Central Coast Physicians Fall 2019

FALL 2019

Graduate Medical Education Grant Awards Challenges of Cultural Diversity in Healthcare Employed Physicians Outnumber Self-Employed Fall 2019

CENTRAL COAST PHYSICIANS

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S AV E T H E D AT E

KEYNOTE: Michael Mack, MD Medical Director, Cardiovascular Surgery Baylor Scott & White Health

SPECIAL GUEST: Kim Allan Williams, Sr., MD, MACC, FAHA, MASNC, FESC James B. Herrick Professor Chief, Division of Cardiology, Rush University Medical Center; Former ACC President MOTIVATIONAL SPEAKER:

Healing the Heart

2020

SECOND ANNUAL CARDIOLOGY SYMPOSIUM

BY COTTAGE HEALTH FRIDAY, FEBRUARY 7, 2020 HILTON SANTA BARBARA BEACHFRONT RESORT

W Mitchell Hall of Fame Speaker, Author, Business Leader and Triumphant Victor

Early Bird Registration (before January 13): Nursing/Allied Health: $160 Physicians: $225 For a list of additional speakers and to register, visit cottagehealth.org/healingtheheart Accreditation Statement: The Santa Barbara County Consortium for CME is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.

Credit Designation Statement: The Santa Barbara County Consortium for Continuing Medical Education designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s)â„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Provider approved by the California Board of Registered Nursing, Provider #00252 for 7.0 contact hours.

Featuring nationally recognized guest speakers including local experts from the Heart & Vascular Center at Cottage Health.

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Fall 2019

VOLUME 4, NUMBER 4 • FALL 2019

{FEATURES}

14 16 22 28 Fall 2019

FRESH LOOK FOR COORDINATING CARE

{DEPARTMENTS} 6 RISK TIP 10 MEN’S HEALTH

PHYSICIANS OF THE YEAR

18 CENCAL HEALTH NEWS HUB 20 CLASSIFIEDS

PREVENTING GUN VIOLENCE

24 PUBLIC HEALTH UPDATE 30 NEW MEMBERS

COMMUNITY-ONSET C. DIFFICILE

CENTRAL COAST PHYSICIANS

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Letter from the CEO

LISTENING TO YOU

Thank you to our members, especially the Board of Directors, who guide the Central Coast Medical Association to provide programs and services that are valuable for you. Below are updates on three areas that physicians have requested we focus.

PRESIDENT Jennifer Hone, MD PRESIDENT ELECT Kevin Casey, MD SECRETARY Ali Javanbakht, MD TREASURER Samira Kayumi-Rashti, MD DIRECTORS Bindu Kamal, MD; Daniel Berger, MD; Joseph Freeman, MD; Joseph Schwartz, MD; Julie Fallon, MD;

Connecting. Physicians have told us that the practice of medicine has changed, and they do not have as many opportunities to socialize with other DANA GOBA physicians. This can lead to physicians feeling isolated and burned out. For past year, we have provided quarterly events for doctors to gather and network with each other. Besides our Annual Membership Celebration, we are hosting socials at wineries for physicians to connect.

Priti Gagneja, MD; Rachel May, MD; Rahim Raoufi, MD; Thomas Hale, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sharon Basham, MD; Edward Bentley, MD; Kevin Casey, MD; David Dodson, MD; Priti Gagneja, MD; Jennifer Hone, MD; Samira Kayumi-Rashti, MD; Christopher Lumsdaine, MD; Joseph Schwartz, MD CMA DISTRICT V TRUSTEE

Communication. To keep physicians up to date, we are reaching out to you in a variety of ways. We launched our quarterly magazine more than two years ago, and our monthly e-newsletter one year ago. We also provide frequent updates on social media, and you can find us @ccmahealth on Facebook, Twitter, and Instagram. We also mailed our biennial Membership Directory in October.

Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Jennifer Hone, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Henning Ansorg, MD; Richard Beswick, PhD; Penny Borenstein, MD, MPH; California Medical Association; CenCal Health;

Advocacy. One of the most important roles of your medical association is advocating for you and your patients. As this issue goes to print, your colleagues are going to Anaheim to participate in the House of Delegates where they will debate on the most important issues affecting members, the association, and the practice of medicine. The major issues for discussion this year are cannabis, homelessness, and augmented intelligence. Besides House of Delegates, members have met with local politicians to ensure your voice is heard at the state and national level.

David Dodson, MD; David Fisk, MD; Karen Hord, MD, MPH; Marjorie Newman, MD; Darrell Ranum, JD; Tenet Health Central Coast CONTRIBUTING PHOTOGRAPHERS CenCal Health, Tenet Health Central Coast SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

If you are interested in learning more about these areas, or if you would like to be more involved with CCMA, you can reach us at 805.683.5333 and ccma@ccmahealth.org. For physicians who aren’t yet members, join your colleagues who are working to improve the future of healthcare. You can become a member at www.cmadocs.org/join or by calling 800.786.4262.

PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 E magazine@ccmahealth.org ADVERTISING rates and information sent upon request.

Together we are stronger.

Sincerely,

Acceptance of advertising in Central Coast Physicians in no way constitutes approval or endorsement by CCMA of products or services advertised. CCMA reserves the right to reject any advertising. All advertising inquiries can be sent to magazine@ccmahealth.org.

A COMPONENT OF THE

Dana Goba Chief Executive Officer Central Coast Medical Association

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We thank you for your support and entrusting us with your patients. We look forward to further serving our community in 2020.

Edward N. Li, M.D. Board Certified Vascular Surgeon VISIT OUR LOCATIONS: Santa Barbara Office 2323 Oak Park Lane, Suite 102 Santa Barbara, CA 93105 Lompoc Office 1025 E. Ocean Avenue, Suite B Lompoc, CA 93436

Fall 2019

OUR PHYSICIANS ARE EXPERTS IN THE TREATMENT OF: • • • • • • •

Abdominal Aortic Aneurysm Carotid Stenosis Dialysis Access Limb Preservation Peripheral Artery Disease Varicose Veins Wound Healing

Eric C. Kuo, M.D. Vascular Surgeon CONTACT WEST COAST VASCULAR: To schedule an appointment, contact our office at:

Phone: 805-643-3330 Fax: 805-569-7699 www.WestCoastVascular.com

CENTRAL COAST PHYSICIANS

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RISK TIP ELECTRONIC HEALTH RECORDS

EHR CONTINUE TO LEAD TO MEDICAL MALPRACTICE SUITS

BY DARRELL RANUM, JD, VICE PRESIDENT OF PATIENT SAFETY AND RISK MANAGEMENT, THE DOCTORS COMPANY

For 8 years, claims in which the use of electronic health records (EHRs) contributed to patient injury have been on the rise.

The Doctors Company’s analysis of claims in which EHRs contributed to injury show a total of 216 claims closed from 2010-2018. The pace of these claims grew, from a low of 7 cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. EHRs are typically contributing factors rather than the primary cause of claims, and the frequency of claims with an EHR factor continues to be low (1.1 percent of all claims closed since 2010). Still, as EHRs approach near-universal adoption, they may become a more prevalent source of risk.

The EHR-related claims closed from 2010-2018 were caused by either system technology and design issues or by user-related issues.

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Top System Technology and Design Issues

Claim Count

Other

30 14%

Electronic systems/technology failure-EHR

26

12%

Lack of or failure of EHR alert or alarm

15

7%

Fragmented record

14

6%

Failure/lack of electronic routing of data

10

5%

Insufficient scope/area for documentation in EHR

8

4%

Lack of integration/incompatible systems

5

2%

Failure to ensure information security

1

0%

Grand Total

104*

Percent

48%

*Note that the percentages are of the total number of electronic health record claims (n=216).

Top User-Related Issues

Claim Count

Incorrect information

29

13%

Pre-populating/copy & paste

29

13%

Hybrid health records/EHR conversion issues

27

13%

User error-other

25

12%

Training and/or education

16

7%

Alert issues/fatigue, user-related

5

2%

Computer order entry workarounds

4

2%

Grand Total

129*

Percent

60%

*Note that the percentages are of the total number of electronic health record claims (n=216).

Here are the top five risks and suggestions to avoid an EHR-related malpractice claim: 1. Risk: Copy/paste may perpetuate incorrect or outdated information.

Solution: Avoid copying and pasting except when describing the patient’s past medical history.

2. Risk: Many EHRs auto-populate fields in the patient’s history and physical exam and in procedure notes, causing the entering of erroneous or outdated clinical information Solution: Contact your organization’s IT department or your vendor if you notice that the auto population feature causes erroneous data to be recorded. If the auto populated information is incorrect, note it and document the correct information.

3. Risk: Templates with drop-down menus facilitate data entry, but an entry error may be perpetuated elsewhere in the EHR. Solution: Review your entry after you make a choice from a drop-down menu.

Fall 2019

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CENTRAL COAST PHYSICIANS

Fall 2019 PATIENTPOP.COM

4. Risk: Doctors are responsible for the information to which they have reasonable access. EHR metadata documents what was reviewed. A patient injury may result from a failure to access or make use of available patient information.

Solution: Review all available data and information prior to treating a patient.

5. Risk: The computer may become a barrier between the doctor and the patient.

Solution: Relocate the computer so the physician’s back is not to the patient and so the patient can view the screen. Remind the patient that you are listening carefully, even though you may be typing during the appointment and summarize or read the note to demonstrate you have listened.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Fall 2019

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CENTRAL COAST PHYSICIANS

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MEN’S HEALTH

h t a de professions, a r e tnhd ethe gender a

p a g e g a w

BY DAVID DODSON, MD

Comparing the income of male CEOs to female custodial staffs obviously isn’t a particularly enlightening exercise, but is what the unadjusted wage gap measures.

