Central Coast Physicians Fall 2021

FALL 2021

Physician Health & Wellness in the Era of the COVID-19 New CenCal Health CEO Electronic Prescribing Mandate NicView

Three minimally-invasive treatment options

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Watchman™ Reduces stroke risk due to AFib

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CENTRAL COAST PHYSICIANS

Fall 2021

IS IT TIME TO EXAMINE

your malpractice insurance?

With yet another of California’s medical liability insurers selling out to Wall Street, there’s an important question to ask. Do you want an insurer that’s driven by investors?

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Fall 2021

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Fall 2021

VOLUME 6, NUMBER 4 • FALL 2021

{FEATURES}

14 16 18 32 Fall 2021

{DEPARTMENTS} ELECTRONIC PRESCRIBING MANDATE NICVIEW PHYSICIAN HEALTH & WELLNESS PHYSICIANS OF THE YEAR

8 PRESIDENT’S MESSAGE 11 RISK TIP 28 CENCAL HEALTH NEWS 30 CLASSIFIEDS 31 NEW MEMBERS 34 IN MEMORIAM

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Letter from the CEO

MOVING IN THE RIGHT DIRECTION

DANA GOBA

Once again, I am feeling optimistic that we are seeing some light at the end of the tunnel. As we go to print, approximately 66% of residents in San Luis Obispo County and 71% in Santa Barbara County are fully vaccinated, of those who are eligible. Since a substantial number of people in our community are now vaccinated, many are feeling more comfortable gathering.

Unfortunately, we had to make a decision regarding our Annual Membership Celebration as Delta was gaining traction, so we once again decided to go virtual.

We hope you enjoyed our virtual Halloween-themed event and the tour with a plague doctor through Prague.

PRESIDENT Priti Gagneja, MD PRESIDENT ELECT Samira Kayumi-Rashti, MD TREASURER Julie Fallon, MD SECRETARY Thomas Hale, MD IMMEDIATE PAST PRESIDENT Kevin Casey, MD DIRECTORS Eric Amador, MD; Michael DiBiase, MD; Todd Engstrom, MD; Jeffrey Gauvin, MD; Jennifer Hone, MD; Bindu Kamal, MD; Rachel May, MD; Rahim Raoufi, 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; Douglas Murphy, MD; Grace Park, MD; Joseph Schwartz, MD CMA DISTRICT V TRUSTEE Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE

Traditionally at our Annual Membership Celebration, we honor our Physicians of the Year, and we look forward to celebrating Dr. Thomas Hale in San Luis Obispo County and Dr. Alex Koper in Santa Barbara County next Spring.

At the event, we also thank our physician leaders. I would like to express my gratitude for physicians and all you have endured. I feel fortunate living on the Central Coast with the medical community we have here. I would especially like to extend my appreciation to the CCMA Board of Directors for supporting the organization this past year as we continued to navigate through the pandemic, most notably our president, Dr. Priti Gagneja who was always thoughtful and uplifting. I also want to acknowledge Dr. Rene Bravo, our California Medical Association Trustee, who ensured the voices of Central Coast physicians were heard in Sacramento. Lastly, I would like to thank all physicians who are members. With your support, we are able to fight for your profession and patients.

We are stronger together.

Sincerely,

EDITOR Priti Gagneja, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Chad Anguilm, MBA; Richard F. Cahill, JD; California Medical Association; CenCal Health; Douglas P. Murphy, MD; Kathleen Stillwell, MPA/HSA, RN; Tenet Health Central Coast CONTRIBUTING PHOTOGRAPHERS CenCal Health, Natus Medical Inc, 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.

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.

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

Dana Goba Chief Executive Officer Central Coast Medical Association

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reject any advertising. All advertising inquiries can be sent to magazine@ccmahealth.org.

A COMPONENT OF THE

Fall 2021

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Please call us at 805-456-8890 to refer your patients to our team.

Daniel B. Alfson, MD

Helping to Build a Healthy Community

info@sbvascularspecialists.com Office: 805.456.8890 | Fax: 805.456.8894

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Fall 2021

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CENTRAL COAST PHYSICIANS

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Rising Drug Costs in the US

The American Dream is a set of ideals in which equality and freedom lend to opportunity for prosperity and success. The definition of success differs per individual.

A patient of mine used to say, “Having medical insurance is my American Dream.”

She just wanted a job that would give her kids and herself financial safety and health care.

Health care for all is a dream for many. But even with health care, are treatments affordable?

I have a 49-year-old patient with out-of-control diabetes who just underwent a partial foot amputation. For years she’s been non-compliant with her medication. She is riddled with side effects from high blood sugar – protein in her urine, retinopathy, and vascular disease. Insulin was too expensive for her. She had insurance but would not refill her insulin because of the cost. She already struggles to afford food, clothes, and school needs for her children. Despite the fact that insulin has been discovered one hundred years ago, it could not help her to save her foot and end organs because of the cost.

The average US manufacturer price per standard unit across all insulins is about $100, compared to $7 in Australia, $12 in Canada, and $7.50 in the UK. Xarelto is $16 per tablet in the US, but only around $1 in Turkey.

Symbicort is $334 but is only $25 or less in other countries.

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PRITI GAGNEJA, MD, PRESIDENT

Fall 2021

Humira’s prices went up. For many, the co-pay used to be $800 per month, but now is $1500/ month.

The vast difference in prices is concerning.

It’s frustrating to see patient’s health crumble due to financially prohibitive medication. Patients lose hope in the medical system. High costs cause patients to avoid filling the prescription altogether, forgo other medical treatments or tests, or turn to alternative and often substandard options. The US has a unique problem with pharmaceuticals. We lack federal law and regulation to effectively keep drug prices in check.

The middleman system we have has part to do with this.

These middlemen are PBMs who work directly with insurance companies. They make a formulary, which is a list of drugs the insurer agrees to cover. They manage the prescription drug claims. The drug makers want their meds on these lists and then offer rebate payments. All this business between these entities determines what’s “preferred.” … Preferred by the middlemen’s pockets!

For some plans, Proair was once covered and Ventolin was not. Now that has switched. Protonix was covered, but now Nexium is preferred. The middlemen hugely influence the medication the patient receives.

PBMs have power. The three that dominate are the common mail order pharmacies which cover over 150 million Americans. This allows them to be aggressive when negotiating with drug manufacturers.

Humira’s price has been driven up 78% due to the cost the pharmaceutical company has to pay the PBM. Some have proposed eliminating the rebate system, changing the way PBMs are paid, reducing patent times, capping a patient’s financial responsibility, or sharing the rebate between insurer and patient. Unfortunately, many insurance plans now tend to make patients pay a percentage instead, which can be very expensive.

More Americans are also purchasing high deductible plans to keep monthly costs low, which becomes a problem when expensive meds are prescribed.

generics, have conversations with patients about affordability, offer alternatives and over the counter options, remind patients about manufacturer discounts and patient assist programs (NeedyMeds and GoodRx).

Some have proposed eliminating the rebate system, changing the way PBMs are paid, reducing patent times, capping a patient’s financial responsibility, or sharing the rebate between insurer and patient. Unfortunately, many insurance plans now tend to make patients pay a percentage instead, which can be very expensive.

