Central Coast Physicians Spring 2019

SPRING 2019

TOGETHER WE ARE

STRONGER

AB 72 Wearable Medical Devices Health Care Dream Team Spring 2019

CENTRAL COAST PHYSICIANS

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Save the Date 18TH ANNUAL

KEYNOTE SPEAKER:

Trauma

Critical Care

Symposium Friday, July 12, 2019 Hilton Santa Barbara Beachfront Resort

Aron Ralston

Registration and speaker schedule available at cottagehealth.org/traumasymposium

Best-selling author of “Between a Rock and a Hard Place”, subject of the Academy Award nominated film “127 Hours” and survivor of a canyoneering accident during which he amputated his own arm.

FEATURED SPEAKER

New Frontier In Critical Care: Saving the Injured Brain E. Wesley Ely, MD, MPH, Professor of Medicine, Vanderbilt University

Accreditation Statement: The Santa Barbara County Consortium for CME is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians.

Credit Designation Statement: The Santa Barbara County Consortium for CME designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credit(s)™. 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 8.0 contact hours.

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VOLUME 4, NUMBER 2 • SPRING 2019

{FEATURES}

6 8 11 16 20 Spring 2019

STROKE CARE IN SAN LUIS OBISPO COUNTY

{DEPARTMENTS} 14 RISK TIP: WEARABLES 28 MEN’S HEALTH: SHRINKING LIFE EXPECTANCY

INDEPENDENT DISPUTE RESOLUTION GRASSROOTS ADVOCACY RECOUPING $29 MILLION

32 CENCAL HEALTH NEWS HUB: RECUPERATIVE CARE

34 CLASSIFIEDS 36 PUBLIC HEALTH: RESPIRATORY DISEASE 38 NEW MEMBERS

TOGETHER WE ARE STRONGER

CENTRAL COAST PHYSICIANS

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Letter from the CEO

GRATEFUL FOR YOU

Thank you to each of our 600+ members for being a part of something greater than yourself.

You understand the importance of our work, and with your support, we are able to protect your profession and patients. I especially want to give thanks to those in leadership positions with the Central Coast Medical Association.

You generously give your valuable time for the betterment of the medical profession.

DANA GOBA

One significant way our members made an impact was with Proposition 56. Thanks to you, the California Medical Association was able to lead a coalition to take on Big Tobacco to improve patient access to care through Medi-Cal, which serves one-third of the state’s population.

Prop 56 funds are providing more than $1 billion annually to improve provider payments, graduate medical education (GME) funding increases, and medical school loan repayments.

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; 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 Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Jennifer Hone, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design

The CalHealthCares physician loan repayment program, which is also known as the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program, will be administered through Physicians for a Healthy California (formerly the California Medical Association’s Foundation). CalHealthCares will award approximately 125 physicians a loan repayment of up to $300,000 in exchange for a five-year service obligation.

CONTRIBUTING WRITERS Penny Borenstein, MD, MPH; Katherine Boroski; CenCal Health; Venkata Dandamudi, MD; David Dodson, MD; Miranda Felde, MHA, CPHRM; Ashish Gajjar, MD; Juli Reavis; Tina Tedesco; Kiron Thomas, MD

CONTRIBUTING PHOTOGRAPHERS CenCal Health, Sierra Vista Regional Medical Center SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are

For physicians who aren’t yet members, join your colleagues who are working to make the medical community better for doctors and patients. You can become a member at www.cmadocs.org/join or by calling 800.786.4262.

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

Together we are stronger.

100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 E magazine@sbmed.org

Sincerely,

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

Dana Goba Chief Executive Officer Central Coast Medical Association

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Spring 2019

HIGHEST HOSPITAL SAFETY RATING. 7 YEARS IN A ROW. Thank you to our nurses, doctors, staff and volunteers for helping Sierra Vista and Twin Cities Hospitals achieve recognition as two of the safest hospitals in America, every year since 2012.

Just five hospitals in the state of California have the honor of this distinction.

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SierraVistaRegional.com

TwinCitiesHospital.com CENTRAL COAST PHYSICIANS

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S t e r k o Stroke o t k S e Care SIERRA VISTA BRINGS ADVANCED

TO SAN LUIS OBISPO COUNTY

Mechanical Thrombectomy at Sierra Vista saves precious time during stroke events

By Venkata Dandamudi, MD; Ashish Gajjar, MD; and Kiron Thomas, MD

As a leader in advanced stroke care, Sierra Vista Regional Medical Center knows treatment time is critical for stroke patients.

When every minute counts, having an advanced stroke center with the technology and capability to care for patients can make all the difference.

Last summer, Sierra Vista brought the standard of care and surgical treatment for local stroke victims to San Luis Obispo County. As a specialized group of interventional neurologists, we joined the Sierra Vista team to bring endovascular treatment to the area.

Our interventional neurology team is on-call around the clock to provide San Luis Obispo County residents with an

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endovascular approach to treating strokes, drastically improving treatment time, and helping to minimize brain damage. When patients arrive at Sierra Vista Regional Medical Center, our specialized staff has the enhanced ability to provide them with the highest level of medical and surgical care available in San Luis Obispo County.

When it comes to stroke, time is brain. That’s because there is only a small window of time for treatment administration to be effective. Previously, only the use of tissue plasminogen activator (tPA) was available in San Luis Obispo County to treat ischemic stroke patients. tPA works by dissolving an apparent clot and improving flow to the part of the brain deprived of blood. At Sierra Vista, we now also offer an endovascular treatment approach

Spring 2019

called mechanical thrombectomy or embolectomy, which allows us to directly remove blood clots more quickly and effectively than tPA alone.

With mechanical embolectomy, we are able to thread a catheter through an artery in the groin up to the blocked artery in the brain and remove a blood clot with a stent retriever device or aspiration technique. Both tPA and mechanical embolectomy need to occur within a few hours in order to be effective and improve chances for stroke survival and recovery.

The use of mechanical embolectomy at Sierra Vista may eliminate the need for emergency ambulance or air transport out of San Luis Obispo County for those patients who qualify, saving precious time and brain cells.

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AB 72 The independent dispute resolution process and how to appeal

By Juli Reavis, Associate Director, Center for Economic Services, California Medical Association

A new California law took effect last year that changed the way that non-contracted physicians bill and are paid for providing non-emergency care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. This out-of-network billing and payment law (AB 72) was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.

While patients with out-of-network benefits can consent to treatment from out-of-network providers, absent a valid consent form, health plans and insurers are required to reimburse out-of-network physicians at an interim payment rate. Without a signed consent, patients are only responsible for their in-network cost sharing.

The interim rate is the greater of the plan/insurer’s average contracted rate (ACR) or 125 percent of the Medicare feefor-service rate for the same or similar services in the general geographic region in which the services were rendered, unless otherwise agreed to by the noncontracting provider and the payor. (By January 1, 2019, both regulators will have adopted a standardized methodology that all payors are required to use to compute the average contracted rate.)

Can I challenge the interim payment?

The law does include a mechanism for physicians to challenge the payment amount if they are dissatisfied—the independent dispute resolution process (IDRP). Payors are required to participate in the IDRP once a physician begins the process.

