November 2014

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: Are Your Ready For The New Prescription Drug Prior Authorization Form?

CMA Responds To CMS 2015 Medicare Fee Schedule New Law Increases Oversight of Health Plan Provider Networks 34th Annual Central Valley Cardiology Symposium

Vital Signs

November 2014 • Vol. 36 No. 11

Success.

It’s what California’s finest physicians strive for... and what CAP can help you achieve.

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE! On October 15, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action Guide for Medical Practices has the answers you need to successfully make the transition.

Request your free electronic or hard copy today!

800-356-5672 CAPphysicians.com/icd10now

Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society November 2014 Vol. 36 – Number 11 Editor Alan Birnbaum, MD Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Board Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD Kern Representative John L. Digges, MD Tulare Representative Francine Hipskind 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.

Contents EDITORIAL.................................................................................................................................5 CMA NEWS................................................................................................................................6 NEWS

HEALTHCARE REFORM............................................................................................................9

CARDIOLOGY: 34th Annual Cardiology Symposium..................................................................10

CLASSIFIEDS..........................................................................................................................15 TULARE County Medical SocieTY.......................................................................................11

• Membership Events and Why Your Membership Counts

• Walk With A Doc

• Tulare County Upcoming Events

Kern County Medical Society...........................................................................................13

• Medical Missionary Journey: Part Four

• Save Date: K CMS Annual Award Membership Meeting: November 18 CMA Annual Session: December 5-7 KCMS Installation of Officers: January 16

Fresno-Madera Medical Society......................................................................................14

• Save the Date: FMMS Gala Installation: November 19

• Walk with a Doc

• In Memoriam: Kenneth R O’Brien, MD

• ICD-10 CM Coding Seminar

Advertising Contact: Display: Annette Paxton, 559-454-9331 apaxton@cvip.net Classified: Carol Rau Yrulegui 559-224-4224, ext. 118 csrau@fmms.org 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 559-2244224, ext. 118.

Cover Photograph: “ Moon Over San Francisco”

By Robert Bernstein, MD

Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee NOVEMBER 2014 / VITAL SIGNS

3

Member Benefit News: Open enrollment for the Fresno-Madera, Kern and Tulare County Medical Societies-sponsored dental plan has started!

You and your family are eligible to enroll in the FMMS/KCMS/TCMSsponsored dental plan only during open enrollment periods.

Apply by December 31, 2014! To be eligible for coverage, applications must be received during the special open enrollment period ending on December 31, 2014.

For more information... Call a Client Advisor at 800-842-3761 for more information.

Or visit www.CountyCMAMemberInsurance.com to download a brochure and application.

Sponsored by: Fresno-Madera Medical Society Kern County Medical Society Tulare County Medical Society

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709

777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance.service@mercer.com 65460 (11/14) www.CountyCMAMemberInsurance.com • Copyright 2014 Mercer LLC. All rights reserved.

4 NOVEMBER 2014 / VITAL SIGNS

EDITORIAL

“Gaudeamus igitur, iuvenes dum sumus” “Let us rejoice then, while we are young” Alan M. Birnbaum, MD Editor, Vital Signs

Perhaps not all of the words of the famous Latin student song that my late pediatrician mother, Nathalie M. Wolfe, MD, loved so much applies.

Many of us are not so young anymore, though hopefully our attitudes and our energy have remained young.

Gaudeamus regardless, let us rejoice, enjoy the season, the reasons and the pleasure of mutual company at each of our Medical Society’s annual Holiday and/or Installation Galas. The Fresno-Madera Medical Society’s Installation and Awards Gala, November 19, 2014, at Fort Washington Country Club; Tulare County Medical Society’s Holiday and Installation Dinner on December 3, 2014; and Kern County Medical Society’s Installation on January 16, 2015.

Person-to-person networking with old friends and especially, discovering and meeting new friends creates community and fosters professional unity and strength.

The last several decades have witnessed, unfortunately, much loss of physician No single physician can autonomy and the erosion of physician-directed health care, and with that, the economic meaningfully deal with such decline for many independent medical practices. At the same time, our patients have measures on his or her own. suffered relative to readily-available access to care. Wait times for care have become too No partnership or group long. Out of pocket expenses for our patients are interfering with personal health decisions.

We all know too well the buzz words, terms, jargon, phrases and practices that rip like a practice can do that either… chainsaw into the heart of a great profession. Appeal. Approved provider. Capitation.

