Spring 2015

ROTACARE CLINIC RISES IN THE

CENTRAL VALLEY PLUS: House of Delegates 2014 Wrap Up Geographic payments for Medicare physicians and more!

Spring 2015

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VOLUME 63, NUMBER 1 • MARCH 2015

House of Delegates 2014

{FEATURES}

12 26 30 43

HOD

House of Delegates

{DEPARTMENTS} 22 IN THE NEWS

ROTACARE CLINIC

A RotaCare Clinic Rises in the Central Valley

New faces and announcements

47 INAUGURAL STOCKTON HEALTH

EMPOWERMENT CONFERENCE

51 DIGNITY HEALTH

ACHIEVING THE IMPOSSIBLE

White Coat Ceremony

A12-year fight for fair geographic payments for Medicare physicians

54 PUBLIC HEALTH

ADDRESSING OBESITY

58 PRACTICE MANAGEMENT:

San Joaquin County residents voice concerns about community health

Vaccine Refusal: A Social Disease?

The key to improving patient outcomes

61 NEW MEMBERS 63 IN MEMORIAM

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PRESIDENT Ramin Manshadi, MD PRESIDENT-ELECT John Zeiter, MD PAST-PRESIDENT Thomas McKenzie, MD SECRETARY-TREASURER George Savage, MD BOARD MEMBERS Raissa Hill, DO, Moses Elam, MD, Grant Mellor, MD, Dan Vongtama, MD, Alvaro Garza, MD, Kwabena Adubofour, MD, Mohsen Saadat, DO, Clyde Wong, MD

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

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Ramin Manshadi, Lisa Richmond, Mike Steenburgh Vanessa Armendariz

COMMITTEE CHAIRPERSONS

MANAGING EDITOR Lisa Richmond

MRAC F. Karl , Gregorius, MD

CREATIVE DIRECTOR Sherry Roberts

DECISION MEDICINE Kwabena Adubofour, MD ETHICS & PATIENT RELATIONS to be appointed LEGISLATIVE Jasbir Gill, MD

CONTRIBUTING WRITERS James Noonan, Alvaro Garza, MD, MPH, Elizabeth Zima, Grant Mellor, MD, Vanessa Armendariz

COMMUNITY RELATIONS Joseph Serra, MD PUBLIC HEALTH Alvaro Garza, MD SCHOLARSHIP LOAN FUND Janwyn Funamura, M.D.

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

NORCAP COUNCIL Thomas McKenzie, MD SUGGESTIONS, story ideas or completed stories

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Roland Hart, MD,

written by current San Joaquin Medical Society members are welcome and will be reviewed by the Editorial Committee.

Grant Mellor, MD, Kwabena Adubofour, MD, Gabriel K. Tanson, MD, Ramin Manshadi, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: 209-952-5299 Fax: 209-952-5298 Email Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM Closed for Lunch between 12pm-1pm

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Letter From The Executive Director

STAFF REPORT

PASSION What is passion? Webster’s Dictionary defines it as: a strong feeling of enthusiasm or excitement for something or about doing something. Everyone talks about finding your passion. So, have you found yours? If not, I believe this issue may just help you do just that!

I am inspired by the passion I see in our physician members on a daily basis. It was evident at the annual House of Delegates meeting last December where physicians from all California counties and all modes of practice met to discuss issues related to health care policy, medicine and patient care. This year over 100 resolutions were introduced and debated in reference committees. Seven SJMS physician members represented you well in these discussions.

LISA RICHMOND

At SJMS we have passion for our mission of encouraging youth to pursue a career in medicine through our Decision Medicine program. This year we were overjoyed when we met an enthusiastic group of students from UC Davis Medical School who shared our excitement for this same mission! They approached us about their hopes of hosting a conference with the goal of empowering the students of San Joaquin County with tools necessary to become a physician and return to practice in the community in which they grew up and are needed the most. Six months later, through a collaboration of many, the first Health Empowerment Conference was born.

There are some people that just have a heart to serve others. Dr. Joe Serra is one of these people.

His accomplishments are too many to list and I know he wouldn’t want me to do so. But, this 2005 SJMS Lifetime Achievement Award recipient has been busy working on his latest project, RotaCare San Joaquin, which will utilize volunteer physicians and allied health professionals to care for the uninsured, underinsured and undocumented at the Dorothy L Jones Family Resource Center in the heart of south Stockton. He has built an impressive board, including SJMS member physicians Walter Wager, MD, Moses Elam, MD and Earl Taylor, MD who are all pictured on the cover. I just know that once you read the feature article, you are going to be to be motivated to get involved!

Finally, please save the date for our 6th Annual SJMS Golf Tournament benefitting the First Tee of San Joaquin and our own Decision Medicine Program. This year the tournament will be held at the beautiful Elkhorn Golf and Country Club Saturday, May 2 at 1pm. Please see enclosed advertisement for more details.

All the Best,

Lisa Richmond

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We believe in 98.6 degrees.

Being a good doctor is about more than practicing good medicine. It’s about preventing illness. Being proactive.

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For more information, visit us online at kp.org/centralvalley SAN JOAQUIN PHYSICIAN

SPRING 2015

A message from our President > Ramin Manshadi MD, FACC

Looking Ahead It is time to look ahead. Last year our focus was to defeat the Proposition 46, and as history has it, it was a landslide victory for the doctors and allied health.

Now, we need to look ahead to more challenges. We need to be proactive and lobby as a unit to benefit the profession of medicine. This advocacy is done on our behalf every day at the Capitol and is one of the many benefits of membership to San Joaquin Medical Society and the California Medical Association. Let’s take a look ahead at a few of the items on CMA’s agenda for 2015.

MEDI-CAL PROVIDER REIMBURSEMENT RATES In 2014, CMA continued to work with the We Care for California Coalition to advocate for an increase in Medi-Cal provider reimbursement rates. The Coalition was successful in convincing the Governor to “forgive” the retroactive collection of recentlyenacted cuts that were enjoined while CMA and other provider groups sought relief in the courts. Regrettably, despite significant interest from both houses of the Legislature in increasing Medi-Cal rates, the Governor left these cuts in place prospectively for future services, an action which solidifies California’s position as one of the worst payors in the country. CMA will continue to work with the Coalition on ways to expand access to care for Medi-Cal beneficiaries, particularly through an increase in rates.

With Medi-Cal estimated to serve one in three Californians by the middle of 2015 and the reluctance of the Governor to invest significantly more resources into reimbursement rates, it is increasingly important to impact how the limited Medi-Cal resources are spent. In the commercial market, the use of Medical Loss Ratios have been a tool for directing resources away from insurance company profits to direct patient care. CMA will be working with legislators and stakeholders to determine whether such an approach would make the most effective use of these limited funds.

REFORMS TO MANAGED CARE CMA will continue to focus its attention on ensuring that physicians have the professional and economic resources to treat their patients. To that end, CMA will again pursue necessary reforms to improve physician participation

ABOUT THE AUTHOR ­ Board Ramin Manshadi MD, FACC is President of the San Joaquin Medical Society and is a Board-Certified Cardiologist

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A message from our President > Ramin Manshadi MD, FACC

in Cover California products, ensure appropriate regulation of network adequacy and provider directory accuracy, and promote fair contracting practices by health plans and insurers.

Last year, CMA worked with the Joint Legislative Audit Committee to audit the provider directories of Medi-Cal Plans for accuracy. While the outcome of that audit is as yet unknown, it may provide an additional opportunity to enact legislative reforms to improve healthcare delivery for both Medi-Cal providers and patients.

2012, SB 863. Problems include lack of access to timely care for injured workers, especially those facing chronic conditions, and the lack of further appeal ability outside of the ineffective IMR process. Potential legislative fixes could begin with requiring UR doctors to accept liability for denying medically necessary treatments, in addition to requiring that they be licensed by the state of California.

PUBLIC HEALTH CMA is committed to continuing to advance important public PHYSICIAN WORKFORCE health issues. Last year, CMA introduced SB 1000 (Monning), which Last year, CMA was successful in securing limited-term funding to required sugary beverages to contain warning labels. The bill generated increase the number of residency slots in California. As you know, a significant amount of earned media and greatly increased public studies show one important factor in determining where a physician awareness about the consumption of sugar sweetened beverages. decides to practice is where he or she does his or her residency.

The coalition formed to support SB 1000 is strongly considering its Additionally, studies show that physicians who attend medical school reintroduction.

As mentioned above, CMA is also already participating in an effort to increase the state’s This year, CMA will work to secure a permanent tobacco tax. The tobacco tax coalition is pursuing a dual strategy, which means it will seek passage in funding source to further the state’s investment the Legislature prior to moving forward with a ballot measure. in developing California physician workforce.

Now, let us further dissect the Medi-Cal reimbursement rates. Unfortunately, things are and residency in the same state are highly likely to stay. only getting worse for most doctors, especially those who still accept This year, CMA will work to secure a permanent funding source Medi-Cal health insurance. Just processing the insurance forms costs to further the state’s investment in developing California physician $58 for every patient encounter. To make ends meet, physicians have workforce. Already, CMA is participating in effort to increase the state’s had to increase the number of patients they see. The end result is that the tobacco tax by $2 per pack, and a portion of that revenue will be directed average face-to-face clinic visit lasts only about 12 minutes. at supporting California residency programs. Government Relations In fact, difficulty dealing with insurers has caused many physicians continues to work with the other centers and external stakeholders to to close their practices and become employees of large groups. But for develop additional opportunities as well. patients, this doesn’t necessarily give them more time with the doctor— since these physicians are also experiencing high patient loads. Most REIMBURSEMENT FOR TELEPHONE/ELECTRONIC patients have experienced the rushed clinic visit, which is where I believe PATIENT MANAGEMENT the breakdown in good medical care begins. “Doctors who are in a rush, (BASED OFF OF HOD RESOLUTION 407-13) don’t have the time to listen.”

Last year, CMA worked with then-Assembly Member Pérez to Yet physicians have to go along, constantly trying to improve their introduce Assembly Bill 1771, which would have provided “productivity” and patient satisfaction scores—or risk losing their reimbursement of telephonic and electronic patient management jobs. Industry leaders are fixated on patient satisfaction, despite the services. The bill passed out of the entire Assembly and the Senate fact that high scores are correlated with worse outcomes and higher Health Committee with strong bi-partisan support. However, the costs. Indeed, trying to please whatever patient comes along destroys measure was held in Senate Appropriations. CMA is working with the the integrity of our work. It’s a fact that doctors give up to the patient committee’s legislative staff to reintroduce the measure in a manner that demands, for narcotics, x-rays, doctor’s notes, despite what survey addresses their remaining concerns. advocates claim. Medicare payments will now be tied to patient The goal of the legislation will still be to require insurers to satisfaction creating a larger problem. Doctors need to have the ability to provide coverage of telephone and other electronic management say no and do what they feel is right. services. CMA’s longstanding policy states that physicians should be The bottom line is that regardless of mode of practice or specialty, we fairly compensated for their professional services, whether patients are are working to ensure the practice of medicine is dedicated to the welfare treated through face-to-face contact, telephone consultation, fax, e-mail, of our patients, rather than the insurance bottom line. We have proven or another communication form. we can accomplish remarkable feats when we stand united.

It is a pleasure to lead this society, and if anyone has any concern or WORKERS’ COMPENSATION issues with medical practice, please feel free to contact our office.

