Spring 2022

Spring 2022

SERVING SAN JOAQUIN,

TUOLUMNE, ALPINE, AMADOR AND CALAVERAS COUNTY PHYSICIANS

A DYNAMIC

PARTNERSHIP

Medical Malpractice Ballot Measure SJMS Holiday Party CalMedForce GME Funding 2021 Federal Wrap Up SPRING 2022

SAN JOAQUIN PHYSICIAN

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HEALTHCARE PROFESSIONALS

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

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ProAssurance.com SPRING 2022

VOLUME 70, NUMBER 1 • MARCH 2022

PICTURED ABOVE: GARBEFF FAMILY

9

PRESIDENT'S MESSAGE

12 COVID-19 SUPPLEMENTAL PAID SICK LEAVE LAW

14 MEDICAL MALPRACTICE BALLOT MEASURE

18 NEW LAWS 2022

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32 IN THE NEWS 38 CALMEDFORCE GME FUNDING

40 2021 FEDERAL WRAP UP 46 PRACTICE NEWS AND RESOURCES

24 SJMS HOLIDAY PARTY

50 PUBLIC HEALTH UPDATE

26 A DYNAMIC PARTNERSHIP

54 NEW MEMBERS

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PRESIDENT Raghunath Reddy, MD PRESIDENT ELECT Cyrus Buhari, DO TREASURER Nguyen Vo, MD BOARD MEMBERS Hyma Jasti, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Stephen Tsang, MD, Maggie Park, MD, Sujeeth Punnam, MD, John Zeiter, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD

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

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Raghunath Reddy, MD MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD

CONTRIBUTING WRITERS Jo Ann Kirby, Raghunath Reddy, MD, Daniel Kim, MPH, MCHES

DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD

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

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

by the Editorial Committee.

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

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Richelle Marasigan, DO, Ramin Manshadi, MD

San Joaquin Physician Magazine

Kwabena Adubofour, MD, Philip Edington, MD

3031 W. March Lane, Suite 222W

Harpreet Singh, MD

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

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SPRING 2022

SAN JOAQUIN PHYSICIAN

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EXECUTIVE DIRECTOR’S REPORT

FEELING HOPEFUL IN 2022

In December, as the Delta variant was winding down and right before Omicron came knocking, we hit the sweet spot and were finally able to honor our 2020 Lifetime Achievement Award recipient, Dr. Peter Garbeff, at our annual Holiday Party. It had been two years since our last event!

Modifications were made, such as limiting attendance and sponsorships.

LISA RICHMOND

It’s hard to describe the “vibe” in the room, other than pure joy. Guests relished in extending best wishes to Dr. Garbeff, catching up with friends and colleagues and simply being together. Among those in attendance, were a record 16 past presidents! I always look forward to our annual dinners, but this one was extra special. It is obvious that the in-person connection to each other is vital.

While we “Zoomed” through business as usual, virtual meetings and events can never replace the real thing. The celebration was a perfect way to end the year as we hope for more normalcy in 2022.

Looking ahead, recruitment and retention of physicians has always been a top priority for SJMS. One of the widely acknowledged strategies for combating shortages is to educate and train physicians in communities, like ours, where they are most needed. There has been great progress towards the goal of becoming a hub for graduate medical education. For St. Joseph’s Medical Center, what began in 2018 with two training programs and a total of 15 residents, has now grown to six programs with 95 residents. We know this kind of success doesn’t happen in a vacuum. As they say, it takes a village.

In addition to providing an update on the growth and the future of these programs, we feel it is important to highlight two key partners in the process since its inception: Balraj Singh and Touro University. In the case of Balraj, it is a story of never underestimating a mom on a mission. Furthermore, what started as a mutually beneficial partnership between the hospital and the osteopathic medical school has resulted in Touro making a significant investment in our community. We invite you to read more on page.

In coming months, there will be an increased volume of information regarding the newest attack on MICRA, otherwise known as the Fairness for Injured Patients Act (FIPA), which will be on the ballot in November. We urge you to educate yourselves and your colleagues to defeat this proposition which would obliterate existing safeguards against out-of-control medical lawsuits, resulting in skyrocketing health care costs and huge windfalls for attorneys. Please see www.cmadocs.org/micra for more details and resources.

Sincerely,

Lisa Richmond

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SAN JOAQUIN PHYSICIAN

SPRING 2022

THE MOST AMAZING CARE ANYWHERE® Parents and providers choose experienced care teams at Shriners Children’s Northern California to provide children with congenital conditions and complex medical needs compassionate, innovative treatment. Shriners Children's Northern California is part of an international pediatric health care system of hospitals, clinics, ambulatory surgery centers and global outreach. Our personalized approach allows children to rise to their full potential. We provide a full range of programs, services and support, caring for children in a welcoming, warm and reassuring environment.

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SPRING 2022

Trust your patients to our cardiac experts.

St. Joseph’s commitment to continually advancing cardiac care has not wavered throughout the pandemic. From new cardiac procedures such as the Convergent procedure for advanced atrial fibrillation, to performing over 300 TAVRs and achieving top-star rating for cardiac surgery, we remain dedicated cardiovascular excellence.

Learn more about St. Joseph’s award-winning cardiac services at DignityHealth.org/Stockton/Heart.

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SPRING 2022

A message from our President > Raghunath Reddy, MD

Protecting Access to Quality Care As a physician, my primary goal is to protect my patients and provide quality medical care to those who need it most. Unfortunately, a measure heading to California’s November 2022 ballot could put patient access to care at risk and make it even more burdensome for physicians like you and I to treat and care for the patients we aim to serve.

The California Medical Association (CMA) has joined with a broad coalition of community clinics, hospitals, nurses, public safety, business, and labor groups to oppose a dangerous measure that will appear on the ballot this fall.

This costly ballot measure, bankrolled and written by an out-of-state trial lawyer, is an effort to eliminate the cap on non-economic damages in medical malpractice cases and erase the current cap on fees lawyers can take in victim damage award cases. This dangerous proposal would pave the way for new rounds of frivolous lawsuits and send the price of health care soaring by hundreds of millions of dollars, according to the state’s nonpartisan Legislative Analyst’s Office.

These costs would be born directly by patients and taxpayers and have a devastating effect on access to care for patients everywhere. It would hit particularly hard for patients in rural and other medically underserved communities.

ABOUT THE AUTHOR Raghunath Reddy, MD is the current president of the San Joaquin Medical Society and practices family medicine at Stockton Primary Care Medical Center

SPRING 2022

At a time when our state is in the midst of an affordability crisis, now is the worst possible time to drive up health care costs and reduce access to care for those who need it most. That’s why I am asking you to join me and CMA in the campaign to defeat this measure in November.

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A message from our President > Raghunath Reddy, MD

The initiative, which does not yet have a ballot number, is bad for patients, taxpayers, and the entire health care system. There has never been a greater need for physicians to band together and use our collective voice to fight for our patients.

This measure was written by one out-of-state trial lawyer trying to change state law so he and his law firm can profit. While proponents will talk a lot about how they are trying to protect patients, make no mistake – this measure is about padding their profits at the expense of patients and taxpayers. Our health laws should protect access to care and control costs for everyone, not be manipulated by a single attorney for his own profit.

KROLOFF.COM

ALWAYS ON THE RIGHT SIDE —

Yours.

When it comes right down to it, there’s really no such thing as a small legal matter when it sits on YOUR desk. Time to call the firm that always has your best interest in mind.

Over the next several months, you’ll hear a lot of rhetoric from the proponents of the measure.

Don’t be fooled. This is just the latest example of an out-of-state trial lawyer trying to fool the voters into thinking this is about something it’s not.

We need your help to educate yourselves, your patients, and your communities about the risk this measure poses for all of California.

Please join me and CMA in this opportunity to rally together to protect the medical profession against forces that are simply trying to enrich themselves, regardless of who may be hurt by this regressive policy proposal.

For more information about how to get involved, please visit cmadocs.org/micra.

Thank you for your support!

