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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

Vital Signs

April 2014 • Vol. V l. 36 No. 4 Vo

See Inside: Patients and Providers to Protect Access and Contain Health Costs Surviving the Third Month of Covered California Obama’s Policy Extension Unlikely to Affect Many in California

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.


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For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors. CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the nearly 12,000 preferred California physicians already enjoying the benefits of CAP membership.

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Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society April 2014 Vol. 36 – Number 4

Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD

Contents EDITORIAL.................................................................................................................................5 CMA NEWS................................................................................................................................7 NEWS

MICRA: Patient and Providers to Protect Access and Contain Health Costs..................................6

CMA EDUCATION SERIES.........................................................................................................7

AFFORDABLE HEALTHCARE ACT: Surviving the Third Month of Covered California.........................9

HEALTHCARE REFORM..........................................................................................................10

PHYSICIAN OPPORTUNITIES: • Physicians Needed for Worker’s Comp Case Reviews..........................................................12

• California Academy of Family Practices Offers Advanced Online DOT Training........................12

BLOOD CENTER: REDS-III and Its Role in the Future Transfusion Medicine.................................13

CLASSIFIEDS..........................................................................................................................19 Fresno-Madera Medical Society......................................................................................14

• Save the Date: May 22 Multidisciplinary Approach to Recognizing & Treating Hyperparathyroidism June 11 & 12: ICD-10 Coding

• Walk with a Doc

• Lock It Up

• In Memoriam: Jack M. Snauffer, MD

Kern Representative John L. Digges, MD

Kern County Medical Society...........................................................................................16

Tulare Representative Thelma Yeary

TULARE County Medical SocieTY.......................................................................................17 • Take A Step Toward Better Health

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 Medi­ cal Society, PO Box 28337, Fresno, CA 93729-8337. Advertising Contact: Display: Annette Paxton, 559-454-9331 Classified: Carol Rau Yrulegui 559-224-4224, ext. 118

• Membership News

• New CMS 1500 Claim Forms to be Used April 1

• Physician Assistance Program Offered

• Visalia Unified High Schools Need You!

• Walk With A Doc

Cover Photograph: “  Pine Flat Wildflowers, 2013” By Ning Lin, OD, 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. APRIL 2014 / VITAL SIGNS


You have to pay for workers’ compensation insurance. But...

YOU DON’T HAVE TO In California, rates for workers’ compensation insurance are soaring. In the second half of 2013, rates increased by an average of 8.7%.1 That’s after a 10% increase in the first half of 2013.2 Source: Workers Compensation Insurance Rating Bureau of California, amended_ppr_filing_complete.pdf


2 Source: Business Insurance, article/20130925/NEWS08/130929901


FMMS/KCMS/TCMS members, call 800-842-3761 to see if you can save!

Are you paying too much for your workers’ compensation coverage? Finding out is easy. Just call 800-842-3761 to compare your current policy with workers’ compensation insurance available through the Fresno-Madera, Kern and Tulare County Medical Society. This members-only program is available through Mercer. As the world’s leading insurance broker, Mercer can provide the outstanding service and expertise you deserve. Call Mercer at 800-842-3761 today to get your free, no-obligation quote.

Fresno-Madera Medical Society Kern County Medical Society Tulare County Medical Society

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 65414 (4/14) Copyright 2014 Mercer LLC. All rights reserved. 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 •


The Practice of Medicine 2014… Where Did We Go Wrong? Horst Weinberg, MD Retired, Pediatrician

As a retired pediatrician who practiced in Fresno for many years and still volunteers at a clinic for the poor in Sacramento, it has been interesting for me to see how the practice of medicine has changed over the years. Having recently spent several weeks touring Australia, I was pleasantly surprised to learn that their current health care system is very similar to the way ours was many years ago when I started my practice. This is how the Australian health care system works: There is a ‘public’ health care system that is paid for out of the taxes that everyone pays. It consists of clinics and hospitals spread throughout the country, and every Australian citizen is eligible to go there and get essentially cheap/free care. If a patient’s financial situation allows, they can buy private health insurance at whatever level they can afford. This gets the patient access to their own physician, who sees them in his/her private office, and access to private hospitals, which provide some of the luxuries (telephones, private rooms, TV, etc.) not available in the public hospitals. Most working Australians buy this private insurance to get quicker, more personalized care. Everyone seems happy with this system. As you may remember, we in Fresno had something very similar. We had the County Hospital and County Clinics. These were paid for by state taxes and were essentially available to anyone who needed health care. The care was good but without many of the non-essential frills. The more affluent patients had the choice to get private physician and hospital care by either paying for it out of their own pockets, or by buying health insurance, which took care of most of the cost. Many of us older, practicing physicians also saw, without charge, needy patients who did not go to the county for care. As with the Australian system, patients still got good medical care while keeping the costs reasonable. What changed all this? We allowed our elected bureaucrats to step in. To lower costs and to ‘curb’ greedy doctors, the health plans proliferated with PPOs, HMOs etc. The County and private “two tier” system was not considered acceptable. Every patient, rich or poor, deserved a hospital room with TV, telephone and all the other extraneous amenities that added nothing to good medical care. Multi-bed hospital ‘wards’ for the poor were discriminatory. County Clinics were discriminatory. Did health care improve? It did not. County hospitals and many ‘Free County Clinics’ have closed. Uninsured patients end up in the emergency rooms, and health care has become more expensive, as the insurance companies make large profits. The result: disruption of the physician-patient relationship. The health plans limited physicians’ fees and patient access by putting an all-powerful bureaucracy (the Plan) in place between the patient and the physician. Employers and patients enrolled, hoping for lower costs. Physicians needed to join the plans in order to get enough patients to survive.

A fact that was totally ignored – most physicians are honest and not greedy. To achieve the promised lower price for their enrollees, services and physician fees had to be cut. Also, and this is the main flaw in the operative theory, there is no possible way to supply a product (medical care) cheaper or better if a ‘middle man’ (the insurance company/Provider Plan) is in place between the physician and the patient. What This middleman needs to be paid, which is usually very generously, leaving changed less moneys for medical care. The end all this? result? Most healthy people are generally happy with the apparently lower cost We allowed until they themselves need medical care, our elected and realization sets in that their care is bureaucrats controlled and curtailed by their ‘Plan.’ As there are always more healthy people than to step in. sick people, the now unhappy ones’ voices To lower are ignored. Obamacare is now the law of the land. Will it improve medical care or costs and to lower costs? ‘curb’ greedy There is no way that 30+ million people doctors, can be insured without a tremendous rise in cost. To control this cost, medicine the health will have to be ‘rationed,’ and our older plans population will bear the brunt of that. Our elected government officials – proliferated federal, state or local – have never been with PPOs, able to do anything efficiently, cheaply or well without huge cost overruns (Social HMOs etc. Security, Medicare are on the brink of bankruptcy). The Electronic Medical Record, which I have to use at the clinic where I volunteer, makes my notes more legible for the next person to read, but to use it correctly, I spend more time on the computer filling everything out than with the patient. This is not the way medicine should be practiced. So where did we go wrong? I believe that physicians, including their organizations should have been more active in controlling their way of practice, rather than turning it over to the insurance companies and the government to handle. Now it is too late. The new generation of doctors will never have the freedom we had to practice good medicine and the control we had over our own destiny. Unhappily, there is no going back....