What can we do?

Both political parties have made many recommendations, but putting them into legislation has been a challenge. Currently the Biden Administration hopes to address high drug prices and released a report September 2021 that supports drug cost transparency, price negotiation, Medicare Part D reform, and caps on spending and legislation that would slow price increases over time on existing drugs and speed entry of biosimilars and generics to the marketplace.

Until then, as physicians, to help patients, we can offer

Fall 2021

The American Dream has always been about progress yielding security and increased opportunity for the future generations. Drowning in medical bills threatens this dream which has now changed, for many, to simply having medical insurance access and affordability.

Priti Gagneja, MD President

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Tenet Health Central Coast

Sierra Vista Regional Medical Center

Health

Stronger Together

Your Partners in Neurosurgical Care Together, with the University of California, San Francisco (UCSF), Sierra Vista Regional Medical Center is providing a stronger network of neurosurgical services on the Central Coast. Combining nationally recognized expertise and advanced technology, we can help keep you close to home for specialized neurosurgical care.

Why Choose Sierra Vista Regional Medical Center?

• Integrated care with UCSF Medical Center, which ranks number two in the nation and best in California in neurology and neurosurgery by U.S. News & World Report • Advanced technology for enhanced precision of brain and spine procedures • Advanced Thrombectomy Capable Stroke Center Certification • Blue Distinction Center+ for Spine Surgery • The only designated trauma center in San Luis Obispo County

To meet our specialists, visit TenetHealthCentralCoast.com/UCSF 10

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Fall 2021

RISK TIP

Open Notes in Healthcare

THE GOOD, THE BAD, AND THE UGLY OF THE CURES ACT

BY CHAD ANGUILM, MBA; RICHARD F. CAHILL, JD; AND KATHLEEN STILLWELL, MPA/HSA, RN

On April 5, 2021, a requirement of the 21st Century Cures Act went into effect: Patients must be able to access information in their EHRs “without delay.” (This requirement does not apply to paper records.) The Cures Act prohibition against information blocking, often referred to as an “open notes” provision, provides patients with transparency in the outcomes of their healthcare via convenient access to information in their EHR, which can positively or negatively impact the patient-doctor relationship.

Patient access to records is not new, and neither is the Cures Act, which dates to 2016. What is new is the requirement that patients have electronic records access that is fast and easy. This requirement is expected to result in more patients—still a small proportion overall, but more patients—accessing additional EHR information, including providers’ notes.

Fall 2021

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The requirement to provide patients with EHR access raises questions for healthcare practices. Some questions are logistical, and some are relational. Concerns include the potential for increased time for patient education, or patient requests for changes to their records that the clinician cannot support.

Healthcare providers should understand the good, bad, and ugly implications of the Cures Act open notes provisions so they can meet the requirements and reap their benefits, while avoiding the potential for fines or sanctions based on noncompliance, or other negative impacts.

services that allow practices to remain in compliance with the Cures Act. It may be necessary for a provider to call their EHR vendor and say, “What are you doing to ensure my interoperability compliance?” Meanwhile, secure drop box options for records requests provide a workaround.

Ugly News About Open Notes

Some patient requests for record amendment are legitimate and easily handled. Some patients, however, will request removal of material they find embarrassing, even though it is accurate.

Good News About Open Notes

Many patients feel better about their provider after reading a note. Positive effects on the patient-provider relationship may be most significant among vulnerable patients, such as those with fewer years of formal education.

Further, open notes have positive impacts on patient engagement and understanding. Patients report that reading notes is a way to better understand and feel more in control of their healthcare. They also say it builds trust with their provider. The nonprofit organization OpenNotes (not a part of the Cures Act) cites helping laypeople maintain trust in scientific medicine as one benefit of the transparency created by the Cures Act open notes provisions.

Concerns about open notes mainly revolve around the potential for conflicts with patients and potential time conflicts.

Concerns include: • Timing: The originally planned implementation date for the open notes provisions in the Cures Act was November 2020. Because of the COVID-19 pandemic, this was pushed back to April 2021. However, many providers and practices are still feeling the pandemic’s effects, leading to the question: “Will new demands never end?”

More frequent requests for records changes from patients could increase already weighty administrative burdens on providers. Worse, some of these requests will be for changes providers cannot support, and making time for careful conversations with patients and providing written responses for requests that are rejected will be a challenge. Inevitably, some of these conversations will not go well, whether through the patient feeling the provider did not adequately respond to their concerns, or through the patient insisting on unreasonable demands. These negative relationship outcomes will add emotional stress on both the patient and the provider, as well as a reputational threat to providers from angry patients posting negative reviews online.

• Uncertainty about the documentation process: Most patients will not understand clinical shorthand, and providers may need added time for explanation. Providers are wondering: “How can I make my notes comprehensible to patients while still writing them quickly?”

More tangibly, noncompliance with the open notes requirement carries the potential for fines, penalties, and/ or sanctions from medical boards. The specifics of potential penalties are not yet known—there are more changes coming with the Cures Act.

Bad News About Open Notes

Concerns about open notes mainly revolve around the potential for conflicts with patients and potential time conflicts.

• Technology: Some EHR vendors are still racing to provide

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Patients have the right to request amendments to their medical records: The Health Insurance Portability and Accountability Act (HIPAA) requires a signed, dated request from the patient regarding what they want changed and why.

Making Changes in Open Notes

Patients will ask providers to amend their medical records. Be familiar with what the patient has the right to ask, what the provider can grant and/or refuse, and how to amend notes. Here are some highlights: • P atients have the right to request amendments to their medical records: The Health Insurance Portability and Accountability Act (HIPAA) requires a signed, dated request from the patient regarding what they want changed and why.

• P roviders have the right to determine whether the requested amendment will be made: The provider must respond, in writing, within 60 days of receipt of the patient’s request.

•C ommon reasons to deny a patient’s request include that the provider who received the request did not create the record entry, or that the medical record is accurate as is.

•T he patient’s request and the provider’s response both become part of the patient’s medical record.

Strategies for Success

When composing notes, certain simple strategies will raise the odds that notes will be well understood and well received.

Beyond being clear and succinct, strategies for success include

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composing at least a portion of the note as instructions directly addressed to the patient—“Start taking lisinopril and check your blood pressure twice a week,” vs. “Initiated lisinopril and instructed her to check her blood pressure twice a week”— and providing a list of commonly used medical terms and abbreviations.

For an in-depth review of strategies for success when composing notes, see 12 Strategies for Success With Open Notes in Healthcare: The Cures Act (www.thedoctors.com/articles/12-strategies-for-success-withopen-notes-in-healthcare-the-cures-act).

Exceptions

Unless an exception applies, clinical notes must not be blocked, but the Cures Act allows for a fairly long list of specific, welldelineated exceptions. For instance, a record can be blocked if a provider believes that viewing a note presents a substantial risk of harm to the physical safety of the patient or someone else.

The Cures Act also recognizes exemptions that apply to certain caregiving situations, such as when parents attempt to access confidential parts of an adolescent child’s records.

