July/August 2019 Bulletin: Physician Practice and Risk Management

July / August 2019

Volume 25 | Number 4

Upcoming Events JULY

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ACLS and BLS Courses

SUNDAY

JULY

25 THURSDAY

WHEN: 9 am – 2 pm REGISTRATION FEE(S): ACLS Course for Nonmembers $275.00; BLS Course for Non-members $100 Please join us for ACLS and BLS courses sponsored by the Society of Facial Plastic Surgery (a specialty society with CMA representation). This course is specifically designed for physicians, fellows, residents and medical students. The course is kept small to provide a practical approach to real-life scenarios encountered in the physician’s practice.

Set goals, make plans, get to work, with action items @SCCMedAssoc July 25 financial success seminar.

Hear from Anthony DiRegolo-SGC Financial & hear keys to financial success, principals to be a successful investor, & more.

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WEDNESDAY

18 WEDNESDAY

Pediatric Pearls-Why Early Oral Healthcare Matters To Children

WHEN: 6:30 pm – 8:30 pm WHERE: Santa Clara County Dental Society Office: 1485 Park Ave, San Jose, CA 95126 REGISTRATION FEE(S): This is a free event.

In this unique interdisciplinary experience, you will learn how and why to address oral healthcare with parents. This FREE event is approved for 2 AMA PRA Category 1 credit(s)™ and includes dinner!

Part 3

WHEN: 6 pm – 8 pm REGISTRATION FEE(S): This is a free event.

OCTOBER

SEPTEMBER

Gearing Up for your Dream Retirement-

30 FRIDAY

SAVE THE DATE: San Jose Giants

vs. Stockton Ports Baseball

WHEN: 7 pm – 9 pm WHERE: San Jose Municipal Stadium 588 E. Alma Ave., San Jose REGISTRATION FEE(S): This is a free event.

Join SCCMA and guests on August 30 for the end of the season as the San Jose Giants take on the Stockton Ports. Tickets are $55 per adult/$30 for kids up to age 12. Ticket includes one BBQ meal and two beverages. Tickets will go on sale shortly, or reach out to Robert Robledo at robert@sccma. org for details and to pre-purchase your tickets!

Benchmarking for your Practice with Debra Phairas, MBA, President of Practice & Liability Consultants

NOVEMBER

WHEN: 12:15 PM – 1:45 PM REGISTRATION FEE(S): MDs and Office Managers: $89.00; Non-members: $150.00 Join us for an informative afternoon about key medical office financial ratios to improve practice profitability presented by an experienced consultant and former practice administrator.

Learning Objectives: Accounts receivable management and cash flow; Importance of profit/loss statements as management tool; Benchmarking overhead categories by medical specialty

YES, pre-register me for the following event(s):

AUGUST

July 21

July 25

Aug. 30

Name:

Company Name:

Email:

Phone:

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WEDNESDAY

Meet Susan Ellenberg from our Santa Clara County Board of Supervisors

WHEN: 6 pm – 8 pm REGISTRATION FEE(S): This is a free event.

Come and hear the latest going on with healthcare in Santa Clara County from our board of supervisor member. Supervisor Ellenberg will discuss all the behind the scenes in the health and hospital committee at the county level. More information to follow.

Sept. 18

Oct. 9

Nov. 6

RSVP is required to guarantee your registration. All events held at SCCMA Conference Room: 700 Empey Way, 2nd Floor, San Jose, CA 95128 unless otherwised noted. Visit www.sccma.org or contact Robert Robledo at robert@sccma.org or 408-998-8850 for details!

MEMBER BENEFITS Collections CME Tracking Discounted Insurance Financial Services Health Information Technology Resources

Santa Clara County's 2019 Annual Awards Banquet

In This Issue

House of Delegates Representation Human Resources Services Legal Services/ Health Law Library Legislative Advocacy/MICRA Membership Directory APP for the iPhone Physicians’ Confidential Line Practice Management Resources and Education Professional Development Publications Referral Services With Membership Directory/Website Reimbursement Advocacy/ Coding Services

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Featured Articles 8 What young physicians should know about personal finance 10 Alternatives to Disability Insurance Article 12 Santa Clara County’s 2019 Annual Awards Banquet 18 Public health Announcement: Syphilis is on the Rise in Santa Clara County. Is it on your Radar?

22 Closing a Practice

Departments 6 Message from the outgoing SCCMA President 7 Message from incoming SCCMA President 15 Meet Sameera Manucher and Robert Robledo 24 Medical Times from the past

July / August 2019 The Bulletin

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The Santa Clara County Medical Association Santa Clara County Medical Association (SCCMA) was founded in 1876 by a small group of physicians who understood it was their duty to fight for their patients and profession. Confronted with the challenges of rampant quackery, epidemics of contagious disease, and a desperate need to establish standards for the profession, physician leaders of the time called upon their colleagues to help them form the Medical Society of the County of Santa Clara “to develop, in the highest possible degree, the scientific truths embodied in the profession.”

OFFICERS

COUNCILORS

President Seema Sidhu, MD

El Camino Hospital of Los Gatos: Lewis Osofsky, MD

President-Elect Cindy Russell, MD

El Camino Hospital: Gloria Wu, MD

Past President Kenneth Blumenfeld, MD VP-Community Health Cindy Russell, MD VP-External Affairs Erica McEnery, MD VP-Member Services Randal T. Pham, MD

Good Samaritan Hospital: Vinit Madhvani, MD Kaiser Foundation Hospital San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Open O’Connor Hospital: Cathy Angell, MD

VP-Professional Conduct Faith Protsman, MD Secretary Martin Wong, MD Treasurer Anh Nguyen, MD

Regional Medical Center: Heather Taher, MD Saint Louise Regional Hospital: Scott Benninghoven, MD

CHIEF EXECUTIVE OFFICER April Becerra, CAE

CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Kenneth Blumenfeld, MD (District VII)

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The Bulletin July / August 2019

Stanford Health Care / Children's Health: John Brock-Utne, MD Santa Clara Valley Medical Center: Clifford Wang, MD

Printed in U.S.A.

