Central Coast Physicians Winter 2021

WINTER 2021

2020 Legislative Wrap-Up • CalMedForce Awards

SANTA BARBARA COUNTY COVID COALITION PARTNERS Working to prevent the spread of COVID in our community MaskedandMighty.org

BECAUSE MASKS MAKE US STRONGER. In the fight against COVID, we all have a part in protecting those around us.

One of our best tools is a face mask. Use a mask to cover both your nose and mouth. Wear one whenever you leave home, and you’ll be protecting your family, yourself and your community. Together we are stronger.

ALSO MIGHTY: Clean hands. Physical distancing. Mighty up, Santa Barbara.

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VOLUME 6, NUMBER 1 • WINTER 2021

{FEATURES}

8 10 15 18 22 26 Winter 2021

{DEPARTMENTS} CALMEDFORCE GRANT AWARDS

7 PRESIDENT’S MESSAGE

PROTECTING PHYSICIAN PRACTICES

12 RISK TIP

2021 NEW HEALTH LAWS CONGRESSIONAL OMNIBUS 2021 BOARD OF DIRECTORS

24 CENCAL HEALTH NEWS 36 PUBLIC HEALTH 38 CLASSIFIEDS 40 NEW MEMBERS 42 IN MEMORIAM

2020 LEGISLATIVE WRAP-UP

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Letter from the CEO

YEAR IN REVIEW

Even though 2020 was a year like no other, it has made me even more grateful to be living on the Central Coast. When we were first hearing about COVID, physicians were seeking out information to learn what they could to be prepared. Once we started getting cases in our area, doctors stepped up to help in a variety of ways. Some of our physician leaders were part of press briefings; others held webinars open to the community. Everyone offered emotional support and understanding since we are in this together.

DANA GOBA

Our office received numerous phone calls from active and retired physicians to check in on their colleagues and find out what the community needed. Once the vaccine became available, physicians, nurses, and other healthcare staff asked how to volunteer to help distribute it to the community.

CCMA’s goal this past year was to help and support physicians and their practices, however necessary. We understand the tremendous sacrifices that have been made and have never been prouder to represent physicians. We will continue working for you and your patients.

I am feeling optimistic for 2021 and am curious how we will live in the new normal.

I have a variety of masks that I’ll continue using. I will also continue checking with others. Zoom fatigue is real, but staying connected is more important.

PRESIDENT Priti Gagneja, MD PRESIDENT ELECT Samira Kayumi-Rashti, MD TREASURER Julie Fallon, MD SECRETARY Thomas Hale, MD IMMEDIATE PAST PRESIDENT Kevin Casey, MD DIRECTORS Eric Amador, MD; Michael DiBiase, MD; Todd Engstrom, MD; Jeffrey Gauvin, MD; Jennifer Hone, MD; Bindu Kamal, MD; Rachel May, MD; Rahim Raoufi, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sharon Basham, MD; Edward Bentley, MD; Kevin Casey, MD; David Dodson, MD; Priti Gagneja, MD; Jennifer Hone, MD; Samira Kayumi-Rashti, MD; Christopher Lumsdaine, MD; Douglas Murphy, MD; Grace Park, MD; Joseph Schwartz, MD CMA DISTRICT V TRUSTEE Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Priti Gagneja, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS California Medical Association; CenCal Health; The Doctors Company CONTRIBUTING PHOTOGRAPHERS CenCal Health SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are welcome. Opinions expressed by authors are their own and

I look forward to staying connected with you, as we all do our part to get us through this year.

Together we are stronger.

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

Sincerely,

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

Dana Goba Chief Executive Officer Central Coast Medical Association

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

A COMPONENT OF THE

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Winter 2021

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2020 YEAR IN REVIEW 2020 was unlike any other year in CMA’s 164-year history. As an association largely founded during a cholera outbreak, we quickly rose to the challenge and shifted all gears to help physician members, elected officials and policymakers navigate the COVID-19 crisis.

This year’s achievements include:

Advised the state’s development of executive orders and laws to ensure physicians could respond to the pandemic, including on telehealth policy, regulatory waivers and public health officer safety.

Distributed more than 60 million pieces of personal protective equipment (PPE) to more than 8,000 physician practices statewide.

Secured more than $100 billion in financial assistance to physician practices in Coronavirus Aid, Relief, and Economic Security (CARES) Act and an additional $75 billion to the HHS Provider Relief Fund in the COVID-19 “Interim Economic Relief” bill.

Convened virtual grand rounds on COVID-19 topics, including transmission, schools re-opening, testing and vaccines.

Created a new COVID-19 website with daily updates, toolkits, webinars and other resources for physicians.

Protected Proposition 56 funding (tobacco tax revenues) in the state budget, including $57 million for physician loan repayment and $38 million for graduate medical education programs.

Sponsored a new ban on flavored tobacco products that will save lives, as well as limit Big Tobacco’s ability to target children and communities of color.

Amended CMA’s mission statement to include health equity.

Helped shape a federal surprise billing ban that includes baseball-style arbitration to resolve disputes between physicians and payors.

Continued our court fight to protect the Affordable Care Act.

Visit cmadocs.org for more information.

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2020

Unforgettable 2020 has been an unforgettable year. Natural disasters, stock market crashes, a mutated virus causing the COVID-19 pandemic, lockdowns, quarantines, oil price wars, conspiracy theories, black holes, artificial intelligence, human rights marches, novel vaccines, and 1.8 million pandemic related deaths worldwide…

The year has been tumultuous, but the resilience of mankind does shine through. Science prevails. The year has seen record breaking times to create diagnostic tests, protocols for safety, and a vaccine. We have been fortunate to be able to do what we love most – practice medicine and help people during a time like this. We are privileged to be able to work and be part of the healing for so many.

I joined CCMA because I see the importance of scientists and doctors having a strong, clear, and unified voice. Decisions around science and medicine need to come from us. I hope to be a liaison for your concerns and needs so we don’t fall into bureaucratic nexuses.

Some goals for the year will include supporting science, our public health department, and physician and patient rights.

I look forward to 2021, a year of hope and progress.

Stay blessed, Priti Gagneja, MD

Winter 2021

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State Tobacco Tax-Funded Program Awards $38.14 Million to Expand California’s Health Care Workforce

101 awardees will help address physician shortage, increase access to care Largest CalMedForce applicant pool, so far, with over $95M requested Physicians for a Healthy California (PHC) announced more than $38 million in CalMedForce awards across the state to support medical training and residency programs and help grow the physician workforce.

The third round of CalMedForce funding, released by PHC and generated by the voter-approved Proposition 56 tobacco tax in 2016, will support 202 residency positions in 101 graduate medical education (GME) programs at hospitals and clinics, with an emphasis on those serving medically underserved groups and communities. This cycle represented the largest applicant pool: 541 residents and 122 applications requesting over $95 million in funding.

The California Future Health Workforce Commission estimated that California will need 4,700 additional primary care clinicians by 2025 and approximately 4,100 more by 2030 to meet demand. PHC, in partnership with

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the University of California (UC), established the CalMedForce

approximately 14% of GME programs are sponsored by the

grant program to help address California’s looming physician

University.

shortage because medical school graduates must continue training in an accredited, specialty-specific GME residency program to

To date, CalMedForce has released over $114 million for 261

obtain a medical license and care for patients independently.

awards to 121 GME programs across California to retain and expand GME programs in primary care (family medicine, internal

“CalMedForce continues to demonstrate the high demand and

medicine, pediatrics, and obstetrics and gynecology) and emergency

need for GME opportunities,” said Lupe Alonzo-Diaz, MPA,

medicine. However, even with the additional funding, the shortage

PHC president and CEO. “The lack of sufficient residency spots

of California residency programs poses an ongoing challenge for

contributes to California’s physician shortage and limits the number

expanding the physician workforce.

of new doctors entering the workforce. With COVID 19 impacting life for the foreseeable future, programs like CalMedForce are even

“We understand the vital statewide need for this program and the

more essential to protect access to care for all Californians.”

funding it provides to support California’s future physicians,” said Cathryn Nation, M.D., Vice President for Health Sciences at UC

The UC is the designated recipient of Proposition 56 funding

Office of the President. “The annual demand for funding reflects the

and has contracted with PHC to administer CalMedForce. All

importance of this program and its focus on the needs of medically

accredited residency programs in the state that meet guidelines are

underserved groups and communities.”

eligible to apply for funding. Of this year’s CalMedForce awardees,

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PROTECTING PHYSICIAN PRACTICES DURING COVID-19 COVID-19 is having a profound impact on physician practices across the state. The California Medical Association (CMA) continues to advocate on all fronts during the COVID-19 pandemic to ensure that the interests of physicians and their patients are considered as local, state and federal governments respond to the rapidly evolving public health emergency. From ensuring physician payments in the Paycheck Protection Program (PPP) to expanding the use of telehealth services, CMA’s advocacy has directly helped thousands of physician practices across California.

CMA also has a wide array of resources and programs to help physicians during the public health emergency: PPE RELIEF: As physician practices continue to struggle to secure the personal protective equipment (PPE) they need to keep themselves and their patients safe, CMA distributed millions of pieces of PPE – including masks, shields, gowns, gloves and hand sanitizer – free to qualifying practices. Practices with 50 or fewer providers were eligible to receive a 60-day supply to ensure they could see patients with proper safety precautions in place.

VIRTUAL GRAND ROUNDS: CMA is partnering with the California Health and Human Services Agency and academic medical centers across the state to host California COVID-19 Clinical Updates, a regular series of virtual grand rounds for the state’s clinicians on the evolving understanding and management of COVID-19 patients. Participants earn free continuing medical education (CME).

TOOLKITS FOR MEDICAL PRACTICES: CMA understands that things are changing rapidly – sometimes daily – during the COVID-19 pandemic. Our team of experts is distilling the information into easy-to-read toolkits that are updated regularly to keep you informed on the changing policy and regulatory landscape.

COVID-19 WEBINAR SERIES: Since the beginning of the public health emergency, CMA has been hosting free COVID-19 webinars to keep California physicians informed on critical topics – from telehealth and reimbursement to legal and employment issues.

