Spring 2016

2016 New Laws San Joaquin Medical Society’s Holiday Party Practice Managers’ Corner Spring 2016 SPRING 2016

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VOLUME 64, NUMBER 1 • MARCH 2016

Stockton’s Health Care Careers Academy

{FEATURES}

15 20 28 34 SPRING 2016

NEW LAWS

The California Legislature had an active year, passing many new laws

SAN JOAQUIN MEDICAL SOCIETY’S ANNUAL HOLIDAY PARTY REFLECTIONS OF VIETNAM

Drs. Peter Salamon and Victor Macko volunteer their time in Vietnam

PASSING THE PURPLE LINE

Stockton’s Health Care Careers Academy

{DEPARTMENTS} 22 IN THE NEWS

New faces and Announcements

31 WESTERN HEALTH CARE LEADERSHIP ACADEMY

43 PRACTICE MANAGERS’ CORNER 60 PUBLIC HEALTH

HIV PrEP

62 PRACTICE MANAGEMENT:

Committed to Improving Quality Health Care

65 NEW MEMBERS

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PRESIDENT John Zeiter, M.D. PRESIDENT-ELECT Moses Elam, M.D. PAST-PRESIDENT Ramin Manshadi, M.D. SECRETARY-TREASURER Kwabena Abudofour, M.D. BOARD MEMBERS Raissa Hill, DO, Grant Mellor, M.D., Dan Vongtama, M.D., Alvaro Garza, M.D., Mohsen Saadat, DO, Clyde Wong, M.D., George Savage, M.D., Phillip Yu, M.D., Peter Garbeff, M.D.

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Nicole Bojorques

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE John Zeiter, Lisa Richmond, Mike Steenburgh MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, M.D. LEGISLATIVE Jasbir Gill, M.D. COMMUNITY RELATIONS Joseph Serra, M.D. PUBLIC HEALTH Alvaro Garza, M.D.

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS James Noonan, John Zeiter, M.D., Alvaro Garza, M.D., M.P.H., Hemal Parikh, M.P.H., Julie Vaishampayan, M.D., MPH

SCHOLARSHIP LOAN FUND Janwyn Funamura, M.D. THE SAN JOAQUIN PHYSICIAN MAGAZINE

CMA HOUSE OF DELEGATES REPRESENTATIVES

is produced by the San Joaquin Medical Society

Robin Wong, M.D., Lawrence R. Frank, M.D., James R. Halderman, M.D., Roland Hart, M.D.,

SUGGESTIONS, story ideas or completed stories written

Grant Mellor, M.D., Kwabena Adubofour, M.D.,

by current San Joaquin Medical Society members

Raissa Hill, D.O., Ramin Manshadi, M.D.

are welcome and will be reviewed by the Editorial Committee.

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

INSPIRATION IS EVERYWHERE Inspiration is defined as a person, place, or experience that makes someone want to do or create something. John Quincy Adams said “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” This quote perfectly describes our friend and colleague, Traci Miller, Principal of Health Careers Academy High School. HCA was born out of the increasing concern regarding the existing and inevitable future shortage of health care professionals in the Central Valley. But, it is Traci’s dynamic personality and gift for building relationships that has rallied support from a diverse group of professionals across San Joaquin County, including several of our member physicians. Her enthusiasm for her students and her school is absolutely contagious! I know you will enjoy reading more about Health Careers Academy. You may just find yourself inspired to get involved.

LISA RICHMOND

Recently, Dr. Kwabena Adubofour came to me with an idea to add a Poetry Corner to our magazine.

He told me he has been inspired by his patients and experiences as a physician to write poetry for years and has provided us with our first poem. If you share this creative outlet, we invite you to send your submissions to Lisa@sjcms.org for inclusion in future issues of San Joaquin Physician.

For those of you passionate about politics, the California Medical Association will host its 42nd annual Legislative Advocacy Day on April 13, 2016. The conference will be held at the Sheraton Grand in Sacramento. This is a unique event for California physicians and is free of charge to all SJMS/ CMA members. Please plan to join more than 400 physicians, medical students and CMA Alliance members who will be traveling to Sacramento to lobby their legislative leaders as champions for medicine and their patients. You may register by simply calling our office at 209-952-5299.

Finally, please save the date(s) for our 7th Annual Golf Tournament to benefit The First Tee of San Joaquin and SJMS’ own Decision Medicine Program on Sunday, May 1 at the lovely Stockton Golf and Country Club. See enclosed advertisement for more details. Our annual Young Physician and Lifetime Achievement Award Dinner will be held on Sunday, June 12. More information and invitations to follow!

All the Best,

Lisa Richmond

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We believe in 98.6 degrees.

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Taking the time to really listen. And giving our patients the personalized care they deserve. So, to all doctors, we’d like to say thanks. Because of you, a healthier life for everyone is as normal as 98.6.

For more information, visit us online at kp.org/centralvalley 8

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SPRING 2016

A message from our President > John Zeiter, M.D.

Meaningful Use, Encrypted Portals, and Telemedicine A referring doctor recently called to let me know that Mr. Jones, a local engineer and mutual patient, was disappointed that I had not responded to several messages he had left me regarding a possible allergy to one of his glaucoma drops. After explaining that I would certainly give Mr. Jones a call to discuss his problem, I searched diligently for the missing messages; for be it patient, relative, friend, or friend-of-a-friend, I cannot remember a time when I failed to return a medically related call. I checked with our call center, the front office staff, the back office staff, and my private office message machine all to no avail. I then called Mr. Jones to discuss his medical issue, to apologize for losing his message, and to uncover with whom he left the message. “Well, Dr. Zeiter, I accessed my health care records and left three separate messages to you.” Gulp. Deep breath. “Mr. Jones, I’ll check into that.”

As it turned out, our EHR provider failed to inform us that they went “live” with their secure, super-encrypted (and apparently top-secret) electronic information portal that is required by Objective 8 of the CMS Meaningful Use program. Fortunately, Mr. Jones was the first (and only) patient to leave us a message in that first week that we went “live.” Now we have systems in place to retrieve patient messages and triage them accordingly; however, the above experience triggered a series of questions in my mind: What exactly does CMS require of us with regards to patient, doctor, and hospital communication? Can we actually accomplish these requirements? How much extra staff will it take to comply? Is there liability in history taking, diagnosing, and treating patients over the phone or internet? And finally, is this considered “telemedicine” and if so, will physicians be reimbursed for their time and expertise? (continued on page 10) ABOUT THE AUTHOR ­ John H. Zeiter, M.D. is the managing partner of Zeiter Eye Medical Group and a Volunteer Clinical Professor at the UC Davis Eye Center. Dr. Zeiter is currently President of the San Joaquin Medical Society.

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First know that the acronyms EMR and EHR are now superseded

by PHR (personal health record) which contains the same types of information as EHR, but are designed to be set up, accessed, and managed by patients. Second, the terms doctor and physician have been replaced with “provider” and “eligible professional” (EP). The CMS “Eligible Professional EHR Incentive Program Objectives and Measures” that require secure, encrypted portal transmission of PHR information between patients

for review, (4) must click on the link taking them to the practice’s secure portal website, (5) must enter personal information such as name, birthdate, etc, (6) must create a password to log into the portal, (7) can now review record and finally, (8) can click a “message” button to upload a message to the EP. Whew! I’m sure that in 30 years close to 100% of Medicare patients (currently 35 years old) will be able to easily accomplish these steps, but by 2017? Not so much.

Once the majority of our patients can access their records Objective 8 requires not only the EPs to allow access to at least 50% of their and transmit comments, patients, but also requires a minimum number of patients to actually go complaints, into the system and view their records, i.e. one patient in 2015, 10% of and questions, then who patients in 2016, and 40% of patients in 2017. If these minimums are not responds to met, the EP gets penalized by 2% of Medicare collections! the messages?

Obviously, a front office and providers include Objectives not only the EPs to allow access to or back office employee could 5, 8, and 9. Objective 5 requires at least 50% of their patients, but handle prescription refills and EPs, who are referring patients also requires a minimum number appointment changes as they to another setting of care or of patients to actually go into the do now (by telephone). This provider, to electronically transmit system and view their records, i.e. may actually save staff time; but a summary of care record to the one patient in 2015, 10% of patients medically related questions will receiving provider in at least 10% of in 2016, and 40% of patients in need to be addressed by the EP, transitions (referrals). Objective 8 2017. If these minimums are not as in the case of Mr. Jones above. requires EPs to allow at least 50% of met, the EP gets penalized by 2% Or can the EP just have the staff their patients timely, online access of Medicare collections! For those make an appointment for patients to their EHR including the ability of us who have a practice heavily complaining of exacerbated to view, download, and transmit weighted with Medicare patients, arthritis, a red eye, a potential to a third party their health this could be a serious problem. allergy to a new medication, or a information within 4 days of being Here are the steps that 40% of our severe headache? I can assure you available. Objective 9 requires patients must conquer to review that is not what CMS wants—their the EP to use secure electronic their record: (1) must have access to ultimate goal is to improve the messaging to communicate a computer, (2) must have a unique efficiency and cost of health care, with patients on relative health email address (cannot be a shared and I believe that most physicians information. with spouse), (3) must receive an (oops, “eligible professionals”) For years now we have been email from EP with instructions on want to achieve those same goals; faxing referring physicians a how to access records electronically however, measures still need to

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“summary of care” record on all patients referred to our practice, but Objective 5 now requires us to access a universal “direct email,” through government approved email providers only, for heightened security with extra encryption.

This is the secure communication that doctors need to use to talk to each other (patients, as of now, are not involved in this system). The alternative is to obtain a secure email from each of your referring doctors, which, of course, many do not have. Objective 8 requires

SPRING 2016

A message from our President > John Zeiter, M.D.

be put into place to protect EPs from the liabilities of dispensing medical diagnosis and treatment over email (Objective 9), videoconference, and telephone. In addition, CMS needs to address compensation for these healthcare services, a touchy subject that you will find nowhere in these Meaningful Use Objectives!

So I called my practice consultant (a good business to be in these days) and asked him, “Do we need to comply with these Objectives immediately and do we need to answer every comment and question submitted by a patient,” and he replied, “Yes and yes,” and then sent

Someone needs to give that information to Medicare, Medical, and all other insurance companies in San Joaquin County; because guess what, the reason telemedicine is so incredibly cost efficient is because no one pays for it!

Although I am usually the eternal optimist and certainly a champion of cost efficiency, I find myself struggling to embrace encrypted portals, meaningful use objectives, and telemedicine. My struggle has nothing to do with my resistance to change. On the contrary, I believe in the advancement of medicine and in what Well apparently “telemedicine” is all the rage. Telemedicine is the remote physicians can accomplish delivery of health care services and clinical information via electronic to improve outcomes and communications used to improve patients’ clinical health status. statistics. I, however, still also me an invoice for $100. I then called my accountant believe in a system where my medical decision making and asked her if I could somehow “write off ” the lost is directed by the full picture of a patient. After all, wages for consulting with patients over the internet and how can a psychiatrist accurately determine a patient’s telephone. She said, “Absolutely not!” and then sent mental well-being when he/she can’t see that this patient me an invoice for $125. Finally, I called my attorney has not bathed for days? How can a Cardiologist know to see if the same malpractice liability exists when I if a patient has gone back into atrial f lutter when he is diagnose and treat patients by email, videoconference, 80 years old and can barely remember to take his beta cell phone pictures, or telephone. He said, “Of course,” blocker? I am not suggesting that encrypted portals, and then sent me an invoice for $150.

