Spring 2013

Game Changer

San Joaquin County Health Information Exchange (SJCHIE) is a Game Changer PLUS: CMA Looks Ahead to 2013 SJMS Launches New Online Health Resource Spring 2013

The Supreme Court’s Decision Didn’t Change One Thing You still need to make important decisions now about rising health insurance premiums.

So what can you do?

• Enroll in a qualified High-Deductible Health Plan and open a Health Savings Account. This provides significant premium savings that can help fund your HSA account. With individual-only coverage, you are eligible to contribute up to $3,250 to your account or $6,450 with family coverage, on a federally taxdeductible* basis (members age 55–64 are eligible to contribute another $1,000).

• Investigate RAF Sales Health plans offer incentives through discounts off their risk adjustment factors (RAFs) for you to change health plans. Instead of large rate increases this

year, we might be able to help you offset some of that increase.

• Mercer Select HRKnowHow If you play a role in your medical group’s health care and benefit plan decisions, stay current on challenging issues.

Access is included at no charge for members who purchase group health insurance through Marsh/ Seabury & Smith Insurance Program Management.

Includes: • News and analysis of important benefit issues.

• Compliance Link tool to assist with health care and group benefit plan administration.

* Marsh and the Society do not provide tax, investment or legal advice.

Please consult with your professional advisors for guidance on these issues.

Please call Marsh at 800-842-3761.

We serve members who want assistance in evaluating the medical insurance choices before them. We can assist you with the information you need to make the critical choices on the road ahead.

Scan to learn more!

Sponsored by:

60993 (3/13) ©Seabury & Smith, Inc. 2013

d/b/a in CA Seabury & Smith Insurance Program Management • 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • CA Ins. Lic. #0633005 • AR Ins. Lic. #245544 2

SAN JOAQUIN PHYSICIAN

SPRING 2013

VOLUME 61, NUMBER 1 • MARCH 2013

{FEATURES}

12 18 38 46 SPRING 2013

CMA LOOKS AHEAD

CMA sets agenda for 2013

SJMS LAUNCHES NEW ONLINE HEALTH RESOURCE

{DEPARTMENTS} 24 IN THE NEWS

New Faces and Announcements

36 DAVINCI

Robotic Technology

healthhubsj.com

42 PUBLIC HEALTH UPDATE

RESPONDING TO ONLINE NEGATIVE COMMENTS

55 ACCOUNTABLE LEADERSHIP

Managing Professional Risk

GAME CHANGER

San Joaquin County Health Information Exchange (SJCHIE)

Read about the latest in health news A Tribute To John Hackworth, PhD

63 IN MEMORIAM 69 NEW MEMBERS

SAN JOAQUIN PHYSICIAN 3

PRESIDENT Raissa Hill, DO PRESIDENT-ELECT Thomas McKenzie, MD PAST-PRESIDENT George M. Khoury, MD SECRETARY-TREASURER Ramin Manshadi, MD BOARD MEMBERS Lawrence R. Frank, MD, Moses Elam, MD, Peter Drummond, DO, Dan Vongtama, MD, Susan McDonald, MD, James J. Scillian, MD, Karen Furst, MD, Kwabena Adubofour, MD, Kristin M. Bennett, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR LIsa Richmond COMMUNITY PROJECT MANAGER Vanessa Armendariz MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Moris Senegor, MD EDITORIAL COMMITTEE Moris Senegor, MD, Kwabena Adubofour, MD, Mike Steenburgh MANAGING EDITOR Michael Steenburgh

COMMITTEE CHAIRPERSONS MRAC F. Karl F. Karl Gregorius, MD DECISION MEDICINE Kwabena Adubofour, MD

CREATIVE DIRECTOR Sherry Roberts CONTRIBUTING WRITERS Lita Wallach, Vanessa Armendariz

ETHICS & PATIENT RELATIONS to be appointed COMMUNICATIONS Moris Senegor, MD LEGISLATIVE Jasbir Gill, MD

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society

COMMUNITY RELATIONS Joseph Serra, MD AUDIT & FINANCE Marvin Primack, MD MEMBER BENEFITS Jasbir Gill, MD NOMINATING Hosahalli Padmesh, MD MEMBERSHIP Ramin Manshadi, MD

SUGGESTIONS, story ideas or completed stories written by current San Joaquin Medical Society members are welcome and will be reviewed by the Editorial Committee.

PUBLIC HEALTH Karen Furst, MD SCHOLARSHIP LOAN FUND Eric Chapa, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

NORCAP COUNCIL Thomas McKenzie, MD

San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Patricia Hatton, MD,

Stockton, CA 95219 Phone: 209-952-5299 Fax: 209-952-5298 Email Address: lisa@sjcms.org

James J. Scillian, MD, Peter Oliver, MD, Roland Hart, MD Kwabena Adubofour, MD, Gabriel K. Tanson, MD, Ramin Manshadi, MD

MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM

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EHR Best Practices: Lessons Learned in Litigation

Saturday, May 11, 2013 - Full Buffet Breakfast and CME - 2 AMA PRA Category 1 Credits™ Stockton Golf and Country Club

To register please call the medical society at 209.952.5299 Who Should Attend

Geared toward all physicians

Educational Objectives

This presentation will support your ability to: Apply risk management strategies to reduce negative effects on patient treatment (and the consequent professional liability risk) associated with EHR implementation and use.

Faculty

Jane Mock Risk Management Specialist NORCAL Mutual Insurance Company

CME Information

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of NORCAL Mutual Insurance Company and San Joaquin Medical Society.

NORCAL Mutual Insurance Company is accredited by the ACCME to provide continuing medical education for physicians. NORCAL Mutual Insurance Company designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Mike Mordaunt, Esq. Defense Attorney Riggio Mordaunt & Kelly

The faculty members—Mike Mordaunt, Esq. and Jane Mock—have no relevant financial relationships to disclose. Planners from NORCAL include Jo Townson (Supervisor, CME) and Christina Cassady (Supervisor, Risk Management)—both of whom have no relevant financial interests to disclose. The planner from San Joaquin Medical Society— Michael Steenburgh (Executive Director)—has no relevant financial interests to disclose.

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SAN JOAQUIN PHYSICIAN 5

Letter From The Executive Director

STAFF REPORT

A BITTERSWEET GOODBYE As many of you know, in late 2011Dustin Corcoran, CEO of California Medical Association, invited me to be the founding Executive Director of a new CMA subsidiary tasked with the responsibility of developing marketing strategies and improved administrative services for all 39 of our component societies. During the past 17 months I’ve attempted to manage both of these jobs but the time has now come for me to fully move on to CMA and relinquish my responsibilities here at SJMS to a new executive director.

MIKE STEENBURGH

Ref lecting back on that initial interview with then SJMS President Javad Jamshidi and other members of the executive committee, I can honestly say I didn’t know what I was getting myself into too. I remember asking few questions over the brief 45 minute interview because the answer was the same each time….. will I be handling such and such, yes came the answer….. can I re-launch the magazine soon, oh yes, came the answer quickly, we expect that right away…… can I rebuild the website, yes of course!..... and on and on it went. I knew the expectations were high, but the support was there from the very beginning and I can honestly say I’ve never felt more appreciated by any organization or employer.

During the past six years I’ve had the pleasure of serving under six of the finest presidents any exec could ask for and each have taught me much in their own way as we’ve spent time developing budgets, planning meeting agendas and crafting our ongoing strategic plan. Of course I will always be in debt to Javad Jamshidi and Robin Wong who interviewed me and invited me to lead this fine organization.

LISA RICHMOND

Of equal importance have been my friendships with past presidents Larry Frank, Jim Halderman, George Khoury and so many board members – past and current. My time with current president Raissa Hill has been a delight as we’ve worked through this difficult year of transition.

Additionally, I want to take this opportunity to thank a few committee chairs who have been equally instrumental to our success. This publication would not be what it is without the unique vision and leadership of Moris Senegor. Whether we’re enjoying a glass of wine together to discuss the next issue or grabbing a quick sandwich in his office between patients, we’ve found an amazing way of working together and I’m extremely proud of our publication and its financial success. Equally, his partner, Karl Gregorius has led our medical review committee for many years and I’ve enjoyed every minute of working with him on this important work.

Continued on page 8 >>

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SAN JOAQUIN PHYSICIAN 7

Letter From The Executive Director

And lastly, I want to thank Kwabena Adubofour, George Khoury and Jim Scillian for the many hours they’ve invested in Decision Medicine. We may never know the full impact of this program on the lives of young students, but I consider it one of the best investments of time we could each make and I hope to have the opportunity of expanding the program in my capacity at CMA.

My new contact information:

The role of board member, committee chair, or president is often dismissed by some, but I assure you, every member owes these fine doctors their gratitude for investing their personal time developing policy, leading a committee, or maintaining the fiscal stability of the society as a board member so generations of physicians can benefit from our programs, the assistance we provide to their practices, and the ongoing advocacy work we do every day on their behalf at the local, state and national level.

I cherish the friendships I’ve made here and remain committed to furthering the success of SJMS. Of course there are two other special people I have to publically thank before signing off. Over this past year I’ve had the special fortune of finding Jessica Peluso who serves as our membership coordinator. Jess is simply amazing – she is bright, friendly, helpful to everyone and exhibits the most amazing work ethic which is not often found these days. Secondly, I want to thank Vanessa Armendariz who has done an equally amazing job developing our community projects this past year. Our board has desired a higher level of community relationship building and Vanessa has certainly delivered it! I’m so grateful that I’ve had the opportunity to work with each of them and feel so confident they will continue the wonderful work we’ve begun together.

Lisa Richmond will be taking the helm on March 1 as your new executive director and I will be around on a very limited basis until the end of June to assist with the transition, the planning of our annual Membership Dinner and our highly successful Decision Medicine summer program.

Lisa spent 10 years working with Primary Care Physicians and Cardiologists in San Joaquin County through her position s as a Pharmaceutical Representative for AstraZeneca Pharmaceuticals. Her most recent role at the American Heart Association has allowed her to further strengthen her relationships with the community while raising money for lifesaving research, programs and education. She brings a fresh perspective to the society with her professional background and engaging personality.

I encourage each of you to take a moment to welcome her if the opportunity presents itself.

Share with her your vision for SJMS as a member – your practice challenges – your concerns for healthcare reform. As your staff, we need and value your input in our role to serve you and I know she would welcome the same opportunity you’ve extended me over the past six years.

All the Best!

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San Joaquin Medical Society and CMA Members Enjoy: Vast CMA Resources:

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

“My Membership provides me a Voice in Sacramento and Washington DC.” Thomas McKenzie, MD

• • • • • • •

Contract Analysis Reimbursement Hotline Legal Hotline Legislative Hotline HIPPA Compliance Free Monthly Webinars on various topics Extensive Online Resources including over 200 letters, agreements, forms, etc.

• Plus – Free Legal Advice with CMA ON-CALL Documents

San Joaquin Medical Society Resources: • • • • • • • • • • •

DocBookMD phone app Annual Directory Free CME Seminars Cost Saving Benefits Quarterly Publication Website/Online Resources Insurance Savings Alliance Membership Annual Social Events Patient Referrals Office Manager Forum and Practice Resources

Your Membership Investment supports our Advocacy efforts on your behalf in Sacramento and Washington DC

Phone: (209) 952-5299

www.sjcms.org

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A message from our President – Raissa Hill, DO

Why Join San Joaquin Medical Society?

Why Join the CMA?

“When you join the CMA, you hire a powerful professional staff to protect the viability of your practice. By protecting your practice from legal, legislative, and regulatory intrusions, your CMA membership lets you focus on what’s really important: your patients.”

ABOUT THE AUTHOR Dr. Raissa Hill is President of the San Joaquin Medical Society and is a second-generation physician who practices family medicine in Stockton.

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The other day I was approached by a colleague regarding why he should join the Medical Society and the CMA, for that matter. I would be remiss if I did not address this basic and very important question. In all honesty, it was not that long ago I was questioning the same issue. Over a decade ago or so, I was told that I had to belong to the Medical Society because they offered a discount to the “Exchange,” which was the universal answering service of the area.

Well, when competition came to the area I found myself without that need. Then I was left with the question why am I still paying dues for membership and what am I getting for my money.

What is the CMA? The California Medical Association is a professional organization representing more than 37,000 physicians in California. The organization was founded in 1856 and is a member of the American Medical Association and the American Osteopathic Association. It includes members of all types of practices and specialties.

History After the 1850 cholera outbreak in Sacramento, the surviving physicians became close colleagues.

They bonded by their commitment to helping their patients despite their unfamiliarity of the diseases inflicting the area such as cholera, encephalitis, typhoid, and smallpox. They began to found county medical societies, with Sacramento and San Francisco being the first. Then on March 12, 1856, the Medical Society of the State of California held its first landmark meeting at the Pioneer Hall

on J Street in what is now Old Town Sacramento.

The first society president was Benjamin Franklin Keene, M.D. and they dedicated their organization to “promote the science and art of medicine, protection of public health, and the betterment of the medical profession.”

