Central Coast Physicians Winter 2023

WINTER 2023

2022 LEGISLATIVE

WRAP-UP 151st Annual House of Delegates Physician-Peer Relationships Visiting Professor of Surgery

TOPICS AND SPEAKERS: Interventional Cardiology Update Joseph Aragon, MD, FACC, FSCAI Contemporary Approach to Diagnosis and Management of HCM Martin Maron, MD

THIRD ANNUAL

Cardiology Symposium Healing the Heart Friday, February 24, 2023 Hilton Santa Barbara Beachfront Resort Virtual tickets will also be available This symposium is designed for cardiologists, cardiac surgeons, physicians in training, registered nurses, nurse practitioners, family practice/internal medicine physicians, hospitalists, physician assistants, cardiology technologists, and other healthcare practitioners involved in the care planning of patients with cardiovascular disease.

Complex Thoracic Aortic Arch Repair- Endovascular and Open Options William Brinkman, MD KEYNOTE PRESENTATION The Lifetime Management of Aortic Stenosis Michael J Reardon, MD Nutrition, the Microbiome and Cardiovascular Mortality Kim Allan Williams, Sr., MD, MACC, FAHA, MASNC, FESC Direct and Indirect Effects of COVID-19 on Cardiovascular Disease Timothy D. Henry, MD, FACC, MSCAI Venous Ethanol Ablation of Cardiac Arrhythmias Miguel Valderrabano, MD, PhD Women and Ischemic Heart Disease: Update 2023 C Noel Bairey Merz, MD, FACC, FAHA, FESC Heart Failure Management Michelle Kittleson, MD, PhD Update on SCAD (Spontaneous Coronary Artery Dissection) Jacqueline Saw, MD

Registration required: cottaghealth.org/healingtheheart 2

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Winter 2023

VOLUME 8, NUMBER 1 • WINTER 2023

{FEATURES}

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LEGISLATIVE WRAP-UP SPINE CLINIC VISITING PROFESSOR PEER RELATIONSHIPS

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CENCAL HEALTH NEWS

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RISK TIP

21 CLASSIFIEDS 40 IN MEMORIAM 43 NEW MEMBERS

HOUSE OF DELEGATES CMA EVENTS

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plan, you can be a member for less than the price of a daily cup of coffee!

Letter from the CEO

SIGN UP AT www.cmadocs.org/join

AN EVENT-FULL 2023 While COVID is still prevalent, we’ve learned to live with its presence, and in 2023 CCMA is planning numerous events, many of which will be in person. We will offer some educational webinars regarding OSHA and Medicare, and others will be brought to you by The Doctors Company and their expert staff. Our in-person events include happy hour socials in the first three quarters, and we’ll cap off the year with DANA GOBA our popular Annual Membership Celebration where we will honor our 2023 Physician of the Year.

We are looking forward to providing the opportunity for physicians to connect with each other and focus on relationships, which helped us get through these past few years. Humans look to social units to provide them with a sense of community, and CCMA works to create a physician community on the central coast.

All physicians are welcome to attend our events, both members and nonmembers.

At our events, we hope nonmembers will learn the value of membership and join the medical association. We continuously strive to protect your practice and patients, and many successes are included in this issue of our magazine.

If you are not a member, you can become part of the CCMA community by joining at www.cmanet.org/join or by calling 800.786.4262.

PRESIDENT Julie Fallon, MD PRESIDENT ELECT Douglas Murphy, MD TREASURER Todd Engstrom, MD SECRETARY Rachel May, MD IMMEDIATE PAST PRESIDENT Samira Kayumi-Rashti, MD DIRECTORS Kevin Casey, MD; Michael DiBiase, MD; Priti Gagneja, MD; Jennifer Hone, MD; Bindu Kamal, MD; Christopher Quijano, DO; Rahim Raoufi, MD; Daniel Roshan, MD CHIEF EXECUTIVE OFFICER Dana Goba, MBA CMA HOUSE OF DELEGATES REPRESENTATIVES Sharon Basham, MD; Edward Bentley, MD; Kevin Casey, MD; David Dodson, MD; Julie Fallon, MD; Priti Gagneja, MD; Jennifer Hone, MD; Samira Kayumi-Rashti, MD; Christopher Lumsdaine, MD; Douglas Murphy, MD; Joseph Schwartz, MD CMA DISTRICT V TRUSTEE Rene’ Bravo, MD CENTRAL COAST PHYSICIANS MAGAZINE EDITOR Julie Fallon, MD MANAGING EDITOR Dana Goba, MBA CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS California Medical Association; CenCal Health; The Doctors Company; Maximilian J. Pany, BA; J. Michael McWilliams, MD, PhD; Janice Rocco; Sansum Clinic; Tenet Health Central Coast CONTRIBUTING PHOTOGRAPHERS California Medical Association, CenCal Health, Sansum Clinic, Tenet Health Central Coast SUGGESTIONS, story ideas, or completed stories written by current Central Coast Medical Association members are

I look forward to seeing you at our 2023 events.

Sincerely,

welcome. Opinions expressed by authors are their own and not necessarily those of the CCMA. CCMA reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

PLEASE DIRECT EDITORIAL INQUIRIES AND SUBMISSIONS TO: Central Coast Physicians 100 N Hope Ave, Ste 14

Dana Goba Chief Executive Officer Central Coast Medical Association

Santa Barbara, CA 93110 T 805.683.5333 • F 805.364.5431 E magazine@ccmahealth.org ADVERTISING rates and information sent upon request.

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

A COMPONENT OF THE

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Winter 2023

New Advanced Technology to Detect Bladder Cancer Tenet Health Central Coast Sierra Vista Regional Medical Center now offers Blue Light Cystoscopy with Cysview®, an advanced technology for detecting bladder tumors that are too small to find with standard cystoscopy. If you know or suspect that a patient has bladder cancer, Cysview is a minimally invasive procedure that can detect bladder cancer cells. Benefits include: Better inspection of the bladder for cancer, especially small or flat tumors ■ Better removal of bladder tumors when they are first discovered ■ Fewer recurrences of bladder cancer ■ Improved information for planning future care for bladder cancer ■

Sierra Vista Regional Medical Center is the only healthcare organization in San Luis Obispo County to offer Blue Light Cystoscopy with Cysview.

Scan code to learn more.

Winter 2023

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$7.3M Payout Rewards Physician Excellence in Healthcare on Central Coast CenCal Health’s provider incentive program supports quality of care for Medi-Cal members In March of last year, CenCal Health launched the Quality Care Incentive Program (QCIP) to maximize the quality of care for its health plan members on the Central Coast.

QCIP is a value-based incentive program that directly rewards plan providers who deliver exceptional medical care in their community. After nine months, the innovative

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initiative resulted in a distribution of over $7 million in payments to participating primary care providers (PCPs).

QCIP emphasizes the clinical priorities of significance to CenCal Health members, such as diabetes and asthma care, breast cancer and cervical cancer screenings, and child and adolescent well-care visits. In Santa Barbara and San Luis Obispo counties, CenCal Health is the Medi-Cal plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to more than 225,000 members.

Winter 2023

Replacing five different incentive programs previously utilized, the single integrated QCIP more extensively supports PCPs to achieve excellence in quality care. Performance is measured monthly and follows pre-defined, industry-standard measurement specifications maintained by the National Committee for Quality Assurance (NCQA).

To promote health equity, QCIP payments are also tied to the diversity of member patients managed by each PCP; as such, payments increase to reflect the proportion of members of greater clinical complexity, for example, the aged or those disabled.

In July 2022, CenCal Health distributed over $3.5 million in QCIP payments to 85 eligible PCPs, marking the first payment for the recently launched pay-for-performance program. In October, the second payout – totaling $3,751,527 – was distributed to 86 PCPs in Santa Barbara and San Luis Obispo counties.

endorsed standard for quality measurement in managed care, the NCQA HEDIS® Volume 2 Technical Specifications.

To monitor progress, PCPs receive monthly performance reports and actionable gaps in care data through CenCal Health’s secure provider portal. No measures used in CenCal Health’s payment calculations encourage withholding of services. Payments are distributed quarterly.

To implement QCIP, CenCal Health’s quality management team, under the direction of Quality Officer Carlos Hernandez, collaborated with all internal departments at the local health With a vision to be a trusted leader in advancing plan, and external organizations such health equity so that the communities we serve as the California thrive and achieve optimal health, CenCal Health Department of Health invites the public to review its 2023-2025 Strategic Care Services, as well as several representative Plan at www.cencalhealth.org/strategicplan. primary care providers.

“QCIP is an innovative value-based incentive program,” said CenCal Health CEO Marina Owen. “As a community-based health plan, we are committed to supporting local providers through programs such as this one.”

In 2003, the Centers for Medicare & Medicaid Services established pay-for-performance initiatives to control healthcare costs and to increase access to care by encouraging more physicians to participate in Medicaid health plans.

More recently, incentive programs have evolved to emphasize quality of care, especially the prevention and management of chronic conditions.

“This incentive program relies on longstanding commitment and participation from our primary care provider partners, which, I’m proud to report, is in abundance,” said Hernandez.

“An exemplary example is Dr. Jeffrey Kaplan, who has demonstrated a track record of extraordinary QCIP performance. Dr. Kaplan’s performance was especially exceptional for pediatric preventive care well-child visits.”

Jeffrey S. Kaplan, MD (pictured) is a pediatrician in Santa Maria, in practice for over two decades. “QCIP is unique, in that the incentives offered only promote increased use of services, aligned with widely accepted, evidence-based treatment recommendations,” said Kaplan.

More information on the Quality Care Incentive Program and CenCal Health is available at cencalhealth.org.

QCIP was designed to encourage increased utilization of evidence-based treatment, screening, and preventive health services. The program encompasses five clinical categories of care – Women’s Health, Pediatric Care, Behavioral Health, Respiratory Care, and Diabetes Care – using the most widely

Winter 2023

CENTRAL COAST PHYSICIANS

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CENTRAL COAST PHYSICIANS

RISK TIP The Doctors Company, the nation’s largest physician-owned medical malpractice insurer and part of TDC Group, is offering a new lecture series, “Financial and Workplace Well-Being for Doctors: Lessons for Life After Medical School,” from Ronald H. Wender, MD, FACA, Chairman Emeritus and Professor of Anesthesiology at Cedars-Sinai Medical Center and member of The Doctors Company Board of Governors.

The 23-part video series is free of charge and provides renowned experts’ advice about the realities of financial planning, medical malpractice, and hospital economics encountered upon graduating medical school.

