California Physician - Winter 2017 by Component Medical Society Services

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House of Delegates The Value of Advocacy #cmadocs WINTER 2017

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Back to Back

SAVINGS on

a Workers’ Compensation insurance program designed

for physician practices! Rates remain level for another year for the CMA-sponsored program. Why buy workers’ compensation insurance from just anyone, when you can purchase it through the CMA-sponsored program and save 5% on your premiums?

Sponsored by:

As you know, if you have employees, Workers’ Compensation is required in California. Looking to your association for a comprehensive program is one of the best ways to make use of your member beneﬁts. CMA partners with Mercer Health & Beneﬁts Insurance Services and Preferred Employers Insurance to provide safety, stability, service and savings to physician practices participating in the program.

Stability: Preferred prides itself on its stability, which includes maintaining some

of the best and most consistent pricing available for members. And because of its Medical Provider Network of credentialed medical professionals, claim costs can be closely monitored and managed while providing quality care to injured employees.

Safety: In addition to mandatory CalOSHA information and videos on workplace safety, Preferred’s team of Risk Advisors are available for consultations when you need them. They also have a strong fraud prevention policy and as a California-based carrier, they know exactly what it takes to do business successfully in this State. Service: Mercer’s team of advisors is knowledgeable about the needs of physician practices and is available to walk you through the application process, either by phone, or in person. Preferred handles and manages its own claims, rather than using third-party adjusters. This means more efﬁcient and expert claim handling. With Preferred, injured employees tend to return to work faster than the industry average and effective management of medical fraud means lower overall insurance costs for members.

Underwritten by:

PREFERRED EMPLOYERS Insurance

| a Berkley Company

Administered by:

All of these features add up to Savings for CMA members! See how safety, stability and service can save you money by requesting a premium indication today! Call a Mercer Client Advisor at 800-842-3761 to get started. Or, visit www.CountyCMAMemberInsurance.com for more information and download a premium indication request form or application.

Scan for more information.

Program Administered by Mercer Health & Beneﬁts Insurance Services LLC

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WINTER 2017

Winter 2017

5 2017 YEAR IN REVIEW

24 THE LIFECYCLE OF LEGISLATION

26 THE VALUE OF ADVOCACY

Thanks to the support of our 43,000 #CMADocs and #TeamCMA’s hard work, it’s been a banner year for CMA.

AN AWESOME RESPONSIBLITY A message from CMA President Theodore M. Mazer, M.D.

Every year, CMA supports and shapes the development of valuable health care policy.

CMA is constantly monitoring legislative threats to the practice of medicine, to ensure bad bills don’t become bad medicine.

8 TOP 10 REASONS TO BE A MEMBER 32 LEADING THE WAY When you become a member, you hire a powerful professional staff to protect your profession from legal, legislative and regulatory intrusions.

UNWAVERING DEFENSE

CMA’s 2017 Legislative Wrap Up

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Physicians of CMA set policy to guide the future of medicine.

44 THANK YOU #CMADOCS SUPERSTARS #CMAdocs showcases California Physicians leading the charge to help their communities thrive.

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CALIFORNIA PHYSICIAN WINTER 2017 California Physician Magazine is a periodic publication produced by the California Medical Associationâ&#x20AC;&#x2122;s Center for Strategic Communications.

VICE PRESIDENT Laura Quigley SENIOR DIRECTOR Katherine Boroski

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: California Physician Magazine

CREATIVE DIRECTOR Sherry Williamson

C/O California Medical Association

ASSOCIATE DIRECTOR Joanne Adams

1201 J Street, Suite 200

ASSOCIATE DIRECTOR Brooke Byrd ASSOCIATE DIRECTOR Ariana Arghandewal

Sacramento, CA 95814 Phone: (800) 786-4262 Fax: (916) 551-2036

CMA EXECUTIVE COMMITTEE:

E-mail: communications@cmanet.org

Theodore M. Mazer, M.D., PRESIDENT David H. Aizuss, M.D., PRESIDENT-ELECT Robert E. Wailes, M.D., CHAIR, BOARD OF TRUSTEES Shannon L. Udovic-Constant, M.D., VICE-CHAIR, BOARD

CMA produces a number of publications to keep members up to date on the latest health care news

OF TRUSTEES

and information affecting the practice of medicine in

Ruth E. Haskins, M.D., IMMEDIATE PAST PRESIDENT

California. Members and registered website users can

Lee T. Snook, Jr., M.D., SPEAKER OF THE HOUSE Tanya W. Spirtos, M.D., VICE-SPEAKER OF THE HOUSE

SUBSCRIPTION INFORMATION

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subscribe to any of these publications by visiting your www.cmanet.org/publications.

WINTER 2017

Secured over $1 billion annually to improve provider payments and graduate medical education funding.

ONEBILLION

Defended medical staff independence in “existential threat” lawsuit against the Tulare Regional Medical Center.

ONEMILLION Recouped nearly $1 million from payors on behalf of physician members.

Expanded member insurance program with state-approved workers comp coverage, new cyber liability program and personal insurance products.

CMA executive awarded “CFO of the Year” for fiscal responsibility and innovative strategic investments.

Defeated irresponsible federal legislation that would have harmed patient access to physicians and decreased health care coverage.

Stood in solidarity with California’s “Dreamers” and in support of diversity and inclusion.

Reaffirmed staff commitment to CMA’s mission by developing a credo.

Developed AB 72 and MACRA resource centers to educate members on rights and responsibilities.

Convinced CMS to further reduce 2018 MACRA reporting burdens.

Debuted a Mother’s Room at CMA headquarters for breastfeeding staff and members.

Declared firearm violence “violates the fundamental human right” to “live safely without fear in a free society.”

@cmaphysicians www.cmanet.org

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Headquarters 1201 J Street, Suite 200 Sacramento, CA 95814 (916) 444-5532

CMA Member Service Center Just one number to call for all your CMA needs! (800) 786-4CMA (4262)

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Theodore M. Mazer, M.D. > How Physicians Treat One Another Matters

An Awesome Responsibility Theodore M. Mazer, M.D.

Leading the California Medical Association (CMA) is an awesome responsibility – one that includes representing physicians in the battles medicine faces in California and nationally; promoting policies that protect our patients, our practices and our ability to care for our communities; and preventing regulations that contribute to the ever-increasing problem of burnout among physicians that is resulting in early retirement or career change, frustrations and even suicide.

we must advocate for physicians as professionals, enabling us to do what is right for our patients. To support the supremacy of the physician-patient relationship, which allows the unfettered sharing of intimate information and decision making, aware of but unhindered by purely economic factors. We must support physicians in all specialties and modes of practice, so that patients can choose to receive care in whatever forum best suits them.

I believe all physicians are responsible to protect the profession of medicine in the present and for the future. And no one can do that alone. We can do it as a team, listening to our colleagues, especially where their insights and needs differ from ours. I am so encouraged by talking to our medical students and young physicians, with their fresh ideas and outlooks, dedicated to the future of patient care.

Every idea starts with one person. The scholar Hillel said that a single candle can light a thousand other candles without diminishing itself. Each of us is such a candle. Each can inspire others to resist forces that impede our ability to care for patients, and each can promote positive changes. Each of us can encourage our colleagues to join us, whether actively or simply as members supporting our efforts. Our actions are for all physicians, and no one should be a bystander.

One of those students, Cecelia Bonaduce-Leggett, put it well when asked why busy medical students would get involved with medical politics, saying: “We believe the future of medicine should have a say in the future of medicine.” If only those who want to tell us how to practice our profession could take a leaf from her book! Listening to those actually practicing medicine to inform public policies for the future. Fulfilling our mission “to promote the science and art of medicine, the care and wellbeing of patients, the protection of the public health and the betterment of the medical profession,”

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I look forward to working hard this year on your behalf. I know that when we work together to find common ground on issues and solutions, regardless of specialty or mode of practice, we build an even stronger CMA, and prove the whole greater than the sum of its parts.

Theodore M. Mazer, M.D. CMA President

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MEMBER BENEFITS AND RESOURCES

EMPOWERING PHY SICIANS

CMA gives me the sens e that I am not alone in the fight to protect my patients and ensure that they get the best and highest qu ality of care.

C. Freeman, M.D. Psychiatrist, Member Since 2006

YOUR PRACTICE

YOUR PROFESSION

YOUR VOICE

Access to practice management experts

Valuable tools and resources

Legislative advocacy

Free CME webinars

Legal support

Free reimbursement helpline

News and updates you need to know

Free access to the most comprehensive health law library

WE GET YOU

WE KEEP YOU UP-TO-DATE

WE ARE YOUR VOICE

Direct payor intervention

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www.cmanet.org/benefits

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MEMBERSHIP

Top 10 Reasons to Be a Member

When you become a member, you hire a powerful professional staff to protect your profession from legal, legislative and regulatory intrusions. But that’s not all. Let’s count down the top 10 reasons to be a member of the California Medical Association (CMA) and your local county medical society.

10. Protect the Profession Your membership affirms your commitment to the medical profession and ensures physicians remain in control of the practice of medicine.

9. Lead by Example

CMA and its county medical societies provide many opportunities to get involved, including opportunities to volunteer; serve on a committee, council or board; and shape the future of the medical profession.

8. Stay in the Know

CMA and its county medical societies produce publications to keep you up-to-date on the latest health care news

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and information affecting the practice of medicine in California.

7. Get Paid

Members receive one-onone assistance from CMA’s reimbursement experts who have recouped $15.5 million from payors on behalf of CMA physicians in the past nine years.

6. Protect MICRA

CMA staunchly defends the landmark Medical Injury Compensation Reform Act (MICRA) year after year, saving each California physician an average of $75,000 per year in professional liability insurance premiums.

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MEMBERSHIP

Through CMA we give important public health “concerns a strong voice and keep elected representatives in tune with changing practice paradigms. – Brandon Woodward, M.D.

”

5. Collaborate with Colleagues

4. Promote Public Health

CMA and its county medical societies bring together physicians from all regions, specialties and modes of practice through leadership, collaboration, social and educational events, and community service.

From tobacco use and obesity to prescription drug abuse and vaccinations, your membership dollars support forward-thinking public health advocacy to improve the health of Californians. Continued on page 19 >>

NEW! Membership is easier than ever with new

monthly payment plan

Membership in the California Medical Association (CMA) and your local county medical society is easy to maintain and hassle-free with automatically recurring monthly payments at an affordable monthly price. If you’re not already a member, enroll today at www.cmanet.org/monthly to start receiving your beneﬁts! If you’re a current member, keep an eye out for your renewal invoices this fall and choose the monthly payment plan. QUESTIONS? Contact CMA’s Member Resource Center at (800) 786-4262 or memberservice@cmanet.org.

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MEMBERSHIP

Ask yourself who will have the most impact on the way you practice “medicine–the government, or physicians in organized medicine through CMA? Be involved or be left behind. ” – J. Brennan Cassidy, M.D.