The first leaders created the state public health department in the 1870s, the precursor to the Medical Board of California of today, and California’s first medical schools which later became Stanford and University of California. They made immunizations mandatory for school children in the 1880s. They began looking at ways of funding health care for the poor in the 1930s. They performed some of the first cornea transplants and set up some of the first organ transplant guidelines in the country.

They established some of the first blood banks (Delta Blood Bank included) and cornea banks in the West and helped create the California Tumor and tissue Registry in 1947.

In more recent times, beyond the 20th century, the CMA has fought against tobacco use and smoking. Despite criticism at the time, they insisted HIV and AIDS patients deserve needed health care.

In the 1970s, the CMA sponsored the Knox-Keene Health Care Services Act, which instituted financial and quality standards for HMOs, required continuity of patient care, and protected the physician-patient relationship in health care decisions.

In 1975, the CMA preserved access to care for many when it forged ahead on a plan to keep medical malpractice rates affordable by orchestrating a

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who recoup an average of 3 million each year for physician members. There are many other practice resources and educational programs as well and there are some local benefits such as subscriptions to DocBookMD and Prescriber’s Letter.

In essence, with so much of health care becoming corporate, the CMA still supports the independent and small group practices. Regardless of your mode of practice, this organization promotes and attempts

Leslie Sackschewsky M.D. (right) and A. Phillip Dodd, M.D., Sutter Gould Medical Foundation, Obstetrics and Gynecology

to preserve the art of medicine and the physicianpatient relationship. By joining at the local level, it translates to the state level as a “voice.” There are many opportunities to get more involved through the various committees, whether it be legislative related such as House of Delegates, scholarships for future doctors, public health related, or community related.

So, join and get active!

InnovatIve PatIent Care HaS alwayS been

Important to Us

Leslie Sackschewsky, M.D. and A. Phillip Dodd, M.D. are now providing minimally invasive gynecological procedures using the daVinci® robot. The benefits of this less invasive surgical method are: • Shorter hospital stay • Faster recovery times • Smaller incisions

• Less blood loss • Fewer infections • Less pain

Our goal is to partner with our patients and to get them back to doing the activities they love, as quickly as possible. suttergould.org

LODi 209-334-3333 STOckTOn 209-948-5940

01264

physician walk out. That year Governor Jerry Brown took into consideration the outcry of CMA physicians who faced rate increases up to 400 percent, during a session of the legislature discussing the malpractice cost crisis. They passed a collection of statutes called the Malpractice Insurance Compensation Reform Act (MICRA), which has served as a model for national medical liability reform since.

In 2000, “they sponsored a bill that gave the Department of Managed Health Care the authority to levy penalties and fines against health plans that engage in unfair business and payment practices.” In the same year “the CMA filed a Racketeer Influenced and Corrupt Organization Act (RICO) lawsuit against for-profit HMOs in California, alleging that they were using fraud and other illegal activities to interfere in the physician-patient relationship.” This became the largest class action health care lawsuit in U.S. history with more than 80,000 physicians and 19 state and county medical associations joining the CMA as plaintiffs. As a result of the suit, besides the combined $585 million in monetary damages, there was the binding commitments made by the insurers to change the way they do business with physicians.

These are just some of the highlights of the historical influence on politics and medicine.

Why join the CMA and your local San Joaquin Medical Society?

“When you join the CMA, you hire a powerful professional staff to protect the viability of your practice. By protecting your practice from legal, legislative, and regulatory intrusions, your CMA membership lets you focus on what’s really important: your patients.”

There you go, straight from the CMA website. But what does that mean to us? From a legal standpoint, for example, membership provides free access to CMA’s online health law library. There is a CMA legal help line with immediate assistance to physicians with questions ranging from human resources, medical issues, to legal issues.

From the legislative standpoint, the CMA hires staff to monitor and protect the interest of California physicians and patients. Some top issues include defending MICRA, preventing Medicare and Medi-cal provider cuts, and stopping insurers from cancelling coverage for patients after they become seriously ill.

From a practice standpoint, there is access to highly trained economic advocates with expertise in physician reimbursement and medical business issues

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CMA Sets Agenda > 2013

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loo looks ook ks k s

ahead CMA sets agenda for 2013

For more than 150 years, the California Medical Association (CMA) has fought on the frontlines of nearly every major policy, political, budgetary, societal and legal campaign affecting the state’s physicians. The shared challenges facing physicians are more formidable today than ever.

As California and the rest of the nation faces a time of unique budgetary challenges and monumental change in health care, it is more critical than ever before that physicians come together with a unified voice to advocate for the profession and for the health and well being of the patients we serve.

In January 2013 the CMA Board of Trustees adopted five distinct goals for the association this year.

Below are details of each of those goals.

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CMA Looking Ahead > 2013

Grow Membership by 5%

Commitment to Public Health CMA has a rich history and legacy of demonstrating its commitment to public health.

CMA has incorporated key public health legislation in its legislative agenda every session and has maintained a high profile on public health issues. Advancing reforms in order to benefit our patients and the public has always been a priority for the association, and continues to be at the top of our list.

In 2013, CMA will be working proactively with public health leaders to

CMA member physicians are our most valuable asset. Without your dues dollars, CMA wouldn’t be able to do its vital work protecting the practice of medicine and ensuring access to quality medical care for all Californians.

Over the past two decades, organized medicine nationwide has seen a gradual decline in membership, and CMA was no different. In 2011 and 2012, we reversed that trend, reaching a 20 year membership high of more than 37,000 members last year.

CMA made a significant investment in membership development in 2012, increasing data analysis and ramping up recruitment and retention efforts. These efforts, along with focused recruitment achievements in select counties, resulted in a net growth of over 2 percent for the year. It may not sound like a lot, but after years of slow decline, 2 percent growth is a significant and laudable achievement.

Our goal for 2013 is to continue the forward momentum and grow membership by 5 percent by year’s end. Increased recruitment activities in 2013 will focus on “pilot projects” with select partner counties.

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track emerging trends and to strategize solutions for continuing challenges.

We will continue to include legislation focusing on public health in the legislative agenda this year. CMA is also exploring new ways of demonstrating its commitment to public health, including providing educational briefings to legislators on public health matters and participating in health fair-type events.

Prosperity for All Physicians At no time perhaps since the creation of Medicare has the health care delivery system seen such dramatic and rapid changes. The transformation of health care in California is largely being driven by three major developments: The rise of large medical groups, integrated delivery systems and advanced analytics, health information technology and population health management.

Health care reformrelated policy changes at the federal and state levels that emphasize care coordination, accountability and paying for “value”—efficient, high quality care.

Purchasers—private insurers in California and the nascent Covered California Health Benefit Exchange— are making it very clear that physicians and hospitals need to control costs or risk being isolated or frozen out of increasingly narrower network products.

These trends will likely

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accelerate as cost pressures grow, and health reform and other private sector initiatives continue to ramp up in 2013 and beyond.

These powerful forces pose particular challenges, and opportunities, for independent physicians and medical groups interested in maintaining a degree of autonomy while market and policy forces are driving the industry towards hospital-led systems. At the end of the day, the system benefits from a diverse set of providers competing to deliver high-quality, high-value care.

Defend MICRA

For more than 40 years, CMA has defended this important law in the legislature, in the courts and in the court of public opinion. We have been successful primarily due to vigilance and allocation of sufficient resources on all fronts.

This year will be no different.

Over the next year, CMA will be working feverishly to help physicians in all modes of practice to not only thrive in the rapidly changing health care marketplace, but to lead the charge towards new patient-centric, physician-led models of care.

One of the biggest challenges for physicians now and in the future is access to capital to invest in their own practices so that they can expand into different markets, adopt new technologies and care models and maximize reimbursement. Without capital for necessary infrastructure, physicians are unable to implement systems to help them remain competitive and independent. In contrast, hospital systems and health plans are at a strategic advantage.

CMA staff are developing three distinct proposals that represent “game-changing” strategies in support of prosperity for all physicians; 1. Study and design physician-led health care delivery models and create a CMA-sponsored backbone for independent physicians and medical groups; 2. Develop and

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recover up to $250,000 in noneconomic damages (pain and suffering). In addition, MICRA includes a sliding pay scale, which ensures that more money goes to patients, not lawyers.

The $250,000 cap on noneconomic damages has proven to be an effective way of limiting meritless lawsuits, but has been targeted by the trial lawyers because it restricts the amount of money they can collect in damage awards.

implement a quality initiative for independent practices with the goal of reducing clinical variation; and 3. Increase physician access to financial capital.

Stay tuned for additional details as these proposed initiatives evolve over the coming months.

As we all know, the trial attorneys have sought to modify or eliminate California’s Medical Injury Compensation Reform Act (MICRA) protections since the state’s landmark medical malpractice insurance reforms were established in 1975.

Under MICRA, injured patients are fairly compensated, medical liability rates are kept in check and physicians and clinics can remain in practice treating patients. MICRA has no limits on the economic damages that can be recovered by injured patients (medical costs and lost wages). Injured patients also can sue for unlimited punitive damages and

Several factors make 2013 a decisive year for defending MICRA. Both houses of the legislature contain Democratic super-majorities, traditional allies of the trial attorneys. Also, nearly half of the members of the Assembly are newly elected without a voting history.

Attorneys are utilizing new and creative arguments to challenge long-standing constitutional approval of MICRA and to move public opinion. They are attempting to use heartwrenching horror stories placed with compliant media outlets in order to defeat MICRA. CMA in 2013 will focus on educating new members of the legislature on the importance of MICRA for their constituents and the role MICRA plays in patient protection and access to care. CMA’s government relations team will also be ready

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CMA Looking Ahead > 2013

Lead Change in Health Care Reform In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the for-profit health insurance industry and beginning in 2014 will provide health insurance to most of the nation’s uninsured. The ACA also formed the CMS Innovation Center to fund myriad pilot programs to test new health care delivery and payment models.

Under the ACA, two thirds of California’s uninsured will be covered by private insurance through a health insurance exchange purchasing pool.

The remaining uninsured will be covered through a massive expansion of the Medicaid program.

CMA in 2013 will continue to monitor implementation of the ACA in California, ensuring that health care reform works for physicians and their patients. Specifically, CMA will remain engaged as Covered California, the state’s health benefit exchange, prepares to open for business. The exchange’s goal is to start pre-enrollment in October 2013. Critical federal regulations and guidance, however, still must be finalized and released.

to jump into action at a moment’s notice should the trial attorneys try and utilize a late “gut and amend” to push an anti-MIRCRA bill through the legislature, as they did at the end of last session.

As always, CMA’s political action committee (CALPAC) will remain involved in the fight, amassing the financial resources that will be needed should a costly MICRA challenge emerge this session.

CMA’s legal team also continues to aggressively monitor court activity and seek out opportunities to provide guidance to courts when they are asked by plaintiff attorneys to weaken or eliminate MICRA.

Together We Are Stronger The shared challenges facing those who practice medicine may never have been more formidable than today. In this uniquely turbulent political and fiscal environment, we have redoubled our efforts to provide the support and services physicians need to be able to focus on their jobs and bring good health and happiness to the lives of millions of Californians.

Changes are coming – and CMA is poised and ready to meet the demands of the future.

Among the critical issues still needing to be hammered out before the exchange opens for business are: the state’s plan for monitoring and enforcing network adequacy requirements; the reconciliation of major discrepancies between state and federal grace period guidelines for premium nonpayment; and how exchange plans will handle the subject of out-of-network benefits.

While the pre-enrollment date is only months away, exchange leadership has yet to select which plans will offer products on the new marketplace, meaning that benefit design, contracting and enrollment policies will need to be developed at a breakneck pace.

CMA will also be working to make sure that physicians understand the implication of contracting with exchange plans and to ensure that doing so places minimal administrative burdens on physicians.

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Community > HealthHubSJ.com

SJMS LAUNCHES New Online Health Resource

Compared to the other 57 counties in California, San Joaquin County has the 5th highest diabetes-related age-adjusted death comprehensive, yet userrate. The Obesity and Chronic Disease Prevention (OBCDP) friendly website that can Task Force created the San Joaquin County 5-Year Chronic Disease Strategic Plan that addresses serious public health be accessed by physicians, issues. The OBCDP serves as the umbrella coalition of seven nurses, medical assistants different workgroups that are working to develop strategies and patients seeking local to reduce the burden of the various chronic diseases. These resources and classes include: Obesity and Diabetes, Asthma, Heart Disease and related to chronic diseases Stroke, Nutrition and/Physical Activity, Health Disparities, Policy Development and Advocacy, and Research/Evaluation.

The San Joaquin Medical Society is part of the Diabetes Workgroup from the OBCDP Task Force and in being funded by grants from the California Diabetes Program as well as the Kaiser Permanente Community Benefit Programs Division-Central Valley Area, we have been able to create a resource hub. Although diabetes education classes are available countywide, the classes have reoccurring low attendance because the public is not well informed.