When I was a resident in Boston, a lab tech wore a lapel pin reading “59 cents” which prompted me to ask what it referred to. The 59 cents earned by women for each dollar earned by men she replied. I won’t date myself, but suffice it to say more recent statistics suggest her pin could now be 80 cents, progress perhaps. The first point when considering this statistic is to distinguish between the adjusted and unadjusted wage gap.

Fortunately, the adjusted gap, which accounts for jobs worked, hours worked, education/qualifications, etc., rather than simply tallying the income of all men vs all women, has narrowed substantially but still persists for the most part, though in some areas professional women are starting to out-earn their male counterparts. Comparing the income of male CEOs to female custodial staffs obviously isn’t a particularly enlightening exercise, but is what the unadjusted wage gap measures.

One particularly stark area of contrast is in the so-called death professions: combat soldiers, miners, deep sea fishermen, firefighters,

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and the like. Such fields have been largely, if not entirely, such fields over higher paying careers. But again, such occupied by men historically. Of course, this has been decisions surely are part of the gender wage gap. changing. Best-selling author Linda Greenlaw writes movingly of her life as the first swordfish captain on the Traditionally, men are raised to be good providers.

East Coast and had a cameo in the movie The Perfect We are taught that “real men” should be able to give Storm. She was then, as now, a distinct anomaly - and our wives and children the things that constitute The more’s the pity, as she is terrific! I like to think that women generally have the good sense to say out of mines A long time ago, feminists pushed the notion of equal and other very hazardous places, pay for equal work. It was called The Equal Rights but I probably run the risk of being “ Amendment and it nearly became law, but it was me-tooed” by saying so. The point is, vehemently opposed by an organization called STOP ERA. some perfectly rational and intelligent people - think artists in general choose to follow their bliss rather than shake a money tree. Who’s to say that unreasonable?

American Dream: a nice home, a good education, But in all probability, it is a factor in the gender wage material comforts in life. Many men who would be gap. happier in more nurturing, less remunerative fields reject them out of hand due to this training. As John Certain female-dominated field such as childcare and Lennon put it in the song Girl “a man must break his teaching certainly are less remunerative than medicine, back to earn his day of leisure”. An overstatement, the law, business, and other fields. To my knowledge, no maybe, maybe not, but the truth is a lot of men are one is forced to choose these fields of endeavor. But the doing jobs that may earn them lots of money but little appeal is undeniable: the hours are defined, the rewards satisfaction. Men are socialized this way. Women are of nurturing are real, and stress levels are generally socialized differently. This also contributes to the lower than being on a battlefield, on a ship at sea, in gender pay gap.

A long time ago, feminists pushed the notion of equal pay for equal work. It was called The Equal Rights Amendment and it nearly became law, but it was vehemently opposed by an organization called STOP ERA - STOP being an acronym for Stop Taking Our Privileges. The leader of the organization and the movement was Phyllis Schlafly who felt that under the ERA women would lose privileges such as exemption from the military draft.

Her campaign, sadly, succeeded. To my mind equal pay for equal work is a no-brainer, but at the time, Ronald

Perhaps the best way forward to equalize pay in the 21st century is through education, and women have certainly figured this out, as women graduate from high school at higher rates than men, attend and graduate from college at higher rates than men, and earn graduate degrees at higher rates than men. a mine, battling a wildfire, or being in an operating room. Such workers can plan on being home with their families at night. These rewards, while not compensated monetarily, are still real, and those who value them over a bigger paycheck should not be disparaged. Again, I for one am not prepared to judge those who choose

Fall 2019

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Reagan campaigned against the ERA and 47% of women voted for him.

know how much they earned, but I felt they walked on water and I was very pleased their money was no good: they were comped for their food and drink and rightly so. Many of them were hundreds of miles from home. One of them lost his life. Men are socialized to work in such professions, and God bless them. God bless the women who care for our children and our elders too. Women can and do choose to work in such demanding professions as firefighters and more power to them. But often they choose to work in fields that offer rewards other than money such as a safe and predictable working environment, unlike fire fighters.

This should not be seen as a bad or wrong choice, but it does contribute to the gender wage gap.

Perhaps the best way forward to equalize pay in the 21st century is through education, and women have certainly figured this out, as women graduate from high school at higher rates than men, attend and graduate from college at higher rates than men, and earn graduate degrees at higher rates than men. This explains why in many urban centers, young women out-earn young men.

Having been evacuated for 11 days during the Thomas Fire 2 years ago, I shared space in a local motel with any number of firemen. I met no fire women. I don’t

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Fall 2019

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A Fresh Look and Brand for Coordinating Care on the Central Coast Both practitioners and patients may notice some changes around the Central Coast landscape this fall as Tenet Healthcare’s multi-platform care providers in the area will be united into a single, identifiable name and brand that is aimed at easing patient coordination: Tenet Health Central Coast.

The updated brand will include Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton, urgent care centers, primary and specialty care clinics, and outpatient laboratory and imaging centers across the Central Coast.

