Fall 2022

Fall 2022

SERVING SAN JOAQUIN,

TUOLUMNE, ALPINE, AMADOR AND CALAVERAS COUNTY PHYSICIANS

DECISION MEDICINE IS BRINGING THEM HOM E A love for science is nurtured into love for serving the community

California’s Big Move on Data Exchange • Lifetime Achievement and Young Physician Award Photos

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HEALTHCARE PROFESSIONALS

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Meet the new best-in-class, where the principle of fair treatment guides every action we take in defense of our medical professionals.

For information regarding the NORCAL Group acquisition > > > 2 SAN JOAQUIN PHYSICIAN

ProAssurance.com FALL 2022

VOLUME 70, NUMBER 3 • SEPTEMBER 2022

PICTURED ABOVE: DECISION MEDICINE 2022 STUDENTS

9 A MESSAGE FROM OUR PRESIDENT

12 CALHEALTHCARES FOCUSES ON HEALTH EQUITY

16 CALIFORNIA’S BIG MOVE ON DATA EXCHANGE

22 L IFETIME ACHIEVEMENT AND YOUNG PHYSICIAN AWARD PHOTOS

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26 DECISION MEDICINE 2022 38 POETRY CORNER 40 IN THE NEWS 50 RESIDENTS' REPORT 52 PRACTICE MANAGEMENT 55 PUBLIC HEALTH

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PRESIDENT- Cyrus Buhari, DO PRESIDENT ELECT- Nguyen Vo, MD TREASURER- Neelesh Bangalore, MD BOARD MEMBERS Stephen Tsang, MD, Maggie Park, MD, Sujeeth Punnam, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD, Raghunath Reddy, MD, Kinnari Parikh, MD, Inderpreet Dhillon, MD and Bhagya Nakka, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Raghunath Reddy, MD MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Jo Ann Kirby, Cyrus Buhari, DO, Nasrat Esmaty, MPD THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society

SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD SUGGESTIONS, story ideas are welcome and will be reviewed CMA HOUSE OF DELEGATES REPRESENTATIVES

by the Editorial Committee.

Robin Wong, MD, Lawrence R. Frank, MD James R. Halderman, MD, Raissa Hill, DO

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Richelle Marasigan, DO, Ramin Manshadi, MD

San Joaquin Physician Magazine

Kwabena Adubofour, MD, Philip Edington, MD

3031 W. March Lane, Suite 222W

Harpreet Singh, MD

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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EXECUTIVE DIRECTOR’S REPORT

LOTS OF GOOD STUFF The summer began with our annual Lifetime Achievement and Young Physician Awards Dinner, where we honored deserving recipients, Drs. Paul Waters and Sanjeev Goswami and celebrated the passing of the gavel from Raghunath Reddy, MD to Cyrus Buhari, DO. We thank Dr. Reddy for his service and look forward to having Dr. Buhari at the helm.

LISA RICHMOND AND FAMILY

After spending time over at the coast in Aptos with family friends, I came back relaxed and ready for the craziness of the fast pace of our Decision Medicine program, which was back to being held predominately in person this year! We do not take for granted all the time and resources spent by our dedicated community partners to ensure the students have a fun, enriching experience.

As our community continues to grow into a bustling hub of graduate medical education, students had even more opportunities to interact with residents. They soaked up the information and advice as they learned there are many paths to medical school. No two personal stories were exactly alike. Undoubtedly, they were encouraged by these varying approaches and usually find someone they can relate to and often find a mentor.

We know you will enjoy reading our feature article on this year’s program and exciting updates from recent medical school admissions and residency matches. I will never tire of hearing from our DM alumni when they check in periodically. After her enrollment in Western University of Health Sciences, College of Osteopathic Medicine, Fatima Iqbal told me, “I have my experiences in Decision Medicine to thank for much of my exposure to medicine and the solidification of my desire for a career as a physician.” She is one of three from the 2016 cohort admitted to medical school this year!

I have mixed emotions as we enter the Fall. My daughter will be heading back for her senior year at UCLA and my last baby bird has graduated high school and will be flying off to study political science at UC Santa Barbara. It feels like just yesterday that we dropped him off at kindergarten! While I’m dreading the day, I’m sure my husband and I will eventually adjust to empty nesting and are looking forward to lots of fun visits down south. :) Finally, please save the date for our annual Holiday Party on Thursday, December 15 at Stockton Golf and Country Club.

Happy Fall,

Lisa Richmond

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60 Years of Compassionate Care Doctors Hospital of Manteca began 60 years ago with the mission to provide the best care possible to Manteca.

Today, we are a top employer in the community with over 370 employees and a staff of more than 180 physicians – many board-certified in their specialty.

From emergencies and screenings to surgical and procedural services, we deliver expertise and compassionate care close to home.

Doctors Hospital of Manteca offers: • 24-Hour Emergency Care and Convenient Online Check-Ins • 24/7 Intensivist Coverage for Critical Care • Advanced Orthopedics for Knee and Hip • Family Birthing Center • Imaging Services, Including 3-D Mammography • Surgical Services, Including Weight Loss Surgery • Women’s Health • Wound Care Center

•

Accredited as a Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®), the leading accrediting body for weight loss surgery •

Designated as a Blue Distinction® Center+ for Bariatric Surgery

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Designated as a Blue Distinction® Center for Knee and Hip Replacement

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Recognized as a Certified Quality Breast Center of Excellence in the National Quality Measures for Breast Centers program

To refer a patient, call (844) 632-5727 or visit DoctorsManteca.com 8

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FALL95336 2022 1205 E. North St. Manteca, CA

A message from our President > Cyrus Fram Buhari, DO

No Rest for the Weary I am humbled and honored to lead the San Joaquin Medical Society as its President. Many challenges lay ahead for the members of our profession. From the constant intrusion of political influences to the expansion of power from insurance companies, to the increased cost to providers to deliver care in the current economic environment. These challenges may at times seem daunting.

But as Abraham Lincoln often said, quoting the Bible, “This too shall pass.”

As physicians we have weathered the uncertainty of The Affordable Care Act, the full-frontal assault on the malpractice protections of MICRA, and daily attacks on the sanctity of the doctor-patient relationship. It is easy to look over the horizon and become depressed or disillusioned. However, I will offer this one piece of solace to all of my fellow physicians. We are not alone. In my opinion we are more together as a profession than at any other time. This is in large part due to physician-led organizations such as the California Medical Association (CMA) and the San Joaquin Medical Society (SJMS).

The unending bombardment of MICRA from outside organizations and trial lawyers caused CMA and the SJMS to devote time, money, and much needed resources year after year to fighting ballot measures with highly disingenuous titles. The MICRA Modernization Act was a leap forward in solidifying certain protections for physicians in California. There are many provisions in the bill that are unfortunate for physicians, however, the battle is done. We must move onward to the next front.

ABOUT THE AUTHOR Cyrus Fram Buhari, DO is the current president of the San Joaquin Medical Society and practices at the San Joaquin Cardiology Medical Group

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As I stated earlier, physicians are facing many challenges. One of the most pressing at this time is the fact that physicians have had to bear increasing costs of delivering care due to higher employee salaries, higher costs due to increased regulatory burdens, and higher cost of materials in healthcare amongst a whole litany of items contributing to higher overhead. This is not merely a financial

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A message from our President > Cyrus Fram Buhari, DO

issue. All of this has a direct effect on access to and delivery of care to the needful members of our community. Despite all of this, our legislators have not acted to stop looming cuts in reimbursement to physicians. In 2023 we are facing an almost 9% cut in reimbursement (4.5% from Medicare fee budget neutrality adjustments, and 4% from PAYGO legislation to offset costs of expanding entitlements). And as we all know, whatever medicare does is followed closely by our national and local insurance providers. Medicare physician payments are lagging nearly 40% behind inflation and the current cost to operate a medical practice. This is not only unsustainable… It is unacceptable. Nursing home and hospital payments have increased by over 60% while physician payments have increased a mere 7% despite increased efficiency resulting in a 1% decline in spending per Medicare patient.

As President of the San Joaquin Medical Society, I will work with the CMA who has declared this a top congressional priority, to continue to press our elected officials to see the value in stopping further cuts to Medicare physician

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payments. Additionally, it is far past time that physicians had a legitimate cost of living adjustment to reimbursement.

These much-needed additional dollars will go toward improving access and care to the members of our community. Amongst those most affected by these cuts are those most vulnerable: elderly, those of low socio-economic status, and minorities. If the United States Congress and the State of California do not act on these issues, we are looking at a devastating physician shortage in the very near future.

Not only will a large portion of the 34% over 60 and 50% over 50-year-olds choose to either retire or change locations, making physician recruitment more of a challenge than it already is.

My term as president will be in large part devoted to enlightening our elected officials and galvanizing our physician membership in unfettered support of both opposition to cuts in physician reimbursement and support of a real cost of living adjustment and inflation offset for physician practices. I look forward to the challenge and hope to bring real accomplishments in this area. Thank you.

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The California Department of Health Care Services (DHCS) recently announced it will fund $64.9 million in student loans for 222 physicians and 35 dentists through the CalHealthCares loan repayment program.

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CalHealthCares focuses on health equity, awards nearly $65M to health care providers to increase Medi-Cal access to care The California Department of Health Care Services (DHCS) recently announced it will fund $64.9 million in student loans for 222 physicians and 35 dentists through the CalHealthCares loan repayment program. The latest round of funding focused on equity, such as languages spoken by physicians, treatment of children ages 0-3, and the number of special needs patients seen by dentists. Also, the scoring considered experience working with underserved communities and the ability to provide culturally and linguistically competent care to Medi-Cal communities.

The CalHealthCares program works collaboratively to support and incentivize physicians and dentists to increase their participation in the Medi-Cal program. Receiving funding from the CalHealthCares program has relieved these providers of the burden of student loan debt, while allowing them to improve access to care and support to the underserved. CalHealthCares requires awardees to maintain a patient caseload comprised of a minimum of 30 percent Medi-Cal beneficiaries and within 10 percent of the Medi-Cal patient caseload proposed in their application.