REOPENING GUIDELINES: Many physician practices have had to close or reduce operating hours amid the COVID emergency. A CMA-convened taskforce of practicing physicians from different parts of the state, different sized practices and various specialties helped the state develop guidelines and recommendations for reopening the health care system.

Visit cmadocs.org/covid-19 for more information on any of these resources.

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ADDITIONAL MEMBER BENEFITS CMA members gain access to valuable members-only services, including: LEGAL RESOURCES Free access to CMA’s online health law library with 5,000+ pages of information and resources.

PROFESSIONAL DEVELOPMENT Grow your leadership skills with tools, resources and opportunities for growth.

REIMBURSEMENT ASSISTANCE CMA physicians have recouped more than $3 million in the past 11 years with the help of CMA’s reimbursement experts.

GROUP-BUYING DISCOUNTS Our extensive network of benefit partners makes it so that your membership can easily pay for itself.

PRACTICE SUSTAINABILITY CMA’s Physician Services Organization ensures that California physicians can practice in the modality of their choosing, armed with bestin-class tools and technologies.

LEGISLATIVE ADVOCACY Learn how to use your voice as a trusted and powerful tool to protect your patients and the practice of medicine.

We Are Here for You Your membership makes these programs and resources possible. CMA and its county medical societies have represented California’s physicians for more than 160 years as the recognized voice of the house of medicine. Become a member of CMA today to help strengthen the political voice of the house of medicine, and get the services you need to help your practice adapt during these turbulent times. Together we stand taller, our combined voices stronger, fighting for the future of medicine and our noble profession.

Become a Member Today Visit cmadocs.org/join or contact CMA’s member resource center at (800) 786-4262 or memberservice@cmadocs.org.

Winter 2021

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Rev. 9.30.20

RISK TIP

REOPENING YOUR PRACTICE AVOID RISKS WHEN TREATING STRESSED PATIENTS DURING COVID-19

BY THE DOCTORS COMPANY

While most resources are directed at screening for COVID-19 and treating affected patients, there is another important aspect of the pandemic: the impact on your patients’ mental health.

Anxiety is being exacerbated by patients’ mistrust of the healthcare system and fear that they or their loved ones will contract the virus. A recent survey indicated that 67 percent of people have increased levels of stress since the start of the COVID-19 outbreak.

What are some warning signs or cues that show a patient is in emotional distress? Watch for the following signs when seeing a patient onsite or via telehealth: • Changes in appetite, sleep, and/or behavior.

• Nonverbal cues during an interview.

• Decreased or no energy.

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• Changes in cognition.

• F eelings of hopelessness/helplessness, being overwhelmed, irritability, fear/worry.

•W ithdrawal from friends/family and activities.

• Increased conflict within relationships.

• L ack of follow-through with seeing therapist and/or psychiatrist.

• New somatic complaints.

• Excessive smoking, drinking, or using drugs.

The following key elements of the Stress First Aid peer support model have been linked to better functioning during times of ongoing stress and should be used in discussion with patients showing signs of anxiety:

If these warning signs are missed and an adverse event—such as suicide—occurs, the healthcare provider may face the risk of a medical malpractice claim.

CONNECT: Connect in a helpful and respectful manner.

While the vast majority of your patients who are anxious and stressed about the COVID-19 virus are not suicidal, it is important to keep in mind the possibility of suicide as you complete your assessment. A helpful resource is the Suicide Prevention Toolkit for Primary Care Practices (www.sprc.org/settings/primary-care/toolkit) from the Suicide Prevention Resource Center and the Western Interstate Commission for Higher Education Mental Health Program.

COVER: Restore and support a sense of safety.

CALM: Calm and orient distressed persons by asking if they have experienced any changes.

COMPETENCE: Remind them of skills that have worked in the past for them.

CONFIDENCE: Foster a sense of hope, limit self-doubt and guilt, and help patients concentrate on strengths During these discussions, explain to patients the importance of selfcare during times of stress and the importance of staying connected to their support system. Provide positive encouragement and reinforcement.

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TenetHealthCentralCoast.com/Telehealth Winter 2021

Significant New California Laws

of Interest to Physicians

for 2021

The California Legislature experienced an unconventional legislative year due to the COVID-19 pandemic.

While legislators introduced the usual number of legislative proposals (2,223 bills), the Legislature suspended legislative activities for over two months and passed only three out of four legislative proposals. While the number of new laws overall is reduced as compared to other years, there was a persistent focus on passing laws related to health care and COVID-19 pandemic related issues. Below is a list of the most significant new health laws of interest to physicians.

For information about these laws, go to www.cmadocs.org.

ALLIED HEALTH PROFESSIONALS AB 890 (Wood) – Nurse practitioners: scope of

practice: practice without standardized procedures

AB 896 (Low) – Registered Dispensing Opticians: Dispensing Opticians Fund: Optometry Fund: mobile optometric offices AB 2253 (Low) – Professional licensure

SB 653 Chang) – Dental hygienists: registered

dental hygienist in alternative practice: scope of practice

SB 1237 (Dodd) – Nurse-midwives: scope of practice

BUDGET

AB 75 (Committee on Budget) – Budget Act of

AB 80 (Committee on Budget) – Public health omnibus

AB 81 (Committee on Budget) – Public health funding: health facilities and services

AB 89 (Ting) – Budget Act of 2020

AB 103 (Committee on Budget) – Unemployment compensation benefits: COVID-19

SB 74 (Mitchell) – Budget Act of 2020

SB 115 (Committee on Budget and Fiscal Review) – Budget Act of 2019: Budget Act of 2020

BUSINESS

SB 934 (Bates) – Corporate taxes: exempt organizations: filing fees

SB 1447 (Bradford) – Income tax: sales and use tax: credit: small business

2019: augmentation

AB 79 (Committee on Budget) – Human services omnibus

Winter 2021

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CANNABIS

AB 1525 (Jones-Sawyer) – Cannabis: financial institutions

DEPENDENT PERSONS

AB 2741 (Rubio, Blanca) – Children’s advocacy centers

AB 1872 (Committee on Budget) – Cannabis

SB 1123 (Chang) – Elder and dependent adult

CLINICAL LABORATORIES

EMERGENCY SERVICES

SB 1244 (Bradford) – Cannabis testing laboratories

AB 2199 (Nazarian) – Healing arts: clinical laboratories

CONFIDENTIAL INFORMATION

AB 713 (Mullin) – California Consumer Privacy Act of 2018

AB 1281 (Chau) Privacy – California Consumer Privacy Act of 2018

AB 2520 (Chiu) – Access to medical records AB 2655 (Gipson) – Invasion of privacy: first responders

COVID-19 PUBLIC HEALTH EMERGENCY

AB 685 (Reyes) – COVID-19: imminent hazard to

employees: exposure: notification: serious violations

AB 1577 (Burke) – Income taxes: federal CARES Act: gross income: loan forgiveness

AB 1710 (Wood) – Pharmacy practice: vaccines

AB 1867 (Committee on Budget) – Small employer

abuse

AB 1544 (Gipson) – Community Paramedicine or Triage to Alternate Destination Act

AB 1945 (Salas) – Emergency services: first responders

HEALTH CARE PLANS & COVERAGE

AB 1124 (Maienschein) – Health care service plans: regulations: exemptions

AB 2118 (Kalra) – Health care service plans and insurers: reporting requirements

AB 2157 (Wood) – Health care coverage:

independent dispute resolution process

SB 406 (Pan) – Health care: omnibus bill

SB 855 (Wiener) – Health coverage: mental health or substance use disorders

HEALTH CARE FACILITIES AND FINANCING

AB 1766 (Bloom) – Licensed adult residential

facilities and residential care facilities for

family leave mediation: handwashing:

the elderly: data collection: residents with

supplemental paid sick leave

a serious mental disorder

AB 2288 (Low) – Nursing programs: state of emergency

AB 2537 (Rodriguez) – Personal protective

equipment: health care employees

AB 2644 (Wood) – Skilled nursing facilities: deaths: reporting

SB 275 (Pan) – Health Care and Essential Workers: personal protective equipment

AB 2037 (Wicks) – Health facilities: notices AB 2377 (Chiu) – Residential facilities

MEDI-CAL

AB 115 (Committee on Budget) – Medi-Cal:

managed care organization provider tax

SB 214 (Dodd) – Medi-Cal: California Community Transitions program

SB 1159 (Hill) – Workers’ compensation: COVID-19: critical workers

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Winter 2021

MENTAL AND BEHAVIORAL HEALTH

AB 465 (Eggman) – Mental health workers: supervision

AB 1976 (Eggman) – Mental health services: assisted outpatient treatment

AB 2265 (Quirk-Silva) – Mental Health Services Act: use of funds for substance use disorder treatment

screening and prevention AB 2847 (Chiu) – Firearms: unsafe handguns SB 793 (Hill) – Flavored tobacco products

SB 1276 (Rubio) – The Comprehensive Statewide Domestic Violence Program

REPORTING REQUIREMENTS

AB 1145 (Garcia, Cristina) – Child abuse: reportable conduct

AB 3242 (Irwin) – Mental health: involuntary

AB 1929 (Rubio, Blanca) – Child abuse and neglect

AB 3371 (Committee on Veterans Affairs) – Veteran

AB 1963 (Chu) – Child abuse or neglect: mandated

SB 803 (Beall) – Mental health services: peer

AB 2821 (Nazarian) – Richard Paul Hemann

commitment

suicides: report

support specialist certification

PRESCRIBING AND DISPENSING

SB 852 (Pan) – Health care: prescription drugs

PROFESSIONAL LICENSING AND DISCIPLINE

AB 2113 (Low) – Refugees, Asylees and Special Immigrant Visa Holders: Licensing

AB 2273 (Bloom) – Physicians and surgeons:

foreign medical graduates: special faculty permits

AB 3092 (Wicks) – Sexual assault and other sexual misconduct: statutes of limitations on civil actions AB 3330 (Calderon) – Department of Consumer

Affairs: boards: licensees: regulatory fees

PUBLIC HEALTH

AB 1989 (Garcia, Cristina) – Menstrual Products Right to Know Act of 2020

AB 2077 (Ting) – Hypodermic needles and syringes AB 2112 (Ramos) – Suicide prevention

AB 2218 (Santiago) – Transgender Wellness and Equity Fund

AB 2276 (Reyes) – Childhood lead poisoning:

Winter 2021

reporting reporters

Parkinson’s Disease Program

SB 932 (Wiener) – Communicable diseases: data collection

REPRODUCTIVE HEALTH

AB 732 (Bonta) – County jails: prisons:

incarcerated pregnant persons

AB 2014 (Maienschein) – Medical misconduct:

misuse of sperm, ova, or embryos: statute of limitations

WORKFORCE AND LABOR ISSUES

AB 1947 (Kalra) – Employment violation complaints: requirements: time

AB 2017 (Mullin) – Employee: sick leave: kin care AB 2143 (Stone) – Settlement agreements: employment disputes

AB 2257 (Gonzalez) – Worker classification:

employees and independent contractors: occupations: professional services

AB 2399 (Committee on Insurance) – Paid family leave: qualifying exigency

AB 2992 (Weber) – Employment practices: leave time

SB 1383 (Jackson) – Unlawful employment practice: California Family Rights Act

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Congressional Omnibus and COVID Relief Year-End Legislation: COVID-19 Relief, Medicare Physician Payments, Extended Health Programs, and Surprise Medical Billing

On December 21, 2020, the 116th Congress adjourned for the year after one of the most acrimonious sessions in recent history.

