Issuu

SPRING 2022

History of Physician Wellness MICRA Modernization • Impact of COVID-19 • Taming the EHR

state-of-the-art

epilepsy care The Cottage Epilepsy Center (CEC) is the only Center of its kind between Los Angeles and the Bay Area. Our comprehensive epilepsy program includes a team of epilepsy specialists and state-of-the-art monitoring equipment. Each patient will receive personalized care during their diagnosis and treatment. • Video-EEG monitoring for differential

HOW TO REFER A PATIENT: To arrange an appointment for your patient or to comanage/transfer care to the epilepsy center, please contact the office of Dr. Michael Gibbs at:

(805) 682-8153

diagnosis of “spells” and pre-surgical evaluation for medically refractory epilepsy • Imaging techniques including 1.5 and 3.0 Tesla high resolution MRI, PositronEmission Tomography (PET) scanning for localization of seizure foci

If you need more immediate assistance or have questions regarding referring a patient, please call Karen Secore, Nurse Navigator for the Epilepsy Center at:

(805) 832-3633

• Specialized neuropsychological testing • Evaluation for medical and surgical management, which may include resection, and neurostimulator implant procedures such as VNS and RNS

CENTRAL COAST PHYSICIANS

Spring 2022

JOIN TODAY FOR ONLY

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!

Spring 2022

CENTRAL COAST PHYSICIANS

Help Reduce Risk of Stroke Less Invasive Treatment for Carotid Artery Disease If you live with carotid artery disease, a new procedure may help reduce your risk of stroke. Tenet Health Central Coast is the first in San Luis Obispo County to offer transcarotid artery revascularization (TCAR), an advanced treatment for patients with carotid artery disease. Find out if you’re a candidate for this alternative to open surgery that often takes less than an hour.

Learn more at TenetHealthCentralCoast.com/TCAR 4

CENTRAL COAST PHYSICIANS

Spring 2022

VOLUME 7, NUMBER 2 • SPRING 2022

{FEATURES}

11 13 15 18 26 Spring 2022

MICRA MODERNIZATION SINGULAR QUALITY HISTORY OF WELLNESS TAMING THE EHR FEDERAL WRAP-UP

{DEPARTMENTS} 8

RISK TIP

PUBLIC HEALTH UPDATE

CLASSIFIEDS

CENCAL HEALTH NEW

NEW MEMBERS

IN MEMORIAM

CENTRAL COAST PHYSICIANS

Letter from the CEO

CONNECTING IN PERSON After holding our first in-person Annual Membership Celebrations since 2019, it feels like we are returning to a new normal. Both events had an amazing turnout to celebrate Dr. Tom Hale in San Luis Obispo and Dr. Alex Koper in Santa Barbara as our 2021 Physicians of the Year. Many people stated it was the first time they attended an event since the beginning of the pandemic, and it was wonderful seeing everyone gathered together DANA GOBA and connecting with their colleagues. People were happy to be back in person, and there was much laughter throughout the evening. Two weeks after our Annual Membership Celebrations, CCMA participated in another in-person event since the beginning of the pandemic. We joined physicians from around the state in Sacramento for the California Medical Association’s Legislative Advocacy Day. Drs. René Bravo, Todd Engstrom, Priti Gagneja, Jennifer Hone, Sam Kayumi-Rashti, and Doug Murphy met with our state representatives to lobby and advocate for physicians and their patients. Our legislators were happy to see us in-person after only holding Zoom meetings for the past two years. CCMA is planning more in-person gatherings this year. We will have a summer soirée for physicians to network and connect with each other. In addition, we will be honoring our 2022 Physicians of the Year in Santa Barbara on September 29 and in San Luis Obispo on September 30 at our Annual Membership Celebrations. We look forward to connecting with you in person because together we are stronger. Sincerely,

PRESIDENT Samira Kayumi-Rashti, MD PRESIDENT ELECT Julie Fallon, MD TREASURER Douglas Murphy, MD SECRETARY Todd Engstrom, MD IMMEDIATE PAST PRESIDENT Priti Gagneja, MD DIRECTORS Eric Amador, MD; Kevin Casey, MD; Michael DiBiase, 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; Julie Fallon, 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 EDITOR Samira Kayumi-Rashti, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS American Medical Association; Penny Borenstein, MD, MPH; California Medical Association; CenCal Health; Nicole Franklin, MS, CPHRM; Bradley Knox, MD; Douglas Murphy, MD; Nihal Naccasha, MD; Steven Van Scoy, MD CONTRIBUTING PHOTOGRAPHERS California Medical Association, CenCal Health, Tenet Health Central Coast SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. 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

Dana Goba Chief Executive Officer Central Coast Medical Association

CENTRAL COAST PHYSICIANS

products or services advertised. CCMA reserves the right to reject any advertising. All advertising inquiries can be sent to magazine@ccmahealth.org. A COMPONENT OF THE

Spring 2022

HOW MUCH ASSURANCE do you have in your malpractice insurance?

With yet another major medical liability insurer selling out to Wall Street, there’s an important question to ask. Do you want an insurer with an A rating from AM Best and Fitch Ratings, over $6.2 billion in assets, and a financial award program that’s paid $120 million in awards to retiring members? Or do you want an insurer that’s focused on paying its investors? Join us and discover why our 80,000 member physicians give us a 90+% satisfaction rating when it comes to exceptional service and unmatched efforts to reward them.

8277_CA_CentralCoast_Assurance_Spring2022_v1.indd 1

3/15/22 5:18 PM

1st Capital Bank Provides SBA Financing for Physicians. Businesses like yours require ready access to capital in order to grow and remain competitive. Our SBA team will work to understand the needs of your practice and will expedite your application to get your loan funded quickly.

Consider an SBA loan for any of the following situations: • Partnership buy-out

• Purchase new medical equipment

• Purchase a new medical practice

• Purchase or refinance real estate for your medical practice

• Refinance existing medical practice debt

Get a no-cost, no obligation SBA loan evaluation. Now is the time to take advantage of record low interest rates with an SBA Preferred lender! Contact SVP, Hillary Olson at 530.220.4613 or email hillary.olson@1stcapitalbank.com to discuss how an SBA loan from 1st Capital Bank will work for you. Member FDIC | Equal Housing Lender | SBA Preferred Lender

Spring 2022

Loans subject to credit approval.

CENTRAL COAST PHYSICIANS

RISK TIP Telephone Communication for Healthcare Providers:

Safety Strategies BY NICOLE FRANKLIN, MS, CPHRM, PATIENT SAFETY RISK MANAGER II, THE DOCTORS COMPANY

The way we communicate has changed dramatically over the years. Even with the introduction of technology-based communications, such as social networking sites, telemedicine, and texting, the telephone call is still the most widely used communication tool between healthcare providers and patients. Telephone conversations can, however, present difficulties and may be inherently deceptive if both parties lack the ability to observe nonverbal communication (for example, facial expressions, eye contact, and gestures) that clarify and qualify what the voice is expressing. When casually or carelessly conducted, telephone communications can lead to diagnostic errors and misunderstandings that may culminate in professional malpractice claims.

To find out more about what differentiates The Doctors Company from other medical malpractice insurance carriers as a physician-first insurer, contact Matt Lawrence at 310.492.4845 or mlawrence@thedoctors.com. CCMA members receive additional savings!