Although I am usually the eternal optimist and certainly a champion of Yes, I’m being cost efficiency, I find myself struggling to embrace encrypted portals, somewhat sarcastic, but you get my meaningful use objectives, and telemedicine. point—every other professional is able to bill for services provided over the phone or by email. meaningful use objectives, or telemedicine have no Well apparently “telemedicine” is all the rage. benefits nor that they have no place in the direction Telemedicine is the remote delivery of health care of healthcare. Technology will likely improve and, in services and clinical information via electronic an ideal world, every patient will have a telemonitor in communications used to improve patients’ clinical their living rooms, complete with electrodes for their health status. Radiologists and pathologists have used precordium. That time, however, is not now. I am telemedicine for years to review radiology films and merely suggesting that measures like encrypted portals, pathology slides from distant locations. According meaningful use and telemedicine, will all be for not to several publications I read, telemedicine improves when physicians are stretched to their practicing limits, patient access, quality of care, and cost efficiencies; both clinically and financially, and if patients, like Mr. and patients are demanding it. And with regards to Jones, do not receive the type of comprehensive care that reimbursement “there is usually no distinction made we all strive to provide. It’s time to take a bigger picture between services provided on site and those provided than what the tele-monitor can provide. through telemedicine, and there is no separate coding required for billing of remote sessions.” Laugh out loud!

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SPRING 2016

NEW HEALTH LAWS 2016

THE CALIFORNIA LEGISLATURE HAD AN ACTIVE YEAR, PASSING MANY NEW LAWS AFFECTING HEALTH CARE. IN PARTICULAR, BILLS MAKING MAJOR CHANGES TO STATE IMMUNIZATION REQUIREMENTS AND END-OF-LIFE OPTIONS WERE ENACTED. THERE WAS ALSO A STRONG FOCUS ON NEW LEGISLATION RELATED TO ALLIED HEALTH PROFESSIONALS, MENTAL HEALTH, MEDICAL RECORDS AND PRIVACY, AND REPRODUCTIVE ISSUES. ON THE FOLLOWING PAGES YOU WILL FIND HIGHLIGHTS OF THE MOST SIGNIFICANT HEALTH LAWS OF INTEREST TO PHYSICIANS.

END OF LIFE

ABX2 15 (Eggman) – End of Life

Enacts the End of Life Option Act authorizing an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal illness, to make a request for a drug for the purpose of ending their life. Establishes procedures and forms for such requests. Provides immunity from civil or criminal liability solely because the person was present when the qualified individual

SPRING 2016

self-administered the drug so long as the person did not assist with the ingestion of the drug. Provides immunity from liability for health care providers who refuse to engage in activities authorized pursuant to its provisions.

Requires a physician to submit specified information to the State Department of Public Health after writing a prescription for an aid-in-dying drug and after the death of individuals who requested an aid-in-dying drug. >>

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New Health Laws > 2016

AB 637 (Campos) – Physician Orders For Life Sustaining Treatment Forms

CMA Position: Sponsor Authorizes the signature of a nurse practitioner or physician assistant acting under the supervision of the physician and within the scope of practice authorized by law to create a valid Physician Orders for Life Sustaining Treatment form.

WORKERS’ COMPENSATION

AB 1124 (Perea) – Workers’ Compensation: Medication Formulary

Requires the administrative director to establish a drug formulary, as part of the medical treatment utilization schedule, for medications prescribed in the workers’ compensation system.

Requires the administrative director to meet and consult with stakeholders, as specified, prior to the adoption of the formulary.

Requires the administrative director to publish at least 2 interim reports on the Division of Workers’ Compensation website describing the status of the creation of the formulary, until the formulary is implemented. Requires the administrative director to update the formulary at least on a quarterly basis to allow for the provision of all appropriate medications, including medications new to the market.

Exempts an order updating the formulary from the Administrative Procedure Act and other provisions, as specified. Requires the administrative director to establish an independent

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pharmacy and therapeutics committee to review and consult with the administrative director in connection with updating the formulary, as specified.

PUBLIC HEALTH

SB 27 (Hill) – Livestock: Use of Antimicrobial Drugs

CMA Position: Support Prohibits the administration of medically important antimicrobial drugs to livestock unless prescribed by a licensed veterinarian or a feed directive. Prohibits the administration of a medically important antimicrobial drug to livestock solely for purposes of promoting weight gain or improving feed efficiency. Requires the development of antimicrobial stewardship guidelines and best practices on the proper use of such drugs. Requires gathering of related information. Provides civil penalties for violations.

SB 277 (Pan) – Public Health: Vaccinations

CMA Position: Sponsor Eliminates the exemption from existing specified immunization requirements based upon personal beliefs. Allows an exemption from future requirements deemed appropriate by the State Department of Public Health for either medical reasons or personal beliefs. Exempts pupils in a homebased private school and students enrolled in an independent study program and who do not receive classroom-based instruction.

Provides an temporary exclusion is only for a child who has been

exposed to a specified disease and whose proof of status does not show proof of immunization against one of specified diseases. After July 1, 2016, prohibits a governing authority from unconditionally admitting to any private or public elementary or secondary school, child day care center, day nursery, nursery school, family day care home, or development center within the state for the first time or admitting or advancing any pupil to the 7th grade level, unless the pupil has be immunized as required by this bill.

SB 792 (Mendoza) – Day Care Facilities: Immunizations: Exemptions

CMA Position: Support Prohibits a person from being employed or volunteering at a day care center or family day care home if he or she not been immunized against inf luenza, pertussis, and measles. Specifies the circumstances under which a person would be exempt from such requirement. Requires maintaining immunization documentation.

HEALTH CARE COVERAGE

SB 137 (Hernandez) – Health Care Coverage: Provider Directories

Requires a health care service plan, and a health insurer that contracts with providers for alternative rates of payment, to publish and maintain a provider directory or directories with information on contracting providers that deliver health care services to the plan’s enrollees or the health insurer’s

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New Health Laws > 2016

insureds. Requires the plan or health insurer to make an online provider directory or directories available on the plan or health insurer’s website. Requires a health care service plan or health insurer to take appropriate steps to ensure the accuracy of the information contained in the plan or health insurer’s directory or directories, and would require the plan or health insurer, at least annually, to review and update the entire provider directory or directories for each product offered.

Requires a health care service plan or health insurer to reimburse an enrollee or insured for any amount beyond what the enrollee or insured would have paid for innetwork services, if the enrollee or insured reasonably relied on the provider directory. Authorizes a delay in payment to a provider if the provider fails to respond to the plan or insurer’s attempts to verify the provider’s information.

SB 282 (Hernandez) – Health Care Coverage: Prescription Drugs

Requires the Department of Managed Care and Department of Insurance to develop the uniform prior authorization form on or before January 1, 2017, and would require prescribing providers to use, and health care service plans and health insurers to accept, only those forms or electronic process on and after July 1, 2017, or 6 months after the form is developed, whichever is later. Deems a prior authorization request to be granted if the plan or insurer fails to respond within 72 hours for non-urgent requests, and within 24 hours when exigent circumstances exist.

ALLIED HEATLH PROFESSIONALS SB 337 (Pavley) – Physician Assistants

Requires that the medical record for each episode of care for a patient identify the physician and surgeon responsible for supervision. Replaces medical record review provisions and requires supervising physician to use one or more of described alternative medical records review mechanisms. Authorizes a physician assistant, under prescribed supervision of a physician, to administer or provide medication to a patient, or transmit an order to furnish medication or medical device. Prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets approved standards. Requires that the medical record of any patient cared for by a physician assistant for whom a physician assistant’s Schedule II drug order has been issued or carried out to be reviewed, countersigned, and dated by a supervising physician and surgeon within 7 days.

SB 407 (Morrell) – Comprehensive Perinatal Services Program: Midwives

Amends the Comprehensive Perinatal Services Program. Authorizes a health care provider to employ or contract licensed midwives for the purpose of providing comprehensive perinatal services. Provides that, upon effective date of regulations adopted by the board, a licensed midwife shall be eligible to serve as a “comprehensive perinatal provider,” as defined.

Requires the State Department of Health Care Services to commence the revision of existing regulations as it determines are necessary for the implementation of these provisions.

These are just a sampling of the new laws impacting health care in 2016 and beyond. For a complete list, see “Significant New California Laws of Interest to Physicians for 2016,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.

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SAN JOAQ UI N MEDICAL SO CI ET Y

Holiday party San Joaquin Medical Society’s annual Holiday Party took place

Thursday, December 10, 2015 at Stockton Golf and Country Club

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In The News

IN THE

NEWS St. Joseph’s Medical Center Awarded Chest Pain Certification from the Joint Commission

St. Joseph’s Medical Center has earned The Joint Commission’s Gold Seal of Approval® for Chest Pain Certification. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. St. Joseph’s underwent a rigorous on-site review last fall wherein Joint Commission experts evaluated compliance with national disease-specific care standards as well as with chest painspecific requirements. Clinical practice guidelines and performance measures also were assessed.

Established in 2002 and awarded for a two-year period, The Joint Commission’s disease-specific care certification evaluates clinical programs across the continuum of care.

It also addresses three core areas including compliance with consensus-based national standards, effective use of evidence-based clinical practice guidelines to manage and optimize care and an organized approach to performance measurement and improvement activities.

To receive this certification, St. Joseph’s had to thoroughly demonstrate a high level of care for patients presenting with chest pain. This certification recognizes St. Joseph’s as a leader in chest pain care, providing a high standard of service for cardiac patients in our community.

St. Joseph’s Medical Center Recognizes George Schilling, M.D. and Amod Tendulkar, M.D. as 2015 Physician Champions

Each year physicians are called upon to nominate their deserving peers to be recognized as a part of St. Joseph’s Medical Center’s Physician Champion Awards. The awards recognize a Champion of Community, a physician

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

who has demonstrated a commitment to improving the health status of the community, and a Champion of Quality, a physician who continuously pursue quality improvement through innovation. This year’s awardees are George Schilling, M.D. for Physician Champion of Community and Amod Tendulkar, M.D. for Physician Champion of Quality.

Dr. Schilling has been a dedicated physician in our community for over 30 years. He’s been instrumental in the development of clinical algorithms to provide the best possible care to patients at St. Mary’s Interfaith Medical Clinic. In addition, Dr. Schilling has served as Medical Director for several Skilled Nursing Facilities in the Stockton Community.

Dr. Tendulkar is a well-respected cardiovascular surgeon who has held leadership roles on various Medical Staff Committees throughout his tenure, including the Interdisciplinary Cardiovascular Committee and the Cardiovascular Department. As the Medical Director for the Surgical Intensive Care Unit at St. Joseph’s, Dr. Tendulkar is known for his stellar communication with staff and for being a true advocate for his patients.

Dignity Health Medical Group Stockton Welcomes Dr. Mai T. Le and Dr. Gurtej Malhi

Dignity Health Medical Group – Stockton is proud to welcome Mai T. Le, M.D. to its team of primary care physicians and Gurtej Malhi, M.D. to its team of specialists.

Before joining Dignity Health Medical Group as a primary care physician, Dr. Mai T. Le was a hospitalist practicing at St. Joseph’s Medical Center. In her current role as a primary care physician, Dr. Le looks forward to helping her patients achieve optimal health by promoting

SPRING 2016

In The News

both teams.

HPSJ Chief Medical Officer Lakshmi Dhanvanthari, M.D., said, “Johnathan joined HPSJ as a resident in HPSJ’s nationally-accredited Managed Care Pharmacy Residency Program, in 2007. He then served as a clinical pharmacist from 2008-2009, and since 2011 he has been our clinical programs director. Throughout his tenure at HPSJ, he has taken on progressively challenging roles and succeeded at each. He also has continued to be involved in the strategic direction of the HPSJ pharmacy programs.”

Gurtej Malhi, M.D.

Mai T. Le, M.D.

healthy lifestyles and disease prevention.