Congress adopted a massive $1.4 trillion spending package to fund the government and other programs and a $900 billion COVID-19 relief package. They also adopted changes to the Medicare physician fee schedule to stop the cuts for almost every specialty, extended several important health care programs, provided 1,000 new graduate medical education (GME) slots and passed a surprise medical billing agreement.

The ban on surprise billing will protect patients from out-of-network bills and establish a baseball-style arbitration process for insurers and physicians to resolve disputes. See highlights from the California Medical Association (CMA) below.

year, Senate leadership became more cautious about future spending on the pandemic, Medicare payments and other issues. While there are disappointments in this year-end package, Congress was able to dedicate billions to help physicians during the pandemic. However, there is more yet to be done.

Our California Congressional leaders are already committing to future COVID aid packages, more Medicare payment assistance and surprise billing clean-up next year. Despite the difficult Congressional environment, CMA will never, ever give up. We will keep fighting so that you can focus on your patients and not be distracted or brought down by administrative burdens, declining reimbursements, outside corporate influences or a devastating virus. You are the true heroes in this pandemic and we will continue to stand with you and advocate on your behalf.

While this was a tumultuous Congress, it was also one of the most difficult and unprecedented times in our nation’s history. After Congress spent trillions of dollars on the pandemic earlier in the

YEAR-END COVID-19 RELIEF PACKAGE After passing four sweeping COVID-19 relief bills earlier in the year, Congress was unable to reach another agreement until this year-end omnibus package. A summary of the latest COVID aid is listed below.

This latest relief package is in addition to the trillions already dedicated to fighting the pandemic, including $185 billion for physicians and hospitals through the Provider Relief Fund, the $660 billion in the Paycheck Protection Program for practices with 50 or fewer employees, and the Medicare Advance payments not repayable for one year. The COVID-19 pandemic threatens to fundamentally alter our nation’s health care delivery system and CMA will continue to push for more aid in 2021 to sustain the viability of physician practices, maintain patient access to care and ensure that every Californian receives a vaccine. The latest $990 billion COVID relief package includes:

• $69 billion for vaccine purchase and distribution, testing and contact tracing, including $22 billion to helpstates with testing,

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CENTRAL COAST PHYSICIANS

tracing and COVID-19 mitigation • New $3 billion in funding for physicians and hospitals through the Provider Relief Fund

Note that on December 16, the U.S. Department of Health and Human Services (HHS) released another $24 billion to physicians who had applied for funding by the November 6, 2020, deadline. It totals 88% of each physician’s lost revenues and increased costs.

• A n additional $284 billion for Paycheck Protection Program (PPP) forgivable loans for physician practiceswith 50 or fewer employees. Some 501(c)(3) nonprofit organizations are also eligible.

• A llows physicians to deduct expenses associated with their forgivable PPP loans, expands employeeretention tax credits for employers and extends a payroll tax subsidy for employers offering workers paidsick leave

• $10 billion for childcare, including for health care workers

Winter 2021

• $7 billion to increase broadband access, including $250 million for telehealth • $4.5 billion for mental health, substance abuse; waivers for mental health telehealth services madepermanent • 1,000 new GME positions. Not less than 10% of the aggregate number of these new positions will be givento hospitals in rural areas or HPSAs, hospitals that are already above their Medicare cap, and hospitals instates with new medical schools or new locations. Hospitals are limited to 25 additional full-time positions.

Many more issues related to the pandemic remain unresolved. CMA urged Congress to provide liability safeguards for physicians and hospitals (beyond the Good Samaritan rules) and more direct aid to the states, particularly for Medicaid, but these issues were turfed to 2021.

Making the telehealth waivers permanent and extending allowances for audio-only telehealth in Medicare Advantage were also moved to the 2021 Congressional agenda.

MEDICARE PHYSICIAN PAYMENT Medicare E/M: The 2021 Medicare physician fee schedule

appropriately increased long overdue primary care evaluation and management (E/M) payment rates by up to 13%, but it also reduced payments to specialists by as much as 10% because the Medicare budget neutrality rules require any payment increases to be offset with corresponding payment reductions. Medicare had also proposed a new CPT code G2211 to report complex cases. In response, CMA and AMA relentlessly urged Congress to intervene and pass HR 8702 (Bera, MD, D-CA and Bucshon, MD, R-IN), which would hold specialists harmless from the 2021 payment cuts while protecting the increases for primary care.

Medicare payment updates. CMA will be pushing for more payment to protect practices through the pandemic and ensure patient access to care.

HEALTH CARE PROGRAMS EXTENDED Funding for several important health care programs were extended through 2023: Community Health Centers, the Teaching Health Center primary care GME Program and the National Health Service Corps. The Affordable Care Act (ACA) Disproportionate Share Hospital (DSH) payment cuts were also suspended.

“NO SURPRISES ACT” – SURPRISE MEDICAL BILLING LEGISLATION

In the last week of the 116th Congress, four bipartisan, bicameral committees agreed to compromise surprise billing legislation, which includes substantial improvements sought by CMA and AMA. We have come a long way from the first committee bills that didn’t even have an arbitration process and only paid median in-network rates.

However, there are still a few difficult provisions that CMA and Congress will be tracking to ensure a balanced system for physicians.

This new law is a better deal for physicians than California’s law and it will set the benchmark for CMA’s advocacy to improve California’s surprise medical billing law. Overall, CMA will continue to fight for improvements and a system that protects patients’ long-term access to physicians and incentivizes insurers to contract in good faith with physicians.

General Structure of “No Surprises Act”

Congress responded by significantly mitigating the budget neutrality adjustment so that most specialties will either see a neutral or positive change in total 2021 Medicare payments. The net impact will depend on physician specialty and each practice’s mix of services. These adjustments will not factor into future calculations of the fee schedule. Congress mitigated the cuts by:

• Delaying the new HCPCS code G2211 for three years • Providing additional funding from the U.S. Treasury and the Federal Supplementary Medical Insurance Trust

Sequestration: Congress continued the extension of the

Medicare 2% sequestration cuts moratorium through March 31, 2021. This provides all physicians with an additional 2% payment increase from January 1 to March 31, 2021.

Finally, some of the health care leaders in Congress are committing to CMA to try to extend the moratorium on sequestration to give physicians a 2% rate increase for all of 2021. Due to arcane budget rules, if this issue is legislated during 2021, there could be a budget savings associated with it that would fund the 2% rate increase and other

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• The bill only applies to federally regulated ERISA plans that comprise 45% of California’s market and doesnot preempt California’s state laws that govern plans regulated by the state.

• Effective January 1, 2022.

• Patients are protected from surprise medical bills and only responsible for the in-network cost-sharingamount for outof-network (OON) emergency services and other services provided in in-network facilities.

• Plans required to list deductibles and cost-sharing for in-network and OON services on enrollee insurancecards.

• Insurers required to make initial payments directly to OON providers for OON services within 30 days. Thelaw does not define the payment rate. (CMA and AMA were successful in eliminating the upfront interimpayment rate set at the median in-network rate paid by the insurer in the geographic region. It would havehad a significant benchmark rate-setting impact, as it did in California with AB 72. In California, insurersreduced contracted rates to the interim rate in the law, and physicians have lost 81 of the 82 Department ofManaged Health Care (DMHC) arbitrations because the arbitrator was heavily influenced by the interimupfront payment rate.)

• If a provider objects to the payment, they may still deposit the payment and then proceed to the disputeresolution process.

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Dispute Resolution Process

• There is no dollar threshold for accessing arbitration. (CMA and

AMA successfully eliminated the $750-$1,000 threshold to take claims to arbitration.)

• The IDR process is baseball-style arbitration, which is better for physicians. There is no negotiation. Bothparties submit a payment rate and the arbiter selects one. This process incentivizes both parties to submitreasonable rates. (CMA and AMA fought for a baseball-style arbitration process.)

• Providers may batch claims for the same or similar services delivered within a 30-day time period by payer.(CMA and AMA won this provision to help improve administrative simplicity.)

• The first step is a 30-day informal “open-negotiation” period, where physicians and insurers may settledisputes over OON claims. In Texas, 70% of the disputes have been settled in this informal process.

• If the parties cannot agree, the physician may request a baseballstyle arbitration process. The physician hasfour days to request arbitration. Independent entities will administer the arbitration.

• The baseball-style arbitration must be resolved in 30 days.

• Once a physician has brought a batch of claims by payer to the arbitration process, there is a differentprocess for the second time and all subsequent submissions.

• For all subsequent submissions to arbitration by payer, there is a 90-day cooling off period. It includes the30-day informal “open negotiation process” so it is an additional 60 days.

However, all claims that occurduring that 90-day “cooling off ” period may go directly to arbitration on day 91. There is also a provisionthat allows the Secretary to change the timeline for low volume claims and to ensure more efficiency. (CMAand AMA urged Congress to reduce the cooling-off period because it is difficult for small physician practicesto wait 120 days to be paid.

