2018 May/June

MAY / JUNE 2018 VOLUME 24 | NUMBER 3

Back to Back

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Scan for more information.

BULLETIN THE

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

700 Empey Way • San Jose, CA 95128 • 408/998-8850 • www.sccma-mcms.org

MEMBER BENEFITS Billing/Collections CME Tracking

Feature Articles

8 Are You Ready to Check CURES?

10 William C. Parrish, Jr. to Retire as CEO 22 CMA Defeats Dangerous Rate Setting Proposal

Discounted Insurance Financial Services Health Information Technology

Departments

5 Discount Ticket Program

6 Message From the SCCMA President

Representation

7 Message From the MCMS President

Human Resources Services

20 Medical Times From the Past

Legal Services/On-Call Library

26 SCCMA-MCMS Members Lead at CMA’s Legislative Advocacy Day

Resources House of Delegates

Legislative Advocacy/MICRA Membership Directory APP for the iPhone Physicians’ Confidential Line Practice Management Resources and Education

28 Physicians News Network 36 Infrastructure & Investment / Hospital News 38 MEDICO News 44 Classified Ads 45 In Memoriam

Professional Development Publications Referral Services With Membership Directory/Website Reimbursement Advocacy/ Coding Services Verizon Discount MAY / JUNE 2018 | THE BULLETIN | 3

The Santa Clara County Medical Association OFFICERS

CHIEF EXECUTIVE OFFICER

COUNCILORS

President Seham El-Diwany, MD President-Elect Kenneth Blumenfeld, MD Past President Scott Benninghoven, MD VP-Community Health Cindy Russell, MD VP-External Affairs Erica McEnery, MD VP-Member Services Ryan Basham, MD VP-Professional Conduct Faith Protsman, MD Secretary Seema Sidhu, MD Treasurer Anh Nguyen, MD

William C. Parrish, Jr.

El Camino Hospital of Los Gatos: Lewis Osofsky, MD El Camino Hospital: Gloria Wu, MD Good Samaritan Hospital: Vinit Madhvani, MD Kaiser Foundation Hospital - San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Martin Wong, MD O’Connor Hospital: Cathy Angell, MD Regional Medical Center: Heather Taher, MD Saint Louise Regional Hospital: Vacant Stanford Health Care / Children's Health: John Brock-Utne, MD Santa Clara Valley Medical Center: Clifford Wang, MD

CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Kenneth Blumenfeld, 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 2018 by the Santa Clara County Medical Association.

4 | THE BULLETIN | MAY / JUNE 2018

President Maximiliano Cuevas, MD President-Elect David Ramos, MD Past-President Craig Walls, MD PhD Secretary Alfred Sadler, MD Treasurer Steven Harrison, MD

CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.

DIRECTORS Valerie Barnes, MD Christopher Burke, MD David Holley, MD William Khieu, MD Eliot Light, MD

Phillip Miller, MD Walter Mills, MD James Ramseur, MD Stephen Saglio, MD Diane Sanchez, MD

SCCMA Annual Awards Banquet and Installation Tuesday, June 5, 2018 6:15 pm Social | 7:00 pm Dinner & Program The Fairmont Hotel, San Jose

Installation Kenneth Blumenfeld, MD, SCCMA President 2018-19

2018-Membership has its benefits

Honoring Seham El-Diwany, MD, SCCMA President 2017-18

www.wildatwork.com “Not Yet a Member” Sign in with your Email Company Name: SCCMA/MCMS

Award Honorees Martin Fishman, MD – Robert D. Burnett, MD Legacy Award http://www.beachboardwalk.com/gad/ Sameer Awsare, MD – Benjamin Cory, MD Award Username: SCCMedicalAssociation William Parrish – William C. Parrish, Jr. Leadership in Healthcare Award Password: SCCMA Ruma Kumar, MD – Outstanding Achievement in Medicine Company Code: GAD2017

John Tatman, MD – Contribution in Medical Education

Thomas Dailey, MD – Contribution to the Medical Association

Suchada Nopachai, MD – Contribution to the Community https://cf-ga.secure.accesso.com/embed/store.php?merchant_id=2877&emerchang_id-300 John & Gini Mitchem – Citizen’s Award Username: cga-sccma SCCMA Alliance & Foundation – Special Recognition Award Password: Fun2018

Formal invitations will be mailed by end of April

http://shop.accesso.com/clients/cedarfair/affiliate/login.php?m=4358&ec=600 USERNAME: SCCMA PASSWORD: 2017fun

MCMS Annual Physician of the https://affiliate.montereybayaquarium.org/default.asp Year Banquet and lnstallation STORE NAME: SCCMA1001

Thursday, June 7, 2018 http://shop.accesso.com/clients/accesso18/affiliate/index.php?m=11872 6:30 pm Social | Dinner & Program to follow Username: SCCMA CODE: SCCMA1 Bayonet and Black Horse, Seaside

Installation David Ramos, MD, MCMS President 2018-19

Call Leslie Sorensen (408) 998-8850 or (831) 455-1008

https://shop.sixflags.com/clients/sixflags/affiliate/login.php?m=15780&ec= Honoring Username: SantaClaraDK Maximiliano Cuevas, MD, MCMS President 2017-18 CODE: SixFlags7

Physician of the Year

To Be Announced

https://ticketsatwork.com/tickets/cagreatamerica?&company=SCCMA Company Code: SCCMA

Formal invitations will be mailed by end of April

MAY / JUNE 2018 | THE BULLETIN | 5

President, Santa Clara County Medical Association

SEHAM EL-DIWANY, MD, FAAP

MESSAGE FROM THE

SCCMA PRESIDENT

Farewell to Bill Parrish

Seham El-Diwany, MD, FAAP is the 2017-2018 president of the Santa Clara County Medical Association. She is a board certified pediatrician with The Permanente Medical Group and is currently practicing with Kaiser Permanente San Jose.

6 | THE BULLETIN | MAY / JUNE 2018

I

t is with mixed sadness and gratitude that I announce the retirement of our beloved CEO, William Parrish. After 23 years at the helm as CEO of SCCMA, Bill will retire from his daily responsibilities at the end of June; from July until the end of December he will serve as a consultant to the executive committee and the new CEO. On behalf of the physicians of Santa Clara County past and present, I would like to extend sincere thanks and appreciation to Bill for his long service and accomplishments throughout the years that are too numerous to mention here. Bill also played an integral part in the recruitment and interviewing process for his successor, April Becerra.

Bill’s career spans several decades in the health care field specifically in the South Bay. However, his skills and leadership are well regarded and recognized through California and the nation. In 2005 Bill was named as one of the 100 most influential people in the region. He joined SCCMA in 1995 back in the days when people looked up their dictionaries when they heard the word Google for the first time. Over the subsequent two decades the information technology revolutionized all aspects of life on the planet and the Silicon Valley was its epicenter. The impact could not be more visible as in the medical profession and SCCMA was at the forefront. During Bill’s tenure, SCCMA moved to be a premier and one of the most influential county medical associations in CMA. Prior to joining SCCMA Bill worked for many years at TPMG (Kaiser) as Director of Medical Offices in Santa Clara.

Bill Parrish is a native Californian; he was born and grew up in West San Jose. His parents moved from Texas where he has decided to live in retirement. As a young boy he always enjoyed the long vacations back in Texas. Bill and his wife Luanne have three daughters, Megan, Jessica and Brooke, and five

grandsons Tyler William, Ryan Jackson, Grayson Coy, Lincoln Parrish and Weston Ryan. Bill is an avid outdoors and sports person. He played baseball, football and coached his daughters’ sports teams (softball, soccer, basketball and racquetball). Bill and Luanne bought a ranch near Austin, Texas close to their children and grandchildren who all live in Austin, a parents dream comes true. He plans to do some consulting, raise some animals, travel…. but above all, enjoy his family and his newfound freedom.

It has been a pleasure and delight working with Bill one on one on many projects at SCCMA and making sure of a smooth transition to the new leadership. On behalf of SCCMA, we all wish Bill a productive and blissful retirement.

Care Coordination

President, Monterey County Medical Society

MAXIMILIANO CUEVAS, MD, FACOG

away. Primary care practices noted that it takes about 6-8 weeks for a patient to get an appointment with a specialty consultant (longer in some specialties) and the specialty consultant office corroborated that it takes this long for their next appointment. The question then arises, “Why does it take so long?” Can we consider the possibility of getting an appointment within two weeks? This is where our discussion got “bogged down.” I will continue this part of the discussion when we get into the purpose and importance of the referral as agreed to by patients, primary care providers, and consultants. For now, identifying procedures for shortening the time for the next available appointment is critical. This will require an analysis of the current appointment schedule that we are using to identify first how many patients the schedule will accommodate. Next, evaluate the “No-Show” rate to get an idea of possible availability that might not be used. Armed with this information, staff can schedule additional patients.

This information can also be shared with the “GoTo” person calling in to the office for a consult or a transition of care from the hospital or emergency room. The increased number of filled appointment slots then translates into increased access to needed care for patients and a shortened wait-time for the next available appointment.

Now that the appointment is made, the “Go-To” person must communicate the information back to the referring office letting the office, as well as the patient, know of the date and time of the appointment. The “Go-To” person in each office must get to know the “Go-To” person in each of the referring offices and vice versa. This “network” should provide the linkage needed between offices so that everyone becomes familiar with each other’s process for referring and receiving back the needed information that each physician requires for the ongoing care of the patient. Each office can identify each other’s payer mix to assist families navigate the reimbursement process. It is very useful to have the “Go-To” person create a list of consultants that includes the name of the “Go-To” person in the other office as well as telephone number and details about the best time to call

MESSAGE FROM THE

O

f course, for this to work, all physicians working with a patient share clinical information and have clear, shared expectations about their roles. These physicians work together to keep the patient and their family informed and to ensure that effective referrals and transitions are occurring.

The Care Coordination article carried in the last newsletter inspired some thoughts in some of my colleagues. A quick hallway consult while leaving the operating room one morning provided some of the strategies that I have added to the following discussion on setting up care coordination in the busy office practice. My busy colleagues pointed out that we, all of us, as physicians are responsible and are accountable for making the health care delivery system work well for our patients. After going back and forth on the various issues raised in the discussion, we agreed that we all can make the care coordination model work by making a few quick changes in some of the office workflows that we are currently using.

We agreed that we are accountable for making the delivery system work for our patients. What our discussion focused on was developing the strategies for providing patient support and guidance for navigating the referral and transition process. Our patients usually access our office by making an appointment and we in turn refer our patients for care provided by a consultant or for laboratory testing. In all instances, our patient has to interact with an office staff.

The most important step in this referral or transitions process is to identify who is the person that is making and following up on the referral or the transition of care in the office or in the consultant’s office. In our hallway discussion we referred to this office staff as the “Go-To” person. Think about it; who is the “Go-To” person currently in the office?

This would be the person in the office, who patients can go to, short of speaking directly to the physician, about a question on how soon can an appointment be given.

The next step to consider is the issue of “next available appointment.” It is not uncommon for the next available appointment to be about 6-8 weeks

MCMS PRESIDENT

“Care Coordination is the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.”

Maximiliano Cuevas, MD, FACOG is the 2017-2018 president of the Monterey County Medical Society.

He is currently the Chief Executive Officer at Clinica de Salud del Valle de Salinas.

Continued on page 45 MAY / JUNE 2018 | THE BULLETIN | 7

Starting October 2, all physicians must consult database before prescribing controlled substances

By Katherine Boroski Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload.

On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018.

WHAT PHYSICIANS NEED TO KNOW

Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed 8 | THE BULLETIN | MAY / JUNE 2018

a five-day supply.

Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: • Admitted to a facility for use while on the premises; • In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply; • As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or • Receiving hospice care.

In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.

CMA FIGHTS FOR CURES PROTECTIONS

CMA worked closely with the bill’s author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.

SAVE THE DATE: CURES WEBINAR WITH DOJ ON 8/22

CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet.org/events.

FOR MORE INFORMATION

For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA’s online resource library at www.cmanet.org/ cma-on-call. Nonmembers can purchase documents for $2 per page.

ADDITIONAL RESOURCES:

• CURES website: oag.ca.gov/cures • CURES FAQ: oag.ca.gov/cures/faqs

New Report Shows California’s Progress Addressing Opioid Crisis

The American Medical Association (AMA) recently issued a new report documenting how California’s physician leadership is advancing the fight against the opioid crisis.

The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid use disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017.

“This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders,” said California Medical Association (CMA) President Theodore M. Mazer, MD. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.”

For more details on the report visit endopioid-epidemic.org.

• Medical Board CURES webpage: mbc.ca.gov/cures • CMA CURES webpage: cmanet.org/cures • CMA Safe Prescribing webpage: cmanet.org/safe-prescribing CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov.

Katherine Boroski is Senior Director of Communications for the California Medical Association.

CMA Publishes Safe Prescribing Resources for Physicians

The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose.

The page includes two CMA white papers on opioid prescribing, links to CMA’s health law library resources on the topic, the Medical Board of California’s “Guidelines on Prescribing Controlled Substances for Pain,” a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state’s prescription drug monitoring database.

Members can find the page at cmanet.org/safe-prescribing.

MAY / JUNE 2018 | THE BULLETIN | 9

William C. Parrish, Jr. to Retire as CEO William C. Parrish, Jr., chief executive officer will retire as CEO effective June 30, 2018. Bill will remain as consultant to the Board and his successor, April Becerra until December 31, 2018, at which time he will retire.

Bill has been the chief executive officer since March 1995, and the chairman of its board of directors since January 1, 1999. He joined SCCMA after a 23-year career with The Permanente Medical Group. He is only the third CEO in SCCMA’s existence.

Bill is past chairman and a current member of California’s medical executive committee of the California Medical Association (CMA). He serves on the boards of the Monterey County Medical Society and the South Bay Emergency Directors Association, and the Bureau of Medical Economics. In addition, he serves on NORCAL Mutual Advisory Board (Chair), California Medical Association Governance Committee, CMA’s Benefits Committee (Chair), CMA’s Insurance Committee, CMA CEO Advisory Committee, California Medical Research Institute, and the Ethics Roundtable of Silicon Valley. He is a member of the American Association of Medical Society Executives, and the American Society of Association Executives.

Parrish writes, “I am grateful and deeply honored to have led this great company for the last 23 years. Serving physicians, their patients, and promoting quality healthcare in Santa Clara and Monterey Counties and California has been an extremely rewarding career.