It all starts with becoming CPT. Deductible. Denial. Downcoding. Exclusive provider. Fee schedule. and staying a MEMBER Formulary. Panel. Pre-authorization. Recoding. Resubmission. Utilization review. Observation. Tier. These words and phrases roll like the alphabetical litany of of our general and specialty sins at a Yom Kippur (Jewish Day of Atonement) service. societies and meeting and No single physician can meaningfully deal with such measures on his or her own. working with fellow members No partnership or group practice can do that either. Nothing less than local, state and at all levels… national medical societies, re-energized by fellowship and common purpose can impact and reverse the erosion of professional power and purpose. It all starts with becoming and staying a MEMBER of our general and specialty societies and meeting and working with fellow members at all levels, including leadership.

The process in parallel starts when one physician talks to another in a clinic/hospital hallway, an operating room, a doctors’ lounge or even on a golf course and discovers common concerns and purpose. It continues when committees meet and work effectively. It progresses further as medical communities unite to deal with issues and outright threats, such as this year’s vexatious Proposition 46… your NO vote ballot has already been mailed, right?

This need for unity and purpose, with promise for the future, lies behind enjoyable social gatherings like our Installation Galas. Meet your fellow physicians. Enjoy the evening at fine facilities. Start the conversations that matter and unify and energize the common purpose of our profession and our ability to promote our patients’ health.

The great sage and writer Hillel challenged his friends, and future generations. “If not me, who? If not now, when?”

Gaudeamus. The future awaits as we too rejoice at our annual galas.

Author may be reached at Siriusguy @aol.com.

NOVEMBER 2014 / VITAL SIGNS

5

CMA NEWS Are you ready for the new prescription drug prior authorization form required on October 1?

Over the next several months, a new law will take

effect that streamlines and standardizes the prior authorization process for prescription drugs.

The new law (SB 866) requires all insurers, health plans (and their contracting medical groups/ IPAs) and providers to use a standardized twopage form for prior authorizations of prescription medications.

The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt, and if they fail to do so the requests will be deemed authorized. The new law does not expand the list of medications that require a prior authorization.

The Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) will be enforcing the regulations on different timetables.

The regulation for DMHC regulated products, which includes all HMOs, their contracting medical groups/IPAs and most Blue Cross and Blue Shield PPOs, becomes effective January 1, 2015. However, the regulation for DOI regulated products, including all other PPOs and the Blue Cross and Blue Shield Life & Health products become effective on October 1, 2014.

In an effort to avoid confusion for practices, some plans/insurers are implementing the new form across most, if not all, of their product lines on October 1. There are exceptions, however, so practices are encouraged to review the payor notices and to call payors with any specific questions they may have.

Fresno-Madera Medical Society (FMMS) member and Chair of the FMMS Legislative Committee John Nelson, MD has spent the last three years involved with getting this authorization form developed. “It’s been a long process to get an uniformed authorization and law passed,“ said Dr. Nelson. “This new, two-page form will reduce the administrative burdens for all physician offices.”

New version of POLST form BEGAN October 1

Physicians across California are successfully using Physician Orders for Life-Sustaining Treatment (POLST) to improve patient care at the end of life. Effective October 1, 2014, a new version of POLST, printed on bright pink paper, makes this tool even more effective.

POLST can prevent unwanted or medically Please see CMA NEWS next page 6 NOVEMBER 2014 / VITAL SIGNS

CMA NEWS Continued from page 6 ineffective treatment, reduce patient and family suffering, and help ensure that patient wishes are followed across treatment settings.

The new version of the POLST form includes goal statements for each potential treatment option so patients can better understand their choices. The treatment options are also listed more consistently (from most aggressive to least aggressive), so patients can better understand what is involved in their choices.

The California Medical Association has recently updated its POLST Kit, which includes legal forms and wallet identification cards, and answers frequently asked questions about end-of-life issues. Physicians are encouraged to keep a supply of forms in their offices for use when having end-of-life discussions with patients. Updated POLST Kits that include the October 2014 POLST form can be purchased from CMA’s online resource library. Single copies are $5 for members ($6 for nonmembers). Significant discounts are available on bulk purchases. For bulk purchase inquiries, please call CMA Publications at 800-882-1262.

Other information relevant to the new POLST can be found, including translations of the form into more than 10 languages. The Coalition for Compassionate Care of California also offers POLST-related educational opportunities. Physicians can also contact their local POLST Coalition, or the Coalition for Compassionate Care of California with any questions about POLST or to arrange a POLST training for their colleagues.