Dr. Gurtej Malhi is board certified in gastroenterology and internal medicine and thrives on providing the best possible care to his patients. His special clinical interests include endoscopic ultrasound, biliary and pancreatic therapeutic endoscopy, and Barrett’s esophagus. Dr. Malhi is committed to educating his patients and involving them closely in their care.

Dignity Health Medical Group Stockton is affiliated with Dignity Health St. Joseph’s Medical Center in Stockton.

Health Plan of San Joaquin promotes senior staffer to new position: Director of Pharmacy and Clinical Analytics

Health Plan of San Joaquin (HPSJ) has announced that Johnathan Yeh, Pharm.D. has expanded responsibility in a newly established senior position within HPSJ. Yeh has been HPSJ’s director of clinical programs with oversight responsibility for the clinical analytics team. He has now transitioned to the new, combined role of director of pharmacy and clinical analytics, and will have Johnathan Yeh, Pharm.D. responsibility for

SPRING 2016

Second Medical Director now on board HPSJ team to enhance analytics capabilities

Health Plan of San Joaquin (HPSJ) today announced that Dorcas Yao, M.D., MBA, has joined the HPSJ team as a Medical Director. Board certified in clinical informatics Dorcas Yao, M.D., MBA and radiology, she previously worked at the VA Health Care system in Palo Alto, and at the VA National Office of Informatics and Analytics. She has extensive experience in clinical radiology and in imaging informatics.

Dr. Yao said, “As a physician with over 15 years of experience in a large, integrated healthcare system, I am passionate about leading positive change and improving health care delivery.”

“Dorcas will provide medical oversight for UM and QM activities, and with her clinical informatics background she will assist us with building our analytics capabilities,” HPSJ Chief Medical Officer Lakshmi Dhanvanthari, M.D., said.

San Joaquin Board of Supervisors appoints two new Commissioners for Health Plan of San Joaquin (HPSJ) Governing Board

San Joaquin County Director of Health Care Services Greg Diederich – chair of the Health Commission –announced that the San Joaquin County Board of Supervisors has formally appointed two new members of the Health Commission, the governing board of the Health Plan of San Joaquin (HPSJ). These new members

SAN JOAQUIN PHYSICIAN

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In The News

IN THE

NEWS

Frank L. “Larry” Ruhstaller are: Community Representative Frank L. “Larry” Ruhstaller and San Joaquin County Senior Deputy County Administrator Rod A. Kawano.

Ruhstaller, a third-generation Stocktonian who owns The

Rod A. Kawano Alder Market Bistro and Catering Company (Stockton), is a graduate of the University of California, Berkeley, and has been extensively involved in civic and philanthropic activities. He previously served on the San Joaquin County Board of

Supervisors where he represented District 2.

Kawano, who has served in the County Administrator’s Office since 2000 – first as a management analyst and then as deputy county administrator – graduated from California State University, Long Beach, with a Bachelor of Science degree in Business Administration/ Finance.

Diederich said, “Part of the Commission’s strength is the blend of public servants, community representatives, and local physicians.

Having Rod Kawano and Larry Ruhstaller join the governing board provides even more opportunities for us to listen to our communities and our members, and to continue providing strong oversight so that

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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SPRING 2016

In The News

we can continue strengthening the program services that are the foremost HPSJ priority.”

Health Plan of San Joaquin (HPSJ) has launched a new initiative- Oral Health for children starts at birth

Unfortunately, access to early dental treatment is a challenge for local children. Concerns are mounting for the potentially devastating impact on their oral health and their ability to grow and thrive. Studies are pointing to additional health impacts as they grow into adulthood, including life-long consequences for children too distracted by poor oral health and related illnesses to perform well at school. Health Plan of San Joaquin (HPSJ), as a Medi-Cal managed care public health plan, is not able to provide coverage for dental visits.

Focusing on what it can do, HPSJ this past fall launched a multi-phase initiative throughout its service area to improve the dental health of HPSJ’s 152,000 youngest members – children from birth through 18 years old.

Called Oral Health for Children Starts at Birth, it includes: • Increased fluoride varnish treatment reimbursements for HPSJ network providers (children 0-6 years) • Expanded pharmacy benefit for fluoride drops and tablets, from a 30-day supply to a 100-day supply (children 0-16 years) • Educational materials and public awareness spots • Training for doctors and their staff, at HPSJ Lunch & Learn presentations and scheduled practice presentations HPSJ Health Careers Scholarships to be offered for a second year

Health Careers Scholarships, Health Plan of San Joaquin’s premiere scholarship offering – recognized as one of only several in the nation – is opening its spring application process. San Joaquin Medical Society’s Decision Medicine will again be one of seven local partner schools/ programs that will participate in the Health Careers Scholarships. A $2,500 Health Careers Scholarship will be awarded to 14 freshman entering college in the fall of 2016.

The program is open to full-time, undergraduate students entering their freshmen year of college and majoring in a medical profession at one of the following schools:

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In San Joaquin County 1. San Joaquin Delta College – Nursing Program 2. San Joaquin Medical Society – Decision Medicine Alumni 3. Health Careers Academy High School 4. University of the Pacific - School of Pharmacy Applications are now available through the Health Careers Scholarships partners and due by March 14. For more, contact Angela Dennis, HPSJ Health Promotions Specialist, Health Careers Scholarship Program, 7751 S. Manthey Road, French Camp, CA 95231, or at adennis@ hpsj.com.

San Joaquin General Hospital recognition of the Rebecca Award for 2015

Congratulations to Bea and Allen Lingenfelter who were recipients of the 2015 Rebecca Award.

The award is given annually to an individual who has clearly gone above and Bea and Allen Lingenfelter beyond in offering of themselves and sharing their time and talents with others in need.

Bea is our Auxiliary President and Allen is our Auxiliary Treasurer. They are husband and wife team they have been volunteering together for many years at San Joaquin General Hospital. They also volunteer in the ICN as baby cuddles. Bea has 500 volunteer hours and Allen has 600 volunteer hours in 2015.

The Rebecca Award is for the year’s most outstanding volunteer, which is dedicated to Rebecca’s memory, who taught so much too so many in such a short time.

The baby Rebecca was just 3 Days old, born with a host of medical problems that prevented her from living beyond 18 months. Her parents made the decision to remove her form life support systems, but were unable to be with her. A volunteer named Betty Jo Larson held Rebecca in her loving arms as she passed away, Betty Jo Larson became the first recipient of this award in 1990.

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25

In The News

IN THE

NEWS San Joaquin General Hospital Auxiliary Department is looking for volunteers for all shifts, especially in the Gift Shop and the Information Desk, if you would like to help our community this is the place.

Interested in volunteering at SJGH? Please contact, Lillianna Carmona, Volunteer Coordinator, at (209) 468-6041 or Lcarmona@sjgh.org.

at Elmhurst Hospital, New York City. Dr. Chander speaks Hindi, Punjabi and Urdu.

San Joaquin General Hospital Welcomes New Physicians:

Alice Kim, D.O., Emergency Medicine

Anthony Cappelli, M.D., Obstetrics / Gynecology

Dr. Capelli is a graduate of the UC Davis School of Medicine with a residency in Obstetrics / Gynecology from Charles Drew University Medical School in Los Angeles. Dr. Capelli is also a fluent in Spanish language speaker.

Harish Chander, M.D., Internal Medicine

Dr. Chander graduated from Maulana Azad Medical College and performed his medical residency at Flushing Hospital in Flushing, New York with a fellowship in internal medicine

Anthony Cappelli, M.D.

Anthony Cappelli, M.D.

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Yinn Htwe, M.D., Internal Medicine

Dr. Htwe received her primary medical education at the University of Miramar Medical School and performed her residency in internal medicine at Coney Island Hospital in New York City.

Dr. Kim graduated from Touro University Medical School in Vallejo, California and performed her residency at both the John Stroger Hospital in Cook County Ill., and San Joaquin General Hospital.

Busava Kunamneni, M.D., Cardiology

Dr. Kunamneni received her medical training at Guntar Medical College, India and performed her residency in cardiology at the Bronx-Lebanon Hospital in New York City.

Harish Chander, M.D.

Neha Nainani, M.D.

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Neha Nainani, M.D., Nephrology

Dr. Nainani graduated from Topiwala National Medical College in Mumbai India. A specialist in Nephrology, she did her residency in Nephrology at The State University Hospital in Buffalo, New York.

Dr. Nainani speaks fluent Hindi and Punjabi.

Bhanu Munnava, M.D., Family Medicine

Dr. Munnava received his medical education from Ghandi Medical College in Secunderabad, India.

He performed his residency in Family Medicine at the E.A. Conway Medical Center in Monroe Louisiana.

San Joaquin General Hospital and Clinics Reach Out To Local Latinas Regarding Breastfeeding

San Joaquin General Hospital is on a campaign to help local Spanish speaking mothers, and mothersto-be, learn the importance of breastfeeding.

Simmons Research shows that only 33% of San Joaquin Valley mothers choose to breastfeed their infants while 67% choose to formula feed infants.

Since 71% of all new or expecting mothers in the San Joaquin Valley are Hispanic, the Hospital has developed a series of community posters to help educated Spanish language mothers on the distinct benefits of breastfeeding. Breastfeeding is proven medically to benefit both mother and infant.

For mothers: Breastfeeding reduces the risk of breast and ovarian cancer. It prevents postpartum depression and Type 2 diabetes. It also reduces bleeding afterbirth.

For Infants: Breastfeeding prevents diarrhea and has been proven to lower the risk of Sudden Infant Death Syndrome. Breastfeeding has also been proven to lower the child’s risk of obesity and developing allergies.

Spanish language communication with expecting mothers and new mothers is under the direction of Guillermina (Gina) Pantoja, RN, IBCLC. Nurse Pantoja is board certified in lactation and speaks fluent Spanish. She also leads the Hospital’s weekly support group at the Family Maternity Center.

To learn more about the importance of infant breastfeeding contact the Hospital’s Breastfeeding

SPRING 2016

P C o o et r r n y er

In The News

Depleted To Renewal

YOU LOOKED INTO MY EYES AND WROTE MY STORY ANEW THAT OLD BOOK WAS FILLED WITH MY FEARS YOU RE-WROTE MY HOPES.

YOUR PARAGRAPHS WERE FILLED WITH DETAILS OF OUR BATTLE PLAN, OF MY WELLNESS AND NOT MY EASE WITH DISEASE. YOU DELETED LINES SEEKING TO CEMENT ANY DOUBTS AS WE TRAVELLED ON THIS JOURNEY TOGETHER OUR NEW STORY MADE ME WHOLE AGAIN. BUT NOW YOU HAVE CHOSEN TO BECOME A DIFFERENT TYPE OF AUTHOR. IN YOUR QUEST TO REWRITE NEW CHAPTERS OF YOUR LIFE YOU ABANDON ME. SO NO, YOU DO NOT HAVE MY PERMISSION NO SABBATICAL HERE NO LUXURY HERE SO UNPACK YOUR BAGS. WHAT YOU HAVE MY PERMISSION TO DO IS TO BASK IN THE MAJESTY OF YOUR CALLING TO REKINDLE THE FIRE TO REFILL YOUR CUP FOR I WILL ALWAYS NEED YOU TO LOOK INTO MY EYES AND REWRITE AND TELL MY STORY WITH THE SAME INTENSITY FOR I WILL ALWAYS NEED YOUR COMPASSION I WILL ALWAYS NEED THE WARMTH, THE REASSURANCE OF YOUR CONFIDENCE. I WILL ALWAYS NEED YOUR EXPERTISE AS AN AUTHOR CHARGED WITH THE PRIVILEGE AND HONOR OF BEING THE CAPTAIN OF THE SHIP ON OUR JOURNEY. SO RE-ENERGIZE LET US EMBARK ON THIS BOOK TOUR OF WELLNESS AND HEALING TOGETHER AGAIN. Kwabena O.M. Adubofour, MD, FACP

Please send your poetry submissions to Lisa@sjcms.org

Support Group. It’s open to all mothers and babies. Find out more on the Hospital’s website specifically for breastfeeding support: http://www. sjgeneral.org/serviceslaboranddeliverybreastfeeding.html Available space to lease for Medical office:

For Medical office in Weber Ranch Professional park, 1801 East March Lane, Stockton, CA; call today at 209-951-8830 or 209-951-8395; 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 MAs, Patient’s bath room, storage room, and Reception (waiting room).