Becoming a unified system will allow physicians to help improve care coordination between the two acute-care hospitals and affiliated entities. Being part of a network also helps strengthen Tenet Health Central Coast’s contractual relationships with health plans and medical groups. As Tenet Health Central Coast, the needs of the entire region are considered in recruitment of new employees, new physicians and new partners who can help enhance care coordination for patients and assist them in making the best use of facilities and resources.

Over the next weeks and months, community members will begin to see the Tenet Health Central Coast name and logo integrated among all of its facilities. The logo represents the three “C’s” of the mission of Tenet Health Central Coast – Community, Compassion and Care – and each facility will share the common “Tenet Health Central Coast” brand name, along with each hospital or service name.

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Partners that will soon come under the “Tenet Health Central Coast” name and logo include:

• First California Physician Partners (FCPP) • MedPost Urgent Care Paso Robles • MedPost Urgent Care Atascadero • Selma Carlson Diagnostic Center • Templeton Imaging Center

“Unifying our resources under the Tenet Health Central Coast brand signals to all of the communities we serve that we offer unique services in a variety of settings from Nipomo to the South to Cambria and Paso Robles in the North,” said Mark Lisa, Tenet Health Central Coast CEO. “Our primary goal is to provide seamless care and service between our hospitals and our clinics, imaging centers and urgent care facilities, for the patients we treat every day. By doing all of this, we demonstrate that Tenet Health Central Coast is truly a community built on care.”

Indeed, the intrinsic tenet of Tenet Health Central Coast is “A Community Built on Care.” Working as a unified system, Tenet Health Central Coast offers advanced, quality care – from preventive and routine healthcare to highly specialized services and advanced treatments – to everyone who walks through the doors.

While many in the community are aware of some of the unique and extraordinary services that are provided

by Tenet-affiliated facilities, the unified brand will help patients and physicians alike see the full scope and comprehensiveness of the care offered – including lifesaving trauma and emergency care, excellent orthopedic and joint replacement programs, premier obstetrics services, a neonatal intensive care unit capable of caring for babies born at 23 or more weeks gestation, highlyspecialized stroke and neurosurgical programs, and advanced technology and treatment of gastrointestinal diseases and disorders.

“We are committed to becoming the care provider of choice for both residents and visitors to this region,” said Lisa. “This not only means continuity of care, which is essential, but also a full range of expert care that includes highly-specialized services at convenient locations throughout our region.”

Fall 2019

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SAN LUIS OBISPO COUNTY:

Stephen R Holtzman, MD, MS The Central Coast Medical Association honored Stephen R Holtzman, MD, MS, as the 2019 Physician of the Year for San Luis Obispo County.

SAN LUIS OBISPO COUNTY

Dr. Holtzman received his undergraduate degree at Occidental College, Los Angeles, where he studied psychobiology. Besides excelling in the classroom, he was a standout baseball player for the school’s team, and he hit for the cycle, which is an accomplishment of hitting a single, a double, a triple, and a home run in the same game.

Dr. Holtzman received his Doctor of Medicine degree from Dartmouth School of Medicine and completed his internship at Dartmouth Hitchcock Medical Center. Before starting his residency, Dr. Holtzman completed his master’s degree in Evaluative Clinical Sciences. Following a residency in Diagnostic Radiology, Dr. Holtzman completed a second residency in Vascular and Interventional Radiology.

DR. STEVE HOLTZMAN (LEFT) AND DR. STEVE HILTY (RIGHT)

The Central Coast Medical Association honors physicians who have worked to improve the quality of healthcare, contributed to the education of other physicians, and engaged in community service and other activities outside of medicine.

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In 2002, Dr. Holtzman joined the Radiology Associates of San Luis Obispo (RASLO) and became CEO in 2010. He noticed that he and the medical team at RASLO would repeat the same information to patients, and frequently, patients would not recall the instructions provided. Dr. Holtzman began making videos of repetitive tasks so patients could re-watch at their convenience. The recordings were a success, so Dr. Holtzman and some colleagues founded The Holvan Group, which creates highquality educational videos that explain complex medical care in a simple format resulting in decreased costs and increased healthcare outcomes.

When presenting the award, Dr. Steve Hilty stated that Dr. Holtzman is committed to doing what is best for patients and always puts them first. Dr. Holtzman thanked his colleagues for creating the incredible medical community in San Luis Obispo, and said he “feels like the luckiest guy in the world.”

Fall 2019

SANTA BARBARA COUNTY:

Philip R Delio, MD The Central Coast Medical Association honored Philip R Delio, MD, as the 2019 Physician of the Year for Santa Barbara County.

Dr. Andy Gersoff presented the award to Dr. Delio and described him as a physician, healer, teacher, and nurturer. After graduating from Georgetown University School of Medicine, Dr. Delio was interviewed by Dr. Gersoff for an internship at Santa Barbara Cottage Hospital. Dr. Gersoff still has his notes from that interview, and he had written, “A keeper.”