The average medical school graduate owes $241,600 in total student loan debt—six times as much as the average college graduate.

“The Doctors Company is proud to partner with Cedars-Sinai Medical Center to offer this lecture series to newly practicing physicians,” said Richard E. Anderson, MD, FACP, Chairman and CEO of The Doctors Company and TDC Group. “It is in our mission to serve those who provide care, and we anticipate all physicians will find this series valuable.”

Winter 2023

In a study published last September, the “International Journal of Medical Education” found that medical residents and fellows have high debt and low levels of financial literacy. A California Medical Association survey in 2021 found that 64 percent of physicians expressed a need for financial assistance, and 95 percent of physician practices reported concern about their financial well-being.

Hyperbaric Chamber Wound Care (HBOT) Has Arrived on the Central Coast!

100% pure oxygen treatment accelerates wound healing and recovery by up to 75%

“When you leave medical school, you need to be prepared for managing debt, finances, and patients who may sue you; we want medical providers to be ready for these harsh realities,” said Dr. Wender. “In my forty-six years of practice, I saw many healthcare providers overwhelmed with life challenges. I hope this will be a useful resource for new physicians in their future endeavors.”

Find all these insights at thedoctors.com/aftermedschool.

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

Have a wound that won’t heal, a surgical incision that has become infected, wounds from diabetic complications or radiation therapy, CCWC wound care specialists can help.

Central Coast Wound Care and Hyperbarics is led by Dr. Steve Sabo, a wound care physician with over two decades of experience.

Contact us today to find out more about our state-of-the-art Hyperbaric chamber wound care treatments.

ccwounds.com

Winter 2023

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In a year where the world was starting to return to “normal,” the California Medical Association (CMA) seized the opportunity to make big gains for physician practices in several areas, from modernizing crucial malpractice legislation, preserving reproductive rights and encouraging grassroots engagement. This year’s achievements include:

MICRA Modernization Facing another statewide ballot proposition that would have effectively eliminated MICRA’s cap on non-economic damages, CMA and Californians Allied for Patient Protection seized an opportunity to end one of the longest running political battles in California. The legislative deal (AB 35), which modernizes MICRA while preserving its underlying principles, has ushered in a new and sustained era of stability around malpractice liability.

Reproductive Rights After the Supreme Court’s Dobbs decision, CMA worked with the Future of Abortion Council to protect and expand access to reproductive health care in California, leading to 15 bills signed into law, $200 million in the state budget and the passage of Prop. 1 to enshrine abortion rights into California’s constitution.

Election Victories CMA member Jasmeet Bains, M.D., joined the California Assembly as its third physician legislator, while incumbent assemblymembers Joaquin Arambula, M.D., and Akilah Weber, M.D., were re-elected. At the federal level, representatives Ami Bera, M.D., and Raul Ruiz, M.D., were re-elected to Congress. CMA also saw its ballot measure positions reflected in election results, including the rejection of Prop. 29 (dialysis clinic requirements) and passage of Prop. 31 (ban on flavored tobacco).

Federal Loan Forgiveness

Billing and Burdens

The U.S. Department of Education overhauled the Public Service Loan Forgiveness Program, including the specific fix that CMA advocated for that will allow all eligible California physicians to receive loan forgiveness.

CMA recouped more than $1 million this year (nearly $40 million over 14 years) on behalf of physician members through direct payor interventions. CMA also stopped Cigna’s burdensome modifier 25 policy.

Health IT CMA achieved significant victories on health information technology issues by extending the COVID telehealth waivers into 2023; permanently extending key Medi-Cal telehealth payment parity; eliminating e-prescribing burdens (AB 852); and helping physicians comply with the new federal information blocking rule while protecting patients’ sensitive medical information (SB 1419).

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Winter 2023

2022 YEAR IN REVIEW Grassroots Engagement CMA saw unprecedented grassroots physician engagement, with nearly 4,000 messages sent to policymakers. These physician voices were key in helping to defeat AB 2060 (public member majority on Medical Board of California) and AB 2236 (allowing optometrists to perform surgical procedures).

Public Health Funding CMA helped administer both the KidsVaxGrant ($22+ million) and COVID-19 Test to Treat Equity Grant ($59 million) programs, providing critical funding for community pediatric vaccinators, public health systems and community health centers.

Community Health Centers CMA saw rapid membership growth among community health centers, resulting in an expansion of our mode of practice forums and House of Delegates representation.

Retention Payments CMA helped secure $1.3 billion in the state budget to provide retention bonuses for many of California’s physicians and other health care workers to stabilize the health care workforce.

Universal Health Care CMA successfully advocated for full-scope Medi-Cal coverage for all income-eligible Californians by January 1, 2024, making California the first state to expand its Medicaid program to provide full benefits to all eligible individuals regardless of age or documentation status.

Virtual Grand Rounds CMA completed its 29th Virtual Grand Rounds webinar, providing critical COVID-19 continuing medical education to nearly 13,500 attendees while expanding topics to include other public health concerns such as long COVID, monkeypox and wildfire smoke.

Visit cmadocs.org/year-in-review to learn more!

Winter 2023

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2022 LEGISL ATI V E WR A P-UP

2022 Legislative Wrap-Up

By Janice Rocco, CMA Chief of Staff

I

n 2021, with emergency use authorization for COVID-19 vaccines, the hope was that the pandemic would end and life could go back to normal. Instead, it wasn’t until 2022 that the state legislature began moving back to something resembling business as usual.

The state declaration of the COVID-19 State of Emergency remains in effect. The State Capitol is again open to the public, but even that has changed in ways that provide less access to legislators and their staff than was the case prior to the pandemic. The Capitol building is undergoing construction and legislators have moved their offices outside the Capitol.

Committee hearings are being conducted in person again, though often with a hybrid phone-in option. Separate from the legislature, public meetings held by state departments and commissions have begun shifting back to a hybrid approach, so that we can be back in person again. These changes mean that we have adjusted and found new ways that we, as advocates, communicate with legislators and their staff.

In California, we had five legislative seats become vacant during the year, which meant five special elections to fill them. By the time each of these races had concluded, a total of five new Democrats had been sworn into office. With these additions, Democrats continue to have a supermajority in both the Assembly and the Senate.

The closing of the 2021–2022 legislative session also brought with it the end of an era for a well-respected member of the legislature. Senator Richard Pan, M.D., spent 12 years serving California in the legislature by focusing on improving the state’s health care system, fighting for patients and the practice of medicine. Though Dr. Pan has many legislative accomplishments, we are particularly grateful for his leadership during the COVID-19 pandemic, where his expertise was critical to our state on a daily basis.

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Winter 2023

HEALTH CARE REFORM

MICRA

As the legislative year began, AB 1400, the single payer health care coverage bill, was before the State Assembly for a vote. That bill died in the Assembly at the end of January, which then shifted the discussion to other health care reform measures. The Governor’s Office of Health Care Affordability proposal from 2021 was back for discussion and debate, with the California Medical Association (CMA) fighting to prevent this broad measure from becoming an administrative burden for physician practices.

When the year began, the expectation was that CMA’s focus in 2022 would be working to defeat the socalled “Fairness for Injured Patients Act” (FIPA) ballot initiative that had qualified for the November 2022 ballot. The ballot initiative, if it had passed, would have eviscerated the protections of California’s Medical Injury Compensation Reform Act (MICRA). After Californians Allied for Patient Protection (CAPP), led by CMA CEO Dustin Corcoran, negotiated a legislative deal with FIPA proponents, Assemblymember Eloise Gómez Reyes put that legislative deal into AB 35, the MICRA Modernization Act. Just 16 days later, Governor Newsom signed the bill into law and FIPA proponents removed their initiative from the ballot. This historic agreement prevented a costly ballot fight and ushered in a new and sustained era of stability around malpractice liability.

Ultimately, we were successful in getting physician practices with fewer than 25 physicians exempted from both the data submission requirements and the cost targets that the state will develop. Similarly, we fought to prevent independent practice associations (IPAs) from being included as a way to impose cost targets and data submission requirements on smaller physician groups, ultimately seeing them removed from the bill. We were also able to get the Newsom Administration to commit to include $200 million in the state budget for grants to assist physician practices with implementation of some of the provisions in Office of Health Care Affordability legislation, such as a shift to alternative payment models.

STATE BUDGET Another victory in the health care reform space was achieved via the 2022–23 state budget. Continuing California’s commitment to achieving universal health care access, the $308-billion budget includes a phasedin system to provide full scope Medi-Cal coverage to all income-eligible Californians regardless of age or documentation status by January 1, 2024. This makes California the first state in the nation to expand its Medicaid program to provide full benefits to all eligible individuals—a critical step in our shared goal of ensuring that every Californian has access to quality health care.

Many other CMA priorities and supported issues were addressed in the 2022–23 budget, including: a permanent extension of key Medi-Cal telehealth flexibilities implemented during the pandemic; full funding for the Prop. 56 Medi-Cal supplemental payments and graduate medical education funding programs; major investments in health care workforce development; $1.3 billion for health care worker retention pay; $700 million in equity and practice transformation payments; and $200 million for reproductive health and reproductive justice issues.

(For more details on the state budget, see cmadocs.org/ budget-22-23.)

MEDICAL BOARD CMA aggressively fought AB 2060 (Quirk), which would have created a public member majority on the Medical Board of California. We were able to kill this bill in its first house.

At the same time, CMA sponsored legislation— AB 1636

by Assemblymember Akilah Weber, M.D. —to preserve the integrity of the medical profession by ensuring physicians convicted of sexual assault with a patient lose their license with no ability for it to be reinstated. This bill removes the medical board’s discretion to give or reinstate the license of a physician or surgeon who lost their license due to sexual misconduct with a patient. This bill would also deny a physician’s and surgeon’s license to an applicant who has been or is required to register as a sex offender.

HEALTH IT CMA had three significant victories addressing health information technology issues. The passage of AB 852 (Wood) eliminates administrative burdens associated with complying with California’s electronic prescribing mandate. AB 32 (Aguiar-Curry) permanently ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, so that this reimbursement reform lasts beyond the public health emergency. Finally, SB 1419 (Becker) helps physicians comply with the new federal information blocking rule and protects patients’ sensitive medical information.

REPRODUCTIVE RIGHTS In June, the U.S. Supreme Court decision in Dobbs v.

Jackson Women’s Health caused shockwaves on a national

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CENTRAL COAST PHYSICIANS

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2022 LEGISL ATI V E WR A P-UP scale, as access to reproductive health care services was stripped away from millions of Americans overnight.

