Central Coast Physicians Summer 2018

PHYSICIAN OF THE YEAR CALL FOR NOMINATIONS Summer 2018

CENTRAL COAST PHYSICIANS

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HOW WE HEAL:

Trauma and Anxiety Support

FREE Cottage Health Support Groups, Post-Disaster Relief Unless noted, groups are held at: Santa Barbara Cottage Hospital 400 W. Pueblo Street Santa Barbara, CA 93105 Programs are FREE and open to all Santa Barbara area residents.

We have licensed clinicians who will assist your recovery with personal attention to your unique situation.

Registration Required Please contact Layla Farinpour, LMFT:

805-569-7501 or howweheal@sbch.org

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You may register anytime throughout the program.

HOW WE HEAL: Intensive Outpatient Program Skill Building/Seeking Safety Group Mondays 6-7:30p.m.

Gaviota Conference Room Tinka Sloss, LMFT This group will be skill specific and will be taught in a psychoeducational fashion. The goals will be skill acquisition, meditation and mindfullness practice.

Survivor Group: Tuesdays 6-7:30p.m.

Gaviota Conference Room Layla Farinpour, LMFT and Peter McGoey, LMFT This group will be specific to those survivors who directly experienced the disaster. Please call 806-569-7501 before attending to determine eligibility or this group.

Process Group/Inspiring Hope: Thursdays 6-7:30p.m.

Gibraltar 2 Conference Room Peter McGoey, LMFT This group will allow individuals to witness how others have healed, and provide a place to start their own healing.

Summer 2018

VOLUME 3, NUMBER 3 • SUMMER 2018

{FEATURES}

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ARE YOU READY TO CHECK CURES? TITLE X: A PUBLIC HEALTH PROGRAM WORTH PROTECTING

{DEPARTMENTS} 6

RISK TIP: LAWSUIT SURVIVAL TIPS

24 MENS HEALTH: BOYS TO MEN 26 PUBLIC HEALTH: N95 MASKS 28 NEW MEMBERS

DEFEATED: AB 3087

30 CLASSIFIEDS

18 NEXT GENERATION OF CMA COORDINATING CARE FOR CHILDREN WITH SERIOUS MEDICAL CONDITIONS

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Letter from the CEO

WE’RE PROTECTING YOU

We want to thank our members for your support so we can continue working on legislation that affects you and your patients.

PRESIDENT Jennifer Hone, MD PRESIDENT ELECT Douglas Murphy, MD SECRETARY Daniel Berger, MD TREASURER Samira Kayumi-Rashti, MD IMMEDIATE PAST PRESIDENT David Dodson, MD

We work to protect you from bad legislation.

Assembly Bill 3087 would have created a commission of unelected political appointees DANA GOBA empowered to cap rates for all health care services in all clinics, hospitals, and physician practices in California. According to AB 3087, the commission would cap prices for commercial payments for all services to Medicare rates. As physicians are aware, Medicare physician pay has declined 19 percent from 2001 to 2017, or by 1.3 percent per year on average, when adjusted for inflation in practice costs. Due in large part to staunch opposition led by CMA, the bill died in the Assembly Appropriations Committee.

DIRECTORS Kevin Casey, MD; Joseph Freeman, MD; Priti Gagneja, MD; Thomas Hale, MD; Ali Javanbakht, MD; Bindu Kamal, MD; Juan Reynoso, MD; Joseph Schwartz, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sam Ahmad, MD; Sharon Basham, MD; Edward Bentley, MD; Charity Dean, MD, MPH; David Dodson, MD; Priti Gagneja, MD; Jennifer Hone, MD; Christopher Lumsdaine, MD; Douglas Murphy, MD; Jenni Nix, MD; Joseph Schwartz, MD; Steven Yao, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Jennifer Hone, MD

We sponsor legislation to help your practice. Senate Bill 189 once again allows appropriate workers’ compensation coverage exemptions for owners, and physician owners of professional corporations will also be able to exempt themselves from workers’ compensation coverage—regardless of percentage of ownership. SB 189 will result in premium savings for individual medical groups ranging from hundreds to hundreds of thousands of dollars.

We provide education to help you with compliance. Effective October 2, 2018, physicians must consult CURES prior to prescribing controlled substances.

CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018, and you can register at cmanet.org/events.

MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Katherine Boroski; Penny Borenstein, MD, MPH; CenCal Health; David Dodson, MD; Douglas McCullough, Esq; Virginia Siegfried, MD CONTRIBUTING PHOTOGRAPHERS CenCal Health, County of San Luis Obispo, Planned Parenthood California 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

It is only through a strong membership foundation that keeps us a dominant force in health care. If you are not a member, help us protect your profession and join us at www.cmadocs.org/join or by calling 800.786.4262. If you want to support candidates and legislators that understand health care, donate to CALPAC, which is the California Medical Association Political Action Committee.

