ACCMA Bulletin May/June Issue

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

HIGHLIGHTS FROM THIS ISSUE:

• ACCMA decides on 2023’s major issues impacting physicians • Lobbying legislators in Sacramento

• Physician Leadership Program concludes • Understanding CalAIM

• Updated training requirements to prescribing controlled substances

May/June 2023

TAKING BACK CONTROL Practical Strategies to Reduce the Administrative Hassles of Daily Medical Practice Friday, June 16th | 9:00 am to 3:00 pm

In-person Event | Lafayette Library, Don Tatzin Room 3491 Mount Diablo Blvd, Lafayette, CA 94549 | Free On-site Parking

Register at bit.ly/3LOjkit Free for members of the Bay Area Medical Societies For Physicians of All Specialties, Modes of Practice, and Career Stages

Join physician colleagues from across the Bay Area for a robust day of thought leadership and information sharing through interactive workshops and panel discussions focused on tackling the daily pain points of medical practice. This conference will equip you with practical tools and skills that you can apply immediately to your medical practice. You should leave feeling empowered with new ideas to minimize administrative burdens and restore joy to the practice of medicine.

Event Topics include: Interactive Workshop: Managing your Inbox, Medication Management, and Other Pain Points of Practice Expert Update: Current Advocacy Efforts to Reduce Administrative Burdens Panel Discussion: Practical Solutions to Alleviate Daily Administrative Challenges

Paul DeChant, MD Event Chair & Keynote Speaker, Presenting: Healthy Workplaces Equal Healthy Physicians - Making Healthy Places for Physicians to Practice

Continental breakfast and catered lunch will be served.

Stay after the event for a summer wine and beer reception!

Limited capacity (no-shows will be invoiced $200 post-event)

Presented in collaboration with:

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ACCMA EXECUTIVE COMMITTEE Edmon Soliman, MD, President Albert Brooks, MD, President Elect Irene Lo, MD, Secretary-Treasurer Robert Edelman, Immediate Past President COUNCILORS Lisa Asta, MD Eric Cain, MD Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD James Hanson, MD Terry Hill, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Steve Lee, MD Terence Lin, MD Kristin Lum, MD Nimisha Mishra-Shukla, MD Aileen Murphy, DO Kiran Narsinh, MD Ross Pirkle, MD Stephen Post, MD Jeffrey Poage, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Suresh Sachdeva, MD Jonathan Savell, MD Sonia Sutherland, MD Clifford Wong, MD Sijie Zheng, MD CMA & AMA REPRESENTATIVES Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, CMA Trustee Katrina Peters, MD, CMA Trustee

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

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News & Comments

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Recent Activities & Upcoming Events

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Building Camaraderie Among Physician Members

YOUR ADVOCACY 7

PRESIDENT’S PAGE Taking the Lead on Major Issues Impacting the Practice of Medicine

By Edmon Soliman, MD, FACP, ACCMA President

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IN YOUR PRACTICE 13

The Conclusion of the 6th Physician Leadership Program

Six Steps to Help You Secure Your Retirement

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May/June 2023 | Vol. LXXIX, No. 3

2023 Legislative Advocacy Day

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Updated Training Requirements for Prescribing Controlled Substances

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Safety Huddles in the Ambulatory Setting By the Medical Insurance Exchange of California (MIEC)

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Meet ACCMA’s Newest Team Members

Understanding CalAIM

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In Memoriam

Honoring a Local Leader Working to Curb the Opioid Epidemic

ACCMA STAFF Joseph Greaves, Executive Director Griffin Rogers, Director, Napa Solano Medical Society David Lopez, Director of Advocacy and Governance Meghan Arthurs, Director of Community Health Jennifer Mullins, Assoc. Director of Education & Events Alejandra Hinojosa, Marketing & Communications Manager Christine Maki, Administrative 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

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

ACCMA BULLETIN | MAY/JUNE 2023

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NEWS & COMMENTS

PRIOR AUTHORIZATION BILL

UPDATED PAYOR PROFILES FOR 2023

HHS AWARDS $147 MILLION TO END THE HIV EPIDEMIC

NOMINATE A DESERVING COLLEAGUE

A CMA sponsored bill to reform the prior authorization process passed out of Senate Health Committee on April 12. Senate Bill 598, authored by Senator Nancy Skinner, would require health plans to institute a one-year “gold card” prior authorization exemption for physicians who are practicing within the plan’s criteria 90% of the time. It would also grant treating physicians the right to have their appeal of a prior authorization denial conducted by a physician in the same or similar specialty.

HHS awarded more than $147 million to 49 recipients to advance the Ending the HIV Epidemic in the U.S. (EHE) initiative, which is part of the Biden-Harris Administration’s ongoing efforts to reduce the number of new HIV infections in the United States by at least 90 percent by 2030. This funding will help states and metropolitan areas with the highest levels of HIV transmission link people with HIV to essential care, support, and treatment, as well as support training and other resources for these jurisdictions. In the Bay Area, San Francisco EMA was awarded over $2.5 million and Oakland TGA was awarded $2 million.

SIMPLIFIED USE OF COVID VACCINES

On April 18, the FDA amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines to simplify the vaccination schedule for most individuals. This action includes authorizing the current bivalent vaccines (original and omicron BA.4/BA.5 strains) to be used for all doses administered to individuals 6 months of age and older, including for an additional dose or doses for certain populations. The monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States.

COVID NO LONGER A GLOBAL EMERGENCY

The World Health Organization declared the end of COVID-19 as a global health emergency, reporting that the situation has markedly improved with less mortality and increased immunity against the virus. In similar news, the CDC announced that it plans to scale back the data the agency will report about COVID-19; one of the biggest changes being that the CDC will no longer regularly track and release the new number of infections.

MIPS HARDSHIP EXCEPTION APP OPEN

Physicians may now apply for an Extreme and Uncontrollable Circumstances hardship exception to avoid an up to 9% penalty in the Merit-based Incentive Payment System (MIPS). The penalty would apply in 2025 based on the 2023 performance period. The exception will not be automatic, and interested physicians and groups must actively request reweighting of one or more MIPS performance categories due to the COVID19 PHE. Requesting reweighting of all four MIPS performance categories will avoid a MIPS penalty in 2025. Applications can be submitted through Jan. 2, 2024.

