ACCMA July/August 2018 Bulletin

ACCMA BULLETIN Serving East Bay physicians since 1860

COVER STORY: CMA Major Issue Report on Physician Workforce (p. 9) Opposing Local Ballot Initiative to Reduce Access to Care (p. 7)

July/August 2018

End-of-Life Option Act Update (p. 21) Seminars/Webinars with Free CME to ACCMA Members (p. 5) NCCI Policy Manual Updates (p. 23)

Are You Ready to Check CURES? (p. 15)

CELEBRATING The

th

1868 2018

Nov. 2, 2018 Reception: 6 p.m.

Dinner: 7 p.m.

The Claremont Club & Spa 41 Tunnel Rd., Berkeley, CA

Sponsor and Reserve Your Table Today!

Individual tickets also on sale now.

Call 510-654-5383 Incoming ACCMA President Lubna Hasanain, MD

Join the East Bay medical community this fall as we celebrate 150 Years of the ACCMA Annual Meeting, an entertaining evening to support medical students and install ACCMA ofďŹ cers.

GIVE All proceeds support medical student scholarships CONNECT Enjoy dinner and a reception with friends and peers ENJOY Each Annual Meeting features a new and engaging keynote speaker PARTICIPATE Enter the rafe for your chance to win a stockpile of wine!

SUPPORT LOCAL MEDICAL STUDENTS

Table for 10 at ACCMA Annual Meeting, including hosted reception, dinner program and valet parking Prominent Recognition at the Event, including verbal recognition during program, logo sign during reception, logo on table and in program Recognition in Promotional Materials, including logo on event promo materials Acknowledgement in the ACCMA Bulletin, distributed to nearly 4,000 East Bay physicians and community leaders Tax Deductible

Sustainer Champion $10,000 $5,000

85%

85%

Supporter $3,000

Sponsor $1,500

100%

50%

Help us continue to support medical students in the UC Berkeley-UCSF Joint Medical Program

ACCMA Executive Committee Thomas Sugarman, MD, President Lubna Hasanain, MD, President-Elect Katrina Peters, MD, Secretary-Treasurer Kurt Wharton, MD, Immediate Past-President Suparna Dutta, MD, Councilor-at-Large Councilors & CMA Delegates Darcy Baird, MD Eric Chen, MD Suparna Dutta, MD Robert Edelman, MD Rollington Ferguson, MD James Hanson, MD Margaret Hegg, MD Shakir Hyder, MD Irina Kolomey, MD Terence Lin, MD Lilia Lizano, MD Abbas Mahdavi, MD Michael McGlynn, Jr., MD Rahul Parikh, MD Andrew Pienkny, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Judith Stanton, MD Michael Stein, MD Brad Volpi, MD CMA & AMA Representatives Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, AMA Alternate Delegate (at Large) Simpson So, MD, CMA Trustee Membership & Communications Committee Mark Kogan, MD, Chair Patricia Austin, MD Sharon Drager, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Robert Nicholson, MD Juan Ordonez, MD Lamont Paxton, MD Katrina Peters, MD Michael Ranahan, MD Ahmed Sadiq, MD Frank Staggers, Jr., MD Michael Stein, MD Ronald Wyatt, MD

Vol. LXXIV, No. 4

Serving East Bay physicians since 1860

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NEWS & COMMENTS

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PRESIDENT’S PAGE

By Thomas Sugarman, MD, ACCMA President 9

HOD Major Issue Report: Physician Workforce

Prepared by ACCMA Staff 15

Are You Ready to Check CURES?

By the California Medical Association 17

Welcome to the Next Generation of CMA

By the California Medical Association 21

End-of-Life Option Act Reinstated Temporarily

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Coding Corner: NCCI Policy Manual Updates

By G. John Verhovshek, American Association of Professional Coders 27

Telehealth Increases Access to Care

By Scott Coffin, CEO, Alameda Alliance for Health

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NEW MEMBERS

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IN MEMORIAM

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CLASSIFIED ADVERTISING

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REDUCE – REUSE – RECYCLE Printed in the U.S.A. with soy inks on paper stock certified by the Forest Stewardship Council.

July/August 2018

Livermore Initiative Would Cripple Access to Care

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ACCMA Staff Joseph Greaves, Executive Director Jan Jackovic, Director of Operations Griffin Rogers, Director of Programs Dianne Thompson, Director, Napa-Solano Medical Societies Nick Draper, Assoc. Dir. of Advocacy & Policy Mae Lum, Assoc. Dir. of Membership & Comms.

Essence Hickman, Operations Coordinator Aimee Coen, Executive Assistant Wendy (Gwen) Roeder, Office Assistant

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

ACCMA BULLETIN | July/August 2018

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NEWS & COMMENTS

Public Health Advisory for Cyclosporiasis Fifty cases of cyclosporiasis (infection with Cyclospora cayetanensis) from around the state have been reported to the California Department of Public Health (CDPH) in patients who have not traveled outside the US. As of July 9, one case was reported to the Alameda County Department of Public Health (ACPHD) and none to the City of Berkeley Public Health Division. The low number could be due to under-detection of this infection, which requires special testing methods. The common source is not known at this time, although prior outbreaks in the US have been associated with imported fresh produce items. To read the joint Alameda County and Berkeley public health advisory, go to www.acphd.org/health-alerts.aspx.

New State Budget Further Improves MediCal Provider Reimbursement The California 2018–19 fiscal year budget includes $500 million in Prop 56 tobacco tax funds allocated for supplemental payments for Medi-Cal providers. The state Department of Health Care Services (DHCS) plans to allocate the funds to increase payments for 23 CPT codes (a 40% average increase in payments for existing codes), which includes 10 new preventive CPT codes (at 100 percent of Medicare rates). The California Medical Association (CMA) has been instrumental in ensuring that Prop 56 funds are being spent as voters intended. To read more, go to bit.ly/2AOhMC4.

Local Opioid Overdose Deaths Fell in 2017 The ACCMA-led East Bay Safe Prescribing Coalition was recognized in a recent San Francisco Chronicle article about the nearly 50% reduction in opioid overdose deaths in Alameda County from 2015 to 2017. Over the same time period, opioid overdose deaths were down 10% in Contra Costa County. The Coalition is a collaborative effort to promote safe and appropriate prescribing practices and reduce prescription drug abuse in our community. ACCMA President Thomas Sugarman is quoted in a statement about the difference that the entire medical community has made in addressing this problem. To read the article, go to bit.ly/2MMU3Eg.

National Guideline Clearinghouse Goes Down The National Guideline Clearinghouse (guideline.gov), maintained by the US Department of Health and Human Services (DHHS), was taken offline on July 16 due to lack of federal funding. The database is a comprehensive repository of medical guidelines that is consulted by physicians and others in the medical community for clinical decision making. Questions can be directed to the DHHS at Mary.Nix@ahrq.hhs.gov.

Physicians meeting or exceeding these benchmarks receive a Premium Designation notation on their physician profiles in the UHC online physician directory to be released in September.

The rankings are based on claims data from January 1, 2015 through February 28, 2018. To review your designation, go to unitedhealthpremium.uhc.com.

What to Do If Your Medicare Patient Doesn’t Have Their New Card The Centers for Medicare and Medicaid Services (CMS) has finished mailing new cards to Medicare patients in California.

If your Medicare patient says they did not get their card, you can print and give them the “Still Waiting for Your Card?” handout in English (go.cms.gov/2uuPmHH) or Spanish (go.cms. gov/2Ojvejl). You can also instruct them to call CMS at (800) 633-4227. In the meantime, physicians can continue to use the Health Insurance Claim Number (HICN). The transition period to the new Medicare Beneficiary Identifiers (MBI) ends on January 1, 2020. For more information, go to go.cms.gov/2tX5kMi.

UPCOMING EVENTS Winding Down Your Practice: Strategies for a Successful Retirement

Wednesday, September 19 | 6 – 8 pm (includes spousal fee; dinner served) $99 (ACCMA members); $199 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

Leadership Lessons from the Wild Friday, October 5 | 12:15 – 1:45 pm (lunch served) $99 (ACCMA members); $199 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

Benchmarking Your Practice: Intro to Practice Finances Friday, Nov. 30 | 9:00 – 11:00 am (refreshments served) $99 (ACCMA members); $199 (non-members) Register at www.accma.org/events or call the ACCMA at (510) 654-5383.

UHC Releases Latest Premium Designation Physician Results In late July UnitedHealthcare (UHC) released its latest rankings of physicians within 16 specialty categories on both national and specialty-specific quality and cost-efficiency benchmarks.

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For the latest news, go to the ACCMA website at www.accma.org/news.

NEWS & COMMENTS

New Medical Board App for Patients The Medical Board of California (MBC) has released a free mobile app that notifies patients about changes to their physician’s license status. For now, the app is available only for Apple iOS devices. ACCMA encourages physicians to periodically check their profiles for accuracy and to advise the board of any corrections, especially their addresses of record. If the information on your profile is incorrect, contact MBC at webmaster@ mbc.ca.gov or (800) 633-2322, or log into www.mbc.ca.gov/ Breeze.

CDPH Revises Guidelines on Parkinson’s Reporting Requirements The California Department of Public Health (CDPH) has revised its guidelines on what cases of Parkinson’s disease must be reported to hie.cdph.ca.gov by physicians beginning July 1, in response to concerns from the California Medical Association (CMA). Among the changes are limiting reportable ICD-10 codes to patient encounters for diagnosis or treatment of

Parkinson’s disease occurring on or after July 1; excluding ancillary encounters (e.g., lab imaging); and extending the reporting compliance date from 90 to 180 days through September 30.

The revised Implementation Guide is at www.cdph.ca.gov/parkinsons. For more information, go to bit.ly/2MntR2s.

