ACCMA Bulletin July/August 2022

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BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

July/August 2022


we are still in this

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ACCMA EXECUTIVE COMMITTEE Robert Edelman, MD, President Edmon Soliman, MD, President Elect Albert Brooks, MD, SecretaryTreasurer Suparna Dutta, MD, Immediate Past President COUNCILORS & CMA DELEGATES Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD James Hanson, MD Terry Hill, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Arden Kwan, MD Terence Lin, MD Lilia Lizano, MD Irene Lo, MD Kristin Lum, MD Ross Pirkle, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Suresh Sachdeva, MD Jonathan Savell, MD Judith Stanton, MD Sonia Sutherland, MD Clifford Wong, MD CMA & AMA REPRESENTATIVES Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, CMA Trustee Katrina Peters, MD, CMA Trustee MEMBERSHIP & COMMUNICATIONS COMMITTEE Mark Kogan, MD, Chair Patricia Austin, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Michael McGlynn, MD Lamont Paxton, MD Katrina Peters, MD Bindoo Rellan, MD Frank Staggers, Jr., MD Ronald Wyatt, MD

Serving East Bay physicians since 1860

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News & Comments

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PRESIDENT’S PAGE Abortion Rights Rolled Back 50 Years By Robert Edelman, MD, ACCMA President

YOUR ADVOCACY 9

HOD 2022 Major Issue – Health Care Reform

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CMA HOD Can Take Bolder Steps Towards Universal Care By Arthur Chen, MD and Steve Tarzynski, MD

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Donate to ACCPAC Today!

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Primary Elections Update and General Election Preview

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ACCMA STAFF Joseph Greaves, Executive Director Mae Lum, Deputy Director Griffin Rogers, Director, Napa & Solano County Medical Societies David Lopez, Assoc. Director of Advocacy and Strategic Initiatives Jennifer Mullins, Assoc. Director of Education and Events Alejandra Hinojosa, Communications Associate Christine Maki, Administrative Assistant

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July/August 2022 | Vol. LXXVIII, No. 4

IN YOUR PRACTICE 17

Reducing Burnout for Bay Area Physicians

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BulletPoints Project for Physicians

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Monkeypox Update

PHYSICIAN LEADERS 12

Lonnie Bristow, MD: Protecting Children Against the Tobacco Industry

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Scott Zeller, MD Wins 2022 Royer Award

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Join Us for the 2022 ACCMA Annual Meeting

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“Medical Care for All, Regardless” (circa 1951) By Victor Hugo Boesen

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Planning for the Launch of 2023 CalAIM Initiatives By Scott Coffin, CEO, Alameda Alliance for Health

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New Members

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Classifieds

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In Memoriam

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Media Training for Physician Leaders

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION 6230 Claremont Avenue, Oakland, CA 94618 Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org

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ACCMA BULLETIN | JULY/AUGUST 2022

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NEWS & COMMENTS

MICRA MODERNIZATION BILL BECOMES LAW

Gov. Gavin Newsom signed AB 35 into law in late May. The new law adjusts MICRA’s cap on non-economic damages effective January 1, 2023. As part of the landmark agreement reflected in AB 35, proponents of the Fairness for Injured Patients Act have withdrawn their initiative from the November ballot. That initiative would have obliterated existing safeguards against out-of-control medical lawsuits and resulted in skyrocketing health care costs. California’s modernized MICRA statutes will provide predictability and affordability of medical liability insurance rates for decades to come. It will also bring greater accountability, patient safety, and trust by making it possible for physicians and patients to have a full and open conversation after an unforeseen outcome. For more information, go to cmadocs.org/micra.

PRIOR AUTHORIZATION BILL ADVANCES

SB 250, introduced by Senator Richard Pan, MD, passed out of the Assembly Health Committee in early June. This CMAsponsored bill would require health plans to exempt physicians from prior authorization rules if they have practiced within the plan’s criteria 80% of the time. All other physicians will have the right under the bill for a prior authorization appeal to be conducted by a physician in the same or similar specialty. Share your story to demonstrate to lawmakers how prior authorization policies are harmful to patients at bit.ly/3P3TWnd.

FIREARM VIOLENCE AND ORGANIZED MEDICINE

Scott Zeller, MD, an ACCMA member for 11 years, received the 2022 J. Elliott Royer Award in Community Psychiatry for his many contributions to the field of psychiatry. The award is hosted by the UCSF Weill Institute for Neurosciences. Doctor Zeller is vice president of acute psychiatry at Vituity, and a past president of the American Association for Emergency Psychiatry. He will be honored at the ACCMA Council meeting on September 8. Read more on page 13.

When President Biden signed a bipartisan gun bill into law in late June, AMA President Jack Resneck Jr., MD applauded the legislation: “For the first time in a generation, we see that bipartisanship is possible on the issue of firearm safety, that compromise can produce meaningful results, and that Congress can come together in response to what the AMA considers a public health crisis of firearm violence.” CMA President Robert E. Wailes stated, “[The] passage of a bipartisan blueprint to address gun violence is a good first step in confronting the public health crisis of gun violence.” To find out what you can do as a physician to help stop gun violence, read about the BulletPoints Project on page 18.

ACCMA MEMBER WINS AMA FOUNDATION AWARD

AMA ADOPTS CLIMATE CHANGE RESOLUTION

ACCMA MEMBER WINS ROYER AWARD

Lonnie Bristow, MD, an ACCMA member for 54 years, won an American Medical Association Foundation Excellence in Medicine Award at the recent AMA Meeting in Chicago. He was honored with the Pride in Profession award, for physicians whose lives encompass the true spirit of being a medical professional through extraordinary patient care. A pioneer in health care equity and policy reform, Doctor Bristow dedicated his career to ethical and socioeconomic issues such as the mistreatment of sickle cell anemia, the tobacco industry’s effect on public health, the death penalty, and HIV/AIDS. In 1995, he was the first Black physician to serve as AMA president. Read more at bit.ly/3NAfcja, and go to page 12 for a conversation with Doctor Bristow.

U.S. HOUSE FAST TRACKS RECKLESS SCOPE OF PRACTICE LEGISLATION

The Improving Access to Workers’ Compensation for Injured Federal Workers Act (HR 6087) passed the House unanimously in early June. The bill is now in the Senate. If passed, this bill would allow nurse practitioners and physician assistants to diagnose, prescribe, treat, and certify an injury and extent of disability for purposes of compensating federal workers under the Federal Employees’ Compensation Act. Not only does H.R. 6087 threaten patients’ health and safety, but its dangerous approach has also been shown to lead to increased health care costs while doing little to expand access, particularly in rural and underserved areas. Tell Congress to vote no on HR 6087 to prevent this reckless legislation from passing by going to bit.ly/3OX6896. 4

At its Annual Meeting in Chicago in early June, the American Medical Association adopted a new policy declaring climate change a public health crisis. According to the resolution coauthored by ACCMA member Ashley McClure, MD, whose recommendations were adopted, “physicians are uniquely trusted messengers and have a responsibility to advocate for science-based policies to safeguard health.” To that end, the AMA House of Delegates declared “climate change a public health crisis that threatens the health and well-being of all individuals.” Read more at bit.ly/3NErvuP.

LOCAL NONPROFITS RECEIVE STATE BEHAVIORAL HEALTH FUNDING

A bill supported by CMA to provide more funding to local behavioral health facilities (AB 172) provided four family support services and crisis centers in Alameda County a combined $18.4 million in June. The funding through the Department of Health Care Services (DHCS) Behavioral Health Continuum Infrastructure Program (BHCIP) ensures that vulnerable populations receive care in less restrictive settings, including outpatient alternatives. This is the third of six grant rounds targeting gaps in the state’s behavioral health facility infrastructure. Additional information is at infrastructure.buildingcalhhs.com.

VACCINE CLAIMS FOR CHILDREN

CMA learned in late June that DHCS has not yet completed the system and operational changes required to enable successful claims adjudication for administration of the PfizerBioNTech and Moderna COVID-19 vaccines for children under

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN


NEWS & COMMENTS

age 5. DHCS is urging physicians to hold Medi-Cal claims for vaccine administration for children under age 5 until further notice. Contact the ACCMA with any questions at (510) 6545383 or accma@accma.org.

CALHEALTHCARES ROUND 4 AWARDEES

Congratulations to the fourth cohort of awardees of CalHealthCares grants for loan repayment on educational debt for California physicians and dentists who provide care to Medi-Cal patients. The physician awardees in Alameda and Contra Costa counties are: • Abigail Burns, MD, Obstetrics and Gynecology, Contra Costa Regional Medical Center • Joseph Cartwright, MD, Internal Medicine, Eastmont Wellness Center • Daniel Kaplan, MD, Endocrinology, Diabetes, and Metabolism, Epic Care • Christine Kim, MD, Otolaryngology, Stanford Health Care • Luyang Liu, MD, Obstetrics and Gynecology, Contra Costa Regional Medical Center • Dorea Martin, MD, Pediatrics, UCSF Benioff Children’s Hospital • Abid Mogannam, MD, Vascular Surgery, General Vascular Surgery Group • Bernard Nelson, MD, Anesthesiology, Highland Hospital • Kara Percival, MD, Pediatrics, Brentwood Health Center • Gaspar Rivera, MD, Pediatrics, UCSF Benioff Children’s Hospital • Luke Rond, DO Emergency Medicine, Sutter Delta Medical Center • Paris Scott, MD, Obstetrics and Gynecology, Contra Costa Regional Medical Center • Ashley Vance, MD, Obstetrics and Gynecology, Contra Costa Regional Medical Center

PREVENTIVE HEALTH SERVICES FOR CHILDREN

The California Department of Health Care Services has published its second annual Preventive Services Report, which describes how Medi-Cal managed care plans (MCPs) deliver preventive health services to children. Based on data from 2020, the PSR shows that the COVID-19 public health emergency (PHE) likely had a significant impact on whether individuals visited health provider locations to receive care, treatment, or screenings. It is also notable that communities of color experienced greater declines in health outcomes than other groups, highlighting the disproportionate impact of the PHE on these populations. Access the report at bit.ly/3NG3NhN.