Managing Editor Sameera Manucher

Opinions expressed by authors are their own, and not necessarily those of The Bulletin, or SCCMA. 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 of products or services advertised. The Bulletin and SCCMA reserve the right to reject any advertising.

Address all editorial communication, reprint requests, and advertising to: Sameera Manucher, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3011 Fax: 408/289-1064 sameera@sccma.org © Copyright 2019 by the Santa Clara County Medical Association.

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President, Santa Clara County Medical Association

KENNETH S. BLUMENFELD, MD, FAANS

MESSAGE FROM THE

SCCMA PRESIDENT

It has been my honor and privilege

T

he statement that “it seems like last year’s banquet was yesterday” may be cliché but the perception is not. Medical technology, translational research and pharmaceutical development has been on an exponential trajectory for my whole career. But only recently has rapidly changing healthcare policy, polarizing politics, public health challenges, and market consolidation been both disruptive and transformational. The SCCMA, CMA, and our partners in this room have been on this journey together. Even in my short tenure as the president of this association think of all that has changed. To list a few…

■■ ■■ ■■ ■■ ■■ ■■

Kenneth S. Blumenfeld, MD, FAANS is the 20182019 president of the Santa Clara County Medical Association.

He is a board-certified Neurological Surgeon with Sutter Health/Palo Alto Medical Foundation and is currently practicing with South Bay Brain and Spine. He also is adjunct clinical professor in Neurological Surgery at UCSF.

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■■ ■■

A new association CEO and staff A new Governor New C-Suites in just about every hospital The transfer of O’Connor and St. Louise Hospital to the County system The rise and defeat of the single payer bill (SB 562) AB 72, the surprise billing legislation, and the statute that followed The passage of Prop 58 and the subsequent return of supplanted funds Measles and SB276

If this were a support group, I’m convinced each table could stand up and tell us their story replete with challenges punctuated by failures and successes. In all likelihood many of the testimonies would be redundant.

When I engaged in organized medicine it was with the purpose of having a voice, specifically with respect to those physicians in solo and small group practice. With time

The Bulletin July / August 2019

and maturity, I have come to realize how many common issues and causes we all have, made even more urgent by a changing healthcare landscape. Moreover, none of us really have the sphere of influence to affect and implement meaningful change without working together.

Which brings me to my outgoing presidential message. While I leave this organization in forward looking capable hands with an exciting future, I am hopeful that our association reshapes itself and becomes a safe harbor where doctors, hospital leadership, and legislators can all convene to have the critical conversations. Without conversation and communication, it’s hard to have collaboration. Without collaboration it’s hard to be successful in achieving our common goals.

While competition in business and life can be helpful, we must never lose sight of the fact that in the end we serve patients.

And it is within SCCMA’s mission to promote excellence in the provision of quality healthcare and to improve the health of our community.

It has been my honor and privilege to serve as your SCCMA president and I thank you from the bottom of my heart for that opportunity. I have had many mentors, in fact too many to name them all. But two in particular I would be remiss not to call out, Jim Hinsdale and Phil Lippe. Lastly and most importantly none of this would have been possible without the support, and tolerance, of my wife Ellen. Lastly, I need to inform everyone that you haven’t quite gotten rid of me yet. I continue on as a district VII trustee.

Dr. Seema Sidhu's Inaugural Speech

T

hank you Ken and Sahej - who by the way - turned 15 today!

All of you have just witnessed one of the most extraordinary moment of my life.. This was pretty cool. Thank you Amrit, Sahej and Aadjot and most importantly my husband - Yudhvir - for letting me pursue my passions and filing up the void my absences left in the family. I am lucky to have you as a partner in creating a home that is loving and emphasizes the value of hard work, compassion, and not taking yourself too seriously. You are at the root of why I am here.

I am also blessed to have exceptional mentors and leaders in my life. Dr. Eric Cain and Dr. Kapil Dhingra, the Physician in Chiefs from Kaiser Greater Southern Alameda Area. Their support and advice is the momentum behind most of my ideas.

Dr Susan Smarr, the Physician in Chief from Kaiser Santa Clara - who is my hero - I want to be just like her when I grow up!

Dr. Efren Rosas, The Physician in Chief of Kaiser San Jose and an exceptional surgeon who taught me the importance of work-life balance.

All of my Santa Clara County Medical Association Staff, colleagues and many mentors who taught me everything I know about organized medicine - to actively work towards improving access to the best health care for our patients.

And finally a big thank you to all of you - my friends and colleagues. Thank you for taking precious time out of your busy lives- time away from your family to be here with me celebrating today. Thank You! Â

Seema Sidhu, MD is the 2019-2020 president of the Santa Clara County Medical Association. She is a practicing OBGYN (Obstetrician & Gynecologist) in Fremont, CA. Dr. Sidhu graduated from Creighton University School of Medicine in 2001 and has been in practice for 18 years. She currently practices at the Fremont Kaiser Medical Center.

July / August 2019  The Bulletin

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What young physicians should know about personal finance Andis Robeznieks Senior News Writer American Medical Association Often faced with staggering debt while working long hours or adjusting to life in new a practice setting, it can be easy for medical residents and young physicians to feel overwhelmed. While no one strategy applies to the myriad variables individual doctors face, it behooves them all to get started with a solid financial plan.