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volunteer work

Vietnam

Drs. Peter Salamon and Victor Macko

Reflections of Vietnam When orthopedic foot and ankle surgeons Victor Macko, M.D. and Peter Salamon, M.D. arrived in Vietnam in June for a one-week humanitarian trip, they found a variety of medical problems not commonly seen in the United States, as well as dedicated young Vietnamese orthopedic surgeons seeking new methods of treatment.

“There were many children with untreated congenital abnormalities, adults suffering from the effects of polio, untreated trauma and undertreated infections,” says Salamon, who practices at the Alpine Orthopaedic Medical Group in Stockton, California. “The

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Vietnamese surgeons were eager to learn and did an excellent job caring for patients with what we would consider limited resources.”

Dr. Macko, who practices with the Sutter-Gould Medical Foundation in Stockton, California, was surprised by the number of patients seeking help. On their first clinic day in Hanoi, 65 patients arrived.

“At our screening clinic, the room was filled with people,” Salamon explains.

“We evaluated patients alongside the local orthopedic surgeons, and as we examined each patient, the door was packed with other patients and families

waiting to be seen. Access to medical care is at a premium, and the crowds came when word got out that the American specialists were coming. We had our work cut out for us.”

“We saw a wide array of deformities and determined which patients we know we could help with surgery. Patients were not afraid to ask for explanations of our recommendations,” says Macko.

“I was able to teach a favorite ankle arthrodesis technique to the residents and junior staff in Hanoi. Like surgeons in the states, they want to provide the best possible outcomes for their patients and were interested in modern surgical

SPRING 2016

volunteer work

Vietnam

Drs. Peter Salamon and Victor Macko

approaches, especially those for trauma and reconstruction.”

Macko and Salamon were among the nine members of the American Orthopaedic Foot & Ankle Society (AOFAS), which organizes the annual Overseas Outreach Project to Vietnam.

Volunteers used basic orthopedic principles to accomplish specific surgical goals because many of the instruments and imaging tests commonly used in orthopedics are not available in Vietnam. In addition, the AOFAS volunteers adapted to the Vietnamese healthcare environment.

Scope of Volunteer Work

This year’s volunteer group evaluated more than 247 patients and performed surgery on 76, all at no cost to the

SPRING 2016

patients. AOFAS volunteers pay their own travel expenses to Vietnam, and incountry expenses are supported by the Orthopaedic Foot & Ankle Foundation (The Foundation) with charitable donations from individuals and industry.

The doctors also brought along medical supplies for the humanitarian service trip. This year’s volunteers worked in teams and fanned out to four cities over a four-week period.

Drs. Macko and Salamon spent time working alongside Vietnamese orthopedic surgeons at Viet Duc University Hospital and the clinic at the Orthopaedic Institute, both in Hanoi.

Other AOFAS member volunteers on the four-week trip included Mario Adames, M.D., Florianopolis, Brazil; D. Scott Biggerstaff, M.D., WinstonSalem, N.C.; Angus McBryde, M.D.,

Mobile, Ala.; Thomas Hearty, M.D., Grand Rapids, Mich.; Naren Gurbani, M.D., Downey, Calif.; L. Daniel Latt, M.D., PhD, Tucson, Ariz.; land Naomi Shields, M.D., Wichita, Kan. In addition to operating and teaching, AOFAS volunteers conducted seminars to share surgical advancements in the treatment of foot and ankle disease and deformity.

Since the first AOFAS outreach project in 2002, more than 1,200 patients have benefited from no-fee surgery by AOFAS volunteers, and more than 2,800 patients have been seen in the clinics. Mobility Outreach International (MOI), partner with the AOFAS in the project, has provided prosthetic limbs to indigent Vietnamese children and adults without charge since the 1990s.

SAN JOAQUIN PHYSICIAN

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The

REMEDY for all your

Financial

NEEDS

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

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

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

209-948-6024

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www.fccuburt.org Federally insured by the NCUA.

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SPRING 2016

TOP

HEALTH CARE MINDS

t o h e a d l i n e t h e We s t e r n H e a l t h C a r e L e a d e r s h i p A c a d e m y 19th annual conference comes to beautiful San Francisco

Leading Change You’re not going to want to miss the 19th Annual Western Health Care Leadership Academy, which is coming for the first time to beautiful San Francisco.

Over the years, the Leadership Academy has made a name for itself as the premier health care event in the western United States, challenging today’s physicians to explore new and innovative solutions in their rapidly changing environment. Some of the top health care minds of our time are regularly featured at the event, leaving guests with the tools and inspiration needed to continue making a difference in their profession.

SPRING 2016

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http://www.imq.org/education/caprrc.aspx SPRING 2016

ATUL GAWANDE, M.D.

“The Western Health Care Leadership Academy is one of the very best meetings I attend,” said Paul Phinney, M.D., a Sacramento pediatrician and past president of the California Medical Association. “The mix of insights on political, economic and social issues affecting physicians is awesome and stimulates out-ofthe-box thinking on ways to shape a better future for physicians and their patients.”

This year, politicos Karl Rove and Donna Brazile will preview the 2016 presidential election and its potential impact on health care. Karl Rove is the former deputy chief of staff and senior advisor to President George W. Bush. Donna Brazile is a CNN commentator, campaign manager for Al Gore’s presidential bid and a vice chair for the Democratic National Committee.

Other keynote speakers rounding out this year’s Leadership Academy include two noteworthy physicians, writer and surgeon Atul Gawande, M.D., MPH, and comedic rap artist and internist ZDoggMD (Zubin Damania, M.D.).

DONNA BRAZILE

KARL ROVE

Dr. Gawande is a staff writer for New Yorker magazine and author of several bestsellers including Being Mortal: Medicine and What Matters in the End, which sparked a PBS Frontline program last year.

He practices general and endocrine surgery at Brigham and Women’s Hospital in Boston. He is professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School.

Dr. Gawande is the winner of two National Magazine Awards, Academy Health’s Impact Award for highest research impact on health care, a MacArthur Fellowship and the Lewis Thomas Award for writing about science.

for his music videos, parodies and comedy sketches about medical issues as well as systemic issues with health care.

Zubin Damania, M.D., is the founder of Turntable Health, a direct primary care clinic in downtown Las Vegas funded by Zappos CEO Tony Hsieh.

Before moving to Las Vegas, Dr. Damania was a practicing hospitalist at Stanford University. As a comedic rap artist, he performs as ZDoggMD, and is an Internet celebrity known

Register today with a VIP upgrade and enjoy more “up close and personal” experiences, including express conference check-in, preferred seating, and private meet-and-greets with Karl Rove and Dr. Gawande, including the chance to ask questions face-to-face in an exclusive setting.

VIP upgrades are available for a limited time only and on a first-come, first served basis.

Continuing its tradition of excellence, this year’s Leadership Academy will bring together top practitioners and thinkers to share strategies and resources for accelerating the shift to a more high-performing and sustainable health care system. We’ll examine the most significant operational, financial and environmental challenges facing health care today and present proven models and innovative approaches that will enable you to transform your organization’s care delivery and business practices.

F o r m o r e i n f o r m a t i o n a n d t o r e g i s t e r, v i s i t w w w . w e s t e r n l e a d e r s h i p a c a d e m y. c o m .

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PASSING THE PURPLE LINE A ground-breaking program at Stockton’s Health Care Careers Academy seeks to ease the shortage of health care professionals in California’s Central Valley while instilling a PASSION for the field in its students.

STORY BY JAMES NOONAN l PHOTOGRAPHY BY DALE GOFF

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Flanking the entrance of the Health Careers Academy High School in Stockton is a pair of royal purple lines that have come to symbolize something of a new beginning.

In the simplest, most literal, sense, the beginning is that of the school day, one which campus administrators ask students to begin with a renewed sense of focus and a desire to learn.

there at the purple line.”

In a much larger sense, however, Miller and her fellow educators at Health Careers Academy hope these new beginnings will deal with the very reasons that Health Careers Academy was founded – the creation of long and fruitful careers in the field of health care for young adults living in the San Joaquin Valley.

In yet another way, this sense of “Once you pass that purple line, you shut off all the distractions. beginnings can be applied to the Health Careers Academy campus On those days when you might not want to be here, or when itself, a place that might never have come to fruition if not for the dogged you’re feeling upset about something outside of school, we ask perseverance of its administrators, its that you leave it all behind right there at the purple line.” supporters and of Stockton’s health care community as a whole.

“We tell students ‘You have passed the purple line,’” Health Careers Academy’s doors first opened to students explains Traci Miller, principal at the Health Careers in the fall of 2011, but Miller notes that idea behind the Academy. “Once you pass that purple line, you shut off all academy was developed more than a decade ago in response the distractions. On those days when you might not want to a growing need within both San Joaquin County and the to be here, or when you’re feeling upset about something Central Valley as a whole. outside of school, we ask that you leave it all behind right “The Health Careers Academy was really a concept that

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SPRING 2016

Passing The Purple Line > Stockton’s Health Care Careers Academy

was started by a group of community leaders in the health profession,” Miller said. “They looked at the situation and saw that the San Joaquin Valley was headed toward a train wreck in terms of being able to supply qualified candidates into the health care field. On top of that, our workforce didn’t represent the diversity with which the Valley is so rich.”

Driven by the promise that an already existing shortage of health care professionals would only grow worse in the coming years, community leaders began approaching the superintendants of both San Joaquin County and the Stockton Unified School District, asking that a dedicated charter program be established to help ease the shortage.

Roughly six years ago, the project was given the green light by county and district educational leaders and Miller was brought on as principal to help get the project off the ground.

Before the campus could begin recruiting students, however, the first of many new beginnings had to take place.

Looking at Health Careers Academy’s campus on East Magnolia Street, one might never know that the location, which today is characterized with such optimism and positivity, once housed such great pain. The building, which is adjacent to the California State University, Stanislaus Stockton Center, had previously served as a California State Hospital, only to be shuttered in the mid 1990s when the state transferred ownership to the university system. When it came time to establish the Health Careers Academy local leaders were faced with the proposal to turn the site into a new juvenile detention facility, something that stands as the antithesis of the academy’s mission of educating and fostering positive careers for area youth.

“There was this opportunity to turn this property into either a prison or school for our kids,” Miller said. “We’ve taken what was a really negative place, and turned it into something very positive for this community.”