Blue Shield Corrects System for AB 72 Claims Issues affecting the accurate payment of AB 72 claims through Blue Shield have been corrected through a system update implemented by the payor on June 28. The California Medical Association (CMA) had been working with Blue Shield to fix problems caused by the manual processing of claims. The system update will allow claims subject to AB 72, the state’s new out-of-network billing and payment law, to be processed automatically. ACCMA members can get additional help by contacting CMA’s Reimbursement Helpline at (800) 401-5911 or economicservices@cmadocs.org. continued on page 18

ACCMA NOW AN ACCREDITED CME PROVIDER! As part of their membership benefits, ACCMA members will be able to claim CME for FREE for most eligible events. Please see below for a list of upcoming CME events and check the events calendar at accma.org for the most current lineup:

The CURES Database: Making it Work for Busy Physicians Tuesday, Sept. 18 | 12:30 – 1:30 pm Webinar CME FREE FOR MEMBERS

Medication Assisted Treatment: Education and Resources for Licensed Prescribers Thursday, Oct. 4 | 12:30 – 1:30 pm Webinar CME FREE FOR MEMBERS

When it Comes to Your Health, Does Your Zip Code Matter More Than Your Genetic Code?

Critical Conversations: An Advance Care Planning Summit for Advocates

MAT 101: Intro to Medication Assisted Treatment

Making Conversations Count: A Workshop on Advance Care Planning

Medication Assisted Treatment: Breaking Down Barriers to Prescribing

To register for events, go to www.accma.org/ events or call the ACCMA at (510) 654-5383.

Tuesday, Sept. 25 | 8:00 – 10:00 am ACCMA HQ, 6230 Claremont Ave., 3rd Fl., Oakland CME FREE FOR MEMBERS

Wednesday, Sept. 26 | 12:30 – 1:30 pm Webinar CME FREE FOR MEMBERS

Thursday, Oct. 11 | 8:30 am – 4:00 pm The California Endowment, 2000 Franklin St., Oakland CME FREE FOR MEMBERS

Monday, Oct. 25 | 8:30 am – 12:30 pm ACCMA HQ, 6230 Claremont Ave., 3rd Fl., Oakland CME FREE FOR MEMBERS

Wednesday, Oct. 3 | 12:30 – 1:30 pm Webinar CME FREE FOR MEMBERS

ACCMA BULLETIN | July/August 2018

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PRESIDENT’S PAGE

Livermore Initiative Would Cripple Access to Care

By Thomas Sugarman, MD, ACCMA President

Thomas Sugarman, MD

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he Alameda Contra Costa Medical Association (ACCMA) joins a coalition of health care providers strongly opposed to a November ballot measure in the City of Livermore seeking to limit local health care charges to 115% of the “reasonable cost of direct patient care.” The measure defines costs in an unrealistic manner that excludes almost all administrative costs, including those essential to providing care, such as office managers and practice managers. The rules would apply to all medical practices located in Livermore.

If the measure passes, maintaining an economically viable medical practice will be next to impossible within the city limits. But sadly, the brunt of

this initiative is not limited to physicians and other providers. Instead our patients living in Livermore will suffer the worst consequences. This initiative incentivizes providers to relocate out of Livermore. Physicians who are close to retirement may speed up their plans, and it will be virtually impossible to recruit new providers into the community (see our feature article on Physician Workforce on page 9). The consequence will be reduced access to quality care for Livermore residents.

The ballot measure would also require the City of Livermore to regulate and monitor all private health care charges, which it does not have the expertise or the resources to do. The City of Livermore would be burdened with figuring out how to enforce this new and complex scheme, at taxpayer expense, which would put other municipal services at risk. The city would have to develop new expertise and hire staff or consultants with health care knowledge. Medical services are already highly regulated at the state and federal levels. Currently, no California city has a similar health care service cost oversight.

SEIU United Healthcare Workers West proposed this initiative and collected enough signatures in Livermore to force the City Council to place the ballot measure on the citywide ballot. A similar proposition is slated to appear on the City of Palo Alto’s

ballot. The union tried, but failed, to obtain signatures for a similar initiative in Pleasanton and is planning on seeking signatures for a proposition in Emeryville in 2020.

Soundly defeating this ill-conceived initiative in November is a top priority for the ACCMA. The ACCMA has already actively engaged in the campaign, with ACCMA leaders speaking at two recent Livermore City Council meetings in opposition to the measure. I thank ACCMA Presidentelect, Doctor Lubna Hasanain, and the ACCMA Councilor from the TriValley area, Doctor Darcy Baird, for ably representing the ACCMA’s strong opposition to this initiative.

Physicians and other impacted providers—especially those who live and/or practice in the City of Livermore—are strongly encouraged to get involved in the campaign against this initiative. There are all kinds of ways to get involved—from speaking at community meetings, to knocking on doors, to media appearances (see next page). One of the ACCMA’s primary goals is to minimize problems that East Bay physicians face in their practices. We provide a forum for doctors to collaborate and address professional challenges, allowing us to care for our patients. If you would like to get involved, contact the ACCMA at (510) 654-5383.

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

ACCMA BULLETIN | July/August 2018

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GET INVOLVED Service Employees International Union-United Healthcare Workers West (UHW) has sponsored an initiative changing how Livermore's hospital, clinics and other health care providers finance patient care. It would lead to staffing cuts and limit the ability to serve patients. The initiative also requires the City of Livermore to enforce the law, adding a financial and administrative burden to the City.

TAKE ACTION NOW TO PROTECT LIVERMORE HEALTH CARE Publicly oppose this initiative. As a concerned community member, your name will help communicate to voters how voting 'no' will maintain the delivery of quality care without jeopardizing access to thousands of medical professionals and patient care.

Walk precincts. Help boost voter turnout and share your message directly with individual voters to demonstrate the community’s opposition to this initiative.

Author letters-to-the-editor or opinion-editorials or agree to be interviewed by local media.

Display or distribute campaign materials or post a campaign sign. Help communicate to voters how voting 'no' will maintain the delivery of quality care by sharing campaign material.

Lend your name or image to materials. Your name could be used in a quote that might be included in mailers, digital advertising, on the campaign website or in fact sheets and other materials.

PAID FOR BY PROTECT OUR LOCAL HOSPITALS AND HEALTH CARE Committee major funding from: California Association of Hospitals and Health Systems Stanford Health Care Kaiser Permanente Please visit protectlivermore.org for more information about the campaign and how to get involved.

HOD MAJOR ISSUE REPORT

CMA House of Delegates Major Issue Report: Physician Workforce The following is an excerpt from the Major Issue Report to the 2017 CMA House of Delegates on Physician Workforce. The recommendations adopted by the House are at the end of this report.

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nsuring that California maintains a physician workforce that allows Californians access to the medical care they need—when and where they need it—continues to be a challenge throughout the workforce pipeline.

Barriers to Maintaining a Strong Physician Workforce

California’s population is growing rapidly and aging, increasing the demand for physicians more than ever before.

At the same time, many of California’s physicians are approaching retirement or simply choosing to leave the profession, and the pipeline designed to replace them is experiencing bottlenecks in both medical school and residency training. Medical school debt is also growing faster than physician income, and is one of the primary reasons that the supply of primary care physicians is lagging even further behind than that of specialists.

CMA is dedicated to ensuring all Californians have access to medical care and can see a doctor when they need one. Physicians know that it is most effective to treat patients as soon as health issues arise. Access is essential to boosting prevention, protecting the public health and tackling early widespread afflictions, such as obesity. With the retirement of the baby boomers, new risks to coverage for millions of insured citizens, and obesity rates at epidemic levels, it is more important

than ever that we continue to assess, address and reform the obstacles facing California’s health care system.

One of the most important obstacles to address is ensuring sufficient and timely access to quality medical care provided by a physician. Maintaining a sufficient supply of physicians practicing in the needed specialties where they are needed is the cornerstone of making sure patients have access to care.

Assessing physician supply is complex, because the supply problem varies by geographic area, specialty, physician willingness to take certain types of insurance, etc. There are several factors that impact California’s ability to maintain a strong physician workforce that has the capacity to provide timely access to quality care for patient. Addressing a single barrier to achieving a robust physician workforce is insufficient and a multi-pronged solution that responds to multiple factors is necessary to provide meaningful improvements to the physician workforce. Significant factors impacting the physician workforce are discussed below.

The Physician Pipeline

Assessing the severity of a physician shortage is complex, but at its most basic level, accurate information is needed regarding the number of individuals entering the profession and the number of individuals exiting profession over time.

Medical residency. Graduate Medical Education (GME) is the hands-on training phase of physician education that is mandatory for doctors to obtain a license for independent practice. Residency programs are

a necessary source of direct clinical medical training. In addition, physicians in California residency programs provide a significant level of direct patient care.

Nationally, there are an insufficient number of residency posts to accommodate all medical graduates who wish to practice medicine in the U.S. In academic year 2014–15, there were 10,865 residents in California, of which 2,496 were PGY1 residents entering a residency program. Each year, a total of about 1,600 students graduate from the 13 medical schools in California. Although the total number of residency positions in California teaching hospitals exceeds the total number of graduates from California medical schools, it can be difficult for a California medical school graduate to stay in-state for residency training, particularly if there is a shortage of residency positions in the desired specialty. In addition, there may be increased competition if students who graduated in previous years were unable to match and are added to the match program for the following year.