In response to the need for people with chronic diseases to have easier access to selfmanagement classes, the San Joaquin Medical Society has developed this online resource to keep track of available classes in one place. >> HealthHubSJ.com is a

Story By Vanessa Armendariz

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HEALTHHUBSJ.COM

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HEALTH HUB MAKING A DIFFERENCE

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Community > HealthHubSJ.com

HEALTHHUBSJ.COM

HEALTH HUB MAKING A DIFFERENCE

About 1 in every

400 children and adolescents has diabetes.

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An estimated

16 million Americans have pre-diabetes, and many of them are unaware of their condition.

The diabetes workgroup believes that it is a shared responsibility of both the healthcare community and the community at large to address the prevention and management of diabetes, hence the “Unite for Diabetes” name. The initial goals of Unite for Diabetes are to raise diabetes awareness and promote one central “Hub” that houses all the diabetes education classes, nutrition classes, diabetes prevention and diabetes treatment programs that are available in the San Joaquin County. The Health Hub provides a comprehensive, yet user-friendly website that can be accessed by physicians, nurses, and medical assistants who are looking for local resources to refer patients to. Our ultimate goal is to make chronic disease self-management education resources available to community members in hopes that they will utilize the resources and attend educational classes to reduce and manage the health risks associated with various chronic diseases.

What Has Been Done

In order to drive as many people as possible to the Health Hub, the diabetes workgroup created a promotional plan that covered various media outlets. 12 billboards, in both English and Spanish, were posted in Stockton, Lodi, Lathrop and Manteca to direct readers to the site. On average, 107,000 people per day view the billboards in Stockton alone. Furthermore, 100 bus posters, also printed in both English and Spanish, were placed in the local Regional Transit District’s bus system. Public Service Announcements promoting the site were also aired in English through KJOY Radio and in Spanish through KMIX. The Stockton Record also wrote an article highlighting both the billboards and the website in the local newspaper, which further increased the awareness of our initiative. Due to the multiple promotional outlets, there has been an increase in the number of page views and visits per day on the website.

What Resources Does the Hub offer?

• Diabetes self-management classes • Screening locations • No cost or low-cost medical care options • Support services: location, providing organization, cost • Links to online diabetes self-management services • Downloadable educational materials (English and Spanish) • Has mobile capability • The “Hub” will eventually be a resource for other chronic diseases such as asthma and heart disease, but will first be focused on diabetes.

• Creates a “community-clinic” linkage that helps create a system for supporting diabetes self management while the patient is outside the health care setting

How Will this Be Implemented?

Ideally, it would be advantageous to have some form of a referral process that is integrated into the clinic process. If a patient is at risk for diabetes or is already diagnosed, they should be referred to the Health Hub. The resources on the Health Hub are very simple to accommodate for readers with variable literacy backgrounds and are available in both English and Spanish. Flyers and rack cards can be provided to the healthcare providers so they can give it to the patient to use as a resource. As part of the patient checkout, it would be beneficial to have a staff member go online with the patient and look for a diabetes selfmanagement education class that would fit the patient’s needs. A staff member can then call

SPRING 2013

SAN JOAQUIN PHYSICIAN 21

Community > HealthHubSJ.com

and help the patient register for the class or give them the proper instructions on how to do it themselves.

For patients that do not have a computer, an updated electronic spreadsheet with all of the available classes will be sent to the facility so they may still provide the information on the classes if needed. In order to teach medical staff how to navigate the website and to use it effectively, we have trainers that can go to your medical office. These trainers will discuss how to use the website, how to get patients signed up for classes, and they can answer any questions pertaining to the Hub. We also have community trainers that will go out into the community directly to promote the site. These community linkages include schools, churches, health fairs, residential living homes, and more.

The Future of the Health Hub

As of now, the Health Hub only has resources relating to the prevention and management of diabetes. In the future, we hope that the Health Hub will also include resources for other chronic diseases such as asthma, heart disease, cancer, etc. Currently, all of the downloadable material is in both English and Spanish, but the rest of the content on the website is in English. Soon, the entire Health Hub and its navigation will be in Spanish as well since diabetes is very prominent in the Hispanic community. It is our hope that the Health Hub will be implemented within health clinics and facilities throughout the San Joaquin County to promote better health and wellbeing to our community.

• How Can the Health Hub Benefit You? • Referral resource • Accreditation requirements • Pay for performance • Meaningful use • Patient satisfaction • Improve patient disease clinical outcomes

If you would like more information about the Health Hub, would like a trainer to train your medical staff, or would like to have materials sent to your office, please call Vanessa Armendariz at (209) 952-5299.

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SPRING 2013

SPRING 2013

SAN JOAQUIN PHYSICIAN 23

In The News

IN THE

NEWS

Dale A. Helman, MD Dale A. Helman, MD: New Neurologist in Stockton Dr. Helman is SJMS’ Newest Member and is a Provider for the Central California Neurology Medical Group. He is known for providing timely diagnostic test results and he has built an excellent reputation for reliability, accuracy and responsiveness to patients and referral sources.

Dr. Helman is Board certified in neurology and accepts new patients and most major insurances and is fully bilingual in Spanish and English.

Dr Helman sees patients on Saturday’s at 2027 Grand Canal Blvd Ste. 29 in Stockton and can be reached at 373-1335.

A New Name for Lodi Memorial Hospital For 61 years it’s been Lodi Memorial Hospital. But for more than 25 years, it’s been more than just a hospital. Today, Lodi Memorial Hospital has about 60 separate programs and services, many of which are free-standing entities

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

beyond the hospital walls.

To better represent its full scope of services, Lodi Memorial Hospital has changed its name to Lodi Health.

“Honestly, we’ve been an integrated-health system for a long time now,” said Lodi Health President and CEO Joe Harrington. “We need a name that better ref lects our ‘system’ and believe Lodi Health captures that.”

Lodi Health operates 16 separate medical practices, a hospital, a homehealth agency, a home-medical-equipment company, an adult-day-care center, a child-care center, a fitness center and numerous outpatient services.

“This has been a board-driven initiative,” said Lodi Health Board Chair Cecil Dillon. “Our board is comprised of community-member volunteers who strongly believe we need to help our friends, family and neighbors know about the full complement of Lodi Health services.”

“We also believe that Lodi Health means a lot to our community, and people may now understand why a bit better. We are the second-largest year-round employer in Lodi and our health services meet just about any need. We have enormously sophisticated medical care and were the first in the county to perform robotic-assisted surgeries and offer electronic-medical records.”

Lodi Memorial Hospital will retain its name for way-finding purposes and come under the Lodi Health umbrella. All other entities will have Lodi Health as part of their name.

St. Joseph’s Home Health Ranks Among Top Agencies in United States St. Joseph’s Medical Center announced that it has been named among the 2012 HomeCare Elite™ Top 500 agencies, a compilation of the topperforming home health agencies in the United States. HomeCare Elite ranks home health organizations by an analysis of performance measures in quality outcomes, quality improvement, and financial performance. This is the sixth consecutive year that St. Joseph’s has been honored among the HomeCare Elite. >>

SPRING 2013

“This honor is earned each year by our incredibly caring staff,” said St. Joseph’s Home Health Director, Laura Roberts. “Our goal is to provide high-quality patient care to our patients in the comfort of their own homes so they can live as independently as possible.”

St. Joseph’s Medical Center’s Home Health Care offers patients skilled services at home including registered nursing care, physical therapy, occupational therapy, speech therapy, home health aide services, and medical social services. St. Joseph’s Home Health Care is a Medicare certified, licensed, Joint Commission accredited, Home Health Agency that serves patients of all ages – from infants to the elderly.

The 2012 HomeCare Elite is the only performance recognition of its kind in the home health industry. The 2012 HomeCare Elite is brought to the industry by OCS HomeCare, the leading provider of homecare information, and DecisionHealth, publisher of homecare’s most respected independent newsletter Home Health Line.

did Gastroenterology fellowship at Medical College of Wisconsin, Wisconsin. Before that, she completed an Internal Medicine Residency at Marshfield Clinic/St. Joseph Hospital in Marshfield Wisconsin. Dr. Sidhu attended medical school at Government Medical College in Patiala, India.

She is a member of the American Gastroenterology Association, the American Society of Gastrointestinal Endoscopy and the American College of Gastroenterology.

“My goal is to provide high quality gastroenterology care with a focus on communicating effectively with my patients and referring physicians.” said Harjot Sidhu, MD.

Health Plan of San Joaquin Invests in Students Future Through A Health Careers Scholarship Program Health Plan of San Joaquin is in its fifth year of providing Health Careers Scholarships to qualifying high school seniors in San Joaquin and Stanislaus Counties. To date, 55 awards totaling nearly $123,000 have been awarded to qualifying students. In addition, through its Continuing Education Program, 18 awards amounting to $18,000 have been awarded to students in their second and third year of undergraduate studies. This year, the HPSJ anticipates funding up to 20 student scholarships of $2,500 each.

Dignity Health Medical Group Stockton Announces New Gastroenterologist/Advanced Endoscopist Harjot Sidhu, MD Dignity Health Medical Group Stockton is pleased to welcome Gastroenterologist/ Advanced Endoscopist Harjot Sidhu, MD to their medical group of Family Practitioners, Internal Medicine Specialists, and General Medicine Practitioners.

Dr. Sidhu joins fellow Gastroenterology Specialist Robert Protell, MD, in the group’s multispecialty physicians’ office located at 1901 N. California Street, here in Stockton.

Dr. Sidhu HPSJ invests in Students Future completed Advanced Therapeutic Endoscopy fellowship at Beth “We take seriously the role of advancing a Isreal Deaconess Medical Center/Harvard future healthcare workforce and we believe in Medical School in Boston, Massachusetts. She the concept of investing on our local youth,” >>

SPRING 2013

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SAN JOAQUIN PHYSICIAN 25

In The News

IN THE

NEWS “Every effort is made to encourage local high school students to pursue a career in healthcare in the Central Valley.” says Mike Steenburgh, Executive Director, Component Medical Society Services, VP, CMA, “Health Plan of San Joaquin’s Scholarships put resources on the table to help students achieve their dream.”

says Dale Bishop, Chief Medical Officer, Health Plan of San Joaquin.

HPSJ’s Health Careers Scholarship Program offers encouragement to students to pursue a health-related degree from an accredited junior or community college, or four-year college or university. Students must also demonstrate an interest in community health, demonstrate financial need and intend to ultimately practice in their field in San Joaquin or Stanislaus Counties.

“Every effort is made to encourage local high school students to pursue a career in healthcare in the Central Valley.” says Mike Steenburgh, Executive Director, Component Medical Society Services, VP, CMA, “Health Plan of San Joaquin’s Scholarships put resources on the table to help students achieve their dream.”

“Health Plan of San Joaquin’s scholarship will help relieve the financial stress of attending college on the path to medical school. It will also give even more incentive to succeed and excel, knowing that there are people who support my dreams of a better future, notes Clifford Liu, scholarship recipient and future physician.

“We make sure that we stay connected with each of our scholarship recipients,” says Shani Richards, Community and Legislative Affairs Liaison for Health Plan of San Joaquin. “We host a reception for students, their parents,

teachers, principals, superintendents, legislators, representatives of the County Board of Supervisors and HPSJ leadership, and we make it an important event. We want these young scholars to know how important they are to us and to the future of this community. The message is clear. We need future qualified healthcare providers here in San Joaquin and Stanislaus Counties.”

St. Joseph’s Named Certified Primary Stroke Center By the Joint Commission The Joint Commission, in conjunction with The American Heart Association/American Stroke Association, recently recognized St. Joseph’s Medical Center with Advanced Certification for Primary Stroke Centers. Achievement of Primary Stroke Center Certification signifies an organization’s dedication to fostering better outcomes for patients. St. Joseph’s Medical Center’s Primary Stroke Center Certification has demonstrated that their program meets critical elements of performance to achieve longterm success in improving outcomes for stroke patients.

St. Joseph’s underwent a rigorous on-site review in November. A Joint Commission expert evaluated St. Joseph’s compliance with the requirements for The Joint Commission’s Disease-Specific Care Certification program as well as primary stroke center requirements, >>

HAVE SOMETHING TO SHARE? We welcome submissions to our In-the-News Section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to nikki@sjcms.org one month prior to publication (Aug 1 for the Fall issue, Nov 1 for the Winter issue, Feb 1 for our 2013 Spring issue and May 1 for our 2013 Summer issue).

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WINTER 2012

In The News

IN THE

NEWS such as collecting Joint Commission core measure data and using it for performance improvement activities.

“This achievement signifies that the services we provide here at St. Joseph’s meet the highest standards for emergency and follow-up care for stroke victims,” says Michael Herrera, DO, Medical Director of St. Joseph’s comprehensive stroke intervention team. “This is the best evidence we can provide to this community that we are committed to providing high quality, safe and effective treatment to patients experiencing strokes.”

St. Joseph’s will be able to display The Joint Commission’s Gold Seal of Approval® for their Advanced Certification for Primary Stroke Centers. Displaying the seal signifies that St. Joseph’s is providing the “next generation of stroke or heart failure care,” and will help patients easily identify this facility as one of quality that has surpassed numerous goals in the treatment of stroke.

