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MEMBERSHIP Together we can move mountains






PHYSICIANS DESERVE Offering top-tier educational resources essential to reducing risk, providing versatile coverage solutions to safeguard your practice and serving as a staunch advocate on behalf of the medical community.

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First Republic Bank (855) 886-4824

CELL PHONE SERVICE Sprint (866) 639-8354 healthcarediscounts


JLL Healthcare Practice Group (858) 410-6377


Tracy Zweig & Associates (800) 919-9141

Vista Community Clinic (760) 631-5000

Please contact these vendors for your business needs.


Additional information can be found at the

Practice Management Resources page at


The Doctors Company (800) 852-8872 Cooperative of American Physicians, Inc. (800) 356-5672 Norcal Mutual Insurance Company (844) 4NORCAL


Medical Billing Strategies (619) 260-0999 Valley Medical Billing Services (800) 807-9843


Whole Bodied Consulting (619) 733-5344

PRACTICE MANAGEMENT Absolute Solutions (858) 256-0351


Soundoff Computing (858) 569-0300



VOLUME 104, NUMBER 9 EDITOR: James Santiago Grisolía, MD EDITORIAL BOARD: James Santiago Grisolía, MD • Mihir Parikh, MD • Robert E. Peters, MD, PhD • J. Steven Poceta, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: Mark W. Sornson, MD, PhD President-elect: David E.J. Bazzo, MD Secretary: James H. Schultz Jr., MD Treasurer: Holly B. Yang, MD Immediate Past President: Mihir Y. Parikh, MD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Sergio R. Flores, MD (Board Representative to Executive Committee) Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Geva E. Mannor, MD, MPH La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Michael A. Lobatz, MD South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Susan Kaweski, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County #1: Neelima V. Chu, MD South Bay: Paul Manos, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Karrar H. Ali, DO, MPH; #3: Alexexandra E. Page, MD; #4: Nicholas J. Yphantides, MD; #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Erin L. Whitaker, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD ADDITIONAL VOTING DIRECTORS Communications Chair: J. Steven Poceta, MD Young Physician Director: Edwin S. Chen, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Meghana Pagadala



13 Membership: Making your Voice Count

departments 4

Objective Review of Potential Risks in a Medical Practice Can Be Beneficial BY TED ABERNATHY, MD

Briefly Noted: Calendar • New and Returning Members • Volunteer Opportunities • And More…



How to Teach Caring

How Medicare Helps People with Diabetes BY GREG DILL




ADDITIONAL NON-VOTING MEMBERS Alternate Young Physician Director: Heidi M. Meyer, MD Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD\ San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President-elect: Theodore M. Mazer, MD CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MP AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Lisa Miller, MD At-large AMA Delegate: Albert Ray, MD (appointed by CMA) At-large AMA Delegate: Robert E. Hertzka, MD (appointed by CMA) At-large AMA Alternate Delegate: Theodore M. Mazer, MD (appointed by CMA)

Physician Marketplace Classifieds


Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to All advertising inquiries can be sent to San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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JLL Healthcare JLL Healthcare Practice Practice Group Group Paul Braun Paul Braun ChrisChris Ross Ross Kelly Kelly Moriarty Moriarty 8910 8910 University University Center Center Lane Lane Suite Suite 100 100 Managing Managing Director Director Senior Senior Vice President Vice President Associate Associate JLL Healthcare Practice Group Paul Braun Chris Ross Kelly Moriarty San Diego, San Diego, CA 92122 CA 92122 858.410.6388 858.410.6388 858.410.6377 Senior Vice 858.410.6359 858.410.6359 Associate 8910 University Center Lane Suite 100 Managing858.410.6377 Director President San Diego, CA 92122 858.410.6388 858.410.6377 858.410.6359 Lic. #: Lic. 00891709 #: 00891709 Lic. #: Lic. 01469025 #: 01469025 Lic. #: Lic. 01963162 #: 01963162kelly.moriarty@a Lic. #: 00891709

Lic. #: 01469025 Lic. #: 301963162 SAN DIEGO PHYSICIAN.ORG

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Physicians: Help Us Help Improve The Health Literacy Of Our San Diego County Communities by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email

For further information or to register for the following events, contact Jen at (858) 300-2781 or at San Diego MGMA Meeting SEP 13, SDCMS Meeting Room Champions for Health and SDCMS Warmly Invite You to The Future of Medicine: A Conference for Physicians SEP 29, 7:30am–4pm Kona Kai Resort & Spa UCI MIND and Alzheimer’s Orange County Chapter for their highly acclaimed 27th Annual Southern California Alzheimer’s Disease Research Conference SEP 30, Irvine Marriott Hotel; events/2016-researchconference/ DIGIMED17 Transforming Healthcare Through Evidence-Driven Digital Medicine OCT 6-7, La Jolla; event/digimed17/ San Diego MGMA Meeting OCT 11, SDCMS Meeting Room The 2017 San Diego Day of Trauma Stop the Bleeding — The Goal: Zero Preventable Trauma Deaths from Hemorrhage NOV 3 San Diego MGMA Meeting NOV 8, SDCMS Meeting Room; event_schedules/2263dayoftrauma




Welcome New and Returning SDCMS-CMA Members! OUR NEW MEMBERS Anthony Porter, MD Orthopaedic Sports Medicine San Diego (619) 229-3939 John Qian, MD Physical Medicine and Rehabilitation San Diego (858) 571-3630

Champions for Health Project Access: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for Medi-Cal receive short term specialty care. Commitment can vary by practice. The mission of the Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or at, or visit Humanitarian Teams Need Medical Volunteers for Haiti: We are looking for physicians and mid-level providers for one-week, primary-care medical clinics in rural Haiti in February, June, and October 2017. This is a rewarding opportunity to work with the people of Haiti and provide care in a very austere environment in a medically underserved area. Seattle-King County Disaster Team (a U.S.-based nonprofit) has been operating these clinics since 1998. We coordinate all incountry travel and logistics. Please contact Bob Downey at (619) 905-7157 or at if you are interested in applying. Visit for further information.