MICRA Patients and Providers to Protect Access and Contain Health Costs

You said what

to the Medical Board’s investigator? Physicians often come to us after they have been interviewed by a Medical Board investigator or after they have already provided a written description of their care. Did you know that a Medical Board investigator is a sworn peace officer, with a gun, and a badge, and the power to arrest you? When the Medical Board demands an explanation, seek help immediately. The attorneys at Baker, Manock & Jensen have helped many physicians through the maze that is a Medical Board investigation. We would be honored to help you.

George L. Strasser 5260 North Palm Avenue Fresno, CA 93704 559 432-5400

MAYBE IT’S TIME TO PURSUE A NEW CAREER FACULTY PHYSICIAN(S) – FAMILY MEDICINE KERN AND FRESNO COUNTIES Board Certified Family Practice Physicians to serve as faculty for the Sierra Vista Family Practice and Rio Bravo residency programs. Full and part-time positions available providing teaching and instruction to residents. Make a difference in the lives of new physicians and join the faculty! Competitive salary and benefits. Positions available in Kern and Fresno counties. PHYSICIAN(S)– FAMILY MEDICINE – FRESNO COUNTY Provide comprehensive medical services to an established patient population, in one or more of several satellite clinics in the Fresno area. The position requires an MD, or DO degree or equivalent and completion of residency training in Family Medicine. Board Certification or Board Eligibility in Family Medicine as evidence of completion of the training requirement is acceptable. Valid California medical license also required. DEPUTY CHIEF MEDICAL OFFICER – FRESNO COUNTY The Deputy Chief Medical Officer (DCMO) is responsible for the overall patient functioning of the medical program of the clinic and satellites, including the day-to-day management, planning and supervision of medical staff activities. The DCMO also assures an efficient system in which quality care is guaranteed to all patients. The DCMO should be a health care provider (MD/DO) licensed to practice in the State of California. The DCMO should have a strong community health/public health orientation, be experienced in patient care management, and have at least two years of experience in an administrative capacity. Interested applicants may contact Clinica Sierra Vista at (661) 979-0812. 6 APRIL 2014 / VITAL SIGNS

Non-partisan report says drug database provisions in MICRA lawsuit ballot measure “cannot be implemented” Troubled government-run database will not be fully functional “ for years,” physicians will be forced to either deny/delay prescriptions drugs to suffering patients or break the law

The Patients, Providers and Healthcare Insurers to Protect Access & Contain Health Costs campaign released a report by non-partisan experts raising serious doubts whether a key provision of a proposed, currently-circulating MICRA lawsuit ballot measure can be practically implemented. Even worse – the report says – it would put physicians and pharmacists in the impossible position of choosing between denying or delaying needed prescription medication to legitimately suffering patients and violating the law. The measure’s proponents, who have already admitted that the non-MICRA provisions were “sweeteners” written by focus groups, not health professionals,1 are currently circulating their measure for signatures. The proposed initiative requires licensed health care practitioners and pharmacists to consult California’s prescription drug monitoring database (known as CURES) prior to prescribing or dispensing Schedule II or Schedule III controlled substances to patients. According to Tim Gage, former Finance Director for the State of California, and Len Finocchio, former Associate Director for California’s Department of Health Care Services, who authored the report, the provision “would almost certainly result in a situation in which prescribing health providers would be legally required to use a database that was in practice not available.” Troublingly, the report also indicates the following: The CURES database cannot now accommodate the 200,000 additional registrants who will need to be added to the system in order to make it universally utilized, according to the Department of Justice. The CURES database will – absent a change in the current timeframe – not be operational at that scale by the November 2014 deadline required in the measure. Please see MICRA on page 18

CMA NEWS CMA announces sponsored bill package for 2014 The California Medical Association (CMA) recently announced its sponsored bill package for 2014,

which includes legislation that would increase access to care in California, restore the 10 percent MediCal provider rate cut and strengthen physicians’ rights when contracting with managed care plans. Below are summaries of CMA’s eight sponsored bills: All Products Clauses (AB 2400) This bill would prohibit health service plans from executing agreements with physicians that contain provisions requiring them to participate in all networks or products that are currently offered or that may be offered by the health plan. The bill would allow physicians to opt-in in each network or product. Sugar-Sweetened Beverages Safety Warning Act (SB 1000) This bill would prohibit the sale of most non-alcoholic beverages with added sugar and over 75 calories per 12 fluid ounces without the following warning label, “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.” Medi-Cal reimbursement (AB 1805) This bill would restore the 10 percent cut to Medi-Cal provider reimbursement rates that was enacted as part of the 2011 State Budget Act. It seeks to bolster provider participation in the Medi-Cal program as the State implements the rollout of health care reform. Funding for Primary Care Residency Programs (AB 2458) This bill would appropriate funding to graduate medical education programs in primary care specialties (internal medicine, pediatrics, obstetrics and gynecology and family medicine) to ensure an adequate and properly distributed supply of physicians, immediately and over the long term. UC Merced (SB 841) This bill would appropriate $2.8 million in an effort to recruit and retain physicians in the Central Valley. Specifically, SB 841 would appropriate $1.8 million for the University of California San Joaquin Valley Program in Medical Education (PRIME) beginning in fiscal year 2015-16, and would appropriate $1 million to begin the planning effort for the establishment of a medical school at UC Merced. Allied Health Professional Supervision Numerical Limits (AB 2346) This bill seeks to increase the capacity of California’s health care system to provide quality, physician-led access to care. It would change current law to allow a physician to supervise up to 6 (current limit is 4) physician assistants, nurse practitioners or certified nurse midwives at any moment in time. Telehealth Reimbursement: Telephone and Electronic Patient Management Services (AB 1771) This bill would require health insurance companies licensed in the State of California to pay physicians for telehealth services, including telephone or other electronic patient management. Administrative Efficiency for Health Facilities (AB 1755) The bill would adopt the Health Information Technology for Economic and Clinical Health (HITECH) Act as the standard for health care data breaches and move state law closer to federal law. CMA will also take a position on hundreds of additional bills over the course of the next few months. CMA’s Council on Legislation (COL) will be meeting on March 20 in Sacramento to discuss the association’s legislative priorities for 2014. COL is composed of more than 60 physicians from around the state who are nominated by their delegation, county medical society or specialty society, and meet annually to discuss and recommend CMA’s positions on numerous pieces of legislation pertaining to the house of medicine. All of the recommended positions taken by COL will be presented to the CMA Board of Trustees for finalization at its April 15 meeting. These then become CMA’s official positions throughout the current legislative cycle.


EDUCATION SERIES CMA Center for Economic Services Webinars At-A-Glance Most webinars are FREE for CMA members and their staff, $99 for non-members.