Congress changed the provision to allow physicians to collect all claims that occur during the cooling off and immediately bring those claims to arbitration. Congress added a study of the arbitration process and the cooling off period to better assess its impact on practices. Finally, it should be noted that the DMHC process in CA is more than 150 days, with the California Department of Insurance taking at least 75 days.)

• In the 30-day baseball arbitration process, the arbiter may only consider the offers made by both parties,and the following additional information, which must be considered equally.

oA ny information that the provider wants to submit except billed charges.(There has been strong bipartisan agreement for two years that Congress opposes allowing physicians tosubmit billed charges. However, allowing physicians to submit any information is a major win. Previousbills restricted arbitration to median in-network rates only.)

o P rior contracting history for the four previous years with that payer. (CMA and AMA also fought for thisto be included.)

oM edian in-network rates as determined by the payer,

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with timely audits by the regulator to ensure theaccuracy of the median in-network rates. The regulators may also conduct audits in response tocomplaints. For purposes of determining median in-network rates, insurers will be held to the rates paidin January 2019 and increased by CPI annually thereafter. (It is important to note that all of thecommittee bills included median in-network rates; we were told that it must remain in one place in thebill. If median is removed completely, the bill costs money and Congress did not want to cut anotherprogram to fund this legislation. CMA and AMA urged the median rate to be removed as the upfrontpayment rate to avoid benchmark rate setting. While we continue to oppose inclusion of median in-network rates being a factor in arbitration, we successfully added other factors that must be given equalconsideration with the median rate.)

o Physician training and experience, complexity of the case, acuity of the patient, good faith efforts toenter (or not enter) into network agreements, and the market share of the insurer and provider.

oA ny information the arbiter requests.

•T he original committee agreement included an allowance for insurers to submit Medicare and Medicaidpayment rates to arbitration. (CMA and AMA strongly opposed and the final version prohibits arbiters fromconsidering public payer rates.)

• Loser pays the arbitration fees and both providers and insurers must pay an additional fee to the regulator to bedetermined.

Timely Billing and Notification Requirements and Studies

• A ll of the burdensome timely billing and notification

requirements that CMA and AMA objected to wereeliminated in the final bill.

• Insurers and providers are responsible for ensuring that insurance company provider directories are up-to-date and accurate.

• Mandates a study by the Government Accountability Office (GAO) on ERISA plan network adequacy, access,premiums and out-of-pocket costs.

• Mandates a study by HHS, FTC and the U.S. Attorney General on effects of this law on consolidation, costsand access.

• Mandates a GAO study on the surprise billing process, specifically including the impact of the cooling offperiod.

• Establishes a grant program to create and improve State All Payer Claims Databases.

CMA will continue to work for improvements to the bill through clean-up legislation and regulation. While CMA does not support the inclusion of median in-network rates to be considered in arbitration, there are firewalls around it to protect physicians in the process and to ensure that other factors must be given equal weight in arbitration decisions.

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OFFICERS

Priti Gagneja, MD President INTERNAL MEDICINE Sansum Clinic Santa Barbara 805.898.3104

Samira Kayumi-Rashti, MD President-Elect PEDIATRICS Children’s Medical Group Santa Barbara 805.965.1095

Julie Fallon, MD Treasurer INTERNAL MEDICINE Templeton 805.434.9900

Thomas Hale, MD Secretary EMERGENCY MEDICINE Central Coast Emergency Physicians Templeton 805.460.7117

Michael DiBiase, MD NEPHROLOGY Central Coast Renal Care San Luis Obispo 805.548.8585

Bindu Kamal, MD NEPHROLOGY Santa Barbara 805.682.5879

Kevin Casey, MD Immediate Past President VASCULAR SURGERY Santa Barbara Vascular Specialists Santa Barbara 805.456.8890

Todd Engstrom, MD INTERNAL MEDICINE Sansum Clinic Santa Barbara 805.681.7500

Rachel May, MD EMERGENCY MEDICINE Vituity San Luis Obispo 805.543.5353

Jeffrey Gauvin, MD GENERAL SURGERY Santa Barbara 805.569.7316

Rahim Raoufi, MD GASTROENTEROLOGY Lompoc 805.740.6633

DIRECTORS

Eric Amador, MD ANESTHESIOLOGY Anesthesia Medical Group of Santa Barbara Santa Barbara 805.682.7751 Jennifer Hone, MD ENDOCRINOLOGY Optum Health Santa Barbara 763.797.2879

CenCal Health NEWS HUB:

CenCal Health to Address Gaps in Care with over $2 Million in Funding for Physician Recruitment, Medical Equipment New Program to Improve Access to Health Care for Children, Seniors, and the Disabled

In response to noted gaps in access to health care, CenCal Health, the publicly-sponsored health plan for Medi-Cal in Santa Barbara and San Luis Obispo counties, is implementing a Network Access Improvement program. The program will focus on increasing primary and specialty care capacity for local Medi-Cal members, as well as improving access to care for children and disabled members.

These priorities will be accomplished in two ways – by recruiting new medical professionals to the network, and by funding specialized medical equipment such as vaccine refrigerators and exam room apparatus that accommodates the needs of the mobility-impaired patient.

Due to membership growth outpacing local resources, CenCal Health has committed $2 million to the recruitment of new medical practitioners to its network on the Central Coast.

This funding will provide financial incentives to current network providers, including covering recruitment costs and salaries for new providers.

CenCal Health is offering this incentive to qualified network providers for up to: • $150,000 for recruitment costs of a specialty care practitioner • $100,000 for recruitment costs of a primary care practitioner • $ 75,000 for recruitment costs of a mid-level

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medical practitioner (such as physician’s assistant or nurse practitioner) “The Access Improvement program is an effort to help ensure that the Central Coast will be able to address both the shortage of certain medical specialists locally; as well as to generally assist in attracting new providers to the area,” said Bob Freeman, CenCal Health CEO. “In the next few years, we will experience a wave of retiring physicians. Hopefully, the program will proactively address this future physician shortage – and also attract new specialists to the area that are currently not here.”

CenCal Health has additional dollars for providers – up to $5,000 per location – to fund medical equipment that will improve access to health care for children, seniors, and disabled patients. The health plan has especially seen gaps in care related to patients’ mobility.

“We have learned that a majority of wheel-chair bound women do not get their annual cervical cancer screening because they cannot transfer from their chair to the exam table,” said Terri Howell, Director of Provider Services at CenCal Health. “These women are at the same risk of getting cervical cancer as the rest of the general population of women in the same age range, but they don’t get the exams. This program will address that with funding for power adjustable, hi-low treatment tables in the provider’s office.”

Other equipment that could be funded to retrofit a medical exam room: exam table overhead trapeze

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bars for patient mobility, and weight scales for the wheelchair bound.

There is also funding assistance for CenCal Health providers who participate in the Child Health and Disability Prevention program for the purchase of Vaccines for Children-compliant refrigerators. These purpose-built refrigerated storage units maintain proper temperatures to protect the viability of infant and childhood vaccines.

“As physicians, it is important that we work with the health plan to identify challenges faced by our Medi-Cal members and identify potential strategies for better managed care,” said Dr. René Bravo of Bravo Pediatrics in San Luis Obispo. “A program like this, which expands the provider network and provides funds for medical equipment, means a greater chance that patients will receive proper care at every appointment.”

CenCal Health’s Network Access Improvement program begins January 2021. Applications are available on the provider portal at the CenCal Health website (cencalhealth.org). Network partners who would like more information can contact their CenCal Health Provider Services Representative directly or reach out to the Provider Services Department at psrgroup@ cencalhealth.org CenCal Health is a community-accountable Medi-Cal health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to more than 190,000 members – about one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County.

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CALIFORNIA’S COMPLETELY UNPREDICTABLE,

TOTALLY CHAOTIC LEGISLATIVE YEAR

As 2019 concluded, reasonable assumptions about 2020 began to emerge. The year was expected to be busy and more polarizing due to the presidential election occurring in November. Large-scale issue-based campaigns calling for new state programs supported by the expected state budget surplus were being announced. State legislators were finalizing their legislative packages. And lastly, the California Medical Association (CMA) was preparing to defeat yet another attempt to eliminate the cap on noneconomic damages incorporated in California’s longstanding professional liability reform law, the Medical Injury Compensation Reform Act (MICRA).

In March, the world changed, and California politics and the legislative process went through an unprecedented transformation.

On March 19 Governor Gavin Newsom issued the nation’s first statewide stay-at-home order in response to the arrival

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of the novel coronavirus (SARS-coV2) in California. All nonessential businesses, such as restaurants, entertainment centers/activities, etc., were immediately shut down until further notice. The State Legislature was forced to take multiple extended recesses, and all in-person lobbying was prohibited, leading to the cancellation of CMA’s annual Legislative Advocacy Day. The legislative process was completely upended. CMA staff worked diligently to adjust to ever-changing dynamics, as both houses of the Legislature scrambled to implement social distancing guidelines and condense their calendars.

In the end, CMA successfully maintained state funding for physician services, defeated proposals to increase or add new administrative burdens onto physicians, and secured a number of Executive Orders to protect medical practices as they faced a pandemic unlike any seen in the past century.

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However, CMA did not escape the legislative session unscathed. The legislature passed, and the governor signed AB 890 (WOOD), which created two new classifications for nurse practitioners (NP). While this measure was passed into law, this matter is far from settled, as the fight to ensure patient safety now moves into the regulatory process. All of CMA’s advocacy centers have prioritized this issue, developed an action plan, and are coordinating with the American Medical Association (AMA) as well as various specialty associations to ensure the bill is implemented in a manner that protects patients and physician practices.

BUDGET – ACCESS TO CARE California began this year with a strong economy, historic reserves and a projected surplus of $5.6 billion. Due to the COVID-19 pandemic, the state’s economy took a significant hit, which meant the Governor had to make several difficult decisions when revising his proposed budget in May. The Governor’s May Revision was a complete redrafting of the state budget proposal released on January 10, 2020.

