2017 November/December

NOVEMBER / DECEMBER 2017

VOLUME 23 | NUMBER 6

Are You Navigating Your 2018 Health Insurance Benefits Alone?

• Are you spending too much time getting small group health insurance quotes?

• Want to sign up for individual and family coverage but you’re just not sure where to turn?

• Wondering what ACA benefits may have changed?

The Santa Clara County Medical Association and Monterey County Medical Society have a resource to help you: Call Mercer!

Mercer is sponsored by SCCMA/MCMS and the CMA and is the largest insurance brokerage firm in the world. They have resources to help you navigate the health insurance marketplace and provide you with the options you’re looking for at no additional cost to your premiums.

If you are an individual/family: you need to get coverage, or make any changes to your current coverage, during the open enrollment period from November 1st to December 15th. If you don’t qualify for the Covered California healthcare exchange visit www.CMACountyHealth.com to see the plans available in your area in the tiers that you prefer. You can enroll online through the site with the carrier you choose.

If you have small group coverage: Mercer can help you find the coverage you want based on your preferences. Or you can keep your current plan and assign it to Mercer, so you can support your association and call on Mercer’s team of Client Advisors, available to you when you need help.

What are you waiting for? Join the SCCMA/MCMS/CMA-sponsored health insurance programs right now! Call a Client Advisor at 800-842-3761, email CMACounty.Insurance.service@mercer.com, or visit www.CountyCMAMemberInsurance.com for more information.

Sponsored by:

Administered by:

Programs Administered by Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709

Click for more info:

777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com 78425 (11/17) Copyright 2017 Mercer LLC. All rights reserved.

BULLETIN THE

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

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

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

Feature Articles 10 CMA’s Legislative Wrap Up 26 2017 CMA House of Delegates 46 Prescription Pad Alert

Departments

5 2017 Medical Office Staff Salary Survey

Representation

6 Message From the SCCMA President

Human Resources Services

7 Message From the MCMS President

Legal Services/On-Call Library

8 In Memoriam

Legislative Advocacy/MICRA

35 Classified Ads

Membership Directory APP for

36 Medical Times From the Past

House of Delegates

the iPhone Physicians’ Confidential Line

38 Physicians News Network

Practice Management Resources and Education Professional Development Publications Referral Services With Membership Directory/Website Reimbursement Advocacy/ Coding Services Verizon Discount NOVEMBER / DECEMBER 2017 | 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: Vacant 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: Gloria Wu, 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 2017 by the Santa Clara County Medical Association.

4 | THE BULLETIN | NOVEMBER / DECEMBER 2017

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

2017 Medical Office Staff Salary Survey TO OUR MEMBERS: We are conducting this survey in an ongoing effort to provide you with information to help you manage your practice. Please take a few moments to answer the questions below about the salary and benefits provided to office staff in your medical practice. We will send the survey results confidentially to the physician completing and answering the survey. If you have any questions, please email Sandie Moore at sandie@sccma.org.

Staff Wages Position

(If more than one employee for a position, please provide the “highest paid wage” under “Employee #1” column and the “lowest paid wage” under “Employee 2” column.)

Employee #1 (Highest) Employee #2 (Lowest)

Office Manager / Practice Manager Biller Coder (Certified? q ) Receptionist Clerk Medical Assistant Physician Assistant Nurse (LVN) Nurse (RN) Nurse Practitioner X-Ray Technician Outside Biller Hourly Transcription Service Expense

Staff Benefits Provide (ü)

Benefit 1

Health insurance for full time staff

1a

Percent of premium paid by employee:

□ PPO

□ HMO

□ Medical Savings Account %

2

Health insurance for dependents

2a

Percent of premium paid by employee:

3

Extra pay in lieu of health insurance

4

Paid vacation

Number of Days:

5

Paid sick leave

Number of Days:

6

Paid holidays

Number of Days:

7

Retirement plan

8

Life insurance

9

Long-term disability insurance (private)

10

Dental insurance

11

Vision insurance

12

Uniform allowance

13

Pay for attendance (and tuition) to seminars

14

Pay for licenses / membership dues

15

Free or discounted medical care

16

Child care allowance

17

Other

%

Type:

□ 401k

Your medical specialty: # of physicians in practice:

□ Other (please specify):

Your zip code: # of employees:

Physician’s name: (please print)

You may fax your completed survey to 408-289-1064 Or email sandie@sccma.org NOVEMBER / DECEMBER 2017 | THE BULLETIN | 5

Kids and Smartphones President, Santa Clara County Medical Association

SEHAM EL-DIWANY, MD

MESSAGE FROM THE

SCCMA PRESIDENT

A “Giant Social Experiment?”

Seham El-Diwany, MD 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.

"W

e Need to Talk About Kids and Smartphones” was the title of a recent article in Time written by Markham Heid. The article leads with the tragic story of a teen attempted suicide and then follows with an analysis of the alarming correlation between teen depression and smartphone screen time.

According to the article, there is a 48% prevalence of suicide-related thoughts or actions among kids who use electronic devices five or more hours a day. Additionally, there has been a 60% rise in teenage depression in the U.S. between 2010 and 2016. According to the American Academy of Pediatrics 75% of teens in the U.S. own smart phones and 25% describe themselves as “constantly connected to the internet.”

Though causality is impossible to establish from these data, these alarming relationships cannot be ignored. Clickbait, the currency of social media, constantly tugs at our attention and emotions and we have yet to understand what impact this has on the adult brain, let alone, the developing child brain.

Frances Jensen, chair of neurology at the University of Pennsylvania’s School of Medicine and author of The Teen Brain, notes that “what this generation is going through right now with technology is a giant experiment.”

Families look for simple answers from the medical community (even when there is none) and pediatricians are often at the front lines. The onslaught of “Social Media” prompted the American Academy of Pediatrics (AAP) to release new policy recommendations complete with online interactive tools to help 6 | THE BULLETIN | NOVEMBER / DECEMBER 2017

families “manage” or at least “cope” with this new phenomenon. The AAP report outlines the positive effects of social media such as enhancing communication and facilitating social interactions. These AAP on-line tools are very helpful and as a pediatrician I always refer parents to them. These reports however, do not even scratch the surface on the profound effects of Social Media on mental health, personality disorders and in rare cases antisocial behavior.

The Time article does cite serious studies and research on adolescent’s still-developing brain at the time when it is “incredibly plastic and able to adopt.”

In one study, lower gray-matter volume in the brain’s anterior cingulate cortex (ACC), a region involved in emotion processing and decision-making was linked to media multitasking-texting, using social media. More research has associated lower ACC volumes with depression and addiction disorder.

It linked social media and other phone-based activities with “an uptick in feel-good neurochemicals like dopamine.”

We can’t escape the role social media plays in moving information around our globe and communities and we can’t escape its ubiquity throughout our country. We can, on the other hand, stay informed about emerging data and advise our patients and families to remain vigilant of the unknowns that lurk in our pockets at all times. As physicians practicing in the cradle of social media, we bear a special responsibility in the stewardship of this “giant social experiment.”

MESSAGE FROM THE

In Monterey County, 60% of the low-income community is reached with current health care resources.

There are more than 51,000 people who are income eligible but not accessing primary care. These low-income populations experience higher rates of obesity, diabetes, and hypertension than state, or even county, averages.

In Assembly District 30, up to 64% of adults 18 years or older are estimated to have pre-diabetes or diabetes. 45% have pre-diabetes, a condition with proper care and regular access to primary care can often be prevented from developing into the costly and complex chronic health condition of diabetes. Up to 22% of Monterey County residents who are Latino and living at 200% Federal Poverty Level or below have a diabetes diagnosis (UCLA AskCHIS, 2016).

Seventy-six percent of county residents are obese or overweight, a major contributor to diabetes. For local Latinos, the rates are as high as 82 percent. Up to 25% of all Monterey County residents have been diagnosed with Hypertension, a range that exceeds 31% for Latinos. These conditions require regular access to preventive and primary care medicine, without regular treatment, these can and do become costly, complex, chronic conditions.

Poverty, race, ethnicity and access to care all impact the rates of specific conditions and health outcomes.

Low-income Monterey County residents are at particular risk for chronic conditions effectively mitigated and managed by access to a healthcare provider.

The following indicators of health disparities are evident in Monterey County: • Adult obesity—targeted population rate 35.1%; 27.6% nationally.

• High rates of high blood pressure—30.6% in Monterey County; 28.7% nationally.

• Births to teen mothers—21.40% in Monterey County; 8.4% nationally.

• Childhood obesity—44.6% in Monterey County, 15% nationally (UCLA Center for Health Policy and California Center for Public Health Advocacy-2010).

• Binge alcohol use in past month—34.1% in Monterey County; 24.1% nationally.

• Percentage of the population linguistically isolated—15% in Monterey County, 10.3% nationally (US Census).

These six indicators require immediate medical intervention by our health delivery system. Where and how do we begin? Let’s consider the following approach: 1. Can we begin by setting ambitious goals for improving population health and health system efficiency? Here is one: ȧȧ Making [list your City] the healthiest in the U.S. a. Engage local businesses, schools, nonprofit organizations, health systems, and public agencies in initiatives and policies to focus public attention and engage residents in healthy lifestyles, improve their emotional health, and prevent substance abuse and violence.

2. Consider our goals key to revitalizing the local economy.

3. Leverage social ties to bring physicians, payers, and community organizations together to improve health care.

MCMS PRESIDENT

GROWING HEALTH DISPARITIES

President, Monterey County Medical Society

onterey County has among the highest rates of preventable illnesses such as hypertension, diabetes, and pre-diabetes, of almost any region in California. The lack of sufficient numbers of physicians places very difficult barriers to overcome in reducing and preventing these expensive chronic illnesses.

MAXIMILIANO CUEVAS, MD, FACOG

M

An Approach to Improve Health Care Disparities

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 8

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 7

Message From the MCMS President, from page 7 ȧȧ Place high value on social capital and social ties. ȧȧ Collaboration (“coopetition”) is a prerequisite for change as no individual effort by payers, providers, or patients would be strong enough to overcome the unsustainable incentives and fragmentation of services that contribute to the dysfunction of U.S. health care. ȧȧ Work with our physician and hospital community to encourage a practice style as well as programs to prevent unnecessary hospitalizations and improve coordination of care. ȧȧ Refine the approach to managed care to build accountable care systems using data and analytics. ȧȧ Partner with local providers to prioritize areas of focus and agree on common measures, thereby amplifying the impact of quality improvement and pay-for-performance programs. ȧȧ Investment in a regional health information exchange can increase efficiency by enabling the sharing of clinical and administrative data among hospitals, physicians, and insurers. ȧȧ Capacity building and support of safety-net providers coming together to identify areas in need of expanded services, which may drive further efficiencies.

4. Establish careful stewardship of health care resources. ȧȧ Work with employers and other community leaders to come to the conclusion that building and sustaining worldclass health care facilities requires reining in spending on inappropriate and duplicative care. ȧȧ Ensure that our communities place a heavy emphasis on identifying and addressing the needs of the underserved, reflecting both a sense of social responsibility and a pragmatic awareness that this could lead to savings downstream. Among the populations targeted for better care: a. Substance abusers and the mentally ill,

b. Women at high risk for adverse birth outcomes, and c. Frequent emergency department users, including patients with significant dental problems who lacked access to dentists. ȧȧ Consider bond initiatives. ȧȧ Consider formation of a community coalition; the coalition convenes community leaders for regional planning to review and recommend whether the state should approve planned investments by competing area health systems in an effort to prevent new construction and purchases of expensive equipment from sparking the equivalent of an arms race, as they have in many other U.S. cities.

5. Seek grants from foundations and governments. ȧȧ Funding used to foster collaboration and build capacity for improvement, which can be sustained over time. Among many diverse programs, focus on training lay health educators or hiring community health workers to find and assist residents who could benefit from health coaching and better chronic disease management, two strategies proven to reduce poor health outcomes and associated health care spending.

6. Payment models: managed care contracting and performance incentive programs to provide significant support for primary care physicians to adopt best practices and improve the quality of care.

7. Openness to innovation involving social change, willing to introduce models of care that change the way patients interact with the health system.

We can begin the dialogue with our friends in the administration of our local hospitals and medical practices. Our patients have to benefit from the changes that we create. I believe that we can bring this discussion to our medical society and use these ideas to create an agenda to guide our staff to work with us to sustain a profitable healthcare delivery system that keeps access and quality at the center of all of our efforts.

In Memoriam William C. Blair, MD

*Pediatrics 4/13/1925 – 9/21/2017 SCCMA member since 1955

Samuel C. Bonar, MD *Internal Medicine 1/22/1923 – 2/14/2017 SCCMA member since 1950

Victor J. De Fino, MD Gastroenterology 9/26/1929 – 11/18/2016 SCCMA member since 1961

8 | THE BULLETIN | NOVEMBER / DECEMBER 2017

Karen B. Devich, MD

*Internal Medicine Nephrology 12/28/1931 – 4/18/2017 SCCMA member since 1973

Elliot M. Finkle, MD

*Diagnostic Radiology 10/16/1940 – 1/31/2017 SCCMA member since 1973

Thomas S. Nelsen, MD *General Surgery 1/1/1926 – 3/17/2017 SCCMA member since 1961

Richard W. Poytress, MD *Anesthesiology 8/5/1921 – 5/2017 SCCMA member since 1950

Herbert M. Vogler, MD *Internal Medicine 1/1/1935 – 4/10/2017 SCCMA member since 1970

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G N I R E V A W UN

E S N E F DE

CMA’S 2017 LEGISLATIVE WRAP UP

BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT

Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it.” -MUHAMMAD ALI

In modern California politics, there is no more imposing figure than Governor Jerry Brown. Since his return to the Governor’s office, Brown and his administration have been able to develop and implement his policy agenda in a nearly flawless manner, overcoming every political obstacle in his way. Nowhere has Governor Brown’s dominance been more evident than in the crafting of the state budget.

Prior to Governor Brown’s return and the passage of the majority-vote budget, the enactment of the state budget was a drawn-out clash of political wills—a battle of ideals and priorities. The governor would present his vision in January. The Legislature would take months re-shaping 10 | THE BULLETIN | NOVEMBER / DECEMBER 2017

and re-focusing the governor’s budget proposal. Tense negotiations would yield significant legislative changes in the budget and a handful of gubernatorial line-item vetoes.