Business | Litigation | Estates & Trusts | Employment | Medical Malpractice | Real Estate

7540 Shoreline Dr., Stockton, CA 95219

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SAN JOAQUIN PHYSICIAN

T: 209.478.2000

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SPRING 2022

SPRING 2022

SAN JOAQUIN PHYSICIAN

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California’s 2022

COVID-19 SUPPLEMENTAL PAID SICK LEAVE LAW BY: JAMIE M. BOSSUAT, ESQ.• KROLOFF, BELCHER, SMART, PERRY & CHRISTOPHERSON

On February 9, 2022, Governor Newsom signed Senate Bill 114 into law, reauthorizing COVID-19 supplemental paid sick leave in California. The law differs from that of 2021, so employers should take note and update any corresponding policies.

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SAN JOAQUIN PHYSICIAN

SPRING 2022

Who is covered under the new law?

All workers employed by a business with 26 or more workers are covered by the new law. The leave can be used for family members including a child, grandchild, grandparent, parent, sibling, or spouse.

What are the effective dates?

The law is retroactive and covers a leave that begins January 1, 2022 through September 30, 2022.

What reasons can employees use the leave?

If the employee cannot work or telework because the employee, or a family member for whom they are caring, is experiencing the following: • Positive COVID-19 test; • COVID-19 symptoms and seeking a diagnosis; • Is advised to self-quarantine or isolate by a health care provider or due to a federal, state, or local order or guidance; • Is attending a vaccine appointment; • Is experiencing vaccine-related side effects; or • The employee is caring for a child whose school or place of care is closed or unavailable due to COVID-19.

How much leave is available?

Full-time employees can use up to 80 hours of paid leave.

This is provided in two leave “banks”: (1) Up to 40 hours for an employee who tests positive for COVID-19 or is caring for a family member who tests positive; and (2) Up to 40 hours for all other covered reasons.

Part-time employees receive one week of their regularly scheduled hours in each leave bank. Employees whose schedule varies receive an allotment based on their average number of hours worked, based on a formula provided in the law.

Time off for vaccines/boosters and related symptoms can be limited to 3 days or 24 hours unless an employee receives

SPRING 2022

verification from a healthcare provider that they are continuing to experience symptoms past this period.

What is the rate of pay?

The pay must be provided at the “regular rate” of pay or under a 90-day lookback specifically defined in the new law. Employers can cap pay at $511 per day and require employees to use other types of paid leave to “top up” their pay to their full daily pay.

What documentation is required?

Employers can require employees to submit proof of a positive test result. Additionally, employers can require a second COVID-19 test on the 5th day after the first test if they pay for the cost of the test.

Employers must list COVID-19 supplemental sick leave used on the pay stub. A mandatory poster will also be required and will be available on the California Labor Commissioner’s website in the near future.

For questions about the new sick leave law, we recommend you contact an employment lawyer for specific advice.

SAN JOAQUIN PHYSICIAN

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Op-Ed: DAY OF INTERNATIONAL

Medical malpractice ballot measure DEMOCRACY would benefit lawyers Perhaps more than any state in America, California continues to make progress toward the historic promise of health access for all.

Vital to that prognosis has been our state’s community health centers, located in medically underserved communities and providing diverse, vulnerable populations with primary and reproductive care.

Pandemic-related stresses on our overall health system, including the most recent hospitalization surge, has underscored the safety-net imperative of a strong and financially solvent system of community clinics.

It would be hard to imagine a worse possible time to pass a ballot measure that would disrupt the financing of California’s community health centers and access to the physicians and

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other clinicians providing essential care to Californians in need while increasing health costs for every Californian. But that’s what the proponents of the misleadingly self-proclaimed Fairness for Injured Patients Act, or Changes to Medical Malpractice Lawsuits Cap Initiative, appearing on the statewide ballot in November are trying to do.

This measure would dramatically impact the cost and delivery of health care in California – but it’s not written by health experts or real-life medical practitioners. Instead it was drafted to allow a few to make millions more from filing personal injury lawsuits.

SPRING 2022

What’s worse is that supporters are not saying what this And who pays for this onslaught of new lawsuits and measure would truly do. attorney payouts? The rest of us. The initiative would place an For many years, California’s medical liability system has unmanageable burden on our health care delivery system at a been protected by a bipartisan series of laws called MICRA, time when many of our community health centers are already the Medical Injury Compensation Reform Act, which has operating on razor thin margins and are faced with staffing balanced the rights of injured patients while keeping health shortages. care more accessible Taxpayers are on and affordable for all the hook as well. The patients. state’s nonpartisan While injured Legislative Analyst To no one’s surprise, the patients can receive Office said the unlimited payments Fairness for Injured Fairness for Injured Patients for economic losses Patients Act “would and medical expenses, likely have a wide Act’s fine print stealthily there is a “cap” on variety of fiscal removes all existing caps on non-economic effects on state and damages. Despite local governments,” attorney’s fees, resulting in what proponents including “annual are saying, the government costs huge financial windfalls for Fairness for Injured likely ranging from Patients Act would the low tens of trial lawyers who sue doctors, dramatically overhaul millions of dollars to nurses, clinicians and other our health system the high hundreds of far beyond a simple millions of dollars.” health providers for a living. increase in the The trickle-down MICRA cap. effect of this measure In fact, the Fairness would result in for Injured Patients community clinics Act brazenly creates closing their doors, a new category of injury with no cap whatsoever – which is essential health services being slashed and health care providers broadly defined and can include outcomes as innocuous as having to limit new patients. The hardest impact will be felt unwanted scarring. This is the loophole that would effectively by women, communities of color and individuals with special obliterate the MICRA cap and start a mad dash by enterprising needs – all when we should be reducing health inequities and attorneys filing countless new lawsuits in already overcrowded expanding access to health care for those who need it most. courts.

That’s why hundreds of organizations have already signed up To no one’s surprise, the Fairness for Injured Patients Act’s to oppose the Fairness for Injured Patients Act in November. fine print stealthily removes all existing caps on attorney’s Clinicians, physicians, nurses, dentists, community clinics, fees, resulting in huge financial windfalls for trial lawyers who health centers, hospitals, public safety organizations and other sue doctors, nurses, clinicians and other health providers for a frontline health care workers across the state are urging voters to living. It also creates a new process that prohibits judges from say “No” to this dangerous, costly measure. independently verifying the truthfulness of statements made by This op-ed, authored by Kerry Hydash, Family Healthcare trial attorneys in the initial court filings – another incentive for Network, originally appeared CalMatters on February, 7, 2022. more frivolous lawsuits.

SPRING 2022

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.

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SPRING 2022

Mako Robotic-Arm Assisted Surgery An innovative approach to total hip, total knee, or partial knee replacement Millions of adults suffer from osteoarthritis of the knees and hips, characterized by the breakdown and eventual loss of joint cartilage, allowing underlying bones to rub together. A patient’s age, weight, previous injuries, and/or recurring stresses are all common risk factors in osteoarthritis.

The Mako Robotic-Arm Assisted Surgery System utilizes CT-based 3D modeling to enable surgeons to create personalized surgical plans based on each patient’s unique bone anatomy.

The system offers innovative total hip, total knee, or partial knee replacement options for adults with osteoarthritis of the knee or degenerative joint disease of the hip. This highly advanced technology transforms the way joint replacement surgery is performed, enabling surgeons to have a more predictable surgical experience with increased accuracy.

Potential advantages of Mako include: • Shorter hospitalization

• Less bone loss

• Rapid recovery

• Less blood loss

• Smaller incision

• Less implant wear and loosening

• Less scarring Visit dignityhealth.org/stockton/ortho to learn more about Mako at St. Joseph’s Medical Center.

SPRING 2022

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NEW

The second legislative

CALIFORNIA

LAWS OF INTEREST TO PHYSICIANS FOR 2022

session during the COVID-19 pandemic continued to focus on pandemic-related policy issues. While the number of new laws overall is significantly reduced as compared to past years, many new and significant laws were enacted. Below is a list of new laws of interest to physicians. For information about these laws, go to www.cmadocs.org.