CMA and other organizations had begun planning for this reality in late 2021 by forming the Future of Abortion Council to develop legislative and budget proposals to ensure that access to abortion care would not be denied in California once the court overturned Roe v. Wade.

This year, 15 reproductive health care bills were signed into law by Governor Newsom, including bills meant to strengthen protections for physicians and other health care providers from civil or criminal actions that could arise in other states if providers treat patients from outside California. Additionally, $200 million was included in the 2022–23 state budget to expand access to reproductive health care, including abortion.

ADMINISTRATIVE BURDENS CMA sponsored SB 250 (Pan) to reduce administrative burdens from health plans’ prior authorization requirements and ensure that patients get the care they need, when they need it. This bill was strongly opposed by the health plans and although it passed the Senate, it fell short in the Assembly Appropriations Committee.

SCOPE OF PRACTICE Another big fight this year was CMA’s work with the California Academy of Eye Physicians and Surgeons to oppose AB 2236 (Low), which would have allowed optometrists to perform certain surgical procedures without the same training as ophthalmologists. This bill was hard-fought in the legislature and was the last bill to pass the Assembly before midnight on the final night of the legislation session, when it eventually received the 41st vote it needed for passage. Even though this bill narrowly made it out of the legislature, Governor Newsom heard from hundreds of physicians and vetoed it to protect patients, issuing a strong statement about the inadequacy of its training requirements.

LOOKING BACK AT A BUSY SESSION By the time the Governor’s bill final signing period for the 2021–22 legislative session ended, Governor Newsom had signed 997 bills into law and vetoed 169 bills.

On the following pages, you will find summaries of many of the key bills that CMA was involved with in 2022.

For more details on the major bills that CMA followed this year, visit cmadocs.org/legwrap2022. Subscribe to CMA’s free biweekly Newswire and stay informed on CMA’s legislative efforts and other issues critical to the practice of medicine at cmadocs.org/subscribe.

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The California Medical Association (CMA), working to empower physicians to lead and transform the health care system, recently welcomed Stuart Thompson, J.D., as its new Senior Vice President. In that role, he will lead the association’s government relations and political operations efforts.

“Stuart’s impressive record of success inside the halls of government and across California’s political landscape will be a great asset as we navigate rapid changes in our health care delivery system and look for opportunities to improve the health of all Californians by helping people get timely, high-quality care,” said CMA CEO Dustin Corcoran.

“We have a big year ahead of us and Stuart’s deep understanding of health care policy, and the legislative and regulatory agencies in California, will position CMA as an even greater force in the health care advocacy space.”

Thompson has over 15 years of legislative, government and legal experience in California, most recently serving as the Chief Deputy Legislative Secretary in Governor Gavin Newsom’s administration. Having already served as Associate Director of Government Relations at CMA for five years prior to joining the Newsom administration, Thompson’s wealth of experience advocating on behalf of physicians and the patients they serve makes him uniquely suited for the role.

“This is a pivotal time for health care in our state and I am thrilled to join CMA’s lobbying team to advance meaningful, measurable improvements in California’s health care delivery system,” said Thompson. “By bridging the gap between policymakers and medical professionals, we can achieve a health care system that delivers for all Californians.”

Winter 2023

SPONSORED BILLS AB 32 (AGUIAR-CURRY): TELEHEALTH

Status: Signed by Governor (Chapter 515, Statutes of 2022).

Assembly Bill 32 ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, adds flexibility for providers to enroll patients in certain Medi-Cal programs remotely, and requires the Department of Health Care Services to complete an evaluation to assess the benefits of telehealth in Medi-Cal

by July 2025.

AB 1636 (WEBER): PHYSICIAN LICENSURE OR REVOCATION – SEXUAL MISCONDUCT

Status: Signed by Governor (Chapter 453, Statutes of 2022).

Assembly Bill 1636, by Assemblymember Akilah Weber, M.D., protects patients and maintains confidence in the medical profession by ensuring physicians convicted of sexual misconduct have their license revoked and cannot acquire or have a license reinstated. This bill removes the Medical Board of California’s ability to give a license to or reinstate a physician who lost their license due to sexual misconduct with a patient.

AB 2055 (LOW): CONTROLLED SUBSTANCES – CURES DATABASE Status: Held in Assembly Appropriations Suspense Committee.

Assembly Bill 2055 would have rehoused the state’s prescription drug monitoring program – the Controlled Substance Utilization Review and Evaluation System (CURES) database – from the Department of Justice to the California State Board of Pharmacy. CURES should be managed with the primary goals of improving patient care and public health, and as such it should be administered by an entity whose mission and policies focus on the use of the database by health care providers and research experts.

AB 2098 (LOW): PHYSICIANS AND SURGEONS – UNPROFESSIONAL CONDUCT

Status: Signed by Governor (Chapter 938, Statutes of 2022).

Assembly Bill 2098 provides that the dissemination of misinformation or disinformation related to COVID-19 by a physician to their patient constitutes unprofessional conduct. The bill clarifies that the medical board may take action if a licensee provides misinformation that departs from the applicable standard of care or did so with malicious intent or the intent to mislead.

The governor issued a statement in conjunction with his signature on the bill, which read in part: “I am signing this

Winter 2023

bill because it is narrowly tailored to apply only to those egregious instances in which a licensee is acting with malicious intent or clearly deviating from the required standard of care while interacting directly with a patient under their care. To be clear, this bill does not apply to any speech outside of discussions directly related to COVID-19 treatment within a direct physician patient relationship.”

AB 2132 (VILLAPUDUA): TUITION FOR MEDICAL SERVICE PILOT PROGRAM

Status: Held in Assembly Higher Education Committee.

Assembly Bill 2132 would have created a pilot program, administered by the California Student Aid Commission, to identify and select individuals from diverse, underrepresented communities to fund their education from community college/undergraduate school through completion of their medical residency program.

The individual would have been required to commit to practicing in medically underserved areas after completing their residency program.

AB 2522 (GRAY): PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM

Status: Held in Senate Appropriations Committee.

Assembly Bill 2522 sought to create a dedicated loan repayment program for the state’s public health workforce.

There are currently no existing retention or recruitment loan repayment programs for non-licensed public health personnel.

SB 250 (PAN): HEALTH CARE COVERAGE

Status: Passed Senate. Held in Assembly Appropriations Committee.

Senate Bill 250 would have comprehensively reformed the prior authorization process by requiring that physicians be included in the development and updating of plan utilization management criteria; requiring plans to create a prior authorization exemption program that allows physicians who are practicing within the plan’s criteria 90% of the time to get a blanket exemption for one year from the plan’s prior authorization requirements; and giving a treating physician who does not have a prior authorization exemption the right to have an appeal of a denial be conducted by a physician in the same or similar specialty.

SB 1419 (BECKER): HEALTH INFORMATION

Status: Signed by Governor (Chapter 888, Statutes of 2022).

Senate Bill 1419 helps California physicians comply with the federal information blocking rule. In spring 2021, the federal 21st Century Cures Act final rule took effect.

That rule has had unintended consequences for patients and physicians regarding sensitive medical information.

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2022 LEGISL ATI V E WR A P-UP SB 1419 improves quality of care by guaranteeing that physicians and patients have all the information needed for integrated health care.

AB 852 (WOOD): ELECTRONIC PRESCRIBING

This bill provides patients with the right to receive results of their imaging scans in written or oral form, the same protection currently provided to lab results. It also provides enhanced protection for sensitive medical information, as defined by the Confidentiality of Medical Information Act.

Assembly Bill 852 gives physicians more flexibility in complying with California’s electronic prescribing mandate. This bill exempts low-volume prescribers (many of them retired or semi-retired physicians who maintain a license), prescribers in areas of natural disasters, and prescribers who are granted a waiver based on extraordinary circumstances. These new exceptions also track with exceptions in the Medicare program.

Additionally, this bill provides a framework for application programming interfaces by incorporating the requirements of the Interoperability and Patient Access final rule for state-regulated health plans and insurers.

CO-SPONSORED BILLS AB 1608 (GIPSON): COUNTY OFFICERS – CONSOLIDATION OF OFFICES

Status: Passed Assembly. Held on Senate Floor.

Assembly Bill 1608 would have eliminated the ability of a county board of supervisors to consolidate the offices of the sheriff and the coroner. The bill would have also required counties that currently consolidate those offices to separate the roles. The intent behind the bill was to retain physician autonomy and prevent forensic pathologists from being pressured to change their cause of death determinations due to pressure from a sheriff/coroner in order to reduce any indications of law enforcement misconduct.

PRIORITY SUPPORT BILLS AB 35 (REYES): CIVIL DAMAGES – MEDICAL MALPRACTICE

Status: Signed by Governor (Chapter 17, Statutes of 2022).

Assembly Bill 35, the MICRA Modernization Act, implements the compromise that was negotiated between CAPP and the proponents of the “Fairness for Injured Patients Act” ballot proposition. The bill extends the longterm predictability and sustainability of the state’s medical malpractice laws and settles a decades-long divide on the issue. After the bill was signed, FIPA proponents withdrew their ballot measure, avoiding a million-dollar fight.

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Status: Signed by Governor (Chapter 518, Statutes of 2022).

AB 1242 (BAUER-KAHAN, BONTA AND GARCIA): REPRODUCTIVE RIGHTS – PROTECTIONS FOR PATIENTS AND PROVIDERS

Status: Signed by Governor (Chapter 627, Statutes of 2022).

Assembly Bill 1242 protects those performing, aiding in the performance of or obtaining an abortion from arrest and prohibits law enforcement from cooperating with or providing information to those outside of California regarding lawful abortion. This bill went into effect immediately when it was signed into law on September 27, 2022.

AB 1666 (BAUER-KAHAN): ABORTION – CIVIL ACTIONS Status: Signed by Governor (Chapter 42, Statutes of 2022).

Assembly Bill 1666 enacts legal protections from civil and criminal liability for clinicians that provide abortions to patients who reside in other states with hostile abortion laws. These protections include precluding liability for any of the following “crimes” in other states: aiding or abetting in the inducing of an abortion; receiving or seeking an abortion; and performing and inducing an abortion. This bill went into effect immediately when it was signed into law on June 24, 2022.

AB 1797 (WEBER): IMMUNIZATION REGISTRY Status: Signed by Governor (Chapter 582, Statutes of 2022).