Following his time at Santa Barbara Cottage Hospital, Dr. Delio completed his neurology residency and fellowship at Stanford University before returning to Santa Barbara and joining the Neurology Associates in 2001. Dr. David Frecker stated, “Bringing him into the practice was the best thing I’ve ever done.”

He was Santa Barbara Cottage Hospital’s Internal Medicine Residency Program’s Teach of the Year twice, was instrumental in obtaining Advanced Certification for Comprehensive Stroke Centers by the Joint Commission, and is currently Chief of Staff. He is also the Vice Chair of the Department of Neurology and Medical Director of the Stroke Program.

DR. ANDY GERSOFF (LEFT) AND DR. PHIL DELIO (RIGHT)

Besides his work at Santa Barbara Cottage Hospital, Dr. Delio is an adjunct professor in the Department of Psychology with the University of California, Santa Barbara. Dr. Delio served as president of the Santa Barbara County Medical Society in 2010, and was also a delegate to the California Medical Association’s House of Delegates.

Upon receiving his award, Dr. Delio recognized his colleagues who continuously raise the bar on the practice of medicine in our community, and said he tries to emulate the physicians he admires. Dr. Delio also thanked his wife and two daughters for their support and said the award is as much theirs as it is his.

Fall 2019

SANTA BARBARA COUNTY

CENTRAL COAST PHYSICIANS

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CenCal Health NEWS HUB:

Medi-Cal Pharmacy Services to Transition Out of Managed Care Plans by January 2021 California Sets-up New Prescription Delivery System In January of this year, California Governor Gavin Newsom issued Executive Order N-01-19 that states “the Department of Health Care Services shall take all necessary steps to transition all pharmacy services for Medi-Cal managed care to a fee-for-service benefit by January 2021 in order to create significant negotiating leverage on behalf of over 13 million Californians and generate substantial annual savings.” The Medi-Cal pharmacy benefits and services administered by the Department of Health Care Services (DHCS) in the new fee-for-service (FFS) delivery system will be identified as Medi-Cal Rx. Included in the Executive Order was the statement “the State’s spending on prescription drugs has increased at an unsustainable rate, including hikes of approximately 20% per year since 2012, constituting a substantial fiscal drain; a relatively small subset of high-cost drugs account for a disproportionate amount of spending, with the 25 most

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CENTRAL COAST PHYSICIANS

Fall 2019

expensive drugs accounting for approximately half of the State prescription drug expenditures.”

A major goal of Medi-Cal Rx is to strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers, especially for those drugs that are most commonly prescribed.

Additionally, Medi-Cal Rx aims to standardize the Medi-Cal pharmacy benefit and the utilization of outpatient drugs - all under one delivery system - in order to save on administration costs.

CenCal Health, the Medi-Cal managed care health plan serving Santa Barbara and San Luis Obispo counties, has been preparing for this pharmacy “carve-out” since the announcement was made. Because DHCS has not yet determined the external pharmacy service vendor that will support Medi-Cal Rx, there are still many unknowns to be worked out, but CenCal Health has already started managing the change.

“The call to save money on prescription drugs is not unique to Medi-Cal or Medicaid,” said Bob Freeman, CenCal Health CEO. “The same experience is seen in Medicare and commercial insurance and reflected in the beneficiary’s increased premiums, co-pay, co-insurance and cost share. While affected by price increases, CenCal Health has been successful, year after year, in managing the expenses below national trends.”

According to DHCS, managed care plans (MCPs) like CenCal Health will retain responsibility for activities, including but not limited to: • Beneficiary care coordination • Clinical aspects of pharmacy adherence • Disease and medication management • Processing and payment of all pharmacy services billed on medical and institutional claims To ensure MCPs are able to continue meeting their existing coordination of care for Medi-Cal beneficiaries, DHCS has committed to facilitating real-time data access, daily data feeds, and support to MCPs.

Fall 2019

“Currently CenCal Health has a broader pharmaceutical offering than that of the Fee-ForService program, so we are projecting what Medi-Cal Rx might look like to our members and plan partners,” said Jeff Januska, Director of Pharmacy Services at CenCal Health. Anticipated challenges include 1) f or Members: access to the same or similar medications that they currently take may require an appointment and discussion with their physician, 2) for Physicians: the need to coordinate, reassess and perhaps change a patient’s medications to match the FFS preferred drug list, 3) for the Health Plan: the yet-to-be-determined framework (call center, access to where prior authorization requests stand and fill history) to support a member’s medication needs.

DHCS is proposing a 90-day continuity period for transitioning beneficiaries that will allow for all prescriptions to be honored without prior authorization. DHCS is developing a “continuity of care” plan, which will describe the processes that will be used for the 90-day transition, such as • Drug Utilization Review requirements to ensure the safety of drugs prescribed • Pharmacy, provider, and beneficiary assistance Notification of the 90-day continuity period and process will be sent to pharmacies, providers, and beneficiaries by DHCS. This is expected no earlier than January 2020.