CENTRAL COAST PHYSICIANS

Spring 2022

TELEPHONE COMMUNICATION WITH PATIENTS

Creating comprehensive, clear guidelines for telephone encounters with patients is critical in mitigating risk. Establish practice guidelines and ensure that all office and clinical staff are trained on their roles in communicating with patients by telephone. Protect yourself from potential liability by following these general practices: • SMILE WHEN GREETING PATIENTS. Research has

shown that people are able to tell if you are smiling by the tone of your voice. Warmly express to patients that you are happy to speak with them today. This interaction may be the first impression that a patient has of the practice or the staff, and it is a factor in patient satisfaction.

• ADHERE TO HIPAA RULES and regulations to maintain

patient privacy when communicating over the telephone, both inside and outside the office. Use a low voice when discussing protected health information, and implement reasonable safeguards to avoid disclosing information to others not involved in the patient’s care.

• DEVELOP WRITTEN PROTOCOLS for front office/

unlicensed personnel to help them respond to patient questions and concerns. An unlicensed individual cannot provide medical or dental advice. Clinical/licensed individuals answering patient calls cannot exceed their scope of practice.

• PRESCRIBE OR ADVISE BY TELEPHONE only when

include abdominal or chest pain, fever of unknown origin, high fever lasting more than 48 hours, convulsion, vaginal bleeding, head injury, dyspnea, casts that are too tight, visual alterations, and the onset of labor. For more information on this topic, read our article, “Telephone Triage and Medical Advice Protocols.”

you have reviewed the patient’s allergies, medications, and medical and surgical history. If providing new instructions to the patient, such as changing a medication dosage, ensure understanding by asking the patient to repeat back the instructions to you. Document the patient’s understanding in the medical or dental record. For more information on this topic, read our article “Rx for Patient Safety: Use Ask Me 3 to Improve Patient Engagement and Communication.”

• OBTAIN AS MUCH INFORMATION AS POSSIBLE about

• ACCEPT A THIRD PARTY’S DESCRIPTION of a medical

• TRIAGE AND REFER ALL CRITICAL CALLS TO EMERGENCY SERVICES. Examples of critical calls

the patient’s presenting complaint, medical and surgical history, current medications, and allergies to help you arrive at an accurate appraisal of the patient’s condition. Listen carefully and allow the caller both the time and opportunity to ask questions.

• SPEAK TO PATIENTS CLEARLY AND SLOWLY, and

enunciate carefully. Use easy-to-understand language that avoids medical terminology.

or dental condition only when you have confidence in that person’s competence to describe what he or she sees. If descriptions are unclear, the patient may require an office visit.

• MAKE PROMPT REFERRALS if the patient’s call concerns

a medical or dental problem that is outside your expertise. Proactively track the consultation and expected report, and follow up with the referred provider and patient.

• OBTAIN THE SERVICES OF AN INTERPRETER IF YOU

• CONFIRM THAT PHARMACISTS UNDERSTAND ALL

ENCOUNTER A LANGUAGE DIFFICULTY. Follow the

DOSAGES and instructions for drug prescriptions given

Americans with Disabilities Act (ADA) requirements for patients using telephone auxiliary aids or services, including interpreters. For more information, see “ADA Requirements: Effective Communication.” • AVOID DISTRACTIONS, such as checking email or

attending to other duties, when speaking with patients. Drowsiness, fatigue, or distraction on the part of either party can affect the ability to communicate effectively.

Spring 2022

by telephone. Spell out any similar drug names and use individual numbers for dosages, such as “five zero” for 50. Include the reason for the use of the drug. Insist that pharmacists repeat information back to you. Do the same with facility personnel who take your telephone orders. A safer approach is to use electronic prescribing or fax the medication order.

CENTRAL COAST PHYSICIANS

• VERIFY AND DOCUMENT THE PATIENT’S ADHERENCE with telephone advice through a follow-up

contact to ensure continuity of care.

PROVIDER CROSS-COVERAGE

When you will be away from your own practice or covering for another provider, these additional strategies can help you avoid problems: • IMPLEMENT A COMMUNICATION PROCESS between

cross-coverage providers. In several instances, a covering provider has been held completely responsible for damages resulting from a telephone misdiagnosis while the original provider was exonerated.

• GIVE A BRIEF STATUS REPORT on your acute patients

with notice of any anticipated patient calls when handing off care.

• DOCUMENT ALL CALLS in the patient record. Brief the

primary provider on all calls during your coverage period.

• PRESCRIBE ONLY THE AMOUNT OF MEDICATION THE PATIENT REQUIRES during the period you are

covering for another provider. Pain medications and narcotics should be refilled or ordered only in small amounts and per state regulations.

DOCUMENTATION

Disagreements about what was said during telephone conversations can be a major problem in professional malpractice cases. Follow these documentation processes to mitigate this risk: • DOCUMENT ALL PATIENT TELEPHONE CONVERSATIONS in the medical or dental record—

including those received and returned after hours. Include the date and time of each contact and when follow-up is completed. • RECORD ALL DETAILS IMMEDIATELY about the

information you received, what you advised, and the orders you gave. This action is especially important when a telephone call occurs after office hours or on a weekend.

• IMPLEMENT AN OFFICE PROCESS for calls received

during office hours. Office staff should tell the caller when the provider is most likely to return the call. Include tracking and follow-up to ensure that the caller’s questions and problems are resolved and documented.

• DOCUMENT A PATIENT’S HOSPITAL MEDICAL RECORD with telephone conversations about the

hospitalized patient—including any conversations with nurses or other providers. Effective telephone communication and its documentation are vitally important in preventing and defending litigation. For additional risk reduction strategies see our telehealth resources and our article “Smartphones, Texts, and HIPAA: Strategies to Protect Patient Privacy.”

For further assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email to patientsafety@thedoctors.com.

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

CENTRAL COAST PHYSICIANS

Spring 2022

MICRA Modernization 2022 Historic agreement brings new and sustained era of stability around malpractice liability. In a historic agreement, Californians Allied for Patient Protection (CAPP) and the Consumer Attorneys of California have announced a consensus on legislation to modernize the Medical Injury Compensation Reform Act (MICRA). The modernized approach to MICRA— introduced as Assembly Bill 35 in the legislature and jointly authored by Assembly Majority Leader Eloise Reyes and Senator Tom Umberg—will extend the longterm predictability and affordability of medical liability insurance premiums, while keeping MICRA’s essential guardrails solidly in place for patients and providers alike. For decades, California’s landmark medical malpractice laws have successfully struck a balance between compensatory justice for injured patients and maintaining an overall health care system that is accessible and affordable for Californians. Over the years, California’s physician and provider communities have repeatedly defended MICRA through expensive battles at the ballot, in the courtroom and in the legislature. This year, with the so-called Fairness for Injured Patients Act (FIPA) slated for the November 2022 ballot, we were again facing another costly initiative battle that could obliterate existing safeguards for out-of-control medical lawsuits and result in skyrocketing health care costs. “For the first time in a generation, we were met with an opportunity to achieve a meaningful consensus between competing interests through a modernized MICRA framework that could protect both the rights of injured patients while keeping MICRA’s essential guardrails solidly in place for patients and providers alike,” says Robert E. Wailes, M.D., president of the California Medical Association (CMA). “At times like these, we have an obligation to protect patient care and to seize a historic opportunity for a brighter future for California’s health delivery system.”