Dameron Hospital Nurse Carolyn Sanders To Receive Humanitarian Award Dameron Hospital’s Carloyn Sanders, RN, Director of Community Outreach and Health Education has been awarded the 2012 Humanitarian award by the Association of California Nurse Leaders- a statewide professional organization that develops nurse leaders and advances the professional practice of nursing. Carolyn Sanders will receive the award at the Association’s annual conference held in San Diego and will have her photo added to the Association’s “Wall of Fame” in recognition of professionalism in today’s nursing.

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Carloyn Sanders, RN Aaron Simko, M.D., Director of Nurseries Dameron Hospital wrote in a letter to the Association of California Nurse Leaders: “Carolyn has taken her talent and developed a skill set that has resulted in a positive impact in the lives of thousands of local residents.”

Dameron hospital is proud that her professional colleagues have recognized her enthusiasm, expertise and the one-on-one personal care she has devoted to the residents of this community.

Carolyn Sanders was born at Dameron Hospital and was raised in Stockton. Carolyn is a graduate of UCSF and holds a Bachelor of Science degree in Nursing and has been practicing at Dameron Hospital for over 20 years.

Carolyn is dedicating her award in memory of her mother who always encouraged her to achieve a life of success through education, care for others and perseverance.

New Sutter Gould Care Center Will Provide Expanded Services in Tracy Sutter Gould Medical Foundation (SGMF) recently approved purchase of the Eaton Medical Center Plaza located adjacent to Sutter Tracy Community Hospital (STCH), a move that will allow for the development of a new Sutter Gould care center at the site. This will also offer our patients the convenience of accessing all their GMG providers at one location, instead of three current sites in Tracy, and will allow for future growth as the community grows.

“Building our new Sutter Gould care center next to Sutter Tracy Community Hospital will enhance our joint mission of delivering highquality, integrated care to our patients in the right place at the right time,” said Paul DeChant, CEO of Sutter Gould Medical Foundation.

“Continued investments in facility development, as well as in technological development like our robust electronic health record, allows our providers and staff to do what they do best: take care of our patients and help foster healthy communities.”

Planning for the new center at the current Eaton site is already underway with occupancy slated for Fall 2014. It is anticipated that the center will be similar in size and scope to the new care center recently announced in Turlock. That project, set to open in mid-2014, will comprise 37,000 square feet and will accommodate up to 30 physicians and offer specialty, pediatric, internal medicine and primary care.

Previous planning studies envisioned developing a care center at the Gateway site in conjunction with a replacement hospital for STCH, however, given current economic conditions, these plans have been put on hold for at least 10-15 years. >>

SPRING 2013

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In The News

IN THE

NEWS Sutter Health is responding to the implications of healthcare reform, placing strong emphasis on expanding its integrated network of physicians and clinics. Today, SGMF, a multi-specialty medical group, comprises 280 physicians and 23 care center locations.

our mission to reach and serve those in need.”

The Community Grants Program was established in 1990 to provide funding to community-based organizations that provide services to individuals in need. Since its inception, the program has distributed over

Over $100,000 in Grants St. Joseph’s Awards Over $100,000 in Grants to Community Benefit Organizations St. Joseph’s Medical Center has awarded $127,800 in grant funding to four local community benefit organizations that provide critical health and human services to residents in San Joaquin County. St. Joseph’s administration, mission, and community benefit representatives distributed the grants during a luncheon held at the medical center.

“We’re proud to continue to provide for a healthier community through our Community Grants program,” said St. Joseph’s Community Health Director, Pat Collier. “By collaborating with these vital community organizations, we strengthen

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$2,130,800 in grant funding to deserving nonprofit community benefit organizations with an interest in building healthier communities by improving health and living conditions. The program encourages organizations attempting to address the underlying causes of illness as well as specific health issues. This year, special consideration was given to programs promoting early access to prenatal healthcare, health and nutrition for children and adolescents, and basic access to health care for the low-income population and homeless Veterans. These health conditions were targeted as a result of community health needs assessments conducted by a partnership effort including local hospitals, county public health departments, and other

community agencies.

This year’s St. Joseph’s Community Grants were awarded to the following area organizations: Catholic Charities – to improve access to early prenatal care and improved access to healthcare for the underserved by providing outreach and educational opportunities to pregnant women about the importance of early prenatal care.

Dorothy L. Jones Community & Health Center/Community Partnership for Families of San Joaquin – to fund an after school fitness program will address childhood obesity and other health related issues among at risk teens.

Mercy Housing California – to provide variety of health needs to low- and very lowincome families.

YMCA of San Joaquin – to educate families and youth on healthy eating and exercise habits, to increase the options and resources for healthy living, and to provide greater access to healthcare.

Two Sutter Health Hospitals in the Central Valley Awarded an “A” for Patient Safety by Hospital Safety ScoreSM Memorial Medical Center and Sutter Tracy Community Hospital, both part of the Sutter Health network of Northern California hospitals, have been honored with an “A” Hospital Safety ScoreSM by The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits.

The A score was awarded in the latest update to the Hospital Safety ScoreSM, the A, B, C, D or F scores assigned to U.S. hospitals based >>

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In The News

on preventable medical errors, injuries accidents, and infections. The Hospital Safety Score was compiled under the guidance of the nation’s leading experts on patient safety and is designed to give the public information they can use to protect themselves and their families.

“We recognize the significance of receiving an ‘A’ score from the Leapfrog Group,” said David Benn, President of Sutter Health’s Central Valley Region. “The ‘A’ grade is the culmination of a

tremendous amount of effort, by all of our care teams, to continually improve our processes to ensure we can provide patient care in a safe, professional manner.”

“Hospitals that earn an A have demonstrated their commitment to their patients and their community,” said Leah Binder, president and CEO of The Leapfrog Group. “I congratulate Memorial Medical Center and Sutter Tracy Community Hospital for their safety excellence,

You Have a Choice Choose Quality (209) 957-3888 www.hospicesj.org James Saffier, MD On-Site Medical Director Hospice & Palliative Care Internal Medicine

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and look forward to the day when all hospitals will match this standard.”

MMC and STCH received additional patient safety recognition in the month of November.

They were both recognized as top performers in the Patient Safety First program, as a result of reducing instances of two types of hospitalacquired infections to zero – and for maintaining that standard for a full year from April 2011 through June 2012.

St. Joseph’s and U.C. San Francisco Medical Center Collaborate to Advance Cancer Care in County St. Joseph’s Medical Center is bringing advanced cancer care to San Joaquin County with a new collaboration between St. Joseph’s Regional Cancer Center and the UCSF Helen Diller Family Comprehensive Cancer Center that will enhance patient care and access to clinical trials.

“Cancer touches the lives of thousands of people in our community-- we are very proud to be combining our expertise with that of UCSF to elevate the level of care available to treat these individuals,’’ said Don Wiley, president and CEO of St. Joseph’s Medical Center.

The affiliation bolsters the excellent care and support already offered at St. Joseph’s Regional Cancer Center – San Joaquin County’s only accredited cancer center – by pairing it with one of the premier cancer centers in the world.

“Our new collaboration with St. Joseph’s ref lects our mission to make high-level cancer care more broadly available to people in Northern California,’’ said Peter R. Carroll, MD, MPH, director of clinical services and strategic planning at the UCSF Helen Diller Family Comprehensive Cancer Center.

The new affiliation will provide: Expanded access to clinical trials. St. Joseph’s patients already participate in clinical trials overseen by the hospital’s institutional review board. Increased opportunities for cancer patients to participate in clinical trials will be available because of UCSF’s leadership in research and the number of clinical trials available at UCSF for patients with a variety of malignancies. Such trials often use novel agents for those with rare cancers or cancers resistant to standard treatment regimens. >>

SPRING 2013

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In The News

Continuing education for doctors, staff, and the public. St. Joseph’s and UCSF will develop educational sessions on cancer prevention, treatment, and other topics.

Participation in “tumor boards” made up of experts in a range of disciplines who review cases. St. Joseph’s may submit cases to UCSF for review and UCSF physicians may take part in St. Joseph’s tumor board conferences.

Referral to specialists. St. Joseph’s may refer patients to UCSF for specialized treatment.

St. Joseph’s Earns Three Year Re-Accreditation With Commendation From Joint Commission Cancer touches the lives of thousands of individuals in San Joaquin County each year. As San Joaquin County’s only accredited cancer facility, St. Joseph’s Regional Cancer Center is helping patients take steps toward survivorship

with comprehensive and compassionate care.

St. Joseph’s has recently earned a threeyear accreditation with commendation by the Commission on Cancer (CoC) of the American College of Surgeons, a distinction that has been consistently achieved since its Regional Cancer Center opened its doors in 1988. St. Joseph’s accreditation preceded an extensive on-site physician evaluation as well as continued monitoring and improvement based on national standards. The four areas of commendation that St. Joseph’s received include: outstanding compliance with outcomes analysis, submission of data to the National Cancer Database, Pathology guidelines, and prevention and early detection programs.

Earning accreditation is an achievement that speaks to a program’s outcomes for patients and a dedication to the advancement of excellence in cancer care. Only hospital-affiliated cancer programs are eligible for accreditation, and only 30% of hospitals in the United States have

earned this distinction.

“This is a huge accomplishment for St. Joseph’s that has made a world of difference to cancer patients in our community,” explained Regional Cancer Center Director Ginger Manss. “This accreditation re-affirms that the best cancer care available is right here in Stockton.”

To be considered for accreditation, a cancer facility must establish an extensive cancer program that encompasses state-ofthe-art clinical, rehabilitation, and support services; quality improvement mechanisms for evaluating and improving patient outcomes; a cancer registry and database that provide the basis for monitoring patient care data; cancer committees that provide leadership; and cancer conferences that provide a forum for patient consultation and physician education.

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neurologic training State-of-the-art  State-of-the-art technology technology for for Daily visits and medical care neurologic neurologic training training by rehabilitation specialist Daily  Daily visits visits and and medical medical carecare Ramnik Clair, MD by rehabilitation by rehabilitation specialist specialist Dedicated 24-hour care by Ramnik Ramnik Clair, Clair, MD MD registered nurses with Dedicated  Dedicated 24-hour 24-hour carecare by by specialized training and registered registered nurses nurses withwith experience in rehabilitation specialized specialized training training and and Coordinated physical, experience experience in rehabilitation in rehabilitation occupational, speech and Coordinated  Coordinated physical, physical, recreational-therapy sessions, occupational, occupational, speech speech and and three hours per day recreational-therapy recreational-therapy sessions, sessions, Emphasis on regaining threethree hours hours per day per day independence for safe Emphasis  Emphasis on regaining on regaining transition backfor to safe home independence independence for safe Clean, spacious facility with transition transition backback to home to home private rooms Clean,  Clean, spacious spacious facility facility withwith Outdoor areas for functional private private rooms rooms activities Outdoor  Outdoor areas areas for functional for functional activities activities

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DaVinci

Robotic Technology Surgeons at Lodi Health, formerly Lodi Memorial Hospital, began using robotic technology last October in the areas of general, urological and gynecological surgeries. Lodi Health is the first health system in San Joaquin County to offer the daVinci surgical robot to its physicians and their patients.

Surgeons at Lodi Health, formerly Lodi Memorial Hospital, began using robotic technology last October in the areas of general, urological and gynecological surgeries. Lodi Health is the first health system in San Joaquin County to offer the daVinci surgical robot to its physicians and their patients.

The system has several unique features designed to provide additional clinical benefits and efficiency in the operating room, many of which translate to exceptional patient care. Those features include:

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• Enhanced 3D, high-definition vision of operative field with up to 10x magnification; • Optional dual console allows second surgeon to provide assistance; • Superior visual clarity of tissue and anatomy; • Surgical dexterity and precision far greater than even the human hand; • Updated and simplified user interface to enhance operating-room efficiency; and • New ergonomic settings for greater surgeon comfort.

SPRING 2013

Combined, these technological advancements provide Lodi Health surgeons with unparalleled precision, dexterity and control that enable a minimally invasive approach for many complex surgical procedures.

Lodi Health surgeons trained in the use of robotic surgery were on hand for the open house Lodi Health hosted for medical society members on Jan. 23.

SPRING 2013

Visiting physicians had the chance to “drive” the technology for themselves via a simulator.

Several physicians competed to be scored on their use of the robot, which included their economy of motion skills.

Surgery department chair and urologist Thomas Sorbera, MD, says, “This minimally invasive surgical technology allows precise dissection and the overall outcomes for patients are better. Most major urologic surgery around the country is done robotically.”

“Additionally, it’s a wonderful incentive to recruit and retain physicians, surgeons and a variety of practitioners to a geography that is underrepresented by medical professionals.”

General surgeon Tom Fahey, MD, is using the technology for multi-port and single-site surgeries. All Lodi Health surgeons using this robotic technology are joined by team of Lodi Health nurses and technicians.

Dr. Sorbera welcomes physician inquiries regarding the technology.

He is reached at Lodi Health Physicians Vine, 209/334-8520.