ALLIED HEALTH PROFESSIONALS

AB 1533 (Committee on Business and Professions) –

AB 356 (Chen) – Fluoroscopy: temporary permit

AB 407 (Salas) – Optometry: assistants and

AB 1534 (Committee on Business and Professions) –

scope of practice

California State Board of

AB 435 (Mullin) – Hearing aids: locked programming software: notice AB 462 (Carrillo) – Licensed Professional Clinical

Optometry AB 1536 (Committee on Business and Professions) – Board of Vocational Nursing

Counselor Act

and Psychiatric Technicians

AB 691 (Chau) – Optometry: COVID-19

of the State of California:

vaccinations and clinical

vocational nursing and

laboratory tests or examinations AB 815 (Luz) – School nurses: credentialing

psychiatric technicians SB 409 (Caballero) – Pharmacy practice: testing SB 509 (Wilk) – Optometry: COVID-19

AB 1015 (Rubio) – Board of Registered Nursing: workforce planning: nursing

Pharmacy

pandemic: temporary licenses SB 534 (Jones) – Dental hygienists

programs: clinical placements AB 1064 (Fong) – Pharmacy practice: vaccines: independent initiation and administration AB 1407 (Burke) – Nurses: implicit bias courses AB 1532 (Committee on Business and Professions) –

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BROADBAND ACCESS AB 41 (Wood) – Broadband infrastructure deployment SB 4 (Gonzalez) – Communications: California Advanced Services Fund

Nursing

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AB 1113 (Medina) – Public postsecondary

BUDGET AB 133 (Committee on Budget) –

education: exemption from

Department of Health Care

tuition and fees: qualifying

Access and Information

survivors of persons providing

SB 171 (Committee on Budget and Fiscal Review) –

medical or emergency services

Health

deceased during COVID-19 California state of emergency SB 242 (Newman) – Health care provider

CANNABIS AB 1305 (Lackey) – The Medicinal and Adult-Use

reimbursements

Cannabis Regulation and

SB 336 (Ochoa Bogh) – Public health: COVID-19

Safety Act: exemptions

SB 510 (Pan) – Health care coverage: COVID-19

SB 311 (Hueso) – Compassionate Access to

cost sharing

Medical Cannabis Act or Ryan’s Law SB 544 (Laird) – Cannabis testing

ELDER AND DEPENDENT ADULTS AB 1243 (Rubio) – Protective orders: elder and dependent adults

CLINICAL LABORATORIES AB 526 (Wood) – Dentists and podiatrists: clinical laboratories and

EMERGENCY SERVICES AB 118 (Kamlager) – Department of Social Services:

vaccines

C.R.I.S.E.S. Grant Pilot Program AB 580 (Rodriguez) – Emergency services: vulnerable populations

PRIVACY AND SECURITY AB 825 (Levine) – Personal information: data

AB 1104 (Grayson) – Air ambulance services

breaches: genetic data AB 1184 (Chiu) – Medical information: confidentiality SB 24 (Caballero) – Domestic violence: protective orders: information pertaining to a child SB 41 (Umberg) – Privacy: genetic testing

END-OF-LIFE AB 439 (Bauer-Kahan) – Certificates of death: gender identity AB 1280 (Irwin) – California Hospice Licensure Act of 1990 SB 380 (Eggman) – End of life

companies HEALTH CARE PLANS, COVERAGE AND INSURANCE COVID-19 PUBLIC HEALTH EMERGENCY AB 80 (Burke) – Taxation: Coronavirus Aid, Relief, and Economic Security

practices: health protection AB 326 (Rivas) – Health care service plans:

Act: Federal Consolidated

Consumer Participation

Appropriations Act 2021

Program

AB 263 (Arambula) – Private detention facilities and public health orders AB 654 (Gómez Reyes) – COVID-19: exposure: notification AB 845 (Rodriguez) – Disability retirement: COVID-19: presumption AB 856 (Maienschein) – Pupil health: COVID-19 Youth Health Information Act

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AB 237 (Gray) – Public employment: unfair

AB 342 (Gipson) – Health care coverage: colorectal cancer: screening and testing AB 347 (Arambula) – Health care coverage: step therapy AB 532 (Wood) – Health care: fair billing policies AB 570 (Santiago) – Dependent parent health care coverage AB 789 (Low) – Health care services

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AB 1020 (Friedman) – Health care debt and fair billing

AB 1042 (Jones-Sawyer) – Skilled nursing facilities:

AB 1082 (Waldron) – California Health Benefits

unpaid penalties: related

Review Program: extension AB 1158 (Petrie-Norris) – Alcoholism or drug abuse

parties AB 1422 (Gabriel) – Health facilities: critical care

recovery or treatment facilities:

units: critical care unit program

recovery residences: insurance

flexibility

coverage

AB 1527 (Ting) – Seton Medical Center: seismic

AB 1511 (Committee on Insurance) – Insurance: omnibus SB 221 (Wiener) – Health care coverage: timely access to care

safety AB 1585 (Committee on Health) – Health care SB 541 (Bates) – Substance use disorder

SB 255 (Portantino) – Health care coverage:

treatment facilities and

employer associations

programs: disclosure of license

SB 280 (Limón) – Health insurance: large group health insurance

and certification status SB 564 (Cortese) – Hospitals: seismic compliance:

SB 283 (Gonzalez) – Life and disability income

O’Connor Hospital and Santa

insurance: HIV tests SB 326 (Pan) – Health care coverage: federal health care reforms

Clara Valley Medical Center SB 650 (Stern) – Skilled nursing facilities SB 664 (Allen) – Hospice licensure: moratorium

SB 368 (Limón) – Health care coverage:

on new licenses

deductibles and out-of-pocket expenses SB 428 (Hurtado) – Health care coverage: adverse childhood experiences screenings SB 535 (Limón) – Biomarker testing

MEDI-CAL SB 48 (Limón) – Medi-Cal: annual cognitive health assessment SB 226 (Pan) – Medi-Cal: County of Sacramento

SB 655 (Bradford) – Insurers: diversity SB 718 (Bates) – Health care coverage: small employer groups

MENTAL AND BEHAVIORAL HEALTH AB 134 (Committee on Budget) – Mental Health Services

HEALTH CARE FACILITIES AND FINANCING

Act: county program and

AB 381 (Davies) – Licensed facilities: duties

expenditure plans

AB 450 (Gonzalez) – Paramedic Disciplinary Review Board AB 451 (Arambula) – Health care facilities: treatment of psychiatric emergency medical conditions AB 665 (Garcia, Eduardo) – Care facilities: internet access AB 749 (Nazarian) – Skilled nursing facilities: medical director certification AB 849 (Reyes) – Skilled nursing facilities: intermediate care facilities: liability

AB 309 (Gabriel) – Pupil mental health: model referral protocols AB 638 (Quirk-Silva) – Mental Health Services Act: early intervention and prevention programs AB 1443 (McCarty) – Mental health: involuntary treatment AB 1477 (Cervantes) – Maternal mental health SB 14 (Portantino) – Pupil health: school employee and pupil training: excused absences: youth mental and behavioral health

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SPRING 2022

SB 465 (Eggman) – Mental health

REPORTING REQUIREMENTS

SB 224 (Portantino) – Pupil instruction: mental

AB 1094 (Arambula) – Sexual orientation and gender

health education

identity data collection pilot

SB 434 (Bates) – Substance abuse and mental

project

health services: advertising

AB 1204 (Wicks) – Hospital equity reporting

and marketing

SB 97 (Roth) – Pupil health: type 1 diabetes

SB 507 (Eggman) – Mental health services: assisted

information: parent

outpatient treatment

notification

SB 578 (Jones) – Lanterman-Petris-Short Act: hearings

REPRODUCTIVE HEALTH AB 367 (Garcia, Cristina) –

PRESCRIBING AND DISPENSING

Menstrual products

SB 310 (Rubio) – Unused medications: cancer

AB 556 (Maienschein) – Misuse of sperm, ova, or

medication recycling AB 527 (Wood) –

Controlled substances

embryos: damages AB 1356 (Bauer-Kahan) – Reproductive health care services

PROFESSIONAL LICENSING AND DISCIPLINE

SB 374 (Min) – Protective orders: reproductive

AB 107 (Salas) – Licensure: veterans and

coercion

military spouses AB 359 (Cooper) – Physicians and surgeons: licensure AND CME

TELEHEALTH AB 457 (Santiago) – Protection of Patient Choice in

SB 801 (Archuleta) – Healing arts: Board of

Telehealth Provider Act

Behavioral Sciences: Board of Psychology: licensees SB 806 (Roth) – Healing arts

TESTING SB 306 (Pan) – Sexually transmitted disease: testing

PROFESSIONAL LIABILITY SB 447 (Laird) – Civil actions: decedent’s cause of action