For information regarding exceptions to open notes, please see What Open Notes Exceptions Does the Cures Act Allow? (www.thedoctors.com/articles/what-open-notes-exceptionsdoes-the-cures-act-allow)?

Seeing Open Notes as Part of HighTouch, High-Value Care While many physicians and other providers have anticipated open notes with dread, most outcomes so far have been positive.

Patients have reacted well to clarity. They have used open notes as a tool to improve their own understanding of and adherence to care instructions. When patients have noted valid issues or miscommunications, they have appreciated being able to quickly clear them up. More than an administrative burden, open notes present an opportunity to improve documentation, patient-provider relationships, and patient safety. By improving patient adherence to treatment plans, open notes have the potential to improve provider satisfaction, as well.

Chad Anguilm, MBA, is Vice President, In-Practice Technology Services, Medical Advantage, part of TDC Group. Richard F. Cahill, JD, is Vice President and Associate General Counsel, The Doctors Company, part of TDC Group. Kathleen Stillwell, MPA/HSA, RN, is Senior Patient Safety Risk Manager, The Doctors Company, part of TDC Group.

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CALIFORNIA’S ELECTRONIC PRESCRIBING MANDATE FREQUENTLY ASKED QUESTIONS Assembly Bill (AB) 2789 of 2018 created a state-level mandate that all prescriptions must be transmitted electronically by January 1, 2022. The law applies to all physicians and almost all prescriptions, with very few exceptions. The California Medical Association (CMA) has compiled these frequently asked questions to help physicians understand their requirements under the new law.

WHEN DOES THE MANDATE TAKE EFFECT? The law takes effect on January 1, 2022. This date aligns with the compliance date for the Medicare mandate for electronic prescribing of controlled substances (EPCS).

DOES THE MANDATE INCLUDE PRESCRIPTIONS FOR CONTROLLED SUBSTANCES? YES. The law stipulates that prescriptions for controlled substances are included in the electronic prescribing mandate.

Physicians are required to comply with federal rules for EPCS. For more information on the federal rules regarding EPCS, please see CMA health law library document #3207, “Electronic Prescribing.”

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ARE THERE EXEMPTIONS FOR SMALL, RURAL, OR SAFETY NET PRACTICES? NO. The law applies to all physicians, regardless of specialty, mode of practice, practice size, or geographic location. There are some limited exceptions that would allow certain prescriptions to be submitted in paper form, as outlined below.

WHAT ARE THE EXCEPTIONS? The following types of prescriptions are exempt from the electronic prescribing mandate:

• Controlled substances prescriptions for use by a patient who has a terminal illness.

• E-prescribing is not available due to a temporary technological or electrical failure.

• The prescribing physician is issuing a prescription to be dispensed by a pharmacy located outside California.

• The prescription is issued in a hospital emergency department or urgent care clinic and either the patient resides outside California, the patient resides outside the geographic area of the hospital, the patient is homeless or indigent and does not have a preferred pharmacy or, the prescription is issued at a time when a patient’s regular or preferred pharmacy is likely to be closed.

• The prescription is issued by a veterinarian.

• The prescription is for eyeglasses or contact lenses.

• The prescribing physician and the dispenser are the same entity.

• The prescription is issued by a prescribing physician under circumstances whereby the physician reasonably determines that it would be impractical for the patient to obtain controlled substances from an e-prescription in a timely manner, and the delay would adversely impact the patient’s medical condition.

• The prescription that is issued includes elements not covered by the latest version of the National Council for Prescription Drug Programs’ SCRIPT standard.

If a physician believes that one of the above exceptions apply, they must document it in the patient record within 72 hours of filing the prescription.

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QUESTIONS? CONTACT:

DAVID T. FORD VICE PRESIDENT, HEALTH INFORMATION TECHNOLOGY CALIFORNIA MEDICAL ASSOCIATION 916.444.5532 DFORD@CMADOCS.ORG

IF A PATIENT RECEIVED A PRESCRIPTION ON PAPER PRIOR TO JANUARY 1, 2022, DO REFILLS OF THAT PRESCRIPTION NEED TO BE FILED ELECTRONICALLY? The law does not specifically address refills. CMA recommends that, if possible, physicians should submit refills electronically.

WHAT IF THE PHARMACY CANNOT RECEIVE AN ELECTRONIC PRESCRIPTION? There are several options under the law in this case. The physician or the patient can submit the prescription to a different pharmacy. If changing pharmacies would cause an unreasonable delay in the patient receiving their medication, the physician should document it as such in the patient’s record and proceed to file the prescription either on paper or by fax.

DOES FAXING A PRESCRIPTION COUNT AS “ELECTRONIC PRESCRIBING?” NO. The law requires physicians to submit prescriptions using “electronic data transmission” as defined in California Business & Professions Code Section 4040. The definition of electronic prescribing in that code section does not include faxing.

WHAT ARE THE PENALTIES FOR NONCOMPLIANCE? Physicians who fail to comply with the law will be referred to the Medical Board of California. The medical board has published several physician communications outlining the requirements of the law but has not proposed any specific enforcement actions they might take.

WHAT STEPS SHOULD A PRACTICE TAKE NOW? First and foremost, CMA recommend that practices assess your current capability for electronic prescribing, especially for controlled substances. Most major electronic health record (EHR) systems come with embedded electronic prescribing software that will support EPCS, but it may need to be turned on or require an upgrade. If a practice’s EHR does not support EPCS, it may be necessary to find a stand-alone electronic prescribing system that does.

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Connecting NICU Parents to Their Babies with Innovation and Compassion For physicians and their patients who have a newborn requiring intensive care, the hardest part is often the feeling of the baby being isolated from the parents. This parental stress is not only acute, but studies have shown that it can influence long-term parenting behavior and child development.

That’s why Tenet Health Central Coast is proud to announce that its Neonatal Intensive Care Unit (NICU) at Sierra Vista Regional Medical Center – the only Level III NICU in San Luis Obispo County – is now utilizing a research-proven innovation that helps parents and loved ones feel connected with their newborn, even when they are physically separate.

This new connectivity tool is a virtual window into the

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baby’s bed in the NICU: Individual cameras are now mounted above the incubators, providing parents with secure real-time viewing of their newborn 24/7 (except at times when the baby is receiving care). It is the NicView live-stream camera system and allows parents to view their baby anywhere in the world by computer or mobile device.

In the age of Covid-19, many have become blasé about video-call platforms like Zoom, FaceTime, and other livestream tools, but for parents of babies that have to be in the NICU, this technology can be an emotional lifeline.

It means that parents can watch their children without taking time off from work. It also means they can see their child more often if there are transportation challenges.

Importantly, during pandemic surges, it allows loved ones to see the child if visitors are limited.

NicView can be accessed via a laptop, smartphone, or tablet and the NicView connection streams securely, which includes no recordings. Login credentials ensure that parents are the only ones with access, and they have the control to share those login credentials with additional loved ones.

Not only does research and real-world, anecdotal evidence

Fall 2021

report that NicView helps make parents feel more connected to the medical team, thereby enhancing confidence in the care being provided, it shows health benefits for the baby and family.