It’s when children are 15, 16, or 17 that they decide whether they want to be a doctor, an engineer, a politician, or go to Mars or the moon. That is the time they start having a dream, and that’s the time you can work on them. You can help them shape their dreams. — A. P. J. Abdul Kalam

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New Mobile Application Provides Dementia Care Resources in the Palm of Physicians’ Hands The AlzDxRx mobile application is now available without charge to all San Diego County physicians. The app, available for both iOS and Android, walks physicians through cognitive decline screening and evaluation, and provides guides for disease management and treatment planning. The application includes well-recognized scoring instruments — MiniCog, AD8, PHQ-9, QDRS, IQCODE, MOCA, and SLUMS — and results in one place, and the ability for patient identified scores to be emailed from the app to the physician’s email for easy addition to the EHR. Utilizing the mobile app helps physicians keep their eyes on the patient rather than the EMR screen. With the rising number of adults over age 65 living longer than ever before, it

comes as no surprise that cognitive decline is an increasing healthcare concern. Recent data has shown that more than 60,000 San Diegans live with dementia and may seek care from fewer than 900 specialists — geriatricians, neurologists, and psychiatrists. With this gap in the specialist-to-patient ratio, primary care physicians will be responsible for screening and care for this growing population. Led by neurologist Michael Lobatz, MD, and County of San Diego Chief Medical Officer Nick Yphantides, MD (both SDCMS/CMA members), The Alzheimer’s Project Clinical Roundtable has developed guidelines using evidence-based tools for the screening, evaluation, diagnosis, and treatment of behavioral issues. To further guide primary care physicians, Champions for Health, which has been facilitating the Clinical Roundtable, has developed the mobile application to incorporate the guidelines and tools generated/supported by the Clinical Roundtable. The mobile application is best used in conjunction with The Alzheimer’s Project: Diagnosing and Treating Patients with Alzheimer’s and Dementia on-demand courses (found here, but can be used as a standalone tool. The app is available and ready for use free of charge in the Apple Store ( alzdxrx/id1264997317?mt=8) and the Google Play Store ( com/store/apps/details?id=com. championsforhealth&hl=en), just search AlzDxRx. The app was recently reviewed by MedApps (https://www.imedicalapps. com/2017/08/alzdxrx-alzheimers-appreview/) and received a 4.5 star rating! For more information, visit or contact Barbara Mandel at Barbara.Mandel@ or (858) 300-2780.

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Sacramento Internship:

Photos of our medical students interning in Sacramento.


San Diego Hepatitis A Outbreak, 2017 SINCE EARLY 2017, the Public Health Services Division, in the County of San Diego Health and Human Services Agency, has been investigating a local Hepatitis A outbreak. The majority of people who have contracted hepatitis A are homeless and/or illicit drug users, although some cases have been neither. The outbreak is being spread person-toperson and through contact with a fecally contaminated environment. No common sources of food, beverage or drugs have been identified that have contributed to this outbreak, though investigation is



ongoing. The Centers for Disease Control and Prevention (CDC) notes that personto-person transmission through close contact is the primary way people get hepatitis A in the United States. Vaccination efforts are being implemented in targeted locations by County staff and in collaboration with health care partners. Health providers are asked to inform the Epidemiology Program if they have a patient suspected to have the hepatitis A infection, before the patient leaves the emergency department or provider’s office (see contact number below).

On September 1, 2017, the San Diego County Public Health Officer declared a local public health emergency due to the ongoing hepatitis A virus outbreak in the county. The County Board of Supervisors ratified this declaration on September 6, 2017 and again on September 12, 2017. The declaration shall be ratified every two weeks by the County Board of Supervisors until the declaration is rescinded. For information and resources, please contact the San Diego Health and Human Services Agency.


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AT A RECENT MEETING of my staff, the topic of diabetes came up. When we went around the table, it turned out that 25 percent of them have problems with blood sugar. That figure exactly matches the percentage of Americans 65 years old and older who have diabetes or a condition called pre-diabetes. I’m shocked that such a large number of Americans are affected by this disease, because it’s a nasty one. If left uncontrolled, diabetes can lead to some really bad outcomes, including kidney problems, glau-

coma and other eye disorders, foot ulcers, amputation of feet or legs, stroke, diabetic coma, and even death. The good news is that people with diabetes can avoid many of these negative outcomes if their disease is diagnosed, treated, and controlled. At Medicare, we’re committed to preventing diabetes as much as possible and treating those who are diagnosed with it. If your doctor thinks you’re at risk for diabetes, Medicare covers screening tests for it. And if you develop the disease, Medicare

You can do many things to control your diabetes. Talk with your doctor about what, how much, and when to eat. Also talk with him or her about how much you should weigh, and the different ways you can reach your weight goal.