DRUG PRIOR AUTHORIZATION AND CLAIM EDITS

DHCS has begun reinstating pharmacy claim edits and prior authorization requirements for prescription drugs through a three-phased approach. Phase I, which was reinstated July 22, consists of claim edits for diagnosis and Drug Utilization Review (DUR) requirements, referred to as DUR 88 and Reject

UPCOMING EVENTS

LEADERSHIP READING AND DISCUSSION GROUP Wednesday, September 7 | 6:00 to 7:30 pm Free | CME Available | Online Physicians are free to join any meeting of the Leadership Reading and Discussion Group; reading the book is not required. Dr. Hilary Worthen, course director of the Physician Leadership Program, facilitates the online discussion group. The book selection for September is “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” by Elisabeth Rosenthal, MD. This book describes how the flawed system of health insurance and delivery has failed patients in the US, and proposes solutions for far-reaching reform. Register at pathlms.com/ medical-society/courses/41913.

BAY AREA PHYSICIAN WELLNESS COLLABORATIVE

Tuesday, September 13 | 6:00 to 8:00 pm Free | CME Available | Online Medical group leaders, chief wellness officers, wellness committee chairs, and others who have been charged with “fixing the physician burnout problem” can make substantive changes to fundamentally change the practice environment in their organization and help restore joy to the practice of medicine. Join regular convenings of the Bay Area Physician Wellness Collaborative, led by Dr. Paul DeChant, to receive expert guidance, share experiences and best practices, and network with your peers. Read more on pages 16 to 17. To request an invitation to enroll, visit bit.ly/3PcTd3L.

ACCMA ANNUAL MEETING

Friday, November 4 | 6:00 to 8:00 pm Claremont Club & Spa, Berkeley, CA The Annual Meeting is a fun and entertaining evening for the East Bay health care community to connect with one another, enjoy dinner and a fun program, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program. This year’s guest speaker is Keena Turner, fourtime Super Bowl champion for the San Francisco 49ers. Read more on page 19. Go to accma.org/ events to purchase tickets online.

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PRESIDENT'S PAGE

Abortion Rights Rolled Back 50 Years By Robert Edelman, MD, ACCMA President

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hen the United States Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization, the ACCMA released a statement strongly disagreeing with the court’s decision to overturn both Roe v. Wade and Planned Parenthood v. Casey, thus effectively denying Americans their constitutionally guaranteed access to abortion services. In our statement, the ACCMA predicted that the decision “will lead to government interference in the patient-physician relationship, dangerous intrusion into the practice of medicine, and potentially the criminalization of critically needed lifesaving care. This decision will significantly reduce access to comprehensive reproductive health care services, exacerbate healthcare inequity, and cause harm to patients.” One month after Dobbs, this is exactly what is playing out. Planned Parenthood of California reportedly saw more out-ofstate patients in the first week and a half post-Dobbs than they saw in the entire previous calendar year. In the Midwest, some reproductive health clinics in states with restrictive abortion laws have been forced to shutter and relocate across state lines to places with less restrictive abortion laws. We have seen other states implement restrictive abortion laws that provide no exceptions for victims of rape or incest or for the health of the mother. In fact, a notable case in Ohio led a 10-year-old rape victim impregnated by her assailant to seek an abortion in a neighboring state because Ohio law prohibits abortions after six weeks, without exception. The fact that some pregnant patients may be able to travel to other states to receive the care they need, or that abortion clinics can be moved across state lines, does not soften the blow of the Supreme Court decision. Delays in care have long-term health and financial consequences. Patients traveling out of state may not get appointments in time at crowded health clinics, and the additional costs for childcare, time off work, hotels, and gas can be prohibitive. Other patients are finding hurdles in receiving standard surgical procedures or medication for miscarriages or failed pregnancies, which are identical to those for abortions. Indeed, there are other cases already emerging about women with ectopic pregnancies and women who are hemorrhaging from miscarriages who had their care delayed and, consequently, their lives endangered because of state laws. The longer that patients

must wait to get an abortion, the more likely the type of medical procedure required turns into a more invasive one, which could become a quality-of-care issue. This cannot be allowed to stand. The ACCMA reiterates our call for leaders in Congress – particularly in the United States Senate – to take immediate action to enshrine in federal law a guaranteed right to comprehensive reproductive health care services, including abortion services, regardless of where someone lives. A handful of judges without medical expertise should not be dictating the healthcare choices of millions of women. The dissenting opinion also points out that this ruling may lead to more draconian efforts to restrict the ability of women in states with restrictive laws from accessing abortion services in other states. Congress must act immediately to reaffirm a woman’s right to her own health care decisions, regardless of where she may live. Recently, the Biden administration issued a letter to all hospitals and health care providers reminding them of their obligation to comply with EMTALA. The Secretary’s letter clarifies that EMTALA requirements preempt any state laws that restrict access to stabilizing medical treatment, including abortion procedures and other treatments that may result in the termination of a pregnancy. Already, the Texas Attorney General has filed suit to block the order so that states can be allowed to deny abortion services even when the life of the mother is at risk. The American Medical Association is seeking additional information and specific examples of how physicians and patients are being impacted by the Dobbs decision and state prohibitions on abortion. If you have examples of access problems related to reproductive health (e.g., miscarriage management) or other areas of care (e.g., prescribing of medications for other conditions), please email Joe Greaves, Executive Director (jgreaves@accma. org). To our patients in the East Bay, we want to affirm that this Supreme Court decision will not limit your ability to access abortion services in our community. California’s strong abortion access laws provide legal protections for those seeking comprehensive reproductive care. Efforts are underway in Sacramento continued on page 9 ACCMA BULLETIN | JULY/AUGUST 2022

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NEWS & COMMENTS

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Code 80 edits. For claims or prior authorization assistance, call the Medi-Cal Rx Customer Service Center at (800) 977-2273, or email MediCalRxEducationOutreach@magellanhealth.com. Read more at bit.ly/3AqLw5h.

ADVOCACY ON ACCESS TO MIFEPRISTONE

The AMA and the American College of Obstetricians and Gynecologists (ACOG) joined on two letters to the White House and FDA to support continued unrestricted access to mifepristone. The AMA and ACOG are encouraging the administration to remove or revise the drug’s current risk evaluation and mitigation strategies (REMS) to remove potential barriers to access to mifepristone and are also supporting the authority of FDA approval to preempt state laws that further restrict access to the drug. Read the letters at bit.ly/3bPBBMg and bit.ly/3nzDgIu.

CIGNA TO REEVALUATE MODIFIER 25 POLICY

After CMA urged rescission of its policy, Cigna has delayed their requirement to submit medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. The reimbursement policy update will therefore not go into effect on August 13, as originally scheduled. Read more at bit.ly/3PB8BGx.

NEW 988 SUICIDE AND CRISIS LIFELINE

The new 988 dialing code replaced the 10-digit National Suicide Prevention Lifeline on July 16. 988 will connect anyone experiencing mental health–related distress and those worried about a loved one who may need crisis support to compassionate, accessible care. The Lifeline is supported by $105 million from the U.S. Department of Health and Human Services, awarded to 54 states and territories to improve response rates, increase capacity to meet future demand, and ensure calls initiated in their states/territories are first routed to local, regional, or state crisis call centers. Read more at bit.ly/3NIHhFd.

CMA ENDORSES PRINCIPLES FOR MEDICARE PAYMENT REFORM

CMA joined 120 organizations that have endorsed AMA’s new Medicare payment reform principles and is advocating for these reforms before Congress and CMS. The principles provide a framework to reshape the Medicare payment system so that it works better for patients and physicians, and puts an end to the annual advocacy exercise of stopping impending payment cuts. The AMA framework represents the first stage in organized medicine’s effort to develop and propose substantial changes to the payment system to improve the financial viability of physician practices and ease its administrative burdens. Read the principles at bit.ly/3uoPhnU.

EXPANDED MEDICAID AND CHIP FOR POSTPARTUM PERIOD

California joined 19 other states to expand Medicaid and Children’s Health Insurance Program coverage to 12 months postpartum. This postpartum care extension includes the full breadth of medically necessary services during pregnancy and the postpartum period, and is automatic for all Medi-Cal patients who report a pregnancy or are postpartum, regardless of immigration status or how the pregnancy ends. Read more at bit.ly/3Amwspa.

UNLAWFUL STI SCREENING LIMITS

The California Department of Insurance (CDI) is warning health insurers that refusing to cover necessary treatments and limiting coverage or sexually transmitted infection (STI) screening to one year is unlawful. At a time when the CDC reports an alarming increase in STIs nationwide, the CDI is finding that several insurers are creating many unnecessary and unlawful obstacles in obtaining treatment for STIs. Both the Affordable Care Act and California law prohibit limiting STI screenings of persons who are at increased risk of infection. Read more at bit.ly/3P3TGoc.

DHCS SUNSET MEDI-CAL VALUE-BASED PAYMENTS

Effective July 1, DHCS have sunset the Prop. 56 funded MediCal Value-Based Payments program. The program incentivized providers to meet specific measures and benchmarks that improve the quality of care provided to Medi-Cal beneficiaries. The Prop. 56-funded Medi-Cal supplemental payments that apply to a set of 23 primary care focused CPT codes and family planning services will not be affected and were made permanent as part of the 2021-22 state budget. Read more at bit.ly/3uWgqPc.

STATE BUDGET CONTINUES TO PRIORITIZE HEALTH CARE

Gov. Gavin Newsom and the state legislature reached agreement on the budget for the 2022-23 fiscal year. The $300.7 billion budget proposal prioritizes health care and demonstrates a continuing commitment to providing universal health care access and coverage for all Californians. CMA President Robert E. Wailes, MD, said, “[The] budget includes important investments to reduce disparities in the health care system and improve access to and quality of care for children’s preventative health, maternity care, women’s reproductive health and integrated behavioral health services.” Read more at bit. ly/3NHhjlk.