In addition, there is a residency mismatch, such that some states have significantly more residency positions per capita than others. California does not have a sufficient number of residency positions to train all graduates of California medical schools, and as such is an “exporter” of medical students. Compared to other states, California ranks 31st when comparing the number of residents and fellows per capita, with a ratio of 26.1 residents per 100,000 population. Other states, such as Massachusetts and New continued on next page ACCMA BULLETIN | July/August 2018

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HOD MAJOR ISSUE REPORT

York, rank at the top with 81.7 and 81.5 residents per 100,000 population respectively.

they can provide safe and high-quality care. Historically, it has not been uncommon for physicians to remain

NOT GETTING OUR FAIR SHARE There is significant variation in Medicare GME payments among teaching hospital and states receiving federal support. When considering only the total amount of GME funding allocated in each state, California ranks 8th nationally. California has the largest population but receives less funding than smaller states. New York, with half the population of California and a total allocation of $1.8 billion, receives 10 times the amount of GME funding as California.

California represents about 12% of the total U.S. population and receives about 3% of total GME funding. Compare that to East Coast states, which represent about 32% of the U.S. population and receive 60% of total GME funding. On a per-capita basis, California receives about $4.60 in GME funding for every Californian. In contrast, East Coast states receive between $80 to $95 per state resident per year.

This funding disparity also translates to large differences in the medical resident workforce supply, with California having about 7 residents to serve every 100,000 in population, as compared to New York, Massachusetts and Rhode Island, which have 57 to 61 medical residents per 100,000 population.

Post-residency retention.

California has the highest practice retention rate in the country. Overall, 77.4 percent of the individuals who completed residency training in California from 2006 through 2015 are practicing in California. Nationally, 53.6 percent of the individuals who completed residency training from 2006 through 2015 are practicing in the state of residency training. Given the high retention rate, if California had more residency positions, it is likely that this would translate into an increased number of physicians staying in and practicing in California.

Physicians Leaving the Practice of Medicine. A critical part of maintaining physician supply is to ensure that physician practice medicine if

in active medical practice for over 50 years. While there have always been some physicians who leave the profession for a variety of reasons—including a desire to enter a new profession, burnout and retirement—there are concerns that an increasing number of physicians are contemplating discontinuing or have already left the practice of medicine.

A report from the American Association of Medical Colleges (AAMC) used data from the 2014 AMA Physician Masterfile to identify the size and characteristics of the current workforce. In 2014, nationally there were approximately 782,210 physicians under age 75 in active practice, compared with about 767,100 in 2013—an increase of about 2%.

Women constituted a third (33%) of the workforce. Physicians within the traditional retirement age between 65 and 75 were 11% of the active workforce, and those between age 55 and 64 made up nearly 26% of the active workforce. The AAMC estimates that it is possible that a third of currently active physicians could retire

(continued)

within the next decade. According to a 2016 report from The Physicians’ Foundation, about half of physicians say they plan to retire, reduce their hours, or leave their clinical positions because of regulatory burdens and other concerns. The report states, “The concern from the public’s perspective is that physicians, as a consequence of poor morale or related reasons, will choose to practice medicine in ways that reduce patient access to their services.”

The Physician’s Foundation survey suggests that the two prerequisites for enhancing medical practice conditions are the reduction of the regulatory/ compliance and administrative burden on physicians and the preservation of their clinical autonomy. Physicians, especially primary care physicians, are often challenged with electronic health record (EHR) and quality measure requirements, low reimbursements, malpractice premiums, overwhelming paperwork, and the responsibility of taking on thousands of patients to offset the rising cost of healthcare.

The increasing volume of patients and responsibility can compromise the overall quality of a physician’s attention. Physician burnout continues to be reported at increased levels and physicians report feeling disconnected from their colleagues and a lack of satisfaction in the workplace.

Primary care physicians also face substantial compensation disparities when compared to medical specialists. To maintain their income levels, primary doctors may take on more patients and more hours to compensate for the transaction costs of dealing with insurance, which can take up nearly 40% of a physician’s income.

Today, the average primary care physician sees dozens of patients a day, and can treat thousands of patients a year.

Primary care physicians may feel the continued on next page ACCMA BULLETIN | July/August 2018

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HOD MAJOR ISSUE REPORT

need to comply with the overloaded standards of today’s healthcare system rather than the best interest of the patient’s health to keep up with patient demand in primary care.

As demonstrated by surveys, such as the Physicians’ Foundation survey, many physicians report that they no longer enjoy practicing medicine. The Physicians’ Foundation survey found that 46.8 percent of respondents said they plan to “accelerate” their retirement plans because of the changes taking place in health care. Over the next one to three years: • 21 percent of respondents said they plan to scale back their hours; • 14.4 percent said they plan to retire; • 13.5 percent said they plan to seek a non-clinical job in health care; • 11.5 percent said they plan to take temporary provider positions; • 10 percent said they plan to move to part-time practice; and • 9 percent said they plan to move to concierge medicine.

Some physicians have switched to concierge or other types of lower volume patient care, or move entirely away from direct patient care into administration or consultant practices. Some physicians with solo and small practices have also found it difficult to maintain viable practices as groups are merged and purchased, sometimes resulting in lower levels of physician autonomy. These many challenges can result in physician burnout and an overall decrease in professional satisfaction and an exit from clinical medical practice. Data on the actual exit of physicians from patient care is limited, but having fewer desirable options for how to practice medicine likely impacts physician supply.

Physicians who are no longer in regular active clinical practice may wish to continue to practicing medicine in other ways, including 12

(continued from page 11)

volunteering without compensation and some level of limited part-time practice. However, it may be difficult to identify these opportunities and to secure appropriate medical malpractice coverage at a reasonable cost, that allows them to practice medicine outside of the traditional model.

Maldistribution: Geographic and By Specialty

In 2015-16, there were 135,375 physicians with active California medical licenses residing in California.

However, not all licensed physicians are in active patient practice and the distribution of physicians around the state does not always align with patient needs.

For example, in 2014, California had 35,725 primary care physicians and about 84.2 primary care physicians per 100,000 residents. While on a statewide basis, this is in the range of acceptable ratios of primary care physicians to patients, there are many areas within California that are experiencing shortages of primary care physicians. As of June 2016, California had 122 Primary Care Health Profession Shortage Areas (HPSAs) with a geographic designation and 94 Primary Care HPSAs with a population designation.1

Physician Diversity

While ensuring that there are enough physicians to serve California’s population is important, it is also important to ensure health workforce diversity.

Many experts believe that a workforce that mirrors the racial and ethnic diversity of California will increase access to care and improve the quality of care that is delivered. Minority health care providers typically provide more care for the poor and uninsured, and more frequently practice in areas with shortages of providers than their nonminority peers. Health

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

workforce diversity also provides increased understanding of minority communities’ health beliefs and methods, enabling better communication that brings an understanding of cultural health beliefs and methods that respect those beliefs into the health care system, which benefits patients and their families. As such, a more diverse cadre of physicians and other health professionals is a crucial strategy for improving the health and wellness of underserved communities.

According to a report from the California Healthcare Foundation, the racial/ethnic breakdown of California physicians was not representative of the state’s diverse population. California’s Latino population was significantly underrepresented in the physician population: 38% of the population was Latino, while only 5% of active patient care physicians were Latino.

Licensure Issues

California medical licensure law sets the minimum competency requirements to diagnose and treat patients, but it is not specialty specific. California physicians and surgeons are issued a plenary license to practice medicine, which gives them unrestricted authority “to use drugs or devices in or upon human beings and to sever and penetrate the tissues of human beings and to use any and all other methods in the treatment of diseases, injuries, deformities, and other physical and mental conditions.”

(Business & Professions Code §2051) Physicians have been concerned that the process and cost for obtaining a California medical license poses a significant barrier to practice for individuals who wish to practice in the state. California law requires that the Medical Board inform applicants within 60 working days regarding whether it is complete and accepted for filing or that it is deficient and

HOD MAJOR ISSUE REPORT

what specific information or documentation is required to complete the application.2 Within 100 calendar days from the date of filing of a completed application, the division shall inform the applicant in writing of the decision regarding the application for licensure.

As of April 2017, the average number of days to complete the initial review of a physician’s and surgeon’s license application was 29 days—the Medical Board’s internal goal is to complete initial reviews within 45 days.

The applicant then is notified in writing of the application status and given an itemized list of documents needed to complete the file. It is the applicant’s responsibility to ensure that any missing documents are sent to the Board. These subsequent documents also will be reviewed in order of receipt. According to the Medical

Board, if the application is complete and approved upon first review (including receipt of the initial license fee) a license will be issued promptly.

There are two fees involved in the licensing process. The first fee is the application fee, which is $491 and includes the $49 non-refundable fingerprint processing fee. Applicants must also pay an initial license fee of $808 before a license can be issued.

California has the highest medical license application and initial license fees in the United States.

CMA Policy Recommendations

To address these barriers, the CMA House of Delegates in 2017 adopted broad, comprehensive policy on physician workforce. Key components of the policy include supporting the

(continued)

development and financing of new medical schools in the Central Valley and Inland Empire, educating medical students on the need for more primary care physicians, increasing graduate medical education capacity, and addressing the high levels of medical school debt. CMA also will develop a multi-year strategic and implementation plan for advancing their physician workforce priorities. To read the full adopted recommendations, go to https://bit.ly/2Mo82zC. ENDNOTES 1 Geographic designation means that there is a shortage of primary care providers for the entire population within a defined geographic area and population designation means that there is a shortage of primary care providers for a specific population group(s) within a defined geographic area (e.g., low income, migrant farmworkers, and other groups). See HPSA map: https://www. oshpd.ca.gov/documents/HWDD/GIS/HPSA_ PrimaryCare.pdf 2 California Code of Regulations § 1319.4: Applications for Medical Licensure.