The first step is to determine whether you are eligible for IDRP. This step is important as there are fees involved, which are split equally with between the payor and the physician. >>

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To be eligible for IDRP a physician must first appeal in writing to the payor for additional payment. If the physician is not successful in resolving the dispute through the payor’s internal appeal process, the physician may then file an IDRP through the appropriate regulator – either the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI), depending on the product type. Claims are only eligible for the IDRP for 365-days from the date of the payor’s written response to the appeal. If a physician attempted the appeal process but the payor was non-responsive, the 365-day limit to file IDRP will begin after 45 business days have passed from the date of receipt of the physician’s appeal. Instances where physicians have had patients sign written consent forms for the use of out-of-network benefits are not eligible for IDRP.

Practice Management: Tip of the Month

You don’t have to fight unfair payment practices alone.

CMA can help.

The IDRP process for both regulators is web and email-based and conducted through the regulators’ portals, with no parallel paper process.

Physicians may bundle up to 50 claims in a single IDRP application.

These claims must all be for services provided by the same physician, for the same payor (health plan, insurer, or delegated entity), and for the same or similar services. While DMHC does not define same or similar services, CDI defines them as those that fall within the same subheading in the CPT or HCPCS manual.

Each application will need to include a copy of the original claim form, corresponding explanation of benefits and a copy of the determination letter from the payor or the physician dispute resolution, if applicable. CDI also requires an IDRP request form with a final offer indicated, an IDRP request claim information spreadsheet when submitting bundled claims, copies of all correspondence between the provider and insurer, both sides of the patient’s ID card, and the assignment of benefits, if applicable. For both regulators, a copy of the appeal to the payor is also recommended.

While not required, it is encouraged that each IDRP application submitted include a narrative summary justification. This should explain the physician’s billed charges or final offer for all claims at issue, including the physician’s training, qualifications, length in practice, the fees usually charged by the physician, other economic aspects relevant to the physician’s practice, any unusual circumstances and other relevant factors.

Members can call on CMA’s practice management experts for free one-on-one help with contracting, billing and payment problems.

Assistance ranges from coaching and education to direct intervention with payors or regulators.

CMA has recovered $29 million on behalf of its physician members over the past 10 years.

For more information, visit cmadocs.org/tips.

Physicians should also include supporting documentation as the independent review organization conducting the IDRP will base its decision on the information submitted when rendering a decision.

Supporting documentation may be a citation referenced in the narrative summary justification or include a provider directory report demonstrating network adequacy concerns, timely access enforcement

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AB 72 Resources CMA has developed a number of resources to help physicians navigate this new law.

These are all available free to members at cmadocs.org/out-of-network-billing.

• FAQ: A Physician’s Guide to AB 72: Questions and Answers • A Physician’s Guide to the AB 72 Independent Dispute Resolution Process • Instructions and Sample Form for Obtaining Patient Consent Under California’s New Law • Sample Payor Appeal Letter for Interim Payments • Billing Requirements and Payment for Out-of-Network Services at In-Network Facilities • AB 72 Payment Monitoring Workbook • Health Law Library Document #7508: Non-Contracting Physicians • Balance Billing Toolkit

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actions and appropriate reimbursement amounts from other payors. There is no page limit for either the narrative summary justification or the supporting documentation.

The DMHC and CDI’s IDRP processes have many differences including arbitration types.

DMHC uses traditional arbitration, meaning the arbiter can select any reimbursement amount he/ she determines is appropriate. CDI uses baseball style arbitration, meaning the arbiter will select one of two the parties’ final offers and no other amount. In both cases, prior to remitting IDRP fees, the parties may agree to a settlement of the claim(s). In all cases of IDRP, the arbiter’s decision is binding on both parties. Payors are required to implement the decision obtained through the IDRP. If dissatisfied, either party may pursue any right, remedy or penalty established under any other applicable law.

Physicians are encouraged to utilize IDRP, as regulators are required to consider information from the IDRP when establishing methodology for determining average contracted rates, which in turn will likely impact payor contracting practices going forward.

For more information on IDRP eligibility, identifying the regulator, the submission processes and what to include in the narrative summary justification and/or the supporting documentation, the California Medical Association (CMA) has created an IDRP guide, “A Physician’s Guide to the AB 72 Independent Dispute Resolution Process.” This and many other valuable resources on navigating the out-ofnetwork billing and payment law can be found in CMA’s AB 72 Resource Center: cmadocs.org/out-of-network-billing.

Practices with additional questions or concerns can contact CMA’s Reimbursement Helpline at 800.786.4262 or economicservices@cmadocs.org.

Spring 2019

YOU ARE OUR MOST POWERFUL

ADVOCATE

By Katherine Boroski, Senior Director of Strategic Communications, California Medical Association

Critical issues affecting today’s physicians are being decided in the legislative arena at a fast and furious pace. Health care reform, medical liability, and scope of practice are just a few of the vital issues being debated and voted on by elected officials in Sacramento.

The California Medical Association (CMA) has some of the best lobbyists, lawyers, and other advocates in the Capitol, but the most powerful weapon in advancing the cause of physicians and their patients is you.

Hearing from a physician with experience on the front lines of medicine can make all the difference for a legislator facing a complicated health care issue. That is why grassroots advocacy is so important.

WHAT IS GRASSROOTS ADVOCACY? Grassroots advocacy is a “bottom up” approach to social change that utilizes real physicians from the community to shape public policy. Grassroots advocacy harnesses the power of effective one-on-one relationships multiplied over and over until a critical mass of support effectuates the desired change.

Effective advocacy is about communication and relationships. Advocacy must be an ongoing commitment and priority. Relationship building is essential and starts with persistence and repetition. Below are tips on how you can become an effective grassroots advocate on behalf of the physicians and patients of California. >>

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RECOGNIZE YOUR POWER: You are the

BE THE RESOURCE: Serve as an advocate on

subject matter expert on how health care issues impact your community. When it comes to matters of health, you are the specialist and the lawmaker is a generalist. Legislators don’t need to know everything you know about a particular issue – they just need to know enough to be convinced to take action.

behalf of the physician community and your patients by offering your expertise and experience.

ENGAGE POLICYMAKERS AND MAINTAIN RELATIONSHIPS: Get to know your elected officials by meeting with them and attending events in the community and at the Capitol. Educate them about your issues and ask to be added to their mailing or e-mail lists for upcoming events. Volunteer for campaigns, attend fundraisers and participate on advisory committees.

TELL YOUR STORY: Tell policymakers your stories to illustrate the entire picture. There is power in sharing the realities of your profession.

SHARE AND AMPLIFY ON SOCIAL MEDIA: Increase public awareness by promoting your legislative advocacy on social media. If you meet with an elected official, post and tag photos on social media and promote with key groups and media.

CONNECTING WITH YOUR ELECTED OFFICIAL THROUGH SOCIAL MEDIA Social media is an excellent platform to communicate with your elected officials, especially Twitter. The key is to “tag” the elected official(s) you’re addressing using their official Twitter account. Keep in mind that many elected officials may have both a campaign Twitter account and an “official” Twitter account – the latter is preferred.

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With Twitter, you have only 140 characters to convey your message, plus an image or link. Try writing out your full message first, then review with a critical eye and pare down accordingly. Always keep it professional, even if you’re tweeting your opposition to a legislator’s bill.

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CMA IS HERE TO HELP AVAILABLE RESOURCES

•C MA’s Legislative Hot List provides a summary and the status of CMA-sponsored bills, as well as the progress of other significant legislation.

•R eal-time call to action alerts for legislative priorities.