Santa Clara County is very fortunate to have some of the best physicians and healthcare facilities in the world. It’s been my pleasure to be involved with so many caring and brilliant individuals.”

Bill Parrish was recognized for his service on June 5th at the SCCMA Awards Banquet at the Fairmont in downtown San Jose with the newly created William C. Parrish Jr. Leadership in Healthcare Award.

Message From Bill Parrish SOMEWHERE BETWEEN… College; finding the perfect partner; having a family; finding the perfect career; coaching; colleges; weddings; cancer; and grandchildren…

I got old!

SCCMA its members, staff, and leadership has been my second family…

I bleed SCCMA blue! I want to thank you one and all for providing me this wonderful opportunity. My tenure here has been more than a job, more than a career; it’s been a huge part of my life, on both a professional and personal level.

So much so, it was with extremely mixed feelings that I made this decision at this time.

Representing and serving our physicians (the best of the best) in the noblest profession has been indescribably rewarding. Words of gratitude are not sufficient to describe how blessed and thankful I am for my time spent. I’ve met, and gotten to know so many brilliant and caring individuals. Please know how truly special and highly regarded you are and thank you for all you’ve done for me, and the patients you serve.

It’s been stated “find something you love to do and you’ll never have to work a day in your life.”

I’ve found that to be true; I feel honored, fortunate, and blessed, to have had this experience. I have so many to acknowledge personally, but I’ll save that for another venue.

I’ve had the time of my life…I wouldn’t have missed it for the world.

10 | THE BULLETIN | MAY / JUNE 2018

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MAY / JUNE 2018 | THE BULLETIN | 11

THANK YOU FOR YOUR 23 YEARS OF DEDICATION TO SCCMA AND BME, BILL! FROM THE SCCMA-BME STAFF

Through the many 23 years Bill has fostered many relationships within the California Medical Association (CMA), the American Medical Association (AMA), his peers state-wide in the other county medical associations, physicians, his staff, vendors/partners, and the legislators. Bill has mentored new association CEO’s, has often been asked by CMA leadership and his peers to lead TACs/Committees, and advisory boards. He has a quiet but effective leadership style, is well respected by all who work with him, and has always been a big thinker. He is known for his sense of humor and wit, and ability to find solutions to sometimes very difficult problems. He has served tirelessly with groups, hospitals, and sometimes physicians as a mediator and is known to negotiate win-win solutions.

He has also helped physicians with medical staff and bylaw issues giving them guidance, advice, and options to positive outcomes.

12 | THE BULLETIN | MAY / JUNE 2018

Bill was also successful in educating groups about the benefits of being members and how important it is for them to have a "seat at the table." He was successful in leading SCCMA to number one in the state with the most members for over 10 years! Another saying he loves is, “It’s better to be at the table than on the menu.” Bill has been available and accessible to physician members 24/7 and we owe him, and especially his wife, Luanne a debt of gratitude and thanks.

Bill’s legislative advocacy through the years is known, appreciated, and respected by all that know him and have worked with him.

He has helped physicians defeat Proposition 46, which would have quadrupled physician’s malpractice premiums if passed. He was successful in maintaining MICRA (despite the attack by trial lawyers), if passed would have raised the cap on pain and suffering law suits. He

has fought to protect the profession of medicine and has fought for patient’s access to quality care. He has even supported an internal program for the past 10 years to help educate high school students in guiding them to begin thinking about becoming a physician to help with the shortage of doctors in our state.

Last but not least, Bill has always taken care of his staff. His philosophy has always been family comes first. Whether a sick child, loss of spouse, parent or loved one, or a parent in the hospital, he was always beyond gracious and understanding. The word “loyal” does not even begin to describe the relationship he has had with his staff and others. Bill has done so much during his career that there isn’t enough paper or time to list it all. He will be sorely missed by us all.

Jean Cassetta Membership Director for 21 years

When I began working at the Medical Association in 2006, I was a bit apprehensive to have a boss again, I had been working and managing my own business for seven years. Was he going to be a micro-manager, was he going to be demanding and unreasonable. I was pretty amazed, and surprised, of how supportive and encouraging Bill was and continues to be to this day. Bill hired me, then pretty much let me fly solo when stepping into the Reimbursement Advocacy position. He trusted me from day one, without even really knowing me! All the while, knowing that if I needed guidance, his door was always open. I came to find out later that this is how he operates. He hires skilled, capable people and allows them the freedom to develop our niche and make the Association our second home. For 13 years, he has always been supportive and encouraging while also gently pushing me toward bettering myself, and for that, I will always be grateful. Bill Parrish will be sorely missed but he is well-deserved of this time of life to spend with his terrific family in the place that he loves the most! Thank you, Bill, for everything and may the future bring you all that you wish for and deserve.

Sandie Moore Administrative Support Team Certified Medical Coder - Physician Advocate

Thank you for your years of service. I’ve enjoyed working for you and sharing our stories and love of our dogs and our grandchildren! I wish you all the best for your retirement years. Take good care always.

Karen Jorgenson BME Client Relations Director

The amazing success of your tenure as CEO of SCCMA is a tribute to your leadership. The legacy you leave is, in part, due to one of your strengths and biggest accomplishment – the development of strong trusting relationships, combined with effective and compassionate communication – this is the cornerstone of any successful person and organization. In your words “The old adage of ‘its not what you know, but who you know’ seems to ring true. Most good things happen when one combines knowledge and strong relationships.” It has been an honor and a privilege working for you.

You have my utmost respect. Thank you for everything and best

wishes for a happy and healthy retirement. Time to make some more wonderful memories with your beautiful family!

Pam Jensen Managing Editor

Your encouragement and kindness will not be forgotten. I am proud to work with a team of achievers, whom you have mentored for many years and who continue to deliver excellent service to the members.

I have learned a lot from your wealth of experience, more than you can ever guess. Your energy and devotion to the role of CEO will be difficult to match and truly missed, but you leave SCCMA a better organization and on a strong footing for those who follow you. Thank you.

April Becerra, CAE Chief Operating Officer

I want to thank you for the opportunity to work for and with you for the past three years. You have been an amazing mentor, leader, and person. All of these qualities have made me feel welcomed and has made coming to work much more enjoyable than I could have imagined. I hope you enjoy retirement and the next chapter of your life with your family in Texas, but don’t forget your family here in California.

Leslie Sorensen Membership Coordinator

You will be missed every day. You are simply the best person, best boss and best friend anybody could hope for. Your loyalty, patience, guidance and humor kept SCCMA a wonderful place to call home for all these years. Here is wishing you a very well deserved and happy retirement! Enjoy every minute with your family and keep having FUN!!

Shannon Landers Lead Bookkeeper

You have been a business partner, friend, and mentor to me.

We both came on board working together about the same time, but it wasn’t until I worked with you as an employee of BME that I truly understood what it is to work with someone who deserves all of the accolades you will be receiving leading up to your retirement. Through work and friendship, we have seen all facets. You have been there as a friend during some difficult personal losses in my life. You were a comforting friend. I can honestly say I have never gone to a Giants game in a business suit before you, on one of many occasions, surprised me by taking me to a game. Though I was the only guy in the park that looked like he had been transported from a 1950’s ballgame, it was a fantastic day at “the yard,” and it was one of many such fun times. I ditched the jacket and tie, I seriously don’t know how the guys in the old pictures managed on hot days. We have had many good times and memories. Thank you for your valued friendship. You have earned this time to be with the important people in your life, family and friends. Enjoy my friend.

Mark Christiansen BME General Manager MAY / JUNE 2018 | THE BULLETIN | 13

If

By Rudyard Kipling

If you can keep your head when all about you Are losing theirs and blaming it on you; If you can trust yourself when all men doubt you, But make allowance for their doubting too: If you can wait and not be tired by waiting, Or, being lied about, don’t deal in lies, Or being hated don’t give way to hating, And yet don’t look too good, nor talk too wise; If you can dream – and not make dreams your master; If you can think – and not make thoughts your aim, If you can meet with Triumph and Disaster And treat those two impostors just the same:.

If you can bear to hear the truth you’ve spoken Twisted by knaves to make a trap for fools, Or watch the things you gave your life to, broken, And stoop and build’em up with worn-out tools; If you can make one heap of all your winnings And risk it on one turn of pitch-and-toss, And lose, and start again at your beginnings, And never breathe a word about your loss: If you can force your heart and nerve and sinew To serve your turn long after they are gone, And so hold on when there is nothing in you Except the Will which says to them: “Hold on!”

If you can talk with crowds and keep your virtue, Or walk with Kings – nor lose the common touch, If neither foes nor loving friends can hurt you, If all men count with you, but none too much: If you can fill the unforgiving minute With sixty seconds’ worth of distance run, Yours is the Earth and everything that’s in it, And - which is more - you’ll be a Man, my son!

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Bill, We Thank You and Wish You the Best in Your Retirement!

The Bill I know is the man who has given his all for the success of SCCMA and Monterey County Medical Society. He had the success and its sterling reputation known all throughout California always in his heart. There were many moments which tested his responsibility and integrity as our CEO. Yet he stood tall and stayed focused on the goals of these two organizations. He held his head high when he was challenged by forces and opinions beyond his control. He was dignified all throughout.

With the support of his loving wife, Luanne, buoyed by the love of his daughters and their family and friends he sailed through his battles to beat his cancer and won.

I have seen him offer his expertise when his opinions were called into play. He has respected us as physicians and we, him. And that is why the poem IF (by Rudyard Kipling) speaks of who Bill Parrish is… a MAN. Eleanor Martinez, MD Past President, SCCMA 2015-16

More About The Poem “If” and Rudyard Kipling Were you to write the biography of Rudyard Kipling as a graph, the first thing that would strike you would be the steep vertical zigzags. The chart would have to start on a high point: his birth in India to a loving set of parents. His childhood would continue for a short period along an upward slope in the wonderland where he was born, and then plunge dramatically at the age of six when he was sent to England for his education. His first five years in England were scarred by the terrible abuse that he endured there from his foster mother. His only break during that period was the holiday month of December, when he would head to London to stay with his mother’s family. After that period he was transferred to a school in Devon where he shone, becoming the editor of the school paper and embarking on his path as a writer, becoming a major success. He was struck by misfortune once more when the bank where he kept his savings collapsed leaving him penniless. He moved to America and continued writing, publishing The Jungle Book along with many other works of fiction. He again hit a low point when he became embroiled in a fight with his brotherin-law which landed them both in court and in local papers, forcing his move back to England. On a trip to America in 1899 his daughter Josephine died of pneumonia at the age of seven, leaving him heartbroken. The wheel continued to turn however, and in 1907 he was awarded the Nobel Prize in Literature for his outstanding work.

An avowed proponent of British involvement in the first World War, he encouraged his son John to enlist. When he failed the physical, Kipling used his connections to get him in, only to watch him die in the battle for Loos leaving him awash in guilt.

His life was one replete with trials and hardships, sorrows which one could never fault anyone for crumbling beneath, but which time and time again he overcame.

This poem, published three years after he won the Nobel Prize, encapsulates the lessons that he learned and that he considered to be the keys to his success. Part of it is engraved on the entrance to Wimbledon to remind players of what it is that makes a man.

Source: https://www.familyfriendpoems.com/poem/if-by-rudyard-kipling

Bill is highly regarded and considered a “steady hand” to the county medical society executives of California and across the country. I have personally valued his friendship, counsel, and support when dealing with difficult issues affecting me professionally and personally. His creativity and innovation in developing new ways to support physicians, and his forthrightness in standing up for the integrity and value of county medical associations, has been instructive and energizing to me and all my colleagues. His leadership will be missed, as will the opportunity to spend time with him. Congratulations on a well-deserved retirement Bill!

Donald Waters Executive Director 1982-2017 Alameda-Contra Costa Medical Association

Have a wonderful, happy and healthy retirement as you have earned it! Yours will be big shoes to fill for your successor.

Under your leadership the medical association grew in size and stature as one of the most well run and organized in California if not the nation.

Your quiet, effective leadership style and dedication to preserving the sanctity of physician practice and doctor patient relationship has been exemplary and effective.

You will be missed.

Rajan Bhandari, MD Physician-In-Chief, Kaiser San Jose (recently retired)

I have known Bill Parrish since the 1980’s when he started working in the Pathology Department at Kaiser Permanente Santa Clara. He worked his way up to Laboratory Manager and then to Assistant Administrator of the Hospital. When Howard Pearce retired as CEO of the Santa Clara County Medical Association, he applied for the position, was interviewed and hired. Due to his business acumen, his negotiating ability, his sense of humor and his striving for excellence, he has built the SCCMA into probably the greatest force, after the CMA, for organized medicine in this state. We are very fortunate to have had Bill lead our organization for these many years and I also feel fortunate calling him my friend.

Tony Nespole, MD Past President, SCCMA 1989-90

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Quiet Leadership Rare is the individual who possesses the business acumen to consistently discern the complexities of emotionally charged issues, the empathy to understand both the political and personal implications, the analytical skills to accurately dissect the issues down to their core components and the diplomatic skills to present them in such an objective manner that the physicians who ultimately adjudicate them do so under the illusion that such matters could not have been more simple to resolve.

Imagine the intellectual prowess required to grapple with issues of such importance they set the health standard for the largest state in the union, with greater than 10% of the nation’s population.

Consider the discipline necessary to never allow yourself to become embroiled in the often passionate and sometimes angry debates that ensue.

And recognize the remarkable humility possessed by one of such superlative skills that he would choose to fade to the background so as to never obfuscate the essential processes of their critical mission.

William (Bill) Parrish is that person.

Chief executive, administrator, counselor, accountant, auditor, ambassador and advocate. How unique it is that an individual could wear so many hats and yet not get a head too big to enter a room.

Always a friend of physicians, Bill has toiled tirelessly and frequently sacrificed time from family to ably represent the Santa Clara County Medical Association, the Monterey County Medical Society, and the California Medical Association for 23 years.

Those of us who have had the good fortune to develop a personal relationship with this man have come to appreciate the personal integrity and quiet oversight he brings to each of his endeavors.

He leaves behind a legacy that consists of an unblemished record of achievement, a staff of maximally capable individuals prepared to continue working at peak performance levels and hundreds of appreciative physicians whose careers he has bolstered and whose lives he has enriched.

Thank you, Bill. We owe a debt of gratitude that can never be repaid.

When you finally pause and take the time to look back, we hope you relish your many accomplishments. As you close out your stellar career, I pray we take the time to individually acknowledge the important role you have played in our lives. And in the future, we wish you nothing but daily enjoyment with your family and years of good health.

