Fall 2019

Stockton Pace gives

frail population

extra time in their home

Decision Medicine CalMedForce GME grants LTA & YPA Dinner Photos FALL 2019

Fall 2019 SAN JOAQUIN PHYSICIAN

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FALL 2019

VOLUME 67, NUMBER 3 • SEPTEMBER 2019

{FEATURES}

12 24 26 31 46 50 FALL 2019

DECISION MEDICINE LIFETIME ACHIEVEMENT AND YOUNG PHYSICIAN AWARDS PHC GRANT APPLICATIONS

{DEPARTMENTS} 9 PRESIDENT'S MESSAGE 36 IN THE NEWS 54 PRACTICE MANAGER 56 PUBLIC HEALTH

STOCKTON PACE SURPRISE BILLING 50 PREVENT GUN VIOLENCE

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PRESIDENT Richelle Marasigan, DO PRESIDENT ELECT Hyma Jasti, MD TREASURER Kismet Baldwin, MD BOARD MEMBERS Peter Garbeff, MD, Sanjay Marwaha, MD, R. Grant Mellor, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Benjamin Morrison, MD, Raghunath Reddy, MD, John Zeiter, MD, Cyrus Buhari, DO, Nguyen Vo, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Maria Rodriguez-Cook

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Richelle Marasigan, DO, Lisa Richmond MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD

CONTRIBUTING WRITERS Richelle Marasigan, DO, Jo Ann Kirby, Ashley M. Lewis, MPH, Tiara K. Johnson, MPH and Kismet Baldwin, MD

MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Kismet Baldwin, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD,

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

James R. Halderman, MD, Grant Mellor, MD, Raissa Hill, DO, Ramin Manshadi, MD,

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD, Philip Edington, MD,

San Joaquin Physician Magazine

Steven Kmucha, MD

3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

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Would you still choose medicine?

Every year it seems we’re asked to see more patients in less time. There’s mounting regulation, more documentation, and longer hours. Let’s face it, this profession has never been easy. Sometimes it seems like health care is more about the business than the healing.

But we keep trying, because we all believe in one thing: Healing begins with human connection.

Dedicated professionals like you have shown us what health care can be when it treats patients like people first. Alongside medicine, it’s our kindness, respect, and compassion that help people truly begin to recover.

Like you, we believe humanity is the key to better health care.

Join us. Help us champion the human connections that make even the best medicine more powerful. Together, we can unite under a rallying cry that puts our common humanity at the heart of health care.

Learn more at DignityHealth.org

St. Joseph’s Medical Center l St. Joseph’s Behavioral Health Center l Mark Twain Medical Center

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EXECUTIVE DIRECTOR’S REPORT

GIRL POWER For those of you who have never visited our SJMS office, I encourage you to come by. I would love to show you our board room which has a very interesting collection of vintage journals, books and medical instruments. The walls are lined with photos of every president for the last 116 years! They are fascinating to look at, but there is something strikingly apparent - there have been very few women to lead the society as president. I wonder if Dr. Margaret Smith (1918) had any idea what a trailblazer she was or that it would be another 28 years until the next woman president, Dr. Dora Lee, was installed. Flash forward almost half a century until Drs. Patricia Hatton (1994) and later Raissa Hill (2012) followed. It just seems crazy to me. But we know the face of medicine is changing. According to the Association of American Medical Colleges, in 2018 women were the majority of matriculants to medical school comprising 51.6% of students for the second year in a row. I am excited that we will almost double the total number of female presidents in the next three years with Drs. Marasigan, Jasti and Baldwin coming up through the leadership ranks. That is some serious girl power!

DRS. MARASIGAN, JASTI AND BALDWIN

Earlier this year, I had the opportunity to visit the new Stockton PACE facility, located in University Park. PACE offers comprehensive integrated medical and social services to seniors that are designed to keep them living in their homes for as long as possible. It is a beautiful facility and warm, welcoming environment. This is a wonderful addition to our community. I know you will be interested to learn more about PACE in this issue’s feature article.

It certainly wouldn’t be summer without Decision Medicine and this year’s class did not disappoint!

These students are truly a bright spot in our year. A huge thank you to our member physicians and all of our community partners for your continued support of this awesome program. You can get a glimpse in to this year’s program on page 13 .

Finally, Fall kicks off of our annual membership campaign! Membership not only provides you with personal benefits but opens a wide array to services to your practice managers and staff, such as our Office Managers Forum. This free-to-members luncheon is held at Papapavlo’s on the second Wednesday of each month and features expert-lead educational topics relevant to your practice. Please see information enclosed for dates and details.

Sincerely,

Lisa Richmond

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A message from our President > Richelle Marasigan, MD

The Struggle is Real “Healing is a matter of time, but it is sometimes also a matter of opportunity”. - Hippocrates.

The last two weeks started as a little bit of a disaster. In the middle of my morning, I received a call from my two-year-old son’s daycare saying he had hand-foot-mouth and needed to be picked up as soon as possible. Of course, the call was in the middle of a busy Monday morning schedule. Thankfully, my husband was off for the week and could pick him up and take care of him during the week.

ABOUT THE AUTHOR ­ Dr. Richelle Marasigan is the President of the San Joaquin Medical Society and is a secondgeneration physician who practices family medicine at HT Family Physicians

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The next several nights were spent consoling my son and desperately trying to sanitize everything in sight to avoid the virus from spreading to my 8-month-old baby boy. Unfortunately, I lost the battle and at the end of the week he had spots around his mouth and on his little hands and feet despite my best efforts. Two sick babies later, I found myself with spots on my hands and feet by the weekend. Never have I had to take a week off for being sick, yet I found myself helpless to this childhood virus and having to cancel a week of patients to be with my sick babies. This experience led me to start to contemplate health and wellness and the concept of work-life balance in a way that I had not considered before. Physician wellness is not just about the importance of work-life balance, but also importance of staying healthy.

The struggle is real. Work-life balance is something every physician parent strives to achieve. We all want to be a “good” parent and a “good” physician.

Unfortunately, we cannot always be in two places at once. How often have you not been able to take time off in the middle of the day to attend the school event? Or not been able to commit to do something because of being “on call” or having to work? The list goes on.

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A message from our President > Richelle Marasigan, MD

When my kids were first born, I balanced being a mother and a physician by bringing them to work and have them close by. I was fortunate to be able to do that for a few months being in private practice. As they have become more mobile, I have had to depend on child care and family to help take care of them during the day. There is some guilt, but I know that my kids are in trusted hands and having fun. I hope someday they will know that we are working hard for them, and maybe they will be more resilient for it. My husband and I are constantly having to make decisions when it comes to prioritizing the children and work. We have always tried to do what is best for us and our family, while balancing our work as physicians.

coordination help with this area.

Culture of wellness. This is defined as “a set of normative values, attitudes and behaviors that promote self-care, personal and professional growth, and compassion for colleagues, patients, and self. Health care organizations will select leaders who demonstrate the characteristics and skills associated with professional fulfillment and well-being.

Personal resilience. This is the set of individual skills, behaviors, and attitudes that contribute to one’s own personal, emotional, and social well-being. In our inherently stressful profession, it is important that we make it a duty to pursue these healthy behaviors such as healthy diet, exercise and sleep.

" When my kids were first born, I balanced being a

mother and a physician by bringing them to work and

It is in addressing these three main factors of physician wellness that we can improve physician wellbeing and improve health care systems. The California Medical Association (CMA) has made physician wellness and prevention of burnout a priority and has launched Well Physician California. This is a project to help promote wellness for all physicians and deliver specific interventions for those at risk for burnout. The “Clinician Well-Being Knowledge Hub” by the National Academy of Medicine is another helpful resource that helps to improve clinician well being and provide solutions to combat clinician burnout and improve patient care.

have them close by. I was fortunate to be able to do that for a few months being in private practice."