A Webinar Invitation for All Physicians and Their Staff

The California Medical Association (CMA) offers programs to educate physicians and staff on a range of practice management issues. Space is limited, so register soon. April 23: Surviving Covered California: What Physicians Need to Know Brett Johnson•12:15-1:15pm California’s health benefit exchange, named Covered California, is now open for business and individuals are enrolling for the 2014 benefit year. As of February 1, Covered California reports that more than 728,000 individuals have enrolled in exchange plans. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect and how to navigate the exchange. In this presentation you will learn more about California’s exchange and what it will mean for physicians, including: • Basic components of the exchange • Patient related issues to consider • Physician issues to watch • Key developments on the grace period • How plans built their networks • How to check participation status with exchange plans • Steps physicians can take if they disagree with their participation status • CMA resources to assist your practice April 30: Stage 2 Meaningful Use-the 2014 Edition What You Need to Know! David Ginsberg• 12:15-1:15p.m. Many changes are in order for the 2014 edition (Stage 2) of Meaningful Use. This informative webinar will assist you in understanding these changes and how they impact your workflows and use of electronic health records (EHR). These webinars are hosted by the California Medical Association. You must register at least one hour prior to the event. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Help Line at 800-786-4262. APRIL 2014 / VITAL SIGNS



How Successful Is Your Practice? Let physician members know your practice is available for referrals Use Vital Signs to advertise your practice at special rates offered to member physicians. contact: Annette Paxton Vital Signs Advertising Representative (559) 454-9331




Surviving the Third Month of Covered California As of February 15, Covered California reports that more than 828,000 individuals have enrolled in exchange plans, which surpasses its original target. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect. To help answer some of the more common questions, the California Medical Association (CMA) offers this third tip sheet to help physicians survive the third month of Covered California: What is the “grace period?” Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months after they have stopped paying their premiums. This is known as the “federal grace period.” How will I know who gets the 3-month grace period? Insurance ID cards for exchange enrollees will have the Covered California logo on them, but generally they will not indicate whether the enrollee is subsidized. While some Blue Shield ID cards indicate “subsidy” in the product name, not all do so. CMA does not recommend practices rely on that wording on the card to determine which patients are subsidized. Current enrollment trends, however, predict that 85 percent of those with exchange coverage will be subsidized and receive the three-month grace period. Thus, practices may want to operate under the presumption that all such cardholders get the federal grace period. How will I know whether an exchange patient is in months two or three of the grace period? Practices should verify an exchange patient’s eligibility, ideally on the date of service, or as near the time of service as possible. If the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive. Furthermore, within 15 days of entering month two of the grace period, the plan is required to notify the primary care provider (PCP) of record and any physicians who have submitted claims on the patient within the previous two months. March 3, 2014, is the first possible date where a practice may encounter a patient who may be in months two or three of the grace period. For patients who paid their premium for January and have not yet paid their February premium, March would be the first month where their coverage status may change to inactive, suspended, pended, etc. It will be extremely important that practices are verifying eligibility on all exchange patients from this date forward. What are my options if a patient presents with inactive coverage on account of the grace period? Practices should have policies in place prior to March 2014, the earliest date that patients may begin entering month two of the grace period. Practices may, for example, require a patient to sign an agreement that they will be responsible for all unpaid charges and may request a payment up front. A practice, however, must consider its own circumstances and, for instance, to what extent applying its current policies on treating uninsured or self-pay patients may be suitable. What about the products sold outside of Covered California that still use the exchange networks? Practices must review patient ID cards and eligibility information closely to identify whether the practice is in or out of network for that particular plan. Every plan offered in the exchange must also be offered outside

of the exchange, using the same provider network. Confusion around these off exchange products, also called “mirror” products, has resulted in a number of practices unknowingly seeing patients out-ofnetwork for products that use an exchange provider network, as these ID cards will not have the Covered California logo. For example, Blue Shield products bought off of the exchange but utilizing the exchange network will list one of the following product names on the patient ID card: Basic PPO/EPO, Enhanced PPO/EPO, Get Covered PPO/EPO, Preferred PPO/EPO or Ultimate PPO/EPO. Anthem Blue Cross products bought off of the exchange but utilizing the exchange network will list “Pathway” on the card. If you see these product names on the ID card, it indicates the patient only has access to the exchange network. If the Anthem Blue Cross card is not available, practices may see the following product names on the eligibility verification screen: Core DirectAccess, Essential DirectAccess, Preferred DirectAccess, Premier Direct/Access, Catastrophic GuidedAccess. How can I avoid patient confusion and frustration related to my participation status at the time of service? With all of the new exchange plans added to the mix, it is no longer satisfactory to simply accept “I have Blue Shield” as an indication of whether the patient can be seen in network. It is important, when scheduling, to determine if the physician is indeed in the patient’s network. The first step is to ensure front office staff has a clear understanding of the physician’s participation status as displayed on the plan websites. Second, upon scheduling request that the patient fax or email a copy of the front and back of their ID card to the practice. This will allow the practice to clearly identify whether they are in the patient’s network and also to verify patient eligibility before the visit and communicate with the patient before the visit. Taking these steps could help avoid out-of-network costs for and frustration from patients when they are faced with a larger than expected bill. Are there any options for patients who purchased a plan based on inaccurate provider directory information? Yes. On February 7, following numerous complaints about accuracy from both enrollees and providers, Covered California removed its cross plan provider directory from the exchange website until further notice. Covered California has said publicly if a patient enrolled in a particular plan based on inaccurate provider directory information, they can contact Covered California’s Service Center at 800-300-1506 to switch to a different plan before the end of the open enrollment period, March 31, 2014. Does CMA have any educational information I can share with my patients to help them understand more about the exchange products and potential narrowed networks? Yes. CMA has just published a document physicians can provide to patients to address the most common patient questions. The document is available free for members at Still have questions? Visit CMA’s exchange resource center at There you will find all of CMA’s exchange resources, including CMA’s comprehensive exchange toolkit, “CMA’s Got You Covered: A Physician’s Guide to Covered California, the state’s health benefit exchange.” CMA members and their staff also have FREE access to our reimbursement helpline at 888-401-5911 or APRIL 2014 / VITAL SIGNS


HEALTHCARE REFORM Obama’s Policy Extension Unlikely To Affect Many in California

HHS Unveils Final Rule To Give Patients Direct Access to Lab Results

According to the California Department of Insurance, most state residents

The Obama administration released a final rule allowing patients and

whose health plans were canceled because they do not comply with the Affordable Care Act’s minimum coverage standards will not be affected by President Obama’s two-year extension of an administrative fix allowing consumers to keep such coverage, the San Jose Mercury News reports (Seipel, San Jose Mercury News, 3/7). California Insurance Commissioner Dave Jones (D) urged Covered California to implement Obama’s proposal. However, Covered California’s board unanimously decided not to allow insurers to continue selling policies that do not meet the ACA’s minimum coverage requirements. How Extension Could Affect California California law states that after Jan. 1, 2014, insurance policies that are noncompliant under ACA standards cannot be sold or renewed. However, the state Legislature and Gov. Jerry Brown (D) could change the law to follow Obama’s two-year extension, according to the Mercury News. Janice Rocco, deputy commissioner of health care policy at DOI, said that “very few” of the 1.1 million state residents whose plans have been canceled would benefit from such an extension because insurers already have been required by state law to only sell or renew ACA-compliant plans. However, Rocco said small businesses with health plan renewal dates at the end of this year potentially could benefit from an extension (San Jose Mercury News, 3/7).