SAN JOAQUIN PHYSICIAN 37

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SAN JOAQUIN PHYSICIAN

SPRING 2013

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SAN JOAQUIN PHYSICIAN 39

NorCal > Managing Professional Risk

NEGATIVE REVIEWS CAN COME FROM ANGRY PATIENTS, DISGRUNTLED EMPLOYEES, AND SOMETIMES EVEN MEMBERS OF THE PUBLIC JUST TRYING TO CREATE UNSUBSTANTIATED PROBLEMS. There are many online sites that allow patients to rate their physicians on various scales, and oftentimes they can leave narratives about their experiences. “Dozens of websites that permit people to rate, review, spin or f lame their doctors have sprung up in the last year, operating in much the same way as online services that help people find the best hotels or avoid plumbers who overcharge,”1 reported the Los Angeles Times in 2008.

As such websites increase in popularity, so does the significance of such ratings. Many patients are using the sites to report negative comments about physicians, and physicians often feel unable to defend themselves due to HIPA A and other privacy regulations. Negative reviews can come from angry patients, disgruntled employees,

Proactive Steps Setup your own practice web page where you can control the content and message you want to share with the community. Work with your group administrator or medical director as necessary.

Develop a social media plan for your practice. This could include

Reactive Steps Do not respond immediately or impulsively. Take time to consider the comment, to reflect on why the individual felt compelled to post, and to decide if it warrants a response. Not all negative comments are worthy of your time to respond. A response may start a chain reaction of negative slurs and comments, potentially leading to litigation.

If you feel the information is “clearly false, inappropriate and

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and sometimes even members of the public just trying to create unsubstantiated problems.

When these attacks occur, sometimes the physician wants to go into a defensive mode to preserve both integrity and reputation. But impulsive responses may do more harm than good.

Recommendations

Because negative online reviews can affect a physician and his or her practice, the issue warrants a two-fold plan of action that is both proactive and reactive in nature.

CONTROL CONTENT Facebook or Twitter accounts where postings can be controlled.

Periodically check websites for yourself or your practice to identify any specific issue or trends. You may want to explore setting up online alerts that advise when comments have been posted about you as a

physician.

Ask patients to go online and rate your services. Positive ratings will help to counter balance negative comments.

Provide a patient complaint process so disgruntled patients can receive timely resolution.

DON’T PANIC solely inflammatory, contact the (Internet) site administrator.”2 Legitimate sites have content guidelines and will probably remove information that violates them.

If you are considering suing a reviewer, there are many potential issues you need to be aware of to avoid pitfalls and countersuits.

Consult with your attorney as soon as possible before taking any steps in that direction.

Periodically follow up with positive

information about your practice on the sites. NEVER post fake consumer reviews, as this may result in significant fines and penalties.

If you choose to respond in writing, limit the response to general information, NEVER use patient identifiers or reveal any protected health information, and do not directly or personally attack the individual posting the comment.

SPRING 2013

Policyholder Dividend Ratio* 49.2%

50% 39.4%

40% 29.3%

30%

38.1%

31.5% 25.6%

20% 10% 0%

11.8% 6.4%

2.2% 2007

2008

5.2% 2009

5.2% 2010

6.9%

7.1%

2011

2012

Med Mal Industry (PIAA Composite)

TBA

2013 MIEC

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MIEC has never lost sight of its original mission, always putting its policyholders (doctors like you) first. For over 30 years, MIEC has been steadfast in our protection of California physicians with conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services.

Added value: n No profit motive and low overhead For more information or to apply: n www.miec.com n Call 800.227.4527 n Email questions to underwriting@miec.com * (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

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Public Health

Update

April 1-5, 2013 IS

NATIONAL PUBLIC HEALTH WEEK

Every year, the American Public Health Association organizes National Public Health Week.

This year, Public Health Week’s focus is “Return on Investment: Save Lives, Save Money,” with daily themes such as Ensuring a Safe, Healthy Home for Your Family; Providing a Safe Environment for Children at School; Creating a Healthy Workplace; Protecting you While You’re on the Move; and Empowering a Healthy Community. The week’s themes will provide the opportunity to highlight the value of prevention and the importance of public health systems for preventing disease and curbing health care spending. For more information about National Public Health Week, go to http://www.nphw.org/about.

San Joaquin County’s Public Health Laboratory Adds

Biosafety Level 3 Facility San Joaquin County Public Health Services (PHS) is pleased to announce that the installation of its Biosafety Level 3 (BSL-3) laboratory is complete.

San Joaquin County’s Public Health Laboratory is a member of the nationwide Laboratory Response Network (LRN), an integrated network of state and local public health, federal, military and international laboratories that respond to bioterrorism, chemical

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terrorism, and other public health emergencies. The LRN program began in 1999 and San Joaquin County was one of the three original California county public health laboratories to join the LRN. Currently, the PHS Laboratory serves seven counties in the region including: Alpine, Amador, Calaveras, Mariposa, Mono, Sierra and Tuolumne.

The BSL-3 laboratory will enhance the

ability of Public Health Microbiologists to perform tests for infectious agents that could cause serious or potentially lethal diseases in a safe and controlled environment. The BSL-3 facility will also provide rapid testing for diseases such as Tuberculosis and Influenza, and for infectious agents such as Anthrax and Plague that may be used for Bioterrorism.

SPRING 2013

Improving the Food Environment in San Joaquin County A LOOK AT THREE STOCKTON NEIGHBORHOODS Nearly two thirds of all San Joaquin County’s adults and over 15% of San Joaquin County’s children are overweight or obese, mirroring trends throughout the state and nation. As we struggle to reverse this alarming pattern, it is helpful to understand the specific environmental and behavioral factors that contribute to the obesity epidemic. There is growing evidence that what people eat and the likelihood of being overweight is influenced by the food environment in which people live. A 2007 study showed that there are four times as many “unhealthy” food outlets (fast food restaurants and convenience stores) as “healthy” food outlets (supermarkets and produce vendors) in San Joaquin County. In many cases, low income people may not have the opportunity to make healthy choices because healthy food alternatives are not available in their neighborhoods.

In the second half of 2012, San Joaquin County Public Health Services (SJCPHS), working with the statewide Communities of Excellence in Nutrition, Physical Activity, and Obesity (CX3) program, took a ground level look at nutrition resources in three low-income communities in Stockton. The CX3 project is a nutrition education component of the US Department of Agriculture’s “food stamps” program, known in California as CalFresh. One goal of the neighborhood-based analysis was to engage community members in learning about the dynamics that shape health behaviors in their local areas.

The SJCPHS team trained 80 volunteers to conduct assessments in neigborhoods north and south of Martin Luther King Boulevard in central and south Stockton, as well as in the West Lane Oaks area of north Stockton. The volunteers scored neighborhood food stores on the availability and affordability of healthy foods, promotional materials for healthy and unhealthy foods, the acceptance of WIC vouchers and food stamps, and walkability surrounding the stores. They also assessed healthy and unhealthy food outlets in a one-half mile radius around schools and parks, as well as alternative food sources such as food banks or farmers’ markets.

The findings of the neighborhood analysis were sobering.

In the three neighborhoods combined, only two grocery stores out of 34 stores surveyed met quality standards. The proportion of healthy food outlets out of all food outlets ranged from 0% to 29%. Only 20 to 24% of the population of the

SPRING 2013

neighborhoods lived within one half mile of a supermarket or large grocery store. The areas surrounding schools and parks were found to be saturated with unhealthy food sources such as fast food restaurants. These findings demonstrate that the opportunity to make healthy choices is lacking for many residents of these neighborhoods.

SJCPHS Health Promotion staff have been raising awareness of these problems with the local food environment by presenting the CX3 findings at community forums and media events. They have also been working with community-based organizations in the affected neighborhoods and other organizations that work to address food security, nutrition, and physical activity to develop a County

Nutrition Action Plan (CNAP). This plan will assist in prioritizing issues to address and possible interventions. Examples of opportunities for immediate action include providing marketing materials and technical expertise to retailers to increase stocking of produce, and working with schools to improve children’s nutrition awareness. In the longer term, transportation, land use, and economic development decisions will play a powerful role in neighborhood food access and the food retail environment. The CNAP will provide a roadmap for government agencies, community members, and local organizations to develop strategies to improve the food environment for the neediest residents of San Joaquin County.

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practice manager Free to SJMS/CMA Members!

resources

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

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

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

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

Registration required.

To RSVP or be added to the mailing list email Jessica Peluso, SJMS Membership coordinator, at Jessica@SJCMS.org or call (209) 952-5299.

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SPRING 2013

MARCH 13TH, 2013: “DIRECTOR OF FIRST IMPRESSIONS” 11:00AM to 1:00PM

The adage that first impressions count can be applied to any real-life scenario, but it is even more important when it relates to intimate issues like health. First Impressions play a role in the success of your Medical Practice, and Part 3 of the Office Managers Educational Series is designed to provide you with the tools to help your office staff with Customer Service, Telephone and Patient Relations Techniques.

Debra Pharias, President of Practice Liability Consultants comes to you with 20 years of experience and is here to assist you by providing superior practice management and customer service.

APRIL 10TH, 2013:

STRATEGIES TO MINIMIZE RISK IN THE PHYSICIAN OFFICE SETTING 11:00AM to 1:00PM

Typical areas of risk in physician offices include medical records management, documentation, follow-up, telephone communication, medication management, and care provided by unlicensed practitioners. When these risks are not identified and managed appropriately, problems can arise for patients and the practice.

Case examples will illustrate how poor systems can expose a medical practice to liability. The goal of this presentation is to support the office manager’s ability to control risk by recognizing common pitfalls and implementing best practices.

Jane Mock, CPHRM Risk Management Specialist, NORCAL Mutual Insurance Company Jane educates NORCAL policyholders on risk reduction strategies through phone consultation, presentations, and on-site practice assessments. Jane joined NORCAL in 1997 as a risk management analyst, editing the monthly Claims Rx publication and developing CME courses.

SPRING 2013

MAY 8TH, 2013:

RECIPE FOR FINANCIAL SUCCESS! 11:00AM to 1:00PM

Physicians and Office Managers need business management skills, particularly in the financial area. This workshop will teach critical skills in analyzing the practice profit/loss statement, accounts receivable ratios and staffing patterns and how to access specialty comparison norms.

Debra Phairas, MBA, President of Practice & Liability Consultants, LLC. Debra is an experienced consultant to over 1600 practices and former practice administrator.

MARCH 21, 2013:

OSHA SAFETY TRAINING 2013 11:00AM to 1:00PM Additional time will be available for Q&A

Join us for our annual OSHA workshop for physicians and office staff. This annual safety training will cover the latest OSHA information and updates for 2013 and will include the following information: · OSHA Facts and Inspections · Exposure Control plan · Life Safety - Emergency Preparation · 2012 - 2013 OSHA Updates · Aerosol Transmissible Diseases Standard (ATD) - Flu & TB · MRSA · Ergonomics · Plus ALL of your individual Questions!

Carrie Champness, RN, BSN, Safety Compliance Specialist. Ms. Champness has over 29 years’ experience in hospital, urgent care and physician office compliance

SAN JOAQUIN PHYSICIAN 45

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SPRING 2013

Game Changer

San Joaquin County Health Information Exchange (SJCHIE) is a Game Changer

story By Lita Wallach Healthcare Consultant l photos by dale goff

T

here is a lot of action in 2013 with respect to healthcare. The truth of the matter is that most of it is in preparation for 2014.

Patient medical records are quickly moving into electronic form. By 2014, we will be able to achieve the goal of ensuring that health data will increasingly be able to follow a patient across the street or across the country. Efficiency isn’t the only benefit.

For individual patients, access to good care becomes easier and safer when records can safely be shared. For physicians and other medical providers, important information needed in a decision-making process -- a patient’s blood type, prescribed drugs, diagnostic test results, medical conditions, psychological status and other aspects of medical history -- can be accounted for securely and quickly. This type of access can be lifesaving when an emergency occurs and accurate patient information is readily available.

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Game Changer > SJCHIE

San Joaquin County Health Data Contributors CMC

SJGH

LABRATORY

DEMOGRAPHICS

EHR

EHR

EHR

HPSJ

SOLO PRACTICE

sjchie EHR

HPSJ Case Management

Public Health Registry

Behavioral Health

Corrections

data users without an ehr-portal

Currently, physicians and patients are at the mercy of a fragmented system where data, in paper form is stored in silos. Hospitals, labs, physician offices and pharmacies each have a piece of a patient’s medical record. Missing pieces of an interlocking puzzle can cause medical errors and delay treatment

Fortunately, this is on the verge of change in San Joaquin County.

Five healthcare safety net providers in San Joaquin County immersed themselves in steadfast collaboration to reconfigure health system silos through a high-tech Health Information Exchange (HIE). Two years ago, these partners from Community “All delivery system reforms are contingent upon a robust Medical Centers, Health Plan of San Joaquin, San Joaquin County information technology system, including Health Information Behavioral Health Services, San Exchanges. This includes the integration of behavioral health, Joaquin General Hospital and San Joaquin County Health Care medical homes and other integrated delivery models. HIEs are Services began work to develop a regional Health Information the backbone of support for all of these.”