CMA responds to CMS 2015 Medicare fee schedule proposals

The California Medical Association (CMA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) commenting on the proposed

rules that would impact many aspects of physician payment and federal regulatory programs for 2015.

The 39-page letter strongly opposes the agency’s plan to accelerate the implementation of the value-based modifier (VBM) payment methodology.

CMS has said it will expand the VBM to all physicians in 2017 and increase the potential penalty from 2 percent to 4 percent.

CMA also argued that because the agency is ignoring the law that requires CMS to adjust the payment rates for the socioeconomic characteristics of the patients the VBM could discourage physicians from accepting the sickest and poorest patients. The value modifier was enacted

by Congress as part of the Affordable Care Act (ACA). A CMA amendment to the law required CMS to risk-adjust the rates, adjust for California’s higher geographic practice costs and certain socioeconomic factors.

The VBM is supposed to pay physicians more if they spend less than the national average per patient and successfully report on quality measures.

It pays physicians less if they spend more than the national average and do not report on quality.

CMA also urged the agency to make revisions to the practice expense relative value units and improvements to the valuation and coding of the global service package. The letter also calls upon CMS to allow physicians to opt-out of Medicare indefinitely rather than every two years, to take CME reporting out of the Physician Payment Sunshine Act, and to scale back the Physician Compare Website until the accuracy of the information can be verified.

More than 2,000 comments were received on the 600-plus-page proposed rule. A final version is expected to be released by Nov. 1.

Contact: Elizabeth McNeil, 800-786-4262 or emcneil@cmanet.org.

NOVEMBER 2014 / VITAL SIGNS

7

Don’t miss the opportunity to attend the 2015 winter cme symposium in Whistler, BC, Canada

10

th

Pursuit of Excellence

Annual Winter CME Symposium

February 25-28, 2015 • Wednesday – Saturday

2015 Winter Symposium Scheduled Speakers Stay tuned for more speakers to come.

Neil Romanoff, MD

Director of Patient Safety Cedar Sinai

Delivering the Safest Care: “What Will Go Wrong Next?”

Ms. Barbara Spurrier

Co-Founder & Administrative Director Center for Innovation, Mayo Clinic Health Care Innovation Strategies: Innovations to Deliver Safer More Efficient Care: Mayo Clinic Experience

Blair Childs

Senior Vice President of Public Affairs for Premier, Inc., the primary spokesperson and communications strategist for Premier on key issues

David Holloway, MD CMO Salem Health

Physician Leadership Development: Improving Quality and Reducing Waste Management.

SGR Fix-Health Policy from his perspective

For more information/details please contact:

Laurie Smith, CMC Manager of Physician Education lsmith@communitymedical.org 559-459-1777 or 1775 Carin Stirrup, SHF Manager of Marketing & Medical Foundation Education cstirrup@santehealth.net 559-228-5441

Sponsored by

No tuition fees-plan to attend now 9 CME (Applied For)

LEARN MORE & REGISTER ONLINE

www.wintersymposium.com

HEALTHCARE REFORM New Law Increases Oversight of Health Plan Provider Networks

Gov. Jerry Brown (D) has signed a bill (SB 964) to increase oversight of insurers’ provider networks, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 10/2).

More than 170 complaints have been filed against Anthem Blue Cross over the insurer’s narrow provider networks, while 130 complaints have been filed against Blue Shield of California over the issue.

In addition, Consumer Watchdog has filed lawsuits against Anthem, Blue Shield and Cigna alleging that the insurers misled consumers who enrolled in their health plans about the size their provider networks (California Healthline, 9/29).

The bill, by Sen. Ed Hernandez (D-West Covina), will: • Direct the Department of Managed Health Care to develop standardized methodologies for health insurers to file required annual reports on timeliness compliance; • Require DMHC to review and post findings on those reports; and • Eliminate an exemption on Medi-Cal managed care plan audits and require DMHC to coordinate those plans’ surveys.

Plans sold through Covered California, the state’s insurance exchange, also will be reviewed annually to determine their compliance with such standards.

Health insurers offering plans through Covered California likely will continue to have narrow physician networks during the state health insurance exchange’s second open enrollment period, according to an analysis by the Los Angeles Times.

No complaints have been filed against Kaiser Permanente, likely because the insurer’s plans include all of its in-house physicians, according to the Times (Terhune et al., Los Angeles Times, 9/28).