“These awards to our doctors and dentists reflect our ongoing commitment to address the long-standing inequities impacting many of our Medi-Cal enrollees, which the COVID-19 pandemic has underscored,” said DHCS Director Michelle Baass. “The awards will remove the added burden that educational debt brings to a physician or dentist influencing where and how they will practice. Our hope is that without

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the financial stress of student loans, health care providers will continue their service to the Medi-Cal population once that patient base is established.”

Of the 257 awardees: 62 percent are persons of color 79 percent also speak a language other than English 67 areas of specialty medicine and four dental specialties are represented 57 percent committed to maintaining a Medi-Cal caseload of 65 percent or higher Among dentists, 80 percent treat patients ages 0-3, and 77 percent treat special needs patients For this fourth round of funding, CalHealthCares received 521 applications totaling approximately $135.4 million in funding requests to support applicant educational debt of nearly $175 million. Since the program launched in 2019, it has awarded $285 million in student loan repayments to 843 providers across California, increasing access to care for 14.8 million Medi-Cal beneficiaries.

CalHealthCares pays up to $300,000 in student loan debt relief in exchange for a five-year commitment to maintaining a patient caseload of at least 30 percent Medi-Cal patients.

Eligible dentists can apply for a loan repayment award up to $300,000 in exchange for a five-year service obligation or a practice support grant of up to $300,000 in exchange for a 10year service obligation. The program is open to providers in the

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first five years of practice.

Medi-Cal provides comprehensive health coverage to more than one-third of Californians, including nearly half of the state’s children, half of all people with disabilities, and more than one million seniors. Medi-Cal also pays for more than 50 percent of births and more than two in three patient days in long-term care facilities.

Already facing a statewide physician shortage, many California physicians and dentists enter practice with hundreds of thousands of dollars in educational debt. The average debt burden of a CalHealthCares applicant is nearly $360,000.

“With our health care system still recovering from the impact of the COVID-19 pandemic, our work is more important than ever to ensure that California’s most vulnerable residents are able to get the care they need,” said Physicians for a Healthy California (PHC) CEO Lupe Alonzo-Diaz. “Student loan debt is one of the biggest financial hurdles new physicians and dentists face. CalHealthCares is proud to be able to remove that burden for our awardees so they can follow their passion and provide care for the underserved.”

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In 2018, SB 849 established the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Program and appropriated a one-time allocation of $220 million for the loan assistance program for recently graduated physicians and dentists. An additional $120 million was added to the program in the 2019-20 state budget, for a total of $340 million. Senate Bill 395 (Chapter 489, Statutes of 2021) provided ongoing funding for the program.

“Without the crushing worries of student loan debt, awarded dentists will have the freedom to serve in communities where the need is greatest,” said Dr. Ariane Terlet, president of the California Dental Association. “CalHealthCares grants, along with other investments the state is making to ensure access to oral health care, will make a significant difference for all Californians.”

DHCS administers CalHealthCares, with PHC contracted to manage daily activities. The next application cycle will open in January 2023. For more information, visit CalHealthCares. org (#CalHealthCares on social media).

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Advanced Urology in Stockton If urological issues are keeping your patients from doing what they love, St. Joseph’s Medical Center is here to help. Our fellowship-trained urologists treat a wide variety of conditions, including those affecting the bladder, kidneys, prostate, and reproductive organs. Our specialists utilize the latest technologies available to treat the entire spectrum of cases, from the most common to the most complex.

Advanced treatment options include: • Robotic-assisted surgeries: • Prostatectomy • Nephrectomy • Cystectomy • Adrenalectomy • Bladder neck contracture • Pyeloplasty • Ureteral reimplant • Cystoscopy (visual scope inspection of the urethra) and bladder/prostate (in men) • Treatments for benign prostatic hyperplasia • Removal of kidney or prostate due to cancer • Removal of kidney stones • Anti-incontinence surgeries To learn more, visit dignityhealth.org/stockton/urology.

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California’s Big Move on Data Exchange With a combination of mandates, a new governing board, and publicly funded assistance, the California Data Exchange Framework (DxF) is set to pull health information exchange into the 21st Century.

Probably every physician practice has had the frustrating experience of trying to deliver the best possible care to a patient, only to be hampered by the inability to access relevant health information. Important pieces of a patient’s history, such as prescriptions, chronic conditions, or previous diagnoses may be trapped in data silos held in a million different places, inaccessible to the patient or the physician at the point of care. Myriad studies of the health care system have shown that lack of health information at the point of care often leads to duplication, waste, and delay.

Despite the widespread adoption of electronic health records (EHRs) across the state, this problem persists. A combination of technology challenges, competitive forces, and some legal uncertainty has kept data locked away from both patients and physicians.

Starting in 2020, the federal government began working to address this problem through the 21st Century Cures Act Final Rule, often known as the “Information Blocking Rule.”

This rule clarified in federal regulation that patients have the right to access their own medical information through the technology of their choosing. For the first time, physicians, hospitals, and health plans must make that information available. This rule started the country down the path of widespread and seamless data exchange.

Now, the California Medical Association (CMA), is working with the State of California to build on the federal regulations to accelerate and expand data exchange efforts here in the state. After a year of legislative negotiations, State Budget appropriations, and stakeholder meetings, the California Health and Human Services Agency (CHHS) on July 5, 2022, published the Data Exchange Framework.

The Data Exchange Framework, usually abbreviated “DxF”, will require all actors in the health care system – physicians, hospitals, health plans, skilled nursing facilities, etc. – to make patient data available to all other actors within the bounds of federal and state privacy laws. It will do this by requiring all those actors to sign the Single Data Sharing Agreement (described below). Once they have signed the agreement, practices and others will be contractually obligated to share data across the health care system.

Importantly, the Data Exchange Framework does not require practices to utilize any

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010101010001010100010 1010101010101010101 0101010100000001111111001001010

particular data sharing technology. The state is not building a “Statewide HIE.” When the law that created the framework was being written, CMA’s position was that physicians should have the flexibility to choose the technology that works best for their practice. Based on CMA’s advocacy, the law prohibits the state from forcing physicians into one system.

Instead, the Framework is intended to be “technology agnostic,” meaning that practices are free to choose the method of data exchange that works best for them. This could include a local health information organization, a national data sharing network, or other data sharing technology.

Now that the Framework has been published, the timeline for implementation is going to move quickly. It will be important for practices to familiarize themselves with the requirements of the Framework and begin their preparations as soon as possible. To help practices prepare, this article will give a high-level overview of the Framework, describe some things practices can do to prepare, and point them to some helpful resources CMA is developing.

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The Data Exchange Framework The Data Exchange Framework consists of four major components: 1. Data Sharing Requirement

As described above, the Framework includes a legal requirement that physician practices and other health care entities make data available to other signatories of the Data Sharing Agreement. The date by which practices must comply with this requirement depends on the size of the practice. In general, practices of more than 25 physicians will need to be engaged in data exchange by January 31, 2024. Practices smaller than 25 physicians will have 2 additional years, until January 31, 2026.

2. Single Data Sharing Agreement

o govern the Framework, the state has created the Single T Data Sharing Agreement (DSA). This document is a contract that all practices are required by law to execute

by January 31, 2023. The intent of the DSA is to act as a contract between physician practices, hospitals, health plans, etc., that they will make data available to each other

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upon request. The DSA lays out the parameters of how that data exchange should happen, predominantly via accompanying Policies and Procedures that describe what data elements need to be exchanged, privacy and security standards, and permitted uses of health data. The DSA also lays out practices’ responsibility to comply with the HHS Data Exchange Board (see below).

3. H HS Data Exchange Board

The State has proposed to create a 5-to-7-member governing body that will oversee data exchange in California. This board will be charged with overseeing and updating the Data Sharing Agreement, ensuring compliance with the DxF, and qualifying health information organizations. The details about this board will be included in a legislative proposal that will be introduced next year.

4. Technical Assistance for Small and Safety Net Practices

The 2022-23 State Budget included $50 million for providing technical assistance to small practices and other safety net providers. As of the writing of this article, there are no additional details to share. CMA is in actively engaged in ensuring that the funding will reach physician practices quickly and efficiently, to help them prepare for the DxF. For more details on these components, CMA members can access the CMA DxF Fact Sheet on the CMA website (see below).

Timeline A general timeline for the Data Exchange Framework is listed in the table below: DATE REQUIREMENT July 5, 2022 CHHS published the final Data Exchange Framework First Quarter 2023 The Governance Entity (see above) begins their work January 31, 2023 All health and human services organizations (including physician practices) must execute the Data Sharing Agreement January 31, 2024 Most health care providers (see table below) must implement the Data Exchange Framework January 31, 2026 Small and safety net practices (see above) must implement the Data Exchange Framework

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As you can see, practices are required to execute (sign) the have already signed an agreement to work together. As more Data Sharing Agreement in just a little over five months from entities become aware of the requirements of the DxF, lead the writing of this article. The state has not yet announced times to sign up with an HIO may become longer; it will help how that process will take place, so please watch for further to approach them soon. announcements from CMA or the State of California. In Finally, be sure to work with your EHR vendor, especially if addition, it is important for physicians to know that you you work with a smaller, specialty system. These systems can must sign the agreement by January require custom interfaces to onboard 31, 2023, even if your practice is small to an HIO, which can be both timeIf you participate in a enough to be in the cohort that does consuming and costly. On the plus medical group or an not have to comply until 2026. side, some EHRs connect through a IPA, a good place to national data sharing network, allowing start is by contacting you to comply without adding a new What Practices Can Do that entity to inquire vendor. Either way, it helps to include Now your EHR vendor early and often. about their plans With these new requirements coming for compliance with down over the next four years, CMA is Here to Help the Data Exchange practices will want to get started To help practices get ready for the on building their game plan for Framework. If you DxF, CMA is developing resources compliance as soon as possible. get access to an EHR as quickly as information becomes If you participate in a medical group system or population available. or an IPA, a good place to start is On June 28, 2022, CMA held an health platform through by contacting that entity to inquire online briefing on the Data Exchange the group or IPA, and about their plans for compliance with Framework. A recording of the briefing the Data Exchange Framework. If they already engage is available on the CMA YouTube you get access to an EHR system or in data exchange, an Channel (https://www.youtube. population health platform through individual practice may com/c/CMAdocs). the group or IPA, and they already In addition, CMA has published not need to sign their engage in data exchange, an individual a Fact Sheet that is available to all own DSA. practice may not need to sign their physician members on the CMA own DSA. website (https://www.cmadocs.org/ The organization will sign the Data LinkClick.aspx?fileticket=xKYGfZ6x7Zs=&portalid=53).