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CMA’s Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, UnitedHealthcare, Medi-Cal and Medicare (Noridian).

Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Visit cmadocs.org/practice-management#payor-profiles.

The Dr. J Elliott Royer Award program provides recognition to persons who practice medicine in Alameda, Contra Costa, or San Francisco counties and have made significant contributions to the advancement of neurology. The award alternates each year between the specialties of Neurology and Psychiatry.

This year, two recipients will be selected for this cash award of $30,000, one to an academic neurologist and the other to a community-based practitioner. The committee will accept no more than three letters - one nominating and two supporting.

The nomination must be accompanied by a curriculum vitae.

Please submit nominations no later than June 2 as one complete PDF to: stephanie.belger@ucsf.edu.

PRIOR AUTHORIZATION FOR GASTROENTEROLOGY SERVICES

UnitedHealthcare (UHC) recently announced it will begin requiring prior authorization (PA) for certain gastroenterology endoscopy services for commercial plan members effective June 1, 2023. The following procedures are included in the new PA requirements: esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies, surveillance colonoscopies. Screening colonoscopy procedures are not included in this new PA requirement.

BILL TO PROTECT CA PHYSICIANS MAILING ABORTION MEDICATION

Doctors in California who mail abortion pills to people in other states would be protected from prosecution under a new bill, SB 345, announced Friday in the state Legislature. The bill would not let CA extradite doctors who are facing charges in another state for providing abortion medication. It would also shield doctors from having to pay fines and it would let CA doctors sue anyone who tries to stop them from providing abortions.

VACCINE FOR RSV RECEIVES APPROVAL

Federal regulators gave the green light to the first-ever vaccine to prevent the respiratory disease RSV on Wednesday, a major breakthrough that’s been decades in the making. The FDA approved Arexvy, developed by GlaxoSmithKline (GSK), to prevent lower respiratory tract disease caused by RSV in adults aged 60 and older. The FDA is also considering Pfizer’s maternal RSV vaccine, intended to be given to pregnant individuals to help protect infant’s against RSV.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEWS & COMMENTS

APM INCENTIVE PAYMENT EXTENDED THROUGH 2023

In December 2022, Congress enacted provisions of the Advanced Alternative Payment Model (APM) Consolidated Appropriations Act, 2023 that extended the availability of an APM Incentive Payment, allowing eligible APM participants for the 2023 performance period to receive a 3.5% APM Incentive Payment in the 2025 payment year. For the 2023 performance period and the associated 2025 payment year, the APM incentive payment will decrease from 5.0% to 3.5% of the participant’s estimated aggregate payments for covered professional services in the performance year. If you meet the requirements to be a QP in the 2023 performance period, you will not need to do anything to receive your payment in 2025, unless CMS is unable to verify your Medicare billing information.

MEDICARE REIMBURSEMENTS

As you may know, physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update. As a result, Medicare physician payments have lagged 26% behind the rate of inflation growth since 2001. During this current period of record inflation and coming on the heels of a highly disruptive pandemic, this statutory flaw often amplifies the impact of other payment policy changes like “budget neutrality” adjustments, performance incentives, and so forth. Please take a moment and contact your legislators and urge them to help fix the flawed Medicare physician payment system by supporting H.R. 2474 today. Visit bit.ly/42v7VJc to send them a quick message.

CMS TO ROLLOUT PECOS 2.0 THIS SUMMER

The Centers for Medicare and Medicaid Services (CMS) announced that it will roll out an update to the Provider Enrollment Chain and Ownership System (PECOS) in the summer of 2023. PECOS is Medicare’s online system allowing users to securely submit and manage Medicare enrollment information. Some of the updated features for PECOS 2.0 include: one application can create multiple enrollments, streamlined data entry, tailored application process, ability to manage group members more efficiently, revalidation reminders, rapid application reviews, and real-time status tracking. While there will be many changes in the new system release, login information will remain the same and all current PECOS enrollment records will transition into PECOS 2.0.

TRAINING FOR PRESCRIBING CONTROLLED SUBSTANCES

Physicians are reminded that effective June 27, 2023, prescribers applying for a new U.S. Drug Enforcement Agency (DEA) registration or renewing their DEA registration must attest to having met the new training requirements for DEA-registered prescribers of controlled substances. A new law requires all prescribers of schedule II – V controlled substances to meet a one-time eight-hour training requirement on identifying, treating, and managing patients with opioid or other substance use disorders. Read more on page 18.

LOOKING FOR SUPPORT?

ACCMA offers sponsored psychotherapy to all members, including residents. Physicians can meet with a therapist for up to four sessions at no charge to you. Visit ACCMA.org/Mental-Health-Clinicians for a list of vetted therapists, give them a call, and let them know you would like to take advantage of ACCMA Sponsored Psychotherapy sessions.

Members of the ACCMA Advisory Committee on Physician Wellbeing are also available to provide immediate peer support at no cost. Peer support can encompass moral and emotional support to physicians who are experiencing stress related to medical malpractice lawsuits or a medical board investigation, as well as support in relation to physician burnout.

Call us or send an email to wellbeing@accma.org​ to request this confidential service.

PHYSICIANS NURSE PRACTITIONERS PHYSICIAN ASSISTANTS LOCUM TENENS PERMANENT PLACEMENT

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COMMITTEES & EVENTS

ACCMA Recent Activities The ACCMA Advisory Committee on Physician Well-Being and Litigation Stress Subcommittee met on March 21 and received an update from Dr. Karen Miotto about the Medical Board of California’s Physician Health and Wellness program.