“Options are increasing” when it comes to paying off medical student-loan debt, said Wende Headley, a financial adviser with Abacus Wealth Partners in Los Angeles, addressing a topic on the minds of many who attended a recent education session on the topic.

Medical student-loan debt is the top financial concern for U.S. medical residents, according to a 2017 AMA Insurance survey cited at the session. But it is not the only concern. In addition to worrying about paying back money they borrowed in the past, residents are concerned about their longterm future.

The good news for residents and young physicians is that there are multiple options and flexible strategies for paying off that debt. The AMA offers tips for managing your medicalstudent loans and understand your options for repayment.

Headley began by describing the differences between 10year fixed, 10-year graduated and 25-year loans. She was followed by Benjamin Meyer, MD, a Medical College of Wisconsin diagnostic radiology (pictured above) resident, who discussed strategies for debt consolidation and managing the six-month grace period new doctors are granted between graduating medical school and making their first loan payment.

INCOME VERSUS SPENDING

These options were put in perspective by Mohammed Minhaj, MD, professor of anesthesia and critical care at the University of Chicago Pritzker School of Medicine who also teaches a course called “Money Management: What Every Young Physician Should Know.”

“In general, in med school, you’re always taught there’s a right answer and a wrong answer,” Dr. Minhaj said at the session, hosted by the AMA Resident and Fellow Section during the 2019 AMA Annual Meeting. “In business school, if you started every answer by saying, ‘It depends,’ you were right.”

The situation of a resident paying $3,000 a month for a studio apartment in San Francisco varies greatly from someone training in Arkansas and paying $600 monthly rent for

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The Bulletin July / August 2019

a three-bedroom apartment, he noted. But a general rule of thumb, he said, is to take stock of your situation every year and assess where you are in terms of net worth, income and spending.

“The thing you will have the most control over in your entire lifetime will be spending,” Dr. Minhaj said. “The worst situation is to be overwhelmed by the amount of debt you’re in, and how little money you’re making compared to the hours you’re working as a resident.”

If you develop financial discipline as a resident, you will be rewarded in the future when your compensation is higher, he advised.

Headley agreed.

“Financial success is about what you keep, it’s not what you make,” she said.

PUTTING AWAY VERSUS PAYING OFF

A related question arose regarding the age-old question of whether to save more money to invest instead of using more to pay off debt.

Headley said that residents should “absolutely” take advantage of any matching retirement fund contribution an employer may offer. She also noted that “pure financial theory” states that, to be worthwhile in this equation, the income earned from the investment must be higher than the interest from the debt.

But, beyond theory, this is also a matter of personal priority, she said. It’s a matter of deciding whether you feel better knowing that you have some money saved or whether you feel less burdened with every dollar of debt that’s removed.

Because there are no one-size-fits-all solutions, Headley recommended seeking the advice of a certified financial planner.

Doctors who don’t already have a financial planner can contact AMA Insurance and inquire about their Physicians Financial Partners program. This program provides physicians access to vetted financial professionals across the country.

“If you’re a medical student or have started training, you will be approached by multiple financial planners,” Dr. Meyer said. He recommended to first develop criteria for evaluating a planner and then you will be prepared to assess them when they offer their services.

A self-evaluation of goals and plans is also important.

“Have that conversation with yourself,” Dr. Meyer said.

Reprinted from the American Medical Association. https:// www.ama-assn.org/.

© Can Stock Photo / Maridav

July / August 2019 The Bulletin

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Alternatives to Dis

ASK YOURSELF THIS ONE IMPORTANT QUESTION

Is my most valuable asset safeguarded as well as my other assets? Stated differently, if you become sick or injured and could not work, would you have enough income to continue paying your bills? If you haven’t done some specific planning, I think you might be uncomfortable with what you discover.

Let’s look at some of the options that many feel will provide them an income while disabled.

First, Social Security: It is very difficult to qualify for Social Security benefits

10

because the disability must prevent a person from doing any ‘gainful occupation’, not your occupation. Social Security’s definition of disability also requires that you be totally disabled, with an expectation that the disability will last at least one year or that the disability is expected to result in death within one year.

Additionally, the process of filing and approval can and does take months, or even years and only about one-third are initially approved. Finally, the amount of benefit payable under Social Security is likely not going to be sufficient.

Second is Workers’ Compensation.

The Bulletin July / August 2019

Workers’ compensation is designed to provide for lost income and some medical costs if one becomes sick or injured while working. The vast majority of disability claims are not work-related and thus not eligible. Finally, these benefits are limited.

Third, you can self-insure against the risk. Let’s look at this option. If you saved 10% of your income each year, a relatively short-term disability could still wipe out years of savings. Once you spend your savings, even after you return to work, it can take years to rebuild your savings.

What would happen to the college sav-

Š Can Stock Photo / Bialasiewicz

sability Insurance

ings for your children or the monies being put aside for retirement? Owning your own disability income policy is a much sounder plan. Some will hope to receive help from friends or family. Again, that may or may not work. Finally, some mention borrowing from a bank. Can you imagine a bank giving you a loan while disabled? Hard to imagine in today’s economic environment.

The prudent plan if you want to be certain that your income is adequately safeguarded while you are disabled, is to design and purchase a disability insurance protection plan. The advantages of

a personally owned disability policy are many, including the ability to design the plan to your needs with variable benefit options on how much you need to cover your daily living expenses, how soon you need benefits to begin paying, and finally, how long you want the benefits to be payable. Additionally, if you own or have ownership interest in the practice, another form of disability insurance is designed specifically for your business needs. A Business Overhead Policy (BOE) is designed to pay the ongoing expenses of the practice and can be structured to start providing dollars to hire a replace-

ment to keep the practice open and accepting revenue-producing patients.