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@sbmed.org

Together we are stronger.

ADVERTISING rates and information sent upon request.

Acceptance of advertising in Central Coast Physicians in

Sincerely,

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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Summer 2018

Summer 2018

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You’ve Been Served

Lawsuit Survival Tips for Physicians A physician incurs nearly $200,000 in medical student loan debt, graduates in the top 10 percent of her class, and dedicates the past 14 years to providing care to patients. One day, out of the blue, the local sheriff ’s office serves her with a lawsuit. Perhaps it is regarding a familiar patient, or maybe a patient the doctor cannot recall. Either way, her mind immediately leaps to: “What did I do wrong?” After the initial shock, the physician is flooded with emotions—fear, anger, betrayal, frustration, anxiety, humiliation, embarrassment. Even shame.

By Douglas McCullough, Esq, Assistant Vice President, Claims, The Doctors Company

Chances are good that as a physician, you will find yourself in a similar situation. On average, each physician spends 50.7 months, or approximately 11 percent of an average 40-year career, on resolving medical malpractice cases—the vast majority ending up with no indemnity payment. That’s the conclusion of a study by the RAND Corporation based on data provided

by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

These findings suggest it is not a matter of if you’ll be sued, but when undermining the medical-school white-coat myth that if you do well in school and rely on your education, skill, and training, you needn’t worry about malpractice.

By the age of 65, more than 75 percent of physicians in low-risk specialties and 99 percent of physicians in high-risk specialties have experienced a claim. Although it’s a reality that the majority of physicians will face a malpractice claim, few are prepared when served with a lawsuit. I routinely survey up to 50 physicians at seminars devoted to litigation preparation only two or three say they received relevant information about medical malpractice in medical school.

I make it a point to advise doctors to take these steps if a claim is filed against them: Contact your medical malpractice carrier. Typically, a lawsuit will name multiple defendants to include various treating physicians as well as medical facilities where alleged negligent care was rendered. The pool of defense attorneys who specialize in medical malpractice defense is a small one. Many malpractice carriers draw from the same pool of

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attorneys, so it is important to notify your carrier as soon as possible to ensure the right defense attorney is retained on your behalf. The defense team is referred to as a “three-legged stool,” including the physician, claim specialist, and defense attorney.

All three need to work in unison to obtain the most favorable result.

Build your defense. The attorney representing your patient has likely already developed a good portion of their case before you were ever aware of its existence.

Therefore, it is critical you be an active member of your defense team to begin building your defense.

Be prepared for extended periods of perceived inactivity. The legal process is inefficient and impossible to control. The litigation process typically lasts two to five years, with claims being filed a year to two years after a negative event of the date of discovery of an injury – depending on state laws. There will be flurries of activity, followed by long periods of perceived inactivity. Trust that your defense team is continuing to work on your behalf. Depositions are often scheduled, canceled, and re-scheduled. Trial dates are routinely continued beyond the control of defense counsel. Knowing in advance these inefficiencies and inconveniences occur may alleviate frustration in the process.

Understand the plaintiff’s strategy. Don’t believe that once you “educate” the plaintiff or, more importantly, the plaintiff attorney on the medical facts, they will drop the suit. The only time you will be given the opportunity to educate and explain the care you provided is at trial. The plaintiffs’ bar is very skillful at taking testimonial “sound bites” and portions of the medical records to fit their narrative.

By understating the plaintiff ’s strategy, you can assist in preparing an effective defense.

Become fully engaged in the process. The key to ensuring a successful defense is preparation. Those physicians who managed to survive litigation, did so by becoming fully engaged in the process—approaching their case as an academic exercise as if they are sitting for a board exam.

Get professional coaching on how to be an effective defendant. Physicians routinely describe the litigation process akin to a roller coaster ride. Every physician will have some emotional reaction to becoming a defendant in a malpractice lawsuit. It’s important to identify and become aware of your emotions in order develop appropriate coping mechanisms. Physicians who develop effective coping mechanisms have a greater chance of successfully navigating the rigors of litigation.

Work on alleviating stress. Remember you are not alone. Focus on the multitudes of patients you help daily. While you can’t divulge details of the litigation to family and friends, talk to them about how the claim is affecting you. And continue to participate in the personal interests and activities that provide you with joy.

Work on alleviating stress.

Remember you are not alone.

Focus on the multitudes of patients you help daily.

While you can’t divulge details of the litigation to family and friends, talk to them about how the claim is affecting you.

To be thoroughly prepared, you must know the medical record. You must also practice for your deposition, know your deposition testimony, and read depositions of other defendant physicians and experts all while caring for your patients and yourself. This is no small task, but successfully defending your professional reputation is worth it.

For more tips, read Malpractice Claims Consume Years of a Physician’s Career.

Further insights from doctors who have experienced litigation are available in The Doctors Company’s What to Expect from Litigation video play list.