covers a wide variety of medications, home testing equipment, supplies and self-management training to help you cope with it. Screening tests are used to detect diabetes early. Conditions that may put you at risk for diabetes include: • High blood pressure • Obesity (with certain conditions) • Impaired glucose (blood sugar) tolerance • High fasting glucose • A history of abnormal cholesterol and triglyceride levels (Dyslipidemia)

Medicare will pay for two diabetes screening tests in a 12-month period. After the initial screening, your doctor will determine when to do the second test. You and your doctor can discuss diabetes and any other health concerns you have during a “Welcome to Medicare” visit. Medicare covers this one-time review of your health, including counseling on any screenings, shots, or other care you may need. (You must have this visit within the first 12 months you’re enrolled in Medicare Part B.) In addition, Medicare covers an annual wellness visit with your doctor, during which you can develop or update a personalized prevention plan based on your current health and risk factors. If you do develop diabetes, Medicare pays for self-management training to help you learn how to successfully manage the disease. Your doctor must prescribe this training for Medicare to cover it. The training covers topics including the risks of poor blood-sugar control; nutrition and how to manage your diet; options to improve blood-sugar control; exercise and why it’s important to your health; and how to take your medications properly. Medicare also covers medical nutrition therapy services to help you learn which foods to eat and how to follow an individualized diabetic meal plan. Generally, Medicare Part B (medical insurance) covers services and supplies needed by people who have or are at risk for diabetes. Medicare Part D (the prescription drug program) helps pay for supplies for injecting or inhaling insulin. These items are covered under Part B: • Home blood-sugar monitors and related supplies, such as test strips, lancet devices, and lancets; • Foot exams and treatment (needed by people with diabetic peripheral neuropathy and loss of protective sensation);

• Glaucoma tests; • External insulin pumps and insulin the devices use; • Therapeutic shoes or inserts. Items covered under Part D include drugs for maintaining blood sugar and insulin that isn’t administered with a pump. You can do many things to control your diabetes. Talk with your doctor about what, how much, and when to eat. Also talk with him or her about how much you should weigh, and the different ways you can reach your weight goal. Take your medications as directed, and discuss any problems you encounter with your physician. Be active for a total of 30 minutes most days. Keep tabs on your blood-sugar level, blood pressure, and cholesterol. If you smoke, stop. Medicare covers counseling on how to quit smoking, if your doctor orders it. If you have a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, your plan must give you at least the same benefits as Original Medicare, but it may have different rules. Your costs, rights, and choices for where you get your care might be different if you’re in one of these plans. You may also get extra benefits. Read your plan materials or call your benefits administrator for more information. For more information on Original Medicare and diabetes, read the brochure “Medicare’s Coverage of Diabetes Supplies & Services” at https://www.medicare. gov/Pubs/pdf/11022-Medicare-DiabetesCoverage.pdf. Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1800-633-4227). SAN DIEGO PHYSICIAN.ORG




Contributed by The Doctors Company (



As healthcare becomes increasingly complex, doctors work hard to ensure the best possible outcomes for their patients using the most proven procedures and standards available. Many healthcare organizations find value in engaging outside experts who can view their practice from a new perspective and identify risks doctors and staff might have overlooked.

Research on the frequency and severity of malpractice claims from The Doctors Company, the largest physician-owned medical malpractice insurer, underscores the importance of a thorough, objective practice review. While the number of claims against physicians has been dropping since 2003, the fact that seven out of every 100 physicians in the U.S. face a claim each year is still unacceptably high. And while we may not be facing as many claims as in the past, the average cost of a claim — defined as a request by a patient for payment — has grown from $69,000 in 2003 to $100,000 today, according to The Doctors Company. Without an independent evaluation, practices face deficiencies in communication, documentation, and tracking that can increase exposure to risk. Errors may be blamed on poor performance rather than viewed as opportunities to make improvements. As managing partner of Pediatric & Adolescent Health Partners headquartered in Midlothian, Va., I read about various risk assessment services and felt we could benefit from taking a closer look at our practice to identify risk factors and gaps in patient safety protocols. While I was confident we were minimizing risks appropriately and adequately, I was less confident in our ability to prove it. Our practice was expanding and I wanted to ensure we had consistent operational systems in place

across locations to foster patient safety. An assessment service offered by The Doctors Company provided our practice with a comprehensive checkup of key areas and a customized action plan. A patient safety/risk manager spent more than half a day at our practice reviewing medical records and procedures for test tracking, appointment setting, telephone communication, informed consent, and other areas. She reviewed records and diagnoses from each of our providers, and interviewed the entire staff and physicians. The management team encouraged the staff to be open and honest during the interviews, and explained that the information collected was designed to improve patient safety and reduce risks, not punish current practices. The findings were presented to clinicians and office administrators, and communicated to the entire 51-member staff in a collaborative, supportive manner. The patient safety/risk manager was thoughtful, caring, and thorough, and put the staff at ease that the program was not intended to find fault, increase premiums, or reduce insurance coverage. Our management team prioritized the recommended actions and implemented several enhancements — many related to improving communication and making better use of our electronic health record (EHR) system’s capabilities. Our customized action plan included:

• Setting up a system that allows staff to capture information digitally and send a summary of phone conversations with pediatric patients’ families within seconds via e-mail or text. This ensures the correct information is communicated to the caller without ambiguity, and becomes part of the patient’s EHR. • Instituting periodic chart reviews to ensure diagnosis codes are supported and medical records accurately describe the patient’s symptoms and history. • Starting a peer review committee as a means of ensuring continuous performance improvement. • Using a digital system to better track patient referrals to specialists and whether patients were following through with appointments. • Digitally tracking whether reports from ordered labs and other tests are getting back to the office. Changing from a handwritten system to a computerized one increases accuracy and assists with follow-ups, which strengthens patient safety. • Monitoring medications more accurately through a medication reconciliation process that documents at every appointment whether patients are continuing their prescribed regimen or have stopped or altered it. The responses are included in the patient’s EHR. These changes have better equipped our practice to minimize risks and have enabled us to prove that the practice is grounded in patient safety. Based on management’s discussions with the staff, employees have more confidence that protocols and standards are working as intended, and feel more empowered to highlight opportunities for improvement and work together to achieve goals. By doing so, we can anticipate issues before they become problems, and can focus on what matters most—providing the best care to our patients. Dr. Abernathy is managing partner at Pediatric & Adolescent Health Partners. SAN DIEGO PHYSICIAN.ORG




Physicians: You are a Health Role Model Model healthy living to patients and staff by inviting them to JOIN YOU at Champions for Health’s Solana Beach Sunset 5K Run/Walk on October 7!

Lead a team of 20 or more patients and staff and receive FREE team t-shirts with your practice/team identification.

Visit to sign up. For more information email

Benefiting the Diabetes Prevention Program at


In Partnership With




5575 Ruffin Rd., Ste 250, San Diego, CA 92123 858.300.2777



Together, We Can Move Mountains BY RUTH HASKINS, M.D.


Top 10 Reasons to Be a CMA Member


Continuing Education




Together, We Can Move Mountains BY RUTH HASKINS, M.D.


ver the past year, I’ve had the privilege to serve as your California Medical Association (CMA) president, and I’ve had the pleasure of discussing the future of medicine with countless physicians across the state. You’ve shared your experiences, perspectives and challenges, and one thing remains clear — serving as a physician isn’t something we do, it’s something we are. It’s a calling. And it can be an unforgiving profession. The responsibility of life and death decisions compounded by administrative burdens often feels overwhelming and isolating. As a solo practicing ob-gyn, I’ve felt helpless plenty of times, faced with seemingly insurmountable obstacles to getting my patients the care they need. Perhaps the most important thing I have learned in my 24 years as a CMA member is that the camaraderie of working with other physicians to fight legislative and regulatory battles for both my patients and my profession is invigorating. It’s revitalizing. It gives me the renewed energy I need to go back to my practice and give my patients the best of my time and talents.



CMA has a track record of “fighting the big fights” for physicians so that we can focus on and care for our patients. One such battle took on a personal tenor for me that began with one patient. Many years ago, I discovered one of my pregnant patients had an abnormal heart condition. She had MediCal insurance, which, because of low reimbursement, makes it harder to see specialists. She needed immediate access to a cardiac specialist to protect herself and her child. But of the two cardiologists in her area — one wasn’t accepting new Medi-Cal patients, and the other had a three-month waiting list. Her options were to travel 60 miles to a car-

diologist out of the area or to rely on the emergency room for care. When I heard her options, I was angered. Fortunately, I was able to pull some strings to get her into a cardiologist immediately, and her issue was controlled. But this incident really drove home the fact that having insurance doesn’t always mean having access to care, and I was determined to do something about it. And through my CMA membership, I have. I’ve spoken to legislators about the fact that low Medi-Cal reimbursement rates means physicians who see Medi-Cal patients often do so at a financial loss to their practices. I’ve testified in committee hearings

During the budget process, CMA mounted public and private campaigns to get the Legislature to honor the will of the voters. And in the end, they did. The final 2017–2018 state budget agreement provides more than $1 billion to improve Medi-Cal provider payments. But the fight is not over, and it’s not a battle that any one of us cannot win in isolation — when we come together and speak with one voice, we can move mountains. To learn how you can make a difference through your CMA membership, reach out to me personally, or to any of your local elected physician representatives. You can also call the CMA Member Resource Center for assistance at (800) 786-4262. Sacramento-area obstetrician and gynecologist Ruth E. Haskins, M.D., currently serves as president of the California Medical Association (CMA).

“Ask yourself who will have the most impact on the way you practice medicine — the government, or physicians in organized medicine through CMA? Be involved or be left behind.” about the fact that physicians have to make heart-wrenching decisions to turn away Medi-Cal patients because increasing our Medi-Cal patient load would mean putting the financial viability of our practices at risk. I’ve spoken at rallies on the Capitol steps, so that our elected officials could see the faces of the patients who are suffering because of an empty promise of coverage, without real access to care. CMA also rightly made this issue one of its top priorities over the past decade. They’ve worked on both the legislative and the legal level — even taking the issue to the Supreme Court. But after these efforts failed and we faced a wall of reluctance to solve the problem in the legislature,


we pivoted and mounted a statewide initiative campaign to provide the funds to increase reimbursement to get these patients the care they need. In 2016, the physicians of California united in a grassroots campaign to pass the CMA-sponsored Proposition 56 (tobacco tax) to provide increased funding for Medi-Cal. It passed in a landslide. When the governor just a couple months later proposed taking that money and putting in the general fund, we fought him tooth and nail.




9 10 Protect the Profession Your membership affirms your commitment to the medical profession and ensures physicians remain in control of the practice of medicine.