As a proud Preferred Business Partner to the Santa Clara County Medical Association, we are here to support you and make sure you, your family and your practice are appropriately protected. As a member of SCCMA, you receive a complimentary disability protection analysis. If you are interested in reviewing your existing disability coverage or learning about your disability income protection options, please call Anthony DiRegolo at 650-2270406 or email him at Anthony.diregolo@ sgc-financial.com

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2019 Santa Clara County Medical Association Awards Banquet On June 4th 2019, over 200 physicians and guests attended the Santa Clara County Medical Association Awards Banquet at the San Jose Westin. An evening filled with food, wine and entertainment to honor and recognize those physicians that go above and beyond the call of duty in various categories; Outstanding Achievement in Medicine, Contribution in Medical Education, Contribution in Medical Association, Contribution to the Community, and recognition of a Citizen’s Awards. This year we recognized five outstanding physicians. This was also a time to celebrate our outgoing, President Dr. Kenneth Blumenfeld, and welcome incoming President, Dr. Seema Sidhu.

FAITH R. PROTSMAN, MD

JEFFREY V. SMITH, MD, JD

CONTRIBUTION TO THE COMMUNITY

CITIZEN'S AWARD

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 is expected of the membership at-large.

The Santa Clara County Medical Asso­ciation, with much admiration and respect, presents this award to Dr. Faith R. Protsman.

This award is given to an individual who is not a member of the Medial Association, who has achieved public recognition for a significant contribution in the health field. It is a great honor to recognize Dr. Jeffrey V. Smith as the recipient for this award.

WILLIAM S. LEWIS, MD

FRANCIS N. CHU, MD

JOANNA READY, MD

CONTRIBUTION TO THE MEDICAL ASSOCIATION

OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION

OUTSTANDING ACHIEVEMENT IN MEDICINE

This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more activities of the Association over and beyond that expected of the membership at-large. Dr. Lewis's contributions to our association have been significant and it is with much pleasure that we recog­nize his time, input, and service with this award.

This award is given to a physician member of the Association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large. It is with great admiration and pleasure that we recognize Dr. Francis N. Chu with this award.

The Outstanding Achievement in Medicine Award is given to a physician who, during his/her medical career, has made unique contributions to the betterment of patient care, for which he/she­has achieved widespread recognition. It is, in a sense, bestowed upon a physician's physician. It is with great esteem and admira­tion that we recognize Dr. Joanna Ready with this award.

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The Bulletin July / August 2019

Jeff Smith with Santa Clara County Board of Supervisors Susan Ellenberg and other guests

Paul Lorenz, CEO of Valley Medical Center and invited guests.

Dr. Sidhu posing besides her family and guests.

Outgoing President, Dr. Kenneth Blumenfeld, Dr. Seema Sidhu (incoming President) and Dr. Seham El-Diwany (past President).

SCCMA Staff: Robert Robledo, Sameera Manucher, Karen Jorgenson, April Becerra, Sandie Moore, Leslie Sorenson, Paul Moore

L to R: Jessica Hernandez, Dr. Donaldo Hernandez (CMA Trustee), Dave Cortese (Santa Clara County Board of Supervisors), seated with Dr. Kenneth Blumenfeld, wife, Ellen Blumenfeld and son, Eric Blumenfeld

Dr. Blumenfeld passing Dr. Sidhu her gavel.

Media sponsors:Â Silicon Valley Magazine Publisher Walter Kupiec and guests.

CEO, April Becerra, having a good time with guests.

Dr. Seema Sidhu (incoming president) celebrating the evening with her beautiful family.

Dr. Seema Sidhu and Sameera Manucher alongside invited medical students

Incoming President, Dr. Seema Sidhu, celebrating her installation with her husband, Yudhvir Sidhu, and friends.

July / August 2019  The Bulletin

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2019 Santa Clara County Medical Association Awards Banquet

Honoree, Dr. Faith Protsman and Dr. Seham El- Diwany (past president).

L to R: Mizgon Darby, Keith Darby (CEO of SMCMA, Aaron Moore (SGC Financial & Insurance Services), Joseph Greaves (CEO of Alameda-Contra Costa Medical Association), Ramina Moore (SGC Financial & Insurance Services), Anthony and Jennifer DiRegalo (SGC Financial & Insurance Services)

Honoree, Dr. Jeffrey V. Smith posing with Dr. Cyndi Ashbrook

Dr. Joanna Ready celebrating her accomplishments with guests

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L to R: Dr Lewis Osofsky( Council), Sandra Kupiec (KNect 365), Walter Kupiec (Silicon Valley Magazine), Robert Robledo (SCCMA Deputy Director), Edwin and Julie Ryu (Legacy Wealth Advisors), Dr. Randal Pham (Executive Committee), Dr. Cindy Russell (Executive Committee/President Elect)

Awardees, Dr. William S. Lewis and Dr. Francis Chu celebrating with their families.

Meet Sameera Manucher and Robert Robledo:

Your Newest SCCMA Staff Members Sameera Manucher Sameera, born and raised in the East Bay, graduated from California State University East Bay with a Bachelor’s Degree in Health Care Administration and a minor in Business.

In January 2019, Sameera joined SCCMA as the Programs and Community Outreach Coordinator. She comes from Resource Area for Teaching (RAFT) as the Project, Event, and Development Coordinator. RAFT is a nonprofit that provides educators with affordable educational activity kits made from recycled materials, affordable workshops and supplies.

As the Programs and Community Outreach Coordinator, Sameera is responsible for reaching out to various community groups and organizations, as well as developing unique and effective programing for the organization. Sameera hopes to cultivate a welcoming, communal environment for all members.