CMA is considering various avenues for addressing problems within Ramin Manshadi MD FACC the workers’ compensation system since passage of the reform bill in President, San Joaquin Medical Society

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HOUS

DELEGA HOUSE

OF DELEGATES

California Medical Association delegates set policy and elect officers at annual meeting

More than 500 California physicians convened in San Diego, December 5-7 for the 2014 House of Delegates (HOD), the annual meeting of the California Medical Association (CMA). Each year, physicians from all 58 California counties, representing all modes of pr actice, meet to discuss issues related to health care policy, medicine and patient care and to elect CMA officers.

>>

SE OF

ATES 2014

This year, nearly 100 resolutions and reports were introduced and debated in reference committees (both in person and online prior to the meeting). During the HOD weekend, the delegates met to debate and vote on reference committee recommendations. A total of 63 resolutions were adopted.

This year also saw an expanded “virtual” reference committee process that will enable a shorter, two-day meeting in future years. Reference Committees A (Science and Public Health), B (Government Health Programs and Health System Reform) and F (Health Professions and Facilities) conducted all testimony online in advance of the meeting.

All CMA members were invited to participate in the online debate, and nearly 500 online comments were recorded. The reference committee members then met via conference call in advance of the meeting to develop their recommendations, which were presented to the House for floor debate.

The House also elected a new president, Humboldt surgeon Luther F. Cobb, M.D., while Riverside physician Steven E. Larson, M.D., was tapped as president-elect.

The full 2014-2015 CMA Executive Committee includes: • President Luther F. Cobb, M.D., Eureka • President-Elect Steven E. Larson, M.D., Riverside • Speaker of the House of Delegates Theodore M. Mazer, M.D., San Diego • Vice-Speaker of the House of Delegates Lee T. Snook, M.D., Sacramento • Chair of the Board of Trustees David Aizuss, M.D., Los Angeles

• Vice-Chair of the Board of Trustees Robert E. Wailes, M.D., Encinitas • Immediate Past President Richard E. Thorp, M.D., Paradise

Reports and Resolutions

The following are summaries of some of the resolutions that were adopted as policy. (The full actions of the HOD are available to members at www.cmanet.org/hod, under the “documents” tab.)

Tobacco CMA has been a tireless advocate for stronger restrictions on the tobacco industry for decades. The House continued that tradition, adopting five antismoking resolutions.

This year, nearly

100 resolutions and reports were introduced 14

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House of Delegates > 2014

CMA has been a tireless advocate for stronger restrictions on the tobacco industry for decades Resolution 104-14 asks CMA to support the removal of the tobacco control pre-emption from the California Penal Code so that local governments would have the ability to increase the legal age of tobacco sales to 21.

Resolutions 101-14, 102-14 and 103-14 address the sales, advertising regulation and taxation of electronic cigarettes. These resolutions seek legislation to ban the usage of electronic cigarette devices in public places, to ban advertising of electronic cigarettes and to urge state government to tax these items to generate funds to support research into their efficacy as smoking cessation aids, the health impacts of electronic cigarettes and for education.

Resolution 105-15 asks CMA to support the concept of a tobacco-free military, including ending sales on military bases and establishing smoke-free military installations, and to refer this for national action.

These resolutions come at a time when CMA is dedicating itself to smoking cessation in the state in an effort to save lives and taxpayer money. In December, CMA announced it had joined an unprecedented coalition of health care groups seeking to increase the tobacco tax by $2-per-pack by the end of 2016 to save lives and to defray the cost of diseases caused by smoking.

Called the Save Lives California coalition, other members include the American Heart Association, American Lung Association, American Cancer Society Cancer Action Network, SEIU California, Health Access California and the California Hospital Association. The group will seek an increase in tobacco taxes either through legislation or ballot measure.

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CMA must use the political capital it has “banked” by recently defeating the trial lawyers’ Proposition 46 to further reshape the future of medical liability.

It is hoped that a tax increase will lower the cost of providing care to smokers in the state. A recent study on California’s tobacco use by the University of California at San Francisco School of Nursing’s Institute for Health and Aging found that smoking costs $18.1 billion in California – $487 for each resident, or $4,603 per smoker – in direct health care costs and indirect costs from lost productivity due to illness and premature death.

By increasing tobacco taxes the group hopes to save more than 100,000 lives per year, prevent more than 150,000 young people from ever smoking and save billions in health care dollars spent on tobacco-related diseases.

End of Life Issues

Resolution 402-14 urges that all public and private health insurers be required to reimburse for counseling for end-of-life planning as an integral part of good medical care. This resolution was referred for national action.

Resolution 501-14 supports the goal of developing a Physician Orders for Life-Sustaining Treatment (POLST) online registry in California that would be secure, easy to fill out online, have real time updates, be HIPAA compliant, contain a review of forms for proper completion and allow accessibility from any electronic health record system.

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Resolution 502-14 supports allowing trained nurse practitioners/advance practice nurses and physician assistants to be authorized to complete and sign POLST orders to improve the use of this type of end-of-life authorizations and also allow for a review by the patient’s supervising physicians, when appropriate.

Other Issues Parent to parent education of child vaccination: In an effort to stem the tide of personal belief vaccine exemptions and prevent more vaccine-preventable disease outbreaks, CMA passed Resolution 115-14 supporting the development and evaluation of educational efforts, based on science and in collaboration with health care providers, for parents who want to help educate and encourage other parents reluctant to vaccinate their children. This resolution was referred for national action.

Physician reimbursement: The CMA delegates passed Resolution 408-14, which asks that CMA continue to advocate for noncontracted physicians’ ability to bill and collect usual, customary and reasonable charges. The resolution also asks CMA to support legislation or regulation requiring that payors reimburse out-ofnetwork providers an interim payment amount at an amount no less than the provider’s charges or a fair payment standard based on an unbiased database of charges, according to specialty and geography.

Once made, the interim payment may be disputed via an appropriate dispute resolution mechanism, such as binding arbitration.

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House of Delegates > 2014

Electronic Health Records: Resolution 513-14 asks CMA to support efforts to harmonize standards and specifications that would enable interoperability of electronic health record systems and facilitate the exchange of health information among health care providers.

Awards and Elections

New CMA president sets sights on tort reform, burdensome regulations and membership growth The new CMA president Luther Cobb, M.D., during his inaugural speech at the association’s annual meeting, said that CMA must use the political capital it has “banked” by recently defeating the trial lawyers’ Proposition 46 to further reshape the future of medical liability.

“Now that the trial attorneys have so amply demonstrated the wrong way to do it, CMA can chart a course for meaningful and durable reform, that is fair to those truly injured by medical mishaps, while protecting the overwhelming majority of doctors who try their best every single day to do the right thing,” said Dr. Cobb, a board-certified, selfemployed physician practicing in general, thoracic and vascular surgery in Humboldt County. “If we can cut out the gross waste on the overhead of the adversarial tort system, all will benefit.”

Dr. Cobb also spoke on the necessity of regulatory reform, saying there were many unnecessary, burdensome regulations that need to be struck from the books. One example he cited was the need for a minimum level of humidity in operating rooms to prevent the risk of sparks from ether anesthesia, which is highly flammable. “We no longer use flammable anesthetics and haven’t for a half century, yet this regulation persists. This makes ORs uncomfortable for surgeons, can interfere with the vision of those wearing protective eyewear and make the patients sweat, increasing the risk of infection,” he said.

Looking out at the diverse members of the CMA HOD, Dr. Cobb said recent growth in CMA membership, which now exceeds 40,000, has been unprecedented in its history. “For many years, we on the board and the executive committee watched as membership numbers slowly declined. The conventional wisdom was that this was inevitable, that physicians just weren’t joiners,” he said. “But, with diligent organization and effort at the grassroots level, our membership has been steadily growing. We set what many thought was a ludicrous goal of 5 percent annual growth and we have achieved that.”

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“And yet, all of us know many physicians who, for whatever reason, have declined to join,” he said. “If it were only for the Proposition 46 victory, they will have saved in a single year’s worth of malpractice premiums enough to pay for a lifetime of membership,” he said.

“But our nonmember friends have to be reminded of how powerful and successful our CMA is, and this is a one-on-one collegial conversation. All of us as individuals and as groups can do better to recruit new membership or re-recruit those who have lapsed. We must pledge ourselves to that effort.”

In addition to his involvement in organized medicine, Dr. Cobb serves as chief of staff of the Mad River Community Hospital in

Arcata, where he has been an active member of the medical staff since 1997. He previously served as the hospital’s chief of staff from 2000 to 2002 and vice-chief of staff from 2009 to 2011. Dr. Cobb is also on the medical staff of St. Joseph Hospital in Eureka.

Previously, Dr. Cobb served as attending surgeon, director of trauma services and director of the vascular surgery clinic at Santa Clara Valley Medical Center in San Jose, as well as clinical associate professor of surgery at Stanford University School of Medicine and the chairman of the surgery department at Mad River Community Hospital.

CMA HOD chooses president-elect, speaker and vice speaker At CMA’s annual meeting, Riverside physician Steven E. Larson, M.D., was named CMA president-elect. He will serve as presidentelect for one year, and will take office as president during the October 2015 annual meeting.

Dr. Larson has served as chair of the CMA Board of Trustees since 2011. He is the current CEO and chairman of the board of Riverside Medical Clinic, a multi-specialty medical group. He has been affiliated with the clinic since 1980.

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House of Delegates > 2014

He is an assistant clinical professor of medicine at Loma Linda University School of Medicine and a clinical professor of biomedical sciences at University of California at Riverside.

His medical staff appointments include Riverside Community Hospital, Parkview Community Hospital and Riverside County Regional Medical Center.

Dr. Larson earned his medical degree from the Medical College of Wisconsin in Milwaukee, graduating in 1975. He completed his residency in internal medicine in 1978 and a fellowship in infectious diseases in 1980, both at the Medical College of Wisconsin Affiliated Hospital in Milwaukee. He earned a master’s degree in public health from Loma Linda University in 1988. He is board certified in both internal medicine and infectious diseases.

Also reelected to the 2014-2015 CMA Executive Committee were Speaker of the House Theodore M. Mazer, M.D., a San Diego otolaryngologist, and Vice Speaker Lee T. Snook Jr., M.D., a Sacramento pain management specialist.

Dr. Mazer is a board-certified otolaryngologist running a small, solo practice. He served on the association’s Board of Trustees from 2002-2010 and has chaired various committees, including those focusing on medical services and access to specialty care. Dr. Mazer served as vice speaker of the CMA House of Delegates for two years before being elected to the post of speaker in 2013.

Dr. Snook is a medical director, president and founder of the Metropolitan Pain Management Consultants, Inc., in Sacramento. He is board certified in anesthesiology, internal medicine, addiction medicine and pain medicine. Dr. Snook is also a certified medical review officer and a qualified medical evaluator. He is also chair of the CMA Worker’s Compensation Technical Advisory Committee and spent nine years as a member of CMA’s Board of Trustees representing the Solo and Small Group Practice Forum.

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CMA elects new chair and vice chair of its board of trustees The CMA Board of Trustees elected David H. Aizuss, M.D., as its new chair and Robert E. Wailes, M.D., as vice chair.

Dr. Aizuss is a board certified ophthalmologist practicing in Los Angeles. Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care.

He also serves as an assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine. Dr. Aizuss is a medical staff member at Tarzana Hospital and West Hills Hospital in Los Angeles County, and belongs to several professional societies, including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society and the American Medical Association.

Dr. Aizuss has served as vice chair of the board since 2011. He is also a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons.