3. Head Seat at the Policy Table

Through aggressive political and regulatory advocacy, CMA and its county medical societies are positioned among the most influential stakeholders in the development and implementation of health policy.

Join or renew your membership today! www.cmanet.org/join

2. Shape the Future of Medicine

Members receive direct access to our state and national legislative leaders to influence how medical care is provided today and in the future.

1. Together We Are Stronger

Together, we stand taller and stronger as we fight to protect patients and improve the health of our communities. We are a dominant force in health care – but all the great work we do wouldn’t be possible without the support of members like you.

ER D R O

RE D N A

AVAILABLE AT 10

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QUESTIONS? Contact our Member Resource Center at (800) 786-4262 or memberservice@cmanet.org.

• WWW.CPLH.ORG • (800) 786-4262 WINTER 2017

CALIFORNIA MEDICAL ASSOCIATION

SEE JANE SAVE WITH CMA Purchased health insurance for her

Purchased workers’ comp insurance

8-person staff through Mercer.

through the Mercer/Preferred

SAVED: $12,120

Employers program.

SAVE: $750

Called CMA’s legal information line and accessed documents from CMA’s online

Earned 16.75 CME by attending

health law library, instead of calling an

CMA’s Western Health Care

attorney for that same information.

Leadership Academy.

SAVED: $2,660

SAVED: $400

Used EnviroMerica to manage

Participated in 3 online webinars.

her practice’s medical waste and

SAVED: $297

regulatory compliance.

SAVED: $1,200

Used CMA’s magazine discount program to subscribe to 10 magazines

Hired CMA partner Mayaco Internet

for her waiting room and exam rooms.

and Marketing to design a new

SAVED: $250

mobile-friendly website.

SAVED: $1,000

Bundled her auto and home insurance through Mercury Insurance.

Called CMA’s reimbursement helpline.

RECOVERED: $800

SAVED: $230 Kept track of her CME credits through

Sent her billing staff to CMA’s

IMQ’s online CME certification portal.

ICD-10 boot camp.

SAVED: $24

SAVED: $800

Bought security prescription EMR Purchased office supplies through

sheets from RxSecurity.

CMA’s Staples Advantage program.

SAVED: $10

SAVED: $750

TOTAL SAVINGS: $21,291 Saving money, having access to unique services, knowing her dues support the California Medical Association’s efforts to protect the2017 viability of her practice, so she can focus on providing her patients with excellent care: PRICELESS WINTER CALIFORNIA PHYSICIAN 11

G N I R E V A UNW DEFENSE CMA’S 2017 LEGISLATIVE WRAP UP BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT

Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it.” -MUHAMMAD ALI

In modern California politics, there is no more imposing figure than Governor Jerry Brown. Since his return to the Governor’s office, Brown and his administration have been able to develop and implement his policy agenda in a nearly flawless manner, overcoming every political obstacle in his way. Nowhere has Governor Brown’s dominance been more evident than in the crafting of the state budget. Prior to Governor Brown’s return and the passage of the majority-vote budget, the enactment of the state budget was a drawn-out clash of political wills—a battle of ideals and priorities. The governor would present his vision in January. The Legislature would take months re-shaping

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and re-focusing the governor’s budget proposal. Tense negotiations would yield significant legislative changes in the budget and a handful of gubernatorial line-item vetoes. During his second tenure, Governor Brown has worked to deliver on-time budgets that do not significantly differ from his January proposals. This year, the state budget process was more critical than ever to the California Medical Association (CMA). The November 2016 election yielded another ballot measure victory for CMA and public health advocates across the Golden State with the passage of Proposition 56. CMA took on Big Tobacco and passed Prop. 56, which increased

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the tax on tobacco products by $2 per pack and stipulated that the new tobacco tax funds should increase access by improving provider payments. Despite being outspent, CMA and its partners in support of the measure got Prop. 56 passed overwhelmingly, providing an influx of new revenue to increase payments to Medi-Cal providers. Governor Brown, however, seeking to secure his legacy of fiscal prudence, sought to re-interpret the provisions of Prop. 56 to redirect the tobacco tax proceeds from Medi-Cal providers to the State General Fund. In his January budget proposal, Governor Brown didn’t include a rate increase for Medi-Cal providers. While there was an initial thought that the Governor was utilizing this proposal as a negotiation tactic to help shape the overarching discussion of the architecture for the state budget, it quickly became apparent that the Governor did not intend to ever support a rate increase for Medi-Cal providers. Thus, the battle began! The Governor’s intentions became more evident with the release of the Department of Finance’s May Revision. Just weeks before the constitutional deadline for the Legislature to pass the budget, the Governor doubled down on this earlier proposal and once again proposed no funding to support a Medi-Cal rate increase for providers. Restoring Prop. 56 funds was CMA’s top budget priority, and we engaged the Legislature through earned media, digital advertising, grassroots outreach and direct advocacy. CMA and its coalition partners, specifically the California Dental Association and Planned Parenthood, devoted the necessary resources to make sure that the Legislature followed the will of the voters and used the tobacco tax money to improve access to care in our state. CMA’s county

medical societies and individual physician members made calls, wrote letters and conducted in-person legislative lobbying visits. Our legislative champions, led by Senator Richard Pan, M.D., and Assembly members Joaquin Arambula, M.D., and Jim Wood, D.D.S., pushed both the State Senate and Assembly to reject the Governor’s budget. The final budget, which Governor Brown signed, provides over $1 billion ($546 million in state funds, with a federal match) to improve provider payments, and nearly $750 million ($375 million in state funds, with a federal match) will be available to physicians. This victory was a collective effort of the entire CMA. A budget team was assembled, comprised of members of the Centers for Government Relations, Health Policy, Strategic Communications and Political Operations. Working in concert, this team successfully pushed the budget as CMA’s top legislative priority. Media coverage of the budget is always competitive, but the issue of Prop. 56 funding garnered a significant amount of attention, even among the sea of other budget fights, thanks to the persistence of the CMA Communications team. CMA’s Political Operations staff organized physicians and county medical society executives to engage in the fight, bringing the issue to the attention of their legislators at in-district meetings and to the Capitol on our Legislative Advocacy Day in April. The CMA Government Relations team, the face of the fight, came armed to each hearing and meeting with the expertise of the CMA Health Policy team. Although this fight will no doubt play out again in some future years and we will need to be vigilant to ensure continued funding, this year’s budget success seals the intent of the voters and will provide relief for California’s shamefully low Medi-Cal reimbursement rates.

AN AGGRESSIVE LEGISLATIVE AGENDA

prescriptions. Our bill would improve privacy protections in the mandated use of CURES. To deal with how opioids are prescribed, Assembly member Joaquin Arambula, M.D., introduced AB 1048, which allowed for partial fill of Schedule II prescriptions and removed the requirement for evaluating pain as the fifth vital sign. These changes will alleviate some of the pressure on physicians to prescribe and reduce the number of opioids given to patients. CMA also successfully pushed a clean-up bill for last year’s AB 2883 (authored by the Committee on Insurance), a workers’ compensation bill that inadvertently created hundreds of thousands of dollars new, burdensome costs to physician practices. CMA’s

Amid the budget battle, the quotidian legislative work continued – as always. However, the routine was not without intensity. CMA this year pushed an aggressive legislative agenda through our package of sponsored bills, seeking to address a wide variety of our members’ issues. Two of our sponsored bills this year pertained to different aspects of the opioid crisis. SB 641 (Lara), which was put on hold for further discussion in the 2018 legislative session, is a supplement to Senator Lara’s SB 482 from last session, requiring use of the Controlled Substance Utilization Review and Evaluation System (CURES) for Schedule II-IV controlled substance

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bill—SB 189 (Bradford)—completely exempted physician practices from the workers’ compensation coverage requirement established by AB 2883, provided they have health insurance coverage. SB 189 will dramatically reduce the administrative cost of running a medical practice. Our highest profile legislative fight was over the Medical Board of California sunset review. This was the Legislature’s scheduled review of the medical board, during which it can make changes to the board’s policies and procedures and, crucially, extends the board past its “sunset” – that is, dissolution – date. What should have been an uneventful, perfunctory bill became a fight for CMA because of the inclusion of several provisions

eroding physicians’ rights. We secured amendments to remove harmful provisions from the bill, including ones that would have reestablished a cost recovery program for the board, provided the board with new authority to issue cease practice orders and required certain physicians to notify their patients of their probation status. As ever with the two-year legislative cycle, the bulk of the first year’s work sets the stage for the second year’s. Discussions will resume in January over a host of issues, and CMA is well positioned in those conversations to protect the interests of physicians and their patients. Our strength this year builds our strength for next year. In Unity, Janus L. Norman

BELOW ARE DETAILS OF THE MAJOR BILLS THAT CMA FOLLOWED THIS YEAR.

CMA-SPONSORED LEGISLATION AB 315 (WOOD): PHARMACY BENEFIT MANAGER TRANSPARENCY This bill requires pharmacy benefit managers (PBMs) to obtain a license from the Department of Managed Health Care before conducting business in California and to renew the license on an annual basis. It also requires PBMs to make quarterly disclosures regarding information with respect to prescription product benefits specific to the purchaser for all retail, mail order, specialty, and compounded prescription products.

Status: Held on the Inactive File of the Senate.

AB 505 (CABALLERO): RESTORING TRUST IN MEDICAL BOARD PROBATION This bill would have prevented a physician or surgeon charged with certain serious allegations from entering into a stipulated settlement that included probation as one of the settlement terms.

Status: Held in the Senate Business, Profession, & Economic Development Committee.

AB 1048 (ARAMBULA): IMPROVED OPIOID MANAGEMENT

prescriber. It also removes the requirement that hospitals assess pain as the 5th vital sign, retaining the assessment but providing hospitals the flexibility in determining the best approach. These provisions ensure that health care providers can provide appropriate medical care while reducing excess opioid supply.

Status: Signed by the Governor (Chapter 615, Statutes of 2017).

AB 1221 (GONZALEZ FLETCHER): RESPONSIBLE BEVERAGE SERVICE TRAINING PROGRAM This bill would require California bartenders, servers, and managers to receive responsible beverage service training (RBS) through a program that must be administered or approved by the Department of Alcoholic Beverage Control or offered by a training provider that has been accredited by an accreditation agency. AB 1221 seeks to help individuals who serve alcohol, to meet their statutory requirement not to serve obviously intoxicated patrons and minors and reduce drunk driving.

Status: Signed by the Governor (Chapter 847, Statutes of 2017).

This bill allows Schedule II controlled substances to be partially filled at the request of the patient or the

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SB 189 (BRADFORD): WORKERS’ COMPENSATION FIX

SB 641 (LARA): PRIVATE PROTECTIONS FOR THE CURES DATABASE

This bill provides a clarification to AB 2883 (Insurance Committee, 2016), which had allowed shareholderemployees with at least a 15-percent ownership stake in a corporation to exempt themselves from coverage. SB 189 reduces the 15-percent ownership threshold to 10 percent and explicitly exempts physician owners of medical corporations from workers’ compensation requirements regardless of percentage of ownership, as long as they have health insurance coverage.