Physician wellness has been a topic of national dialogue as multiple studies have showed that approximately half of all physicians experience symptoms of burnout, including exhaustion, cynicism and feelings of reduced effectiveness.

This has a huge impact on the quality of care, patient safety, turnover rates and patient satisfaction.

According to an article from the NEJM Catalyst published in 2017, the main drivers of burnout and physician wellness fall into 3 major categories: efficiency of practice, a culture of wellness, and personal resilience. Each category influences the other, so a balanced approach is crucial to ensure physician well-being.

Efficiency of practice. These are the factors that help physicians with efficiency of practice such as workplace systems, processes, and practices that help provide compassionate, evidence-based care for patients. Physicians want to provide optimal care so this aims to help work flows and environment. Improvements in electronic medical records, adequate staffing and facilitating reliable care

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In the week that I spent home fighting a virus that preys on babies and toddlers, and me apparently, I was able to reflect on my own work life balance. I was able to take the time to evaluate areas where I can improve. I would encourage all of us to take a step back and reflect and invest in our own well-being.

Sources: “Physician Well-Being: Efficiency, Resilience, Wellness.” NEJM Catalyst, 26 Nov. 2018, catalyst.nejm.org/physician-well-beingefficiency-wellness-resilience/.

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FALL 2019

Growing Our

OWN: Decision Medicine 2019

By Andrew Ochoa

“ Your parents did not raise you in the Bay Area. They did not raise you in Los Angeles. They raised you here and we need you to come back to serve YOUR community.”

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These were perhaps the most memorable words given by Drs. Adubofour and Khoury at the Decision Medicine Banquet. It was recently reported that the San Joaquin County has 25% fewer primary care physicians than the state average. The need for physicians in the valley is increasing and one way to combat this is to encourage our local students pursue medicine.

Since the start of the program in 2001, the San Joaquin Medical Society has taken high achieving students from high schools across the county and provided them a glimpse in to life of physicians through discussions, lectures and hands-on experience in various hospitals and clinics. Simply put, it allows the students to experience what it’s like to be a physician in their own community. >>

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As an example of the caliber of students who apply, this year we had 82 applicants, interviewed 42, and finally accepted our 24 students with an average GPA of 4.11 They represented 16 high schools from Escalon to Tracy to Lodi. This elite group of students not only demonstrated academic excellence, they were also involved in a myriad of extracurricular activities and handled themselves extremely well in the interview among a panel of physicians and facilitators, which can be just a little nerve-racking.

“ ...this year we had 82 applicants, interviewed 42, and finally accepted our 24 students with an average GPA of 4.11 They represented 16 high schools from Escalon to Tracy to Lodi. �

Each year the program kicks off with a ropes course to develop teamwork and rapport within the group.

Here they are broken up into teams where they create their own team name, logo, and cheer. Our teams this year were The Lifesavers, The Phunky Physicians, Las Tortugas, and The Dreamies. It was evident, even on day one, that this group would work well together.

There was so much encouragement and camaraderie, that even those who were afraid to go up on the ropes course challenged themselves and ultimately concurred their fears.

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Name

High School

Heather Bastiansen

Lincoln High School

Amir Brooks

St. Mary’s High School

Ariana Chavez

Tracy High School

Iyonna Jackson

Cesar Chavez High School

Sarisha Jacobs

Weston Ranch High School

Danish Khan

Tokay High School

Keeley Kosier

Lincoln High School

Christian Labasan

Tracy High School

Kiana Mikami

Ripon High School

Adriana Monroy

Health Careers Academy High School

Safah Nassimi

Lathrop High School

Sanah Nassimi

Lathrop High School

Vianda Nguyen

Aspire Benjamin Holt College Preparation Academy

Aqsa Noreen

Health Careers Academy High School

Lumin Oo

Lincoln High School

Isabela Ortega-Ochoa

Stockton Unified Early College Academy

Andrea Ramos

Lodi High School

Ashley Rivas

Stockton Collegiate International School

Arlen Sanchez

Cesar Chavez High School

Maliha Shahzad

Middle College High School

Ashlet Villa

Edison High School

Diego Villanueva

Stockton Collegiate International Secondary School

Anthony Yap

Stockton Early College Academy (SECA)

Jonathan Yepiz

Escalon High School / Grace Davis High School

DM

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Each hospital/medical center provides a different focus and set of activities. St. Joseph’s Medical Center always starts us off on the right beat as they focus heavily on the heart. As soon as the students put on the bunny suits for the first time, the joy on their face is evident. And it never leaves, even through the exhaustion from hundreds of compressions on a mannequin in CPR training and certification.

DM Our next stop for half of the students was the San Joaquin General Hospital, where the focus

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is on what it’s like to be in medical training. The students joined large groups of physicians, interns and residents and followed them from patient to patient, picking their brains for medical knowledge and school advice. In addition, the students learned how to enter an artery from a interventional radiologist. The feedback from students is that is very “Grey’s Anatomy-like”, but I’m sure it involved much less drama. Meanwhile, the other half was matched with a SJMS physician member for a oneon-one day of shadowing in their clinic, leaving the students with palpable excitement.

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Perhaps the most eye-opening visit was to Channel Medical Center and Gleason House in downtown Stockton. Their assemblage of medical professionals dedicated to serve the less fortunate was truly inspiring. Finishing the day with volunteer work at St. Mary’s Dining Hall provides the students with knowledge of the important programs available in our community.

“ Their assemblage of medical professionals dedicated to serve the less fortunate was truly inspiring.”

We concluded week one with a visit to UC Davis School of Medicine, where the focus was on the brain,

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whether it be learning about it, holding it, or using it. Later, we walked to Shriners Hospitals for Children, where they were exposed to the wide array of services provided to children. They toured the facility and enjoyed “medical play� with current patients. This is typically where the future pediatricians shine, but with this group of students, they all shined. It is heartwarming to see the joy on both the students and patients faces during this activity!

Week two began at Dameron Hospital where the focal point was on blood typing, nutrition, and infection control. After students toured the captivating blood lab,

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DM

HPSJ Health Careers Scholarships Decision Medicine Students Honored During the 2019 Decision Medicine Celebration

education grants as past HPSJ scholars continue their

Banquet, at Stockton Golf and Country Club, HPSJ Chief

health-related studies.” She told the students, “We

Medical Officer Lakshmi Dhanvanthari, MD, (pictured

are proud of the way you blend hard work, academic

in the center) presented $3,000 HSPJ Health Careers

excellence, and the passion for service. As we continue

Scholarships to DM alumni Cynthia Torres (on the far

to support your progress through academia, including

left with her mentor, HPSJ’s behavioral health consultant

mentors from our likewise dedicated health plan staff,

Jayne Hardy), who will attend University of California,

we hope your journey will always bring you back to

Merced and is interested in the surgical field, and

your Central Valley roots and outstanding health care

Jazmin Parra-Santos (on the far right with her mentor,

careers.”

HPSJ Senior Accountant Elida Pinto), who will attend University of California, Berkeley. Each HPSJ Health

Health Plan of San Joaquin continues to invest in local

Careers Scholarship program student has their own

health career scholarships as a means to tackle the

Health Plan of San Joaquin mentor.

severe local health workforce shortages, and because of its commitment to supporting talented local students

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Dr. Dhanvanthari said, “Health Plan of San Joaquin is

pursuing their healthcare career dreams as they

this year investing a combined $61,000 in scholarships

embark upon – and continue on – their education

for Health Careers Scholars, and for $1,000 continuing

pathways.

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they practiced putting on surgical suits and washing their hands the proper way to avoid the spread of infection. On top of that they typed out their blood, which was exciting because most had not previously known their blood type.