Dr. Wailes, a pain specialist and board certified anesthesiologist, is the founder, co-owner and medical director of Pacific Pain Medicine Group in Oceanside and Encinitas.

He has served as president of the San Diego County Medical Society and represents the American Academy of Pain Medicine at the American Medical Association.

Two other new members of the Board of Trustees were also elected: Jerry Abraham, M.D., Resident and Fellow Section, and Mark Ard, Medical Student Section.

For a complete list of the Board of Trustees, visit www.cmanet.org/bot.

Firebaugh internist wins CMA’s annual “country doctor” award More than 30 years ago, Oscar M. Sablan, M.D., an internist, and his wife Marcia Sablan, M.D., a family physician, decided to work in a rural area for three years to get their medical loans forgiven as part of the National Health Service Corp, a federal program to supply debt relief to newly graduated physicians who agree to work in underserved areas.

The couple moved from tropical Hawaii, where Dr. Sablan was serving his integrated medicine residency at the Queen’s Medical Center, Honolulu, to the dusty rural town of Firebaugh, 100 miles east of Fresno. The plan was for the couple to do their three-year service in rural Fresno County and then walk away with their debts forgiven. They started their practice on the corner of O and 9th streets and have been there ever since.

During the 2014 CMA House of Delegates, Dr. Sablan received the Frederick K.M. Plessner Memorial Award, an award given each year to honor the California physician who best exemplifies the ethics and practice of a rural country practitioner.

Dr. Sablan and his wife are the only full-time doctors in the tiny town of 7,800 and they are still treating many of the same families as when they arrived three decades ago.

The whole town, from wealthy ranchers to migrant farm workers, relies on the couple.

The Sablans have guided Firebaugh families through pneumonias, accidents, injuries, cancers and bypass surgeries to better health.

As the Sablans built up their medical practice, they realized that they could only do so much in the exam room. So they turned to politics. Dr. Sablan has served on the local school board for close to 20 years and his wife has served as Firebaugh’s mayor for 10 years and has sat on the city council for over 30 years.

SPRING 2015

RESOLVE PAYMENT AND CONTRACTING ISSUES

With one-on-one assistance from the practice management experts in CMA’s Center for Economic Services (CES). CES has recovered $5.6 million on behalf of physician members in the past two years.

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SPRING 2015

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House of Delegates > 2014

In addition to practicing medicine and community service in public positions, in 1981 the couple started the community’s annual free Christmas day dinner, which feeds 650 plus people every year. Dr. Sablan has also served as the Firebaugh-Las Deltas Unified School District team physician for all sports for 33 years.

including more than 35 medical students and residents. Also in attendance was the largest ever contingent of past CMA presidents (20) attending the event.

It is common knowledge that rural regions of California have long faced shortages of doctors. While small towns near Firebaugh struggle to hang onto doctors, Dr. Sablan’s long-standing commitment to the community makes him an exception.

Learn more about Dr. Sablan by watching the award video, available on CMA’s YouTube channel, www.youtube.com/cmaphysicians.

CMA’s 2014 Nye Award given to Santa Monica psychiatrist Santa Monica psychiatrist Maria T. Lymberis, M.D., was named the 2014 recipient of CMA’s Gary S. Nye, M.D., Award in recognition of her 30 years of leadership in the area of physician well-being.

This award, given annually during the association’s House of Delegates meeting, was established in 2009 in recognition of Dr. Nye, who has been a leader in bringing attention to and developing solutions to the issue of physician impairment and rehabilitation.

Dr. Lymberis’ career has been defined by a commitment to the development and defense of ethical medical standards. For the past three decades, she has also worked on issues involving physician health, rehabilitation of physicians and malpractice prevention.

Dr. Lymberis has been in full-time solo private practice specializing in psychotherapy in Santa Monica since 1970. Certified by the American Board of Psychiatry and Neurology in both psychiatry and child/adolescent psychiatry, Dr. Lymberis is a clinical professor of psychiatry at the Geffen UCLA School of Medicine and a graduate psychoanalyst of the Los Angeles Psychoanalytic Institute, where she taught for over 20 years as a senior faculty member. She is also a senior expert consultant for the Medical Board of California.

Among her many accomplishments, Dr. Lymberis is the founder and president of two nonprofit organizations: Hellenic American Psychiatric Association and The Psychiatric Education and Research Foundation.

Other News Annual gala r aises more than $50,000 for public health progr ams The CMA President’s Reception and Awards Gala hosted members of the CMA House of Delegates and guests for an evening of dinner, dancing and a live auction. The event raised more than $50,000 to support the public health projects of the CMA Foundation.

Held at the elegant U.S. Grant Hotel in San Diego immediately following CMA’s annual House of Delegates session on Saturday evening, the event was sold out with over 450 people in attendance,

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Among the big ticket items auctioned off were a trip to New York City, golfing in Scotland and a San Juan Island getaway.

A special thank you goes out to the 2014 gala sponsors: NORCAL Mutual, Union Bank, The Doctors Company, Pfizer, Cooperative of American Physicians, Mercer, The Permanente Medical Group, Southern California Permanente Medical Group and United Healthcare.

Join the CMA Foundation’s antisugary bever age campaign!

The CMA Foundation kicked off a social media campaign at the CMA House of Delegates to engage physicians in educating their patients about sugary drinks and how they increase the prospect of developing diabetes. The CMA Foundation and the Network of Ethnic Physician Organizations are both sponsoring the campaign with funding from the California Endowment.

As part of the campaign, physicians can request a poster for their offices that shows a large can of soda with the lettering “Type 2 Diabetes” and “Did you know that one junk drink a day can increase your risk of Type 2 diabetes by 25 percent.” Physicians are encouraged to place the posters in their waiting rooms where patients can see it to help open a dialog on the topic of sugary drinks and their effect on health.

Physicians are also asked to take pictures of themselves engaged in conversations with their patients and post them to social media, like Twitter or Facebook, with the hashtags #beatthesweet and/or #sugarlesspour. These hashtags will allow the foundation to find your post. The CMA Foundation will repost photos with these hashtags to its Facebook page.

To get your free poster contact Lisa Kirkland at lkirkland@ cmafoundation.org or (916) 779-6643.

SAN JOAQUIN PHYSICIAN

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In The News

IN THE

NEWS Doctors Hopsital Manteca Announces New Chief Nursing Officer

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

ex officio member of the San Joaquin Health Commission.

With over 19 years in private and public sectors of the health care industry, he most recently spent seven years at Stanislaus County Health Services Agency where he was associate director for clinical services.

Doctors Hospital of Manteca recently promoted Kathy Daley to the position of Chief Nursing Officer.

Kathy has been with Doctors Hospital and Tenet for the past 26 years, working most recently as the Director of the Medical/ Surgical Department.

Kathy Daley

The newly appointed Chief Nursing Officer was first a Certified Nursing Assistant (CNA) while still in high school, she then went on to become a Licensed Vocational Nurse (LV N) and then worked toward her Bachelor of Science Degree in nursing. She is now in the process of obtaining her Masters’ Degree.

Kathy first worked as a Staff Nurse in Medical Surgical and then to OB and Labor and Delivery. Then she became the Director of Education and Performance Improvement. After a short period in a corporate position she came back as the Director of the Medical/Surgical Department.

New Leader for HPSJ Governing Board Adds to Already Strong Provider Expertise Greg A. Diederich is the new chair of the San Joaquin Health Commission, HPSJ’s 11-member governing board, as of January 14. January 5 was his first day on the job as Director of the San Joaquin County Health Services Agency, and as an

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Greg Diederich While there, many at HPSJ had the pleasure of working with him as we expanded the Medi-Cal program in Stanislaus County. In addition to being well-informed about that region of the HPSJ geographic service area, Greg Diederich has a deep understanding of the current health care landscape and he adds to the already considerable provider expertise contributed by current San Joaquin Health Commission members Drs. Marvin H. Primack, Gentry Vu, Mohsen Saadat, and Michael Herrera.

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In The News

New Physicians Join Dignity Health Medical Group Dignity Health Medical Group Stockton recently welcomed four new physicians to the group. Longtime Stockton physicians Surinder Raron, MD, Pediatrics, and Paul Waters, MD, Family Practice are the latest primary care physicians to join the team. Two new specialists, Paul Lee, MD, Urology and Jennifer McNeil, MD, Colon & Rectal Surgery, have also joined the team.

Surinder Raron, MD, is board certified in pediatrics. Dr. Raron has practiced medicine in Stockton since 1992.

He currently serves as the Chief of Pediatrics at St. Joseph’s Medical Center and was named The Record’s Best of San Joaquin last year. Dr. Raron is passionate about medicine and is committed to helping children and teens

Surinder Raron, MD

achieve optimal health.

He prides himself on being ever-learning and on his dedication to serving patients with the utmost respect.

Paul Waters, MD, received his medical degree from Creighton University School of Medicine and has been in practice for over 50 years. As a well-known and highly respected physician, Dr. Waters is driven by a sincere interest in the well-being of people. Throughout his distinguished career, Dr. Waters has been affiliated with various medical societies and hospitals throughout the community.

Paul Waters, MD

Paul H. Lee, MD, is a board certified urologist specializing in both adult and pediatric urology services. Dr. Lee received his MD from UMDNJ-New Jersey Medical School; completed surgery internship/residency at The John’s

Introducing the new HPSJ website!

As 88% of HPSJ providers already know, our website’s DRE (Doctors’ Referral Express) provider portal is essential to the smooth running of both the care and business sides of practices.

To give you each a much more efficient online tool kit, as we completely revamped the website – www.hpsj.com – we loaded the DRE provider portal with many more functions that will be valuable for you and your practice team. It’s easier to use, works with all types of devices, and is now a one-stop location for much of the information you

SPRING 2015

need – whenever you need it. For a complete list of online provider functionality now available to you, please see page 2, Topics of Interest to Providers on the HPSJ Website.

If you have not already done so, please sign up for portal access. It’s easy.

Provider Services is here to help, at 209•942•6340

Check patient eligibility Access provider searches Search the formulary and latest updates Support your transition to ICD-10 coding (October 1, 2015 transition)

Log on to www.hpsj.com and click Providers icon button to: Submit authorizations or check the status

SAN JOAQUIN PHYSICIAN

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In The News

IN THE

NEWS Jennifer McNeil, MD, is board certified in colon and rectal surgery with over 20 years of experience as a surgeon, most recently practicing in Oklahoma. She received her MD from the Uniformed Services University of the Health Sciences, in Bethesda, MD and completed her residency/ internship at the Walter Reed Army Medical Center, Washington. Dr. McNeil is excited to have returned to her native home of California, and looks forward to getting involved and providing expert care to the community.

Paul Lee, MD

Jennifer McNeil, MD

Hopkins Hospital in Baltimore and urology residency at The University of Massachusetts Medical Center, Worcester, M A. Prior to coming to Stockton, he was with Kaiser Permanente for 24 years where he

served as Chief of Urology, Chairman of the Regional Urology Technology Committee, and Pediatric Urology Consultant for Northern California.

He also serves The Medical Board of California as an expert reviewer.

St. Joseph’s recognized as a Top Performer by The Joint Commission St. Joseph’s Medical Center was recently named a Top Performer on Key Quality Measures® by The Joint Commission, the leading accreditor of health care organizations in America.

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 lisa@sjcms.org one month prior to publication (February 1st for the Spring issue, May 1st for the Summer issue, August 1st for the Fall issue and November 1st for the Winter issue).