With love for traveling, Sameera has been to several different parts of the world to experience and learn about new cultures and religions. When she is not traveling or working, Sameera dedicates her time to her large, Middle Eastern family, shopping, reading, hiking, and exploring new cuisine.

Robert Robledo Robert is a lifetime resident of Silicon Valley and a product of local public schools, graduating with a Bachelor’s Degree in Communication Studies from San Jose State University. He is a long time leader in the business community and works closely with our elected officials in various capacities.

In April, Robert transitioned from his Director of Events role at the Silicon Valley Business Journal to his role here at SCCMA as the Deputy Director, working directly with CEO April Becerra. “I met April when I was at the business journal and she was the current Executive Director at AIA (an International Architect association) and instantly had a strong rapport with her. She truly is a leader in our community and a great mentor for any business woman in Silicon Valley”, said Robledo.

In this role, Robert is responsible for managing business partnerships and creating new revenue generating opportunities with sponsors. He also will work with Becerra to retain and grow SCCMA membership, and working on various projects within the organization.

A strong brand ambassador, Robert has considerable experience serving on boards, commissions, and other volunteer capacities. He is a graduate of the Latin Board Leadership Academy (class of 2015) operated by the Hispanic Foundation of Silicon Valley. He currently serves as a board of governor member at the Silicon Valley Capital Club. Robert is also a founding member and past President of the Rainbow Chamber of Commerce Silicon Valley, past President of the Lakeview Terrace Home Owners Association, . He has also worked on various events supporting the Health Trust of Silicon Valley.

When he is not hard at work generating brand awareness or networking, he loves to travel, is an avid gym goer, enjoys golf, wine tasting, hiking, hanging out at the Silicon Valley Capital Club, and other outdoor activities.

July / August 2019 The Bulletin

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The Bulletin July / August 2019

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2242 Camden Ave, San Jose BRAND NEW exteriors, lobby & full ADA upgrades! Close to Good Samaritan Hospital & Los Gatos.

Easy access to Hwys 880 & 17.

Premier class A medical office building with diverse tenant mix.

Convenient access to Hwys 85, 87 & 101.

High end medical office in great central Palo Alto location. Includes on and off-street parking.

1,885 SF FOR LEASE

1,750 SF FOR LEASE

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14911 National Ave, Los Gatos

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Built out and fully furnished medical office building. Flexible floorplan. Cornerstone to O’Connor Hospital.

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Medical/dental suite in the Rose Garden area. Great corner visibility with monument signage. Easy access to Hwy 280 and Hwy 880.

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Class A medical office building less than 1 mile from Good Samaritan Hospital. Easy access to Hwys 17 and 85. Exceptional visibility.

Conveniently location on S. Bascom’s medical/dental corridor. Great visibility with monument signage.

Easy access to Hwys 85/17/880/280.

2930 Aborn Square Rd, San Jose Neighborhood shopping center with wide array of retail tenants anchored by Ross Dress For Less.

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

July / August 2019 The Bulletin

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Syphilis is on the Rise in Santa Clara County. Is it on Your Radar?

Rosalyn Plotzker, MD, MPH; Sundar M. Thapaliya, MPH; Wen Lin, MD, PhD, MSc.

In Santa Clara County, early syphilis1 tripled between 2014 and 2018, from 178 cases (9.4 cases per 100,000 people) to 528 cases (27 cases per 100,000 people).

In 2018, males were four times more likely than females to be affected. However, recent increases have been more dramatic among females, with a tenfold increase of early syphilis from 2014 to 2018, compared to approximately a twofold increase among males in the same time period.

Most recently, early syphilis among females more than doubled from 45 cases (4.7 cases per 100,000 females) in 2017 to 104 cases (10.7 cases per 100,000 females) in 2018.

CDIs provide resources for complex clinical cases, including linkage to clinical consultation on diagnosis and management of syphilis. Finally, at the population level, CDIs monitor the health status of our community with local surveillance data to identify and respond to syphilis outbreaks.

Clinical Scenarios: How Can a CDI Help?

Three’s Company

Cindy, a pregnant 22-year-old woman, was diagnosed with secondary syphilis.2 Her sexual partner, Orville, 24, was treated for syphilis less than a month earlier. Orville’s former sexual partner, Lynne, 19, was treated for gonorrhea and chlamydia the previous year (however not tested for syphilis at that time); 3 months later she sought care for a rash as well as genital/rectal lesions, however was again not tested for syphilis.

How can a CDI help? CDIs can assist with ensuring that Cindy is treated correctly and that her infant is too. They can also confirm that Orville is retreated for his possible re-exposure, and contact Lynne about being screened and treated for syphilis, which may have been misdiagnosed when she presented with a rash.

Increasing syphilis rates among females coincide with subsequent cases of syphilis in infants, or congenital syphilis (CS). In 2018, four CS cases were reported in Santa Clara County; this year, as of July 8, 2019, seven CS cases have already been reported.

How Can Public Health Help?

The Santa Clara County Public Health Department‘s Communicable Disease Investigation (CDI) Program employs seven CDIs dedicated to syphilis and HIV case investigations in collaboration with clinicians and the California Department of Health (CDPH) to ensure adequate syphilis treatment along with partner notification. Certified as HIV Test Counselors, and trained in CDC developed Passport to Partner Services, CDIs develop tailored risk reduction strategies for patients. For providers,

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The Bulletin July / August 2019

Not All Penicillins are Created Equal

Tomas, 24, was diagnosed with latent syphilis of unknown duration at an urgent care facility. He was started on a series of three doses of Bicillin C-R. injections 2.4 million units intramuscularly for treatment.