In January, the budget proposal increased our state’s investment in health care, which included growing California’s physician workforce. The May Budget Revision, however, sought to reverse course, proposing to cut Proposition 56 funding for increased physician reimbursements, reduce patient benefits in Medi-Cal and strike all investments seeking to expand the physician workforce. Through the budget process in the Legislature, CMA was able to protect: •

$1.2 BILLION in Proposition 56 (tobacco tax) funding, which provides supplemental payments for physician and dental services, family health services, developmental screenings, non-emergency medical transportation and value-based payments. This includes the continuation of all future cohorts of the Proposition 56 Physician and Dentist Loan Repayment Program (years 2-5 of the 5-year program).

•

$1.5 MILLION in General Fund monies to maintain the Proposition 56 Graduate Medical Education program at an ongoing total of $40 million.

•

$33.3 MILLION in ongoing General Fund monies for the continuation of the Song-Brown Healthcare Workforce Training Program.

•

THE EXPANSION OF POST-PARTUM MENTAL HEALTH SERVICES for individuals diagnosed with a maternal mental health condition.

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Through the budget process in the Legislature, CMA was able to protect $1.2 billion in Proposition 56 (tobacco tax) funding, which provides supplemental payments for physician and dental services, family health services, developmental screenings, nonemergency medical transportation and value-based payments.

In addition, the revised budget proposal included a 47% increase to the Medical Board of California’s physician and surgeon licensing fee. Through CMA’s advocacy, the Legislature rejected that proposal. Still, the Legislature could revisit the discussion in 2021 when the Medical Board is subject to a review of all of its operations through the Sunset Review process. It is anticipated that the Medical Board will seek a license fee increase in the context of that process.

SURPRISE BILLING – AB 72 FIX Since the implementation of AB 72 (Bonta) related to surprise billing, CMA has been working with the Legislature to mitigate the negative impacts on the physician community. This year, AB 2157 (WOOD) was introduced to address the issues surrounding the independent dispute resolution process (IDRP). Along with several specialty societies, CMA was able to secure amendments that allowed physicians to provide more substantial evidence to better defend their claims during an AB 72 payment dispute. Through CMA’s advocacy in the legislative process and with the Department of Managed Health Care (DMHC) directly, an IDRP determination has been in the physician’s favor, a first since the law became effective. However, our work on this issue does not end there. CMA continues to work with regulators and legislators to further ensure a process that is fair and accessible to any physician needing to use it.

PUBLIC HEALTH Flavored tobacco products are often the entry point for young people who use tobacco. Over the last several years, a spike in e-cigarette use among the nation’s youth

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has been linked to targeted advertisements of flavored tobacco. Menthol cigarettes, sweet cigars, candy vapes and other flavored tobacco products serve one purpose: to mask tobacco’s harshness and get users hooked to a dangerous life-long addiction. In 2020, CMA combined forces with a large coalition of health care, youth and community organizations to support SB 793 (HILL), which prohibits tobacco retailers, or any tobacco retailers’ agents or employees, from selling, offering for sale, or possessing with the intent to sell or offer for sale, a flavored tobacco product or a tobacco product flavor enhancer. This ban includes e-cigarettes and vaping products, as well as traditional tobacco products. SB 793 crossed the legislative finish line and was quickly signed by Governor Newsom once it reached his desk. The new law will take effect on January 1, 2021.

DECREASING ADMINISTRATIVE BURDENS CMA worked with ASSEMBLYMEMBER LORENA GONZALEZ ON AB 2257 to further address challenges for physician practices resulting from a bill passed last year (AB 5) that made significant changes to the definitions of independent contractors and employees, in an attempt to be consistent with the court decision in the Dynamex case. Last year, AB 5 included an exemption for physicians, but there continued to be a need to address business-to-business and referral agency arrangements.

CMA successfully secured amendments to address those outstanding concerns, and the bill was signed into law.

CMA also helped lead a coalition to defeat SB 977 (MONNING), which sought to expand the California Attorney General’s existing authority related to mergers and acquisitions in the health care industry. Although CMA policy supports governmental actions designed to ensure hospital market competition, this broadly drafted legislation established a wide definition of health care transactions, which included leasing and other medical contracting arrangements. SB 977 ultimately failed to move off the Assembly floor.

CMA worked with Senator Dr. Richard Pan to exempt independent medical practices from the mandate, and secured physician involvement in future rulemaking and guidance on this issue and supply chain sustainability.

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In addition to the above, CMA worked with multiple legislative offices to stop the creation of new administrative burdens related to the COVID-19 pandemic. AB 685 (REYES) requires employers to provide written notification within 24 hours to their employees if they were potentially exposed, at the workplace, to a person who has COVID-19.

As this would have required physician practices to report this information daily, CMA secured amendments that exempted employees who conduct COVID-19 testing or screening or that provide direct care to individuals known to have tested positive for COVID-19. This approach balanced CMA’s support for notifying employees of possible exposure and protecting physician practices from being overburdened.

Senator Richard Pan, M.D., introduced legislation requiring the state and health care employers to procure a stockpile of personal protective equipment (PPE) as a means of addressing future equipment shortages like the one experienced at the outset of the pandemic. As introduced, the bill would have created a significant burden on independent physician practices. CMA worked with Dr. Pan to exempt independent medical practices from the mandate, and secured physician involvement in future rulemaking and guidance on this issue and supply chain sustainability.

IMPLEMENTING TELEHEALTH At the onset of the statewide public health emergency, CMA worked to build upon AB 744 (AGUIAR-CURRY, 2019), which required commercial health plans to implement payment parity for services provided via telehealth. An association-wide advocacy effort allowed CMA to secure widespread payor coverage across the entire health care system that required all commercial, Medi-Cal and workers’ compensation payors to immediately cover telehealth services at the same rate as in-person services. To achieve this outcome, CMA worked with each independent agency and department to ensure consistency between the DMHC and the Department of Health Care Services (DHCS) as well as the California Department of Insurance (CDI) and employers under the Department of Workers’ Compensation (DWC). Each agency continued to post updated guidance consistent with CMA’s input, and often referenced CMA’s sponsored telehealth legislation (AB 744) as their models.

CMA also advocated for the Governor to waive existing laws requiring consent prior to providing telehealth services. During the COVID-19 state of emergency, these waivers ensure that no enforcement action would be authorized against covered health care providers providing telehealth services via remote communication technologies that may not fully comply with these privacy laws. CMA was successful in receiving these waivers at the state and federal levels.

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DECREASING LIABILITY FOR MEDICAL PRACTICES CMA worked with a coalition of health care and other business organizations to defeat AB 2570 (STONE). This bill would have exposed physicians and their practices to frivolous lawsuits, making it more difficult for physicians to maintain the viability of their practices.

SCOPE OF PRACTICE As discussed earlier, ASSEMBLYMEMBER JIM WOOD’S AB 890 creates two new categories of nurse practitioners, who would be allowed to provide services without standardized procedures. Despite the fervent work of CMA, the AMA and numerous specialty societies, the bill passed the legislature and was enacted in law. The bill does not eliminate physician supervision and leaves room for interpretation regarding the role supervision can still play in the physician-NP relationship. It should also be noted that existing NPs are not impacted by AB 890 and must continue practicing under standardized procedures. In addition, the measure includes a delayed implementation of three years to allow for the completion of the regulatory process. A detailed factsheet on this bill can be found on the CMA website at cmadocs.org.

Despite this setback, the fight to protect patient safety will now roll into the regulatory process. CMA will continue to work in tandem with AMA and our grassroots network to keep physicians engaged on this issue.

UNCERTAINTY CONTINUES Although the 2019-2020 legislative session has finally concluded, uncertainty continues. In November, a new fiscal outlook will reveal whether the state budget is still facing a multi-billion shortfall. December will provide an idea of whether the Legislature will reopen the Capitol and allow for in-person lobbying. The political process will continue to be uncertain. However, there will be a consistent truth among all the unpredictable chaos: CMA will always be in the midst of every critical political and legislative battle, utilizing our resources to advance an agenda that protects physician practices and empowers the physician voice.

On the following pages, you will find details of the major bills that CMA followed this year.

In unity,

Janus L. Norman CMA Senior Vice President Centers for Government Relations and Political Operations

CMA will always be in the midst of every critical political and legislative battle, utilizing our resources to advance an agenda that protects physician practices and empowers the physician voice.

In other scope developments, CMA and the American College of Obstetricians and Gynecologists (ACOG) resolved a long-standing issue with the certified nursemidwives (CNM) through SB 1237 (DODD). This bill creates a framework for CNMs to perform certain functions within the scope of midwifery independently while maintaining a collaborative relationship with a physician and surgeon. The measure also includes a requirement for informed patient consent as well as patient outcome reporting requirements.

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PRIORITY BILLS

SUCCESSFULLY NEGOTIATED BILLS

AB 2157 (WOOD): HEALTH CARE COVERAGE: INDEPENDENT DISPUTE RESOLUTION PROCESS

AB 288 (CUNNINGHAM): CONSUMER PRIVACY: SOCIAL MEDIA COMPANIES

This bill codified fixes to the independent dispute resolution process under AB 72 (2015). Specifically, AB 2157 codifies a process by which all parties may submit confidential information to provide evidence for their claim in the IDRP that cannot be seen by the other party. Other provisions of the bill codify current regulations that the Department of Managed Health Care has already adopted because of CMA’s advocacy.

Status: Signed by the Governor (Chapter 278, Statutes of 2020).

SB 483 (PAN): DEPARTMENT OF MOTOR VEHICLES: RECORDS: CONFIDENTIALITY This bill would add public health officers to the list of public officials and employees whose home addresses are prohibited from disclosure in the records of the Department of Motor Vehicles. However, existing law already affords public health officers the same level of privacy as other elected officials, when it comes to the disclosure of personal information.

An existing program was identified that offers stronger protections than SB 483. The Safe at Home program, administered by the Secretary of State, shields the applicant’s home address from the public record. CMA advocated for the urgency of adding public health officials to the Safe at Home Program; Governor Newsom issued Executive Order N-80-20 to that effect. The order permits public health officials to participate in the Safe at Home address-confidentiality program, to reduce the kind of harassment many public health officials have been subject to in recent months.

Status: Implemented through Executive Order.

