Page 1

Official Magazine of FRESNO COUNTY Fresno-Madera Medical Society KERN COUNTY Kern County Medical Society KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Medical Society TULARE COUNTY Tulare County Medical Society

See Inside: • CMA’s Education Series • Managing Professional Risk Tips • Connecting Valley Residents to Health Resources

April 2011 • Vol. 33 No. 4

Vital Signs


A P R I L 2 0 1 1 / V I TA L S I G N S

Vital Signs Official Publication of Fresno-Madera Medical Society

Contents CMA NEWS ................................................................................................................................5 NEWS

Kings County Medical Society Kern County Medical Society

CMA EDUCATION SERIES: April-May 2011 Programs ...................................................................7

Tulare County Medical Society

MICRA: $67,861 Ways FMMS/CMA Is Working for You! ..............................................................9 BLOOD CENTER: D.A. Points, Sporting ABC Logo, and ‘Carl’ Win Pebble Beach Golf Tourney .......10

April 2011 Vol. 33 – Number 4 Editor, Prahalad Jajodia, MD Managing Editor, Carol Rau Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD John T. Bonner, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative Sheldon R. Minkin, MD Kern Representative John L. Digges, MD Tulare Representative Gail Locke

PRACTICE MANAGEMENT: Managing Professional Risk Tips for Lowering Ambulatory-Care Risks .........................................................................................11 HEALTH COLLABORATIVE: Connecting Valley Residents to Health Resources...............................12 AIR QUALITY: Landmark Law Saved 160,000 Lives in 2010 Alone.............................................13 IMQ Professionalism Program .................................................................................................18 CLASSIFIEDS............................................................................................................................19 FRESNO-MADERA MEDICAL SOCIETY .......................................................................................14 • General Society Meeting May 11 KERN COUNTY MEDICAL SOCIETY ............................................................................................15 • President’s Message • Membership Recap • Membership Directory Updates TULARE COUNTY MEDICAL SOCIETY.........................................................................................17 • It’s A Busy Life • Annual Wine Social, May 13 • Version 5010 and ICD-10 Are Coming? Are You Ready?

Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medical Society, PO Box 28337, Fresno, CA 93729-8337. Advertising Contact: Display: Annette Paxton, 559-454-9331 Classified: Carol Rau, 559-224-4224, ext. 118

Cover photography: The Lonely Pine, Monterey by Joseph Hawkins, Jr., MD Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion pieces accepted for publication do not necessarily reflect the opinion of the Medical Society. All medical societies require authors to disclose any significant conflicts of interest in the text and/or footnotes of submitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118. V I TA L S I G N S / A P R I L 2 0 1 1


Bringing business banking solutions to your community


A P R I L 2 0 1 1 / V I TA L S I G N S

Gil Lara 437-3163

Tom Andersen 437-3147

Brian Donovan 437-7628

Frank Gallegos 437-7600

Come in today and let us get to know you so we can provide your business with the financial resources and tools to help you reach your business goals.


The California Medical Association (CMA) has launched a new resource to help physicians estimate savings and return on investment if they make the switch from traditional paper medical records to electronic health record (EHR) technology. The resource is called the ROI Calculator. To use the calculator, click on either “primary care practice” or “specialty practice” and begin by answering some basic questions about your practice, including average number of patients seen per year, average charge per office visit, and what percentage of patients’ visits are considered new patients. When you have answered all the questions, you will be able to estimate your administrative savings, how much you qualify for in federal incentive payments and what the overall return on investment would be from converting to electronic health records. Also coming soon is CMA’s model EHR contract. The model contract will provide CMA members with an example of a physician-friendly vendor agreement that can be used in negotiating vendor contracts. For the latest information on health information technology (HIT), go to CMA’s HIT Resource Center. Contact: CMA member help center, 800-786-4CMA (4262) or WHAT’S NEW AT CMA ON-CALL: PATIENT RETENTION/RESTRICTIVE COVENANTS

Physicians who leave a medical practice often have questions concerning restrictions that may prohibit them from continuing to treat patients they have seen during their former practice. Although it must be emphasized that the facts specific to each case may completely change the legal analysis, CMA On-Call document #0275, “Patient Retention/Restrictive Covenants,” provides general answers to commonly asked questions regarding these two issues. Under “Covenants Not to Compete,” the document begins by addressing the following question: “My contract with the group I just left contains a provision that says that I am prohibited from setting up a medical practice in my county for three years after I leave the group. Is this lawful?” The answer provides a legal analysis of restrictive covenants for physicians who are: • employees of a medical group, • independent contractors, • partners in a medical group, or • owners of, or shareholders in, a medical practice. Included in the answer is the opinion discouraging restrictive covenants issued by the Council on Ethical and Judicial Affairs of the American Medical Association. Additionally, the document addresses the legality of requiring residents and fellows to sign a covenant not to compete as a condition of enrollment in a teaching institution. The document also deals with the scope of restrictive covenants and notification of patients when a physician’s employment contract with a medical group or managed care plan is not renewed.