During his second tenure, Governor Brown has worked to deliver on-time budgets that do not significantly differ from his January proposals.

This year, the state budget process was more critical than ever to the California Medical Association (CMA). The November 2016 election yielded another ballot measure victory for CMA and public health advocates across the Golden State with the passage of Proposition 56. CMA took on Big Tobacco and passed Prop. 56, which increased

the tax on tobacco products by $2 per pack and stipulated that the new tobacco tax funds should increase access by improving provider payments.

Despite being outspent, CMA and its partners in support of the measure got Prop. 56 passed overwhelmingly, providing an influx of new revenue to increase payments to Medi-Cal providers. Governor Brown, however, seeking to secure his legacy of fiscal prudence, sought to re-interpret the provisions of Prop. 56 to redirect the tobacco tax proceeds from Medi-Cal providers to the State General Fund.

In his January budget proposal, Governor Brown didn’t include a rate increase for Medi-Cal providers. While there was an initial thought that the Governor was utilizing this proposal as a negotiation tactic to help shape the overarching discussion of the architecture for the state budget, it quickly became apparent that the Governor did not intend to ever support a rate increase for Medi-Cal providers. Thus, the battle began!

The Governor’s intentions became more evident with the release of the Department of Finance’s May Revision. Just weeks before the constitutional deadline for the Legislature to pass the budget, the Governor doubled down on this earlier proposal and once again proposed no funding to support a Medi-Cal rate increase for providers.

Restoring Prop. 56 funds was CMA’s top budget priority, and we engaged the Legislature through earned media, digital advertising, grassroots outreach and direct advocacy.

CMA and its coalition partners, specifically the California Dental Association and Planned Parenthood, devoted the necessary resources to make sure that the Legislature followed the will of the voters and used the tobacco tax money to improve access to care in our state. CMA’s county

medical societies and individual physician members made calls, wrote letters and conducted in-person legislative lobbying visits. Our legislative champions, led by Senator Richard Pan, M.D., and Assembly members Joaquin Arambula, M.D., and Jim Wood, D.D.S., pushed both the State Senate and Assembly to reject the Governor’s budget.

The final budget, which Governor Brown signed, provides over $1 billion ($546 million in state funds, with a federal match) to improve provider payments, and nearly $750 million ($375 million in state funds, with a federal match) will be available to physicians.

This victory was a collective effort of the entire CMA. A budget team was assembled, comprised of members of the Centers for Government Relations, Health Policy, Strategic Communications and Political Operations. Working in concert, this team successfully pushed the budget as CMA’s top legislative priority.

Media coverage of the budget is always competitive, but the issue of Prop. 56 funding garnered a significant amount of attention, even among the sea of other budget fights, thanks to the persistence of the CMA Communications team. CMA’s Political Operations staff organized physicians and county medical society executives to engage in the fight, bringing the issue to the attention of their legislators at in-district meetings and to the Capitol on our Legislative Advocacy Day in April. The CMA Government Relations team, the face of the fight, came armed to each hearing and meeting with the expertise of the CMA Health Policy team.

Although this fight will no doubt play out again in some future years and we will need to be vigilant to ensure continued funding, this year’s budget success seals the intent of the voters and will provide relief for California’s shamefully low Medi-Cal reimbursement rates.

AN AGGRESSIVE LEGISLATIVE AGENDA

prescriptions. Our bill would improve privacy protections in the mandated use of CURES. To deal with how opioids are prescribed, Assembly member Joaquin Arambula, M.D., introduced AB 1048, which allowed for partial fill of Schedule II prescriptions and removed the requirement for evaluating pain as the fifth vital sign. These changes will alleviate some of the pressure on physicians to prescribe and reduce the number of opioids given to patients.

CMA also successfully pushed a clean-up bill for last year’s AB 2883 (authored by the Committee on Insurance), a workers’ compensation bill that inadvertently created hundreds of thousands of dollars new, burdensome costs to physician practices. CMA’s

Amid the budget battle, the quotidian legislative work continued – as always. However, the routine was not without intensity. CMA this year pushed an aggressive legislative agenda through our package of sponsored bills, seeking to address a wide variety of our members’ issues.

Two of our sponsored bills this year pertained to different aspects of the opioid crisis. SB 641 (Lara), which was put on hold for further discussion in the 2018 legislative session, is a supplement to Senator Lara’s SB 482 from last session, requiring use of the Controlled Substance Utilization Review and Evaluation System (CURES) for Schedule II-IV controlled substance

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 11

bill—SB 189 (Bradford)—completely exempted physician practices from the workers’ compensation coverage requirement established by AB 2883, provided they have health insurance coverage. SB 189 will dramatically reduce the administrative cost of running a medical practice.

Our highest profile legislative fight was over the Medical Board of California sunset review. This was the Legislature’s scheduled review of the medical board, during which it can make changes to the board’s policies and procedures and, crucially, extends the board past its “sunset” – that is, dissolution – date. What should have been an uneventful, perfunctory bill became a fight for CMA because of the inclusion of several provisions

eroding physicians’ rights. We secured amendments to remove harmful provisions from the bill, including ones that would have reestablished a cost recovery program for the board, provided the board with new authority to issue cease practice orders and required certain physicians to notify their patients of their probation status.

As ever with the two-year legislative cycle, the bulk of the first year’s work sets the stage for the second year’s.

Discussions will resume in January over a host of issues, and CMA is well positioned in those conversations to protect the interests of physicians and their patients. Our strength this year builds our strength for next year.

In Unity, Janus L. Norman

BELOW ARE DETAILS OF THE MAJOR BILLS THAT CMA FOLLOWED THIS YEAR.

CMA-SPONSORED LEGISLATION AB 315 (WOOD): PHARMACY BENEFIT MANAGER TRANSPARENCY This bill requires pharmacy benefit managers (PBMs) to obtain a license from the Department of Managed Health Care before conducting business in California and to renew the license on an annual basis. It also requires PBMs to make quarterly disclosures regarding information with respect to prescription product benefits specific to the purchaser for all retail, mail order, specialty, and compounded prescription products.

Status: Held on the Inactive File of the Senate.

AB 505 (CABALLERO): RESTORING TRUST IN MEDICAL BOARD PROBATION This bill would have prevented a physician or surgeon charged with certain serious allegations from entering into a stipulated settlement that included probation as one of the settlement terms.

Status: Held in the Senate Business, Profession, & Economic Development Committee.

AB 1048 (ARAMBULA): IMPROVED OPIOID MANAGEMENT This bill allows Schedule II controlled substances to be partially filled at the request of the patient or the 12 | THE BULLETIN | NOVEMBER / DECEMBER 2017

prescriber. It also removes the requirement that hospitals assess pain as the 5th vital sign, retaining the assessment but providing hospitals the flexibility in determining the best approach. These provisions ensure that health care providers can provide appropriate medical care while reducing excess opioid supply.

Status: Signed by the Governor (Chapter 615, Statutes of 2017).

AB 1221 (GONZALEZ FLETCHER): RESPONSIBLE BEVERAGE SERVICE TRAINING PROGRAM This bill would require California bartenders, servers, and managers to receive responsible beverage service training (RBS) through a program that must be administered or approved by the Department of Alcoholic Beverage Control or offered by a training provider that has been accredited by an accreditation agency. AB 1221 seeks to help individuals who serve alcohol, to meet their statutory requirement not to serve obviously intoxicated patrons and minors and reduce drunk driving.

Status: Signed by the Governor (Chapter 847, Statutes of 2017).

SB 189 (BRADFORD): WORKERS’ COMPENSATION FIX

SB 641 (LARA): PRIVATE PROTECTIONS FOR THE CURES DATABASE

This bill provides a clarification to AB 2883 (Insurance Committee, 2016), which had allowed shareholderemployees with at least a 15-percent ownership stake in a corporation to exempt themselves from coverage. SB 189 reduces the 15-percent ownership threshold to 10 percent and explicitly exempts physician owners of medical corporations from workers’ compensation requirements regardless of percentage of ownership, as long as they have health insurance coverage.

This bill clarifies that law enforcement must get a warrant to obtain information from the Controlled Substance Utilization Review and Evaluation System (CURES), which aligns the CURES privacy protections more closely with those provided a patient’s medical record.

Status: Signed by the Governor (Chapter 770, Statutes of 2017).

SB 457 (BATES): OUT-OF-HOSPITAL BIRTHS This is a comprehensive approach for California licensees assisting out-of-hospital births (M.D.s, CNMs, and LMs) to establish proper protocols, increase patient safety, and clarify the appropriate scope of practice for both CNMs and LMs assisting births outside a hospital. CMA is co-sponsoring this legislation with ACOG.

Status: Held in the Senate Business, Profession, & Economic Development Committee.

Status: Held in the Assembly Public Safety Committee.

SB 647 (PAN): SILENT PPO AND HEALTH CARE PROVIDERS’ BILL OF RIGHTS In 2003, the Legislature enacted the Health Care Providers’ Bill of Rights, in part to ensure that third-party payers are automatically bound by the terms of the original health plan/provider contract. Recently, the appellate court decision in the UFCW & Employers Benefit Trust v. Sutter Health (2015) ruled that a third-party payer was not bound by the terms of the original health provider/ health plan contract even though that payer had benefitted from the lower provider rates in the contract. The UFCW case has undermined protections that were established by a CMA-sponsored bill. We will be working with the California Hospital Association, to sponsor legislation to re-establish the automatic binding of a third-party payer to the original health plan/provider contract.

Status: Held in the Senate Health Committee.

SUCCESSFULLY NEGOTIATED LEGISLATION AB 40 (SANTIAGO): CURES DATABASE: HEALTH INFORMATION TECHNOLOGY SYSTEM This bill would require the Department of Justice to make a patient’s Controlled Substance Utilization Review and Evaluation System (CURES) history of dispensed controlled substances available to a practitioner through either an online Internet Web portal or an authorized health information technology system. The bill would authorize an entity that operates a health information technology system to establish an integration with and submit queries to the CURES database, if the system entity can certify, among other requirements, that the data received from the CURES database will not be

used for any purpose other than delivering the data to an authorized health care practitioner or performing data processing activities necessary to enable delivery, and that the system meets applicable patient privacy and information security requirements of state and federal law. The bill would also authorize the Department of Justice to require an entity operating a health information technology system that is requesting to establish an integration with the CURES database, to enter into a memorandum of understanding or other agreement setting forth terms and conditions with which the entity must comply.

Status: Signed by the Governor (Chapter 607, Statutes of 2017).

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 13

AB 182 (WALDRON): HEROIN AND OPIOID PUBLIC EDUCATION This bill would require the Department of Public Health, until January 1, 2023, to develop, coordinate, implement, and oversee a comprehensive multicultural public awareness campaign, to be known as “Heroin and Opioid Public Education (HOPE),” upon appropriation by the Legislature or receipt of state or federal grant funding.

The bill would require the HOPE program to provide for the coordinated and widespread public dissemination of information that is designed to, among other things, describe the effects and warning signs of heroin use and opioid medication abuse, to better enable members of the public to determine when help is needed and identify pathways that are available for individuals to seek help. The bill would require the HOPE program to use appropriate media types as specified, employ a variety of complementary educational themes and messages that are tailored to appeal to different target audiences and use culturally and linguistically appropriate means.

Status: Failed in the Senate Appropriations Committee.

AB 334 (COOPER): SEXUAL ASSAULT This bill would have set the time for commencement of any civil action for recovery of damages suffered as a result of sexual assault, to the later of within 10 years from the date of the last act, attempted act, or assault with intent to commit an act, of sexual assault by the defendant against the plaintiff or within 3 years from the date the plaintiff discovers or reasonably should have discovered that an injury or illness resulted from an act, attempted act, or assault with intent to commit an act, of sexual assault by the defendant against the plaintiff.

Current law defines an employer for purposes of those provisions. This bill would have expanded the definition of “employer” for purposes of these provisions to include a person who directly or indirectly, or through an agent or any other person, employs or exercises control over the wages, hours, or working conditions of a person engaged in a period of supervised work experience to satisfy requirements for licensure, registration, or certification as an allied health professional.

Status: Failed in the Assembly.

AB 413 (EGGMAN): CONFIDENTIAL COMMUNICATIONS: DOMESTIC VIOLENCE This bill would allow a party to a confidential communication to record the communication for the purpose of obtaining evidence reasonably believed to relate to domestic violence and the evidence so obtained would not be rendered inadmissible in a prosecution against the perpetrator for domestic violence.

Status: Signed by the Governor (Chapter 191, Statutes of 2017).

AB 702 (LACKEY): DRIVING UNDER THE INFLUENCE: CHEMICAL TESTS

Status: Failed in the Senate Public Safety Committee.

When a person is convicted of violating specified drivingunder-the-influence (DUI) provisions, and at the time of the arrest leading to that conviction the person willfully refused a peace officer’s request to submit to, or willfully failed to complete, a specified chemical test, existing law requires a court to impose additional penalties. This bill would make it a crime for a person to willfully refuse to submit to, or willfully fail to complete, a breath test after being lawfully arrested for a violation of specified offenses.

Status: Failed in the Senate Appropriations Committee.

AB 387 (THURMOND): MINIMUM WAGE: HEALTH PROFESSIONALS: INTERNS

AB 715 (WOOD): WORKGROUP REVIEW OF OPIOID PAIN RELIEVER USE AND ABUSE

Current law requires the minimum wage for all industries to not be less than specified amounts to be increased from January 1, 2017, to January 1, 2022, inclusive, for employers employing 26 or more employees and from January 1, 2018, to January 1, 2023, inclusive, for employers employing 25 or fewer employees, except when the scheduled increases are temporarily suspended by the Governor, based on certain determinations.

This bill would require the Department of Public Health to convene a workgroup, comprised of members selected by the department, to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers for instances of acute, short-term pain.

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Status: Vetoed by the Governor.

AB 859 (EGGMAN): ELDERS AND DEPENDENT ADULTS: ABUSE OR NEGLECT The Elder Abuse and Dependent Adult Civil Protection Act, provides for the award of attorney’s fees and costs to, and the recovery of damages by, a plaintiff when it is proven by clear and convincing evidence that the defendant is liable for physical abuse or neglect, and the defendant has also been found guilty of recklessness, oppression, fraud, or malice in the commission of that abuse. This bill would instead apply a preponderance of the evidence standard to any claim brought against a residential care facility for the elderly or a skilled nursing facility for remedies sought pursuant to the above provisions, upon circumstances in which spoliation of evidence has been committed by the defendant.