Summer 2018

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Are you ready to check CURES? STARTING OCTOBER 2, ALL PHYSICIANS MUST CONSULT DATABASE BEFORE PRESCRIBING CONTROLLED SUBSTANCES

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

Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload.

On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-toconsult taking full effect on October 2, 2018.

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WHAT PHYSICIANS NEED TO KNOW Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply.

Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are:

• Admitted to a facility for use while on the premises; • In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply; • As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or • Receiving hospice care.

In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.

CMA FIGHTS FOR CURES PROTECTIONS CMA worked closely with the bill’s author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.

Summer 2018

CMA PUBLISHES SAFE PRESCRIBING RESOURCES FOR PHYSICIANS The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose.

The page includes two CMA white papers on opioid prescribing, links to CMA’s health law library resources on the topic, the Medical Board of California’s “Guidelines on Prescribing Controlled Substances for Pain,” a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state’s prescription drug monitoring database.

Members can find the page at www.cmadocs.org/safe-prescribing.

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NEW REPORT SHOWS CALIFORNIA’S PROGRESS ADDRESSING OPIOID CRISIS The American Medical Association (AMA) recently issued a new report documenting how California’s physician leadership is advancing the fight against the opioid crisis. The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid us disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017.

“This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance

SAVE THE DATE: CURES WEBINAR WITH DOJ ON 8/22 CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at www.cmadocs.org/events.

FOR MORE INFORMATION For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA’s online resource library at www.cmadocs.org/health-law-library.

Nonmembers can purchase documents for $2 per page.

Additional Resources:

• CURES website: oag.ca.gov/cures

• CURES FAQ: oag.ca.gov/cures/faqs

• Medical Board CURES webpage: mbc.ca.gov/cures

• CMA CURES webpage: cmadocs.org/cures

• CMA Safe Prescribing webpage: cmadocs.org/safe-prescribing

use disorders,” said California Medical Association (CMA) President Theodore M. Mazer, M.D. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.”

For more details on the report visit endopioid-epidemic.org.

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CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement.

Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov.

Summer 2018

CURES Duty-to-Consult Mandate Takes Effect October 2 Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – before prescribing Schedule II, III or IV controlled substances.

When Must I Consult CURES?

Physicians must consult the database before prescribing controlled substances to a patient for the first time and at least once every four months thereafter.

Save the Date:

Free CURES webinar with the California Department of Justice on 8/22.

Register at cmadocs.org/events.

For More Information CMA CURES webpage: cmadocs.org/cures CURES website: oag.ca.gov/cures Summer Summer2018 2018

CENTRAL CENTRALCOAST COASTPHYSICIANS PHYSICIANS 1111

Title X A Public Health Program Worth Protecting

BY VIRGINIA SIEGFRIED, MD, MEDICAL DIRECTOR, PLANNED PARENTHOOD CALIFORNIA CENTRAL COAST

As a result of expanded access to birth control, the United States is experiencing a 30 year low for unintended pregnancy, a historic low for pregnancy among teens, and the lowest rate of abortion since Roe v. Wade. A central contributor to this progress is the Title X Family Planning Program, which for over 40 years has enabled lowincome women to access services such as breast and cervical cancer screenings, well-woman exams, sexually transmitted infection testing and treatment, and birth control.

In fact, Title X is the only federal program dedicated solely to providing people with comprehensive family planning services and it has been life changing for millions of Americans. No other federal program ensures that every person — regardless of where they live, how much money they make, their background, or whether or not they have health insurance — has access to basic, preventive reproductive health care. It’s a common sense public health program worth protecting.

Despite the success and public health benefits of this program, it is being targeted by the Trump-Pence Administration. In late May, the administration issued a proposed rule creating a domestic “gag” rule on Title X. The gag rule is intended to do three things: First, doctors, nurses, hospitals, and community health centers across the country would be prohibited from referring their patients for safe, legal abortion.

Second, it would remove the guarantee that a Title X patient gets full and accurate information about their health care from their medical providers.

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Third, it would make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood.

Bottom line, this policy is designed to block women from obtaining complete, accurate, and unbiased information to make informed decisions with their health care provider. Planned Parenthood health centers serve 41 percent of the patients who get care through Title X -yet this rule is designed to block patients from going to Planned Parenthood health centers for critical care like cancer screenings and birth control.

As a physician and medical director for Planned Parenthood, under the new proposed rule, if I have a patient who is pregnant and wants or needs an abortion, I would be prohibited from giving that information. Or if a woman’s pregnancy would severely affect her health — for example, she discovers that she’s pregnant after being diagnosed with cancer — I would be forced to withhold information about the full range of her medical options.

This new rule is not only an attack on the basic rights of my patients to access the care they need; it is an attack on my medical ethics and duty to provide the best care possible. No health care provider should be forced to put politics above the needs of their patients.