For example, mothers report using video interactions to stimulate breast milk flow while pumping, and breast milk is an essential tool for the newborn’s growth and improvement.

Recent research shows that mothers using the technology reported a sustained intention to breastfeed or provide breast milk to the baby (83% compared to 66% of mothers who did not use the technology).

Further, NICU nurses report that, even though the connection is virtual, the parent bonding is tangible and families can watch and learn their newborn’s routines in the NICU, helping to smooth the transition to life at home. These reports are supported by recent research with parents where there was a statistically significant increase in self-perceived parental involvement in their baby’s care.

In terms of impact on the stress facing parents of NICU babies, research published this year in the Journal of Perinatology found that parents’ perceptions of using this tool while their infants were in the NICU were consistently positive. In fact, stress scores for both mothers and fathers were significantly lower when they were using the NicView.

Sometimes our loved ones have to stay in the hospital and it can be particularly anguishing when a newborn is in intensive care and parents have to go home without their baby. It’s simply not possible to stay in the hospital with our loved ones 24/7 but, with NicView, parents can stay connected.

And, they can take heart that Tenet Health Central Coast is always there for them and their family, as a part of a Community Built on Care.

Fall 2021

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Fall 2021

Physician Health & Wellness in the Era of the COVID-19

BY DOUGLAS P. MURPHY, MD

“What is wellness? A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” World Health Organization As I began writing this second installment on the series, “Physician Health & Wellness in the Era of COVID-19” I was struck by how much had changed in the last 6 months regarding COVID-19. Based on my research for the first article and the favorable trajectory of the pandemic was taking, my thesis for this second article seemed set: “Physician Health & Wellness in the Era of COVID-19 in the Rearview Mirror: A World Coming Out of Pandemic.”

At that time there was much of this hope and optimism.

Coming out of the horror of the pandemic-ravaged Winter, this hope was desperately needed. Baseball was back, and though the Yankees weren’t doing well, people were watching and they were having fun! Businesses, restaurants, and theatres were opening. People were making plans; they were getting back to living life. New York City was hosting an international flagship event cancelled in 2020 due to the pandemic: the US Open, one of the so-called Grand Slam events of tennis. This US Open was unique as sport history of the highest order. Novac Djokovic, a favorite to win, would accomplish two historic feats: break the record for Grand Slam victories at 21; and completing the “Calendar Slam,” winning all 4 Grand Slams in a single year.

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This had not been accomplished in the men’s tennis since Rod Laver did it 52 years ago in 1969. Considering the shocking state the city was in just 6 months before, the change was remarkable.

Flushing Meadows was alive with smiles and activity. People were relaxed, casual in conversations, and having fun. As I watched it seemed to me that both Djokovic and New York City were climbing their own Mt. Everest, one for tennis glory, and the other for a place out of the horror that had been the COVID-19 pandemic.

Sadly, it was not meant to be. Djokovic did not summit his Mt. Everest being taken down in the final by a surgent Danil Medvedev. New York City was unknowingly beset with another surge of COVID-19: the Delta Variant.

Better Days Ahead: The Rollout of Vaccines

By March 2021, case rates were dropping, and vaccines were rolling out with great demand. At that time, it was conceivable that 70-85% of the population could be vaccinated before the onset of the fall flu. An end to the pandemic seemed to be in sight. Three vaccines were approved for Emergency Use: Pfizer/ Biontech, Moderna, and Johnson & Johnson.

However, a series of new variants began to cloud the picture with potentially dangerous properties that could threaten to

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derail the recovery. They were found to be more contagious than “wild type” COVID and were making their way across Europe causing severe illness and death, largely to the many unvaccinated at that time. The Kent (B.1.1.1) or Alpha variant was the dominant strain at that time; though more infectious, it was susceptible to immunity conferred by the new vaccines.

Good news. Two other variants, the South African (B.1.351) or Beta and Brazilian (P.1) or Gamma were also of concern.

But research showed the threat to be minimal when fully vaccinated.

In California, the vaccination program rolled out robustly with the most vulnerable prioritized. Vaccination rates continued to rise through April 2021, peaking on April 20, and then began to decline. At this time case rates in the US were still decreasing and municipalities began to loosen up on restrictive public health measures. Public health tier designations dropped from purple, to red, to orange and yellow, and finally dropped altogether. There was a sense of hope and ease as it felt like we were coming out of pandemic.

By May, the demand for vaccinations was dropping and vaccine hesitancy was being discussed alongside some very confusing reasoning. We hadn’t quite reached the half-way point of fully vaccinating the population. “Come if you are vaccinated” policies began to take place in businesses and entertainment venues to show they were safe to attract audiences and provide an incentive for more people to get vaccinated. There seemed to be little impact.

The Rise of Delta About the time Novak Djokovic was making his historic run

at the US Open, June and early July saw some of the lowest case rates in the US. After 18 months of pandemic, the nation was ready to live again. Life was returning to normal again. But again, it was not meant to be.

The Delta variant, first identified in India in December 2020, spread rapidly through the mostly unvaccinated country of India causing massive numbers of cases, hospitalizations, and deaths. In the UK, the Delta variant also spread rapidly despite high vaccination coverage, although there was a much slower increase in hospitalizations and deaths.

In the US, the Delta variant was first identified in March 2021. By early July immune escape properties were associated with this variant. Our greatest fear realized? However, soon we learned that vaccines, especially mRNA vaccines, when fully dosed, conferred a robust immunity. Not as potent as originally tested. But vaccines offered very good immunity against infection and strong protection against severe illness, hospitalization and death. However, fully vaccinated individuals could be infected by Delta, “breakthrough infection,” taking away the sense of ease the vaccinated had become accustomed to. But that infection would almost certainly not lead to severe illness, hospitalization, or death.

By mid-late July COVID began to surge again in the US with increasing infection rates similar to those seen in the winter. Public health policies of social distancing and other restrictions returned.

“Many found it difficult to subject themselves to restrictions again when they had just been exulting in freedom from the waning pandemic. It seemed that we were being sucked back into a nightmare we had just woken up from.”

The Pandemic of the NonImmunized And Delta was infectious, very infectious.

It quickly became the dominant strain.

This led to a surge beginning in late-July that peaked in late-August. Hospitals began to fill up again with the sick and dying. The surge hit the south eastern US and in places where community vaccination rates were low.

In fact, the spread of Delta was largely a reflection of the uneven vaccination coverage in

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the US, with substantially higher numbers of cases, hospitalizations, and deaths among states with low vaccination rates.

Protection offered by available vaccines against Delta was coming in and the news was favorable. Data from the UK suggest that full vaccination with the Pfizer BioNTech vaccine gave good effectiveness against asymptomatic infection with 88% protectivity. This is lower than the original 95% protection found in initial studies, but it is still very good. It is clear that

protection conferred from both mRNA vaccines provides very good protection against infection and robust protection against severe illness, hospitalization and death.

Yet, hospitalization and death rates began to climb again.