Debate Continues Over CalifORNIA Law To Expand Role of Pharmacists

Some physician groups are raising concerns about a new California law that gives pharmacists more responsibilities, arguing that expanded scopes of practices could negatively affect patient safety, HealthyCal reports. The law is aimed at addressing California’s physician shortage (Richard, HealthyCal, 2/11). Only 16 of the California’s 58 counties have the supply of physicians recommended by the federal government. In addition, the Association of American Medical Colleges says that nearly 30% of California’s doctors are nearing retirement age. The California Legislature in September 2013 approved a bill (SB 493), by Sen. Ed Hernandez (D-West Covina), to expand the scope of practice for pharmacists to help boost access to health care (California Healthline, 9/17/13). Once California State Board of Pharmacy protocols are approved, the law will allow pharmacists in the state to perform certain medical services, such as providing routine vaccinations and certain prescription drugs for travelers. Meanwhile, some physician groups have raised concerns about the changes in scope of practice, Kaiser Health News reports. For example, the American Medical Association said that it supports physician-led teams that include pharmacists but that it does not approve giving pharmacists prescription privileges without the supervision of a physician. The California Medical Association, however, supports the law, but only after certain amendments were added that limited the medications pharmacists could prescribe to patients. Jon Roth, CEO of the California Pharmacists Association, said the law is a step forward for pharmacists who will now be able to use their education and training in full capacity. He added that the measure “fundamentally changes the face of health care, where the pharmacy becomes more than just a place where you pick up medications” (HealthyCal, 2/11). 10 APRIL 2014 / VITAL SIGNS

their designees to directly access laboratory results, instead of having to request them from physicians, the Washington Post reports (Somashekhar, Washington Post, 2/3). The rule, which amends the Clinical Laboratory Improvement Act, allows both patients and designees – such as developers of personal health record systems – to access the results. In addition, the rule eliminates CLIA-covered labs’ Health Insurance Portability and Accountability Act exemptions. Under the rule, CLIAcovered labs must provide patients with copies of their lab test results within 30 days of receiving a request. Labs will have 180 days from the rule’s effective date to comply. The rule estimates that compliance will cost labs about $59 million annually for the first five years. However, the rule recommends that labs offset the costs with “a reasonable, cost-based fee” charged to patients who request copies of their results (Conn, Modern Healthcare, 2/3). HHS Secretary Kathleen Sebelius in a statement said the rule will give individuals broader control over their health care, possibly “empower[ing]” them “to track their health progress, make decisions with their health care professionals and adhere to important treatment plans” (Kennedy, USA Today, 2/3). The American Medical Association and the American Association of Family Physicians warned that allowing patients to directly access their lab results could lead to confusion. AAFP President Reid Blackwelder said that “harm” can come from patients receiving abnormal results and not “know[ing] what to do with that information.” However, neither group opposed the rule (Washington Post, 2/3).

CIRM To Award $40M for Stem-Cell Genomic Research

The California Institute for Regenerative Medicine is planning to invest

up to $40 million in stem-cell genomic research, AP/Modern Healthcare reports. According to AP/Modern Healthcare, stem-cell genomic research could “revolutionize” the medical field by creating more personalized treatments (AP/Modern Healthcare, 1/26). In 2004, California voters approved Proposition 71, which created CIRM. The agency was launched to advance development of stem cellbased disease treatments. Since 2004, CIRM has allocated about $1.7 billion to 68 institutions to support advances in stem-cell research and regenerative medicine (California Healthline, 3/11/13). However, according to AP/Modern Healthcare, the institute has not yet developed any new therapies, which could pose problems when CIRM re-applies for additional funding in three years (AP/Modern Healthcare, 1/26).

DEA Launches Investigation Over Missing Rx Pills at Calif. CVS Stores


Sacramento office of the U.S. Drug Enforcement Agency is investigating the disappearance of about 37,000 hydrocodone tablets from four CVS locations in California, according to officials with the U.S. Attorney’s Office, Capital Public Radio’s “KXJZ News” reports. Hydrocodone is a narcotic that is found in painkillers, such as Vicodin, and is widely misused. Please see next page

HEALTHCARE REFORM Continued from page 10 In 2013, more than three million prescription pills were lost or stolen from California pharmacies, according to the state Board of Pharmacy, including: • One million pills lost in transit; • 358,000 that were tied to employee pilferage; • Nearly 500,000 taken in break-ins at night; • 100,500 taken in armed robberies; and • 5,500 stolen by consumers. According to DEA warrant requests, the tablets were reported lost or stolen at CVS locations in: • Dixon; • Fairfield; • Modesto; and • Turlock. DEA investigator Brian Glaudel said the agency believes the stores could have violated the federal Controlled Substances Act by improperly keeping records of prescription drug distributions (Dembosky, “The California Report,” KQED, 3/12). Lauren Horwood, a spokesperson for the U.S. Attorney’s Office, said CVS could be charged with more than 2,900 possible violations of the law and could be fined up to $29 million (Lazarus, Los Angeles Times, 3/10).

Appeals court rules that health plans may be responsible for payment when they irresponsibly delegate risk

For the first time, a California appellate court has recognized a legal cause of action that holds California’s health plans liable when they negligently delegate risk to an independent practice association (IPA) that subsequently fails to reimburse providers. In a precedentsetting opinion in Centinela Freeman Emergency Medical Assocs. v. Health Net et al., the court is allowing emergency care providers to proceed with such a negligent delegation claim against the state’s largest health plans. In 2011, the Centinela physicians filed a lawsuit against health plans that delegated risk to La Vida IPA to seek reimbursement for claims for emergency medical care that were left unpaid after La Vida went bankrupt. The lawsuit alleged that La Vida was having trouble paying providers, yet the health plans did nothing to rectify the situation and continued to delegate their enrollees to La Vida. When La Vida went bankrupt it owed the emergency care physicians over $3 million. The California Medical Association (CMA) Please see Healthcare Reform on page 19 APRIL 2014 / VITAL SIGNS