Assembly Bill 1797 requires health care providers and other agencies, including but not limited to, schools, childcare facilities, Women, Infants, and Children service providers, health care plans, foster care agencies, and county human services agencies to disclose immunization information to local health departments and the California Department of Public Health (CDPH). The data includes disclosure of a new data point related to a patient’s or client’s race and ethnicity. This bill was part of the legislature’s broader “vaccine work group” legislative package.

Winter 2023

AB 2223 (WICKS): REPRODUCTIVE HEALTH

Status: Signed by Governor (Chapter 629, Statutes of 2022).

Assembly Bill 2223 clarifies the law to prevent anyone in California from being investigated, prosecuted, or incarcerated for ending a pregnancy or experiencing pregnancy loss.

AB 2626 (CALDERON): MEDICAL BOARD OF CALIFORNIA – LICENSEE DISCIPLINE – ABORTION

SB 883 (ROTH): UMBILICAL CORD BLOOD COLLECTION PROGRAM

Status: Signed by Governor (Chapter 604, Statutes of 2022).

Senate Bill 883 extends the University of California’s Umbilical Cord Blood Collection Program through January 1, 2026. Stored umbilical cord blood is a lifesaving resource that is used to treat more than 80 diseases such as leukemia, lymphoma and immune deficiency.

SB 1473 (PAN): HEALTH CARE COVERAGE

Status: Signed by Governor (Chapter 565, Statutes of 2022).

Status: Signed by Governor (Chapter 545, Statutes of 2022).

Assembly Bill 2626 prevents state licensing boards from suspending or revoking the license of someone who performs an abortion in accordance with California law.

Additionally, the bill prohibits the boards from taking an adverse action against an applicant or licensee that was disciplined in another state for performing an abortion if the abortion met the applicable standard of care for the procedure in California.

Senate Bill 1473 requires health plans to cover COVID-19 therapeutics consistent with current law related to coverage of COVID-19 testing and vaccinations, which was signed into law in 2021 through CMA-sponsored SB 510 (Pan). Additional provisions of the bill extend coverage for out-of-network cost-sharing for COVID-19 testing and vaccination to six months after the federal public health emergency expires.

SB 866 (WIENER): MINORS – VACCINE CONSENT

Status: Passed Senate, but not taken up on Assembly Floor.

Senate Bill 866 would have allowed minors 15 years of age or older to consent to vaccines that the United States Food and Drug Administration and Advisory Committee on Immunization Practices have approved. Existing law allows minors 12 years of age or older to make certain medical decisions without parental consent, most notably as it relates to consenting to general medical care if the minor lives separately from their parents or legal guardians. Due to timing and vocal opposition, this legislation was not taken up for a vote on the Assembly floor.

SB 871 (PAN): PUBLIC HEALTH – IMMUNIZATIONS

Status: Held in Senate Health Committee.

Senate Bill 871 would have added the COVID-19 vaccine to the list of required vaccinations before a pupil can be admitted into any private or public elementary or secondary school, childcare center, day nursery, nursery, family day care home or development center. The bill also would also have removed the personal belief exemption for the COVID-19 vaccination. This bill was part of the legislature’s broader “vaccine work group” package of legislation.

Winter 2023

SCA 10 (ATKINS): REPRODUCTIVE FREEDOM

Status: Signed by Governor (Chapter 97, Statutes of 2022).

Senate Constitutional Amendment 10 creates a pathway for California to constitutionally protect an individual’s right to reproductive freedom and to obtain health services, including abortion and contraception. Approved with a two-thirds vote of the legislature, the provisions of this bill became Proposition 1 on the November 2022 ballot, which passed with an overwhelming margin of support.

PRIORITY OPPOSE BILLS AB 1278 (NAZARIAN): PHYSICIANS AND SURGEONS – PAYMENTS: DISCLOSURE: NOTICE

Status: Signed by Governor (Chapter 750, Statutes of 2022).

Assembly Bill 1278 requires physicians to provide each patient with a written or electronic notice about the federal Open Payments database at their initial office visit, and obtain a signature from the patient or a patient representative.

This bill was introduced in 2021 and originally would have required physicians to provide each patient with detailed information about the physician’s personal receipt of gifts or funds from pharmaceutical companies, device manufacturers, etc., as reported by those entities in the federal Open Payments database on an annual basis. CMA sought amendments, and the bill was narrowed to a onetime, general notice to patients about the existence of the Open Payments database.

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2022 LEGISL ATI V E WR A P-UP

AB 1328 (IRWIN): CLINICAL LABORATORY TECHNOLOGY AND PHARMACISTS Status: Held on Senate Floor.

Assembly Bill 1328 would have created a scope infringement allowing pharmacists to order and perform over 1,400 Clinic Laboratory Improvement Amendmentsapproved tests, not limited to temperature, pulse and respiration. This bill would also have authorized a pharmacist to order and interpret any test results they ordered to “promote patient health.” CMA worked hard to seek amendments and ultimately stop the bill on the Senate Floor.

AB 1400 (KALRA): GUARANTEED HEALTH CARE FOR ALL Status: Held on Assembly Floor.

Assembly Bill 1400, the California Guaranteed Health Care for All Act, would have created the CalCare program to administer and provide universal single payer health care coverage and a health care cost control system in the state. The bill contained minimal details regarding the administration of such a program.

AB 1785 (DAVIES): CALIFORNIA PARENTS’ BILL OF RIGHTS ACT

Status: Held in Assembly Education Committee.

Assembly Bill 1785 attempted to create a “California Parents’ Bill of Rights” by making numerous technical and substantive amendments to various code sections. This bill would have undermined existing protections for health care decisions, and the resulting records, that a minor has a statutory right to make. In addition, the bill attempted to erode the ability of a school district to require certain immunizations.

AB 2060 (QUIRK): MEDICAL BOARD OF CALIFORNIA Status: Killed on Assembly Floor.

Assembly Bill 2060 sought to change the composition of the Medical Board of California to a public member majority and eliminate the licensee majority of the board’s disciplinary panels. This was the second consecutive legislative session that the Legislature sought this change to the board’s composition.

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AB 2080 (WOOD): HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT OF 2022 Status: Held in Senate Health Committee.

Assembly Bill 2080 would have required any medical group, hospital, hospital system, health care service plan or pharmacy benefit manager to provide written notice to the Attorney General (AG) at least 90 days before agreeing to a merger, acquisition or change in control with another health care entity if the transaction had a value of $15 million or more. The bill would authorize the AG to consent to, give conditional consent to, or not consent to the agreement, and if the AG did not consent to the agreement, the transaction would be stopped.

AB 2236 (LOW) OPTOMETRY: CERTIFICATION TO PERFORM ADVANCED PROCEDURES Status: Vetoed by Governor.

Assembly Bill 2236 would have authorized optometrists to perform laser and surgical procedures on a patient’s eye if they met minimal education and training requirements, including performing 43 procedures on live patients. The bill failed to adequately educate optometrists to develop clinical competency and judgment to identify, manage and mitigate complications during surgery to prevent permanent damage to patients’ eyes and eyesight.

Echoing CMA’s concerns, Governor Newsom vetoed the bill with a statement indicating: “I am not convinced that the education and training required is sufficient to prepare optometrists to perform the surgical procedures identified.

This bill would allow optometrists to perform advanced surgical procedures with less than one year of training. In comparison, physicians who perform these procedures must complete at least a three-year residency program.”

SB 920 (HURTADO): MEDICAL BOARD OF CALIFORNIA: INVESTIGATIONS: RECORD REQUESTS

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

Senate Bill 920 sought to erode privacy protections for both patients and physicians by allowing Medical Board of California investigators to inspect records prior to requesting a subpoena for the records in order to establish good cause for further investigation. This was the second consecutive legislative session that the Legislature sought this change.

Winter 2023

SB 1023 (HURTADO): HEALTH PROFESSIONS – TRAINING AND EDUCATION: BLUE RIBBON COMMISSION Status: Held in Assembly Health Committee.

Senate Bill 1023 sought to create a Blue-Ribbon Commission on Strengthening our Health System

by Transforming Medical Training and Education to Improve Patient Protection. The bill was a misguided effort to address broader concerns about the regulation of physicians and surgeons by the medical board. In particular, the bill sought to reconsider the evidentiary standard used in disciplinary cases. CMA was able to negotiate amendments with the author to refocus the bill on seeking information and reporting on methods to increase the number of diverse physicians entering the workforce, particularly in low-income and rural communities.

SB 1467 (KAMLAGER): MATERNAL MENTAL HEALTH

Status: Held in Senate Health Committee.

Senate Bill 1467 sought to ensure that all biological mothers are offered maternal mental health care services or are screened appropriately for maternal mental health conditions. CMA expressed concern that the term biological mother may exclude a population of people that may be pregnant or become pregnant.

CMA’s Council on Legislation took an oppose unless amended position and sought an amendment to change the term biological mother to birthing person. Instead, the bill failed to garner a hearing in its first committee.

ACA 11 (KALRA): TAXES TO FUND HEALTH CARE COVERAGE AND COST CONTROL Status: Held in Assembly Rules Committee.

Assembly Constitutional Amendment 11 was the companion funding mechanism for the single-payer health care system proposed under AB 1400 (Kalra, 2021), which the association took an oppose unless amended position on. ACA 11 would have raised the gross receipts tax, increased the employer and employee shares of the payroll tax, and increased the personal income tax on high earners.

This bill was never referred out of the Assembly Rules Committee.

Winter 2023

SUCCESSFULLY NEGOTIATED BILLS AB 1704 (CHEN): LIMITED PODIATRIC RADIOGRAPHY PERMITS

Status: Signed by Governor (Chapter 580, Statutes of 2022).

Assembly Bill 1704 adds health care professionals operating leg-only podiatric radiography equipment under the supervision of a licensed podiatrist to the list of individuals exempted from the existing requirements of state law regarding who is permitted to operate radiological equipment in California. It also tried to remove the CDPH Radiologic Health Branch’s authority to determine certification and move it to the Podiatric Medical Board of California. CMA was able to retain the certification authority within CDPH and provide more specificity related to the requirements to receive this permit.

AB 1809 (AGUIAR-CURRY): NURSING FACILITY RESIDENT INFORMED CONSENT PROTECTION ACT OF 2022 Status: Vetoed by Governor.

Assembly Bill 1809 would have required informed consent be given by a skilled nursing facility resident before being prescribed and administered any psychotherapeutic medication. Additionally, the prescribing physician could be charged with criminal battery for not obtaining the consent from the resident. CMA secured amendments to narrow the drugs affected by the bill, remove the charge of criminal battery from the bill and to require only the relevant information about the prescribed medication be given to the resident for consent purposes.