Join the ACCMA at www.accma.org/membership/join-now 8

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN


HOD MAJOR ISSUE

HOD Major Issue – Health Care Reform

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he 2022 CMA House of Delegates meeting, to be held in Los Angeles from October 22 to 23, will discuss three major issues, two that are actionable (Physician Workforce and Health Care Reform) and one for information (Mental Health). The Health Care Reform Major Issue would include review of and action on recommendations that come out of the Health Care Reform Technical Advisory Committee (TAC). The Health Care Reform TAC was convened to help CMA navigate its engagement with the Healthy California for All (HCFA) Commission, which released its final report to the state legislature and the Governor in April. Its report presented information on a range of topics that would need to be considered if California were to undertake an effort to establish a unified financing system for health care delivery in California. The Health Care Reform TAC, as part of its mission to provide analysis and counsel to the CMA Board of Trustees, developed a set of draft guiding principles that could guide CMA engagement in unified financing discussions. The TAC clarified that the proposed principles are intended to provide guidance for public policy discussions around the development of a unified financing system in California but should not be misconstrued as indicating that CMA either supports or opposes a unified

STAY INFORMED — UPDATE YOUR CONTACT INFORMATION! We want you to receive meeting information and more in a timely manner and are asking for your help in updating our database. If you have not been receiving our communications, please email your preferred and alternate email addresses, mailing addresses, and phone numbers to accma@accma.org. Thank you for helping us to better serve you.

financing system. After review by the CMA Council on Medical Services and the CMA Board of Trustees, the full Major Issue report will be released in late September for member input and HOD consideration. Some of the policy questions for HOD discussion are: Is CMA’s current policy related to health care reform sufficient to guide CMA’s advocacy for the next five years of policy deliberations? Should CMA establish guidelines that delineate state-level criteria, like requiring any state proposal to have received necessary federal waivers and segregation of funding from the State’s General Fund? Should CMA guidelines specify that eligibility for coverage not be linked to employment? To read the opinion of an ACCMA member on the HCFA Commission report, turn to page 10. Stay tuned for upcoming opportunities for ACCMA members to provide input to the ACCMA HOD delegation. If you have any questions or want more information, contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives at dlopez@accma.org or 510-654-5383.

PRESIDENT'S PAGE (continued from page 7)

to further protect access to abortion services, including through a constitutional amendment. The ACCMA respects the diversity of religious and ideological viewpoints about the ethics of abortion. We believe physicians should have the choice of whether to perform abortions, and that patients should have the choice, within reasonable limits, of whether to obtain abortions. In consultation with their physician, patients should continue to have the ability to make choices about their health care, regardless of where they may live.

Put Your ACCMA Membership to Work! Go to www.accma.org > Membership, or call ACCMA at (510) 654-5383 for help.

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OP-ED: DR. ARTHUR CHEN

CMA HOD Can Take Bolder Steps Towards Universal Care By Arthur Chen, MD and Steve Tarzynski, MD, MPH, FAAP Arthur Chen, MD

Steve Tarzynski, MD

The opinions expressed in this article are those of the authors. They do not purport to reflect the opinions or views of the ACCMA or its members. “No matter how good the health care in a particular country, people will complain about it.” T.R. Reid, The Healing of America (2010) “Health care reform is long overdue in the U.S. Americans are needlessly losing lives and money.” Alison Galvani, PhD, Yale School of Public Health

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n October, the CMA HOD leadership will have the opportunity to take bold and courageous steps towards universal coverage for all Californians that is affordable, comprehensive, equitable, high quality and cost conscious. Although this has already been achieved in all other high-income countries, we stand out in our failure to pass legislation that would protect all of our people against illness and death, let alone bankruptcy, hunger, disability and homelessness. Decades of health disparities among communities of color have been accentuated by COVID and beckons for health equity in health care reform. What is needed more than ever are evidence-based and time-tested solutions with successful track records and accomplishments. The need is urgent and we can no longer dither and put off meeting this challenge. The Healthy California for All Commission (HCFA) was launched in December 2019 by the Governor and the state legislature, and its members included health experts in business, philanthropy, academia, and labor. Its purpose was to advance comprehensive health care reform by developing a plan “for advancing progress toward a health care delivery system in California that provides coverage and access through a unified financing system (UF), including but not limited to, a single-payer financing system for all Californians.” The Commissioners, led by Secretary of Health and Human Services, Mark Ghaly, MD, compiled extensive public testimony from experts and stakeholders. Their final report, Key Design Considerations for a Unified Health Care 10

Financing System in California, published in April 20221, showed close alignment with CMA values, interests, and policy, as stated in the report issued by the CMA Health Care Reform Technical Advisory Committee (TAC) in January 2022. The TAC updated the CMA position on single payer to engage more effectively and constructively in public policy debate on the HCFA report and in the state’s consideration of legislation to create a single-payer health care system. CMA’s guiding principles for a unified system of health care financing are as follows: • The health care system should deliver high quality, affordable, evidence-based care to all. • The health care system should be designed to further health equity rather than perpetuate and exacerbate health disparities. • The health care system should be funded in a sustainable and stable way to maintain uninterrupted access to care. • The health care system should value investments in public health, wellness, preventive care, and primary care. The HCFA report states, “a sustainable unified financing system for health care services provides safe, timely, efficient, equitable and person-centered health care that advances the mental and physical health and well-being of all Californians.” WHAT IS UNIFIED FINANCING (UF)? The concept of UF describes a time-tested model in countries (Canada, UK, France, Germany, etc.) with different versions (single payer, national health system, multi-payer not-for-profit system) of government-guaranteed health care financing and universal health care coverage. At the state level, it would mean: • All Californians will be entitled to receive a standard package of health care services. • Entitlement will not vary by age, employment status, disability status, income, immigration status, or other characteristics. • Distinctions among Medicare, Medi-Cal, employer-sponsored insurance, and individual market coverage will be eliminated.

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OP-ED: DR. ARTHUR CHEN

The benefits of UF would address for each group: Employers: Through the elimination of the employer health benefit procurement role, administrative burden would be reduced, thus enabling a focus on business goals rather than employee health coverage needs. Individuals: Through universal coverage, more equitable financing, and delivery system changes, health care quality, accessibility, and equity would improve. Health Care Providers: A single set of rules for payment, quality, and other outcomes would simplify the reimbursement process.

WHAT ABOUT COSTS AND SUSTAINABILITY? The Commission found that absent a shift to UF, aggregate health care spending in the state is estimated to increase by $158B, or approximately 30%, in 2022 dollars over nine years. Under almost all the scenarios analyzed, in the first year of implementation, UF is expected to result in lower total health care expenditures than under the status quo – and for single-payer public UF, $9 to $35 billion in savings would be realized, depending on income-related cost-sharing and long-term care coverage and with health plan intermediaries. Significant savings from UF would accrue to the vast majority of California employers and households, which will on average pay less to support UF than they pay in the status quo. Financing can be stable over time but will depend on controlling cost growth and securing agreements with the federal government on the rate of growth in federal payments. WHAT ABOUT PROVIDER PAYMENT? The Commission did not dictate any specific formulas or processes. They acknowledged the benefits of hospital global budgeting based on the Maryland Total Cost of Care model. They called for physician payment negotiations for fee-for-service and acknowledged capitation and salaries as options, along with necessary incentives for quality, health equity, addressing complex patients and social drivers of health, and increasing physician supply in underserved areas. WHAT ABOUT HEALTH EQUITY? COVID revealed an even uglier side of structural racism, which has disproportionately impacted communities of color for decades preceding the pandemic. In seeking community input from marginalized communities through interviews and surveys, HCFA found strong support for a single, statewide, government-run health care program that covers all people who live in California. Their poll suggests that 65 percent of Californians with

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low incomes support the concept, with people of color showing greater support: 76 percent of African Americans, 71 percent of Latinos, 73 percent of Asian/Pacific Islanders, 65 percent of Native Americans, and 54 percent of whites. They also found that Californians with low incomes would value three key attributes of a reimagined healthcare system, including cost and affordability, access to care, and cultural humility and respect. In summary, the HCFA Commission report signals Unified Financing as a bold step toward achieving universal coverage that is affordable, high quality, and cost conscious while advancing health equity. They found the single-payer version of UF would yield the most savings. They estimated that universal coverage would save 4,000 or more California lives annually. On a national scale, a recent Yale study projected that as of mid-March 2022, universal health care could have saved more than 338,000 lives from COVID-19 alone, and that the U.S. could also have saved $105.6 billion in health care costs associated with hospitalizations from the disease – on top of the estimated $438 billion that could be saved in a non-pandemic year.2 Close to home, the SF Latino Task Force and the SF Latino Parity and Equity Coalition, which serves 20 nonprofits crucial to San Francisco’s COVID response and focuses on Black and Latino residents disproportionately impacted by COVID, faces a $9.5 million cut in proposed funding. The mayor’s office said that COVID services were funded by temporary, one-time payments from the state and federal governments that “no longer exist.” Isn’t it about time we physicians took a bolder step towards universal coverage that is transformational and true to our patients’ and community’s interests – especially our low-income and marginalized communities? No system will be perfect and every system will require our ongoing advocacy and wise counsel in seeking continual improvement. This is our opportunity to accelerate toward true universal coverage, to avoid the ongoing pain and suffering wrought by our current system and structures that rations care based on the ability to pay and the color of one’s skin. As California goes, so goes the nation. Let’s lead! Arthur Chen, MD is a Senior Fellow in Family Medicine at Asian Health Services in Oakland and a past president of the ACCMA. Steve Tarzynski, MD, MPH is a retired SCPMG pediatrician and President of the California Physicians Alliance (CaPA). NOTES 1 Jessica Altman et al. (2022) Key Design Considerations for a Unified Health Care Financing System in California, delivered to Members of the Healthy California for All Commission, April. bit.ly/3afxwRe 2 Rachel Nuwer (2022) Universal Health Care Could Have Saved More Than 330,000 U.S. Lives During COVID, Scientific American, published online June 13.