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In The News pursues quality improvement through innovation.

Dr. Soung was recognized as the Physician Champion for Community for his dedication and commitment to serving those most in need.

For decades, Dr. Soung has treated both uninsured and underinsured patients in his practice without charging them.

Lian Soung and Chris Hudlin St. Joseph’s was recognized for its achievement on measure sets regarding the treatment of heart attacks, heart failure, and pneumonia, and in surgical care. The ratings are based on an aggregation of accountability measure data reported to The Joint Commission during the 2013 calendar year.

The Top Performer program recognizes hospitals for improving performance on evidence-based interventions that increase the chances of healthy outcomes for patients with certain conditions. St. Joseph’s was one of only two hospitals in San Joaquin County to be recognized as a Top Performer.

Dr. Hudlin was named Physician Champion for Quality. He has served as Chair of the Surgery/Trauma Quality Committee at St. Joseph’s for nearly two decades, making many contributions to improvements in the quality of care provided for surgical patients at St. Joseph’s Medical Center

St. Joseph’s Announces Physician Champion Award Recipients Christopher Hudlin, MD and Lian Soung, MD were recently named the recipients of St. Joseph’s Medical Center’s 2014 Physician Champion Awards.

Each year, physicians are called upon to nominate their deserving peers to be recognized as a part of St. Joseph’s Physician Champion Awards. The annual awards recognize a Champion of Community, a physician who has demonstrated a commitment to improving the health status of the community, and a Champion of Quality, a physician who continuously

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Imad Kafilmout, MD Imad Kafilmout New Family Medicine Physician Imad Kafilmout, M.D. has joined San Joaquin General Hospital in French Camp practicing family medicine.

Dr. Kafilmout is looking forward to welcoming new patients at the Hospital’s French Camp location.

He received his Medical degree

from Baghdad University College of Medicine with additional medical training at West Suburban Hospital in Oak Park Illinois. Dr. Kafilmout also received an additional fellowship in obstetrics at West Suburban Hospital.

Dr. Kafilmout is a board certified family medicine physician and will perform family medical services through the community clinics of San Joaquin General Hospital.

Available space to lease for Medical office: For Medical office in Weber Ranch Professional park, 1801 East March Lane, Stockton, CA; call today at 209951-8830 or 951 83 95; 1367 sq. ft. fully finished ready to move in with 4 exam rooms, Doctor’s Chamber with separate bath room. Manager’s room, work station for M As, Patient’s bath room, storage room, and Reception (waiting room).

San Joaquin County Public Health Services has an excellent opportunity for an experienced physician who has a passion to serve children in the San Joaquin County community.

The Assistant Health Officer (CCS Medical Director) is responsible for providing medical oversight to the California Children’s Services Program and will be a liaison to the state’s CCS and local health care providers. The Public Health Services campus is located in Stockton, CA. The health department provides a culturally diverse community (685,660 pop.) with classic public health services. The Department has a tradition of strong community involvement and leadership in health promotion.

Apply Online: www.sjgov.org/hr By mail or in person: San Joaquin County Human Resources 44 N. San Joaquin Street Suite 330 Stockton, Ca 95202

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ROTACARE CLINIC RISES IN THE

CENTRAL VALLEY AREA PHYSICIAN LOOKS TO BRING HEALTH CARE TO SOME OF STOCKTON’S MOST IN-NEED COMMUNITIES

RotaCare > In The Central Valley

In the living room of his north Stockton home, Dr. Joseph Serra is an idea, if you think we can do it, let’s give it a whirl.’” working to build something great.

More than a year and a half later, it’s safe to say the whirl is underway.

Here, surrounded by handwritten notes, spreadsheets detailing Today, the RotaCare San Joaquin Board of Directors has grown to financial information and printed copies of countless email 14 people, with Serra and Cathy Peterson, a doctor of physical therapy conversations, Serra is reminiscent of an architect thumbing over and professor at the University of Stoctkon, serving as the founding blueprints in the days before ground is broken on his latest endeavor. advisory council. Doug Wilhoit, a former San Joaquin County In a way, this isn’t too far from the truth.

“In our community, we’re seeing the Over the past 18 or so months, Serra and a handful of other .” physicians, community leaders and working professionals have embarked on a journey to bring free healthcare to some of Stockton’s most Supervisor and current head of the Greater Stockton Chamber of impoverished neighborhoods. Together, they make up the Board of Commerce, serves as chairman of the RotaCare Board, while Dr. Walt Directors for the RotaCare San Joaquin Clinic, and after months of Wager, a Stockton family practitioner, serves as the board’s medical work, the proverbial finish line looks to finally be in sight. director.

“It all started like this,” Serra said, shifting his gaze from one handBack in Serra’s living room, Wager joins Serra in rattling off the written page to the next. “Now, everything’s falling into place.” names of the other board members, including a grant writer, an Serra and his fellow board members hope to have the doors of attorney, a retired nurse, a CPA, the CEO of United Way of San Joaquin their new clinic opened by summer of 2015, offering free medical County, area physicians Dr. Earl Taylor and Dr. Moses Elam, and treatment for non-emergency conditions, screenings and referrals to several others. outside resources to the underinsured residents of Stockton and the “I don’t know how you talked all these guys into this, Joe,” Wager surrounding areas. quips.

At the onset, the clinic will provide care one evening per week, with The diversity of this board is part of the reason that the RotaCare the understanding that services could expand in the future. effort in Stockton has moved forward as quickly, and smoothly, as it “In our community, we’re seeing the ongoing need for these types has. of clinics,” Serra said. “A lot of people think that with the advent of the “The city is well represented and they are so enthusiastic about what Affordable Care Act, these types of services are no longer necessary, we are doing,” he said. but there are tens of thousands of people right here that are still without The enthusiasm for this project doesn’t begin and end with coverage.” the members of the board, however, as members of the Stockton While it will be new to San Joaquin County and the Central Valley, community who will likely benefit from the RotaCare Clinic’s presence the idea for RotaCare – health clinics bolstered by the support of local are also beginning to take notice of the effort.

Rotary Clubs – has existed for more than two and half decades in the “These individuals, whether uninsured, underinsured or Bay Area, where RotaCare Bay Area operates a dozen clinics serving undocumented are in dire need of medical care,” Serra said. “There’s populations from San Rafael down to Monterey. definitely a void to be filled.”

Had geography not been what it was, Stockton could very well have Once launched, the RotaCare San Joaquin Clinic will be housed in the Dorothy L. Jones Family Resource Center, “We’re starting to see people getting involved,” Serra said. “They’re a relatively new facility located within south , they’re aware of the problems but Stockton’s Williams Brotherhood Park. they’re working to . In a It wasn’t too long ago that this park could be seen as a microcosm for matter of only a few years, the people have taken back that park.” the many ailments facing been the 13th installation of the existing Bay Area network, Serra said, the neighborhoods of south Stockton. Drugs, gangs and street crime recalling that after hearing a RotaCare presentation in Pleasanton back seemed to f lourish here, while surrounding households faced the daily in 2013, he instantly expressed interest in having RotaCare Bay Area challenges that come along with unemployment, poverty and limited set up shop in Stockton. access to health care.

“I asked them about joining and their response was ‘And where In many ways, this could be viewed as the last place you would want exactly is Stockton?” he laughed, noting that the representative to set up a facility like the family resource center, but only because it encouraged he and his fellow Rotarians to strike out on their own and was also the area that needed it the most. establish a new network in the Central Valley. “We said, ‘This is a hell of Since the facility opened, however, a transformation has been

ONGOING NEED FOR THESE TYPES OF CLINICS

AWARE OF THE GANGS KEEP THE COMMUNITY SAFE

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RotaCare > In The Central Valley

underway.

“We’re starting to see people getting involved,” Serra said. “They’re aware of the gangs, they’re aware of the problems but they’re working to keep the community safe.

In a matter of only a few years, the people have taken back that park.”

When the Dorothy L. Jones center was built, a fully furnished medical clinic was included within the building but left vacant until a tenant could be secured. Beginning this summer, the RotaCare Clinic will begin operating out of that clinic.

“It’s an amazing fit,” Wager said. “It’s like someone opened up this jewel and said ‘Come on in, we’re ready for you.’”

While the site was available, anyone who has been involved with the formation of the RotaCare effort will be quick to tell you that building a clinic from the ground up takes much more than four walls and a staff of volunteers. Concerns such as providing malpractice insurance, fundraising, procuring equipment and messaging the program to the public all had to be taken into consideration, and many times during the formation effort, the RotaCare board was faced with new concerns that seemed to arise only after old ones had been solved.

“I think Joe had the vision. He had the vision from the beginning, but for the rest of us, it was sort of daunting to start this from scratch,” Wager said. “This isn’t a matter of just going down and sticking a few doctors and nurses in a building and having people come in for treatment.”

The work is also far from over.

Over the next few months, Serra, Wager and the other members of the RotaCare board will begin the process of soliciting physician volunteers to actually staff the clinic when it opens this summer. Funding is also another ongoing issue, as the RotaCare San Joaquin’s 501(c)(3) non-profit status is currently being established. In the interim, donations are being collected through the United Way with the designation that they be used to fund the Stockton clinic.

Along the way, existing clinics within the RotaCare Bay Area Network have been a vital resource for the San Joaquin Board.

While there is still much to done in the present, both Serra and Wager can’t help

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but think about the clinic in Stockton being only the beginning of a much larger campaign. Central Valley communities such as Modesto, Fresno and Lodi all have health care access issues similar to those seen in Stockton, as well as thriving Rotary clubs that could take up the charge.

“Who knows how far it could go,” Wager said. “There’s certainly no shortage of fertile ground here in the Central Valley.”

Interested in volunteering at the RotaCare Clinic? For more information,

contact the San Joaquin Medical Society at (209) 952-5299 or Lisa@sjcms.org.

Donations to the RotaCare effort are currently being accepted by United Way of San Joaquin County.

To make a donation, or to receive more information, please visit www.unitedwaysjc.org.

SAN JOAQUIN PHYSICIAN

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ACHIEVINGTHE

IMPOSSIBLE How one “prick of conscience” launched a 12-year fight for fair geographic payments for Medicare physicians

BY ELIZABETH ZIMA, CMA STAFF WRITER

In 2002, Larry De Ghetaldi, M.D., met with his Congresswoman, Anna G. Eshoo (CA-18), to see if he could enlist her help in changing the way that Medicare reimbursed physicians in Santa Cruz County.

Something was wrong with the Medicare geographic payment regions tied to the reimbursement formula known as the Geographic Practice Cost Index (GPCI). In his own Santa Cruz County, physicians were paid by Medicare approximately 20 percent less than in the next county north, Santa Clara, while the cost of providing care in both counties was essentially the same. The reason? Santa Cruz County was designated as “rural,” while Santa Clara County was not.

In fact, the sixth largest city in the United States, San Diego, was also designated by Medicare as rural. Consequently, physicians seeing Medicare patients in San Diego were paid about 10 percent less than physicians in neighboring Orange County. >>

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May 29 - 31, 2015

LE IL A Bct E AVA D A ra with R te in G d P an V IP U portunities to meet Mukherjee, M.D!

op artha Exclusive and Siddh Gladwell lm co al M

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Hollywood, CA

Acheiving the Impossible > Medicare

WHAT BEGAN FOR DR. DE GHETALDI AS A “PRICK OF

Since the 1990s, hospitals have been paid according to the local costs in their Metropolitan Statistical Areas (MSAs). The MSAs are defined by the federal Office of Management and Budget and annually updated by the Centers for Medicare and Medicaid Services (CMS), so that reimbursement accurately ref lects local costs to deliver care. But for physicians, CMS used county-based localities, and these localities have not been updated in 17 years. As a result, 14 recently urbanized California counties, such as San Diego, Santa Cruz and Sacramento, were still designated as rural.