Exchange. The partnership - Lisa Folberg, VP Medical and Regulatory Policy, California Medical Association established a project budget of $1.3 million and successfully secured time. According to a Nationwide Health Information Network (NHIN) over $800,000 in funding, including a $500,000 project start-up grant from report, physicians spend 20-30% of their time searching for information and, Blue Shield of California Foundation. up to 80% of the time, they don’t find what they need in a patient’s record.

In general, HIEs are quickly changing the face of the healthcare industry.

Physicians attempt to ensure continuity of care and often exchange patient Locally, the new San Joaquin County Health Information Exchange information by calling, faxing or hand delivering information. This practice (SJCHIE) is a unique model developed to best meet the needs of the can be unreliable, leading to duplicative services and incorrect diagnoses. community. The SJCHIE mission is to promote the holistic well-being of

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SPRING 2013

“Although the

behavioral health in the equation.”

“San Joaquin County Behavioral Health SJCHIE is starting Services’ participation in the SJCHIE will help improve coordination of care and behavioral with safety net health outcomes. Ultimately, we can improve general health outcomes. The latter is very providers, there is significant as mental health consumers/patients a real opportunity currently live an average of 25 years less than the average American. Improved coordination for many more of healthcare services can help consumers/ of the county’s patients reclaim years of life time expectancy,” according to Vic Singh, LCSW, Director of San medical providers Joaquin County Behavioral Health Services. to be involved That holistic viewpoint is exemplified in the SJCHIE vision, “To connect participating and to exchange health care organizations in San Joaquin County through a health information exchange information about that is designed to improve the quality of life their patients. This and longevity of county residents.”

From a hospital perspective, “The SJCHIE is our hope that project is beneficial to San Joaquin General more providers get Hospital, its doctors, clinics and ultimately its patients. It will provide easy access to shared involved.” medical information among the five partners and to other providers that join SJCHIE in the - Dr. Paul Mascovich Medical Director, future. San Joaquin General Hospital will be San Joaquin County Behavioral able to send results of labs, diagnostic imaging Health Services studies and operative reports electronically to Community Medical Centers, Health Plan of San Joaquin and San Joaquin County Behavioral Health Services. At the present time these reports are either mailed or faxed, possibly resulting in delays of sharing important patient care information among the various parties, “says David Culberson, CEO, San Joaquin General Hospital.

Another upside to the SJCHIE is that diagnoses and treatment decisions can improve with readily “It is really important for those of us taking care of the mind and those accessible health data. “The greatest taking care of the body to be in sync with what each other is doing,” benefit to our patients is that they Dr. Paul Mascovich Medical Director, San Joaquin County Behavioral Health Services will be receiving more effective and of resources. This is important, particularly expeditious referrals to the hospital and other among safety net providers such as San Joaquin partnering agencies. Right now we have to send General Hospital, Community Medical Centers patient data by facsimile and it takes a long time and San Joaquin County Behavioral Health. to get someone referred to a specialist. The Also, we are fortunate to have Health Plan of SJCHIE will speed up the process and include San Joaquin, which is, in my opinion, more appointment confirmations to the patient,” says enlightened than most health plans because of Kathleen Marshall, Acting Chief Executive their recognition of the importance of including Office, Community Medical Centers.

SPRING 2013

everyone in San Joaquin County through the secure exchange of health information. It is designed in partnership with one of the largest HIEs in the nation but, most importantly, it retains local San Joaquin governance. SHCHIE maximizes local control and is responsive to community needs. SJCHIE partners understand the importance of meeting every aspect of patient care. This includes medical and behavioral health.

“The psychiatric illnesses of our patients have a huge bearing on their medical illnesses and the reverse is also true,” says Paul Mascovich, M.D., Medical Director, San Joaquin County Behavioral Health Services. “If providers lack a patient’s complete picture, it will impact the ability to achieve high quality care. Both the physical and psychiatric needs complete the whole picture of delivering optimum care. For example, if someone who is depressed is not adequately treated, it will negatively impact a physical illness, like diabetes or heart disease.

Most people with chronic illnesses, such as diabetes, are more prone to depression. Also, many of the medications that psychiatrists prescribe can have physical medical side effects.

Likewise, many medications that general physicians use can have psychiatric side effects.”

“It is really important for those of us taking care of the mind and those taking care of the body to be in sync with what each other is doing,” said Dr. Mascovich. “In San Joaquin County we have significant problems associated with chronic illnesses, poverty and poor health indices. This is a challenge for all of us in the medical and related fields. The silver lining of the SJCHIE is that many providers are motivated to collaborate to make optimum use

SAN JOAQUIN PHYSICIAN 49

Game Changer > SJCHIE

hope that more providers get involved,” said Dr. Mascovich.

“The SJCHIE is creating a system where the repository of information is centralized. At Stockton Diagnostic Imaging, we are looking forward to full implementation of this pilot and expanding it into the entire community,” says George Khoury, M.D., Stockton Diagnostic Imaging. “This is especially important because with the current system, when a test is ordered we don’t always receive the information needed.

With the SJCHIE, we will be able to readily access the patient’s chart to ensure that the right test is completed.” Dr. Khoury added, “The SJCHIE will eliminate the problem of

“The Inland Empire Health Information Exchange is one of the tipping points in healthcare that will make a huge impact for caring for patients. It does the entire community good and will change the way that physicians communicate with each other and it improves our system of patient-centered care. We are thrilled that San Joaquin County chose to join the IEHIE. San Joaquin County brings their expertise and ideas to the table and adds value to the entire HIE. Patients don’t stay in one location so ultimately wherever the patient goes, their information follows them. Sharing in the costs helps all of us and ensures the viability of the system.”

- Dolores Green,

Executive Director, Riverside County Medical Association

From the SJCHIE planning team perspective, “An HIE is only as valuable as the number of people exchanging data within it,” says Dale Bishop, M.D., Chief Medical Officer at Health Plan of San Joaquin.

“During our research phase, we examined efficiencies of a potential system. After exploring our options, we found an experienced partner and joined the Inland Empire Health Information Exchange. We control our own governance in San Joaquin County but at the same time we strengthen our backbone with a 52-organization HIE that has technical experience and 21 hospitals, 25 medical groups, two medical associations, the hospital association, Public Health Departments and community clinics. Like the IEHIE, we ultimately plan to take SJCHIE beyond the safety net and involve the entire community.”

“Although the SJCHIE is starting with safety net providers, there is a real opportunity for many more of the county’s medical providers to be involved and to exchange information about their patients. This is our

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incomplete requisition slips where a patient’s medical history is missing. This will help with patient quality of care and at the same time help to reduce unnecessary imaging or repeating of tests. Duplication is a problem and the SJCHIE is a solution for that.”

With the holistic design of the SJCHIE, including behavioral health, added security is built into the system.

Secure data exchange with all participating SHCHIE members include clinical messaging, real-time alerting of patient updates, access to data sources based on clinician’s permissions, patient records and medical histories, discharge summaries, laboratory and radiology results, ECG/EKG data and secure and private access for patients for particular clinical data. Stricter HIPPA (Health Insurance Portability and Accountability) regulations related to behavioral health guide the security and safe access to patient data through the SJCHIE. The issue of patient privacy and system security has been at the top of our list throughout our planning

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SAN JOAQUIN PHYSICIAN 51

Game Changer > SJCHIE

"The San Joaquin County Health Information Exchange (SJCHIE) represents a strategic enterprise of tremendous importance to local healthcare providers, payers, and patients alike.

This exciting collaboration will connect organizations in our community that together strive to achieve the triple aim of improving population health, enhancing the patient experience, and reducing the overall cost of high quality healthcare. Because San Joaquin County Behavioral Health Services is among the initial participants, this will serve the important objective of increasing communication between physical and mental healthcare service providers.

Such integration is one of many important principles driving novel delivery system mechanisms. Here at San Joaquin General Hospital, we look forward to the evolution of the SJCHIE as well as other innovative technologies to enable holistic, patientcentered, and high-performing accountable care."

- Farhan Fadoo, M.D., M.S. Chief Medical Information Officer Attending Physician, Family Medicine San Joaquin General Hospital

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process,” says SHCHIE planning team member Don Johnston, Chief Information Officer, San Joaquin General Hospital. “Strict compliance is critical, especially when we are subject to more stringent regulations related to behavioral health. The SJCHIE is a highly secure system that can ensure privacy at the same time provide physicians with important patient information at the time they need to know it.”

The potential for significant quality improvements in patient care is clear.

Benefits to providers joining the SJCHIE include immediate access to valued clinical information, case management and more informed treatment decisionmaking. The features include a shared database with the ability to access secure messaging among providers.

“Bringing advanced technology to the community to meet common goals and objectives serves as a core driver of meeting the needs of provider and patient stakeholders,” says Lori Hack, CEO, Object Health, LLC. “Object Health is involved to provide strategic support and help the SJCHIE planning team through a successful process. We spent months conducting research and extensively reviewing vendors. We determined that the Orion platform, with its worldwide experience, was the best fit for our needs. During this extensive research phase, we discovered that in Riverside County, the Inland Empire Health Information Exchange has been based on the Orion platform. From an organizational and business perspective, it made sense to consider participating with the IEHIE. After weighing various options, the planning team elected to join the financially solid IEHIE organization.

More so, the IEHIE is becoming the largest HIE in the nation. Members of the IEHIE include hundreds of physicians, Dignity Health, Kaiser Permanente, Sutter Health and many others. It’s important to ensure a dynamic HIE that goes beyond the individual health system.”

The development of the SJCHIE was deliberate and the design process included members of the community.

“Throughout the entire process, our broad set of participants, including physicians, nurses and administrators, participated in system demonstrations and everyone had the opportunity to rate each vendor. These important stakeholders provided valuable input on the most suitable technology for our HIE platform. As a result, the reviewing team concluded that the Inland Empire Health Information Exchange offered the best opportunities. We wanted to ensure that this system would be user friendly with simplicity in access and robust in function,” says Cheron Vail, PhD, Chief Information Officer, Health Plan of San Joaquin.

As 2014 rapidly approaches, the SJCHIE aligns with the Health Information Technology for Economic and Clinical Health (HITECH) Act and provides physicians and other medical providers with important tools for improving patient care. Health and Human Services (HHS) Secretary Kathleen Sebelius has outlined next steps in helping doctors and hospitals use health information technology. The HITECH Act is divided into three stages. Stage 1 sets basic functionalities of electronic health records. Stage 2 begins in 2014 and health information exchanges like the SJCHIE, must capture data electronically and in addition, promote patient engagement, including offering secure online access to health information.

Then, Stage 3 will continue to expand meaningful use objectives to improve healthcare outcomes.

The safety net providers believe that the SJCHIE will improve their ability to provide more accessible and appropriate care for their patients. Ultimately, all providers who join the SJCHIE will do so with the goal of improving patient care, which is one of the motivations behind the HITECH Act. For more information about the San Joaquin County Health Information Exchange, contact Fran Hattner at 209.461.2389 or fhattner@hpsj.com.

SPRING 2013

16th Annual California Health Care Leadership Academy

May 31 - June 2, 2013 • Planet Hollywood, Las Vegas

Welcome to the era of health reform. Increasing demand for services. Intensifying pressure for cost and quality accountability. Small practices joining larger groups seeking safe harbor. Undercapitalized medical groups sinking.

Hospitals and health plans acquiring practices in a “vertical integration” (consolidation?) of the health care market.

Can physicians control their own destiny – and the future of medical practice?

Hear from experts and leaders of change and attend a comprehensive slate of practice management seminars and workshops to position your practice for success.

Keynote: “The Future of Medical Practice” • Jeff Goldsmith, Ph.D., President, Health Futures Inc. Early-Bird and Multiple Registration Discounts Save up to $200 per person when you register before May 3!

Register at 800.795.2262 or caleadershipacademy.com SPRING 2013

SAN JOAQUIN PHYSICIAN 53

Sometimes You Just Need a Little Help.

Fourth Annual Golf Tournament Join fellow San Joaquin Medical Society members and invited guests (golfers of every level are invited to play) for a relaxing round of golf, a special Cinco de Mayo themed lunch and after golf party. Plus an opportunity to benefit our local First Tee of San Joaquin program. Your hosts will be Drs. Kwabena Adubofour, George Herron and George Khoury who are committed to making this an event to remember with multiple events and prizes for closest-to-the-hole, longest drive, lowest score and many others!

Saturday, May 4th, 2013 • Brookside Country Club • 4 Person Scramble FREE Golf Shirt and embroidered Cap for every golfer signed up and paid by April 15th!!

$150 per golfer - Price includes Green Fees, Golf Cart, Lunch, Professional Golf Shirt and Cap, lots of freebies, after golf party! - $50 of every entry fee goes to The First Tee of San Joaquin program Registration and Range Balls at 11:00am • Buffet Lunch at 12 Noon • Shotgun start at 1:00pm

To sign up, please call the San Joaquin Medical Society office at 209-952-5299 54

SAN JOAQUIN PHYSICIAN

SPRING 2013

A Tribute > John Hackworth, PhD

accountable

leadership

A Tribute To John Hackworth, PhD l Story By Lita Wallach

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

John Quincy Adams Running an organization can be an adventure, especially when a visionary leader can perceive challenges as growth opportunities and can inspire people to produce extraordinary results. Such a person is John Hackworth, PhD, who will retire from his role as CEO of Health Plan of San Joaquin (HPSJ) in late spring 2013.