TOBACCO AB 541 (Berman) – Tobacco assessment SB 395 (Caballero) – Excise tax: electronic

PUBLIC HEALTH

cigarettes: Health Careers

AB 45 (Aguiar-Curry) – Industrial hemp products

Opportunity Grant Program:

AB 73 (Rivas) – Health emergencies:

Small and Rural Hospital Relief

employment safety:

Program

agricultural workers: wildfire smoke

WORKFORCE, EMPLOYMENT AND LABOR ISSUES

AB 653 (Waldron) – Medication-Assisted Treatment

AB 615 (Rodriguez) – Higher Education Employer-

Grant Program SB 742 (Pan) – Vaccination sites: unlawful

Employee Relations Act: procedures relating to

activities: obstructing,

employee termination or

intimidating, or harassing

discipline

SB 823 (Committee on Health) – Public health: omnibus bill

SB 331 (Leyva) – Settlement and nondisparagement agreements

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

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

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

PHYSICIAN WELL-BEING: CMA believes physician

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

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

Tom McKenzie, M.D. Member since 1991

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

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

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

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OUT-OF-NETWORK BILLING: California’s out-of-network billing and payment law (AB 72, 2017) changed the billing practices of non-participating physicians providing non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. CMA has dedicated significant resources to achieve the best possible outcomes for physicians under the new billing restrictions. CMA has also developed resources to help physicians navigate this new law.

HEALTH LAW LIBRARY: Updated annually, CMA’s online Health Law Library contains nearly 5,000 pages of information on a variety of subjects of importance to practicing physicians. The library – available free to members – includes content from the California Physician’s Legal Handbook, as well as more specialized information on peer review, payor contracting and other topics.

PAYOR CONTRACT ANALYSIS: CMA members have free access to objective written analyses of major health plan contracts designed to help physicians understand their rights and options when contracting with third-party payors, as well as which contract provisions are prohibited by California law.

WEBINAR SERIES: CMA’s webinar series gives physicians the opportunity to watch online presentations on important topics of interest and interact with legal and financial experts from the comfort of their homes or offices.

The webinars are free to CMA members and their staff. CMA also has 100+ archived on-demand webinars.

SEMINAR SERIES: Experts from CMA’s various centers travel to local county medical societies throughout the state, holding live seminars for members and their staff on a variety of issues. Contact your local county medical society for more information.

NEWSLETTERS: CMA produces publications to keep members up-to-date on the latest health care news and information affecting the practice of medicine in California. Subscribe to any of these newsletters online at cmadocs.org/newsletters.

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CMA and its county medical societies have represented California’s physicians for more than 165 years as the recognized voice of the house of medicine. Together we stand taller, our combined voices stronger, fighting for the future of medicine and our noble profession.

Rev. 12.14.2020

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The Happiest of Holidays On December 9, 2021, after nearly two years of canceled events, members of the San Joaquin Medical Society were excited to celebrate the holidays and 2020 Lifetime Achievement Award recipient, Dr. Peter Garbeff.

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A DYNAMIC PARTNERSHIP

TOURO UNIVERS IT Y AND ST. JOSEPH’S MEDICAL CENTER MAKE S IGNIFICANT PROGRESS IN E XPANDING RES IDENCY TRAINING

BY JO ANN KIRBY

St. Joseph Medical Center’s flourishing evolution as a teaching hospital,

in partnership with Touro University California, is bringing more specialists to San Joaquin County and training the next generation of doctors while

creating better health outcomes for our medically underserved community.

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The mission is threefold: To continue to build up SJMC as an educational institution, to increase the number of medical professionals that practice in our underserved community, and to offer service lines for specialties that are either scarce or nonexistent, so vulnerable patients don’t have to travel out of the area for care.

“We now have six accredited residencies.

We have 95 residents currently.,” Don Wiley, CEO and president of SJMC, said.

“It attracts physicians we might not have attracted because they want to teach.

Service lines are being stabilized and strengthened in specialties.”

In addition to the initial residencies SJMC started in emergency medicine and family medicine, St. Joe’s has since added residencies in anesthesiology, internal medicine, psychiatry, and transitional year.

And SJMC is also pursuing accreditation for residencies in orthopedic surgery, neurology, urology and interventional radiology. Once established, there would be room for 220 residents overall.

Graduate medical education — GME — is a hospital-based training program for doctors who have finished medical school and earned an M.D. or D.O. degree.

GME includes residency, internship, fellowship, specialty, and subspecialty programs. Becoming a teaching hospital isn’t something that was undertaken overnight. It requires a significant amount of commitment, time, and preparation.

An effort by SJMC board member Baraj Singh to help her daughter, who was a medical student at Touro University, land a clerkship in Stockton to complete her clinical rotations was just the spark.

A clerkship program for third- and fourth-year medical students to learn from our community’s physicians designated SJMC as a teaching site for clinical rotations and the committee formed to make that happen decided there was more work to be done. Dr. Ben

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Weiderhold, director of SJMC’s emergency room department, had been advocating for a residency program in emergency medicine. After the success of delving into undergraduate medical education with the clerkship program, the group began to explore the possibility of expanding into graduate medical education. It was an idea that gained traction and Touro came on early in the journey as educational consultants.

Dr. Richard Riemer, a Touro associate senior dean said because its Vallejo medical school doesn’t have its own hospital, it looks to form partnerships where its students can complete their clerkships and residencies. “When putting together a strategic plan for St. Joe’s … the idea was to develop programs that fit the need of the community because this is a health provider shortage area,” Dr. Riemer said.

The idea was to grow our own physicians in the community that could fill the gaps in shortage, Dr. Riemer said, and even more ambitiously, to grow physicians in areas of specialties where there had been none at all.

Accreditation for two residency programs, one in emergency medicine and one in family practice, brought 15 residents to Stockton in its inaugural year back in 2018.

“It’s really incredible. We’ve got a really good team here and we’ve added professionals who have experience in teaching. We are most proud of our goal of being able to serve our community and strengthen our ability as a health care provider,” Wiley said. “We want to train and increase the number of

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physicians in the Central Valley. It’s really important.”

The residency program is dedicated to training highly skilled physicians in a community where patients, many of whom are enrolled in Medi-Caid or other public insurance, might not have the basic means to travel out of the county for specialized care.

A well-documented shortage of primary care physicians and specialists makes the program even more important.

The partnership with Touro and their investment in our community has brought more physicians who are practicing medicine here, teaching residents, making San Joaquin County their home, and raising their families here.

Touro University Medical Group, an affiliate practice of Touro University California College of Osteopathic Medicine, opened its clinical office in Stockton and is home to physicians who are part of the St. Joe’s staff and teaching in

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“ I t’s really incredible. We’ve got a really good team here and we’ve added professionals who have experience in teaching. We are most proud of our goal of being able to serve our community and strengthen our ability as a health care provider. We want to train and increase the number of physicians in the Central Valley.

It’s really important.”

DON WILEY,

CEO AND PRESIDENT OF SJMC

its GME programs. “It is the university faculty practice where we recruit and staff the residencies for internal medicine, psychiatry, neurology and urologic surgery,” Dr. Riemer, who is a neurologist, said. “Our faculty are here in our clinic, we have privileges at the hospital, we have teaching faculty appointments within the residency programs. … and with that we are sort of linked at the hip if you will as we’ve integrated ourselves into the community and St. Joseph’s.”

The medical group gives residents the opportunity to see patients in an outpatient setting and it continues to grow to fulfill the teaching needs and the community needs. Their offices are now in several locations in Stockton and the plan is to move all their divisions, within to two to three years, into new construction at University Park.

Dr. Howard Feinberg, also a dean with Touro University, said the medical practice stepped up in partnership with the hospital to build up a clinic system to provide services to the community as well as provide teaching and training to students and residents in the community. As the residency programs grow and as SJMC gains accreditation for more, Touro continues to recruit additional doctors to grow its faculty. The partnership is an ambitious effort with a big payoff.