Physicians with questions about Medi-Cal Rx may contact Jeff Januska, PharmD at 805.562.1635, jjanuska@cencalhealth.org or the Provider Services Department 805.562.1676, psrgroup@cencalhealth.org

CENTRAL COAST PHYSICIANS

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CL

DS

F I S IE S A

Office Space Available

NEWLY REMODELED MEDICAL OFFICE SPACE for rent across from Santa Barbara Cottage Hospital. Suite is home to one OBGYN. Available for rent is one office and one or two exam rooms. Staff can be shared and all equipment, supplies, and utilities included. Please call for more information 805.563.9100.

Positions Available

ESTABLISHED PRIVATE INTERNAL MEDICINE PRACTICE in the heart of wine country in the beautiful Santa Ynez Valley within Santa Barbara County seeks a BC/BE internist to join a busy practice within the lovely Danish town of Solvang. Competitive salary and benefits while living and working in a small community with excellent schools, short commutes, fine restaurants, entertainment, and Mediterranean climate with no smog or traffic. Enjoy excellent quality of life while practicing medicine in a small clinic affiliated with

Cottage Health. For more information, please contact Office Administrator Amy Comer at 805.688.2600.

The COUNTY OF SAN LUIS OBISPO is committed to serving the community with pride to enhance the economic, environmental, and social quality of life in San Luis Obispo County. Physician openings can be found at www.slocounty.ca.gov.

The COUNTY OF SANTA BARBARA delivers exceptional services so Santa Barbara County’s communities can enjoy a safe, healthy, and prosperous life. Physician openings can be found at www.sbcountyjobs.com.

SANSUM CLINIC is the largest and oldest multispecialty group between San Francisco and Los Angeles with over 180 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Physician openings can be found at www. sansumclinic.org/physician-provider-job-opportunities.

If you would like to submit a listing to our Classifieds, contact ccma@ccmahealth.org.

Listings are free for members with reasonable rates for nonmembers.

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One new name.

An extensive network of care.

A COMMUNITY BUILT ON CARE Sierra Vista Regional Medical Center and Twin Cities Community Hospital are becoming Tenet Health Central Coast. We’re putting together a robust network of care facilities located across our community’s region to meet all healthcare needs. So from urgent care centers, primary and specialty care clinics, and outpatient diagnostic services to our two acute-care hospitals, you can count on us to deliver advanced, compassionate care for your patients.

To learn more, visit TenetHealthCentralCoast.com Fall 2019

CENTRAL COAST PHYSICIANS

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WHAT PHYSICIANS CAN DO TO HELP PREVENT

Gun Violence The United States continues to struggle with an epidemic of firearm violence. Over the past month, dozens of people were gunned down in cold blood in El Paso, Texas, Dayton, Ohio, and Gilroy, California.

Physicians are on the front lines of these tragic events, treating the wounds and injuries of the victims of this senseless gun violence. The California Medical Association (CMA) recently released a statement demanding action to bring sanity to our nation’s gun laws. >>

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CENTRAL COAST PHYSICIANS

Fall 2019

“Policies to prevent these senseless tragedies are not matters of ideology or constitutionality. They are long overdue. We can no longer accept our leaders standing idly by while more innocent victims – children, parents, family members and friends – are struck down by weapons that have no place on our streets,” said CMA President David H. Aizuss, M.D., said in the statement. “On an issue where common sense seems nearly impossible to find in some sectors of our politics, it is time for the overwhelming majority of Americans who support common sense reforms to demand action and bring some sanity to our nation’s gun laws.”

WHAT CAN YOU DO TO PREVENT GUN VIOLENCE?

Physicians are in a unique position to assess risk, provide education and change behaviors related to firearm violence, and they may also address this issue more broadly as a consumer safety and public health issue.

The CMA Firearm Violence Prevention Technical Advisory Committee (TAC), composed of physician experts, performed a comprehensive review and analysis of existing CMA policy, epidemiological data and current scientific research and developed a CMA position statement on the prevention of firearm violence.

“CMA recognizes that fundamentally, firearm violence is a human and civil rights matter; it violates the fundamental human right to life, liberty, and security of person—the right to live safely without fear in a free society,” the committee wrote in the position statement.

“As with other public health issues, physicians have a unique responsibility as trusted public health figures to respond to the harms associated with firearm violence, both as individual clinicians and as community advocates.”

Through the committee’s work, CMA has identified several opportunities and resources that may aid

Fall 2019

physicians in addressing firearm violence as a public health issue. The TAC compiled the following ways for physicians to get involved and help prevent gun violence:

TAKE THE PLEDGE. Make a commitment to ask your patients about firearms when, in your judgment, it is appropriate, and follow through with support and resources to keep patients safe.

EDUCATE YOURSELF AND YOUR PATIENTS. Expanded education and training

are needed to improve clinician familiarity with the benefits and risks of firearm ownership, safety practices, and communication with patients about firearm violence. Make sure patients are aware of their right to seek a gun violence restraining order if someone they know is experiencing a crisis and is in danger of harming themselves or others.