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ACCMA BULLETIN | July/August 2018

13

The Alameda-Contra Costa Medical Association presents:

Winding Down Your Practice:

Strategies for a Successful Retirement Wednesday, September 19, 2018, 6:00–8:00 PM Dinner included ACCMA, 6230 Claremont Avenue, Oakland Effectively transitioning your practice for your patients, staff, and family requires careful planning and sufficient time to accomplish. During this seminar, you will learn creative strategies to help you accomplish your goals, including: bringing in an associate, recruiting, selling the practice, or closing the practice. We will also cover the latest information on valuation methodology for selling, divorce, or estate planning.

PRESENTERS

TOPICS INCLUDE • What you need to know to sell your practice • Latest valuation methodology for selling your practice and planning your estate • Merging practices: equalizing assets, structure decisions, expense share, partnership corporations • Preparing for retirement while you practice: finances, lifestyle, work/life balance • Legal and ethical duties to patients when retiring

Brad D. Berman, MD, a developmental and behavioral pediatrician in Walnut Creek, will also present his experience and advice with transitioning to retirement.

Debra Phairas is President of Practice & Liability Consultants, a nationally recognized firm specializing in practice management and malpractice prevention. Her consulting experience includes over 2,000 practices of all sizes and specialties. www.practiceconsultants.net

REGISTRATION FEES ACCMA members: $99 (includes spousal fees) Non-members: $199

Registration Information Please register online - no login required! Go to www.accma.org, click “Calendar”, and then click “List of Upcoming Events.” Select the program title from the calendar to complete your registration online. You may also fax this form to 510-654-8959, send it by mail to the ACCMA at 6230 Claremont Avenue, Oakland, CA 94618, or call the ACCMA at 510-654-5383.

Attendee:_____________________________________ Spouse:______________________________________ Fax: _________________ Phone:__________________ Email: ______________________________________ Credit Card Number:______________________________________ Security code:__________ Exp.:________ Name as it appears on card: ___________________________________________________________________ Billing Address: _____________________________________________________________________________ Fax to ACCMA at 510-654-8959

CURES

Are You Ready to Check CURES? Starting October 2, all physicians must consult database before prescribing controlled substances By the California Medical Association

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ffective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES)—prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish, or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that

the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload. On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use.

The certification began a six-month transition period, with the duty-toconsult taking full effect on October 2, 2018.

What Physicians Need to Know

Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part

of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply.

Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: • Admitted to a facility for use while on the premises; • In the emergency department of a general acute care hospital, so continued on next page

THE CURES DATABASE: MAKING IT WORK FOR BUSY PHYSICIANS Tuesday, Sept. 18, 2018, 12:30–1:30 PM Free Webinar | CME Available* Presented by the ACCMA in collaboration with the California Department of Justice and local pain management specialist Ruben Kalra, MD At the completion of this activity, the learner will be able to: • Consult the CURES database when legally required to do so.

• Utilize the information found in CURES to inform patient care.

• Effectively discuss with patients the risks involved with drug misuse and abuse and doctor shopping.

Three ways to register: (1) Online at http://www. accma.org/events; (2) email rsvp@accma.org; or (3) call (510) 654-5383. * Non-ACCME members who wish to claim CME credits for this program will be charged a $49 admin fee to help cover the costs of providing CME. ACCMA members will receive the CME free-of-charge as part of their membership benefits.

Accreditation Statement: The Alameda-Contra Costa Medical Association is accredited by the Institute for Medical Quality/ California Medical Association (IMQ/CMA) to provide continuing medical education.

Credit Designation Statement: The Alameda-Contra Costa Medical Association designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ACCMA BULLETIN | July/August 2018

15

CURES

(continued from page 15)

long as the quantity of the controlled substance does not exceed a seven-day supply; • As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or • Receiving hospice care.

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

CMA Fights for CURES Protections

CMA worked closely with the bill’s author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 481, Lara). Among the negotiated amendments are

liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.

For More Information

For more information, register for the free ACCMA webinar on September 18 (see sidebar on previous page) or consult CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA’s online resource library at www.cmanet.org/cma-on-call.

Nonmembers can purchase documents for $2 per page.

ADDITIONAL RESOURCES • • • •

CURES website: oag.ca.gov/cures CURES FAQ: oag.ca.gov/cures/faqs Medical Board CURES webpage: mbc.ca.gov/cures CMA CURES webpage: cmanet.org/cures Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@ doj.ca.gov.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CMA WEBSITE

Welcome to the Next Generation of CMA By the California Medical Association

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ince 1856, the California Medical Association (CMA) has supported physicians and the practice of medicine to keep the Golden State healthy and thriving. CMA’s success is rooted in our ability to effectively connect, communicate, and engage with members. Because together, we are stronger.

“Diverse organizations like CMA need a bold brand and

modern website to reinforce our mission through impactful design, messaging, and imagery,” said CMA Vice President of Strategic Communications Laura Braden Quigley. “Our website was last updated in 2011, and our brand family had been untouched since the early 1990s. Given that CMA’s family includes 37 county medical societies, a political action committee, a foundation and other partners, it is

critically important to demonstrate a cohesive and consistent brand across all communications channels, affiliates and platforms.”

CMA’s website functionality, design, and content strategy was reimagined with a focus on membership recruitment and engagement.

Enhanced features of the new website include: One Login: We’ve simplified the login process so you don’t have to keep track of multiple usernames and passwords. The joint CMA/ACCMA login means that your ACCMA login now grants access to your CMA account.

My CMA (cmadocs.org/my-cma): From public health to Medi-Cal, choose your preferences for custom content and personalized alerts.

Mobile Responsive Design: CMA’s new site is optimized for mobile devices, so you can stay engaged from your phone or tablet.

Search: The new and improved search function returns more relevant results, making it easier for you to find what you need. continued on page 19

CHANGE YOUR BOOKMARKS: CMADOCS.ORG In addition to the new website, CMA is also moving to a new URL that is easier to remember and more representative of who we are: CMAdocs.org. We have also moved to @CMAdocs on Facebook, Twitter, YouTube, Instagram, and LinkedIn.

ACCMA BULLETIN | July/August 2018

17

NEWS & COMMENTS

(continued from page 5)

Medi-Cal Managed Care Providers Are Required to Enroll All contracted physicians in a Medi-Cal managed care network must enroll in the Medi-Cal program by December 31, 2018.

There are two enrollment options: through the managed care health plan’s own enrollment process or through the California Department of Health Care Services (DHCS) fee-for-service (FFS) enrollment portal. (Enrolling through DHCS does not obligate the provider to also see FFS patients.) The federal rule that took effect this year requires states to screen and enroll, and periodically revalidate, all network physicians of managed care organizations. For more details, go to bit.ly/2LVvUyH.

CMS Proposes New 2019 Medicare Fees & QPP Rules On July 12, the Centers for Medicare & Medicaid Services (CMS) announced a plan to combine Medicare paperwork and levels of payment into one form and one flat rate for each office visit with a patient, with the option of filing for an “add-on” payment of $67 for more complex patients. An analysis by the American Medical Association (AMA) of the impact by Medicare specialty of the proposed E/M changes can be viewed at bit. ly/2ALePSO. Other proposals include geographic payment updates for California physicians, a proposal sponsored by the California Medical Association (CMA) (bit.ly/2vtrEfB), and reductions in MIPS reporting burdens. The comment period for the proposed rule ends on September 10. To submit a comment, go to www.regulations.gov, type “CMS-1693-P” in the Search box, and click the Comment Now button on the next screen.

To read more about the CMS proposed measures, go to bit. ly/2vinyGX.

UHC Reimbursement for After-Hours and Weekend Care Effective August 18, 2018, UnitedHealthcare (UHC) will allow reimbursement for CPT code 99051 (services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) when billed with acute care services by a primary care physician (PCP). The change in policy supports reimbursement for primary care practices with additional hours providing convenient access for members to see their own PCPs. If your medical practice needs reimbursement assistance, ACCMA members can contact the California Medical Association at (888) 401-5911 or economicservices@ cmadocs.org.

Early Success for State Drug Pricing Transparency Law Some planned price increases for at least 10 drugs were cancelled or reduced after SB 17, California’s drug pricing transparency law, went into effect this year. The law requires pharmaceutical companies to give drug purchasers at least 60 days’ notice of price increases of more than 16 percent in a two-year period. The Office of Statewide Health Planning

18

and Development (OSHPD) maintains a registry of over 150 public and private purchasers for purposes of the 60-day advance notice requirement. The ACCMA and the California Medical Association supported SB 17. To read more, go to lat. ms/2LXjtSZ.

Check Your 2019 MIPS Payment Adjustment Calculation For providers who participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is available for review on the Quality Payment Program (QPP) website (qpp.cms.gov). To understand your MIPS performance feedback, consult the Performance Feedback Fact Sheet prepared by the Centers for Medicare and Medicaid Services (CMS). Contact the Quality Payment Program at (866) 288-8292 or QPP@cms.hhs.gov with any questions. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, which will range from –4% (for clinicians who do not participate) to +4%, you have until September 30 to request a targeted review. Check the Targeted Review Fact Sheet (go.cms.gov/2MHUSgQ) and User Guide (go.cms.gov/2ua8c6B) for more information about targeted reviews.

Projected State Shortage of Mental Health Professionals California is expected to face a shortfall of 729 to 1,848 psychiatrists by 2025, compared to 336 psychiatrists in 2016. The calculation was made based on federal regulations that stipulate a population-to-mental health provider ratio of 30,000 to 1.

A study released in February by the Healthforce Center at UC San Francisco cites current and expected retirement levels as a leading cause of the shortage, as those older than 60 make up 45 percent of psychiatrists. Other reasons for the shortage include low rates of reimbursement, burnout, and burdensome documentation requirements. It is estimated that 20 percent of the US population needs treatment for mental illness or substance use and/or dependence but do not receive any care.