UPCOMING EVENTS ACCMA ADVISORY COMMITTEE ON PHYSICIAN WELLBEING MEETING Thursday, June 1 | 6:00 to 7:30 pm

EAST BAY SAFE PRESCRIBING COALITION STEERING COMMITTEE MEETING Tuesday, June 6 | 6:00 to 7:30 pm

LEADERSHIP READING & DISCUSSION GROUP Wednesday, June 7 | 6:00 to 7:30 pm

DISTRICT IX DELEGATION MEETING Thursday, June 8 | 6:30 to 8:00 pm

TAKING BACK CONTROL - CONFERENCE Friday, June 16 | 9:00 to 3:00 pm

ACCMA MED SERVICES, TECHNOLOGY, & QUALITY OF CARE COMMITTEE MEETING Thursday, June 22 | 6:00 to 7:30 pm

HEALTH EQUITY TASK FORCE MEETING Thursday, June 29 | 6:30 to 8:00 pm

Additionally, the committee continued their discussion around physician coaches and reviewed a potential resolution that can be submitted to the CMA Year-Round Resolution process.

The ACCMA Community Health Committee met on March 23 and received a presentation from Yesenia Lott, Alameda County Behavioral Health Care Services Interim Division Director, and Yolanda Takahashi, Alameda County CATT Project Manager, on the Mobile Crisis Team and the Community Assessment and Transport Teams in Alameda County. The committee also discussed medication drug shortages and the effects this issue is having on providing the best quality of care for our patients.

The ACCMA Executive Committee held their annual retreat between April 14 to 16. During the Retreat, the Executive Committee discussed ACCMA’s strategic priorities and how to better engage members of group practice and inform them of the efforts of the ACCMA. The Executive Committee ended the Retreat with a discussion on organizational business efforts and plans to work with ACCMA Council on prioritizing business recommendations for the upcoming year. Topics discussed included things like member affinity group engagement, bulletin review, and much more.

The ACCMA Finance Committee met on April 25 and received a presentation from Delucci Hawn on the Annual Financial Review. They also reviewed the ACCMA Investment Portfolio that was presented by Well Fargo Advisors. On top of that, the committee reviewed the financials and bank statements for ACCMA and all its subsidiaries, revised investment policy statement, and banking services.

BAY AREA PHYSICIAN WELLNESS COLLABORATIVE Tuesday, July 11 | 6:00 to 8:00 pm

JOINT MEETING OF THE EXECUTIVE AND FINANCE COMMITTEES Tuesday, July 25 | 6:00 to 8:00 pm

SAVE THE DATE

ACCMA 155TH ANNUAL MEETING Friday, November 3rd, 2023

Whether you are a member at large or serve on an ACCMA Committee, all members are welcome to join any meeting or event to learn more about what the association is focused on. Call us at (510) 654-5383 to RSVP or if you have any questions.

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PRESIDENT'S PAGE

Taking the Lead on Major Issues Impacting the Practice of Medicine

By Edmon Soliman, MD, FACP, ACCMA President

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very year, physicians around the East Bay are tasked with thinking about the biggest issues facing the practice of medicine and developing recommendations for the CMA House of Delegates (HOD), which convenes in October. It marks the start of an important process that steers the course of our statewide advocacy efforts and helps establish broad policy based on what we, as physicians, have determined to be the major issues affecting the practice of medicine.

Our members serving on the ACCMA District IX Delegation meet throughout the year to debate and outline policy in preparation for the HOD. Last year, mental health, physician workforce, and health care reform were the three major issues at the forefront of the conversation.

This year, we have elected to submit three topics to the CMA House of Delegates for consideration of major issues for the year: medication drug shortages, gun violence, and the politicization of evidence-based scientific and medical information. These issues have had a significant impact on our patient population, continuing to put patient lives at risk and threatening our ability to provide quality care.

Many physicians are currently facing or will soon face medication drug shortages that inhibit our ability to provide the best care for our patients. According to a recent US Homeland Security and Government Affairs report, drug shortages increased by nearly 30% in 2022. This includes common antibiotics, anesthetics, and sterile fluids used to keep intravenous drug tubes clean1. Medication drug shortages will continue to occur in the coming years, and California must take the lead on this issue before it gets worse. California is already taking one step with Governor Newsom’s plan to produce low-cost insulin. It is imperative to continue to work together to ensure that we develop ways to combat medication drug shortages so that we can provide the best care for our patients.

Of course, we have all seen the toll that gun violence has taken on our communities. The medical community should

continue to speak against gun violence and expand on CMA’s and AMA’s current policy by developing novel approaches on how physicians can aid in preventing the destruction caused by this epidemic. Emergency physicians and trauma surgeons must be brought to the forefront of the discussion, as they are at the frontline, treating most gun wounds that arrive at the hospital. We cannot discuss gun violence without also incorporating mental health into the conversation, with the priority of developing a preventative care plan to tackle both issues.

Since the COVID-19 pandemic began in 2020, medical misinformation and politicization of evidence-based scientific information has increased worldwide2. This issue creates challenges when trying to meet our patients’ needs and in delivering medical care. One such example of the impact of the politicization of evidence-based practices is the debate on vaccinations that was exacerbated by COVID-19, leading to misinformation and challenges in preventing the spread of the virus. This is tantamount to political hijacking of medical recommendations which would otherwise sit squarely “in our lane” as physicians, resulting in lack of patient care and the censorship of physicians. We must work to develop policy and bring this issue forward to protect our patients and help society regain trust in physicians and in the practice of medicine.

Ultimately, the “major issues” for HOD are decided through a thorough and democratic process in the CMA. Whatever they end up being, the ACCMA looks forward to providing further advocacy and guidance on the topics we submitted for the betterment of the communities in which we live.

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Jewett, C. (2023, March 22). Rising rate of drug shortages is framed as a national security threat. The New York Times. Retrieved May 5, 2023, from https://www.nytimes.com/2023/03/22/health/drug-shortages.html Hendrix, J. M., Sharp, C. D., Page, S. L., & Popovich, M. (2023, April 1). The disinformation and politicization of Health Care. ASA Monitor. Retrieved May 5, 2023, from https://pubs.asahq.org/monitor/article/87/S4/40/137964/ The-Disinformation-and-Politicization-of-Health

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MIDWEEK WIND DOWN

Building Camaraderie Among Physician Members

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CCMA invited local physicians to enjoy a Wednesday evening "Midweek Wind Down" in Downtown Walnut Creek. Members gathered from around the area to enjoy good

Drs. Christian Kirman, Irene Lo, Aileen Murphy and Merry Uchiyama enjoying an ACCMA-hosted event at Retro Junkie in Walnut Creek

food and drinks, as well as watch our Golden State Warriors defeat the Sacramento Kings. It was a fun, relaxing evening and we hope you will join us for upcoming social events in the near future.