SB 793 (HILL): FLAVORED TOBACCO PRODUCTS CMA and a large coalition of health care, youth and community organizations supported SB 793. The new law will take effect January 1, 2021, and will prohibit retail stores and vending machines in California from selling flavored tobacco products.

Status: Signed by the Governor (Chapter 34, Statutes of 2020).

This bill would have allowed social media users to have their information permanently deleted by social media companies at their request. The definition used in the bill for “social media company” was broadly defined to include any entity providing electronic services and accounts; therefore CMA successfully negotiated an exemption for physicians and medical services to ensure they weren’t inadvertently captured under the legislation.

Status: Failed in the Assembly Privacy and Consumer Protection Committee.

AB 1131 (GLORIA): MEDI-CAL: COMPREHENSIVE MEDICATION MANAGEMENT This bill would have established comprehensive medication management (CMM) services as a covered benefit under the Medi-Cal program, and would have required CMM services to include the development of a care plan in collaboration with the beneficiary and the beneficiary’s health care providers to address identified medication therapy problems. CMA collaborated with the author and sponsors to limit the instances when pharmacists can perform CMM, to if the physician refers the patient due to specific criteria outlined in the bill.

Status: Failed in the Senate Appropriations Committee.

AB 1611 (CHIU): EMERGENCY HOSPITAL SERVICES: COSTS AB 1611 would have required a health care service plan contract or an insurance policy to provide that if an enrollee receives covered services from a non-contracted hospital, the enrollee or insured is prohibited from paying more than the same cost sharing that the enrollee would pay for the same covered services received from a contracting hospital.

The bill would have also required a health care service plan or insurer to pay a non-contracted hospital for emergency services (excluding post-stabilization services) rendered to an enrollee pursuant to the reasonable and customary value of the services provided. CMA secured amendments that would have ensured that the provisions of the bill did not apply to physicians and surgeons.

Status: Failed in the Senate Health Committee.

AB 1998 (LOW): DENTAL PRACTICE ACT: UNPROFESSIONAL CONDUCT This bill was introduced to ensure patient protections for

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Winter 2021

dental patients receiving services through telehealth from direct-to-consumer orthodontic businesses. Initially, the language required an in-person exam by a treating dentist prior to a patient receiving orthodontic therapy. Given the specific focus on providing orthodontic therapy through telehealth, CMA worked with the California Dental Association on amendments to this legislation that attached protections to the orthodontic standard of care, rather than the method of delivery or technology, consistent with CMA telehealth advocacy on behalf of physicians.

Status: Failed in Senate Business, Professions and Economic Development Committee.

AB 2014 (MAIENSCHEIN): MEDICAL MISCONDUCT: MISUSE OF SPERM, OVA, OR EMBRYOS: STATUTE OF LIMITATIONS AB 2014 would allow for prosecution, both civil and criminal, for crimes involving the unlawful use or implantation of sperm, ova, or embryos to be commenced within three years after the discovery of the offense. CMA secured amendments that remove the civil provisions of the bill and bring the statute of limitations in-line with MICRA to limit liability exposure.

Status: Signed by the Governor (Chapter 244, Statutes of 2020).

AB 2257 (GONZALEZ): WORKER CLASSIFICATION: EMPLOYEES AND INDEPENDENT CONTRACTORS: OCCUPATIONS: PROFESSIONAL SERVICES This bill, AB 2257 – previously AB 1850 – became the designated vehicle to clean-up last year’s AB 5, regarding Dynamex and independent contractors, acknowledging the need for additional clarifications to the now existing law. CMA received an exemption for physicians in last year’s Dynamex legislation (AB 5, Gonzalez). This year, CMA advocated for and secured language in this bill to better allow medical groups to continue contracting with other non-exempted medical provider practices. In particular, CMA received clean-up language in the physician exemption section from last year, as well as language better ensuring medical groups can utilize the existing business-tobusiness and referral agency exemptions in the bill. This bill included an urgency provision and has already been signed by the Governor; therefore these fixes are already in effect.

Status: Signed by the Governor (Chapter 38, Statutes of 2020).

AB 2273 (BLOOM): PHYSICIANS AND SURGEONS: FOREIGN MEDICAL GRADUATES: SPECIAL FACULTY PERMITS

Medical Centers like Cedars-Sinai to apply for and receive Special Faculty Permits (SFP) for physicians with specialized expertise by allowing these academic medical centers to directly apply for an SFP without changing any state licensing requirements or allowing a non-licensed California physician to practice outside of the current special permit requirements.

Status: Signed by the Governor (Chapter 280, Statutes of 2020).

AB 2276 (REYES): CHILDHOOD LEAD POISONING: SCREENING AND PREVENTION This bill seeks to improve blood lead screening for children enrolled in a Medi-Cal Managed Care Plan through increased accountability measures highlighted in a recent state audit. CMA obtained clarifying amendments to ensure the accountability rests squarely with the Medi-Cal Managed Care Plan and not physician practices.

Status: Signed by the Governor (Chapter 216, Statutes of 2020).

AB 2300 (COOPER): CALIFORNIA YOUTH FOOTBALL ACT This bill would authorize a certified emergency medical technician, state-licensed paramedic, or higher-level licensed medical professional to provide prehospital emergency medical care or rescue services consistent with their certification or license during a football game.

CMA worked with the author’s office to ensure that in cases where a player is removed from the game due to injury, they are not allowed to return unless evaluated by a licensed medical professional and receive written clearance to return to athletic activity.

Status: Signed by the Governor (Chapter 49, Statutes of 2020).

AB 3092 (WICKS): SEXUAL ASSAULT AND OTHER SEXUAL MISCONDUCT: STATUTES OF LIMITATIONS ON CIVIL ACTIONS This bill specifies that a civil action may be brought against any person or entity who owed a duty of care to the plaintiff for committing sexual assault or other criminal sexual conduct. The bill would also revive sexual misconduct claims, brought by or on behalf of a patient who suffered sexual misconduct at a student health center. The author took CMA’s amendments to narrowly tailor the bill to apply to victims of James Heaps at the University of California, Los Angeles. Amendments also limited the provisions to the dates at which James Heaps worked at UCLA. Status: Signed by the Governor (Chapter 246, Statutes of 2020).

This bill streamlines the process for Independent Academic

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AB 3330 (CALDERON): DEPARTMENT OF CONSUMER AFFAIRS: BOARDS: LICENSEES: REGULATORY FEES This bill increased the CURES licensing fee to fund the implementation of recently passed legislation related to the program – AB 149, AB 528, AB 1750, AB 1753, and SB 482. The budget process deferred action on a proposed 133% CURES fee increase, but negotiations were rekindled on the item with mere weeks remaining in the legislative session. CMA staff engaged to ensure the increase required was reasonable and justified. Ultimately the fee was negotiated down to $11 for two years, and $9 ongoing.

Status: Signed by the Governor (Chapter 359, Statutes of 2020).

SB 275 (PAN): HEALTH CARE AND ESSENTIAL WORKERS: PERSONAL PROTECTIVE EQUIPMENT In response to the current shortage of personal protective equipment, this legislation was introduced and initially focused around requiring stockpiles to mitigate such shortages during future emergencies. CMA strongly supports better PPE access and long-term solutions to efficiency focused supply chain management as the focus for necessary, but largely commoditized, products like masks, gowns and gloves. However, without that access and those solutions currently in place, CMA worked with the author and sponsor to make sure independent physician practices were explicitly removed from the health care employer and provider stockpile mandates in the bill.

Status: Signed by the Governor (Chapter 301, Statutes of 2020).

SB 855 (WIENER): HEALTH COVERAGE: MENTAL HEALTH OR SUBSTANCE USE DISORDERS Require a health care service plan or health insurer, on and after January 1, 2021, to provide coverage for the diagnosis and medically necessary treatment of mental health and substance use disorders in the same manner as other medical conditions and not limit coverage to short-term or acute treatment. CMA secured amendments that removed the ability for class action lawsuits to be more easily brought by patients against physicians and plans, limited the ability of health plans to recoup money for services already paid for by the plans, and protected the ability of physicians to advocate on behalf of their patients when determining what is medically necessary during the course of a patient’s treatment.

Status: Signed by the Governor (Chapter 151, Statutes of 2020).

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SB 1123 (CHANG): ELDER AND DEPENDENT ADULT ABUSE This bill brings parity for elder and dependent abuse in both the Penal Code and the Welfare and Institutions Code (WIC). Specifically, the Penal Code lacked definitions of physical, mental, and emotional abuse which were found in the WIC. CMA secured amendments that ensured the language that was added in the Penal Code was identical to that found in the WIC and did not inadvertently expose physicians to further liability.

Status: Signed by the Governor (Chapter 247, Statutes of 2020).

SB 1237 (DODD): NURSE-MIDWIVES: SCOPE OF PRACTICE SB 1237 is a measure which allows certified nurse midwives to independently practice midwifery to the full extent of their license without removing the requirement for collaborative relationship between a certified midwife and a physician.

CMA worked with ACOG, the California Nurse-Midwives Association, and Senator Dodd’s office to craft language which would appropriately define their scope without physician collaboration, how and when collaboration with a physician is necessary, and when it is necessary to transfer care to a physician. This bill maintains critical patient safeguards by requiring a certified nurse midwife have an established agreement in place with a physician (mutually agreed upon protocols and procedures) if they provide any services to patients which fall outside of the scope of midwifery. If they choose not to have an agreement with a physician, the midwife cannot provide those services and must transfer the care of the patient to a physician.

Status: Signed by the Governor (Chapter 88, Statutes of 2020).

OPPOSED BILLS AB 503 (FLORA): GUN-FREE SCHOOL ZONE This bill would have allowed an individual who holds a concealed carry license to carry their firearm in a church, synagogue or other place of worship, and on the grounds of a public or private school with permission from the school.

Status: Failed in the Assembly Public Safety Committee.

AB 780 (BROUGH): HEARING AID DISPENSERS: PRACTICE: CERUMEN MANAGEMENT: APPRENTICE LICENSE AB 780 sought to expand the scope of practice for hearing aid dispensers to include tympanometry and cerumen management. AB 780 also would have removed continuing education requirements and an exam related to

Winter 2021

tympanometry, created an “advanced practice certificate,” and added in supervision by a mentor or trainer.