Spring 2022

The Threat If approved by voters, the FIPA initiative would have effectively eliminated MICRA’s cap on non-economic damages by creating a new, broadly-defined category of injuries not subject to the cap. This would have resulted in a significant increase in litigation with unpredictably high verdicts and no less than an immediate doubling of malpractice insurance premiums. The non-partisan state legislative analyst predicted FIPA would have resulted in more than $11 billion a year in increased health care costs. This would have had a chilling effect on the entire health care system, with the trickledown effect borne primarily by low-income patients, who would face higher costs and restricted access to care. The initiative also directly targeted physicians, putting personal assets at risk.

A Modernized Framework A new consensus has been reached between health care, legal and consumer advocates on legislation to modernize MICRA. This agreement unifies stakeholders and puts the interests and wellbeing of Californians ahead of historic conflicts. The compromise reflected in this legislation will ensure that health care is accessible and affordable, while balancing compensation for Californians who have experienced health care related injury or death. “This balanced proposal modernizes and updates MICRA while preserving its essential guardrails, strengthening provider protections and providing for fair compensation for injured patients,” said Dustin Corcoran, CMA CEO and Chair of the Campaign to Protect Access and Contain Costs. “This framework is essential to our shared goal of health access for all Californians. We look forward to working with the Legislature and the Newsom Administration to enact this historic proposal.”

CENTRAL COAST PHYSICIANS

The modernized framework preserves MICRA’s protections while providing a fair and reasonable increase to MICRA’s established limit on non-economic damages for medical negligence starting on January 1, 2023 – with gradual increases over the next 10 years and a 2.0% annual inflationary adjustment thereafter. Other important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offers of proof for making punitive damages allegations and allowing other sources of compensation to be considered in award determinations. Critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff’s attorney’s contingency fees. “This compromise will help to ensure that community health centers across California that serve some of our state’s most vulnerable patients will have continued access to safe, affordable health care,” said Jodi Hicks, Planned Parenthood Affiliates of California President and CEO. “It was important for Planned Parenthood to have a voice in this process because the proposed initiative would have caused significant harm to California’s safety net. We’re pleased to see a solution that creates long-term stability and protects access to care for those who need it most.” CAPP reached the agreement with the initiative’s proponent, Nick Rowley, and the Consumer Attorneys of California, the state’s largest organization representing plaintiffs’ attorneys.

Changes to the MICRA Cap Current law limits recovery of non-economic damages to $250,000, regardless of the number of defendants. The modernized framework would increase the existing limit to $350,000 for non-death cases and $500,000 for wrongful death cases on the effective date of January 1, 2023, followed by incremental increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases, after which a 2.0% annual inflationary adjustment will apply. The proposal will also create three separate categories of caps, which could apply depending on the facts of each case: + One cap for health care providers (regardless of the number of providers or causes of action) + One cap for health care institutions (regardless of the number of providers or causes of action) + One cap for unaffiliated health care institutions or providers at that institution that commit a separate and independent negligent act A health care provider or health care institution can only be held liable for damages under one category, regardless of how the categories are applied or combined.

CENTRAL COAST PHYSICIANS

New Protections for Benevolent Gestures and Statements of Fault Often, a patient’s decision to file a medical malpractice lawsuit is triggered by a failure in communication, not negligence. The modernized framework establishes new evidentiary protection for all pre-litigation expressions of sympathy, regret or benevolence, including statements of fault, by a health care provider. Allowing physicians and patients to have full and open conversations about adverse events and unexpected health care outcomes will foster greater trust and accountability, while facilitating improved patient safety.

Next Steps The proposal reflected in this legislation strikes a prudent and patient-focused balance between fair compensation to injured patients and the need for universal, high-quality and cost-effective health care. More significantly, in the shadow of the most sweeping public health crisis in a century, it demonstrates a unifying willingness to put the interests of California patients ahead of divisive political positions. Our broad and diverse coalition of physicians, community health centers, dentists, hospitals, nurses and hundreds of other organizations dedicated to affordable, accessible health care will be working closely with the Newsom Administration and the California Legislature to ensure this updated approach to medical negligence cases is enacted and signed into law. CMA and the provider community remain united and committed to the principle of high-quality health care that is accessible and affordable to all Californians.

Californians Allied for Patient Protection (CAPP) is the large and diverse coalition working to protect access to health care through the Medical Injury Compensation Reform Act (MICRA). Its membership includes the California Medical Association (CMA), California Hospital Association, California Dental Association, CMA’s component medical societies, medical malpractice insurance carriers, community clinics, Planned Parenthood Affiliates of California and many more. (You can see the full membership at micra.org.) CAPP and its members also made up the core of Californians to Protect Patients and Contain Health Care Costs, the campaign CMA has been leading to defeat this dangerous ballot measure. CAPP reached the agreement with the initiative’s proponent, Nick Rowley, and the Consumer Attorneys of California, the state’s largest organization representing plaintiffs’ attorneys.

Spring 2022

Singular Quality is Something to Care About BY BRADLEY KNOX, MD; NIHAL NACCASHA, MD; AND STEVEN VAN SCOY, MD

Health care is an important concern for all citizens, and we must demand both the highest and safest level of quality care. Fortunately, Tenet Health Central Coast is one of the nation’s safest and elite hospitals (from nationally-recognized independent sources, such as The Joint Commission, Health Grades, The Leapfrog Group, to name a few), an amazing honor that lends even more significance to living in such a breathtaking region. As physicians that have practices at Sierra Vista Regional Medical Center, we are privileged to offer high-quality care to all residents. But the quality of the County’s outstanding health care is in danger of diminishing if we don’t stand up together as physicians to oppose dangerous duplication of specialized services. While we agree that competition is good in most cases,

Spring 2022

this type of duplicative competition in a county as small as San Luis Obispo will be detrimental to patients and the community. Here are some important facts to consider: • Numerous studies show that more care is not necessarily beneficial: along with the increased likelihood of medical errors, it can make care less affordable and accessible (Asian Bio Ethics Review, August 2020). • The more a hospital performs a surgical procedure, the safer it is. Many reports dating as far back as 1979 identify a link between higher mortality rates (more deaths) and low surgical volume (less experience with a particular operation). (JAMA Pediatrics, August 2015).

CENTRAL COAST PHYSICIANS

• Having a highly-honored hospital helps with the recruitment and retention of highly trained and skilled physicians of all disciplines. Studies show that physicians seek areas that strive for quality and provide outstanding opportunities. As SLO County’s Trauma Center and only hospital with 24/7/365 Pediatric and Obstetrics (OB) Physician Hospitalists, Sierra Vista Regional Medical Center is directly accountable to the community it serves. Volunteers and patient advocates make up Sierra Vista’s Board of Directors, along with physicians, and promote patient safety to ensure that Sierra Vista provides the highest quality care possible. This is evident in the hospital’s more than 50 awards in patient safety and satisfaction and in recognition of excellent outcomes for quality patient care. Sierra Vista provides cutting-edge, nationally-acclaimed innovations such as the NicView, Ion Robotic-Bronchoscopy, Transcarotid Artery Revascularization (TCAR) and has been recognized with the IBCLC Award for maternity care and support, putting Sierra Vista in the top two percent of community hospitals in the nation. Sierra Vista Regional Medical Center’s Level III NICU has given advanced newborn intensive care to the tiniest, most vulnerable patients – a level of care rarely found in communities the size of San Luis Obispo County. To have the safest outcomes and not put babies at risk, it must have a high volume of babies. In addition to the NICU, Sierra Vista specializes in high-risk pregnancy and offers the County’s only Obstetric Hospitalist Program. Since opening its Neonatal Intensive Care Unit (NICU) in 1986, Sierra Vista has taken care of about 7,000 highrisk newborn babies. This high volume has created an experienced, well-educated, local team that is prepared for any newborn crisis.