Family is everything: Dr. Sonica Shah, ACCMA President Dr. Edmon Soliman, Dr. Arseen Soliman, and Jolene Soliman.

Drs. Lilly Chen and Cathy Dugan from The Permanente Medical Group.

Feeling full and happy from Villas Tacos: Drs. Eric Chen, Edmon Soliman, Sonica Shah, Jonathan Savell, and Dr. and Mrs. Sachin Kapoor.

TPMG Pediatricians gather: Drs. Khattar, Co, and Byrnes-Finger.

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LEGISLATIVE DAY

2023 Legislative Advocacy Day

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n April 19, the ACCMA attended the California Medical Association’s (CMA) 49th Annual Legislative Advocacy Day in Sacramento, CA. Each year CMA’s Legislative Advocacy Event hosts more than 400 California physicians, medical students, and CMA Alliance members as they lobby legislative leaders in the State’s Capitol. This year we had the opportunity to meet with all our East Bay legislators to discuss several priority bills.

PHARMACISTS SCOPE OF PRACTICE Oppose SB 524 (Caballero) – This bill would allow pharmacists to perform tests that are Clinical Laboratory Improvement Amendments (CLIA) waived and Food and Drug Administration (FDA) approved. Pharmacists will be authorized to furnish and prescribe treatments for any positive test outlined in this bill, including antibiotics for various illnesses, conditions, and diseases.

This bill poses a risk to patient safety by removing physicians from the care team and undermines the importance of person-centered care, treating symptoms instead of the patient.

REFORMING PRIOR AUTHORIZATION Support SB 598 (Skinner) – This bill reforms the prior authorization process to ensure timely access to treatments, improve patient health outcomes and improve the efficiency and effectiveness of physician practices to increase patient access to care. The bill allows physicians practicing within a health plan’s utilization criteria 90% of the time to get a one-year exemption from prior authorizations. SB 598 is a balanced approach that ensures physicians practice within a plan’s criteria without undue burdens from the plan.

PROTECTING PHYSICIAN TITLES Support AB 765 (Wood) – This bill would limit non-physicians from using terms that would make patients believe they are physicians when they are allied health professionals or other providers. An example of this would be preventing nurse anesthetists from calling themselves “nurse anesthesiologists.” The bill protects physician titles from being improperly represented and protects patients from making misinformed decisions.

OPTOMETRISTS SCOPE OF PRACTICE Oppose AB 1570 (Low) – This bill would expand the scope of practice for optometrists to perform advanced surgical and laser procedures with minimal training. These procedures include corneal crosslinking and laser trabeculoplasty, among others.

Under this bill, optometrists would then qualify to perform these advanced procedures after completing only 43 various eye surgical procedures. This bill would put patients at harm by allowing the underqualified optometrist to perform advanced continued on page 12 ACCMA BULLETIN | MAY/JUNE 2023

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2022 ANNUAL MEETING

Medical Professionals BE A MEDICAL MISSIONARY IN YOUR OWN BACKYARD You do not need to go overseas to serve the under-privileged and poor!

Are you looking for an opportunity to volunteer just a few hours a month to help bring quality health care to the poor and uninsured in your local community? We provide urgent and primary care in East Contra Costa County.

Please join our VOLUNTEER team at the RotaCare Pittsburg Free Medical Clinic at: St. Vincent de Paul, 2210 Gladstone Dr., Pittsburg, CA, 94565 We are in great need of licensed Physicians (Adult Medicine, ER, GP, Family Practice, or Internal Medicine) to volunteer just 3 hours once a month or every other month. We are open on Wednesdays and the second and fourth Saturday of each month.

The fully equipped,

licensed clinic has 4 exam rooms, an on-site pharmacy, lab, X-ray, and diagnostic services. All malpractice insurance provided.

Contact our Clinic Administrator to learn more: Pittsburg@rotacarebayarea.org or (925) 439-2009

PHYSICIAN LEADERSHIP

Celebrating the Conclusion of the 6th Physician Leadership Program

By Dr. Hilary Worthen, Course Director

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his April, the 6th annual Bay Area Physician Leadership Program came to a close. The Physician Leadership Program originally began under the auspices of the ACCMA in collaboration with UC Berkeley’s Schools of Public Health and Haas School of Business, and is now a program of the Bay Area Medical Societies. The program offers physicians frameworks, concepts, tools, and skills to support effective leadership across organizational contexts. The course continues to benefit from grant support from The Physicians Foundation.

The ACCMA was happy to welcome our 41 physician leaders in person again for the first and final sessions of the program. The remaining sessions were held online, all lead by our seasoned faculty. Participants represented 18 institutions from five Bay Area Medical Societies.

We look forward to building on our successes and meeting a new cohort of physicians and, of course, continuing the privilege of working with our faculty. For information on participating in the next cohort, contact Jennifer Mullins at jmullins@accma.org or the (510)-654-5383.

Course Director, Dr. Hilary Worthen, offering a final inspiring lesson for our newly-trained physician leaders

Participants join a group activity to enhance their story telling skills.

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PHYSICIAN LEADERSHIP (continued from page 11)

Dr. Man Kit Leung from San Francisco participates in discussion on how to inspire individuals, a valuable tool in leadership.

Dr. Heyman Oo from Marin Community Clinics provides insight into the discussion on Influence and Inspiration led by Course Director, Dr. Hilary Worthen.

LEGISLATIVE ADVOCACY DAY (continued from page 9)

eye surgeries. This same bill, AB 2236 (Low) was vetoed by the Governor last year. No changes were made to it before it was re-introduced this year.