Medical ethics and standards of care require providers to give patients complete information about their health care so patients can make meaningful, informed, individual medical decisions. This bedrock principle is the foundation of the provider-patient relationship and critical to ensuring that patients trust the medical system.

In addition, for nearly two decades, Title X law has been clear: health care providers cannot withhold information from patients about their pregnancy options. Under this rule, they can.

Public comment on the proposed rule ended on July 31 and it will take at least a month after comment review for the final rule to be enacted. Let’s hope common sense prevails.

Summer 2018

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CMA defeats dangerous rate setting proposal AB 3087 would have decimated California’s health care delivery system

BY KATHERINE BOROSKI

In late May, the California Medical Association (CMA) killed a reckless legislative proposal that would have put a new government bureaucracy in charge of health care. Assembly Bill 3087 (Kalra) would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. By unilaterally setting the price for all medical services, the bill would have essentially eliminated the commercial health care market in California.

Due in large part to staunch opposition led by CMA, the bill died in the Assembly Appropriations Committee.

“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said CMA President Theodore M. Mazer, M.D. “Had this bill passed, it would have reversed the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.” Since passage of the ACA, the state’s uninsured rate has dropped to an all-time low of 7.1 percent.

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A Groundswell of Physician Opposition Key to the bill’s demise was a groundswell of physician opposition.

Through CMA’s Grassroots Action Center, thousands of physician members contacted their legislators because AB 3087 would have: • Decimated California’s health care delivery system.

• Disrupted care and limited choice for millions of California patients.

• Caused 175,000 health care workers to lose their jobs.

• Forced hospitals to close and pushed health care providers into early retirement • Caused a “brain drain” of talented medical students and residents f leeing California for more ideal working conditions.

The Wrong Answer to a Real Problem This poorly conceived legislation would have done nothing to solve the fundamental problems of the health care payment system.

“Simply setting physician rates without addressing the rising cost of providing care will do nothing to address health care spending,” said San Francisco pediatrician Shannon Udovic-Constant, M.D., vice chair of the CMA Board of Trustees. “AB 3087 would have driven a lot of physicians out of our state, and it doesn’t address the underlying reasons around rising health care costs in our state.”

This dangerous rate setting proposal would have also moved California away from value-based care and universal access, backwards to an antiquated fee-for-service model that discourages contracting and stif les innovation. Instead of addressing the underlying issues, this bill would have forced hospitals to close, pushed health care providers into early retirement and caused a “brain drain” of talented medical students and residents f leeing California for more ideal working conditions.

Medicare Should Not Be a Benchmark for Costs AB 3087 would have required the commission to cap prices for commercial payments for all services to Medicare rates, which is a fundamentally f lawed approach that does not address coverage and benefits or the costs to provide care. Medicare was created to reimburse medical services for an age-specific population based on federal budgetary and regulatory constraints. Medicare rates do not keep up with inf lation or the cost of running a practice.

Adjusted for inf lation in practice costs, Medicare physician pay has declined 19 percent from 2001 to 2017, or by 1.3 percent per year on average. Medicare rates are not intended to represent the fair

Summer 2018

market value of health care services. Rather, they f luctuate based on variables unrelated to the services provided, such as the federal budget.

AB 3087 Did Not Address Medi-Cal Rates Medi-Cal is the largest Medicaid program in the nation, with 13.5 million people—about one-third of the state’s population— enrolled in the program. And yet, California still pays among the lowest reimbursement rates of all 50 states, creating a serious access issue for patients.

California’s Medi-Cal rates don’t come close to covering the cost of providing care—meaning that physicians lose money for every Medi-Cal patient they serve. Due to low Medi-Cal rates, physicians must make up revenue through their commercial contracts to keep their doors open. Because the AB 3087 proposal did nothing to address California’s sub-standard Medi-Cal rates, hospitals and health care providers would have continued to be underpaid by these governmental programs, putting them in an untenable situation.

AB 3087 Would Have Driven California’s Physicians Out AB 3087 also ignored the recommendations from the University of California, San Francisco’s report—commissioned by the Assembly—to achieve universal access to health care, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas.

Currently, six of nine California regions are facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030—a 32 percent increase.

“AB 3087 would have caused an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” said Dr. Mazer.

“When I look at the economics of my own practice, it’s enough to tell me that I could not survive that environment and continue to see Medi-Cal patients. And probably at this stage of my career, it would drive me out of practice earlier that I might otherwise.”

The bill also operated on the false premise that the cost of professional services—in other words, what physicians and hospitals charge for their services—is what’s behind the increase in health care spending in California.

Data shows, however, that the price of prescription drugs and

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Thank You Physician Members!

We Defeated AB 3087 In May 2018, the California Medical Association (CMA) announced the resounding defeat of Assembly Bill 3087 (Kalra) – dangerous legislation that would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California.

Thousands of physician members contacted their legislators because AB 3087 would have: ∙ Decimated California’s health care delivery system.