This caused many California physicians to be paid up to 13 percent per year below what Medicare says they should be paid if they were correctly classified.

Because physicians were paid less in Santa Cruz County, Dr. De Ghetaldi noted that many Medicare patients were having problems finding physicians to care for them. In fact, no physician group in Santa Cruz was accepting new Medicare patients.

For this reason, he asked Congresswoman Eshoo to help him convince CMS to reconsider the payment regions it used to reimburse doctors.

“This was a week after Congress voted to go to war in Iraq,” Dr. De Ghetaldi said.

“We had already spent several hours with CMS trying to get them to change the formula, but they had little incentive to do so.”

After explaining the issue to Eshoo, she told him: “Larry, it is easier to go to war, than to change this. We will leave Iraq before this fix is in place.” She said it with such certainty that Dr. De Ghetaldi was stunned – he didn’t want to believe that she was correct.

CONSCIENCE” ABOUT THE LACK OF CARE FOR SENIORS IN HIS COUNTY BECAME AN OBSESSION.

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THE LONG HAUL

What followed was a 12-year odyssey that included divisive debates within the California Medical Association (CMA) House of Delegates (HOD); changes in administration from the Bush White House to the Obama White House; several changes in leadership of key congressional committees and their staff; innumerable frustrating meetings between CMA and CMS; and countless rounds of relentless Congressional lobbying by CMA leadership.

What began for Dr. De Ghetaldi as a “prick of conscience” about the lack of care for seniors in his county became an obsession. He, in turn, found a small cadre of activists who formed a team that could not look away from what turned out to be a problem for the whole country – the fact that many areas that CMS had judged as rural in 1997 had become more urbanized with changing costs and demographics, but had not been updated to accurately reimburse physicians. This, in turn, was stymieing seniors from getting the care they needed. It was a huge national problem, and unconscionable that CMS had not kept pace with physician payments.

The team for the long haul was composed of physicians, lobbyists and Members of Congress and their staff. The key players that took the issue from the CMA HOD f loor to the national stage included Dr. De Ghetaldi; Edward Bentley, M.D.; Theodore Mazer, M.D.; Representative Sam Farr (D-Monterey, Santa Cruz) and his chief of staff, Rochelle Dornatt; and Elizabeth McNeil, CMA Vice President of Federal Government Relations.

Dr. Bentley, an internist with a specialty in gastroenterology, was presidentelect of the Santa Barbara Medical Society in 2002 when he became aware of the GPCI locality issue. “I had been in practice in Ventura County, so I knew that reimbursements were lower (in Santa Barbara County).” But, he didn’t know why.

“I approached Dr. George Wolf [a CMA delegate] from Santa Cruz County and asked him to put forward a resolution asking CMA to do something about the problem,” said Dr. Bentley. This caused a ruckus the first time the motion was introduced at HOD. “It was a divisive resolution,” he said. Part of the problem was that CMS required that the fix be accomplished in a budget-neutral way. Unfortunately, this meant that in order to raise reimbursement levels for the underpaid counties, other counties would have to foot the bill.

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Acheiving the Impossible > Medicare

To get to some agreement on the issue, a CMA task force was formed. It was headed by current CMA President, Richard Thorp, M.D. “He lived in a county that benefitted from the locality arrangement that had been established by CMS, so he was in a difficult position,” said Dr. Bentley.

Trying to put together a compromise that would gain consensus from all counties turned out to be so contentious it took three years to pass through the HOD.

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When the task force looked at the issue, there were “clear winners and losers.” The other requirement CMS had for action on this issue was that there had to be 100 percent approval from the state medical association to make changes.

For McNeil, who says a substantial part of her job at CMA for the past 12 years has been focused on a solution to the locality problem, the CMS requirement for consensus was a tactic to discourage

change. But, instead, she says, it served to galvanize the group to come up with a solution for the state that would promote unanimity and justice in payments.

What CMS had wrought when it created the California localities in 1966, and further distorted them in 1997, was a mishmash of counties grouped together.

In 1997, Locality 99 was comprised of 47 rural counties, but over the last decade at least 13 had become more urban. Payments for all counties within Locality 99 are averaged, which produces inaccurate payments not based on local costs to provide care. CMS had failed to keep pace with the changing demographics.

“Our objective (in the task force) was to improve the accuracy of the payments,” said Dr. Bentley. It turned out to be very hard to do because Medicare is a budgetneutral program, where any payment change produces winners and losers.

While the task force worked on a solution to the problem, the group had restarted talks with CMS to see if it would take into consideration some creative plans to refine the payment regions.

CMA, Rep. Farr and Dornatt started working with the powerful thenChairman of the House Ways and Means Committee, Representative Bill Thomas (R-Bakersfield). He fully agreed with CMA about the problem and said he would help to fix it. Yet year after year, he stalled any action on a fix.

In 2003, during markup of the Medicare Part D bill in the Ways and Means Committee, Rep. Farr tried to introduce language to fix the locality problem, but Rep. Thomas blocked the move. It was then that the “famous $100 bet” was struck on the House f loor. Frustrated and ready to take a swing at Thomas, Farr instead bet Thomas that he would never permit a solution to the locality problem in California to pass. Thomas took the bet, telling him he would get it through. When Thomas retired in 2007, he made good on the bet, paying Farr $100.

Meanwhile, the CMA task force had achieved near consensus across the state that all California physicians would take a one-time, 1 percent cut to pay for the update without harming the rural physicians. “We presented the idea to CMS

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Acheiving the Impossible > Medicare

and their lawyers were afraid they would get sued. So we proposed a pilot project that had to go through public hearings, but CMS wouldn’t budge,” said McNeil.

In 2005, CMS proposed to update the payment regions and thus, the payments for the most harmed counties in California — Santa Cruz and Sonoma counties. The announcement disappointed doctors in other impacted counties and created angst throughout CMA membership because some physicians would see a small payment cut.

The proposed regulation died because there wasn’t 100 percent consensus within CMA. “I thought CMA’s failure to reach consensus on this proposal was a real set-back, because we could have updated a few counties every two years until all were updated,” McNeil lamented. “We might have actually gotten it done before 2014!”

DEAD END

The group had reached a dead end. “We had tried the regulatory path and then realized the only way to solve it was through an act of Congress,” said Dr. Bentley. CMS can only change payments in a budget-neutral manner with winners and losers, so any change that holds rural physicians harmless from cuts requires additional funding and Congressional action.

Up to this point, CMS had been keeping private its

“We had tried the regulatory path and then realized the only way to solve it was through an act of Congress” -Dr. Bentley cost inputs for the locality payments. In 2004, a staffer leaked the information to Dr. Bentley. He quickly went through the data and discovered that this problem was not confined to California. “The payment disparities were a national problem,” he said.

Working with CMA, Rep. Farr introduced several bills over the coming years, some with his Republican counterpart Representative Brian Bilbray (R-San Diego), but nothing moved. CMA tried to educate the other negatively impacted state medical associations and get them on board. “It was like herding cats,” McNeil recalls.

“It was an extremely difficult process. In the end, we were afraid it would take more time to bring on 10 medical associations than it would take to get the bill through Congress for California only.” In the 2014 legislation that ultimately passed, CMA attempted to insert a national study to help the other states. But in the end, Congress only chose to help California.

Rep. Thomas did, however, do the group one favor.

Before he retired, he asked the U.S. General Accounting Office (GAO) to study the problem. In 2006, Drs. Bentley and De Ghetaldi prepared a white paper for the Medicare Payment Advisory Commission (MedPAC),

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an independent body established to advise Congress on Medicare payment issues. “They acknowledged the problem,” said Dr. Bentley. The same paper was presented to the GAO who took up the problem and studied it. “The GAO issued a report that validated our white paper,” he added.

In 2008, when California Representative Pete Stark (D-Fremont) became Chair of the House Ways and Means Subcommittee on Health, he (at the urging of Rep Farr, CMA and other representatives) included a California GPCI solution in the Children’s Health and Medicare Protection (CHAMP) Act, which passed the House in 2008. He used the GAO report to justify its inclusion. Unfortunately, it did not pass the Senate.

Another turning point came in 2009, when CMA hosted a Congressional “GPCI Summit” between the House, Senate, CMS and MedPAC. All of the House and Senate committee leaders were in a neutral meeting place in the basement of the Capitol. This summit is where CMA started to gain general buy-in that the problem needed to be fixed, particularly from the Senate. In 2010, both Drs. Bentley and DeGhetaldi were invited to testify on behalf of CMA before the Institute of Medicine (IOM). “We presented the white paper,” said Dr. Bentley.

“I presented the data that demonstrated the payment inaccuracies. The IOM took our presentation and the white paper and refined it.” The IOM report confirmed the locality problem and recommended the CMA proposed solution to move localities to Metropolitan Statistical Areas consistent with the hospital payment regions. It was at this point that Congress began to really listen to the group. “When you have the backing of the IOM, the GAO and MedPAC, they will listen,” Dr. Bentley said.

In 2009-10, Chairman Stark inserted the California locality update into the House’s version of the Affordable Care Act (ACA). The House passed it, but the Senate version did not include the fix. Although the GPCI fix was adopted during the House-Senate Conference Committee on health care reform, when the Senate Democrats lost the majority, Congress was eventually forced to accept the Senate version of the bill without the California GPCI provision. “I felt like a beaten dog, at this point,” said Dornatt. But the problem was still there.

“Doctors were still coming in the door [complaining]; and beneficiaries complained they could not find doctors to care for them.”

STARTING OVER

The group started over again looking for a solution that would pass both Houses of Congress. The Senate had been extremely critical of a California-only solution.

Some called it the “California gold rush.” CMA and Rep. Farr enlisted the help of Representative Darrell Issa (R-San Diego). Issa, the powerful Chairman of the House Oversight and Government Reform Committee, agreed

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Acheiving the Impossible > Medicare

“The Medicare bill was intended to be a comprehensive payment reform bill, so we knew we had a shot at getting the California locality reform in” - McNeil to work with Farr to push their respective leaders to include the GPCI fix in any budget or Medicare legislative packages moving through Congress.

At the same time, California Senator Dianne Feinstein found a California-only funding source for the locality legislation that would diminish the California “pork barrel” criticisms.

Unfortunately, after the passage of the ACA, Congress became even more dysfunctional; the only Medicare bills moving through Congress were the last-minute Medicare sustainable growth rate (SGR) short-term patch bills. Congressional leadership told the CMA team that no new policy issues would be included in those patch bills, which once again nixed CMA’s chances to achieve California locality reform in 2011 and 2012. However, that didn’t stop Farr and CMA from trying.

In early February of 2013, both the House and Senate began working on bills to solve the Medicare SGR issue. In 2012, the Republicans took control of the House with new leadership.

Representative Kevin McCarthy (R-Bakersfield), who had replaced his mentor, Bill Thomas, became the House Majority Whip.