Kaiser Permanente Modesto was the last location within the valley and was a memorable day. The students participated in a mock hazardous emergency, toured the facility, and visited the simulation lab. The highlight of the day was the Case Study activity, where they worked in small groups with a physician to diagnose a patient with a “mystery disease.”

DM The program culminated this year at UCSF School of Medicine, a first for the program. It was awesome for the students to meet Decision Medicine alumna and current second year medical student, Jazzmin Williams, who coordinated a wonderful day of activities. The students enjoyed a Q&A session with Jazzmin and other medical students, before taking part in a very intense and realistic Code Blue simulation. After leaving UCSF, we headed to

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Pier 39 for a fun, Forrest Gump themed dinner at Bubba Gump’s.

The most important thing we hope to provide to the students during the program is encouragement and inspiration to become physicians and an awareness of the need in our community, so that they will ultimately want to return to practice here. Each year, they will encounter someone or hear something during the program that they can relate to and that has often turned in to a mentor opportunity. During this long road to medicine, they often experience self- doubt and need someone remind them that they CAN do this, that anything is possible with hard work. We are happy to report that many of our alumni have continued on the path to medicine.

Currently we are aware of one practicing physician, one in residency, 16 in medical school and approximately 120 in biology, health science and other pre-med majors in undergrad. It takes a long time to see the return on investment, but we know it will be worth the wait!

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SJMS Presents 3rd Annual Rick Halligan Memorial Scholarship

During the recent celebration banquet, Tatum Halligan presented two deserving DM Alumnus with a $3000 scholarship in memory of her father, Rick Halligan. Anna Lucostic (2017) will be studying Biological Science at UC Santa Barbara this Fall and Duc Nguyen (2018) will be studying Biochemistry and Molecular Biology at UC Santa Cruz. Both plan to become physicians. Rick Halligan was a Diagnostic Imaging Supervisor at San Joaquin General Hospital. He was the DM program coordinator for SJGH and one of the most passionate volunteers. “Rick will always be remembered for his incredible sense of humor and enthusiasm for his profession and our Decision Medicine students�

DM said Lisa Richmond, Executive Director of the San Joaquin Medical Society.

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Lifetime A & Young P Lifetime A & Young P Lifetime Achievement & Young Physician Award Dinner SUNDAY, JUNE 9, 2019

LAWRENCE FRANK, MD SUJEETH PUNNAM, MD

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Achievement Physician Achievement Physician FALL 2019

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PHC ANNOUNCES SECOND APPLICATION CYCLE FOR CALMEDFORCE GME GRANTS

PHC announces second application cycle for CalMedForce GME grants Physicians for a Healthy California (PHC) is excited to announce the second grant cycle for the graduate medical education (GME) grant program, CalMedForce, which will award approximately $38 million to primary care and emergency medicine residency programs in California. The application will be released September 23, 2019. and is due by October 28, 2019. at 11:59 p.m. (PST). Priority will be given to programs in medically underserved areas and programs who serve medically underserved populations.

In the inaugural cycle of CalMedForce in January 2019, PHC funded 156 physician residency positions at 73 residency programs throughout the state. >>

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ABOUT CALMEDFORCE

CalMedForce—a program of the California Medical Association (CMA) foundation, Physicians for a Healthy California (PHC)—was made possible by the Proposition 56 tobacco tax, which was sponsored in 2016 by CMA, the California Hospital Association and Service International Employees Union-United Healthcare Workers West. The University of California is the designated recipient of the funding and has contracted with PHC to administer the annual grants.

For more information about CalMedForce, visit phcdocs.org.

PROGRAMS ENCOURAGED TO SUBMIT EARLY! All applications submitted will receive a preliminary score. The preliminary scores will be sent to the primary contact and program director as provided in the application. Applications submitted by October 11, 2019, 11:59 p.m. (PST) will have the opportunity to edit their application, if needed. Early application submission is strongly encouraged.

Applications submitted between October 12, 2019 and October 28, 2019 will be considered final, and, no supplemental information or changes can be made to the application.

Programs that plan to apply for funding are encouraged to start gathering the needed information now to ensure they are ready to complete the application by the deadline. While the application itself is not lengthy, it may take some time to collect and prepare the required information.

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Among the information needed is: • Health professional shortage area (HPSA) score • Structure of residency program, including the number of residency positions overall and the number of positions for which you are requesting funds • ACGME/AOA accreditation letters for both the sponsoring institution and specialty • Information about program graduates, including where they are practicing, in what specialty and in what type of practice from the past three years • Details about your patient population payor mix • Justification of your funding needs Please share this information with colleagues who may benefit from this funding. If you would like to be added to our distribution list for future updates, please email CalMedForce@phcdocs.org with “subscribe” in the subject line.

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•• S JOAQ AN M IU N •• S JOAQ AN

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FALL 2019

The One Thing Hackers Hope You Never Discover Imagine not being able to send or receive e-mail for days, possibly weeks. Don’t think this could happen because you have a reputable anti-virus software installed? If so, you’re operating on a false sense of security and hackers are praying that you keep thinking that way. Here’s why: Most business owners think that because they have anti-virus software installed and a software firewall, that their network is “secure.” Not so. One of the most common stunts hackers pull is breaking through a software firewall to hijack a server. Once they’re in, they use YOUR server to relay spam and other viruses to millions of users in a matter of seconds.

1. In no time flat, your company’s server and email gets “blacklisted”, which means the big email delivery hubs (like Comcast, Google, Verizon, etc.) flag ALL e-mails coming from your server as “dangerous” and won’t let them through; and on the net, you’re guilty until proven innocent, which means it could take days or weeks to get your name cleared. During that time, you are completely without e-mail.

2. Your patients, prospects and vendors start getting Viagra ads and invitations to XXX-rated web sites from your company. Not good.

The absolute best way to make sure this never happens is to invest in a top-grade managed services provider.

This investment is worth twenty times the cost in peace of mind and saved time.

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Stockton Pace gives

frail population extra time in their home

BY J O A NN K I R BY

Shirley Grimes had suffered a bad fall in October that left her with a vertebrae fracture in her back.

“This one kept me down for three months,” the 82-year-old Stockton resident said, of the time she spent in a rehabilitative center before she was able to return home, albeit wheelchair bound and unable to do many basic tasks without assistance.

checkups and more. “I like working with the physical therapist, my goal is to be able to stand up and use my walker. She’s teaching me how to get up and each week I’m doing more than the week before.”

She enrolled in Stockton PACE, a program of all-inclusive care for the elderly that opened its doors to the local community in January.

On a recent visit to the program’s bright and cheery resort-style facility on Harding Way, Grimes was proud to share that she had regained enough strength to walk 21 feet during that day’s PT appointment. >>

“They offered me all the things I needed,” she said, citing dental, vision, hearing, physical therapy,

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STOCKTON PACE AIMS TO How did she feel? “Tired,” she said with a laugh.

Stockton PACE is one of scores of independent PACE organizations across the national that serve as both health plans and medical service providers to eligible seniors by offering meals, checkups, physical and occupational therapy, transportation, home visits, and other support services that enable enrollees to preserve their independence. Eligible participants must be 55 years of age, be certified by the state as eligible for nursing facility level of care, be able to live safely at home and in the community and reside in the Stockton PACE service area. Most participants, if they have Medi-Cal or a combination of Medi-Cal and Medicare, enjoy PACE services free of charge.

“ We are dealing with a very frail populations and what they need today may not be what they need next week. We are able to get incredibly creative.” - Jillian Simon, Executive Director

PROVIDE A CARE PLAN SPECIFIC TO EACH CLIENT’S NEEDS BY PROVIDING: • Medical care. Personalized care from primary care physicians and a network of specialists and hospitals.

• Prescriptions. Medicine delivered to the client’s home with no-copay and easy-to-follow instructions.

• Home support. Visits by staff to assess necessary equipment and supplies.