“We are a community hospital and the typical community hospital that starts a residency might do family medicine or emergency medicine and that’s hard,” Wiley said, explaining that the accreditation process is arduous and painstaking. “What we are trying to do, become a teaching hospital, is very highly

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unusual. This is very ambitious. It’s incredible for a little hospital like us.”

Already, a half dozen doctors who completed their residencies in emergency medicine alone have stayed to continue their careers here. And that medical student looking for a clerkship in Stockton? Well, Dr. Jasmine Singh started her own psychiatry practice here in Stockton.

California ranks second in the United States in retention of physicians who have gone to medical school and trained here, Dr. Riemer said, adding that “if we can get a person to Stockton, there’s an 80 to 90 percent chance that they are going to remain in California and a high percentage will remain in our area.”

The symbiotic partnership between SJMC and Touro has not reached its full potential. Dr. Reimer sees potential for continued growth in GME over the next three to five, especially with SJMC’s plans to add more hospital beds. And Wiley has plans to do even more.

“Once we are fully built out in 2025 or 26, we will turn our eye to fellowships,” Wiley said, adding that is a logical consequence to growing as a teaching hospital and fulfilling the community’s health needs for specialists.

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HOW IT STARTED HOW IT’S GOING A MOTHER’S DETERMINATION PAYS OFF

BY JO ANN KIRBY

Dr. Jasmine Singh was attending medical school at Touro University when it was time for her to start a clerkship. There was a need for clinical rotations that wasn’t being filled locally and Dr. Singh’s mother was determined to change that.

The result? “My daughter was the first student from Touro to do rotations in Stockton,” said Balraj Singh, a former clinical scientist who is serving as a practice manager for her husband’s medical office in Stockton.

Getting there took persistence that paid off, she said. “I was going to keep on asking everyone until I went down the list,” she said, describing how she went through all her contacts to gauge interest and support. Her husband, nephrologist Dr. Jagjit Singh, arranged a meeting with St. Joseph’s Medical Center President and CEO Don Wiley. Dr. Gregg Lund, who was a dean at Touro University at the time, was among those who attended the initial pitch.

“The meeting was supposed to be an hour.

I’m so happy and grateful that he listened to us and we formed a committee,” she said of Wiley’s enthusiasm.

Balraj called on doctors and even delivered applications that would get them on board as Touro assistant professors. She stayed with the mission until it was completed. “She’s one of a kind and I’m not just saying that because she’s my mom,” Dr. Singh said.

As a student in her third year of medical school, Jasmine felt right at home completing her rotations in St. Joe’s. “I remember it was so surreal because this is a place my father has worked for 30 years and my mother was on the board,” she said. “I would meet dad for lunch in the cafeteria when I was a kid.”

She recognized her father’s colleagues in the hallways and knew the layout of the hospital. It felt like home. After she started, she bumped into her dad one day who was momentarily surprised to see her until he remembered she had begun her clerkship.

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After graduation from medical school, the psychiatrist completed her residency at UCSF Fresno because there wasn’t a program in place for someone in her field here. That would change with time as an effort to start rotations for medical students here blossomed into a concerted push to establish graduate medical education programs.

“Balraj was instrumental and had an interest because of her daughter,” said Wiley. “And Dr. Ben Wiederhold, director of our emergency room department, also urged us to do this.

For her work, Touro honored her with its Dean’s Recognition Award to thank her for her “ongoing help which has been instrumental in forging and continuing the relationship between TUC and St. Joseph’s Medical Center.”

She said she is very thankful that Wiley took the time to listen to her dream. “Everyone can make a difference in the community,” she said. “You just have to be passionate, persistent and hardworking and never take no for an answer.”

The effort to host rotations was a seed that, once planted, bloomed and grew. The homegrown effort also paid off in bringing Dr. Jasmine Singh back to Stockton and those involved educating doctors here hope more specialists who serve their rotations and complete their residencies in San Joaquin County will see the benefits and stay as well.

“I’m on the committee for the residency programs and if I can’t convince my daughter that doesn’t look good,” Balraj Singh said, laughing.

Turns out, her daughter didn’t need much convincing.

“I went to L.A. to try and make it on my own. The biggest thing I missed is there was no sense of community. I returned because I missed my people, especially during the pandemic. And professionally, I had a dream of opening my own practice,” Dr. Singh said.

Professionally and personally, she has never been happier, adding that the support of her community means the world to her. And practicing here allows her to be part of a bigger support group. “Psychiatry is very underserved. To be in a place where people really want to get better mentally is very gratifying,” she said. “To bring the expertise here and be valued is very gratifying.”

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Closer to home + enhanced referrals = easier access to world-class care Frank Ing, M.D., F.A.C.C., M.S.C.A.I.

UC Davis Health offers nationally ranked expertise — now with added convenience for our referring providers From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley.

Your referred patients benefit from shorter drives, less traffic gridlock, affordable lodging, and more support from local family and friends. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.

Referring your patients to UC Davis Health specialty and subspecialty care is now easier than ever. Our physician referral liaison team is here to serve as direct lines of communication — helping to navigate and expedite referrals.

Our liaisons can also help to: ■

■

■

■

■

Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and/or webinars with our clinicians Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and events such as tumor boards, grand rounds, symposiums, etc.

Reach out to your local Physician Referral Liaison today:

Northern San Joaquin Valley | 916-734-7463 hs-physicianliaisons@ucdavis.ed

referrals.ucdavis.edu

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In The News

IN THE

NEWS

Grant Mellor, MD and Xochitl Mellor Pediatrics, a Family Affair Dr. Grant Mellor, past president of SJMS, is working alongside his daughter, Xochitl Mellor. She is a 4th year medical student at Case Western, completing her outpatient rotations with Kaiser Permanente in Stockton. She is following her dad and older brother into pediatrics. Dr. Mellor is proud to be one of her teachers.

San Joaquin Medical Society Celebrates Residents February 25 was “Thank a Resident Day.” SJMS distributed goodie bags to every resident in training programs at San Joaquin General Hospital and St. Joseph’s Medical Center as a token of appreciation for their hard work and dedication to providing quality patient care. They serve as an integral part of the healthcare team. Residents enjoy free membership at

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

SJMS Celebrates Residents the San Joaquin Medical Society and the California Medical Society, and they are encouraged to get involved!

Shriners Children’s Northern California empowers young women to pursue orthopedics Women make up more than half of medical school entrants but only 6-8% of orthopedic surgeons are female. Among medical specialties, orthopedics may have the biggest gender disparity problem.

Eight female orthopedic surgeons from Shriners Children’s and UC Davis Health organized a one-day workshop for 30 female, high school students to teach them about the field. The students participated in mock surgeries and education seminars as part of The Perry Initiative, a nationwide effort to interest females

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in orthopedics and engineering. An October 2021 study said that, while only 16% of active orthopedic surgery residents are female, 20% of those participants in the Perry Initiative who went on to match into a residency program chose orthopedics.

Shriners Children’s provides educational opportunities for current and aspiring healthcare professionals to help change and improve children’s lives.

Reminder: Transition from HPSJ to Medi-Cal Rx As of January 1, 2022, the pharmacy benefits for Health Plan of San Joaquin members were transitioned to administration by Medi-Cal Rx, the new California State agency. Medi-Cal Rx is responsible for filling most outpatient pharmacy drugs for MediCal plans. Providers can call the 24/7 Medi-Cal Rx Call Center Line, 1.800.977.2273, TTY/ TDD 711, or visit www.MediCalRx.dhcs.ca.gov for help. Prior authorization request forms can be submitted to Medi-Cal Rx via CoverMyMeds, the MediCal Rx Secured Provider Portal, or via fax at 1.800.869.4325.

Access the Medi-Cal Rx Provider Manual at https://medicalrx.dhcs.ca.gov/provider/forms for detailed coverage information such as restrictions on covered medical supplies.

Frequently asked questions about Medi-Cal Rx are at https:// medi-calrx.dhcs.ca.gov/home/faq/. If there are any further questions and Medi-Cal Rx is unable to assist, contact the HPSJ Pharmacy Team at pharmacydepartment@hpsj. com or contact them directly via HPSJ’s secure voicemail at 209.461.2212. The team will respond within one business day.