This bill clarifies that law enforcement must get a warrant to obtain information from the Controlled Substance Utilization Review and Evaluation System (CURES), which aligns the CURES privacy protections more closely with those provided a patient’s medical record.

Status: Signed by the Governor (Chapter 770, Statutes of 2017).

SB 457 (BATES): OUT-OF-HOSPITAL BIRTHS This is a comprehensive approach for California licensees assisting out-of-hospital births (M.D.s, CNMs, and LMs) to establish proper protocols, increase patient safety, and clarify the appropriate scope of practice for both CNMs and LMs assisting births outside a hospital. CMA is co-sponsoring this legislation with ACOG.

Status: Held in the Senate Business, Profession, & Economic Development Committee.

Status: Held in the Assembly Public Safety Committee.

SB 647 (PAN): SILENT PPO AND HEALTH CARE PROVIDERS’ BILL OF RIGHTS In 2003, the Legislature enacted the Health Care Providers’ Bill of Rights, in part to ensure that third-party payers are automatically bound by the terms of the original health plan/provider contract. Recently, the appellate court decision in the UFCW & Employers Benefit Trust v. Sutter Health (2015) ruled that a third-party payer was not bound by the terms of the original health provider/ health plan contract even though that payer had benefitted from the lower provider rates in the contract. The UFCW case has undermined protections that were established by a CMA-sponsored bill. We will be working with the California Hospital Association, to sponsor legislation to re-establish the automatic binding of a third-party payer to the original health plan/provider contract.

Status: Held in the Senate Health Committee.

SUCCESSFULLY NEGOTIATED LEGISLATION AB 40 (SANTIAGO): CURES DATABASE: HEALTH INFORMATION TECHNOLOGY SYSTEM This bill would require the Department of Justice to make a patient’s Controlled Substance Utilization Review and Evaluation System (CURES) history of dispensed controlled substances available to a practitioner through either an online Internet Web portal or an authorized health information technology system. The bill would authorize an entity that operates a health information technology system to establish an integration with and submit queries to the CURES database, if the system entity can certify, among other requirements, that the data received from the CURES database will not be

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used for any purpose other than delivering the data to an authorized health care practitioner or performing data processing activities necessary to enable delivery, and that the system meets applicable patient privacy and information security requirements of state and federal law. The bill would also authorize the Department of Justice to require an entity operating a health information technology system that is requesting to establish an integration with the CURES database, to enter into a memorandum of understanding or other agreement setting forth terms and conditions with which the entity must comply.

Status: Signed by the Governor (Chapter 607, Statutes of 2017).

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AB 182 (WALDRON): HEROIN AND OPIOID PUBLIC EDUCATION This bill would require the Department of Public Health, until January 1, 2023, to develop, coordinate, implement, and oversee a comprehensive multicultural public awareness campaign, to be known as “Heroin and Opioid Public Education (HOPE),” upon appropriation by the Legislature or receipt of state or federal grant funding. The bill would require the HOPE program to provide for the coordinated and widespread public dissemination of information that is designed to, among other things, describe the effects and warning signs of heroin use and opioid medication abuse, to better enable members of the public to determine when help is needed and identify pathways that are available for individuals to seek help. The bill would require the HOPE program to use appropriate media types as specified, employ a variety of complementary educational themes and messages that are tailored to appeal to different target audiences and use culturally and linguistically appropriate means.

Status: Failed in the Senate Appropriations Committee.

AB 334 (COOPER): SEXUAL ASSAULT This bill would have set the time for commencement of any civil action for recovery of damages suffered as a result of sexual assault, to the later of within 10 years from the date of the last act, attempted act, or assault with intent to commit an act, of sexual assault by the defendant against the plaintiff or within 3 years from the date the plaintiff discovers or reasonably should have discovered that an injury or illness resulted from an act, attempted act, or assault with intent to commit an act, of sexual assault by the defendant against the plaintiff.

Current law defines an employer for purposes of those provisions. This bill would have expanded the definition of “employer” for purposes of these provisions to include a person who directly or indirectly, or through an agent or any other person, employs or exercises control over the wages, hours, or working conditions of a person engaged in a period of supervised work experience to satisfy requirements for licensure, registration, or certification as an allied health professional.

Status: Failed in the Assembly.

AB 413 (EGGMAN): CONFIDENTIAL COMMUNICATIONS: DOMESTIC VIOLENCE This bill would allow a party to a confidential communication to record the communication for the purpose of obtaining evidence reasonably believed to relate to domestic violence and the evidence so obtained would not be rendered inadmissible in a prosecution against the perpetrator for domestic violence.

Status: Signed by the Governor (Chapter 191, Statutes of 2017).

AB 702 (LACKEY): DRIVING UNDER THE INFLUENCE: CHEMICAL TESTS

Status: Failed in the Senate Public Safety Committee.

When a person is convicted of violating specified drivingunder-the-influence (DUI) provisions, and at the time of the arrest leading to that conviction the person willfully refused a peace officer’s request to submit to, or willfully failed to complete, a specified chemical test, existing law requires a court to impose additional penalties. This bill would make it a crime for a person to willfully refuse to submit to, or willfully fail to complete, a breath test after being lawfully arrested for a violation of specified offenses. Status: Failed in the Senate Appropriations Committee.

AB 387 (THURMOND): MINIMUM WAGE: HEALTH PROFESSIONALS: INTERNS

AB 715 (WOOD): WORKGROUP REVIEW OF OPIOID PAIN RELIEVER USE AND ABUSE

Current law requires the minimum wage for all industries to not be less than specified amounts to be increased from January 1, 2017, to January 1, 2022, inclusive, for employers employing 26 or more employees and from January 1, 2018, to January 1, 2023, inclusive, for employers employing 25 or fewer employees, except when the scheduled increases are temporarily suspended by the Governor, based on certain determinations.

This bill would require the Department of Public Health to convene a workgroup, comprised of members selected by the department, to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers for instances of acute, short-term pain.

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Status: Vetoed by the Governor.

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AB 859 (EGGMAN): ELDERS AND DEPENDENT ADULTS: ABUSE OR NEGLECT The Elder Abuse and Dependent Adult Civil Protection Act, provides for the award of attorney’s fees and costs to, and the recovery of damages by, a plaintiff when it is proven by clear and convincing evidence that the defendant is liable for physical abuse or neglect, and the defendant has also been found guilty of recklessness, oppression, fraud, or malice in the commission of that abuse. This bill would instead apply a preponderance of the evidence standard to any claim brought against a residential care facility for the elderly or a skilled nursing facility for remedies sought pursuant to the above provisions, upon circumstances in which spoliation of evidence has been committed by the defendant.

Status: Vetoed by the Governor.

AB 1061 (GLORIA): VICTIM’S RESTITUTION This bill would update the administration of the Crime Victim Compensation Board. It would prohibit a suspected perpetrator of the crime for which compensation is sought from being an authorized representative for the purposes of filing a claim. The bill would provide an indefinite application period for certain crimes, including rape, as specified. The bill would add preparation for testimony as a condition the board may consider for extending the time for application.

Status: Failed in the Assembly Appropriations Committee.

AB 1116 (GRAYSON): PEER SUPPORT AND CRISIS REFERRAL SERVICES This bill would create the Peer Support and Crisis Referral Services Act, which would allow for the creation of “peer support teams” to provide counseling services to individuals who respond to critical incidents. These services would be available to physicians who provided emergency services who need mental health counseling or peer support.

Status: Failed on the Senate Inactive File.

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AB 1250 (JONES-SAWYER): COUNTIES: CONTRACTS FOR PERSONAL SERVICES This bill would have established specific standards for the use of personal service contracts by counties requiring the County Board of Supervisors to make a number of findings, before awarding a government service contract to a private third party, including non-profits. The bill does not apply to existing contracts and any extension or renewal of those contracts. Additionally, the bill does not apply to services that are expert in nature or to services where there are not sufficient number of county employees in the workforce to reasonably provide the service.

Status: Failed in Senate Rules Committee.

AB 1312 (GONZALEZ FLETCHER): SEXUAL ASSAULT VICTIMS: RIGHTS This bill would require a law enforcement authority or district attorney to also notify a sexual assault victim that he or she has the right to request to have a person of the same gender or opposite gender as the victim present in the room during any interview with a law enforcement official or district attorney, unless no such person is reasonably available. It would require that emergency contraception be provided to the victim for free. It would require law enforcement to develop and provide, and for medical personnel to provide, if available, a card with information on the rights of sexual assault victims. It would require the forensic medical examiner to allow the victim to shower or bathe, if facilities are available. It would establish a minimum time for law enforcement to store a rape kit or evidence from a sexual assault.

Status: Signed by the Governor (Chapter 692, Statutes of 2017).

AB 1316 (QUIRK): PUBLIC HEALTH: CHILDHOOD LEAD POISONING: PREVENTION This bill would change the definition of “lead poisoning” to include concentrations of lead in arterial or cord blood. The bill would require that the regulations establishing a standard of care include the determination of risk factors for whether a child is at risk for lead poisoning be updated by July 1, 2019 and would require the department, when determining those risk factors, to consider the most

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significant environmental risk factors. It would require the California Department of Public Health, to annually publish information regarding efforts to increase lead screening in children and efforts to reduce lead exposure. Finally, it would require lead screening done pursuant to the screening regulations to be covered by insurance.

Status: Signed by the Governor (Chapter 507, Statutes of 2017).

AJR 19 (ARAMBULA): OPIOID AWARENESS AND DEPENDENCY PREVENTION This measure urges hospital-based pain management formularies, to consider the inclusion of a range of non-opioid alternatives and urges the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.

AB 1560 (FRIEDMAN): NURSE PRACTITIONERS: CERTIFIED NURSE-MIDWIVES: PHYSICIAN ASSISTANTS: PHYSICIAN AND SURGEON SUPERVISION

Status: Signed by the Governor (Chapter 208, Statutes of 2017).

The Physician Assistance Practice Act authorizes a physician assistant licensed by the Physician Assistant Board, to be eligible for employment or supervision by any physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision. The act prohibits a physician and surgeon from supervising more than 4 physician assistants at any one time. This bill would prohibit a physician and surgeon from supervising more than 12 nurse practitioners, certified-nurse midwives, and physician assistants at any one time.