Under his leadership, the House Republican Committee leaders renewed the call to fix the SGR. Their Democratic predecessors in the House had repealed the SGR twice, only to fail in the Senate. “We knew that both the House and the Senate wanted to fix the SGR because the cost of the fix had dropped dramatically,” Dornatt said. “The Medicare bill was intended to be a comprehensive payment reform bill, so we knew we had a shot at getting the California locality reform in,” said McNeil. Dornatt and McNeil began to push for the insertion of a GPCI fix for California. The proposal updated the California Medicare physician payment regions. It increased payments in the new urban areas and prevented payment reductions to California rural physicians, by using a hold harmless provision that was financed with administrative savings from the formation of a Medicaid County Organized Health System in Alameda County.

But, said Dr. Bentley, “no one likes to do a one-state deal; it is considered pork. This was a sensitive issue, and we were trying to run under the radar.”

Several committees in both the House and Senate were working on an unprecedented bipartisan, bicameral solution to the Medicare payment reform issue. With the help of Rep. Henry Waxman (D-Los Angeles), who was the Ranking Democrat on the House Energy Commerce Committee, and Committee

Chair Fred Upton (R- Michigan), Dornatt and McNeil managed to insert language to update the California localities into the bipartisan Energy and Commerce Medicare SGR payment reform legislation (H.R. 2810), which unanimously passed the Committee on

July 31, 2013.

“We were frantically still negotiating language the morning of the mark-up,” recalled McNeil. “And we were literally one of the last amendments accepted into the bill. It was incredibly stressful.

I knew we had to get GPCI into the first policy committee bill.

Otherwise, we would be fighting an uphill battle the rest of the way, particularly going into the Senate.”

This version of the locality update was a compromise between Reps. Upton and Waxman. It was based on legislation proposed by Reps. Farr and Issa. House Majority Whip Rep. McCarthy was key to the agreement, with CMS also stepping in to assist. California Energy Commerce Committee members Reps. Anna Eshoo, Lois Capps and Doris Matsui, who all have impacted districts, also helped to push the solution.

DOING THE UNTHINKABLE

In the fall of 2013, it looked like Congress would do the unthinkable — solve the f lawed Medicare SGR. Two other powerful committees were expected to introduce versions of the SGR bill: the House Ways and Means Committee and the Senate Finance Committee. “There was unprecedented unanimity in

“We were frantically still negotiating language the morning of the mark-up, and we were literally one of the last amendments accepted into the bill. It was incredibly stressful.

I knew we had to get GPCI into the first policy committee bill. Otherwise, we would be fighting an uphill battle the rest of the way, particularly going into the Senate.”

SPRING 2015

- McNeil Congress that the time was now to fix the Medicare reimbursement problem,” said McNeil.

While the SGR reform policy bill passed out of these committees before the winter holidays, there was no consensus on how to pay for it. The House Republicans and the Senate Democrats couldn’t agree on the funding sources, so they passed a policy-only bill.

On February 7, 2014, the three congressional committees announced a final joint bipartisan, bicameral agreement on the Medicare SGR repeal and payment reform legislation, H.R. 4015/S. 2000. Now Congress just needed to marry the policy to the funding sources to the tune of $150 billion.

The California GPCI fix had made it into the final compromise bill, and the group worked feverishly to get the bill passed. But as the SGR deadline grew closer, the group realized there would be no compromise on the funding sources, and that Congress would yet

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Acheiving the Impossible > Medicare

again — for the 17th time in a decade — I watched the Senate vote,” he said. Then McNeil says, she has to take the long pass a short-term patch to stop the doublehe went numb. He decided he couldn’t view on some of the issues she works on. digit SGR reimbursements cuts. McNeil celebrate what had been a long, hard-fought “It takes at least five to 10 years to pass and Dornatt swung into action to see if battle, until President Obama signed the a bill through Congress. Especially if it they could at least insert the California measure into law. is a new idea and only affects a subset of GPCI fix into the patch legislation.

Dr. Bentley felt the same way. “Every people, so I suppose we are on track. This “When we knew there was the potential time we thought it was a done deal, is a particularly sweet victory because for a patch, we went to the top players in something happened at the last minute to it was so difficult and achieved during the House and Senate to get the California prevent its passage. After so many years, one of the most contentious times in GPCI into it,” McNeil said. “Because of you somehow don’t believe it is actually Congress. This was a hard-won geographic our lobbying efforts over the years, our happening. I was preparing myself for more formula fight between physicians, relationships with the Congressional work.” involving an agency that never takes risk, leadership and the committee staffers, they In the end, Dr. De Ghetaldi said, Eshoo a dysfunctional Congress and a state legitimately listened and were interested in was right. “It took us much longer than the unpopular in Congress that was singled helping.”

Iraqi war to pass the fix.” out for assistance. The odds were definitely “However, a special California provision The GPCI fix was ultimately signed against us. But CMA was fortunate to have would never make it into such a small bill, by the president and requires the a team of wise and relentless physician so we had to find a larger, more national reimbursement formula to be calculated leaders who never gave up.” argument,” said McNeil “When the based on same Metropolitan Statistical “It is safe to say that everyone on Capitol Committee staff revealed to us that the Areas used to pay hospitals, which more Hill is grateful and relieved that they will SGR patch bill would include an extension accurately ref lect the cost of practicing never hear CMA utter the word ‘GPCI’ of the national Medicare work GPCI medicine. The higher payments will be ever again,” laughs McNeil. payment f loor, I knew we had an angle.” phased in over a six year period starting in Nearly every other state in the country 2017. except California benefits from the work GPCI payment f loor, so if physicians in other states were receiving an extension, McNeil and Dornatt argued that Congress should do something to help California physicians and patients.

“California doesn’t benefit Helping Families Cherish Life from the work GPCI f loor AseraCare Hospice® provides quality, compassionate care when you need it most. because our localities are so Our family-centered, holistic approach ensures that the needs and wishes of our out of whack,” said McNeil. patients and their families are met when faced with life-limiting illness.

“We urged GPCI payment parity for California and, Our services include: incredibly, the leaders agreed.

• Physician managed care • Admissions 24 hours a day, seven days a week It was incredible!”

• End-of-life decision making assistance One day before the patch • Special veterans recognition bill was up for a vote, McNeil was given a heads up that the Rated above average by CalQualityCare.org California GPCI fix was in the legislation.

AseraCare Hospice–Stockton “CMA didn’t want the 2529 W. March Lane, Ste. 101 SGR patch; we wanted Stockton, CA 95207 comprehensive reform, but we 209-474-8349 www.AseraCare.com wanted the GPCI fix to come through. CMA was incredibly For more information, contact us today. conf licted,” she said.

Dr. DeGhetaldi said he felt once again like the San This facility welcomes all persons in need of its services and does not discriminate on the basis of age, disability, race, color, national origin, ancestry, Francisco Giants had won the religion, gender, sexual orientation or source of payment. AHS-10269-13 World Series. “I felt chills when

SPRING 2015

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ADDRESSING

OBESITY AND CHRONIC CONDITION THROUGH COLLABORATION AND POLICY CHANGE

By San Joaquin County Obesity and Chronic Disease Prevention Task Force leadership

Residents of San Joaquin County, particularly the City of Stockton, have voiced concerns about the health and safety of their community. Obesity continues to be a significant health issue and contributing factor to other chronic diseases.

In San Joaquin County, 41.6% of low-income children between the ages of 5 and 19 are overweight and obese (CDC PedNSS) and 34.7% of adults are obese (CHIS). >>

SPRING 2015

SAN JOAQUIN PHYSICIAN

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San Joaquin County > Obesity

Fear of violence and crime, as well as unsafe sidewalks and streets, limit opportunities for walking and bicycling to work or school. In 2012 alone, bicycle- and pedestrianrelated injuries resulted in 1,313 visits to emergency departments across the county.

Nearly 40% (514) of these collisions involved youth under the age of 18 (CDPH EpiCenter). To address these concerns, the Obesity and Chronic Disease Prevention Task Force chose to take a policy approach to obesity prevention.

The Taskforce comprised of over twenty community-based organizations, school districts, youth organizations, faith-based organizations and health agencies is designed to function as an umbrella coalition to promote community-wide collaboration to address the goal of reducing obesity and chronic disease.

SAN JOAQUIN COUNTY YOUTH OBESITY

COLLABORATION The OCDP Task Force selected Safe Routes to School (SRTS) as a priority policy area to address identified barriers and promote walking and bicycling in and around the community and school environments.

As a result the Task Force in collaboration with Community-based organizations is engaging in the City of Stockton’s General Plan Amendment process to ensure the inclusion of SRTS and strategies that promote a healthy community.

In the City of Stockton General Plan Amendment process, the OCDP Task Force has achieved the following: • Helped to establish the Sustainable Communities/ General Plan Coalition • Partnered with the California Department of Public Health Safe and Active Communities Branch and ChangeLab Solutions to conduct trainings for Task Force members on developing strong SRTS policies and engaging in a general plan process • Fostered a partnership with the City of Stockton’s Community Development Department to support the inclusion of active transportation in the plan amendment

POLICY INTERVENTION The research clearly indicates that in order to reduce obesity and chronic disease, system-wide environmental changes are needed in the way our neighborhoods and communities are being built. These infrastructure changes are specially needed in areas high in crime and poverty. Major players such as California Endowment, Robert Wood Johnson Foundation, CDC, and other funders embrace proposals that emphasized policy, system and environmental change.

Members of the San Joaquin County Obesity and Chronic Disease Prevention (OCDP) Task Force understand the challenges that residents face in trying to be physically active in communities where they may not feel safe. Fear of violence and crime as well as unsafe sidewalks and streets are reasons why they and others choose not to walk or bike to work or allow their children to walk or bike to school. OCDPTF members voted and selected Safe Routes to School (SRTS) as a policy priority to address concerns about children’s health (e.g. obesity, asthma, etc.) and safety. When the opportunity to participate in the City of Stockton’s General Plan Amendment came up, the Taskforce reviewed the City’s General Plan and noticed the focus on growth and exclusion of SRTS. As a result, we met and formed relationships with the City of Stockton’s Planning Commissioners and the Deputy Director of Community Development. Thus, the OCDP Task Force is participating in the City of Stockton’s General Plan Amendment process to create policies that will make it safer for children and adults to walk and bike in their neighborhoods.

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SAN JOAQUIN PHYSICIAN

• Actively participated in the City of Stockton’s General Plan Amendment Workshops and Planning Commission meetings

SAN JOAQUIN COUNTY CRIME INFORMATION

SPRING 2015

San Joaquin County > Obesity

GIS MAPS OF PEDESTRIAN AND BICYCLE COLLISIONS IN SAN JOAQUIN Proximity of Reported Pedestrian Collisions to Elementary Schools, San Joaquin County, CA 2007-2011

/

OAK VIEW UNION

GALT JOINT NEW HOPE

Proximity of Reported Bicycle Collisions to Elementary Schools, San Joaquin County, CA 2007-2011 å

å å LODI UNIFIED

/

OAK VIEW UNION

GALT JOINT NEW HOPE

å

å å åå å å å åå å åå å å å å å

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å

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å å åå å å å åå å åå å å å å å

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å

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å å åå å å å åå å å å åå å åå ååå å å å å å å å å å å åLINCOLN å å UNIFIED å LINCOLN UNIFIED å å åååå å åå å å åå åå å å åå å åå å åUNIFIED STOCKTON å åå å å å åå åå å å å å å å å å åå TRACY UNIFIED å

LINDEN UNIFIED

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BANTA

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LAMMERSVILLE å

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4 - 9 Collisions

å å å

4 - 9 Collisions 10 - 16 Collisions 17 - 26 Collisions

27 - 73 Collisions 6.5

13 Miles

Data sources: California Department of Education; Transportation Injury Mapping System (TIMS), Safe Transportation Research and Education Center, UC Berkeley

Elementary School 0 - 3 Collisions

JEFFERSON

17 - 26 Collisions

3.25

å

1/2 Mile School Radius

10 - 16 Collisions

0

å åå

RIPON å UNIFIED

å NEW JERUSALEM

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å

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VALLEY HOME JN

åå å MANTECA å UNIFIED

BANTA

å å å å åå å å å åå å

åå

å

27 - 44 Collisions 0

3.25

6.5

13 Miles

Data sources: California Department of Education; Transportation Injury Mapping System (TIMS), Safe Transportation Research and Education Center, UC Berkeley

SUSTAINING SUCCESS

The Task Force will expand relationships to non-traditional partners such as the city’s Public Works Department, local law enforcement, and Chamber of Commerce, to help implement strategies listed in the General Plan’s Movement and Health/Safety Chapters. Task Force will also develop SRTS network to facilitate work between schools, transportation/land use planners, public health, law enforcement, and community members.