Physician workforce is a major advocacy issue for the ACCMA and the California Medical Association (CMA) (see page 9 of this issue). To read more, go to bit.ly/2m9RboQ.

Anthem Required to Publish Effective Dates for Clinical Policies The Department of Managed Health Care (DMHC) is requiring Anthem Blue Cross to publish effective dates for their medical and clinical utilization management policies, and to clearly indicate whether a policy applies in California, as the result of a California Medical Association (CMA) inquiry in March.

Physicians and patients had been unable to determine which of Anthem’s published policies were effective and what medical services were covered. CMA is continuing to monitor Anthem’s compliance with the DMHC order. To read more, go to bit. ly/2LXD31h.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

CMA WEBSITE

Grassroots Action Center (cmadocs.org/grassroots-action-center): The Grassroots Action Center is the new hub for all of CMA’s advocacy efforts. Make your voice heard, join the Physician Advocate program, receive training from CMA experts, and more!

Policymaking (cmadocs.org/ policymaking): Submit and comment on resolutions through CMA’s yearround policymaking process.

Discussion Forums (cmadocs. org/my-cma/discussion-forums): With improved features, we’ve made it much easier and faster to connect with physician colleagues.

Legislative Hot List: Receive realtime updates on health care legislation impacting your patients and medical practice.

Newsroom: In addition to press releases and breaking news, CMA now has media training and other resources available, just for members.

You can also join our Social Media Ambassador program or become a Media Surrogate!

Join CMA: We have streamlined the application process so it is fully integrated with our membership database. Join or renew today and immediately get full access to your “My CMA” dashboard and valuable member benefits.

“CMA’s brand and website serve as powerful recruitment and engagement tools to keep California’s physicians at the forefront of an everchanging health care landscape,” said CMA President Theodore M. Mazer, MD. “It also sends a bold message to physicians that we continue to be ready to embrace tomorrow’s challenges and opportunities. Much has changed since 1856, but CMA’s mission remains constant: to promote the science and art of medicine, protect public health, and better the medical profession.”

(continued from page 17)

HOW TO LOG INTO CMA’S NEW WEBSITE The ACCMA and CMA websites now share a single sign-on. If you’re an ACCMA/CMA member, that means you can log into the CMA website with your ACCMA website username and password. In most cases, your username will be your email address or your medical license number. If you do not know your ACCMA login credentials, simply use the username and/or password retrieval. If you have any problems accessing your account, please contact the ACCMA at (510) 654-5383.

PLEASE NOTE: Changing your password on the CMA website changes your password on the ACCMA website, and vice versa.

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ACCMA BULLETIN | July/August 2018

19

MEMBER BENEFIT: DELTA DENTAL

A project of the Alameda-Contra Costa Medical Association (ACCMA)

CRITICAL CONVERSATIONS:

THURSDAY, OCTOBER 11, 2018 Registration: 8:30 a.m.

Summit: 9:00 a.m. – 4:00 p.m.

The California Endowment 2000 Franklin St., Oakland, CA 94612 Registration FREE – Lunch Provided CME/CE Available!*

AN ADVANCE CARE PLANNING SUMMIT FOR ADVOCATES The East Bay Conversation Project's advance care planning summit is the premier event in the East Bay for anyone involved with advance care planning.

Join us for inspiration and insight from topic experts, as well as the opportunity to refine the critical skills and knowledge to engage in "The Conversation."

KEYNOTE SPEAKER: LOUISE ARONSON,

GENERAL SESSION: CULTURAL CONSIDERATIONS AM BREAKOUTS:

MD, MFA, Geriatrician, author, and professor of medicine at UCSF.

PM BREAKOUTS:

Healthcare Agents & Surrogate Decision Makers End of Life Options Ethical & Legal Dimensions of “The Conversation”

Living with Dementia: Honoring Wishes Conversation Starters Ethical & Legal Dimensions of “The Conversation” (2nd Chance)

5.5 CME Hours Available Approved by the Nursing Home Administrator Program for 5.5 CE credit hours Provider approved by the California Board of Registered Nursing, Provider Number CEP17013 for 5.5 contact hours. CE provided in collaboration with “Yes! Press Consulting and Education” More info at www.eastbayacp.org.

TO REGISTER

Go online to www.eastbayacp.org -or- FAX this completed form to (510) 654-8959.

For questions, please call (510) 654-5383.

Name: _________________________________________ Email: _________________________ Organization: __________________________________ Phone: ________________________ *Non-ACCMA members who wish to claim CME credits for this program will be charged a $300 admin fee to help cover the costs of providing CME. ACCMA members will receive the CME free-of-charge as part of their membership benefits.

Accreditation Statement: The Alameda-Contra Costa Medical Association is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians.

Credit Designation Statement: The Alameda-Contra Costa Medical Association designates this live activity for a maximum of 5.5 AMA PRA Category 1 Credits(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The EBCP is funded by Alameda County Measure A Essential Services Initiative and the Thomas J. Long Foundation.

END OF LIFE OPTION ACT

End of Life Option Act Reinstated Temporarily

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state appellate court has stayed the Riverside County Superior Court’s judgment issued on May 24, 2018, declaring California’s End of Life Option Act void and unconstitutional. Due to the lower court’s judgment, physicians had been advised against relying on the Act to prescribe aid-in-dying medication in caring for patients with terminal illnesses. The appellate court’s stay effectively reinstates the California’s aid-in-dying law for the time being, while the courts consider the constitutional questions surrounding the Act. The California Attorney General’s Office requested the stay to alleviate the confusion caused by the Act’s invalidation. Edward Damrose, MD, chief of staff at Stanford Health Care hospital and clinics, submitted a supporting declaration and stated that the “uncertainty over the Act is disrupting and impeding the ability of physicians to care for terminally ill patients,” and that a stay is needed to “afford more time to physicians to transition their practice and treatment of terminally ill patients.” Fourteen other declarations were submitted by terminally ill patients, other physicians and state officials. “It is clear that, without a stay,” the Attorney General argued, “terminally ill patients will suffer great harm, and some will be forever foreclosed from benefiting from any relief that this Court might eventually provide in a decision on the merits.”

While the Act currently remains in full force and effect due to the appellate court’s stay order, the Act’s fate ultimately remains unresolved.

Under the California Constitution, the legislature has authority to pass laws in a special legislative session only if they fall within, or are reasonably related to, the scope of a governor’s proclamation calling for the special session.

The lower court’s judgment reasoned that the Act was unconstitutional because it was not reasonably related to the health care issues that were the subject of Governor Brown’s proclamation for a special session in fall 2015. The appellate court ordered full briefing on this constitutional question to be completed by July 25, 2018.

Oral argument will be scheduled and a decision from the appellate court can be expected within 30–45 days thereafter.

California is one of eight jurisdictions with this end-of-life care option, along with Colorado, Hawaii, Montana, Oregon, Vermont, Washington, and Washington, D.C. For more information, or if you would like to discuss the potential

impact of the trial court’s decision on your practice, contact the California Medical Association’s Legal Information Line at (800) 786-4262 or legalinfo@cmanet.org.

ADDITIONAL RESOURCES For more information, consult CMA On-Call document #3459, “The California End of Life Option Act” and #3452, “Documenting Decisions Regarding Life-Sustaining Treatment and End-of-Life Options.” On-Call documents are free to members in CMA’s online resource library at www.cmanet.org/cma-oncall. Nonmembers can purchase documents for $2 per page.

DATA REPORTED BY PHYSICIANS • • • • •

577 individuals received prescriptions under the Act, written by 241 unique physicians.

374 individuals (64% of those who received prescriptions) died following their ingestion of the prescribed aid-in-dying drug.

11 of these individuals received their prescription in 2016.

86 individuals (14.9%) died without ingestion of the prescribed aidin-dying drug There was a total of 269,044 deaths in California in 2017; medical assistance in dying (MAID) deaths account for 0.139% of them.

Source: California End of Life Option Act 2017 Data Report, California Department of Public Health

ACCMA BULLETIN | July/August 2018

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NEW MEMBERS

NEW & RETURNING REGULAR MEMBERS Epic Care 1240 Central Blvd., Brentwood

Epic Care 20400 Lake Chabot Rd., Castro Valley Anthony Chan, MD General Surgery

Chelsea Ai-leen Chung, DO Family Medicine The Permanente Medical Group 3400 Delta Fair Blvd., Antioch Michael William Parmley, MD, FACP Internal Medicine

Epic Care 6380 Clark Ave., Dublin

The Permanente Medical Group 4501 Sand Creek Rd., Antioch

Vivian Vi-uyen Le-Tran, DO Surgical Oncology

John Robert Lawerence, MD Family Medicine

Epic Care 365 Hawthorne Ave., Oakland

Julia Page Polk, MD Obstetrics and Gynecology

Azure Greeson, MD General Surgery

The Permanente Medical Group 27303 Sleepy Hollow Ave. S., Hayward

Epic Care 13851 E. 14th St., San Leandro

Ruth Jou Chiang Kao, MD Pediatrics

Kruthika Proddatoori, MD Internal Medicine Epic Care 1844 San Miguel Dr., Walnut Creek Stacey Marija Logan, MD Pediatrics

The Permanente Medical Group 3505 Broadway, Oakland Judy Trota Fuentebella, MD Pediatric Gastroenterology Luis Alesandro Larrazabal Martinez, MD Pediatric Cardiology

Island Anesthesia Associates 2070 Clinton Ave., Alameda

The Permanente Medical Group 3600 Broadway, Oakland

Lisa Maria Collins, MD Anesthesiology

Liping Liu, MD Selective Pathology

Kaiser Permanente Chemical Dependency Recovery Program 969 Broadway

Kimberly Marie Ray, MD Radiology

Lynn D. Bertram, MD Psychiatry

The Permanente Medical Group 3801 Howe St., Oakland Sanju K. Thomman, MD Family Medicine