Existing law requires a court, on petition of a party to an arbitration agreement alleging (1) the existence of a written agreement to arbitrate a controversy and (2) that a party to the agreement refuses to arbitrate the controversy, to order the petitioner and the respondent to arbitrate the controversy if the court determines that an agreement to arbitrate exists, unless the court makes other determinations. This bill would add to these determinations instances in which a financial institution, as defined, is seeking to apply a written agreement to arbitrate, contained in a contract consented to by a consumer, to a purported contractual relationship with that consumer that was created by the petitioner fraudulently, without the consumerâ&#x20AC;&#x2122;s consent and by unlawfully using the consumerâ&#x20AC;&#x2122;s personal identifying information.

Status: Failed on the Senate Inactive File.

AB 1650 (MAIENSCHEIN): EMERGENCY MEDICAL SERVICES: COMMUNITY PARAMEDICINE This bill would have, until January 1, 2022, created the Community Paramedic Program in the authority. The bill would have authorized the authority to authorize a local EMS agency that opts to participate in the program to provide specified services, such as case management services and linkage to nonemergency services for frequent EMS system users, through a local community paramedic program.

Status: Failed in the Assembly Appropriations Committee.

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SB 33 (DODD): ARBITRATION AGREEMENTS

Status: Signed by the Governor (Chapter 480, Statutes of 2017).

SB 43 (HILL): ANTIMICROBIAL-RESISTANT INFECTION: REPORTING This bill would have required specified general acute care hospitals and clinical laboratories to submit a report to the California Department of Public Health, commencing July 1, 2019, and each July 1 thereafter, containing an antibiogram of the facility for the previous year. The bill would have required the Antimicrobial Stewardship and Resistance Subcommittee of the Healthcare Associated Infections Advisory Committee of the department, on or before January 1, 2019, to develop and recommend to the department the acceptable electronic format

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for the report and a method for the department to accurately estimate the number of deaths that result from antimicrobial resistant infections for specified types of antimicrobial infections. It would also require CDPH to annually publish information related to the number of antimicrobial-resistant infections and the estimated number of deaths.

Status: Failed in the Assembly Health Committee.

SB 199 (HERNANDEZ): THE CALIFORNIA HEALTH CARE COST, QUALITY, AND EQUITY ATLAS This bill would have required the Secretary of California Health and Human Services, in furtherance of the goal of creating the California Health Care Cost, Quality, and Equity Atlas, to convene an advisory committee composed of a broad spectrum of health care stakeholders and experts. The bill would require the secretary to charge the advisory committee with identifying the type of data, purpose of use, and entities and individuals that are required to report to, or that may have access to, a health care cost, quality, and equity atlas, and with developing a set of recommendations based on specified findings of the March 1, 2017 report.

Status: Failed in the Assembly Appropriations Committee.

SB 219 (WIENER): LONG-TERM CARE FACILITIES: RIGHTS OF RESIDENTS This bill would make it unlawful for any long-term care facility, to take specified actions wholly or partially on the basis of a person’s actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status, including refusing

to use a resident’s preferred name or pronoun and denying admission to a long-term care facility, transferring or refusing to transfer a resident within a facility or to another facility, or discharging or evicting a resident from a facility.

Status: Signed by the Governor (Chapter 483, Statutes of 2017).

SB 349 (LARA): CHRONIC DIALYSIS CLINICS: STAFFING REQUIREMENTS This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year.

Status: Failed on the Assembly Inactive File.

SB 698 (HILL): DRIVING UNDER THE INFLUENCE: ALCOHOL AND MARIJUANA This bill would have, until January 1, 2021, made it a crime for a person who has between 0.04% and 0.07%, by weight, of alcohol in his or her blood and whose blood contains any controlled substance or 5 ng/ml or more of delta-9-tetrahydrocannabinol to drive a vehicle. The bill would have required a person to fail field sobriety tests to establish probable cause for a chemical test to test the person’s blood. The bill would have made a first violation punishable as an infraction and would have made subsequent violations punishable as a misdemeanor.

Status: Failed in the Senate Appropriations Committee.

OPPOSED LEGISLATION AB 221 (GRAY): WORKERS’ COMPENSATION: LIABILITY FOR PAYMENT Current law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury. This bill would have provided that for claims of occupational disease or

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cumulative injury filed on or after January 1, 2018, the employee and the employer would have no liability for payment for medical treatment, unless one or more of certain conditions are satisfied, including, among others, that the treatment was authorized by the employer.

Status: Failed in the Assembly Insurance Committee.

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AB 320 (COOLEY): CHILD ADVOCACY CENTERS This bill would have authorized a county, in order to implement a multidisciplinary response to investigate reports involving child physical or sexual abuse, exploitation, or maltreatment, to use a Child Advocacy Center. The bill would have required a Child Advocacy Center to meet specified standards, including the use of representatives from specified disciplines and providing dedicated child-focused settings for interviews and other services. The bill would have authorized multidisciplinary team members to share with each other information in their possession concerning the child, the family of the child, and the person who is the subject of the abuse or neglect investigation.

Status: Failed in the Assembly Human Services Committee.

AB 595 (WOOD): HEALTH CARE SERVICE PLANS: MERGERS and ACQUISITIONS This bill would have required specified entities that intend to merge with, consolidate, acquire, purchase, or control, directly or indirectly, a health care service plan doing business in this state to give notice to, and secure prior approval from, the Director of the Department of Managed Health Care. The bill would have required that entity to apply for licensure as a health care service plan. The bill also would have required the department, prior to approval, conditional approval, or denial of the proposed agreement or transaction, to hold a public hearing on the proposal and make specified findings.

Status: Failed in the Assembly Appropriations Committee.

AB 700 (JONES-SAWYER): PUBLIC HEALTH: ALCOHOLISM OR DRUG ABUSE RECOVERY: SUBSTANCE USE DISORDER COUNSELING This bill would have established a career ladder for substance use disorder counseling to be maintained and updated by the State Department of Health Care Services. The bill would have established classifications for substance use disorder (SUD) counselor certification or registration to be implemented by the organizations that certify substance use disorder programs. The bill would

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have required any person who engages in the practice of SUD counseling to be certified by, or registered with, a certifying organization, unless specifically exempted. The bill would establish additional standards for registrants and interns, as defined, and impose additional requirements on SUD counselors. The bill would have provided authority to the department to discipline a certificate holder or registrant. The bill would have authorized the department to implement these provisions by regulation.

Status: Failed in the Senate Health Committee.

AB 748 (TING): PEACE OFFICERS: VIDEO AND AUDIO RECORDINGS: DISCLOSURE This bill would allow a video or audio recording that relates to a matter of public concern because it depicts an incident involving a peace officerâ&#x20AC;&#x2122;s use of force, or is reasonably believed to involve a violation of law or agency policy by a peace officer, to be withheld for a maximum of 120 calendar days if disclosure would substantially impede an active investigation.

Status: Failed in the Senate Judiciary Committee.

AB 889 (STONE, MARK): SECRECY AGREEMENTS Current law generally permits the parties to a civil action to include, as a condition to a settlement, a provision requiring that information about the settlement or the underlying dispute be kept confidential; however, existing law prohibits a confidential settlement agreement in a civil action with a factual foundation establishing a cause of action for civil damages for an act that may be prosecuted as a felony sex offense. Existing law also establishes that flouting this prohibition is grounds for professional discipline for an attorney, and it requires the State Bar of California to investigate and take appropriate action in any case brought to its attention. This bill would have instead authorized but not required the State Bar to investigate these cases of attorney misconduct.

Status: Failed in the Assembly.

AB 937 (EGGMAN): HEALTH CARE DECISIONS: ORDER OF PRIORITY The Health Care Decisions Law provides for an individualâ&#x20AC;&#x2122;s use of a request regarding resuscitative

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measures, which is a written document, signed by an individual with capacity or a legally recognized health care decision maker for the individual, and the individual’s physician, that directs a health care provider regarding resuscitative measures for the individual. This bill would have provided that, to the extent of that conflict, the most recent order signed by the individual or instruction made by the individual is effective. The bill would have deemed a request regarding resuscitative measures signed by specified persons on behalf of the individual to be signed by the individual.

AB 1402 (ALLEN, TRAVIS): PROSTITUTION: MINORS This bill would have made the prohibitions on prostitution and related offenses applicable to a person under 18 years of age.

Status: Failed in the Assembly Public Safety Committee.

AB 1612 (BURKE): NURSING: CERTIFIED NURSE-MIDWIVES: SUPERVISION

This bill would have exempted from the Alcoholic Beverage Control Act the use of powdered alcohol as an ingredient in non-powdered products and the production, sale, or offering for sale or delivery, receipt, or purchasing for resale of powdered alcohol for use as an ingredient in non-powdered products.

This bill would have repealed the requirement that a certified nurse-midwife be under the supervision of a licensed physician and surgeon. The bill would authorize a certified nurse-midwife to consult, refer, or transfer care to a physician and surgeon as indicated by the health status of the patient and the resources and medical personnel available in the setting of care. The bill would provide that a certified nurse-midwife practices within a variety of settings, including, but not limited to, the home setting. The bill would have specified that nurse-midwifery care emphasizes informed consent, preventive care, and early detection and referral of complications.

Status: Failed in the Assembly Governmental Organization Committee.

Status: Failed in the Assembly Appropriations Committee.

AB 1110 (BURKE): PUPIL HEALTH: EYE AND VISIONS EXAMINATIONS

ACR 8 (JONES-SAWYER): ADVERSE CHILDHOOD EXPERIENCES: POST-TRAUMATIC “STREET” DISORDER

Status: Failed in the Senate Health Committee.

AB 1054 (BROUGH): POWDERED ALCOHOL

This bill would have required, during the kindergarten year or upon first enrollment or entry at an elementary school, including a charter school, a pupil’s eyes and vision to be examined by a physician, optometrist, or ophthalmologist in accordance with specified provisions, unless the pupil’s parent or guardian submits a written waiver to the school or charter school. The bill would have required, in a pupil’s kindergarten year or upon first enrollment or entry at an elementary school that is not a charter school, the pupil’s vision to be appraised in accordance with the above-specified provisions only if the pupil’s parent or guardian fails to provide the results of the eye and vision examination.

Status: Failed in the Assembly Appropriations Committee.

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This measure would recognize post-traumatic “street” disorder as a mental health condition with growing implications for our state.

Status: Signed by the Governor (Chapter 139, Statutes of 2017).

SB 72 (MITCHELL): BUDGET ACT OF 2017 This bill included the Senate’s budget package, which would have allocated only $348 million in Proposition 56 funding to improve access to care, $150 million of which would have been for a high-need specialty access pool to provide rate increases for physicians that are tied to the Access Assessment study required by the Medi-Cal 2020 waiver, to network adequacy standards established by the new federal Medicaid rule, or to more closely align Medi-Cal rates with those in the Medicare program. The remaining Prop. 56 funding it his budget would have been

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allocated to the Medi-Cal program to support regular program growth as proposed by the Administration. Additionally, this bill would have implemented the Administration’s proposal to allocate $50 million in Prop. 56 funding to the University of California (UC), while also cutting $50 million from the General Fund base, which would require the UC to use this funding for its base operation and not to increase graduate medical education opportunities for medical school graduates seeking to complete their residencies in California. Finally, this bill only allocated $6 million from the General Fund to the Office of Statewide Health Planning and Development for the Song-Brown program, rather than the full $33 million that the Governor had cut from the budget in his proposal.