NEW for Health Plan of San Joaquin (HPSJ) Members – National Diabetes Prevention Program Health Plan of San Joaquin is offering a CDC-approved online diabetes prevention program with Melon Health.

HPSJ members can self-refer or be referred to the program by their PCP. Throughout the virtual program, members are taking part in weekly program modules, connecting with an online group, texting and calling their personal health coach, keeping a daily health record, and staying active. The Diabetes Prevention Program is NOT for those who have Type 1 or Type 2 diabetes or are pregnant at this time. HPSJ patients who would like to learn more about the National Diabetes Prevention Program, or self-refer, are invited to contact HPSJ’s Health Education team at 209.942.6356, or healtheducation@ hpsj.com

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Shani Hanh Truong, MD

Lauren Kendall Brown-Berchtold, MD

Modesto Bee Spotlight – Two local doctors share how women can stay safe from COVID during pregnancy Lauren Kendall Brown-Berchtold, MD and Shani Hanh Truong, MD are physicians in family medicine at San Joaquin General Hospital and clinics affiliated with HPSJ. In January they coauthored an important Modesto Bee opinion piece which can be read at https://tinyurl.com/425e9h8n.

Improved Payment Experience for HPSJ Providers In 2022, Health Plan of San Joaquin will implement a new provider payment system. In addition to a more responsive experience, practices have an opportunity to experience faster payments.

Payments are offered in the following ways: • Electronic Funds Transfers (EFT) for direct bank deposits (preferred) • Paper checks (by mail) • V-cards (credit cards) HPSJ encourages providers to sign up for EFTs directly to their bank to prevent delays or checks lost in the mail, and to avoid additional fees that may be assessed by your practice’s credit card company.

HPSJ is offering to assist practices that want to consider this EFT choice. If not already completed, HPSJ providers are asked to register for the new payment system at www.hpsj.com/paycontact, or call HPSJ Provider Services for support at 1.888.936.PLAN (7526).

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In The News

IN THE

NEWS St. Joseph’s Earns Top Star Rating for Cardiovascular Surgery St. Joseph's Medical Center has earned a distinguished threestar rating from The Society of Thoracic Surgeons for its patient care and outcomes for both isolated coronary artery bypass grafting (CABG) and Aortic Valve Replacement (AVR) procedures. The three-star rating, which denotes the highest category of quality, places St. Joseph's among the elite for CABG (top 20%) and AVR (top 5-8%) in the United States and Canada. The latest analysis of data covers a 3-year period from July of 2018 to June of 2021. Learn more about St. Joseph’s award-winning cardiac services at DignityHealth.org/ Stockton/Heart.

Eleze Armstrong

Doctors Hospital of Manteca Names Eleze Armstrong Chief Executive Officer Doctors Hospital of Manteca has appointed Eleze Armstrong as its new Chief Executive Officer (CEO).

Effective January 3, 2022, Armstrong will assume responsibility for all hospital operations, executive planning and directing medical services.

Murali Naidu, MD, FACS, our current CEO of Doctors Hospital of Manteca, has been appointed as the new CEO of Emanuel Medical Center, our sister hospital in Turlock. He will

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

serve as CEO of both hospitals until Armstrong’s effective date.

Armstrong joins Doctors Hospital of Manteca from Sierra Vista Regional Medical Center, our sister hospital in San Luis Obispo, where she has served as Chief Operating Officer since 2018.

She previously served as the Chief Strategy Officer (CSO) at Twin Cities Community Hospital, our sister hospital in Templeton. She started at Twin Cities in 2010 as Director of Imaging and Cardiovascular Services, then moved into the role of Market Director of Neuroscience Services before becoming CSO. Armstrong is a graduate of the Tenet Leadership Academy.

She earned her Bachelor of Arts in Healthcare Administration from the University of Ottawa in Kansas and a Master’s in Healthcare Administration from Grand Canyon University in Arizona. She is also a member of the American College of Healthcare Executives.

Doctors Hospital of Manteca Now Offering 3D Mammography Doctors Hospital of Manteca is now offering 3D mammography (breast tomosynthesis) for breast cancer screening. Breast cancer screening with tomosynthesis when combined with a conventional 2D mammography has a 40 percent higher invasive cancer detection rate than conventional 2D mammography alone.

The new 3D mammography system is located at the Women’s Imaging Center inside Doctors Hospital of Manteca. The Women’s Imaging Center is a Certified Quality Breast Center of Excellence in the National Quality Measures for Breast

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Centers Program™ (NQMBC™). This distinguished honor represents a commitment by the DHM Women’s Imaging Center to provide the highest level of quality care to patients in the Manteca community and surrounding areas.

3D mammography with digital breast tomosynthesis (DBT) offers exceptionally sharp breast images, and an advanced design providing more patient comfort. The tomosynthesis platform is designed to deliver superior screening and diagnostic performance for all breast types. It produces a threedimensional view of the breast tissue that helps radiologists identify and characterize individual breast structures without the confusion of overlapping tissue.

In addition to her Interim CNO responsibilities, Tina has also been serving as Director of Clinical Quality Improvement/ Patient Safety, Sepsis Coordinator, Stroke Coordinator and Dialysis Coordinator. Her previous roles at Doctors Hospital of Manteca have included Critical Care Services Director, Clinical and Shift Manager of Inpatient Nursing Services, and Clinical Nurse in Multispecialty Services.

Tina earned her BSN from CSU Stanislaus and MSN from Grand Canyon University. She was named Employee of the Year in 2005 and was a Tenet Hero Nominee in 2010.

Breast tomosynthesis has the potential to benefit all screening and diagnostic mammography patients and is especially valuable for women receiving a baseline screening, those who have dense breast tissue and/or women with a personal history of breast cancer.

The tomosynthesis screening experience is similar to a traditional mammogram. During the exam, multiple, low-dose images of the breast are acquired at different angles. These images are then used to produce a series of one-millimeter-thick slices that can be viewed as a 3D reconstruction of the breast.

Tina Burch

Doctors Hospital of Manteca Names Tina Burch Chief Nursing Officer Doctors Hospital of Manteca has appointed Tina Burch as its new Chief Nursing Officer (CNO).

Tina assumes responsibility for all nursing and designated patient care functions within Doctors Hospital of Manteca. She will oversee and coordinate the nursing units and their daily operations. Tina has been serving as the hospital’s Interim CNO since May 2021.

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Jerry Weiner, MD Retires Longtime Surgeon at Doctors Hospital of Manteca Retires A longtime general surgeon at Doctors Hospital of Manteca has retired after 36 years at the hospital.

Jerry Weiner, M.D., started working at Doctors Hospital of Manteca in October 1985 and retired in December 2021.

Dr. Weiner has been a wonderful asset to Doctors Hospital of Manteca and the hospital is grateful for his incredible commitment and dedication to its patients, hospital and community for so many years.

“Dr. Weiner has provided expert clinical knowledge, superb surgical skills, and care for this community for 36 years. His contributions to Doctors Hospital of Manteca are very much appreciated,” said Murali N. Naidu, M.D., former CEO of Doctors Hospital of Manteca. “He has served as a mentor to other physicians and a leader for our medical staff. Most

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In The News

IN THE

NEWS recently, his calm demeanor and expert knowledge were invaluable to our patients and staff during the pandemic.”

“I have been blessed to know Dr. Jerry Weiner for 35 years. He is a devoted, humble, kind, caring and compassionate surgeon.

He is well-known for always going the extra mile to help. His contributions to the hospital, the medical staff, patients and the community have been invaluable,” said Marla Terrell, Director of Medical Staff Services.

Operation Access is Seeking Volunteer Surgeons and Specialists Operation Access organizes medical volunteers and arranges

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Providing staff, physicians, and patients with relevant & up to date information surgical and specialty care. They are working to launch in San Joaquin County and have been working with various participating hospitals who have generously agreed to donate charity care that is performed through the program.

Patients are low-income, uninsured, and referred by community clinics. Operation Access provides intensive case management and interpreters to make it easy to volunteer and to patients arrive to their appointments fully prepared.

For more information, consult www.operationaccess.org. If you are interested in becoming involved as a volunteer, please contact Program Director Ali Balick at (415) 733-0062 or by email at ali@operationaccess.org.