• S ample letters for advocating positions on legislation/ regulations.

• S ample telephone call scripts for calling Capitol offices to voice positions on legislative bills/issues.

OTHER WAYS TO GET INVOLVED

•T ext DocLobby to 52886 to sign up for text alerts and you

Most legislation can be viewed as either solving a problem – or creating one, depending on which side you stand.

When tweeting in support of something, or to encourage a vote for something, make sure you’re stating WHY (i.e., the problem) and what you want the legislator to DO about it (i.e., the solution). Keep in mind that a legislator may not be familiar with all the bill numbers in a session, especially if they’re not the ones introducing that legislation. Any reference to legislation should be #hashtagged, with a very short description of the bill after.

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will immediately be notified when we need you to take action.

• Participate in CMA’s Legislative Advocacy Day, which is held annually in April. This year’s Legislative Advocacy Day is April 24, at the Sacramento Convention Center.

• Become a CMA social media ambassador.

• Represent CMA by participating in media interviews for television, radio, newspapers and podcasts.

• Author op-eds to educate the public on health policy issues.

• Become featured as one of our #CMAdocs.

• Follow @doclobby on Twitter.

LEARN MORE AT cmadocs.org/grassroots.

For example: As a practicing physician, I know how critical vaccinations are to prevent the spread of disease. @ DrPanMD, vote YES on #SB277 #vaccine bill.

You can also sigh up for the CMA Social Media Ambassador program, which provides training, advice and content to help keep your colleagues and other medical professionals informed, connected and engaged.

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Wearable Medical Devices Give Abundant Data-and Risks

By Miranda Felde, MHA, CPHRM, Vice President, Patient Safety and Risk Management

Since 2013, the number of US consumers tracking their health data with wearables has doubled. And that number continues to rise: During the third quarter of 2018, the wearables market saw a nearly 60 percent increase in earnings over the prior year.

Wearables are electronic devices worn on the body, often like a watch. Wearables can track patient data like heart rate, blood pressure, or blood glucose. They can also track activity level, e.g., counting steps.

Promoters of wearables believe wearables will drive the transition to intelligent care, whereby physicians have access to more data—in which they can identify actionable components. Florence Comite, MD, a New York endocrinologist who describes wearables as “almost like magic,” uses data from wearables to tailor her interventions for patients with chronic conditions.

Wearables can help patients take action, too. In one recent study, diabetes patients using a wearable app showed randomized controlled trial results comparable or superior to patients taking diabetes medications.

Though each device has its pros and cons, all wearables generate concerns for physicians, including:

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• Poor data quality: Data from wearables may or may not be reliable enough for medical use.

• Data fixation: Patients may fixate on one number—steps per day, for instance—at the expense of other health variables, such as their diet, sleep habits, etc.

• Lack of interoperability with electronic health records (EHRs): If a patient’s wearable cannot stream data to the patient’s EHR, then how can the physician’s practice securely acquire the data?

• Data saturation: Physicians receiving patient data from wearables risk being soaked by a data fire hose. Physicians need a plan and a process to determine what measurements are relevant to a given patient.

• Unclear physician responsibilities for collecting, monitoring, and protecting data: HIPAA applies to patient data collected by physicians, but differing state laws mean that a physician’s specific responsibilities for monitoring and protecting patient data vary by location.

• Lack of data security—and liability for physicians: Wearables are subject to cyberattack. In addition to presenting obvious risks to patient safety, this may also present liability risks to physicians—who may be expected to notify patients of recalls issued for their wearables.

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Health Care DREAM CMA’s economic advocates recoup $29 million on behalf of physician members

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By Tina Tedesco

TEAM

California physicians have a powerful ally when it comes to dealing with problematic payors—the California Medical Association (CMA) Center for Economic Services (CES).

Staffed by practice management experts with a combined experience of more than 125 years in medical practice operations, the CES team has recovered $29 million on behalf of its physician members over the past 10 years.

Each member of the CES team brings something unique to the table, allowing them to bounce ideas off each other when trying to help practices.

“We are the dream team of health care,” said Mark Lane, CES Director of Publications and Resources. “There are few issues presented that we do not have experience dealing with in some capacity. We can also draw upon our vast network of contacts to find a resource or point person to help address almost any issue. No other organization, that I am aware of, can assist physicians or their practices on this level,” said Lane.

Lane began his career as a claims processor for plans such as Blue Shield of California and Health Net. Before long, he had moved up to a position in provider relations, allowing him to get a unique vantage point on the relationship between physicians and payors.

Empowering Physician Practices CES also provides one-on-one practice management assistance to physician members and their staff on reimbursement, practice operations and contract-related issues. The center’s goal is to empower physician practices by providing resources and guidance to improve practice success. Assistance ranges from coaching and education to direct intervention with payors or regulators.

“The ultimate goal is to empower practices to be able to advocate successfully for themselves,” said CES Vice President Jodi Black.

“Sometimes processes fail and that’s when we intervene on their behalf.”>>

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In the first three quarters of 2018, CES recovered more than $9 million on behalf of physician members, up from $3 million in all of 2017. One of the biggest success this year was getting Anthem Blue Cross to agree not to pursue a $4.2 million recoupment from a member practice.

Anthem had notified the practice it was planning to recoup more than $4 million due to problems with the renewal of a fictitious name permit. CMA escalated the issue to Anthem’s medical director, highlighting that upon renewal, the medical board showed no lapse in the permit. As a result, Anthem agreed not only to not pursue the recoupment, but also to release approximately $600,000 in pending claims for payment.

Another success story was getting Medicare to agree to reinstate billing privileges and release almost $1 million in pending payments to another practice that had its billing privileges revoked when Medicare discovered an undisclosed criminal offense by a practice employee.

CMA, the American Medical Association and Noridian, California’s Medicare Administrative Contractor, worked together to get the practice’s appeal reviewed within three days, rather than the normal 90 days as allowed by law, to help get the practice’s billing privileges reinstated and avoid overpayments dating back nine years.

Meet Your Advocates Jodi Black, Vice President Jodi is the Vice President of CMA’s Center for Economic Services. She has spent the past 14 years working through practice operational issues and advocating on behalf of members of CMA and its county medical societies. Prior to her time at CMA, Jodi spent 15 years working with a group of emergency physicians. “Our team not only provides one-on-one assistance when needed, but we also work hard to educate and empower practices to be able to advocate successfully for themselves.”

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“This is money that would have likely gone unrecouped if we didn’t step in,” said Black, who has been with CMA for 14 years, building relationships with both physicians and payors on behalf of CMA. Prior to joining CMA, she spent 15 years working with a group of emergency physicians, a field she entered while still in college. She changed her major to health care administration because she believed in the cause so much.

CES is constantly developing resources and tools to assist practices with new laws, including its monthly CMA Practice Resources newsletter, webinars, seminars, and phone conversations. These services are free to all members.

“It feels great to help our doctors, so they can get back to work helping their patients,” said Juli Reavis, CES Associate Director, who focuses largely on helping physicians with California’s new out-of-network billing and payment law (AB 72). The law, which went into effect July 1, 2017, placed limits on what physicians can bill patients for using an out-of-network physician at in-network facility. CES has created more than 10 new resources to help practices succeed and comply with these new requirements.

You Are Not Alone In just the first eight months of 2018, CES assisted physicians and their office staff with nearly 900 calls from 555 different practices within 30 different component medical societies.