Status: Vetoed by the Governor.

AB 1061 (GLORIA): VICTIM’S RESTITUTION This bill would update the administration of the Crime Victim Compensation Board. It would prohibit a suspected perpetrator of the crime for which compensation is sought from being an authorized representative for the purposes of filing a claim. The bill would provide an indefinite application period for certain crimes, including rape, as specified. The bill would add preparation for testimony as a condition the board may consider for extending the time for application.

Status: Failed in the Assembly Appropriations Committee.

AB 1116 (GRAYSON): PEER SUPPORT AND CRISIS REFERRAL SERVICES This bill would create the Peer Support and Crisis Referral Services Act, which would allow for the creation of “peer support teams” to provide counseling services to individuals who respond to critical incidents. These services would be available to physicians who provided emergency services who need mental health counseling or peer support.

Status: Failed on the Senate Inactive File.

AB 1250 (JONES-SAWYER): COUNTIES: CONTRACTS FOR PERSONAL SERVICES This bill would have established specific standards for the use of personal service contracts by counties requiring the County Board of Supervisors to make a number of findings, before awarding a government service contract to a private third party, including non-profits. The bill does not apply to existing contracts and any extension or renewal of those contracts. Additionally, the bill does not apply to services that are expert in nature or to services where there are not sufficient number of county employees in the workforce to reasonably provide the service.

Status: Failed in Senate Rules Committee.

AB 1312 (GONZALEZ FLETCHER): SEXUAL ASSAULT VICTIMS: RIGHTS This bill would require a law enforcement authority or district attorney to also notify a sexual assault victim that he or she has the right to request to have a person of the same gender or opposite gender as the victim present in the room during any interview with a law enforcement official or district attorney, unless no such person is reasonably available. It would require that emergency contraception be provided to the victim for free. It would require law enforcement to develop and provide, and for medical personnel to provide, if available, a card with information on the rights of sexual assault victims. It would require the forensic medical examiner to allow the victim to shower or bathe, if facilities are available. It would establish a minimum time for law enforcement to store a rape kit or evidence from a sexual assault.

Status: Signed by the Governor (Chapter 692, Statutes of 2017).

AB 1316 (QUIRK): PUBLIC HEALTH: CHILDHOOD LEAD POISONING: PREVENTION This bill would change the definition of “lead poisoning” to include concentrations of lead in arterial or cord blood.

The bill would require that the regulations establishing a standard of care include the determination of risk factors for whether a child is at risk for lead poisoning be updated

by July 1, 2019 and would require the department, when determining those risk factors, to consider the most

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 15

significant environmental risk factors. It would require the California Department of Public Health, to annually publish information regarding efforts to increase lead screening in children and efforts to reduce lead exposure.

Finally, it would require lead screening done pursuant to the screening regulations to be covered by insurance.

Status: Signed by the Governor (Chapter 507, Statutes of 2017).

AJR 19 (ARAMBULA): OPIOID AWARENESS AND DEPENDENCY PREVENTION This measure urges hospital-based pain management formularies, to consider the inclusion of a range of non-opioid alternatives and urges the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.

AB 1560 (FRIEDMAN): NURSE PRACTITIONERS: CERTIFIED NURSE-MIDWIVES: PHYSICIAN ASSISTANTS: PHYSICIAN AND SURGEON SUPERVISION

Status: Signed by the Governor (Chapter 208, Statutes of 2017).

The Physician Assistance Practice Act authorizes a physician assistant licensed by the Physician Assistant Board, to be eligible for employment or supervision by any physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision. The act prohibits a physician and surgeon from supervising more than 4 physician assistants at any one time. This bill would prohibit a physician and surgeon from supervising more than 12 nurse practitioners, certified-nurse midwives, and physician assistants at any one time.

Existing law requires a court, on petition of a party to an arbitration agreement alleging (1) the existence of a written agreement to arbitrate a controversy and (2) that a party to the agreement refuses to arbitrate the controversy, to order the petitioner and the respondent to arbitrate the controversy if the court determines that an agreement to arbitrate exists, unless the court makes other determinations. This bill would add to these determinations instances in which a financial institution, as defined, is seeking to apply a written agreement to arbitrate, contained in a contract consented to by a consumer, to a purported contractual relationship with that consumer that was created by the petitioner fraudulently, without the consumer’s consent and by unlawfully using the consumer’s personal identifying information.

Status: Failed on the Senate Inactive File.

AB 1650 (MAIENSCHEIN): EMERGENCY MEDICAL SERVICES: COMMUNITY PARAMEDICINE This bill would have, until January 1, 2022, created the Community Paramedic Program in the authority. The bill would have authorized the authority to authorize a local EMS agency that opts to participate in the program to provide specified services, such as case management services and linkage to nonemergency services for frequent EMS system users, through a local community paramedic program.

Status: Failed in the Assembly Appropriations Committee.

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SB 33 (DODD): ARBITRATION AGREEMENTS

Status: Signed by the Governor (Chapter 480, Statutes of 2017).

SB 43 (HILL): ANTIMICROBIAL-RESISTANT INFECTION: REPORTING This bill would have required specified general acute care hospitals and clinical laboratories to submit a report to the California Department of Public Health, commencing July 1, 2019, and each July 1 thereafter, containing an antibiogram of the facility for the previous year. The bill would have required the Antimicrobial Stewardship and Resistance Subcommittee of the Healthcare Associated Infections Advisory Committee of the department, on or before January 1, 2019, to develop and recommend to the department the acceptable electronic format

for the report and a method for the department to accurately estimate the number of deaths that result from antimicrobial resistant infections for specified types of antimicrobial infections. It would also require CDPH to annually publish information related to the number of antimicrobial-resistant infections and the estimated number of deaths.

Status: Failed in the Assembly Health Committee.

SB 199 (HERNANDEZ): THE CALIFORNIA HEALTH CARE COST, QUALITY, AND EQUITY ATLAS This bill would have required the Secretary of California Health and Human Services, in furtherance of the goal of creating the California Health Care Cost, Quality, and Equity Atlas, to convene an advisory committee composed of a broad spectrum of health care stakeholders and experts. The bill would require the secretary to charge the advisory committee with identifying the type of data, purpose of use, and entities and individuals that are required to report to, or that may have access to, a health care cost, quality, and equity atlas, and with developing a set of recommendations based on specified findings of the March 1, 2017 report.

Status: Failed in the Assembly Appropriations Committee.

SB 219 (WIENER): LONG-TERM CARE FACILITIES: RIGHTS OF RESIDENTS This bill would make it unlawful for any long-term care facility, to take specified actions wholly or partially on the basis of a person’s actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status, including refusing

to use a resident’s preferred name or pronoun and denying admission to a long-term care facility, transferring or refusing to transfer a resident within a facility or to another facility, or discharging or evicting a resident from a facility.

Status: Signed by the Governor (Chapter 483, Statutes of 2017).

SB 349 (LARA): CHRONIC DIALYSIS CLINICS: STAFFING REQUIREMENTS This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year.

Status: Failed on the Assembly Inactive File.

SB 698 (HILL): DRIVING UNDER THE INFLUENCE: ALCOHOL AND MARIJUANA This bill would have, until January 1, 2021, made it a crime for a person who has between 0.04% and 0.07%, by weight, of alcohol in his or her blood and whose blood contains any controlled substance or 5 ng/ml or more of delta-9-tetrahydrocannabinol to drive a vehicle. The bill would have required a person to fail field sobriety tests to establish probable cause for a chemical test to test the person’s blood. The bill would have made a first violation punishable as an infraction and would have made subsequent violations punishable as a misdemeanor.

Status: Failed in the Senate Appropriations Committee.

OPPOSED LEGISLATION AB 221 (GRAY): WORKERS’ COMPENSATION: LIABILITY FOR PAYMENT Current law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury. This bill would have provided that for claims of occupational disease or

cumulative injury filed on or after January 1, 2018, the employee and the employer would have no liability for payment for medical treatment, unless one or more of certain conditions are satisfied, including, among others, that the treatment was authorized by the employer.

Status: Failed in the Assembly Insurance Committee.

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 17

AB 320 (COOLEY): CHILD ADVOCACY CENTERS This bill would have authorized a county, in order to implement a multidisciplinary response to investigate reports involving child physical or sexual abuse, exploitation, or maltreatment, to use a Child Advocacy Center. The bill would have required a Child Advocacy Center to meet specified standards, including the use of representatives from specified disciplines and providing dedicated child-focused settings for interviews and other services. The bill would have authorized multidisciplinary team members to share with each other information in their possession concerning the child, the family of the child, and the person who is the subject of the abuse or neglect investigation.

Status: Failed in the Assembly Human Services Committee.

AB 595 (WOOD): HEALTH CARE SERVICE PLANS: MERGERS and ACQUISITIONS This bill would have required specified entities that intend to merge with, consolidate, acquire, purchase, or control, directly or indirectly, a health care service plan doing business in this state to give notice to, and secure prior approval from, the Director of the Department of Managed Health Care. The bill would have required that entity to apply for licensure as a health care service plan.

The bill also would have required the department, prior to approval, conditional approval, or denial of the proposed agreement or transaction, to hold a public hearing on the proposal and make specified findings.

Status: Failed in the Assembly Appropriations Committee.

AB 700 (JONES-SAWYER): PUBLIC HEALTH: ALCOHOLISM OR DRUG ABUSE RECOVERY: SUBSTANCE USE DISORDER COUNSELING This bill would have established a career ladder for substance use disorder counseling to be maintained and updated by the State Department of Health Care Services. The bill would have established classifications for substance use disorder (SUD) counselor certification or registration to be implemented by the organizations that certify substance use disorder programs. The bill would

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have required any person who engages in the practice of SUD counseling to be certified by, or registered with, a certifying organization, unless specifically exempted.

The bill would establish additional standards for registrants and interns, as defined, and impose additional requirements on SUD counselors. The bill would have provided authority to the department to discipline a certificate holder or registrant. The bill would have authorized the department to implement these provisions by regulation.

Status: Failed in the Senate Health Committee.

AB 748 (TING): PEACE OFFICERS: VIDEO AND AUDIO RECORDINGS: DISCLOSURE This bill would allow a video or audio recording that relates to a matter of public concern because it depicts an incident involving a peace officer’s use of force, or is reasonably believed to involve a violation of law or agency policy by a peace officer, to be withheld for a maximum of 120 calendar days if disclosure would substantially impede an active investigation.

Status: Failed in the Senate Judiciary Committee.

AB 889 (STONE, MARK): SECRECY AGREEMENTS Current law generally permits the parties to a civil action to include, as a condition to a settlement, a provision requiring that information about the settlement or the underlying dispute be kept confidential; however, existing law prohibits a confidential settlement agreement in a civil action with a factual foundation establishing a cause of action for civil damages for an act that may be prosecuted as a felony sex offense. Existing law also establishes that flouting this prohibition is grounds for professional discipline for an attorney, and it requires the State Bar of California to investigate and take appropriate action in any case brought to its attention. This bill would have instead authorized but not required the State Bar to investigate these cases of attorney misconduct.

Status: Failed in the Assembly.

AB 937 (EGGMAN): HEALTH CARE DECISIONS: ORDER OF PRIORITY The Health Care Decisions Law provides for an individual’s use of a request regarding resuscitative

measures, which is a written document, signed by an individual with capacity or a legally recognized health care decision maker for the individual, and the individual’s physician, that directs a health care provider regarding resuscitative measures for the individual. This bill would have provided that, to the extent of that conflict, the most recent order signed by the individual or instruction made by the individual is effective. The bill would have deemed a request regarding resuscitative measures signed by specified persons on behalf of the individual to be signed by the individual.

AB 1402 (ALLEN, TRAVIS): PROSTITUTION: MINORS This bill would have made the prohibitions on prostitution and related offenses applicable to a person under 18 years of age.

Status: Failed in the Assembly Public Safety Committee.

AB 1612 (BURKE): NURSING: CERTIFIED NURSE-MIDWIVES: SUPERVISION

This bill would have exempted from the Alcoholic Beverage Control Act the use of powdered alcohol as an ingredient in non-powdered products and the production, sale, or offering for sale or delivery, receipt, or purchasing for resale of powdered alcohol for use as an ingredient in non-powdered products.

This bill would have repealed the requirement that a certified nurse-midwife be under the supervision of a licensed physician and surgeon. The bill would authorize a certified nurse-midwife to consult, refer, or transfer care to a physician and surgeon as indicated by the health status of the patient and the resources and medical personnel available in the setting of care. The bill would provide that a certified nurse-midwife practices within a variety of settings, including, but not limited to, the home setting.

The bill would have specified that nurse-midwifery care emphasizes informed consent, preventive care, and early detection and referral of complications.

Status: Failed in the Assembly Governmental Organization Committee.

Status: Failed in the Assembly Appropriations Committee.

AB 1110 (BURKE): PUPIL HEALTH: EYE AND VISIONS EXAMINATIONS

ACR 8 (JONES-SAWYER): ADVERSE CHILDHOOD EXPERIENCES: POST-TRAUMATIC “STREET” DISORDER

Status: Failed in the Senate Health Committee.

AB 1054 (BROUGH): POWDERED ALCOHOL

This bill would have required, during the kindergarten year or upon first enrollment or entry at an elementary school, including a charter school, a pupil’s eyes and vision to be examined by a physician, optometrist, or ophthalmologist in accordance with specified provisions, unless the pupil’s parent or guardian submits a written waiver to the school or charter school. The bill would have required, in a pupil’s kindergarten year or upon first enrollment or entry at an elementary school that is not a charter school, the pupil’s vision to be appraised in accordance with the above-specified provisions only if the pupil’s parent or guardian fails to provide the results of the eye and vision examination.

Status: Failed in the Assembly Appropriations Committee.

This measure would recognize post-traumatic “street” disorder as a mental health condition with growing implications for our state.

Status: Signed by the Governor (Chapter 139, Statutes of 2017).

SB 72 (MITCHELL): BUDGET ACT OF 2017 This bill included the Senate’s budget package, which would have allocated only $348 million in Proposition 56 funding to improve access to care, $150 million of which would have been for a high-need specialty access pool to provide rate increases for physicians that are tied to the Access Assessment study required by the Medi-Cal 2020 waiver, to network adequacy standards established by the new federal Medicaid rule, or to more closely align Medi-Cal rates with those in the Medicare program. The remaining Prop. 56 funding it his budget would have been

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 19

allocated to the Medi-Cal program to support regular program growth as proposed by the Administration.