• We risk mediocre care and higher mortality rates. No one can be the expert if volume for any program goes down. National data indicates mediocre care contributes to poorer outcomes in general and ultimately higher mortality (death) rates. • We risk losing our physicians. If overall quality care decreases or there is a loss of opportunity, physicians across disciplines might leave the area entirely. • We risk losing quality programs. Sierra Vista Regional Medical Center has worked hard to become an elite center for care; it is not something that happens overnight, and the community already has too much of a vested interest in the quality services, such as with a NICU, to let it fail now. It’s simple: duplication of specialized medical programs in such a small community will increase local health care costs, reduce quality of care, and hurt retention of our best and brightest physicians. That’s a price too expensive to pay.

It’s simple: duplication of specialized medical programs in such a small community will increase local health care costs, reduce quality of care, and hurt retention of our best and brightest physicians. That’s a price too expensive to pay.

As physicians, we need to advocate for best practices over more places to practice. What are we risking by duplication of specialized services? • We risk increasing health care costs locally. Duplication of services means a duplication of costly, highly specialized equipment and staff, resulting in increased health care costs for the patient.

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Dr. Knox is a volunteer Board Member and the Medical Chief of Staff. Dr. Van Scoy is the NICU Medical Director. Dr. Naccasha is a Perinatologist (Maternal/Fetal Medicine) and the Medical Director for Obstetrix Medical Group of the Central Coast.

Spring 2022

W The History of Wellness BY DOUGLAS MURPHY, MD

Though considered by many a newer concept, the tenets of wellness date back to antiquity. Long before recorded history, human drive for survival and exposure to the ubiquity of physical suffering and death must have elicited a desire to escape or at least defer that inevitability. And with that desire, a search for the means by which do so. This is perhaps the most basic human drive: to live longer, healthier, and better.

Wellness as an Ancient Concept By most accounts, ancient concepts of wellness are attributed to Ayurveda, originating as an oral tradition in approximately 3,000 B.C. Ayurveda was a holistic system which aimed to create harmony between body, mind, and spirit and were tailored to individual constitution (their nutritional, exercise, social interaction, and hygiene needs) – with the goal of maintaining a balance that prevents illness. Yoga and meditation are critical to this tradition. Ancient Hebrew concepts of health and wholeness are less clearly defined in texts but also have ancient

Spring 2022

origins. Hebrew scholars have argued that though there is no Hebrew word for “health,” the whole of Hebrew scripture is about health. The word nephesh, commonly translated “soul”, implies all the functions of man: spiritual, mental, emotional, and physical. According to some Hebrew scholars, health is the first mitzvah of the Jew and of anyone who believes in God and that the Hebrew word Shalom means “complete,” “whole,” mostly with the connotation of health. Early Christian concepts defined health as a gift of God but emphasized service to one another “in health, sickness, and suffering.” An overview of these principles defines life itself as a gift emphasizing stewardship

CENTRAL COAST PHYSICIANS

over one’s health, not overindulging in food or drink, seeking spiritual health, being kind to others and praying. Similarly, for Muslims, health is a state of physical, psychological, spiritual, and social well-being and is considered the greatest blessing God has given humankind. Muslims are to receive illness with patience, prayers, and meditation. The ancient cultures of China, India, Greece, and Rome had a very sophisticated understanding of how to maintain health, and they tended to emphasize a “whole person” or “harmonious” approach to staying well. Ancient Systems of Medicine Traditional Chinese medicine is one of the oldest systems of medicine in the world. Influenced by Taoism and Buddhism, it applies a holistic perspective to achieving health and

CENTRAL COAST PHYSICIANS

wellbeing through the cultivation of harmony within one’s life. Therapies that evolve out of traditional Chinese medicine, such as acupuncture and herbal medicine, are notably still in practice and increasingly being integrated into Western medical practices. The ancient Greek physician Hippocrates, considered to be the father of Western medicine, is possibly the first physician to focus on preventing sickness instead of just treating disease. Hippocrates was credited with separating the discipline of medicine from religion, arguing that disease was not punishment by the gods, but that illness came from poor lifestyle choices. He argued that disease is a product of lifestyle and environmental factors, diet, and living habits. Ancient Roman medicine emphasizes the prevention of disease over curing disease, and it adopted the Greek believe that diseases

Spring 2022

are a product of diet and lifestyle. They had a highly developed public health system with a system of aqueducts, sewers, and public baths, which helped prevent the spread of germs and maintain the health of the population. Though the earliest western mention of the term wellness can be found in 1654 in a diary entry by Sir Archibald Johnston, a modern concept of wellness derived from a diverse set of intellectual, religious, and medical movements in the 19th century, being refined in the 1950s through 1970s, and coming to the forefront of healthcare consciousness and policy over the last 25 years. Hence, the concept of wellness is not modern at all, but ancient, deriving from the most basic human drive: to

Spring 2022

live longer, healthier, and better. Let us hope we with the vast resources we possess in modern society, we can achieve more broadly effective application of wellness principles - better nutrition, exercise, stress management, and restorative sleep - in our own lives as physicians, while teaching and modeling this for our patients. In the next installment of this series, we will consider modern concepts of wellness and more specifically how these are being applied.

CENTRAL COAST PHYSICIANS

Taming the Electronic Health Record Playbook

The following pages are an excerpt from the American Medical Association’s Taming the Electronic Health Record Playbook. For the full playbook, use the QR code within the pages or go to www.ama-assn.org/ practice-management/ama-steps-forward/taming-ehr-playbook.

from the AMA STEPS Forward™ Playbook Series

CENTRAL COAST PHYSICIANS

Spring 2022

About the AMA STEPS Forward™ Playbook series This Playbook is part of the AMA STEPS Forward™ interactive practice transformation program. Each Playbook in the series highlights key messages and links to free online toolkits, videos, podcasts, and practical tools to start creating change today. The objective of the Playbook series is to offer you a high-level overview of an area that you can choose to dive deeper into at your own pace. Access the digital Playbook for the optimal experience. To fully engage with the Playbook and access all the relevant links, scan this QR code to view the PDF on your smart device or computer.

About the AMA STEPS Forward™ practice innovation strategies The AMA STEPS Forward program offers practice innovation strategies that allow physicians and their teams to thrive in the evolving health care environment by working smarter, not harder. Physicians looking to refocus their practice can turn to AMA STEPS Forward for proven, physician-developed strategies for confronting common challenges in busy medical settings and devoting more time to caring for patients. This collection offers more than 70 online toolkits and other resources that help physicians and medical teams make transformative changes to their practices, including in the areas of managing stress, preventing burnout, and improving practice workflow. The AMA STEPS Forward™ Innovation Academy expands on the program to give participants the flexibility to customize their practice transformation journey. The Innovation Academy offers a spectrum of opportunities to learn from peers and experts, including webinars, telementoring, virtual panel discussions, bootcamps, and immersion programs. Learn more at www.stepsforward.org.