There was much talk and anecdotal data amongst clinicians who treat critically ill patients. The consensus has been that the overwhelming majority of seriously illness, hospitalization, and death from COVID-19 have been in non-vaccinated

If you missed Part I of this series, you can read it in the Spring 2021 issue of Central Coast Physicians, which can be found at https://issuu.com/centralcoastphysicians

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populations. I have heard many sad sentiments from those doses administered. In the United States (population 328.2 treating COVID patients whose suffering they see as million) there were 42,887,401 cases (13.1% population) preventable. “If only they had gotten the vaccine.” and 687,572 deaths (1.6%) with 387,914,498 vaccine doses Research from a CDC data review have recently shown administered with an estimated 183,400,00 fully vaccinated that unvaccinated Americans have died at 11 times the rate representing 65% of the US population age 12 an older of those fully vaccinated since the delta variant became the (vaccine-eligible). Of Americans age 65 and older, 83% are dominant strain. The study goes on to state that vaccinated fully vaccinated. The United States has an overall mortality people are 10-times less of 209 per 100,000 likely to be admitted to the general population. In The five main individual determinants hospital and five times less California, (population likely to be infected than 39.7 million) there were for vaccine hesitancy: confidence, unvaccinated. An Israeli 4,676,539 cases (11.78% of complacency, convenience (or study showed that Israel’s population), 68,551 deaths constraints), risk calculation, and unvaccinated population (1.47% cases) (0.17% collective responsibility. of 17% now account total), 50,255,214 vaccine for 65% of all serious doses administered COVID-19 cases. In the and 23,724,626 fully study they stated that per capita, for every death of an Israeli vaccinated which is 60.39% of the general population. In Santa over 60 that had received the booster shot, there are 15 deaths of Barbara, (population 448,200) there were 43,353 cases, 505 unvaccinated Israelis in the same age group. deaths (1.16% cases) (0.1% total) and 540,306 vaccine doses A wide array of data supported the safety and effectiveness administered with 68.0% of eligible residents over age 12 fully of vaccines against the Delta variant, especially in preventing vaccinated, 76.2% partially vaccinated (countyofsb.org). In San serious illness, hospitalization and death, and that breakthrough Luis Obispo, (population 283,111) there were 28,582 cases, 324 cases in fully vaccinated individuals tend to be less serious. deaths (1.13%) and 326,028 vaccine doses administered with 63.2% of residents over age 12 fully vaccinated, 70.6% partially vaccinated (recoverslo.org).

Vaccine Hesitancy The WHO defines vaccine hesitancy as a “Delay in acceptance or refusal of safe vaccines despite Mental Health Effects of the available vaccine services.”

COVID-19 Pandemic on Vaccine hesitancy, the reluctance of people to accept proven Physicians and effective vaccines was already a growing concern before the For most physicians, the practice of medicine is as much a COVID-19 pandemic. A framework developed from research calling as it is a profession. The calling of this practice is rooted done in high income countries, called ‘the 5C models of the in the character of the physician whose daily decisions and drivers of vaccine hesitancy’ provides five main individual patient interactions are the outcomes of a commitment to values determinants for vaccine hesitancy: confidence, complacency, that supersede one’s own self-interest. However, though medical convenience (or constraints), risk calculation, and collective training is highly rigorous, and most doctors are exposed responsibility. Promoting the uptake of vaccines will require to the inevitability of patient death in medical school, the understanding whether people are willing to be vaccinated, the unprecedented scale of severe infection and death associated reasons why they are willing or unwilling to do so, and the most with COVID-19 has taken a toll on doctors providing direct trusted sources of information in their decision-making. patient care.

Present State of the COVID-19 Pandemic in Numbers Numbers for COVID-19 pandemic from Johns Hopkins as of September 25, 2021, were, worldwide 231,379,222 COVID-19 cases and 4,741,510 deaths (2.2%) with 6,061,054,605 vaccine

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In a study performed by Feingold et al in October 2020, “Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Workers During the Pandemic Surge in New York City,” the authors reported on psychological impact on frontline health care workers (FHCWs) during the major surge in COVID-19 cases from March to May 2020 that

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brought as yet unimaginable levels of suffering and death to New York City hospitals. At that time, New York City was the epicenter of COVID-19 cases in the US. This would be followed by an even bigger surge in December to January 2021. The author’s findings were that 39% of FLHWs suffered met criteria for symptoms of COVID-19related PTSD, MDD, or GAD. The study did not make formal diagnoses as the measurements used were screening instruments: PCL-4-5 for PTSD, PHQ-8 for MDD and the GAD-7 for GAD. These are reliable instruments that are used widely for screening in clinical practice. Of the 39% of FLHWs that screened positive, 23.3% screened positively for PTSD symptoms, 26.6% for MDD symptoms, and 25.0% for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19-related PTSD (odds ratio [OR] 2.10), MDD (OR 2.83), and GAD (OR 2.68).

These scores are significantly higher than those found in the general population.

Higher perceived support from hospital leadership was associated with a lowest risk of all outcomes [PTSD (OR 0.75), MDD (OR 0.72), and GAD (OR 0.76)].

The authors compare results with other studies of the psychological impact of pandemics. They hypothesized

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Where to Find Help California Medical Association (CMA) www.cmadocs.org/wellness Meeting the need of physicians’ challenges at the organizational and systemic level while providing innovative resources to help physicians prevent or address burnout.

American Medical Association (AMA) www.ama-assn.org/amaone/equipping-physiciansmanage-burnout Free, easy-to-use online resources, quick tips on implementing practice improvement strategies and exclusive insights into how other physicians manage burnout.

Physician Support Line 1.888.409.0142 Volunteer psychiatrists offering free and confidential counseling to physicians and medical students.

National Suicide Prevention Lifeline 1.800.273.TALK Free, confidential support on a 24/7/365 basis to anyone of any age.

Local Resources Cottage Health www.cottagehealth.org/coronavirus-covid-19/ wellness/

Dignity Health www.dignityhealth.org/central-california/classes-andevents/community-wellness-program

Sansum Clinic www.sansumclinic.org/medical-services/medicalservice/details/health-education-classes-events

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Multitude of coronavirus variants found in the US — but the threat is unclear

3/24/21, 6:17 AM

Motorists queueing at the United States’ largest COVID testing site, outside the Dodger Stadium in Los Angeles, California. Credit: Ringo Chiu/Zuma Wire

and found that their study numbers were in agreement surgeons are at greater risk.

For the scientists who have spent the past year poring over hundreds of thousands of with a study performed in Wuhan during the peak surge of A review by Banerjee in July 2020, reported that risk factors coronavirus genomes, the United States has been an enigma. having world-leading COVID-19 onset, and higher than other less intense pandemic for suicidality Despite align strongly with the impact of the COVOD-19 genome sequencing infrastructure and experiencing moreso COVID infections than anySuicide otherremains events suggesting a dose-dependent response on the percentage pandemic as to create a dual vulnerability. of cases within the sample.

Thishas alsountil suggests a high laggedamong the top ten causes of death globally.

A Lancet review in country, theexposed United States recently far behind in sequencing coronavirus level of validity in the that higher levels of PTSD, MDD and June 2020 stated, “Suicide is likely to become a more pressing genomes and spotting worrisome variants.