Additionally, this bill would have implemented the Administration’s proposal to allocate $50 million in Prop.

56 funding to the University of California (UC), while also cutting $50 million from the General Fund base, which would require the UC to use this funding for its base operation and not to increase graduate medical education opportunities for medical school graduates seeking to complete their residencies in California. Finally, this bill only allocated $6 million from the General Fund to the Office of Statewide Health Planning and Development for the Song-Brown program, rather than the full $33 million that the Governor had cut from the budget in his proposal.

Status: Failed in Senate Budget Committee.

SB 350 (GALGIANI): INCARCERATED PERSONS: HEALTH RECORDS

SB 538 (MONNING): HOSPITAL CONTRACTS This bill would have prohibited contracts between hospitals and contracting agents or health care service plans from containing certain provisions, including, but not limited to: setting payment rates or other terms for nonparticipating affiliates of the hospital; requiring the contracting agent or plan to keep the contract’s payment rates secret from any payor, as defined, that is or may become financially responsible for the payment; and requiring the contracting agent or plan to submit to arbitration, or any other alternative dispute resolution program, any claims or causes of action that arise under state or federal antitrust laws after those claims or causes of action arise, except as provided. The latest amendment required health plans and health insurers to be responsible for including and disclosing relevant terms of the provider contract with the third-party payor. The bill would make any prohibited contract provision void and unenforceable.

Current law authorizes a provider of health care or a health care service plan to disclose medical information when the information is disclosed to an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor, or other person or entity responsible for paying for health care services rendered to the patient, to the extent necessary to allow responsibility for payment to be determined and payment to be made. This bill would have additionally authorized the disclosure of information between a county correctional facility, a county medical facility, a state correctional facility, or a state hospital to ensure the continuity of health care of an inmate being transferred between those facilities.

Status: Failed in the Assembly Health Committee.

Status: Failed in the Senate Appropriations Committee.

SB 636 (BRADFORD): ADDICTION TREATMENT: ADVERTISING: PAYMENT

SB 419 (PORTANTINO): MEDICAL PRACTICE: PAIN MANAGEMENT

This bill would have prohibited a person, firm, partnership, association, or corporation, or an agent or employee thereof, from making payments for services that recommend any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary. The bill would also have prohibited a person, firm, partnership, association, or corporation, or an agent or employee thereof, from using runners, cappers, steerers, or other persons to procure clients, patients, or customers for any form of medical care or treatment provided by an alcohol-related or narcotic-related program, facility, or dispensary.

This bill would have prohibited a person from prescribing oxycodone, by whatever official, common, usual, chemical, or trade name designated, to a patient under 21 years of age.

The bill would have made a violation of this prohibition subject to a civil penalty. The bill would also have authorized a patient who was prescribed oxycodone in violation of the prohibition, and who sustained economic loss or personal injury as a result of that violation, to bring a civil action to recover compensatory damages, reasonable attorney’s fees, and litigation.

Status: Failed in the Senate Business, Professions, and Economic Development Committee.

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SB 562 (LARA AND ATKINS): THE HEALTHY CALIFORNIA ACT This bill, the Healthy California Act, would have created the Healthy California program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

Status: Failed in the Assembly.

Status: Failed in Senate Health Committee.

SB 746 (PORTANTINO): PUPIL HEALTH: PHYSICAL EXAMINATIONS

SB 798 (HILL): HEALING ARTS: BOARDS

Current law authorizes a physician and surgeon or physician assistant to perform a physical examination that is required for a pupil to participate in an interscholastic athletic program of a school. This bill would have additionally authorized a doctor of chiropractic, naturopathic doctor, or nurse practitioner practicing in compliance with the respective laws governing their profession to perform that physical examination.

Status: Failed in Senate Education Committee.

SB 790 (MCGUIRE): HEALTH CARE PROVIDERS: GIFTS AND BENEFITS This bill would prohibit pharmaceutical and device manufacturers from providing physicians anything of value and create new regulations that govern interactions between these companies and physicians.

Status: Failed on the Assembly Inactive File.

This bill would extend the authorization of the Medical Board of California for another four years; add licensed midwives to peer review laws and the Moscone-Knox Professional Corporation Act; add medical board-appointed physician members to the Health Professions Education Foundation, eliminate the medical board’s authority to approve American Board of Medical Specialties-equivalent boards; establish a post-graduate training license for physicians and require two additional years in residency training before a physician can practice independently; make the Board of Podiatric Medicine independent of the medical board; impose fines for failing to submit reports pursuant to Business and Professions Code 805.1; change the adverse event reporting requirements for outpatient surgery settings, change the requirements for use of an expert witness in disciplinary cases; end, as of January 1, 2019, the requirement for concurrent engagement of investigators and prosecutors in medical board cases; extend the authorization of the Osteopathic Medical Board of California; make changes to continuing medical education for OMBC-licensed physicians, and make other changes to the medical-board’s administration.

Signed by the Governor (Chapter 775, Status: Statutes of 2017).

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NOVEMBER / DECEMBER 2017 | THE BULLETIN | 21

Santa Clara County Medical Association 700 Empey Way • San Jose, CA 95128 • 408/998-8850 • FAX 408/289-1064 November 2017 TO:

All Members, Santa Clara County Medical Association (SCCMA)

FROM:

Kenneth Blumenfeld, MD, Chair, 2017-2018 Awards Committee

At the 2018 Medical Association’s annual banquet, the association will honor several individuals with its perpetual awards. These awards are significant honors which reflect the respect, recognition, and appreciation of our membership. The recipients are selected from among our outstanding members who have distinguished themselves with extraordinary service to medicine in general, to the association, to the community, or to medical education.

Selections are made by the Awards Committee, with the aid of input from the membership at-large. Your suggestions for recipients for each of the awards, outlined on the next page of this memo, will be appreciated.

Please complete the form below to submit suggestions, keeping in mind the requirements for each award as listed on the opposite page. If you would like to nominate more than one person, or for more than one award, please photocopy this form or send a letter.

Suggestions must be received by February 16, 2018. Thank you for your recommendations.

If you previously suggested a candidate who was not given an award, please feel free to resubmit that name.

I THINK _____________________________________________________ WOULD BE A GOOD CANDIDATE FOR THE _____________________________________________________________________________________ . (Name of Award) PLEASE ATTACH ALL SUPPORTING INFORMATION, INCLUDING ACCOMPLISHMENTS AND CONTRIBUTIONS THAT WILL HELP THE AWARDS COMMITTEE EVALUATE THE CANDIDATE FOR THE AWARD SELECTED. YOU MAY MAIL, FAX, OR EMAIL THE INFORMATION TO PAM JENSEN AT SCCMA. SUBMITTED BY: ___________________________________________________________________________________ MD (Please print) MAIL FORM TO: SCCMA

Attn: Pam Jensen

700 Empey Way

San Jose, CA 95128 EMAIL: pjensen@sccma.org FAX: 408/289-1064 DEADLINE: February 16, 2018 22 | THE BULLETIN | NOVEMBER / DECEMBER 2017

Santa Clara County Medical Association

ANNUAL AWARDS

ROBERT D. BURNETT, MD LEGACY AWARD

For a physician member of the Medical Association who has demonstrated extraordinary visionary leadership, tireless effort, selfless long-term commitment, and success in challenging and advancing the health care community, the wellbeing of patients, and the most exalted goals of the medical profession. The only six recipients of this award are Robert D. Burnett, MD, Philipp Lippe, MD, Robert Pearl, MD, Sharon Levine, MD, Richard J. Slavin, MD and James G. Hinsdale, MD.

BENJAMIN J. CORY, MD AWARD

For a physician member of the Medical Association who has displayed forwardlooking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.

AWARD FOR OUTSTANDING ACHIEVEMENT IN MEDICINE

For a physician member of the Medical Association who, during his/her medical career, has made unique contributions to the betterment of patient care, for which he/she has achieved widespread recognition. Consideration shall be given to research and/or the development of procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine.

Benjamin J. Cory, MD Award

1994 1995 1996 1997 1998 1999 2000 2001

Robert W. Jamplis

Outstanding Outstanding Contribution To The Contribution In Medical Association Medical Education

AWARD FOR OUTSTANDING CONTRIBUTION TO THE MEDICAL ASSOCIATION

For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the Association over and above that expected of the membership at-large.

AWARD FOR OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION

For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large.

AWARD FOR OUTSTANDING CONTRIBUTION IN COMMUNITY SERVICE

For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large.

CITIZEN’S AWARD

For an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. (This usually will be a non-physician, although physicians are not categorically excluded.)

Outstanding Achievement In Medicine

Richard M. O’Neill

John B. Shinn

Thomas J. Fogarty

---

Robert W. Andonian

Ronald L. Kaye

Norman E. Shumway

Christopher C. Chow

David M. Rosenthal

William C. Fowkes

Thomas A. Stamey

---

Bernice S. Comfort

Robert J. Frascino

Mansfield F. W. Smith

Stanley D. Harmon

Howard R. Porter

Donald J. Prolo

Steven S. Fountain

Sharon A. Bogerty ---

Outstanding Contribution In Community Service Arthur A. Basham / Arthur L. Messinger ---

Citizen’s Award Gary W. Steinke, MD / Mrs. Pamela Steinke Mr. Howard W. Pearce

Cindy Lee Russell / Minoru Yamate

Florene Poyadue, RN

Michael R. Fischetti

Suzanne Jackson, RN

Burton D. Brent

William A. Johnson

Judge Leonard Edwards

C. Michael Knauer

Jack S. Remington

M. Ellen Mahoney

Rigo Chacon

Stephen H. Jackson

Theodore Fainstat

Richard P. Jobe

Barbara C. Erny

Janet Childs

Roger P. Kennedy

Bert Johnson

Nelson B. Powell / Robert W. Riley

Robert Michael Gould

Tony & Brandon Silveria

Elliot C. Lepler

Allen H. Johnson

Bruce A. Reitz

David Morgan

Tom Campbell / Ted Lempert

Joseph E. Mason, Jr.

Anthony S. Felsovanyi

David A. Stevens

Martin D. Fenstersheib

Michael E. & Mary Ellen Fox

2002 2003

Robert M. Pearl

2004 2005 2006

Robert Wuerflein

Eugene W. Kansky

Barry Miller

D. Craig Miller

Elizabeth Menkin

Jayne Haberman Cohen, DNSc

Harvey J. Cohen

Richard L. Miller

Gus M. Garmel

Rodney Perkins

Elouise Joseph

Doris Hawks, Esq.

Arthur A. Basham

Robert W. R. Archibald

G. David Adamson

Harmeet S. Sachdev

Edward A. Hinshaw, Esq.

2007 2009 2010 2011 2012 2013 2014 2015 2016 2017

Stephen H. Jackson

Cindy L. Russell

Catherine L. Albin

John R. Adler, Jr.

Madhur Bhatnagar

Debbi Ricks

Bernadette Loftus

Martin L. Fishman

George P. Kent

Thomas Krummel

Seham El-Diwany

Peggy Fleming-Jenkins

Melvin Britton

James G. Hinsdale

David Levin

Gary Steinberg

Leo Strutner

Judge Lawrence Terry

Tanya Spirtos

Dennis Siegler

Robert Armstrong

Gary Silver

Kathleen King

Steven S. Fountain

Robert Gould

William Jensen

Eleanor Levin

David Quincy

Assemblymember Jim Beall

James G. Hinsdale

Stephen C. Henry

Rosaline Vasquez

Diane E. Craig

Jeffrey D. Urman

Congresswoman Anna Eshoo

Martin L. Fishman

David H. Campen

Jonathan H. Blum

Gary E. Hartman

Keith A. Fabisiak

Gay Crawford

John P. Sherck

J. Ronald Tacker

James D. Wolfe

Stephen L. Wang

Susan E. Kutner

Senator Jerry Hill

Raj Bhandari

Lynn B. Rosenstock

Danny L. Sam

Daniel I. Jacobs

Paul M. Jackson

Janice Bremis & Robin Riddle

Susan C. Smarr

Howard Sutkin

Patrick J. Kearns, Jr.

Tung B. Le

Kris Karlen

Margaret McLean, PhD & Assemblymember Ash Kalra

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NOVEMBER / DECEMBER 2017 | THE BULLETIN | 23

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NOVEMBER / DECEMBER 2017 | THE BULLETIN | 25

STORY BY KATHERINE BOROSKI PHOTOGRAPHY BY JEFF WALTERS

26 | THE BULLETIN | NOVEMBER / DECEMBER 2017

H

undreds of physicians, residents and medical students met October 21-22 in Anaheim for the 146th annual meeting of the California Medical Association (CMA) House of Delegates (HOD). During the meeting, the delegates discussed major issues affecting the practice of medicine, installed new officers and recognized the recipients of CMA’s annual physician awards.

Before debating the major issues—which this year were mental health, health care reform and physician workforce, the delegates heard from experts in each major issue area, with continuing medical education (CME) credit offered for these educational sessions.

The House also installed a new president, San Diego otolaryngologist Theodore M. Mazer, M.D., while Los Angeles ophthalmologist David Aizuss, M.D., was tapped as president-elect.

The full 2017-2018 CMA Executive Committee includes: • President: Theodore M. Mazer, M.D., San Diego • President-Elect: David H. Aizuss, M.D., Los Angeles • Chair of the Board: Robert E. Wailes, M.D., Oceanside/Encinitas • Vice-Chair of the Board: Shannon L. Udovic-Constant, M.D., San Francisco • Speaker of the House: Lee T. Snook, Jr., M.D., Sacramento • Vice-Speaker of the House: Tanya W. Spirtos, M.D., Redwood City • Immediate Past President: Ruth E. Haskins, M.D., Folsom

2017 MAJOR ISSUES

CMA physician delegates establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine. This year’s major issues were: Health Care Reform: While the future of federal health care reform remains unclear, CMA continues to work with federal and state lawmakers to ensure that the health care system works for physicians and patients.

The CMA House of Delegates discussed recommendations and regulations that will assist with federal health care reform, and debated how single payer or public health care options might work.

Physician Workforce: Maintaining a physician workforce that ensures all patients have sufficient and timely access to quality medical care continues to be a challenge for California. The delegates discussed barriers that impact the practice of medicine in California and analyzed various

strategies and policies to address the physician workforce problem.