Taming the Electronic Health Record Playbook authors: Jill Jin, MD, MPH; Jessica Reimer, PhD; Marie Brown, MD, MACP; Christine Sinsky, MD, MACP AMA STEPS Forward also acknowledges the authors of the individual toolkits referenced in the Taming the EHR Playbook for their contributions: Melinda Ashton, MD (Getting Rid of Stupid Stuff); Peter Basch, MD, MACP (EHR Optimization); John Bulger, DO, FACOI, FACP (Choosing Wisely); Catherine DesRoches, DrPH (Sharing Clinical Notes With Patients); Jane F. Fogg, MD, MPH (EHR Optimization); Matt Handley, MD (Choosing Wisely); Kevin Hopkins, MD (Patient Portal Optimization); James Jerzak, MD (EHR Inbox Management); Christopher Joseph (EHR Optimization); CT Lin, MD, FACP (EHR Optimization); Margaret Lozovatsky, MD (Patient Portal Optimization, EHR Optimization); Paola Miralles (Sharing Clinical Notes With Patients); Wendy K. Nickel, MPH (Choosing Wisely); James Rice, MD, MHA (Patient Portal Optimization). © 2022 American Medical Association https://www.ama-assn.org/terms-use Spring 2022

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Introduction 50% of the physician’s day

spent on EHR and desk work1

37% of visit time with

patients spent on non-clinical tasks1

1 to 2 hours

of extra work each day, including long hours before and after clinic completing “between visit” work1

TAMING T

Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165(11): 753-760. doi:10.7326/M16-0961

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Introduction

Spring 2022

The EHR Problem: How Did We Get Here?

he electronic health record (EHR) has profoundly changed the practice of medicine and is perceived as both a blessing and a burden by clinicians who use it. Most physicians who did not begin their training and enter practice using a sophisticated EHR only learned enough to “get by.” Younger physicians who did go through medical training using a modern-day EHR typically did not have the bandwidth to focus on mastering the EHR along with their medical knowledge. Furthermore, the near-universal adoption of virtual care and telehealth during the COVID-19 pandemic has increased patient expectations and awareness about EHR-based communication tools, resulting in increased physician time spent on the EHR.2

THE EHR

Meanwhile, the EHR has evolved dramatically, in both positive and negative ways. While most EHRs now have customizable tools that, if used optimally, can save physicians time, there are also many more unnecessary “clicks” and automated messages clogging up inboxes. The EHR burden is a major contributor to physician burnout, and it has become a problem that individual physicians cannot fix on their own. It is imperative for organizations to learn how to “tame” the EHR by implementing effective team-based care principles and responding to feedback for continuous system-level improvement.

Physicians don’t quit their jobs, their patients, or their bosses; they quit their inboxes. —CT Lin, MD, FACP, FAMIA; Chief Medical Information Officer, UCHealth-Colorado

Holmgren AJ, Downing NL, Tang M, Sharp C, Longhurst C, Huckman RS. Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use. J Am Med Inform Assoc. 2021;ocab268. doi:10.1093/jamia/ocab268

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How Can We Tackle This Problem?

What’s In Your Control?

The EHR problem can be thought of as encompassing a few buckets:

To accomplish any of these changes, it is imperative to work with leadership. Some changes will be easy to make, others will be more difficult. Some changes may be institution- or organization-specific, while others may be governed by federal regulations. Having a shared understanding between leaders and practicing clinicians of “what’s in your control” helps overcome inertia (or resistance to change) while building trust and transparency (Table 1).

•

• •

the volume of unnecessary work that is being done (eg, extra clicks and mental bandwidth spent on filtering signal from noise, patient questions and requests that could have been avoided with better teamwork and workflow re-engineering) the volume of necessary work that needs to be done, but can be shared by nonphysician team members (eg, chart review, order entry, documentation, inbox management) the technology itself

This Playbook will focus on addressing each of these buckets so that individual clinicians and their practices can:

Who Is This Playbook for? This Taming the EHR Playbook is for:

• •

Daily EHR users (eg, physicians, physician assistants, nurse practitioners, nurses, medical assistants)

TAMING THE EHR

Minimize the unnecessary work by deimplementing nonessential rules and looking upstream to stop irrelevant notifications and results from entering the inbox

• • •

Organizational leaders (eg, Chief Medical Information Officers [CMIOs] and Chief Compliance Officers [CCOs]) Medical directors

Practice managers Operations leaders

Manage the necessary work by utilizing team-based care principles to offload inbox management, order entry, and documentation from physicians alone

Anyone interested in maximizing the benefits and minimizing the burdens of the EHR can learn from the content outlined and linked to within this Playbook.

Become more personally proficient at using EHR technology

This Playbook contains highlights from 11 AMA STEPS Forward™ toolkits.

Access the digital Playbook for the optimal experience. To fully engage with the Playbook and access all the relevant links, scan this QR code to view the PDF on your smart device or computer.

CENTRAL COAST PHYSICIANS

Spring 2022

Upcoming Events HowFOR to AvoidONLY a Medical Board JOIN TODAY

OSHA Workshop

Cal-OSHA Office Staff Training for the Central Coast

Wednesday, May 18, 2022 10:00 AM – noon Zoom

Presenter: Carrie Champness, RN, BSN CCMA Members/Staff $20 Nonmembers/Staff $50

Complaint August TBD

6:00 – 7:30 PM Zoom

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Nonmembers/Staff $10

Best Practice: Documenting Disruptive Patient Behavior

Annual Membership Celebration

6:00 – 7:30 PM

2022 Physician of the Year

A MONTH!

May 26, 2022

Honoring Santa Barbara County’s

TOGETHER, WE Hilton ARESanta STRONGER. Barbara Beachfront Resort

Zoom

Presenter: The Doctors Company CCMA Members & TDC Insured Complimentary

Thursday, September 29, 2022 6:00 – 9:00 PM

CCMA Members & TDC Insured

Nonmembers $10

Complimentary

& GuestsMedical $50 When you join the California Medical Association andNonmembers Central Coast Medicare Workshop Association, you join more 45,000 members statewide who are actively Updates for 2023than & Beyond Annual Membership Thursday, September 2022 protecting the practice of15, medicine and defending public health. Celebration 12:30 – 1:30 PM

Honoring San Luis Obispo County’s

Zoom

of the Year Membership is affordable and easy to maintain. With2022 ourPhysician monthly payment Presenter: Cheryl Bradley Madonna Inn plan, you canCCMA be aMembers/Staff member for less than the price ofFriday, a daily cup of coffee! Complimentary September 30, 2022 Nonmembers/Staff $10

6:00 – 9:00 PM

CCMA Members & TDC Insured Complimentary Nonmembers & Guests $50

www.ccmahealth.org/events

Spring 2022

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Public Health

Update

Please, be the one who starts the conversation and makes that difference for your patients. (If you would like to request resources for your practice to support these conversations – posters, brochures, buttons, and postcards – please contact my team at slopublichealth.org or 805.781.5500).