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

Top 10 Reasons to Be a CMA Member


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



8 Stay in the Know CMA and its county medical societies produce publications to keep you up to date on the latest healthcare news and information affecting the practice of medicine in California.

7 Get Paid Members receive oneon-one assistance from CMA’s reimbursement experts, who have recouped $15.5 million from payers on behalf of CMA physicians in the past nine years.

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

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

“When we found we could refinance our student loans with our First Republic personal banker, we jumped at the chance.” C H R I S T I N A P H A M , M . D. , UCSF Medical Center J O H A N N E S K R AT Z , M . D. , UCSF Medical Center

(855) 886-4824



New York Stock Exchange symbol: FRC





3 5 Collaborate with Colleagues CMA and its county medical societies bring together physicians from all regions, specialties and modes of practice through leadership, collaboration, social and educational events, and community service.

4 Promote Public Health From tobacco use and obesity to prescription drug abuse and vaccinations, your membership dollars support forward-thinking public health advocacy to improve the health of Californians.

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

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

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

Join or renew your membership today! Questions? Contact our Member Resource Center at (800) 786-4262 or

“Being a CMA member gives me the platform to translate the issues I see regarding access to care and health disparities into actionable policy and change for my patients and their communities.” — ABHINAYA NARAYANAN, UCLA MEDICAL STUDENT



Operations: Managed Solutions for your practice - so you can focus on your patients.

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ne of the noteworthy benefits of being a member of the California Medical Association is having free access to a robust library of on-demand webinars. ¶ CMA’s webinars give physicians and their staff the opportunity to watch presentations on important topics of interest from industry experts in the comfort of their homes or offices. CMA’s webinars are unique because all of our live webinars are archived for on-demand viewing, meaning you can access these webinars at any time that is convenient to you. ¶ The webinars are free to CMA members and their staff, and provide the timely information needed to help run a successful medical practice. ¶ Below is a sampling of the more than 200 webinars currently in our library. For more information and to view our full on-demand webinar library, visit



Assembly Bill 72: What Physicians Need to Know About the New Law on Payment and Billing for Out-Of-Network Services (Members Only) This webinar provides an overview of the new law, when it applies, the interim payment plans/ insurers will be required to pay, the process to “opt out” of the AB 72 payment scheme, how to challenge the interim payment, how you can lend your voice to CMA advocacy efforts, and free resources available for CMA members.

Cannabis in Medicine: A Review of Policy and Scientific Evidence In this webinar, we cover the new state requirements under the Adult Use of Marijuana Act and present the most current clinical information pertaining to the potential medical uses of cannabis as well as its medico-legal policy context. The webinar explicitly focuses on whether or not evidence exists, and how strong any evidence is, for the use of cannabis to treat symptoms of a handful of diseases — with particular focus on chronic and neuropathic pain.

Closing a Medical Practice This webinar goes over some of the major practical and legal issues that may arise when closing a medical practice, and assists physicians who are retiring or otherwise leaving their practice as well as families or estates of deceased physicians. Issues that are addressed in this webinar include people and agencies to notify when a physician practice closes, medical record retention, and other issues and considerations when selling a medical practice.

Medicare Changes: 2017 and Beyond This webinar focuses on changes to the Medicare program in the upcoming year, including the Medicare Access and CHIP Reauthorization Act (MACRA), the 2017 Medicare physician fee schedule, annual updates and other changes. We also provide you with educational resources that help you understand what these changes mean for your practice.

Preventing Burnout: Individual and Organizational Intervention By recognizing and responding to burnout, physicians and their institutions can reduce sources of stress and intervene with tips and tools that support professional wellbeing. This webinar covers different evidence-based individual and organizational strategies available to implement into daily practice.

The California End of Life Option Act: An Overview This webinar reviews the requirements of the End of Life Option Act, including who qualifies to participate, what is required if a physician opts out, and what the documentation and reporting obligations are. It also covers advance care planning, including the completion of important documents like Advance Health Care Directives and POLST forms, as well as strategies on how to incorporate advance care planning discussions and documentation into your practice. This webinar is free to ALL interested parties.

“As doctors, we are committed to the care of each of our individual patients. Through CMA, we extend that professional commitment to all patients, and leverage our influence far beyond our exam rooms. CMA membership is part of our responsibility to our communities, our patients, our peers, and our profession.” — W. LEE WAN, M.D.



HIPAA Compliance: Key Risks All Physicians Should Know In this webinar, CMA’s HIPAA adviser, David Ginsberg, gives his annual HIPAA compliance update. This webinar summarizes recent federal enforcement and what this means for every medical practice. We also discuss the top HIPAA privacy and security gaps and risks, along with simple steps to comply.

Aligning Clinical Practice with Diabetes Prevention: Screen, Test, and Refer This webinar describes the clinical practice burden and trends in prediabetes and type 2 diabetes in California; reviews the evidence that supports systematically screening patients for prediabetes and referring to a community based program, like the National Diabetes Prevention Program; and discusses the tools available to help identify patients with prediabetes and establish a referral process. This webinar is free to ALL interested parties.

Paying Employees Correctly: Wage and Hour Laws for Health Care Employers Federal and state laws exempt certain employees, including some physicians, from wage and hour requirements, including overtime pay. This webinar covers the basic wage and hours laws for healthcare employers in California and helps you ensure your practice is classifying and paying employees appropriately.