GAD are an expected result. concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups.”

But in recent weeks, US researchers have identified a host of new variants, including in Physician Suicide TheCalifornia, lifetime risk ofNew completed patientsand with elsewhere.

The Story of Lorna Breen, Yorksuicide State,among Louisiana And they are continuing to ramp up SARSuntreated depressive disorder is nearly 20%.

Each year, 300 to MD, Emergency Medicine, CoV-2 sequencing efforts.

400 doctors in the U.S. take their own life, says the American New York City Federation for Suicide Prevention. One per day. That’s more https://www.nature.com/articles/d41586-021-00564-4 This story is a tragic one which, though dramatic, isPage not 2asof 11 than double the rising rate in the general population. In 2018, unique as it may seem. Born in Charlottesville, Virginia, and the suicide rate among males was 3.7 times higher (22.8 per raised by caring supportive parents, she was closest to her sister 100,000) than among females (6.2 per 100,000). Even then, Lorna, 22 months her younger. Even during their adult years, the number is probably an undercount. Among specialties, they talked daily. She graduated from Wyoming Seminary anesthesiologist, psychiatrist, general practitioners, and general in 1988 and received a master's degree at Cornell University

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before attending Medical College of Virginia and completing almost a quarter of the people admitted to Allen for COVID-19 double residency at Long Island Jewish Medical Center Internal would die.

Medicine and Emergency Medicine. At the time of her death, On April 4, Dr. Breen worked another 15 hours. A colleague she was medical director of the emergency department at New texted her: “Prayers to u Lorna. Stay strong.” She replied, York-Presbyterian Allen Hospital. She was a driven clinician but “Hardest time of my life. Am trying to focus.” The following day, did make time for herself and for friends. An avid snow-skier, a colleague noted she appeared confused and overwhelmed. Dr. snow-boarder, and half-marathoner, she taught herself to play Breen wrote a message to her Bible study group. “I’m drowning the cello and took up salsa dancing as some of her avocational right now — May be AWOL for a while,” she typed. She soon activities. stopped replying to friends’ messages altogether.

At a time when the rest of the medical community was Dr. Breen called her sister on April 9. She sounded so unlike watching COVID-19 spread across the globe, she stated that herself that Ms. Feist wondered if the virus had altered her brain. she believed Ms. Feist called COVID-19 was Dr. Angela Mills, going to catch chief of emergency Each year, 300 to 400 doctors in the U.S. take hospitals in New medicine, Dr. their own life, says the American Federation York unprepared.

Breen’s supervisor. for Suicide Prevention. One per day.

In February A psychiatrist 2020 she took friend of Dr. a ski trip with Breen’s soon her sister to Big Sky, Montana, and returned to a pandemic arrived to see her. After spending some time, the friend called already raging in New York. Dr. Breen was confronted by the Ms. Feist and said her sister needed to be hospitalized. horror of medicine on the front line of the pandemic. Nobody After 11 days in an inpatient psychiatric ward, she appeared could have been prepared for the amount of severe illness and to rally, and chatted on the phone with a close friend who was death that she would be confronted with. Emergency doctors relieved to hear her voice. She seemed strong and was soon are particularly vulnerable to post-traumatic stress — while discharged to her mother in Charlottesville. She appeared more working in a profession that encourages toughing it out. The herself, making jokes. She mentioned returning to her M.B.A. coronavirus had presented unusual mental health challenges for studies. She started going for long runs. Family members her emergency physicians throughout New York, the epicenter of talking about getting back to New York. the crisis in the United States.

But on Sunday, April 26, 2020, Dr. Breen took her own life.

“To her friends and family, she had described an In the days before her death, the Dr. Breen recounted to onslaught of patients who were dying before they family her experience of traumatic scenes she'd witnessed, could even be taken out of ambulances.” seeing so much death and suffering, patient dying before they Doctors are accustomed to responding to all sorts of grisly could be taken from ambulances. According to her father: tragedies. But rarely do they have to worry about getting sick "She was truly in the trenches of the frontline. She themselves, or about infecting their colleagues, friends, and tried to do her job, and it killed her.” family members. Then, exposed at work, Dr. Breen contracted COVID-19 herself. It was thought to be a mild case. Ten days Practicing Wellness in the later she was back to work after isolating for a week and a half.

Midst of the COVID-19 It did not take long for the structure Dr. Breen had once Pandemic so deliberately constructed began to completely cave in. She “Wellness is a state of complete physical, mental, started working long days that bled together one into another, and social well-being, and not merely the absence of some required overseeing EDs at both Allen and the main disease or infirmity.” World Health Organization Columbia medical campus. There could be no balance, no There are a myriad of ways to approach wellness, many release, no pragmatic steps to escape the horrible impact of are excellent. Here I will suggest some basic strategies to add the pandemic. There was only the sick and the unfathomable: the component of wellness to your life each and every day. It’s bodies every day. Ultimately, during the worst of the crisis, amazing how simple these practices are. But their effects may

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be profound if they become a practice and remain a priority. For the physician on the journey to a more healthful and fulfilling life, skipping practice of the wellness component on a busy day will not hinder you from your goal. However, if a week goes by without engaging this practice, it is remarkably easy to find it’s been 2 weeks, or a month. Then it feels like starting over again from the beginning. In order for the wellness component to be effective, it must be a priority. Just do it!

James Lake, M.D., wrote in a June 2020 article in the Psychiatric Times on “4 Pillars of Good Mental Health.” Dr. Lake states, “It is of utmost importance to focus on improving lifestyle factors, which may then translate into improved general mental health, and more resilience in the face of stress.” These four pillars are Nutrition, Physical Activity, Sleep and Stress Management. We will cover these in greater detail in a subsequent article in this series.

Conclusion The principles of Physician Health & Wellness may seem to pale in urgency and importance to the pressing issues associated with the global pandemic.

However, it is important to consider, “If not now, when?” There will be an end to the pandemic. It’s time to get serious about physician health and wellness.

As stated previously, that is not something we as physicians can accomplish without the support of other stakeholders in the healthcare industry. Perhaps recognition of the profound suffering of many doctors during the COVID-19 world pandemic may prompt change. But for the present, change must start with us. We can all practice healthy resilience strategies and seek to balance engagement outside our jobs that we may find fulfilling. If we don’t act proactively, we may find ourselves in a state of emotionally tragedy or worse. If that is the case, I hope each of us will reach out. Doctors are notoriously poor when it comes to asking for help. However, there are times that the strongest and wisest thing we can do is humbly ask for help. I have provided resources below for anybody that is in a situation where they may need such help. This will serve your loved ones, your patients and yourself.

If you are suffering, please don’t suffer alone.

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JOIN TODAY FOR ONLY

$

90

A MONTH!

TOGETHER, WE ARE STRONGER.

When you join the California Medical Association and Central Coast Medical Association, you join more than 45,000 members statewide who are actively protecting the practice of medicine and defending public health.

Membership is affordable and easy to maintain. With our monthly payment plan, you can be a member for less than the price of a daily cup of coffee!