Mental Health: For decades, CMA policy has strongly supported adequate funding and provisions for high-quality mental health care. However, despite raised awareness, mental illness continues to go un-recognized and underfunded in California; many people with mental illnesses do not receive the help they need. The delegates discussed significant factors affecting the mental health system including access and infrastructure, and established policies to support and improve the mental health system.

Final reports detailing the actions taken by delegates are posted now at www.cmanet.org/hod.

SUBMIT A RESOLUTION A recent change to the CMA governance process was the introduction of a year-round (quarterly) resolution process. Any CMA member may author a resolution and have it submitted to the Board of Trustees using the year-round process for consideration between annual meetings.

This approach preserves the ability of individual members to participate in and influence CMA policy-making in a more timely way, rather than waiting for a once-a-year opportunity at HOD. This allows CMA to be more nimble and effective in making decisions on critical issues that are important to physicians.

If you have a resolution you would like to submit, e-mail it to resolutions@cmanet.org. Please visit www.cmanet.org/hod and read the guidelines before submitting a resolution. Resolutions that do not follow the guidelines will be rejected.

AWARDS AND ELECTIONS CMA INSTALLS SAN DIEGO OTOLARYNGOLOGIST AS 150TH PRESIDENT CMA installed San Diego otolaryngologist Theodore M. Mazer, M.D., as its 150th president. Dr. Mazer has been a CMA and San Diego County Medical Society (SDCMS) member for 29 years. He has served on the CMA Board of Trustees since 2002, as Speaker of the House of Delegates from 2013 to 2016, and chaired various committees, including those focused on medical services and access to specialty care. Dr. Mazer is a past president of SDCMS and a delegate to the American Medical Association.

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 27

“I take the role of leading this organization as an awesome responsibility,” said Dr. Mazer. “I look forward to working hard this year to ensure practicing physicians have a seat at the table to promote policies that protect our patients, our practices and our ability to care for our communities.”

A defender of patients’ right to access medical care, he has fought for Medi-Cal access all the way up to the Supreme Court and worked for over a decade with Congress and CMA to correct improper Medicare payment rates in San Diego and throughout California.

Dr. Mazer currently practices at Sharp-Grossmont Hospital, where he has served as chair of surgery, and at Alvarado Hospital Medical Center, where he has served as chief of staff. Dr. Mazer is a consultant to the Alvarado Hospital Medical Executive Committee and was a member of the national Physicians Advisory Commission at Anthem Blue Cross. He completed his residency at Baylor College of Medicine in Houston, Texas.

Dr. Mazer is very active in San Diego’s medical community. He is founder and member of several Independent Practice Associations (IPA) and management groups. He served as a board member and medical director for several years with Mercy Physicians Medical Group. He presently serves as a director with Scripps Mercy Physicians Partners messenger model IPA and its management group, which provides integrative support services for small and medium practices. He has been selected as a San Diego Top Doctor several times and awarded the San Diego Business Journal’s Health Leaders Award.

“CMA can forge ahead with confidence with Ted Mazer at our helm,” said CMA Immediate Past President Ruth Haskins, M.D. “He has the will to get the job done, the data to back up his plan, the heart to steer us in the right direction and the energy to move us steadily forward.”

CMA presidents serve a year-long term, starting and ending in October. Dr. Mazer was elected to serve as president for the 2017-18 year.

You can view Dr. Mazer’s inaugural address to the CMA House of Delegates at www.youtube.com/cmaphysicians.

CMA NAMES LOS ANGELES OPHTHALMOLOGIST 2017-18 PRESIDENT-ELECT David Aizuss, M.D., a board-certified ophthalmologist practicing in Los Angeles, was selected as the association’s president-elect. He will serve in this capacity for one year and will be installed as president at the conclusion of next year’s HOD. Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He also serves as an assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine.

Dr. Aizuss is a medical staff member at Tarzana Hospital and West Hills Hospital, in Los Angeles County, and belongs to several professional societies, including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society and the American Medical Association.

He received his medical degree from Northwestern University Medical School and his bachelor’s degree in medicine from Northwestern University. He completed his residency in ophthalmology at the Jules Stein Eye Institute in Los Angeles, where he also undertook a fellowship in cornea and external ocular disease from 1984 to 1985.

He is a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons. Before being elected as president-elect, he served as the chair of the CMA Board of Trustees.

28 | THE BULLETIN | NOVEMBER / DECEMBER 2017

EUREKA SURGEON RECEIVES CMA’S PRESTIGIOUS “COUNTRY DOCTOR” AWARD Renowned breast cancer researcher and surgeon Ellen Mahoney, M.D., was honored with CMA’s most prestigious award, the Frederick K.M. Plessner Memorial Award. The award recognizes a California physician who best exemplifies the ethics and practice of a rural country practitioner.

The first of her family to graduate from college, Dr. Mahoney broke the glass ceiling by graduating from Stanford Medical School as one of the first woman general surgeons. After completing her residency—also at Stanford—she became the first woman ever to open a private surgical practice in Palo Alto. In addition to her private practice, Dr. Mahoney served on faculty at Stanford, where she performed general, trauma and oncology surgery.

Dr. Mahoney helped designed Stanford’s first comprehensive cancer center. In 1994, she opened Palo Alto’s Community Breast Health Project (now known as Bay Area Cancer Connections), which provides support and information to breast cancer patients.

Dr. Mahoney’s Community Breast Health Project harnessed the power of peer support, bringing together cancer survivors and those newly diagnosed or in treatment, providing compassionate support and access to current information to aid them on their cancer journey.

Colleagues describe Dr. Mahoney as incredibly generous with her time and knowledge, all in the service of providing the best and most upto-date care for patients. She has a passion for solving problems and bringing together collaborators to design solutions.

In 2000, Dr. Mahoney “retired” to rural Humboldt County, where her husband, CMA past president and surgeon Luther Cobb, M.D., had joined the medical staff at Mad River Hospital. When she saw the acute cancer care deficits in this remote part of California, she had a vision for comprehensive cancer care for residents of Humboldt County so that they could get the same quality of care locally that they would get in Palo Alto.

Dr. Mahoney recognized that in a rural area, the psychosocial needs were perhaps even more acute; and the resources more diffuse. She has since committed her professional life to providing care to patients diagnosed with breast cancer and developing collaborative teams to ease the passage of patients through the complex web of medical care that often overwhelms one of our more vulnerable populations—those diagnosed with cancer. Today, she is the director of the Cancer Care Program at St. Joseph Hospital in Humboldt County.

Dr. Mahoney has also pursued a very ambitious international research program from her base in Humboldt County. She has collaborated with her colleagues at Stanford to create a joint videoconference tumor board. Under her leadership, the joint weekly tumor board has become a vibrant, standing-room only demonstration of collaboration and the constant search for each patient’s best possible care.

For more about Dr. Mahoney’s remarkable story, see the award video at www.youtube.com/cmaphysicians.

LOS ANGELES PUBLIC HEALTH PHYSICIAN HONORED WITH CMA MEMBERSHIP AWARD Mitchell Katz, M.D., director of the Los Angeles County Health Agency, was named the 2017 recipient of the Dev A. GnanaDev, M.D., Membership Award, which recognizes a special or unique effort toward membership recruitment.

The Los Angeles County Health Agency is a newly created agency that combines the Departments of Health Services, Public Health and Mental Health into a single entity to provide more integrated care and programming within Los Angeles.

At head of the new agency, Dr. Katz brought in 768 new members in 2016, making it possible for CMA and the Los Angeles County Medical Association to better engage with Los Angeles county physicians to combat public health issues facing their communities.

Before being tapped to head the Los Angeles County Health Agency, Dr. Katz served as director of the Los Angeles County Department of Health Services, the second-largest public safety net system in the United States. During this time, he created the ambulatory care network and empaneled over 350,000 patients to a primary care home.

He also moved over 1,000 medically complex patients from hospitals and emergency departments into independent housing, thereby eliminating unnecessary expensive hospital care and giving the patients the dignity of their own homes.

Before he came to Los Angeles, Dr. Katz was the Director and Health Officer of the San Francisco Department of Health for 13 years. He is well known for funding needle exchanges, creating Healthy San Francisco, outlawing the sale of tobacco at pharmacies, and winning ballot measures to rebuild Laguna Honda Hospital and San Francisco General Hospital.

SAN FRANCISCO OB-GYN RECEIVES CMA’S 2017 COMPASSIONATE SERVICE AWARD San Francisco ob-gyn Pratima Gupta, M.D., was selected as the 2017 recipient of the Compassionate Service Award, which honors a CMA member physician who best illustrates the association’s commitment to community and charity care.

Throughout Dr. Gupta’s medical career, she has shown an unwavering commitment to public health and community service. She spent a research year during medical school in Quito, Ecuador. During that year, she founded and staffed a free clinic for transgender health care. From 2006 to 2014, she travelled internationally as a volunteer, providing training and education to doctors and health care providers in Peru, India, Zambia, Nigeria, Uganda, Nicaragua and South Sudan. In 2013, she participated on a disaster relief team sent to typhoon-stricken Tacloban, Philippines.

Her volunteer work in California is equally impressive. Since 2005, she has volunteered her time to provide care to female, transgender and male sex workers at St. James Infirmary in San Francisco, where she is currently the volunteer medical director.

Dr. Gupta is a fierce proponent of patient reproductive rights, and is known for encouraging other physicians in California and throughout the United States to become advocates for their patients, public health and the practice of medicine.

SACRAMENTO PAIN SPECIALIST RECEIVES CMA NYE AWARD Sacramento pain specialist Lee T. Snook, Jr., M.D., was awarded the Gary S. Nye Award for Physician Health and Well-Being. The award honors a CMA member who has made significant contributions toward improving physician health and wellness.

Dr. Snook, who currently serves as Speaker of the CMA House of Delegates, has been an outspoken advocate for physician wellness for more than 25 years. He has served on numerous CMA committees relating to physician wellness, as well as on the Board of Directors of the California Public Protection and Physician Health organization since its inception in 2009. Using his unique insight, Dr. Snook has spent the past 25 years working to develop policies and programs that have achieved positive results for the health and wellness of all physicians and for the practice of medicine.

He was an advocate for approaches to preventing physician burnout long before it became a popular thing to talk about.

This award was established in honor of Gary Nye, M.D., a leader in

bringing attention and developing solutions for physician impairment and rehabilitation.

PERMANENTE PHYSICIAN WELLNESS PROGRAM HONORED The Southern California Permanente Medical Group’s Physician Wellness Program, led by Dawn Clark, M.D., and Edward Ellison, M.D., was awarded the Gary S. Nye, M.D., Award for Physician Health and Well‐Being. The program has significantly shifted the culture of wellness for 8,500 physicians in California, and is exemplary for the innovative, all‐encompassing approach it brings to enhancing physician well‐being.

The medical group, a physician‐led organization, supports wellness and well‐being of physicians at every level.

Both Dr. Clark and Dr. Ellison have led the way in developing and implementing the program’s “5 Pillars”: prevention, professional fulfillment, practice management, collegiality and community service, and health.

Their commitment to physician wellness led to the creation of a program that continues to evolve to meet the needs of physicians. The medical group has seen first‐hand the results that a sustained, systems‐based approach can make in the lives of its physicians. It works in part because, while the programs touches physicians individually, the 5 Pillar Program has also reset the culture to emphasize wellness.

The Physician Wellness program is an innovative and increasingly successful model for promoting physician well‐being, and offers a variety of proven techniques and tools that could lay the groundwork for a future program for all physicians in the state of California.

The program and its leaders have also been recognized on the local, state and national levels for their effective and innovative work in physician wellness.

This award was established in honor of Gary Nye, M.D., a leader in bringing attention and developing solutions for physician impairment and rehabilitation.

OTHER NEWS CMA PRESENTS RESOLUTION HONORING AMA FOR WORK IN PROTECTING MEDICAL STAFF RIGHTS CMA has been actively and aggressively supporting the medical staff at Tulare Regional Medical Center in their lawsuit against the hospital for illegally terminating and replacing the entire medical staff and its duly elected officers. If left to stand, the hospital’s actions will create a dangerous precedent that could have much broader implications for the fundamental rights of medical staffs and physicians’ ability to care for patients in hospitals.

Recognizing the critical national implications of this case, the Litigation Center of the American Medical Association (AMA) has provided significant legal support and monetary contributions to this case. AMA President David O. Barbe, M.D., recently travelled to Anaheim to speak to the CMA House of Delegates about the unprecedented attack on medical staff self-governance in the Tulare case. AMA’s contributions to the litigation in this case represent the single largest legal contribution in the history of the AMA. CMA presented Dr. Barbe with a resolution recognizing AMA for its extraordinary commitment to protecting medical staff rights to independence and self-governance.

This case was recently featured in a New York Times op-ed, which provides a good look at why this local conflict could have a dangerous effect on patient care in U.S. hospitals.

If your medical staff is interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, email swolley@cmanet.org.

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 29

Vice Speaker of the House Dr. Tanya Spirtos and Speaker of the House Dr. Lee Snook, Jr. at HOD – Disney magic!

CMA Senior VP Janus Norman, CMA President Dr. Theodore Mazer, and CMA District VII Trustee –Dr. Kenneth Blumenfeld (also SCCMA’s PresidentElect and Delegate).

CMA District VII Trustee –Dr. Kenneth Blumenfeld (also SCCMA’s President-Elect and Delegate) poses with Dr. Harrison Chow (Delegate) and Dr. Jeffrey Coe, (SCCMA/ CMA Delegate).

30 | THE BULLETIN | NOVEMBER / DECEMBER 2017

CMA District VII Trustee –Dr. Kenneth Blumenfeld (also SCCMA’s President-Elect and Delegate) poses with Dr. Adam Dougherty, Jay Hansen (CMA), and Mrs. Dougherty.

Vice Speaker of the House Dr. Tanya Spirtos, CMA Delegate Dr. Darla Holland, and CMA Past President Dr. Ruth Haskins.

SCCMA/CMA Delegate Dr. James Crotty, Dr. Paul Phinney, and CMA President Dr. Theodore Mazer.

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 31

Our very own SCCMA-MCMS CEO William Parrish and his wife Luanne.

SCCMA President and Delegate Dr. Seham El-Diwany and SCCMA Past President and Delegate Dr. Eleanor Martinez.

CMA District VII Trustee and Delegate Dr. Thomas Dailey and his wife Rosemary.