Acting Now and Looking Ahead: Responding as a Community to the Impact of COVID-19

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

After two long years responding to the COVID-19 pandemic, we now find ourselves as a community in what I can only describe as an optimistic but unstable time. Our society, here on the Central Coast and around the world, is moving step by step toward a new phase of learning to live with COVID-19 and mitigate its harms as much as possible. While I believe many of us in the medical and public health communities would love nothing more than to decisively close this chapter and move on, the reality is the virus is not yet ready to move on from us. Our community’s caring and astute physicians will continue to see and respond to the impact of this pandemic for quite some time – perhaps for our patients’ lifetimes. Right now, in this relative lull, the short-term need is clear: we must ensure as many people as possible are protected by the safe, effective vaccines we are so fortunate to have widely available free of charge. Despite increased breakthrough with Omicron, the vaccines remain remarkably effective at preventing hospitalization and death. And despite increased rancor and politicization of the conversation around vaccine, Americans continue to rank their doctor as their most trusted source of information on this topic.

CENTRAL COAST PHYSICIANS

Spring 2022

I often hear people opine that those who wish to get vaccinated have already done so. Yet at Public Health, we continue to see people every week coming in for their first dose. We continue to meet people who are open to getting vaccinated when a doctor, nurse, or outreach worker takes time to hear their concerns and answer questions. This is not fast or easy work, but it is critically important. Please, be the one who starts the conversation and makes that difference for your patients. (If you would like to request resources for your practice to support these conversations – posters, brochures, buttons, and postcards – please contact my team at slopublichealth.org or 805.781.5500). Also important in the short term is the work of providing treatment to those who are at highest risk of severe illness and death from this painful disease. While treatment was scarce only a few months ago, it’s now widely available on the Central Coast. I encourage you to find answers to questions you may have about available treatments and help connect your patients with treatment when appropriate. As we do this work of increasing vaccination and access to treatment, with the pandemic not yet fully behind us, we must also rise to the challenge of addressing the next waves of patient need brought on by this virus. This includes mental illness exacerbated by the difficulties of the last two years of COVID infection; it includes the wide and serious range of symptoms brought on by long COVID, sometimes months or even a year after the initial infection; and it includes the potentially very serious impacts of deferred care. This work stretches ahead of us with perhaps as many unknowns as we faced two years ago when we mobilized to address this virus. We now know so much more than we did two years ago about this virus and have so much more in our arsenal to address it – but many of us are also, if I may say it, more tired. This crucial work of connecting patients with mental health supports, identifying, and addressing post-COVID symptoms and ameliorating the impact of deferred care is falling to the same physicians, nurses, and other health care workers who have been shouldering so much, for so many months, in the fight against this virus. Large studies of health care workers in the U.S. and internationally continue to document the increase in work-related depression, anxiety, stress, burnout, and emotional distress brought on by pandemic response. While there are no easy solutions, I want to recognize this challenge and encourage all of us to do what we can to care for our own well-being as we look to the large and ill-defined challenges ahead. And, I hope we might find cause for optimism in looking ahead to the next chapter of this response. We are already moving away from thinking of case rate as the most important indicator (as more testing shifts to homebased antigen tests) and are instead focused more on hospitalizations and deaths from COVID-19. Public Health is shifting more toward education – as we do with so many diseases – rather than mandates. Part of this involves working with populations and patients so they are ready to assess their risk and navigate daily decisions in a safe and overall healthy way.

Spring 2022

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2021 Federal Wrap-Up Another Tough Year…But Important Wins for Physicians By Elizabeth McNeil, CMA Vice President of Federal Government Relations 2021 proved to be another challenging year for physicians and a nation continuing to face a raging pandemic. It brought us tough confrontations over COVID-19 mask mandates and vaccination efforts, legal challenges that threatened to overturn the Affordable Care Act (ACA), a renewed fight for racial equity and an insurrection at the U.S. Capitol that challenged our democracy. But through it all, the California Medical Association (CMA) was there, fighting for physicians and ensuring that our nation’s healers were able to continue providing care to patients as the pandemic raged on. The nation inaugurated a new President, Joseph Biden, and the first woman Vice President, California Senator Kamala Harris, who set out to heal a nation experiencing the worst public health crisis in history. As the Biden Administration settled in, key California leaders were placed in important positions in the federal government, giving CMA unprecedented access at the federal level. California Secretary of

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State Alex Padilla was appointed to the U.S. Senate to fill the vacancy left by Vice President Harris, while and California Attorney General Xavier Becerra was named Secretary of the U.S. Department of Health and Human Services. Californians Nancy Pelosi and Kevin McCarthy were both reelected to their respective positions as Speaker of the House and Minority Leader.

Unprecedented Challenges The COVID-19 pandemic will be remembered as one of the most unprecedented and challenging times in our nation’s history. Physicians rose to their calling in heroic numbers to battle the virus, vaccinate the public, and fight for science and truth to protect public health. Physicians demonstrated their compassion and courage – risking their lives and the lives of their families to care for the sickest of patients. CMA successfully fought alongside the American Medical Association (AMA) and others in organized medicine to ensure physicians were able to continue providing quality care to their patients during and beyond the public health emergency. Many physicians either implemented or expanded their use of telehealth as a treatment modality. CMA worked hard to ensure that Congress and the Biden Administration provided telehealth payment parity and waivers to allow physicians to provide a broad range of telehealth and audio-only services in a broad range of settings. CMA made sure policymakers understood how telehealth allowed physicians to meet their patients’ needs during the pandemic.

A Test of Stamina The second year of the pandemic truly tested physician stamina. Frontline physicians fought burnout and massive health staffing shortages; all physicians worked to sustain the viability of their practices;

CENTRAL COAST PHYSICIANS

Spring 2022

CMA Federal Wrap Up 2021 and physicians began to address the secondary impacts of the pandemic – worsening health conditions caused by delays in care, as well as a tsunami of mental health and substance abuse issues. CMA warned Congress that the long-term fallout from the pandemic would be felt by patients for years to come and fundamentally alter the long-term stability of physician practices. Congress honored the sacrifices made by physicians and responded by dedicating substantial resources to help physicians fight the pandemic and sustain the viability of their practices for future patients. In 2020-21, Congress enacted legislation to address all aspects of the COVID-19 battle providing nearly $2 trillion in funding, including hundreds of billions for physician practices: +

$190 billion to the Provider Relief Fund

$10 billion to reimburse physicians treating the uninsured

$1 trillion to the Paycheck Protection Program and fair tax treatment for such grants

2% Medicare payment increase by waiving the sequestration cuts

Billions in funding for personal protective equipment, mental health, substance abuse, public health, testing and vaccines

Medicare Payment Cuts Stopped

WRAP UP

As if the COVID-19 pandemic was not enough, physicians also faced 9.75% in Medicare payment cuts on

January 1, 2022. It was a perfect storm of Medicare payment cuts resulting from an expiring 2% sequestration waiver, 3.75% budget neutrality cuts imposed by the fee schedule and an unintended 4%

cut due to a legislative “pay as you go” budget neutrality rule.