INCREASING MEDI-CAL RATES The California Legislature has done a tremendous job expanding health care coverage in the state and fundamentally revamping Medi-Cal through CalAIM. Now we need to work on creating more access for Medi-Cal recipients to physicians. Medi-Cal’s base reimbursement rates paid to health care providers have not been raised since the 2000-2001 budget. In fact, due to budget deficits, California cut rates in 2008 and 2011, including reductions that continue to this day. To truly provide Health Care for All, we need to address the issues of rates, which often fail to cover even a fraction of the cost of providing care and make it difficult for providers to see Medi-Cal patients.

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We would like to thank our East Bay legislators and attendees for making this Legislative Day a success. For any questions regarding any of these issues please contact Mr. David Lopez, ACCMA Director of Advocacy and Governance, at dlopez@ accma.org or (510) 654-5383.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

THANK YOU, LEGISLATORS! The ACCMA thanks the following legislators who met with ACCMA members on priority health care issues during 2023 Legislative Advocacy Day: Senators Nancy Skinner, Steve Glazer, and Aisha Wahab; and Assemblymembers Tim Grayson, Mia Bonta, Buffy Wicks, Rebecca Bauer-Kahan, Liz Ortega-Toro, and Alex Lee

HEALTH EQUITY

Understanding CalAIM ABOUT CALAIM California Advancing and Innovating Medi-Cal (CalAIM) is a state-led initiative aimed at improving the quality of care and health outcomes for Medi-Cal beneficiaries1. Governor Newsom describes CalAIM as, “a once-in-a-generation opportunity to completely transform the Medicaid system in California.”

More specifically, CalAIM provides a five-year roadmap to make Medi-Cal more equitable and person-centered2 by strengthening partnerships between managed care programs, community organizations, healthcare providers, counties, and the state legislature. Implementation of CalAIM began in January of this year and will continue into 2027.

CalAIM has several goals, including: 1) to address health disparities and promote health equity by improving access to care and addressing the social determinants of health; 2) to provide comprehensive, coordinated, and patientcentered care that addresses the physical, behavioral, and social needs to Medi-Cal beneficiaries; and 3) to emphasize value-based care rather than the volume of services provided (i.e., providers are paid based on quality of care and health outcomes).

CALAIM TARGET POPULATION According to the California Health Care Foundation, CalAIM will serve the following patient populations: • Those with significant behavioral health needs (e.g., mental illness, substance use disorder, etc.)

• Those experiencing homelessness • Those transitioning from jail or prison back to the community • Older adults and/or individuals living with disabilities • Children with complex medical conditions (e.g., cancer, congenital heart disease, etc.)

• Children in foster care CHALLENGES TO IMPLEMENTATION There are several challenges to implementing CalAIM. There is a need for significant funding to implement and sustain the program amid on-going state budget cuts and other funding constraints. CalAIM involves significant changes to California’s Medicaid program, and implementing these changes will require significant funding.

Another challenge is the relatively small community workforce. CalAIM will require a well-trained and diverse workforce to deliver person-centered care and provide services in community-based settings; however, there may be challenges in recruiting and sustaining a sufficient number of qualified providers to meet the needs of the Medi-Cal population.

There are also challenges in the ability of many state and community organizations to collaborate and share data. CalAIM relies heavily on data to identify areas for improvement and track progress towards its goals; however, there may be challenges in collecting and analyzing this data, particularly in rural and underserved areas.

Finally, ensuring effective engagement and collaboration among a wide range of stakeholders, including patients, providers, community organizations, and policymakers requires significant effort on all parties and proves to be a challenge in implementation of CalAIM. WHAT CALAIM MEANS FOR PHYSICIANS CalAIM will affect clinical practice by changing the way in which care is delivered to Medi-Cal patients. Under CalAIM, providers will be expected to help provide holistic, person-centered care, including addressing the social determinants of health that may impact their patients’ health outcomes. They may also be required to participate in value-based payment models and focus on improving the quality of care and patient health outcomes.

Interested in learning more? The ACCMA is hosting an educational event in July centered around how and where physicians fit into CalAIM. More details coming to your inbox soon, or call ACCMA at (510) 654-5383 if you want to learn more.

Explore the following resources for more information about CalAIM: • California Department of Health Care Services (DHCS) –DHCS.ca.gov/CalAIM provides a wide range of information about CalAIM as well as links to additional resources for providers and stakeholders.

• California Health Care Foundation (CHCF) – The CHCF is an independent, nonprofit philanthropy organization based in Oakland, California. CHCF works in collaboration with a wide range of stakeholders continued on page 17

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ACCMA STAFF

ACCMA's

155

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ANNUAL MEETING

Friday, November 3, 2023 Claremont Club & Spa, Berkeley, CA

Support our students

Become a sponsor for the ACCMA Annual Meeting and attend an evening of celebration and camaraderie. All proceeds benefit the ACCMA Scholarship Program that supports local UCSF/UC Berkeley medical students – the more money we raise, the more medical students we can support!

Contact Jennifer Mullins, Associate Director of Education and Events, at (510) 654-5383 or jmullins@accma.org to secure your sponsorship or for more information.

ACCMA STAFF

Meet ACCMA’s Newest Team Members IAN ERLICHMAN, OPIOID OVERDOSE PREVENTION COORDINATOR an Erlichman is an AmeriCorps VISTA and the newest addition to the ACCMA’s East Bay Safe Prescribing Coalition. Ian’s experience in social work and research have sharpened his compassionate drive to help people in need through practical, data-driven solutions. Before coming to the ACCMA, Ian managed clients at a local homeless shelter while ghostwriting and editing manuscripts for a small publishing company. His foray into social service began shortly before. While volunteer teaching in highland Nepal, Ian created a campaign for rural teachers in financial jeopardy. He successfully raised $7,000 for the fund, securing employment for at least one teacher last year, with many more to come. Though he discovered many things in Nepal, education was not one of them. In the years prior, Ian worked as a private writing tutor and preschool teacher to pay the bills as he explored the world of academia.