How can a CDI help? The treatment of latent syphilis of unknown duration is benzathine penicillin G (Bicillin L-A), 2.4 Million Units IM every 7-9 days, for 3 doses (7.2 MU total). Bicillin C-R—a combination of benzathine penicillin and procaine penicillin—is not appropriate treatment. A CDI can intervene when they see that Tomas’s treatment was inadequate, ensure he is retreated with the correct regimen, and discuss the differences between penicillin preparations with the provider to avoid future confusion.

Communicable Disease Investigators are here to help! Consultation is available for the following: • • • • • • • •

Diagnosis and treatment history in California of your patient A patient has not returned for treatment Your facility has difficulty accessing bicillin for treatment Partner Services for your patient’s partners Evaluation and management of complicated syphilis cases, including congenital syphilis Rapid treatment for patients with signs or symptoms of syphilis Assistance with completing Confidential Morbidity Report (CMR) Assistance with completing Adult HIV/AIDS Case Report Form (ACRF)

Call 408-792-3739 to learn more.

Who Needs a Syphilis Test?

Any person with signs or symptoms suggestive of syphilis should be tested for syphilis. Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with syphilis should be tested for syphilis and be treated empirically for early syphilis due to the exposure.

Pending test results should not delay treatment.

Regardless of potential exposure, all pregnant patients in Santa Clara County should be screened at the first prenatal encounter, as well as in the third trimester (ideally between 28 and 32 weeks’ gestation) and at delivery. Finally, all patients who use HIV Pre-Exposure Prophylaxis (PrEP) should be tested for syphilis on a quarterly basis, alongside screening for gonorrhea and chlamydia at all exposed sites.

Consider testing for syphilis if your patient has one of the following recognized risk factors: • • • • • • • • • • •

In addition, patients with certain risk factors should be screened for syphilis even if they are asymptomatic and have no known exposure via a sex partner who has syphilis. Talk with your patients about their risk factors to determine if they should be tested for syphilis or other STDs.

•

Is a man who has sex with men (MSM) Is a woman who has a male partner who also has sex with men Reports multiple sex partners Is HIV positive Has a history of syphilis infection Diagnosis of another STD within the past 12 months Methamphetamine use Intravenous drug use Having sex under the influence of alcohol or drugs Is homeless or has unstable housing Recent incarceration, or a sex partner who was recently incarcerated Having sex in exchange for resources, such as money or drugs

Serologic Diagnosis Syphilis: Syphilis diagnosis requires: A positive non-treponemal test such as RPR or VDRL, which is at least fourfold higher than the patient’s previous non-treponemal test if they have had syphilis in the past.

AND

A positive confirmatory treponemal test such as TP-PA, FTA-ABS, or EIA.

July / August 2019 The Bulletin

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Staging and Treating Syphilis Syphilis is treated according to stage of disease.

Stages are clinically determined. All patients diagnosed with syphilis should have a thorough physical exam in order to stage and treat appropriately—including neurologic exam with visual and hearing exam to rule out signs of neurosyphilis.

Selection of the appropriate penicillin preparation is important to properly treat and cure syphilis.

Combinations of some penicillin preparations (e.g., Bicillin C-R, a combination of benzathine penicillin and procaine penicillin) are not appropriate treatments for syphilis.

For alternative syphilis regimens for patients with a type-1 penicillin allergy, as well as information regarding appropriate follow-up by stage, please refer to the CDC’s STD Treatment Guidelines.

Primary: Patient presented with a chancre Step 1: STAGE

Secondary: Patient has a syphilitic rash, condyloma lata, alopecia, or mucous patches.

Early-Latent: Patient has no signs or symptoms and infection occurred within one yeara

Step 2: TREAT

Benzathine penicillin G 2.4 Million Units, Intramuscularly (IM) Once

Late-Latent or Unknown Duration NO symptoms, and infection does not meet criteria for early latenta

Benzathine penicillin G 2.4 Million Units IM every 7-9 days, for 3 doses (7.2 mu total) If any doses are late or missed, restart the entire 3-dose series.

Patients who are pregnant should receive doses exactly 7 days apart.

Persons can receive a diagnosis of early latent if, during the prior 12 months, they had a) seroconversion or sustained fourfold titer rise (RPR or VDRL); b) unequivocal symptoms of P&S syphilis, or c) a sex partner with primary, secondary, or early latent syphilis.

a

LEARN MORE ABOUT PARTNER SERVICES AVAILABLE TO YOUR PATIENTS Partner Services is a free program offered by the Santa Clara County Public Health Department (SCCPHD) that helps patients determine how to best notify their needle sharing or sex partners. Let your patients know that CDIs and social workers routinely work with patients diagnosed with syphilis and HIV to offer partner services.

Partners Services staff will also help confidentially contact any partners and offer STD and HIV testing, treatment, and linkage to prevention services such as Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP).

Partner notification is important because treating partners can prevent reinfection and prevent further disease transmission and complications.

Call 408-792-3739 to learn more.

ENDNOTES 1 Inclusive of primary, secondary, and early latent stages 2 All names and ages in the article were changed to protect the patient’s identity.

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The Bulletin July / August 2019

July / August 2019  The Bulletin

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T

Closing A Practice – Essential Tasks

here may be many reasons why a physician will need to close a practice. These include: retiring, starting up a new practice, accepting a position elsewhere, selling the practice, divorce, illness or death. Physicians may be surprised to realize the many unique responsibilities that accompany the decision to close the practice.

There are many people who will be affected by the physician closing a practice. These are: your patients, staff, referring physicians, spouses or significant others, heirs, insurance companies, hospitals and vendors.

In a physician death, it is wise to have another physician as soon as possible see patients, and this can be either a colleague or a locum tenens physician. A spouse can legally run the practice and bill for the deceased physician for 6 months after death in California. This gives time to either sell or close the practice while still having income flowing in. All the notification tasks outlined when retiring or moving must also be done with death for closing of the practice.