Details of Narrow Provider Networks According to the analysis, 75 percent of licensed physicians in the state have contracted with 10 insurers through Covered California. Altogether, more than 80,000 health care providers will participate in exchange plans in 2015. However, the Times notes that many of those providers are only available to treat patients in one or two plans.

For next year, some networks have opted to offer more-narrow physician networks, according to the Times.

For example, HealthNet has proposed shutting down its preferred provider organization network and switching to a network with 54% fewer physicians and no coverage for out-of-network care. However, the slimmed-down plan will cost up to nine percent more than the PPO coverage, according to the Times. HealthNet said the change was necessary to keep rates affordable.

Meanwhile, Blue Shield of California has proposed a physician network for 2015 that will have up to four percent fewer providers in certain areas, and Anthem Blue Cross plans to maintain its current physician network, according to the Times.

Covered Calif. Still Lacks Comprehensive Doctor Directory In related news, Covered California still does not have a comprehensive directory of physicians that are included in each exchange health plan, the Times reports.

There is no estimate for when the provider director will be available, and the exchange is telling consumers to contact individual insurers for more information on plan networks, according to the Times (Los Angeles Times, 9/28).

New Law Enables Comparisons of Drug Coverage in Exchange Plans

Gov. Jerry Brown (D) signed a bill (SB 1052) that will allow consumers to better compare prescription drug coverage when selecting a health insurance plan, KPCC’s “Impatient” reports.

The new law, by state Sen. Norma Torres (D-Pomona), requires the California Department of Managed Health Care and the Department of Insurance to develop a uniform template for insurers to use when they share drug formularies. The agencies have until Jan. 1, 2017, to create the standardized template, at which point the formularies must be updated every month (Glickman, “Impatient,” KPCC, 9/26).

In addition, the law requires the Covered California board to: • Create a search tool on the site for consumers to compare health plans’ cost and coverage of particular drugs; and • Provide Web links on the exchange website to health plans’ drug formularies (Gorn, California Healthline, 8/18).

New Law Allows Undocumented Immigrants To Practice Health Care A new California law (SB 1159) allows undocumented immigrants to practice the occupation they have been trained for, including those trained as dentists, doctors and nurses, KPCC’s “Multi-American” reports (Huang, “Multi-American,” KPCC, 9/29).

According to an estimate by the Public Policy Institute of California, about 1.85 million individuals in the state workforce are undocumented immigrants.

To obtain a medical license in California, applicants previously had to provide a valid Social Security number. Under the new law, about 40 occupational licensing boards across the state would be able to accept a federal taxpayer identification number as proof of identification instead of a Social Security number (California Healthline, 5/12).

Response From Covered California Covered California Executive Director Peter Lee said the exchange is monitoring the exchange plans’ networks to ensure that policyholders have adequate access to care.

Lee said, “If it looks too thin, we say you have to add capacity. However, he added, “But how much do we put our thumb on the scale of saying more is better? More isn’t always better. The days of every doctor in every network are over.”

NOVEMBER 2014 / VITAL SIGNS

9

CARDIOLOGY

Cardiovascular Update 2014

34th Annual Central Valley Cardiology Symposium A Continuing Medical Education Course “Imagination does not become great until human beings, given the courage and the strength, use it to create.”

– Dr. Maria Montessori

Distinguished Colleagues and Friends,

On behalf of FMMS, I would like to take this opportunity to invite all of you to Cardiovascular Update 2014, our Medical Society’s 34th Annual Central Valley Cardiology Symposium. Since its commencement in Madera over three decades ago, the objective of Cardiovascular Update has been to create an inter-professional forum for physicians, nurses, students and other allied health professionals to come together to imagine, share and create solutions to advance the heart health of our Central Valley communities through education and dialogue on cutting edge developments in clinical and translational “Bench-to-Bedside” cardiovascular research, technology and innovation.

We are deeply honored to have an extraordinary panel of distinguished experts and physician leaders who are renowned for their scholarship and dedication to community engagement. Each of our 34th Annual Central Valley speakers have published Cardiology Symposium extensively on a wide range of issues in cardiovascular November 8, 2014 medicine and each of TorNino’s Banquet Hall, them has demonstrated a Fresno profound commitment to educating and training the 8:00am to 3:30 pm next generation of physician No charge: FMMS members, Retired leaders.