“Fear of violence and crime as well as unsafe sidewalks and streets are reasons why they and others choose not to walk or bike to work or allow their children to walk or bike to school”

YOUR INVOLVEMENT IS KEY

Join the San Joaquin County Obesity and Chronic Disease Prevention (OCDP) Task Force to help promote healthy living in our county. Find out ways to make pedestrian- and bicycle-friendly neighborhoods and support programs and policies that encourage physical activity. Share your thoughts and give us feedback on ways we can work together to create a safer and more active San Joaquin County. Contact Obesity and Chronic Disease Prevention Taskforce @ 209-468-8637.

SPRING 2015

SAN JOAQUIN PHYSICIAN

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LOCAL Medical Students BY: VANESSA ARMENDARIZ PHOTOS BY: JOSEPH KIM

Host Inaugural Stockton Health Empowerment Conference: Students Today, Doctors Tomorrow SPRING 2015

Dr.Kwabena Adubofour shouted out to a crowd of impressionable minds, “Students Today…” while awaiting the roaring response of, “Doctors Tomorrow.” On January 24, 2015, over 100 students and parents gathered to attend the first Stockton Health Empowerment Conference. Six months ago, the idea of this conference was merely a dream of current second year UC Davis medical student, Charles Danh. For many medical students, studying is their top priority and they have little to no time to spare.

Although initially hesitant, Charles approached other medical students to gauge their interest. He was overwhelmed by the support that he had not only from his classmates, but from various organizations as well. San Joaquin Delta College, the UC Davis School of Medicine, UC Davis School of Medicine Office of Students and Resident Diversity, San Joaquin Medical Society, Kaiser Permanente, and others all played a large role in making the conference come to fruition.

SAN JOAQUIN PHYSICIAN

47

Sometimes You Just Need a Little Help.

Sixth Annual Golf Tournament Join fellow San Joaquin Medical Society members and invited guests for a relaxing round of golf, BBQ lunch, and Kentucky Derby Day themed dinner and after golf party. Plus an opportunity to benefit our local The First Tee of San Joaquin program and SJMS’ Decision Medicine Program. Your hosts, Drs. Kwabena Adubofour, George Herron, Prasad Dighe and George Khoury are committed to making this an event to remember!

Saturday May 2nd, 2015 • Elkhorn Golf and Country Club • 4 Person Scramble $150 per golfer - Price includes green fees, golf cart, lunch, dinner and after golf party! $50 of every entry fee goes to The First Tee of San Joaquin program • Hole Sponsorships benefit SJMS’ Decision Medicine Program

Registration and Range Open 11:00am • Putting Contest Qualifying 11:00am - 12:30pm Buffet Lunch 12:00pm • Shotgun start 1:00pm

To sign up, please call the San Joaquin Medical Society office at 209-952-5299 48

SAN JOAQUIN PHYSICIAN

SIXTH ANNUAL

Golf Tournament SPRING 2015

When planning the conference, the committee wanted to make sure to not only provide general information about applying to college, financial aid, and writing a personal statement but also wanted to speak to the students about the different social and environmental barriers in which many of these students will face. The medical students involved in planning the conference were extremely diverse and represented a vast array of backgrounds. Some are from Stockton, some are the first in their family to attend college, some had physician parents, while others will be the first in their family to become a physician. Despite the differences, the students had a common goal: to inspire Stockton high school and community college students to pursue a medical career and encourage them to come back to serve their community. Charles explained, “Our goal is to empower the students of Stockton so that they have the tools necessary to become a physician and return to Stockton and empower their communities and practice where they are needed most.”

Dr. Darin Latimore, associate dean for student and resident diversity, spoke on the importance of the conference by saying, “People who are less economically advantaged are still steered to community colleges, but the poorest students are not given the guidance and counseling that it’s possible to go to a four-year school. It’s not the message they are hearing that economics are possible.” With the goal of “empowerment” in mind, workshops were tailored to inspire students. These specialized workshops included Overcoming Personal and Environmental Barriers, Underrepresented Women in Higher Education and Medical School, and DREAMer’s, which was a workshop that provided resources for undocumented students. Students were able to hear testimonials from medical students who were raised in similar environments and under similar circumstances, which motivated and inspired them to face adversity with confidence.

Perhaps one of the unique aspects of the conference was the parent workshop that was provided. For many parents, it is difficult to navigate the college application process and filling out the forms for financial aid. Some of the medical students had their parents serve as panelists so they could talk to people who actually went through the process with their own children. The twopronged approach of providing educational resources to both the parents and their children ensured that they were completely informed.

Overall, the conference was very successful and many partner organizations have already committed to sponsoring this conference to make it an annual event. There is no doubt that this conference had a large impact not only on the students, but also on the many people who helped plan the conference.

Furthermore, Dr. Adubofour was elated to see the impression that local physicians could make on students. Manjot Sandhu, a second year medical student on the planning committee, was a participant in the Decision Medicine Program in 2006, which was the brainchild of Dr. Adubofour and started by the San Joaquin Medical Society. Sandhu credits his involvement in the Decision Medicine program to his interest in medicine and pursuit of medical school.

He is committed to returning to practice in the San Joaquin Valley. Another medical student who helped with the conference, Baljit Singh, is from Tracy, CA and is currently receiving a loan from the San Joaquin Medical Society’s Scholarship Loan Fund. The resources and programs that the San Joaquin Medical Society provides to the community were created with the same goal in mind, to motivate local students to pursue a career in the medical field in hopes that they return to our community to help alleviate the physician shortage.

With the examples of Manjot, Baljit, and many others, it is evident that these programs are working.

SPRING 2015

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Lodi Memorial Hospital Acute Physical Rehabilitation (APR) Twenty-three years of specialized, inpatient rehabilitation services for stroke, brain-injury, spinal-cord-injury, multiple-trauma and patients with other neurological conditions

Lodi Health’s team of physical rehabilitation experts.

The county’s only acute, inpatient physical-rehabilitation program, featuring:       

Emphasis on safe and independent transition home Coordinated physical, occupational, speech and recreational-therapy sessions, three hours daily State-of-the-art technology for neurologic training 24-hour care by rehabilitation-trained, experienced nurses Daily physician visits Outdoor areas for rehabilitation and recreational activities Private rooms and room-service meals for patients and their family members

APR outcomes for 2013 Functional Independent Measurement (FIM) Average stay in hospital Return to home

Lodi Memorial

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32 13 days 86%

29 16 days 72%

Medical director Ramnik Clair, MD

Lodi Memorial Hospital Acute Physical Rehabilitation Ramnik Clair, MD, Medical Director 209/712-7905 Tel 209/333-3082 Fax 975 S. Fairmont Ave., Lodi, CA 95240

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Dignity Health > White Coat Ceremony

Dignity Health ST. JOSEPH’S MEDICAL CENTER SPONSORS WHITE COAT CEREMONY AT HEALTH CAREERS ACADEMY

DESTINI WILSON, SYDNIE SPORE, LINDA ZARO AND JULIA SANTIAGO. PHOTO CREDIT-VERONICA LYNCH

BY: VANESSA ARMENDARIZ

On January 9, 2015, the high school seniors at Health Careers Academy (HCA) were honored at the first annual white coat ceremony. Kristen Birtwhistle, Kaiser Permanente Medical Group Administrative Consultant explained that the idea of a white coat ceremony came from her experience at the Decision Medicine celebration banquet where a student claimed that when given the coat, she felt like she “had wings.” Kristen took the idea to the Community Partnership Advisory Council (CPAC), a group of business and community organizations that are invested in the welfare of the students at the HCA. They serve as a resource to the students by providing unique opportunities to expose them to various health careers. >>

SPRING 2015

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SPRING 2015

Dignity Health > White Coat Ceremony

How Can You Get Involved?

Many of our medical society physician members are interested in becoming more involved in the community.

If you are interested in making a difference, please consider helping in the following ways: DOUG WILHOIT CONGRATULATING STUDENT, DAYVON PATTERSON. PHOTO CREDIT-VERONICA LYNCH

Dignity Health St. Joseph’s Medical Center, one of the CPAC partners, committed to donate the white coats to the 105 seniors and have already committed to funding it again next year. Joann Marks, Director of Cardiovascular Health at St. Joseph’s Medical Center, explained, that “we at Dignity Health believe in the mission and vision of the school and wanted to be a significant part of the students education, whom already are committing to a life of ANDREA BURRISE, SUSD BOARD MEMBER; TRACI MILLER, HCA PRINCIPAL; human kindness through caring ALYSSA CARILLO, HCA STUDENT. PHOTOCREDIT-VERONICA LYNCH for the community in their times was an inspired moment and many said, “I of health needs.” The white coat not only feel like a doctor now.” On this day they began provides the students with confidence, but to believe that their dreams of being a part of it serves as a reminder to the student of their health care were really going to come true! commitment to try their best to accomplish I noticed that all students stood a little taller their health career goals and to exhibit the that day!” Traci Miller, HCA Principal, added maturity and confidence that is necessary to that “the ceremony itself nicely demonstrated be a healthcare professional. since the inception of the school, how the Birtwhistle commented, “The smiles that community has rallied around and continue the students had on their faces when receiving to support HCA. It served as an inspiration the coat was priceless. They shared that this both to me and the school community.”

SPRING 2015

Serve as a mentor physician to a Decision Medicine student on July 8th or 15th Join the Community Partnership Advisory Council (CPAC) for Health Careers Academy High School Allow local students to shadow you in your practice at your convenience Serve as a guest speaker at a local high school Serve as a panelist at a future pre-health conference If you are interested in any of the aforementioned opportunities, please contact the San Joaquin Medical Society at (209) 952-5299.

SAN JOAQUIN PHYSICIAN

53

Public Health

Update

WHAT ARE THE REASONS TO VACCINATE MY BABY? Protecting your child’s health is very important to you. That’s why most parents choose immunization.

Nothing protects babies better from 14 serious childhood diseases.

Choose immunization. It’s the powerful defense that’s safe, proven, and effective.

For more information: http://www.cdc.gov/features/ ReasonsToVaccinate/

Vaccine Refusal: A Social Disease?