Status: Failed in Senate Budget Committee.

SB 350 (GALGIANI): INCARCERATED PERSONS: HEALTH RECORDS

SB 538 (MONNING): HOSPITAL CONTRACTS This bill would have prohibited contracts between hospitals and contracting agents or health care service plans from containing certain provisions, including, but not limited to: setting payment rates or other terms for nonparticipating affiliates of the hospital; requiring the contracting agent or plan to keep the contract’s payment rates secret from any payor, as defined, that is or may become financially responsible for the payment; and requiring the contracting agent or plan to submit to arbitration, or any other alternative dispute resolution program, any claims or causes of action that arise under state or federal antitrust laws after those claims or causes of action arise, except as provided. The latest amendment required health plans and health insurers to be responsible for including and disclosing relevant terms of the provider contract with the third-party payor. The bill would make any prohibited contract provision void and unenforceable.

Current law authorizes a provider of health care or a health care service plan to disclose medical information when the information is disclosed to an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor, or other person or entity responsible for paying for health care services rendered to the patient, to the extent necessary to allow responsibility for payment to be determined and payment to be made. This bill would have additionally authorized the disclosure of information between a county correctional facility, a county medical facility, a state correctional facility, or a state hospital to ensure the continuity of health care of an inmate being transferred between those facilities.

Status: Failed in the Assembly Health Committee.

Status: Failed in the Senate Appropriations Committee.

SB 636 (BRADFORD): ADDICTION TREATMENT: ADVERTISING: PAYMENT

SB 419 (PORTANTINO): MEDICAL PRACTICE: PAIN MANAGEMENT

This bill would have prohibited a person, firm, partnership, association, or corporation, or an agent or employee thereof, from making payments for services that recommend any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary. The bill would also have prohibited a person, firm, partnership, association, or corporation, or an agent or employee thereof, from using runners, cappers, steerers, or other persons to procure clients, patients, or customers for any form of medical care or treatment provided by an alcohol-related or narcotic-related program, facility, or dispensary.

This bill would have prohibited a person from prescribing oxycodone, by whatever official, common, usual, chemical, or trade name designated, to a patient under 21 years of age. The bill would have made a violation of this prohibition subject to a civil penalty. The bill would also have authorized a patient who was prescribed oxycodone in violation of the prohibition, and who sustained economic loss or personal injury as a result of that violation, to bring a civil action to recover compensatory damages, reasonable attorney’s fees, and litigation.

Status: Failed in the Senate Business, Professions, and Economic Development Committee. 22

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SB 562 (LARA AND ATKINS): THE HEALTHY CALIFORNIA ACT This bill, the Healthy California Act, would have created the Healthy California program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

Status: Failed in the Assembly.

Status: Failed in Senate Health Committee. WINTER 2017

SB 746 (PORTANTINO): PUPIL HEALTH: PHYSICAL EXAMINATIONS

SB 798 (HILL): HEALING ARTS: BOARDS

This bill would extend the authorization of the Medical Board of California for another four years; add licensed Current law authorizes a physician and surgeon or midwives to peer review laws and the Moscone-Knox physician assistant to perform a physical examination that Professional Corporation Act; add medical is required for a pupil to participate in an interscholastic board-appointed physician members to the Health athletic program of a school. This bill would have Professions Education Foundation, eliminate the medical additionally authorized a doctor of chiropractic, board’s authority to approve American Board of Medical naturopathic doctor, or nurse practitioner practicing Specialties-equivalent boards; establish a post-graduate in compliance with the respective laws governing their training license for physicians and require two additional profession to perform that physical examination. years in residency training before a physician can practice Status: Failed in Senate Education Committee. independently; make the Board of Podiatric Medicine independent of the medical board; impose fines for failing to submit reports pursuant to Business and Professions SB 790 (MCGUIRE): HEALTH CARE Code 805.1; change the adverse event reporting PROVIDERS: GIFTS AND BENEFITS I’VE RECOVERED requirements for outpatient surgery settings, change the This bill would prohibit pharmaceutical and device requirements for use of an expert witness in disciplinary $ manufacturers from providing physicians anything of cases; end, as of January 1, 2019, the requirement for Increate the new past nine years, CMA’s Center for value and regulations that govern interactions of investigators and prosecutors from my payors using Services has recovered over concurrent engagement betweenEconomic these companies and physicians. in medical board cases; extend the authorization of the CMA’s Center for $15.5 million from payors on behalf of Economic Services Osteopathic Medical Board of California; make changes Status: Failed the Assembly Inactive File. CMAon members. to continuing medical education for OMBC-licensed CMA’s Center for Economic Services is staffed by physicians, and make other changes to the medical-board’s practice management experts with a combined administration.

CALIFORNIA MEDICAL ASSOCIATION

TROUBLE GETTING PAID? CMA CAN HELP!

70,000

experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice.

Status: Signed by the Governor (Chapter 775, Statutes of 2017).

CALIFORNIA MEDICAL ASSOCIATION

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

TROUBLE GETTING PAID? CMA CAN HELP! I’VE RECOVERED

CMA members can call on CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

70,000

In the past nine years, CMA’s Center for • Are your claims being denied after obtaining prior • Do you have questions about the new law on payment Economic Services has recovered over authorization? from my payors using and billing for out of network services (Assembly Bill 72)? CMA’s Center for $15.5 million from payors on behalf of Economic Services •CMA Do you members. have questions about Covered California? • Do you need help with Medicare-related issues? CMA’s Center for Economic Services is staffed by practice management experts with a combined experience of over 125 years in medical practice •operations. Are you not Our being paidisaccording to your contract? goal to empower physician practices by providing resources and guidance to •improve Are you receiving untimely requests for refunds or is a the success of your practice. • Are your claims not being paid in a timely manner?

payor recouping money from your check without

• Have you been presented with a managed care contract and you’re not sure if the terms are consistent with California law? • Have you done everything you can to resolve an issue with a payor, but have hit a brick wall?

Assistance ranges coaching andrequest? education to first notifying you infrom writing of a refund direct intervention with payors or regulators.

Access to CMA’s reimbursement experts is a FREE, members-only benefit. help? Call 786-4262 or email economicservices@cmanet.org. CMANeed members can call on (800) CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help. WINTER 2017

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HOW A BILL BECOMES A LAW Change is happening, and change will always happen. CMA remains focused on the future and will act boldly to shape the world of health care to support physicians and patients.

BILL IS INTRODUCED

COMMITTEE HEARINGS COMMITTEE HEARINGS IF PASSED (SENT TO OTHER HOUSE)

FLOOR ACTION

FLOOR ACTION RETURNED TO ORIGINAL HOUSE

IF PASSED WITH AMMENDMENTS IF PASSED WITHOUT AMMENDMENTS

BILL GOES TO GOVERNOR IF ORIGINAL HOUSE CONCURRS

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IF NOT VETOED

MOST BILLS BECOME LAW JAN. 1 OF THE NEXT YEAR

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THE LIFECYCLE OF

Legislation

FROM IDEA INTO L AW

The California Medical Association (CMA) is the largest, most influential medical organization in California, and an aggressive advocate for doctors and patients. CMA relies on the involvement of its members to communicate the physician vision of medical care to the public, to lawmakers and to the regulators who determine how medicine is practiced. An idea is born: Ideas for new health policy are born in a number of places. One of them is in the hearts and minds of the physicians of California. CMA members can directly influence the association’s health care advocacy agenda by submitting a resolution for consideration to the CMA House of Delegates. CMA policy is established: Resolutions are assigned to councils and subcommittees for study and development, then opened up for discussion by your physician colleagues before recommendations are developed for action by the CMA Board of Trustees. Many of CMA’s sponsored bills have their genesis in an idea submitted by our physician members. While not all CMA policies result in direct legislative action, they are used to guide CMA’s positions on the hundreds of health care bills that are introduced into the State Legislature each year. Bills are introduced: The California Legislature operates on a two‐year session. Each year, primarily in January and February, bills are introduced by lawmakers for consideration. The governor may also call a special session of the Legislature to deal with specific subjects. CMA takes a position: Each year, with physician input, CMA monitors more than 500 bills and takes a public position on around 200 bills. Those positions include watch, support, oppose, support if amended and oppose unless amended.

CMA also may choose to sponsor or co-sponsor legislation that is of critical importance to the physicians of California. Bills move through the process: If a bill is to become law, it must be passed out of one or more committees, approved by a simple majority of both houses, and signed by the governor. Laws ordinarily take effect on January 1 of the following year. Briefly, a bill progresses through the following steps: 1. A bill is introduced. 2. The bill is heard in one or more committees in its house of origin (either Senate or Assembly), including public testimony. 3. If the bill passes out of committee(s), it goes to the house floor for a vote. If it passes out of the house, it is sent to the other house for consideration following the same process described above. 4. If approved by both houses, the bill goes to the governor for signing. 5. The governor has three choices: sign the bill into law, allow it to become law without his or her signature, or veto it. A governor’s veto can be overridden by a two-thirds vote in both houses. CMA monitors and protects physician interests: CMA’s powerful government relations team works tirelessly with legislators to educate them on how legislation could enhance or threaten patients’ health or physicians’ ability to practice medicine. Their activities include reading and tracking bills and amendments, shaping bill language, meeting with legislators, testifying in committee, conducting research, and preparing policy papers and position letters. Every year, CMA not only supports and shapes the development of valuable health care policy, but the association also stops a number of harmful legislative proposals.

For more information on CMA’s legislative advocacy, and how you can get involved, visit www.cmanet.org.

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The Value

ADVOCACY

Dear Health Care Professional, This report details the California Medical Association’s (CMA) efforts, on your behalf, to increase practice profitability and save physician practices from bad bills that would have:

RAISED YOUR OPERATIONAL COSTS INCREASED YOUR PROFESSIONAL LIABILITY DECREASED ACCESS TO CARE FOR YOUR PATIENTS SADDLED YOU WITH EVEN MORE ADMINISTRATIVE BURDENS

CMA is one of the most influential stakeholders in the development and implementation of health policy. Our past, present and future success is rooted in one principle: California’s physicians are stronger when we stand together. With over 80 years of combined experience in Sacramento politics, our team is constantly monitoring legislative threats to the practice of medicine, and working to ensure that bad bills don’t become bad medicine. >>

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CMA > The Value of Advocacy

The bills in this report were introduced this year, the first of a two-year legislative session. This means they could possibly move forward or get re-introduced next year. CMA will continue to keep you engaged and informed on these important matters that could have a profound impact on your practice. To join this fight and stay informed on issues critical to the practice of medicine, please contact us at (800) 786-4262. You can also receive regular updates by subscribing to our free biweekly Newswire at www.cmanet.org/newsletters.