SCCMA and CMA Past President Dr. James Hinsdale and CMA President Dr. Theodore Mazer.

32 | THE BULLETIN | NOVEMBER / DECEMBER 2017

Dr. Seema Sidhu (Vice Chair of our delegation) with Dr. Tinh-Uyen Le.

Dr. Seema Sidhu (Vice Chair of our delegation) with Trustee Dr. Donaldo Hernandez.

Vice Speaker of the House Dr. Tanya Spirtos and Speaker of the House Dr. Lee Snook, Jr.

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Thursday, January 11, 2018 Embassy Suites, Monterey Bay 8:00 am – 4:00 pm

14 th Annual Employment Law & Leadership Conference LITTLER’S EMPLOYMENT UPDATE

AM GENERAL SESSION

Keeping Your Organization on the Path of Legal Compliance! Learn from the leading Littler Attorneys about the latest employment law twists and turns to bring you up to speed on the regulatory front as well as trends to watch for in the future. Learn about the many compliance issues that are of greatest concern to corporate counsel, human resource professionals, executives and other managers on a day-to-day basis. Littler’s Employment Law Update is a thought-provoking overview and analysis of the most critical employment and labor law issues confronting employers right now.

AFTERNOON BREAK-OUT SESSIONS

12:45pm – 4:00pm

 WAGE & HOUR: Mistakes Companies Still Make and What to do About Them!

Mel Cole, Esq., Littler

Littler will cover commonly misunderstood and incorrectly applied principles of wage and hour compliance under California law and the Fair Labor Standards Act (FLSA) that (collectively) cost employers millions of dollars each year. Including properly classifying employees as exempt and what to do if someone has been misclassified; how to navigate the treacherous waters of piece rate compensation; new developments that limit the ways employers can pay commissions; the latest developments in the laws relating to meal and rest breaks, and much more!

 HR Q&A: Balancing both Legal and Leadership Perspectives!

Marlene Muraco, Esq., Littler Shareholder & Melissa Irwin, SPHR-CA, SHRM-SCP, TPO Senior Consultant/Training Specialist

Talk about brain power – a whole session with Marlene & Melissa sharing both legal & HR answers and advice about the most critical questions on the minds of our conference participants – many you didn’t even know to ask. This fun and fast-paced session is back again by popular demand!

 DO I COACH, CORRECT or SAY GOODBYE?: Where the Rubber Meets the Road!

Gina de Miranda, M.A., SHRM-SCP, SPHR, PHRca, TPO Bilingual Consultant/Trainer

Leaders coach…that’s what they do. Good coaching is what makes a manager a leader. How do you move from developmental coaching, to course correcting and even needing to say goodbye? Drawing on decades of experience, Gina will break this down with stories and tools to supercharge your performance management skills.

 RESPECT & INCLUSION: Leveraging Cultural Differences & Diversity in the Workplace!

Dennis Hungridge, M.A., SHRM-SCP, SPHR, TPO Consultant/Training & Development Specialist

Do a quick mental scan of the people you work with. Notice anything? It’s diverse and includes a rich variety of backgrounds, styles, perspectives, values and beliefs! Join us for a fast-paced and active discussion of how leveraging cultural differences and diversity at work can spark your organization’s performance.

 THE AG EMPLOYER: Cultivating Compliance – Best Practices to Avoid Employment Liability!

Littler Attorney

Littler will address issues in areas that are particularly relevant to the agricultural industry, including the new overtime rules, the proper way to implement piece rate compensation, rest & recovery period obligations, and ways to reduce potential liability when using farm labor contractors.

AFFILIATE SHOWCASE

7:30am – 2:30pm

An impressive collection of professionals Affiliates providing high quality services and support to business. Be sure to take advantage of the opportunity to learn more about how our talented Affiliates can enhance and improve your business practices!

Use code SCCMA/MCMS for Santa Clara County Medical Association/Monterey County Medical Society Discount Rate of $249! ($299 AFTER EARLY BIRD DEADLINE OF 12/22/17 – REGULAR RATE $349)

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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.

BLUM PLAZA MEDICAL DENTAL BUILDING (CAMDEN AT BASCOM AVE.) Lessor to construct ‘Turn Key’ 1,615 sq. ft.

Medical Office designed for 4 Treatment Rooms, Sterilization Room, Physician Offices, Break Room and Restroom. $3.25 per sq. ft., Modified full service. Call PM Sheldon at 408/377-7383. www.Blumplaza.com

MEDICAL OFFICE SPACE TO SUBLET • MTN VIEW Mountain View Medical Office space to sublet. 1,100 sq. ft. Available three days a week.

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

In large medical complex, behind El Camino Hospital. Basement storage, utilities included. Large treatment rooms, small lab space, bathroom, private office, etc. Call Dr. Klein.

Cell 650/269-1030.

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.

LOS GATOS OFFICE FOR LEASE 850 sq. ft. available January 1, 2018. Four rooms, plus reception area. In Suite restroom. Large adjacent parking lot. Downtown location. Call Barbara at 408/489-8411.

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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.

PEDIATRICIAN NEEDED IN LOS GATOS Four member Pediatric Group looking for a new physician to replace retiring partner. Office is independently owned and operated.

Congenial working environment. Partnership track available, or remain as an associate indefinitely. Contact sbezecny@comcast. net.

FOR SALE PRIVATE PRACTICE / OFFICE / MEDICAL BUILDING FOR SALE FP/GP. Primary Care Practice for sale including inventory, equipment and medical building. 132 Alta Street, Gonzales, CA 939263005. If interested, please call Dr. Gines at 831/262-9238.

OFFICE SPACE FOR LEASE AND OR SALE

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.

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.

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NOVEMBER / DECEMBER 2017 | THE BULLETIN | 35

Benjamin Rush America's Founding Physician

By Michael Shea, MD Leon P. Fox Medical History Committee Perhaps no other MD in American history has influenced medical practice as Benjamin Rush did in the early 1800’s. In addition to medicine, Rush was active as a politician, social reformer, educator, and humanitarian.

He was born on January 4, 1746 in Byberry township, Pennsylvania, one of seven children of John Rush (farmer and gunsmith) and Susanna Hall Harvey. At age five his father died and his mother moved the family to Philadelphia where she operated a grocery store to support the family. At the age of eight, in order to secure a quality education, he was sent to live with his maternal uncle Rev. Dr. Samuel Finley. Finley, pastor and headmaster of Nottingham Academy, provided Rush a formal education, including Greek and Latin. A bright student, Rush entered The College of New Jersey (now Princeton) as a junior in 1759. He was 14 years old. He received a BA two years later.

Choosing medicine as his career, he apprenticed under a well-known Philadelphia physician, Dr. John Redman. He also attended cadaver anatomy classes under Dr. Wm. Shippen Jr., first in his home and later at The College of Philadelphia Medical Department (America’s first medical school). Thinking it best to attend a high-ranking European medical school, he enrolled at The University of Edinburgh in Scotland. Two years later he received his MD degree.

Returning to the States, he accepted a chair in chemistry (later elected to professor of chemistry) at The College of Philadelphia and at the same time began his private practice. He ultimately published the first textbook on chemistry and was very active in lecturing to the school’s medical 36 | THE BULLETIN | NOVEMBER / DECEMBER 2017

students. Over a 40-year span he taught more than 3,000 students. He is also credited with founding Dickinson College in Carlisle, Pennsylvania.

He not only conceived and founded the school, but through tireless campaigning was able to provide the funds to maintain the school in the early years.

The practice of medicine for Benjamin Rush was centered around the theory of diseases causing an imbalance in bodily fluids. This had its origin in the four humors: blood, phlegm, black bile, and yellow bile. If symptoms were fever or a hyper state (i.e. rapid pulse, sweating, restlessness), the treatment was bloodletting. This would, in theory, place the body at rest and resolve the excited state. Purges and emetics were also believed to accomplish the same goal.

Amounts of blood drawn would be anywhere from ten to fifteen oz. to over 150 oz. – Bleeding and purging gradually fell out of favor and by the mid 1840’s were seldom used. Benjamin Rush, however, never changed his mind in this treatment and even at his death asked his attending physician to bleed him twice before he died.

In 1793, a yellow fever epidemic occurred in Philadelphia. The treatment recommended by Dr. Rush and his supporters was bleeding and purging. There were a number of physicians who disagreed with this.

There were clashes between Dr. Rush and many of his colleagues. A famous slander suit was brought by Dr. Rush against an unmerciless editor, William Cabbet, who repeatedly accused the doctor of murdering his patients during the epidemic. The trial, in 1799, resulted in a judgment against Cabbet plus a fine of $5,000.

In the field of psychiatry, he fought for more humane treatment and an improved environment for the mentally ill. He believed mental illness was the result of an inflammation of the brain’s arteries. Thus he would

prescribe bleeding, purges, diet, salivation, and a cold bath. In 1812, Dr. Rush published “Medical Inquiries and Observations, Upon the Diseases of the Mind,” which became the standard reference work for mental illness in the U.S. Two devices invented by Dr. Rush for the mentally ill patient were the straight jacket and the gyrator. The straight jacket was for violent patients and was designed with a chair and a hood in an attempt to quiet the patient and thus reduce any arterial agitation in the brain. The agitator was a turntable affair that used centrifugal force to increase blood flow to the brain. These devices were in use for only a short time.

Some of Benjamin Rush’s non-medical activities were during the Revolutionary Period in America. He was active in the Sons of Liberty, and was elected as a delegate to the Continental Congress. He encouraged Thomas Paine to write his famous pamphlet “Common Sense,” which profoundly influenced the independence movement in the Colonies. His signature is on the Declaration of Independence, the only MD to sign this historic document. He also served in the War of Independence as surgeongeneral of the Middle Department for the Continental Army.

His lifelong stance against slavery, including his participation in and later presidency for the Pennsylvania Society for Promoting the Abolition of Slavery, helped free many slaves.

He also stood against the death penalty and led the State of Pennsylvania in establishing the first penitentiary, The Walnut Street Prison in 1790.

He was the chief consultant for the Lewis and Clark Expedition and personally taught Lewis about frontier illness and the performance of bloodletting.

In regard to his personal life, Rush was a remote relative of William Penn, who established Pennsylvania. Before the Revolutionary War, he was engaged to Sarah Eve, daughter of prominent Philadelphian Captain Oswell Eve Sr. She died before their scheduled wedding on January 11, 1776. Rush later married Julia Stockton (1759-1848), daughter of Richard Stockton, signer of the Declaration of Independence. They had 13 children, nine of whom survived their first year. One son, Richard, became a member of the cabinets of James Madison and James Monroe.

Benjamin Rush died of Typhus on April 19, 1813 at age 68. He was buried in the Christ Church Burial Ground in Philadelphia, not far from where Benjamin Franklin is buried.

To honor his memory, a bronze statue was erected, in 1904, on the grounds of the U.S. Naval Museum for Hygiene and Medical School, in Washington D.C., by the American Medical Society.

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

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

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 37

Report Examines the Value of Digital Health, Names Top Apps The impact of digital health on patient care is accelerating with the increasing adoption of mobile health apps and wearable sensors. Health-related mobile applications available to consumers now surpass 318,500 — nearly double the number available just two years ago — with approximately 200 new apps added to the market each day. This rapid app expansion, coupled with more than 340 consumer wearable devices on the market worldwide, and 571 published efficacy studies, provide evidence of digital health’s accelerating innovation and generation of a subset of proven tools to impact human health, according to a new report recently released by the IQVIA Institute for Human Data Science.

While general wellness apps still account for most mobile health apps available, the number of apps focused on health condition management — those often associated with patient care — are increasing at a faster rate, representing 40% of all health-related apps.

The report found the sheer volume of available apps presents an overwhelming amount of options for consumers, resulting in 85% of all health apps having fewer than 5,000 downloads. However, there are some clear category leaders within the space, where 41 apps have registered at least 10 million downloads, together representing nearly half of all app download activity. Separately, there is also now at least one high-quality app for each step of the patient journey — an encouraging finding for patient outcomes. Use of just five of these top health apps could save the U.S. healthcare system an estimated $7 billion per year.

The study, “The Growing Value of Digital Health: Evidence and Impact on Human Health and the Healthcare System,” is the most comprehensive of its kind conducted to date and extends the Institute’s landmark examination of consumer-focused mobile apps in the health system conducted in 2015. For the new report, researchers drew on IQVIA’s proprietary AppScript data and analytics platform, including the AppScript App Database, the AppScript Clinical Evidence Database, the AppScript Score app quality rating system, and the AppScript Essentials Value Model to provide the first exhaustive global assessment of overall app quality, clinical evidence, and implications for health outcomes and care costs. This includes an analysis of 22,357 unique healthcare apps available in the U.S. Apple iTunes and Android app stores — a representative sample of the most widely used digital health apps by consumers.

As part of the study, the Institute also conducted additional primary research using the AppScript Device Database, ClinicalTrials.gov Database, as well as structured interviews with health- and technology-focused thought leaders and executives on the role of digital health in regards to patient care.

“The research suggests an inflection point is occurring within digital health trends regarding innovation, evidence and adoption,” said Murray Aitken, executive director of the IQVIA Institute for Human Data Science. “The convergence of those three digital drivers combined with other macro factors aligns with the development of the newly defined and emerging discipline of human data science that combines advances in information, transformative technology and analytics with human data beyond the patient journey to measure and improve health decisions and outcomes. Within that 38 | THE BULLETIN | NOVEMBER / DECEMBER 2017

context, we believe the growing innovation, evidence and adoption of digital health tools can have an increasingly positive impact on human health outcomes overall.”

The report’s key findings include the following: • Potential healthcare savings could be significant in the future. The use of digital health apps and wearables across five patient populations where they have proven reductions in acute care utilization (diabetes prevention, diabetes care, asthma, cardiac rehabilitation and pulmonary rehabilitation) could save the U.S. healthcare system an estimated $7 billion per year. This represents about 1.4% of total costs in these patient populations. If this level of savings could be achieved across all disease areas, annual cost savings of $46 billion could be achieved. These estimates extrapolate just from existing evidence, but continued investment in evidence generation continues across stakeholders.

• Clinical evidence regarding digital health efficacy has grown substantially. This growing body of work includes 571 published studies, including randomized controlled trials (RCTs) and meta-analysis studies, enabling the identification of a list of apps with increasingly robust clinical evidence. Particularly compelling findings now exist for use in diabetes, depression and anxiety, making these categories strong candidates for inclusion in standard of care recommendations by clinical guideline writers.