Beginning in his senior year of undergraduate studies, Ian designed and co-authored a two-year protest research project investigating the effects of newspaper publications on protest movement success. Currently in peer-review, this project granted Ian rare fluency in data literacy, formal prose, and is proving relevant to current challenges faced as an Opioid Overdose Prevention Coordinator with the ACCMA. With these experiences in tow, Ian will develop a white paper on the obstacles and avenues for expanding Medication-Assisted Treatment (MAT) among the East Bay homeless population while aiding in grant writing and website management. During the coming year, Ian will seek to improve systems of care that treat substance use disorder (SUD) and opioid use disorder (OUD) patients while gaining community knowledge to fuel his future in homelessness relief projects.

In his spare time, Ian enjoys dancing, singing, and creative writing. Most recently, he has taken up brewing homemade kombucha but he has yet to find any test subjects willing to try it.

I

HANNAH EL-SABROUT, HEALTH EQUITY INTERN annah El-Sabrout (she/her) is a second-year medical student at the UC Berkeley-UCSF Joint Medical Program (JMP) as well as a UCSF Program in Medical Education for the Urban Underserved (PRIME-US) scholar. Hannah joins the ACCMA for a summer internship focused on health equity.

Hannah grew up primarily in San Diego but considers both San Diego and Egypt (where her extended family lives) to be home. She attended UCLA and graduated with a BS in Human Biology and Society and a concentration in Public Health and Medicine. She set out to learn more about community health by taking classes that exposed her to disease prevention in at-risk populations, and the effects low socioeconomic status, racism, and gender could have on health and well-being. Moreover, she joined organizations that allowed her to work with community members in clinical and non-clinical settings. As a result, she began to understand some of the subtleties of the healthcare system and a physician’s role within it. Through a combination of community service clubs and learning about the intersections of health and society as part of her undergraduate major, she realized how multifaceted physicians’ roles are. They not only help remove barriers to care in the clinic but also strive to extend healthcare access throughout the community. This aspect drew Hannah to a path in medicine. By combating the issues patients experience, she aims to help, empower, and uplift marginalized groups within society who are often overlooked.

Hannah chose to attend medical school at the JMP because of its focus on health equity and social justice since this was a large part of why she wanted to become a physician. More specifically, the JMP drew her attention because of its emphasis on interdisciplinary collaboration and culture of intellectual exploration. At the JMP, she has been able to broaden her understanding of healthcare while simultaneously exploring its connections with other fields, including policy, quality improvement, ethics, and law.

Hannah is excited to be a part of the ACCMA as a Health Equity Intern to learn more about medicine, to better understand healthcare systems, and to seek solutions for the challenges patients face.

H

ACCMA BULLETIN | MAY/JUNE 2023

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PHYSICIAN LEADERS

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FINANCIAL PLANNING

Six Steps to Help You Secure Your Retirement Adopted from Wells Fargo Advisors

W

e all have goals in life — providing for our families, saving for our children’s or grandchildren’s education, retiring comfortably, or leaving a legacy for future generations. For many of us, however, a very important goal is to enjoy a financially secure retirement.

Planning for retirement can be a very daunting process for some. This step-by-step process will help you get to where you want to be.

STEP 1: CHALLENGES A smart retirement strategy can account for challenges you may encounter along the way—even the unexpected—and help make sure that they don’t stand in your way.

STEP 2: WHERE YOU STAND TODAY The second step toward a comfortable retirement is to take a quick inventory of your current situation.

STEP 3: FUNDING YOUR DREAMS AND GOALS Now that you know where you are, you can start putting together a plan to get you where you want to be. There are a number of important factors to consider, including your need for income versus growth, types of risk, your need for rebalancing, and Asset allocation.

STEP 4: PICTURING YOUR RETIREMENT Utilize an envision process to help achieve a comfortable retirement. The Envision process’s goal is to let you live the one life you have the best way you can, without undue financial sacrifice or overexposure to risk.

STEP 6: BRINGING IT ALL TOGETHER After you implement your plan, the Envision process helps you continue to monitor and test your plan as you progress through your life. You can assess the effects that your actual savings and spending patterns, investment returns, and portfolio values have on your plan result.

Join us on Tuesday, August 22 from 6-8 pm at the ACCMA offices to walk through the step-by-step process to assist you in your financial goals whether you are just starting to think about retirement planning or have already started the process. We will be joined by Wells Fargo Advisors to provide guidance and answer questions. Look out for registration to open in early July.

NOTE If you retire at age 65, the average years in retirement are 19 for a man and 21 for a woman. With that in mind, you can expect to spend 19 or more years in retirement.* *Source: Based on average life expectancy, July 2020, ssa.gov.

UNDERSTANDING CALAIM (continued from page 13)

including healthcare providers, policymakers, community organizations, and advocates to achieve its mission. Visit CHCF.org/resource/calaim-in-focus/.

NOTES 1 Medi-Cal is the Medicaid program in California that provides health care coverage for low-income individuals and families. It serves over 14 million, or 1 in 3, Californians.

2 “Person-centered” care is a holistic approach that prioritizes the individual needs, preferences, and values of the patient. It places the patient at the center of their care and empowers them to actively participate in their own health care decisions.

STEP 5: YOUR DREAMS AND GOALS We all have different — sometimes very different — ideas of what is most important to us. But setting your personal priorities is the first and most important step toward achieving a successful retirement. What do you want your retirement to look like? Take a moment to order the priorities for you and your spouse or partner.

ACCMA BULLETIN | MAY/JUNE 2023

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PRESCRIBING CONTROLLED SUBSTANCES

Updated Training Requirements to Prescribing Controlled Substances

T

he Omnibus Bill, passed by Congress in December 2022, changed requirements for prescribing controlled substances under the Medication Access and Training Expansion (MATE) Act. The MATE Act requires all prescribers of schedule II-V controlled substances to complete a total of 8 hours of training on treating opioid use disorder (OUD) or substance use disorder (SUD).

ELIGIBILITY Currently, many physicians hold prior eligibility and do not need to complete an additional 8 hours of training.