• Care team. Comprehensive team that includes nurses, nutritionists,

“You have this whole care team that can holistically look at you and create a customized plan,” Jillian Simon, executive director of Stockton PACE, and a licensed clinical social worker, said.

The model for PACE dates back to San Francisco in the 1970s at a time when there was a lack of nearby nursing homes for elderly people tightknit communities who were also reluctant to leave their families for an institutionalized setting.

“We are dealing with a very frail populations and what they need today may not be what they need next week,” Simon said. “We are able to get incredibly creative.”

It starts with a home visit to assess the patients living space, said nurse practitioner and Stockton PACE clinical services director, Alma Poblador-Lopez. “For these underserved clients, maybe a walker was given to them, but it doesn’t fit through the doorframe. We want to be very aware of what the home environment is like and assess for safety to see if maybe there’s an assistive device that can help keep them in their home,” she said.

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pharmacists, physical, occupational and speech therapists.

• Dental, vision, hearing. Dentures, eye glasses and hearing aids when approved by the care team.

• Transportation. Rides to the PACE center and medical appointments as scheduled by the care team.

• Nutritious meals and activities. Visits twice a week to the PACE center include nutritious meals, activities such as corn hole and bingo, and meetings with the care team.

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“ I don’t have to wait until someone falls and breaks their hip to offer PT. I can offer it before they fall so that they can improve their mobility,” - Dr. Kendell M. Cannon, M.D

Included in a care plan for Grimes is twice-weekly visits to the Stockton PACE center where there is a clinic, spa, workout room, laundry, and dining area dishing up hot restaurant style meals. Because Grimes can’t get in and out of a vehicle without assistance, a Stockton PACE care team provides transportation and goes inside her house to greet her and her pet dog before helping her to the van.

The PACE model is designed to promote coordinating care from an interdisciplinary team of professionals who provide all primary care services and oversee specialists’ services. Care teams are able to prevent or quickly address problems, resulting in better health and quality of life and produce 15 percent lower costs than traditional Medicare, according to one study. Currently, according to the National PACE Association, there are 260 PACE organizations in 31 states serving some 49,000 participants.

“I don’t have to wait until someone falls and breaks their hip to offer PT. I can offer it before they fall so that they can improve their mobility,” said Dr. Kendell M. Cannon, M.D.

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Cannon is the Stockton PACE center’s medical director and is hoping to team up with area specialists and primary care physicians who care for the elderly population. The internist specializing in geriatrics completed a fellowship with the Stanford Clinical Excellence Research Center in improving care in value-based organizations for those in late-life last year.

met some new friends through her twice-weekly visits, said she has another goal she wants to accomplish once is back to be able to get up and walk unassisted.

“I hope this year I can get back to baking for Christmas,” she said. “I have some gifts I want to bake.”

“I’ve been looking for partners in the community who have patients who are frail but want to stay in their home. They can stay with their PCP, but we can be the wraparound,” she said of PACE’s ability to contract with health care providers in the community Cannon says she is looking for doctors to whom this sort of model “speaks to their soul.”

Currently, Stockton PACE has about 64 participants but can expand its services to care for between 500 and 600. “We chose San Joaquin and Stanislaus counties because this represents the largest population of underserved PACE eligible seniors in California. Despite paying into Medicare and Medi-Cal their entire lives, the residents of this region have never had access to 24/7, concierge-like services that PACE offers,” Dr. Si France, chief executive officer of Stockton PACE, said. “Research shows that PACE participants live 1/3 longer, hospitalization goes down, nursing home use goes down, depression goes down, while satisfaction and sense of empowerment go up.”

Shirley, who has been with the program since February and has

FALL 2019

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In The News

IN THE

NEWS

Providing staff, physicians, and patients with relevant & up to date information

Calling All Mentors!

Do you worry about who will take care of your patients when you retire? Are you looking for a meaningful way to give back to your community? If so, look no further! SJMS is currently recruiting volunteer mentors to join our Bridge to Medicine (BTM) committee. BTM guides high achieving students (high school & college) along their academic journey so that they have the best chance of being accepted to medical school and ultimately, return to practice in our community.

The committee meets every other month and consists of physicians (working & retired), alliance members Adventist Health Lodi Memorial National Award for Stroke Care and even a local college professor. Most importantly, you don’t need to be an expert! We have committee members with a wide array of skill sets and treatment according to nationally recognized, research-based resources, so you are never alone. For more information please data. The medical center also qualified for the Stroke Elite contact Lisa Richmond at 952-5299 or Lisa@sjcms.org.

Honor Roll.

“With stroke, time is critical, and this award demonstrates our commitment to ensuring patients receive fast, quality Adventist Health Lodi Memorial Earns stroke care based on nationally respected clinical guidelines,” says Adventist Health Lodi Memorial President Daniel National Award for Stroke Care Wolcott. “Stroke care is one of our key focuses, with emphasis After receiving its stroke designation last year, Adventist on timely diagnoses, treatment and recovery.”

Health Lodi Memorial has already been honored by the At a ceremony in July, physicians, nurses and employees at American Heart Association with a national quality award in Adventist Health Lodi Memorial gathered as the American stroke care. The Get With the Guidelines Silver Plus Quality Heart Association/American Stroke Association’s regional Achievement Award, presented to the Lodi stroke team this director of quality and systems improvement, Andy Hoedt, week, recognizes the Lodi medical center’s commitment presented the award to Adventist Health Lodi Memorial to ensuring stroke patients receive the most appropriate

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FALL 2019

Gastroenterologist George Tan, MD quality nurse and stroke coordinator, Amanda deNu. He and the stroke team also presented the award to employees in specific care areas of the hospital that are crucial components of the stroke team, including the emergency room, intensive care unit and diagnostic imaging.

Adventist Health Lodi Memorial earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions.

In Adventist Health Lodi Memorial’s emergency room, patients brought in with stroke symptoms are taken immediately to CT for diagnostic testing to determine the course of treatment, deNu said. This process helps expediate treatment to assure every stroke patient receives the care they need for a fast recovery.

FALL 2019

Adventist Health Lodi Memorial Welcomes Board-Certified Gastroenterologist George Tan, MD Adventist Health Lodi Memorial is pleased to announce board-certified gastroenterologist George Tan, MD, has joined the medical center and Adventist Health Physicians Network – Gastroenterology.

Tan provides patients comprehensive care with expertise in screenings for colon, esophageal and stomach cancers and interventional procedures including colonoscopy, interventional endoscopy and endoscopic ultrasound. He also cares for patients with celiac disease, peptic ulcer disease and inflammatory bowel disease. He is board-certified by the American Board of Internal Medicine and American Board of Integrative and Holistic Medicine.

After earning his medical degree from Virginia Commonwealth University in Richmond, VA, Tan completed his internship and residency in internal medicine at the University of California at Irvine Medical Center in Orange, CA, and a fellowship in gastroenterology/hepatology at Augusta University in Georgia. He also holds a Master of Business Administration in Healthcare degree from The George Washington University School of Business in Washington, D.C. A native of San Francisco, Tan combined his love of science and passion for helping others into a career in the medical field.

Of his chosen specialty, he said, “One of the most rewarding aspects of the field of gastroenterology is the ability to perform both diagnostic and therapeutic interventions to help my patients feel better. It is also amazing to be able to prevent certain cancers, including colorectal and esophageal cancers, through proper screenings and early interventions.”

When not seeing patients, Tan enjoys spending time with his wife and daughter, as well as practicing martial arts, traveling, playing basketball and following the Golden State Warriors.

He is accepting new patients and may be reached at Adventist Health Physicians Network – Gastroenterology, located at 999 S. Fairmont Ave., Ste. 125, in Lodi.

Appointments may be made by calling 209-334-8514.