∙ Disrupted care and limited choice for millions of California patients.

∙ Caused 175,000 health care workers to lose their jobs.

∙ Forced hospitals to close and pushed health care providers into early retirement.

∙ Caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

"I want to thank each of you for your support and dedication to CMA. We could not have dealt this bill such a resounding defeat without the united voices of our physician members.

Together, we stand taller and stronger."

– CMA President Theodore M. Mazer, M.D.

Join the Fight to Protect Medicine 16

Your voice is key to our success. All you need is the desire to make an impact, and CMA will give you the rest. Join CMA's Physician Advocate Program today! Learn more at cmadocs.org.

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increases in health care utilization are what’s driving health care spending growth. Professional services had relatively low impact on spending growth. In fact, nationally, California had lower than average annual growth in per capita spending on physician and clinical services over the past 20 years. The primary driver of spending on doctor visits is increased utilization, not price. “Physicians want real solutions to these problems too,� said Valencia Walker, M.D., chair of the CMA Council on Legislation. “We remain focused on real solutions that would protect the access and coverage gains made under the ACA, further value-based care, ensure patients can access health care in a timely and affordable manner, and tackle California’s health care workforce shortage.�

California Physicians: Thank You for Your Support

a resounding defeat without the united voices of our physician members. Together, we stand stronger.�

CMA applauds the Assembly for recognizing that this deeply f lawed legislation would result in enormous costs to the state and restricted access to care for millions. CMA remains fully committed to working with stakeholders on a practical solution that addresses the affordability and accessibility of health care in California.

Join the Fight to Protect Medicine Your voice is key to our success. All you need is the desire to make an impact, and CMA will give you the rest. Join CMA’s Physician Advocate Program today! Learn more at www.cmadocs.org.

“I want to thank each of you for your support and dedication to CMA,� said Dr. Mazer. “We could not have dealt this bill such

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w men 2018 in medicine

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Save The Date Join us for the inaugural Southern California Women in Medicine Conference!

[Top Tier Panels]

[keynote]

Susan Blumenthal, MD, MPA | Former Asst. US Surgeon General | Rear Admiral, USN | Sr. Advisor, US Dept. of Health & Human Services |

[Female Physician Leadership] [Advocacy & Political Engagement] [The Business of Medicine] [Wellness & Self Care]

[Central Coast] [LA County] [Orange County] [Riverside County] [San Bernardino County] [San Diego County]

[cma socal Partnership]

Friday, November 9, 2018 | Hotel Irvine | Irvine, CA for details: Katie Tomarchio, OCMA | ktomarchio@ocma.org | 949.398.8100

Summer 2018

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WELCOME TO THE NEXT GENERATION OF CMA Since 1856, the California Medical Association (CMA) has supported physicians and the practice of medicine to keep the Golden State healthy and thriving. CMA’s success is rooted in our ability to effectively connect, communicate and engage with members. Because together, we are stronger.

“Diverse organizations like CMA need a bold brand and modern website to reinforce our mission through impactful design, messaging and imagery,” said CMA Vice President of Strategic Communications Laura Braden Quigley. “Our website was last updated in 2011, and our brand family had been untouched since the early 1990s. Given that CMA’s family includes 37 county medical societies, a political action committee, a foundation and other partners, it is critically important to demonstrate a cohesive and consistent brand across all communications channels, affiliates and platforms.”

One Login: We’ve simplified the login process so you don’t

CMA’s website functionality, design and content strategy was reimagined with a focus on membership recruitment and engagement. Enhanced features of the new website include:

relevant results, making it easier for you to find what you need.

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have to keep track of multiple usernames and passwords. The joint CMA/county login means that your county medical society login now grants access to your CMA account.

My CMA: From public health to Medi-Cal, choose your

preferences for custom content and personalized alerts.

Mobile Responsive Design: CMA’s new site is optimized for mobile devices, so you can stay engaged from your phone or tablet.

Search: The new and improved search function returns more

Grassroots Action Center: The Grassroots Action

Center is the new hub for all of CMA’s advocacy efforts. Make your voice heard, join the Physician Advocate program, receive training from CMA experts and more!

Summer 2018

For additional information and resources: Customize Your Website Content: cmadocs.org/my-cma Website How-to Webinar and Usage Guide: cmadocs.org/cma-next-generation Contact the CMA Communications Team: communications@cmadocs.org.

Policymaking: Submit and comment

on resolutions through CMA’s year-round policymaking process.

Discussion Forums: With improved

features, we’ve made it much easier and faster to connect with physician colleagues.

Legislative Hot List: Receive

real-time updates on health care legislation impacting your patients and medical practice.

Newsroom: In addition to press releases and breaking news, CMA now has media training and other resources available, just for members. You can also join our Social Media Ambassador program or become a Media Surrogate!