How to Manage Your Professional Reputation Online In today’s digital world, monitoring and managing an online presence has become essential. This webinar provides an overview on how to monitor your digital presence, take control of information about you and your practice online, and develop and implement a social media policy.

“Through CMA we give important public health concerns a strong voice and keep elected representatives in tune with changing practice paradigms.” — BRANDON WOODWARD, M.D.

Additional Webinars Medical Staff Self-Governance and the Tulare Medical Staff Trial

MACRA: Guidance on the Merit-Based Incentive Payment System

This webinar will provide an overview of the rights and responsibilities of the self-governing medical staff under state and federal law, including credentialing, establishing clinical criteria and standards, organizing committees to monitor patient care, reviewing medical records, working with hospital administrators and governing bodies, and peer review. This webinar will also discuss the recent lawsuit against the Tulare Regional Medical Center for violating self-governance rights of its medical staff, and an update on where the case stands.

This webinar, presented by the California Health Information Partnership and Services Organization (CalHIPSO), will provide guidance on MACRA reporting. We will review the “pick your pace” options for participating in the Merit Based Incentive Payment System (MIPS), data submission and reporting deadlines to ensure your practice is able to meet the requirements and maximize your score. This webinar will also highlight free resources available to assist your practice to avoid a negative payment adjustment and identify successful strategies for improving quality of care.

Assembly Bill 72: How to Challenge the Interim Payment for Out-of-Network Services at In-Network Facilities (Members Only) This webinar will provide an overview of the new law, the interim payment plans/ insurers are required to pay, the different options for challenging the interim payment, including the newly created Independent Dispute Resolution Processes, how to access the dispute options, and the resources available for CMA members.

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Be it legal information, help with a problematic payor, or details about your member benefits, call CMA’s Member Help Line: (800) 786-4262



Each month, every physician in San Diego County receives a copy of San Diego Physician magazine (over 10,000 in July). What better way to ensure other physicians know about your medical practice than through a referral ad? Advertising packages are available at very attractive price points, and, for a limited time, member physicians receive 45% off of rates.





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CLASSIFIEDS PHYSICIAN POSITIONS AVAILABLE SEEKING A FULL/PART TIME DERMATOLOGIST to join a co-op situation at a brand new Medical and Day spa. Share space with two Licensed Massage Therapist and Esthetician in a new start up office on Miramar Rd/805. Opportunity to do Cosmetic, Cool sculpting, Botox, Fillers, and Laser procedures. 3,000 sq ft office with reception area, lobby, kitchenette, bathroom. Free parking, handicap access. Short term or up to a 5-year lease available. $1,300/per month. Have 3 extra large offices available. Please call 760-815-3236 or email me at 9/4 PART TIME OR FULL-TIME SUBINVESTIGATOR: Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol specific procedures. Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Prior clinical research experience preferred. Skills/Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction. Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multi-disciplinary team. Send resume to: 7/28 FAMILY MEDICINE POSITION AVAILABLE: The Sycuan Medical Dental Center is a tribal health center, located on the Sycuan Indian Reservation in El Cajon, CA. This is a fulltime position to provide outpatient care, no OB. Current CA and DEA licenses required. Student loan repayment possible. Must be BC/ BE. Competitive compensation, full benefits. If interested, please e-mail CV to Amy Laughner ( or apply online at 7/21 ASSISTANT, ASSOCIATE OR FULL PROFESSOR (HS CLIN, CLIN X, ADJUNCT, IN RESIDENCE - PEDIATRICT GASTROENTEROLOGIST WANTED: THE UCSD Department of Pediatrics is committed to academic excellence and diversity within the faculty, staff, and student body and is recruiting for fulltime gastroenterologists for our inpatient care at RCHSD, and at our outpatient clinics located throughout San Diego County. Candidates must have an MD, be board-certified or board-eligible in pediatric gastroenterology, with general clinical GI experience and be licensed/licensable to practice medicine in the state of California. Applications must be submitted through the UC San Diego’s Academic Personnel RECRUIT system at: The University of California is an EOE/AA Employer.

DERMATOLOGIST NEEDED: Premier dermatology practice in La Jolla seeking a fulltime/part-time BC- or BE-eligible dermatologist. Existing practice taking over another busy practice and looking to add dermatologist. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two energetic dermatologists and a highly trained staff in a positive environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic, and surgical dermatology. Please call practice administrator at (858) 761-7362 or email for more information. [612] PRIVATE PRACTICE INTERNAL MEDICINE OPPORTUNITY IN BEAUTIFUL NORTH SAN DIEGO COUNTY: Unique opportunity to practice outpatient internal medicine in a private practice setting. Practice is part of a well-established internal medicine group with a 30+ year history of outstanding care in the community, seeking physician who enjoys providing thoughtful, personalized patient care. Exceptional office staff, flexible scheduling options, small group environment, autonomy, and very high quality patient care are among the many benefits of this opportunity. Office is easily accessible from all parts of San Diego County, as well as Orange County. Seeking BC/BE applicants. Please send CV to or call (619) 2482324. [611] FULL-TIME PRIMARY CARE PEDIATRIC POSITION AVAILABLE in beautiful San Diego, California, to provide coverage for newborn care in Maternal Child Health Unit and community outpatient pediatric clinic. Job duty includes supervision and teaching of residents and medical students. Average 20–25 patients daily. No evening or weekend calls or attendance of deliveries. Centrally located in San Diego with easy access to gorgeous beaches, parks, hiking trails, San Diego Zoo, and fine dining. Opening available now. Must be certified for PALS and NRP. BC or BE. Must have a valid California medical license. An additional part-time position is also available. Please submit inquiry and CV to [610] FAMILY PRACTICE MD / DO WANTED for urgent care and family practice office in Carlsbad. Flexible morning, afternoon, evening, and weekend shifts available for family practice physician. Exceptional office staff and flexible scheduling options at this busy, well-established private practice. Please fax or email CV to (760) 603-7719 or gcwakeman@ [609] LOOKING FOR A FAMILY PRACTITIONER: Well-established solo family practitioner located in suburban San Diego wishing to transition into retirement and looking for a fellow family practitioner to assume fully operational practice. This practice is part of a 15-member incorporated family practice medical group with lab, X-ray, and MRI facilities. All interested candidates will be