AB 1896 (QUIRK): GAMETE BANKS Status: Vetoed by Governor.

Assembly Bill 1896 would have added notification requirements to gamete banks. Specifically, this bill attempted to require gamete banks to notify clients of the risk of inbreeding and steps to mitigate that risk.

In addition, the banks would have been required to implement a secure process for tracking future sperm donations and sharing that information with other gamete banks. CMA staff successfully negotiated amendments that minimized this bill to being education-based only, while reducing the administrative burdens and liability risk that were originally part of the bill.

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2022 LEGISL ATI V E WR A P-UP AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

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designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE

Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES – ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

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CL

DS

F I S IE S A

POSITIONS AVAILABLE

Whether you are a seasoned physician or just out of residency, the CALIFORNIA PHYSICIAN CAREER CENTER offers the opportunities and resources you need to advance your career. This benefit includes tips on resume writing, interviews, and networking, as well as hundreds of current job openings in California. Opportunities can be found at https://careers.cmadocs.org.

CENCAL HEALTH is a community-accountable health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering patient care to more than 200,000 members in Santa Barbara and San Luis Obispo counties.

Opportunities can be found at www.cencalhealth.org/workwithus.

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST is a nonprofit organization operating federally qualified health centers that provide comprehensive care. Since 1978, CHC has grown to over 30 locations serving over 120,000 unique patients annually across San Luis Obispo and northern Santa Barbara counties. We are always looking for skilled, compassionate providers of all levels. Opportunities can be found at chccares.link/careers.

The COUNTY OF SAN LUIS OBISPO is committed to serving the community with pride to enhance the economic, environmental, and social quality of life in San Luis Obispo County. Opportunities can be found at www.slocounty.ca.gov.

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

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

PLANNED PARENTHOOD CALIFORNIA CENTRAL COAST is a dynamic and fulfilling place to work. Our staff is caring, knowledgeable, dedicated and we are committed to a diverse workplace and encourage you to apply. Opportunities can be found at https://jobs.lever.co/ppcentralcoast.

SANSUM CLINIC is the largest and oldest multi-specialty group between San Francisco and Los Angeles with over 180 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine.

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

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

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

Listings are free for members with reasonable rates for nonmembers.

Winter 2023

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Bringing Back Care Tenet Health Central Coast and UCSF Health Open Innovative & Integrative Spine Clinic in San Luis Obispo County There is axiom among back specialists that spine health is one thing that people never notice until something goes wrong. What makes that significant is that, when something does go wrong, all the other parts of the body that depend on the spine can be affected – and quality of life can diminish dramatically.

That’s why it’s so important that a new spine clinic is now open as the next phase of the Tenet Health Central Coast-UCSF Health neurosurgery affiliation. The clinic, which is located on the campus of the Sierra Vista Regional Medical Center, will offer experts from both THCC and UCSF to diagnose and treat spine or neuro issues with holistic and innovative treatments.

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Winter 2023

“Surgery is really a last resort,” said Dr. Phillip Kissel, the Director of Neurosurgery for Tenet Health Central Coast. “Therefore, a state-ofthe-art spine center that can effectively treat a myriad of spine and neuro conditions, bridges the gap between surgery and pain management. It’s really a tremendous benefit to the community to create greater local access to these integrative diagnostics and treatments.”

Indeed, a wide array of services are provided, including: • Platelet-Rich Plasma (PRP) injection therapies; • Interruption and blocking techniques to stop pain signals from reaching the brain; • Electrodiagnostic testing, which is used to diagnose injuries and disorders of the peripheral nervous system (this testing includes analysis of the complex connections of the spinal nervous system and common conditions such as carpal tunnel syndrome); • Diagnostic Imaging, including cervical, and lumbar discograms; • Cervical, lumbar, and thoracic transforaminal epidural injections to ease pain in the lower back, mid-back and neck; • Lumbar and cervical intralaminar injections to decrease inflammation and irritation of nerve roots or herniated disks; • Costovertebral joint injections to help ease breathing; • Minimally invasive spine surgeries – a technique that uses smaller incisions that, generally, can reduce the risks involved with traditional surgery; • Holistic and physical therapies.

Typical conditions that can be treated, include: • Back or spine fractures; • Degenerative disc disease; • Herniated disc; • Kyphosis; • Radiculopathy; • Scoliosis; • Spondylolisthesis.

Dr. Robert Gamburd, a professor on the UCSF Department of Neurological Surgery, is on the staff at the Tenet Health Central CoastUCSF Health spine clinic. The significance of the affiliation is underscored by the fact that U.S. News & World Report recognized UCSF Medical Center as the nation’s best hospital for neurology and neurosurgery in the 2021-22 Best Hospitals survey.

Importantly, Dr. Gamburd personally understands the patients’ point of view: “I live it every day,” said Dr. Gamburd, who has had two lower back surgeries. “So I have to practice what I preach about being an active participant in one’s own recovery and in self care. My condition is something I have to deal with for the rest of my life, so I know how the patients feel, often first hand. I try to provide approaches that are tailored to each patient’s needs, because each one is unique.”

Winter 2023

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Sansum Clinic Announces 2023 Visiting Professor of Surgery Fabrizio Michelassi, MD, has been selected as the Visiting Professor of Surgery for Surgical Academic Week 2023 (March 13-16) announced Dr. W. Charles Conway, FACS, Visiting Professor of Surgery Program Administrator.

Fabrizio Michelassi, MD, FACS, E.S.A. (Hon.), S.I.C. (Hon.), S.A.C.P.N.E. (Hon.) Lewis Atterbury Stimson Professor and Chairman, Department of Surgery Weill Cornell Medicine Surgeon-in-Chief New York-Presbyterian/Weill Cornell Medical Center

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A world-renowned gastrointestinal surgeon with a strong expertise in the surgical treatment of gastrointestinal and pancreatic cancers as well as inflammatory bowel disease, Dr. Michelassi has contributed new insight in the surgical treatment of pancreatic and colorectal cancers, ulcerative colitis and Crohn’s disease though research and participation in multiple clinical trials. His experience and expertise in treating Crohn’s disease led him to develop a novel bowel-sparing procedure, now known as the Michelassi strictureplasty, designed to avoid sacrificing large amounts of the bowel at the time of surgery and facilitating quiescence of the acute disease affecting the diseased intestinal loops.

Dr. Michelassi has an abiding interest in educating and training the next generation of academic surgeons. Sansum Clinic’s Visiting Professor of Surgery Program provides expert educational seminars for practicing Santa Barbara surgeons and physicians. More importantly, the program

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allows surgical residents in training at Santa Barbara Cottage Hospital the chance to interact with the icons, leaders, and outstanding teachers of the art of surgery.

Dr. Michelassi will present a public lecture on Thursday, March 16 at 5:30pm at the Ridley-Tree Cancer Center at Sansum Clinic in the Lovelace Hall at 540 West Pueblo Street.

His topic: In the Eye of the Storm: Lessons Learned from the COVID Pandemic. The first COVID patient was admitted to New York Presbyterian Hospital on March 9, 2020. By April 12, New York Presbyterian Hospital had more than 2,600 COVID + inpatients. Elective and urgent cases were brought to a halt; resources were stressed from PPE’s to ICU capacity.

The system reacted with innovative solutions; physicians, residents and staff were redeployed; ICU capacity was more than doubled. The needs of the healthcare providers were met with free meals, free downtown accommodations, mental health care sessions, and daily communications. Many lessons were learned which helped during the successive waves and which we have incorporated in our daily lives.

Reservations are required for the presentation. Please contact Devin Scott at 805.681.7762 or dscott@sansumclinic.org.

This unique educational program advances the level of surgical care available in our community and is made possible by generous support from the Title Sponsor Cottage Health,

and grateful patients, medical groups, individual community surgeons and physicians, and corporate donors.

Dr. Michelassi follows eight previous Visiting Professors: Dr. John L. Cameron (Johns Hopkins) 2012, Dr. Hiram C. Polk, Jr. (University of Louisville) 2013, Dr. Julie Ann Freischlag (UC Davis School of Medicine) 2014, Dr. Keith D. Lillemoe (Massachusetts General Hospital) 2015, Dr. Michael G. Sarr (Mayo Clinic) 2016, Dr. Barbara Lee Bass (Houston Methodist Hospital), Professor O. James Garden (University of Edinburgh) 2018 and Dr. David V. Feliciano (University of Maryland Medical Center) 2019. In 2021 we featured the following speakers: Deanna J. Attai, MD, FACS (David Geffen School of Medicine at UCLA), Wen T. Shen, MD, MA (University of California, San Francisco), Jennifer Suzanne Davids, MD (University of Massachusetts Memorial Medical Center), and Alfredo M. Carbonell, II, DO, FACS, FACOS (UCS School of Medicine Greenville, SC).

Dr. Conway took over the reins of the Visiting Professor of Surgery Education Program in 2018 from Dr. Ronald G. Latimer, who established the program in 2010 with the Department of Surgery and Sansum Clinic. Dr. Conway joined Sansum Clinic in 2017 and is a fellowship-trained surgical oncologist at the Ridley-Tree Cancer Center, with nearly 10 years of high-volume surgical experience dealing with complex cases.

Thursday, March 16 5:30pm Ridley-Tree Cancer Center at Sansum Clinic Lovelace Hall 540 West Pueblo Street Reservations are required. Please contact Devin Scott at 805.681.7762 or dscott@sansumclinic.org

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Do physician-peer relationships motivate improved specialist care for patients?

By Maximilian J. Pany, BA; and J. Michael McWilliams, MD, PhD It is well understood that physician behavior is a primary driver of patient outcomes and health care spending. Physicians are expected to be well-informed agents who are intrinsically motivated to optimize care for their patients. Yet deficits in quality are pervasive, and effective strategies to influence physician decisions and performance remain elusive. That physicians are also motivated by profit has inspired 2 decades of efforts to link payment to performance on quality measures. These pay-forperformance schemes have produced minimal gains for various reasons, including measurement challenges and inherently weak incentives, and have had unintended consequences.

More recently, interventions have focused on nonfinancial incentives that influence physician behavior. The application of behavioral science to health care has conceived a range of nudges

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(eg, use of defaults, public commitments, or information framing) that have successfully prompted higher-value decisions. While a clear advance, these approaches have so far been applied mainly to specific measures or clinical decisions using scripted interventions, such as peer performance comparisons or required justification to discourage inappropriate antibiotic prescribing. Broader applications could have a greater impact.