Seventeen percent of those calls were from first-time callers.

Often, the only way CES finds out about an issue is by members contacting the call center. Typically, if an issue is affecting one practice, it’s impacting others. Small errors, sometimes on the part of the payor, sometimes on the part of the physician, can have a snowball effect.

“Our goal is to take the noise out of the system so doctors can get back to treating patients,” said Black.

“I always felt a need to help others and prevent pain and suffering wherever I could,” said Lane. “The role I serve at CMA, assisting physicians and their practice staff, has given me the opportunity to fulfill my mission. It’s the most rewarding role I have ever had in my 25 years of health care.”

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When do I call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help: Are your claims not being paid in a timely manner or according to your contract?

Do you need assistance regarding the new law on payment and billing for outof-network services (AB 72)?

Are you receiving untimely requests for refunds or is a payor recouping money without first notifying you in writing of a refund request?

Do you need assistance creating a business case as to why a payor should consider contracting/re-contracting with your practice?

Do you need help with Medicare-related issues?

Are your claims being denied after obtaining prior authorization?

Are you receiving unreasonable requests for medical records?

Do you need help identifying common practice mistakes costing you money?

Have you been presented with a managed care contract and you’re not sure if the terms are consistent with California law?

Have you done everything you can to resolve an issue with a payor, including appealing, and have been unsuccessful?

Call CMA’s reimbursement helpline today at 888.401.5911 and they will arm you with the knowledge you need to identify and fight unfair payment practices. Learn more about how CMA’s practice management experts can help you at cmadocs.org/ces.

Meet Your Advocates Cheryl Bradley, Physician Advocate Cheryl specializes in Medicare issues. Before joining CMA, Cheryl served as a provider outreach and education specialist for Noridian Healthcare Solutions, California’s Medicare contractor. She came to CMA with over seven years of Medicare experience. “Our goal is to empower CMA member physicians and their staffs to use tools and resources that increase their understanding of the health care topics at hand – and their bottom lines.”

Mark Lane, Director of Publications and Resources For more than a decade and a half before joining the CMA team in 2010, Mark had a career as a claims processor for plans such as Blue Shield and Health Net. Before long, he had moved up to a position in provider relations, giving him a unique vantage point on the relationship between physicians and payors. “Communication really is the answer to a lot of payor issues. CMA has the contacts and the relationships to cut through the red tape and get things done.”

Kris Marck, Physician Advocate Before joining CMA in 2011, Kris spent 23 years working on the payor side of the health care industry. This previous experience makes her a very effective and approachable advocate for physicians in need of reimbursement and contracting assistance. “Working with payors is challenging and the reimbursement process is complex.

Don’t hesitate to call us. It’s easy to give the easy answer, but it’s difficult to go and find the right answer. We’ll get you the right answer.”

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Juli Reavis, Physician Advocate Juli primarily focuses on helping members navigate the new AB 72 billing restrictions for out-of-network services at in-network facilities. “We are fighting to ensure that payors do not game the system to set artificially low physician payment rates. If you’re being negatively impacted by AB 72’s new billing and payment restrictions, call me. I can help.” Learn more at cmadocs.org/ab-72.

Jennifer Williams, Executive Assistant Jennifer, who has spent the last 12 years with CMA, is often the first point of contact for practices in need of reimbursement assistance or practice management advice. “A lot of practices think we’re too busy to answer questions or don’t want to ‘bother’ us with what they think is a ‘silly’ question. Please don’t wait to call us. We’re here to help our members; it’s our job.”

Mitzi Young, Physician Advocate Mitzi has spent more than 20 years in health care settings, including county organized health programs, surgery centers and specialty health care practices, and brings a variety of skills suited to help CMA members tackle their practice management questions. “With over 125 years of practice management experience on the CES team, we can help medical practices work smarter, not harder.”

The CES team can be reached at 888.401.5911 or economicservices@cmadocs.org.

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TOGETHER WE ARE

STRONGER The Central Coast Medical Association and California Medical Association

THANK THE FOLLOWING PHYSICIANS for membership and support to protect physicians’ profession and patients.

If your name is not on this list, join your colleagues by contacting CCMA at 805.683.5333 or sbcms@sbmed.org.

Membership list as of March 31, 2019.