An additional 24 categories have one or more RCTs with positive results making associated apps strong candidates for adoption across provider organizations and payer networks. Additional evidence-building efforts continue with 860 clinical trials worldwide now incorporating digital health tools, including 540 in the U.S., with two-thirds of these focused on apps and text message interventions to smartphones. Eighty-two percent of these trials are sponsored by universities, hospitals, health systems and other patient care institutions, demonstrating the increased efforts to fit digital health into clinical practice. Digital tools for remote patient monitoring of chronic health conditions are a key focus.

• Apps appear to be improving based on user experience.

Fifty-five percent of apps in the AppScript App Database that launched within the past two years have ratings higher than four stars, compared to 31% of those launched before 2015. With clear market-leading apps in many health categories, developers getting low star ratings may either remove apps more rapidly from the store or invest more continuously in updates based on user feedback — increasing the value of available apps to the consumer.

App stores have also begun removing low-quality apps, including those that are outdated, abandoned, no longer meet current guidelines or don’t function as intended.

Additionally, while 73% of apps are available in English, mobile health apps are increasingly supporting a global audience.

• Digital sensors linked to apps are bringing innovation and adding value in three key areas: the creation of smart

devices, digital diagnostics and new human-centered clinical trial designs.

Many of the most popular apps also connect to sensors that detect patient vital signs and activity, no longer relying purely on manual patient inputs. New value will be brought to healthcare by algorithms built on top of such wearable activity monitors to create “digital biomarkers” of health. By tracking parameters beyond sleep and steps that correlate to disease severity, these digital tools will contribute to precision medicine, enabling stratification of patients by symptoms identified by sensors as well as traditional biomarkers. Digital-enabled ‘smart’ devices such as asthma smart inhalers, connected pens for diabetes and smart blister packs are also being developed to track medicine usage remotely and encourage patient adherence. These have shown improved therapeutic outcomes, and broad investment in smart inhalers indicates these may become the new standard of care in asthma.

Additionally, smart sensors can improve clinical trial designs by enabling the collection of patient experience data in the “real world,” even within the bounds of clinical trials.

• Barriers still exist to widespread adoption of digital health, but initiatives have emerged to accelerate the ongoing adoption of digital health tools by care provider organizations. Notably, curation platforms are facilitating the creation of Digital Therapeutics Formularies; privacy and security guidelines are being published; providers are now incentivized to use digital health through value-based payments; and data integration vendors are facilitating more integrated use of digital health data with existing electronic medical record systems.

Additionally, investments by healthcare and provider organizations in digital health continue to grow, with an estimated 20% of large health networks shifting from pilot programs to more full-scale rollouts. Within the next five years, this progression is likely to be true for most healthcare companies and, within 10 years, the use of digital health is likely to be mainstream for most organizations delivering human health.

The full version of the report, including a detailed description of the methodology, is available at www.IQVIAInstitute.org. The study was produced independently as a public service, without industry or government funding.

TOP APPS The report also generated a top apps list: To generate a “Top Apps” list, a top-rated free and publicly available app as well as a top clinical rating app (regardless of business model) was selected across 15 high-priority digital health app categories with high app demand and app quality. This yielded 25 Top Apps within top “Free and Publicly Available” apps and top “Clinical Rating” app classifications. Top Apps listed in the report include: TOP FREE AND PUBLICLY AVAILABLE

TOP CLINICAL RATING

WELLNESS AND PREVENTION Exercise

Runkeeper by FitnessKeeper, Inc.

Fitbit by Fitbit wireless device and smart-scale connectivity

integrated Healthy Eating & Weight Management

MyFitnessPal by MyFitnessPal.com

Noom Coach: Health & Weight by Noom, Inc.

Food log with barcode scanning capability; HealthKit integrated

Subscription-model health coaching with tracking and relevant content

Stress Management

Headspace By Headspace meditation limited

Headspace by Headspace meditation limited

Proprietary guided meditations as well as useful educational background videos

Proprietary guided meditations as well as useful educational background videos

Smoking Cessation

Kwit by Kwit SAS

Clickotine by Click Therapeutics, Inc.

Alcohol Moderation

AlcoDroid Alcohol Tracker by Myrecek

Drinkaware by The Drinkaware Trust

Alcohol consumption tracker, drinks diary and blood alcohol content calculator

Lifestyle app that tracks the units and calories in your drinks

Subscription program includes coaching, connection to quit aids, as well as various tracking and educational features

CONDITION MANAGEMENT Alcohol & Substance Abuse

My Spiritual Toolkit - AA 12 Steps App Alcoholics

by LOOK BEFORE YOU LEAP NET, LLC Content, personal diary, and calculators for recovering alcoholics

Contains a series of interactive therapy lessons with information to help support your recovery

Omada by Omada Health, Inc.

Diabetes Prevention

Diabetes

Pear reSET by Pear Therapeutics Inc.

Intensive behavioral counseling (IBC) app shown to promote weight loss and reduce T2D incidence mySugr by mySugr GmbH

BlueStar Diabetes by WellDoc, Inc.

Auto-logs data via connected devices for blood

FDA-cleared app with 2 RCTs demonstrating

blood sugar control Kardia by AliveCor, Inc.

AF Screening & Dysrhythmias

Hypertension

Works with FDA-cleared Kardia Mobile-a clinically validated mobile EKG solution SmartBP by Evolve Medical Systems, LLC

Twine – Collaborative Care by Twine Health, Inc.

Manages blood pressure measurements and track progress

A collaborative care platform, designed to engage patients in all care team activities Healarium (Mayo Clinic Instance) by Apollo Medical Holdings

Cardiac Rehab

individual patients Cancer

Asthma

OWise Breast Cancer by Px HealthCare B.V.

MoovCare by Sivan Innovation

Helps individuals regain control during chaotic times of illness and treatment

Application that delivers surveys to cancer patients enabling targeted follow up

AsthmaMD by Mobile Breeze

Propeller Health by Reciprocal Labs

Asthma management application. Asthma diary and visualize asthma activity on a color graph.

FDA-cleared, CE marked technology that works with existing asthma and COPD inhalers

PRESCRIPTION FILLING AND COMPLIANCE Medication

Medication Management

Walgreens by Walgreen Co.

Walgreens by Walgreen Co.

Online pharmacy serving needs for prescriptions, health & wellness products and health information

Online pharmacy serving needs for prescriptions, health & wellness products and health information

Medisafe Meds & Pill Reminder by MediSafe Inc.

AiCure by AiCure, LLC

Personalized medication management including reminders, educational content, and biometrics

It reminds and monitors if you have not taken your medication with interactive visual and audio guidance that automatically adjust to your needs.

Source: IQVIA AppScript Essentials, Aug 2017

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 39

CMS Says 2018 Physician Fee Schedule, QPP Final Rules Help Lift Regulatory Burdens for Providers Key takeaways from CMS guidance on how to get credit for this activity includes, according to C and M Health: • Clinicians should use digital tools in such a way that allows them to provide ongoing guidance and assessments for patients outside of the in-office visit. This includes the collection and use of patient generated health data (PGHD).

• Clinicians must use health technology platforms and devices that collect patient data as part of an “active feedback loop,” which CMS defines as “providing PGHD in real or near-real time to the care team, or generating clinically endorsed real or real-time automated feedback to the patient.”

• Platforms and devices used for this improvement activity must be, at a minimum, “endorsed and offered clinically by care teams to patients to automatically send ongoing guidance (one way).”

• CMS makes a distinction between technologies covered by this activity versus “passive platforms or devices” that collect but do not transmit PGHD in real-time. The latter is not eligible technology under this activity.

The Centers for Medicare and Medicaid Services (CMS) announced important reimbursement changes with the 2018 Physician Fee Schedule Final Rule and a final rule with comment period for the Quality Payment Program (QPP), taking effect Jan. 1, 2018.

While part of CMS’s broader strategy to relieve regulatory burdens for providers, these rules also reflect the agency’s efforts to promote innovation in healthcare delivery aimed at lowering prices, increasing competition and strengthening the relationship between patients and their doctors.

“During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients,” said Seema Verma, administrator of CMS. “These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over vol40 | THE BULLETIN | NOVEMBER / DECEMBER 2017

ume of tests, and encouraging innovation and competition within the American healthcare system.”

As part of the president’s priority to reduce drug costs for Americans, CMS is taking an important step in the Physician Fee Schedule to modernize the Medicare payment system through innovation in the biopharmaceutical market. Beginning in 2018, CMS will update payment for biosimilars, which are lower-cost alternatives to certain types of drugs known as “biologicals.” This change promotes competition to ensure millions of patients will have access to new lower cost therapies.

To strengthen access to care, especially for those living in rural areas, CMS is transforming access to Medicare telehealth services by paying for more services and making it easier for providers to bill for these services.

Improving access to telehealth services reflects CMS’s work to modernize Medicare payments to promote patient-centered innovations.

A d d i t i o n a l l y, this rule includes a number of policies designed to provide clinicians with a smoother transition to the QPP. The QPP final rule includes policies that reduce burden and support clinicians in small and rural practices to successfully participate in this program.

CMS is decreasing the number of clinicians required to participate.

To further ease clinician burden, CMS is adding an option to help clinicians and small, rural practices join together and share the responsibility of participating in value-based payments. CMS is also adding a new hardship exception to assist small practices and clinicians impacted by hurricanes Harvey, Irma and Maria. This change mitigates the absence of electronic health records as a result of the natural disasters.

The final rule provides additional detail on clinician participation in Advanced Alternative Payment Models (APMs). Clinicians can receive credit for payment bonuses through participation in these APMs. In keeping with its theme of innovation in healthcare delivery, CMS intends to develop a demonstration project testing the effects of counting as credit participation prior to 2019 and through 2024 in Medicare Advantage plans that meet certain criteria.

Cost of Physician Burnout the Focus at American Conference on Physician Health The cost of worsening of physician burnout was a hot topic at the 2017 American Conference on Physician Health held on Oct. 12-13. Nearly half of physicians — 45% — currently show at least one symptom of burnout.

Not only do burned-out physicians provide lower-quality care, noted Tait Shanafelt, MD, chief wellness officer at Stanford Medicine, but replacing physicians who leave because of burnout costs the United States $5 billion a year.

Lloyd Minor, MD, Stanford’s dean of the School of Medicine, was one of the speakers. “The reason it was such an eye-opening experience was that it had been in front of me for years,” Dr. Minor told the attendees. “I put it all together. This is not just individuals acting out; this is really a systemic issue we face as a profession, and it’s affecting our ability to deliver the very best care to our patients.” Speakers at the conference also included Sarah Krevans, president and CEO of Sutter Health; Steve Strongwater, MD, president and CEO of Atrius Health; and Tina Shah, MD, a former White House fellow at the U.S. Department of Veterans Affairs who agreed that a “toxic culture” in many healthcare organizations, entering information into EHRs, and filling of prescriptions were to blame for physician unhappiness, ultimately leading to physician suicide.

When Abraham Verghese, MD, professor of medicine at Stanford and an award-winning author, took the stage, he asked the attendees if they knew fellow physicians who had killed themselves. Nearly every hand was raised. “Every year it takes three medical school classes to replace the physicians who committed suicide,” he said. Dr. Verghese addressed a “fear of showing weakness” among physicians and that the loneliness of a physician often enables acts of depression and addiction.

Kelly McGonigal, PhD, a health psychology lecturer at Stanford, encouraged conference attendees to practice “self-compassion.” Noting that while perfectionism “can get people into the medical profession,” she said that “it can be toxic when paired with a belief system of being hard on yourself.”

Self-compassion is more than just pampering yourself, she said; it’s allowing yourself to receive compassion from others: “Self-compassion means opening yourself to the compassion that’s available to you.”

“This is a skill that you can actually practice,” she said, offering examples such as meditating on connections with others, celebrating self-care, accepting condolences and remembering that no one is alone in suffering.

Research has shown that such practices can decrease burnout, she said.

Creating a culture in healthcare organizations that encourages physicians’ well-being starts with placing the right people in leadership positions, said Vivek Murthy, MD, a former U.S. surgeon general. Organizations should hire people for the way they treat others, he said, not for their ability to win a Nobel Prize. “Kindness is spread more quickly than infectious diseases,” he said.

The Mayo Clinic studied the factors that affected physician satisfaction and found that good supervisors were critical, added Dr. Shanafelt, who came to Stanford this year from Mayo and is the director of Stanford’s WellMD Center. It came down to “Leadership 101,” he said, “communication, appreciation, asking opinions and facilitating career development.”

After developing leadership skills and instituting practices such as regular colleague meetings, Mayo saw burnout levels drop. “As the national numbers continued to worsen, Mayo was able to reverse the trend,” Dr.

Shanafelt said.

E H R s take much of the blame for physician diss at i sf ac t ion, but better systems will ultimately reduce the administrative burden, said Robert Wachter, MD, chair of medicine at UC-San Francisco. Nearly all healthcare organizations have gone digital in less than 10 years, he said: “It’s a huge, huge t ra nsformation in a relatively short period of time.”

The kinks are still being worked out, he added. Many EHRs, for example, prompt caregivers to ask repeated, pointless questions. “The EHR is creating a huge amount of silly work for well-trained people,” he said.

Over time, he asserted, the EHR will improve, much the way smartphones have become easier to use. “Eventually, productivity gets better,” he said.

Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association, said organizations can save three to five hours a day of physicians’ work time by simply re-engineering practices.

She provided an example of a physician whose two medical assistants take care of the administrative work. They accompany him to patient rooms, where they type information into the EHR; they also renew prescriptions and retrieve lab results.

A few simple equipment fixes — such as using card readers instead of requiring passwords, and having printers in patient rooms — can also shave time off a physician’s day, Dr. Sinsky added.

“We have physicians and nurses spending hours and hours per week that do not add value to the patient,” she said.

But Dr. Minor said that using medical assistants and scribes, who remotely transcribe conversations between patients and doctors, is “at best an intermediate step.” A better solution, he said, is to “design front ends that make workflow more efficient.”

Ultimately, improving physicians’ well-being will require a number of changes to the practice of medicine, with input from all parties. “We need to get our communities to help us,” Dr. Minor said, “and be intentional about involving everyone in our organization.”