MDs, Medical students, Interns, Dr. John A. Ambrose Residents & Fellows is a Professor of Medicine at $75 Physicians UCSF and serves as the Chief $45 Allied Professionals of Cardiology at UCSF Fresno – he is an acclaimed physi- Information: 559-224-4224 x 118 or cian scholar and educator in csrau@fmms.org the field of coronary artery disease and has gained distinction for his seminal work in acute coronary syndromes. Dr. Ambrose specializes in cardiac consultation, cardiac catheterization and coronary angiography--including angioplasty, stenting and angioplasty utilizing the radial (wrist) approach.

His discussion will provide an overview of current studies on the proper evaluation of troponin functionality and testing techniques as they relate to the accurate diagnosis of myocardial infarction.

Dr. Paul D. Francis is a Clinical Professor of Pediatrics at UCSF, and serves as the Chief of Pediatrics at UCSF Fresno and as Chair of Pediatrics at Children’s Hospital Central California. Dr. Francis has won numerous teaching awards and is highly esteemed for his commitment to excellence in medical education. He specializes in general pediatric cardiology, pediatric electrocardiography and echocardiography, adult congenital heart disease

and cardiac intensive care. His lectures will focus on treatment options and management challenges for the spectrum of congenital heart diseases in the adult population and will also lay out approaches for addressing and treating congenital heart disease for pregnant women and women contemplating pregnancy.

Dr. Chandra K. Katikireddy serves as an Assistant Professor of Medicine at UCSF and is the Director of the Cardiac Imaging Section at UCSF Fresno. Dr. Katikireddy specializes in adult cardiovascular medicine and advanced cardiovascular imaging and is well respected for his scholarship and dedication in this field. His talk will outline the decision processes for CT angiography vs. MR angiography, including the benefits and limitations of each test, and will also elaborate on the proper protocols for ensuring an accurate reading of the tests.

Dr. Puja K. Mehta is Director of the Non-Invasive Vascular Function Research Laboratory and Co-Director of the Cardio-Oncology Program in the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute in Los Angeles. Dr. Mehta is a prominent preventive cardiologist with specialized training in women’s heart disease. Her clinical interests lie in the treatment of persistent chest pain and heart disease prevention through behavioral approaches such as exercise, nutrition and stress reduction. Dr. Mehta’s lectures will discuss controversies in hormonal therapy for perimenopausal women as it relates to heart disease and sexspecific diagnostic approaches in evaluating symptomatic women for obstructive CAD. Our reputable panel of physician leaders will engage with some of the most pressing and critical issues impacting the cardiovascular health and wellness of central San Joaquin Valley communities. Our Valley is afflicted with some of the highest rates of cardiovascular disease in California and all of us in the medical community must come together to imagine and create solutions to address this epidemic. I encourage all FMMS members and the greater Central Valley medical community to attend and engage Cardiovascular Update 2014, for what promises to be a highly informative and stimulating learning experience.

I would like to give special thanks to all of our guest faculty speakers, to the dedicated members of our symposium committee, and to the entire FMMS staff for all of your tremendous efforts in making this CME initiative possible.

Yours collegially, Dr. Ranjit S. Rajpal Program Director Please join us for Cardiovascular Update 2014 on Saturday, November 8, 2014 at TorNino’s Banquet Hall in Fresno, CA. Registration begins at 8:00 a.m.

Accreditation Statement: The Fresno-Madera Medical Society (FMMS) is accredited by the Institute for Medical Quality/ California Medical Association (IMQ /CMA) to provide continuing medical education for physicians.

Credit Designation Statement: The FMMS designates this live activity for a maximum of 6 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA certification in Continuing Medical Education.

10 NOVEMBER 2014 / VITAL SIGNS

Tulare

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

Boone Team trying their hand at the electronic games.

Dr. Kamboj always ready with fatherly advice!

Dr. Bosman getting ready to scale the wall!

Membership Events and Why Your Membership Counts!

Francine Hipskind Executive Director

The Tulare County Medical Society Family Day proved to be a success

with over 100 attendees gathering at the McDermont Field House in Lindsay. Whether it was challenging the arcade games, scaling the rock wall, braving the Wave Rider or shooting hoops on the courts, there was an activity for everyone to enjoy. It was great to see physicians talking, laughing and relaxing with one another while the kids ran around the huge warehouse-like arena.

The October General TCMS Member Meeting welcomed Dr. Luther Cobb, incoming California Medical Association President for 2015.

He hailed all the way from Eureka, California despite the travel woes staff ready to enter the laser tag encountered along his way. His talk focused on the reason why Proposition TCMS combat zone.