PREVENTED ADMINISTRATIVE BURDENS, LOWERED OPERATIONAL COSTS AND INCREASED PROFITABILITY Recent studies have suggested that physicians spend twice as much time completing administrative tasks as they do seeing patients. This is unacceptable and negatively affects delivery of care. CMA aims to lessen or streamline the administrative requirements placed on physicians so they can spend more time with patients, which improves health outcomes, increases access and increases practice profitability. AB 40 (Santiago): CURES database: health information technology system Obtained amendments to remove the Department of Justice’s ability to influence the electronic health record (EHR) vendor market by establishing a narrow vendor list of EHRs allowed to interface with the Controlled Substance Utilization Review and Evaluation System (CURES), and unilaterality dictating the terms of being able to interface. AB 120 (Ting): Proposition 56 tobacco tax funds Appropriates Proposition 56 funds to the Department of Health Care Services (DHCS) and contains language allocating over $700 million ($325 million plus the federal match) in funding to physicians. Additional provisional language states that provider payments may be adjusted up to $800 million in the 2018-19 fiscal year. The bill was signed by the Governor in June as part of the Budget Act of 2017.

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AB 221 (Gray): Workers’ compensation Defeated this workers’ compensation legislation that would have broadly limited payments to physicians for treatment provided to workers suffering from occupational cumulative trauma injuries. AB 387 (Thurmond): Minimum wage: health professionals: interns For the purposes of paying minimum wage, AB 387 expanded the definition of employer. CMA obtained amendments to mitigate the impact of the bill on physician practices by excluding all practices. The bill was ultimately defeated in the Assembly. AB 700 (Jones-Sawyer): Public Health: alcoholism or drug abuse recovery Stopped this measure that would have required physicians who provide substance use disorder services to get certified by DHCS, in addition to their medical license, to provide these services in programs authorized by DHCS. AB 715 (Wood): Workgroup review of opioid pain reliever use and abuse Worked with the author to avoid the creation of duplicative opioid prescribing guidelines, which could have created further confusion and complication around prescribing for chronic pain, narrowing the bill to create a guideline focused exclusively on acute prescribing. AB 1250 (Jones-Sawyer): Counties: contracts for personal services Obtained amendments that exempt physician services from newly proposed stringent requirements for a county and a third party to enter into a contract to provide government services. AB 1250 was defeated in the Senate. AB 1312 (Gonzalez Fletcher): Sexual assault victims: rights Obtained amendments to remove a requirement that physicians provide sexual assault victims information about the investigation process, evidentiary process and the rights of victims under criminal laws. AB 1316 (Quirk): Public health: childhood lead poisoning: prevention Obtained amendments to remove mandatory universal lead screening for all young children.

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Allowing physicians to practice without worrying about the threat of a frivolous lawsuit is one of CMA’s core tenets.

SB 43 (Hill): Antimicrobial-resistant infection: reporting Obtained amendments to remove a proposed new requirement to list antimicrobial-resistant infections as a cause of death on a person’s death certificate. SB 189 (Bradford): Workers’ compensation fix Effective July 1, 2018, all owners of medical corporations will be able to exempt themselves from workers’ compensation coverage, regardless of percentage ownership, as long as they submit a waiver and have health insurance coverage. This will result in thousands of dollars in premium savings for physician practices. SB 199 (Hernandez): The California Health Care Cost, Quality and Equity Atlas Defeated this measure that would have created additional administrative reporting requirements on physician practices. SB 419 (Portantino): Medical practice: pain management Defeated this measure that would have legislated the practice of medicine by preventing physicians’ ability to appropriately prescribe pain relief medications. SB 636 (Bradford): Addiction treatment: advertising: payment Stopped this measure that would have created an additional disciplinary process for physicians providing substance use disorder treatment in DHCS-certified programs. SB 640 (Hertzberg): Sales tax on services Obtained an exemption for health care services in this proposed services tax legislation.

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SB 790 (McGuire): Health care providers: gifts and benefits Defeated this measure that would have unfairly curtailed what expenses a pharmaceutical company could provide a physician, including all those expenses connected to educational seminars, research and events.

DECREASED LIABILITY Allowing physicians to practice without worrying about the threat of a frivolous lawsuit is one of CMA’s core tenets. We work to ensure that the trial lawyers’ efforts to increase malpractice liability are beaten back, and we oppose any effort to increase malpractice premiums. Additionally, we advocate to protect physicians from exposure to new areas of liability. AB 334 (Cooper): Sexual assault/forensic medical exams Obtained amendments to remove provisions that would have increased physician liability by allowing forensic medical exams on unconscious patients without the patient’s consent. AB 859 (Eggman): Elders and dependent adults: abuse or neglect Obtained amendments that exempt physicians from a proposed lowering of the standard of review in elder abuse cases from “clear and convincing” to a “preponderance of the evidence” if the court found that a defendant intentionally destroyed evidence. The bill was vetoed by the Governor. AB 889 (Stone): Secrecy agreements Defeated this measure that would have prevented certain confidentiality agreements to be enforced if keeping the information secret presented a “public health hazard” or “environmental danger.” CMA was concerned about how this law would affect medical malpractice settlement agreements.

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CMA > The Value of Advocacy

Protecting the economic viability of physician practices ensures that physicians are financially capable of providing service for patients and protects access to care.

AB 1422 (Daly): Workers’ compensation insurance: fraud Obtained amendments to ensure due process protections for workers’ compensation physicians facing certain types of fraud accusations. SB 33 (Dodd): Arbitration agreements Obtained amendments to exempt physician arbitration agreements from a new consumer protection that invalidates arbitration clauses in contracts upon a showing of fraud. SB 219 (Wiener): Long-term care facilities: right of residents Obtained amendments to ensure that physician liability would not be increased for those practicing in long-term care facility settings acting in the best medical interests of their patients. SB 349 (Lara): Chronic dialysis clinics: staffing requirements Obtained amendments to remove liability for medical directors of chronic dialysis clinics related to the proposed staffing requirements. SB 617 (Bradford): Workers’ compensation Stopped workers’ compensation legislation that would have required outreach reports to physicians without sufficient privacy protections.

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ACCESS TO CARE AND THE PHYSICIANPATIENT RELATIONSHIP CMA defends and advocates to improve physicians’ ability to negotiate fair contracts with payors. Protecting the economic viability of physician practices ensures that physicians are financially capable of providing service for patients and protects access to care. Additionally, CMA advocates to protect patient privacy, recognizing that it is an essential component of quality medical care and the patient-physician relationship. AB 595 (Wood): Health care service plans: mergers and acquisitions Obtained amendments to ensure that the Department of Managed Health Care and the Department of Insurance, for any health care service plan merger, consider the impact on physicians’ ability to secure competitive contracts and patient access to care prior to approving the mergers. SB 350 (Galgiani): Incarcerated persons: health records Obtained amendments ensuring consistency in medical information privacy laws to limit confusion on when medical information and records can be disclosed. The bill was ultimately defeated in the Senate. SB 538 (Monning): Hospital contracts Defeated this measure that allowed health plans and health insurers to eliminate the Provider’s Bill of Rights, which helps guard a physician’s ability to negotiate fair and reasonable contracts and break up integrated health care systems.

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CALIFORNIA MEDICAL ASSOCIATION

DRIVING THE FUTURE OF MEDICINE MEMBERSHIP IS FREE FOR MEDICAL STUDENTS Do you want to enhance California public health, impact health outcomes in your local communities or improve the overall health care system? The California Medical Association (CMA) and its county medical societies are looking for interested, engaged and passionate medical students to add their voices to the physician community. CMA serves more than 43,000 members in all modes of practice and specialties representing the patients of California. We are dedicated to serving our members through a comprehensive program of legislative, legal, regulatory, economic and social advocacy. CMA relies on the involvement of members to communicate the physician vision of medical care and public health to the public, to lawmakers and other policymakers. Over the past several years, there have been several key public policy advancements with our medical student members involved at every turn. •

Want to improve vaccination rates? In 2015, medical students led the grassroots charge to eliminate personal and religious exemptions for school vaccinations. (SB 277)

•

Do you want to stay in California for your residency? Medical students helped secure an additional $7 million in funding in the 2014 state budget to expand California’s primary care residency programs.

•

Have an idea to enhance public health? In 2014, a medical student developed a proposal to require warning labels on sugar-sweetened beverages. (SB 1000)

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2017 HOUSE OF DELEGATES Physicians of the California Medical Association set policy to guide the future of medicine STORY BY KATHERINE BOROSKI l PHOTOGRAPHY BY JEFF WALTERS

Hundreds of physicians, residents and medical students met October 21-22 in Anaheim for the 146th annual meeting of the California Medical Association (CMA) House of Delegates (HOD). During the meeting, the delegates discussed major issues affecting the practice of medicine, installed new officers and recognized the recipients of CMA’s annual physician awards. Before debating the major issues—which this year were mental health, health care reform and physician workforce, the delegates heard from experts in each major issue area, with continuing medical education (CME) credit offered for these educational sessions. The House also installed a new president, San Diego otolaryngologist Theodore M. Mazer, M.D., while Los Angeles ophthalmologist David Aizuss, M.D., was tapped as president-elect. >>

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The full 2017-2018 CMA Executive Committee includes: • President: Theodore M. Mazer, M.D., San Diego • President-Elect: David H. Aizuss, M.D., Los Angeles • Chair of the Board: Robert E. Wailes, M.D., Oceanside/Encinitas • Vice-Chair of the Board: Shannon L. Udovic-Constant, M.D., San Francisco • Speaker of the House: Lee T. Snook, Jr., M.D., Sacramento • Vice-Speaker of the House: Tanya W. Spirtos, M.D., Redwood City • Immediate Past President: Ruth E. Haskins, M.D., Folsom

2017 MAJOR ISSUES

CMA physician delegates 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. This year’s major issues were:

HEALTH CARE REFORM: While the future of federal health care reform remains unclear, CMA continues to work with federal and state lawmakers to ensure that the health care system works for physicians and patients. The CMA House of Delegates discussed recommendations and regulations that will assist with federal health care reform, and debated how single payer or public health care options might work.

PHYSICIAN WORKFORCE: Maintaining a physician workforce that ensures all patients have sufficient and timely access to quality medical care continues to be a challenge for California. The delegates discussed barriers that impact the practice of medicine in California and analyzed various strategies and policies to address the physician workforce problem.

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MENTAL HEALTH:

For decades, CMA policy has strongly supported adequate funding and provisions for high-quality mental health care. However, despite raised awareness, mental illness continues to go unrecognized and underfunded in California; many people with mental illnesses do not receive the help they need. The delegates discussed significant factors affecting the mental health system including access and infrastructure, and established policies to support and improve the mental health system. Final reports detailing the actions taken by delegates are posted now at www.cmanet.org/hod.