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MEMBER IN FOCUS

Lonnie Bristow, MD: Protecting Children Against the Tobacco Industry ACCMA member and past AMA President Lonnie Bristow, MD received an AMA Foundation Excellence in Medicine 2022 Award for dedicating his career to ethical and socioeconomic issues such as the tobacco’s effect on public health. The following is an edited conversation with Doctor Bristow in early July 2022 about the Yes on 31 campaign (voteyeson31.com), which would uphold the law passed by voters in 2020 to end the sale of candy-flavored tobacco in California.

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n the upcoming November election, there is a ballot measure to uphold a landmark law in California that requires tobacco product makers to remove flavors and minty menthol from them. The reason that law (SB 793 – Hill) has been suspended, even though it passed two years ago, is because it’s been tied up by the tobacco industry, using legal maneuvers to prevent it from being implemented. Now the tobacco industry is going so far as to sponsor this referendum to overturn the law. California was the second state in the nation, after Massachusetts, to pass a law requiring those limits on flavored tobacco products. It’s fairly apparent that the tobacco industry sees this referendum as their effort to stop the restrictions in California before they spread any further in the nation. E-cigarettes have only been with us for about a dozen years. The other states, along with California, had to get some idea of what was going to happen. This is a public health threat because currently 19% of teenagers are using vaping products across the nation. The context is that tobacco, of course, has been a health hazard and killing Americans and others for many decades. Back in 1990, 46% of all adults in America were cigarette smokers. At that time, smoking was common in restaurants, in movie theaters, on airplanes, and in other places. When I was Chairman of the AMA Board of Trustees in 1993, I used to go to AMA headquarters once a month and visit every department to ask if there was anything we could do to help them facilitate our mission. One month my secretary told me, there are three gentlemen who would like to have dinner with you this evening, and they say they are the Attorneys General from three states. I asked them during dinner why they had wanted to dine with me, and they said they were members of the national association of attorneys general. At that time, they had 46 members. They said that in all the states, they had incurred heavy expenses because of tobacco-related diseases and they had

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decided as an organization to go after the tobacco industry to try to recover tobacco-related healthcare costs of the people in their states. They asked if the American Medical Association would like to join their effort. I had a quick conference call with the Board of Trustees, explained the circumstances, got their support, and came back to the attorneys general, all at the same dinner. I told them our cooperation depended on what they were asking of us. I said the AMA is not going to sue for monetary losses, but we have some public health interests that are important to us. And they said fine, we will carry your interests with equal weight. And for the next two years, we held a series of negotiations with the tobacco industry, occurring about every six to eight weeks at hotels in different cities around the country. In those meetings, there would always be a very long table, on one side would be 25 to 30 attorneys from tobacco companies in America and on the other side would be state attorneys general and one doctor – which would be me. I was the only doctor in the room. We negotiated for two years. It resulted in the largest monetary settlement in the history of the United States; there has never been one as large before or since then. Well over $200 billion over 25 years was going to the states for anti-smoking programs. I got what I went in with the intent of getting from the tobacco companies – my concerns were what they were doing to young people and about their recruitment tactics – so the agreement was that they could never use cartoon characters again in advertising any tobacco products, including Joe Camel and the hotel bellboy used in Philip Morris ads. They also had to agree not to put advertising in any major league baseball or football stadium in America, or to give away candy cigarettes to children in school. They could no longer sell cigarettes at substantially reduced prices to our men and women in the armed forces around the world. And this agreement has held for the last 25 years. As a result, whereas in 1990 46 percent of American adults were smokers, in 2020 it’s down to 15% of adults, which is a wonderful achievement. The rates of lung cancer and deaths from chronic lung disease in the US have come down drastically. I got my greatest personal pleasure about two or three weeks ago at the AMA Annual Meeting, when I was giving a talk to a group of medical students about this issue. Afterwards a medical student continued on page 24

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[short title: Yes on 31 Campaign] ROYER AWARD

Scott Zeller, MD Wins 2022 Royer Award

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cott Zeller, MD, an ACCMA member for 11 years, received the 2022 J. Elliott Royer Award in Community Psychiatry for his many contributions to the field of psychiatry. The award is hosted by the UCSF Weill Institute for Neurosciences. He will be honored at the ACCMA Council meeting on September 8. Doctor Zeller is nationally known for his pioneering work in psychiatric emergency care in developing what is known as the “Alameda Model,” developed during his time as chief of psychiatric emergency services at John George Psychiatric Hospital. Under his leadership, the center was transformed from a traditional ward, where restraints were common, into one that treats patients in a more supportive, living room–like setting. This psychiatric emergency service (PES) works with 11 area medical emergency departments to provide intensive treatment with the goal of rapid stabilization. It is staffed around the clock by psychiatrists and nurses and serves all medically stable patients regardless of their ability to pay. Services are provided on an outpatient basis, and the maximum length of stay in the PES is 24 hours, which is fully covered under the “crisis stabilization” provision of California’s Medicaid program. The PES model reduces the need for hospitalization, freeing up scarce inpatient beds for those who are truly in need. Consequently, psychiatric boarding at Alameda County EDs has been substantially reduced. Once medically cleared, the average behavioral health patient waits less than two hours for transfer to the PES. Since developing this model, Doctor Zeller has had the opportunity to lead similar transformational efforts around the country. He has authored multiple textbooks, book chapters, and peer-reviewed articles, lectures internationally, and is known as the co-inventor of On-Demand Emergency Telepsychiatry and the creator of the EmPATH Unit (Emergency Psychiatry Assessment, Treatment and Healing Unit) model for behavioral health emergency care. He currently serves as Vice President for Acute Psychiatry at the multistate, multispecialty physician group partnership Vituity, leading a team of over 150 psychiatrists in 34 California hospitals. He is also an assistant professor at University of California–Riverside School of Medicine and Touro University College of Osteopathic Medicine in California. He has held numerous leadership roles, serving as Past President of the American Association for Emergency Psychiatry; Past Chair of the National Coalition on Psychiatric Emergencies; and, as previously noted, as former Chief of Psychiatric Emergency Services

for the Alameda Health System in Oakland, where he cared for over 90,000 emergency patients in his 29 years, and where he developed the influential “Alameda Model.” Doctor Zeller has consulted for over 50 hospitals and state associations to improve behavioral healthcare, including assisting in the creation of several dozen emergency psychiatry programs across the US, Canada, and Australia, and he recently served as Subject Matter Expert for both the Institute for Healthcare Improvement’s Emergency Department Behavioral Health project and the Facility Guidelines Institute’s Committee on Architecture and Design for Behavioral Health Crisis Units. He led Project BETA (Best Practices in the Evaluation and Treatment of Agitation), which produced guidelines that have revolutionized the care approach to agitated individuals around the world, replacing coercion with compassion and collaboration, resulting in greatly improved safety and patient outcomes. His contributions to the field of psychiatry have been widely recognized. He was awarded the 2015 USA Doctor of the Year by the National Council for Behavioral Health, the 2017 AAEP Garland Holloman Award for Lifetime Achievement in Emergency Psychiatry, the 2019 California Hospital Association Ritz E. Heerman Memorial Award for making a landmark contribution to improving California healthcare, and in 2020 was named one of the “ten most influential people in healthcare design” by Healthcare Design magazine. Locally, he was awarded the 2009 Alameda Health System Physician of the Year, 2012 San Francisco Business Times “Heroes of Healthcare” Award, 2013 California Hospital Association Simanek Award (California Behavioral Health Person of the Year), and 2014 Alameda Health System “Provider of the Quarter.” Doctor Zeller’s achievements have also been featured in the national media, including CNN and NPR. Doctor Zeller’s leadership in the field of psychiatry has made an enormous and lasting contribution toward improving quality and access to mental health services in the Bay Area and far beyond. Because of his work, patients experiencing a psychiatry emergency are more likely to receive the appropriate level of care in the appropriate setting. He has devoted countless hours to sharing his knowledge and experience with others to ensure that as many patients as possible are able to benefit from his good work. The ACCMA congratulates Doctor Zeller on this notable accomplishment!

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ACCPAC

DONATE TO ACCPAC TODAY! As a leader within the local medical community and supporter of legislative advocacy on behalf of your profession, you can support the ACCMA political action committee – ACCPAC. Please consider donating at least $10 per month, either on a recurring monthly basis by credit card or by making a one-time $120 annual donation. ACCPAC makes it possible for the ACCMA to provide financial support to candidates for local office who can respond to our concerns about health care matters. Recently, ACCPAC supported Rebecca Kaplan and Lena Tam, who are running for the Alameda County Board of Supervisors (BOS)

District 3 seat, and also supported Carlyn Obringer and Debra Allen for the Contra Costa County BOS District 4 seat. ACCPAC further provides financial support for local health-related ballot measures, such as Measure AA to renew Alameda County’s sales tax for public health programs, and ballot measures to establish taxes on sugary sodas in Berkeley and Oakland. We encourage you to support ACCPAC by making a donation at accma.org/donate. If you have any questions, contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at 510-654-5383 or dlopez@accma.org.

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ELECTIONS 2022

Primary Elections Update and General Election Preview

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he 2022 California Primary Election was held on June 7 and the General Election is scheduled for November 8. During the 2022 election cycle, a few legislators will either be termed out or will not be seeking re-election.