Sharing Agreement on your behalf, and data exchange will be The Fact Sheet summarizes the requirements and handled at that level. components of the DxF and includes a Frequently Asked For more independent practices, now is a good time to Questions document that will be updated regularly as more familiarize yourself with the health information organizations information becomes available.

(HIOs) that serve your community. Members of the Finally, CMA members can always call the CMA Member California Association of Health Information Exchange Helpline at 800-786-4262 for assistance. (https://www.ca-hie.org/about/members/) represent the largest and most well-established HIOs in the state. They

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The Most Amazing Care Anywhere® Shriners Children's Northern California celebrates 25 years in critical, surgical and rehabilitative burn care for children with exceptional patient outcomes and satisfaction. We are verified by the American Burn Association (ABA) and the American College of Surgeons (ACS) as a pediatric burn center.

With vast experience in the treatment of all types of burns, the burn team combines multi-disciplinary expertise with specialized equipment and individualized treatment plans. Our multidisciplinary team accepts children at any stage of burn injury and recovery. Our care also includes a wide range of treatments for various conditions: Conditions Acute Injuries Emergent Burn Care (burns of any size) Dog Bites Necrotizing Fasciitis Purpura Fulminans Stevens-Johnson syndrome Toxic Epidermal Necrolysis (TENS) Traumatic Wounds

Treatments Burn Reconstruction Burn Rehabilitation Critical Care Skin Grafting Scar Management

To Refer a Patient

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Emergency referrals: (916) 453-2111 | Non-emergent referrals: (916) 453-2191 FALL 2022 Email: referrals.ncal@shrinenet.org

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REIMBURSEMENT HELP: Members receive one-onone assistance from CMA’s reimbursement experts, who have recouped $33 million from payors on behalf of CMA physicians in the past 12 years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.

COVID-19: CMA understands that many physician practices are struggling in the wake of the COVID-19 outbreak. We are working closely with state and federal lawmakers to ensure physician practices remain viable, and that physician networks remain robust amid the financial uncertainty created by the COVID-19 crisis.

TELEHEALTH: Telehealth services have proven to be a critical tool for physicians so they can safely provide care to those who need it during the COVID-19 public health emergency. CMA has worked to ensure that government agencies understand the regulatory flexibilities necessary so that physicians can continue serving patients during the COVID-19 pandemic. From telehealth flexibility and payment parity, to waivers on privacy and security requirements to expedite the incorporation of telehealth into practice workflows, CMA has been at the table making sure policymakers understand the needs of physicians and their patients.

PHYSICIAN WELL-BEING: CMA believes physician

“The value that CMA brings to physician practices cannot be understated.

Membership is not a cost to my practice – it is an investment. I couldn’t run my practice without it.”

Tom McKenzie, M.D. Member since 1991

well-being and professional fulfillment are critical factors in maintaining patient access to quality care, and we must address this challenge at the organizational and systemic level. CMA’s Wellness Program launched Care 4 Caregivers Now in March 2020 to provide physicians with one-on-one emotional support from trained medical professionals in a safe, confidential and non-judgmental space.

EXPERT GUIDANCE: Staffed by experts with a combined experience of over 125 years in medical practice operations, CMA’s Center for Economic Services empowers physicians by providing resources and guidance to improve the success of their medical practices. Whether it’s identifying and fighting unfair payment practices, improving the efficiency of your practice, or guiding physicians through the contract evaluation and negotiation process, CMA has tools and resources to help.

QUESTIONS? CMA’s live-person call center is available Monday through Friday during business hours at (800) 786-4262 or via live chat at cmadocs.org.

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In June, SJMS celebrated Lifetime Achievement and Young Physician Award recipients, Drs. Paul Waters and Sanjeev Goswami, as well as passing of the gavel from Raghunath Reddy, MD to Cyrus Buhari, DO.

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Excellence in minimally invasive care.

St. Joseph’s Medical Center offers comprehensive interventional radiology (IR) services to treat many conditions that once required surgery. By utilizing minimally invasive techniques, IR procedures generally result in decreased risks, less pain, and shorter recovery times for patients when compared to traditional surgery. Whether your patients are experiencing back pain, chronic kidney disease, heart and vascular conditions, cancer, or men’s or women’s health issues, IR treatments are available to address many health concerns.

St. Joseph’s interventional radiologists have a wealth of experience and expertise in leading-edge, minimally invasive procedures. Featured services and treatments include: • • • • • • • • •

Angiography for vascular malformation Balloon kypohoplasty for vertebral compression fractures Cryoablation for kidney cancer Pain management to treat nerve pain (pain blocks) Percutaneous transhepatic biliary drainage (PTBD) Peripheral arterial and venous disease Prostate artery embolization (PAE) Radioembolization for liver cancer (Y90) Uterine artery / uterine fibroid embolization (UAE / UFE)

For more information, visit dignityhealth.org/stockton/IR or call IR scheduling at (209) 467-6323.

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T H E K E Y TO A B E T T E R YO U I S RIGHT NEXT DOOR. Dedicated to Family and Internal Medicine PROVIDERS

Dominic Pennisi, M.D., Internal Medicine

Guido Abellera, M.D.

Humayun Popal, NP

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SAN JOAQUIN PHYSICIAN 25 GILLPRIMARYCARE.COM • ACCEPTING NEW PATIENTS

DECISION MEDICINE IS BRINGING THEM HOM E A love for science is nurtured into love for serving the community

BY JO ANN KIRBY This summer’s Decision Medicine cohort featured two dozen highly motivated high school students who quickly learned that a job in health care can look very different than what they imagined but that all medical careers typically share a common goal of serving the community with passion and care. >>

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The two week program featured a fast-paced schedule of team-building, tours, mentoring, demonstrations, shadowing, Q&As, hands-on training and even detective work when they tried to add up health symptoms to reach a diagnosis on a baffling medical case.

Whether the career is one as a surgeon, physician assistant, nurse, ob/gyn, anesthesiologist, occupational therapist or any of dozens of others, these students learned in a Zoom session with Kaiser Permanente and other encounters throughout the program that working in the medical field is about serving the community with “our heads, our minds, our hands and our hearts.” Dr. Alain Flores, assistant physician in chief, The Permanente Medical Group, told the students that health professions are an opportunity to serve.

“To me, being involved in health care, whatever avenue of health care that you pursue, is really a vocation, it’s really a purpose. And when we go to join health care it’s really about

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providing service to others and in a different way,” he said.

It was a message that was repeated throughout the twoweek summer program.

Dayanara Flores, who is starting her senior year at Linden High School, was able to watch Dr. Jaicharan Iyengar, the chairman and interim program director of St. Joseph’s Orthopaedic Surgery Residency Program, perform two orthoscopic shoulder repair surgeries. It was something she vows to never forget, and she realized that being a surgeon

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I learned that the best interac tions are created by genuinely listening to w h a t o n e f e e l s . Ta k i n g t h e t i m e t o l o o k a w a y f r o m a s c r e e n o r p i e c e o f p a p e r m a k e s o n e f e e l l i k e t h e y m a t t e r. ” - DAYA N A R A F L O R E S , D M ‘ 2 2

requires more than years of training and experience, it requires an empathetic ear. “Dr. Iyengar is an individual that I will think about as I continue my life inside and outside of school,” she said. “After spending the day with him, I learned that the best interactions are created by genuinely listening to what one feels. Taking the time to look away from a screen or piece of paper makes one feel like they matter.”

Dr. Iyengar said he looks forward every summer to Decision Medicine. “I’ve found it to be incredibly fulfilling to see the whole life cycle of this,” he said. “I’ve had some of them come back in the summers after Decision Medicine to work on research projects with me. I’ve seen some come back as residents. I think the students are incredibly talented and energetic. Whenever I get Decision Medicine students, I try to schedule them on my OR days so they can see surgery, which can be very dramatic and very cool. They love it.”

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The goal of Decision Medicine, which was created by the San Joaquin Medical Society and is now in its 21st year, is to encourage high achieving, underprivileged and under-represented students, to consider a career in medicine in their home community by immersing them in a program that exposes them to the health care field up close and personal. While Covid-19 has continued to make some aspects of the program virtual, this year, the students had even more opportunities to see the innerworkings of health care up close and in person with program partners such as St. Joseph’s Medical Center, Adventist Health Dameron Hospital, UC Davis Medical School of Medicine, San Joaquin General Hospital, and others. Field trips to St. Mary’s Dining Hall and Gleason House gave students an eye-opening glimpse at the health needs of our community’s most vulnerable.