MORE THAN 60 YEARS William H Gausman, Jr, MD Edward R Wallace, MD

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40 TO 49 YEARS

C Seybert Kinsell, MD

Walter Anderson, MD

Stephen Lemon, MD

Rollin C Bailey, MD

Myron Israel Liebhaber, MD

Robert K Baum, MD

Donald Lindblad, MD

Christel Bejenke, MD

Thomas S Lossing, MD

David A Bernhardt, MD

Edward J McGinn, MD

Andrew Binder, MD

Robert A Harway, MD

Randall G Michel, MD

Charles Bradley, III, MD

Richard Miller, MD

Bruce Howard, MD

Joel H Brandt, MD

Arthur Morel, MD

W Blake Jamison, MD

Blaine Braniff, MD

Peter Morris, MD

James Cavins, MD

James J Murray, Jr, MD

Ramona Clark, MD

Thomas Ochsner, MD

David Doner, Jr, MD

Robert W Olson, MD

Donald Omar Fareed, MD

Theodore Polos, MD

Mary Elina Ferris, MD

George Primbs, MD

Michael Fisher, MD

William Rack, MD

P Joseph Frawley, MD

Robert Alfred Reid, MD

Jeffrey Charles Fried, MD

H Douglas Roberts, MD

Donald Gillies, MD

Timothy Leigh Rodgers, MD

David S Gillon, MD

Joaquin Roses, MD

Richard E Hammond, MD

Lewis Rubin, MD

Lawrence Phillip Harter, MD

James Scheib, MD

Jeff Herten, MD

Louis M Tedone, MD

David Hirt, MD

Barry Williams, MD

Douglas R Jackson, MD

Carl Williams, MD

Robert Jacoby, MD

Michael L Wyatt, MD

Karl Kassity, MD

Steven H Young, MD

50 TO 59 YEARS John Ackerman, MD Maria I Barrows, MD Barry Coughlin, MD Stephen L Hansen, MD

James McNamara, MD David Medina, MD James Wells, MD

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CENTRAL COAST PHYSICIANS

Garry Richard Kolb, MD Ronald Latimer, MD

Spring 2019

30 TO 39 YEARS Thomas Allyn, MD

Steven Hartzman, MD

Stanley Ostern, MD

Andrew Martin Anthony, MD

Robert Hawkins, MD

Steven Pearson, MD

Dennis Baker, MD

Richard Allen Hendricks, MD

Timothy J Perrin, MD

David L Bearman, MD

William J Heringer, MD

Kathleen Pojunas, MD

Edward Bentley, MD

David Hernandez, MD

Richard Ponce, MD

Ernest Blakey, MD

Stephen Hosea, MD

Robert Poulin, MD

Rabindra Braganza, MD

Randall Howard, MD

Elliot Prager, MD

Stuart Braverman, MD

David Oscar Javitz, MD

Ralph Quijano, MD

Rene Henry Bravo, MD

Thomas Jones, MD

Thomas Reaper, MD

William K Brokken, MD

Darol D Joseff, MD

Brian Michael Roberts, MD

Thomas Albert Caruso, MD

Richard Kahmann, MD

Philip Scheinberg, MD

Mary P M Cederberg, MD

Frederic Kass, MD

Carl Schlosser, MD

Cary Conyers, MD

Phillip Kissel, MD

Ayesha Shaikh, MD

P Kent Cullen, Jr, MD

Roger Kohn, MD

Timothy M Spiegel, MD

David Michael Cumes, MD

Robert A Kolarczyk, MD

Donald Larry Stanton, MD

Daniel Curhan, MD

Karen S Kolba, MD

Robert G Stewart, MD

David d’Ablaing, MD

Ernest Kolendrianos, MD

Mark Wayne Surrey, MD

Olga Daiber, MD

Alex Koper, II, MD

Paul John Swedberg, MD

Gustavo Dascanio, MD

Bradley Shawn Kurgis, DO

Victor A Tacconelli, MD

Patricia Erbe, MD

David LaPatka, MD

Julie Taguchi, MD

Douglas Etsell, MD

Arthur Lee, MD

Ronald G Ungerer, MD

Todd Fearer, MD

Morgan Lloyd, MD

Gary Van Deventer, MD

Robert I Fishburn, MD

Laurence Hamilton Lotz, MD

Thomas Van Meter, MD

Richard Fulton, MD

Lawrence Luan, MD

Fred Steve Vernacchia, MD

John Gainor, MD

Tomas Manuel Machin, MD

Christian J Voge, MD

Frank R Gamberdella, MD

Laurence Mamlet, MD

Martin Walker, MD

William James Gealy, Jr, MD

Lowell McLellan, MD

Alex J Weinstein, MD

Andrew Scott Gersoff, MD

Arnold Medved, MD

Thomas Weisenburger, MD

Robert Lawrence Gong, MD

Monica Micon, MD

Paul Willis, MD

Cory Gusland, MD

James F Mitchell, Jr, MD

Stuart Robert Winthrop, MD

Thomas Walter Hale, MD

Ted B Newman, MD

Edmund M Wroblewski, MD

Jeffrey Hankoff, MD

Charles H Nicholson, MD

Steven Zelko, MD

Robert D Harbaugh, MD

Pierre Nizet, MD

James Zmolek, MD

Marvin Harrah, MD

Kevin C Osburn, MD

Spring 2019

CENTRAL COAST PHYSICIANS

23

20 TO 29 YEARS Mark Abate, MD

Gregory Greaney, MD

Michael Paveloff, MD

David Abbott, MD

Howard Gregersen, MD

Kim L Peters, MD

Rushdi Abdul-Cader, MD

Howard Gross, MD

David Phreaner, MD

Shields Brewster Abernathy, MD

William Hahn, MD

Mark Ford Pomerantz, MD

Mitchell Adler, MD

Saida Hamdani, MD

Christopher S Proctor, MD

Gilbert O Andersen, MD

Laurel Hansch, MD

Susanne L Ramos, MD

Thomas G Anderson, MD

Patrick Joseph Haran, MD

Kurt Ransohoff, MD

Robert L Avery, MD

Stephen A Hilty, MD

David Raphael, MD

Vida Baron, MD

John Hans Hirschberg, MD

Donald Rhodes, MD

H Richard Barthel, MD

Glenn Hollingshead, MD

Thomas George Ronay, MD

Sharon L Basham, MD

Barbara A Hrach, MD

Margot Roseman, MD

Thomas Beamer, MD

James Ingersoll, MD

Barry J Ross, MD

Michael J Behrman, MD

Steven Craig Johnson, MD

Lynn A Rudman, MD

Jeoffrey P Benson, MD

Douglas Katsev, MD

Paul Ryack, MD, MPH

Daniel Berger, MD

Robin P Knauss, MD

Karl Sandin, MD, MPH

David L Birken, MD

James L Kwako, MD

John Michael Sawyer, MD

Cindy Blifeld, MD

Roger I Lane, MD

Joseph Alan Schwartz, MD

Jeffrey Martin Bloom, MD

Vikki Lane, MD

Stuart Segal, MD

Gary M Blum, MD

Kyle Lemon, MD

William A Shapiro, MD

Michael Bordofsky, MD

Suresh C Lodha, MD

William Sheehan, MD

Gary Bradley, MD

Mark Logan, MD

Anthony W Sheplay, MD

Jessica Brown, MD

Bryant Jay Lum, MD

Alex Soffici, MD

Roman Platon Bukachevsky, MD

George Philip Lum, MD

Mark Ian Soll, MD

David Alan Canvasser, MD

Christopher George Lumsdaine, MD

Marta Sovilj, MD

Eduardo Enrique Clark, MD

Douglas J Mackenzie, MD

Mareeni T Stanislaus, MD

Kevin Francis Colton, MD

Kari Mathison, MD

Owen Stormo, MD

Daniel F Craviotto, Jr, MD

David L McAninch, III, MD

Gerald Svedlow, MD

Thomas Daughters, Jr, MD

John McCaffery, MD

Michael Trambert, MD

Julia Delgado, MD

Andrew Mester, MD

Vincent C Tubiolo, MD

Kamlesh M Desai, MD

Kelli Miller, MD

Marc W Weise, MD

Robert Dichmann, MD

Alan P Moelleken, MD

Richard Wikholm, MD

Christopher Donner, MD

Karen Moyes, MD

Judith Willis, MD

Margaret L Echt, MD

Douglas P Murphy, MD

Donna Elaine Winingham, MD

James Egan, MD

Mark Musicant, MD

Jay Winner, MD

John Elder, MD

Robert M Nagy, MD

John Dean Wrench, MD

Yvonne Ferguson, MD

Ma’an Nasir, MD

Robert Simpson Wright, MD

Gregory John Frye, MD

David Nomeland, MD

J Gregory Gaitan, MD

Michael Jon Omlid, MD

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CENTRAL COAST PHYSICIANS

Spring 2019

10 TO 19 YEARS Thomas Aguirre, MD Eric Michael Alltucker, MD Eric Rey Amador, MD Seth Eli Anderson, Jr, MD Joseph Aragon, Jr, MD Bruce R Bailey, MD Polly Baldwin, MD, MPH Steven Colin Barkley, MD Richard A Belkin, MD Steven Niels Benaron, MD James Benzian, MD Michael Bernstein, MD Julia Billington, MD Scott Edward Bisheff, MD Jerold Black, MD Mark C Bocchicchio, MD Penny Borenstein, MD, MPH Jason Boyatt, MD Daniel Brennan, MD James Brewer, MD Leanne Renee Buckner, MD Daryl Burgess, DO William E Buys, DO Alessandro A Castellarin, MD Julie Adele Chacko, MD Rosa Choi, MD Bernard Chow, MD Nicole Christiano, MD Richard Y Chung, MD Gregory Alexander Cogert, MD Stephen Couvillion, MD Kenneth Daughters, MD Bret Davis, MD Philip Delio, MD Steven E Dosch, MD Raul Benjamin Easton-Carr, MD, MPH Bryan Christian Emmerson, MD Duard Enoch, III, MD Julie Cecilia Fallon, MD