PRIMARY OPEN SEAT ELECTION RESULTS Senate District (SD) 10 is currently held by Senator Bob Wieckowski, who has reached his term limit in the Senate. SD 10 encompasses cities in both Alameda and Santa Clara counties. The results for this primary race were: Lily Mei received 35.20%, Aisha Wahab received 26.1%, Paul Pimentel received 22.1%, Jamal Khan received 7.6%, Raymond Liu received 5.5%, and Jim Canova received 3.4% of the votes. Lily Mei and Aisha Wahab will advance to the November General Election. Assembly District (AD) 20 is currently held by Assemblymember Bill Quirk, who will not be seeking re-election. AD 20 encompasses Ashland, Castro Valley, Cherryland, Fairview, Fremont, Hayward, Pleasanton, San Lorenzo, Sunol, and Union City. The results for this race were: Liz Ortega received 31.6%, Shawn Kumagai received 25.3%, Joseph Grcar received 22.6%, and Jennifer Esteen received 20.5% of the votes. Liz Ortega and Shawn Kumagai will advance to the November General Election. Alameda County Board of Supervisors (BOS) District 3 is currently held by Supervisor Dave Brown, who will not be seeking election. Supervisor Brown was appointed to the seat after the tragic passing of Supervisor Wilma Chan. District 3 encompasses Alameda and San Leandro; a portion of the city of Oakland, including the Chinatown, San Antonio, Fruitvale, and Melrose neighborhoods; the unincorporated communities of San Lorenzo and Hayward Acres; and a portion of the unincorporated community of Ashland. The results for this race were: Rebecca Kaplan received 38.67%, Lena Tam received 30.39%, David Kakishiba received 18.41%, and Surlene G. Grante received 12.52% of the votes. Rebecca Kaplan and Lena Tam will advance to the November General Election. Contra Costa County BOS District 4 is currently held by Supervisor Karen Mitchoff, who will not be seeking re-election. District 4 encompasses Walnut Creek, Concord, Pleasant Hill, San Miguel, and Clayton. The results for this race were: Ken Carlson received 27.72%, Debora Allen received 25.61%, Carlyn Obringer received 24.17%, Roxanne Carrillo Garza received

13.28%, and Ed Birsan received 9.22%. Ken Carlson and Debora Allen will advance to the November General Election. NOVEMBER ELECTIONS PREVIEW Besides the open seat election races, the ACCMA is monitoring the following measures in the November Election. Dialysis Initiative – SEIU-UHW is back a third time with another dialysis proposition. The new proposition is nearly identical to Proposition 23, which 63% of voters overwhelmingly rejected in 2020. This initiative would arbitrarily require a physician, nurse practitioner, or physician assistant to always be onsite at dialysis clinics. This measure would move doctors and other providers away from patient care into administrative roles. ACCMA opposed the two prior initiatives and is also opposed to this initiative. This latest proposition will again jeopardize access to care, worsen our health care provider shortage, and increase health care costs for all Californians. California Flavored Tobacco Products Ban Referendum – Proponents of the veto referendum seek to overturn Senate Bill 793 (SB 793), which was signed into law on August 28, 2020. SB 793 had the support of CMA and was designed to ban the sale of flavored tobacco products and tobacco product flavor enhancers, with exceptions for hookah tobacco, loose-leaf tobacco, and premium cigars. Retailers would be fined $250 for each sale that violated the law. The California Coalition for Fairness is campaigning for the veto referendum to repeal SB 793. Through December 31, 2021, the campaign had received $21.16 million, including $10.33 million from R.J. Reynolds Tobacco Co. and $9.83 million from Philip Morris USA. California Pandemic Early Detection and Prevention Initiative – This initiative will modernize local public health departments across our state and invest in science and technology to detect, prevent, and defeat diseases before they can cause a deadly and devastating pandemic. It would authorize an additional income tax of 0.75% on individuals with incomes over $5 million for a 10-year period beginning in 2023 and ending in 2032. CMA strongly supports this initiative because everyone deserves to live a long and healthy life. If you have any questions or want more information, contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at dlopez@accma.org or 510-654-5383.

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AMA NO SURPRISES TOOLKIT

TheThe rootroot cause cause of physician of physician burnout burnout is the is the practice practice environment environment in which in which theythey work. work. TheThe onlyonly wayway to dramatically to dramatically reduce reduce the the prevalence prevalence of clinician of clinician burnout burnout is toistackle to tackle the the myriad myriad of factors of factors thatthat distract distract fromfrom clinical clinical medicine, medicine, create create stress, stress, andand addadd burdens burdens to ato a physician’s physician’s workday. workday. But But hope hope is not is not lostlost – there – there are are many many tangible tangible andand actionable actionable strategies strategies thatthat medical medical groups, groups, community community health health centers, centers, hospital hospital staffs, staffs, medical medical residency residency programs, programs, andand other other physician physician organizations organizations cancan employ employ to improve to improve the the working working liveslives of their of their clinicians. clinicians.

TheThe BayBay Area Area Physician Physician Wellness Wellness Collaborative Collaborative aims aims to bring to bring together together medical medical group group leaders, leaders, chief chief wellness wellness officers, officers, wellness wellness committee committee chairs, chairs, andand others others whowho have have been been charged charged withwith “fixing “fixing the the physician physician burnout burnout problem” problem” andand providing providing them them withwith expert expert guidance, guidance, tools tools andand resources, resources, a forum a forum for sharing for sharing experiences experiences andand bestbest practices, practices, andand a a model, model, the the BayBay Area Area network network of peers of peers to support to support theirtheir work. work. Using Using a group a group coaching coaching Physician Physician Wellness Wellness Collaborative Collaborative will will provide provide a highly a highly structured structured roadroad mapmap for for participating participating organizations organizations to make to make substantive substantive changes changes overover a three-year a three-year period period thatthat cancan fundamentally fundamentally change change the the practice practice environment environment in your in your organization organization andand helphelp restore restore joy joy to the to the practice practice of medicine. of medicine. We We invite invite youyou to join to join ourour efforts efforts to restore to restore joy joy to the to the practice practice of medicine, of medicine, together. together.

To To request request an an invitation invitation to enroll, to enroll, visit visit https://bit.ly/3PcTd3L https://bit.ly/3PcTd3L


WELLNESS COLLABORATIVE

Reducing Burnout for Bay Area Physicians

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articipants in the next meeting of the Bay Area Physician Wellness Collaborative on September 13 will discuss building the organizational culture to support prioritizing and investing in physician wellness. The bimonthly meetings of the regional wellness collaborative, which will alternate between focusing on building organizational culture and implementing practice-level interventions, are two-hour deep-dive sessions led by program director Paul DeChant, MD, on Tuesday evenings. Each meeting will feature an expert guest speaker, provide guidance for physician organizations to develop custom strategies targeted to the needs of their organization, enable shared knowledge and action items, and extend peer support from all members of the collaborative. Medical group leaders, chief wellness officers, wellness committee chairs, and others who have been charged with “fixing the physician burnout problem” can join the collaborative by filling out a brief form at bit.ly/3PcTd3L. Between regular sessions, virtual office hours with Doctor DeChant, such as the one scheduled for October 4, are opportunities to ask questions and receive additional guidance. Collaborative participants have access to recorded sessions, the wellness leadership conference that was held in late April, readings to supplement the regular sessions, and an online discussion board to maintain engagement with Doctor DeChant and other participants between meetings. On the organizational level, one way that leadership can demonstrate their commitment to prioritizing physician wellness is by creating a formal well-being committee that is separate from employee assistance programs or by designating a wellness lead or chief wellness officer. This wellness lead or committee can take a variety of forms depending on the size, nature, and resources of the physician organization. Once the position is established and the wellness lead or committee members are chosen, there are concrete steps that can be taken to implement a leadership strategy for physician professional satisfaction. The September 13 meeting of the Bay Area Physician Wellness Collaborative will address these issues with the guidance of an expert speaker and participants will be able to discuss their current wellness roles and activities so that they can share their best practices and get guidance on next steps.

In sessions on implementing practice-level interventions, such as the one scheduled for November 15, participants will learn about and share with one another the small and large steps that medical practices and health systems can take right away to reduce unnecessary tasks in a physician’s day—the ones that don’t improve clinical outcomes, can free up critical time, and help improve a physician’s efficiency. These steps can be as focused as triaging EHR inbox messages that aren’t necessary for a physician to read, or as broad as implementing daily interdisciplinary team huddles to review safety and quality concerns in the past day and to look ahead that day to flag concerns proactively. Other areas of focus that the wellness collaborative will cover are: Diagnostic Assessments: Explore the variety of wellness and burnout surveys available to help an organization choose the right survey for its needs. Learn how to analyze the results and establish benchmarks to measure progress. Leadership Culture: Discuss the function of various leadership roles, from patient-facing roles up to senior leaders, reviewing the impact each has on the wellbeing of physicians and providing recommendations to serve most effectively in each role. Management Systems: Evaluate organizational structure and management processes with a focus on how different systems positively or negatively impact physician wellbeing. EHR Optimization: Consider approaches to optimizing the EHR, including innovations that significantly reduce documentation burden and in-basket overwhelm. Peer Support and Burnout Coaching: Examine different options for providing support for physicians, reviewing how each approach provides unique value based on the needs of the individual and organization. The Bay Area Physician Wellness Collaborative is sponsored by all eight Bay Area county medical societies, including the ACCMA. Please see the flyer on the opposite page or go to accma. org/Advocacy/Bay-Area-Physician-Wellness-Collaborative for more information. To request an invitation to enroll, visit bit. ly/3PcTd3L. Feel free to also contact your local county medical society or Mae Lum, ACCMA Deputy Director, at mlum@accma. org or (510) 654-5383 with any questions.