While the health care community’s support for the project was crucial to the Health Care Academy getting off the ground, that same

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COMMUNITY PARTNERS ADVISORY COMMITTEE Maxine Areida - Health Careers Academy High School Anne Baird - Susan Talamantes Eggman Assemblymember 13th District Lynn Beck, RN, EdD - University of the Pacific Kristen Birtwhistle - The Permanente Medical Group Rae Charos, RN,MSN,FNP - St. Joseph’s Medical Center Lakshmi Dhanvanthari, M.D. - Health Plan of San Joaquin Kathy Garcia - Stockton Unified School District Deborah Griego - Sutter Health Kathy Hart, Ph.D - San Joaquin Delta College Kevin Huber - Grupe Commercial Company Sheila James - US Department of Health & Human Services, Office of the Assistant Secretary for Health/Office of the Regional Health Administrator Julie Kay - San Joaquin Delta College Dan Keyser - Grupe Commercial Company Lisa Lucchesi - San Joaquin Delta College Joann Marks - St. Joseph’s Medical Center Grant Mellor, M.D. - The Permanente Medical Group Nancy Mellor, Ph.D - Retired School Superintendent Traci Miller - Health Careers Academy High School Becky Moffitt - Tuleburg Kim Petersen - California Health Care Facility Linda Philipp - Community Foundation of San Joaquin Frances Richardson - JobRedi Foundation Lisa Richmond - San Joaquin Medical Society Annette Sanchez - Council for the Spanish Speaking Joseph Serra, M.D. - San Joaquin Medical Society Steve Smith - Stockton Unified School District Margaret Szczepaniak - SJC Health Care Services Salvador Vargas - San Joaquin Delta College Diane Vigil - Dameron Hospital Foundation Lita Wallach - Wallach and Associates Doug Wilhoit - Greater Stkn Chamber of Commerce Moses Zapien - San Joaquin County Board of Supervisors

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LIFE

Get Back To It Dameron Hospital’s comprehensive cardiac program provides the community with access to a broad range of advanced cardiac care services including cardiac surgery, a cardiac catheterization lab, peripheral vascular treatment and a cardiac EP lab for treatment of abnormal heart rhythms. In addition, Dameron Hospital is a designated STEMI receiving center for emergency care for heart attacks. Dameron’s highly-skilled cardiologists, cardiac surgeons and nurses combine expert knowledge with advanced technology to care for patients with all levels of advanced cardiac needs.

Excellence in Cardiac Care

209-944-5550 DameronHospital.org Stockton, CA

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SPRING 2016

Passing The Purple Line > Stockton’s Health Care Careers Academy

support is now called upon to ensure the project’s ongoing success in the form of the Community Partners Advisory Committee, or CPAC. This broad group of stakeholders, covering everything from developers and physicians to educators and local business professionals, has consistently worked to advance the academy’s mission, and today, speaks glowingly of the results.

“I spent a decade teaching school before going into medicine, so I can recognize a good school when I see one. I was immediately impressed the Health Careers Academy,” said R. Grant Mellor, M.D., chief of pediatrics at Kaiser Permanente’s Stockton campus and a member of the Health Careers Academy’s CPAC. “There was a palpable positive attitude among the students. You could feel it in the classrooms and the halls.”

Mellor’s involvement with the academy began with a talk about college preparation and applications to the school’s first class of juniors. Following the talk, Miller explained some of the harsh realities facing students at the Health Careers Academy.

“She told me that most of these students wouldn’t have access to the type of test preparation I was recommending,”

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Mellor said.

Fueled by this information, Mellor worked with the leadership of the local Permanente Medical Group to hire the Princeton Review and offer a full-scale, test preparation program to 20 students at the Health Careers Academy. In addition, Mellor’s involvement helped launched a mentoring program between academy students and physicians from his pediatrics group.

“Each student has his or her own physician mentor to help with things like choosing colleges or preparing essays,” he said.

In addition to Mellor, dozens of community stakeholders sit on the academy’s CPAC, each making their own valuable contribution toward the success of the program.

“We have people that have been coming religiously for five years, pushing us to make this school better,” Miller said. “The idea behind the CPAC was to show community support for this program, and it’s gone above and beyond that.”

Lakshmi Dhavanthari, M.D., the chief medical officer of the Health Plan of San Joaquin, notes that commitment of CPAC members only seeks to mirror the passion seen on

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Passing The Purple Line > Stockton’s Health Care Careers Academy

the Health Career Academy campus itself.

“When Traci first gave me a tour of the school, I was so impressed by the commitment of the teachers and the energy and attitude of the students,” Dhavanthari said.

“Seeing that helped make the decision to join the CPAC and help students stay engaged in their quest of pursuing a career in health care.”

Dhavanthari notes that, when it comes to retaining homegrown medical personnel, the San Joaquin region faces incredible competition from neighboring cities and suburbs, further exasperating the shortage of qualified health care professionals. Involvement in the CPAC is one way the local health care leaders hope to instill a sense of community in Health Care Academy graduates, something they hope will draw students back to the region following their medical education.

Through the CPAC, the academy has been able to place student volunteers in facilities thanks to partnerships with Kaiser, Sutter and other medical groups. Recently, St. Joseph’s Medical Center held their annual white coast ceremony for the academy’s incoming seniors, something that goes a long way toward illustrating community support in the eyes of the students.

“The support has been incredible,” Miller said, noting that partners quickly see the value in the health care-specific education offered by the academy. “When we place student

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volunteers, the feedback we get is always, ‘Wow, they speak our language, they understand where we’re coming from.’”

Now, roughly five years after the academy welcomed its first 120 freshman students, the campus has become a rallying point for the Stockton community, one that’s beginning to produce the very successes its earlier backers had envisioned.

Today, roughly 460 students attend the Health Careers Academy, with the first class of graduating seniors having left the campus last year. Of those graduates, more than 40 percent went on to attend four-year universities, while another portion makes up a cohort at Stockton’s Delta College. Miller notes that some graduates have entered the health care workforce immediately, while others are currently on pre-med or nursing tracks at places like Baylor University, the University of Oregon and UCLA. Making these results even more impressive is the fact that, without the Health Careers Academy, many of these opportunities may not have been possible.

“Roughly 83 percent of our students qualify for free or reduced lunch,” Miller said, noting that the student body is also incredibly diverse, with more than 70 percent being Hispanic. “In these ways, we really are the Central Valley.”

At the Health Careers Academy, these students are exposed to instruction that focuses on very specific skills needed in the health care industry, while also incorporating the full complement of high school coursework.

“These kids are taking courses in things like biomedical science, but if they’re a little behind in math or a little behind in English, we have classes for them as well,” Miller said.

In addition to academic pursuits, Miller and the rest of the team at the academy hope to instill a strong sense of community within the study body, something that’s evident in their mantra of “P.A.S.S.I.O.N.” “It stands for Professional, Academic, Service to Others, Strong, Inspiring, Optimistic and Nurturing,” Miller said.

“This is what we hope to instill in the students and what we hope they’ll carry into their future careers.”

With the first class of students having now graduated from the Health Careers Academy, career paths that will hopefully lead them back to the health care field in San Joaquin County are being charted. How many, and to what degree, they return remains to be seen, but what appears certain is the fact the Health Careers Academy will continue to churn out qualified young candidates for years to come.

“We’re light years ahead of people that have been doing this for a while, and it’s all because of the partnerships we’ve been able to form with the health care community,” Miller said. “I think what we have here is pretty special.”

SPRING 2016

A caregiver with CUSTOMER FOCUS

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Fortunately, there’s the Manteca Wound Center.

Hard-to-heal wounds demand advanced care. At the Manteca Wound Center, we use the latest treatments and sophisticated case management to help patients with chronic wounds heal faster. And when wounds heal, lives improve.

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(209) 823-7190 42

SAN JOAQUIN PHYSICIAN

SPRING 2016

PR ACTICE MANAGERS’ CORNER News from the California Medical Association’s practice management experts, focusing on critical payor and health care industry changes and how they directly impact the business of a physician practice

SPRING 2016

REMINDER: EXCHANGE PATIENTS, ELIGIBILITY AND THE 90-DAY GR ACE PERIOD Practices are reminded that under the Affordable Care Act, exchange enrollees who receive federal premium subsidies (approximately 90 percent of enrollees) to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums.

In the first month of the grace period, federal law and California regulations require plans to pay for services incurred even if the patient fails to pay the premiums due by day 90 (CCR §1300.65.2(b)(1)(A)). But in months two and three of the grace period, plans can “suspend” coverage and pend or deny claims if the patient doesn’t true up on his or her premiums by day 90.

SAN JOAQUIN PHYSICIAN

43

Practice Manager’s Corner > Spring 2016

In 2014, CMA was successful in advocating that plans be required to clearly communicate to practices through their real-time eligibility and verification systems if an enrollee’s coverage is suspended during the second and third months of the grace period. Further, the regulation requires plans to reflect “suspended” coverage on day one of the second month of the grace period, and requires plans to use one of three eligibility status indicators to reflect suspended coverage – “coverage pending,” “coverage suspended” or “inactive pending investigation” (CCR §1300.65.2(b)(C)).

If a plan fails to reflect suspended coverage using one of the above indicators on day one of the second month of the grace period, and a physician provides services to a subsidized enrollee, the plan is financially responsible for the claims incurred (CCR §1300.65.2(d)(5)). However, practices must be able to prove that the plan did not comply with the regulation.

For this reason, it is extremely important that practices verify eligibility on all exchange patients, ideally on the date of service, or as near the time of service as possible, and that the practices retain a printout of the eligibility verification and includes it as part of the patient’s chart. If a patient’s eligibility verification comes back indicating his or her coverage is suspended, the practice can treat the situation as it would any other patient who has had a lapse in coverage. For non-emergency services, patients may be given the option to either pay cash at the time of service or reschedule to a later date.

Further, California regulations require the plan to notify any provider with an outstanding prior authorization if the patient is in months two or three of the grace period (28 CCR §1300.65.2 (d)(2)).

If the plan fails to comply with the notice requirement and the services are provided in good faith, pursuant to the authorization, the plan is responsible for paying the authorized claim(s) (28 CCR §1300.65.2 (d)(5)).

For more information, download “Covered California: Understanding the Grace Period for Subsidized Exchange Enrollees,” available in CMA’s exchange resource center at www.cmanet.org/exchange. In the resource center, you can download CMA’s Surviving Covered California tip sheets

44

SAN JOAQUIN PHYSICIAN

as well as a number of other CMA exchange resources.

CMA members and their staff also have FREE access to our reimbursement helpline at (888) 401-5911 or economicservices@cmanet.org.

NEW APPROVAL TIMEFR AMES FOR PRESCRIPTION DRUG PRIOR AUTHORIZATIONS TOOK EFFECT JAN. 1 A new law took effect January 1, 2016, that requires health plans and health insurers to respond to prescription drug prior authorization requests within 72 hours for non-urgent requests and 24 for urgent requests. The law (SB 282) deems such requests to be granted if the payor fails to respond within these timeframes. A previous law (SB 866) had required a determination within two business days or the request was deemed approved.

SB 282 also requires the Department of Managed Health Care and the Department of Insurance to create a standard electronic prior authorization request form no later than January 1, 2017. Prescribers and payors will be required to use and accept this uniform electronic prior authorization form beginning July 1, 2017, or six months after the form is developed, whichever is later. Previously, SB 866 had required use and acceptance of a paper uniform prior authorization form.

A second and related law (AB 374) requires that prior authorization for prescription drug step therapy override requests be submitted in the same manner—and using the same electronic form, when available—as a prescription drug prior authorization requests. Plans and insurer must also respond to such requests within the timeframes set forth in SB 282.

UNITED HEALTHCARE TO DELAY PREMIUM DESIGNATION ASSESSMENT UNTIL JANUARY 2017 United Healthcare (UHC) has announced it will delay the next version of its Premium Designation physician quality and cost assessment program until January 2017. The program uses clinical information from health care claims to evaluate physicians against various quality and costefficiency benchmarks.

SPRING 2016

SPRING 2016

SAN JOAQUIN PHYSICIAN

45

CALIFORNIA MEDICAL ASSOCIATION

TROUBLE GETTING PAID? CMA CAN HELP! I’VE RECOVERED In the past five years, CMA’s Center for Economic Services has recovered over $10 million from payors on behalf of CMA members.

70,000

$

from my payors using CMA’s Center for Economic Services

CMA’s Center for Economic Services is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice.

Assistance ranges from coaching and education to direct intervention with payors or regulators.

CMA members can call on CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

• Do you have questions about Covered California?

• Do you need help with Medicare related issues?