Spring 2019

Kevin L Ferguson, MD David Fisk, MD Cary J Fitchmun, MD Christopher Flynn, MD Peter Ford, MD Daniel Fox, MD Priti Gagneja, MD Brett A Gidney, MD Rebecca D Golgert, MD William Golgert, MD Frank D Gonzales, MD Daniel Reif Greenwald, MD Mukul Gupta, MD Gloria Hadsall, MD Jeffrey Hadsall, MD George Robert Hansen, MD Peter Lee Hasler, MD Jennifer Hone, MD Bradley E Hope, MD Robert Michael Hullander, MD Graham R Hurvitz, MD Kimberly Hurvitz, MD Ali Javanbakht, MD Karen Johnson, MD Daniel L Jurewitz, MD Bindu Kamal, MD Kathleen April Kennedy, MD Rachel Kernoff, MD Brian Koch, MD Li-Sheng Kong, MD Kenneth S Kosik, MD Brent Kovacs, MD Kenneth Dale Krone, MD Sanjay Kumar, MD Christopher Kuzminski, MD Cedric Kwon, MD Christopher V Lambert, MD Wonuk Lee, MD Susan Lemon, DO

Hollanda Leon, MD Anne E Little, MD Keith Llewellyn, MD Adam D Lowenstein, MD Gary Michael Lucchesi, MD Theresa Lueck, MD David Mandel, MD Rachel May, MD Stanley McLain, Jr, MD Steven Douglas Mcmurtry, MD Anthony Mendesh, MD Toni Meyers, MD James Moghtader, MD Ralph Mozingo, DO Ian Blair Murton, MD Gregg Newman, MD Diane Nguyen, MD Joseph A Nunez, MD Cecilia O’Dowd, MD Arbi George Ohanian, MD Andrew Osburn, MD Edwin Pai, MD Nancy A Pawlik, MD Dante Pieramici, MD Laura Polito, MD Liza Presser Belkin, MD Bruce Dudley Ragsdale, MD Rahim Ali Raoufi, MD Cinnamon Hampikian Redd, MD Jason M Redd, MD Juan Reynoso, MD Mark G Richmond, MD Joseph Andrew Robinson, MD Anthony Rogers, MD Anthony C Romero, MD Andria Ruth, MD Robert M Ruth, MD Jeffrey Seymour Sager, MD, MSc

CENTRAL COAST PHYSICIANS

25

10 TO 19 YEARS (CONT.)

Mary-Louise Scully, MD Laleh Shaban, MD Eric F Shepherd, MD Virginia Ann Siegfried, MD Mark Silverberg, MD John Sim, MD Sean Snodgress, MD Kenneth Glenn Starr, MD Gary Strachan, MD David Strumpf, MD Sasha Lynn Szytel, MD Brian Taber, MD Stefan Robert Teitge, MD Heather Terbell, MD Casey Toole, DO Mandana A Toole, DO Rachel Trautwein, MD Jon R Uyesaka, MD Rafael Sollesa Victoria, Jr, MD David J Vierra, MD John Vowels, MD Takashi Michael Wada, MD, MPH J Patrick Wheelock, MD Avery Wilmanns, MD Steven Yao, MD, MS Jeffrey Yim, MD John Yoon, MD Hsien Young, MD Alois Zauner, MD Marc Zerey, MD

26

CENTRAL COAST PHYSICIANS

5 TO 9 YEARS Sam Hosam Ahmad, MD Thomas Robert Anderson, MD John Onssy Anis, MD Benton Turner Ashlock, MD Matthew Wayne Backer, MD J Kevin Beckmen, DO Laurel Bliss, MD Sushila L Braganza, MD Kristin Nicole Castorino, DO Jinny Ei Chang, MD Linda Sian Chen, MD Dugald Donald Chisholm, MD Shane Eric Cotter, MD, PhD Carin Craig, MD Karen B DaSilva, MD Vincent DeRosa, MD Brian Anthony DiCarlo, MD Benjamin Diener, MD Benjamin N Dirkx, DO David Charles Dodson, MD William H Dunbar, V, MD Todd Michael Erickson, MD Edwin Feliciano, MD Charles C Fenzi, MD Joseph Dreyfuss Freeman, MD Bryan Leigh Gammon, MD Jeffrey M Gauvin, MD Vishal Goyal, MD Kimberly Painter Grafton, MD Khawar Gul, MD Sawyer Bailey Haig, DO Muhammad Salman Ul Haq, MD Kathryn Claire Haran, DO Noah Francis Hawthorne, MD Bryce Richard Holderness, MD Douglas W Jacobson, MD Lauren Elaine Jacobson, MD Matti Rose Jansen, MD Benjamin Leonard Johnson, MD Samira Kayumi-Rashti, MD Robert Jeffrey Kershaw, MD Tamir H Keshen, MD Case H Ketting, MD John Khan-Variba, MD, MPH Sylvia Kim, MD

Bradley C Knox, MD Erica J Lambert, MD Ann Miehyung Lee, MD Winifred K Leung, MD Edward Ned Li, MD Miguel Angel Loya, DO Robin Elizabeth Malone-Cunnison, MD Alexander Eduard Morf, MD Joann Ng, MD Jenni Lynne Nix, MD William Kiernan O’Callaghan, MD William Michael Pace, MD Michael John Paisley, MD David Paul, MD, PhD Jordan Eliot Pinsker, MD David C Pires, DO Michael Polo, MD Christian Harrington Powell, MD Spencer Eugene Price, MD Beverly Joy Sanson Ramos, MD Sang-Gyou Rho, MD Jonathan Lee Riegler, MD Anne O`Meara Rodriguez, MD Brian David Santacrose, MD Matthew Bennett Scales, MD Wesley G Schooler, MD Roberta Sengelmann, MD Colin David Shafer, MD Michael Mourad Shenoda, MD Eric Sincoff, DO Margaux Kelly Snider, MD Nathan C Steinle, MD Noah Stites-Hallett, MD Monica Leigh Straatmann, MD Alan Mark Sugar, MD Reyna Maria Talanian, MD Sara Taroumian, MD Caleb Daniel Thompson, MD Christopher John Thrash, MD Stephen J Vara, MD Anne White, DO Brett Wilson, II, MD David Zisman, MD

Spring 2019

TO A L L O U R M E M B E R S

THANK YOU FEWER THAN 5 YEARS

Natalie Achamallah, MD, MA, MS Allison E Akers, DO Michael Edward Aldridge, MD Hamid Alipour, MD Bashir Allahdadi, MD Henning Ansorg, MD Iman Arafa, MD Taylor Austin, MD Keith Alan Ayrons, MD Summer Baird, MD Julian Bandura, DO Alex Glenn Bergman, MD Alan Barry Bernstein, MD Tania Bhatia, DO Elliott Aaron Birnstein, MD Brittany Alice Bryan, MD Mark E Burnett, MD Hugh Randolph Byers, MD, PhD Christopher Carls, DO Claudia Carranza, MD Kevin Michael Casey, MD Jennifer Chen, MD Sean David Christiansen, DO Katherine Chung, MD Nathaniel M Collins, MD Kathleen Anne Coquia, DO Charles Davis, MD Chelsea Lynne Dean, MD Barbara Joan Donnelly, MD K Charmian Dresel-Velasquez, MD Aroma Dulku, MD Todd William Engstrom, MD Ryan James Fante, MD Elizabeth A Finken, DO Kaitlin Ford, MD