SUPPORT RESEARCH. The suppression of

firearm research has stripped federal and state funding for data surveillance, research and analysis, and prevented the advancement of evidence-based policies as benefiting other major public health issues.

RECOGNIZE WARNING SIGNS AND RESPOND APPROPRIATELY TO PATIENTS WITH MENTAL ILLNESS – they are at higher

risk for suicide and to be a victim of violence, and access to firearms is associated with increased suicide risk.

UNDERSTAND YOUR LEGAL OBLIGATIONS TO REPORT. Physicians should know their legal

obligations for reporting specified medical conditions and the clinical interventions that might restrict a patient’s ability to own or possess a firearm.

Learn more about what you can do to help prevent firearm violence at cmadocs.org/firearm-violence.

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Public Health

Update

Vaping Associated Pulmonary Injury Responding as a Community to Emerging Threats

by Penny Borenstein, MD, MPH, Health Officer/Public Health Director, County of San Luis Obispo

As I’m sure physicians across the Central Coast are aware, our nation is experiencing an outbreak of severe lung injury associated with vaping. This immediate risk for vaping-associated pulmonary injury (VAPI) is in addition to the known and potential (currently unknown) long-term damage that vaping can cause.

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CENTRAL COAST PHYSICIANS

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We are able to recognize and respond to this outbreak in large part thanks to the keen observation and reporting of the physicians in Wisconsin and Illinois who first noticed the injury as distinct and shared their observation with local public health authorities, who in turn raised the alarm to state and national officials. More than a thousand cases have since been reported nationally and over 100 in California.

This process sometimes works so smoothly that it’s easy to take for granted. But I want to take this occasion to emphasize: it is thanks to the astute observation and instinct of these physicians and public health officials—and the important close relationship of the medical and public health communities—that we are today responding to this outbreak as a nation.

I want to express my gratitude to the many medical professionals here on the central coast who keep a keen eye out for unusual situations and promptly report unusual or suspicious cases or clusters in addition to the many diseases they are required by law to report.

I sometimes hear from clinicians who apologize when they call at odd hours to report a suspected case or tell me they hesitate to call about something that strikes them as unusual but isn’t mandatory to report. As health officer, 3 a.m. phone calls are part of my job—and while I may be saddened by the news they report, I’ve never been unhappy that they chose to call.

I encourage us all to take this situation as a reminder to take a curious, observant, humble, and collaborative perspective as we approach the day-to-day work of healthcare. Every illness we readily diagnose today was originally discovered by someone who recognized it as different from other diseases and chose to share that hunch with others.

Today, we face the challenge of keeping up not only with changes to pathogens but also with illnesses and injuries—like VAPI—that result from new technologies and behaviors. Your keen observation and prompt reporting can have an impact not only through the diagnosis of individual patients but also through helping activate a public health response that protects other members of the community.

Fall 2019

While this outbreak is rightfully making headlines, it follows a serious problem that has been simmering for some time nationally and here on the Central Coast: the rapid increase in vaping among young people.

This widespread increase has broad public health implications, from the increased risk of illness and injury such as VAPI to long-term addiction. There is also the fact that widespread youth vaping also brings an unknown.

Because the market is so diverse and inconsistently regulated (some cannabis products are regulated in California by the state department of public health, many products are unlicensed and unregulated), we don’t know what substances teens (or adults) are vaping. Even in cases where we do know that a substance is included as an ingredient in a vape liquid or pod, we generally do not have long-term data on the health consequences of inhaling a vaporized version of that substance.

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The known and unknown risks are potentially compounded by the fact that young people are disproportionately affected.

Teens and young adults often have more years ahead for chronic disease to develop and more years to face addiction.

They may also be more vulnerable as their bodies are still growing.

Like public health departments nationwide, our team has observed this issue and our tobacco control team has pivoted in recent years to address vaping and particularly the risk to young people. Our colleagues in behavioral health are responding to the same trends, particularly in their work with students. If you are interested in connecting patients with educational resources or getting involved with this issue locally, I encourage you to contact our team at the Tobacco Control Program at 805-781-4305 or via our Program Manager Inger Appanaitis at IAppanaitis@co.slo.ca.us.

These two crisis—VAPI and widespread youth vaping—will ultimately require different but likely connected responses from the medical, public health and policy communities. As with spotting unusual cases, developing appropriate policy and program responses will require us to keep a vigilant and curious perspective as we observe data, analyze its implications, and take action to protect our communities, particularly the young people who are so directly affected.

While I’m encouraged by state and national dialogue about possible policy change in this area, I want to remind us all that this discussion does not preclude the need for local policy.

I am interested in hearing about your experiences with the health-related implications of vaping. Please feel free to contact me to discuss your experiences and needs as we take on this challenge.