You are eligible to continue prescribing as is and do not need additional training if you have fulfilled ANY of the following requirements: 1) you are a board-certified physician in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, the American Board of Addiction Medicine, or the American Osteopathic Association; 2) you have completed X-waiver training at any point in your medical career; 3) you have completed the one-time 12-hour CME training on pain management and the treatment of terminally ill and dying patients which included 8 hours of training on buprenorphine or other opioid replacement treatments; 4) you completed at least 8 hours of training from an accredited ACCME source, within (must have graduated after June 27th, 2018) or outside of medical school, on treating and managing patients with OUD/SUD; 5) you completed at least 8 hours of training on the safe pharmacological management of dental pain and screening, intervention, and treatment referral for OUD and SUD. You are not eligible and need to complete 8 hours of training if: 1) You graduated from medical school prior to June 27, 2018, and have not completed 8 hours of training on treating and managing patients with OUD/SUD nor completed 8 hours of

trainings on the safe pharmacological management of dental pain and screening, intervention, and treatment referral for OUD/ SUD; 2) you have not registered with the DEA to prescribe schedule II-V controlled substances.

GET TRAINED The training requirements, although extensive, are flexible in what trainings can be used to complete the total eight hours of training.

You do not need to complete all eight hours in a day and can split up training sessions as you personally see fits your schedule best.

Visit accma.org/News and click the Updated Requirements on Prescribing Controlled Substances article to access free, self-paced trainings through the Provider Clinical Support System (PCSS), including the SUD 101 Core Curriculum and Buprenorphine training.

REPORTING ELIGIBILITY All physicians must record their eligibility during their DEA license renewal (every 3 years) or during their initial application to prescribe controlled substances. You will not need to submit documentation of completed training. Eligibility is based on honest self-reporting from prescribing physicians.

June 27th, 2023 is when the MATE Act will take effect and is not a deadline for registration with the DEA. You will only be able to report your eligibility to the DEA after June 27th. Keep in mind, the renewal date for DEA registration is unique to each provider and is due 3 years after initial registration. All physicians who wish to prescribe schedule II – V controlled substance must report their eligibility during their registration renewal or upon initial registration. Visit accma.org/News for more information or call us at (510) 654-5383.

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18

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

OPIOID EPIDEMIC

Honoring a Local Leader Working to Curb the Opioid Epidemic pril Rovero, Founder of the National Coalition Against Prescription Drug Abuse (NCAPDA) and critical force behind the East Bay Safe Prescribing Coalition, has received country-wide recognition for her contribution to opioid overdose and prescription drug abuse prevention. A veteran of 13 years in the world of substance use prevention and harm reduction, April shares her journey: from mother to community leader.

A

education, policy change, and legislative advocacy. We spend time educating people in our community education and for the last three and a half years we’ve taken advantage of the California Naloxone Distribution Project and distributed over 2,000 boxes of Narcan. We do overdose education, rescue training, and we distribute fentanyl test strips with the intent of saving lives through primary prevention and harm reduction.”

WHAT LED YOU TO CREATE THE NCAPDA? “My 21-year-old son Joey passed away from an accidental overdose from prescription medications. He died while taking his prescription of Xanax and Oxycodone, and just enough alcohol to put him above the legal limit. With one less pill and one less drink he probably would have been fine…

He died from prescription drugs that we had no understanding of and had never been educated about and I came to realize pretty quickly that there are no organizations that included prescription drug safety in any of their community education.

So, I started speaking out at an event that was held in San Ramon. It was meant to be a parent education session. As I thought about what I could do for other families, I felt like everybody else was at equal risk for this happening because they didn’t understand how dangerous commonly prescribed medications can be.

I really felt that it was important to start my own organization.

Instead of being just a mom going into a school, I created the National Coalition Against Prescription Drug Abuse. It sounds like a big organization, but it was really just me and it gave me a structure to deliver presentations to the public. First at Joey’s school, in San Ramon and then it just spread from there.”

WHAT AWARD DID YOU RECENTLY RECEIVE? “I received the Beacon of Hope award at the annual Rx Summit in Atlanta, GA. It was initially given 4 years ago to Kentucky Congressman Hal Rogers who recognized early on what a huge problem prescription drug abuse had become.

I have so much gratitude. That this Summit continues and that my work over all these years is being recognized at that high level. You know, nobody does this work for recognition; that’s the last thing I’m looking for. But to be recognized, puts that stamp of approval on what I’m doing. It gives me the encouragement that everybody needs to keep going after all these years. The NCAPDA actually turns 13 years old on June 2nd, so it’s been a long time.”

WHAT IS THE NCAPDA’S MISSION? “Our mission has been to prevent prescription drug related substance use disorder and overdose death through community

WHAT ASPECTS OF THE OPIOID EPIDEMIC SHOULD WE PAY ATTENTION TO? “The fentanyl issue. There is a low perception of harm around prescription drugs, and many counterfeit prescription drugs in the form of Xanax, Adderall, Percocet, and Oxycodone pills contain lethal amounts of fentanyl.

They are sought out by people who have a substance use disorder or teens and college students who want to experiment.

They can’t go to a doctor to get these drugs, so they turn to fake pharmacies online. We’re seeing more and more young teens even dying from prescription drug related overdoses caused by counterfeit medication.”

continued on page 20 ACCMA BULLETIN | MAY/JUNE 2023

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OPIOID EPIDEMIC (continued from page 19)

WHAT ARE YOU MOST PROUD OF? “If I have to pick one thing, it would be forming the Contra Costa County Meds Coalition back in 2012. At that point, it was really just me – concerned about this issue and wanting to make a difference in my own county. For the last 10 years, I’ve led that Coalition with the NCAPDA as the financial sponsor. Recently, the CCC Meds Coalition became financially independent with its own manager. That’s a key achievement because it’s not easy to build coalitions from the ground up.

Beyond that, I never really know how many lives my work has saved, but at a core level I feel that I have had an impact through education and narcan distribution.”

April plans to expand prevention and harm reduction programs into Alameda County; developing schools and universities into hubs of awareness for opioid use and substance use disorder. She is eager to share her hard-won knowledge and

act as a mentor to anyone interested in preventing substance related overdose death. Contact NCAPDA for resources and education services on their website: ncapda.org.