TO SUBMIT A CLASSIFIED AD, email SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.



considered. Please email CV with contact information to [607] SEEKING PART-TIME PHYSICIAN: Anderson Medical Center is a busy primary care, sports, and occupational medicine practice housed in a state-of-the-art urgent care facility in Pacific Beach. We’re seeking a part-time physician. Experience in a busy practice, emergency department, or urgent care; with musculoskeletal medicine, X-ray, and sutures/wound care required; and ability to provide compassionate care in a fast-paced environment necessary. We seek someone who values: integrity and quality medical care; with impeccable bedside manner, emotional / professional maturity, ability to work well with patients / team members, easily manages multiple priorities / patients; detail-oriented and team-focused. We’re open 8:00am– 8:00pm, Monday–Friday, 8:00am–4:00pm weekends. Providers share day, night, and weekend coverage. Contact Anderson Medical Center at (858) 224-7977. CVs may be emailed to [606] OFFICE SPACE / REAL ESTATE AVAILABLE

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp & Rady Children’s. Ready-to-occupy suites ranging from 1,300-5,000 SF with mix of exam rooms and offices. Will consider short-term & long-term leases. For details, floor plans and photos contact David DeRoche (858) 966-8061 |


Grow your business and upgrade to a new Class “A” medical office in TriCity’s leading outpatient health center. Collegial environment with more than 40 physicians in 15+ specialities. Strong primary care referral base. Fully renovated offices with today’s modern finishes. Close hospital proximity. Multiple sizes available ranging from 1,200-6,800 SF. For more information, including floor plans, please call Greg Petree at (858) 792-0696 x112 or visit KEARNY MESA MEDICAL OFFICE SPACE AVAILABLE FOR SUBLEASE: 1500 sq.ft Frost Street office with 2 exam rooms, 2 offices, front office area, bathroom, kitchenette and lobby. Easy access to Sharp Memorial Hospital and Rady Children’s Hospital and the 163 and 805 freeways. Up to 4 month lease with possible extension. Please call (858)467-1899. 8/3 POWAY OFFICE SPACE AVAILABLE PARTIME: Spacious 5 exam room office including large treatment room. Located

across the street from Palomar Medical Centery Poway (aka Pomerado Hospital). Well suited for surgical or medical specialty. Contact 7/21 SOLANA BEACH OFFICE SHARED OFFICE SPACE AVAILABLE: Office space, beautifully decorated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-606-3046. CARLSBAD OFFICE TO SHARE: New Medical office in Carlsbad close to Carlsbad outlet mall; with 4 exam rooms, a large nurse station, and break room. All days available. Please call Katia at : 760-352-4103. 6/28 PRACTICE FOR SALE

UNIQUE MEDICAL SPA FOR SALE-OWNER RETIRING Fantastic opportunity for medical doctor/group seeking a vibrant business with outstanding reputation. Committed clientele, growing revenues/ profits plus expansion possibilities. Bank pre-approved for SBA financing. Offered at $999,000 by Transworld Business Advisors of San Diego Central (CalBRE#02019152). Contact Robert Cunio MBA, (888) 604-8221 /

MEDICAL EQUIPMENT / FURNITURE FOR SALE USED OFFICE FURNITURE FOR SALE: Exam tables, stools, chairs, x-ray view boxes, executive desk, waiting room chairs, tables, filing shelves and cabinets. Please call (858)467-1899. 8/3 USED MEDICAL EQUIPMENT FOR SALE: (2 )centrifuges, excellent condition. Price new was $400.00 each. Offering at $ 200.00 each. Sonosite portable ultrasound machine (2006), good condition, with 2 soni printers and a stand. Price new was over $20,000.00. Offering at 1000.00. Summit Doppler Vista ABI system w/ stand for performing Ankle Brachial index. (2012) Price new was $5400.00 . Barely used. Offering at $2000.00. Call 619-606-3046. NONPHYSICIAN POSITIONS AVAILABLE POSITION AVAILABLE FOR DYNAMIC NURSE PRACTIONER OR PHYSICIAN ASSISTANT to join our team of Women Healthcare providers specializing in Reproductive Medicine. We are offering a competitive salary, excellent benefits and a flexible schedule. Requirements: Obtain detailed medical history, review medical records, and collaborate with physician in developing a thorough infertility evaluation and treatment plan. Perform transvaginal sonograms for follicular measurements and collect data to monitor IVF cycles. Perform early OB ultrasounds and monitor early preganancy lab values. Master’s in Nursing or equivalent. 2-4 years experience in OB/GYN. Fertility experience preferred. Please email or call 760-274-2000. Visit our website at