In particular, the influence of peer observation and approval is likely to be powerful in medicine and could be more productively deployed. Physicians are motivated to demonstrate their competence to other physicians not only for financial gain (eg, to earn favorable evaluations as trainees or to attract referrals), but also because they may derive professional satisfaction from upholding standards when observed.

Behavioral science has long demonstrated peer and audience effects, by which the physical or imagined presence of others improves performance. These effects can be particularly powerful when peer relationships are strong and when peers share high standards and common purpose. Accordingly, an audience of familiar peers may elevate physician performance, not only by subjecting it to informed scrutiny, but also by providing an opportunity to demonstrate commitment to what is valued by the profession. If strong, the motivational effects of peer interaction could have profound implications for the organization of care delivery, including potential gains from models

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GET TO KNOW YOUR PEERS encouraging peer familiarity and visibility—gains that could accrue over many dimensions of care without requiring decision-specific interventions.

CCMA Physician Happy Hours

Grassini Tasting Room, Santa Barbara Tuesday, January 31, 2023 Tuesday, May 2, 2023 Tuesday, August 1, 2023

In this study, we used 2016 to 2019 electronic health record data on referrals initiated by primary care physicians (PCPs) from a large academic health system to investigate the association between PCP-specialist co-training and patient experiences with specialist care. Training together is 1 source of professional peer relationships that, when present, may motivate physicians to deliver better care. Specialists are aware that PCPs can observe aspects of their care through reading their notes and talking to patients; the presence of a strong peer relationship may also remind them of commonly valued precepts of professionalism. Accordingly, specialists may aspire to deliver their best care when seeing patients whose PCPs they know.

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Read the full study, Physician-Peer Relationships and Patient Experiences With Specialist Care, on JAMA Internal Medicine, originally published online January 3, 2023. doi:10.1001/ jamainternmed.2022.6007

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Delivering the best imaginable service Info Box:and unrivaled rewards is at the core of who we are. As an organization Get to know your peers founded and led by physicians, we understand the value of CCMA Physician Hours superior care. Because for us, it’s not just a bestHappy practice, Grassini Tasting Room, Santa Barbara it’s in our unique code. Join us at thedoctors.com

Tuesday, January 31, 2023 Tuesday, May 2, 2023 Tuesday, August 1, 2023 Café Roma, San Luis Obispo Wednesday, February 1, 2023 Wednesday, May 3, 2023 Wednesday, August 2, 2023

Winter 2023

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Winter 2023

House of Delegates

CMA ELECTS NEW OFFICERS AND ESTABLISHES POLICY ON MAJOR HEALTH CARE ISSUES The California Medical Association (CMA) recently convened its 151st annual House of Delegates (HOD) meeting in Los Angeles.

During the first in-person meeting of the HOD since the pandemic, more than 500 California physicians gathered to debate and establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine.

The association also installed its new officers, including new CMA President Donaldo Hernandez, M.D., an internist who is one of the longest-serving hospitalists in Santa Cruz County.

The major issues the delegates focused on this year were: Physician Workforce: Our state is facing a physician shortage that has reached crisis proportions, and the COVID pandemic has placed additional pressure on an already strained system. And, as California continues to grapple with longstanding workforce challenges, the Dobbs decision is creating new ones, particularly for medical students and residents in states that restrict or ban abortion services. The delegates discussed policies to expand and strengthen the physician workforce so that every patient has timely access to affordable, quality care.

Health Care Reform: In 2019, the Healthy California for All Commission was formed and charged with developing a plan to move our state toward a unified financing system for health care delivery. CMA’s commitment to universal access remains steadfast, but CMA strongly believes that the health care system must be funded in a way that is sustainable, so that health care coverage is not simply an empty promise and that all patients have equal access to quality care. The delegates discussed and debated a set of principles to ensure that any health care reforms will delivery highquality, affordable and evidence-based care to all.

Mental Health: Over the last five years, California has committed to investing billions of new dollars into improving mental health services for all Californians across all delivery systems. The scope of these investments is sweeping, and implementation of many of the initiatives, along with growing the state’s mental health workforce, will take years to accomplish. Delegates heard from Diana Ramos, M.D., the newly appointed California Surgeon General and longtime CMA member and delegate about California’s efforts to improve and expand mental health care.

You can view the final reports on each of these topics online at cmadocs.org/HOD. Winter 2023

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Elections Santa Cruz Internist Donaldo Hernandez, M.D., Takes Office as CMA’s 154th President Santa Cruz internist and hospitalist Donaldo M. Hernandez M.D., FACP, was installed as CMA’s 154th president.

“As we emerge from the mire that was the pandemic, I think it’s clear that we cannot go back to the system that existed before the world shut down,” said Dr. Hernandez.

“Business as usual left too many behind, left too many gaps, and left too many of us asking, ‘Is this what I signed up for?’”

Dr. Hernandez has long been a tenacious agent for change, and as president his goal is to position CMA at the forefront of change and innovation.

“I believe that an energized and engaged physician community is the best path toward a reimagined and integrated care delivery system, insulated from political gamesmanship and special interests,” said Dr. Hernandez.

“A system that focuses on relationships – particularly the core relationship between patient and physician – is the solution for affordable and equitable care delivery.”

“Physicians are the only segment of the care delivery infrastructure that swore a sacred oath to uphold a values-based construct as we care for our fellow humans. Adherence to that oath positions us to truly lead the necessary transformation of health care. The path forward must be physician-led and patient-focused.”

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Born in Southern California, Dr. Hernandez received his undergraduate degree from the University of California, Berkeley; his medical degree from the University of California, San Diego; and completed his internal medicine residency, and a fellowship in general internal medicine at Harbor-UCLA Medical Center in Torrance.

Dr. Hernandez is one of the longest-serving hospitalists in Santa Cruz County and is currently a shareholder in the Palo Alto Medical Foundation, considered one of the highest quality hospital medicine programs in Central and Northern California.

Dr. Hernandez has been a member of CMA and the Santa Cruz County Medical Society (SCCMS) since 2003.

Prior to joining the CMA Executive Committee as President-Elect, he was elected to two terms as SCCMS president, then served on the CMA Board of Trustees for 10 years, representing the geographically and ethnically diverse District 7, which includes Monterey, Santa Cruz, San Benito, Santa Clara and San Mateo counties.

He has also served since 2016 as chair of CMA’s Justice, Equity, Diversity and Inclusion Committee.

Winter 2023

House of Delegates

Donaldo Hernandez, M.D., CMA President

Winter 2023

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Elections Redwood City ob-gyn Tanya Spirtos, M.D., Becomes CMA President-Elect Redwood City ob-gyn Tanya W. Spirtos, M.D., was named CMA president-elect. She will serve on the CMA Executive Committee in that role for one year before being installed as president at the conclusion of next year’s annual meeting.

Dr. Spirtos is a board-certified obstetriciangynecologist in full-time practice in a group of six physicians, now part of foundation model Packard Medical Group/Stanford Medicine. She is also on the active medical staff of El Camino Hospital and Sequoia Hospital.

Dr. Spirtos earned her undergraduate degree at the University of Chicago and her medical degree at Northwestern University Medical Center. She completed her residency at Los Angeles County Medical Center/University of Southern California and is a fellow of the American Congress of Obstetricians and Gynecologists.

She was a member of the Board of Trustees of Sequoia Hospital Systems from 2003-07 and served on the Community Board of Directors of Sequoia Hospital from 2007-15. She has also been an adjunct clinical faculty of Stanford University Medical School since 1995, with an academic appointment as adjunct clinical assistant professor from 2006-14.

and is a member of both the San Mateo County Medical Society and Santa Clara County Medical Association—the latter of which she served as president from 2005-06. She was elected to the CMA Board of Trustees in 2009 and continues to serve on the CMA delegation to the AMA. Since 2016, she has served on the CMA Executive Committee, first as vice speaker of the House of Delegates, then as speaker.

She lives with her husband, Elias Eleftheriades, in Redwood City, where they are both active in the Greek community and culture. Her children, Michael and Alexandra, born in 1989, have grown up surrounded by the practice and profession of medicine.

Alex is currently an ob-gyn resident at the University of Texas Southwestern Medical Center in Dallas; Mike is a practicing lawyer with Cleary Gottlieb Steen and Hamilton in New York City in the division of mergers and acquisitions.

Since 2010 she has served at the Arbor Free Clinic with Stanford medical students and has been recognized for exemplary contributions in teaching. Despite this—and her participation on various health boards—she receives 100% of her compensation from patient care.

Dr. Spirtos has been a member of the CMA and American Medical Association (AMA) since 1985,

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Winter 2023

Elections Los Angeles Family Medicine Physician Jack Chou, M.D., Elected CMA Speaker of the House Los Angeles family physician Jack Chou, M.D., was elected the new speaker of the CMA House of Delegates. He previously served three years as vice speaker.

Dr. Chou has split his clinical time between primary care, urgent care and hospitalist duties at Kaiser Baldwin Park Medical Center since 1999. He has been the physician-in-charge for the Family Medicine Department at Kaiser Baldwin Park Medical Center, Family Medicine Medical Office Building since 2006. Dr. Chou became the Chief of Service of the Family Medicine Department in July 2018, overseeing five medical office locations.

Dr. Chou was raised in a small rural town in Taiwan and later earned his Bachelor of Science in biology from the University of Miami, Florida, and his medical degree from the University of Southern California. He completed his family medicine residency at Kaiser Permanente Woodland Hills.

Dr. Chou and his wife, Kathy, are proud parents of twin daughters, Sarah and Samantha, and son, Nathan. He spends most of his free time dedicated to traveling with his family as part of his children’s education.

Dr. Chou is a partner of the Southern California Permanente Medical Group (SCPMG) and is the Regional Chair for Health Information Management and Regional Co-Chair for Scanning Oversight Committee at SCPMG. Since medical school, Dr. Chou has embraced leadership at all levels – local, state and national. Dr. Chou has been a member of CMA and the Los Angeles County Medical Association (LACMA) since 1992 and he has been an AMA member since 1996.

Dr. Chou has served as a member of the CMA House of Delegates since 2001. He was elected to represent LACMA on the CMA Board of Trustees in 2010 and served on the CMA Council on Ethical Affairs from 2011 to 2016.

Dr. Chou is also active in his local, state and national specialty societies, including serving as president and speaker of the California Academy of Family Physicians Congress of Delegates.