Status: Failed in the Assembly Appropriations Committee.

AB 888 (LOW): OPIOID PRESCRIPTIONS: INFORMATION: NONPHARMACOLOGICAL TREATMENTS FOR PAIN This bill would have required a prescriber to offer patients receiving opioids a referral to a non-pharmacological treatment provider such as a chiropractor or acupuncturist.

AB 888 also sought to make prescribers obtain written, informed consent from patients receiving an opioid with specific informed consent language.

Status: Failed in the Senate Business, Professions and Economic Development.

AB 890 (WOOD): NURSE PRACTITIONERS: SCOPE OF PRACTICE: PRACTICE WITHOUT STANDARDIZED PROCEDURES AB 890 created two new types of nurse practitioners who would be allowed to perform certain functions without standardized procedures. The law specifies the education, training, testing, regulatory and governance requirements for these new NPs, including the circumstances in which an NP must consult with or refer patients to a physician. Significant provisions of AB 890 are ambiguous, necessitating additional clarification and guidance from regulators.

Though the law will be enacted in the fall of 2020, full implementation and training of these new categories of nurse practitioners will not happen until the required regulations and guidance are approved by state regulators.

Status: Signed by the Governor (Chapter 265, Statutes of 2020).

AB 1909 (GONZALEZ): HEALING ARTS LICENSEES: VIRGINITY EXAMINATIONS OR TESTS This bill would have prohibited a healing arts licensee from performing an examination or test on a patient for the purpose of determining whether the patient is a virgin.

The bill would have also made a violation of its provisions deemed as unprofessional conduct and grounds for disciplinary action by the licensing board for the healing arts licensee.

Status: Failed in the Assembly Business and Professions Committee.

AB 1933 (MAIENSCHEIN): PUPIL HEALTH: SUDDEN CARDIAC ARREST: ATHLETIC ACTIVITIES

parent or guardian to request the administration of an electrocardiogram as part of the pupil’s evaluation for purposes of being permitted to return to participate in an athletic activity. CMA was negotiating amendments with the author when the bill was held in Committee.

Status: Failed in the Assembly Education Committee.

AB 2204 (ARAMBULA): HEALTH CARE COVERAGE: SEXUALLY TRANSMITTED DISEASES AB 2204 would have required health plans and insurers, beginning January 1, 2021, to provide coverage for sexually transmitted disease testing and treatment at a contracting or noncontracting health facility at the same cost-sharing rate an enrollee or insured would pay for the same services received from a contracting health facility.

Status: Failed in the Assembly Health Committee.

AB 2242 (LEVINE): MENTAL HEALTH SERVICES AB 2242 would have required a health care service plan or insurer to approve the provision of mental health services for enrollees under the plan who are detained for 72-hour treatment and evaluation. Additionally, the bill would have required that health plan to schedule an inpatient appointment for the patient within 48 hours of the patient’s release from detention and would have prohibited a noncontracting provider from billing the patient more than the cost-sharing amount the patient would pay to a contracting provider. CMA was negotiating amendments with the author when the bill was held in Committee.

Status: Failed in the Assembly Health Committee.

AB 2417 (PATTERSON): MATERNAL MENTAL HEALTH: BEREAVED MOTHERS This bill would require that education and information to be made available to bereaved mothers. The bill would define a bereaved mother as one who has experienced a miscarriage, stillbirth, or fatal fetal diagnosis. CMA opposed the bill given the additional requirements placed on physicians who care for women in settings other than the hospital to develop a program. Patients who have difficulty with miscarriage are already screened for depression in the outpatient setting and referred for services. Additionally, this bill is similar to legislation that has been introduced throughout the country by the anti-abortion lobby as a strategy to potentially expand the definition of personhood to limit access to reproductive care.

Status: Failed in the Assembly Health Committee.

This bill would have authorized a student or the student’s

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AB 2418 (PATTERSON): PERINATAL HOSPICE This bill sought to require the Department of Public Health to collect information regarding perinatal hospice and make it available to patients, providers, and hospitals.

This is legislation that has been introduced throughout the country by the anti-abortion lobby as a strategy to potentially expand the definition of personhood to limit access to reproductive care. CMA opposed the bill given it would interfere with patient/physician communications concerning reproductive health care and go against CMA policy supporting continued patient access to reproductive health care (HOD 617a-00).

Status: Failed in the Assembly Health Committee.

AB 2515 (NAZARIAN): CONTINUING MEDICAL EDUCATION: GERIATRIC MEDICINE This bill would take the current requirement in statute for general internists and family physicians who have a patient population of which 25% are 65 and older to complete at least 20% of all mandatory CME hours in a course related to geriatric medicine or the care of older patients and changes the percentage to at least 10% of patients who are 50 years of age and older.

Status: Failed in the Assembly Business and Professions Committee.

AB 2570 (STONE, MARK): FALSE CLAIMS ACT This bill would have exposed physicians and their practices to all kinds of frivolous lawsuits by allowing the materiality of a false record or statement charge to “focus on” the potential effect (as opposed to the actual effect) of the false record or statement when the record or statement was made. The bill would also specify that that amount of damages that may be awarded include consequential damages. CMA, along with a coalition of health care and business organizations, stopped the bill in the Senate Judiciary Committee.

Status: Failed in the Senate Judiciary Committee.

AB 2786 (NAZARIAN): HOSPITAL EMERGENCY DEPARTMENTS: HIV TESTING AB 2786 would have required the Department of Public Health to develop protocols for emergency departments to implement and would have required those departments to integrate an opt-out HIV testing program for their patients into their standard of care. This bill was held in the Assembly Health Committee.

Status: Failed in the Assembly Health Committee.

AB 2801 (OBERNOLTE): SEARCH WARRANTS: SEXUALLY TRANSMITTED INFECTION TESTING This bill would have expanded the testing that a court may order of an accused individual to include testing of additional bodily fluids for any sexually transmitted disease.

The bill would have also enabled a parent or guardian, if the victim is a minor, or an authorized representative of the victim to exercise the victim’s rights in terms of disclosure regarding sexually transmitted disease testing.

Status: Failed in the Assembly Public Safety Committee.

AB 2817 (WOOD): OFFICE OF HEALTH CARE QUALITY AND AFFORDABILITY AB 2817 would have created the Office of Health Care Quality and Affordability to analyze the health care market for cost trends and drivers of spending and create a strategy to control health care costs, including through the use of growth targets the state and each sector and entity of the health care delivery system would need to comply with.

The Office would also be given broad authority over data collection and analysis and mergers and acquisitions of all health care entities under its jurisdiction. The conversation around cost and affordability transferred over to the budget process where the fiscal realities of the state stopped the idea from moving forward.

Status: Failed in the Assembly Health Committee.

AB 2830 (WOOD): HEALTH CARE PAYMENTS DATA PROGRAM This bill would have implemented a new expansive state program for the collection and analysis of health care cost, equity, and quality information. Due to the budgetary impacts of the bill, the conversation shifted to the budget process and was addressed in AB 80. The proposal adopted in the State budget was consistent with CMA policy on the collection of health care information and our position on the creation of the All-Payors Database.

Status: Failed in the Senate Health Committee.

SB 201 (WIENER): MEDICAL PROCEDURES: TREATMENT OR INTERVENTION: SEX CHARACTERISTICS OF A MINOR SB 201 would have prohibited a physician from performing any treatment or procedure on the sex characteristics of an intersex minor until the minor patient provides informed consent to the physician. The bill makes an exception for any procedure or treatment that is deemed medically necessary, which is defined in such a way that cannot properly address the complexity of such cases.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

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Winter 2021

SB 977 (MONNING): HEALTH CARE SYSTEM CONSOLIDATION: ATTORNEY GENERAL APPROVAL AND ENFORCEMENT To address concerns around health care consolidation and impacts on access and affordability, this bill expanded the Attorney General’s existing oversight authority related to mergers and acquisitions involving nonprofit entities. CMA policy supports governmental actions designed to assure hospital market competition and assure quality of care, including the authority to disapprove hospital mergers and acquisitions whenever such transactions are expected to have negative consequences on affordability and/or quality of care (HOD 617a-00). However, this legislation was drafted as an overbroad approach that would subject a vast array of healthcare transactions – including leasing and other physician contracting arrangements – subject to the AG’s approval. Enacting this legislation during a public health emergency and economic crisis would have only further restricted the additional flexibility and resources CMA is working to ensure for struggling physician practices.

Status: Failed on the Assembly Floor.

SB 1084 (UMBERG): PHARMACY: DISPENSING: CONTROLLED SUBSTANCES This bill would have required a pharmacist who dispenses in solid oral dosage form a controlled substance in Schedule II or Schedule III of the federal Controlled Substances Act to dispense it in a lockable vial, provide an educational pamphlet on controlled substances, and, if the lockable vial uses an alphanumeric or other code, include the code in any patient notes in the database or other system used by the pharmacy in the dispensing of prescription drugs. The patient or patient’s legal guardian would choose the code.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

SB 1097 (DURAZO): MEDICAL SERVICES: CREDIT OR LOAN SB 1097 would have made it more difficult for physicians to arrange for loan options for patients after receiving medical services. CMA was negotiating amendments with the author when the bill was held in committee.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

SB 1252 (MOORLACH): ADVANCE HEALTH CARE DIRECTIVES: MENTAL HEALTH TREATMENT

Advance Health Care Directives, creating opportunity for an argument that mental health treatment is somehow not included under other sections of law that refer to health care generally.

Status: Failed in the Senate Judiciary Committee.

SB 1265 (DAHLE): COMPREHENSIVE SEXUAL HEALTH EDUCATION AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION EDUCATION This bill would have required the sexual health education and HIV prevention instruction notice to parents and guardians of pupils and the written and audiovisual educational materials used in comprehensive sexual health education and HIV prevention education to be translated if certain conditions are met, as specified.

Status: Failed in the Senate Education Committee.

SB 1394 (MORRELL): COMPREHENSIVE SEXUAL HEALTH EDUCATION AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION EDUCATION This bill would have authorized a school district to require active parental consent (“opt-in”) with a signature for any sexual health education and HIV prevention education for a pupil in a grade lower than grade 7.