Be well, my friend. You will be sorely missed.

James E. Ramseur, Jr, MD Past President, MCMS 2011-12

I've had the honor to work with Bill Parrish for over 20 years, in various positions with SCCMA and CMA. He deserves credit for the immense amount of effort, skill and experience he has brought to our associations. We owe him the highest recognition for making us what we are today, a vibrant and leading voice for our patients and colleagues. We would not be here without him.

Martin Fishman, MD Past President, SCCMA 2002-03 Past CMA Trustee 2005-14

During my career I had the opportunity to work with some tremendously talented individuals. Bill has always been truly committed to professionally serving his members, trying to make sure that they had everything they needed to run their practices. If he could make their lives easier, he made it happen.

Sometimes you get lucky and the opportunity grows into a friendship that lasts a lifetime. Bill’s friendship is a treasure at the top of my list. Bill, along with our lovely wives Luanne and Teri, have shared many memorable trips together. We look forward to Bill’s retirement so when he’s ready to take a break from Texas, we can enjoy many new adventures in the years ahead. Congratulations on your retirement good friend!!!

Roy S. Lyons

It seems like yesterday we met each other at our first MEC meeting ~ 23 years ago!

Thank you for your leadership, keen insights, calm demeanor and especially for the friendship we have developed – beyond that of just colleagues. It’s not often that you work with people over such a long period of time and get to know and watch their families grow and share in the joys and heartbreak as we move through life events.

Thank you for being you and for your friendship and guidance. I will miss you – but wish you only the best in this next phase in your wonderful life. You deserve every amazing experience retirement has to offer!

Love to you.

Dolores Green Executive Director Riverside County Medical Association

I would like to recognize Bill Parrish for his leadership of SCCMA as CEO for the last 23 years. Under his leadership the SCCMA has grown to be the largest county medical association in our state. Bill’s leadership has led to the betterment of the medical profession in our county, state and nation. His tireless advocacy has benefited our patients and physicians. Bill is a collaborator and had the foresight to partner with the Monterey County Medical Society so that it could work together with the SCCMA on issues that are important to our patients and physicians. On a personal note I want to thank Bill for his friendship and for his support and mentoring during the time I was on the SCCMA Council and as President. Bill, I wish you the very best in your retirement and hope our paths cross in the future.

Sameer V. Awsare, MD Past President, SCCMA 2013-14

I feel honored to be invited to send greetings to Bill on the occasion of his retirement. Given I retired 18 years ago, I will leave the laudatory comments regarding his accomplishments, service, commitment, and so forth, to those who have enjoyed a more contemporaneous association, and focus instead on the qualities of the man who was my boss, my colleague, and remains my friend.

In 1995, upon the retirement of Howard Pearce, I was invited, by the then SCCMA President, John Granato, to serve on the Search Committee, charged with identifying a new Executive Director. Hands down, Bill was my first choice from the very start of the interview process.

His ultimate selection was fortuitous for the SCCMA and for me. While we only worked together for six years before my retirement in 2001 after 40 years of service with the SCCMA, Bill and I enjoyed an almost instant rapport. We often marveled at our compatibility and the mutual satisfaction our partnership produced. Given I was an employee of long standing, and knew all the nuts & bolts, and Bill was the “new kid on the block,” it could have been dicey. It wasn’t. Bill told me he would always keep me in the loop. He did. We conferred, he sought my opinion, we laughed, confided, and most importantly did, in our estimation, some excellent work together. I will always be grateful for Bill’s kindness, his sense of fair play, generosity of spirit, and friendship.

It is with great affection, that I wish him a happy retirement. Love and Happy Trails to Bill and Luanne.

Suzanne Finklang SCCMA Alumna

MAY / JUNE 2018 | THE BULLETIN | 17

Bill’s retirement indeed marks the end of an era. What an era it has been! I am proud to have been a participant in the process that led to Bill’s hiring. Not only did we “get it right,” we could not possibly have done any better. The growth and development of SCCMA under his oversight is nothing short of magnificent. It has been a joy to see organized medicine thrive here during a time when, overall, it is beset by myriad difficulties.

On top of all that, he is the only other person I know who frequented Craterville Amusement Park as a small boy. Just one more distinction!

Bill, I wish you all the very best in your upcoming retirement. I know you’ll be as successful there as you have been in all else that you have done over the years.

Joseph E. Mason, Jr, MD Past President, SCCMA 1997-98

For nigh unto a quarter century Bill Parrish has honorably served as the master of our vessel, the Santa Clara County Medical Association (SCCMA). He has been our compass setting our goals; he has been our main sail powering us onward; he has been our rudder steering us straight; he has been our ballast providing stability, and; he has been our anchor assuring security. He and his able crew sailed our vessel strategically over calm seas, as well as over a few memorable episodes of the “perfect storm”. Yet, no matter what, he never wavered. Rather he succeeded in making the SCCMA, one of the most successful and one of the largest county medical societies in the nation -- one that is admired and envied by other societies.

Over these many years I came to recognize and admire Bill’s many talents. He became a good friend, professionally and personally. He always was gracious in responding to my needs for advice, support and succor.

For this I will be forever grateful.

Bill, speaking for myself, for my family and my friends, thank you for all the time you have spent with us. You have rightfully earned your retirement and all the blessings it brings. We all wish you a good, healthy and happy long life filled with serenity, pleasurable adventures and fulfillment.

With all my respect, admiration and affection.

Philipp M. Lippe, MD Past President, SCCMA 1978-99

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When it comes to med execs, Bill is among the best of the best. His passion for organized medicine, his creativity in developing member benefit programs, his smart strategic thinking, and his unwavering commitment to the betterment of the medical profession are just some of the reasons Bill has become such an accomplished medical association executive. Bill has been a role model, counselor and friend to many of his medical association colleagues around the state. His leadership and mentorship has been much appreciated by me and many others, and he will be sorely missed. Thank you, Bill – have a wonderful retirement!

Joe Greaves Executive Director Alameda-Contra Costa Medical Association

It is difficult to imagine the Santa Clara County Medical Association without you.

Through the yearly rotation of presidents and officers the stability of our organization came from your subtle (and sometimes not so subtle) guiding hand that served to keep us all on track. If it is said that getting doctors to work collaboratively in the workplace is like herding cats, what analogy can possibly capture the challenge of having physicians from different locations and modes of practice coordinate to become an effective political force. Somehow, you always helped us accomplish this seemingly impossible feat. I will miss your wisdom, your vision, and especially your calming manner. Congratulations and thank you for your years of service. It has gone by too quickly…..

Tom Dailey, MD Past President, SCCMA 2010-11 CMA Trustee

You are a true leader who has inspired us all. You have modeled integrity, humility and persistence despite setbacks. You have given us the vision and reality of a smooth-running organization in the SCCMA. You have enabled physicians in different practice modes and with different perspectives to work together effectively and respectfully for the common good – ourselves, our patients and our communities. You have assembled a dedicated and skilled staff that we all appreciate and depend on. Thank you for all you have done for the SCCMA and the medical community at large. Your good work will continue. We will miss you. Enjoy your well-deserved retirement with your lovely family.

Cindy Russell, MD Vice President Community Health, SCCMA

Physicians here should all thank you for all you have done for medicine in your career at SCCMA, but I want to especially thank you for all you taught me when I was a medical association officer. In well run not-for-profit organizations, there is a dynamic tension between the volunteer (in our case physician) leadership, and the organization's professional staff. When managed well the relationship yields great benefits for the organization and growth and satisfaction for those involved with it.

Thank you for supporting me and being accountable to me in my career with SCCMA. I am very fortunate to have been able to put the lessons I learned working with you to good use afterwards. It was a pleasure and a great honor to serve with you. Best of luck to you!

Elliot Lepler, MD Past President, SCCMA 1998-99

Bill, it has been an honor and pleasure working with you so closely over the past 20 years. It has been marvelous to see the Association grow and prosper under your leadership. You truly are a visionary and I admire how you took over the reins of the SCCMA and developed it to where it is today. You have also built a great team at the SCCMA and the BME with whom we at Legacy have enjoyed working with immensely. Your efforts have laid a foundation for the next era, and it’s wonderful to see April taking the baton from you to carry forward that tradition. You will be sorely missed. We know that you won’t be just “retiring” and that there will be many wonderful years ahead. You and Luanne will have time to enjoy your children and grandchildren in beautiful Austin, TX; but with your active mind and spirit there is bound to be a new chapter of accomplishments ahead of you. We fondly recall many SCCMA and MCMS Award Banquets over the years that we attended, but one of our favorite memories, as shown here, was the MCMS Banquet held at the Del Monte Beach House in Monterey. We at Legacy, as well as I personally, will treasure the memories of the past 20 years and look forward to hearing about your future endeavors and successes.

Best wishes for a well-deserved retirement!

Ed Ryu President, Legacy Wealth Advisors, LLC

“Bill’s contribution to the betterment of life for practicing doctors is simply immeasurable. I learned from him how to help other doctors. More importantly, I learned how to look for ways to help other doctors. He was always a steady personality, even when we were attacked and disrespected as a profession. Never angry, always optimistic, he brightened a lot of days for us doctors and made our world better.”

Jim Hinsdale, MD Past President, SCCMA 1999-00 Past President, CMA 2010 AMA Delegate

Bill, congratulations on your well earned retirement. I have enjoyed the pleasure and benefit of our professional and personal relationship over the many years we have worked together. You have consistently demonstrated impressive skill and leadership in your career representing the interests of physicians in Santa Clara and statewide in a professional and respectful style. Your successful record of creating growth in the membership, positive influence in addressing California and national medical issues, and the respect of your colleagues and allied associations is one that should bring you great pride and satisfaction in your retirement. Your ability to reach out to other organizations and create alliances to create and promote the many successful programs, policy issues and member benefits the SCCMA and other Bay Area associations is a model that should be emulated throughout the country.

Thank you for the great memories of our many years of working together and always being a great colleague who could be relied on to bring loyal and successful support.

Enjoy your retirement!

Bill Guertin Executive Director (Retired) Alameda-Contra Costa Medical Association

MAY / JUNE 2018 | THE BULLETIN | 19

Great Moments in Medical History The Birth of American Gynecology & Gynecological Surgery — Part 2

By Gerald E. Trobough, MD Leon P. Fox Medical History Committee Part 1 described the great accomplishments of Dr. Ephraim McDowell in the early part of the nineteenth century. The second American to achieve fame in the field of gynecology was Dr. James Marion Sims.

Marion Sims (1813-1883) was born in South Carolina and was the oldest of eight children. Despite the urging of his mother to become a minister and that of his father to become a lawyer, Sims chose medicine.

He registered for lectures at the Medical College of Charleston, graduating at the age of 21 in 1834. The following year, he went to Jefferson Medical College in Philadelphia receiving an MD degree in 1835.

Sims initially established a practice in Lancaster, South Carolina but felt insecure in caring for patients. He wrote in his autobiography that he had seen little sickness and had no hospital experience. To undermine his confidence even more, the first two patients he attended were infants and both died under his care. He seriously considered giving up medicine.

The young doctor decided to move to the frontier town of Mount Meigs, in Alabama and establish his practice. It was there his fortunes changed. His surgical patients survived, his medical patients improved and his practice thrived. After three years in Mount Meigs, Sims and his family contracted severe cases of malaria. He was determined to seek a 20 | THE BULLETIN | MAY / JUNE 2018

healthier climate for his family and moved to Montgomery, Alabama.

In Montgomery, Sims regained his health and became recognized as an excellent physician and outstanding surgeon. He had an unusual aptitude for surgery and treated a wide variety of conditions including club feet, cleft lip and strabismus eye surgery. He wrote his first paper that was published in a major dental journal referencing an operation to correct a cleft lip and a deformed upper jaw. To recover his surgical patients, he built a one story frame building in the rear of his homestead that would accommodate eight patients.

Until 1845, Dr. Sims had little interest in treating women. However, in June, 1845, Marion was called in consultation to help a 17-year-old slave girl who had been in labor for 72 hours. Sims successfully delivered the child with forceps, but the patient, whose name was Anarcha, was left with complete urinary incontinence. Sims was touched by her tragic condition.

He explored the literature, searching for surgical treatments. The repair of vesico-vaginal fistulas appeared to be an incurable condition. The fistulas occurred after childbirth when the fetal head was impacted in the pelvis and it obstructed blood flow to anterior vaginal wall causing necrosis.

Over the next two months, Sims was asked to see two other slave girls Betsy and Lucy, who also had vesico-vaginal fistulas. He had decided to tell the girls and the owners their cases were hopeless and he could not help them. Several days later, Sims was called to see a woman who was thrown from her horse and developed severe pelvic pain. Sims wrote, “If

there was anything I hated, it was investigating the organs of the female pelvis. But this poor woman was in such a condition that I was obligated to find out what was the matter with her. I did a digital exam and found there was an acute retroversion of her uterus …”. He remembered from one of his medical school lectures about putting a patient in the knee-chest position. In this position he was able to push the impacted, retroverted uterus out of the pelvis. The patient was cured of her pain instantly.

Sims thought if he could place one of the vesico-vaginal fistula patients in the knee chest position, he could see the relationship of the fistula to the surrounding tissues. On his way to the office, he stopped by a store and purchased a large pewter spoon. With the help of two assistants, he put his patient in the knee-chest position. He bent the handle of the spoon 90 degrees and then inserted the bowl of the spoon into the vagina. He was able to retract the rectum upward exposing the anterior wall of the vagina.

He wrote, “I saw everything, as no man has seen before. The fistula was as plain as the nose on a man’s face. Why cannot these things be cured.”

He was so confident he sent for the three patients and told the owners he would put them up at his expense until they were well.

For the next four years, Sims experimented with a number of slave girls with fistulas. His first operations were failures. While the fistulas were smaller, infections developed around the silk sutures he used. The smaller fistulas leaked as much as the larger ones. Finally, in 1849, on the thirtieth operation on Anarcha, he used pure silver wires as sutures and securing them with pieces of lead and the operation was successful. No infection occurred around the silver sutures. In the next two weeks he cured Betsy and Lucy using the same techniques.

Sims was criticized for doing human experimentation on slave girls. He did not use anesthesia even though ether had become available 5-10 years earlier. Anesthesia was not fully accepted into surgical practices at this time. He did use opium after their surgeries which was an accepted therapeutic practice of the day.