• Medical Directors • Social Workers

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Fall 2019

TO OUR ADVERTISERS

FOR SUPPORTING CENTRAL COAST PHYSICIAN THIS YEAR

Financial Services

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Healthcare

West Coast Vascular

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Insurance

Sansum Clinic

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Berkshire Hathaway HomeServices 805.705.4485 805.335.0158

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CENTRAL COAST PHYSICIANS

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SIGNIFICANT SURGE IN

C DIFF DISEASE Dear Colleagues: C. difficile disease is a concern for communities and hospitals across the nation. We are in the midst of a significant surge in C diff disease in Santa Barbara County. In our individual practices, we may not see C. difficile cases often or at all depending upon our specialty/practice type, but in the aggregate, this disease is now driving significant morbidity and contributing to some mortality in our region. Every patient we care for, though, and our families, are at much greater risk of this disease than they were a few years ago. The authors of this letter are writing to ask for your partnership to lessen the impact of this illness that in many ways we inadvertently cause by prescribing antibiotics. The reality of the situation is that antibiotics are much riskier to prescribe now than they were to prescribe even five years ago.

Presently, regional C. difficile cases and trends generating particular concern include:

• Pediatric cases, including infants • Persons diagnosed with C. difficile who have not been prescribed antibiotics in several months or years • Increased number and severity of cases in immunocompromised patients • Health care providers diagnosed with C. difficile • An upsurge in cases that relapse repeatedly • Cases leading to sepsis • Cases requiring colectomy • A doubling in the percentage of positive PCR test results on samples submitted to Pacific Diagnostic Labs, from all sources, since 2013 (now up to approximately 20%).

• Increased hospital admissions for community onset C. difficile in Santa Barbara County

COMMUNITY-ONSET C. DIFFICILE Community Acquired CDifficile INPATIENT ADMISSIONS Inpatient Admissions 300 250 200 150 100 50 0

2012

2013

2014

2015

2016

2017

2018

Cottage Health facilities have seen a 300% increase in community onset C difficile over the past 5 years. The numbers below show this dramatic and concerning increase, yet these numbers just represent the tip-of-theiceberg, as these are only those that require admission to treat. We have concluded this disease upsurge is real and not an artifact of altered testing modalities.

Cottage Health, Santa Barbara County Department of Public Health, Sansum Clinic, and CenCal representatives are forming an alliance to address this major health problem. We will be launching educational campaigns to prescribers and patients. Our goals for this outreach are:

• To reduce unnecessary antibiotic prescribing • To encourage use of antibiotics that are less likely to trigger C. difficile, when antibiotics are needed • To reduce patient requests for antibiotics for non-bacterial illnesses (sinusitis, bacteriuria, bronchitis, etc.)

• To track epidemiologic trends so we can address geographical or clinical “hot spots” as they evolve.

Based on improved evidence, we now have opportunities to use shorter courses of antibiotics for many conditions. Most uncomplicated UTIs can be treated in 3 days, many bacteremias in 7 days, pneumonias in as few as 3 to 5 days, endocarditis in 4 weeks, etc.

New diagnostics also can help us avoid or reduce antibiotic use (respiratory PCR panels that identify viral pathogens, procalcitonin assays, and others.).

Right now, you can work to educate your patients about this new reality that we all face and work to optimize your antibiotic prescribing, given there have been significant changes in the state-of the science in the past decade. It will take a joint effort by all of us to strike out C. difficile.

Sincerely, David Fisk, MD

Cottage Health Medical Director of Infection Prevention and Control Cottage Health Antibiotic Stewardship Program Sansum Clinic, Infectious Diseases

Henning Ansorg, MD

Health Officer Santa Barbara County Public Health Department

Richard Beswick, PhD

Vice President of Research and Chief Research Officer Cottage Health

Karen Hord, MD, MPH Acting Chief Medical Officer CenCal Health

Marjorie Newman, MD Medical Director Sansum Clinic

8 New & Rejoining The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

Roy Gordon Bryan, II, MD, MBA Diagnostic Radiology Santa Barbara Radiology Medical Group Santa Barbara 805.569.7279

Danny Leroy Lickness, MD Obstetrics and Gynecology San Luis Obispo 805.441.0410

Jacob L Harter, MD Diagnostic Radiology Pueblo Radiology Medical Group Santa Barbara 805.682.7744

Casey Nicole Rives, MD Hospitalist Sansum Clinic Santa Barbara 805.681.7500 Resident

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Charles Michael Hubeny, MD Diagnostic Radiology Pueblo Radiology Medical Group Santa Barbara 805.682.7744

Arpan J Desai, MD, MBA, MS Radiology Santa Barbara Cottage Hospital Program

Pierre-Alain Hueber, MD, PhD Urology Urology Specialists of Santa Barbara Santa Barbara 805.687.7719

Ralph Quijano, MD Santa Barbara Obstetrics and Gynecology

CENTRAL COAST PHYSICIANS

Retired

Fall 2019

Fall 2019

CENTRAL COAST PHYSICIANS

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