For Gurleen Sharma, a student at Bear Creek High School, it was an eye-opening experience. Like many of

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Decision Medicine Class of 2022 Jessica Alcala Stockton Early College Academy

Sukhpreet Kaur Health Careers Academy

Ariana Barraza Health Careers Academy

Isabella Lopez Lincoln High School

Guadalupe Celis Edison High School

Anthony Luna Stockton Early College Academy

Alondra Cervantes Ben Holt College Preparatory Academy

Shelby Miller Stockton Early College Academy

Manraj Chahal Ben Holt College Preparatory Academy Suleet Correa Lopez Health Careers Academy Kamerin Creighton Stockton Early College Academy Prabhnoor Dhillon Sierra High School Dayanara Flores Linden High School Hailey Gayler East Union High School Camila Mendez Franklin High School

Ashley Peterson Health Careers Academy Xadria Roberts Lathrop High School Isabel Santos Langston Hughes Academy Gurleen Sharma Bear Creek High School Sophia Sulamo East Union High School Jason Yan Stockton Early College Academy Laibah Zubair Ben Holt College Preparatory Academy

Suchi Kamboj Stockton Early College Academy

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her peers in the program, she is interested in medicine because she loves science. But she said Decision Medicine taught her “how we should give back and come back.”

It's a mantra that two Decision Medicine alumni took to heart after participating in the program when they were high school students.

Dr. Arashpreet Gill was a student at Tracy High School when she took part in Decision Medicine in 2011 and shadowed a family medicine physician. Now, she’s in the family medicine residency program at St. Joseph’s Medical Center. “There is a large part of our population who do not have access to doctors and Decision Medicine is a huge part of opening my eyes to that,” Dr. Gill said, adding that she was struck by the relationships she witnessed between a family medicine physician and their underserved patients when she shadowed during the program. “Honestly, it made it that much more exciting to come back to this community.”

Decision Medicine continued to have a positive impact on her journey well after high school.

“I even got advice for residency applications from someone who was a mentor in Decision Medicine,” Dr. Gill said. “I reached out even though I hadn’t talk to her in years. Dr. Vanessa Armendariz was a great resource. It does create those lifelong connections.”

Dr. Farwa Feroze, also a Tracy High School grad who returned to the area as a resident in San Joaquin General’s family medicine program, had a similar experience. “The main thing I remember was we went to the community health centers. That was one of my first experiences seeing homelessness in my community. There are these people there for them, trusting them with their health.

That was a side of medicine I had not been exposed to. That sparked my interest in public health,” said Dr. Feroze, who was initially inspired to go into medicine because of her family’s experience obtaining medical care for her nonverbal, autistic younger sister. “I loved that there was someone who was taking care of her and our family and checking up on us. I loved that aspect of it,” she said. “We need doctors who have strong connections with the community. I did choose to do my residency in our community to practice preventive health and public health.”

She and Dr. Kwabena Adubofour, who remembered

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“ W e n e e d d o c t o r s w h o h a v e s t r o n g c o n n e c t i o n s w i t h t h e c o m m u n i t y. I d i d c h o o s e t o d o m y r e s i d e n c y i n o u r c o m m u n i t y to prac tice preventive health and public health .”

- FA R WA F E R O Z E , D O

each other from her stint with Decision Medicine, reconnected while she was in medical school and rotating through outpatient clinics in Stockton. He was honored when she invited him to attend her hooding ceremony upon her medical school graduation from Touro University.

Dr. Adubofour is beyond thrilled with the success Decision Medicine has had in fulfilling its mission of inspiring young people to pursue a career in medicine here in their community. “I get teary-eyed when I think about it,” he said. To date, 20 DM alumni are in medical school, ten are currently in residency programs (four locally), two practicing

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physicians, a whopping 75 are in college with the aim of becoming doctors and 45 have embarked on careers as nurses, nurse practitioners, physician assistants or other related health careers. He has big plans for the future, connecting St. Joe’s internal medicine residents with students in the community, all with the same goal of encouraging them to pursue health careers in San Joaquin County.

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Medical School Admissions

Konterri Khun-Loyoza Touro University

Decision Medicine 2010

Fatima Iqbal

Western University of Health Sciences - College of Osteopathic Medicine of the Pacific

Jackey Tang

Drexel University College of Medicine

Decision Medicine 2016

Decision Medicine 2016 Bridge to Medicine Mentor: Amir AssadiRad, PhD

Kira Maszewski

UCSF Medical School

Decision Medicine 2015

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Jerice Banola

Johanna Bedoy

Decision Medicine 2016

UCLA Med School- Charles Drew

Boston University School of Medicine

(NOT PICTURED)

Decision Medicine 2015

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Residency Matches

Arashpreet Gill, DO

Jamie Lam, MD

Vida Seyedkazemi, DO

Decision Medicine 2011

Decision Medicine 2011

Decision Medicine 2012

Family Medicine Progam St. Joseph’s Medical Center

Emergency Medicine Kaiser Central Valley

Family Medicine Program Kaiser Los Angeles

Karen Hoi, MD

Aloukika Shah, MD

Farwa Feroze, DO

Decision Medicine 2011

Decision Medicine 2011

Decision Medicine 2013

Otolaryngology-Head and Neck Surgery UC Davis

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Internal Medicine- Primary Care Track UCSF

Family Residency Program San Joaquin General Hospital

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HPSJ Health Careers Scholarships Decision Medicine Students Honored During the 2022 Decision Medicine (DM) Celebration Banquet, at Brookside Country Club, Health Plan of San Joaquin (HPSJ) was there to present HPSJ Health Careers Scholarships to three of this year’s DM alumni. Pictured, from right to left, are DM graduates: Morgan Peters who will attend UC Davis and major in psychology with a focus in biology and minor in neurosciences with the ultimate goal to be a clinical neuropsychologist with a pediatric focus; Ahmad Karabala who will attend California North State University College of Health Science to study human biology and plans to be an oncologist or neurologist in San Joaquin County; and Arshdeep Gill who will attend University of the Pacific and major in computer science with plans to become a physician – and ultimately help bridge the technology/ medicine gap to advance the healthcare system.

Joining them (far left) is HPSJ Director of HEDIS and Accreditation Kathleen Dalziel, MHA, CPHQ. Attending the DM Celebration but not pictured is HPSJ Member Development Representative Diana Pauls, MSW, who coordinates the annual HPSJ Health Careers Scholarships.

Health Plan of San Joaquin (HPSJ) has been a long-time supporter of the Decision Medicine (DM) program. Years ago, they began to offer a scholarship to alumni of the program, which later grew to two recipients.

This year, with their unwavering commitment to the program, HPSJ leadership again elected to award three scholarships totaling $9,000.

HPSJ Chief Medical Officer Lakshmi Dhanvanthari,

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MD, said: “We believe that as our practicing providers and community are collaborating to get patients back to care over the coming years, it becomes even more essential HPSJ looks ahead now to support and encourage this next generation of students. The three awardees each received a $3,000 HPSJ Health Careers Program scholarship. Importantly, they will also have the benefit of a personal mentor from our professional HPSJ staff. Each mentor supports in myriad ways a hardworking, committed mentee for their health careers journey.”

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SJMS Presents Annual Rick Halligan Memorial Scholarship In 2017 SJMS established the Rick Halligan Memorial Scholarship. Rick was a Diagnostic Imaging Supervisor at San Joaquin General Hospital. He spent many years serving as Decision Medicine program coordinator for San Joaquin General Hospital and was one of its most passionate volunteers. Sadly, he passed away unexpectedly in late 2016.

During the recent celebration banquet, Jennifer Halligan presented Giselle Murillo, DM ‘21 with the $2500 scholarship in memory of her late husband.

Giselle will be studying Biology at the University of the Pacific this Fall and aspires to become a physician.

Jennifer is a quality review nurse at SJGH and has continued Rick’s legacy, becoming a champion for the program and assisting with coordination of the students’ visits to the hospital.

“Rick will always be remembered for his incredible sense of humor and enthusiasm for his profession and our Decision Medicine students” said Lisa Richmond, Executive Director of the San Joaquin Medical Society.

Thank You for Your Support!

Premier Financial Sponsor

Shadow Day Mentors

Health Plan of San Joaquin

Amin Esfahani, MD Bhagya Nakka, MD Diego Ferro, MD Erica Waters, MD Gauravjit Singh, MD Gentry Vu, MD George Khoury, MD Jaicharan Iyengar, MD John Canzano, MD John Olowoyeye, MD Kwabena Adubofour, MD Linda Sakimura, MD Marina Castillo, MD

Community Partners Adventist Health Dameron Hospital Community Medical Centers Kaiser Permanente San Joaquin General Hospital St. Joseph’s Medical Center St. Mary’s Dining Room UC Davis School of Medicine UCSF School of Medicine

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Mohammad Pathan, MD Raissa Hill, DO Randeep Bajwa, MD Richard Waters, MD Richelle Marasigan, DO San Tso, DO Sujeeth Punnam, MD Thomas McKenzie, MD

And so many more who contributed their time and expertise!

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Poetry Corner You are the Software

Remember this always and with every patient encounter.

The patient never came to see the stiff ware encased in the EHR. Your healing codes were never Written in bits and bytes.

Your language has never been binary, It has always been rich and extraordinary.

Remember who you are.

You are the true software.

You are more than a doctor.

You are a healer filled with dignity and kindness.

Your software is a heart unmatched, A brain that cannot be replaced by AI. For your operating systems are not filled with ones and zeros.

Your operating systems are built on the rich Tapestry of love and empathy and compassion.

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A software language seeped in intermingled nerves and nano amounts of neurotransmitters.

A software language beautifully arranged with unimaginable grandeur and complexity.

You are beautifully created.

You are not the stiff ware labelled EHR Turn around. Face your patient Listen quietly.

Listen to really listen, Listen to understand and be mindful Of every complaint whether they be shallow or deep Be in attendance.

Be present.

Palpate and marvel in every pulse, every breath sound.

You have 10 to 20 minutes. Use it.

Relegate the stiff ware to the minor leagues.

You are a major player in these healing arts Remember who you are – the true software.

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We are Resilience

We are nurses We are physicians Our other name is resilience.

Bestowed on us by experience.

For what is resilience If not a heart that refuses to race Arbitrarily at the sight of adrenaline.