Formed in 1994 and licensed by the State in 1996 as San Joaquin County’s Local Initiative for Medi-Cal Managed Care, Health Plan of San Joaquin looks much different today than it did in 2005, when Dr. Hackworth arrived as the new leader of the publicly sponsored, not-for-profit, health plan. For example, in 2005, HPSJ had 70,000 members and $70 million in revenue.

Today, at 180,000 members, HPSJ has annualized revenue of $400 million.

“Prior to my career as a CEO for both nonprofit and for-profit health plans, I taught health care and leadership at Indiana University. That early experience has always provided a framework for how I envision leading a company,” says Dr. Hackworth. This belief has produced results at Health Plan of San Joaquin. Every aspect of business development, including HPSJ’s service area expansions into Stanislaus and Merced Counties, is backed by a team of employees working as an extended family to produce positive results. This growth has not been at random. “My

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SAN JOAQUIN PHYSICIAN 55

A Tribute > John Hackworth, PhD

focus is in three core strategic areas,” says Dr. Hackworth. “Vision, alignment and motivation.”

Vision is the way Dr. Hackworth places a focus on company performance and business objectives.

“Part of the challenge of implementing new business strategy has been to examine how to effectively manage growth,” says Dr. Hackworth.

“Our Health Commission, leadership team and staff made a deliberate decision to engage in ‘smart growth’ while capitalizing on our core business strengths, such as government programs. As a result, we’ve found ways to expand Medi-Cal, Healthy Families and other programs.

“In order to compete effectively, we have to achieve economies of scale. As we expand the size of our organization, this becomes more important.

Our administrative costs are at 7-8% and are much lower than standard commercial plans where the industry norm is up around 13-15%,” says Dr. Hackworth. According to Dr. Hackworth, this kind of efficiency and new business development just doesn’t happen. “I attribute a lot of our success related to our growth to the governance

Coupled with the Stanislaus Medi-Cal launch, HPSJ also prepared for a transition in San Joaquin County, as the commercial competitor heath plan for Medi-Cal Managed Care changed. Impacted

community. That helped make this effort much less stressful,” says David Hurst, V.P., Marketing and Public Affairs. “We pulled together as a team because our staff clearly understood the goals and objectives

“John made a point of consistently refocusing staff on the vision of this growth effort, and what the outcome would mean for our organization, physician and provider partners, and the community. That helped make this effort much less stressful.”

members, physicians, community organizations and other stakeholders turned to HPSJ for help in understanding the changes, while HPSJ staff embarked on operational preparation for thousands of members who would ultimately choose HPSJ during the transition. Complicating efforts, the transition in San Joaquin County was effective on the same day as the Stanislaus “golive.”

of this new business expansion.”

Strategically, HPSJ operates with a clear vision and motivated employees who engage in team decisionmaking processes. Internally and externally, all of this is supported through a system of recognitions and incentives related to company-wide objectives.

According to Dr. Hackworth, while a forward vision is the most important aspect of successfully running an organization, he notes that it is key to look for ways to create a “win-win” for all stakeholders. That alignment is “I attribute a lot of our success related to our growth to the essential to the HPSJ’s growth.

For example, “It can be difficult to get governance of the HPSJ. The San Joaquin County Health an adolescent into an annual physical Commission, our governing board, supports us strategically examination. Health Plans throughout and reinforces our vision. We’ve also been so fortunate to have the the state have experienced this. We took support from physicians, hospitals, other healthcare organizations, the a look at the various factors involved San Joaquin County Board of Supervisors, community leaders and of and developed shared incentives for course, our HPSJ team of employees.” both the primary care physicians and the members. As a result, the physicians prioritize the well-adolescent visits, the Having provided Medi-Cal Managed Care kids get movie tickets, and our metrics improved. It of the HPSJ. The San Joaquin County Health services in San Joaquin County since 1996, and has worked exceptionally well, and can be replicated Commission, our governing board, supports us Healthy Families in San Joaquin County since in other efforts,” says Dr. Hackworth. strategically and reinforces our vision. We’ve 1998 and Stanislaus and Merced Counties since An emphasis on relationships with physicians also been so fortunate to have the support 2007, HPSJ has ample experience in welcoming and members is only part of the success equation. from physicians, hospitals, other healthcare substantial new member enrollment. So, after Motivating employees in the workplace is a popular organizations, the San Joaquin County Board of planning for over a year for both the Stanislaus and sometimes complex topic. According to Dr. Supervisors, community leaders and of course, our County Medi-Cal launch, and the commercial Hackworth, it’s fairly simple. “I learned that over HPSJ team of employees.” plan transition in San Joaquin County, HPSJ time, the more I get out and interact with the staff, In January 2013, HPSJ extended its Mediemployees were ready for over 40,000 new Medithe better.”

Cal Managed Care plan to Stanislaus County Cal Managed Care members on January 1st, 2013 On any given day, a HPSJ employee can expect after being awarded the role of Stanislaus between the two counties. a drop-in visit from Dr. Hackworth. “I personally County’s Local Initiative through a competitive Rapid growth like this can place high demands walk around to interact with staff to get to know procurement. This opportunity to bring its on the employees who implement the changes. them individually,” says Dr. Hackworth. “We services to Stanislaus Medi-Cal recipients follows “John made a point of consistently refocusing don’t separate managers from anyone else and we HPSJ’s expansion of its successful Healthy staff on the vision of this growth effort, and what encourage people to interact and get to know each Families plan to Stanislaus and Merced Counties the outcome would mean for our organization, other.” in 2007, becoming the only Local Initiative in the physician and provider partners, and the State to move beyond its county of origin.

“At first I wasn’t used to having a CEO appear

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SAN JOAQUIN PHYSICIAN

SPRING 2013

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A Tribute > John Hackworth, PhD

at my desk and ask how things are going,” says Gerri Casillas-Nunez, a 17-year employee who supervises HPSJ’s outreach efforts. “But now I anticipate a visit and look forward to talking with John. It’s a chance to share what I’m doing, and what I’m hearing about HPSJ when I’m in the community. He’s always interested, engaged, and has something positive to say about my own efforts or those of my team.”

From her experience as a member on the San

Joaquin County Health Commission, Patricia Hatton, MD has experienced Dr. Hackworth’s brand of leadership, and has seen the results.

“John took the plan to a very high level by motivating the employees toward a team effort in striving for excellence. His leadership has integrated healthcare delivery with important local stakeholders to improve the health of the community.”

Aside from program expansions, new

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initiatives, such as HPSJ’s role as a collaborator in the San Joaquin County Health Information Exchange, are ways that HPSJ continually reinvents itself. Preparing for and responding to new technology and market changes are components of a business plan.

Decisions that drive community solutions are equally critical. “During John’s tenure, HPSJ has garnered over $16 million in external funding to develop, sustain and pilot community health efforts and improved healthcare infrastructure,” says David Hurst, V.P. Marketing and Public Affairs. In addition to leveraging external funding, HPSJ has also prioritized community reinvestment of its own. Last year alone, HPSJ contributed nearly $250,000 through its Community Wellness Funding Grants program toward communitybased efforts focused on children’s health, nutrition, and health improvement for seniors and people with disabilities. Another priority includes funding for safety net programs, including a new mammography unit at San Joaquin General Hospital in 2012. In fact, overall, since 2009, HPSJ has committed community support of over $1.8 million for programs ranging from the Decision Medicine Program, to Public Health vaccination and prenatal health campaigns, to the development of primary care medical homes and integration of behavioral health.

“Our growth and efficiencies create more opportunities for giving back to the community that we serve,” says Dr. Hackworth. “We look for ways to expand access to medical care and empower healthier communities.”

Summarizing the highlights of a career filled with so many achievements could fill volumes to describe Dr. Hackworth’s contribution to the HPSJ and to the community.

So, what is next? “My next steps are a mix of several things,” says Dr. Hackworth. “I see myself staying engaged in some non-profits or the international health arena. But, I’m also looking forward to skiing, boating and hiking, and playing my guitar!”

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2013 Education Series MAR 6

March 6: Fraud and Abuse: Dangers and Defenses DHCS • 12:15 – 1:15 p.m.

Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the importance of documentation, present suggestions for implementing internal controls, and increase awareness of preventive measures to protect your practice from fraud or abuse.

MAR 6

March 7: Essentials for ICD-10-CM: Part 1 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m.

Continued on March 14 and 21.

This three-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice.

MAR 13

March 13: Utilizing the New State Disability Insurance (SDI) Online System Employment Development Dept. • 12:15 – 1:15 p.m.

SDI is a California state-mandated, employee-funded benefit that provides partial wage replacement. SDI is transitioning to a system with online capability for your patients and you. This webinar will show you how to create an SDI online physician’s account, authorize representatives to assist in completing the doctor’s certificates, and learn how to complete the new online doctor’s certificate.

MAR 14

March 14: Essentials for ICD-10-CM: Part 2 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m.

Continued from March 7 and ends March 21.

This three-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice.

MAR 20

March 20: EHR Selection – Top 10 Tips for Success David Ginsberg • 12:15 – 1:15 p.m.

The past several years have seen a tremendous increase in the adoption of electronic heath records (EHR) systems by California physicians. Not all selections and implementations, however, have been successful. This webinar is designed to teach the top 10 selection tips for a successful purchase and implementation. Determine the best EHR for your practice, how to correctly select an EHR, and contract negotiation dos and don’ts.

MAR 21

March 21: Essentials for ICD-10-CM: Part 3 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m.

Continued from March 7 and 14.

This three-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice.

The above webinars are being hosted by the California Medical Association. Please register at www.cmanet.org/events. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Member Help Line at (800)786-4262.

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Please note that this calendar does not include CMA’s ICD-10 training courses to be offered in 2013.

SAN JOAQUIN PHYSICIAN

SPRING 2013

MAR 27

March 27: Successful Medi-Cal Provider Enrollment for Physician Providers DHCS • 12:15 – 1:45 p.m.

Physicians must re-enroll in Medi-Cal as one of the provisions of the Affordable Care Act (ACA). This training will cover basic instructions and guidelines on the proper way to complete a Provider Enrollment Application Package. We will discuss the importance of reviewing and understanding program requirements and how to avoid common mistakes when completing enrollment forms. We will also cover specialized physician enrollments, important changes to the program due to ACA implementation, and where to find additional program information and PED contact information.

APR 3

April 3: Strategic Planning From Vision to Action - A Self-Guided Process Rachel Smith • 12:15 – 1:15 p.m.

Learn how simplified strategic planning and personal coaching can get you, your practice or your organization where you want to go. In this interactive webinar you will get to develop your own vision and strategic plan with tools to ensure you can walk away with immediate items, tools you can use again and how to obtain coaching support to implement the remaining steps of your plan.

APR 10

April 10: Preparing for EHR Implementation and Conversion David Ginsberg • 12:15 – 1:15 p.m.

Many EHR system implementations fail or stumble due to common mistakes made during implementation. This webinar will review common pitfalls, what you should insist your vendor provide (project plans, timelines), setting up files (order sets, pick lists, etc.), the importance of all stakeholder involvement, the danger of scanning paper charts, and resources to support you.

APR 17

April 17: Valuing, Selling, Buying or Transitioning a Practice Debra Phairas • 12:15 – 1:15 p.m.

Considering retirement? Selling or wanting to buy a practice? Making this transition requires planning and sufficient time to accomplish this effectively for your patients, staff and family. California has a high cost of living, which makes it more difficult for physicians to sell, transition, start, or purchase a practice. Learn creative strategies to help you accomplish your goals. This seminar will discuss the options, including: bringing in an associate, recruiting or selling the practice. Included is the latest information on valuation methodology for selling, divorce or estate planning.

APR 24

April 24: California’s Health Benefit Exchange: How it Will Impact Your Practice and Change Commercial Insurance Brett Johnson • 12:15 – 1:45 p.m.

Beginning in 2014, California’s private health insurance market will never look the same – individuals and small employers will be able to purchase health insurance coverage through the state’s health insurance exchange, now named Covered California. It is estimated that by the end of 2016, over one in five Californians will get their health insurance through the Exchange. Furthermore, with the selection of exchange plans occurring no later than April of 2013, payors are likely to begin reaching out to physicians regarding exchange products soon, if they have not already (e.g., Anthem Blue Cross and Blue Shield of California). In this presentation, you will learn more about California’s exchange and what it will mean for physicians. You will also gain an understanding of some of the risks and benefits of contracting to provide services to exchange enrollees.

MAY 1

May 1: The Power of the Pen – The Physician’s Responsibility in Prescribing and Referring for Medi-Cal Patients DHCS • 12:15 – 1:15 p.m.

Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the importance of documentation, understand the physician’s role in prescribing/ordering/referring, and increase awareness of fraud and abuse in prescribing and referring.

MAY 8

May 8: Time Management – How to Quickly Make Decisions on What Matters Most Rachel Smith • 12:15 – 1:15 p.m.