Spring 2019

William Ganske, MD Eric Gavarre, MD Liana Gonzalez, MD Rachel M Greatwood, DO Justin Lee Greene, MD Alicia Amelia Guevara, MD Blake E Hansen, DO Paul Dietrich Hennig, MD Taylor James Holve, MD Camille Marie Hunter, MD Zohair Amjad Hussain, MD Robert Carr Kanard, MD Lindsay Blake Katona, DO, MPH Sarah Kempe-Mehl, MD Oma Christine Knox, MD Tatyana Kopilova, MD Hannah Kornfeld, MD Jennifer Backer Kosek, MD Sarah Elizabeth Langdon, MD Jeremy William Lash, MD Baochuong Quy Le, DO, MS Edward Lee, MD Steven Seth Lipman, MD Caitlin Rae Loseth, MD Thuthiri Lwin, MD Cory Malone, MD Catherine Aline Martin, DO, MPH Sean McGuinness, MD Aklecia Violet Mcvoy, MD, MPH Melanie Miller, MD Jamil Suheil Muasher, MD Hoang Nguyen, MD Grace Eunmi Park, MD John Keenam Park, MD, PhD

Miriam Farzaneh Parsa, MD, MPH Meredith Ann Perrin, MD Scott Patrick Piazza, DO Matthew Alan Pifer, MD Robert Houston Price, MD Daya Raman, MD Pedram Rashti, MD Atheer A Razzouk, MD Alexandra Reis, MD Sylvia Cristina Rivera, MD Adam Warren Rives, MD Alexandra E Rogers, MD Isaiah James Coupland Roggow, MD Andrew Gregory Ross, MD Stephanie Joy Rothman, DO Rebecca Lynn Ruebsamen, DO Rebecca Salvo, DO River Saul, DO Heather Melanie Schultz, MD Kenneth Shortt, MD Laura Sices, MD Cameron James St Hilaire, MD Nicole Gaye Stern, MD Rachel Subramanian, MD Benita Tjoe, MD Scott Baringer Tobis, MD David Tseng, DO Nicolas Asher Walton, DO Sharon Evelyn Watson, MD Douglas Peter Webster, DO Sara Pennington Wilson, MD Yvonne Yang, DO Mira Yoon, DO, MPH Andrea Isabela Zambrano Sequera, MD

CENTRAL COAST PHYSICIANS

27

MEN’S HEALTH

Life Expectancy Blues

BY DAVID DODSON, MD

The CDC publishes an annual abstract called Health United States (year). The last one, Health United States 2017, was something of a blockbuster, even for folks who normally consider such documents as about as exciting as watching paint dry. This is because the trend for steadily increasing life expectancy, which added over 30 years to life expectancy at birth from 1900 through 2016, reversed itself in 2014.

While this occurred for both men and women, the trend was more pronounced in men than in women and was the result of increases in 5 of the 12 leading causes of death, including accidents, suicide, homicide, and liver cirrhosis. Drug overdoses, primarily opioids, made a major contribution and were classified as accidental deaths.

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Spring 2019

It would appear that a significant demographic in our country finds itself in a situation where life is lacking in hope and meaning These developments varied geographically and by race, by age, and by gender, as well as by education level. Life expectancy continued to increase among African Americans, narrowing the gap in life expectancy between whites and blacks. The declines were most prominent in middle-aged whites with a high school education or less who experienced declining life expectancy on the order of that seen in men in Russia following the collapse of the Soviet Union, i.e. of a catastrophic order. This demographic has seen a 19% decrease in real income levels from 1999 to 2013.

What accounts for this catastrophe? It would appear that a significant demographic in our country finds itself in a situation where life is lacking in hope and meaning, leaving drugs and alcohol to fill the void, resulting in violence, accidents including overdoses, severe alcoholism leading to cirrhosis, and suicide, all on an unprecedented scale. Men in particular are raised to find meaning in being good providers for their families but now find that opportunities that used to abound for high school graduates to do that have evaporated. The state hardest hit by overdose deaths is West Virginia in the heart of coal country. Although they have promised the coal industry will come back, the truth is that employment in the coal industry has been declining for a century and those jobs are not coming back. The truth is, our economy has evolved from an agricultural and manufacturing based one to a services and technology based one, and the clock cannot be turned back.

Physicians have been often criticized for our role in the opioid epidemic, and we are now held accountable for new rules surrounding

Spring 2019

the prescription of controlled substances, including offering Narcan and having to consult prescription monitoring databases. And while undoubtedly there are bad doctors out there among the hundreds of thousands of practicing physicians in the country who have overprescribed narcotics and continue to do so, no one blames doctors for creating the existential malaise which has seen life expectancy fall after over a century of steady increases.

It is obvious that there are no easy answers to the problem of increased mortality in middle aged,

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CENTRAL COAST PHYSICIANS

29

MEN’S HEALTH predominantly undereducated white people who used to be able to make a comfortable living in industry and no longer can. Clearly education is one of the most important factors. But faith - faith in themselves, in their families, and perhaps religious faith, is also important and the lack thereof is literally killing enough of our fellow Americans to have lowered our national life expectancy statistics. Sadly, we live in bitter, polarized times. We cannot afford it. No other advanced nation has experienced the drop in life expectancy the USA has.

Which means there are plenty of “national role models” we could learn from, if we had the will do so. I am full of wonder that at a time like this, the political party that controls the White House and Senate has proposed to revoke the Affordable Care Act thereby jeopardizing the health care of 20 million of fellow Americans. We can

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CENTRAL COAST PHYSICIANS

and must do better. In my home state of Massachusetts, the uninsured rate is 3.5%. If this could be replicated nationwide, another 15 million people would gain health insurance coverage, many of whom desperately need it for help treating addiction and depression.

Surely that is also a needed part of the solution to the problem of falling life expectancy among poor and middle-class white people.

The data cited are mostly from Health United States 2017 published last year by the CDC and also from Case and Deacon’s 2015 paper in the Proceedings of the National Academy of Sciences which drew attention to these trends. The opinions are my own. As always, I look forward to your comments, criticisms, and thoughts.

Spring 2019

Upcoming Events MAY 2019

SEP 2019

OCT 2019

VARI OUS www.CCMAHealth.org/events Spring 2019

CENTRAL COAST PHYSICIANS

31

CenCal Health NEWS HUB: Recuperative Care Program Established on Central Coast to Help Plight of Local Homeless

CenCal Health recently announced a collaborative new program that provides safe recuperative care to local homeless who are not sick enough to remain hospitalized, but are too frail to recover from their illness or injury on the streets. The goals of this Recuperative Care Program (RCP) are to (1) address where and how the homeless recover after hospitalizations in order to improve health outcomes, (2) break the costly cycle of emergency room as first-line medical care, and (3) improve the lives of the most vulnerable in the health plan’s service area of Santa Barbara and San Luis Obispo Counties. RCPs launched in other communities have shown that the program reduces Emergency Department utilization and hospital readmission rates of homeless residents.

“We became aware of this need in the community through on-going relationships with our medical partners and local social service agencies,” said Bob Freeman, CEO of CenCal Health. “We are proud to be able to provide payment for up to 90 days for those Medi-Cal members who need these comprehensive medical services. Together with our local partners, we plan to disrupt the cycle of preventable re-

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CENTRAL COAST PHYSICIANS

Spring 2019

hospitalizations for our members experiencing homelessness.”

CenCal Health will provide a funding plan for the Recuperative Care Program in both counties with up to a $1 million budget allocation, based on utilization.

For San Luis Obispo County and northern Santa Barbara County, CenCal Health is partnering with Dignity Health, Tenet Healthcare, Community Action Partnership of San Luis Obispo (CAPSLO) and Good Samaritan Shelter. RCP partners in Santa Barbara include Cottage Health and People Assisting the Homeless (PATH).