CMA On-Call is an online library with over 3,000 pages of medical-legal, regulatory and reimbursement information. The searchable library contains all the information available in the California Physician’s Legal Handbook, an annual publication of CMA’s Center for Legal Affairs. CMA On-Call documents are available free to members at CMA’s members-only website. Nonmembers can purchase OnCall documents for $2 per page. Contact: Samantha Pellon, 916-551-2872 or


The Department of Managed Health Care (DMHC) is once again attempting to legalize discount health plans in California via the regulatory process. The California Medical Association (CMA) recently learned that DMHC is planning to license Care Entrée, a discount health plan, notwithstanding the fact that its proposed regulations were disapproved by the Office of Administrative Law. Discount health plans charge patients a monthly membership fee in exchange for a list of physicians whose services they can supposedly access at a discounted rate. These plans are deceptive and harmful. The promised discounts are often illusory, and the physicians are often listed without their consent or knowledge. CMA has opposed discount health plan regulations since 2008 on three grounds: • an attorney general (AG) opinion concluded that discount health plans are illegal referral services under current law; • the Legislature has not given DMHC the authority to regulate discount health plans; and • legitimizing discount health plans contravenes sound public policy because they offer no real benefits to patients, discourage patients from obtaining legitimate health care coverage, and are inherently deceptive as they falsely imply that they are health care insurers when they take zero risk in their product. On Dec. 31, 2010, the Office of Administrative Law – a regulatory body in charge of approving or disapproving regulatory proposals – disapproved the DMHC discount health plan regulations. One of the primary reasons for disapproval was that the proposed regulations are inconsistent with the AG opinion concluding that discount health plans are illegal, a point that CMA has argued for the last two years. DMHC claims it has an administrative law judge opinion allowing it to license Care Entrée. “This is a blatant circumvention of the regulatory process on the part of DMHC, and it is unfortunate and shameful that Director [Cindy] Ehnes has chosen this to be one of her last final acts as a regulator,” said James Hinsdale, MD, CMA president. CMA is prepared to raise this issue with the incoming director of DMHC. Contact: Armand Feliciano, 916-551-2552 or CMA’S CAPITOL HILL MEETINGS PRESS CONGRESS ON WIDE RANGE OF ISSUES

CMA’s delegation to the nation’s capital met with 30 members of Congress and pushed for changes in the new health care Please see CMA on page 19 V I TA L S I G N S / A P R I L 2 0 1 1



A P R I L 2 0 1 1 / V I TA L S I G N S

CMA NEWS EDUCATION SERIES: April - May 2011 April 6

“Coding for Medical Necessity and Quality Care” – 12:15-1:15pm & 6:15-7:15pm Webinar: Medicare and private payers all recognize medical necessity as a deciding factor for claims payment and it is important that all practices know the rules. This session will be led by Mary Jean from Sage Associates. Register at www.cma

April 20

“Implementing a Compliance Program – a Practical Perspective” – 12:15-1:15pm & 6:15-7:15pm Webinar: Formal compliance programs, while a very good idea, have not been mandatory until recently when health care reform legislation passed containing a provision making compliance plans mandatory for certain providers. Implementing a compliance program in a physician's office does not have to be a daunting task. Mary Jean from Sage Associates will lead this informative session. Register at

May 4

“Dealing with Sensitive Personnel Issues” – 12:15-1:15pm & 6:15-7:15pm Webinar: This program is an informative discussion of state and federal laws, and best practices managers may use for handling difficult employee issues. Debra Phairas, President of Practice and Liability Consultants, will review the dos and don'ts for avoiding lawsuits. Register at

May 18

“Finding Answers to Your Legal Questions in 5 Minutes or Less: A Guide to CMA’s Amazing Legal Library” – 12:15-1:15pm Webinar: CMA's Center for Legal Affairs will walk physicians and their staff through navigating and utilizing CMA's invaluable Medical-Legal Library. Register at calendar. Seminars are in-person events. Please call the number provided for registration information, including any fees. Webinars provide you with the opportunity to learn from one of the leaders in the industry without having to leave your business. No travel, no time away from the office. Webinars are FREE for CMA members, $99 for non-members. Questions? CMA Member Help Center: 800-786-4262.

V I TA L S I G N S / A P R I L 2 0 1 1



$67,861 WAYS FMMS/CMA IS WORKING FOR YOU! The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s Trial Lawyers have launched an attack to undermine MICRA and its protections and we need your help. Membership has never been so valuable!

Fresno-Madera physicians are saving an average of $67,861 this year.

2011 Fresno-Madera Medical Society MICRA Premium Savings Chart Fresno-Madera Dade County, CA County, FL

Specialty Allergy Anesthesiology Cardiology (Invasive) Cardiovascular Surgery Dermatology (Lipo/Cosmetic) Emergency Medicine Family Practice (Non-Surgical) General Surgery Internal Medicine (Non-Invasive) Neurosurgery OB/GYN Ophthalmology (LASIK/Cosmetic) Orthopaedics Otolaryngology (Cosmetic) Pathology Pediatrics (Non-Surgical) Plastic Surgery Proctology Psychiatry (Non-Shock) Radiology (Non-Invasive) Thoracic Surgery Urology Average - All Specialties

$3,283 $8,641 $9,857 $24,899 $23,031 $14,163 $8,284 $23,031 $6,869 $42,902 $30,463 $6,869 $23,031 $23,031 $4,781 $6,869 $23,031 $23,031 $4,781 $6,869 $24,899 $9,857 $16,021

Long Island Wayne FL-NY-MI New York County, MI Average

$24,183 $48,367 $95,007 $172,739 $54,413 $95,007 $44,912 $200,377 $50,094 $248,744 $200,377 $50,094 $146,828 $60,459 $44,912 $31,093 $95,007 $69,096 $24,183 $95,007 $172,739 $60,459 $94,732

$10,826 $37,657 $40,738 $121,665 $36,779 $58,971 $26,817 $121,665 $36,779 $321,713 $196,111 $36,437 $146,084 $108,110 $24,769 $26,817 $108,110 $64,281 $10,826 $61,100 $100,500 $64,281 $80,047

$16,909 $41,697 $66,711 $174,918 $23,797 $87,121 $33,893 $143,445 $34,350 $201,512 $135,935 $37,955 $144,667 $81,556 $19,524 $28,928 $91,565 $53,751 $17,853 $45,293 $154,089 $55,655 $76,869

$17,306 $42,574 $67,485 $156,441 $38,330 $80,366 $35,207 $155,162 $40,408 $257,323 $177,474 $41,495 $145,860 $83,375 $29,735 $28,946 $98,227 $62,376 $17,621 $67,133 $142,443 $60,132 $83,883

Are you an FMMS/CMA member?