In response to intense advocacy from CMA, AMA and other medical societies, Congress recognized that physicians could not continue to fight the pandemic, sustain their practices and care for patients under a 9.75% Medicare payment cut. Led by California physician Congressman Ami Bera (D-CA), Congress enacted legislation to stop most of the 9.75% payment cuts. The 2% sequestration cuts will be phased back in by July 1, 2022. CMA also successfully worked with AMA and organized medicine to rally Congress to: +

Double the Medicare COVID-19 vaccine administration payment rates

Provide a Merit-Based Incentive Payment System quality reporting exemption

Extend the telehealth waivers through the public health emergency

Delay mandatory e-prescribing for controlled substances until 2023

Delay the Radiation Oncology Alternative Payment model and the Appropriate Use Criteria program until 2023

Fighting Back on Surprise Medical Billing CMA continues to fight an ill-conceived federal regulation that disregards the balanced arbitration process in the No Surprises Act (NSA) law and threatens patient access to in-network physicians. While CMA strongly supports the parts of the law that protect patients from surprise medical bills, the arbitration regulation will harm patients and drive up costs in the long term.

Spring 2022

CENTRAL COAST PHYSICIANS

CMA Federal Wrap Up 2021 In the NSA’s statutory language, Congress established a balanced process to fairly resolve payment disputes between physicians and insurers for certain unanticipated out-of-network medical bills, using several different criteria. However, the implementing regulations are blatantly inconsistent with the clear language of the statute and Congressional intent. They effectively upend the law, giving insurers an unfair advantage by relying almost exclusively on the insurers’ self-determined median in-network billing rate, instead of considering the multitude of factors called for under the law. Nearly 200 Members of Congress and the Chairman of the powerful Ways and Means Committee stood with physicians, objecting to the regulations in multiple bipartisan letters. CMA also submitted extensive comments to the regulators warning that the NSA regulations would produce the same unintended consequences that physicians and patients have experienced under California’s Assembly Bill 72. CMA provided detailed evidence from California that demonstrated how insurers cancelled long-standing contracts or imposed significant rate reductions that forced physicians out-of-network and reduced patient access to in-network physicians, particularly regarding on-call panels of physician specialists who treat patients in emergencies. Several lawsuits have been filed against the federal government over its misguided implementation of

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the NSA. The suits argue that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians and other providers will routinely be undercompensated by

commercial insurers, and that patients will have fewer choices for access to in-network services.

Through the Physicians Advocacy Institute, CMA, along with other state and national specialty societies, filed amicus briefs in support of a lawsuit brought by the Texas Medical Association and the AMAAmerican Hospital Association lawsuit. The American College of Emergency Physicians, American Society of Anesthesiologists and American College of Radiology also filed a joint legal action.

Public Service Loan Forgiveness In 2021, CMA continued to aggressively fight for a legislative or regulatory change to allow California and Texas physicians to participate in the Public Service Loan Forgiveness (PSLF) program like their colleagues in the other 48 states. Congress established the PSLF program in 2007 to improve access to care by encouraging physicians to pursue careers working in nonprofit settings. When implementing regulations were issued, they were severely narrowed to require physicians to be “hired and paid by” hospitals in order to receive loan forgiveness. Because California and Texas law prohibit hospital employment of physicians, most physicians in California and Texas are precluded from participating in the program, while their counterparts in all other 48 states receive loan forgiveness. With an average $250,000 in student loan debt, the narrow regulation places California and Texas at a severe disadvantage in recruiting new physicians, thereby harming patient access to care in our underserved communities. On behalf of CMA, California Congressman Josh Harder (D-Stanislaus) introduced HR 1133, the “Stopping Doctor Shortages Act,” and has led an intense advocacy effort in the House to fix this problem with the

CENTRAL COAST PHYSICIANS

Spring 2022

CMA Federal Wrap Up 2021 support of his co-authors, Congressmen Jay Obernolte (R-San Bernardino), Joaquin Castro (D-TX) and Van Taylor (R-TX). Identical legislation was introduced in the Senate (S 311) by Senators Dianne Feinstein (D-CA), John Cornyn (R-TX) and Alex Padilla (D-CA). Throughout 2021, CMA urged Congress to pass a legislative fix but the high cost has made it extremely difficult. Also in 2021, the U.S. Department of Education reopened its regulations to make changes to the Higher Education Act, which includes the PSLF. CMA testified before the education department and organized a joint bipartisan letter from the majority of the California and Texas Congressional delegations. Speaker Pelosi, Rep. Harder and Senator Feinstein have also met with the Secretary of Education on CMA’s behalf. This is a top priority for CMA; we will continue to urge regulators and Congress to resolve the problem as soon as possible.

Access to Affordable Health Care CMA has urged Congress to address two of our nation’s highest health care priorities in President

WRAP UP

Biden’s Build Back Better social programs infrastructure legislation – permanent access to more

affordable health insurance through the ACA and lowering prescription drug costs. Although the 2021 American Rescue Plan Act (ARPA) expanded eligibility for ACA health insurance tax credits and assistance, these provisions were only authorized for two years. CMA is urging Congress to ensure the long-term affordability and effectiveness of the ACA by making the provisions of the ARPA

permanent. The Medicare drug pricing provision in the Build Back Better plan would allow Medicare to negotiate drug prices on many of the highest-priced drugs directly with pharmaceutical companies – including all insulin drugs. The legislation is estimated to save Medicare and privately insured patients 40-60% on drug costs.

Pathways to Practice President Biden’s Build Back Better legislation would also authorize 4,000 new graduate medical education (GME) residency positions. The nation is currently facing a 15,000 residency position shortage. This CMA-supported provision would add residency slots to allow more medical students to match with a residency program and increase the overall supply of physicians. The legislation also includes the new CMA-supported “Pathways to Practice” program – an innovative program that will allow more marginalized and minority students to go to medical school and choose a career in medicine. It provides tuition assistance, living stipends and expands the number of GME positions. It requires such students to serve in underserved areas for six years.

Spring 2022

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CMA Federal Wrap Up 2021 This program is a significant step forward in helping our nation address racial injustice and advance health equity. It will lead to real improvements in building a more equitable health care system for providers and patients. Also this year, CMA supported multiple bills that addressed racial injustice and health care disparities and promoted adoption of AMA’s plan to “Embed Racial Justice and Advance Health Equity.”

Conclusion CMA was honored to fight for physicians in the virtual halls of Congress this year and we will keep fighting so that you can focus on your patients and not be hindered by administrative burdens, declining reimbursements or a devastating virus. While Congress did not finalize all of CMA’s priorities, important groundwork was laid for Congress to enact a more stable Medicare payment system that keeps pace with increasing practice costs, Medicare Advantage prior authorization reforms, public service student loan forgiveness for California physicians, the health care provisions in the Build Back Better plan, permanent telehealth waivers and bills that address physician workforce shortages. CMA will continue to stand with you and advocate on your behalf.

FEDERAL WRAP UP For Sale

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With 28 clinics from Cambria to Los Alamos, CHC is always looking for skilled, caring providers of all levels. For more info visit chccares.link/careers COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST

Spring 2022

POSITIONS AVAILABLE Whether you are a seasoned physician or just out of residency, the CALIFORNIA PHYSICIAN CAREER CENTER offers the opportunities and resources you need to advance your career. This benefit includes tips on resume writing, interviews, and networking, as well as hundreds of current job openings in California. Opportunities can be found at https://careers.cmadocs.org. 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. COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST is a nonprofit organization with 28 federally qualified health centers caring for patients across San Luis Obispo and Santa Barbara counties since 1978. We are always looking for skilled, compassionate providers of all levels. Currently, we are seeking OB/GYN providers to help expand our Women’s Health Services. For details, email mmasatani@chccc.org. Other opportunities can be found at www.communityhealthcenters.org/careers. 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.