Pain Medicine Consultants 2550 Morello Ave., Pleasant Hill Ruben Kalra, MD Anesthesiology Pain Medicine

Sabrina T. Sood, MD Family Medicine The Permanente Medical Group 2417 Central Ave., Alameda

Bassem Mourad Said, MD Otolaryngology

NEWS & COMMENTS William Cooper Longton, MD

Palo Alto Foundation Medical Group 3200 Kearney St., Fremont

The Permanente Medical Group 275 W. MacArthur Blvd., Oakland

Angela Yan Shen, MD Anesthesiology Kunal Sidhar, MD Interventional Radiology and Diagnostic Radiology Candice Chin Wong, MD Internal Medicine The Permanente Medical Group 3555 Whipple Rd., Union City Tajinder Bir Kaur, MD Obstetrics and Gynecology The Permanente Medical Group 320 Lennon Lane, Walnut Creek Robert Hatsuo Ozaki, DO Family Medicine The Permanente Medical Group 1425 S. Main St., Walnut Creek Brandon Rock Esenther, MD Anesthesiology The Permanente Medical Group 1515 Newell Ave., Walnut Creek Janneth Paola Momiy, MD Vascular Surgery Joseph Michael Pirolo, MD Orthopaedic Surgery Sutter East Bay Medical Group 3000 Colby St., Berkeley Ben-Hwa Hu, MD Family Medicine Sutter East Bay Medical Group 20103 Lake Chabot Rd., Castro Valley Anita Pravin Gandhy, MD, MPH, MA Hospice and Palliative Medicine San Ramon Regional Medical Center 167 Oakridge Dr., Danville Joseph Daniel Toscano, MD Emergency Medicine

(continued from page 5) MD Anish Amin,

Richard Craig Shinaman, MD Pain Management (Anesthesiology)

Emergency Medicine

The Permanente Medical Group 901 Nevin Ave., Richmond Erica Levack Canales, MD Obstetrics and Gynecology

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The Permanente Medical Group 2500 Merced St., San Leandro

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEW RESIDENT MEMBER Nicolas Kenji Taylor, MD UCSF Internal Medicine Residency Program

CODING CORNER

The Coding Corner: NCCI Policy Manual Updates

By G. John Verhovshek, American Association of Professional Coders

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ach year, the Centers for Medicare and Medicaid Services (CMS) releases an updated version of the National Correct Coding Initiative (NCCI) Policy Manual. The annual updates reflect changes to the CPT® and HCPCS code sets, as well as new and revised coding guidelines.

Here we’ll discuss the most significant recent updates to chapters 1–7 of the Policy Manual that affect coding, compliance and reimbursement for providers.

Chapter I: General Correct Coding Policies

To reduce the paid claims error rate, CMS has instituted Medically Unlikely Edits (MUE), which define the maximum units of service that a provider may report, under most circumstances, for a single beneficiary, on a single date of service, for a specific HCPCS/CPT® code. As part of the 2018 update, the Policy Manual includes additional examples to demonstrate how the edits are applied, as follows: • The MUE for a knee brace is “2” because there are two knees and Medicare policy does not cover back-up equipment.

• The MUE value for a lumbar spine procedure reported per lumbar vertebra or per lumbar interspace cannot exceed “5,” since there are only five lumbar vertebrae or interspaces.

• The MUE value for a procedure reported per lung lobe cannot exceed “5,” since there are only five lung lobes (three in right lung and two in left lung).

•

If a code descriptor uses the plural form of the procedure, it must not be reported with multiple units of service. For example, if the code descriptor states “biopsies,” the code is reported with “1” unit of service regardless of the number of biopsies performed.

• The MUE value for a procedure with “per day,” “per week” or “per month” in its code descriptor is “1” because MUEs are based on number of services per day of service.

• The MUE value of a code for a procedure described as “unilateral” is “1” if there is a different code for the procedure described as “bilateral.”

• The MUE value for CPT code 86021 (Antibody identification; leukocyte antibodies) is “1” because the code descriptor is plural including testing for any and all leukocyte antibodies. On a single date of service only one specimen from a patient would be tested for leukocyte antibodies.

The new examples do not change policy but clarify guidelines already in place.

describes “collection of blood specimen using an established central or peripheral venous catheter, not otherwise specified.”

These codes shall not be reported with any service other than a laboratory service. That is, these codes may be reported if the only nonlaboratory service performed is the collection of a blood specimen by one of these methods.

Similarly, irrigation of implanted venous access device for drug delivery may be reported only if it is the sole service provided: CPT code 96523 describes “irrigation of implanted venous access device for drug delivery system.”

This code may be reported only if no other service is reported for the patient encounter.

Chapter II: Anesthesia Services CPT Codes 00000–09999

Chapter IV: Musculoskeletal System CPT Codes 20000–29999

New language stresses that collection of blood specimen is reported only in addition to lab services, or if blood collection is the only service provided: CPT code 36591 describes “collection of blood specimen from a completely implantable venous access device.” CPT code 36592

Chapter III: Integumentary System CPT Codes 10000– 19999

The above guidelines regarding blood collection (36591, 36592) and irrigation of venous access device (96523) are repeated in this chapter, and several times throughout the Policy Manual.

New text clarifies that you may not separately report integral anterior instrumentation (e.g., 22845-22847) with either 22853 or 22854, which describe insertion of interbody biomechanical device(s) into intervertebral disc space(s), if the purpose of the continued on page 26 ACCMA BULLETIN | July/August 2018

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PERSPECTIVE

PUT YOUR ACCMA MEMBERSHIP TO WORK! When you join the Alameda-Contra Costa Medical Association, you join the California Medical Association as well. Together ACCMA-CMA can help with the success of your practice.

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Your annual dues can be more than offset when using membership services and discounts, and you get personal assistance with practice management and payment recovery issues to improve your bottom line. Join the ACCMA to be a better leader for your staff and patients, and to amplify your voice to influence policy and legislation. The ACCMA brings together an active community of physicians in order to improve the larger community. Our mission is physician-driven, and we want to help you solve your biggest practice management issue. Join the ACCMA today!

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Free CME for most ACCMA seminars and webinars to help physicians maintain their licenses.

ACCMA: (510) 654-5383 www.accma.org/events

Discounts on credit card processor and collections services.

360 Payment Solutions: (408) 755-0360 Bureau of Medical Economics: (408) 286-6219

Confidential support and assistance to physicians affected by substance abuse, or an emotional or physical problem.

ACCMA: (510) 654-5383 www.accma.org/member-resources/ physician-wellbeing

Discount on hourly consulting fee for practice assessments, valuation, brokerage, partnerships, etc.

Practice & Liability Consultants (415) 764-4800 www.practiceconsultants.net

Discounts on compliance toolkit and training.

PrivaPlan (877) 218-7707 www.privaplan.com

Discounts on suite of ICD-10 solutions, general and specialty training, and documentation review.

CMA: (888) 401-5911 memberservice@cmadocs.org

Discounts on Delta Dental and long-term disability insurance.

Dublin Insurance Services: (925) 803-1880 Dave White & Associates: (925) 277-2698

10% discount on hourly rate for new clients.

Phillip Goldberg, Kessenick, Gamma & Free, LLP: (415) 568-2014 www.kgf-lawfirm.com

MEMBER SPOTLIGHT A COS1T8 6 0MEDIC

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Free on-demand webinars on quality measures & online tool to create custom MIPS plan.

ACCMA (510) 654-5383 www.accma.org/macra

Up to 89% off the cover price of hundreds of magazines for your home, office, and waiting and patient rooms.

Consumer Subscription Services (800) 289-6247 www.buymags.com/cma

Medical IDs

Discounts on 24-hour emergency identification and family notification services.

MedicAlert Foundation (800) 253-7880 www.medicalert.org/cma

Medical Professional Liability Insurance

Physician-owned malpractice insurance company that pays annual dividend credits.

MIEC: (510) 428-9411 www.miec.com

Messaging App

Free HIPAA-secure messaging app for physician-to-physician/care team communication.

DocBookMD www.docbookmd.com

Office Supplies

Save up to 80% on office supplies and more.

Staples Advantage (800) 786-4262 www.cmadocs.org/benefits/practice

Trained economic advocates with expertise in physician reimbursement and medical practice issues.

ACCMA: (510) 654-5383 CMA: (888) 401-5911

Physician Leadership Program

Enhance your leadership effectiveness through the Berkeley Physician Leadership Program, and save $400.

UC-Berkeley and ACCMA executive.berkeley.edu/ACCMA

Practice Resources

Help for practices of all sizes: legal handbooks, practice mgmt. guides, patient education materials, etc.

CMA Resource Library www.cmadocs.org/resource-library

Get paid: members receive one-on-one assistance. We have recouped $16 million from payors in the last 10 years.

ACCMA: (510) 654-5383 CMA: (888) 401-5911

15% discount on tamper-resistant security prescription pads and printer paper.

RxSecurity (800) 667-9723 www.rxsecurity.com/cma-order

Free CME for most educational programs for physicians and their staff.

ACCMA: www.accma.org/events CMA: www.cmadocs.org/events

Special low rates and terms for refinancing your medical school student loan.

Gayatri Brar, First Republic Bank (415) 364-4337 gbrar@firstrepublic.com

Discounts on website design packages, including mobile-friendly websites.