Winter 2023

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San Francisco Dermatologist Lawrence Cheung, M.D., Elected CMA Vice-Speaker

Elections

San Francisco physician Lawrence Cheung, M.D., was elected the new vice-speaker of the CMA House of Delegates.

San Francisco Dermatologist Lawrence Cheung, M.D., Dr. Cheung has been a dermatologist in solo Elected CMA Vice-Speaker private practice for 17 years. As a part of his practice, Dr. Cheung conducts and serves as principal investigator forLawrence clinical trials.

He also San Francisco physician Cheung, serves as a volunteer dermatology preceptor M.D., was elected the new vice-speaker of theat St. Mary’s Medical Center in San Francisco.

CMA House of Delegates.

Dr. of theinCMA Dr. Cheung Cheung has has been been a a member dermatologist solo Board of Trustees since 2020, after having private practice for 17 years. As a part of his previously served as chair of the CMA House practice, Dr. Cheung conducts and serves as of Delegates District VIII and a principal investigator for Delegation clinical trials.

Heas also member the CMA Council on Science and at serves as of a volunteer dermatology preceptor Public Health.

He also previously served on St. Mary’s Medical Center in San Francisco. the Board of Directors for San Francisco Health Dr. Cheung has been a member the CMA Plan as a mayoral-appointed Sanof Francisco Board of Trustees since 2020, after having County Commissioner. previously served as chair of the CMA House Dr. Cheung has beenVIII a member of CMA of Delegates District Delegation and and as a the San Francisco Marin Medical Society since member of the CMA Council on Science and 2006. is also a member of the served American PublicHe Health.

He also previously on the Medical Association, the American Academy Board of Directors for San Francisco Health of Dermatology and the American Society for Plan as a mayoral-appointed San Francisco Dermatological Surgery.

County Commissioner.

Dr. Cheung has been a member of CMA and the San Francisco Marin Medical Society since 2006. He is also a member of the American Medical Association, the American Academy of Dermatology and the American Society for Dermatological Surgery.

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Winter 2023

Elections THE FULL 2022-2023 CMA EXECUTIVE COMMITTEE INCLUDES:

Donaldo Hernandez, M.D. President

Tanya Spirtos, M.D.

President-Elect

Jack Chou, M.D.

Speaker of the House

Shannon Udovic-Constant, M.D. Chair, Board of Trustees

Lawrence Cheung, M.D. Vice-Speaker of the House

Sergio R. Flores, M.D.

Vice-Chair, Board of Trustees

Robert E. Wailes, M.D. Immediate Past President

DISTRICT V REPRESENTING

San Luis Obispo, Santa Barbara, and Ventura counties

Winter 2023

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Other News CMA House of Delegates Approves New Community Health Centers Forum The CMA House of Delegates approved the creation of a new Community Health Centers Mode of Practice Forum. The new delegation participated in its first meeting at this year’s House of Delegates in Los Angeles.

empower community health center physicians to partner with the broader house of medicine to advocate for policies that support the health center model of care and expand access to care to our state’s most diverse communities.”

California’s 1,300 community health centers provide care for more than 5 million patients every year, and are a critical piece of our state’s health care safety net. They provide comprehensive, quality health care services, particularly for low-income, uninsured and underserved Californians, who might otherwise not have access to health care.

CMA’s other mode of practice forums include the Solo and Small Group Practice Forum, the Medium Group Practice Forum, the Large Group Practice Forum, the Very Large Group Practice Forum, the Academic Practice Forum, the Administrative Medicine Forum, the Government Employed Physicians Forum and the Hospital-Based Physicians Forum.

“As a member of CMA and a board member of the California Primary Care Association, I am excited that the community health center physician perspective will have its own forum within CMA’s governance structure,” said Rakesh Patel, M.D., Chief Executive Officer of Neighborhood Healthcare. “This forum will

Membership in these forums is determined by each member’s self-selected mode of practice.

Delegates for each forum represent their modes of practice by attending and actively participating in delegation caucus meetings and in the annual CMA House of Delegates.

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Winter 2023

Upcoming California Medical Association Events Register for these and other CMA events at www.cmadocs.org/events.

Virtual Grand Rounds: COVID-19 Therapeutics - When and How to Treat for COVID-19 February 14, 2023 Noon – 1:00 pm We have entered another calendar year in which COVID-19 remains a predominant part of our lives. We are armed with a variety of outpatient treatment options for COVID-19, yet few patients are receiving treatment as recommended by California public health authorities. In this webinar, we will hear from California State Epidemiologist Erica Pan, M.D., MPH, about the state of COVID-19 in California, as well as other relevant public health announcements. We will also hear from experts about COVID-19 therapeutics – including efficacy, treatment recommendations, interactions and other details – that may help clinicians support their patients with appropriate therapeutics.

Webinar: New NP Classifications What Physicians Need to Know February 23, 2023 12:15 – 1:15pm Assembly Bill 890 (Wood), signed into law in September 2020, created two new classifications of nurse practitioners (NPs) 103 and 104 NPs - who can perform certain functions without standardized procedures and protocols in California. The regulations implementing the bill became effective as of January 1, 2023. These regulations set the minimum standards for the law’s "transition to practice" requirements for NPs seeking to apply for licensure under these classifications. NPs can elect, but are not required, to transition to these new classifications. This webinar will provide an overview of the law and regulations, explain under what circumstances 103 and 104 NPs can practice and where, and show how this may impact physicians and patients.

Winter 2023

Webinar: 2023 ICD-10 Coding Updates February 28, 2023 12:15 – 1:15pm There are significantly more new, deleted, and revised ICD-10 diagnosis codes in 2023 than in previous years - nearly 1,500.

This webinar will cover updates to some of the most significant changes, including behavioral and neurodevelopmental disorders as well as new cardiovascular, musculoskeletal, genitourinary, pregnancy, childbirth, puerperium, injuries, and poisoning codes. Of special interest are many new codes related to vascular dementia.

Webinar: Working with Different Generations April 4, 2023 12:15 – 1:15pm This presentation focuses on how bridging the generational gap in the workplace doesn’t have to be difficult. Presented by one of CMA’s experienced practice management experts, this presentation will dive into how to understand the differences in generations and work together to manage the gaps to ensure a positive and efficient work environment. Topics covered include understanding generation names and timeframes, understanding assumptions, how to work as a team, workplace characteristics by generation, and workplace values and best practices.

Health IT: Powering Value-Based Care May 22, 2023 9:00 am – 4:00 pm Sacramento, CA The CMA Health IT Conference will bring together thought leaders from across California and the nation to explore the intersection of technology and payment reform. CMA expects a diverse set of attendees that will include physicians, medical groups and IPAs, health plans, health information organizations (HIOs) and others who will take the learnings from this conference to change how care is delivered in this state.

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Congressional Year-End Omnibus Legislation (Summary) Medicare Payment Cuts + Congress stopped 6% of the 8.5% Medicare fee-for-service payment cuts facing physicians. Therefore, physicians will experience a 2.5% conversion factor payment cut to the 2023 Medicare Fee Schedule.

Physicians will also see a 1.25% cut in 2024. + The expiring 5% bonus payment for Advanced Alternative Payment Models, including Accountable Care Organizations was extended for one year at 3.5%.

Medicare Telehealth Flexibilities Extended for Two Years + Congress extended all COVID-19 telehealth waivers through the end of 2024. (Payment parity with inperson visits, audio and video, no restrictions on geographic regions or originating sites so patients can be at home.)

More Graduate Medical Education Residency Positions + Provides 200 new GME residency positions; half of the positions are dedicated to psychiatry and psychiatry subspecialties to meet the nation’s growing mental health needs.

Physician Wellness Program Expansion + Provides an exception to the Stark laws to allow hospitals and other entities to also provide evidence-based physician wellness programs, to improve mental health, increase resiliency, and prevent suicide. This builds on the Lorna Breene, MD Act that Congress passed earlier in the year.

Enhanced Medicaid Pandemic Funding to States Ends, But Additional Coverage Provided + Enhanced Medicaid FMAP provided to states during the COVID-19 pandemic ends April 1, 2023. States must begin the process of initiating redeterminations of eligibility over a period of at least 12 months.

States would be able to receive enhanced Medicaid funding from April 1 through December 31, 2023, subject to meeting certain conditions such as updating beneficiaries’ contact information and using more than one modality to contact beneficiaries in the event of returned mail. + Provides every child in Medicaid and CHIP (40 million children nationwide) one year of continuous coverage when they enroll. This will reduce disruptions in coverage and care for children. + Provides funding for 12 months of postpartum coverage to pregnant women in Medicaid and CHIP. California and 26 other states have already implemented this coverage.

Combating Medical Supply and Drug Shortages + New initiatives to strengthen the medical supply chains, increase stockpiles, and actively address drug shortages, including incentivizing domestic manufacturing. + Requires HHS to award new contracts to increase the domestic manufacturing capacity of certain antibiotic drugs with identified supply vulnerabilities, or the active pharmaceutical ingredient or key starting material of such antibiotic drugs.

Increased Pandemic Preparedness + Updates the nation’s ability to respond to future pandemics, with new plans to strengthen medical supply chains and stockpiles, bolster public health agencies, revitalize the public health workforce, enhance biomedical research and more.

Rev. 12/21/2022

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Winter 2023

Maternal Health, Mental Health and Substance Use Disorder Investments + Reauthorizes existing funding and makes new investments in mental health grants, suicide prevention, substance use disorder prevention-treatment-recovery services, opioid crisis response, high quality recovery housing, maternal mental health, the mental health workforce with an emphasis on pediatric mental health, grants to train primary care and mental health professionals on eating disorder treatments, and expands mental health parity protections. + Improves treatment for opioid addiction by expanding physicians’ ability to prescribe medication-assisted treatment.

Medicare Improvements + Makes substantial improvements to Medicare coverage of mental health, including coverage of intensive outpatient mental health care and payment for mental health mobile crisis units. Requires GAO to do a study on mental health parity between Medicare Advantage and traditional Medicare. + Requires HHS to conduct outreach to physicians on the requirements to determine eligibility and bill for opioid treatment services. + Delays for one year the Clinical Lab payment reduction and reporting requirements. + Permits coverage of oral antiviral drugs with an emergency use authorization (EUA) from the Food and Drug Administration (FDA) under Medicare Part D through December 31, 2024. + Provides Medicare coverage of physician-prescribed compression garments for seniors with Lymphedema – a chronic condition often occurring with aging or cancer treatment. + Provides permanent Medicare coverage for items and services related to the administration of intravenous immune globulin (IVIG), beginning on January 1, 2024. + Extends for one year the temporary blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non-competitive bid areas. + Extends the expiring Medicare Dependent Hospital program and the Low Volume Adjustment Hospital program for two years which helps rural and low-income communities.