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In The News

IN THE

NEWS Adventist Health Lodi Memorial Receives A Rating for Patient Safety for the Spring 2019 Leapfrog Hospital Safety Grade Adventist Health Lodi Memorial has been awarded an A from The Leapfrog Group for its commitment to keeping patients safe and meeting the highest safety standards in the United States.

The Leapfrog Group is a national nonprofit organization committed to improving health care quality and safety for consumers and purchasers. The Safety Grade assigns an A, B, C, D or F grade to hospitals across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care.

“Our care providers are proud to receive the distinction of an A-grade hospital,” said Daniel Wolcott, president of Adventist Health Lodi Memorial. “We prioritize patients first, and this recognition illustrates the dedication of our physicians, nurses and employees who are committed to providing an exceptional quality of care to Lodi-area communities.”

Developed under the guidance of a national expert panel, the Leapfrog Hospital Safety Grade uses 28 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. acute-care hospitals twice per year.

The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are free to the public.

“To be recognized nationally as an A hospital is an accomplishment the whole community should take pride in,” said Leah Binder, president and CEO of The Leapfrog Group. “Hospitals that earn an A grade are making it a priority to protect patients from preventable medical harm and error. We congratulate hospital leaders, board members, staff, volunteers and clinicians who work so hard to earn this A.”

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Providing staff, physicians, and patients with relevant & up to date information

To see the grades for all San Joaquin County hospitals and to access patient tips for staying safe in the hospital, visit www.hospitalsafetygrade.org and follow The Leapfrog Hospital Safety Grade on Twitter and Facebook.

Women’s Health: HPSJ Breast Health Campaign – “I CHOOSE ME” New Provider Materials Available As part of their HPSJ-provider partnership for women and families, physicians and specialists can find the most current Clinical Practice Guidelines at https://www.hpsj.com/womens-health/.

Facts, figures and ways to support families and women’s health, are now available for all providers on the Women’s Health page, at https://www.hpsj.com/wp-content/ uploads/2019/06/PCP-web.pdf, and from HPSJ Provider Services Representatives during their extensive schedule of office, clinic, and facilities visits.

HPSJ’s “I Choose Me” Breast Health Campaign is a focused Women’s Health program that includes mammograms as an essential part of every women’s healthy lifestyle.

FALL 2019

Electronic Signature Testation Option added to the State-Required Fraud, Waste, and Abuse Training – All Now on the HPSJ website Health Plan of San Joaquin, as a licensed health care services plan regulated by the Department of Managed Health Care (DMHC) and contracted with the Department of Health Care Services (DHCS), is committed to protecting members, our network of providers, and public interests by preventing, detecting, investigating, correcting, and reporting Fraud, Waste, and Abuse (FWA).

Under legal requirements overseen by the federal Centers for Medicare & Medicaid Services (CMS), 42 C.F.R. §422.503 and 42 C.F.R. §423.504, health care providers are required to either complete the FWA training offered on the HPSJ website and send HPSJ a signed attestation, or attest that they have completed another, acceptable FWA training.

Online Training Resources NOW Available for HPSJ Network Providers To help providers meet this annual FWA training requirement, Health Plan of San Joaquin is now offering this training at www.hpsj.com/fraud-waste-and-abuse-preventiontraining. Providers also are now able to sign the attestation digitally.

UPDATED, On a Single Sheet! –Vaccination Schedule for Children [English & Spanish] Well-Child Check-Ups, Shots, and More! For Children from birth to 17 years old.

This fact sheet has been created - with parent and provider input - to be a clear, concise, all-in-one place where our members (and every local parent) can map the route to their children’s best health. It’s even been created as a fun tool for kids to start helping out with their own good health practices as they grow.

This is the single sheet all our parents – and providers and community partners – have been waiting for!

Download (in English and Spanish) at https://www.hpsj. com/wp-content/uploads/2019/07/VaccionationShedule.pdf Get printed sheets from HPSJ Provider Services Representatives during their extensive schedule of office, clinic, and facilities visits.

FALL 2019

Sunny T. Cooper, MHS, CHIE HPSJ Announces Compliance & Privacy Officer – Meet Sunny T. Cooper, MHS, CHIE Health Plan of San Joaquin (HPSJ) has announced that Sunny T. Cooper, MHS, CHIE, has joined HPSJ as Compliance and Privacy Officer. Cooper, who comes to HPSJ with extensive senior executive experience in Medicaid (known as Medi-Cal in California), as well as Medicare and commercial health insurance, is a widely respected leader in establishing internal controls to ensure health plan operations are compliant with HIPAA (Health Insurance Portability and Accountability Act) and regulatory requirements.

HPSJ CEO Amy Shin said: “Through her experiences and career-long values that perfectly match up with many of our HPSJ values – including accountability, integrity, and stewardship – Sunny Cooper is leading our Compliance team to improve our program of regulatory compliance. She has already had success improving HPSJ processes and systems thereby creating efficiencies and workflow clarities.” She added that “Sunny’s many years of broad experience as a seasoned leader in Medi-Cal managed care, at both San Francisco Health Plan and L.A. Care Health Plan, make her an ideal person to join our leadership team.”

Most recently, as chief information officer at San Francisco

SAN JOAQUIN PHYSICIAN

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In The News

IN THE

NEWS Health Plan (SFHP), Cooper’s many accomplishments included leading the team that built strong IT infrastructure, and secure data and business systems – a team that continues to protect San Francisco Health Plan members and providers.

This commitment to upcoming generations is another sign of how Cooper’s values match up with HPSJ values. HPSJ is a leading collaborator in developing local career opportunities, both as a major employer and as a nonprofit, public health plan investing in scholarships – including San Joaquin Medical Society’s Decision Medicine. Also, for the HPSJ scholarships program, HPSJ employees volunteer their time to mentor talented young women and men on track to be future health care providers – hopefully in our community where we are tackling severe local health workforce shortages.

St. Joseph’s Offers New Procedure to Reduce Stroke Risk in Patients with Afib In July, St. Joseph’s Medical Center became the first hospital in the Central Valley to offer the WATCHMAN Device, which reduces the risk of stroke in atrial fibrillation patients. The first three WATCHMAN Devices were successfully deployed

by Walter Chien, MD, Rashaad Chothia, MD, David Lim, MD, Gurinder Grewal, MD, and Manreet Basra, MD. The WATCHMAN Implant closes off an area of the heart called the left atrial appendage (LAA) to keep harmful blood clots from the LAA from entering the blood stream and potentially causing a stroke. Patients who are considered suitable for warfarin by their physicians, but have reason to seek a nondrug alternative are candidates for this procedure.

Substance Abuse Navigator at St. Joseph’s St. Joseph’s Medical Center is proud to introduce a new

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Providing staff, physicians, and patients with relevant & up to date information

Substance Use Navigator service. The Substance Use Navigator will help to connect patients with substance abuse issues to outpatient community resources, so patients can continue their journey to recovery, beyond the hospital.

This new position is part of St. Joseph’s Participation in the California ED Bridge Program, which seeks to prevent deaths related to opioid use, by offering medication assisted treatment.

Recognizing Physicians with Humankindness Each quarter, St. Joseph’s Medical Center recognizes physicians in the community that go beyond clinical excellence to deliver healing with compassion and kindness, also known as humankindness. Most recently, Eugenia Hurlbut, DO, OB/GYN; Patrick Eugenia Hurlbut, DO Manookian, MD, General Surgery; Shawn Fu, MD, General Surgery; and Matthew Kiefer, MD, Emergency Medicine, were recognized by their patients and peers for going above and beyond and displaying genuine kindness to their patients.

St. Joseph’s invites you to nominate physicians practicing humankindness at St. Joseph’s or in the community to receive recognition. Call 209.467.6486 or email Catherine.Swenson@dignityhealth.org for more information.