46 has to be defeated, the basic structure of the Medicare Sustainable Growth Rate Formula (SGR) and why lobbying needs to continue to our Federal legislators to do away with the existing flawed formula for good. Now is the time to develop a fair and equitable way to reimburse physicians for care rendered to Medicare patients. He also analogized a story from when he was a child how his father showed him how easily it was to break a single tree branch. But when several branches are joined together, a break is almost impossible.

The analogy is true of your medical society membership. While you may feel your own membership may not make a difference, the collective strength of membership allows for loud voices to carry in the legislative halls in Sacramento and Washington on your behalf.

In a recent Wall Street Journal article (Why Doctors Are Sick of Their Profession; August 29, 2014) Dr. Jauhar, the author of the article opines “When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I’d be: impatient, occasionally indifferent, at times dismissive or paternalistic. Many Please see Membership on page 12

Our esteemed Dr. Gray, TCMS President, guiding the show.

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 Membership Dana Ramos Administrative Assistant

The Wu’s and Mrs. Pantera enjoying the company.

NOVEMBER 2014 / VITAL SIGNS

11

Tulare Kings Tulare County Medical Society presents

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.

TULARE: Del Lago Park Saturday, November 22, 2014 8:00am to 9:00am VISALIA: Riverway Sports Park Saturday, November 8, 2014 8:00am to 9:00am Anyone can attend!

For more information, please contact Tulare County Medical Society at (559) 627-2262

Tulare County Medical Society Upcoming Events Transform Your Front Desk Thursday, November 13, 2014 • 1:00 to 4:00 p.m.

Focus of training to be for front office staff on the following: • Communication skills • Importance of collecting Co-pays • HIPAA compliance & confidentiality • Short-notice appointments

Chart Auditing for Physician Services This class is a five-day class.

November 13, 2014 • 9:00 a.m. to 12:00 p.m

Certified Medical Coder Course and Exam This class is a five-day class.

November 14, 21, Dec. 5, 12, & 15, 2014 • 8:30 a.m. to 4:30 p.m. (one hour lunch break)

HOLIDAY & INSTALLATION DINNER Wednesday, December 3, 2014 Watch your mail for notices If you have any questions, please feel free to call the Tulare County Medical Society office at 559-734-0393 and ask to speak to Dana Ramos. You may also email her at DRamos@tkfmc.org .

National Health and Wellness Observances in November American Diabetes Month • www.diabetes.org National Hospice Month • www.nhpco.org Alzheimer’s Disease Awareness Month •www.alz.org National Healthy Skin Month •www.aadermatology.com Epilepsy Awareness Month • www.epilepsy.com

Membership Continued from page 11 of my colleagues are similarly struggling with the loss of their professional ideals.” I can see and empathize how many of you would feel the same with the fight of Proposition AT Still Medical students getting to know Dr. Luther Cobb, CMA Incoming President 46, ICD-10 looming and, Medicare PQRS cuts in reimbursement on January 1, 2015, being among the many issues you are facing. It is more important than ever to continue on with your membership and encourage your colleagues who are not members to join because they are reaping benefits on your dime. The organization of medicine is constantly dodging attack as many entities or individuals envy your profession and societal stature. As evidenced in Proposition 46, they go to great lengths to do it permanent harm.

Dr. Jauhar, in the same article, sums up nicely what I think society knows and believes about most physicians.

“What’s most important to me as a doctor, I’ve learned, are the human moments. Medicine is about taking care of people in their most vulnerable states and making yourself somewhat vulnerable in the process. Those human moments are what others – the lawyers, the bankers – envy about our profession, and no company, no agency, no entity can take those away. Ultimately, this is the best hope for our professional salvation.”

If you have questions or comments, feel free to contact me: Fran@tkfmc.org.

12 NOVEMBER 2014 / VITAL SIGNS

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

Kern Guest Editorial

Medical Missionary Journey Thomas R. Larwood, MD with Portia Choi, MD PART IV – FINAL

Back to my story. We were blessed with our third son, Dean, who was born on February 1, 1955 at Severance Hospital.

The Methodist Mission Board wanted me to help start a western medical facility in Wonju, a city east of Seoul, a task to which I had been assigned. We made one visit to Wonju which included fording the Han River way up near Wonju where it was narrow enough to allow this. The trip took a long time (I’m told it is now one hour by freeway!). It was a getacquainted visit with long-time resident Methodist missionaries Carl and Margaret Judy, who would soon become our associates and mentors. Margaret was born in Korea to American missionary parents, and was naturally bilingual.