PHYSICIAN OPPORTUNITIES California Academy of Family Physicians (CAFP) Offers Advanced Online DOT Medical Examiner Training New Federal Requirement: Beginning May 21, 2014, all CDL medical

certificates issued to interstate commercial vehicle drivers must be issued by MEs on the National Registry of Certified Medical Examiners (NRCME)*. The Federal Motor Carrier Safety Administration (FMCSA) has established a National Registry of Certified Medical Examiners (NRCME) with requirements that all medical examiners who conduct physical examinations for interstate commercial motor vehicle drivers must complete a training course and pass a certification examination to be listed on the registry. CAFP is pleased to offer a self‐paced 2.5 hour Medical Examiner training program. “Improving Transportation Safety: Commercial Driver Medical Examiner Training” includes case‐based learning that covers all eight core competency areas designated by NRCME, sample test questions, a comprehensive resource toolkit of study material and forms. Delivered 100% online, this course is designed to meet the needs of busy medical professionals. No travel, no classroom time, no time away from work or home. You can access and participate in this training when and where you choose. This advanced‐level 2.5 hour course assumes comprehensive clinical knowledge and a prior mastery and skill set in the basics of history and physical examination techniques. We will continually update the course’s FAQs document throughout the year with questions and answers from learners. Details and Registration: ONLINE COURSE • Faculty: Nancy Swikert, MD, past president of the Kentucky AFP, is a DOT certified medical examiner. •A  AFP Members: $350 •N  on‐AAFP Members: $500 • Group pricing available To Register: Expiration date: 12/31/2014 For more information, contact Jerri L. Davis, CCMEP, Director, CME/ CPD,, 916-780-0393. The California Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The California Academy of Family Physicians designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credit(s). TM This course has been reviewed and is acceptable for up to 2.5 Prescribed credits by the American Academy of Family Physicians. *The NRCME certification exam is administered by a separate FMCSA‐approved testing organization.


Physicians Needed for Worker’s Comp Case Reviews Health Services Advisory Group, Inc. (HSAG) is the Quality Improvement Organization (QIO) for Medicare for the State of California. HSAG is currently assisting in the review of Worker’s Compensation cases in California. These reviews involve injured California workers who have been denied a service, treatment, etc. under Worker’s Compensation, and the denial is being appealed. In order to complete these reviews, HSAG is recruiting physician reviewers to participate in the case reviews. Physician reviewers are needed in the following specialties: Orthopaedic Surgery, Occupational Medicine, Physical Medicine and Rehabilitation, OMM/NMM, and Pain Management. Other specialties, such as Internal Medicine, Emergency Medicine, Family Practice, Cardiology, Psychiatry, and surgical specialties are also acceptable. Details: • Training materials will be provided. • Work can be done from any computer with a secure internet connection. • Review time averages 30-45 minutes per case, and reviewers can work as many or as few hours per week as they like. • Reviewers will be reimbursed at an hourly rate for two hours of training time; following that, compensation will be provided at a per-case rate. Requirements: • Reviewers must be a licensed physician, MD or DO. California license is preferred but not required. • Reviewers must be board-certified in a specialty • Reviewers must have worked clinically with patients an average of 16 hours per week for two of the last four years. If you are interested in getting involved, or have questions, please contact HSAG directly and contact, Marianne Clinch, RN, CPHQ , Project Manager II, Medical Case Review, Health Service Advisory Group, 3133 E. Camelback Rd., #300 , Phoenix, AZ 85016, 602-801-6922 or email:

BLOOD CENTER REDS-III and Its Role in the Future of Transfusion Medicine Patrick Sadler, MD Medical Director, Central California Blood Center

The Recipient Epidemiology and Donor Evaluation Study, or REDS-III,

is a large, multicenter research program seeking to improve outcomes in blood donors and transfusion recipients. The seven-year endeavor, which began in 2011, is the latest installment in a United States governmentfunded research effort that is now in its third decade, building and expanding upon the findings of two earlier REDS programs. Although it is only partially complete, it already is producing results that will shape blood banking and transfusion medicine far into the future, according to REDSIII investigators and other experts. The goal of REDS-III is to improve the safety and availability of transfused blood products in the United States and internationally. Under the umbrella of REDS-III, there are four separate but related research programs: one multicenter U.S. domestic effort and three international collaborations in Brazil, China and South Africa. Each program contains multiple focused studies, some of which are structured as hypothesisdriven clinical studies while others are based on mining data from core databases recording blood donor, blood product and recipient information. The U.S. portion of the study is linking donor, blood product and recipient information through comprehensive databases. The infrastructure assembled for the domestic program, connecting major academic centers and associated hospitals and allowing the collection of blood donor and patient data on an unprecedented scale, will greatly impact the future of research and practice in blood banking and transfusion medicine, according to Steven Kleinman, MD, steering committee chair for REDSIII, clinical professor of pathology at the University of British Columbia and AABB’s senior medical advisor. “Now REDS-III is targeting areas of recipient research – ‘How is blood utilized in hospitals?’ ‘Who gets it?’ ‘What are the outcomes in recipients?’ We hope that REDS-III, by creating this model of infrastructure, will not only make helpful observations of its own, but also stimulate other groups to do related types of recipient-based research,” he said. The Structure of REDS-III: As with the previous REDS programs, REDS-III is funded by the National Heart, Lung, and Blood Institute, or NHLBI, of the National Institutes of Health. The original Retrovirus Epidemiology Donor Study was launched in 1989 because of concerns regarding HIV, and it quickly expanded to study overall blood safety and availability. REDS-II, which began in 2002, had an increased emphasis on donor safety issues. REDS-II also included an international component, with studies in Brazil and China examining HIV-related issues. The major aims addressed by research in REDS and REDS-II included evaluation of infectious disease risk, availability of donated blood and characteristics of blood donors. The first two REDS programs combined have yielded more than 150 published studies.1 Although the acronym for REDS-III remained the same, the name was changed to Recipient Epidemiologyand Donor Evaluation Study to reflect the inclusion of recipient-based research in the U.S. portion of the study.2 The domestic component of REDS-III is composed of four participating hubs, each of which has a blood center and two or more hospitals – at least one large tertiary academic hospital and one community hospital. The REDS-III structure also includes a data coordinating center and central laboratory. In REDS-III, both the international and domestic programs include multiple investigator-generated research protocols. These include

phase 1 studies conducted in the first two years of REDS-III and already producing data,3,4 and longer-term phase 2 studies. A list of examples of phase 1 and phase 2 studies is shown in the table. Donor, Recipient Databases: One core activity of REDS-III is the development of large, detailed databases. The domestic proREDS-III Phase 1 and gram has a detailed research Phase 2 Studies Phase 1 (completed): database that links data on blood donors and donations; • Recovery of Hemoglobin the components made from Stores Following Whole those donations; and data Blood Donation extracted from the electronic • A Population-based Study of the Detection and medical records, or EMRs, Prediction of In-hospital of patients receiving those Transfusion-related Adverse components. “The 12 affiliatEvents ed hospitals, as part of their • A Retrospective Cohort commitment to REDS-III, Study of Plasma Use, Transfusion-Associated are providing the electronic Circulatory Overload (TACO), health information on every and the Risk Associated transfusion recipient over an with the Use of ABOongoing four-year period in compatible, Non-identical addition to some basic inforPlasma mation on every single patient Phase 2 (planned): seen in the hospital — even those who have not been • Severe Transfusion transfused,” said Darrell TriReactions including ulzi, MD, medical director of Pulmonary Edema (STRIPE). the Institute for Transfusion The overall objective of this prospective case-control Medicine, one of the REDSstudy is to provide scientific III hubs, and an AABB past data for the development president. “We are basically of strategies that will collecting everything that prevent or reduce adverse could be relevant, from a clintransfusion reactions, focusing on TACO. ical or laboratory perspective, to a transfused patient and extracting that data from the EMR,” Triulzi continued. “The rule is that if it’s not electronic, we’re not collecting it. This is really a proof of principle that we can collect all the data we need from the EMR. The NHLBI selected the hub sites because they all have strong EMRs.” The inclusion of controls (nontransfused patients) in the outcomes database facilitates comparative effectiveness studies to improve transfusion practices, noted Edward L. Murphy, MD, MPH, a REDS-III principal investigator at University of California at San Francisco and Blood Systems Research Institute. “When studies look at outcomes only in patients who get transfused that introduces the ‘indication bias:’ the reason a person gets a transfusion makes him or her somehow different, and probably sicker, than a similar patient who didn’t get transfused,” Murphy explained. “So a study may identify bad outcomes that appear to be related to transfusion, but that are really due to something else about the patient. We are excited about the database capabilities, and the potential for using more advanced statistical techniques to try to get at some of these issues.” Please see REDS-III on page 19 APRIL 2014 / VITAL SIGNS