MICRA Savings $14,023 $33,933 $57,628 $131,542 $15,299 $66,203 $26,923 $132,131 $33,539 $214,421 $147,011 $34,626 $122,829 $60,344 $24,954 $22,077 $75,196 $39,345 $12,840 $60,264 $117,544 $50,275 $67,861

• Note: Comparison reflects mature annual premium costs for $1 million maximum per case/$3 million maximum for all cases in a given year. • Sources: NORCAL (San Francisco, CA); First Professionals Insurance Company (Dade County); American Physicians Assurance Corporation (Wayne County, MI); Medical Liability Mutual Insurance Company (Long Island, NY).

The practice of medicine is about to undergo revolutionar onarryy changee.. Are you prepared?









V I TA L S I G N S / A P R I L 2 0 1 1



When It Comes to Quality, We’re Setting the Standard! Sierra Imaging is certified by the American College of Radiology. To you, it means we abide by the highest standards in radiology. To us, it’s another day of good work.

(Photo: Getty Images, used with permission from ABC Newsletter, February 18, 2011)

Meet Mark Alson, MD Board Certified Radiologist

3 Tesla MRI

231 W. Fir Avenue, Clovis

Open MRI

Multislice CT

Sporting a lucky ABC logo golf shirt, D.A. Points beams after winning the recent Pebble Beach National Pro-Am golf tournament with his amateur partner, actor Bill Murray. It was Mr. Points’ first PGA title.




Scheduling 559.322.4271

D.A. Points, Sporting ABC Logo, and ‘Carl’ Win Pebble Beach Golf Tourney by Patrick C. Sadler, MD, Medical Director, Central California Blood Center

Maybe skill had something to do with it; maybe it was the distracting antics of his famous sidekick. But maybe, just maybe, the good-luck charm – an America’s Blood Centers logo – that adorned the orange golf shirt worn by Darren Andrew “D.A.” Points gave him the edge he needed to shoot par on the 18th green and win his first PGA tournament. With Bill Murray as his amateur partner, Mr. Points holed out from 100 yards for eagle on the diabolical 14th green to take the lead in the February 2011 Pebble Beach National Pro-Am in Pebble Beach, California. That carried him to a 5-under 67 and a two-shot victory. Even sweeter, it was the first time Mr. Murray won the Pro-Am title. He now gets his name on the wall below the first tee. Since last summer, Mr. Points has been sporting an ABC logo shirt as part of the Institute for Transfusion Medicine (ITxM) CEO Jim Covert’s sponsorship of SFX Golf, an event management company, which organizes, among other tournaments, the Ladies US Open. He wore it during the Links for Life golf tournament, Please see Golf on page 18 10

A P R I L 2 0 1 1 / V I TA L S I G N S


Managing Professional Risk Tips for Lowering Ambulatory-Care Risks by Karen D. Davis, MA, CPHRM Risk Management, PMSLIC Insurance Company and the NORCAL Group

Among the factors that influence the safety of ambulatory care and the liability risk levels of office-based physicians, three of the main ones are: • the level of communication with other healthcare providers about patients’ care; • the effectiveness of office follow-up processes; and • the attention given to documentation of telephone calls. The following tips may help physicians and office staff members increase patient safety and lower liability exposure related to these factors. COMMUNICATION WITH OTHER HEALTHCARE PROVIDERS • When you refer a patient to another physician, have some mechanism in place to determine whether your referral recommendation has been carried out and the patient has been seen by the recommended consultant (or another physician of the patient’s choice). • Communicate in writing with the consultant about the requested consultation. An effective way to convey significant details to another physician is to prepare a “fact sheet” with the patient’s clinical information and your impression. • After your patient is seen by a consultant, you and the consultant should establish who is responsible for which aspects of the patient’s care and who will order further testing and consultations if necessary. If there is a question about what you or the consultant will do, you should take the time to communicate physician-to-physician and to document the understanding you reach in your discussion.

EFFECTIVENESS OF FOLLOW-UP PROCESSES • Systematically monitor compliance with appointments. Establish a process whereby a designated staff member reviews all no-show appointments to determine which patients must be called and rescheduled. Document no-shows, along with the steps taken to contact the patient and reschedule the visit. • When a patient is advised to undergo a test, three areas of concern require follow-up: Has the patient complied with the recommendation? Have test results been received and reviewed by the ordering physician? Has the patient been notified about the results? An appropriate follow-up system provides answers to these questions. • Patients should not be solely responsible for making appointments for tests, to see consultants or for calling the office to obtain results. You should assist patients in making appointments in order to be assured that the appointment has been made. It is also prudent to notify all patients of all test

results (rather than just reporting abnormal results). Such a policy helps close each testing loop and reduces the possibility of patient information “falling through the cracks.” • Your follow-up system for tests should not only confirm receipt of test results but also ensure that you review the results. The review should be timely. A test result should never be filed until you (as the ordering physician) have personally reviewed, dated, and initialed it. Without such a method, a positive result can be accidentally misplaced or filed away before you review it or the patient is notified. If the patient later alleges that harm occurred as a result of a delay in diagnosis and treatment, the mishandled test result may well be viewed as concrete evidence of negligence.