Mayaco (209) 957-8629 www.mayaco.com/physicians

MACRA Assistance

Magazine Subscriptions

Personal Assistance

Reimbursement Assistance Security Prescription Pads Seminars and Webinars Student Loan Refinance Program

Websites

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anterior instrumentation is to anchor the interbody biomechanical device(s) to the intervertebral disc space. The guidelines do allow, however, that “additional anterior instrumentation (i.e., plate, rod) unrelated to anchoring the device may be reported separately appending an NCCI-associated modifier such as modifier 59.”

Chapter V: Respiratory, Cardiovascular, Hemic, and Lymphatic Systems CPT Codes 30000–39999

New guidelines stipulate, “Flexible laryngoscopy and direct laryngoscopy shall not be reported for the same patient encounter.” No exceptions to this rule are allowed, per the Policy.

Added text now instructs, “Thrombectomy of thrombus in the vascular territory of a diseased artery is inherent in the work of an atherectomy procedure.” As such, you may not report 37186 Secondary percutaneous transluminal thrombectomy for the removal of such a thrombus. “For example, if a physician performs a lower extremity endovascular revascularization atherectomy, removal of any thrombus from the vascular territory of the vessel treated with atherectomy is not separately reportable.”

Collection of venous blood by venipuncture is to be reported with a single unit of 36415, per episode of care, regardless of how many times venipuncture is performed. Per the Policy, “An episode of care begins when a patient arrives at a facility for treatment and terminates when the patient leaves the facility.”

Bone marrow aspiration and biopsy codes received updates in CPT® 2018. Existing codes 38220 Diagnostic bone marrow; aspiration(s) and 38221 Diagnostic bone marrow; biopsy(ies) were revised, and 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) was 26

added to report aspiration and biopsy performed during the same encounter.

CPT® guidelines tell us not to report 38222 with 38220 or 38221 (because both biopsy and aspiration are included in 38222). Additionally, you should never report 28220 and 38221 together to report biopsy and aspiration at the same location; in such a case, 38222 is appropriate.

The NCCI Policy Manual clarifies that you may report 28220 and 28221 together if the aspiration and biopsy occur at different locations: The column one/column two code edit with column one CPT code 38221 (Diagnostic bone marrow biopsy) and column two CPT code 38220 (Diagnostic bone marrow, aspiration) includes two distinct procedures when performed at separate anatomic sites (e.g., contralateral iliac bones) or separate patient encounters. In these circumstances, it would be acceptable to use modifier 59. However, if both 38221 and 38220 are performed on the same iliac bone at the same patient encounter which is the usual practice, modifier 59 shall NOT be used. Although CMS does not allow separate payment for CPT code 38220 with CPT code 38221 when bone marrow aspiration and biopsy are performed on the same iliac bone at a single patient encounter, a physician may report CPT code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)).

Chapter VI: Digestive System CPT Codes 40000–49999

New text bundles the use of mesh or other prosthesis during hernia repair, unless specific instruction in the CPT codebook advises otherwise: Most CPT codes that describe a procedure that includes a hernia

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

repair include insertion of mesh or other prosthesis. CPT codes describing implantation of mesh or other prosthesis (e.g., 15777, 49568, 57267, 0437T) shall not be reported with a procedure including a hernia repair unless there is a CPT Manual instruction specifically stating that the implantation of mesh or other prosthesis CPT code may be reported with that procedure.

In addition, arterial anastomosis of the hepatic artery and anastomosis of the extrahepatic biliary ducts (e.g., 47760, 47780, 47800) are new specifically included as a part of (not separately reported with) liver allotransplantation (e.g., 47135).

Chapter VII: Urinary, Male Genital, Female Genital, Maternity Care, and Delivery Systems CPT Codes 50000–59999

The Policy Manual now defines radiofrequency ablation of uterine fibroid(s) (e.g., 58674, 0404T) and myomectomy of leiomyoma(ta) (e.g., 58140-58146, 58545, 58546, 58561) as mutually exclusive procedures for the same leiomyoma: For example, if a physician initiates a laparoscopic radiofrequency ablation of a uterine fibroid but must complete the procedure by laparoscopic myomectomy, only the completed procedure, laparoscopic myomectomy, may be reported. In the unusual circumstance where a physician performs radiofrequency ablation on one or more leiomyoma(ta) and it is medically reasonable and necessary to perform a myomectomy on a different leiomyoma, the physician may report both procedures.

ALAMEDA ALLIANCE

Telehealth Increases Access to Care

By Scott Coffin, CEO, Alameda Alliance for Health

Scott Coffin

A

lameda Alliance for Health (the Alliance) is proud to serve over 269,000 low-income children and adults in Alameda County. Here you will learn about why the Alliance believes that supporting Telehealth services can improve access to care for patients. You will also learn why satisfaction rates among Alliance providers improved 21 percent over the last two years, and be updated on supplemental payments from Proposition 56.

State law defines Telehealth as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care.

In 1996, California passed one of the first state telemedicine laws in the country - the Telemedicine Development Act. Since then, the state has updated and replaced the term telemedicine to the broader Telehealth, as well as expanded the range of

services. While California led the way with innovative Telehealth legislation, today’s state laws have remained mostly unchanged, even as technology has significantly evolved.

Today there is growing evidence that Telehealth is an effective alternative method for the delivery of health care. As an important component of our larger health care system, it can address challenges of access to care, cost-effective services, and delivery of limited specialty providers. With the use of technology, Telehealth can provide services, care coordination, and monitoring from a distance when the patient and provider are not in the same location. This can ensure that individuals are diagnosed and treated earlier and in turn lead to improved outcomes and less costly treatments such as emergency room visits. Education services provided via Telehealth, such as nutrition and diet control for individuals as well as exercise promotion, could also be effective ways to prevent future chronic diseases.

Additional services that may be effective utilizing Telehealth include prenatal and post-natal counseling and screening, mobile health–based complex case management, and cancer screening programs. Currently the Alliance is exploring a Telehealth pilot in order to address network constraints within behavioral health. The goal of this pilot is to use technology to increase timely access to behavioral health care that is much needed by our members.

The Department of Health Care Services (DHCS) pays for limited services provided via Telehealth and

is currently considering expanding access to these types of services.

While an expansion has the potential to improve health care outcomes for our members, we must ensure that we develop a comprehensive framework that allows us to evaluate the safety, efficacy, and quality of any future Telehealth services and programs that we offer.

Significant Gains in Provider Satisfaction at the Alliance

Provider satisfaction is often tied to sustainable and effective health care systems. That is why, at the Alliance, we strive to create a system where our providers feel valued and supported. The Alliance is happy to report that satisfaction among our providers increased to 79 percent, a significant improvement from a 58 percent rating only two years ago. The numbers reflect the results of a survey conducted by a third-party firm between November and December of 2017 of primary care physicians, specialty care physicians, and behavioral health clinicians within the Alliance network. The survey measured provider satisfaction and how well the Alliance is meeting their needs and expectations. Providers were asked to rate their overall satisfaction, compare the Alliance to other health plans, as well as other aspects. When asked whether they would recommend the Alliance to other physicians’ practices, 88.8 percent of survey respondents said they would.

Over the last couple of years, the continued on next page

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ALAMEDA ALLIANCE

(continued from page 27)

Alliance has moved from a programmatic to a member-centered approach where the health and wellness of the whole person comes first. By focusing on the coordination of care that Alliance members receive, providers are able to become better partners and contribute more greatly to delivering high-quality services. The Alliance has also focused on removing barriers to the delivery of care, greater operational efficiency and capacity, and strengthening communication with providers to better facilitate payments, authorizations, and information about patients’ medical history.

In the next year, the Alliance will be developing a new provider portal that will offer detailed views of assigned members, historical utilization, and equip providers with care management resources to deliver the best possible care. As the local health plan of choice, the Alliance provides mission-driven and publicly accountable access to care, and is dedicated to continuing to build a highly motivated provider network that promotes sustainable health care delivery practices.

Proposition 56 Supplemental Payments

In November 2016, California voters passed Proposition 56, which increased the tax rate on cigarettes and other tobacco products by two dollars per pack. The California Department of Health Care Services (DHCS) subsequently developed a supplemental payment program that requires Managed Care Plans, such as the Alliance, to make directed payments to individual providers rendering qualifying services.

During the last week of July, the Alliance issued payments to providers who rendered eligible services

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between July 1, 2017 and April 30, 2018. Payments will be issued on a monthly basis, 90 days after the payment is received from the DHCS, for services rendered after May 1, 2018.

For more information on qualifying services, please visit the DHCS website at www.dhcs.ca.gov.

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 more than 269,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care programs.

Practice & Liability CONSULTANTS Health Care Practice Management In a special arrangement with Practice & Liability Consultants, ACCMA members may purchase the following practice management kit at a reduced price: • Office StaffPersonnel Policies an d Procedures Manual

Practice consulting services available.

Debra Phairas

461 Second Street, Suite 229 San Francisco, CA 94107 (415) 764-4800 Fax (415) 764-4802 www.practiceconsultants.net

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

IN MEMORIAM

DOCTOR HAROLD (HAL) W. LUEDERS (1923– 2018) passed away peacefully in Hercules, California. Doctor Lueders was born on October 2, 1923 to William and Charlotte Lueders, and grew up in Reading, Pennsylvania. He graduated as valedictorian of his class at Muhlenberg High School in 1941, and later attended Albright College in Reading and then the Long Island College of Medicine in Brooklyn, New York (now known as the State University of New York Downstate Medical Center). Doctor Lueders served honorably in the U.S. Army as a private during WWII from 1942 to 1946, and after medical school, as a First Lieutenant during the Korean War from 1951 to 1953, where he led a Mobile Medical Lab in Chuncheon, South Korea. In 1957, he completed his surgical residencies at the Albany Medical Center in Albany, New York and moved to California, settling in the San Francisco East Bay. Doctor Lueders spent the next half-century working as a plastic surgeon, focusing on reconstruction of the head, face, and hands, and burn treatment. He published three research papers in the journal Plastic and Reconstructive Surgery that continue to be cited to this day. He was a member of the ACCMA for 44 years. He will be remembered fondly by all for more reasons than space allows here—a few of which include his cheerful humor, tireless work ethic, and wonderful bowties.