PART TIME OR FULL-TIME SUBINVESTIGATOR: Work under the supervision of the Medical Director/Principal Investigator performing a variety of scientific clinical research activities to include the direct assessment of study participants and execution of protocol specific procedures. Required Education and Experience: M.D., Board Certification (or Board eligible) in Internal medicine, Family practice or Emergency Medicine, Prior clinical research experience preferred. Skills/Competencies: Excellent professional communication, punctual and responsible, friendly and outgoing demeanor, must demonstrate a passion for direct patient interaction. Demonstrate clinical competence, positive leadership and ability to work collaboratively with a multi-disciplinary team. Send resume to: 7/28 RECEPTIONIST POSITION AVAILABLE: Solo private practice Menopause Management office in Hillcrest. Back-office experience is not required. Free parking is available onsite. Please fax CV and last two years work experience only to (619) 794-2942. 7/24

with the consulting psychiatrist to students at the University of San Diego. Qualifications: graduate of approved training program for graduate nursing program; current active California licensure as NP with specialty training as a psychiatric NP; possession of a current valid CPR certificate is required; current knowledge of drug and treatment protocols common to ambulatory care; prior experience in university student health is highly desirable. Wellness area at USD: The University of San Diego places great importance on providing students with the support services necessary to help them maximize their educational experience and to challenge them to develop knowledge, values, and skills to enrich their lives. The Counseling Center, the Center for Health and Wellness Promotion, Disability Services, and the Student Health Center seek to support student academic success and personal development by providing a comprehensive and integrated range of wellness services. Interested candidates may apply and submit a cover letter and resume to (Job: IRC23760) [616] PRODUCTS / SERVICES OFFERED

SEEKING RHEUMATOLOGY NURSE PRACTITIONER: Private Practice in Chula Vista seeking full or part time NP. Bilingual in English/Spanish helpful. Must have current CA NP license. No weekend or night shifts. Please apply even if you do not have experience in Rheumatology as we are happy to train you. Send CV to PSYCHIATRIC NURSE PRACTITIONER: University of San Diego has a full-time (11-month term ) employment opportunity for a psychiatric nurse practitioner in the wellness area. In this position, the incumbent will provide psychiatric care in collaboration

PHYSICIAN OFFICES IN NEED OF ASSISTANCE FOR MEANINGFUL USE ATTESTATION of their electronic health records can avail themselves of technical assistance from Champions for Health, the sister organization to SDCMS. Practices attesting on the Medi-Cal Incentive Program with at least 30% of patients billed to Medi-Cal can receive free assistance thanks to a federal funding source. Medicare practices can receive the same great service at a very reasonable rate, and SDCMS-CMA members receive a discount. For more information, email or call (858) 300-2780. [559]

PLACE YOUR AD HERE Contact Dari Pebdani at 858-231-1231 or



P E R S O N A L & P R O F E S S I O N A L D E V E LO P M E N T

To teach caring, we should demonstrate caring toward our students, trainees, and colleagues.


PHYSICIANS ARE expected to be continually present to the needs of our patients and staff, and to care about and deal efficiently and competently with those needs. The stakes are high, as patients’ lives are at risk. But how are we prepared for this? When we teach children to be kind and honest, we model and explain these behaviors. When we learn a technique, we watch others perform it and mimic their movements and thought process. To teach caring, we should demonstrate caring toward our students, trainees, and colleagues. Unfortunately, we treat each other in very uncaring ways. When my father suffered a severe MI during my residency, I was coldly informed that I could be with my family only if I arranged coverage for my on-call nights. Another intern, in the



middle of her first on-call night, learned that her daughter had broken her leg. Her attending physician refused her request to spend a few minutes consoling her daughter in the Emergency Department. What are we teaching our new colleagues with these reactions? With the many changes we are facing in healthcare, there are important battles we should be fighting together, as a unified group of professionals. Instead, we splinter our corps by failing to support each other in being the best we can be, making it even more difficult to thrive in our challenging environment. In place of compassion, we deliver judgment. Rather than encouragement, we serve up criticism. I’m not suggesting we accept mediocrity or a poor work ethic. But I am inviting each

of us to respond to each other with caring. In what ways can you show kindness to your colleagues? A simple “thank you” for a favor rendered or the excellent care of a shared patient goes a long way. Reaching out to a colleague who has become less enthusiastic about medicine or appears sad or stressed, expressing your caring and offering to listen or help, may make the difference between life and death. Three hundred to 400 physicians take their own lives each year. And for those who have taken on administrative roles, please remember where you came from. You, more than anyone, know the stresses your colleagues are feeling. Asking for their side of each story and including them in finding a solution to any conflict that arises will help them feel supported rather than disrespected and devalued. Happy, balanced doctors provide better patient care, are more productive, and can, in turn, support others who are struggling. If we are to play the important role we should in the evolution of healthcare, we need all of us working together with passion and a unified commitment to our patients, our profession, and our own health. Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at

Being a physician can be tough. At CAP, we try to make your job a little easier.

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You give your all to helping others live full, healthy lives. You go the extra mile to seek out answers and cures, knowing that sometimes even your best efforts aren’t enough. You’re a physician, and that’s how you do your job. At CAP, we salute your dedication and support you in every way we can — with protection to reduce the worry of professional liability lawsuits, but also with a host of value-added services to help manage your practice so you can focus on the highest quality professional care. Ask for a no-obligation quote and more information on CAP membership.

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September 2017  
September 2017