DOCUMENTATION OF TELEPHONE CALLS • Generally, the types of telephone calls from patients that should be documented include: clinical questions and what advice was given, calls for prescriptions or renewals, after-hours calls, and calls to an on-call physician. Calls to patients that should be documented include: calls to share test results, calls to contact no-show patients, calls to give patients instructions or to advise about further access to care, and unsuccessful attempts to contact patients. • Telephone contacts should be documented in the appropriate medical record. If your office simply keeps a call log, information about a specific call can be difficult to retrieve. The facts surrounding a call are not readily available if they are recorded in a call log; thus, using a log can be detrimental if a malpractice claim is filed and your office must produce information about the patient’s interactions with the practice. • You should have a system for documenting all after-hours phone calls. You can use telephone call forms or a tape recorder or dictation machine to record patient name, time of and reason for the call, and your advice or action. When the call is from a patient, the information should be added to the patient’s chart as soon as possible. • Giving clinical or medical advice over the telephone without timely, face-to-face follow-up increases your liability exposure. Prescribing over the phone is also risky, as it requires you to assess the patient sight unseen. You should not prescribe for a patient unknown to you without seeing the patient. It is also prudent to have established parameters as to when prescriptions will be renewed by phone. • Consider developing the preceding suggestions as policy and including them in a policy manual. Make sure all employees review your policy and consider asking them to sign off yearly that they have been advised of the policy and understand it.

Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL Mutual insureds. To learn more, visit V I TA L S I G N S / A P R I L 2 0 1 1



Connecting Valley Residents to Health Resources Do you know where to access local information and resources on physical activity, nutrition and diabetes? The Network for a Healthy California – Central Valley Region and the Central Valley Health & Nutrition Collaborative (CVHNC) want you to know that this type of information can be easily accessed through newly created, online directories aimed at helping residents and health care professionals find resources in their area. PHYSICIAL ACTIVITY AND NUTRITION SERVICES DIRECTORY The first directory, available at resourcedir/resdir.html, offers free and low-cost physical activity and nutrition services, and includes the counties of Fresno, Madera, Merced, Mariposa, Kern, Tulare and Kings. Each county lists different categories of physical activity (free and low-cost) for all ages. Each resource listed for physical activity contains a program description, contact information, target age ranges and cost information. Need help finding a local food bank or locating a farmers’ market? Click on the Nutrition Resources link and you’ll find this information as well as local health clinics and housing services. “We created the directories in response to the need of Valley residents for easy-to-find, health-related services in their community,” said Collaborative Coordinator Brandi Muro, Central Valley Health Network. “There simply wasn’t anything out there that offered this type of information in one central location. With the rates of obesity and chronic diseases such as diabetes at an all-time high, residents need easy access to this type of information.”

DIABETES RESOURCES DIRECTORY A second directory focusing on Diabetes Resources can be found at This directory was developed by the Collaborative’s Diabetes Action Team, which aims to provide education on diabetes care and prevention. The directory offers information on where to go for diabetes counseling, retinopathy screening, pharmacy services, and monitoring supplies, including no cost and low cost glucose monitoring supplies. The directories are user-friendly and intended for a wide audience, including health care professionals who want to connect patients to community resources. For more information, contact the Central Valley Health & Nutrition Collaborative at 559-255-4300.


A P R I L 2 0 1 1 / V I TA L S I G N S resourcedir/resdir.html


In the News: Air Quality Bulletin by Michelle Garcia, FMMS Air Quality Director



A report released by the US Environmental Protection Agency

The suit challenges the Fresno County Board of Supervisors’ approval of the development of Friant Ranch on grounds that it goes against Fresno County’s General Plan. The suit contends that the Environmental Impact Report prepared for the project is inadequate at addressing environmental concerns, including clean air improvements that would improve public health benefits. To learn more about the lawsuit visit: http://www.

(EPA) estimates that the benefits of reducing fine particle and ground level ozone pollution under the 1990 Clean Air Act amendments will reach approximately $2 trillion in 2020 while saving 230,000 people from early death in that year alone. The report studied the effects of the Clean Air Act updates on the economy, public health and the environment between 1990 and 2020. To view the full report visit: sect812/prospective2.html.


MEDICAL SOCIETY DONATES AIR QUALITY FLAGS FLYING AT KAISER PERMANENTE FRESNO Kaiser Permanente Fresno is raising the flag on the Valley’s air quality with a series of colored flags indicating the daily forecast because of a donation by the Fresno-Madera Medical Society. To learn more about the Air Quality Flag Partnership visit:

Media Campaign: The Air Quality Program is teaming up with KMPH Fox 26 and KMJ Radio to put together a creative and fun campaign titled Cleaner Air California that highlights 50 Ways to Reduce Pollution. The campaign is focused on educating the public about simple things everyone can do to help clean up the air. Benefits of getting involved: • There’s room to include your personal messages beyond a logo and name mention. • Four sponsorship levels (1k, 2k, 5k and 10k) • Every time someone sponsors this campaign FMMS will create community awareness of its presence. To learn more about how you can become involved contact Michelle Garcia at or 559-224-4224, ext. 119. The Air Quality Program is also preparing to unveil its new Air Quality Program Page complete with a new program logo. The page will be more user-friendly and interactive for both physicians and the community-at-large and will include clean air education, research, news and more. Stay tuned!

UPCOMING MEETINGS AND EVENTS: Air Quality Sub-Committee Meeting: May 31, 2011, at 6pm at the Fresno-Madera Medical Society office. Agenda highlights: Presentation by Union of Concerned Scientists on their work, why renewable energy is an important part of clean air advocacy and how FMMS can become more involved.