To develop his technique of the fistula repair, Sims introduced the Sims position (a lateral position with thighs flexed onto abdomen) and a special curved retractor called a Sims speculum. He also developed an indwelling catheter to keep the bladder empty while the fistula was healing and he learned the value of using silver wire for the repair to avoid sepsis. For his dedication and ingenuity he deserves great credit.

He sacrificed his good office practice and income, four years of his life and he maintained six or seven slaves for four years.

Weeks after his successful fistula surgery, Sims developed severe dysentery that was often fatal in patients living in Southern States.

For this reason, Sims and his family moved to New York. Being acutely ill and fearing death, Sims published his series of fistula repair in the American Journal of Medical Sciences in January, 1852. Initially, that article met with some skepticism.

Sims struggled to get a foothold in New York City. He was in poor health, his money depleted and jealousy from his colleagues held him back. His conviction that women deserved greater consideration by the medical profession led to the idea of a specialty hospital for the care of women. He had little support from the New York physicians. Fortunately, he befriended a free-lance writer, named Henri Stuart, who knew many of the wealthy philanthropic leaders in New York City. With their help he was able to plan and construct the Women’s Hospital of New York. It opened on May 4, 1855 and was the first women’s hospital in the United States.

Initially, Dr. Sims was the only staff member.

Gradually, the staff grew and it became a teaching hospital for gynecological procedures.

During the Civil War, Marion Sims and his family moved to Europe. His southern sympathies were unpopular in New York. In 18701871, he served as a military surgeon in the Franco-Prussian War. For his impartial service to wounded soldiers, Sims was decorated by both the French and German governments. He was also named personal surgeon to Empress Eugenie of France and treated her for several years.

Sims returned to New York and the Women’s Hospital in 1872. In 1874, he was prohibited from admitting a cancer patient to the hospital because the Board of the Hospital felt cancer was a contagious disease. The distraught Sims resigned from the hospital. Determined to provide care, Sims was instrumental in forming the first cancer institute called the New York Cancer Hospital in 1874.

Sims was elected President of the AMA, serving from 1876 to 1877. In 1878, he described an operation for the removal of gall stones that

J. Marion Sims he named cholecystectomy. In 1880, Dr. Sims was elected president of the American Gynecological Society. At age 71, Sims was writing his autobiography when he suddenly died of an apparent heart attack on November 13, 1883.

Dr. J. Marion Sims, who is considered to be the father of modern gynecology, developed surgical techniques and invented new instruments to complete his surgery. His most significant accomplishment was the successful repair of vesico-vaginal fistula. He taught this procedure to many American physicians at the women’s hospital he had founded. He also carried his brilliant ideas and techniques to Europe.

Trained physicians provided relief of urinary incontinence to thousands of women worldwide who were afflicted with a heretofore hopeless and incurable condition.

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 serving as chairman of this committee, please contact Pam Jensen at SCCMA at (408) 998-8850 or pjensen@sccma.org.

MAY / JUNE 2018 | THE BULLETIN | 21

CMA Defeats Dangerous Rate Setting Proposal AB 3087 would have decimated California’s health care delivery system

I

n late May, the California Medical Association (CMA) killed a reckless legislative proposal that would have put a new government bureaucracy in charge of health care. Assembly Bill 3087 (Kalra) would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. By unilaterally setting the price for all medical services, the bill would have essentially eliminated the commercial health care market in California.

Due in large part to staunch opposition led by CMA, the bill died in the Assembly Appropriations Committee.

“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said CMA President Theodore M. Mazer, MD. “Had this bill passed, it would have reversed the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.” Since passage of the ACA, the state’s uninsured rate has dropped to an all-time low of 7.1 percent.

A GROUNDSWELL OF PHYSICIAN OPPOSITION

Key to the bill’s demise was a groundswell of physician opposition. Through CMA’s Grassroots Action Center, thousands of physician members contacted their legislators because AB 3087 would have: • Decimated California’s health care delivery system.

• Disrupted care and limited choice for millions of California patients.

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• Caused 175,000 health care workers to lose their jobs.

• Forced hospitals to close and pushed health care providers into early retirement.

• Caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

THE WRONG ANSWER TO A REAL PROBLEM

This poorly conceived legislation would have done nothing to solve the fundamental problems of the health care payment system.

“Simply setting physician rates without addressing the rising cost of providing care will do nothing to address health care spending,” said San Francisco pediatrician Shannon Udovic-Constant, MD, vice chair of the CMA Board of Trustees. “AB 3087 would have driven a lot of physicians out of our state, and it doesn’t address the underlying reasons around rising health care costs in our state.”

This dangerous rate setting proposal would have also moved California away from value-based care and universal access, backwards to an antiquated fee-for-service model that discourages contracting and stifles innovation. Instead of addressing the underlying issues, this bill would have forced hospitals to close, pushed health care providers into early retirement and caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

MEDICARE SHOULD NOT BE A BENCHMARK FOR COSTS

AB 3087 WOULD HAVE DRIVEN CALIFORNIA’S PHYSICIANS OUT

AB 3087 also ignored the recommendations from the University of California, San Francisco’s report—commissioned by the Assembly—to achieve universal access to health care, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas.

Currently, six of nine California regions are facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030—a 32 percent increase.

“AB 3087 would have caused an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” said Dr. Mazer. “When I look at the economics of my own practice, it’s enough to tell me that I could not survive that environment and continue to see Medi-Cal patients. And probably at this stage of my career, it would drive me out of practice earlier that I might otherwise.”

The bill also operated on the false premise that the cost of professional services—in other words, what physicians and hospitals charge for their services—is what’s behind the increase in health care spending in California.

Data shows, however, that the price of prescription drugs and increases in health care utilization are what’s driving health care spending growth. Professional services had relatively low impact on spending growth. In fact, nationally, California had lower than average annual growth in per capita spending on physician and clinical services over the past 20 years. The primary driver of spending on doctor visits is increased utilization, not price.

“Physicians want real solutions to these problems too,” said Valencia Walker, MD, chair of the CMA Council on Legislation. “We remain focused on real solutions that would protect the access and coverage gains made under the ACA, further value-based care, ensure patients can access health care in a timely and affordable manner, and tackle California’s health care workforce shortage.”

“We could not have dealt this bill such a resounding defeat without the united voices of our physician members. Together, we stand stronger.”

AB 3087 would have required the commission to cap prices for commercial payments for all services to Medicare rates, which is a fundamentally flawed approach that does not address coverage and benefits or the costs to provide care.

Medicare was created to reimburse medical services for an age-specific population based on federal budgetary and regulatory constraints. Medicare rates do not keep up with inflation or the cost of running a practice.

Adjusted for inflation in practice costs, Medicare physician pay has declined 19 percent from 2001 to 2017, or by 1.3 percent per year on average. Medicare rates are not intended to represent the fair market value of health care services. Rather, they fluctuate based on variables unrelated to the services provided, such as the federal budget.

AB 3087 DID NOT ADDRESS MEDI-CAL RATES

Medi-Cal is the largest Medicaid program in the nation, with 13.5 million people—about one-third of the state’s population—enrolled in the program. And yet, California still pays among the lowest reimbursement rates of all 50 states, creating a serious access issue for patients.

California’s Medi-Cal rates don’t come close to covering the cost of providing care—meaning that physicians lose money for every Medi-Cal patient they serve. Due to low Medi-Cal rates, physicians must make up revenue through their commercial contracts to keep their doors open.

Because the AB 3087 proposal did nothing to address California’s substandard Medi-Cal rates, hospitals and health care providers would have continued to be underpaid by these governmental programs, putting them in an untenable situation.

CALIFORNIA PHYSICIANS: THANK YOU FOR YOUR SUPPORT

“I want to thank each of you for your support and dedication to CMA,” said Dr. Mazer. “We could not have dealt this bill such a resounding defeat without the united voices of our physician members. Together, we stand stronger.”

CMA applauds the Assembly for recognizing that this deeply flawed legislation would result in enormous costs to the state and restricted access to care for millions. CMA remains fully committed to working with stakeholders on a practical solution that addresses the affordability and accessibility of health care in California.

JOIN THE FIGHT TO PROTECT MEDICINE

Your voice is key to our success. All you need is the desire to make an impact, and CMA will give you the rest. Join CMA’s Physician Advocate Program today! Learn more at www.cmanet.org.

MAY / JUNE 2018 | THE BULLETIN | 23

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MAY / JUNE 2018 | THE BULLETIN | 25

SCCMA/MCMS Members Lead at CMA’s Legislative Advocacy Day

T

he California Medical Association kicked off its 44th Annual Legislative Advocacy Day on April 18th. The SCCMA and MCMS had approximately 30 physicians, residents and students who joined over 500 California physicians, residents and medical students to meet with legislators to share their voice and concern over AB 3087. With a record turnout of physician leaders and a unified voice advocating around the potential negative impact of AB 3087, it was a tremendously successful day at the Capitol.

The day kicked off with a briefing delivered by Janus Norman, CMA’s Senior Vice President, Centers for Government Relations and Political Operations, regarding the harmful impacts of AB 3087, a bill that was introduced on Monday, April 9, 2018, by Assemblymember Ash Kalra (D-San Jose). Assembly Bill 3087 would establish an undemocratic, government-run commission with nine political appointees who would unilaterally set the price for all medical services that are not already controlled by the government, essentially eliminating commercial healthcare markets in California.

The SCCMA, MCMS members visited with Assembly members Ash Kalra and Mark Stone, co-sponsors of the bill. Additionally, we spoke to nearly all of our County representatives delivering a unified and focused message on opposing the bill and educating lawmakers on the consequences of passing such a bill.

As a physician and member of SCCMA and MCMS, you have a strong and credible voice that can be used in defeating dangerous legislation that would harm your practice and patients.

We are happy to report that in late May, due in large part to staunch opposition led by CMA, the bill died in the Assembly Appropriations Committee.

Leg Day provides a unique opportunity for physician members to go to the Capitol throughout the day to meet with legislators on a variety of healthcare issues affecting communities and healthcare practices throughout the state. We hope you consider joining us in 2019 so our elected representatives can hear directly from you.

26 | THE BULLETIN | MAY / JUNE 2018

MAY / JUNE 2018 | THE BULLETIN | 27

New Apple API Offers Patients Personalized, More Holistic Use of Health Records

The Medisafe app will integrate with Apple’s Health Records API to help consumers keep track of medications and learn about harmful drug-drug interactions. Photo via Apple.com Apple recently released a Health Records API for developers and researchers to create an ecosystem of apps that use health record data to better manage medications, nutrition plans, diagnosed diseases and more. The Health Records feature allows patients of more than 500 hospitals and clinics to access medical information from various institutions organized into one view on their iPhone.

Consumers will be able to share medical records from multiple hospitals, helping them improve their overall health.

“Medical information may be the most important personal information to a consumer, and offering access to Health Records was the first step in empowering them. Now, with the potential of Health Records information paired with HealthKit data, patients are on the path to receiving a holistic view of their health,” said Jeff Williams, Apple’s chief operating officer, in a statement. “With the Health Records API open to our incredible community of developers and researchers, consumers can personalize their health needs with the apps they use every day.”

Health Records data is encrypted on iPhone and protected with the consumer’s iPhone passcode. When consumers choose to share their health record data with trusted apps, the data flows directly from HealthKit to the third-party app and is not sent to Apple’s servers.

Developers building health apps can individualize experiences, with the user’s permission, based on the user’s unique health history across key categories, including: 28 | THE BULLETIN | MAY / JUNE 2018

Medication Tracking: Medisafe, a medication management app, will connect with the Health Records feature so consumers can easily import their prescription list without manual entry, quickly enabling pill reminders and allowing the user to receive relevant medication information. Medisafe will be able to warn patients of problematic drug-drug interactions because they have the comprehensive view of the patient’s exact medication list from several hospitals and clinics.

Disease Management: A diabetes app could access a patient’s lab results from their Health Records as well as their diet and exercise details through the existing iOS HealthKit integration, allowing for a more complete picture of the consumer and the best ways to encourage them to stay on track.

Nutrition Planning: A healthy eating app could offer consumers tailored programs based on their high blood pressure or cholesterol results by serving up low salt or high fiber meal plans.

Medical Research: With the new Health Records API, doctors can integrate patient medical data into their ResearchKit study apps for a more complete view of their participants’ health background.

Traditionally, researchers used arduous survey questionnaires to determine pre-existing conditions, which puts the burden on the patient to remember the details. Now, with the participants’ approval, researchers can access that patient-specific information to ensure more comprehensive research. This integration continues Apple’s commitment to providing the medical community with ResearchKit tools that could further their discoveries.

Patients of more than 500 hospitals and clinics can access their medical records in one view. Photo via Apple.com

Stanford Symposium Presents Poll Results Reflecting Physicians’ Views on Using EHRs American physicians want substantial improvements in the way electronic health records (EHRs) work, according to new research by Stanford Medicine, conducted by The Harris Poll.

In a poll conducted online of over 500 primary care physicians (PCPs), respondents expressed a range of views on the current state of EHRs, the impact EHRs have had on their professional satisfaction, and their potential as clinical tools. The results were presented recently at a national symposium hosted by Stanford Medicine, at which health leaders convened to discuss the future of EHR technology.

PHYSICIANS SEE VALUE IN EHRS BUT WANT SUBSTANTIAL IMPROVEMENT Sixty-three percent of physicians think EHRs have generally led to improved patient care, and 66% are at least somewhat satisfied with their current systems; however, a large portion see room for improvement.

• 59% think EHRs need a complete overhaul • 40% believe there are more challenges with EHRs than benefits • Only 18% reported being “very satisfied” with their current systems

PCPs POINT TO EHRs AS DETRACTING FROM PROFESSIONAL SATISFACTION AND CLINICAL EFFECTIVENESS; MOST BELIEVE EHRs CONTRIBUTE TO PHYSICIAN BURNOUT PCPs also had much to say on the impact that EHRs had on the quality of their work life. More than half reported that using an EHR detracts from their professional satisfaction and, more importantly, their clinical effectiveness. Even more agreed that EHR use contributed to the number of hours worked daily and believed that EHRs are a large contributing factor to the physician burnout crisis.

• The majority of PCPs (54%) say using an EHR detracts from their professional satisfaction • Half (49%) think using an EHR detracts from their clinical effectiveness • Nearly three-quarters agree EHRs have increased the total number of hours they work daily (74%) and that EHRs greatly contribute to physician burnout (71%)

PATIENTS AND EHRs COMPETE FOR PHYSICIAN ATTENTION PCPs reported spending a disproportionate amount of time per visit interacting with EHR systems, and many feel that EHRs are competing with their patients for already limited time and attention. On average, over the course of a 20-minute in-person patient visit, PCPs reported spending 12 minutes interacting with the patient, and eight minutes interacting with the EHR system. This does not include another 11 minutes of EHR interaction once the patient visit had concluded.