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MEDIA TRAINING

Media Training for Physician Leaders

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he ACCMA expanded its Physician Leadership curriculum this past spring to include a new series, “Media Training for Physician Leaders.” A complimentary program offered to ACCMA members, it was planned to reflect the expanding role of physicians in the media spotlight. In the current healthcare climate, the public relies on community physician leaders to provide clear, accurate messaging on medical information in the media. During this three-part series, participants learned how to effectively communicate with compelling storytelling, advocate with a strong voice and proper messaging, and utilize social media properly. Each session was led by nationally recognized faculty using a dynamic online format. The series led off with Molly Weedn, Senior Associate at Axiom Advisors, who spoke on media writing for the physician advocate. In her session, participants learned how to hone their message via captivating storytelling and how to advocate effectively by pitching newsworthy stories through writing. The second session was led by Patricia Clark, a nationally recognized communications expert known for her work on preparing senior spokespersons for interviews. Pat’s specialty is

teaching the techniques for making powerful speeches, the tricks of controlling the media interview, the strategies of message development, and the keys to delivering successful testimony before legislatures. Pat’s instruction was followed by one-on-one mock interviews on difficult topics ranging from COVID-19, Roe v. Wade, and vaccine mandates. Pat’s effective approach and feedback prepared the participants to confidently represent their organizations in future media interviews. The series wrapped up with Emmie Johnson, who emphasized how physicians can create and manage their online presence to reach the correct audience and to advocate on important issues affecting patients, medical practices, and their community. ACCMA will continue to offer continuing medical education so physicians will have the skills and attributes they need to advocate for their profession and for their patients. Visit pathlms.com/ medical-society to explore upcoming live and on-demand programs. For questions, contact Jenn Mullins, ACCMA Associate Director of Education and Events, at jmullins@accma.org or 510-654-5383.

BulletPoints Project for Physicians

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he BulletPoints Project develops training programs and resources for physicians to work with patients to prevent firearm-related injuries. It is funded by the state and developed by the California Firearm Violence Research Center at UC Davis. Their website (bulletpointsproject.org) explores clinical scenarios in which firearms may increase risk, available interventions to reduce risk, and strategies for talking with at-risk patients. Clinical scenarios include counseling patients with risk factors for suicide to reduce firearm access; counseling at-risk veterans to reduce access to lethal means; talking to parents and caregivers about the risk of unintentional firearm injury and how to reduce it; screening for intimate partner violence; utilizing interventions on those who display warning signs prior to committing acts of violence; screening patients with cognitive decline for risk of firearm-related injury; supporting patients at increased risk for violence involvement; and educating patients who are hospitalized with a nonfatal firearm injury and connecting to resources 18

that will decrease their risk of reinjury with a gun. Potential interventions to reduce risk include emphasizing the importance of safe storage of guns; advising the temporary storage of firearms outside the home for the duration of a crisis; considering a 5150 hold to connect patients to mental health services; invoking the Tarasoff duty to protect potential victims; being prepared to discuss options for civil protective orders; and utilizing hospital-based violence intervention programs to reduce community violence. The BulletPoints project also demonstrates strategies for talking with at-risk patients to effectively assess risk and their access to firearms, and intervening appropriately. Handouts are available in English and Spanish. A video library comprises informational videos, recorded presentations, and conversations with experts in firearm injury prevention. To find these and many other resources, go to bulletpointsproject.org.

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2022 ANNUAL MEETING

Join Us for the 2022 ACCMA Annual Meeting

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CCMA will be celebrating its history, the achievements of East Bay physicians, and the installation of its 2023 officers— while also raising funds for medical student scholarships—during our 2022 Annual Meeting, to be held Friday, November 4 from 6 to 9 p.m. at the Claremont Club & Spa in Berkeley. Sponsorships and single tickets are now available for purchase. Over the decades, the Annual Meeting has served as a fun and entertaining evening during which the East Bay health care community can connect with one another, enjoy dinner and a fun program, recognize outgoing and incoming ACCMA officers, and help raise funds for the ACCMA Medical Student Scholarship Program. This year’s program is packed with an engaging guest speaker, highlights of local physician accomplishments, and poster presentations from previous student scholarship winners. About 200 people are expected to attend. All proceeds from the Annual Meeting go to the ACCMA’s scholarship fund, which support students doing local health care research in the UC Berkeley–UCSF Joint Medical Program (JMP). The JMP Program, which began in the mid-1960s with the support of the ACCMA, is the East Bay’s only medical school training program and one of the few in California with a focus on primary care in underserved communities. Research projects supported by our scholarship fund are aimed at reducing health disparities, expanding access to care, and improving community

health outcomes. Selected projects must improve care for underserved populations in a lasting way and have relevance for practicing physicians in our community. We are excited that this year’s keynote speaker is Keena Turner, legendary #58, and 4-time Super Bowl champion for the San Francisco 49ers. He will join us to discuss sportsmanship, teamwork, the championship mindset, and what it took to win and sustain dominance during his 11-year professional football career. Now, as Vice President and Senior Advisor to the General Manager of the 49ers, Keena is a pillar in the community and supports several organizations focusing on our community’s youth. ACCMA is now accepting sponsorships from medical staffs, practice groups, hospitals, and health care advocates who would like to support or attend this year’s event. The Sponsor level includes a table for 10 and acknowledgment in the ACCMA Bulletin, which is sent to nearly 5,000 physicians. A substantial portion of your sponsorship is tax deductible. Please contact Jennifer Mullins, ACCMA Associate Director of Education and Events, at jmullins@accma.org or (510) 6545383 for a complete breakdown of sponsor benefits and to reserve your table today. You can also contact her for individual tickets or purchase tickets online by going to www.accma.org/events. We look forward to seeing you on November 4!

MEET KEENA TURNER

Keena Turner

A native of Chicago, Keena Turner attended Purdue University and was a two-time All-Big Ten, All American and Boilermakers’ MVP. In 1980, Keena was drafted in the second round by the San Francisco 49ers and played outside linebacker with the “Team of the Decade” until his retirement in 1990. His 11-year contribution to the team resulted in four Super Bowl wins and a trip to the Pro Bowl. He championed the 49ers to victory as Captain of the 1984 team and was chosen by his teammates to receive the Len Eshmont Award for his courageous and inspirational play. Keena’s dedication to excellence is not limited to the playing field. For the past 30 years, he has supported The Koret Family House in San Francisco. He also created and served as a judge in a student essay contest for the Tracy Middle School system to emphasize the importance of academics. And over 25 years, the Keena Turner Boys and Girls Clubs Golf Tournament has raised over $6 million.

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MONKEYPOX UPDATE

Monkeypox Update

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s of July 14, there were 250 cases of monkeypox in California, 17 of them in Alameda County residents, and at least one in Contra Costa County. The symptoms are similar to but milder than smallpox. The classic presentation of monkeypox infection includes a flu-like illness lasting a few days, followed by the appearance of a characteristic rash. On average, symptoms appear within six to 13 days of exposure, but can take up to three weeks. Patient history is also important in identifying possible cases, such as recent travel, sexual history, and smallpox immunization history. If a patient is suspected of monkeypox infection, contact your local public health department immediately. • Alameda County Public Health: (510) 267-3250 during business hours or (925) 422-7595 after hours • Berkeley Public Health: (510) 981-5292 during business hours or (510) 981-5911 after hours • Contra Costa Public Health: (925) 313-6740 during business hours or (925) 646-2441 after hours Infection control should be implemented as soon as possible. Patients with monkeypox should isolate until cleared by public health officials; the illness typically lasts two to four weeks. Starting in early July, physicians have been able to use commercial laboratories to perform monkeypox tests. Previously testing was available through 10 public health laboratories in California, and monkeypox testing required prior approval from local health departments to determine if patients meet clinical and epidemiological criteria. The monkeypox test involves swabbing one of the lesions that typically accompany the disease, but testing should also be done for people who do not have the symptoms.1 Bay Area clinics are offering vaccinations against monkeypox, limited to groups with a known exposure or who may have been exposed to the virus, including: • People with a sexual partner diagnosed with monkeypox • Individuals with certain risk factors, even if they have not had documented exposure to someone with confirmed monkeypox, such as people who attended an event or venue where monkeypox was identified • People at occupational risk of monkeypox, including laboratory workers who perform monkeypox testing, and clinical and public health workers who collect monkeypox specimens Other routes of monkeypox transmission include from mother to fetus via the placenta or during close contact during and after birth. The US Department of Health and Human Services (HHS) shipped more than 56,000 doses of the monkeypox/smallpox 20

vaccine JYNNEOS to states with the most cases and where the population is most at risk, including California. An additional 131,000 doses became available nationwide in mid-July. Demand for the vaccine is outpacing the nation’s supply. A previously ordered 2.5 million doses should begin arriving later this year, and another 2.5 million doses is scheduled to arrive early next year. The JYNNEOS vaccine is administered in two doses, delivered 28 days apart. Patients should be vaccinated between four to 14 days after a possible monkeypox exposure, and they will have maximum immunity 2 weeks after the second dose. A second vaccine, ACAM2000, which is normally used to prevent smallpox, is also available but it has the potential for more serious side effects and is not appropriate for immunocompromised patients or those with heart disease or skin problems. Currently there is no treatment specifically approved for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs developed for use in patients with smallpox may be used to treat monkeypox virus infections. One antiviral drug, called tecovirimat or TPOXX, can be used for severe monkeypox. Most children and adults with healthy immune systems are not likely to get severely ill if they come down with monkeypox. However, there are two groups at high risk: infants younger than six months, and many older adults who are somewhat protected by their decadesold smallpox vaccinations. Those adults maintain a very high level of antibodies and the ability to neutralize the virus.2 NOTES 1

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

The New York Times, “Demand for Monkeypox Vaccine Exceeds Supply, CDC Says,” July 18, 2022, nytimes.com/2022/07/15/health/monkeypoxvaccine-supply.html The New York Times, “Who Is Protected Against Monkeypox?” May 26, 2022, nytimes.com/2022/05/26/health/monkeypox-vaccine-immunity.html

MONKEYPOX INFORMATION •

• • •

General Information at CDPH website at cdph.ca.gov/Programs/CID/DCDC/Pages/ Monkeypox.aspx. Vaccine information at eziz.org/resources/ monkeypox. Screening checklist of JYNNEOS vaccine at eziz.org/assets/docs/IMM-1433.pdf Patient communications at cdph.ca.gov/ Programs/OPA/Pages/CommunicationsToolkits/Monkeypox.aspx


MEDICAL CARE FOR ALL

“Medical Care for All, Regardless” (circa 1951) By Victor Hugo Boesen

This article, found in the ACCMA archives, concisely and eloquently describes the nationally acclaimed programs started by the ACCMA in 1945–46 to improve quality and access to care. It was written in 1951 by journalist and author Victor Hugo Boesen (1908–2006), who began his career as a news reporter, then served as a war correspondent in the Pacific Theater during WWII, after which he became a freelance writer for national magazines such as Look, Saturday Evening Post, Collier’s, Coronet, Esquire, Nation’s Business, Skyways and West. He also authored several books and was recognized by the National Science Teachers Association and the Children’s Book Council.