F I S IE S A

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 www.dignityphysiciancareers.org. PLANNED PARENTHOOD CALIFORNIA Central Coast is a dynamic and fulfilling place to work. Our staff is caring, knowledgeable, dedicated and we are committed to a diverse workplace and encourage you to apply. Opportunities can be found at https://jobs.lever.co/ppcentralcoast. 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-job-opportunities. 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. Spring 2022

CENTRAL COAST PHYSICIANS

CenCal Health NEWS HUB:

CENCAL HEALTH PRESENTS ITS 2021 COMMUNITY REPORT

“Building on a Legacy” is theme of annual report from local health plan established in 1983

Referencing its decades-long history in healthcare on the Central Coast, CenCal Health recently published its annual community report. Titled “Building on a Legacy: Evolution · Progression · Transition,” the multi-media account of the health plan’s current position in the community is readily available in English and Spanish at cencal2021.org. Established in 1983, CenCal Health is the Medi-Cal health plan that serves one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. In 2021, CenCal Health’s membership in both counties grew to 210,248 members, marking an increase of almost 15,000 beneficiaries. Out of 56 contracted Medi-Cal

CENTRAL COAST PHYSICIANS

Managed Care entities in California, the health plan ranked #1 in well-child visits for children 15 to 30 months of age in Santa Barbara County, and #3 in overall quality of care in San Luis Obispo County. Nationwide, CenCal Health ranked in the top 5% of Medicaid plans for timeliness of women’s postpartum care, in both counties it serves. The report opens with a welcome video from CEO Marina Owen, who was named to the position in November 2021 after the retirement of former CEO Bob Freeman, who served the organization in various positions for 28 years. This is Owen’s second time with CenCal Health, having worked for a decade as the agency’s Provider Services Director and Program Development Director. Most recently, Owen was Chief Operating Officer of Central California Alliance for Health, serving Monterey, Santa Cruz, and Merced counties. “Our legacy is strong as is our focus on advancing the organization into the future,” said Owen. “I am pleased to have been appointed by our Board of Directors to this role of serving the community. If the past year has taught us anything, it is a lesson in resilience. We find strength in our local providers and community partners who stepped up to serve those in need with bravery and courage.” CenCal Health’s 2021 Community Report emphasizes the

Spring 2022

The 2021 Community Report is available to the public at cencal2021.org. important work of its 1500+ local providers and community partners including Community Health Centers of the Central Coast; Santa Barbara Neighborhood Clinics; Santa Barbara County Public Health Department; senior meal program Meals That Connect in San Luis Obispo County; and Camp Mariposas, providing pediatric therapies during the summer in both Santa Barbara and Atascadero. Featured in the report are several of the innovative programs that CenCal Health executed due to COVID-19, such as the multi-faceted Vaccination Response Plan. Because the Medi-Cal population participated in COVID-19 vaccination at a lower rate than the general population, special incentives were created and implemented to increase members’ protection against COVID-19. Incentives included easy-to-access neighborhood “pop-up” vaccination sites, a $50 gift card for members who received their first vaccine dose, and a bilingual website – whyshouldI.org – that specifically addressed the vaccination concerns of Medi-Cal members. Another CenCal Health program highlighted in the report was created and carried out in spite of the COVID-19

Spring 2022

lockdown. The purpose of the Healthy Mothers Healthy Families program is to increase the rate of timely postpartum appointments for CenCal Health members who have recently delivered babies in San Luis Obispo County. These medical appointments are vital in the early detection of serious, often life-threatening health complications like postpartum hypertension, infections, blood clots, hemorrhage, and depression. Through attention-getting marketing and case management, Healthy Mothers Healthy Families provided support services like appointment scheduling assistance and transportation, to help new moms achieve optimal health outcomes – even during a pandemic. Also in the all-digital report are sections outlining the 2021 financials and the leadership at CenCal Health, with its 13-member Board of Directors including (now former) VNA Health CEO Lynda Tanner, RN, MSH; Santa Barbara County Director of Public Health Van Do-Reynoso, MPH, PhD; Dr. Rene Bravo of Bravo Pediatrics; and Sue Andersen, President & CEO of Marian Regional Medical Center, among other community representatives.

CENTRAL COAST PHYSICIANS

New Members

5 New & Rejoining

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way. David Thomas Clark, MD Emergency Medicine Templeton Central Coast Emergency Physicians 805.460.7117

Jeffrey Steven Kurz, MD Emergency Medicine Templeton Central Coast Emergency Physicians 805.460.7117

Residents Roxana Ardebili, MD Internal Medicine Santa Barbara Cottage Hospital

Philip Ka Chun Wan, DO Internal Medicine Santa Barbara Cottage Hospital

Stefan Martin Lampe, MD Psychiatry San Luis Obispo County of San Luis Obispo Behavioral Health 805.781.4850

Congratulations to our members who have retired Gregory John Frye, MD Emergency Medicine Templeton

CENTRAL COAST PHYSICIANS

Thomas Walter Hale, MD Emergency Medicine Templeton

Spring 2022

In Memoriam

In Memoriam MELVIN DEAN VOGEL, MD 1933-2021 M. Dean Vogel, MD, passed away on December 26, 2021. He was 88. Dean is lovingly remembered by his wife Mary; his children Theresa (Elias), Stephen, Phillip (Robin), and Paula (Sam); his grandchildren Brian, Michelle (Peter), Christina (Tim), Deanna, Theo, and Pearl; his great grandchildren Quinn, Sutton and Olive; and his sister Ettna “Honey” Miller. Dean grew up in Indiana and Los Angeles, playing high school championship basketball in the Hoosier State and serving as senior class president and valedictorian. He attended medical school at Indiana University and met Mary, the love of his life and wife of 60 years, while interning at Charity Hospital in New Orleans. They married in Rochester, MN where he completed his medical residency at the Mayo Clinic. In 1963, Dean and Mary moved

Spring 2022

to Santa Barbara, CA where Dean opened a private practice in Internal Medicine. He was drafted into the Army in 1966 and he and Mary moved their family near Fort McArthur in San Pedro, CA. Dean later returned to private practice in Santa Barbara where he remained an involved and respected member of the medical community until the end of his life. He was instrumental in bringing coronary care to Southern California in 1968 when the field was in its infancy. Dean was named 1995 Physician of the Year at the former St. Francis Medical Center of Santa Barbara and served on several hospital committees at St. Francis Hospital and Santa Barbara Cottage Hospital. In retirement, he served on the board at the former Rehabilitation Institute at Santa Barbara. Dean has been lauded as “the quintessential physician” and “a true healer.” Medicine was his passion and his love for helping others followed him throughout his life. He was always willing to listen and provide guidance – professionally and personally. Dean enjoyed playing tennis with Mary and their friends. He loved watching sports and was a big USC fan, especially of football. A lifelong learner, Dean was an amateur photographer and astronomer. His humor, dry wit, and generous spirit are greatly missed. Originally published in the Santa Barbara Independent

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