Change your Bookmarks: CMAdocs.org In addition to the new website, CMA is also moving to a new URL that is easier to remember and more representative of who we are: CMAdocs.org. We have also moved to @CMAdocs on Facebook, Twitter, YouTube, Instagram and LinkedIn. CMA’s emails have been updated to email@cmadocs.org, and the staff directory remains the same: the f irst letter of the f irst name and last name (e.g.: dcorcoran@cmadocs.org).

Join CMA: We have streamlined the

application process so it is fully integrated with our membership database. Join or renew today and immediately get full access to your “My CMA” dashboard and valuable member benefits.

“CMA’s brand and website serve as powerful recruitment and engagement tools to keep California’s physicians at the forefront of an ever-changing health care landscape,” said CMA President Theodore M. Mazer, M.D. “It also sends a bold message to physicians that we continue to be ready to embrace tomorrow’s challenges and opportunities. Much has changed since 1856, but CMA’s mission remains constant: to promote the science and art of medicine, protect public health, and better the medical profession.”

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How to Login to CMA’s New Website In most cases, your username will be your email address or your medical license number. If you do not know your login credentials, simply use the username and/ or password retrieval. If you have any problems accessing your account, please contact the CMA Member Resource Center at 805.786.4262 or memberservice@cmadocs.org.

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Saving Medical Groups Millions

Thanks to a new CMA-sponsored law, California medical groups will save millions in workers’ comp premiums.

As of July 1, 2018, physician owners of professional corporations will be able to exempt themselves from workers’ compensation coverage—regardless of percentage of ownership—resulting in significant premium savings.

The Problem

In 2016, the legislature changed the definition of “employee,” requiring owners with less than a 15% ownership to have workers’ comp coverage.

Because of this law, some medical groups were forced to pay drastically increased premiums for coverage they neither needed nor wanted.

The CMA Solution

CMA sponsored a law to once again allow appropriate coverage exemptions for owners, which will save individual medical groups hundreds to hundreds of thousands of dollars in workers’ comp premiums.

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Learn more about SB 189 and how it affects your medical group at cmadocs.org/sb189.

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Coordinating Care

for Children with Serious Medical Conditions

CONTRIBUTED BY CENCAL HEALTH

CenCal Health provides health insurance for approximately 20 percent of residents in Santa Barbara and San Luis Obispo counties, or nearly 180,000 members.

For more information or questions about WholeChild Model and California Children’s Services, please contact the CenCal Health Provider Services Department at (805) 562-1676 or email psrgroup@cencalhealth.org.

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(California Children’s Services)

As of July 1, CenCal Health is now managing all the health care needs for its members under 21 years of age who are eligible for California Children’s Services (CCS). In order to better coordinate care for these children with complex medical needs, the California Department of Health Care Services authorized the change, called the Whole-Child Model, in order to improve the integration of services and overall outcomes for these children.

CenCal Health is now responsible for case management and authorizing medically necessary covered services of both CCS and non-CCS health conditions, including coordinating pediatric referrals, hospital stays, medications, supplies, and durable medical equipment for CCS-eligible Medi-Cal members.

Care coordination of CCS clients who are not CenCal Health members will remain as the responsibility of the local County CCS offices.

The CCS program was designed to assist children with serious medical conditions requiring specialty medical care or rehabilitative services. Children with CCS-eligible conditions previously received services related to their CCS condition from the County in which they reside and CenCal Health coordinated the remaining services outside of their CCS condition. This model of care led to additional complexity for families trying to navigate access to care. The WholeChild Model seeks to eliminate a bifurcated system and provide comprehensive treatment.

“CenCal Health has helped families obtain quality care for 34 years,” said Dr. Takashi Wada. “The Whole-Child Model will improve the function and quality of life for children with severe disabling conditions by simplifying the coordination of their care.”

To be eligible for CCS, a child must be under 21, meet residential and financial requirements, and must have a CCS eligible medical condition such as neoplasms

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“The Whole-Child Model will eventually roll out to all 21 specified counties with a County Organized Health System or Regional Heath Authority.”

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(cancers, tumors), Cystic Fibrosis, chronic lung disease, congenital heart disease, rheumatic heart disease, Cerebral Palsy, Epilepsy, or other severe conditions that fall under the CCS eligibility criteria.

The Whole-Child Model will eventually roll out to all 21 specified counties with a County Organized Health System or Regional Heath Authority. CenCal Health is among the first health plans to implement this change.

In preparation for this transition, CenCal Health formed a Family Advisory Committee comprised of CCS members and their families in order for CenCal Health to receive continuous feedback on the transition and ongoing program.

CenCal Health also has a Pediatric Clinical Advisory Committee and encourages input from physicians.

Anyone can refer a child to CCS including family, school personnel, physicians, and other providers.

CenCal Health’s pediatric team requires medical documentation and prescriptions from providers to authorize services. Providers must be CCS paneled and approved for services to be authorized.