FALL 2019

Patrick Manookian, MD

Shawn Fu, MD

St. Joseph’s Recognized for Stroke and Heart Attack Care St. Joseph’s Medical Center has recently been recognized by the American Heart Association for outstanding stroke and heart attack care, receiving the Get With The Guidelines® Target: Stroke Honor Roll Gold Quality Achievement Award and the Mission: Lifeline® Gold Receiving Quality Achievement Award.

St. Joseph’s earned the 2019 American Heart Association/ American Stroke Association’s Get With The Guidelines® Target: Stroke Honor Roll Gold Quality Achievement Award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

This award recognizes St. Joseph’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines.

St. Joseph’s has also received the Mission: Lifeline® Gold Receiving Quality Achievement Award for the treatment of patients who suffer severe heart attacks. St. Joseph’s earned the award by meeting specific criteria and standards of performance for quick and appropriate treatment through emergency procedures to re-establish blood flow to blocked arteries in heart attack patients coming into the hospital directly or by transfer from another facility.

FALL 2019

St. Joseph’s Welcomes Second Class of Residents St. Joseph’s Medical Center welcomed its second class of Family Practice and Emergency Medicine residents to its campus over the summer, bringing the total number of residents to 30. With plans to Matthew Kiefer, MD launch 12 residency programs over the next five to seven years, St. Joseph’s plans to train 184 doctors yearly, once the program is fully implemented, making it one of the largest and most complex graduate medical education programs in Northern California. With both primary care physicians and specialists being in chronically short supply in the Central Valley, St. Joseph’s Graduate Medical Education Program will help to meet both the current and future need for care in our community.

Billie-Jean Martin, MD, Joins Dameron Hospital as New Cardiothoracic Surgeon Billie-Jean Martin, MD, Ph.D., FRCSC, has joined Dameron Hospital as its new fulltime cardiothoracic surgeon under the Stanford Cardiac Surgery Program. She received her medical degree at the University of Alberta in Alberta, Canada, and her Ph.D. in Cardiovascular Sciences, Obesity, and Cardiovascular Disease at the University of Calgary in Calgary, Alberta, Canada.

Dr. Martin served Billie-Jean Martin, MD her cardiothoracic

SAN JOAQUIN PHYSICIAN

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In The News

IN THE

NEWS surgery residencies at the University of Calgary and Dalhousie University in Nova Scotia, Canada, and held two fellowships in Congenital Cardiothoracic Surgery; one at the University of California in San Francisco, and the other at the University of Alberta. She is also a Fellow of the Royal College of Physicians and Surgeons of Canada for Cardiac Surgery.

Dr. Martin brings with her many years of professional experience, and she has won numerous awards and distinctions. Her professional interests include coronary revascularization, valve replacement and repair, endocarditis, temporary mechanical support, TAVR, Cardiac Rehabilitation, and quality assessment and improvement.

Shriners Hospitals for Children — Northern California Ranked as a Top 10 Provider of Pediatric Orthopaedics by U.S. News & World Report For the eighth year in a row, Shriners Hospitals for Children Northern California is ranked as one of tthe nation’s elite providers of pediatric orthopaedic care by U.S. News & World Report.

In its annual Best Children’s Hospitals rankings, U.S. News & World Report ranks the Northern California Shriners Hospital as number eight in pediatric orthopaedics in conjunction with the UC Davis Children’s Hospital. The Northern California Shriners Hospital also achieved the ranking of 20th in Urology in conjunction with UC Davis.

Rankings are based on a combination of clinical data and reputation with pediatric specialists. According the

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Providing staff, physicians, and patients with relevant & up to date information

U.S. News & World Report web site, U.S. News generates hospital rankings by evaluating data on nearly 5,000 hospitals in 16 adult medical specialties, 9 adult medical procedures or conditions and 10 pediatric specialties. To be nationally ranked in a specialty, a hospital must excel in caring for the sickest, most medically complex patients.

Among the thousands of children treated by the orthopaedic team each year are children with scoliosis, limb deficiencies, sports injuries, hand, wrist, elbow, and shoulder malformations, brachial plexus birth palsy, spinal cord injury, spina bifida, and cerebral palsy. The hospital also is engaged in clinical trials and scientific research to advance orthopaedic care.

U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of sick children find the best medical care available. The rankings open the door to an array of detailed information about each hospital’s performance. The full rankings and methodology are available at www.usnews.com/childrenshospitals.

Hospice of San Joaquin is Pleased to Announce New Medical Director, Kurpa S. Sharma MD HMDC. Dr. Sharma brings several years of experience in the health care industry, with Board Certification in Hospice, Palliative Medicine, as well as Internal Medicine through the American Board of Internal Medicine. Dr. Sharma completed her internship and residency at Maricopa Medical Center in Phoenix, Arizona, and began her early career as a hospitalist at Kaiser in Hayward, California

FALL 2019

A COMMUNITY BUILT ON

COLLABORATION Doctors Hospital of Manteca is excited to introduce a first-of-its-kind resource for physicians and patients in Manteca: the da Vinci Xi robot. Local access to roboticassisted surgery techniques provides doctors the ability to offer helpful benefits for treating a range of conditions with less invasive surgery, shorter hospital stays, faster recovery times and less scarring.

To learn more about the program, call (209) 988-2283.

FALL 2019

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Kurpa S. Sharma MD HMDC

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before finding her calling working in the impatient palliative care program at Kaiser in Modesto, California.

Soon after, Dr. Sharma joined Sutter Gould working in the Advanced Illness Management (AIM) program and worked as the Associate Medical Director for Community Hospice Inc. (CHI) before assuming roles as Associate Medical Director at Optimal Hospice and Medical Director of the Stanislaus County Chapter of the Physician Orders for Life-Sustaining Treatment (POLST) Coalition.

Dr. Sharma has a passion for teaching and enjoys speaking to various audiences about Palliative Care and Advanced Care Planning. In her spare time, she enjoys baking, reading, browsing Pinterest, and spending time with her husband and three beautiful children. “I am honored and humbled to be part of a great organization that is working to change the stage of dying into a chapter full of love, life, and comfort for Patients and their families.� says Dr. Sharma.

FALL 2019

Complete Women’s Health Care VOTED BEST OB/GYN PRACTICE IN SAN JOAQUIN COUNTY!

Over 90,000 Healthy Babies Delivered • Gill OB/GYN is the Leading OB/GYN Practice in SJ County • Expertly Trained Physicians and Staff • 65 Years of Experience • Specializing in High Risk Pregnancy • Leading the Way with Minimally Invasive Robotic Assisted Surgery

HEALTHCARE JUST AS UNIQUE AS YOU! Complete Pregnancy Care • High Risk Pregnancy • Infertility • Gynecology • Endometriosis • Urinary Incontinence Ovarian Cystic Disorder • Laparoscopy • Hysteroscopy Diagnosis & Treatment Of Cervical, Uterine, Ovarian Cancers • Robotic Surgery

Advanced Non-Invasive Aesthetic Services BioTE Bioidentical Hormone Replacement Therapy

Hydrafacial, Vampire Face Lift & Breast Lift

FALL 2019

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Congress is getting serious about

SURPRISE

BILLING; PHYSICIANS NEED TO MAKE THEIR VOICES HEARD!!

Congress will soon return to Washington, D.C., and get back to work on a long list of unfinished business that must be tackled before the year ends. Included on that list is the issue of surprise billing. In the weeks leading up to the August recess, Congress had taken significant steps in moving legislation aimed at tackling the issue of surprise billing by passing bills out of committees in both the House and Senate.