Additional Health Care and Research Programs + Extends for two years the flexibility to exempt telehealth services from the deductible in high-deductible health plans that can be paired with a Health Savings Account. + Provides five years of funding at higher levels for the Maternal, Infant and Early Childhood Home Visiting Program. + Improves access to health care for justice-involved youth through Medicaid and CHIP by helping them maintain coverage and get connected to needed services. + Makes a series of FDA reforms, including protecting the infant formula supply, ensuring diversity in clinical trials, regulating cosmetics, and modernizing the accelerated approval process. + Authorizes the Advanced Research Projects Agency for Health (ARPA-H) to accelerate innovation in health and medicine by investing in novel, broadly applicable, high-risk, high-reward research projects.

Rev. 12/21/2022

Winter 2023

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In Memoriam

In Memoriam FREDERICK CARL HEIDNER II, MD

1929-2022 A life well-lived leaves a lasting and positive impact on those who shared in that life, and Dr. Frederick (Fred) Carl Heidner II certainly lived his life well. Fred passed from this life on July 2, 2022, at the age of 93 from natural causes. Fred’s final residence was at the Valle Verde retirement community, where he was an enthusiastic and active resident for the past 13 years.

Fred was born to Dr. Frederick and Esther Heidner in Milwaukee, WI on February 7, 1929, and lived a joyful and carefree youth with his brother and best friend, John N. Heidner.

Fred completed his college education and medical school studies at the University of WisconsinMadison, and his medical resident training in the United States Navy.

In 1961, he began his career as a urologist at Sansum Clinic where he practiced medicine with skill and compassion during what he considered to be the golden age of medicine, until his retirement in 1990.

While in medical school, Fred met the love of his life, Patricia Jean Watzke, whom he married in 1954. Fred and Patricia raised a daughter, Greta, and three sons: Frederick (Fritz), Hans and Kurt. Fred also experienced the joy of being a grandfather to two granddaughters, Anja and Nicola, and three grandsons, Ryan, Niels, and Eric. Fred was also blessed by a special

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relationship with two individuals brought into his life following the death of his son Fritz. To the day of his passing, Fred considered Matthew Grul and Jeannie Moore to be members of his family. Others dear to his heart include his son-in-law, Russell Greene, and his daughters-in-law, Faith Heidner (Hans) and Suzi Heidner (Kurt).

Fred lived a full and impactful life, and the days that remain for his family and friends will be all the more joyful and meaningful for having shared in that life. Their joy will come from having shared life with a man who radiated positivity and optimism, had a smile for all, and displayed unconditional love and support for his family and friends. They will remember Fred’s keen intellect, his quick wit, and his playful and gentle sense of humor. They will remember a man who modeled the qualities of honesty, integrity, generosity, love, and kindness, but rarely spoke of them. And they will fondly remember the joy he received from cheering for his beloved Green Bay Packers football team. While we are sad at his passing, we are tremendously grateful for the time we had together.

Adapted from the Santa Barbara Independent

CLIFT SEYBERT KINSELL, MD

1923-2022 Dr. Clift Seybert “Sey” Kinsell was born in Oakland, California, on July 25, 1923, and moved to Santa Barbara at age three. With this move commenced a long and fruitful life full of travel. His main love was for his family and service to others. Sey died on December 31, 2022.

Sey loved “all things Santa Barbara.” He first attended Roosevelt School, then La Cumbre Jr. High School, Santa Barbara High School and eventually Stanford University. After Stanford he began the practice of medicine.

Winter 2023

In Memoriam

In Memoriam Sey graduated Stanford Medical School in 1947 and trained first at San Francisco Children’s Hospital, and later at Los Angeles Children’s Hospital. He practiced medicine for 37 years at the Santa Barbara Children’s Medical Clinic and was well known to all as “Doctor Sey.” He was president of the Alpha Resource Center for six years and received a lifetime achievement award for his service.

He enjoyed a lifelong membership in the Episcopal Church, first attending Trinity Episcopal Church where he was a member of the vestry and he taught Sunday school. Later, he was a member of All Saints-by-the Sea Episcopal Church, where he was active every Tuesday morning at communion.

He was active in the Santa Barbara community serving on the Police and Fire Commission for six years, and on the Santa Barbara County Parole Board for three years. He was president and a Paul Harris Fellowship recipient of the Santa Barbara Rotary Club, which he joined in 1954. He also enjoyed the Chamber of Commerce Governmental Review Committee meeting for many years.

Retirement changed his emphasis from caring for children to caring for the elderly. He delivered Meals on Wheels, and he was a long-time bedside volunteer for Hospice/VNA helping people who stayed at home in their last days. Sey found great pleasure in helping others and he liked almost everything except asparagus, string beans, and snakes.

Sey is survived by his wife Tamara Kinsell; his children

Winter 2023

Suzanne (Kinsell) Padrick (Steve), Jeff Kinsell (Marie) and Kirk Kinsell (Carrie); his grandchildren Scott Padrick, Natalie (Padrick) Rodrigue and Ryan Padrick, Amy Kinsell and Pam (Kinsell) Phan, and Kyle Kinsell and Catelyn (Kinsell) Potter; and 14 great-grandchildren. Sey was preceded in death by former spouses Shirlee Kinsell, Lilabeth Kinsell; and siblings Beverly (Kinsell) Danielson and Henry Kinsell.

Adapted from Noozhawk

JAMES MICHAEL MCCULLAGH, MD

1941-2022 Mike McCullagh was a fourth-generation Floridian. Born in Jacksonville, he attended the Ortega Elementary School, the Bolles School, and Emory at Oxford. He received his undergraduate and medical degrees from Emory University, where he graduated Magna Cum Laude in Internal Medicine.

Mike served as a doctor in the Marines during the Vietnam War and was awarded a Bronze Star. After returning to Jacksonville, he married Jane Vason in 1972. For twelve years, Mike worked as an Internist in private practice with his father Harry (Psychiatrist), brother Henry (Cardiologist), and Emory classmate Harry Lee (Internist) in the Riverside neighborhood.

In 1984, he and his family moved to Santa Barbara, California, where he practiced at the Santa Barbara Medical Foundation Clinic. He lived in Santa Barbara

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In Memoriam

In Memoriam for 34 years and returned to Jacksonville in 2019.

Along the way, Mike and Jane built vacation homes in the Keys, South Ponte Vedra, and Steinhatchee in Florida as well as in the Bahia de Los Angeles and Cabo Pulmo in Mexico. He was grateful to have traveled throughout Europe and Asia and to have driven both the Atlantic and Pacific coasts of the US. Mike was a proud father, grandfather, and husband, and recently celebrated fifty years of marriage. He was tall, handsome, and modest, but his kindness and gentle spirit were his main characteristics. A naturalist and outdoorsman, he enjoyed being on the water most of all.

He is survived by his wife; daughter Jennifer Brown and son-in-law Greg Brown of Santa Barbara; daughter Sarah McCullagh of Santa Barbara; and daughter Mary Russo and son-in-law Gregor Russo of Switzerland as well as grandsons Ben McAvene, Mills Vining, and Michael Russo.

Adapted from the Florida Times Union

LEONARD ATKINSON PRICE, MD

1935-2022 Leonard Atkinson Price, MD, passed away October 6, 2022, at age 87 at his home in Santa Barbara after a long-term illness.

This beloved man was husband of Diane D. Price; father to Dawn Laura (Price) Schroeder and Geoffrey Leonard Price; previous father-in-law to Richard Schroeder and Jeanette Price; and proud grandfather of Grant Gregory Schroeder, Erica Diane Schroeder, Griffen Atkinson Price, and Victoria GiGi Price.

Born in Ogdensburg, New York, on May 31, 1935 to Dr. George LeRoy Price and Mrs. Laura Atkinson Price, Leonard

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(known to friends as “Cap”) attended college at St. Lawrence University and was a proud Phi Sigma Kappa. He worked and was on active duty in the Army’s Military Police as he saved money for medical school.

He attended Queen’s University in Canada to earn his M.D. and during his residency at Hurley Hospital in Flint, Michigan, he met nurse and his future wife Diane DeWeese Watters. They married in 1964 and later moved to La Jolla, California, for a fellowship at Scripps Clinic. He spent two years treating patients at the VA Hospital for lung disease. In 1969 the family moved to Santa Barbara to begin a practice in allergy/ internal medicine.

Leonard was involved in his local community as past president of the Santa Barbara County Medical Society, specialist at UCSB student health center, teaching staff at Cottage and Goleta Valley hospitals, board member of Santa Barbara Scholarship Foundation, an elder at the First Presbyterian Church, sponsor of Momentum 4 Life triathlon teams, volunteer basketball coach at San Marcos High School, and volunteer tutor in the Goleta Union School District.

Leonard enjoyed many hobbies, such as singing in the church choir, playing golf, fishing, gardening, growing roses, loving all sports, throwing Fourth of July and Halloween parties, making photo montages, his poker group, the game of bridge, and most of all relishing in the pursuits of his children and grandchildren with family time.

Adapted from Noozhawk

Winter 2023

New Members

9 New & Rejoining

The Central Coast Medical Association welcomes the following physicians as members

...and even more on the way.

Summer Kathleen Baird, MD Internal Medicine Santa Barbara 805.682.7111

Emily Regina Fonda, MD Internal Medicine Santa Barbara CenCal Health 805.685.9525

Christine Denise Kilcline, MD Dermatology San Luis Obispo Coastal Dermatology + Aesthetics 805.544.5567

Brent Michael Pennelly, MD Physical Medicine & Rehabilitation Arroyo Grande 805.473.7663

Steven R Sabo, MD Undersea & Hyperbaric Medicine San Luis Obispo Central Coast Wound Care & Hyperbarics 805.888.4744

Winter 2023

Ragui Wassef Sedeek, MD Ophthalmology Santa Maria Central Coast Retina 805.876.3050

Kenneth Anthony Spearman, MD Diagnostic Radiology Arroyo Grande Central Coast Vein & Vascular 805.473.8346

RESIDENTS Arielle Simone Kanner, DO, MS Internal Medicine Santa Barbara Cottage Hospital

Sri Mandava, MD Internal Medicine Santa Barbara Cottage Hospital

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

Presorted Presorted Standard Standard U.S. Postage Postage U.S. PAID PAID San Dimas, CA Permit #500 Permit No. 410 Claremont, CA

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