For what is resilience If not a heart that spikes With compassion at every spike of this pandemic.

For what is resilience If not a heart that spikes with kindness and empathy And dignity at every spike of this pandemic.

For what is resilience If not a heart that spikes with Enduring professionalism At every spike of this pandemic.

For what is resilience If not a hear that refuses to turn away And be smothered in a little corner of the universe.

We are resilient Do not tell us otherwise.

We were born resilient.

That is why we do what we do With spikes of grace With spikes of joy With spikes of gratitude, Every day and at every turn.

The spikes of this pandemic

About the author:

Kwabena O.M Adubofour, MD, FACP practices internal medicine at the East Main Clinic and Diabetes Center. He is the chair of the medical staff wellness committee and co-chair of the graduate medical education wellness committee at St. Joseph’s Medical Center.

Will never out-spike Our willingness to stay true to this calling To stay true to this vocation.

We are not just nurses We are not just doctors We are healers with extraordinary fortitude.

Creative writing is a wonderful outlet for physicians for overall wellness.

Do you have a poem or other piece to share? Please email to Lisa@sjcms.org

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In The News

IN THE

NEWS

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

Shriners Children's Uses Unique Expertise to Describe Burn Survival At Shriners Children's Northern California, severely burned children have significantly increased odds of survival. The hospital was able to put together a case series describing the prognosis in the 21st century.

Among other things, the series showed that for children with burns covering 50% or more of total body surface area, the number of days in the hospital tends to be about twice the body-surface-area percentage, and approximately half of that is in the intensive care unit. The average number of surgical procedures is six.

In most severe burn injury fatalities, significant inhalation injury is present. Forty percent of the patients in the series had an inhalation injury. Their risk of death was three times higher than for those without.

Prior to this data, providers had little idea of what to tell patients and their families about expectations during their hospitalization, said Sally Martens, FNP-C, the lead author of the publication, which is in the Journal of Burn Care & Research.

Adventist Health Lodi Memorial Receives QUEST® Award for High-Value Healthcare Adventist Health Lodi Memorial received the Premier QUEST® Award for High-value Healthcare. The award recognizes hospitals for achieving top performance in all five dimensions of the quality improvement program, as well as the top performers in six different peer groups.

The QUEST collaborative was created by Premier Inc.,

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Adventist Health Lodi Memorial a leading healthcare improvement company. Adventist Health Lodi Memorial was one of only six recipients of the QUEST® Award for High-Value Healthcare in the nation.

Adventist Health Lodi Memorial and Dameron Hospital Receive Get With The Guidelines® Stroke Awards Adventist Health Lodi Memorial and Dameron Hospital have received the American Heart Association/American Stroke Association’s 2022 Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award and Stroke Silver Award, respectively.

The prestigious awards recognize both hospitals’ commitment to ensuring stroke patients receive the most appropriate treatments, according to nationally recognized, research-based guidelines.

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To receive the Gold Quality Achievement award, Adventist Health Lodi Memorial had to receive 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for at least 24 consecutive months.

The Gold Plus Quality Achievement is an even more advanced level of recognition, acknowledging the hospital’s consistent compliance with quality measures. The Silver Award recognizes Dameron Hospital’s adherence to the achievement indicators for a span of 12 months.

Adventist Health Lodi Memorial earned further recognition for Target: Stroke Honor Roll award which means 75 percent or more of acute ischemic stroke patients who were treated with IV tPA, received thrombolytic therapy within 60 minutes.

Additionally, both hospitals received the Association’s Target: Type 2 Diabetes Honor Roll award. To qualify for this recognition, hospitals must meet quality measures with more than 90 percent compliance for twelve consecutive months for the “Overall Diabetes Cardiovascular Initiative Composite Score.”

“It is always an honor to be recognized for outstanding patient care” said Chief Medical Officer Eric Cornwell, MD. “These awards are a reflection of the hard work and dedication of our stroke teams, who are committed to providing advanced stroke treatments to our patients as quickly and effectively as possible.”

Introducing Amarin Suriyakhamhaengwongse, MD Amarin Suriyakhamhaengwongse, MD, treats acute physical rehabilitation patients at Adventist Health Lodi Memorial.

Dr. Suri, as he prefers, partners with our acute physical rehabilitation team of experts to treat adult patients of all ages, bringing with him extensive training.

Amarin Suriyakhamhaengwongse, MD an advocate for my patients and community.”

Dr. Suri is fluent in English, Punjabi and Hindi; originally from Bakersfield, he is excited to expand his practice in Lodi.

Introducing Osama Zahriya, MD Dr. Zahriya is a board-certified general surgeon with experience in laparoscopic, scope and robotic surgery, treating common conditions such as hernias, gallbladder removal and colon resections.

Dr. Suri received his medical degree from St. George’s University School of Medicine before completing an internship at Flushing Hospital Medical Center and his residency at Kingsbrook Jewish Medical Center. His training in physical medicine and rehabilitation enables him to treat patients in stroke rehabilitation, brain injury rehabilitation, pulmonary and cardiac rehabilitation, and sports medicine.

Dr. Suri truly enjoys being a physician. “My favorite part is the opportunity to help patients during their rehabilitation journey and helping to improve their quality of life,” says Dr. Suri. “I love developing rapport with patients and their families and being

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Osama Zahriya, MD

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In The News

IN THE

NEWS Originally from Michigan, Dr. Zahriya trained internationally at the American University of the Caribbean before completing his residency at the Detroit Medical Center. He was first inspired to practice medicine by his father, who is also a general surgeon. Dr. Zahriya is continually driven by a desire to help others and his favorite part of his job is seeing a patient immediately feel better after an operation.

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

intensivist program may include increased survival rates, reduced morbidity, reduced ICU length of stay, fewer clinical/procedural complications, improved patient and staff satisfaction, and a higher focus on patient safety.

When Dr. Zahriya is not in the operating room, he can be found staying active in the gym playing racquetball or making pizza with his wife and five children. He is incredibly excited to serve the Lodi community and offer the highest level of care possible to his patients.

This program allows Doctors Hospital of Manteca to care for critically ill patients in their own community. Oftentimes, small community hospitals are forced to transfer their highest acuity patients to larger hospitals outside of the community, placing additional stress on patients and their families during an already stressful time. Our patients can rest assured they are getting the highest-quality and most knowledgeable care right here in Manteca.

Doctors Hospital of Manteca Launches ICU Intensivist Program To meet the growing need for critical care services available close to home, Doctors Hospital of Manteca has launched an ICU Intensivist Program.

Doctors Hospital of Manteca Auxiliary Awards Scholarships to Local Students The Doctors Hospital of Manteca Auxiliary has awarded $20,000 in scholarships to four students for the 2022-2023 school year.

Effective Thursday, Sept. 1, 2022, intensivists will provide 24/7 comprehensive care to the hospital’s critically ill patients in the Intensive Care Unit (ICU). Intensivists are physicians who are board-certified in critical care medicine.

Congratulations to the following students:

Historically, Doctors Hospital of Manteca’s ICU has been covered by hospitalists with consultations provided by community pulmonologists. The hospital is now teaming up with its sister hospitals, Doctors Medical Center in Modesto and Emanuel Medical Center in Turlock, to utilize the same group of intensivists to provide a continuum of care across all three hospitals. There will be five intensivists providing critical care coverage at Doctors Hospital of Manteca.

Cole Mattila – William Jessup University, majoring in Physical Therapy

Some of the benefits associated with having a dedicated

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Gurleen Kaur – University of California, Berkeley, majoring in Psychiatry

Kiersten Melan – California State University, Stanislaus, majoring in Nursing Gagandip Singh – University of Alabama at Birmingham School of Medicine, focusing on General Surgery Profits from the hospital gift shop funded these scholarships for college students who are pursuing careers in healthcare.

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Applicants must be a permanent resident of San Joaquin County and from the Manteca Unified School District, which includes Lathrop, French Camp, and Weston Ranch, or from the Ripon Unified School District. They must also be at least a second year student taking pre-requisite coursework to be accepted into a medical or health-related program.

Doctors Hospital of Manteca Earns ACR ReAccreditation Doctors Hospital of Manteca has been awarded a three-year term of re-accreditation in computed tomography (CT) as the result of a recent review by the American College of Radiology (ACR).

Applications are reviewed on grade point averages, volunteer history, community involvement, leadership experience and financial need.

Doctors Hospital of Manteca has voluntarily gone through a vigorous review process to ensure the facility meets nationallyaccepted standards of care.

“Offering the latest diagnostic imaging technology by highlyqualified technologists has always been a priority for Doctors Hospital of Manteca,” said Paul Bhangu, Director of Imaging Services. “We are proud to receive this accreditation which attests to that dedication. Patients can rest assured that their prescribed imaging tests will be done at a facility that has met the highest level of imaging quality and radiation safety.”

Tenet’s CMO Retires

Doctors Hospital of Manteca offers advanced technology that looks inside the body to aid in the diagnosis of disease or injury.

With a board-certified radiologist and imaging technologists, Doctors Hospital of Manteca provides a full range of diagnostic testing to help area providers provide the best care possible.

Tenet’s Northern California Group Chief Medical Officer Retires The Chief Medical Officer (CMO) for Tenet Healthcare’s Northern California Group hospitals, Adrian “Eric” Ramos, M.D., FAAFP, retired from his role at the end of June.

Dr. Ramos had been serving as Tenet’s Group CMO since November 2020. The group includes Doctors Medical Center, Doctors Hospital of Manteca, Emanuel Medical Center, San Ramon Regional Medical Center, Sierra Vista Regional Medical Center and Twin Cities Community Hospital. He brought a wealth of healthcare leadership experience to this role in which he focused on helping the hospitals optimize quality of care through outcome measurements and performance improvement processes.

Dr. Ramos was a true asset during the pandemic. His comprehensive knowledge in leading healthcare teams has been evident throughout his tenure. He has been an excellent leader for the hospitals and their medical staffs.