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Now Offering 3D Mammography in Manteca Doctors Hospital of Manteca is now offering 3D mammograms, also called breast tomosynthesis, at the Women’s Imaging Center. A 3D mammogram is an advanced technology that helps detect breast cancer early, sometimes long before symptoms appear.

What are the Benefits of 3D Mammography?

• Exceptionally sharp imaging quality • Reduced number of false positives • Improved detection of breast cancer for all breast types, including dense breast tissue

To refer a patient, call 844-632-5727 or visit DoctorsManteca.com/Mammogram SPRING 2022

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Demand for CalMedForce GME funding at all time high with over

$99.5M requested

Physicians for a Healthy California (PHC) today announced more than $39 million in CalMedForce awards across the state to support medical training and residency programs and help grow the physician workforce.

The fourth round of CalMedForce funding, generated by the voter-approved Proposition 56 tobacco tax of 2016 and administered by PHC, supports 209 residency positions in 114 graduate medical education (GME) programs at hospitals and clinics, with an emphasis on those serving medically underserved groups and communities. This cycle marks the largest applicant pool to date, with 125 applications requesting over $99.5 million in funding to support 558 resident positions.

The California Future Health Workforce Commission estimated that California will need 4,700 additional primary care clinicians by 2025 and approximately 4,100 more by 2030 to meet demand. PHC, in partnership with the University of

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California (UC), established the CalMedForce grant for 376 awards to 133 GME programs across California to program to help address California’s looming physician retain and expand GME programs in primary care (family shortage by supporting the residency programs where medicine, internal medicine, pediatrics, and obstetrics and medical school graduates must continue training to obtain a gynecology) and emergency medicine. medical license and care for patients independently.

“We understand the vital statewide needs for this program “The popularity of CalMedForce and the funding it provides continues to demonstrate the to support California’s future high demand and need for GME physicians,” said Cathryn opportunities and the program Nation, MD, Vice President for “ We understand the vital continues to rise to the occasion Health Sciences at UC Office to meet these needs,” said Lupe of the President. “The growing statewide needs for this Alonzo-Diaz, MPA, PHC president demand for funding reflects program and the funding it and CEO. “The lack of sufficient the importance of this program providestosupportCalifornia’s residency spots contributes to and its focus on the needs of California’s physician shortage and medically underserved groups future physicians.” limits the number of new doctors and communities.”

Cathryn Nation, MD, Vice President entering the workforce. With the “This year’s funding is another for Health Sciences at UC Office of ongoing COVID-19 pandemic crucial step towards combating the President. impacting life for the foreseeable the ongoing shortage of future, programs like CalMedForce California residency programs are even more essential to protect that poses an ongoing challenge access to care for all Californians.” for expanding the physician The UC is the designated workforce, and improving recipient of Proposition 56 funding and ensuring access to care in and has contracted with PHC to administer CalMedForce.

California,” said Alonzo-Diaz.

All accredited residency programs in the state that meet For more information, visit CalMedForce.org. (@PHCdocs / guidelines are eligible to apply for funding. Of this year’s #CalMedForce) CalMedForce awardees, approximately 17% of GME programs are sponsored by the University.

To date, CalMedForce has allocated over $153 million

San Joaquin Programs Awarded $1,275,000 San Joaquin General Hospital Family Medicine Residency Program. . . . . . $450,000 San Joaquin General Hospital Internal Medicine Residency Program . . . . . $300,000 St. Joseph’s Medical Center Family Medicine Residency Program . . . . . . . . $150,000 St. Joseph’s Medical Center Emergency Medicine Residency Program. . . . . $150,000 St. Joseph’s Medical Center Internal Medicine Program. . . . . . . . . . . . . . . . . . $225,000

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2021 Federal Wrap-Up Another Tough Year…But Important Wins for Physicians

By Elizabeth McNeil, CMA Vice President of Federal Government Relations 2021 proved to be another challenging year for physicians and a nation continuing to face a raging pandemic. It brought us tough confrontations over COVID-19 mask mandates and vaccination efforts, legal challenges that threatened to overturn the Affordable Care Act (ACA), a renewed fight for racial equity and an insurrection at the U.S. Capitol that challenged our democracy. But through it all, the California Medical Association (CMA) was there, fighting for physicians and ensuring that our nation’s healers were able to continue providing care to patients as the pandemic raged on.

The nation inaugurated a new President, Joseph Biden, and the first woman Vice President, California Senator Kamala Harris, who set out to heal a nation experiencing the worst public health crisis in history. As the Biden Administration settled in, key California leaders were placed in important positions in the federal government, giving CMA unprecedented access at the federal level. California Secretary of State Alex Padilla was appointed to the U.S. Senate to fill the vacancy left by Vice President Harris, while and California Attorney General Xavier Becerra was named Secretary of the U.S. Department of Health and Human Services. Californians Nancy Pelosi and Kevin McCarthy were both reelected to their respective positions as Speaker of the House and Minority Leader.

Unprecedented Challenges The COVID-19 pandemic will be remembered as one of the most unprecedented and challenging times in our nation’s history. Physicians rose to their calling in heroic numbers to battle the virus, vaccinate the public, and fight for science and truth to protect public health. Physicians demonstrated their compassion and courage – risking their lives and the lives of their families to care for the sickest of patients.

CMA successfully fought alongside the American Medical Association (AMA) and others in organized medicine to ensure physicians were able to continue providing quality care to their patients during and beyond the public health emergency. Many physicians either implemented or expanded their use of telehealth as a treatment modality. CMA worked hard to ensure that Congress and the Biden Administration provided telehealth payment parity and waivers to allow physicians to provide a broad range of telehealth and audio-only services in a broad range of settings. CMA made sure policymakers understood how telehealth allowed physicians to meet their patients’ needs during the pandemic.

A Test of Stamina The second year of the pandemic truly tested physician stamina. Frontline physicians fought burnout and massive health staffing shortages; all physicians worked to sustain the viability of their practices;

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CMA Federal Wrap Up 2021 and physicians began to address the secondary impacts of the pandemic – worsening health conditions caused by delays in care, as well as a tsunami of mental health and substance abuse issues.

CMA warned Congress that the long-term fallout from the pandemic would be felt by patients for years to come and fundamentally alter the long-term stability of physician practices. Congress honored the sacrifices made by physicians and responded by dedicating substantial resources to help physicians fight the pandemic and sustain the viability of their practices for future patients. In 2020-21, Congress enacted legislation to address all aspects of the COVID-19 battle providing nearly $2 trillion in funding, including hundreds of billions for physician practices: +

$190 billion to the Provider Relief Fund

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$10 billion to reimburse physicians treating the uninsured

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$1 trillion to the Paycheck Protection Program and fair tax treatment for such grants

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2% Medicare payment increase by waiving the sequestration cuts

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Billions in funding for personal protective equipment, mental health, substance abuse, public health, testing and vaccines

Medicare Payment Cuts Stopped As if the COVID-19 pandemic was not enough, physicians also faced 9.75% in Medicare payment cuts on January 1, 2022. It was a perfect storm of Medicare payment cuts resulting from an expiring 2% sequestration waiver, 3.75% budget neutrality cuts imposed by the fee schedule and an unintended 4% cut due to a legislative “pay as you go” budget neutrality rule.

In response to intense advocacy from CMA, AMA and other medical societies, Congress recognized that physicians could not continue to fight the pandemic, sustain their practices and care for patients under a 9.75% Medicare payment cut. Led by California physician Congressman Ami Bera (D-CA), Congress enacted legislation to stop most of the 9.75% payment cuts. The 2% sequestration cuts will be phased back in by July 1, 2022.

CMA also successfully worked with AMA and organized medicine to rally Congress to: +

Double the Medicare COVID-19 vaccine administration payment rates

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Provide a Merit-Based Incentive Payment System quality reporting exemption

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Extend the telehealth waivers through the public health emergency

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Delay mandatory e-prescribing for controlled substances until 2023

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Delay the Radiation Oncology Alternative Payment model and the Appropriate Use Criteria program until 2023

Fighting Back on Surprise Medical Billing CMA continues to fight an ill-conceived federal regulation that disregards the balanced arbitration process in the No Surprises Act (NSA) law and threatens patient access to in-network physicians. While CMA strongly supports the parts of the law that protect patients from surprise medical bills, the arbitration regulation will harm patients and drive up costs in the long term.