V I TA L S I G N S / A P R I L 2 0 1 1



Post Office Box 28337 Fresno, CA 93729-8337 1382 E. Alluvial Avenue #106 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website:

General Membership Meeting “Strategies for Physicians to Collaborate and Succeed in the Era of Health Reform”

FMMS Officers Oscar Sablan, MD President Krista Kaups, MD Vice President Prahalad Jajodia, MD Secretary/Treasurer Harcharn Chann, MD Past President Board of Governors A.M. Aminian, MD Hemant Dhingra, MD Ujagger-Singh Dhillon, MD David Hadden, MD Sergio Ilic, MD S. Nam Kim, MD Stuart Mason, MD Ranjit Rajpal, MD Rohit Sundrani, MD Mohammad Sheikh, MD Phillip Tran, MD CMA Delegates FMMS President John Bonner, MD Adam Brant, MD Michael Gen, MD Sergio Ilic, MD Brent Kane, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-elect Prahalad Jajodia, MD Toby Johnson, MD Peter T. Nassar, MD Trilok Puniani, MD Dalpinder Sandu, MD Salma Simjee, MD Steven Stoltz, MD Rajeev Verma, MD CMA YPS Delegate Paul J. Grewall, MD CMA YPS Alternate Yuk-Yuen Leung, MD CMA Trustee District VI Virgil Airola, MD Staff: Sandi Palumbo Executive Director


A P R I L 2 0 1 1 / V I TA L S I G N S


Astrid Meghrigian, Esq. Legal Counsel, California Medical Association

Michael W. Goldring, Esq. Health Care Specialist, Fishman, Larsen, Goldring and Zeitler Wednesday, May 11, 2011 6:00 pm: Wine Tasting Social 6:30 pm: Dinner & Meeting FMMS Offices: 1382 E. Alluvial #106 Cost: No charge: FMMS member $20 non-FMMS member Federal Healthcare Reform has created a host of payment reforms and authorizes the Medicare program to contract with Accountable Care Organizations (AFOs) to improve quality and reduce cost through more coordinated healthcare systems. This presentation will provide information on how independent physicians can create systems and negotiate collectively in order to succeed in this new era of health reform. Don’t miss this opportunity to learn: • Organizational options for physicians to consider • Practical business considerations for a practice • Legal and financial issues to consider if affiliating with a hospital • How improving quality gives physicians a competitive edge in the marketplace RSVP: 559-224-4224, ext. 118 or


2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website:

President’s Message PHYSICIAN WELLNESS

How important is your wellness to you, to your patients and your practice? KCMS Officers Portia S. Choi, MD President Joel R. Cohen, MD President-elect Calvin J. Kubo, MD Secretary Ronald L. Morton, MD Treasurer Mark L. Nystrom, MD Immediate Past President Board of Directors Alpha Anders, MD Brad Anderson, MD Noel Del Mundo, MD John Digges, MD J. Michael Hewitt, MD Peter McCauley, MD Wilbur Suesberry, MD Tonny Tanus, MD Edward Taylor, MD CMA Delegates: Jennifer Abraham, MD Eric Boren, MD John Digges, MD Ronald Morton, MD CMA Alternate Delegates: Lawrence Cosner, Jr., MD Patrick Leung, MD Michelle Quiogue, MD Staff: Sandi Palumbo, Executive Director Kathy L. Hughes Membership Secretary

We physicians are always giving and providing for others, always. Whether it is for the care of our patients or providing for our families, we may neglect the most important person, the physician. In this regard Daniel Grabski, a psychiatrist and an honorary medical staff at Kern Medical Center, was interviewed. Dr. Grabski described our current times where there is a rise of dysfunction and drastic change. There is amalgamation of corporation with physician groups eating up smaller groups. These changes can lead to anxiety and depression. There has been a deprofessionalization of medicine and a depreciation of our medical profession. These changes can result in substance abuse, depression and career burnout. Some physicians may lose their medical license or even their life! These dysfunctional responses can dramatically affect the physician’s life, their practice and their families. There are steps that can be taken to diagnosis and treat this ailment. Awareness is the first step. There is a prodrome to the full-blown dysfunctional illness. Dr. Grabski described these prodromal signs, such as: • Increased drinking. One outcome is driving under influence (DUI) citation and even incarceration. • Use of drugs, sexual misconduct, and negligence could lead to disciplinary action by the Medical Board of California. • Problems at work, such as getting to the office very late, not showing up for appointments. • Increased trouble at home. Acceptance is the next step. Those who are concerned about the physician has to accept that there may be a problem. That nagging feeling that “something is not right” can be one of the indications. It may be the office manager who notices the tardiness and missed appointments. It may be another physician who has noticed that a physician drinks a lot. A family member notices changes and is concerned. It may be a behavior that seems “off”. One may not be able to describe why, but it is that uneasy feeling. Action is the final step. The physician, officer manager, colleague or the family member can take action. There is counseling and therapy. There are confidential help lines. The Kern County Medical Society has established a Physician Wellness Committee to obtain information and form a Physician Wellness Program. Until a program is established in Kern County, there is a confidential, 24-hour telephone line through the California Medical Association and California Dental Association. The Physicians’ and Dentists’ Confidential Line is available 24-hours-a-day, seven-days-a-week at 213-383-2691. This is a confidential line in which a person will answer the phone. The line is available to the physician, colleagues, office staff and family. The person answering the telephone call will assess the information, and based on the need, the call can be directed to a physician on call. Contact information for Portia Choi MD,, 661-868-0461.