Along the way I went to medical clinics in rural areas of South Korea. There was a trip with Dr. Weiss to Daejon, where we stayed at the home of Charlie and Arlene Stokes. While there I had my first bath where one washes off, then climbs into hot water up to the neck. I was totally relaxed and at one with the world!

We were continuing our life learning the Korean language and preparing to go to Wonju when suddenly, our eldest son, David, lost the use of his right leg and was diagnosed with poliomyelitis in August 1955. Ten days later, I became very weak and by the end of the day could hardly move and hurt all over. By the next day I could not move anything but my right arm, barely. Arrangements were made and I was taken by ambulance to the U.S. Eighth Army Hospital at Inchon. I barely avoided the iron lung but did need a chest respirator to help me breathe. Slowly improving, I took my first airplane ride from Seoul to Tokyo, where I remained in the U.S. Army hospital for two or three weeks, until they thought it was safe for me to take the next lap of the trip. On the first Sunday it was deemed that I was fit, I was wheeled to church service on a gurney. When I tried to sing a hymn I was shocked to find that no voice came out! It took a while longer for me to sing. When it was safe for me to fly, it was off to Hawaii, again with the chest respirator. The family had already flown home to the U.S. There I continued to make very slow progress. One day, strapped onto a tilt table, my head was slowly elevated.

What a thrill--to look the world straight in the eye after being flat on one’s back for weeks! Being able to throw a bean bag an inch or two, then a few more, then a whole foot, then a ball. (The things we take for granted!) The last lap was to Travis Air Force Base in California and hence to Fresno General Hospital. (The Board of Missions paid my expenses).

There, it was gradually on to a wheelchair, then crutches.

Beginning my Internal Medicine residency, I became able to walk without cane or crutches on flat surfaces, and continued so for 35 years. Early in my 33 years of active medical practice, I was the Director of Internal Medicine at Kern General Hospital for three years. Later, I worked part-time for some thirteen years.

As I have become older, my weak muscles have become weaker (and whose haven’t?) but I still go to the gym.

Others at the gym marvel that I still go. I am just exercising.

Ever since, I have reflected “Who IS a missionary?” My contention is that everyone is a missionary for whatever they profess to believe, by what they do and how they do it. But this is a story, not a sermon!

Editorial Note: The establishment of a Christian hospital in Wonju was somewhat delayed due to the Larwood family’s illnesses. In November 1959, the Wonju Christian Union Hospital was founded by the Board of World Mission of The United Church of Canada, the America Methodist World Mission Board, and the Presbyterian Church in the Republic of Korea and the Korean Methodist Church under the doctrine of ‘Christian Mission through Medical Service.’ The hospital had a cooperative agreement with Severance Hospital, Seoul, Korea until March 1976, when Wonju hospital merged with Yonsei University. It is now called Yonsei University, Wonju Severance Christian Hospital. The hospital has grown remarkably to become the biggest university hospital in central Korea. When founded, it had 50 beds. Currently, it has 850 beds and 29 clinical departments.

Dr. Portia Choi was born in Wonju, South Korea in 1948. At the end of the Korean War in 1953 and until 1955, she lived in Daejon. She was probably in Daejon at the time that Dr. Larwood was visiting Charles and Arlene Stokes in Daejon. The Stokes helped Dr. Choi’s family tremendously during and right after the war.

Authors can be reached at trlarwood@bak.rr.com or ssportia@aol.com.

2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org 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 Vipul Dev, MD John Digges, MD Lawrence N. Cosner, Jr., MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

SAVE THESE DATES • Tuesday, November 18, 2014: KCMS Annual Awards Membership Meeting, Padre Hotel • Friday, December 5-7, 2014: CMA Annual Session, San Diego Marriott Marquis & Marina • Friday, January 16, 2015: KCMS Installation of Officers, The Bell Tower

NOVEMBER 2014 / VITAL SIGNS

13

Fresno-Madera You are cordially invited to attend the

Post Office Box 28337 Fresno, CA 93729-8337 1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: www.fmms.org 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, MD Trilok Puniani, MD Khalid Rauf, MD George Saul, 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

Fresno-Madera Medical Society 2014 Installation and Awards Gala for an evening of fun and entertainment as we honor