He is preceded in death by his wife Eleana, and sons Lance, Mark, Louie, and Timothy, and leaves behind sons Kevin and Matthew, and daughters Lesley and Emilie.

DOCTOR EUGENE (GENE) STANLEY SHREYER (1924–2018) was born July 10, 1924 in Windsor, California, and died on June 13, 2018, in Silverton, Oregon, one month short of his 94th birthday. He suffered from a massive stroke, which was the ultimate cause of his death. Doctor Shreyer was the son of Albert and Jessie (Woodbury) Shreyer. His father was born in Sereth Bukovina, Romania and his mother in Lincoln, Nebraska. He was a lifelong member of the Seventh Day Adventist Church. He was home schooled by his mother for the first few years and then attended Seventh Day Adventist Christian schools for the remainder of his schooling. This included Pacific Union College in California and then the medical school at the College of Medical Evangelists (now known as Loma Linda University School of Medicine), from which he graduated in 1948. He interned at Porter Adventist Hospital and Sanitarium in Denver, Colorado from July 1948 to July 1949.

From there, he set up a general practice in Somerton, a small town in southern Arizona, where he served one term as mayor.

During WWII, Doctor Shreyer was in the US Army Reserve and was sent back to school to finish his pre-med course with no active duty. Then the Korean War started and there was a special draft of all doctors who had less than two years of active duty during WWII. By then, he had completed one year of residency in Anesthesiology at the White Memorial Hospital in Los Angeles. He was also married and had three children. His orders were to be sent to the 10th Field Hospital in Wurzburg, Germany. He was there for a couple of months before he was able to bring his family over to join him for the remainder of

his time in the service. Doctor Shreyer was married to Phyllis Jean Kesler, his high school sweetheart, on July 4, 1946 in Berkeley, California. They had three children—Karen, Donald, and Cynthia. Phyllis passed away in 1977 at age 51 from cancer. A year later, on March 19, 1978, Doctor Shreyer was married to Joy (Coon) Semmens, a widow belonging to the same church at which he and Phyllis were members, the Seventh Day Adventist Church in Pleasant Hill, California. He was a member of the ACCMA for 41 years.

Doctor Shreyer had many interests, chief of which were reading, eating, and napping. Both he and Joy shared mutual interests in rockhounding (amateur geology) and birdwatching; they belonged to a couple of rockhounding clubs and also to the Audubon Society. Doctor Shreyer served several times as head Elder in his church in Pleasant Hill, was on the church board, and was honored twice for his active support of the Pleasant Hill Adventist Academy School, which all of his three children attended. Recently he was in charge of Disaster Preparedness at his local Seventh Day Adventist Church in Silverton, Oregon.

Doctor Shreyer also loved to travel but mostly in the western US where there are wide open spaces. He and Joy were also active in starting annual camping trips for the church. They started out as rockhounding trips to central Oregon but later became an all-church event.

Doctor Shreyer leaves his wife Joy and three children: Karen Davis, Donald Shreyer, Cynthia Perrin; three grandchildren: Stephanie (Perrin) Sherman, Matthew Perrin, Andrea Davis; five great-grandchildren: Maxson Sherman, Aiden Sherman, Katherine Perrin, Jessie Sherman, and Anna Perrin; many nieces and nephews; sisters-in-laws Ramona Resseger and Nancy Edgar; brother-in-law Hugh Coon; and many friends in the Seventh Day Adventist Church.

DOCTOR STEPHEN JOHN SOMMER (1939– 2018) passed away from Parkinson’s disease on May 26 in Napa with his family by his side. He is survived by his wife Suzanna of 46 years (Napa), daughters Amalia Kulczycki (Napa), April Maurath Sommer (Walnut Creek), Tiffany Sommer (Portland, Oregon), and four grandchildren. He is fondly remembered as a generous, quiet, compassionate person, with a humble heart—a man of few words but whose words were almost always heartfelt and meaningful. He was born and raised in Lincoln, Nebraska to Rachel and Henry Sommer, who were of Volga Deutsch descent—a heritage of which Steve was very proud. He is survived by his brother Michael (Petaluma) and sisters Susan and Melody.

Doctor Sommer was a childhood survivor of polio and this was a powerful impetus for him to become a physician. He attended the University of Nebraska, where he earned his BA (zoology, Phi Beta Kappa), MS (cellular biology), and MD (1968).

He completed his residency at Kaiser Hospital in Oakland.

In 1976 Doctor Sommer opened Avenue Family Practice on Piedmont Avenue in Oakland and became the neighborhood physician for generations of families. In 2004 he opened a continued on next page

ACCMA BULLETIN | July/August 2018

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CLASSIFIEDS

POSITION AVAILABLE – 1

OFFICE ADMINISTRATOR IN ANTIOCH: Busy Antioch medical practice is seeking an Office Administrator to manage four locations and a surgery center. We are looking for a candidate who can think critically and work independently. Must be a team player who is organized, innovative, energetic with good communication skills, and attention to detail. Will need three (3) years of experience in human resources, employee hiring, EHR RCM, and purchasing. It is important that candidates have experience in a medical practice. Responsibilities to include, but not limited to, facility management, including optical shop and surgery center. Administrator will communicate and report to managing partners. BA or equivalent experience. Competitive salary. Email cecmgr@pacbell.net. (1 – July/ Aug – Sept/Oct) PHYSICIAN IN EAST BAY: Epic Care is seeking an Internal Medicine or Family Practice physician to join our busy primary care practice in the East Bay. This is an outpatient-only clinic. Full-time or part-time options are available. Please

IN MEMORIAM

send CV and inquiries to hr@epic-care. com with your contact information. (1 – July/Aug – Sept/Oct)

OFFICE FOR RENT – 3

CASTRO VALLEY MEDICAL OFFICE SPACE AVAILABLE: 2,400 s.f. newly renovated office space on Lake Chabot Road directly across from Eden Hospital.

Location ideal for many uses. Original design as two medical office suites but has been combined now into one large unit, or willing to divide into 1,000 s.f. and 1,400 s.f. office suites again, each with separate entrances and utilities.

Ground-level single-story building with three suites. Ample off-street parking, seven exam rooms (three/four, six with sinks), very large reception area, and front office workspace. Break room and lab areas. Each unit has a private office. Tons of storage, windows, and natural light in all rooms. Two private courtyards. Owner occupies third suite. $6500/mo. ($2700/$3800, if divided), plus PG&E (separately metered) and garbage. Simple lease. Call (510) 914-3928 or stop by 20100 Lake Chabot Road. (3 – July/Aug – Sept/Oct)

(continued from page 29)

second office close to home in Lafayette where he practiced until his retirement in 2015. Patients knew him as a reliable, caring, and compassionate family physician who was willing to spend as much time necessary with every patient. He had a special gift for counseling, helping patients find peace of mind and equilibrium in their lives.

He was very proud of the fact that he had multiple generations of the same families as patients. He was a member of the ACCMA for 41 years, and served on the ACCMA Professional Liability Committee from 2012 to 2016.

He loved his girls, his garden, and his pet dogs, cats and rabbits. As a father, he was engaged, generous, mild-mannered, and unconditionally proud and loving. He listened with an open heart and encouraged his daughters to find and explore their own paths—he was happy if they were happy. He enjoyed lunch dates with kids at Fenton’s and Chow, chocolate, ice cream, and the German language. He was a baby whisperer. Cooking was his forte although he was also known for lovingly made but sadly unappetizing kids’ school lunches. He made sure his children got to know the US on frequent family trips, his favorite being New Orleans for Mardi Gras. Education was a core value for Steve and he made it possible for his wife and daughters to reach their educational goals as professional women.

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

PRIME PILL HILL MEDICAL/ SURGICAL OFFICE SPACE AVAILABLE: Well-appointed 940 sq. ft. office opposite Summit Hospital, beautiful view, available for sublease. Currently set up for minor office procedures, available fully equipped and furnished, or not, as desired. The office comes with a shared waiting room and two parking places. For further information, contact Rod Perry, MD at (510) 419-0211. (3 – May/Jun – Jul/Aug)

PRACTICES FOR SALE – 10

IN CONTRA COSTA COUNTY: This is a 2,500 sq. ft. esthetic skin care and phlebology practice that grossed over $1.4 million in 2017, a long-established practice that sees up to 185 patients/ month. Three exam rooms and two fully equipped surgery rooms are included in the modern, high-end office. The office features a very dedicated staff, including esthetic RNs and an LVN, all of whom are able to stay on board through a sale.

Please contact Venus Gutierrez at (888) 277-6633 for more information. (10 – May/Jun – July/Aug)

To place a classified ad, go to www. accma.org > About Us > Advertising,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.

Helping People in Our Community Since 1996

A L A M E D A

C O U N T Y

www.alamedaalliance.org

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

PRSRT STD US POSTAGE PAID 85719 PERMIT NO 271

ADDRESS SERVICE REQUESTED

MIEC just announced $15 Million in dividends.* As a member-owned exchange, MIEC provides policyholders with medical professional liability insurance with a vastly superior dividend policy. Our mission is to deliver innovative and costeffective medical professional liability protection and patient safety services for physicians and other healthcare professionals.

MIEC has never lost sight of the medical associations who support our policyholders, and continues to provide the service and support they deserve.

To learn more about becoming an MIEC policyholder, or to apply, visit miec.com or call 800.227.4527. *On premiums at $1/3 million limits. Future dividends are not guaranteed.

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