V I TA L S I G N S / A P R I L 2 0 1 1




MEMBERSHIP NEWS Membership Recap MARCH 2011 Active ............................................................261 Resident Active Members.................................0 Active/65+/1-20hr ............................................4 Active/Hship/1/2 Hship ....................................0 Government Employed ...................................10 Multiple memberships .......................................2

Retired .............................................................63 Total ..............................................................340 New members, pending dues.............................0 New members, pending application .................0 Total Members..............................................340

2011 KCMS Membership Directory The 2011 KCMS Membership Directory is here! Changes/Corrections and Additions are listed below. To order additional copies, please contact the KCMS Office, 661-325-9025. NEW MEMBERS (Also Add to “Membership By Specialty List”) BHINDER, Sumeet K. IM*/RHU* 3933 Coffee Rd. Ste B, 93308-5024 Gov’t. Med. College, India 1997 588-4001 / FAX: 588-4049

CHANGES/CORRECTIONS ARBEGAST, Neil – Remove phone number (Retired Section pg.37) BARNARD, Jo Ellen – 2700 Panorama Drive, 93306-1016 (Retired Section pg.37) BUSTAMANTE, Javier – FAX: 663-4740 Email: BUXTON, John – 3838 San Dimas St. #B231, 93301-1494 Same Phone/Fax COHEN, Joel – FAX: 852-3600 EMAIL Addresses to be Removed: Vipul Dev, MD; Long Dinh, MD; Dana Edwards, MD; Sze Ho, MD; Royce Johnson, MD; Hau Lin, MD; Anil Mehta, MD; David Moore, MD; Umesh Patel, MD and Jacqueline Williams-Olango, MD HEWITT, J. Michael – Email: OLSEN, Gary – Move to Retired Section (page 38) – 20942 Lola Lane, Tehachapi, CA 93561-8418; Phone: 822-7927 SHAKIR, Shabbir – Email: SHANKERMAN, Robert – 815 Dr. Martin Luther King Blvd., 93307-1365 Phone: 322-3905 FAX: 322-1370 TAYLOR, Edward – 3838 San Dimas St. #B231, 93301-1494 Same Phone/Fax TEHACHAPI HOSPITAL – Medical Staff – remove Debra Portell – Email:


A P R I L 2 0 1 1 / V I TA L S I G N S

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 KCMS Officers Mario Deguchi, MD President Daria Majzoubi MD President elect Theresa P. Poindexter, MD Secretary Treasurer Jeffrey W. Csiszar, MD Past President

Board of Directors Bradley Beard, MD Bhupinder Chatrath, MD James E. Dean, MD Laura Howard, MD H. James Jones, MD Ying-Chien Lee, MD Bo Lundy, MD Kenny Mai, MD Sheldon R. Minkin, DO

CMA Delegates: James E. Dean, MD Jeffrey W. Csiszar, MD CMA Alternate Delegates: Sheldon R. Minkin, DO Mario Deguchi, MD Staff: Marilyn Rush Executive Secretary


It’s a Busy Life… by Parul Gupta, MD

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website:

TCMS Officers Steve Carstens, DO President Gaurang Pandya, MD President-Elect Mark Reader, DO Secretary/Treasurer Ralph Kingsford, MD Immediate Past President Board of Directors Steve Cantrell, MD Karen Haught, MD Thomas Gray, MD Parul Gupta, MD Monica Manga, MD H. Charles Wolf, MD CMA Delegates: Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates: Robert Allen, MD Ralph Kingsford, MD Mark Tetz, MD Sixth District CMA Trustee James Foxe, MD Staff: Steve M. Beargeon, Executive Director Francine Hipskind Provider Relations Gail Locke Physician Advocate Maui Thatcher Executive Assistant

So, here I am, a mother of a high school freshman, wife of a busy doctor and myself, a busy OB/GYN in solo practice. Apart from being a volunteer in some committees at work and at my son’s school, my life is constantly running. The week goes by in a flash, and I am constantly changing the hat I wear in the course of a single day – depending on what I am doing and where I am. You get the scenario. The other day I had a laboring patient and a full office, and in the midst of it all, my son had to be picked up from school and dropped off to the venue of his FFA activity. We were also expecting houseguests that day, and I was wondering how I am going to manage everything. But things work out. My patient delivered during my lunch break, my son got a ride from his coach and my office went smoothly with no interruptions. Also, years of juggling and organizing came to my rescue. In the morning, I left the slow cooker on with stew and chicken ready for the oven. When our visitors arrived in the evening we had a home cooked meal and no pressure! I have decided that the slow cooker is one of my best friends. Others are understanding patients, and most importantly, caring family, husband and son are my greatest strengths. That is why I can do what I do week after week. This scenario repeats itself frequently like an episode from a popular soap. Being an OB/GYN makes my schedule unpredictable, and there have been many instances where I have had to miss out on a lot of my only son’s school activities. The guilt that comes with it has been a burden that has weighed on me for a long time. However, when I read what my son wrote the burden lightened like it never existed. He writes… Doctors for Parents Living with doctors for parents is, well, interesting. Everyday is a new adventure. Some days sleeping is impossible when my dad and mom are constantly getting calls at night, and my dad insists on yelling like there is a jetliner taking off in our living room. Some days I wish my parents weren’t doctors so that they could spend more time with me. For example, when I was playing a soccer game when I was 8 years old, my dad and mom had to leave in the middle of the game, and even today I still don’t get to see them as often as I would like to. Also, since I am the only child of two accomplished and brilliant people and people say “he’s going to be just like his father”, I feel like Atlas with the world on my back. But as I got older, I have realized that all the things that are tough about being the child of two doctors are far outweighed by the benefits. I love my parents, and I now know that my parents work so hard, because they want the best for me and want to give me the best opportunity to succeed in my life. Unlike other children my age, I value the time my parents spend with me. As a matter of fact, I cherish my parents spending time with me more than I cherish my X-box (and that’s saying something). My parents have always told me that no matter what I want to be when I grow up, they will always love and support me. I guess having doctors for parents is okay. I get to enjoy the big house and the nice cars, but the real way God blessed me was by giving me the two most loving parents in the world - even if I have to give up a little sleep. And that is why this busy life is worth every bit. We now have additions to our household of two puppies, a black lab and a golden retriever. It adds to the mayhem but we will manage! Please save the date…