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SUBMIT A RESOLUTION A recent change to the CMA governance process was the introduction of a year-round (quarterly) resolution process. Any CMA member may author a resolution and have it submitted to the Board of Trustees using the year-round process for consideration between annual meetings. This approach preserves the ability of individual members to participate in and influence CMA policy-making in a more timely way, rather than waiting for a once-a-year opportunity at HOD. This allows CMA to be more nimble and effective in making decisions on critical issues that are important to physicians. If you have a resolution you would like to submit, e-mail it to resolutions@cmanet.org. Please visit www.cmanet.org/hod and read the guidelines before submitting a resolution. Resolutions that do not follow the guidelines will be rejected.

AWARDS AND ELECTIONS CMA INSTALLS SAN DIEGO OTOLARYNGOLOGIST AS 150TH PRESIDENT CMA installed San Diego otolaryngologist Theodore M. Mazer, M.D., as its 150th president. Dr. Mazer has been a CMA and San Diego County Medical Society (SDCMS) member for 29 years. He has served on the CMA Board of Trustees since 2002, as Speaker of the House

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of Delegates from 2013 to 2016, and chaired various committees, including those focused on medical services and access to specialty care. Dr. Mazer is a past president of SDCMS and a delegate to the American Medical Association.

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“I LOOK FORWARD TO WORKING HARD THIS YEAR TO ENSURE PRACTICING PHYSICIANS HAVE A SEAT AT THE TABLE TO PROMOTE POLICIES THAT PROTECT OUR PATIENTS, OUR PRACTICES AND OUR ABILITY TO CARE FOR OUR COMMUNITIES."

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"I take the role of leading this organization as an awesome responsibility,” said Dr. Mazer. “I look forward to working hard this year to ensure practicing physicians have a seat at the table to promote policies that protect our patients, our practices and our ability to care for our communities." A defender of patients’ right to access medical care, he has fought for Medi-Cal access all the way up to the Supreme Court and worked for over a decade with Congress and CMA to correct improper Medicare payment rates in San Diego and throughout California. Dr. Mazer currently practices at Sharp-Grossmont Hospital, where he has served as chair of surgery, and at Alvarado Hospital Medical Center, where he has served as chief of staff. Dr. Mazer is a consultant to the Alvarado Hospital Medical Executive Committee and was a member of the national Physicians Advisory Commission at Anthem Blue Cross. He completed his residency at Baylor College of Medicine in Houston, Texas. Dr. Mazer is very active in San Diego’s medical community. He is

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founder and member of several Independent Practice Associations (IPA) and management groups. He served as a board member and medical director for several years with Mercy Physicians Medical Group. He presently serves as a director with Scripps Mercy Physicians Partners messenger model IPA and its management group, which provides integrative support services for small and medium practices. He has been selected as a San Diego Top Doctor several times and awarded the San Diego Business Journal’s Health Leaders Award. "CMA can forge ahead with confidence with Ted

Mazer at our helm,” said CMA Immediate Past President Ruth Haskins, M.D. “He has the will to get the job done, the data to back up his plan, the heart to steer us in the right direction and the energy to move us steadily forward.” CMA presidents serve a year-long term, starting and ending in October. Dr. Mazer was elected to serve as president for the 2017-18 year. You can view Dr. Mazer’s inaugural address to the CMA House of Delegates at www.youtube.com/ cmaphysicians.

CMA NAMES LOS ANGELES OPHTHALMOLOGIST 2017-18 PRESIDENT-ELECT David Aizuss, M.D., a board-certified ophthalmologist practicing in Los Angeles, was selected as the association’s president-elect.

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He will serve in this capacity for one year and will be installed as president at the conclusion of next year’s HOD. Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He also serves as an assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine. Dr. Aizuss is a medical staff member at Tarzana Hospital and West Hills Hospital, in Los Angeles County, and belongs to several professional societies, including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society and the American Medical Association. He received his medical degree from Northwestern University Medical School and his bachelor’s degree in medicine from Northwestern University. He completed his residency in ophthalmology at the Jules Stein Eye Institute in Los Angeles, where he also undertook a fellowship in cornea and external ocular disease from 1984 to 1985. He is a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons. Before being elected as president-elect, he served as the chair of the CMA Board of Trustees.

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EUREKA SURGEON RECEIVES CMA’S PRESTIGIOUS “COUNTRY DOCTOR” AWARD Renowned breast cancer researcher and surgeon Ellen Mahoney, M.D., was honored with CMA’s most prestigious award, the Frederick K.M. Plessner Memorial Award. The award recognizes a California physician who best exemplifies the ethics and practice of a rural country practitioner. The first of her family to graduate from college, Dr. Mahoney broke the glass ceiling by graduating from Stanford Medical School as one of the first woman general surgeons. After completing her residency—also at Stanford—she became the first woman ever to open a private surgical practice in Palo Alto. In addition to her private practice, Dr. Mahoney served on faculty at Stanford, where she performed general, trauma and oncology surgery. Dr. Mahoney helped designed Stanford’s first comprehensive cancer center. In 1994, she opened Palo Alto’s Community Breast Health Project (now known as Bay Area Cancer Connections), which provides support and information to breast cancer patients. Dr. Mahoney’s Community Breast Health Project harnessed the power of peer support, bringing together cancer survivors and those newly diagnosed or in treatment, providing compassionate support and access to current information to aid them on their cancer journey. Colleagues describe Dr. Mahoney as incredibly generous with her time and knowledge, all in the service of providing the best and most up-todate care for patients. She has a passion for solving problems and bringing together collaborators to design solutions.

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In 2000, Dr. Mahoney “retired” to rural Humboldt County, where her husband, CMA past president and surgeon Luther Cobb, M.D., had joined the medical staff at Mad River Hospital. When she saw the acute cancer care deficits in this remote part of California, she had a vision for comprehensive cancer care for residents of Humboldt County so that they could get the same quality of care locally that they would get in Palo Alto. Dr. Mahoney recognized that in a rural area, the psychosocial needs were perhaps even more acute; and the resources more diffuse. She has since committed her professional life to providing care to patients diagnosed with breast cancer and developing collaborative teams to ease the passage of patients through the complex web of medical care that often overwhelms one of our more vulnerable populations—those diagnosed with cancer. Today, she is the director of the Cancer Care Program at St. Joseph Hospital in Humboldt County. Dr. Mahoney has also pursued a very ambitious international research program from her base in Humboldt County. She has collaborated with her colleagues at Stanford to create a joint videoconference tumor board. Under her leadership, the joint weekly tumor board has become a vibrant, standing-room only demonstration of collaboration and the constant search for each patient’s best possible care. For more about Dr. Mahoney’s remarkable story, see the award video at www.youtube.com/cmaphysicians.

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LOS ANGELES PUBLIC HEALTH PHYSICIAN HONORED WITH CMA MEMBERSHIP AWARD Mitchell Katz, M.D., director of the Los Angeles County Health Agency, was named the 2017 recipient of the Dev A. GnanaDev, M.D., Membership Award, which recognizes a special or unique effort toward membership recruitment. The Los Angeles County Health Agency is a newly created agency that combines the Departments of Health Services, Public Health and Mental Health into a single entity to provide more integrated care and programming within Los Angeles. At head of the new agency, Dr. Katz brought in 768 new members in 2016, making it possible for CMA and the Los Angeles County Medical Association to better engage with Los Angeles county physicians to combat public health issues facing their communities. Before being tapped to head the Los Angeles County Health Agency, Dr. Katz served as director of the Los

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Angeles County Department of Health Services, the second-largest public safety net system in the United States. During this time, he created the ambulatory care network and empaneled over 350,000 patients to a primary care home. He also moved over 1,000 medically complex patients from hospitals and emergency departments into independent housing, thereby eliminating unnecessary expensive hospital care and giving the patients the dignity of their own homes. Before he came to Los Angeles, Dr. Katz was the Director and Health Officer of the San Francisco Department of Health for 13 years. He is well known for funding needle exchanges, creating Healthy San Francisco, outlawing the sale of tobacco at pharmacies, and winning ballot measures to rebuild Laguna Honda Hospital and San Francisco General Hospital.

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SAN FRANCISCO OB-GYN RECEIVES CMA’S 2017 COMPASSIONATE SERVICE AWARD San Francisco ob-gyn Pratima Gupta, M.D., was selected as the 2017 recipient of the Compassionate Service Award, which honors a CMA member physician who best illustrates the association’s commitment to community and charity care. Throughout Dr. Gupta’s medical career, she has shown an unwavering commitment to public health and community service. She spent a research year during medical school in Quito, Ecuador. During that year, she founded and staffed a free clinic for transgender health care. From 2006 to 2014, she travelled internationally as a volunteer, providing training and education to doctors and health care providers in Peru, India, Zambia, Nigeria, Uganda, Nicaragua and South Sudan. In 2013, she participated on a disaster relief team sent to typhoon-stricken Tacloban, Philippines. Her volunteer work in California is equally impressive. Since 2005, she has volunteered her time to provide care to female, transgender and male sex workers at St. James Infirmary in San Francisco, where

she is currently the volunteer medical director. Dr. Gupta is a fierce proponent of patient reproductive rights, and is known for encouraging other physicians in California and throughout the United States to become advocates for their patients, public health and the practice of medicine.

SACRAMENTO PAIN SPECIALIST RECEIVES CMA NYE AWARD Sacramento pain specialist Lee T. Snook, Jr., M.D., was awarded the Gary S. Nye Award for Physician Health and Well-Being. The award honors a CMA member who has made significant contributions toward improving physician health and wellness. Dr. Snook, who currently serves as Speaker of the CMA House of Delegates, has been an outspoken advocate for physician wellness for more than 25 years. He has served on numerous CMA committees relating to physician wellness, as well as on the Board of Directors of the California Public Protection and Physician Health organization since its inception

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in 2009. Using his unique insight, Dr. Snook has spent the past 25 years working to develop policies and programs that have achieved positive results for the health and wellness of all physicians and for the practice of medicine. He was an advocate for approaches to preventing

physician burnout long before it became a popular thing to talk about. This award was established in honor of Gary Nye, M.D., a leader in bringing attention and developing solutions for physician impairment and rehabilitation.