DEATH

If there is enough time, for example more than one year, it is best to try to sell or transition the practice. If you do not either sell or find a custodian of records, the physician or estate will be responsible for retention of the medical records for as long as the malpractice carrier wishes them to be retained. This responsibility also includes release of information requests from the patient to copy or send records to a new physician. This can be 10 or more years and a significant burden! One of the first tasks is finding out from your malpractice carrier their current records retention guidelines. In one practice, the manager shredded all records more than 7 years from date of service and the malpractice carrier guidelines were 10 or more years.

Selling the practice or finding a custodian of records will relieve the physician or estate of maintaining records. In both sce-

The most heartbreaking scenario is when a physician dies unexpectedly. The spouse/heirs are grieving yet at the same time, there are many responsibilities for them to complete. The most loving thing a physician can do for the family is to make sure they are fully educated and prepared to close the practice.

A living trust is an essential estate planning tool to avoid probate and taxes. Don’t put this off! Please keep a copy of this article with your trust and will. Have your heirs immediately call your local Medical Society. They can assist your spouse, heirs, executor, or estate trustee in many ways. Assure that your heirs can locate passwords, bank accounts, safe deposits, credit cards, income tax reports, lease agreements, malpractice and all health, life, disability insurance policies and staff employment data.

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The Bulletin  July / August 2019

MOVING, RETIRING, SELLING OR TRANSITIONING THE PRACTICE

© Can Stock Photo / welcomia

WHEN TO NOTIFY STAFF MEMBERS ABOUT YOUR PLANS TO CLOSE THE PRACTICE

narios, a legal agreement should be written that spells out the responsibilities of the buyer or custodian of records, including length of retention, access to the records for departing physician in the case of a professional liability claim and hold harmless agreements for both parties.

The departing physician will need to write a letter to “active” patients to avoid abandonment. A physician can’t just simply put a sign up “retired, gone fishing!” There is no absolute guidelines to what “active” patients are but usually the last 2-3 years of patient care is sufficient. Any surgical or cancer follow up patients should receive the letter. If you are selling or engaging a custodian of records, you can combine the notice with an introduction to the purchasing or custodian of records physician.

If the patient does not wish to transition to the recommended physician, you can offer a release of information form to transfer the records and also charge the patient for copying records according to California guidelines. These are $4.00 per quarter hour of time plus $.25 per page. Record release requests must be complied within 15 working days.

Please consider writing a warm thank you to your patients for being entrusted with their healthcare and that you are grateful to have been a part of this patient’s care for these years. A physician showed me a retirement letter than complained about insurance companies, fear of malpractice and other negative reasons for retiring. This is sour grapes and not recommended! The patients want to be assured that you loved being a physician and enjoyed taking care of them. It is also a good idea to put out an ad in the local paper announcing your retirement which also proves you did not abandon patients. It is also recommended to send out a letter to your referring physicians in the community as well for notification.

It is recommended a few days or a week prior to sending out the letter to patients. You may wish to offer a small severance to encourage them to stay until the closing of the practice. You also need to arrange for continued billing and collection work after the close of the practice. Notify 401K or pension administrators regarding rollover for pension/401K plans. You will need to issue the final paycheck with all vacation accruals paid. If you provide health insurance, the brokers will need to be alerted to send out COBRA information to your staff. Maintain employee files indefinitely.

Medicare, Medi-Cal, insurance payor companies, IPAs and hospital privileging usually require a 90 day notice of closing a practice. Your landlord may require a 30 or 60 day notice. You may be able to extend a lease on a month to month basis until close. Vendors may require an advanced notice of discontinuance of services, particularly biohazard waste.

If you have controlled drugs in the practice, you must keep a record of inventory for 3 years after closing the practice. Also, you should not throw away any drugs, especially controlled drugs into waste receptacles. There are specified companies that will remove controlled drugs. Two times per year, April and October anyone can take controlled drugs to participating police departments, free of charge and they will be disposed. For more info, visit: http://www.deadiversion.usdoj.gov/drug_disposal/takeback If you no longer wish to practice medicine in any capacity, you must deactivate your DEA number. AFTER you have disposed all drugs, you must deactivate your medical license in California via the California Medical Board, and professionally shred any prescription pads.

Decide where you wish your mail to go and notify the US postal service of the address change. Cancel telephone, internet, websites and utilities. Keep your bank account open for practice checks to be deposited for at least a year. Speak with your CPA regarding closing or winding down a corporation.

It is recommended to create a checklist of tasks with a timeline to the final closure to avoid forgetting any important tasks and successfully close the practice. © Copyrighted 2019 Debra Phairas, Practice & Liability Consultants. (415) 764-4800 www.practiceconsultants.net

July / August 2019 The Bulletin

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Medical Times From the Past 24

Grover Cleveland’s Secret Surgery

By Michael Shea, MD

Leon P. Fox Medical History Committee

O

n May fifth,1893, President Grover Cleveland noticed a rough spot on the roof of his mouth. It was near his molars on the left side, his cigar chewing side. The 24th president was now facing a personal health issue, as the country was falling deeper into a financial crisis.

Robert M. O’Reilly, the White House Physician, biopsied the quarter size lesion. The pathology report was epithelioma, known today as squamus cell carcinoma.

Joseph Decatur Bryant, a prominent New York surgeon, and personal friend of the president, recommended surgical excision as soon as possible. Consent by the president had three conditions: complete secrecy, the surgery to be done aboard a friend’s yacht, and at the time of his choosing (hardly a typical doctor-patient relationship).