• 62% of time that PCPs devote to each patient is being spent in the EHR • Seven in 10 (69%) say using an EHR takes valuable time away from their patients • Seven in 10 (69%) believe EHRs have not strengthened their patient relationships

is data storage, compared to clinical abilities such as disease prevention/ management (3%), clinical decision support (3%), and patient engagement (2%). These responses confirm that physicians largely see EHRs as a storage utility, rather than a clinical tool designed to help them improve patient care.

IDEAS FOR IMPROVEMENT Those polled believe EHR systems can be improved in the following ways: Top three short-term improvements: • Nearly three in four PCPs (72%) would like to see improved EHR user interface design to eliminate inefficiencies and reduce screen time • Almost half of PCPs (48%) would like to shift more EHR data entry to support staff • Four in 10 PCPs (38%) would like to increase use of highlyaccurate voice recording technology that acts as a scribe during patient visits Top three long-term improvements: • Seven out of 10 PCPs (67%) think solving interoperability deficiencies in the next decade should be the focus • Nearly half (43%) want improved predictive analytics to support disease diagnosis, prevention, and population health management • Nearly one-third of PCPs (32%) indicate they would like to see the integration of financial information into the EHR to help patients understand the costs of their care options.

“EHRs have transformed how healthcare is documented in the U.S., but for all the information we’ve now captured digitally, we are rarely wiser as a result,” said Lloyd Minor, MD, dean of the Stanford University School of Medicine. “Insights that could lead to better patient care or new medical discoveries remain buried within piles of disconnected data. Moreover, EHR use has eroded professional satisfaction among physicians. This national poll underscores what many physicians have felt for a while: Their needs are not reflected enough in the design of these systems. Fixing the problem goes far beyond technology, and it will take many stakeholders working together to make EHRs more user-friendly and capable of achieving their true potential.”

“When we first set out to help Stanford Medicine understand the perceptions of electronic health record systems among primary care physicians, the focus was on identifying what problems doctors are encountering to inform the implementation of future solutions,” said Deana Percassi, managing director at The Harris Poll. “The results of this poll underscore the vital role EHRs play in our national healthcare conversation.”

STANFORD MEDICINE’S EHR NATIONAL SYMPOSIUM: SETTING A NEW VISION FOR EHRs Stanford Medicine recently hosted a national symposium to discuss the implications of this new research as well as the future of EHRs. Experts in patient care, technology, design thinking and public policy convened to reimagine what EHRs can do for physicians and their patients.

PCPs VALUE EHRs PRIMARILY FOR DATA STORAGE, NOT CLINICAL ABILITIES Nearly half (44%) of PCPs report that the primary value of their EHR MAY / JUNE 2018 | THE BULLETIN | 29

Health Trust in SC County Joins California “Food Is Medicine” Pilot Program

The Health Trust in Santa Clara County and five other non- a statement: “This new statewide program will usher in a new era profit organizations throughout California are participating in a for Project Angel Food. At the end of the program, there will be a new “Food Is Medicine” state pilot, a medically tailored meal ser- published finding definitively proving our nutritious meals reduce vice with the goal of reducing overall medical costs caused by pa- healthcare costs.” tients not getting the necessary nutrition.

Published research into a similar project in Philadelphia that Project Angel Food launched the three-year, $6 million pilot delivers three meals and one snack per day every week to low-inprogram to prove medically tailored meals can reduce healthcare come people who are in danger of malnutrition during a serious costs for Medi-Cal recipients with congestive heart failure (CHF). illness showed the meals had an impact on patient quality of life It is estimated that 1 in 8 Americans (42 — and also major reductions in hospital million) are insecure of the foods they eat costs, catching the attention of politicians in Project Angel Food and five sister and do not eat enough nutrients to sustain a California, according to the Huffington Post. agencies, Project Open Hand in healthy and active lifestyle. Meanwhile, the With high rates of food insecurity, chronic San Francisco, Ceres Community rate of chronic disease caused by poor nutriillness and Medicaid enrollment, CaliforProject and Food For Thought in tion, such as hypertension, coronary heart nia was looking for a way to bring down the the North Bay Area, The Health disease, hepatitis, stroke, cancer, asthma, overall costs of Medi-Cal, the state’s MedicTrust in Santa Clara County, and diabetes and arthritis, is on the rise. aid program, with efforts that have a proven Mama’s Kitchen in San Diego, are “The purpose of this groundbreaking return on investment. participating in the pilot launched pilot is to prove our medically tailored meals With a significant number of Califorby the California Food Is Mediand medical nutrition intervention can renians living well below the federal poverty cine Coalition. duce hospital admission rates and healthcare level, those undergoing treatment for breast costs within a 12-week period,” according cancer are often left to choose between their to the announcement. Participants in the pilot will receive 100% next meal or keeping up with their quickly-accumulating medical daily nutrition, which includes breakfast and two entrees, for three bills. They may also forgo healthier meals, opting instead for cheapmonths. They will also be provided with intensive medical nutrition er canned foods that provide little in the form of nutrition. therapy including two in-home visits by a registered dietitian and “We believe food is medicine and that this food will keep two follow-up telephone calls. people out of the hospital, thus saving Medi-Cal hundreds of thouThis is the first time any state has funded a pilot of this kind. sands, if not millions, of dollars,” said Ayoub.

Richard Ayoub, executive director of Project Angel Food, said in 30 | THE BULLETIN | MAY / JUNE 2018

California Voters In November’s Election Could Help Determine Fate of ACA In the state that’s leading the opposition to many of President Donald Trump’s health policies, California voters will face a stark choice on the November ballot: Keep up the resistance or fall in line.

The results of June’s primary have set up general-election contests between candidates — for governor, attorney general, insurance commissioner and some congressional seats — with sharply differing views on government’s role in healthcare.

The outcome in the Golden State could help shape the fate of the Affordable Care Act and influence whether Republicans in Washington take another shot at dismantling the landmark law.

“For the Affordable Care Act, California is a bellwether state,” said David Blumenthal, president of the Commonwealth Fund, a New York-based health policy research organization.

If California voters don’t elect more Democrats to Congress, it will be harder for the party to gain legislative control, and “the Affordable Care Act will continue, as it has been, to be under attack from an empowered Republican majority,” he said.

Despite being targeted for voting last year to repeal the ACA and cut Medicaid funding, several Republican incumbents performed well at the polls in California.

“California was supposed to lead the blue wave, but that’s not what we saw” in the primary, said Ivy Cargile, an assistant professor of political science at California State University-Bakersfield.

In the California governor’s race, Democratic front-runner Gavin Newsom quickly sought to cast the November contest as a referendum on Trump and his effort to undo much of President Barack Obama’s legacy, particularly on healthcare.

A series of Trump tweets endorsing Republican candidate John Cox, a multimillionaire real estate investor, helped propel the political outsider to the general election.

“It looks like voters will have a real choice — between a governor who will stand up to Donald Trump and a foot soldier in his war on California,” Newsom said last Tuesday night to supporters in San Francisco.

California has embraced the federal health law enthusiastically and stands to lose more than any other state if the ACA is gutted. About 1.5 million Californians buy coverage through the state’s Obamacare exchange, Covered California, and nearly 4 million have joined Medicaid as a

result of the program’s expansion under the law.

Newsom, a former San Francisco mayor and the current lieutenant governor, has pledged to defend the coverage gains made under the ACA. He has vowed to go even further by pursuing a state-run, single-payer system for all Californians.

Newsom won the primary with 33% of the vote, and Cox placed second with 26%. Some mail-in votes and provisional ballots continue to be counted.

Cox has slammed Newsom and fellow Democrats for imposing government controls on healthcare that he says make coverage too expensive for families. He said he isn’t interested in defending the Affordable Care Act and that, if the law is scrapped, millions of Californians can go into high-risk insurance pools — an idea that predates the health law.

Andrew Busch, a government professor at Claremont McKenna College, said the political divide over healthcare has grown even wider this year as single-payer has gained support from mainstream Democrats in California.

“I’d say the Republican candidates are pretty much where the Republicans have been, but the Democratic candidates have shifted to the left, so the choice is starker than it has been,” Busch said.

Heading into last Tuesday’s primary, it wasn’t clear that California voters would face such drastically different choices on the November ballot. Under the state’s primary system, the top two vote-getters, regardless of party affiliation, advance to the general election. That left many experts predicting single-party matchups across the state.

But that scenario also didn’t pan out in the race for attorney general, a position that has played a key role in California’s resistance politics since Trump was elected. Democratic incumbent Xavier Becerra, who has become a national leader against Trump’s agenda, will face off against Republican Steven Bailey in the fall.

Becerra has filed more than 30 lawsuits on healthcare and other issues since taking office in January 2017.

Bailey, a criminal attorney and former judge, has blamed the Affordable Care Act for driving up healthcare costs, and he favors less industry regulation. He also has criticized Becerra for fixating too much on Trump.

“Just because a tweet comes out of Washington, it doesn’t require a lawsuit to be filed the next day,” Bailey said.

Healthcare could also play a role in several of California’s congressional races. Democrats are trying to win back control of the House, in part to better block Republican efforts to roll back the ACA. “The actions of the Trump administration, the elimination of the individual mandate and its impact on markets will become more of an issue,” said Chris Jennings, a former healthcare adviser in the Obama administration. “The conservative caucus has been forcefully advocating for another aggressive return to the repeal effort.”

One of the most-watched races nationally is in a district of California’s San Joaquin Valley where Republican incumbent Jeff Denham drew several Democratic opponents after voting to repeal the health law last year — as did all of California’s Republican House members.

Denham led a crowded primary field with 38% of the vote Tuesday. Democrat Josh Harder is holding on to second place with nearly 16%, just ahead of a Republican challenger. The results are pending until late-arriving ballots are counted.

Harder said the Republicans’ repeal-andreplace effort on healthcare was a major reason he decided to run. He made it a centerpiece of his campaign and ran ads criticizing Denham for voting to take away coverage from thousands of his constituents. About 40% of residents in this Modesto-area district are enrolled in Medicaid, the government insurance program for the poor and disabled.

Denham has defended his repeal vote, saying that patients’ access to doctors has only gotten worse since coverage was expanded under the ACA. In a statement last year, Denham said, “coverage does not necessarily equal care, and families must resort to overflowing emergency rooms to be seen.”

But Dan Schnur, a Republican political strategist who teaches at the University of Southern California and the University of CaliforniaBerkeley, said healthcare has gone from a negative to a positive for Democratic candidates, who have spent the past several elections defending Obamacare.

“As a result, they’re doing everything they can to emphasize the healthcare debate rather than run away from it,” he said.

SOURCE: By Chad Terhune, Pauline Bartolone, Ana B. Ibarra and Alex Leeds Matthews |California Healthline

MAY / JUNE 2018 | THE BULLETIN | 31

Covered California Takes Aim At Hospital C-Section Rates Covered California, the state’s health insurance marketplace under the Affordable Care Act, has devised what could be a powerful new way to hold hospitals accountable for the quality of their care. Starting in less than two years, if the hospitals haven’t met targets for safety and quality, they’ll risk being excluded from the “in-network” designation of health plans sold on the state’s insurance exchange.

“We’re saying ‘time’s up,’” said Lance Lang, MD, chief medical officer for Covered California. “We’ve told health plans that by the end of 2019 we want networks to only include hospitals that have achieved that target.”

Hospitals will be measured by performing fewer unnecessary cesarean sections, prescribe fewer opioids and cut back on the use of imaging (X-rays, MRIs and CT scans) to diagnose and treat back pain. Research has shown these are problem areas in many hospitals — the procedures and pills have an important place but have been overused to the point of causing patient harm, healthcare analysts said.

C-sections, in particular, have come under scrutiny for years.

Hospitals get paid more to perform a C-section than a vaginal delivery, and C-sections usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Many women who don’t need a C-section often get one anyway, according to the data — and rates vary by hospital. Even in low-risk cases, several California hospitals are delivering 40% of babies by C-section, Dr. Lang said. At one hospital, it’s 78%.

“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Dr. Lang.

C-sections are major surgery. Doing them when they’re not needed exposes women to unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.

That’s not quality healthcare, Dr. Lang said, and that’s why Covered California is telling hospitals they need to reduce their Csection rates to 23.9% or lower, for low-risk births.

In this case, “low-risk” is defined as a healthy, first-time mom who has carried a single baby with its head down all the way to full term — 39 weeks gestation.

Medi-Cal, the state health program for low-income residents; CalPERS, the retirement program for state employees; and the Pacific Business Group on Health, which represents self-insured employers, are also calling on hospitals to improve their quality measures. Together, these groups pay for the healthcare of 16 million Californians, or 40% of the state, which gives them substantial leverage with hospitals.

But only Covered California is telling hospitals that if they don’t play by the rules, they’ll be benched.

“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the Leapfrog Group, a Washington, D.C.-based nonprofit that rates hospitals on quality.

Expecting hospitals to meet external metrics for quality control is a recent phenomenon, and compliance is still largely volun32 | THE BULLETIN | MAY / JUNE 2018

tary, she said.

“Back in the ’80s and ’90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said.

“There’s never been a culture of accountability.”

Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach — 1.4 million people buy coverage through the marketplace — and they shop among plans offered by 11 state-approved insurance companies.

Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.

Overall, California’s hospitals are on board with the C-section goal. Of the 243 maternity hospitals in the state, 40% have met the target, Dr. Lang said, and another 40% have taken advantage of coaching and consulting to help educate doctors on how they can adjust their practices. They’re also finding they have to educate patients who request C-sections about the procedure’s risks.

“While many may prefer [the surgery], when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the Hospital Quality Institute, a subsidiary of the California Hospital Association. Both groups support the Csection reduction goals as “the right thing to do,” she said.

The strategy has raised some concerns among mothers who hear about the 23.9% target and worry about rationing.

“We don’t just chase rates,” Morath said in response to that concern, “but rather look at what the clinical needs are and how to best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”

Still, not all hospitals will find it easy to comply. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.

“If you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a Csection is way higher than someone who is not all those things,” said Malini Nijagal, MD, an OB-GYN at Zuckerberg San Francisco General Hospital. “And so the problem is, how do you adjust for the patient population of a hospital?”

At Memorial Hospital of Gardena, the C-section rate is 45.2%.