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MEN’S HEALTH

Boys to Men

BY DAVID DODSON, MD

My pastor friend, David Moore, has been sermonizing on the subject “Detoxifying Masculinity in Christ” these past 3 weeks. It’s a big subject, in part because David would be quick to expand the subject to detoxifying masculinity in Christ, Buddha, any other spiritual tradition, or none. The problems with masculinity unbound are apparent and topical with the Me-too movement and other manifestations of power-hungry male egos run amok. This phenomenon literally threatens civilization, as we know it in the form of “my missiles are bigger and stronger than yours” nuclear brinkmanship.

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A good case can be made that ultimately bad men are made, not born. The problem is one of nurture rather than of nature. I have written of the positive aspects of masculinity: drive, ambition, loyalty, courage, strength of both body and moral fiber, devotion to family. Each of these can be perverted into such characteristics as overdrive, aggressiveness, lechery, avarice, and so forth. What determines whether an innocent child becomes a good, decent man or a monster? David Moore has been exploring the subject in his sermons, and in open discussions.

Clearly boys are molded into men in the context

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For Lease For Lease

For Lease

For Lease

of their schooling, both in the home and outside of sympathies are with the girl in question, one could it. Some children are blessed to be born into good, say the young man suffered from a lack of moral nurturing environments and privileged to have instruction and it is fair to say this lack derailed what good educations and are given every advantage had looked like a promising future. and opportunity to turn into people who make Obviously this diagnosis - the lack of moral positive contributions to society, others not so education of boys - does not present a ready much. The key determinant is not money, but moral solution. Any easy solution to the problem would capital. Eric, one of Reverend Moore’s parishioners, have been applied eons ago. But while we as a described growing up “CLEARLY BOYS ARE MOLDED INTO MEN IN THE African American in a household with a strong CONTEXT OF THEIR SCHOOLING, BOTH IN THE mother and aunts but no HOME AND OUTSIDE OF IT.” father present. These many women in his life taught him values of love, respect, generosity, and self-reliance. society rail against men who are bad actors, we Money can’t buy such an education, and the world would do well to look at root causes. Bad men are is a better place for Eric and his mentors, and people a product of morally deficient upbringing in many like them. if not most cases, and a solution to the problems A Manichean worldview such as “men bad, they cause including violence on the domestic scale women victims” is thus facile and belied by the to the international scale should look to correcting reality of stories such as Eric’s. Eric is a good, kind, such deficiencies. decent, strong gentleman who can thank women in his life for helping mold him into that kind of man.

Ideally, boys should have positive male and female figures to emulate growing up. Eric demonstrates Looking for medical space? that an absent father need not mean the boy grows into a damaged man. Similar stories could Goleta Santa Maria be told of boys (and for that matter girls) who grow up lacking a mother but are not damaged in the process. The difference again is moral capital, not money.

434 S Patterson Ave 1414 E Main St By that, I mean values of respect, civility, • 2,000 - 20,000 SF • 1,964 - 8,488 SF hard work, and intellectual curiosity need to • New building across from • Great visibility across from Cottage Hospital Marian Hospital be instilled in children by mentors both in and Call Francois DeJohn Call Michael Martz out of the home. These values are not religious, 805.898.4365 805.898.4363 and may or may not be supported in a religious Santa Barbara Goleta community.

To illustrate, a wealthy pillar of the community may spend a small fortune sending his son to the best schools, but without passing on moral 330 State St 5370 Hollister Ave character to him, that child may become dissolute • 5,452 SF • 1,952 SF and flounder. I am thinking of a senior at an • Reserved parking and a • Efficient layout with elite private school in New Hampshire who was prime downtown location 8 exam rooms/offices accepted to Harvard. The school had a tradition Call Kristopher Roth Call Caitlin McCahill among seniors (unofficial and unsanctioned of 805.898.4361 805.898.4374 course) of encouraging sexual exploits with coeds, HayesCommercial.com and this young man wound up going to jail for 222 E Carrillo St, Suite 101 sexual assault instead to Harvard. Although my Santa Barbara, California

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Public Health

Update

Should I Wear a Mask?

Evolving Use of N95 Respirators During California Wildfires

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

When smoke from the Thomas Fire began to drift to San Luis Obispo County in last December, the phones at the Public Health Department began to ring with one clear question: Should I wear a mask?

The Public Health Department in Santa Barbara County—where air quality was affected much more significantly and directly by the smoke and fires—distributed N95 respirators and health officials urged residents to wear them when spending time outdoors. News coverage in our shared media market focused in on distribution points in Santa Barbara County. This followed the Sonoma County wildfires in October, when national news spotlighted N95s and stores across the Bay area sold out as residents sought protection from drifting smoke.