Hospitals and health plans nationwide have faced considerable challenges in identifying appropriate discharge options for patients who do not have safe, clean homes where they can convalesce. This situation often results in unnecessary hospital stays, preventable readmissions, and increased costs for the health care system. To circumvent those negative outcomes, the Recuperative Care Program model provides: • 2 4-hour bed with supervision of meals, showers, clothing, and basic Activities of Daily Living (ADL) •T ransportation to pharmacies and medical appointments •M edication reconciliation, dosing, and set up •R eview of compliance and patient education •C ommunication with providers and coordination of care •C ase management

Spring 2019

• Discharge planning • Coordination with home health, mental health, drug/ alcohol, and other supportive services • Referrals and linkages to housing, self-sufficiency, social services, etc.

In 2017, CenCal Health, along with CAPSLO, successfully completed a RCP pilot in San Luis Obispo County, which included supervised shelter, meals, showers, patient education and transportation to medical appointments among other supportive services. The positive outcome of the year-long pilot resulted in the continuation and expansion of that program into northern Santa Barbara County, and helped inspire the recent launch of a similar program in southern Santa Barbara County.

Both Central Coast counties now have Recuperative Care Programs in place. In October of 2018, CAPSLO moved the RCP to its new 40 Prado Homeless Service Center in San Luis Obispo, where the number of available RCP beds increased by 50%. Primary medical services and a pilot to provide behavioral health services are now available at the 40 Prado location. Integrated primary care and behavioral health services are also provided at Good Samaritan Shelter in Santa Maria.

For more information, visit cencalhealth.org.

CENTRAL COAST PHYSICIANS

33

CL

Positions Available The COUNTY OF SAN LUIS OBISPO is seeking physicians to fill the role of Staff Psychiatrist.

For more information, go to www.slocounty.ca.gov.

The COUNTY OF SANTA BARBARA is seeking physicians to fill the role of Supervising Physician in Lompoc, and the Behavioral Wellness Department is seeking physicians to fill the roles of Medical Director for Inpatient & Crisis Psychiatric Services,

DS

F I S IE S A

Psychiatrist and Psychiatrist (Child-Adolescent Specialty).

For more information, go to www.sbcountyjobs.com.

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. Physician openings can be found at www.sansumclinic.org/physician-providerjob-opportunities.

If you would like to submit a listing to our Classifieds, contact magazine@sbmed.org. Listings are free for members with reasonable rates for nonmembers.

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CENTRAL COAST PHYSICIANS

Spring 2019

Spring 2019

CENTRAL COAST PHYSICIANS

35

Public Health

Update

Source: California Department of Public Health

Respiratory Disease Differentiation on the Central Coast LOCAL TOOLS TO HELP TAKE ON A UNIVERSAL CHALLENGE

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

From our profession’s earliest days, astute clinicians have faced the challenge of rapidly differentiating infectious respiratory diseases so as to not only provide the most direct path to treatment for each patient but also to protect members of the community from infectious disease. For patients of all ages and backgrounds, respiratory disease is a major driver to seek health care.

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Today, we have the benefit of more detailed data and more specific laboratory testing than ever before.

However, these diseases can be confounding, even for the most insightful and experienced clinicians. Respiratory diseases often present in a way that defies ready differentiation.

The advent of increased data and testing, however,

Spring 2019

has shed light on the power of geography in supporting the diagnosis of respiratory disease.

The regional epidemiology of these illnesses— plus the unique natural and social features of our communities—can help inform diagnosis. With this in mind, I’m pleased that the Public Health Department is able to present new resources to support Central Coast clinicians in discerning the respiratory diseases our communities face.

In particular, I urge us all to make use of local information that can help differentiate among influenza, community-acquired pneumonia, coccidioidomycosis (Valley fever), and tuberculosis (TB).

In SLO County, we see distinct trends and challenges in accurately diagnosing these illnesses.

TB, for example, is quite uncommon in SLO County, with an incidence rate of 2.2 per 100,000 (well below the state average of 5.2). Yet we frequently see TB on the differential diagnosis for patients who present with respiratory symptoms.

This creates the need for isolation, thereby adding a burden to the patient and to our health care system—a burden we should ask them to carry only when truly needed.

Valley fever, on the other hand, is relatively common in SLO County with an incidence rate of 150.4 per 100,000. (This compares to a state average of 18.8). Our county sees the thirdhighest rate and third-highest number of cases in California, after only Kern and Kings counties.

Yet Valley fever is often not suspected until other possibilities have been eliminated. For patients, that can mean unnecessary antibiotics, uncomfortable tests, and weeks or months of anxiety as symptoms worsen.

While we also see strong and predictable patterns in the seasonality of disease—we’re all familiar with “flu season” and may look for more Valley fever after the dry, windy summer months—I’m also struck by the exceptions to these seasonal patterns. This year, we have been seeing influenza well into April.

In 2018, SLO County saw 216 cases of Valley fever diagnosed in the rainy first quarter (January-March) and 88 cases diagnosed in the dry, windy third quarter (July-September).

We are fortunate on the Central Coast to have many excellent clinicians in the community and wonderful infectious disease colleagues who provide valuable guidance.

I’d also like to offer the Public Health Department as an additional resource. We’re available (805-781-5500, M-F 8-5; 805-781-4553 after hours) to consult on infectious respiratory disease cases and other communicable diseases. Our Public

Spring 2019

Health Laboratory is a strong local resource. The lab carries out early seasonal influenza surveillance at no charge and can expedite testing in many cases. We can obtain answers quickly in cases of suspected TB and, in rare cases where TB is confirmed, we can facilitate assessing antibiotic resistance through the state laboratory. Our lab’s respiratory disease panel screens for 17 agents with same-day turnaround.

We are publishing a new at-a-glance poster, developed with insight from the California Department of Public Health Center for Infectious Diseases, to support local clinicians in respiratory disease differentiation. If you would like to receive copies of this new tool or would like us to meet with your team to discuss new data to support respiratory disease differentiation in more detail, please let me know. I would also be eager and interested to hear about your clinical experiences, observations, and insights in navigating this challenge.

CENTRAL COAST PHYSICIANS

37

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

...and even more on the way.

Michael Edward Aldridge, MD Internal Medicine Santa Barbara Cardiovascular Medical Group Santa Barbara 805.682.7707

Steven Seth Lipman, MD Anesthesiology Anesthesia Medical Group of Santa Barbara Santa Barbara 805.682.7751

Brian Anthony DiCarlo, MD Hematology Oncology Dignity Health PCCHC SLO Oncology & Hematology Health Center San Luis Obispo 805.543.5577

Robert Houston Price, MD Neurology Santa Barbara 805.845.2225

Zohair Amjad Hussain, MD Anesthesiology Anesthesia Medical Group of Santa Barbara Santa Barbara 805.682.7751

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CENTRAL COAST PHYSICIANS

Adam Warren Rives, MD Hand Surgery Associated Hand Surgeons Santa Barbara 805.682.2267

Spring 2019

Donna Elaine Winingham, MD Diagnostic Radiology Central Coast Radiology Associates Templeton 805.485.9062

RETIRED Mary Ferris, MD Family Medicine Goleta

David LaPatka, MD Otolaryngology Santa Barbara

Richard Hendricks, MD Otolaryngology San Luis Obispo

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