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n Oakland, California, a woman complained to the AlamedaContra Costa Medical Association (ACCMA) that a member had charged $122 for treating her son’s broken finger. She felt that this figure was much too high. “Thank you for bringing this to our attention,” she was told politely. “We’ll look into it.” The grievance was promptly referred to the Association’s committee on fee complaints, which found, among other excessive charges in the doctor’s bill, $7.50 for each X-ray taken. In the Oakland area, this amount is customary only for the first X-ray, after which the charge drops to $5 each. The committee readjusted the bill to $62.50, and the doctor accepted it without argument. A man phoned the Association to ask the name of a new doctor for his wife. Almost casually, he explained that she had suffered a back injury while their doctor was giving her a shock treatment. The Association, however, was far from casual. It turned the case over to its committee on malpractice; and the patient was rushed to a top orthopedist, who found her suffering from a fractured vertebra caused by a spasm during the shock therapy. The Association paid the woman $1,500 to cover all expenses and leave a little something besides. This use of the arbitrational round table is an essential part of a plan whereby doctors in the Oakland area are seeking to give fuller affect to the first principle of medical ethics: “The prime object of the medical profession is to render service…” The essence of their formula is simple: Guarantee, unconditionally, that anyone who calls for a doctor gets one; see that the doctor’s work is up to the highest standards, that his or her fee is right, and that when the patient is dissatisfied, something is done about it.

Behind this human approach is recognition of the fact that sometimes a doctor or patient may be wrong, that arbitration and understanding will work in the delicate doctor-patient relationship as in any other. How the 1,349 doctors embraced by the “Alameda Plan,” named for its origin in Alameda County, have gone about reaching this goal is being watched by medical groups throughout the country. The adjoining county of Contra Costa was admitted equal partnership in the Plan a year ago, accounting for the Association’s compound name. The story goes back to 1945, when the doctors of Alameda County, prompted by public criticism, took an inward look at themselves; and noted with concern that many were getting pretty far afield from the first ethical principle: “Reward or financial gain is a subordinate consideration.” Besides excessive fees, there was a disturbingly high rate of malpractice suits. It was sometimes true, as people complained, that they couldn’t get a doctor when they called for one; that doctors “hung together,” permitting no recourse against excessive fees or unsatisfactory treatment. The popular discontent with these things, nationally, was hardly calculated to abate the growing talk of medical socialization. The crisis came after a doctor charged $1,200 for removing a splinter from a girl’s eye. To her father’s protest, the doctor retorted callously: “Isn’t your daughter’s eye worth $1,200?” To shocked leaders of the Alameda County Medical Association, this was practically “biological blackmail.” They resolved to set their house in order—before someone else did it for them. They had heard of Rollen Waterson and the public-relations plan he had worked out for Indiana’s Lake County Medical Association and invited him to tell them more about it. The keystone of Waterson’s plan was the first ethical principle. Did they really believe in it, or didn’t they? “If you don’t,” said Waterson, “we’ll still do a job, but we’ll tell people you don’t mean it.” The doctors did mean it, they decided, and placed Waterson on the payroll. A careful survey was made of all physical facilities for medical care, public and private, in the area. Where there were gaps, the doctors agreed to fill in. Then the public was startled by this ad in the Oakland Tribune: WANTED – Information concerning anyone in Alameda continued on page 22 ACCMA BULLETIN | JULY/AUGUST 2022

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MEDICAL CARE FOR ALL

(continued from page 21)

County who believes they cannot get needed medical care because they haven’t the means to pay the doctor. Call the Alameda County Medical Association, through which the ethical private physicians in this county guarantee medical care to everyone. Round-the-clock attendants manned the Association’s switchboard, with doctors taking turns in placing themselves on call. A system of bureaus and committees was devised to deal with every conceivable public matter in which doctors might be concerned.

An elderly pensioner who had eye trouble but an income of only $93 a month, most of which went for room and board, brought his problem to the medical-social consultant of the ACCMA-owned Bureau of Medical Economics, Mrs. Muriel B. Hunter. Five dollars a month was as much as he could muster, the patient said. Mrs. Hunter called a doctor, who agreed to do the examination for $5, and, if glasses were indicated, to refer the patient to an optician with a recommendation for time payments. The patient got his glasses, which he needed badly, and the doctor and optician got their money. Everyone was satisfied. If the old man had been unable to pay anything, Mrs. Hunter would have arranged for his care with the proper public institution. The point is, he would have gotten his glasses, in any case. If a patient has neglected their bill, the Bureau again takes a hand. Formerly, such bills were prone to end up in a commercial collection agency, a course that made no friends for the doctor. The Bureau first sends the delinquent its “Number One Letter.”

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This diplomatically points out that some people are unable to pay, others merely procrastinate or have a complaint about the bill, and a few—a mere two percent— “just won’t pay their bills.” Since the Bureau doesn’t know which category the recipient falls into, the letter invites him or her to “Please contact us at your convenience within the next seven or eight days…” If the patient classifies himself or herself as one of those short of money, Mrs. Hunter helps work out a solution satisfactory to all concerned. A widow, for example, still owed nearly half of her late husband’s doctor bill. She was barely getting by. Could she pay, say, half the balance, Mrs. Hunter asked, if the doctor cancelled the rest? Yes, that would be a big help. Mrs. Hunter described the circumstances to the doctor, who hadn’t known about them, and he offered to cancel the bill entirely. If it turns out that a patient hasn’t paid the doctor’s bill simply because it’s not his or her custom to pay doctors, that patient may find themself under pressure. Careful not to demand payment where there is a hardship, the Association is equally determined to make people understand that when they can, they must pay the doctor. Another of the Association’s ads reads: The charging of fees which appear to you to be excessive, or which you cannot pay without depriving yourself of necessities of life, should be reported to your County Medical Association. Such reports go to the fee complaints committee, which determines the going rate for the service involved. If the doctor is found to be out of line, he or she is so informed, and generally reduces the fee accordingly. For people who feel the doctor has done a poor job, the Association advertises: Health and lives must not be endangered by incompetence or unnecessary procedures. It isn’t necessary that you know the code of medical ethics to decide whether a doctor has been unethical. Any professional act of a doctor opposed to the best interests of the public is unethical. If you know of such acts, they should be reported to your County Medical Association. Formerly, when a doctor ran into malpractice trouble, the doctor got together with his or her insurance company, and the pair decided to do whatever was cheapest: pay off or let it go to court. The merits of the patient’s case were not a factor. This is still the way it’s done in many places. At Oakland, the idea is to settle on the basis of what’s right and fair for both sides. To find out if the doctor is at fault, the complaint against him or her is turned over to the malpractice continued on page 25

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN


ALAMEDA ALLIANCE

Planning for the Launch of 2023 CalAIM Initiatives By Scott Coffin, Alliance CEO

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lameda Alliance for Health (the Alliance) is proud to serve over 310,000 children and adults in Alameda County. In this article, you will read about the Department of Health Care Services’ Population Health Management initiative that will proactively assess and address the care needs of Medi-Cal beneficiaries with tailored interventions. You will also read about additional CalAIM reforms that will impact individuals receiving long-term care and the new populations of focus that will be eligible for Enhanced Care Management and Community Supports – starting in 2023. POPULATION HEALTH MANAGEMENT This year, the Alliance launched several components of the Department of Health Care Services’ (DHCS) CalAIM initiative, including the Enhanced Care Management, Community Supports, and the transition of major organ transplants into MediCal managed care. These programs, along with other CalAIM initiatives, will help managed care health plans improve outcomes for the millions of Californians served by Medi-Cal, particularly those with the most complex health care needs. On January 1, 2023, the DHCS will launch another major CalAIM initiative, Population Health Management (PHM), which will require all Medi-Cal managed care plans – including the Alliance – to develop and maintain a system for person-centered population health management. PHM will establish a comprehensive, accountable plan of action that will address member needs and preferences across a continuum of care. It will assist health plans to build trust and meaningfully engage their members, gather, share, and assess timely and accurate data on member preferences and needs that will help identify effective and efficient opportunities for interventions, as well as identify gaps in care. While many of the other CalAIM initiatives are focused on the most vulnerable Medi-Cal members, PHM requires plans to prioritize prevention strategies and identify health-related issues before they become bigger problems. PHM will also focus on connecting members to public health, social services and

supports that will help them stay healthy, as well as providing case management, care coordination, and transitions for members who need additional support. PHM will help managed care plans focus on identifying and mitigating social determinants of health with the ultimate goal of reducing disparities across all member populations. DHCS has proposed to develop a platform at the individual member level to expand access to medical, behavioral, and social services data. Using this new platform and leveraging the social health information exchange and community health record systems that were previously established by our local safety net partners, we anticipate that we will successfully set up an effective PHM program. We look forward to receiving additional guidance from the DHCS on the PHM initiative and preparing for a successful launch that will address our members’ needs and ultimately improve their health outcomes. UPCOMING MAJOR CALAIM REFORMS Another major CalAIM reform initiative, the institutional longterm care (LTC) carve-in, will be launched on January 1, 2023, and care in nursing homes and other institutional settings will be provided as a benefit through the Alliance. Currently, Alliance members who are admitted to long-term care institutions are disenrolled after spending more than 60 days there and enrolled in Fee-For-Service (FFS) Medi-Cal. Starting January 1, the Alliance will be responsible for members who need ongoing skilled care services and for members living in LTC facilities. This population of members will remain enrolled with the Alliance and have access to our case management services, ensuring that they have access to high-quality care and other navigation services. Moving forward, we will work closely with our contracted LTC facilities and many of our community-based partners to provide care and ongoing support for these members. We anticipate that approximately 1,800 members living in institutional settings will be enrolled into the Alliance on January 1, 2023. The new LTC managed care benefit aligns with the continued on page 24 ACCMA BULLETIN | JULY/AUGUST 2022

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ALAMEDA ALLIANCE

(continued from page 23)

Medi-Cal Populations of Focus (PoFs), which will be eligible for our Enhanced Care Management benefit and Community Supports services. These new PoFs include nursing facility residents who may be candidates for transitioning back to the community, and individuals at risk for institutionalization; in addition, the benefit includes people who are eligible for long-term services in their home and have the ability to live safely with wrap-around supports. With the support of our case management teams and community-based partners, we are committed to providing these important services that will help members avoid institutionalization while helping others safely transition into the community. While many of these major reforms are a huge undertaking for managed care health plans across the state, the Alliance remains committed to improving care integration and ensuring

that members have full access to person-centered services and supports that are needed to maintain their health and well-being. ABOUT ALAMEDA ALLIANCE FOR HEALTH Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 310,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products.