SIGN UP AT www.cmadocs.org/join

Fall 2021

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CenCal Health NEWS HUB:

CENCAL HEALTH NAMES MARINA OWEN TO SUCCEED LONGTIME CEO

CenCal Health, the publiclyfunded health care program for Santa Barbara and San Luis Obispo counties, announced that Marina Owen will serve as its CEO, effective November 1.

Owen succeeds Bob Freeman who retired after 28 years with CenCal Health.

As CEO of one of the first and oldest Medicaidonly managed care plans of its kind in the nation, Owen will be responsible for the overall strategic direction, management and administration of programs and services while ensuring that CenCal Health fulfills its mission, goals, and objectives.

Marina Owen has more than 15 years of health plan management experience, most recently as Chief Operating Officer at Central California Alliance for Health. There, she was responsible for enterprise-wide operations and executive leadership of member services, claims, project management, provider services, grievance, process improvement and regional operations. As a CenCal Health alum, Owen previously served as its Director, Provider Services and Community Engagement from 2008 until 2017. Owen becomes just the fourth CEO in the organization’s 38-year history.

“I am honored to serve CenCal Health once again,” said Owen. “I look forward to partnering with our board, members, providers and community organizations to improve the health and wellness of our diverse communities and advance health equity in the future.”

Bob Freeman is credited with managing CenCal Health’s growth to a current membership of over 205,000. During

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his tenure, a specialized pediatric unit was created to support Medi-Cal members who are also eligible for California Children’s Services, special health services for children and teens who have chronic medical conditions. Freeman also initiated an annual donation to two area non-profits for senior nutrition programs serving low-income seniors. Since 2016, the total contribution is over $2 million. Freeman led an organization that is listed at the top of Best Places to Work on the Central Coast in the Pacific Coast Business Times’ annual survey.

“I leave CenCal Health knowing the types of things we accomplished under my tenure will continue under Marina Owen,” said Freeman. “I have known and worked with Marina for almost 20 years. I leave the organization I love in very good hands.”

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CENCAL HEALTH FUNDS PHYSICIAN RECRUITMENT, MEDICAL EQUIPMENT AT THREE AREA HEALTH CENTERS

Four new physicians – three primary care doctors and one pediatrician – were recently retained by Community Health Centers of the Central Coast (CHC). The health care provider employed these medical professionals for its clinics in Lompoc, Arroyo Grande, and Santa Maria, with funding ensured by CenCal Health. Santa Barbara Neighborhood Clinics (SBNC) recruited a pediatrician for its Goleta clinic, as well as a psychiatric nurse practitioner in Santa Barbara, also with funds granted by CenCal Health. Six new medical practitioners are now serving local communities because of a unique initiative that covers physician recruitment costs and salaries, among other improvements for patient care.

In response to noted gaps in access to health care locally, CenCal Health implemented a Network Access Improvement program. The initiative focused on increasing primary and specialty care capacity for Medi-Cal members, as well as improving access to care for children and disabled members. These priorities were accomplished in two ways Fall 2021

– by recruiting medical professionals to the health plan’s network, and by funding specialized medical equipment.

CHC recently received funding approval for a power adjustable, hi-low treatment table to help disabled patients transfer from their wheelchair to the exam table, and a new vaccine refrigerator. SBNC has been authorized funds for one Hoyer lift to support patient mobility in its Isla Vista clinic, and the Lompoc Health Care Center of Santa Barbara County Public Health will receive funds for an audiometry machine.

“Our provider partners often experience difficulty recruiting medical professionals from outside of our service area, who are willing to relocate to serve the underserved in our neighborhoods,” said CenCal Health Provider Services Director Terri Howell. “It’s important that we support our partners in employing more medical experts, who in turn, can serve more of our members.”

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CL

DS

F I S IE S A

POSITIONS AVAILABLE CENCAL HEALTH is a community-accountable health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to more than 200,000 members in Santa Barbara and San Luis Obispo counties. Opportunities can be found at www.cencalhealth.org/workwithus.

CENTRAL COAST HOME HEALTH AND HOSPICE is a fast-growing freestanding company with the energy, flexibility, and commitment to do more than other corporate based home health agencies. Opportunities can be found at www.centralcoasthomehealth.com.

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. Opportunities 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. Opportunities can be found at www.sbcountyjobs.com.

DIGNITY HEALTH is a mission-driven, not-for-profit organization of more than 40 hospitals and care centers across California, Arizona, and Nevada. Opportunities can be found at dignityphysiciancareers.org.

SANSUM CLINIC is the largest and oldest multi-specialty 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.

Opportunities can be found at www.sansumclinic.org/physician-provider-jobopportunities.

Whether you are interested in employment, relocating your practice or joining the staff of one of our urgent care centers, TENET HEALTH most likely has an opportunity that’s right for you. Opportunities can be found at www.tenethealth.com/for-physicians/physician-careers.

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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Fall 2021

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

...and even more on the way.

Felipe Arce, MD Pediatrics Santa Barbara Arce Medical Care 805.324.4399

Gurjit Marwah, MD Pediatrics Lompoc Community Health Centers of the Central Coast 805.737.1169

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Ashton Regalado-Magdos, MD Radiology Santa Barbara Pueblo Radiology Medical Group 805.682.7744

RESIDENTS Robert Maciel, MD Diagnostic Radiology Santa Barbara Cottage Hospital

David Nunnelly, MD Diagnostic Radiology Santa Barbara Pueblo Radiology Medical Group 805.682.7744

Nedeljko Uncanin, Jr, MD Radiology Santa Barbara Cottage Hospital

Kim Peters, MD Internal Medicine Santa Barbara American Indian Health & Services 805.681.7144

Brandon Welbourn, MD Radiology Santa Barbara Cottage Hospital

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PHYSICIANS OF THE YEAR

SANTA BARBARA COUNTY ALEX KOPER, MD

SAN LUIS OBISPO COUNTY THOMAS HALE, MD

Urology Sansum Clinic

Emergency Medicine Central Coast Emergency Physicians

CONGRATULATIONS TO OUR PHYSICIANS OF THE YEAR! WE LOOK FORWARD TO CELEBRATING WITH YOU NEXT SPRING Fall 2021 32 CENTRAL COAST PHYSICIANS

REIMBURSEMENT HELP: Members receive one-onone assistance from CMA’s reimbursement experts, who have recouped $33 million from payors on behalf of CMA physicians in the past 12 years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.

COVID-19: CMA understands that many physician practices are struggling in the wake of the COVID-19 outbreak. We are working closely with state and federal lawmakers to ensure physician practices remain viable, and that physician networks remain robust amid the financial uncertainty created by the COVID-19 crisis.

TELEHEALTH: Telehealth services have proven to be a critical tool for physicians so they can safely provide care to those who need it during the COVID-19 public health emergency. CMA has worked to ensure that government agencies understand the regulatory flexibilities necessary so that physicians can continue serving patients during the COVID-19 pandemic. From telehealth flexibility and payment parity, to waivers on privacy and security requirements to expedite the incorporation of telehealth into practice workflows, CMA has been at the table making sure policymakers understand the needs of physicians and their patients.