Learn how to value what matters most and achieve your goals by understanding what you are giving away and practicing simple tools to find solutions (not excuses) to get what matters most checked off the list. This interactive webinar will provide live one-on-one coaching to illustrate and use the techniques taught in this session.

MAY 15

May 15: Enforcement Provisions of the Medical Practice Act Medical Board • 12:15 – 1:15 p.m.

Presented by the Medical Board of California, this webinar will describe basic facts about physicians licensed by the Board, including residence, age and specialties. Additionally, learn about laws regarding the Medical Board’s enforcement program, including the factors that can get a physician into trouble (most common mistakes, complaints and actions); the process from complaint receipt to adjudication; and why there is a physician interview and the benefits to fully responding. The webinar will also cover the sunset review process and the issues that are being discussed at the legislative level to enhance the law for consumer protection.

MAY 16

May 16: Essentials for ICD-10-CM: Part 1 AAPC • 7:45 – 8:45 a.m. or 12:15 – 1:15 p.m.

Continued on May 23 and 30.

This three-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice.

SPRING 2013

SAN JOAQUIN PHYSICIAN 61

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SPRING 2013

In Memoriam

In Memoriam Robert Kendell Salter, M.D. • Louis P. Armanino, M.D. • Harold Leonard Berkman M.D.

Dr. Salter earned both his Bachelor’s of Science Degree in 1944 and his Doctor of Medicine in 1946 from University of Wisconsin.

SPRING 2013

ROBERT KENDELL SALTER, M.D. Jan. 27, 1923 - Feb. 15, 2013 Robert Kendell Salter, M.D. passed away on February 15, 2013. The illness that took his life never took his spirit or smile. Words cannot express the depth of emptiness and loss we all feel at his passing.

Robert was 90 years old and lived a remarkable life. He was a brilliant, loving, gentle man.

He is survived by his wife Joan, six children, Ellen Salter Williams (Rudy) of Marysville, WA, Steven Salter (Cynthia) of West Bend, WI, David Salter (Kathleen) of Kanab, UT, James Salter (Patricia) of Folsom, CA, Donald Erwin (Nancy) of Stockton, CA, and Drew Erwin (Sheri) of Ripon, CA, 16 grandchildren and 34 great grandchildren.

Robert was born in West Bend, Wisconsin to Milo Park Salter and Jessie Mae Swanton and grew up on the family’s working dairy farm. The one hundred and fifty year old Salter farm is still in the family, a source of great pride to him.

Dr. Salter earned both his Bachelor’s of Science Degree in 1944 and his Doctor of Medicine in 1946 from University of Wisconsin. He also graduated with a Master of Science in 1952 from Marquette University, Milwaukee, Wisconsin. Dr. Salter opened his medical practice in 1954 in Stockton, CA. He specialized in thoracic and vascular surgery and pioneered the field in this area. He practiced medicine in the San Joaquin Valley for over 50 years and was also a respected instructor at San Joaquin General Hospital in their surgical residency programs. Throughout his career he devoted many hours to teaching the specialty of thoracic surgery and considered this to be one of the most important and rewarding elements of his career.

Dr. Salter was a member of the San Joaquin Medical Society since 1955 and served as the Society’s President from 1972-1973. He had a multitude of committee appointments.

Dr. Salter was a founding member of the Clinical Society of Vascular Surgeons, Fellow of the College of Chest Physicians, Member of the American Thoracic Society, and Fellow

SAN JOAQUIN PHYSICIAN 63

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In Memoriam

of the American College of Surgeons. Dr. Salter was names 1997 Respirologist of the Year by the Respirology Club of San Joaquin and as elected president of Delta Independent Practice Association Board of Directors. He retired in 1998 at the age of 75 and stayed actively engaged in many professional seminars and conferences.

One of his great passions was listening to classical music.

His favorite composer was Beethoven. Many times you could find Robert reading a medical journal, watching a ballgame, and listening to classical music all at the same time. He enjoyed a challenging game of chess and remained a loyal fan of the Chicago Bears.

In retirement he was involved in community organizations and enjoyed meetings of the Weber Point Coffee Club.

Robert was a very proud and patriotic man. He served our country in two wars, first in WWII as a Naval Officer and then in the Korean War with the US Army as the Assistant Chief of General Surgery at William Beaumont Army Hospital, El Paso, TX.

LOUIS P. ARMANINO, M.D.

medical service.

He also was president of the professional staff and chief of the medical service at St. Joseph’s Hospital, the San Joaquin Medical Society in 1956, and the San Joaquin County Heart Association. He became the co-chair of the Stockton Post Graduate Study Club and served as the chairman of the sixth district of the California Medical Association delegation, including all eight of the San Joaquin Valley counties’ delegations.

Appointed to both the local and the CMA Committees on Ageing, this was followed by earning a fellowship in the American College of Physicians in 1966. For several years after retiring from private practice, he served as associate physician at the Student Health Center at UOP. Yearly vacations with his wife and family allowed him to travel worldwide. He enjoyed bicycling and was an accomplished watercolor artist. A highlight of his travels was a working stint at the Vellore Medical College and Hospital in south India where he and his wife Dorothy, a nurse, lived for several months.

Feb. 17, 1916 - Jan. 22, 2013 Louis P. Armanino Jr., aged 96, died in Stockton on January 22, 2013. His wife of 66 years, Dorothy, predeceased him. He was the father of four children: Steven Armanino (Nancy) of Corona, CA; Peter Armanino of Orangevale, CA; Annette Silver (Ben) of Stockton; and Arlene Gresehover (Karl) of Weiser, ID. His grandchildren include Steven Christopher Armanino (Anna) of Fullerton, CA; Katharine Grieco (Tony) of Big Bear, CA; James Silver (fiancee Soumya Kantamneni) of Washington DC; and Joseph Silver (Jaslyn) of Honolulu.

He is also survived by great grandchildren Allison and Ethan Armanino, and Lauren and Luke Grieco.

Louis P. Armanino was born and lived in Stockton where he practiced medicine from 1945 to 1985. After attending local schools and College of the Pacific, he graduated from UC Berkeley, and then received his medical degree at UC San Francisco. After serving an internship and residency at UC Hospital, and continuing his education at Vanderbilt University Hospital as a resident physician, he returned to UCSF as an instructor in medicine, an associate student-health physician, and an examiner for the San Francisco Induction Center.

Returning to Stockton, he established a partnership with Drs. Wirt Scott and David Green lasting 28 years. He became an attending physician on the teaching staff at the San Joaquin General Hospital, and served the last 18 years as the chief of the

SPRING 2013

HAROLD LEONARD BERKMAN M.D. April 1, 1918December 23, 2012 Harold Leonard Berkman, M.D. devoted father, grandfather, and great grandfather died at the age of 94.

Dr. Berkman, known to those closest to him as either “Hal” or “Boppee,” was born in New York City in 1918. He moved to California as a teenager and went on to get his B.S. and M.S. degrees in zoology from UCLA. From there, he received his medical degree from the University of California, San Francisco, in 1945. While he was a student at UCSF, he met his beloved wife Geri, a Stockton native and an undergraduate at U.C. Berkeley. After marrying Geri in 1943 at the original site of Temple Israel , they gave birth to their daughter, Ronna, in 1945, and son, Randy, in 1948. The

SAN JOAQUIN PHYSICIAN 65

In Memoriam

family resided in Geri’s hometown of Stockton for most of their lives, following Hal’s Army Medical Corps service in Germany from 1952 to 1953.

Hal specialized in obstetrics and gynecology and had an active practice spanning more than four decades, delivering thousands of Stockton’s babies. After his official retirement, he continued to assist other doctors and participated in continuing education courses until shortly before his death. Besides his passion for his career, he brought equal passion to his lifelong hobbies. Hal was an avid traveler, photographer, tennis player, skier, and investor.

“He was always puttering around the house and made all kinds of gadgets. He loved to work with his hands” said his wife, Geri Berkman.

He was an active member of the San Joaquin County Medical Society since 1947, the Stockton Tennis Club and Temple Israel. He

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also served on multiple committees including: Medical problems, Mental Health, and Public Relations. Although his later years kept him off the ski slopes and tennis courts, he always kept his mind active through constant learning, developing great interest in technology in his later years. “We all know that he was physically active: he skied all over the world and played tennis up until his final months,” said granddaughter Ariel Morris. “But in addition, he was mentally active - always learning new things and keeping up to date with medicine and finances and technology.”

Above all else, he was a devoted family man.

Despite the loss of his daughter Ronna in 2004, and his son Randy in 2011, he never lost his jovial spirit; he remained an active and involved grandfather, and earlier this year, became a great grandfather.

Ariel and Lilah Morris are their surviving

granddaughters. Both were born to Jim Morris, a Stockton attorney, and Ronna. Lilah followed in her grandfather’s footsteps; she is a surgeon in Houston.

Ariel, who spoke at the Temple Israel funeral, long ago gave him a nickname that stuck. “When she was a baby, she couldn’t say ‘Grandpa,’ “ Geri Berkman said. “So she called him Boppee.”

It was a proud moniker and was placed on Hal Berkman’s license plate.”My Boppee was a constant figure in my life,” Ariel said. “He was like another father, only with less hair.”

Hal is survived by his wife of 69 years, Geri.

He was a devoted father-in-law to Jim Morris and Robin Appel, doting grandfather to Lilah and Ariel Morris, and great grandfather to 10-month old Arabella Wiseman.

SPRING 2013

We are Seeking

YOUR LIFETIME ACHIEVEMENT AND YOUNG PHYSICIAN AWARD NOMINATIONS Don’t miss the opportunity to recognize a fellow colleague who has inspired or mentored you in your own medical career. Each year our society recognizes two outstanding physician members who have demonstrated exemplary care - not just for their patients, but also their community and the world in which they live.

We will accept nominations via fax or mail for each of these awards up to Friday, March 22, 2013. Please provide us detailed information on your nominee’s accomplishments and community involvement. The Young Physicians Award is exclusive to physicians under the age of 45. Nomination Forms are available online at www.SJCMS.org and have also been mailed directly to each member.

Our Nominating Committee (consisting of all past presidents and past LTA recipients, some of which are pictured here) will evaluate all submitted nominations for each of these awards.

The following criteria will be taken into consideration for these prestigious awards: • Dedication to high standards of medical practice.

• Dedication to the care and well being of the patients of their community.

• Dedication to the support of physician colleagues in the medical community.

• Involvement in humanitarian activities.

• Involvement in community civic activities.

• Leadership in the medical and/or civic communities.

Your input in this process is very important. To submit your nominations for the Lifetime Achievement Award and/or the Young Physicians Award please fax them to 209-952-5298 or, should you have any questions please call 209 952-5299.

SPRING 2013

SAN JOAQUIN PHYSICIAN 67

New Members

9 NEW

MEMBERS IN THE PAST 60 DAYS!

...and even more on the way.

Benjamin Morrison M.D. Family Practice Community Medical Centers, Inc P.O. Box 779 Stockton, CA 95201 (209) 373-2829 Medical College of Va Commonwealth University School of Medicine - 2000

Anna Robinov M.D. OB/GYN Kaiser Permanente-Stockton 7373 West Lane Stockton, CA 95210 (209) 476-2000 University of California Davis Medical School - 2008

Robert Jackson M.D. Dermatology Kaiser Permanente 7373 West Lane Stockton, CA 95210 (209) 476-3300 Meharry Medical College - 1978

Vijayalakshmi L.D. Vadrevu M.D. Opthalmology Center for Sight 1899 W March Lane Stockton, CA 95207 (209) 623-4700 Osmania Medical College - 1983

Dang Nguyen M.D. Family Practice Kaiser Permanente-Manteca 1721 W Yosemite Ave Manteca, CA 95337 (209) 825-3700 Western University of Health Sciences - 2005

Daniel Levinsohn M.D. Opthalmology Center for Sight 1899 W March Lane Stockton, CA 95207 (209) 623-4700 Albert Einstein College of Medicine - 2008

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SAN JOAQUIN PHYSICIAN

Deanna Louie M.D. Opthalmology Center for Sight 1899 W March Lane Stockton, CA 95207 (209) 623-4700 University of Michigan Medical School - 2008 Petre Motiu M.D. OB/GYN 52 Laurel Street Valley Springs, CA 95252 (209) 772-1190 Georgetown University School of Medicine 1993 Dale Helman M.D. Neurology Central California Neurology Medical Group 2027 Grand Canal Blvd, Ste 29 Stockton, CA 95207 (209) 373-1335 Pritzker School of Medicine - 1984

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22,689 To improve patient safety, you need to stay on top of best practices. That’s why, as shown by the 2011 numbers above, we provide you the risk management advice you need, when and how you want it. It’s why we provide industry-leading CME online and through Claims Rx, our monthly publication based on closed claims. And why we tailor solutions to help with your specific risk issues. The results include 98% policyholder retention, the highest-level CME accreditation and reduced risk for you.

Call 877-453-4486 or visit norCalmutual.Com Proud to be endorsed by the San Joaquin County Medical Society

Our passion protects your practice