At East Los Angeles Doctors Hospital, the rate is 48.1%, according to publicly available state data listed on CalHospital Compare and Yelp. Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for Avanti Hospitals, which owns both hospitals.

Sutter Health Asks Court to Decline Suit Filed by State’s AG

She said the hospitals will meet the 23.9% benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay out-of-network fees to be seen there, or they would have to travel farther to another facility that was still in the network.

“We are in underserved, economically challenged urban neighborhoods, and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.

Health plans can request an exemption from Covered California’s contract rules (in order to keep noncomplying hospitals in their networks) — as long as they document their reasoning.

“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the California Association of Health Plans, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators. And health plans have to ensure that patients continue to receive services in a timely manner.”

So far, the prospect of exclusion, plus the coaching for hospitals on how to reduce the rates, have functioned as an effective motivator.

By 2020, Covered California’s Dr. Lang predicted, all hospitals will either have met the target or be on their way.

“It’s a quality improvement project,” Dr. Lang said, “but with a deadline.”

SOURCE: By April Dembosky | Kaiser Health News

In a high-stakes legal battle over medical market power, Sutter Health has accused California Attorney General Xavier Becerra of overstepping his powers and acting like a “healthcare policy czar.”

Becerra filed an antitrust lawsuit against the large Sacramento-based health system in March.

The complaint accuses Sutter of illegally quashing competition and for years overcharging consumers and employers. The case has attracted widespread attention amid growing concerns nationally about consolidation among hospitals, insurers and other industry players.

In court papers filed last week, Sutter said the attorney general’s lawsuit is “unprecedented in scope and threatens to upend Sutter’s business model.” The nonprofit chain asked the court to decline to hear the case because Becerra wants “to assume the role of healthcare policy czar” so he can “dismantle the Sutter system.”

Sutter owns 24 hospitals and 36 surgery centers, in addition to working with more than 5,500 physicians across its network. The health system had $12.4 billion in revenue last year. Sutter denies the allegations of price gouging and said its charges are in line with what other nearby hospitals charge.

The Sutter case is being closely watched in the industry because the chain has grown so dominant in the Northern California marketplace.

“The Sutter story is representative of what is happening in a lot of markets nationally,” said Barak Richman, a professor of law and business administration at Duke University.

However, he said, there is no easy fix. “Once mergers are allowed it’s very hard to break them up and inject new competition.”

To reduce Sutter’s market power, the state’s lawsuit seeks to force Sutter to negotiate reimbursements separately for each of its hospitals and to prohibit Sutter executives from sharing the details of those negotiations across their facilities. Becerra said Sutter has required insurers and employers to contract with its facilities systemwide or face “excessively high out-of-network rates.”

In a May 14 court filing, Sutter said the creation of “walled-off negotiating teams” would harm consumers by boosting the market power of large health insurers, such as Anthem Blue Cross and Aetna.

A San Francisco County Superior Court judge has already granted Becerra’s request to merge his case with a similar class-action suit, led by a health plan covering unionized grocery workers.

The plaintiffs in the class action are seeking to recoup $700 million for alleged overcharges plus damages of $1.4 billion if Sutter is found liable for antitrust violations. The combined cases are scheduled for trial next year.

Chad Terhune, a senior correspondent at California Healthline and Kaiser Health News, talked with KQED health editor Carrie Feibel about what this litigation may mean for patients and the healthcare industry.

SOURCE: California Healthline

MAY / JUNE 2018 | THE BULLETIN | 33

Amazon’s Alexa to Become Health and Wellness Tool

In a continuing effort to become more relevant in the medical field, Amazon has put together a “health & wellness” team within its Alexa voice-assisted division, according to CNBC.

The team, whose work is still confidential, includes over a dozen members and is focusing on diabetes management, care for mothers and infants, and aging, according to team members who wish not to be named.

“With this pioneering challenge, innovators have a unique opportunity to help navigate uncharted territory: experimenting with and developing new solutions for those managing a chronic condition,” said Aaron Friedman and Dario Rivera, healthcare and life sciences partner solutions architects with Amazon Web Services, in a blog post. “Communicating through voice, rather than just on a screen, has the potential to empower patients to change habits and improve their overall well-being.”

Amazon still has several regulatory obstacles to adhere to before the public sees the health and wellness tool. Alexa must first become compliant with the Health Insurance Portability and Accountability Act (HIPAA), along with an array of complex data privacy regulations and the Children’s Online Privacy Protection Act, which requires parental consent before gathering data on children under 13. This could allow Alexa-powered devices and apps the ability to upload and share sensitive health data with patients and medical professionals.

Last year, it was reported that Amazon had started a health IT team called 1492, with the focus on making EHR data more readily available to patients and clinicians, and earlier this year the company announced a joint initiative with Berkshire Hathaway and J.P. Morgan to provide healthcare to its 1.1 million employees.

VA Telehealth Bill Expands Use Across State Lines A new $52 billion reform that will allow Department of Veterans Affairs (VA) doctors, nurses and other healthcare providers to administer care to veterans using telehealth, or virtual technology — regardless of where in the United States the provider or veteran is located, including when care occurs across state lines or outside a VA facility — cleared the Senate last month with a 92-5 vote after passing in the House 347-70.

The bill states that the “VA could share medical record information with non-department entities for the purpose of providing healthcare to patients or performing other healthcare-related activities” and requires all “contracted providers submit medical records of any care or services furnished, including records of any prescriptions for opioids, to VA in a timeframe and format specified by VA.” “This final rulemaking clarifies that VA healthcare providers may exercise their authority to provide health care through the use of telehealth, notwithstanding any State laws, rules, licensure, registration, or certification requirements to the contrary,” the rule, dated May 8, states. “In so doing, VA is exercising Federal preemption of conflicting State laws relating to the practice of healthcare providers; laws, rules, regulations, or other requirements are preempted to the extent such State laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.”

Previously, it was unclear whether VA providers could furnish care to veterans in other states through telehealth because of licensing restrictions or state-specific telehealth laws. This new rule 34 | THE BULLETIN | MAY / JUNE 2018

exercises federal preemption to override those state restrictions, paving the way for VA to expand care to veterans using telehealth.

VA worked closely with the White House Office of American Innovation and the Department of Justice for implementation of the new rule.

“This new rule is critical to VA’s ‘Anywhere to Anywhere’ initiative,” said VA Acting Secretary Robert Wilkie. “Now that the rule has been finalized, VA providers and patients can start enjoying the full benefits of VA’s telehealth services.”

By enabling veterans nationwide to receive care at home, the rule will especially benefit veterans living in rural areas who would otherwise need to travel a considerable distance or across state lines to receive care. The rule also will expand veterans’ access to critical care that can be provided virtually — such as mental health care and suicide prevention — by allowing quicker and easier access to VA mental health providers through telehealth.

VA first announced the proposed rule, titled “Authority of Health Care Providers to Practice Telehealth,” at a White House event last August, during which VA and President Donald Trump launched the “Anywhere to Anywhere” initiative.

In the announcement, VA also unveiled VA Video Connect, a video conferencing app for veterans and VA providers. Through this new rule, VA providers will be able to use VA Video Connect and other forms of telehealth to furnish care to veterans anywhere in the country, including in the veteran’s home.

Enrollment Begins for Ambitious NIH Precision Medicine Project The All of Us Research Program is officially open for national enrollment. Led by the National Institutes of Health (NIH), All of Us is an unprecedented effort to gather genetic, biological, environmental, health and lifestyle data from volunteer participants living in the United States, with a goal of 1 million. A major component of the federal Precision Medicine Initiative, the program’s ultimate goal is to accelerate research and improve health.

Unlike research studies that are focused on a specific disease or population, All of Us will serve as a national research resource to inform thousands of studies, covering a wide variety of health conditions. Researchers will be able to access data from the program to learn more about how individual differences in lifestyle, environment and biological makeup can influence health and disease. Participants will be able to access their own health information, summary data about the entire participant community and information about studies and findings that come from All of Us. To learn more about the All of Us Research Program and how to join, please visit JoinAllofUs.org.

• Participants are asked to share different types of health and lifestyle information, including through online surveys and electronic health records, which will continue to be collected over the course of the program.

• At different times over the coming months and years, participants may be asked to share physical measurements and provide blood and urine samples.

• To sign up at UCI, please go to https://www.joinallofus.org/en/ get-started-step1 and enroll.

• For participant questions, please call 949-824-0281 or email allofus@uci.edu.

In California, the All of Us Research Program is being implemented by the California Precision Medicine Consortium, which is co-led by Anton-Culver and Lucila Ohno-Machado, MD, PhD, at UC San Diego Health and also includes UC Davis, UC San Francisco, Keck School of

Medicine of the University of Southern California, Cedars-Sinai Medical Center and the San Diego Blood Bank. In San Diego, San Ysidro Health is also enrolling participants, and the Scripps Translational Science Institute at The Scripps Research Institute is working with corporate partners to enroll participants nationwide.

“We hope Californians will want to join in All of Us to help make history by changing the future of health research and the level of participation by people from all backgrounds,” said Robert Hiatt, MD, PhD, who leads the program for UCSF Health. Dr. Hiatt is a professor of epidemiology and biostatistics and associate director of population sciences at the UCSF Helen Diller Family Comprehensive Cancer Center. “We look forward to creating a new way that human research is done and to sharing this exciting journey with our many participants.”

Congress has authorized $1.5 billion over 10 years for All of Us. More than 25,000 people nationwide have already joined the program as part of a year-long beta testing phase that helped shape the participant experience.

“The time is now to transform how we conduct research — with participants as partners — to shed new light on how to stay healthy and manage disease in more personalized ways. This is what we can accomplish through All of Us,” said NIH Director Francis S. Collins, MD, PhD. To ensure that the program gathers information from all types of people, especially those who have been underrepresented in research, not everyone will be asked to give physical measures and samples. In the future, participants may be invited to share data through wearable devices and to join follow-up research studies, including clinical trials. Also, in future phases of the program, children will be able to enroll, and the program will add more data types, such as genetic data.

MAY / JUNE 2018 | THE BULLETIN | 35

Kaiser to Invest $2M in Research on How Its Doctors, Hospitals Can Help Prevent Gun-related Injuries, Death Kaiser Permanente announced in April that it will be investing $2 million in research to prevent gun injuries and death, which will involve doctors and other professionals at their centers and hospitals nationwide.

This initial research funding demonstrates Kaiser Permanente’s commitment to the health of the communities it serves by addressing preventable gun-related injuries and death, whether by suicide, homicide or accident. As part of this effort, Kaiser Permanente has launched the Kaiser Permanente Task Force on Firearm Injury Prevention.

“Going forward, we will study interventions to prevent gun injuries the same way we study cancer, heart disease and other leading causes of preventable death in America,” says Bechara Choucair, MD, Kaiser Permanente’s chief community health officer and task force co-lead. “The best-in-class preventive and specialized care Kaiser Permanente provides is accomplished, in part, by using rigorous research, without bias, to determine which strategies are effective.”

With a long history of investigating issues of importance to health systems and the nation, Kaiser Permanente is bringing the same expertise and rich data sources to gun-injury research. This clinician-guided research will identify evidence-based tools to guide clinical and community prevention efforts.

In 2016, firearm-related injuries claimed over 30,000 lives in America. Kaiser Permanente physicians and nurses treated more than 11,000 victims of gunshot wounds in 2016 and 2017.

“Our doctors and nurses, along with our safety net partners in the community, are on the front lines, every day, saving the lives of gunshot victims,” says David Grossman, MD, MPH, a nationally recognized leader in gun injury prevention research, Washington Permanente Medical Group and task force co-lead. “Oftentimes, families and communities are

left shattered. Our mission, to improve the health of Kaiser Permanente members and the communities we serve, requires us to take preventive action.”

Kaiser Permanente will collaborate with key stakeholders to share findings and disseminate best practices through various channels such as webinars, white papers and peer reviewed publications.

“We will share our insights and provide practical, real-world guidance in clinical and community settings,” notes Elizabeth McGlynn, PhD, vice president for Kaiser Permanente Research, who will lead development of the research initiative with Dr. Grossman. “We plan to make our research results publicly available and hope to serve as a model for addressing and effectively disseminating research findings in communities nationwide. We encourage other private-sector and philanthropic organizations to join us in funding this much needed public health research.”

Allied Pain & Spine Institute Announces Opening of New Surgery Center in Silicon Valley Allied Pain & Spine Institute has opened a new facility in Silicon Valley. Trinity Surgery Center, located at 1610 Blossom Hill Road, Suite 10, in San Jose, is a modern and spacious surgical center that will allow James Petros, MD, and other leading physicians to provide a wide range of pain management procedures, including epidural injections, discography, radiofrequency ablation, spinal cord stimulation and stem cell therapy. These advanced procedures can be performed on an outpatient basis at Trinity Surgery Center, which means patients can achieve tailored pain relief without hospital stays or 36 | THE BULLETIN | MAY / JUNE 2018

lengthy recovery times. “I couldn’t be more pleased with the opening of Trinity Surgery Center, as I believe it extends the promise of Allied Pain & Spine Institute — to provide unparalleled, integrative care to help optimize patient wellness,” said Dr. Petros, who is founder and medical director at Allied Pain & Spine Institute and a clinical instructor at Stanford University.

The Trinity Surgery Center offers same-day appointments for urgent care and physicianreferrals. The cutting-edge facility was uniquely designed by Kohan, an architecture engineering interiors company based in San Francisco.

Trinity Surgery Center is easily accessible from the freeway system with plentiful parking. “Our medical providers at Allied Pain & Spine Institute are qualified under the Drug Addiction Treatment Act to prescribe Suboxone, a medication to reduce withdrawal symptoms and drug cravings,” said Dr. Petros. “Combined with psychosocial support and counseling, our patients are safely removed from improper opioid medications. Given the opioid crisis this country is experiencing, we are very proud of our work in this area.”