• Are your claims not being paid in a timely manner?

• Are your claims being denied after obtaining prior authorization?

• Are you not being paid according to your contract?

• Have you been presented with a managed care • Are you receiving unreasonable requests for medical records?

• Are you receiving untimely requests for refunds or is a payor recouping money from your check without

contract and you’re not sure if the terms are consistent with California law?

• Have you done everything you can to resolve an issue with a payor, but have hit a brick wall?

first notifying you in writing of a refund request?

Access to CMA’s reimbursement experts is a FREE, members-only benefit.

Need help? Call (800) 786-4262 or email economicservices@cmanet.org.

46 SAN JOAQUIN PHYSICIAN SPRING 2016

Practice Manager’s Corner > Spring 2016

Originally scheduled to publish its latest results in January 2016, UHC has stated it is delaying in order to allow for improvements to the quality measures and cost-efficiency metrics in response to feedback provided by physicians. This means that the currently posted ratings will remain in place through the end of 2016. Although the California Medical Association (CMA) recognizes that this additional delay may frustrate some physicians, UHC reports it is a necessary delay in order to allow it to make system changes to benefit physicians going forward.

The most recent results were released publicly via UHC’s online physician directory on January 1, 2015, and were based on claims data from January 1, 2011, through February 28, 2014.

CMA had previously voiced concerns about the UHC Premium Designation program citing reliance on data that was more than a year old to determine current physician cost and quality designations and for failing to adequately account for the performance of physicians who have modified their practice patterns since their last Premium Designation assessment.

Premium Designation assessment results are accessible online on the United Healthcare website at www. unitedhealthcareonline.com. Physicians wishing to still dispute their 2015 Premium Designations may do so by submitting an online reconsideration request via the UHC website through July 2016. Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designation can contact United Healthcare at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve their issues with United Healthcare directly should contact CMA.

NEW LAW REQUIRING ACCUR ATE PROVIDER DIRECTORIES INCLUDES PROVIDER OBLIGATION TO UPDATE INFORMATION On July 1, 2016, a new law will take effect that requires plans and insurers to comply with uniform standards, and provide timely updates, for their provider directories. The law (SB 137) includes multiple components aimed at providing

SPRING 2016

patients with more accurate and complete information to identify which providers are in their payor’s network.

SPECIFICALLY, THE LAW REQUIRES: • Plans/insurers must offer an online provider directory available to the public, including physicians, without any restrictions or limitations.

• The directory must be searchable electronically by, at a minimum, name, practice address, city, zip code, license number, NPI, admitting privileges to an identified hospital, product, tier, provider language, provider group, hospital name, facility name, or clinic name, as appropriate. This provision takes effect July 31, 2017, or 12 months after the date provider directory standards are developed, whichever occurs later.

• The directory must use a consistent method of network naming, product naming, or other classification method to ensure easy identification of which providers participate in which networks for which products. This provision is effective July 31, 2017, or 12 months after the date provider directory standards are developed, whichever occurs later.

• The directory must state whether a provider is accepting new patients.

• The directory must include an email address and telephone number for providers and members of the public to report directory inaccuracies.

• The directory must not include providers who do not have a current contract with the plan/insurer. If a provider is listed as participating in error and an enrollee reasonably relied upon that information, the plan/insurer may be required to pay for covered services and to reimburse the enrollee for any amount beyond in-network cost sharing.

• Plans/insurers must promptly investigate, and, if necessary, correct any issues within 30 business days if they receive a report of a possible inaccuracy in the directory.

• Plans/insurers must update paper directories at least quarterly and online directories at least weekly.

• Plans/insurers must file an amendment with the regulator

SAN JOAQUIN PHYSICIAN

47

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

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

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

• • • • • • •

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

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

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

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

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

Phone: (209) 952-5299

www.sjcms.org

48

SAN JOAQUIN PHYSICIAN

SPRING 2016

Practice Manager’s Corner > Spring 2016

if there is a 10 percent change in the network size for a product in a region.

• Plans/insurers must include a contractual requirement that providers inform the plan within five business days if they are not accepting new patients or if they were previously not accepting new patients but are now open to new patients.

the directory and delay payment, after providing at least 10 business days advance notice.

• The directory must inform enrollees of their rights to language interpreter services and access to covered services under the ADA.

SB 137 EFFECT ON PHYSICIANS The new law also establishes certain requirements for physicians.

The requirements underscore the importance of ensuring that practice demographic information, including whether or not the practice is accepting new patients, is up-to-date with contracted

• Plans/insurers must have a process to ensure accuracy, and must at least once per year conduct a thorough review and update of the directory. This process must include notification to contracting providers to advise them of the information the plan has about them in the directory.

Group providers will be noticed annually and other providers will be noticed every six months. The notice must include information about how providers can update their directory information using an online interface, which must generate an acknowledgment of receipt by the plan. The notice must also include a statement that the failure to respond may result in a delay of payment.

• If the payor does not receive updates to any information or confirmation from the provider that the information is accurate, the plan is required to verify the provider’s information by contacting the provider in writing, electronically and by telephone. The plan must document the outcome and each attempt to verify the information.

If the payor is unable to verify the provider’s information, the payor may remove the provider from

SPRING 2016

SAN JOAQUIN PHYSICIAN

49

Sometimes You Just Need a Little Help.

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

Sunday May 1st, 2016 • Stockton Golf & Country Club • 4 Person Scramble $175 per golfer - Price includes green fees, golf cart, lunch, and entry into the raffle for a grand door prize announced during the after golf dinner and party! (must be present to win). $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

Practice Manager’s Corner > Spring 2016

payors and any changes to practice demographics are communicated to the plan/insurer in a timely manner.

Specifically, the law requires: • Providers will be required to notify plans and insurers within five business days if they are no longer accepting new patients or, alternatively, if they were previously not accepting new patients and are now open to new patients.

one calendar month, beginning on the first day of the following month.

To help physicians understanding how to update their provider demographic information, until the electronic online option is required, the California Medical Association (CMA) queried the major payors on

their processes. Their responses have been compiled into a membersonly resource for physicians, “Updating Provider Demographic Information with Payors,” which is available free to CMA members at www.cmanet.org/ces.

• If a provider is not accepting new patients and is contacted by a new patient, the provider must direct the patient to the plan/insurer to find a provider or to the regulator to report a directory inaccuracy.

• Providers will be required to respond to plan and insurer notifications regarding the accuracy of information in the provider directory by either confirming the information is correct or updating demographic information as appropriate. Failure to do so may result in a delay in payment and removal from the provider directory.

Additionally, a provider group may terminate a contract with a provider for a pattern or repeated failure to update the required information in the directories.

• For providers that have capitated payor contracts, the plan can delay up to 50 percent of the next scheduled capitated payment for up to one calendar month if they fail to update their provider demographics or fail to confirm the accuracy of the current information. Payments to providers who have fee-for-service contracts can be delayed for up to

SPRING 2016

A Professional Law Corporation

MICHAEL R. MORDAUNT PETER J. KELLY CORINNE K. REYNOLDS STEPHANIE ROUNDY LORI A. REIHL

Our firm devotes its practice to civil litigation with decades of experience representing healthcare professionals in: • MEDICAL MALPRACTICE ACTIONS • MEDICAL BOARD INVESTIGATIONS • HOSPITAL CREDENTIALING PROCEEDINGS • PERSONAL INJURY LITIGATION

2509 West March Lane, Suite 200 Stockton, California 95207 Phone (209) 473-8732 Fax (209) 957-9165

SAN JOAQUIN PHYSICIAN

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WEBINARS

EDUCATION •

SEMINARS

•

PODCASTS

•

AND MORE

DID YOU KNOW? CMA offers free webinars to its members Through its robust webinar series, the California Medical Association (CMA) gives physicians and their staff the opportunity to watch live presentations on important topics of interest and interact with legal, financial, and practice management experts, and financial experts, to name a few, from the comfort of their homes or offices. The webinars are free to CMA members and members’ staff and provide the timely information needed to help run a successful medical practice. What’s more, all webinars are available on-demand immediately following the live airing, providing an ever-growing resource library accessible at any time.

Closing a Medical Practice March 9, 2016 | 12:15pm - 1:15pm

MARCH

9

This webinar will cover some of the major practical and legal issues that may arise when closing a medical practice, and will assist physicians who are retiring or otherwise leaving their practices and/ or families or estates of deceased physicians. Issues that will be addressed in this webinar will include people and agencies to notify when a physician practice closes, medical records retention and other issues, and considerations when selling a medical practice.

CURES 2.0: Navigating the State’s New Prescription Drug Monitoring Database

MARCH

16

March 16, 2016 | 12:15pm - 1:15pm

The Controlled Substance Utilization Review and Evaluation System (CURES) is a database of Schedule II, III and IV controlled substance prescriptions dispensed in California. Effective July 1, 2016, physicians with an active medical license and a Drug Enforcement Agency certificate must be registered for access to CURES. This webinar will give physicians an overview of the registration process and key features of the newly upgraded system.

CMA Legislative Advocacy Day Webinar Training MARCH

23 MEMBERS ONLY

March 23, 2016 | 7:00pm - 8:00pm

CMA will host its 42nd annual Legislative Advocacy Day on Wednesday, April 13, at the Sheraton Grand in Sacramento.

Attendees will also go to the Capitol to meet with legislators on health care issues. More than 400 physicians, medical students and CMA Alliance members will be coming to Sacramento to act as champions for medicine.

PRESENTER: Lisa Matsubara is Legal Counsel in the Center for Legal Affairs at the California Medical Association. She also manages CMA’s legal educational resources, including the California Physician’s Legal Handbook and the legal information help line.

PRESENTERS: Austin Weaver is an Associate Governmental Program Analyst with CURES, where he serves as a subject matter expert in the use of, eligibility for and access to the CURES database.

Emer McKenna is a Data Processing Manager III for the Criminal Justice Information Technology Services Bureau. Prior to joining DOJ, McKenna spent over 20 years in the private sector working as a technical consultant.

PRESENTER: Janus Norman is CMA’s Senior Vice President for Government Relations and Political Operations, and serves as CMA’s chief lobbyist. Prior to joining CMA, he served as Legislative Advocate for the American Federation of State, County and Municipal Employees.

In preparation for Legislative Advocacy Day, CMA will host a special webinar that will review in detail CMA’s list of bills to be lobbied, effective advocacy tips and other relevant program information.

REGISTER ONLINE TODAY! WWW.CMANET.ORG/EVENTS

52

*Webinars are free for CMA members and their staff ($99 for non-members).

SAN JOAQUIN PHYSICIAN

SPRING 2016

APRIL

6

MACRA Implementation: A Review of the CMS Proposed Rule April 6, 2016 | 12:15pm - 1:15pm

This webinar will review the details of the proposed rule around the new Medicare Merit-Based Incentive Payment System (MIPS) implementation. We’ll also discuss any new details available regarding the Alternative Personnel Management System (APMS), and review the next steps toward implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

APRIL

20

How to Reduce Overhead Expenses and Increase Profitability April 20, 2016 | 12:15pm - 1:15pm

There are only three ways to realize increased net income: raise fees, increase productivity or decrease overhead. With managed care contracting difficulty, increased fees are difficult to achieve. The doctor/ group may already be working at maximum capacity so this may not be an option. In California, practices have higher overhead costs than national norms. The only way to assure profitability is to control and reduce overhead expenses. This webinar will provide information on how to do just that in a way that works for your practice.

MAY

4

Contract Renegotiations: How to Get Past “No” with a Payor May 4, 2016 | 12:15pm - 1:15pm

When submitting a request to renegotiate, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. However, many practices fail to present a business case, which often results in a quick reply from the payor indicating that they are not in a position to renegotiate at this time. This webinar will cover steps practices can take to build their best business case and identify the uniqueness of their practice to prevent the “auto-reply” and present a thoughtful renegotiation request.