Status: Failed in the Senate Education Committee.

SB 1407 (MOORLACH): VACCINE INJURY: INFORMATIONAL MATERIALS This bill would have required the State Department of Public Health to develop and make available to licensed physicians and surgeons written materials identifying specified federal resources on vaccine warnings, injuries, and deaths. The bill would have also required a physician and surgeon to provide those materials to a child’s parent or guardian before or at an appointment at which a vaccine is to be administered.

Status: Failed in the Senate Health Committee.

SCR 93 (MELENDEZ): STATE OF EMERGENCY: COVID-19: TERMINATION This resolution would have declared that the state of emergency proclaimed by the Governor on March 4, 2020, is at an end, thereby terminating the emergency powers granted to the Governor as a result of that proclamation.

Status: Failed in the Senate Rules Committee.

This bill explicitly added mental health treatment to the definition of health care decisions for purposes of

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Public Health

Update

Volunteers Needed to Give COVID-19 Vaccinations

Physicians, nurses, medical assistants, and other medical personnel are needed for Point of Dispensing (PODs) to provide COVID vaccinations for the Public Health Department.

Go to https://www.healthcarevolunteers.ca.gov to register.

Be certain to specify either San Luis Obispo County Medical Reserve Corps or Santa Barbara County Medical Reserve Corps.

San Luis Obispo County Medical Reserve Corps www.slocounty.ca.gov/mrc Santa Barbara County Medical Reserve Corps www.countyofsb.org/phd/ems/mrc-home.sbc

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Winter 2021

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CL

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F I S IE S A

POSITIONS AVAILABLE

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-job-opportunities.

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

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. Physician openings can be found at www.tenethealth.com/for-physicians/ physician-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. Physician openings can be found at www.slocounty.ca.gov.

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

SPACE AVAILABLE

Beautiful MEDICAL OFFICE for rent, 216 W Pueblo, near Cottage Hospital. $4500/mo, water and trash service included. NOT TRIPLE NET. Good sized parking lot.

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

Listings are free for members with reasonable rates for nonmembers.

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Winter 2021

Feel More Empowered in Just 30 Minutes Struggling to find balance in your work and personal life amid the pandemic?

Frustrated, angry or anxious that public health guidelines are ignored while COVID-19 remains prevalent?

Experiencing racial or social injustice?

Worried about your financial stability?

Feeling burned out, unable to sleep or wishing you could just talk to someone who understands?

Did you have an emotional response as you read these questions?

It’s okay. CMA Wellness understands.

The California Medical Association’s wellness initiative (CMA Wellness) supports the well-being of the state’s health care workers with free and confidential peer coaching. Through Care 4 Caregivers Now (C4CN), clinicians will: Partner with a trained peer coach for free and confidential virtual sessions (via Zoom) that are held weekly for 30 minutes (no mandated reporting requirement) Receive emotional support to feel calmer, more focused and in control Find clarity and peace to better plan for the future Our trained coaches are fellow clinicians who understand the rigors and emotional stresses of the profession and know the value of a safe, confidential and non-judgmental space.

Coaching is available for physicians (M.D. and D.O.), physician assistants, nurse practitioners, registered nurses, certified respiratory therapists, registered respiratory therapists, residents/fellows, medical students, public health officers and medical reserve corps volunteers.

Sign up to receive support today at care4caregiversnow.org or contact us directly at cmawellness@wellphysicianca.org.

Winter 2021

CENTRAL COAST PHYSICIANS

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

...and even more on the way.

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Chadler Burgoyne, MD Orthopaedic Surgery Santa Barbara Sansum Clinic 805.681.7584

Kristin Fontes, MD Emergency Medicine Santa Barbara 805.682.7111

Gayle Cekada, MD Internal Medicine San Luis Obispo 805.903.1391

Maryam Guiahi, MD, MSc Obstetrics and Gynecology Santa Barbara Planned Parenthood California Central Coast 805.963.2445

Steve Clarke, MD Family Medicine Santa Maria Community Health Centers of the Central Coast 805.361.8073

Kateryna Markova, MD Endocrinology, Diabetes, and Metabolism Santa Barbara Sansum Clinic 805.681.7820

Douglas Duncan, MD, MPH Family Medicine Santa Barbara Santa Barbara County Public Health Department 805.568.2099

Shane Rostermundt, DO Pediatrics Santa Maria Pediatric Medical Group of Santa Maria 805.922.3548

Lynn Fitzgibbons, MD Infectious Disease Santa Barbara 805.569.7315

Pansy Tsang, MD Internal Medicine Santa Barbara Sansum Clinic 805.681.7602

CENTRAL COAST PHYSICIANS

Winter 2021

I SI N T R E V D A

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In Memoriam

In Memoriam DAVID HARRIS, MD

1948 - 2020 Dr. David Lloyd Harris, 72, passed away peacefully surrounded by his children on September 26, 2020.

He was born in San Diego in 1948 and lived most of his young life in Oceanside. Growing up, he worked in the family radiator business, Harris Radiator, and developed a lifelong love of the sea through sailing and surfing. David later attended CSU Long Beach, where he matriculated his BS in Zoology.

David’s love of adventure and international travel emerged when he moved to Manila, the Philippines, for 5 years to complete Medical School at the University of the East, Ramon Magsaysay College of Medicine. He then returned to the US to complete his residency at Cottage Hospital in Santa Barbara. It was during this time that he met his future wife Annchen and began a 45-year love of the Central Coast.

While the Central Coast was home, David was a worldwide traveler, and enjoyed sharing stories about his time in Australia, Europe, Asia, and many far-flung places. During these trips, he delighted not only in the new sights and surroundings, but in the new people he was able to meet. He made many good friends on these travels, with whom he maintained close contact with for the rest of his life.

David worked in private medical practice for 25 years, then for 15 years at Cal Poly San Luis Obispo,

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eventually serving as the Executive Director for Health and Counseling Services. He always considered it one of the great honors of his life to bring compassion and healing to so many during his medical career, and he was widely respected by both his patients and his coworkers.

David’s legacy is one of multitudes, but he will be consistently remembered for his kindness, generosity, and genuine spirit. His hope and lack of cynicism is something that all who loved him hope to take forward into the future.

David is survived by his two children, Ariana & Morgan Harris, former wife Annchen Harris, his sister Sally Harris, and niece Jena Harris.

Adapted from the San Luis Obispo Tribune

SPENCER KULICK, MD

1944-2020 Dr. Spencer Kulick passed on September 5, 2020.

Spencer Lee Kulick was born in South Dakota but grew up in New York City. He received his undergraduate education at the University of Michigan, and he attended medical school at the State University New York Downstate. He completed his residency in Internal Medicine at the Mt. Sinai Medical Center in New York City and then started his fellowship in cardiology at Cornell Medical Center. His training was interrupted by service to his country. He served a twoyear tour of duty as a major in the U.S. Army Medical Corps at Fort Ord, California and in South Korea.

He completed his training in cardiology at the University of California, San Francisco Medical Center,

Winter 2021

In Memoriam

and the San Francisco VA Medical Center. He started his cardiology practice in San Luis Obispo in 1976, where he practiced until his retirement from the Coastal Cardiology medical group in 2013.

Spencer was a talented, brilliant, and compassionate physician and cardiologist. He had broad experience in all aspects of cardiac disease but held a special interest in congestive heart failure. He had trained under luminaries in cardiology including Thomas Killip III, MD. Spencer was an iconic figure in our community. He had a wry sense of humor, a broad range of interests and was well informed and educated in many subjects. He was as talented at diagnosing a difficult cardiac problem or negotiating a business transaction as he was at welding or repairing something mechanical.

His interests included competitive target shooting, for which he won many awards as a marksman, working in his home machine shop, and SCUBA diving. He loved to collect, repair and discharge firearms, communicate on his HAM radio and, later in life, travelling the world on ocean cruises with his wife.

Spencer was larger than life for most of us—a mentor, a friend, and a wealth of entertainment. His anecdotes and witty quips will be remembered and quoted for a long time to come.

Spencer survived by his wife, Christine, and his two sons, Aaron and Benjamin.

SCOTT SMELSER, MD

1964 - 2020 Dr. Scott Randall Smelser died on August 20, 2020, at the age of 56 years. He passed in a hospital bed in Kentfield, California, surrounded and held by his immediate family members: his mother and father (Joan Phyllis Smelser

Winter 2021

and Lee Frank Smelser), his two brothers (Ronald Lee Smelser and Steven Douglas Smelser), his three daughters (Annalise Janelle Smelser, Kristina Tamiko Smelser, Sabrina Renae Smelser), and his wife of 25 years, Julie Nakao Smelser.

Scott was born in Glendale, California, on May 30, 1964. He attended Hart High School and UC Irvine for undergrad. In 1990, he graduated from UCSD medical school and, after a year of internship in internal medicine at Cedars Sinai, moved to attend anesthesia residency at UCSF where he met his wife on their first day of training.

After completing their residency, Scott and Julie were married. In 1995, they moved to San Luis Obispo to begin their careers and family. Both Scott and Julie began work at French Hospital and later expanded their services to many other area hospitals as founding members of the newly formed Coastal Anesthesia Medical Associates (CAMA). Scott practiced with CAMA for the remainder of his career.

Scott’s home life, the space he took most joy in, revolved around raising his three kids. He attended every landmark event, big or small, in his daughters’ lives as often as he could. He was the loudest fan in the soccer, basketball, and gymnastics stands, the steadiest hand behind the family video camera, and the ever present voice of reason, love, and reassurance in his phone-calls, letters, and dinner table conversations.

Scott found fulfillment in bike riding both on the road and in the mountains, working in his garden, staying politically informed, reading, constantly learning outside and within his domain of professional expertise, passionately watching professional sports, listening to ‘70s rock and hip hop, and spending evenings with friends and family. His endless humility, patience, generosity with his time, and commitment to listening well made him an ideal friend and partner and family member.

Adapted from the San Luis Obispo Tribune

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

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Virtual

The Painted Cabernet

Tuesday, March 30 6:00 - 8:00 pm RSVP ccmahealth.org/events