PERMANENTE PHYSICIAN WELLNESS PROGRAM HONORED The Southern California Permanente Medical Group’s in part because, while the programs touches physicians Physician Wellness Program, led by Dawn Clark, M.D., individually, the 5 Pillar Program has also reset the and Edward Ellison, M.D., was awarded the Gary S. culture to emphasize wellness. Nye, M.D., Award for Physician Health and Well‐Being. The Physician Wellness program is an innovative and The program has significantly shifted the culture of increasingly successful model for promoting physician wellness for 8,500 physicians in California, and is exemplary for the innovative, BOTH DR. CLARK AND DR. ELLISON HAVE LED THE WAY all‐encompassing approach it brings to IN DEVELOPING AND IMPLEMENTING THE PROGRAM’S enhancing physician well‐being. The “5 PILLARS”: PREVENTION, PROFESSIONAL FULFILLMENT, medical group, a physician‐led organization, PRACTICE MANAGEMENT, COLLEGIALITY AND supports wellness and well‐being of COMMUNITY SERVICE, AND HEALTH. physicians at every level. Both Dr. Clark and Dr. Ellison have led the way in developing and implementing the program’s well‐being, and offers a variety of proven techniques and “5 Pillars”: prevention, professional fulfillment, practice tools that could lay the groundwork for a future program management, collegiality and community service, and for all physicians in the state of California. health. The program and its leaders have also been recognized Their commitment to physician wellness led to the on the local, state and national levels for their effective creation of a program that continues to evolve to meet and innovative work in physician wellness. the needs of physicians. The medical group has seen This award was established in honor of Gary Nye, first‐hand the results that a sustained, systems‐based M.D., a leader in bringing attention and developing approach can make in the lives of its physicians. It works solutions for physician impairment and rehabilitation.

OTHER NEWS CMA PRESENTS RESOLUTION HONORING AMA FOR WORK IN PROTECTING MEDICAL STAFF RIGHTS CMA has been actively and aggressively supporting the medical staff at Tulare Regional Medical Center in their lawsuit against the hospital for illegally terminating and replacing the entire medical staff and its duly elected officers. If left to stand, the hospital’s actions will create a dangerous precedent that could have much broader implications for the fundamental rights of medical staffs

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and physicians’ ability to care for patients in hospitals. Recognizing the critical national implications of this case, the Litigation Center of the American Medical Association (AMA) has provided significant legal support and monetary contributions to this case. AMA President David O. Barbe, M.D., recently travelled to Anaheim to speak to the CMA House of Delegates about the

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unprecedented attack on medical staff self-governance in the Tulare case. AMA’s contributions to the litigation in this case represent the single largest legal contribution in the history of the AMA. CMA presented Dr. Barbe with a resolution recognizing AMA for its extraordinary commitment to protecting medical staff rights to independence and self-governance. This case was recently featured in a New York Times op-ed, which provides a good look at why this local conflict could have a dangerous effect on patient care in U.S. hospitals. IF YOUR MEDICAL STAFF IS INTERESTED IN CONTRIBUTING TO CMA’S LEGAL DEFENSE FUND, WHICH IS USED TO LITIGATE CASES OF CRITICAL IMPORTANCE TO PHYSICIANS, EMAIL SWOLLEY@CMANET.ORG.

20 PHYSICIANS IN TRAINING PRESENT ORIGINAL RESEARCH AT 2ND ANNUAL HOD POSTER PRESENTATION The California Medical Association (CMA) and Network of Ethnic Physician Organizations (NEPO) jointly hosted the second annual poster session to showcase research by medical students, residents and fellows across California. This year’s poster session was a huge success, with 20 posters selected for the presentation—twice the number of last year’s competition. The research was well received by all, and we hope that this will become a permanent ﬁxture at future meetings and encourage more future physicians to take an active role within CMA. The amazing quality of the research is evidenced by the fact that the judges selected six winning presentations this year (see full list below)! One of the winners in the clinical research category was a second-year medical student from the University of California, Riverside (UCR) School of Medicine, Michelle Epps. Epps did her research on provider knowledge of celiac disease and how physicians can improve disease diagnosis in high-risk populations. “After reviewing the existing literature, it became so evident that there is this huge deﬁcit in provider knowledge about screening and diagnosing celiac disease,” Epps said. “Current research suggests that over 80 percent of individuals with celiac disease are either misdiagnosed or undiagnosed

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and, consequently, are at higher risk for clinical complications. As providers, we need to do a better job at identifying these individuals.” Another winner, UCLA third-year medical student Anthony Bui, presented research on police violence and its racial underpinning in the United States. “Providing objective evidence to public health issues is critical to informing honest and fair health policymaking,” said Bui. “Collaborating with colleagues of mine at Harvard and Berkeley, we aimed to provide more evidence that could inform the need for policy change and resource allocation focused on reducing deaths related to police violence.” UCR medical student Marissa Fox was also recognized for her research on how resident-centered education intervention can improve physicians’ knowledge and attitudes toward providing care to transgender patients. “The lack of adequate transgender education for medical students and residents contributes to the barriers that transgender patients face when attempting to access a provider that is knowledgeable about their care,” said Fox. “It is my hope that we can improve physician knowledge, comfort and awareness in dealing with transgender patients, with the ultimate goal of improving the health outcomes in this marginalized population.”

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THE FULL LIST OF WINNERS IS BELOW. Social science/health policy research: • David Deemer, Loma Linda University School of Medicine, MS-2: “Do psychological safety and grumpiness vary by professional discipline? An analysis of VA health trainees” • Anthony Bui, MPH, UCLA David Geﬀen School of Medicine, MS-3: “Quantifying years of life lost due to encounters with law enforcement in the United States, 2015-2016”

The judges also selected two additional winners whose research demonstrated an immediate clinical relevance to pressing issues facing underserved communities: • Jennifer Perdomo, University of Southern California Keck School of Medicine, MS-2: “Revealing barriers and identifying solutions to improve medication adherence amongst Latino underserved patients with type 1 and type 2 diabetes”

Clinical research: • Melissa Vanover, M.D., UC Davis, Department of Surgery, PGY-5: “Pediatric falls from buildings: a persistent problem”

• Marissa Fox, UC Riverside School of Medicine, MS2: “Improving resident physicians’ knowledge and attitudes towards providing care to transgender patients using a resident centered education intervention”

• Michelle Epps, UC Riverside School of Medicine, MS-2: “Improving the diagnosis of celiac disease in at risk populations through resident education”

To view the winning poster session abstracts, visit www.cmanet.org/poster-session. To view photos of the poster presentations, visit www.flickr.com/californiamedicalassociation.

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THANK YOU #CMADOCS

SUPERSTARS! #CMAdocs: We want to share YOUR story

California’s doctors aren’t just health care and medical experts. They’re also community leaders, philanthropists, entrepreneurs and policymakers dedicated to ensuring that patients receive quality health care at an affordable cost. #CMAdocs showcases California physicians leading the charge to help their communities thrive. Share your story or celebrate a deserving colleague today at www.cmanet.org/cmadocs.

Name: Pratima Gupta, M.D.

Specialty: Obstetrics/Gynecology City: San Francisco Member Since: 1996

“When I say I’m ‘pro-life,’ I mean that the literal sense of the word ‘life,’ not the way it’s been twisted by anti-choice advocates who want to shame, punish, and control women, their bodies, and their choices.”

Name: Jesus Rodriguez, M.D. Specialty: Family Practice City: Fresno Member Since: 1999

“My passion is to get the youth involved and to look at careers in medicine as an option… The more outreach we do and the more we can encourage the youth, especially from underserved minority populations, the better we will be able to serve California as a whole.”

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Name: Thomas Horowitz, D.O. Specialty: Family Practice City: Los Angeles Member Since: 1986

“It is not hyperbole to say that if physicians do not educate policymakers, our patients will suffer the results. Much legislation has no reliable feedback loop. It is upon us to highlight the unintended consequences so that problems can be addressed.”

Name: Valencia Walker, M.D. Specialty: Neonatology City: Los Angeles Member Since: 2006

“The work that needs to be done (in promulgating state legislation for public health), must involve physicians. We can translate many of our critical thinking and problem-solving skills from medicine into the public policy arena.”

Name: Edward Ellison, M.D Specialty: Family Medicine City: Pasadena Member Since: 1996

“Physicians are ailing...We need to change our thinking, and change our culture inside and outside of the medical profession across society…We have to declare our physicians’ humanity.”

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CALIFORNIA PHYSICIAN

CORPORATE

LEADERSHIP COUNCIL

The Corporate Leadership Council serves as a valuable forum for corporate leaders, California Medical Association, and the California Medical Association Foundation to share innovative ideas and insights. Together we explore collaborative opportunities, and collectively discuss common goals and challenges.

NORCAL Mutual Insurance Company PhRMA Pfizer, Inc. US HealthWorks Cooperative of American Physicians, Inc. First Citizens Bank Novo Nordisk, Inc. The Doctors Company AbbVie, Inc.

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TO JOIN, CONTACT YOUR LOCAL COUNTY MEDICAL SOCIETY: Alameda-Contra Costa Medical Association

Kern County Medical Society

Napa County Medical Society

San Francisco Marin Medical Society

Solano County Medical Society

(510) 654-5383

(661) 325-9025

(707) 255-3622

(415) 561-0850

(707) 255-3622

Butte-Glenn Medical Society

Kings County Medical Society

North Valley Medical Association

San Joaquin Medical Society

Sonoma County Medical Association

(530) 342-4296

(559) 582-0310

(530) 247-0293

(Serving San Joaquin, Calaveras,

(707) 525-4375

Central Coast Medical Association

Lassen-Plumas-ModocSierra County Medical Society

Orange County Medical Association

(209) 952-5299

(Serving Santa Barbara and San Luis Obispo County)

(805) 683-5333 Fresno-Madera Medical Society (559) 224-4224 Humboldt-Del Norte County Medical Society (707) 442-2367 Imperial County Medical Society (760) 554-1901 Inyo-Mono County Medical Society (916) 551-2541

(949) 398-8100

(530) 258-4116 Los Angeles County Medical Association (213) 683-9900 Mendocino-Lake County Medical Society

Placer-Nevada County Medical Society (530) 822-7770

Stanislaus Medical Society

San Mateo County Medical Association

(209) 527-1704

(650) 312-1663

Tehama County Medical Society (530) 247-0293

Santa Clara County Medical Association

Riverside County Medical Association

(408) 998-8850

Tulare County Medical Society

(951) 686-3342

Santa Cruz County Medical Society

(559) 627-2262

San Benito County Medical Society (831) 635-0604

(831) 479-7226

Tuolumne County Medical Society (209) 586-5431

(916) 551-2541 Merced-Mariposa County Medical Society (209) 723-2976

Amador and Alpine County)

San Bernardino County Medical Society

Monterey County Medical Society

(909) 273-6000

(831) 455-1008

San Diego County Medical Society

Sierra-Sacramento Valley Medical Society (Serving Sacramento, El Dorado and Yolo County)

(916) 452-2671 Siskiyou County Medical Society (530) 247-0293

(858) 565-8888

Ventura County Medical Association (805) 484-6822 Yuba-Sutter-Colusa County Medical Society (530) 673-6894

CMA Member Service Center 1201 J Street, Suite 200 • Sacramento, CA 95814 • 800.786.4262 • www.cmanet.org facebook.com/cmaphysicians • twitter.com/cmaphysicians • flickr.com/californiamedicalassociation

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