New Facility Opens in Marina to Meet Needs of Monterey County’s Mentally Ill Residents For the hundreds of Monterey County residents living with both a mental illness and a drug or alcohol addiction, securing housing and treatment is a difficult task. Visiting a psychiatric hospital or rehab facility can cost thousands, and most affordable treatment centers in the area are near or at capacity. Fortunately, a new facility opened in Marina designed to meet the needs of Monterey County’s growing population of mentally ill low-income residents. The $4.5 million facility, located in Bayonet Circle in Marina, will provide support services and temporary housing to a growing number of adults struggling with mental illness and substance abuse disorder in Monterey County. The nonprofit Interim Inc. secured funding for the New Bridge House through a combination of loans, awards and donations, including a $2.5 million grant from the Central California Alliance for Health. Barbara Mitchell, executive director of Interim, says the new facility was built to meet the “overwhelming” need for residential treatment services for Monterey County residents suffering from a men-

tal illness and a substance use disorder. “We were seeing more and more people who had both a psychiatric disability and a substance problem, and we decided that we really needed to increase the amount of dual diagnosis treatment,” said Mitchell. “Opening New Bridge House will expand our ability to treat people (with a mental illness and a substance abuse disorder) in Monterey County by 75%, but there is still a lot of unmet need,” said Dr. Amie Miller, behavioral health director for the Monterey County Health Department. Last year, the Monterey County Homeless Census reported homelessness in the county was at its highest level in 10 years — an estimated 2,837 individuals were experiencing homelessness in Monterey County during January 2017, with only 26% of them having access to shelter. Nearly a quarter of the chronically homeless individuals who participated in the census claimed mental health issues were the primary cause of their homelessness. Roughly twice as many respondents identified substance abuse disorders as the primary cause of their homelessness.

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Warning: Beware of Doctor SCAM with DEA Posers The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extortion scheme.

The criminals call the victims and identify themselves as DEA agents or law enforcement officials from other agencies. The impersonators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine. In most cases, the impersonators instruct their victims to pay the “fine” via wire transfer to a designated location, usually overseas.

If victims refuse to send money, the impersonators often threaten to arrest them or search their property. Some victims who purchased their drugs using a credit card also reported fraudulent use of their credit cards.

Impersonating a federal agent is a violation of federal law. The public should be aware that no DEA agent will ever contact members of the public by telephone to demand money or any other form of payment.

THE SCAM A phone call made to you, perhaps to your mobile phone, with a call back number from a DEA agent officer Gavin McWhite or Kevin Casey who leave a voicemail regarding “a serious matter to discuss” and “to step out of work and into a private place.” A woman answers who transfers the call. They read you your Medical License number and NPI number to verify it is you. They then proceed to state that “a crime was committed under your name with 2 million dollars of smuggled opioids narcotics other drugs across the Mexican border. There were casualties as well leading to a major criminal investigation with you as the prime suspect.” They included a few other statements to ensure you understood the seriousness of the crime and your role in it.

The entire pitch whittled down to the all too common phrase of “Go

to your bank and wire money directly to an account and routing number I will give you.” The bay area scam that we are aware of included a request for $14,679 to First Trade Inc. with a NY address as receiver.

Words of advice: • DEA would never call about this by phone • DEA would never use a field officer in NY for Sunnyvale, instead from SF • Always ask badge number and field office • Always hang up and call back if you must or not at all • Be wary of serious business being conducted on a telephone • When they say don’t talk or tell anyone this is a confidential investigation--hang up!

• They never say “don’t tell anyone”!

However, anyone receiving a telephone call from a person purporting to be a DEA special agent or other law enforcement official seeking money should refuse the demand and report the threat using the online form below. Please include all fields, including, most importantly, a call back number so that a DEA investigator can contact you for additional information. Online reporting will greatly assist DEA in investigating and stopping this criminal activity. https://apps.deadiversion.usdoj.gov/esor/spring/ main?execution=e1s1

REFERENCES:

• https://www.consumer-action.org/alerts/articles/dea_calling_ no_its_a_scam_hitting_doctors_and_consumers • https://www.scam-detector.com/article/dea-call • https://www.aarp.org/money/scams-fraud/info-11-2011/buyingprescription-drugs-online-scam-alert.html

New Resource to Help Medical Staffs Address Disruptive Physician Behavior A free, 30-minute learning module is available in the AMA Education Center at http://bit. ly/2GZOza0. The module shows physicians how to define appropriate, inappropriate, and dis38 | THE BULLETIN | MAY / JUNE 2018

ruptive behavior; presents guidelines for dealing with these behaviors in a fair manner; and provides users with their own downloadable copy of the AMA Model Medical Staff Code of Con-

duct that they can integrate into their medical staff bylaws.

(CMA Newswire, June 11, 2018 issue)

New Parkinson’s Reporting Requirements Take Effect July 1 Health care providers diagnosing or providing treatment to Parkinson’s disease patients will be required to report each case of Parkinson’s disease to the California Department of Public Health (CDPH) beginning July 1, 2018.

All providers who will be required to report must first register with CDPH through the designated provider gateway, which is available on the CDPH Parkinson’s Disease web page.

In April, CDPH issued its initial version of the California Parkinson’s Disease Registry Implementation Guide that details how health care providers can comply with the reporting mandate. The guide, available at www.cdph. ca.gov/parkinsons, provides information for reporting Parkinson’s disease data, outlines who is required to report, the timeline for reporting, and the manual and electronic methods for transmitting data to the California Parkinson’s Disease Registry.

Since the issuance of the initial implemen-

tation guide, the California Medical Association (CMA) and other stakeholders have expressed concerns to CDPH about the scope, breadth and timing of this new reporting obligation. CDPH is taking a number of steps in response to those concerns. CDPH will release an updated version of its implementation guide, as well as slide presentations and updated FAQs in early June.

CDPH will also continue to work closely with physician offices, medical groups and large health systems to optimize integration of the reporting interface with electronic health record systems. Manual entry will remain an option for all providers.

The data collected will be used to measure the incidence and prevalence of Parkinson’s dis-

ease. California’s large and diverse population makes it ideal for expanding the understanding of this disease to improve the lives of Parkinson’s patients.

For more information, see CDPH’s fact sheet, which provides more details related to the new law.

(CMA Newswire, June 11, 2018 issue)

San Francisco Bans Sale of Flavored Tobacco Products San Francisco voters passed Proposition E by a 68-32 percent margin to uphold the city’s law prohibiting the sale of flavored tobacco products that are regularly marketed to children and young adults in the City and County of San Francisco. The California Medical Association (CMA) strongly supported this sensible, public health measure.

“CMA has long been at the forefront of advocating for public health prevention and

education awareness programs for tobacco use reduction and cessation,” said CMA President Theodore M. Mazer, MD. “Tobacco is deadly regardless of the flavor, and flavored tobacco products that are designed to appeal to children threaten the progress made in reducing and eliminating tobacco use over the past 50 years.

Proposition E is a sensible public health measure to ensure these harmful products do not create a new generation of Californians addicted to to-

bacco.”

In its support, CMA joined a broad coalition of parents, doctors, health organizations and community groups working to protect our children and youth from becoming addicted to flavored tobacco products. For more information on Proposition E, visit sfkidsvsbigtobacco. com.

MAY / JUNE 2018 | THE BULLETIN | 39

(CMA Press Release, June 12, 2018 issue)

Blue Shield of California and CMA Collaborate to Build Health Care Model of the Future Blue Shield of California and the California Medical Association (CMA) today announced a multi-year collaboration to develop and support a new health care model that gives Californians access to quality, comprehensive and sustainably affordable care that improves the health of individuals and their communities.

Blue Shield will invest $30 million to support the initiative, beginning with two pilot projects in Monterey and Butte counties designed to bring health care into the digital age, tie pay to value, and create a patientcentered experience through home- and community-based services. To achieve this, a new technology infrastructure will be built to help physicians focus their attention on care delivery, rather than administrative work. The goal is for Blue Shield and CMA to scale the projects statewide with a focus on supporting independent physicians.

The nonprofit health plan will work closely with CMA’s leadership and physicians in those local communities to build new models of care that will: • Bring health care into the digital age: Use the latest technology to create a real-time, automated environment, reducing physicians’ administrative burden and facilitating personalized health care for members (e.g., realtime transcription services that complete the electronic medical record on behalf of the physician without any additional data entry).

• Tie pay to value: In collaboration with physicians and hospitals, identify clinical best practices and ensure health care providers are rewarded for using them (e.g., use best available testing to ensure the optimal treatment options are considered for cancer patients).

• Create a patient-centered experience: Focus on all the factors that influence an individual’s health status including their housing, food security, transportation, social, emotional and physical well-being. Mobilize, organize and deliver a personalized solution for each patient so they have their best chance to live the healthiest possible life (e.g., establish a health care advocate who helps those in need receive the necessary support to optimize their health; home care for chronically and seriously ill patients; and shared decision-making with providers to choose the right care).

• Improve physicians’ ability to practice: Greatly reduce the capital requirements and financial burdens on physicians as they move into value-based care and alternative payment models.

“Today’s announcement is part of Blue Shield’s ongoing effort to create a health care system worthy of our family and friends and sustainably 40 | THE BULLETIN | MAY / JUNE 2018

affordable. We do this by collaborating with physicians, hospitals, clinicians and other health care leaders to put people at the center of the health care system,” said Blue Shield President and CEO Paul Markovich. “We are starting small but thinking big.”

“CMA is proud to collaborate with Blue Shield to bring California’s health care system further into the modern age,” said CMA President Theodore M. Mazer, MD. “This innovative pilot project will utilize stateof-the-art technology to build a new health care model that expands and streamlines patient access to care while reducing administrative work. I would like to thank Blue Shield for recognizing the importance of investing in this effort to improve patient treatment, while reducing overwhelming administrative burdens, freeing physicians to be doctors rather than data entry technicians. We can, in this manner, create personal 21st century care.”

“This new pilot project will greatly improve patient care by utilizing technology to better meet the needs of patients in Butte County,” said former CMA President and Paradise Medical Group CEO Richard Thorp, MD. “By streamlining administrative burdens for physicians and improving the delivery of high-quality care, this pilot project will enable physicians to focus more on treating patients rather than paperwork, and make it easier for small practices that serve rural areas to continue to provide care to our community.”

“The task for Clinica de Salud del Valle de Salinas and our partners is to increase access to quality health care at a price that is affordable for working families in Monterey County,” said Monterey County Medical Society President Maximiliano Cuevas, MD. “This is an opportunity to work with our partners to explore putting in place a health care delivery system that removes the fragmentation of care that currently exists, and replaces it with a system that easily coordinates care between physicians, hospitals, emergency departments and social service agencies.”

For Blue Shield, this is the latest step in the nonprofit health plan’s ongoing efforts to transform health care.

Earlier this year, Blue Shield announced it is taking steps toward providing its members access to patient-centered care by expanding its suite of home-based care programs. The health plan is collaborating with Landmark Health to bring comprehensive care to the homes of people suffering from multiple-chronic conditions, and Blue Shield’s nationally-recognized in-home palliative care is now available in all 58 California counties.

Also this year, Blue Shield and Gemini Health announced a new drug-price transparency service for prescribers and patients that provides real-time, patient specific cost information on their prescriptions and alternative drugs during the doctor visit.

(CMA Newswire, June 11, 2018 issue)

New Report Shows California’s Progress Addressing Opioid Crisis The American Medical Association (AMA) issued a new report documenting how California’s physician leadership is advancing the fight against the opioid crisis.

The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s prescription drug monitoring program (PDMP), number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid use disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017.

“This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders,” said California Medical Association (CMA) President Theodore M. Mazer, MD. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.”

Other key findings include: • Opioid prescribing decreases for fifth year in a row. Physicians have decreased opioid prescriptions nationwide for the fifth year in a row. Between 2013 and 2017, the number of opioid prescriptions decreased by more than 55 million – a 22.2 percent decrease nationally. In California, opioid prescribing decreased by 24.3 percent, surpassing the national average since 2014.

• PDMP registration and use continues to increase. In 2017, health care professionals nationwide accessed state databases more than 300.4 million times – a 148 percent increase from 2016. States with and without mandates to use the PDMP saw large increases. California has increased utilization of its state database by more than 6.4 million since 2014.

• Physicians enhancing their education. In 2017, nearly 550,000 U.S. physicians and other health care professionals took continuing medical education classes and other education and training in pain management, substance use disorders and related areas. California physicians are required to complete 12 hours of continuing medical education in pain management.

CMA offers physicians who prescribe opioids and other controlled substances access to up-to-date information on a wide range of issues, including how to provide treatment that meets the community standard of care, and how to manage the risks that can come with prescribing opioids.

• Access to naloxone rising. Nationwide, naloxone prescriptions more than doubled in 2017, from approximately 3,500 to 8,000 naloxone prescriptions dispensed weekly. So far in 2018, that upward trend has continued; as of April, 11,600 naloxone prescriptions are dispensed weekly - the highest rate on record.

In California, naloxone has been available without a prescription since 2015.

• Treatment capacity increasing. As of May this year, there were more than 50,000 physicians certified to provide buprenorphine in office for the treatment of opioid use disorders across all 50 states – a 42.4 percent increase in the past 12 months.

“We encourage policymakers to take a hard look at why patients continue to encounter barriers to accessing high quality care for pain and for substance use disorders,” said Patrice A. Harris, MD, MA, chair of the AMA Opioid Task Force. “This report underscores that while progress is being made in some areas, our patients need help to overcome barriers to multimodal, multidisciplinary pain care, including non-opioid pain care, as well as relief from harmful policies such as prior authorization and step therapy that delay and deny evidence-based care for opioid use disorder.”

To further address the opioid crisis, CMA urges policymakers and insurers to remove barriers to care for pain and substance use disorders.

These steps include: • All public and private payers should ensure that their formularies include all FDA-approved forms of medication assisted treatment (MAT) and remove administrative barriers to treatment, including prior authorization. CMA is sponsoring Assembly Bill 2384 (Arambula), which would remove burdensome insurance barriers to MAT and make it easier for patients to access effective treatment.

• Policymakers and regulators should increase oversight and enforcement of parity laws for mental health and substance use disorders to ensure patients receive the care that they need.

• All public and private payers – as well as pharmacy benefit management companies – must ensure that patients have access to affordable, non-opioid pain care.

• The Drug Enforcement Agency should fix its antiquated and burdensome process for e-prescribing controlled substances, which has created impediments to physician participation. More than 90 percent of physicians e-prescribe, yet only 21 percent e-prescribe controlled substances.

• Put an end to stigma. Patients with pain or substance use disorders deserve the same care and compassion as any other patient with a chronic medical condition.

Patients seeking MAT still struggle to access it with insurance utilization management policies posing a significant obstacle. AB 2384 would help to ensure that those seeking treatment for substance use disorders are able to receive it without long, arduous delays and waiting for health plan approval.

“While California has achieved promising outcomes with its multifaceted approach to addressing opioid misuse, more emphasis should be placed upon increasing access and availability of medication-assisted treatment, and reducing stigma associated with drug use and addiction,” said Dr. Mazer. “Congress and the California legislature must enact policies that focus on treatment for those suffering from substance use disorders, and ensure access to high-quality, evidence-based treatment.”