PHYSICIAN WELL-BEING: CMA believes physician

“The value that CMA brings to physician practices cannot be understated.

Membership is not a cost to my practice – it is an investment. I couldn’t run my practice without it.”

Tom McKenzie, M.D. Member since 1991

well-being and professional fulfillment are critical factors in maintaining patient access to quality care, and we must address this challenge at the organizational and systemic level. CMA’s Wellness Program launched Care 4 Caregivers Now in March 2020 to provide physicians with one-on-one emotional support from trained medical professionals in a safe, confidential and non-judgmental space.

EXPERT GUIDANCE: Staffed by experts with a combined experience of over 125 years in medical practice operations, CMA’s Center for Economic Services empowers physicians by providing resources and guidance to improve the success of their medical practices. Whether it’s identifying and fighting unfair payment practices, improving the efficiency of your practice, or guiding physicians through the contract evaluation and negotiation process, CMA has tools and resources to help.

QUESTIONS? CMA’s live-person call center is available Monday through Friday during business hours at (800) 786-4262 or via live chat at cmadocs.org.

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In Memoriam

In Memoriam THOMAS GAITANO ALTAVILLA, MD

1927 – 2021 What does a golfer do on his day off? Putter around. Just one of the many bad jokes we will truly miss from Dr. Thomas G. Altavilla who passed on August 3, 2021, at the age of 94.

A loving husband, father, grandfather, brother and friend, Thomas will be truly missed and will always be remembered for his wit and kindness.

Thomas and his twin brother Peter were born on May 20, 1927, in Passaic, New Jersey.

He grew up with his four brothers and one sister in New Jersey.

One of his fondest childhood memories was winning the state baseball championship with his twin brother Peter.

During WWII, he served in the US Navy and after the war he joined the US Air Force. He then used the GI Bill for schooling to become a Doctor of Medicine.

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During this time, he met the love of his life, Esther Tinklepaugh. They were married on June 14, 1958, and moved to Rochester, NY where he did his residency at Highland Hospital. They soon started a family and had three boys.

He moved the family to Goleta, CA in 1969 and started his practice in medicine as a General Practitioner. Thomas was an old school doctor who carried a little black bag and made house calls. As a family doctor, he cared for many generations of local families at his practice and at the Goleta Valley Hospital.

It is impossible to convey the many stories of all the people he helped, healed, and saved as a Doctor. One of the last times he saved a person’s life was 20 years after he retired. While out playing golf, a man in the foursome in front of him collapsed with a heart attack. Thomas quickly ran over and started performing CPR while directing another man to call 911. He continued CPR until the paramedics arrived and in doing so saved the man’s life. He wondered why older gentlemen always wanted him in their foursome. After that day, he realized why.

Thomas had the life that most people dream of living. He had a long, happy, and healthy life and loved healing people as a doctor. He was married to the beautiful Esther, the woman he adored, for 63 years and was an amazing father to his three sons. Esther was by his side holding his hand and telling him how much she loved him on the day he passed. He is now in heaven rejoicing with his parents (Atillia and Samuel), his brothers Pete and George, and niece Annie. He is survived by his wife Esther, sons: Alex, Thomas and Brad, grandchildren: Amber, Rachel, and Jacob, Siblings: Alex, Robert and Mildred, and daughter-in-law: Valerie.

Adapted from the Santa Barbara News Press

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In Memoriam

In Memoriam WALTER BURKE ANDERSON, MD

1933 – 2021 Walter Burke Anderson, MD passed away peacefully on June 17, 2021, in Lompoc.

He was born in 1933 in Santa Barbara, CA to the gifted pianist and composer Grace Burke Anderson and Lompoc town doctor Walter Marius Anderson, MD. With his twin brother John Richard Anderson, he graduated from Lompoc High School in 1951.

Burke completed his medical studies at Loma Linda University School of Medicine in Southern California.

Between his junior and senior years, he was won over by Registered Nurse, Beverly Joan Ekroth, and the two were married in Pasadena in 1960. His internship was taken at Los Angeles County/University of Southern California General Hospital.

Picking up his fathers practice at the office that had been vacated since the elder Andersons death in 1957, he began general practice in Lompoc in 1962 tending to the medical needs of a town booming with Vandenberg Air Force Bases space program. However, he is best remembered for his leadership at Lompoc Hospitals Emergency Services, which he directed from 1976 to 1989.

Burke and Joan raised three children in Lompoc, William Burke, who practices patent law in Carlsbad, CA; Steven Craig, who runs his own engineering company in Lompoc; and Jennifer, who writes and publishes in San Francisco under the pen name Jen Burke Anderson.

In 1981, he tragically lost his twin brother, John Richard Anderson, who had made his career as a newspaper journalist,

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working both for the Lompoc Record and Santa Barbara Newspress. The two had been inseparable companions and confidants, and it was the greatest loss in Burkes life.

He was a member of the Vaqueros de los Ranchos, again following his dad’s footsteps. The elder Anderson had been a Charter Member of the group in 1938. His other enthusiasms ranged from the stock market, World War II History, train travel and singing.

He loved the Lord.

Before leaving practice in 1998, he turned to traditional family practice with the Valley Medical Group.

One of his fondest memories was the VMGs retirement gift to him: a flight over the Central Coast in a B17G bomber, The Flying Fortress as it was fondly known.

Burkes last years were spent at home with the family he loved so dearly: Joan and his son Steve, with visit and support from his son Bill, daughter-in-law Kay, and their children, Samantha, Scott, and Seth, Burkes youngest, Jen; and affectionate nieces and nephews from Burbank to Berlin. They will miss his humor, brilliance, and wisdom, and are grateful to have had him in their lives.

Adapted from the Lompoc Record

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CCMA/CMA Sponsored Insurance Programs

Your Membership Offers Additional Savings of 5%* on Already Low Rates!

Preferred Employers Insurance workers’ compensation rates have the potential for savings to physicians. Central Coast Medical Association/CMA members are eligible to save an additional 5%* because of their membership!

CCMA and CMA partner with Mercer Health & Benefits Insurance Services LLC and Preferred Employers Insurance to provide best-in-class Workers’ Compensation insurance that includes safety and risk management advice along with outstanding customer service and an easy to navigate website in the event of a claim.

This program is already serving the needs of hundreds of California physicians. Have you considered the Safety, Service, Stability, and Savings, offered by Preferred?

Save today! It’s easy to get a quote. Visit CountyCMAMemberInsurance.com for information or call 855-770-5257 to speak to a Client Advisor.

Sponsored by:

Underwritten by:

Administered by:

PREFERRED EMPLOYERS Insurance

| a Berkley Company

* Most practices will qualify for group pricing and receive the 5% discount; however some practices will need to be underwritten separately when they do not qualify for the special program terms and conditions. A minimum premium applies to very small payrolls.

Program Administered by Mercer Health & Benefits Insurance Services LLC

CA Insurance License #0G39709 • Copyright 2021 Mercer LLC. All rights reserved.

633 West 5th Street, Suite 1200, Los Angeles, CA 90071 • 800-842-3761 • CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com • 93998 (10/21)