Dr. Ramos has been a part of the community for many years and he will be missed. Tenet thanks Dr. Ramos for his incredible service and wishes him the best in his retirement.

15,000 Servings of Cereal Donated Hospitals Collect Nearly 15,000 Servings of Cereal for Local Families Doctors Medical Center, Emanuel Medical Center and Doctors Hospital of Manteca are pleased to announce the three hospitals together donated nearly 15,000 servings of cereal and more than $3,700 to Second Harvest of the Greater Valley, during their Healthy Over Hungry Cereal Drive on June 6-13, 2022.

The donations collected helped provide local children and adults

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In The News

IN THE

NEWS

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

struggling with hunger with a healthy breakfast during the summer.

Good nutrition is essential to good health, and summer is a particularly tough time for many food-insecure families because children can no longer rely on schools for nutritious meals, putting an added burden on these families.

The monetary donations collected will be used to buy perishable items such as milk, fruit/vegetables, and lean protein that can complement whole grains and help create a complete healthy breakfast.

Doctors Medical Center, Emanuel Medical Center and Doctors Hospital of Manteca are proud to help so many in our community and are grateful for the support of staff members and the community in this effort.

St. Joseph’s Medical Center Receives Fortune/ Merative 100 Top Hospitals® Recognition Dignity Health St. Joseph’s Medical Center (SJMC) has been named a 2022 Fortune/Merative 100 Top Hospitals®. The recognition is St. Joseph’s first time among the top-performing teaching hospitals in the U.S. Merative, a data, analytics, and technology partner for the health industry, has identified the top hospitals from a rigorous evaluation of 2,650 short-term, acute care, non-federal hospitals in the U.S. The annual list recognizes excellence in clinical outcomes, operational efficiency, patient experience, and financial health.

Merative, formerly IBM Watson Health, established the list to help identify best practices that may help other healthcare organizations achieve consistent, balanced, and sustainable high performance. This year, the 100 Top Hospitals program incorporated a community health measure into its ranking process, it was weighted equally with other ranked measures, and SJMC’s efforts scored 100% in that measurement category.

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Pavan Khanna, MD St. Joseph’s Medical Center Completes 500th Minimally Invasive Y90 Cancer Treatment Procedure Dignity Health St. Joseph’s Medical Center (SJMC) has reached the milestone of completing 500 Yttrium-90 (Y90) procedures, led by Dr. Pavan Khanna, Chair and Medical Director, Department of Diagnostic and Interventional Radiology.

Radioembolization selectively delivers high doses of internal radiation to tumors through the arteries and utilizes millions of microscopic glass radioactive spheres containing radiation, called Yttrium-90 (Y90). Radioembolization is one of the few treatment options for hepatocellular carcinoma, the second fastest growing and fifth most common cancer.

Dr. Khanna started the liver cancer treatment program at SJMC in July 2017, making it the first hospital in the Central Valley to offer Y90 radioembolization. Over the past five years, Dr. Khanna’s team has performed more Y90 procedures than any other community hospital on the West Coast, ranking it as one of the top treatment centers in the country.

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SJMC Receives $20K Medical Education Diversity and Inclusion Grant The Alliance for Academic Internal Medicine, the American Board of Internal Medicine, the ABIM Foundation, the American College of Physicians, and the Josiah Macy Jr. Foundation have awarded a total of $400,000, split among 24 projects at medical schools and training programs. A $20,000 grant is being distributed to St. Joseph’s Medical Center (SJMC) to improve the quality of education and training to build a more trustworthy health system.

With this funding, SJMC will use didactic education and experiential opportunities with community-based organizations and opportunity youth to enhance internal medicine residents’ understanding of the relationship between social determinants of health and the importance of health equity. Black, Southeast Asian, and Hispanic community members’ trust will be measured, and medical residents will follow a cultural competency/sensitivity curriculum to increase their awareness of the beliefs, values and biases they bring to patient encounters, and improve their ability to interact effectively with individuals different from themselves.

St. Joseph’s Foundation of San Joaquin Appoints Two New Board of Directors St. Joseph’s Foundation of San Joaquin selected two new board of directors to join in their mission of supporting quality healthcare in the community. James Acosta and Mark Rishwain are stepping into their roles effective July 1, 2022.

The foundation board of directors consists of volunteer board members representing the San Joaquin community. The expertise and talents of our board members includes business, finance, law, medical, and more.

James Acosta is a local certified public accountant and senior manager at Iacopi, Lenz & Company in Stockton. “I have been involved, as a volunteer, with St. Joseph’s Medical Center and the foundation for over 30 years. During those years, I have had the pleasure of meeting and working alongside many individuals who also believe in supporting our community,” said Acosta.

Mark Rishwain has practiced law in California since 1986 and is a partner at Rishwain & Rishwain, P.C. in Stockton. “I’m excited to serve on the foundation board. The foundation has a fantastic team.

I look forward to helping increase public awareness and interest in the many new healthcare programs and services the medical center is providing to support our community,” said Rishwain.

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The Board of Directors of St. Joseph’s Foundation of San Joaquin also includes officers Suzanne Ledbetter, chair; Patrick Velasquez, vice chair; Donald Wiley, president; Nikki Ochoa, treasurer; and Jamie Spaulding, secretary.

Lauren Brown-Berchtold, MD

Latest pregnancy resource is available in San Joaquin County!

Pregnancy Connections is a prenatal program serving any pregnant person who lives in San Joaquin County who is also either unhoused (or unstably housed), and/or using substances, and/or has been diagnosed with syphilis at any time in their lives.

Family Medicine Residency Program (FMRP) Associate Director Lauren Brown-Berchtold, MD, oversees the Pregnancy Connections program which is housed within San Joaquin Health Centers (previously known as San Joaquin County Clinics). The program, available at SJ Health’s French Camp health center, is one of only five such prenatal pilot clinics in the U.S. Dr. Brown-Berchtold said: “Entering prenatal care is the single most effective way to support the health of mom and baby. In particular, the risk of untreated maternal syphilis, and subsequent diagnosis of a newborn with congenital syphilis, can be significantly reduced with appropriate pregnancy care. This is important as syphilis and congenital syphilis cases are on the rise across much of the United States. San Joaquin County has one of the highest rates of syphilis in California.”

Pregnancy Connections offers prenatal patients multilingual,

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16 months of membership for the price of 12 Starting September 1, new medical organizations that join and pay in-full for the next year will receive the remaining months of this year for free.

Join nearly 50,000 physicians making a direct impact on the practice of medicine and the health of California.

Visit cmadocs.org/join or call (800) 786-4262 to unlock your benefits today!

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FALL 2022

culturally sensitive care including easy scheduling, drop-in hours, resource referrals, and door-to-door transportation support to help patients access the prenatal care they deserve.

Community-Based Organizations working with potentially eligible pregnant clients are encouraged to reach out to the Pregnancy Connections case manager (626-669-5046) for referrals, to obtain brochures and flyers, or to schedule a meeting for more information regarding program services. Healthcare providers can also contact the case manager to learn how the program can support prenatal patients that might benefit from this model of care.

SJ Health supports patients served by Medi-Cal (Regular and Managed Care), Medicare, Family Pact, and those without health coverage.

Expanded transportation support for some Health Plan of San Joaquin members Transportation via rideshare is now available with a simple call to Customer Service at 888.936.PLAN (7526), TDD/TTY 711, for: HPSJ prenatal members going to their doctor, and for HPSJ members up to 15 months going to their well child appointments.

Infant Formula Guidance The infant formula shortage is a continuing challenge for many parents. Though the shortage is affecting families nationwide there are things we can do locally to keep kids fed and healthy. Stanislaus County Health Officer Dr. Julie Vaishampayan and Dr. Priti Golechha, Associate Chief Medical Officer for Health Plan of San Joaquin, have coauthored Q & A guidance and tips, plus advice for those who want to get their breast/chest milk supply up. Find their article at hpsj.com/infant-formula-shortage/. The online newsletter of San Joaquin County Public Health Services has an Infant Formula Update at sjcphs.org/.

Getting Ready for a Healthy School Year Immunizations, developmental tests & health screenings As provider partners stand ready to welcome patients back to care, Health Plan of San Joaquin continues to reach out to parents and guardians, reminding them to schedule FREE annual well child visits for young HPSJ members. A quick Well Child guide by age is available to all members at https://tinyurl.com/4bks7amn. HPSJ

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members up to 21 years of age may be eligible for a $25 reward for annual well child visits. They can learn more at www.hpsj.com/ myRewards. Information on related HPSJ provider incentives that can help practices improve quality and increase earning potential, is at hpsj.com/provider-incentives/. Also while there providers will find access to the secure portal for GAP reports, to see if their HPSJ patient is up to date with wellness visits.

HPSJ Adolescents & Young Adults (11-21) Need Family Well Visits Too! During a time of many physical, emotional and relationship changes, Well Child visits tailored to their needs are essential as each prepares for a healthy adulthood. Well Child visits make sure they keep up with recommended vaccinations to prevent diseases (listed on the CDC site, https://tinyurl.com/2p9f74cp), get ahead of potential problems with important screenings (including diabetes, anemia, depression, STDs, and tobacco/alcohol/drug use) – and allow them to ask their doctor questions about what’s happening with their body. This complete annual exam is FREE for Health Plan of San Joaquin members – and is more thorough than a sports physical.

Improved Payment Experience for Health Plan of San Joaquin (HPSJ) Providers In October 2022, HPSJ will implement a new provider payment system. If not already completed, HPSJ providers are asked to click https://tinyurl.com/4zkrfhkn to update their contact information or call their HPSJ Provider Services for support at 1.888.936.

PLAN (7526).

Local Cooling Zones For staff and patients, Health Plan of San Joaquin offers "How to Avoid Deadly Heat Sickness" at https://tinyurl.com/54kf63dn, including links to San Joaquin and Stanislaus County information on nearby cooling hubs. Please check with locations to confirm hours.