Fresno-Madera SAVE THE DATE

Post Office Box 28337 Fresno, CA 93729-8337 1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: Officers Prahalad Jajodia, MD President A.M. Aminian, MD President-Elect Hemant Dhingra, MD Vice President Ahmad Emami, MD Secretary/Treasurer Ranjit Rajpal, MD Past President Board of Governors Alan Birnbaum, MD S.P. Dhillon, MD William Ebbeling, MD Anna Marie Gonzalez, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Alan Kelton, MC Constantine Michas, MD Trilok Puniani, MD Khalid Rauf, MD Roydon Steinke, MD CMA Delegates FMMS President Don Gaede, MD Michael Gen, MD Brent Kane, MD Brent Lanier, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD Praveen Buddiga, MD Surinder P. Dhillon, MD Trilok Puniani, MD Oscar Sablan, MD CMA Trustee District VI Virgil Airola, MD Staff Sandi Palumbo Executive Director


Multidisciplinary Approach to Recognizing and Treating Hyperparathyroidism May 22, 2014 • 6pm-8pm featuring: Aron Gould-Simon, MD Radiologist Joseph Hawkins, MD Endocrinologist Christina Maser, MD Surgeon Fresno-Madera Medical Society Office 1040 E. Herndon Ave. #101 1.5 CME hours. Information: 559-224-4224, ext. 118 ••••••••

ICD – 10 TRAINING FOR OFFICE CODERS June 11 and 12, 2014 Cost: $399/physician- member staff Bella Pasta Restaurant LEARN: • The basics and guidelines, changes, additions and differences in format, conventions and coding rules of ICD-10 • Key preparation steps for a successful transition • Billing & clinical documentation concepts

Fresno-Madera Medical Society presents

Just Walk! Walk with a Doc ‘Walk with a Doc’ strives to encourage healthy physical activity in people of all ages and reverse the consequences of a sedentary lifestyle. WHO CAN ATTEND: Participation is open to anyone interested in taking steps to improve their health. GRAB A FRIEND AND HEAD TO THE PARKS ON SATURDAY MORNINGS


Woodward Regional Park Sunset View Shelter Registration 8:45am Walk Event 9:00am-10:00am April 26, 2014 May 31, 2014

Jack M. Snauffer, MD 57-year member

Jack M. Snauffer, MD, a retired general surgeon, died February 25, 2014 at the age of 92. Dr. Snauffer was born in Sunbury, PA in 1921. He received his medical degree from Temple University School of Medicine in 1946 and completed his internship and general and thoracic surgery residency training at the Espiscopal Hospital in Philadelphia. He then served two years as Chief of Thoracic Surgery at the US Army Hospital in Colorado. Dr. Snauffer moved to Fresno in 1955 and worked for a short time at the Veterans Administration Hospital, before opening his private surgical practice. He retired from surgery in 1986, but worked as a medical consultant for the State of California until fully retiring in 1998. Dr. Snauffer is survived by his two children and two grandchildren.


Town & Country Park Pavilion Area Registration 8:15am Walk Event 8:30am-9:30am April 5, 2014 May 3, 2014 FURTHER INFORMATION Fresno-Madera Medical Society (559) 224-4224, ext. 110 or at

Find us on Facebook: Fresno-Madera Medical Society




Kern Kings MEMBERSHIP NEWS New Member 2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: Officers Alpha J. Anders, MD President Michelle S. Quiogue, MD President-Elect Eric J. Boren, MD Secretary Bradford A. Anderson, MD Treasurer Wilbur Suesberry, MD Past President Board of Directors Alberto Acevedo, MD Lawrence N. Cosner, Jr., MD Vipul R. Dev, MD John L. Digges, MD Susan S. Hyun, MD Kristopher L. Lyon, MD Ronald Morton, MD Mark L. Nystrom, MD Edward W. Taylor, III, MD CMA Delegates Jennifer Abraham, MD John Digges, MD Lawrence N. Cosner, Jr., MD CMA Alternate Delegate Joseph H. Chang, MD CMA YPS Representive Joseph H. Chang, MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

The following physicians’ names, etc. are being published in compliance with the KCMS Constitution & Bylaws. Board Certification will be listed only if the physician has been certified by a Specialty Board recognized by the American Board of Medical Specialists, as approved by the American Medical Association.

Kvamme, Corrine L., MD (Emergency Medicine* ) 2615 Chester Ave., 93301-2014 661-395-3000 / FAX: 661-869-6971 U of N. Dakota 2008

Directory Updates CHANGES/CORRECTIONS • 2014 KCMS BOARD OF DIRECTORS – Add Alberto Acevedo, MD to Board of Directors (General Membership Tab) •COSNER, Lawrence – 760/499-3855 (pg. 36) •DEETHS, Tony – 7701 Calle Cerca Dr., 93309-7134 Ph: 834-6434 Cell: 889-2003 (Retired Section pg. 37) •KOTHARY, Hemmal – 9500 Stockdale Hwy., Ste. 200, 93311-3621 Ph: 327-1431 FAX: 321-3286 • McBRIDE, Albert – George Washington U, DC 1963 (pg.34) 2701 Chester Ave., 93301 716-1070 (pg.78) • M UKHOPADHYAY, Madan – 6020 De La Guerra Terrace, 93306-9754 Ph: 872-8717 (Retired Section pg. 38) • PEINADO, Albert - 9500 Stockdale Hwy., Ste. 200, 93311-3621 Ph: 3271431 FAX: 321-3286 • ZERLIN, Gary –

ADD/DELETE To “MEMBERSHIP BY SPECIALTY LISTING” • JUNG, Sung – Add to PEDIATRICS (pg. 43) • KVAMME, Corrine – Add to Emergency Medicine (pg. 41) • McBRIDE, Albert – Add to UROLOGY (pg. 44) • MOON, Cyrus – Add to SURGERY (pg. 44 – Delano) • M UKHOPADHYAY, Madan – Delete from HEMATOLOGY and ONCOLOGY (pg. 42/43)

