approved for 1.25 CE credits

ALL healthcare providers (MD, DO, RN, PhD, LCSW, MSW) are encouraged to take this valuable course! 



Course available 24/7 Pre-register NOW at: http://www.imq.org/education/caprrc.aspx

54 | THE BULLETIN | JULY / AUGUST 2016

Success.

It’s what California’s finest physicians strive for... and what CAP can help you achieve.

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice, and we are committed to supporting you with a range of valuable programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

Prepare for Value-Based Compensation with CAP’s Free Guide As payers move toward a more value-focused model of reimbursement, your practice’s revenue stream may soon be tied entirely to clinical outcomes and patient experience.

CAP’s Physician’s Action Guide to Value-Based Compensation is replete with valuable information and tips to help you stay ahead of the VBC curve and attain fair and prompt reimbursement from public and private payers.

Request your free electronic or hard copy today!

800-356-5672 | CAPphysicians.com/Value

CAP_1589_SCCB_03.16.16.indd 1

JULY / AUGUST 2016 | THE BULLETIN | 55

3/16/16 4:29 PM

BULLETIN THE

Address service requested

Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society

700 Empey Way, San Jose, CA 95128-4705

NORCAL

GROUP

OF

PRSRT STD U.S. Postage PAID San Jose, CA Permit No. 503

COMPA N IE S

GUIDE GUARD ADVOCATE

MEDICAL PROFESSIONAL LIABILITY INSURANCE

PHYSICIANS DESERVE Offering top-tier educational resources essential to reducing risk, providing versatile coverage solutions to safeguard your practice and serving as a staunch advocate on behalf of the medical community.

Talk to an Agent/Broker about NORCAL Mutual today. © 2015 NORCAL Mutual Insurance Company. nm0681

NORCALMUTUAL.COM | 844.4NORCAL