MAY / JUNE 2018 | THE BULLETIN | 41

(CMA News, June 18, 2018 issue)

End of Life Option Act Reinstated While State Appellate Court Reviews Its Constitutionality A state appellate court has stayed the Riverside County Superior Court’s judgment issued on May 24, 2018, declaring California’s End of Life Option Act void and unconstitutional.

Due to the lower court’s judgment, physicians had been advised against relying on the Act to prescribe aid-in-dying medication in caring for patients with terminal illnesses. The appellate court’s stay effectively reinstates the California’s aid-in-dying law for the time-being, while the courts consider the constitutional questions surrounding the Act. The California Attorney General’s Office requested the stay to alleviate the confusion caused by the Act’s invalidation. Edward Damrose, MD, chief of staff at Stanford Health Care hospital and clinics, submitted a supporting declaration and stated that the “uncertainty over the Act is disrupting and impeding the ability of physicians to care for terminally-ill patients,” and that a stay is needed to “afford more time to physicians to transition their practice and treatment of terminally-ill patients.” Fourteen other declarations were submitted by terminally-ill patients, other physicians and state officials. “It is clear that, without a stay,” the Attorney Gen-

eral argued, “terminally ill patients will suffer great harm, and some will be forever foreclosed from benefitting from any relief that this Court might eventually provide in a decision on the merits.”

While the Act currently remains in full force and effect due to the appellate court’s stay order, the Act’s fate ultimately remains unresolved. Under the California Constitution, the legislature has authority to pass laws in a special legislative session only if they fall within, or are reasonably related to, the scope of a governor’s proclamation calling for the special session. The lower court’s judgment reasoned that the Act was unconstitutional because it was not reasonably related to the health care issues that were the subject of Governor Brown’s proclamation for a special session in fall 2015.

The appellate court has ordered full briefing on this constitutional question to be completed by July 25, 2018. Oral argument will then be scheduled and a decision from the appellate court can

be expected within 30-45 days thereafter.

For more information, or if you would like to discuss the potential impact of the trial court’s decision on your practice, contact the California Medical Association’s Legal Information Line at (800) 786-4262 or legalinfo@cmanet.org.

(CMA Newswire, June 11, 2018 issue)

Have You Received Your Prop 56 Supplemental Medi-Cal Payments Yet? The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. A total of $325 million was allocated for physician payments in the budget for 2017-18, with $488 million proposed for 2018-19.

The California Department of Health Care Services (DHCS) began disbursing supplemental fee-for-service payments in January 2018 and completed the issuance of retroactive payments (dating back to July 1, 2017, dates of service) in March 2018.

Federal approval of the supplemental Medi-Cal managed care payments was delayed, which resulted in delayed payment for Medi-Cal managed care services. DHCS issued an All Plan Letter that contained instructions for managed care plan distribution of the funds on May 1, 2018, and began dispersing the funds to the plans as part of its capitated payments in May. As a result of advocacy by the California Medical Association (CMA), DHCS is requiring managed care plans to ensure that Prop 56 supplemen42 | THE BULLETIN | MAY / JUNE 2018

tal payments are issued to providers within 90 calendar days of the date the plan receives the funds from DHCS. This includes both the go-forward payments and the retroactive payment for clean claims or accepted encounter data with dates of service between July 1, 2017, and the date the plan received the Prop 56 funds.

DHCS also included language suggested by CMA requiring plans to have a formal process to resolve provider grievances related to the payments, as well as a designated point of contact for provider questions, which will be published on the DHCS website.

Medi-Cal managed care plans are also required to have a process to communicate with providers about the payment process that must, at a minimum, include how payments will be processed, how to file a grievance and how to determine who the payor will be.

Since capitated payments to plans are disbursed throughout the month, physicians may not start seeing the supplemental payments until late August (i.e., 90 days after the plans received the money).

Physicians with questions can contact CMA’s Reimbursement Helpline at (888) 401-5911 or economicservices@cmanet.org.

(CMA Newswire, May 29, 2018 issue)

CMA Expands Program to Cultivate Equity in the Medical Profession The California Medical Association (CMA) has long believed that diversity and inclusion strengthens the health of our profession and California’s communities.

To that end, CMA launched a Diversity and Inclusion Technical Advisory Committee (D&I TAC) in 2014 to usher in a new generation of policies and initiatives focused on: • Developing resources and programs that demonstrate why diversity and inclusion is a business imperative.

• Implementing policies and practices that make diversity and inclusion goals a permanent strategic focus.

• Designing a strategic plan to achieve diversity and inclusion within CMA, including the Board of Trustees, component medical societies, CMA staff and leadership.

• Supporting efforts to achieve diversity and inclusion within the physician workforce and in California medical schools.

CMA’s diversity and inclusion mission statement reinforces our dedication to “ensure that the work we do, how we carry out our work and the issues we address all reflect the rich diversity of the patients and the physicians we serve and represent.”

Donaldo Hernandez, MD, chairs the D&I TAC and is joined by C. Freeman, MD; Dexter Louie, MD; Margaret Juarez, MD; Rafael Silva, MD; Vito Imbasciani, MD; Andrea Rudominer, MD; Resident Pooja Desai, MD and medical student Allen Rodriguez.

“Diversity is the who and inclusion is the how – the behaviors and policies that welcome and embrace diversity,” said Dr. Hernandez. “One supports the other, and the D&I Tac is pursuing comprehensive external and internal strategies to cultivate equity in the medical profession.”

“Our research highlights current demographics and realities to explain why diversity and inclusion is imperative for advancing CMA’s mission, economic sustainability and membership growth,” said Dr. Juarez. “Implementing strong policy and procedural changes will keep CMA at the forefront of California’s evolving patient population and provider demographics.”

Ongoing D&I TAC activities include: • Publishing demographic and educational resources.

• Expanding the pipeline for entry into medical schools for underrepresented populations.

• Sharing best practices that physicians can utilize in their employment practices.

• Identifying pathways to increase member engagement through the Network of Ethnic Physician Organization (NEPO) and Ethnic Medical Organization Section (EMOS).

• Reviewing policies and procedures on leadership development, staff hiring and promotion practices for CMA and the county medical societies.

“California is facing a physician shortage and our current workforce doesn’t reflect the state’s patient population,” said Dr. Silva. “The D&I TAC is examining various strategies to support or expand mentoring programs and outreach to middle and high school students who show an interest in science and medicine. And we’re pursuing proactive ways to tackle the barriers to enter medical school, including financial aid assistance and promoting implicit bias training.”

“Our initial research has also discovered the need to support our physician colleagues serving ethnic and historically underrepresented communities,” said Dr. Desai. “From financial assistance programs and trained translators to culturally responsive care and succession planning support for retiring physicians, we’re exploring strategies to ensure California’s physician workforce can respond to the needs of its patient population.”

The D&I TAC will present research at the July 2018 Board of Trustees meeting highlighting the benefits of diversity and inclusion efforts towards clinical outcomes and demonstrating why it is a business imperative, as well as recommendations for new CMA policy and procedures and joint engagement between NEPO and EMOS. This article is the first of an ongoing series to provide regular updates on D&I TAC’s mission and objectives. All interested physician members who want to learn more or get involved are encouraged to email communications@cmanet.org.

(CMA Newswire, May 29, 2018 issue)

New Member Benefit: Student Loan Refinancing The California Medical Association (CMA) has announced a new partnership with SoFi, an online personal finance company, to provide CMA members with a unique opportunity to refinance and consolidate existing student loans through the SoFi at Work program.

Sofi will offer CMA members student loan refinancing options, which include low-variable and fixed rates with terms ranging from five to 20 years, with an additional rate discount of 0.25 percent through the sofi.com/CMA link. Parent PLUS loans can also be refinanced. There are no prepayment penalties. Borrowers could save $15,767 over the life of their loans on average when they refinance their student loans with SoFi. “We are proud to collaborate with SoFi to offer this valuable benefit to our members,” said CMA President Theodore M. Mazer, MD. “CMA will continue to find innovative ways to help our members manage their education costs as part of our mission to increase the physician workforce in California to meet patient needs.

This SoFi program gives our members the flexibility to lower their costs and tailor their repayment schedule to meet their needs, making practicing in California a more attractive option for physicians.”

The California-based SoFi is a leader in student loan refinancing and marketplace lending in the United States, with more than $30 billion in loans to date.

“People often face a hard choice between saving for retirement or paying down student debt when the answer is they should and can do both,” said Wayne Thorsen, Senior Vice President, Marketing and Strategic Partnerships at SoFi. “Forward-thinking companies and associations like CMA are thinking about the most meaningful ways to address these stresses and their members’ overall financial wellness.”

CMA members who refinance with SoFi also become SoFi members, which unlocks other benefits including complimentary career counseling, networking events and a referral program incentive.

MAY / JUNE 2018 | THE BULLETIN | 43

Classifieds OFFICE SPACE FOR RENT/LEASE MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA Medical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500– 4,000 sq. ft. Call Rick at 408/228-0454.

MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Timeshare also available. Call Betty at 408/8482525.

BEAUTIFUL MENLO PARK OFFICE TO SHARE New office, upscale and modern – to share with existing pain management practice.

Ideal for psychologist or psychiatrist. Contact Dr. Maia Chakerian at 408/832-3930.

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

MEDICAL OFFICE SPACE TO SUBLET • GILROY Medical Suite available next to Saint Louise Hospital in Gilroy. Please call today and get in tomorrow. Can share staff, phone, Internet. Contact Mil at (650) 618-1661.

44 | THE BULLETIN | MAY / JUNE 2018

MEDICAL OFFICE SPACE TO SHARE • CAMPBELL Specialist wanted to share a private office with family practitioner in Campbell. Hamilton/Winchester area. Contact Mary Phan at (408) 364-7600.

MEDICAL OFFICE TO SHARE • LOS GATOS Newly remodeled. Next to ECH-LG 2,400 sq. ft. Doctor’s office, five exam rooms, waiting room, reception area. Can bring own staff or share. Surgery Center, PT, and radiology in building. Ample parking. Call Elena at (408) 374-1110.

EMPLOYMENT OPPORTUNITY WANTED FAMILY PHYSICIAN Family medicine physician needed to share a growing outpatient practice. Start at 16 hours/week and share patient load. Practice caters to 75% PPO, rest Medicare and HMO. Contact ntnbhat@yahoo.com / 408/8396564.

VOLUNTEER PHYSICIANS NEEDED • ADULT PRIMARY CARE Consider volunteering at a homeless/free clinic in Palo Alto. You can volunteer in half a day blocks as frequent or infrequent as you want. Bring altruism back to medicine! Contact drhsheik@gmail.com.

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.

SHORT-TERM MEDICAL VOLUNTEERS NEEDED Global Health Teams is looking for physicians, mid-level providers and nurses for one-week, primary-care medical clinics in rural Haiti every February, June, and October. This is a rewarding and fun opportunity to work with the people of Haiti and provide care in a rural clinic in a medically underserved area. GHT is an experienced U.S.based nonprofit and has been operating these clinics since 1998. We coordinate all incountry travel and logistics. Please contact Bob Downey at (619) 905-7157 or at bob@ globalhealthteam.org if you are interested in applying. Visit www.globalhealthteam. org to see what we do and learn about the clinics and volunteer experience.

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

In Memoriam Kenneth E. Averill, MD

Ronald Kaye, MD

David M. Rosenthal, MD

Leo H. Berk, MD

Jeffrey M. Lehr, MD

Theodore Shiff, MD

David L. Breithaupt, MD

Robert J. Masi, MD

Lawrence D. Stern, MD

Nancy S. McCall, MD

Leo D. Stuart, MD

Ronald C. Pillsbury, MD

Ronald R. Uyeyama, MD

Family Medicine 11/13/1929 – 11/30/2017 SCCMA member since 1959

*Plastic Surgery 3/2/1939 – 11/23/2017 SCCMA member since 1973

*Rheumatology 1/1/1932 – 3/3/2018 SCCMA member since 1964 Allergy Medicine 4/29/1942 – 11/14/2017 MCMS member since 2015

*Internal Medicine Addiction Medicine 4/5/1930 – 6/19/2017 SCCMA member since 1961

Donald J. Cariani, MD *Obstetrics & Gynecology 7/5/1936 – 8/28/2017 SCCMA member since 1970

Nelson E. Goldschneider, MD Anesthesiology 3/15/1941 – 11/18/2017 SCCMA member since 1972

*Ophthalmology 10/28/1945 – 10/3/2017 SCCMA member since 1980 Gynecology 9/9/1927 – 7/26/2017 SCCMA member since 1956 Cardiovascular Disease *General Surgery 3/28/1935 – 9/11/2017 SCCMA member since 1981

Classifieds, from page 44 FOR SALE ENDOCRINOLOGY PRACTICE FOR SALE • MOUNTAIN VIEW Long established practice with revenue of $1.1 million on 2.5 doctors. High referral rates from physicians and other patients. Pent-up demand indicated by long waiting times for appointments. Photos available. Offered at only $403,800. Contact Medical Practices USA. info@MedicalPracticesUSA.com. 800-576-6935. www.MedicalPracticesUSA.com.

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

*Pediatrics 9/26/1931 – 8/8/2017 SCCMA member since 1963 *Gastroenterology 6/13/1939 – 11/3/2017 SCCMA member since 1979

*General Surgery 1/1/1929 – 10/8/2017 SCCMA member since 1960 *Pediatrics 4/25/1931 – 1/3/2018 SCCMA member since 1980 *Internal Medicine Cardiovascular Disease 1/1/1937 – 3/10/2018 SCCMA member since 1972

Care Coordination, from page 7 to schedule a consult. Once each office has their contact list, use it.

The final step in providing patient support is to have a system in place to measure or track whether or not the patient got the referral appointment, showed up for the appointment, and the clinical information made it to and from the consultant’s office.

Tracking systems are part of all electronic health records (EHR) or if the office is using a paper patient record, a log can be created that includes information such as appointment made, consultant received information, consultant appointment kept, report received by primary care, and patient admitted to the hospital or seen in the emergency room.

The overarching goal is to have a consistently full schedule and not a schedule that looks full. The “Go-To” person in both the referring office and the consulting office can work together to resolve logistical issues or financial barriers to completing the referral, they can help get timely appointments, they can assure the transfer of clinical information, and they can track progress and assist patients encountering difficulties in receiving needed health care.

MAY / JUNE 2018 | THE BULLETIN | 45

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