Dr. Bryant selected a team of five additional medical professionals: Robert O’Reilly, William Keen, one of the country’s most famous doctors, Edward Janeway, professor at Bellevue Hospital, John Erdmann, Bryant’s assistant and protege, and Ferdinand Hasbrouck, a dentist and experienced anesthetist.

Bryant would be the lead surgeon; Keen and Erdmann would assist. Hausbrook would handle tooth extractions and assist with anesthesia, and Janeway would monitor vital signs. All were sworn to secrecy.

The operation took place June 31st aboard the yacht, Oneida, as it cruised on Long Island Sound, an estuary just off the eastern shores of Bronx County, New York City.

Janeway started by washing the president’s mouth with an antiseptic named Thiersch’s solution This was a mixture of salicylic acid and boric acid. Adhering to Joseph Lister’s advice, they all washed their hands with soap and water, sterilized the instruments by boiling them, and pulled crisp white aprons over their dark suits. Hasbrouck administered nitrous oxide and extracted two left upper bicuspids. Electrocautery was used to control the bleeding. Cocaine solution was injected around the tumor. More nitrous oxide was given. Bryant made an incision around the lesion, using what is now called a Bovie Unit. Ether was then administered by mask to deepen the anesthesia stage.

Removal of the tumor was next. This entailed re-

The Bulletin July / August 2019

moving part of the president’s upper left maxilla, part of the hard palate, and the tumor itself. Three more teeth were removed. All of the excised matter was carefully placed in a small jar. They irrigated the wound with Thiersch’s Solution and packed President Grover Cleveland it with gauze. The operation had taken only an hour and a half. Morphine intramuscularly was used to control immediate post op pain.

Post operatively, the president did remarkably well. He had no significant complications. He was later fitted and received a prothesis to wear over the defect in his hard palate. His speech and appearance were so normal that no one could detect any evidence of the surgery.

Reporters were told that he had an infected tooth extracted and was now in excellent health. The deception held in spite of one reporter, E.J. Edwards. He discovered the truth, indirectly, from the dentist Hasbrouck. Edwards article, exposing the actual surgery, was published August 29, 1893, in the Philadelphia Press, but was essentially white-washed by the White House and attending surgeons. The truth was ultimately told by W. Keen, himself, in an article he submitted to the Saturday Evening Post on September 22, 1917.

Grover Cleveland died in 1908 at the age of seventy-one. Cause of death was listed as heart failure. There was no recurrence found of the cancer.

An interesting foot note to this story is the pathology exam done in 1975 on the preserved specimen. It was performed by two eminent Philadelphia Pathologists, Horatio Enterline and John Brooks. The diagnosis was verrucous carcinoma, a rare squamus cell malignancy, which does not metastisize but does grow locally and can cause symtoms of obstruction and pressure.

Reference: Algeo, Matthew. THE PRESIDENT IS A SICK MAN. Chicago Review Press, 2011.

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OFFICE SPACE FOR LEASE AND OR SALE Medical office space 1,969 sq. ft. on Jackson Avenue opposite to Regional Medical Center for sale or lease, with option to buy. Very well maintained office building.

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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 information.

WANTED FAMILY PHYSICIAN Family medicine physician needed to share a growing outpatient practice. Start at 16 hours/week and share patient load.

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PRIVATE PRACTICE AND BUILDING FOR SALE Family Practice for sale, including inventory, equipment and Real Estate (can also be leased). Great downtown San Jose location. Financing may be available. Minor Laser Surgery performed as well. Call 415/308-3064.

GREAT BUSINESS OPPORTUNITY • PART-TIME OR ADD-ON TO YOUR EXISTING PRACTICE Medically-supervised weight loss program with 30-year track record. Cash, no insurance. Practice obesity medicine and help patients overcome their weight problems and improve their health. Seeking an associate to train with eventual sale. Contact me at southbayweightloss@gmail.com.

OTHER MEDSKILLS INC. MEDICAL SCRIBES MedSkills is a local Bay Area medical scribe matchmaking service. MedSkills offers physicians medical scribe candidates and specialized scribe training. Sign up for MedSkills monthly subscription by downloading the MedSkills Mobile Application or contact info@medskills.com for more information.

Medical office space 1,969 sq. ft. on Jackson Avenue opposite to Regional Medical Center for sale or lease, with option to buy. Very well maintained office building.

Please call 408/926-2182 or 408/315-4680.

Visit our Website: metromedicalbilling.com

July / August 2019 The Bulletin

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The Bulletin  July / August 2019

ar

Santa Clara County and San Mateo County Medical Association Present

Email Marketing Trends 2019 Strategies to grow your practice Now is the perfect time to determine the next move for your business and how to stand out from your competitors. It’s time to think about your email strategy for the year ahead so you can focus your energy and make the most out of your time.

Join us as we explore the top email marketing trends for small businesses and simple ideas to incorporate them into your marketing strategy. You’ll learn:

How to create more personalized email messages How to do more business and save time with automation How to provide value to grow your practice and expand your brand/service

Webinar October 3, 2019 12:30pm-1:30pm Free for members

Featured Speaker

Tracey Lee Davis Tracey Lee Davis, founder of ZingPop Social Media, is passionate about helping small businesses grow and succeed through their online marketing efforts.

From social media coaching to total management for email marketing campaigns, ZingPop Social Media turns busy small business owners into online marketing rockstars. Tracey Lee is Alignable's 2018 Small Businessperson of the Year for San Jose; a Certified Content Marketing Strategist; a Master Certified Solutions Provider for Constant Contact; a Hootsuite Certified Professional; and the Co-Owner and Vice President of the Women’s Networking Alliance. She also really, really loves cheese.

Register Today www.sccma.org

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