How to Increase Workers’ Compensation Revenue JUNE

8

June 8, 2016 | 12:15pm - 1:15pm

Workers’ compensation payors can substantially reduce your revenue in two ways: by systematically downcoding evaluation and management codes and by paying the wrong reimbursement due per California’s Official Medical Fee Schedule. To combat downcoding and incorrect reimbursements, this webinar explains how to easily appeal these reduced payments. This webinar will also provide the correct reimbursements for popular CPT codes and break down the new mandated appeal process into easy step-by-step instructions.

If you treat injured workers, this webinar will make it easy to know whether your payments are correct and how to appeal downcoded and incorrect payments.

PRESENTER: Ashby Wolfe, M.D., MPP, MPH is a board-certified family physician who currently serves as Chief Medical Officer for California, Arizona, Nevada, Hawaii and the Pacific Territories for the Centers for Medicare and Medicaid Services (CMS).

PRESENTER: Debra Phairas is President of Practice & Liability Consultants, LLC, a nationally recognized firm specializing in practice management and malpractice prevention. Her background includes medical clinic administration and loss prevention management for NORCAL Mutual, a physician malpractice insurance carrier.

PRESENTER: Kristine Marck is an Associate Director in CMA’s Center for Economic Services.

With over 20 year of experience in the health care industry, she offers a unique perspective as well as a balance of working for and with physicians and a drive to assist them in difficult times.

PRESENTER: Sarah Moray’s broad experience in workers’ compensation and medical billing spans over 12 years, ranging from ground level experience in medical practices, to consulting, to co-founding DaisyBill. At DaisyBill, not only is Moray the go-to expert on all matters relating to workers’ compensation billing.

SIGNING UP FOR WEBINARS IS AS EASY AS 1, 2, 3…

(1) Go to www.cmanet.org/events, (2) Select the webinar you would like to join and (3) Register to attend. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Member Help Line at (800) 786-4262.

SPRING 2016 SAN JOAQUIN PHYSICIAN 53

Hilton San Francisco Union Square

May 13 - 15, 2016

San Francisco, CA

Physicians, nurses, medical practice managers and all other health care industry professionals—Join us in the heart of San Francisco to prepare for changes affecting your profession, your practice and your economic future.

Health care power players will share strategies and resources for accelerating the shift to a more integrated, high performing and sustainable health care system. Speakers include Dr. Atul Gawande, distinguished surgeon, teacher and writer – named one of TIME magazine’s 100 most influential thinkers; Karl Rove, former Deputy Chief of Staff and Senior Advisor to President George W. Bush; and Donna Brazile, Al Gore campaign manager and Democratic National Committee Vice Chair.

800.795.2262 www.westernleadershipacademy.com 54

SAN JOAQUIN PHYSICIAN

SPRING 2016

Physician Shortage > The Problem and Solution

PHYSICIAN SHORTAGE

THE PROBLEM:

1) More than $40 MILLION that funds the training of California primary care physicians is expiring: A three-year, $21 million California Endowment grant supporting the Song-Brown Health Care Workforce Training Program expires in 2016.

2) California faces a long-standing shortage of primary care physicians at a time when demand for their services has never been greater: Only 36 percent of California’s active patient care physicians practice primary care;4 23 of California’s 58 counties fall below the minimum required primary care physician to population ratio.

In 2014, the Legislature appropriated a one-time $4 million infusion into Song-Brown to help meet the demand for primary care physicians in areas of unmet need, but that funding was not renewed.

California needs an estimated additional 8,243 primary care physicians by 2030 to prevent projected shortages in the state (about 412 new primary care physicians per year).

The federal Primary Care Residency Expansion program, which awarded more than $18 million in grants to California to create new primary care resident positions,2 ended in 2015.

More than 32 percent of California’s practicing primary care physicians are age 60 or older – only four other states have a larger percentage of soon-toretire physicians.

Each year in California, only 368 slots are available to the thousands of medical students seeking to train in family medicine.

If the funding described above is not replaced, 158 OF THOSE SLOTS WILL BE LOST, creating a terrible deficit of primary care physicians in California’s underserved communities.

3) Californians face daunting access to care issues because of increased health plan enrollment and inadequate physician networks: Approximately 4.7 million people have gained health insurance since 2013 (1.3 million through Covered California;8 nearly 3.4 million through Medi-

SPRING 2016

SAN JOAQUIN PHYSICIAN

55

Gill Obstetrics & Gynecology

THE VALLEY’S LEADER IN ROBOTIC SURGERY FOR WOMEN VOTED #1 BEST OB/GYN PRACTICE IN SAN JOAQUIN COUNTY! Proud to be the First Medical Group Offering Single Site Robotic Surgery in the Valley Highly Skilled Minimally Invasive Surgical Team

Just like no two individuals are exactly alike, each woman has unique healthcare needs. For over 60 years, the specialists of Gill Obstetrics & Gynecology have been trusted to provide innovative, personalized care to women in our community. For women with gynecological issues requiring surgery, our team of highly skilled surgeons will help you consider the options just right for you, including single site robotic surgery.

Robotic Assisted Gynecologic Surgery

Smaller incisions • Shorter hospitalization • Reduced pain & discomfort • Faster recovery time • Reduced blood loss • Minimal scarring

We are pleased to announce the association of

Eugenia L. Hurlbut, D.O.

Chikanele E. Okorie, M.D.

Kayla D. Mapps, M.D.

Healthcare Just as Unique as You!

PRENATAL & POSTPARTUM CARE • HIGH RISK PREGNANCY • INFERTILITY • INVITRO FERTILIZATION GYNECOLOGY • ENDOMETRIOSIS • URINARY INCONTINENCE • OVARIAN CYSTIC DISORDER • LAPAROSCOPY HYSTEROSCOPY • DIAGNOSIS & TREATMENT OF CERVICAL, UTERINE, OVARIAN CANCERS • ROBOTIC SURGERY

Param K. Gill, M.D.

David L. Eibling M.D.

Vincent P. Pennisi, M.D.

Harjit Sud, M.D.

Jasbir S. Gill, M.D.

Thomas Streeter, M.D.

Maya Nambisan, M.D.

Darrell R. Burns, M.D.

Linda Colliflower, RNC, NP

William Colliflower, M.D.

Catherine Mathis, M.D.

Jacqualin Miller, D.O.

Tonja Harris-Stansil, M.D.

Lynette Bird, R.N., B.S.N.

Linda Bouchard, M.D.

Vicki Patterson-Lambert, R.N.P.C.

Maria E. Escalona, M.D.

Philip D. Ross, M.D.

Convenient locations to serve you Stockton: 1617 N. California St., Ste. 2A – Ph. (209) 466-8546

2509 W. March Lane, Ste. 250 - Ph. (209) 957-1000 Lodi: 999 S. Fairmont Ave., Ste. 225 & 230 – Ph. (209) 334-4924 • Galt: (209) 745-7473 Jackson: 817 Court St., Ste. 8, Jackson, CA 95642 – Ph. (209) 223-1031

Manteca: 1234 E. North St., Ste. 102 – Ph. (209) 824-2202

56

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GILLOBGYN.COM

SPRING 2016

Physician Shortage > The Problem and Solution

Cal9), placing immense strain on our primary care workforce.

Recent audits by the California State Auditor10 and the Department of Managed Health Care (DMHC)11 found California lacking in accurate and adequate physician networks.

THE SOLUTION:

Increase funding for the Song-Brown program through a state budget appropriation and create a robust and consistent funding source to stem the loss of primary care physicians.

The Song-Brown Program provides an existing state infrastructure to support an increase in the number of primary care providers serving California’s underserved populations. Programs that receive Song-Brown funding must have a proven record of training health care professionals who care for underserved populations in underserved areas and expanding the ethnic diversity of the health care workforce. By investing in Song-Brown, California will realize an immediate return on investment as each primary care resident provides an average of 600 ADDITIONAL PATIENT VISITS PER PHYSICIAN PER YEAR DURING TRAINING ALONE. Our longterm workforce also would grow significantly as the vast majority of physicians who train in a region stay there to practice. California leads all fifty states in the percentage of residency program graduates who stay in the state in which they trained.12 Nearly 70 percent of medical residents who train in California practice here after graduation.

Contact: Jodi Hicks Phone: 916-662-1725 CAFP Legislative Advocate

Email: jhicks@ lawpolicy.com

decreased mortality from cancer, heart disease and stroke. An increase of one primary care physician per 10,000 people in a state is associated with a rise in that state’s quality rank by more than 10 places and a reduction in overall spending of $684 per Medicare patient.

Does California have a sufficient primary care physician workforce?

Forty percent of California’s counties fail to meet the recommended primary care physicians to patient ratio. Many other counties barely meet the recommended number of primary care physicians and now likely face a shortage as the number of insured individuals has grown from Medi-Cal expansion and Covered California enrollment. The Inland Empire, Central Coast, San Joaquin Valley and the Northern and Sierra regions are areas of particular concern.

How many primary care physicians do we need?

The Council on Graduate Medical Education, the group authorized

by Congress to assess workforce needs and make recommendations, recently reported that AT MINIMUM, 40 percent of the U.S. physician workforce should be primary care. California is well under this minimum recommendation at 36 percent practicing primary care physicians. Our state barely creates enough new physicians to replace those we lose to retirement or other reasons. Since one-third of California’s physicians are nearing retirement age and millions of our state’s residents are entering our health care system under the Affordable Care Act, California’s demand for primary care physicians is even more pronounced. To respond to the health needs of our aging and growing population, by 2030 we will need 8,243 more primary care physicians.

Why invest in primary care training?

The value of primary care physicians is welldocumented. Primary care reduces hospitalization rates and costs while improving quality. States with higher ratios of primary care physicians to population have better health outcomes, including

SPRING 2016

SAN JOAQUIN PHYSICIAN

57

The CMA/SJMS’s exclusive new Workers’ Compensation program can help your practice save money!

Savings

CMA members qualify for an additional 5% discount* on top of Preferred Insurance’s already competitive rates. Preferred’s rates are set for long term consistency, and are managed by focusing on safety and injury prevention, fraud prevention and the control of medical costs for your practice by getting employees back to work as soon as practical.

Service Mercer’s team of insurance advisors is knowledgeable about the needs of physicians and is available to walk you through the application process. Preferred’s claims examiners are experts in helping members with an employee injury or illness claim. Plus Preferred’s payroll management and flexible payment plans help you manage your premiums in the way that works best for you and your practice’s cash-flow needs.

Safety In addition to mandatory CalOSHA information and videos on workplace safety, Preferred’s team of Risk Advisors are available for consultations when you need them. They also have a strong fraud prevention policy and as a California-based carrier, they know exactly what it takes to do business successfully in this State.

Stability Preferred Insurance prides itself on its stability, which includes maintaining some of the best and most consistent pricing available for CMA members. And because of its Medical Provider Network of credentialed medical professionals, claim costs can be closely monitored and managed while providing quality care to injured employees.

Call Mercer today at 800-842-3761 for a premium indication.

CMACounty.Insurance.service@mercer.com or www.CountyCMAMemberInsurance.com.

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*Most practices will qualify for group pricing and receive the 5% discount; however some practices will need to be underwritten separately when they do not qualify for the special program terms and conditions. A minimum premium applies to very small payrolls.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 • Copyright 2016 Mercer LLC. All rights reserved. • 74522 (3/16) 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com 58

SAN JOAQUIN PHYSICIAN

SPRING 2016

Public Health

Update

HIV PrEP

(Pre-Exposure Prophylaxis); an Important New Tool Hemal Parikh, MPH, Julie Vaishampayan, M.D., MPH and Alvaro Garza, M.D., MPH

More than 30 years into the global HIV pandemic, infection rates remain high in San Joaquin County. There is a need for more effective HIV prevention measures. In the early years of the AIDS epidemic, public health officials focused on lowering the risk of HIV infections by trying to get people to change their behavior using the ABC model: abstaining from sex altogether, being faithful to one partner, and using condoms correctly and consistently. Regular and consistent condom use has been shown to be about 70% effective in reducing HIV infection. In recent years, medications have become a vital part of HIV prevention.