Tulare County Medical Society

Annual Wine Social Friday, May 13 • 6:30-8:30PM Chinese Cultural Center, Visalia

V I TA L S I G N S / A P R I L 2 0 1 1


Tulare Version 5010 and ICD-10 Are Coming: Will You Be Ready? All HIPAA covered entities that submit transactions electronically are required to upgrade from Version 4010/4010A to Version 5010 transaction standards by January 1, 2012. Testing should be conducted both internally and with external business partners in preparation for the January 1, 2012, compliance deadline. Internal testing of Version 5010 should have been completed by December 31, 2010. Now is the time to begin external testing. Stay ahead of the Version 5010 and ICD-10 transitions! Know the deadlines and mark your calendars: • January 1, 2011 – Begin external testing of Version 5010 for electronic claims • CMS begins accepting Version 5010 claims • Version 4010 claims continue to be accepted • December 31, 2011 – External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance • January 1, 2012 – All electronic claims must use Version 5010; Version 4010 claims are no longer accepted • October 1, 2013 – Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures; CPT codes will continue to be used for outpatient services CMS has resources that can help you with the Version 5010 and ICD-10 transition.

IMQ Professionalism Program The Medical Board often requires physicians who come to its attention to take an Ethics Course which meets certain specifications. IMQ offers that precise course! For many years CMA, and subsequently IMQ, offered a one day ethics course for physicians. In 2005, IMQ Professionalism Program was developed to comply with the MBC’s new requirements for an ethics course. While the primary attendees are referred by the Medical Board, some Medical Staffs have chosen this option when encountering ethical issues in their hospital. The IMQ Professionalism Program centers on both the legal and ethical dimensions of the practice of medicine in California, and it introduces participants to a range of resources to address present or future problems. The Program is divided into three components. The pre-course component consists of a background assessment application, a baseline knowledge test and pre course reading. The purpose of this component is to determine the participant’s knowledge/awareness of ethical/legal issues related to the practice of medicine in California, as well as information about the participant’s knowledge of the legal and ethical issues related to the specific case(s) for which the participant has been referred to the program. The second component is the two-day ethics course, which is limited to twelve participants and courses are scheduled based on enrollment. It includes a series of components that move from demonstration to practice and application. Issues covered include: what are ethical issues and when they arise, clarification of legal issues, resources to analyze situations and a decision making model. The course is heavily interactive, and designed to provide participants with a full understanding of the ethical and legal aspects of their own violations and knowledge about how to access resources to deal with future issues. The third component is required assessments over a one-year period following the course On completion of the course, a report is sent to the Medical Board and a Certificate of course completion awarding twenty-two (22) AMA PRA Category 1 Credits™ hours is provided to each participant. The course is taught by William May, PhD, a retired USC professor. Response and evaluations by attendees is very positive. A brochure is available at For additional information, please call Paulette Richardson at 415- 882-3387.

Golf Continued from page 10 held at Fox Chapel golf course in Pittsburgh, PA, on Aug. 30. The tournament, hosted by ITxM, benefited the Foundation for ABC. Another PGA player, Jarrod Lyle, also participated in Links for Lifewhile wearing an ABC logo shirt.


A P R I L 2 0 1 1 / V I TA L S I G N S

Mr. Points grew up idolizing Bill Murray, whether it was his “Caddyshack” role as assistant greenskeeper Carl Spackler or his antics at Pebble Beach over the years. To have him as an amateur partner made this week great before it even started. “It’s a dream come true,” Mr. Points said. “To win on the PGA Tour, and especially at Pebble Beach, and especially with Bill Murray… don’t think I could dream this up.” (Central California Blood Center is a long time member organization of America’s Blood Centers.)

Gar McIndoe (661) 631-3808 David Williams (661) 631-3816 Jason Alexander (661) 631-3818

Classifieds MEMBERS: 3 months/3 lines* free; thereafter $20 for 30 words. NON-MEMBERS: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30. *Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

MEDICAL OFFICES FOR LEASE 1902 B Street – 1,695 sf. 2701 16th St. – 2,400 - 4,800 - 10,000 rsf. 2007 17th Street – 5,090 rsf. 2031 17th Street – 1,776 rsf. 608 34th St. – 1,935 rsf. Crown Pointe Phase II – 2,000-9,277 rsf. Meridian Professional Center – 1,740-9,260 rsf. 4040 San Dimas St. – 2,035 rsf. 9300 Stockdale Hwy. – 3,743 - 5,378 rsf. 9330 Stockdale Hwy. – 1,500-7,700 rsf. 3115 Latte Lane – 5,637 rsf. 2731 H Street – 1,400 sf. 3941 San Dimas Street – 3,959 rsf. SUB-LEASE 1401 Commerce, Suite 210 – 1,098 sf. 6001 Truxtun Ave #120 – 1,200 sf. 3850 River Lakes Dr. – 2,859 rsf. 4100 Truxtun Ave. – 11,424 rsf. Medical Admin and Chart Storage DENTAL OFFICE FOR LEASE OR SALE 3115 Latte Lane – 5,697 rsf. 2023 Brundage Ln – 3,500 sf. FOR SALE 2633 16th Street – 4,800 rsf. 2701 16th Street – 10,000 sf. Crown Pointe Phase II – 2,000-9,277 rsf. Meridian Professional Center – 1,740-9,260 rsf. 2000 Physicians Plaza – 17,939 sf. gross 9900 Stockdale Hwy. – 2,000-6,000 rsf.