Both bills would protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated by an in-network physician. And the California Medical Association (CMA) agrees patients should be protected from surprise medical

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FALL 2019

bills. However, neither bill holds health insurers

for emergency physicians and on-call surgeons,

accountable.

anesthesiologists and other specialists who care for patients in emergencies. If on-call physicians

Both bills would resolve payment disputes between

no longer have a contract and will only be paid the

physicians and insurers by setting out-of-network

low rate in the law, they cannot afford to accept call

payments at the median amount each insurer pays

responsibilities. In fact, the Department of Managed

for in-network care. However, neither bill includes a

Health Care has reported a 48% increase in patient

fair process that incentivizes insurers to contract at

access to care complaints since the passage of AB

reasonable rates.

72.

These are serious flaws that need to be fixed.

CMA and all of organized medicine are urging Congress to support H.R. 3502, the “Protecting

The physician advocacy community will have

opportunities with two other House committees to make further improvements on these and other elements in the legislation, but we can’t leave anything to chance. That’s why physician advocacy on this

It is critical that there be a fair and balanced mechanism for arriving at the appropriate rate for those providers who do not have a contract with a given insurer.

issue is so important.

Urge Congress to Adopt New York Surprise Coverage Law The current House and Senate bills mirror

California’s unsuccessful surprise billing law (AB 72). While California succeeded in protecting patients from surprise medical bills, the rest of the law is not working. Insurers across the state are

People from Surprise Medical Bills Act,” authored by physician Congressmen Raul Ruiz, M.D., (D-CA) and Phil Roe, M.D., (R-TN), which is based on the proven, successful New York model.

A Fair and Balanced Dispute Resolution Process It is critical that there be a fair and balanced

cancelling long-standing contracts with physician

mechanism for arriving at the appropriate rate for

groups, particularly anesthesiologists, or imposing

those providers who do not have a contract with

significant (25-45%) payment cuts. Insurers have

a given insurer. At no point should negotiated,

decided they no longer need to contract because

discounted in-network rates be used as a

they can just pay the low rate established by state

benchmark to determine fair payment to out-of-

law.

network physicians, and at every point commercial data from independent sources should inform the

Physician networks are diminishing and access to

payment standard.

care is in jeopardy for in-network care, as well as

FALL 2019

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When the minimum payment from the payor for out-of-network care is insufficient, an independent dispute resolution process (IDRP) should be developed to determine a fair payment by the health insurance company for the care provided. The IDRP should be structured with clear factors that an arbiter, familiar with health care billing, must consider when deciding, such as the complexity of the case, the experience of the physician, and the rate that physicians charge for that service in the area.

To ensure that patients are completely protected, benefits should be assigned to the physician or other providers so that they may pursue payment for services provided directly with the insurer without further involving the patient. This is to ensure that games that have been played by insurers, such as making periodic payments directly to the patient, are not allowed and that the patient is fully kept out of the middle.

Congress should ensure that patients are reasonably able to access the benefits their health plans promised when they signed up for coverage. Insurers must also ensure that their provider directories are accurate and up-to-date so patients can make informed decisions about their care.

Physicians Voices Must Be Heard

We need to be sure that physicians’ voices have been heard on this issue. CMA is urging physicians to contact their members of Congress and ask them to support surprise billing legislation that protects the patient and holds insurers accountable for failing to provide adequate networks of physicians.

Visit the American Medical Association Physicians Grassroots Network (physiciansgrassrootsnetwork.org) to send a

message to your members of Congress. Tell them to:

Y

• Protect patients from surprise medical bills.

MY

CY

• Establish a fair process that incentivizes

CMY

insurers and physicians to contract, with

K

a dispute resolution process that uses a reasonable market-based payment benchmark.

• Preserve patient access to in-network physicians, emergency physicians and on-call physician specialists who care for patients in emergencies.

• Cosponsor Ruiz-Roe H.R. 3502 “Protecting People from Surprise Medical Bills,” based on the proven New York model.

billing talking points and AMA’s surprise billing action kit, visit cmadocs.org/grassroots.

SAN JOAQUIN PHYSICIAN

M

CM

For more information, including CMA’s surprise

48

C

FALL 2019

The

REMEDY for all your

Financial

NEEDS

As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff !

In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money.

Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.

209-948-6024

•

www.fccuburt.org Federally insured by the NCUA.

FALL 2019

SAN JOAQUIN PHYSICIAN

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WHAT PHYSICIANS CAN DO TO HELP PREVENT

Gun Violence The United States continues to struggle with an epidemic of firearm violence. Over the past month, dozens of people were gunned down in cold blood in El Paso, Texas, Dayton, Ohio, and Gilroy, California.

Physicians are on the front lines of these tragic events, treating the wounds and injuries of the victims of this senseless gun violence. The California Medical Association (CMA) recently released a statement demanding action to bring sanity to our nation’s gun laws. >>

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FALL 2019

“Policies to prevent these senseless tragedies are not matters of ideology or constitutionality. They are long overdue. We can no longer accept our leaders standing idly by while more innocent victims – children, parents, family members and friends – are struck down by weapons that have no place on our streets,” said CMA President David H. Aizuss, M.D., said in the statement. “On an issue where common sense seems nearly impossible to find in some sectors of our politics, it is time for the overwhelming majority of Americans who support common sense reforms to demand action and bring some sanity to our nation’s gun laws.”

WHAT CAN YOU DO TO PREVENT GUN VIOLENCE?

Physicians are in a unique position to assess risk, provide education and change behaviors related to firearm violence, and they may also address this issue more broadly as a consumer safety and public health issue.

The CMA Firearm Violence Prevention Technical Advisory Committee (TAC), composed of physician experts, performed a comprehensive review and analysis of existing CMA policy, epidemiological data and current scientific research and developed a CMA position statement on the prevention of firearm violence.

“CMA recognizes that fundamentally, firearm violence is a human and civil rights matter; it violates the fundamental human right to life, liberty, and security of person—the right to live safely without fear in a free society,” the committee wrote in the position statement.

“As with other public health issues, physicians have a unique responsibility as trusted public health figures to respond to the harms associated with firearm violence, both as individual clinicians and as community advocates.”

Through the committee’s work, CMA has identified several opportunities and resources that may aid

FALL 2019

physicians in addressing firearm violence as a public health issue. The TAC compiled the following ways for physicians to get involved and help prevent gun violence:

TAKE THE PLEDGE. Make a commitment to ask your patients about firearms when, in your judgment, it is appropriate, and follow through with support and resources to keep patients safe.

EDUCATE YOURSELF AND YOUR PATIENTS. Expanded education and training

are needed to improve clinician familiarity with the benefits and risks of firearm ownership, safety practices, and communication with patients about firearm violence. Make sure patients are aware of their right to seek a gun violence restraining order if someone they know is experiencing a crisis and is in danger of harming themselves or others.

SUPPORT RESEARCH. The suppression of

firearm research has stripped federal and state funding for data surveillance, research and analysis, and prevented the advancement of evidence-based policies as benefiting other major public health issues.

RECOGNIZE WARNING SIGNS AND RESPOND APPROPRIATELY TO PATIENTS WITH MENTAL ILLNESS – they are at higher

risk for suicide and to be a victim of violence, and access to firearms is associated with increased suicide risk.

UNDERSTAND YOUR LEGAL OBLIGATIONS TO REPORT. Physicians should know their legal

obligations for reporting specified medical conditions and the clinical interventions that might restrict a patient’s ability to own or possess a firearm.

Learn more about what you can do to help prevent firearm violence at cmadocs.org/firearm-violence.

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Call Today to Schedule a Tour!

To qualify for Stockton PACE enrollees must meet all of the following: • Be age 55 or older • Reside in San Joaquin or Stanislaus counties (zip codes are listed at stocktonpace.com) • Be certified by the State as eligible for nursing facility level of care • Be able to live safely at home and in the community with PACE services without jeopardizing health and safety of themselves and others

582 E. Harding Way • University Park • Stockton, CA 95204 209-442-6077 • StocktonPace.com

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LIFE

GET BACK TO IT

Dameron Hospital is recognized for supporting all of San Joaquin County with award-winning care. With a 100+ year heritage and the region’s top physicians, we are committed to providing excellence in quality, compassionate health care to our community for generations to come.