To better understand HIV prevention tools, it’s useful to

60

SAN JOAQUIN PHYSICIAN

first review factors that inf luence HIV transmission. The risk of getting HIV varies widely depending on the type of exposure (Table). The highest risk, after blood transfusion, is receptive anal intercourse followed by needle sharing during injection drug use (IDU).

Presence of a sexually transmitted infection (STD) increases the risk of HIV transmission. Having an ulcerative STD such as herpes or syphilis more than doubles the risk of sexual HIV transmission. Non-ulcerative STDs such as gonorrhea and chlamydia are also thought to increase risk of transmission, although accurate estimates are not available. Ulcerative STDs generally increase HIV shedding

SPRING 2016

use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners).

TYPE OF EXPOSURE RISK PER 10,000 EXPOSURES For people who inject drugs, increased Parenteral risk for HIV infection includes those who Blood Transfusion 9,250 have injected illicit drugs in the past six Needle-Sharing During Injection Drug Use 63 months and who have shared injection Percutaneous (Needle-Stick) 23 equipment or been in drug treatment for Sexual injection drug use in the same time period.

Receptive Anal Intercourse 138 The only FDA-approved medication for Insertive Anal Intercourse 11 PrEP is a combination of two antiretroviral Receptive Penile-Vaginal Intercourse 8 drugs, tenofovir and emtricitabine Insertive Penile-Vaginal Intercourse 4 (Truvada), taken as a single pill daily. PrEP Receptive Oral Intercourse Low should not be offered as a sole intervention Insertive Oral Intercourse Low for HIV prevention and should only be Other prescribed as part of a comprehensive Biting Negligible prevention plan that includes Spitting Negligible Counseling and education about Sharing Sex Toys Negligible consistent and correct condom use, saferSource: http://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html sex practices and risk-reduction counseling, and the importance of adherence to PrEP, Frequent HIV testing and screening for in the genital tract and inf lammatory STDs increase the other sexually transmitted diseases (STDs) that can facilitate concentration of HIV in the urethra, semen, and cervical HIV transmission, and f luid.

For individuals in sero-discordant relationships, counseling One of the most important factors inf luencing the risk on the importance of suppressive ART (treatment as of transmission is the level of viremia in the HIV-infected prevention) for HIV-infected partners. person. The highest level of viremia and the greatest risk Studies have shown that the use of Truvada as PrEP to of spread is seen in acute HIV infection, peaking at about prevent HIV infection is safe and effective. When taken 17 days after seroconversion. The risk of transmission every day, PrEP has been shown to be 99 percent effective at during acute HIV infection is 7.25 times the risk during the preventing HIV infection, regardless of whether a condom is middle stage of HIV infection (more than six months after used. Missing doses reduces PrEP effectiveness. infection).

Identifying the populations at high risk for HIV infection Once a person is diagnosed with HIV, antiretroviral and for whom PrEP use would be most effective, and linking therapy (ART) with viral suppression reduces the risk of and retaining them in care, is one of the emerging challenges. transmission 96%. This treatment as prevention is a great PrEP doesn’t work if it isn’t taken consistently and correctly. strategy to reduce HIV transmission, but doesn’t prevent the PrEP does not protect a person against other STDs. But, transmission that occurs prior to diagnosis. This is why prea combination of interventions including expanded HIV exposure prophylaxis (PrEP) is such a valuable addition to testing, test and treat programs that harness the power of HIV prevention.

HIV treatment to prevent the spread of the virus, PrEP, and PrEP is indicated for people who are HIV-negative and sexual behavioral changes can be effective ways to prevent are at high-risk for getting infected with HIV. High-risk for HIV infections. sexual transmission includes PrEP is covered by most insurance plans. San Joaquin Anyone who is in an ongoing relationship with an HIVCounty Public Health Services is now offering PrEP as part positive partner. of their clinical services. If you’d like more information, Anyone who is not in a mutually monogamous relationship please call (209) 468-3830. We also offer technical with a partner who recently tested HIV-negative, and is a assistance to any provider who would like to begin offering gay or bisexual man who has had anal sex without a condom PrEP in their practice. More information can be found on or been diagnosed with an STD in the past six months; the Centers for Disease Control and Prevention website at or heterosexual man or woman who does not regularly http://www.cdc.gov/hiv/risk/prep/index.html.

ESTIMATED PER-ACT PROBABILITY OF ACQUIRING HIV FROM AN INFECTED SOURCE

SPRING 2016

SAN JOAQUIN PHYSICIAN

61

practice manager Free to SJMS/CMA Members!

resources

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

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

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

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

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

MARCH 9TH 2016:

“STEPS TO REDUCE BAD DEBT” 11:00AM to 1:00PM Getting proper information from patients, explaining patient responsibility, adhering to a collection time-table and much more will be discussed during this presentation.

Ana Molina~ CB Merchant Services Collections Manager with over 30

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

years accounts receivable and collection experience and is directly responsible for compliance and training of collection personnel.

APRIL 13TH 2016:

IDENTIFY YOUR PRACTICE POTENTIAL- “MANAGING THE MISSED OPPORTUNITIES” 11:00AM to 1:00PM Leading an organization to a target net income is hard work. The number of variables are endless. The presentation will focus on the roles that each staff member can play in the effort to reach your goals. This is a workflow management focus that will address some innovative approaches to creating successful outcomes.

Irv M. Barnett, MBA, Founder, V2V Management Solutions~ Irv has more than 25 years of experience helping physicians

from the is thly bulletin This bulletin is a free mon nomic Services. practice Eco ces (CPR) f improve tice Resour ciation’s Center for r office staf CMA Prac ical Asso ns and thei sicia Med phy nia ifor CMAtool Cal , sign Practice s to help Resources (CPR) is Aetna to require addition and up to date a free monthl tips Californ stay of To y al bulletin . ia accredit full Medical RS: from the ation requireAssociation’sNEW ments SLETTE Econom and viability : in order to be atio ire- surgical paidnfor CMA Center for certain requ efficiency full of tips andANY tools OTH ewsletters.ic Services. This eagues. is toERhelp physicia y services In this issuepatholog t.ornsg/n accredit and their office staffrs and collbulletin efficienc CPR OR viability orke improve practice additional certain surgical www.cmane ire Update 1 SUBSCRIBE TO y and on two ptions at . for Anthem Blue Cross 1 to your cow Aetna to requ r to subscri SUBSCR be paid issues pending IBE TO CPR OR ANY this bulletin with ardOTHER up for free CMA NEWSLE ments in orde ices the Department of Managed Health up for Please forw D:subscrip free 1 serv Meet Your CMA s issues pending Care tions at www.cmanet.org TTERS: To stay up toem ts THE WOR pathology Center for Economic 1 Cros SPREAD SPREAD /newsletters. uir date,ensign Blue req Services em n Care THE WORD: Please Anth : Markaged tio two Advocate LaneHealth forward this redita bulletin seracc Update on of Man to your coworkers 2 artm CMAent andycolleagues.

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1201 J Stre rvices@cmanet.org economicse

build successful practice performance through business development, strategic planning and effective governance activity. He brings his years of experience in accounts

CMA Practice Resources (CPR)

receivable management, contracting and employee

is a free monthly e-mail bulletin

development to each engagement, providing a critical path for the practice to achieve improved levels of performance.

from CMA’s Center for Economic

He leads the process implementation efforts to measure,

Services. This bulletin is full of

monitor and manage net income objectives to meet the

tips and tools to help physicians

unique needs of each practice. Most of this experience has been gained in consulting assignments and senior

and their office staff improve

management roles with rapidly growing medical groups,

practice efficiency and viability.

university based specialty clinics and hospitals. Irv is Past President of the California Medical Group Management Association, and served as Chairperson for the MGMA Western Section Leadership Team.

MAY 11TH 2016: “TBD” 11:00AM to 1:00PM

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Call us today for a complimentary consultation at (209) 390-4670 64

SAN JOAQUIN PHYSICIAN

SPRING 2016

New Members

14 NEW

MEMBERS THIS FALL!

...and even more on the way.

Manreet Basra, M.D.

Tracy Bigelow, M.D.

David Magorien, M.D.

Genghui Zhu, M.D.

1801 E. March Lane, Ste

2545 W Hammer Ln

999 S Fairmont St., Ste 130

7373 West Lane

D400 Stockton, CA 95210 (209) 464-3615

Stockton, CA 95209 (209) 948-1641

Lodi, CA 95240 (209) 366-2001

Chai Chang, M.D.

C Walthour, M.D.

Stockton, CA 95210 (209) 476-5524 Capital University of Medical

1700 Coffee Road

447 West Eaton Ave

Khin Chit, M.D.

OB/GYN

Modesto, CA 95355 (209) 524-1211

Tracy, CA 95376 (209) 524-1211

Occupational Medicine 7373 West Lane

1617 N California St, Ste 2A

American University of The

Pennsylvania State University,

Stockton, CA 95210

Stockton, CA 95204

Caribbean

College of Medicine

Institute of Medicine I Rangoon

Erin Fuller, M.D.

Lan Zhang, M.D.

Vijaya Yelisetty , M.D.

2545 W Hammer Ln.

2505 W Hammer Ln

1779 W Yosemite Ave

Pediatrics

Stockton, CA 95209 (209) 957-3821

Stockton, CA 95209 (209) 954-3370

Manteca, CA 95337

2505 W Hammer Ln Stockton, CA 95209

Khin Ma, M.D.

Zhejiang Col of Traditional Chinese Medicine

Cardiovascular Disease

Baba Farid University of Health Sciences

Kayla Mapps, M.D.

(209) 466-8546 University of Texas Medical School - Houston

Krystle Balduzzi, M.D.

Orthopaedic Surgery

Anesthesiology

Dermatology

Cardiovascular Disease

Orthopaedic Surgery

Internal Medicine

Hospitalist

Sciences

Internal Medicine

Pamir Mateen, M.D. Internal Medicine

(209) 924-1211

Internal Medicine

New York Medical College

2545 W Hammer Ln.

500 W Hospital Rd French Camp, CA 95231

Stockton, CA 95209

(209) 468-7834

(209) 943-5185

Universidad Central del Este

SPRING 2016

SAN JOAQUIN PHYSICIAN

65

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SAN JOAQUIN PHYSICIAN

SPRING 2016

STOCKTON MRI & Molecular Imaging Medical Center, Inc. 2320 N. California Street • Stockton, CA 95204 PHONE 209-466-2000 • Fax 209-466-2600 w w w. stockton m ri . com

The Most Advanced and Comprehensive Medical Imaging Center in San Joaquin County Just Got Better with the Addition of the Central Valley’s only 128 Multislice CT Scanner with Lowest Radiation Dose Imaging Services Include: • The first PET-CT since 2003 • Full service of Nuclear Medicine • Most advanced G. E. High Field MRI (1.5 Tesla) • Full service of Digital Radiography and Fluoroscopy • New GE Logic 9e 3D & 4D Ultrasound Unit • 128 Slice Siemens CT Scanner

All Board Certified Radiologists with fellowship: Javad Jamshidi, MD Francis Isidoro, MD Brian Morrow, MD Salma H. Khan, MD

The Fastest 128 Multislice High Resolution CT in community practice:

Siemens Somatom Definition AS+ (128) SPRING 2016

SAN JOAQUIN PHYSICIAN

67

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

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