For many medical professionals who strongly associate N95s with a specific role in infection control, this use for on-the-go protection from wildfire smoke requires a new way of thinking about a familiar tool. It means putting aside deeply-ingrained habits around fit testing and known caveats about size (adult masks generally do not fit children), existing medical conditions

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such as asthma (masks restrict oxygen flow), and even facial hair (beards inhibit a proper fit). The protection an N95 can provide in this context is imperfect but potentially significant.

Where does this new perspective lead us?

Here in San Luis Obispo County, the Public Health Department decided not to distribute N95s during the Thomas Fire simply because the conditions here did not warrant it. While our neighbors to the south faced heavy smoke and ash, San Luis Obispo County experienced mostly blue skies with some mild smoke and haze. The air quality consistently remained well within the “good to moderate” range across the county. On one day when smoke darkened the sky, it remained mostly in the upper atmosphere where it affected visibility dramatically but did not significantly affect air at the level we breathe.

The Public Health Department team closely monitored the situation with the Air Pollution Control District (APCD) team, and worked together to share daily updates on air quality and related health recommendations. The APCD collects air quality data 24 hours per day, seven days per week at nine permanent stations across the county and at temporary sites in areas that may be most affected.

This data informed the decision regarding N95s.

The Public Health Department team also worked with the County Office of Emergency Services to ready large numbers of masks to distribute if air quality deteriorated.

Fortunately, we did not need to put these plans in action.

Our public information about air quality and health during the Thomas Fire included FAQs about the use of N95s, our decision not to provide them to the public, and brief recommendations for those

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who wished to purchase masks from retailers as an extra precaution.

Like our colleagues at the state level and in counties across California, we will continue addressing these questions as our collective use of N95s evolves and expands to new situations.

Wildfires are part of life in California, and N95s have become part of our toolkit to protect the public’s health when wildfires affect air quality.

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13 New

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

Dela Amoussou, MD Neurology Vituity Santa Barbara 805.682.7111

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Paul Guarino, MD, FACP Gastroenterology Santa Barbara

Sean Andrews, DO Emergency Medicine Central Coast Emergency Physicians Templeton 805.434.1869

Kathryn Haran, DO Emergency Medicine Central Coast Emergency Physicians Templeton 805.434.1869

Benton Ashlock, MD Pulmonary Critical Care Medicine Sansum Clinic Santa Barbara 805.898.3400

Noah Hawthorne, MD Emergency Medicine Vituity San Luis Obispo 805.543.5353

Alan Bernstein, MD, MPH Pediatrics CenCal Health Santa Barbara 805.562.1054

Jeremy Lash, MD Internal Medicine Sansum Clinic Santa Barbara 805.681.7500

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Steven McMurtry, MD Family Medicine Sansum Clinic Santa Barbara 805.898.3311

Arbi Ohanian, MD Neurology Vituity Santa Barbara 805.682.7111

Christopher Miller, MD Anesthesiology Anesthesia Medical Group of Santa Barbara Santa Barbara 805.682.7751

Laura Sices, MD Pediatrics Grotenhuis Pediatric Clinic Goleta 805.879.4240

RESIDENTS Cameron St. Hilaire, MD General Surgery Santa Barbara Cottage Hospital

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CL

DS

F I S IE S A

Billing Services

Office for Rent

K & H MEDICAL BILLING SOLUTIONS We are a local central coast billing company who is in touch with California’s everchanging insurance community. We customize our billing solutions to what it is that you want and need. Contact Heather at kandhmbs@yahoo.com or 805.722.5449.

LARGE OFFICE for rent, available by mid-August, ideal location (by State St & Micheltorena) in Santa Barbara. Currently a busy medical practice, office is fully equipped, approximately 2,300 sq ft with 5 rooms, 3 baths, a lab area, reception area, waiting room, storage space, a large conference room, and 4 parking spaces in shared lot. Rent is $4,200/mo.

Call 805.698.8282.

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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OFFICE SPACE available to sublease/rent: Office, exam rooms, reception area; shared parking with French Hospital in San Luis Obispo.

For more information call 805.541.4700 or email orthopedicofficeslo@gmail.com.

Summer 2018

Positions Available The COUNTY OF SAN LUIS OBISPO is seeking physicians to fill the roles of Deputy Health Officer, Staff Psychiatrist, Staff Physician - County Jail, and Medical Doctor at the County Jail - Contract. For more information, go to www.slocounty.ca.gov.

ARE YOU READING CPR? CPR contains the latest practice management news, and tips on reimbursement and contracting related issues.

The COUNTY OF SANTA BARBARA Behavioral Wellness Department is seeking physicians to fill the roles of 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-provider-jobopportunities.

Summer 2018

CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.

SUBSCRIBE NOW Sign up now for a free subscription at www.cmadocs.org/subscribe

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Central Coast Medical Association 100 N Hope Ave, Ste 14 Santa Barbara, CA 93110 CHANGE SERVICE REQUESTED

Presorted Standard U.S. Postage

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