NOVEMBER / DECEMBER 2017 | THE BULLETIN | 41

CMA Offers Free, Confidential Help to Physicians Struggling with Stress, Drug Abuse, Mental Health Issues One of the most valuable but least wellknown services provided by the California Medical Association (CMA) is the Physicians’ and Dentists’ Confidential Assistance Line, a completely confidential, doctor-todoctor service dedicated to assisting physicians who may feel overwhelmed by aspects of their personal or professional lives.

The 24-hour service connects callers to a physician with extensive experience in helping health professionals having problems with stress, substance abuse or mental health issues to provide support and referrals to better manage whatever issues with which they may be struggling.

“When you call the confidential line, you reach an answering service that relays the message (name and phone number) to the on-call physician, who then returns the call. Physicians staffing the line are selected because of their experience with alcoholism, drug dependence and mental health

and their ability to work with doctors as patients,” according to CMA. “They speak with the caller and gather enough information to make the best referral to an appropriate consultant. They may also, if appropriate, refer calls from spouses to trained counselors who are also members of the CMA Alliance.”

The goal is to help physicians and dentists before their lives and practices are in jeopardy. “If you’re a physician or dentist looking for help with substance abuse or a psychological or emotional problem, we’re here to help. If you’re a colleague, family member or friend of a physician or dentist in need of assistance, please don’t hesitate to call.”

This service is free, and it will not result in any form of disciplinary action or referral to any disciplinary body.

Are you a physician or dentist or a spouse of a physician or dentist who is trying to live with the following problems?

• • • •

Depression/ Anxiety/ Anger?

Alcoholism?

Drug Abuse?

Severe Stress?

You are not alone. You and your family are important. Asking for help is one of the most difficult and heroic things you can do.

The Physicians’ and Dentists’ Confidential Assistance Line (650) 756-7787 (Northern California) (213) 383-2691 (Southern California)

Supervisors OK Inpatient Psychiatric Unit for Santa Clara County Teens The Santa Clara County Board of Supervisors voted unanimously last month to support the construction of a county-run inpatient psychiatric unit for adolescents at Santa Clara Valley Medical Center in San Jose.

The facility will focus on teens dealing with mental health concerns who before had to seek facilities in other counties for treatment.

According to Supervisor Joe Simitian, more than 600 youth are transferred from local emergency rooms to hospitals outside of Santa Clara County each year.

“On any given day, nearly 20 Santa Clara County children are being hospitalized for psychiatric emergencies outside the county, some as far away as Sacramento,” said Simitian in a recent Palo Alto Daily Post article. “It’s better therapeutically for these kids to be close to their community when they’re in crisis, close to their family, their friends and their own local mental health providers.”

“It’s time to ask and answer this threshold question: Is our board and our county prepared to say, ‘Yes, this is a responsibility we want to take on’?” Simitian told Palo Alto Online. “I think we can and we should.”

According to Palo Alto Online, the initial estimate for the facility is $50 million to $70 million. County Executive Jeffrey Smith cautioned last month that even this price range is “inaccurate” given there are not yet any architectural or construction plans. Smith 42 | THE BULLETIN | NOVEMBER / DECEMBER 2017

said the county should be able to fund the project with lease revenue bonds, which are paid off by lease payments from the facilities that were financed by the bond. He said a more exact cost estimate will come back to the board for approval in the next four to six months.

The county is preliminarily planning to tear down the hospital’s existing emergency psychiatric services building, which Smith described as outdated, and build a unit with about 36 to 40 beds for adolescents, according to the article.

In addition to the new facility, the county is reaching out to local private hospitals and mental health service providers to partner and create a “continuum of care” for the teens who go through the inpatient unit. Potential partners include Lucile Packard Children’s Hospital Stanford, Kaiser Permanente, Uplift Family Services (which runs a 24/7 mobile service for teens in crisis and a shortterm stabilization unit for youth in San Jose), El Camino Hospital in Mountain View and others.

CEO of the Santa Clara Valley Medical Center Paul Lorenz said in a statement that there are advantages to the county having a facility of this type on its existing campus.

“The hospital will provide acute inpatient care,” he said, “and when a child is ready for discharge we would work closely with Behavioral Health Services on case management and transition to a community-based setting.”

AMA Launches Integrated Health Model Initiative to Improve, Organize, Share Healthcare Data A new collaborative initiative founded by the American Medical Association (AMA) recently announced it is working to unleash a new era of better, more effective patient care by introducing a data evolution for improving, organizing and sharing healthcare information.

The Integrated Health Model Initiative (IHMI) is a platform for bringing together the health and technology sectors around a common data model that is missing in healthcare. IHMI fills the national imperative to pioneer a shared framework for organizing health data, emphasizing patient centric information, and refining data elements to those most predictive of achieving better outcomes. Evolving available health data to depict a complete picture of a patient’s journey from wellness to illness to treatment and beyond allows healthcare delivery to fully focus on patient outcomes, goals and wellness.

Participation in IHMI is open to all healthcare and technology stakeholders, and early collaborators include IBM, Cerner, Intermountain Healthcare, American Heart Association, American Medical Informatics Association and a growing list of other organizations. IHMI supports a continuous learning environment with an online platform that enables a common data model to evolve with real-world use and feedback from participants.

“We spend more than $3 trillion a year on healthcare in America and generate more health data than ever before. Yet some of the most meaningful data – data to unlock potential improvements in patient outcomes – is fragmented, inaccessible or incomplete,” said AMA CEO James L. Madara, MD. “The collaborative effort of IHMI will help the health system learn how to collect, organize and exchange patient-centered data in a common structure that captures what is most important for improving care and long-term wellness, and transform the data into a rich stream of accessible and actionable information.”

By offering a common data model for the health system to collect, organize, exchange and analyze critical data elements, IHMI imagines all clinicians equipped with essential information to shift care plans towards achieving outcomes that are more relevant to a patient’s quality of life and consistent with the patient’s lifestyle, goals and health status. Given the

high economic and societal burden of chronic diseases, IHMI will initially prioritize its resources and efforts in clinical areas such as hypertension, diabetes and asthma.

A common data model with clinically validated data elements can accelerate the development of improved data organization, management and analytics. This collective effort will foster patient care models that achieve better outcomes, as well as technical innovations to address poor interoperability, cumbersome or inadequate data structures, and an overload of point-and-click tasks that dampen clinician morale.

As IHMI launches, the AMA is currently focused on: • Hosting clinical and issue-based communities focused on costly and burdensome areas. This fosters collaborative efforts around common interests and areas of need, such as hypertension management, diabetes prevention, asthma function and identifying the best available science and practices that define patient-centric care.

• Providing a clinical validation process to determine and apply appropriate clinical frameworks. Participants will provide contributions and feedback online to specify data elements and relationships. Clinical content submissions will go through a validation process to review clinical applicability.

• Specifying a model to encode information in the IHMI data model. Clinical content will enable configurations of the model and reference value sets that can be distributed.

Additional communities will be developed and added to the online platform based on market needs throughout 2018.

“IHMI is the latest development in the AMA’s ongoing work to build bridges with health technology leaders and bring the physician voice into the innovation space. Patients deserve — and the marketplace should expect — physician input on the real-world value and feasibility of products and health technologies,” said AMA Senior Vice President of Health Solutions Laurie McGraw. “With a proven track record as a trusted, neutral convener, the AMA is uniquely qualified to lead and facilitate a collaboration that helps physicians take on a greater role in leading changes that will move technological innovations forward.”

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AMA Develops Online Platform for Physician Experts to Collaborate with Health Tech Entrepreneurs As part of its ongoing work to shape and support effective digital health innovation using physician expertise, the American Medical Association (AMA) recently announced an online platform designed to bring physicians and health tech companies together to develop and improve healthcare technology solutions. The new Physician Innovation Network is an online community where physicians can find and connect with companies and entrepreneurs who are seeking physician input in the development of healthcare technology products and services.

The Physician Innovation Network provides an open online forum for physicians to explore paid and volunteer opportunities to collaborate with health tech companies, and allows companies to search for physicians with specific expertise who are interested in and can offer feedback on their solutions. The platform also provides both physicians and health tech entrepreneurs with opportunities to learn from like-minded innovators and medical professionals, including access to virtual panel discussions with experts.

“The AMA is committed to shaping a future where digital health tools are evidence-based, validated, interoperable and actionable to ensure patients are receiving high-quality care. To make this a reality, the AMA is working with leaders across healthcare who are keenly focused on technologies that work better for patients and physicians and seeking ways to bring the physician voice into the innovation space,” said AMA President David O. Barbe, MD. “We know that when physician expertise is aligned with input from partners on the leading edge of health technology, we produce meaningful results. The Physician Innovation Network will help ensure that physicians play a greater role in leading digital health innovations that expand the bounds of science, enhance patient care, and shape a better healthcare system, and improve the health of the nation.”

The AMA will continue to expand its efforts to advance digital health innovation by providing physicians with additional oppor44 | THE BULLETIN | NOVEMBER / DECEMBER 2017

tunities to engage in innovation and share their ideas, expertise and real-world perspective on the effectiveness of technology in medical practice settings. The AMA’s most recent efforts to spur innovative health solutions between health tech companies and physicians include the following collaborations: • The AMA’s new Integrated Health Model Initiative (IHMI) is bringing together the health and technology sectors around a common data model that is missing in healthcare. Participation in IHMI is open to all healthcare and technology stakeholders, and early collaborators include IBM, Cerner, Intermountain Healthcare, American Heart Association, American Medical Informatics Association and a growing list of other organizations.

• The AMA is the founding partner of Health2047, a healthcare innovation company that bridges the gap between Silicon Valley and the medical community by partnering with established companies to optimize their entries in the healthcare marketplace, co-developing products, and originating early-stage ideas aimed at transforming healthcare.

• The AMA has expanded its partnership with MATTER, Chicago’s healthcare technology incubator, to allow entrepreneurs and physicians to collaborate on the development of new technologies, services and products in a simulated healthcare environment.

• The AMA is working in collaboration with Sling Health, a student-run biotechnology incubator, which helps inspire and support the next generation of young entrepreneurs to tackle unmet needs in healthcare delivery and clinical medicine.

• The AMA is one of four founding organizations of Xcertia, a collaboration dedicated to improving the quality, safety and effectiveness of mobile health applications.

Governor Signs Prescription Drug Transparency Bill California Gov. Jerry Brown defied the drug industry last month by signing a sweeping drug price transparency bill that will force drugmakers to publicly justify big price hikes.

“Californians have a right to know why their medical costs are out of control, especially when pharmaceutical profits are soaring,” Brown said.

“This measure is a step at bringing transparency, truth, exposure to a very important part of our lives. That is the cost of prescription drugs.”

The new law will require drug companies to give 60 days’ notice to state agencies and health insurers anytime they plan to raise the price of a drug by 16% or more over two years on drugs with a wholesale cost of $40 or higher. They must also explain why the increases are necessary.

The advance notification provisions take effect January 1, while the other reporting requirements don’t kick in until 2019.

Brown said the bill is part of a larger effort to correct growing income inequality in the United States.

He called on top pharmaceutical leaders to consider doing business in a way that helps Americans who are spending large sums of money for lifesaving medications.

“The rich are getting richer. The powerful are getting more powerful,” he said.

“We’ve got to point to the evils, and there’s a real evil when so many people are suffering so much from rising drug profits.”

The drug lobby fiercely opposed the bill, SB 17, spending $16.8 million on lobbying from January 2015 through the first half of this year to kill an array of drug legislation in California, according to data from the secretary of state’s office. For the pricing bill alone, the industry hired 45 lobbyists or firms to fight it.

The bill drew support from a diverse coalition, including labor and consumer groups, the hospital industry and even health insurers, who agreed to share some of their own data. Under the new law, they will have to report what percentage of premium increases is related to drug prices.

“Health coverage premiums directly reflect the cost of providing medical care, and prescription drug prices have become one of the main factors driving up these costs,” said Charles Bacchi, CEO of the California Association of Health Plans. “SB 17 will help us understand why so we can prepare for and address the unrelenting price increases.”

Drug companies criticized the governor’s move, saying the new law focuses too narrowly on one part of the drug distribution chain — and ultimately won’t help consumers afford their medicine.

“There is no evidence that SB 17 will lower drug costs for patients

because it does not shed light on the large rebates and discounts insurance companies and pharmacy benefit managers are receiving that are not always being passed on to patients,” said Priscilla VanderVeer, spokeswoman for the Pharmaceutical Research and Manufacturers of America.

Indeed, some experts have said transparency alone is not enough to bring down drug prices, and that California’s law may lack the muscle being applied in other states to directly hold drug prices down.

This year, at least two states have passed laws that may have a more immediate effect on consumer costs than the California measure. Maryland and New York, for example, adopted bills that use a variety of legal levers to impose financial penalties or require discounts if

prices are too high.

But other policy experts argue that California’s law is part of a broader campaign to adopt stronger drug price measures across the country. So it makes sense to start with the source of the drug prices: the drugmakers themselves, said Gerard Anderson, a health policy professor at Johns Hopkins Bloomberg School of Public Health who tracks drug legislation in the states.

“The manufacturers get most of the money — probably about threequarters or more of the money that you pay for a drug — and they’re the ones that set the price initially,” he said. “So they are not the only piece of the drug supply chain, but they are the key piece to this.”

SOURCE: By April Dembosky | California Healthline

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PRACTICE MANAGEMENT

CA Health & Safety Code 11162.1(a)(10) MEMBER PHYSICIANS:

This is to advise you that SCCMA-MCMS has received recent calls from pharmacies in our counties that they have been notified by the California State Board of Pharmacy that many current circulating controlled substance prescription blanks do not meet the Department of Justice requirements for security. In particular, many are lacking the check boxes associated with prescription refills. CA Health & Safety Code 11162.1(a) (10) states that “Check boxes shall be printed on the prescription form so that the prescriber may indicate the number of refills ordered.� The num-

46 | THE BULLETIN | NOVEMBER / DECEMBER 2017

bers 1-5 must be present, each preceded by a check box. The State Board is currently enforcing this requirement and has advised the pharmacies that if they accept non-compliant blanks on the prescription forms they will be subject to citations and fines. For legal interpretation or clarification, we recommend that you contact the DOJ or the Board of Pharmacy.

An alternative quick fix for this issue is for prescribers to sign up for electronic prescribing with CII privileges. CII prescribing is allowed via e-script with special digital certificates. Please contact your e-script vendor for procedures on how to do this.

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