What Every Doctor in San Joaquin County Needs to Know

By Alvaro Garza, MD, MPH, and R. Grant Mellor, MD

One cornerstone of our health system and one of the best disease prevention tools we have is our children’s immunizations (see table from MMWR Supplement, October 7, 2011, Vol 60). That is now threatened by growing under-immunization in Northern California, 12.4% in 2010-2012, according to a recently published study by T A Lieu, et al.1 The recent Disneyland-centered measles outbreak demonstrates our population’s continued

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vulnerability to vaccine-preventable diseases. In San Joaquin County, we have many measles-exposed cases requiring evaluation, testing, treatment, and/or quarantine and monitoring. As of 30 January 2015, California has had 91 confirmed measles cases reported since late December 2014, the majority linked to the Disneyland exposure. The U.S. was declared measles-free in the year 2000. Why are measles and other vaccine-preventable diseases making a comeback?

SPRING 2015

We might say we have had an antivaccination epidemic brewing for some years in certain communities.

The Lieu study identified five geographic clusters of underimmunization and vaccine refusal in Northern California. Two of these clusters are close to San Joaquin County: one in East Sacramento, and others in Western Contra Costa and Northern Solano Counties. They found that under-immunization corresponds to vaccine refusal or vaccination delay. Recent research has demonstrated that most parents who refuse or delay vaccines identify with other like-minded parents.2 Groups of such parents spread and perpetuate anti-vaccine beliefs. These parents tend to be highly educated but they are making an uneducated, mis-guided, and dangerous choice; and putting their, and other, children at risk.

completion rates for licensed child care facilities to monitor compliance with the state’s school immunization law. Reporting for the 2014-2015 year shows that, for all child care centers, 92.4% of entrants had all required immunizations, 0.29% had permanent medical exemptions, and 0.91% had personal belief exemptions; this last one is down from 1.21% the year before. The personal belief exemption in Sacramento County was threefold greater, at 2.79%. In San Joaquin County private child care centers, the

personal belief exemptions were 1.41%, higher than the 0.37% for public child care centers, and 0.30% for Head Start centers. We need to work together to maintain and improve our county’s immunization rates.

The Centers for Disease Control and Prevention (CDC) Guide to Community Preventive Services (www.thecommunityguide.org) archives systematic reviews and recommends program and policy interventions that have been

Currently, childhood immunization rates in San Joaquin County are relatively good. We have not identified significant pockets of vaccine-refusal; however, there are some concerning data. The California Department of Public Health annually assesses the immunization

SPRING 2015

SAN JOAQUIN PHYSICIAN

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proven effective. For improving vaccinations, some of the recommendations include a) reminders to providers that individual clients are due for specific vaccinations, b) reminding clients or families that vaccinations are due (reminders) or late (recall), c) standing orders to authorize nurses, pharmacists, or other healthcare personnel to assess a client’s immunization status and administer vaccinations according to a protocol approved by the physician or practitioner (www.immunize.org/standing-orders) , and d) confidential, population-based, computerized immunization information systems that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

usually not effective.3 Many parents have read more articles and may have more (mis)information at their disposal than you have! Second, don’t threaten to remove these families from your practice! Although you should make it clear that you don’t support their decision, you should remain their faithful caregivers, preserving future chances to educate and persuade.

The Association of State and Territorial Health Officials reported in 2010 on a survey of U.S. parents and guardians on “Communicating Effectively About Vaccines”. The most

The most influential person giving parents the most convincing positive messages about vaccines was the healthcare provider.

The San Joaquin County immunization information system since 1996 is the Regional Immunization Data Exchange (RIDE), accessible at the Healthy Futures website (www. myhealthyfutures. org). Useful reports or information available include the yellow California Immunization Record, the blue California School Immunization Record, the Standard Chart Immunization Record, immunization coverage, a Vaccine Inventory Overview, reminder labels, and vaccine usage. Having all health care providers enter all vaccines given allows for more accurate assessments and can decrease over-vaccination.

Our recommendations: a) Make up-to-date vaccination a priority at all medical practices; b) Assume the best of parents. According to a 2013 article in Pediatrics, parents are more likely to respond positively when the physician uses an approach that assumes parents will comply with all vaccine recommendations; c) Resist two natural reactions physicians may have when encountering parents who refuse or delay vaccines. First, don’t argue with scientific facts/figures; this is 56

SAN JOAQUIN PHYSICIAN

influential person giving parents the most convincing positive messages about vaccines was the health-care provider. The most believable and convincing positive message was: “Vaccination is one of the most important ways you can protect your child from life-threatening illness and offers the best known protection against a number of infectious diseases.” Negative messages are not recommended.

In contrast to our colleagues in adjacent counties, we are privileged to serve a population that accepts childhood vaccination. We need to keep it this way, by having every physician voice unequivocal support of the standard vaccination schedule, and by striving to immunize every child whose parents are willing.

SPRING 2015

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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).

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MARCH 11TH, 2015: “GETTING PAID: A PHYSICIANS GUIDE TO TAKING CHARGE OF ACCOUNTS RECEIVABLE” 11:00AM to 1:00PM

~Mark Lane, Associate Director in the CMA’s Center for Economic Services.

18 years of experience allowed him to understand the needs and positions of both Physicians and Payors, making him an ideal candidate to educate providers on overcoming the ever changing challenges of the healthcare landscape.

APRIL 8TH, 2015: “2015 EMPLOYMENT LAW UPDATE”

ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.

11:00AM to 1:00PM

New employment laws and appellate decisions are issued at a rapid-fire pace. This program will provide an update on changes that affect businesses and medical practices: • Wage and Hour Law • Hiring and Employment • Discrimination & Retaliation • Mandatory Sick Leave Law • Arbitration Agreements & Class Actions • NLRB Decisions ~Velva Lim & Jamie BossuatKroloff, Belcher, Smart, Perry & Christopherson

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PROFESSIONALS AND MEDICAL ASSISTANTS: ENHANCING PATIENT SAFETY AND REDUCING LIABILITY RISKS” 11:00AM to 1:00PM

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MAY 13TH, 2015: “ADVANCED PRACTICE

from the is s bulletin thly bulletin a free mon nomic Services. Thi practice (CPR) is CMARes ources e Resoursces ter foris Eco office staff improve tice Practic (CPR) athei freer monthly bulletin ciation’ Cen CMA PracCaliforical Medica ns and from the l Associa sicia Med nia Asso tion’s phy nia Center ifor for Econom full of tips sign Cal to help to date s.,This and toolsand tools to help physicians and To stay icupService bulletin is efficienviab their . full of tips RS: office staff improve cy and ilityviability. practice NEWSLETTE y and efficiencSUBSCR OTHER CMA t.org/newsletters. eagues.

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CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.

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In Memoriam

In Memoriam Norman D. King • James Buckingham, MD

“Dr. King served in the United States Navy Reserve, earning a WWII American Area Medal, WWII Victory Medal and an Honorable Service Button.”

SPRING 2015

NORMAN D. KING September 19, 1922 - January 14, 2015 Beloved husband, father, grandfather, great grandfather, dear and trusted friend and physician to countless souls, Norman D. King passed away peacefully at his home on January 14, 2015, at the age of 92. A more authentic life is rarely observed.

Born in Seattle, Washington, in 1922, Dr. King graduated from University of Washington with a Bachelor of Science degree in 1943, and from Wayne State Medical School in Detroit in 1948.

He did his internship at King County Hospital in Seattle, and his residency in general practice at Monterey County Hospital in Salinas, before taking his residency in anesthesiology at New York University, Bellevue Medical Center. He was certified as a Diplomat by the National Board of Medical Examiners in 1948 and by the American Board of Anesthesiology in 1958.

Dr. King served in the United States Navy Reserve, earning a WWII American Area Medal, WWII Victory Medal and an Honorable Service Button. He also served in the US Medical Corp from January, 1951 to November, 1952, during the Korean conflict. He was awarded an Army Commen-dation Medal, Army of Occupation Medal with Japan Clasp, National Defense Service Medal, Korean Service Medal with two bronze stars, United Nations Service Medal, Korean War Service Medal and Combat Surgeons’ Medal.

In 1955, Dr. King joined the Lodi Memorial Hospital staff as its first board-certified anesthesiologist. He served on the hospital Board of Directors from 1956-1969, as a Board Member of the Delta Blood Bank from 1956 until his death, and received much recognition for his tireless volunteer work ensuring quality health care for all Lodians and surrounding communities.

His championing of outpatient procedures came to fruition when he became founding Medical Director of the Lodi Outpatient Surgical Center, as well as its anesthesiologist from 1984 until his retirement in 1998. LOSC was the first freestanding outpatient surgery center in northern California, the first designated non-smoking hospital in California, and the first California surgical center to allow parents to remain with their children during induction of anesthesia and to be present in the recovery room as they awakened, assuaging children’s fears, as well as parents’ anxiety, of surgical procedures. On his retirement, the three surgeries were renamed “The Norman D. King Operating Room Suites.”

Despite his devotion to the medical profession and long hours at the hospital, Dr. King also relished his involvement in civic organizations in the Lodi community. An advocate for the arts, he was a founding Board Member of Hutchins Street Square in 1984 and established the Vacuum Buddies. As King of his loyal followers, The Knights of the Uprights, he diligently vacuumed the carpets on a daily basis. In addition to this “dirty work,” he was instrumental in securing permanent financing to reimburse the City of Lodi for completion of Hutchins Street Square’s Senior Center.

SAN JOAQUIN PHYSICIAN

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He was also a Life Member of the Lodi Art Center and Gallery and amassed a stunning personal collection of artwork that has adorned his Lodi homes for decades.

Norm’s greatest source of pride and delight was his family. He will be greatly missed by them. He is survived by his wife of 57 years, Joye; his daughter, Keri Vanderlans, and her children, Jessica Combs (and husband, Ryan), Joseph and Matthew; and his great-granddaughter, Addison Joye. His precious son, Kevin, predeceased him.

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JAMES BUCKINGHAM, MD December. 18, 1926 - Dec. 27, 2014 James H. Buckingham passed away peacefully on December 27th after a nearly decade-long illness, “Buck” as everyone knew him, was born on Dec. 18, 1926 to Rose and James Gilmore Buckingham in Meridian, Mississippi.

He grew up in St. Louis, Missouri, graduating from Vashon High School in 1943. He attended Lincoln University in Jefferson City, Missouri until May of 1945 when he was drafted into the US Army. He served until November of 1946. Upon discharge he continued with his education, putting himself through college at Wayne State University in Detroit, Michigan.

In 1953 he then went on to Meharry Medical College in Nashville, Tennessee, where he received a scholarship after his first year.

He interned at Hurley Hospital in Flint, Michigan, and then completed a fellowship in Pulmonary Chest Medicine at Highland Alameda Hospital in Oakland, California in1959. Shortly thereafter he opened his own medical practice in Stockton, as well as the Stockton Emergency Medical Clinic, where he faithfully served the community for over 40 years.

He was an avid fisherman and world traveler (passions second only to his dedication to his patients and medical practice). He loved the music of Dinah Washington and Billie Holiday, playing Keno, weekends at the coast, telling jokes, and spending time with close friends.

He is survived by his devoted wife, Linda; son Mark of Phoenix, Arizona: daughter Dana Buckingham of Stockton: daughter Leah Buckingham-Dunmore (Stephen) and their children Lauren and Stephen James of Montclair, New Jersey; and cousins Jackie Caffee (Leroy) and Cassandra Curry. He was preceded in death by his parents and sister, Delores Howard.

Buck leaves behind a legacy of love, compassion, and generosity. His sense of humor and gentle spirit will be forever missed by all who knew him.

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