CMA Continued from page 5 reform law, including increases in the Medi-Cal reimbursement rate, and elimination of the Independent Medicare Payment Advisory Board (IPAB). CMA continued to advocate for a repeal of the Medicare Sustainable Growth Rate (SGR) physician payment formula. CMA reminded lawmakers that physicians face a 27 percent Medicare SGR payment cut on Jan. 1, 2012, unless Congress acts to stop the cuts and maintain access to physicians for California’s seniors and military families. CMA is working with other groups in organized medicine to develop an alternative to the flawed Medicare SGR payment formula to present to Congress before the end of the year. The delegation also urged members of Congress to give seniors increased freedom to see the physician of their choice. To improve access to care, CMA is proposing legislation that would allow seniors to use their current Medicare

FRESNO / MADERA ANNOUNCEMENT Omni Laboratory is pleased to announce the implementation of the ThinPrep Imagining System for Pap smear screening. As the only one in Fresno to utilize the Imaging System, Omni Laboratory uses this cancer screening method that improves detection of the high risk HPV by more than 42% over the usual screening method that you may currently be using. We would also like to announce our new partnership with Saint Agnes Pathology Medical Group, who directs our laboratory efforts. If you would like to offer this comprehensive test, at no additional cost to you or your patients, or if you have questions regarding this screening tool; please contact our Lab Manager Jerome Simpson, Jr. at 559-495-3120. Dr. Naeem M. Aktar, Ambreen Khurshid and Mikhail Alper PA-C at California Gastroenterology Associates have moved to 7121 N. Whitney Ave. Fresno; north of Maple/Herndon avenues. Drs. Jajodia and Shah of Digestive and Liver Disease Medical Group are proud to welcome Dr. Win to their practice. All new patients will be seen within 10 days. We accept PPO, Medicare and HMO patients. Fax 559-447-8400.

coverage to see a physician who does not participate in Medicare through a private contract with the physician. CMA also lobbied the lawmakers for protection of the Medical Injury Compensation Reform Act (MICRA), California’s landmark medical liability law, which has saved billions of dollars in health care costs for both physicians and patients across California. CMA is keeping a close watch on federal medical liability legislation to make sure that it does not undermine California’s successful law. Contact: Elizabeth McNeil, 415-8823376 or

Drs. Prahalad Jajodia, Min Win and Kalyani Shah at the Digestive and Liver Disease Medical Group have moved to 7085 N. Maple Ave., Fresno (Herndon and Maple avenues). Drs. Arora, Mitroo and Kim are proud to welcome Dr. Sandeep Sekhon to their gastroenterology practice. He is accepting new patients. Fax 559451-0172. Drs. Arora, Mitroo, Kim and Sekhon of Fresno Gastroenterology have moved to 7095 N. Chestnut #101, Fresno. NW corner of Chestnut/Herndon. University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5 pm. Call 3200580.

FOR LEASE OR RENT Medical office space, 2,100sf; $1.30psf+. Pavillion Gardens, 7407 N. Cedar. Call Cindy at 559-287-3279. Professional office building at 7095 N. Chestnut (Chestnut & Herndon) 900-4,000sf. Rate negotiable. Call Cindy at 559-287-3279. Medical office space, 3,000 to 7,000sf approx.; near Fresno Surgical Hospital in prime location at a very reasonable rate. Rates negotiable. Please call, 559-273-0600. Medical office space, 1,650sf approx. on Fir Avenue in medical complex in prime location at very reasonable rate. Rates negotiable. Please call, 559-273-0600.

PHYSICIAN / PROVIDER WANTED Primary Care MD needed. Physician-centered friendly work environment. Part/full time. Flexible hours. Income potential of $100+/hr. Send resume to Integrative Medical Practice seeking 1-2 yr exp. IM or FP for exciting practice opportunity in Fresno. Comp salary & bonus. Contact Aamer at

SERVICES OFFERED Disability Income Protection with Guardian, Standard & Principle. Contact Scott Karl at 559307-6103.

CMA HOTLINES AND MEMBERSHIP BENEFITS • Membership Help Line: 800-786-4262 • Legal Information Line: 415-882-5144 • Reimbursement Help Line: 888-401-5911 • Contract Analysis: 415-882-3361 • Legislative Hotline: 866-462-2819 • Medical-Legal Documents: On-Call at

V I TA L S I G N S / A P R I L 2 0 1 1


PRSRT STD U.S. Postage PAID Fresno, CA Permit No. 30

VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337 HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

Your reputation matters. Period.

Our passion protects your practice

Some insurers cap their defense costs or take them from your coverage limits. NORCAL Mutual does not.* We are committed to protecting you regardless of the cost. There is no cap on the value of the reputation youâ&#x20AC;&#x2122;ve earned.

NORCAL Mutual is proud to be endorsed by the Tulare County Medical Society as the preferred medical professional liability insurer for its members.

Call NORCAL Mutual today at 800.652.1051. Or, visit

* Except for DataShieldâ&#x201E;˘, our coverage enhancement for risks associated with information and network security. DataShield coverage limits include defense costs.

2011 April  
2011 April