LOOK & LEARN - NEW Virtual Series from Health Plan of San Joaquin HPSJ providers are now receiving monthly invitations for short, mid-day sessions. Click https://tinyurl.com/sfjcasyp to catch up on the first video recordings in this series and save the dates for

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In The News

IN THE

NEWS upcoming Look & Learns including: (September 21) Preparing for Fall Flu Season, Preventive Care Gap Reports and COVID-19 Update; (October 19) breast cancer awareness month, and men & women’s preventative health care; (November 16) 2023 Provider Incentive Program and a long term care (LTC) presentation; and (December 21) overview of changes coming in 2023.

Kaiser Permanente Hospitals in Northern California Recognized for Providing High-Quality Stroke Care The American Heart Association is recognizing 20 Kaiser Permanente Northern California hospitals with an award for delivering high-quality stroke care, using practices that speed recovery and reduce death and disability for stroke patients.

These Kaiser Permanente Northern California hospitals received the Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award and the Target Stroke Honor Roll Elite Plus Award: Antioch, Fremont, Fresno, Modesto, Oakland, Redwood City, Richmond, Roseville, Sacramento, San Francisco, San Jose, San Leandro, San Rafael, Santa Clara, Santa Rosa, South Sacramento, South San Francisco, Vacaville, Vallejo, and Walnut Creek.

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

“Our Kaiser Permanente clinicians and staff work together to deliver excellent patient-care outcomes with a focus on prevention and use evidence-based treatment protocols to get the right care to our stroke patients as quickly as possible,” said Carrie Owen Plietz, FACHE, president of Kaiser Permanente’s Northern California region. “We are proud to be recognized for our commitment to providing high-quality care to our stroke patients so we can give them the best chance at a full recovery.”

To qualify for this award, the hospitals had to meet specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period of time.

These measures include evaluation of the proper usage of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines to speed recovery and reduce death and disability for stroke patients. Before discharge, stroke patients also needed to receive education on managing their health and schedule a follow-up visit, as well as other care transition interventions.

“This recognition is a testament to the commitment of our physicians and clinicians, who continue to be at the forefront of delivering innovative care and highly-effective treatments to our stroke patients,” said Richard S. Isaacs, MD, FACS, chief executive officer and executive director of The Permanente Medical Group (TPMG).

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BECOME A MEMBER OF SJMS/CMA

Here are just some of the benefits ...

San Joaquin Medical Society Resources: • Annual Directory • Quarterly Magazine • • • •

Social Events Office Managers Forum Leadership Opportunities Patient Referrals

CMA Resources: • • • • • •

Legal Help Contract Analysis Billing Assistance Education Resources News Updates Practice Resources

• Member Discounts

Federal, State, and Local Advocacy: Dues support advocacy efforts to protect the profession of medicine and your patients

Serving the counties of San Joaquin, Calaveras, Alpine, and Amador

(209) 952-5299 www.sjcms.org FALL 2022

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RESID

ENTS' REPORT A PLACE FOR ALL NEWS HIGHLIGHTING RESIDENTS AND GRADUATE MEDICAL EDUCATION

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SJGH INTERNAL MEDICINE PROGRAM WELCOMES INTERNS As the 2022-2023 academic year has begun, the Internal Medicine Residency Program here at SJGH would like to extend a warm welcome to our incoming interns Class of 2025. In addition, the program has been approved through our Sponsoring Institution (SJGH) and ACME to increase our compliment to 30 residents and would like to welcome the additional 2nd year residents who have joined us. We look forward to another successful year.

The NEW Resident’s Report is dedicated to all the good news related to our hard-working residents training at San Joaquin General Hospital and St. Joseph’s Medical Center.

Please email your submissions, written in third person with accompanying photo to Lisa@sjcms.org.

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SJGH’S SIM LAB OFFERS HANDS-ON TRAINING The Internal Medicine Residency program has always fostered the concept of education in new arenas. Our Simulation Lab utilizes mannequins to conduct Mock Codes on a regular basis to train our interns, residents, and med-students to respond to codes called in the hospital.

ST. JOSEPH’S MEDICAL CENTER WELCOMES NEW RESIDENTS Over the summer, St. Joseph's Medical Center welcomed 60 new residents, with specialties including Anesthesiology, Emergency Medicine, Family Medicine, Internal Medicine, Psychiatry, Neurology, and Urology. For Academic Year 22-23, St. Joseph's has a total of 138 residents.

In June, nine Emergency Medicine residents and four Family Medicine residents graduated. Of the graduating residents, six will stay locally at SJMC and eight of the thirteen graduates will remain in the Central Valley.

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INTERNAL MEDICINE RESIDENTS SHARE THEIR EXPERIENCE In July, during the San Joaquin Medical Society’s Decision Medicine program, a panel of St. Joseph’s internal medicine residents joined the students during their college preparation day. They each shared their journey to medicine and how they handled obstacles along the way. No two were the same, illustrating that there are many ways to achieve the goal of becoming a physician. They concluded the session with a Q & A that could have continued for hours. The students were grateful for their time and insights. In following months, the internal medicine residency program will be implementing a plan to provide mentorship and further engagement with students in our community.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. This monthly forum is normally held on the second Wednesday of each month, in person at Papapavlo’s.

Registration is required!

If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org

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September 14, 2022: 11:00AM to 1:00PM

“CPR on the Road” This presentation focuses on an overview of recent CMA Practice Resources (CPR) hot topics that include critical payor and health care industry changes and how they directly impact the business of a physician practice. Presented by one of CMA’s experienced practice management experts, the presentation will cover various topics in healthcare highlighting concerns, challenges, options, grassroots efforts and advocacy efforts to address these issues.

Mark Lane, Director of Publications and Resources in the CMA’s Center for Economic Services, began his career as a claims processor for plans such as Blue Shield of California and Health Net. Over the next 23 years, Mark has rose steadily through the healthcare ranks to fulfill leadership roles in claim operations, customer service, provider relations and contracting allowing him to gain a unique vantage point on the relationship between physicians and payors.

October 12, 2022: 11:00AM to 1:00PM

“ Top Ten Tips to Avoid “Practice Management Hypertension”

Physicians and Managers today are feeling the stress of many aspects of running the practice and this can lead to many forms of “Practice Management Hypertension”.

This workshop will provide tips to lower your blood pressure and resultant anxiety to successfully navigate the business side of the practice. Most medical schools never teach physicians in residency about the business principles. It is just as important to invest in education about the business side of medical practice throughout your career as the clinical aspects.

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Learning Objectives: Attendees will learn strategies to: • Lessen the stress of running the business side of the practice • Avoid risks to the practice such as labor law, insurance and malpractice claims • Benchmark the practice with Key Performance Indicators to hold staff accountable and increase net income

Topic covered include: 1. “EMR Hypertension” 2. “Health Care Reform Hypertension” 3. “Cash Flow Hypertension” 4. “Malpractice Hypertension” 5. “Personnel and Labor Law Hypertension” 6. “Medicare Fraud and Abuse Hypertension” 7. “OSHA/HIPAA Compliance Hypertension” 8. “Mergers, Acquisitions, Foundations, Practice Integration Hypertension” 9. “IPA/Health Plan interaction Hypertension” 10. ‘Physician/ Manager Burnout Hypertension” Debra Phairas, President of Practice & Liability Consultants, LLC

November 9, 2022: 11:00AM to 1:00PM

“ Health Plan of San JoaquinHow to sell prevention to your patients + Tips to help your practice succeed”

Learn from HPSJ staff and public health partners how to engage HPSJ members in your practice for lead testing, oral health fluoride varnish application, childhood immunizations and more. Additionally, the staff will present information regarding the transition to the new payment system, transportation for members and share claims updates.

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December 14, 2022: 11:00AM to 1:00PM

“ Medicare Changes 2023 and Beyond” 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!

DHCS has decide to further delay implementation of Reject Code 80 (Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria) due to stakeholder feedback that implementation of Reject Code 80 could necessitate submission of prior authorizations prior to the timeframe targeted for prior authorization reinstatement, which could interfere with the delivery of timely and safe pharmacy services to Medi-Cal beneficiaries.

Cheryl BradleyAssociate Director of CMA’s Center for Economic Services

Although claims submitted to Medi-Cal Rx will not be edited for a diagnosis code, DHCS is reminding providers of their obligation to meet and document Code 1 restrictions and to keep that information readily available.

CMA PRACTICE RESOURCES

It is unclear when Reject Code 80 will be turned back on. However, DHCS has previously indicated that sometime in August, the following drug classes will again require prior authorization: Diuretics Lipotropics, including statins and omega‐3 fatty acids

Medi-Cal Rx: DUR 88 edit now live; Reject Code 80 postponed UHC delays Designated Diagnostic Provider program in CA until Jan. 1, 2022

The California Department of Health Care Services (DHCS) has elected to postpone implementation of Medi-Cal Rx Reject Code 80, despite recently announcing it would be included in the first of three phases to reinstate pharmacy claim edits and prior authorization requirements for prescription drugs.

Drug Utilization Review edits (DUR 88) will take effect July 22, 2022, as previously announced.

Earlier this year the DHCS began waiving prior authorizations from the Medi-Cal Rx program, retroactive to January 1, 2022, to minimize disruptions in patient access to prescription medications that occurred due to challenges with the Medi-Cal Rx transition.

In the first of the three phases, claim edits for Drug Utilization Review edits will be turned on

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effective July 22, 2022. DUR Reject Code 88 alerts are triggered by instances such as drug-drug interactions, high dose, early refills, etc.

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Hypoglycemics, including glucagon Coronary vasodilators (nitrates and pulmonary arterial hypertension agents) Cardiovascular agents, including antiarrhythmics and inotropes Anticoagulants and antiplatelets Niacin, Vitamin B, and Vitamin C products Stay up to date with the latest Medi-Cal Rx news by signing up for the Medi-Cal Rx Subscription Service. For questions, please contact the Medi-Cal Rx Customer Service Center at (800) 977-2273, available 24 hours a day, 365 days a year, or email MediCalRxEducationOutreach@magellanhealth.com.