Edward Mosely, MD

2014 Physician Community Service Lifetime Achievement Award, Posthumously

Charles Touton, MD

2014 Physician Community Service Special Project Award

Paul Madsen, MD

2014 Physician Community Service Lifetime Achievment Award

A.M. Aminian, MD 2015 FMMS President

Wednesday, November 19, 2014 6:00pm Social • 6:45pm Dinner • 7:45pm Program Fort Washington Country Club 10271 N. Millbrook Avenue, Fresno Cost: $49 per person; $95 per couple; $375 for a table of 8 RSVP (559) 224-4224, ext 112 or dchaparro@fmms.org Our sincere appreciation to our Event Sponsor

NORCAL

Fresno-Madera Medical Society Physicians: Looking for ways to: • Add more physical activity to your lifestyle?

• Be a role model and inspiration to your patients and your community?

• Spend more time with your family and friends?

Consider volunteering ONE HOUR every month or two in the Fresno-Madera Medical Society’s: WALK WITH A DOC Program This walking program is risk free and requires no preparation. Physicians just need to: SPEND A SATURDAY MORNING: • Presenting a 2-3-minute talk on the health benefits of walking from the perspective of your specialty • Leading a 45-50 minute walk around Woodward Park in Fresno or Town & County Park in Madera • Answering potential questions from the walkers Encourage patients to take steps to improve their health

FRESNO: NOVEMBER 15 Woodward Regional Park Sunset View Shelter Registration 8:45am Walk Event 9am-10am

MADERA: NOVEMBER 1 Town & Country Park Pavilion Area Registration 8:15am Walk Event 8:30am-9:30am

Ready to Volunteer? Call the FMMS office: 559-224-4224x110 or send email to receptionist@fmms.org

14 NOVEMBER 2014 / VITAL SIGNS

Find us on Facebook: Fresno-Madera Medical Society

www.facebook.com/ pages/Fresno-Madera-Medical Society/107731015917068

Fresno-Madera

CLASSIFIEDS

Kenneth R. O’Brien, MD 49-year member

Kenneth O’Brien,, MD, a retired general practitioner, passed away on October 11, 2014, ten days shy of his 95th birthday.

Dr. O’Brien was born in Fresno in 1919. He received his osteopathic medical degree in 1943 and completed his internship and residency training from LA County Hospital in 1945.

He began his private practice in Fresno in 1945 and retired in 2002.

Dr. O’Brien was a founder and board member of Sequoia and Sierra hospitals and board member of Community Medical Centers. He is survived by his three children, four grandchildren and two greatgrandchildren.

­­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 Dr. Paul James Nugent earned in May 2014 his Masters in Public Health at UC Berkeley & will use this knowledge to deliver innovative care to spine & orthopedic patients, focusing on elaborating “up stream” negative social determinants effecting physicians’ health.

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 RENT / SALE .

Class ‘A’ Medical Space • Visalia • 8,190 sf, all/part, available for lease/purchase. Across the street from Kaweah Delta Hospital. Call 559804-7419 or 804-7421. See ad on page 4 for pictures/details.

PHYSICIAN WANTED .

Spruce Multispecialty Group of Fresno, committed to the private practice of medicine, is recruiting a BE/BC IM, Rheumatology or Pulmonary specialist. Contact Rathin at 559-289-9518 or tharathin@gmail.com.

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

MEDICAL OFFICES FOR LEASE 1902 B Street – 2,030sf.

8327 Brimhall – 1,629 rsf.

8327 Brimhall – 2,288 rsf.

223 China Grade Loop – 8,497 sf.

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. – 16,618 sf.

9330 Stockdale Hwy. – 5,754 rsf.

9900 Stockdale Hwy. – 2,085 sf.

2019 21st Street – 2,856 sf.

SUB-LEASE 4100 Truxtun Ave. – Adm. & Billing – 6,613 rsf.

FOR SALE 3015 Calloway – 1,465-10,318 sf.

4939 Calloway #103 – 1,827 sf.

223 China Grade Loop – 8,497 sf.

Crown Pointe Phase II – 2,000-9,277 rsf.

NOVEMBER 2014 / VITAL SIGNS

15

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.

Proud to be endorsed by the Fresno-Madera, Kern, Kings and Tulare County Medical Societies

Our mission begins and ends with you, the policyholder.

That means connecting our members to the highest quality products and services at the lowest responsible cost. Join us as we enter a new phase of our journey and advance with our vibrant new look and expanding offerings.

hello.norcalmutual.com

N O RC AL M utuAL I N s u R AN Ce CO M pAN y