MEMBER IN FOCUS (continued from page 12)

came up to me sheepishly and said, “Can I ask you a question? You mentioned something in your speech, and I’d like to know, what is a Joe Camel?” No kidding – what is a Joe Camel? His generation had never even heard of him, and I felt so good about it. You can’t imagine how good I felt about that. Those are the kind of wonderful things that organized medicine is doing all the time, behind the scenes. We have been too modest, we have not let the public know what we’ve been doing. If you went to any city in America today and asked 100 people on the street three questions – one, what is the AMA; two, what does it do; and three, what has it done for you – you will probably hear that the AMA is the American Motorcycle Association or the American Manufacturers Association. Some of them will know that it’s the American Medical Association, and that’s good. The second question, what does it do? They may say, I guess it works for doctors or it’s a club or something like that. A few might say, it has something to do with standards for doctors, and that would be good. But if you ask the third question, what has it done for you? They will tell you, it doesn’t do anything for me. They don’t know that their risk of dying from lung cancer has changed. We should continue doing good things for public health, but we also want to let the public know that we’re doing it because we

are genuinely concerned about them. Whatever concerns them concerns us as their physicians and we’re going to work with them to correct these problems. That’s why this referendum is so important. Organized medicine should realize the tobacco industry is coming after our kids again and we should work with allies, like we did before. It’s not enough to have a policy position. You’ve got to find the right partners to put pressure in the right places and to make sure that voters know that the tobacco industry is going after our children. Every doctor in California should tell their patients to vote for the ballot measure. Lonnie Bristow, MD, an ACCMA member for 54 years, won an American Medical Association Foundation Excellence in Medicine Award at the recent AMA Meeting in Chicago. He was honored with the Pride in Profession award, for physicians whose lives encompass the true spirit of being a medical professional through extraordinary patient care. A pioneer in health care equity and policy reform, Doctor Bristow dedicated his career to ethical and socioeconomic issues such as the mistreatment of sickle cell anemia, the tobacco industry’s effect on public health, the death penalty, and HIV/AIDS. In 1995, he was the first Black physician to serve as AMA president. Read more at bit.ly/3NAfcja.

Explore ACCMA Volunteer Opportunities! Visit ACCMA.org/Volunteer, or call ACCMA at (510) 654-5383 to find out more.

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MEDICAL CARE FOR ALL

(continued from page 22)

what Alameda and Contra Costa Counties boast now: “Medical Care for all, regardless.” The ACCMA recently published an in-depth book on the development and impact of the groundbreaking “Alameda Plan” described in this article. Similarly titled “Medical Care for All, Regardless” and authored by former ACCMA Executive Director Donald Waters, the book can be viewed at accma.org/About-Us/Our-History and is available in paperback to ACCMA members free of charge. To request a copy, contact the ACCMA at (510) 654-5383 or accma@accma.org. Additionally, an online presentation on the ACCMA’s book, sponsored by the UCSF Library, Archives and Special Collections Department, may be viewed at archive.org/details/MedCareForAll_DonaldWaters.

committee. If the findings raise the least doubt as to the doctor’s position, the decision is in favor of the patient. On the other hand, if the doctor’s position is found to be without question, the policy is to stand inflexibly behind that doctor. Since the new order began, the Association has won every one of the 19 times it has chosen to fight. This showing has discouraged those who made a racket of shaking down doctors. By dealing fairly with the patient who has a complaint, seeing that the service he or she gets is best, and treating him or her as an adult who can be told about the bill, the Association doctors have reduced malpractice troubles to a fraction of the old figure. This has won them a reduction in insurance premiums, exceeding the $75,000 which they annually pay in Association dues. But this saving is important to them primarily as it reflects improved relations with the public. The doctors of Alameda and Contra Costa Counties don’t claim to have the answer to socialized medicine—that was never the purpose. But they do have something which more and more doctor-groups are showing an urge to adopt purely as a matter of good business practice. New York’s Westchester County Medical Association has taken over the plan virtually intact; and the California State Medical Association, urging the plan on its component county groups, aspires to be able to say for the State group ACCMA BULLETIN | JULY/AUGUST 2022

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CLASSIFIEDS

Primary Care Physician Wanted. Premise Health, the nation’s leader in employer-based healthcare, has an opening for a physician to provide primary care 30 hours per week in our outpatient clinic in Oakland; this is a benefited position. Premise Health is the world’s leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest employers in the US. Premise partners with its clients to offer fully connected care—in-person and in the digital environment. Operating more than 800 wellness centers in 45 states and Guam, Premise delivers care through onsite, nearsite, mobile, and event solutions. Join Premise Health today! What makes this opportunity unique: • Practice evidence-based medicine where you are not paid for production • Great compensation and benefit plan • Bottom line is measured by the quality of patient care • A work-life balance that is not just promised • A collaborative approach with a focus on each individual patient • Practice in a supportive, collaborative environment • Less paperwork and administration time For more information, please contact Jeff Ligon, Physician Recruiter, at (615) 468-6233 or jeff.ligon@premisehealth.com. Concierge Family Practice for Sale. Thriving East Bay Area concierge family practice with great growth potential. Above average net with seeing 10 to 15 patients/day, 4 days/week, and 6+ weeks of vacation. Great location. Loyal long-term staff. Everything is in place to someone to step in. Does require patience, compassion, and desire to develop doctor-patient relationships to make it work. Serious inquiries, email mtobmd@gmail.com.

IN MEMORIAM CHAPLIN LIU, MD (1954–2022) was born in Honolulu and received his MD from Howard University College of Medicine in 1984. Dr. Liu completed his residency, internship, and fellowship at LAC-USC Medical Center in 1990. He was board-certified in nephrology and internal medicine. Dr. Liu is survived by his wife Carol. He was a member of the ACCMA for 30 years. WAYNE L. WRIGHT, JR., MD (1921–2022) passed away peacefully on June 13, at the age of 101 in Castro Valley. He was born in Reading, Michigan and was active in many sports while in high school. He received an athletic scholarship to the University of Michigan. Because of the wartime need for more physicians, he attended medical school year-round at SUNYBuffalo School of Medicine and graduated in 1946. Dr. Wright then completed a dermatology residency at New York Hospital. He was assigned to the US Naval Hospital in San Diego and served as a medical officer on ships. He settled permanently in Castro Valley in 1950 and had a thriving private practice in dermatology while attending once weekly at UCSF Medical School. He served as Chief of Staff at Eden Hospital and was on the Board of the Eden Foundation, including a two-year stint as President. He was a member of the SF Dermatological Society and the American Academy of Dermatology. He served on the Doctors’ Insurance committee and was its chair from 1974 to 1995. Dr. Wright retired in 1989. By age 90, Dr. Wright had achieved 17 holes in one, all but three at Sequoyah. He is survived by his wife Barbara, two children, two stepchildren, and four grandchildren. He was a member of the ACCMA for 47 years.

Office Space to Rent/Lease in Oakland, across the street from Summit Medical Center. Beautiful medical office building with gorgeous view. Total space is 1580 sf, willing to rent half or what is needed. Two office spaces with exam room, shared waiting room, medical equipment, shared kitchen, and bathroom. Pharmacy, lab, and radiology services in building. We only do VA comp/pension exams and are not busy. Serious call to discuss pricing at (510) 919-1029.

NEW & RETURNING MEMBERS John Y.-H. Siu, MD Anesthesiology Vituity David T.-Y. Wong, MD Gastroenterology Tri-Valley Gastroenterology

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

To place a classified ad, go to www.accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383. ACCMA members can place a classified ad for four months online and in two issues of the ACCMA Bulletin at NO CHARGE.


The Alameda-Contra Costa Medical Association …. requests the pleasure of your company

COUNCIL REPORTS

(continued)

Friday, November 4, 2022 | Reception begins at 6:00 pm The Claremont Club & Spa 41 Tunnel Road, Berkeley, CA

Join us

for the 154th ACCMA Annual Meeting this November. Enjoy a lively reception, formal dinner, and presentation featuring our 2023 ACCMA President, Edmon Soliman, MD, and a very special guest speaker.

GUEST SPEAKER

KEENA TURNER

LEGENDARY #58 AND 4-TIME SUPER BOWL CHAMPION FOR THE SAN FRANCISCO 49ERS

Keena Turner will join us to discuss sportsmanship, teamwork, the championship mindset, and what it took to win and sustain dominance during his eleven-year professional football career. Now, Vice President and Senior Advisor to the General Manager, Keena will highlight his “Team of the Decade", the future of today's Niners, and successful leadership tools and qualities.

COVID-19 SAFETY

Your safety is important to us. We will ensure all county guidelines are being met at the time of the event.

Please visit accma.org/events to register online. Contact us at accma@accma.org or call (510) 654-5383 with any questions.


Alameda-Contra Costa Medical Association 6230 Claremont Avenue P.O. Box 22895 Oakland, California 94609-5895

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