CLINICAL PROVIDER QUICK TIPS ADDRESSING SUBSTANCE USE IN PRIMARY CARE SETTINGS

WEWWHATW WHAT YOU NEED TO KNOW

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20

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

MIEC

Safety Huddles in the Ambulatory Setting By the Medical Insurance Exchange of California

H

ealthcare has a lot of moving parts that rely on multidisciplinary teamwork, communication, and process.

When there is a disruption in anyone of these areas it can have a compounding effect that leads to frustration, workarounds, and sometimes patient harm. Communication failures continue to be one of leading cause of sentinel events, which brings us to safety huddles. Daily safety huddles, present an opportunity for staff to flag unsafe conditions and take proactive steps to solve for and eliminate matters that pose a threat to patient safety1. While safety huddles originated in hospitals, these meeting can occur in any clinic or ambulatory setting. The huddle lasts only 15 minutes and has the same standing agenda. 1) Look back – Share concerns that occurred in the last 24 hours. 2) Look ahead – Anticipate needs or disruptions in the next 24 hours. 3) Follow-up – Identify what needs to occur to mitigate newly identified safety issues. In a nutshell, safety huddles create the time and space for healthcare workers to discuss what they need to do their jobs safely. Whether it is a supply issue, equipment issue, staffing issue, IT issue, etc. this brief meeting provides the venue for efficient communication and problem solving.

Ideally, the people that attend the huddle are supervisors, charge nurses, managers, directors and at least one practice administrator or CEO who can escalate more serious concerns that require administrative action. It is also vital that staff see executive leaders at these meetings to show their commitment and support for patient safety. The safety huddle is typically facilitated by the CEO, Practice Manager or identified Safety Officer. Whoever holds the lead role in facilitating should take steps to ensure that the meeting remains on task and on time

and does not become punitive. Each attendee is asked to report out needs/concerns for their respective departments. If longer discussions are needed to create a plan, the facilitator can identify who should participate in a post-safety huddle meeting to come up with a solution. This allows the meeting to be respectful of everyone’s time but still solution-focused.

The safety huddle provides continual awareness of the stress levels within an organization, and a mechanism for frontline staff to share concerns through their supervisors. As an added benefit to team cohesion, these meetings often naturally move towards celebrating successes. When a CEO or Practice Manager learns about a near miss event that a frontline staff escalates, the CEO can later personally thank or recognize the frontline worker for speaking up for patient safety.

The benefits of the safety huddle may not always be evident at the outset and carving out the time can be challenging. For this reason, leadership commitment is crucial in getting started but typically after 6 months staff begin to see the value. Persistence will pay off by improving risk identification, interdisciplinary collaboration, and increasing the organization’s proactive approach to risk reduction.

For more information about how to implement a safety huddle in your setting please reach out to MIEC Patient Safety Risk Management Department at patientsafetyriskmgmt@miec. com.

NOTE 1 Shaikh, U. (2020). Improving Patient Safety and Team Communication through Daily Huddles. Psnet.ahrq.gov. https://psnet.ahrq.gov/primer/ improving-patient-safety-and-team-communication-through-daily-huddles

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

ACCMA BULLETIN | MAY/JUNE 2023

21

IN MEMORIAM

ALEXANDER ROGERSON, MD (1922-2022)

Dr. Alexander Greenleaf Rogerson, a longtime Berkeley pediatrician, died peacefully in Walnut Creek, California on August 24, 2022 after a brief illness. He was 99 years old.

Born in 1922 in Milton, Massachusetts, Alex attended Milton Academy, Harvard University, and Harvard Medical School. He then did an internship at Boston Children’s Hospital, a residency in pediatrics at Bassett Hospital in Cooperstown, NY, and a Chief Residency at Philadelphia Children’s Hospital.

He served in the U.S. Army Medical Corps from 19431946 and again in 1950-53, rising to the rank of Captain. He then joined the Berkeley Pediatric Medical Group, where he practiced until his retirement. While in practice, he was an associate clinical professor at UCSF and spent 50 years teaching and attending at Oakland Children’s Hospital.

Alex was a serious athlete. In his younger years, he wrestled, boxed, and pole-vaulted. In California he took up competitive running, sailing, tennis, skiing, and rowing. He ran more than one marathon and was running more than seven miles a day when he was 75. At the age of 95 he set the U.S. record for 2,000-meters in men’s indoor rowing in the 95-99 age bracket.

He is survived by his wife, Britta, his children, Charles (Sharon Sagan), Janice, Lindsay (Zada Jan), Mark (Jan), and John, six grandchildren, and two great-grandchildren.

Dr. Rogerson was an ACCMA member for 47 years.

22

WILLIAM ELLIS, MD, FACS (1942-2023) Dr. William

Ellis unexpectedly left this earth on January 18, 2023, doing what he loved the most: flying his airplane. He was a man who loved adventure, taking up flying in his 50s.

William, called Bill by his friends and family, was born on December 28, 1942, in the Bronx. When Bill was 13, his family moved to the Bay Area where his father became a community college biology teacher.

Dr. William Ellis, MD, FACS dedicated his career to bringing innovative surgical techniques to the restoration of vision. He began his career by studying electrical engineering at the University of California, Berkeley. He then attended medical school at Washington University in St. Louis. Dr. Ellis completed a surgical internship at Duke University and residency at Stanford University Medical Center. He was then Board Certified in general ophthalmology. He was also certified as a sub-specialist in cataract, intraocular lens implantation, and refractive surgery.

Dr. Ellis was a leader and innovator in the field of refractive surgery. He studied radial keratotomy surgery with Professor Svyatslov Fyodorov in the Soviet Union. Dr. Ellis wrote three textbooks on Keratoplasty surgeries. Professor Fyodorov, who pioneered modern radial keratotomy, is a co-author of his last textbook. He is survived by his sons, Willian Benson Ellis and Charles Edward (Annie) Ellis, along with grandchildren Rose Ellis and Axel Ellis.

Dr. Ellis was an ACCMA member for 47 years.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

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