DELETIONS (Remove from “Membership By Specialty List” & Remove * from their listing in “All KC Physicians Section”) • KASARJIAN, Julie • PHAN, Oliver • WITT, John (Deceased pg. 39)

March 2014 Membership Recap Active.........................................................253 Resident Active Members...................2 Active/65+/1-20hr..................................4 Active/Hship/1/2Hship.....................0 Government Employed........................4 Multiple Memberships.........................1 16 APRIL 2014 / VITAL SIGNS

Retired.........................................................61 Total.........................................................325 New Members (Pending Dues).........................................1 New Members (App Pending)........0 Total Members...............................326

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 Officers Jeffrey W. Csiszar, MD President Vacant President-Elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President Board of Directors Bradley Beard, MD James E. Dean, MD Thomas S. Enloe, Jr., MD Ying-Chien Lee, MD Uriel Limjoco, MD Michael MacLein, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

Tulare Take A Step Toward Better Health Ravi I. Kumar, MD, ABFM, FAAFP

Walk with a Doc, initiative was started by Dr. David Sabgir, a board-certified cardiologist practicing in Ohio at Mount Carmel St. Ann’s. The mission of Walk with a Doc is to encourage healthy physical activity in people of all ages, and reverse the consequences of a sedentary lifestyle in order to improve the health and well-being of the community and the nation. The program is dedicated to everyone in the community, more so towards your patients whom you can personally invite to join the walk, helping them change the course of heart disease, diabetes, obesity and their quality of life. According to the American Heart Association, walking has the lowest dropout rate of any physical activity. Walking for as little as 30 minutes a day can • Reduce the risk of coronary heart disease • Improve blood pressure and blood sugar levels • Maintain body weight and lower the risk of obesity • Enhance mental well-being • Improve blood lipid profile • Reduce the risk of osteoporosis THE RESULTS ARE IN • Reduce the risk of breast and colon cancer • 90.8% of participants feel they • Reduce the risk of Type 2 diabetes are more educated since starting Walking is low impact, easier on the joints than running, safe – Walk with a Doc. for people with orthopedic ailments, heart conditions, and those who • 75.2% of participants get significantly more exercise since are more than 20% overweight. In addition, research has shown that starting Walk with a Doc. one could gain two hours of life for each hour of regular exercise! That • 70.1% of participatns fell more quick stroll around the block seems a little more worthwhile now, empowered. doesn’t it? • 98.5% enjoy the refreshing concepet of pairing physicians Make walking a part of your patient’s fitness regimen. By asking with communities outside the your patients and other people to join the “Walk with a Doc”, they traditional setting. feel more encouraged to walk in the very presence of a doctor, have an opportunity for an open dialogue with their doctors outside the Additional benefits of the walk include: high level of camaraderie, clinic or doctor’s office environment. They meet new friends and have increased energy, safer communifun at the park while making great strides for a healthier lifestyle. ties, participants are happier, makes Healthcare providers at the same time gets a boost in their public them want to make a difference, and image in the society (what a noble way of helping and getting a free much more! publicity without paying hefty advertising costs). We encourage them to bring friends, loved ones or come alone, and enjoy a refreshing, rejuvenating walk in the park. Physicians, specialists and healthcare professionals, certified fitness trainers from the community join in and provide support and answer questions.

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: Officers Thomas Gray, MD President Monica Manga, MD President-Elect Virinder Bhardwaj, MD Secretary/Treasurer Steve Cantrell, MD Past President Board of Directors Anil K. Patel, MD Carlos Dominguez, MD Pradeep Kamboj, MD Christopher Rodarte, MD Antonio Sanchez, MD Raman Verma, MD CMA Delegates Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates Robert Allen, MD James Foxe, MD Mark Tetz, MD Sixth District CMA Trustee Ralph Kingsford, MD Staff Francine Hipskind Executive Director Thelma Yeary Executive Assistant Dana Ramos Administrative Assistant

Our Heartfelt Thanks We have been conducting this Walk very successfully for the last six months in Tulare with the help of dedicated team of Tulare Community Health Clinic and it’s very supportive CEO Ms. Graciela Soto-Perez and the board of directors, who regularly join the walk. Our strides wouldn’t be nearly as big as they are without the help of our sponsors. Thank you for your generosity and your belief in and enthusiasm for Walk with a Doc. Our tremendous thanks for support from Francine Hipskind of Tulare County Medical society, Sarah M. Barajas-Clements of Health net of California, “Food-Link” to provide us with generous supplies of fresh fruits, and Blue Cross of California. We walk every third Saturday of the month at Del Lago park in Tulare (behind Home Depot) and the turnout has been increasingly very impressive and encouraging. I urge my fellow physicians and healthcare providers in Tulare, Kings, Madera and Kern counties to take initiative and get involved in this healthy activity and make a difference in the health of the nation. To start a WWAD in your community email or call 614-714-0407. APRIL 2014 / VITAL SIGNS


Tulare New CMS 1500 Claim Forms to be Used April 1, 2014 The National Uniform Claim Committee (NUCC) revised the CMS 1500 Claim Forms. Essentially

this was done to differentiate and accommodate the upcoming use of ICD-10 codes that will be in effect on October 1, 2014. What you need to know: On April 1, 2014, Medicare will accept paper claims on only the revised CMS 1500 claim form 02/12. After April 1, 2014 Medicare will no longer accept claims on the old CMS 2500 claim form, 08-05. Medicare Learning Network Matters: MM8509, 1/6/14. For further instructions or questions, please contact Noridian MAC at 855-609-9960 from 6 a.m.-5 p.m., PT Monday-Friday. Please have your authentication information available prior to the call (e.g. NPI, PTAN, TIN, etc.)

Dr. Ravi Kumar hosts a Tulare

Physician’s Assistance Program Offered The issues that physicians and their spouses face today can be incredibly overwhelming. The

Foundation for Medical Care Board of Directors along with the Tulare County Medical Society Board recognize that often the burden of caring for others can be taxing to the point that assistance may be needed. To help support and assist fellow colleagues who actively practice primarily in Tulare or Kings Counties, as well as their spouses, there is a program in place to access professional counseling resources with the assurance of full confidentiality. This program allows up to six outpatient visits to professionals that are contracted specific to this program. The Foundation for Medical Care is billed for the services directly but the providers do not reveal to whom the services have been provided to. If you have questions regarding these benefits or would like to access the services, please feel free to call 559-627-2262 (you do not need to identify yourself), mention you would like information on the “Physician’s Assistance Program” and we can assist you.

Calling All Tulare County Medical Society Members! Visalia Unified High Schools need you!

Here’s your chance to volunteer for a great cause!