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Medi-Cal RADs will no longer be mailed due to supply chain issues

Recently, the California Department of Health Care Services (DHCS) announced that Medi-Cal will no longer mail Remittance Advice Details (RADs), Electronic Fund Transfer (EFT) statements or No Pay documents. According to DHCS, this change was necessitated due to supply chain issues.

However, DHCS has clarified that it will continue printing documents until its supply is exhausted.

Providers who have not yet transitioned to PDF RADs (which includes the embedded financial summary information) are strongly encouraged to do so at this time. To sign up for PDF RADs: Log in to your Medi-Cal account on the Medi-Cal Providers website under the Transactions tab.

Click on the “Other” tab Click on the “Remittance Advice Detail (RAD)” link Once enrolled, the PDF RAD and Medi-Cal Financial Summary are accessible on under the Transaction Services page. To access the transaction, providers must have a signed Medi-Cal Point of Service Network/Internet Agreement form on file.

For any questions regarding PDF RAD access, contact the Medi-Cal Telephone Service Center at (800) 5415555.

DHCS advises physicians to hold Medi-Cal claims for monkeypox tests

The California Department of Health Care Services (DHCS) released guidance regarding a new CPT code created to streamline the reporting of orthopoxvirus (e.g., monkeypox) testing (87593). As soon as DHCS has updated its systems, physicians will be able to bill CPT code 87593 as a MediCal benefit. Until then, physicians are advised to administer the test as needed, but to hold the claim for submission.

Additionally, the American Medical Association has also created two new CPT codes for monkeypox vaccines. The new monkeypox CPT codes are: 87593: Infectious agent detection by nucleic acid [DNA or RNA]; orthopoxvirus [e.g., monkeypox virus, cowpox virus, vaccinia virus], amplified probe technique, each 90622: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use 90611: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use For additional information on monkeypox symptoms, testing, treatment and vaccination, view the California Department of Public Health and the Centers for Disease Control and Prevention websites.

ARE YOU READING CPR? SUBSCRIBE NOW Sign up now for a free subscription at www.cmadocs.org/subscribe FALL 2022

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Public Health

Update

Childhood Lead Poisoning – A Silent Enemy Within BY: NASRAT ESMATY, MPD, PUBLIC INFORMATION OFFICER Lead poisoning is, indeed, a silent enemy. Lead exposure can cause a myriad of problems for growing children including damage to the brain and nervous system or death. It impairs growth and development (lower IQ, ADHD) while the young patient may exhibit no evident signs or symptoms.

However, there are many signs such as constipation, abdominal pain, vomiting, irritability, speech delays, reduced attention span, learning disabilities, headaches, weight loss, anemia, hyperactivity, general fatigue, muscle soreness or weakness or joint pain. Seizures can occur with extremely elevated blood lead levels (BLLs). Some or all of these could be signs of other health issues, causing clinicians to overlook a diagnosis of lead poisoning.

“The only way to determine if a child has lead poisoning is through blood lead testing”, according to Maryesther Sanchez, Program Coordinator for the Childhood Lead Poisoning Prevention Program (CLPPP) at San Joaquin County Public Health Services (SJCPHS). California state statutes and regulations impose specific responsibilities on doctors, nurse practitioners, and physician's assistants doing periodic health care assessments on children between the ages of 6 months and 6 years. In the State of California, “screening” means testing an asymptomatic child for lead poisoning by analyzing the child's blood for concentration of lead. California regulations require a blood lead test at 12 and 24 months of age and catch-up testing for missed tests up to 72 months of age. Parents may also request a BLL test for a child from the ages of birth to 21 if the child is at risk.

A higher BLL can affect pregnancies, too, as lead can pass

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through the placenta to the fetus. Miscarriage, premature birth and intrauterine growth restriction and brain, kidney and nervous system damage to the newborn are all possible outcomes. Even after delivery, mothers can pass lead to newborns during lactation.

Blood Lead Reference Value (BLRV)

The Centers for Disease Control and Prevention (CDC) established the blood lead reference value (BLRV) for children aged 1 – 5 to 5 μg/dL in 2012 and further lowered it to 3.5 μg/dL in 2021. The BLRV is not a clinical reference level defining an acceptable range of blood lead levels in children. It is only a toxicity threshold that can predict health outcomes since no level of lead in the body is known to be safe.

Thanks to public health efforts and federal regulations, such as removal of lead from gasoline and the ban on lead-based paint and lead plumbing solder for residential uses, the BLL in kids has seen a historic decline in the past 50 years. A study carried out by CDC’s National Center for Environmental Health observed a 95% decrease in BLL in kids. The study looked at BLLs in U.S. children between the ages of 1 – 11 who were born between 1976 and 2016.

Major Sources of Lead

That said, we have yet to overcome lead poisoning. Lead exposure occurs when a child comes in contact with lead by touching, swallowing, or breathing in lead or lead dust.

Lead-based paint is identified as the major lead source,

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but ingestions of omnipresent lead-contaminated materials also cause damages. House dust and residential soil are the major pathways for exposure, especially for kids who play in the dirt and have pica tendencies.

Here in San Joaquin County, we look to houses built before 1978, pottery and ceramics, stained glasses, traditional home remedies (such as Azarcon & Greta, used for constipation or stomach problems), peeling paint, fishing sinkers, some candies and spices, sindoor (used in cosmetics, in religious ceremonies and as a symbol of marital status in India), surma/kohl (used to darken eyelids and eyebrows and believed to strengthen babies’ eyes and protect them from “evil eye”), and even toys and jewelry. Construction, soldering, bullets, some plastics, battery manufacturing, recycling, artistic painting and auto refinishing workers can carry home lead from work, too.

San Joaquin County Public Health Services Childhood Lead Poisoning Prevention Program (CLPPP)

SJCPHS has a robust CLPPP. They provide services to the community with the goal of increasing awareness of lead hazards and providing education and assistance in order to reduce lead exposure and increase the number of children who receive a blood test for lead poisoning. The CLPPP provides case management services and home inspections and environmental investigations to families of children found to be severely lead poisoned. In addition, information and education are provided to the general public, medical providers, and community-based organizations.

The CLPPP follows up with caregivers whose children are determined to have elevated BLLs regularly. The goal is to ensure that the BLLs of children are reduced to 4.5 μg/dL or below within a year after an elevated BLL is determined. The CLPPP investigates the home environment, identifying likely sources of the lead toxin. Advice is given to caregivers on keeping the house clean and dust-free, avoiding sanding, scraping, power washing or sand blasting paint, and preventing children from ingesting paint chips.

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If appropriate, the CLPPP introduces mothers to our Women, Infant and Children (WIC) Program. WIC staff offer breastfeeding and nutrition classes in addition to offering monthly healthy food vouchers so that both mothers and children eat well. WIC clinical staff advise that (the exposed) children eat foods high in iron, calcium and Vitamin C because these nutrients reduce the body’s ability to absorb lead. It is recommended to feed a child every 3-4 hours with foods high in iron, vitamin C, and calcium to prevent the storage and absorption of lead in their bodies and, hence, lower the lead level.

The CLPPP works most closely with pediatricians who participate in the Child Health and Disability Prevention Program (CHDP). “We strive to keep a wider audience of physicians informed about the risks of lead poisoning through many forms of outreach. said Surbhi Jayant, SJCPHS Interim Children’s Medical Services Program Manager. “The California Department of Public Health (CDPH) hosts Lead Week, a national annual campaign, to bring awareness and prevent childhood lead exposure. This year, Lead Week, focused on lead in drinking water, especially during service line replacement, will be held from October 23 through October 29. We encourage the public and physicians to participate in various activities they are offering.” she continued.

In summary, providers should always track developmental milestones in all children who have documented lead exposureand act early if there is a concern. The good news is that childhood lead exposure is preventable and lead screening is widely available. It is important that all clinicians who talk to families are familiar with the risks and are equipped to educate families on lead poisoning prevention.

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YO U ’ R E M A D E F O R

Quality orthopedic care — getting you back to the activities you love.

We were made for more. More growth. More exploration. More awe-inspiring moments with those we love most. Our team is here to help you on your journey by providing access to whole-person, orthopedic care across Calaveras, Sacramento, San Joaquin and Tuolumne counties. Through our team of primary care providers and extended network of Adventist Health orthopedic specialists, our vision is to provide excellent orthopedic care close to home.

Learn more at: AdventistHealthSonora.org/Orthopedics LodiMemorialOrthopedics.org 58

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San Joaquin Medical Society Member Only Benefits • Complimentary Dark Web Compromise Credential Report ✓ Over 11 billion accounts have been compromised – Has yours?

• Complimentary Phone System Assessment ✓ Is your phone bill higher than you would like? Does your phone system allow you to work from anywhere?

• Complimentary Security and Risk Assessment ✓ Have you conducted your Risk Assessment yet?

Call Mark Williams @ 209-623-1023 or email mark@ce-technology.com FALL 2022

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San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568 RETURN SERVICE REQUESTED

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

Community Partnership Wellness

HPSJ BUILDS HEALTHIER COMMUNITIES BY INVESTING IN PREVENTION Continuing to address challenges from the pandemic, HPSJ is committed to getting our members back to care by engaging our community to catch up on well-checks and immunizations. To do so, we offer myRewards to HPSJ members who complete necessary checkups. We also offer support to our primary care providers and clinics to reconnect with their HPSJ patients through incentive programs, collaborative patient outreach strategies and dedicated quality staff to help your practice identify gaps in care and opportunities for improvement.

Call to learn more about ways we are partnering to create a healthier community!

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Join our network: www.hpsj.com/provider • 888.936.PLAN (7526)

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