EXCELLENCE IN ORTHOPEDIC PROG RAMS R A PID STRIDES ACCE LERATED RECOVERY KNE E R EPL ACEMENT PROG RA M INT E NS IVE C ARE S TA NFORD C ARDIAC SURG ERY AT DA MERON HOSPITAL C A R D IO L OG Y

S TE M I ( HE ART ATTACK) RE CE IVIN G CE N TE R GE N E RAL S URGE RY GE N E RAL ACUTE C ARE B ARIATRIC W E IGHT L O S S L UM IVAS CUL AR TRE ATM E N T P RIM ARY S TRO KE CE N TE R E M E RGE N CY S E RVICE S

525 West Acacia Street Stockton, CA 95203 209-944-5550 | DameronHospital.org

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practice manager Free to SJMS/CMA Members!

resources

The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice.

Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership Coordinator, at Jessica@SJCMS.org or call (209) 952-5299.

SEPTEMBER 11TH, 2019: 11:00AM TO 1:00PM TBD

OCTOBER 9TH, 2019: 11:00AM-1:00PM “CA APPROVED SEXUAL HARASSMENT TRAINING”

For more information on our Decision Medicine Program, please visit our website at decisionmedicine. com. We are looking for new Doctors who would be willing to host a student in their office on July 17th and/or July 24th from 9:00AM-2:30PM. If you are interested, please contact Jessica@sjcms.org or call 209-952-5299!

Julian Goduci- CEO- Enviromerica~ EnviroMerica, Inc. has provided health care facilities with Regulatory Compliance, and Regulated Medical Waste services for over 16 years. They specialize in compliance with OSHA, HIPAA, and requirements for DHHS, OCR, EPA, DTSC, Medical and Dental Boards, and Insurance companies.

NOVEMBER 13TH, 2019:

11:00AM TO 1:00PM “HEALTH PLAN OF SAN JOAQUIN – LATEST WAYS TO HELP PRACTICES SUCCEED” A team of HPSJ staff will bring ideas, new tools, and suggestions to help every practice, including: • HEDIS - What are the new MCAS Measures • Timely Access Requirements

• Opioids – Latest Strategies & Required Practices around Pharmacy, Behavioral Health, and the new San Joaqiun County Mom & Baby Initiative • Women’s Health: The Breast Health Campaign • Newest Tech Helps – CLAIMS & CREDENTIALING • Cultural Competency and HPSJ Supports • Oral Health Starts at Birth

DECEMBER 11TH, 2019: 11:00AM TO 1:00PM “2020 MEDICARE UPDATES”

Join us for our annual Medicare Update workshop for physicians and office staff.

This 2 hour seminar will cover relevant information about current, future and proposed changes for the coming year!

Cheryl Bradley~ Associate Director, CMA Center for Economic Services

Public Health

Update

E-cigarettes and Flavored Tobacco: New Versions of An Old Public Health Problem Ashley M. Lewis, MPH, Tiara K. Johnson, MPH, and Kismet Baldwin, MD

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The Issue

Under the guise to help current smokers quit, companies beckon adults who use traditional combustible cigarettes to make the switch to e-cigarettes. While companies may build a smokescreen to give the illusion that their products are intended to help adults, their actions tell a different story. E-cigarette products are aggressively marketed to our youth and young adults. These products can take on various shapes, forms, and names. Some devices look like regular cigarettes, while others look like USB flash drives and pens. With youth friendly packaging and an everyday tech design, combined with the false sense of being “safer�

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than traditional cigarettes, e-cigarettes have become the new gadget to get youth and young adults hooked on nicotine. In San Joaquin County, 5 % of students as young as 7th grade have used e-cigarettes and 16% of 11th graders have used e-cigarettes at least 4 times according to California Department of Education’s California Healthy Kids Survey.

The intention of e-cigarette companies may be to ween adults off combustible cigarettes, however the cost may be having another generation hooked on tobacco– and Big Tobacco knows that it.

Unicorn milk, buttered popcorn, peach rings, and blue raz cotton candy are not the newest food items for sale; instead, they are just four of over 15,000 “e-juice” flavors currently on the market.

Flavored tobacco is another strategy that Big Tobacco uses to addict new users. Addressing and defeating this latest attempt to recruit new tobacco users will require a unified community effort.

Practitioners are a key group in achieving this goal.

The provider role as patient educator and advocate cannot be overstated.

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What Practitioners Can Do

Practitioners can play an important role in educating parents and youth about the risks and signs of e-cigarette use and vaping. Often mistaken to be harmless, e-cigarettes contain the highly addictive substance, nicotine. Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. As we know, youth and young adult brains continue to develop well into their late twenties. For this reason, teens become more easily addicted to nicotine at a faster rate than adult consumers (U.S. Department of Health and Human Services, 2015). Although nicotine dependence can look different from person to person, symptoms may include cravings, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, and depressed mood. Nicotine can also have adverse physical health effects as it increases blood pressure and heart rate, which can increase the likelihood of cardiovascular complications. Lastly, defective e-cigarettes batteries have caused fires, explosions, and serious injuries. The truth is that vaping is another addiction that negatively impacts the health and safety of those that use them.

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it gives opportunities for retailers to enhance their store with healthier options that benefit the community. Over 100 local jurisdictions and cities throughout the state of California have adopted and implemented TRL programs and have seen a significant reduction in youth tobacco usage (The Center for Tobacco Policy and Organizing, 2018).

Another effective method at countering this strategy is through prohibition of the sale of flavored and mentholated tobacco products. Passage of local flavor policies reduces the opportunity for youth to have access to these detrimental products. Cities such as Sacramento, Livermore, Oakland, and San Francisco have already taken this step to protect their youth. When practitioners weigh-in on initiatives such as these, it can have a powerful effect in their community.

Conclusion

Getting Involved on a Larger Scale

It is equally important for practitioners to be advocates. Patient education is an integral step in achieving behavior change; however, combined with upstream approaches, behavior change can be more wide spread. There are evidence based, upstream approaches that have been proven to reduce or even eliminate youth tobacco initiation and usage. One approach that has been utilized across the state is the implementation of local Tobacco Retailer Licensing (TRL) programs. A TRL program gives the decision making voice back to the residents, so that they can determine how, when, and where tobacco products can be sold and marketed in their communities. Additionally,

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It has been documented that Big Tobacco has purposely targeted youth, communities of color, LGBTQ communities, and individuals experiencing low socioeconomic conditions to hook them on their deadly products (www.thetruth.com/thefacts). These populations then end up bearing a greater deal of the health consequences and diseases caused by tobacco usage.

Healthcare professionals can play an integral role in preventing another generation from being hooked on tobacco by being aware of the signs and symptoms of nicotine dependence, educating patients and parents about the harms of vaping, and being advocates for policies that prevent youth initiation of tobacco products.

The San Joaquin County Public Health Services Smoking and Tobacco Outreach/Prevention Program (STOPP) works in partnership with the community to promote a healthy and tobacco-free county for all who live, work and play in our communities. The STOPP Community Coalition collaborates with diverse community partners and residents to achieve a smoke and tobacco-free San Joaquin County. To get involved contact the STOPP Team at 209-468-2415.

Resources:

The Center for Tobacco Policy and Organizing. (2018).

Tobacco Retailer Licensing is Effective [Fact sheet].

Retrieved from https://center4tobaccopolicy.org/wp-content/ uploads/2018/09/Tobacco-Retailer-LIcensing-is-EffectiveSeptember-2018.pdf U.S. Department of Health and Human Services. (2015).

Let’s Make the Next Generation Tobacco-Free. Retrieved from https://www.hhs.gov/sites/default/files/consequences-smokingconsumer-guide.pdf

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