Once again the Tulare County Medical Society is assisting the high schools in the Visalia Unified School District to provide annual sports physicals for athletes. In the past many of you have graciously agreed to participate in the event and we would like to ask you to do so again. We have scheduled two days of physicals with two high schools each day. • May 13, 2014, 12pm-3pm; location: Golden West High School, Redwood High School • May 20, 2014, 12pm-3pm; location: Mt. Whitney High School, El Diamante High School For more information, or to volunteer for this meaninful project, please contact, Thelma yeary, TCMS, at 559-627-2262 or

MICRA Continued from page 6 The provisions in the initiative related to CURES “cannot be implemented” as written in the measure. If passed, the measure would potentially force physicians to choose between “denying treatment to their patients or violating” the law. Jim DeBoo, campaign manager for Patients, Providers and Healthcare Insurers to Protect Access & Contain Health Costs, the political committee organized to oppose any ballot measure designed to intensify the proliferation of the medical malpractice lawsuits and increase costs for both patients and taxpayers, said, “This report underscores what we already know – that the non-MICRA provisions of this measure 18 APRIL 2014 / VITAL SIGNS

were hastily written in focus groups without providing language to actually make it work. The drafting errors make it impossible to practically implement.” “In the meantime,” said DeBoo, “this measure would increase costs, reduce access and cause statewide chaos as physicians and pharmacists wrestle with figuring out how to provide needed medicines to patients without violating a new, poorly-drafted law.” For further information, contact Jason Kinney at 916-806-2719.

1 “The drug rules are in the initiative because they poll well, and the backers figure that’s the way to get the public to support the measure. ‘It’s the ultimate sweetener,’ says Jamie Court, the head of Consumer Watchdog. He says that when his group brought the proposal before focus groups, ‘the only thing that made them light up was drug testing of doctors’.” – Michael Hiltzik, Los Angeles Times, December 10, 2013

Join us at the next Walk With A Doc to take a step toward a healthier you! All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness. Dates: Saturday, April 12, 2014 and May 17, 2014 Beginning at 8:00AM Location: Del Lago Park, Tulare, CA Who can attend: ANYONE For more information, please contact Roberta Hurtado at (559) 685-4607


The RED-III program is focused on disseminating study findings as expeditiously as possible to inform current scientific debates in blood banking and transfusion medicine.

Continued from page 13 Value of REDS-III: The inclusion of recipient research in REDS-III distinguishes it from the first two REDS programs, where the principal focus was donor issues. The short-term phase 1 studies and longer-term studies planned for phase 2 examine a number of factors related to transfusion outcomes. “There have been some clinical trials in transfusion medicine, but there hasn’t been an ability to look more broadly at good and bad outcomes of transfusion,” Murphy said. “That’s the importance of REDS-III, adding this capability. Edward Snyder, MD, a REDS-III principal investigator at Yale New Haven Hospital, noted that the REDS-III program will allow the NHLBI to establish the importance of transfusions in clinical outcomes. “There is a tremendous need to understand the worth and value of blood transfusions,” Snyder said. “Many relatively small studies show conflicting outcomes in blood transfusion. REDS-III, by looking at thousands of patients over multiple sites over multiple years [and] mining the electronic database, allows us to establish exactly what the outcomes are.”

Healthcare Reform Continued from page 11 had filed an amicus brief in July 2013 in the case on behalf of a broad coalition of health care provider associations. The defendant health plans in this lawsuit

REFERENCES: 1. Kleinman S, King MR, Busch MP, et al. National Heart Lung Blood Institute Retrovirus Epidemiology Donor Study; Retrovirus Epidemiology Donor Study-II. The National Heart, Lung, and Blood Institute retrovirus epidemiology donor studies (Retrovirus Epidemiology Donor Study and Retrovirus Epidemiology Donor StudyII): twenty years of research to advance blood product safety and availability. Transfus Med Rev. 2012;26(4):281-304. 2. Kleinman S, Busch MP, Murphy EL, et al. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS- III). The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS- III): a research program striving to improve blood donor and transfusion recipient outcomes [published online ahead of print November 4, 2013]. Transfusion. doi: 10.1111/ trf.12468. 3. Triulzi D, Gottschall J, Murphy EL, et al. A descriptive analysis of plasma use in the REDS- III hospital network. Paper presented at: AABB Annual Meeting and CTTXPO;Denver; Oct. 11-15, 2013. 4. Kiss JE, Cable RG, Brambilla D, et al. Hemoglobin recovery after blood donation and the effects of iron supplementation: the Hemoglobin and Iron Recovery Study (HEIRS). Paper presented at: AABB Annual Meeting and CTTXPO; Denver; Oct. 11-15, 2013.

are Health Net of California, Inc., Blue Cross of California Anthem Blue Cross, PacifiCare of California, California Physicians’ Service Blue Shield of California, Cigna HealthCare of California, Inc., Aetna Health of California, Inc., and SCAN Health Plan. Contact: CMA’s legal information line, 800786-4262 or

Be sure to purchase the FMMS Pictorial Directory $20 FMMS Members $30 Non-FMMS member Directories can be purchased and picked up at the FMMS office at: 1040 E. Herndon Ave. Suite 101, Monday-Thursday 8am-4:30pm Friday by appointment only. Call 559-224-4224x118 or

­­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.

FRESNO ANNOUNCEMENTS Fresno Gastroenterology welcomes boardcertified physicians Dr. Paul Hanchett and Dr. Vivek Mittal. Referrals appreciated. Call 559323-8200 or Fax: referral to 559-323-9200. University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Call 559-3200580. FOR LEASE Office space at Chestnut/Herndon. Build to suit. 1,200 sf. Call 559-287-3279. PHYSICIAN WANTED Full or part time physician for Family Medicine office in Fresno. Good salary. Optional ownership in the future. Call Krystyna at 559-970-9191. Full or Part time physician wanted for local occupational medicine clinic to perform physicals on new hires. Call Su Rosenthal at 559-287-0172 or

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

MEDICAL OFFICES FOR LEASE 2323 16th St. – 1,194 rsf. 2323 16th St. – 1,712 rsf. 2323 16th St. – 2,568 rsf. 8327 Brimhall – 1,629 rsf. 8327 Brimhall – 2,288 rsf. Crown Pointe Phase II – 2,000-9,277 rsf. 3115 Latte Lane – 5,637 rsf. 3115 Latte Lane – 2,660-2,925 rsf. 1150-1160 Lerdo Hwy, Shafter 1,766 to 3,793 sf. 9300 Stockdale Hwy. – 3,743 sf. 9330 Stockdale Hwy. – 5,754 rsf. 9508 Stockdale Hwy. – 454 sf. (lab/draw station) 9900 Stockdale Hwy. – 2,085 sf. SUB-LEASE 4100 Truxtun Ave. – Adm. & Billing – 6,613 rsf. FOR SALE 2019 21st Street – 2,856 sf. 3015 Calloway – 1,465-10,318 sf. Crown Pointe Phase II – 2,000-9,277 rsf. APRIL 2014 / VITAL SIGNS


VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337

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

HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

NORCAL Mutual is owned and directed by its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. Visit, call 877-453-4486, or contact your broker.

A N o r c A l G r o u p c o m pA N y

April 2014