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CMA Federal Wrap Up 2021 In the NSA’s statutory language, Congress established a balanced process to fairly resolve payment disputes between physicians and insurers for certain unanticipated out-of-network medical bills, using several different criteria. However, the implementing regulations are blatantly inconsistent with the clear language of the statute and Congressional intent. They effectively upend the law, giving insurers an unfair advantage by relying almost exclusively on the insurers’ self-determined median in-network billing rate, instead of considering the multitude of factors called for under the law.

Nearly 200 Members of Congress and the Chairman of the powerful Ways and Means Committee stood with physicians, objecting to the regulations in multiple bipartisan letters.

CMA also submitted extensive comments to the regulators warning that the NSA regulations would produce the same unintended consequences that physicians and patients have experienced under California’s Assembly Bill 72. CMA provided detailed evidence from California that demonstrated how insurers cancelled long-standing contracts or imposed significant rate reductions that forced physicians out-of-network and reduced patient access to in-network physicians, particularly regarding on-call panels of physician specialists who treat patients in emergencies.

Several lawsuits have been filed against the federal government over its misguided implementation of the NSA. The suits argue that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians and other providers will routinely be undercompensated by commercial insurers, and that patients will have fewer choices for access to in-network services.

Through the Physicians Advocacy Institute, CMA, along with other state and national specialty societies, filed amicus briefs in support of a lawsuit brought by the Texas Medical Association and the AMAAmerican Hospital Association lawsuit. The American College of Emergency Physicians, American Society of Anesthesiologists and American College of Radiology also filed a joint legal action.

Public Service Loan Forgiveness In 2021, CMA continued to aggressively fight for a legislative or regulatory change to allow California and Texas physicians to participate in the Public Service Loan Forgiveness (PSLF) program like their colleagues in the other 48 states.

Congress established the PSLF program in 2007 to improve access to care by encouraging physicians to pursue careers working in nonprofit settings. When implementing regulations were issued, they were severely narrowed to require physicians to be “hired and paid by” hospitals in order to receive loan forgiveness. Because California and Texas law prohibit hospital employment of physicians, most physicians in California and Texas are precluded from participating in the program, while their counterparts in all other 48 states receive loan forgiveness.

With an average $250,000 in student loan debt, the narrow regulation places California and Texas at a severe disadvantage in recruiting new physicians, thereby harming patient access to care in our underserved communities.

On behalf of CMA, California Congressman Josh Harder (D-Stanislaus) introduced HR 1133, the “Stopping Doctor Shortages Act,” and has led an intense advocacy effort in the House to fix this problem with the

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CMA Federal Wrap Up 2021 support of his co-authors, Congressmen Jay Obernolte (R-San Bernardino), Joaquin Castro (D-TX) and Van Taylor (R-TX). Identical legislation was introduced in the Senate (S 311) by Senators Dianne Feinstein (D-CA), John Cornyn (R-TX) and Alex Padilla (D-CA).

Throughout 2021, CMA urged Congress to pass a legislative fix but the high cost has made it extremely difficult.

Also in 2021, the U.S. Department of Education reopened its regulations to make changes to the Higher Education Act, which includes the PSLF. CMA testified before the education department and organized a joint bipartisan letter from the majority of the California and Texas Congressional delegations. Speaker Pelosi, Rep. Harder and Senator Feinstein have also met with the Secretary of Education on CMA’s behalf.

This is a top priority for CMA; we will continue to urge regulators and Congress to resolve the problem as soon as possible.

Access to Affordable Health Care CMA has urged Congress to address two of our nation’s highest health care priorities in President Biden’s Build Back Better social programs infrastructure legislation – permanent access to more affordable health insurance through the ACA and lowering prescription drug costs.

Although the 2021 American Rescue Plan Act (ARPA) expanded eligibility for ACA health insurance tax credits and assistance, these provisions were only authorized for two years. CMA is urging Congress to ensure the long-term affordability and effectiveness of the ACA by making the provisions of the ARPA permanent.

The Medicare drug pricing provision in the Build Back Better plan would allow Medicare to negotiate drug prices on many of the highest-priced drugs directly with pharmaceutical companies – including all insulin drugs. The legislation is estimated to save Medicare and privately insured patients 40-60% on drug costs.

Pathways to Practice President Biden’s Build Back Better legislation would also authorize 4,000 new graduate medical education (GME) residency positions. The nation is currently facing a 15,000 residency position shortage.

This CMA-supported provision would add residency slots to allow more medical students to match with a residency program and increase the overall supply of physicians.

The legislation also includes the new CMA-supported “Pathways to Practice” program – an innovative program that will allow more marginalized and minority students to go to medical school and choose a career in medicine. It provides tuition assistance, living stipends and expands the number of GME positions. It requires such students to serve in underserved areas for six years.

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CMA Federal Wrap Up 2021 This program is a significant step forward in helping our nation address racial injustice and advance health equity. It will lead to real improvements in building a more equitable health care system for providers and patients.

Also this year, CMA supported multiple bills that addressed racial injustice and health care disparities and promoted adoption of AMA’s plan to “Embed Racial Justice and Advance Health Equity.”

Conclusion CMA was honored to fight for physicians in the virtual halls of Congress this year and we will keep fighting so that you can focus on your patients and not be hindered by administrative burdens, declining reimbursements or a devastating virus.

While Congress did not finalize all of CMA’s priorities, important groundwork was laid for Congress to enact a more stable Medicare payment system that keeps pace with increasing practice costs, Medicare Advantage prior authorization reforms, public service student loan forgiveness for California physicians, the health care provisions in the Build Back Better plan, permanent telehealth waivers and bills that address physician workforce shortages. CMA will continue to stand with you and advocate on your behalf.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare.

For the time being, we will be offering Zoom Meetings until we can get back to meeting in person.

This monthly forum is normally held on the second Wednesday of each month. Registration is required!

If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org for the Zoom call info!

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March 9th, 2022: 12:00PM to 1:00PM

“ New 2022 Laws that are affecting physicians and their practices” The California legislature experienced another unconventional legislative year due to the COVID-19 pandemic. While the reduction in the number of new laws continued for a second year, there was a notable emphasis on issues related to the COVID-19 pandemic and future public health emergencies, allied health professionals, health care plans, coverage and insurance, and mental health.

Please join us for a one-hour webinar to hear California Medical Association (CMA) Senior Counsel and Director of Legal Advocacy Joey Cachuela and Legal Counsel Lance Martin discuss the new 2022 laws that are affecting physicians and their practices, highlight pending health legislation and explain CMA’s legal resources available to members.

Joey Cachuela is Senior Legal Counsel for the California Medical Association where he focuses on CMA’s legal and legislative advocacy.

Prior to joining CMA, he was a senior associate at a boutique law firm specializing in health care litigation. Cachuela also served for seven years as a Judge Advocate in the United States Air Force, as regional counsel to the Air Force’s west coast medical centers, a federal prosecutor, and a deployed legal advisor to US ForcesAfghanistan.

Cachuela is a graduate of the University of Michigan, Ann Arbor, and UC Berkeley School of Law, where he served as submissions editor on the Asian American Law Journal at Berkeley Law and co-chair of the Asian Pacific American Law Student Association.

Lance Martin is Legal Counsel for the California Medical Association where he focuses on CMA’s legal and legislative advocacy.

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Prior to joining the CMA, he was a senior associate at a boutique law firm specializing in healthcare litigation and regulatory compliance matters, as well as a seconded attorney at Blue Shield of California. Lance is a graduate of the University of the Pacific and UC Davis School of Law.

April 13th, 2022: 12:00PM to 1:00PM

“ Top 5 Ways to Reduce Legal Exposure in 2022” In this presentation, attorney Jamie Bossuat will address five ways to reduce legal exposure in 2022. Topics will include: (1) common issues in business contracts, (2) independent contractor misclassification, (3) employee leaves of absence, (4) employee wage and hour pitfalls, and (5) reviewing employment policies.

Jamie M. Bossuat is a Shareholder with Kroloff, Belcher, Smart, Perry & Christopherson. Her practice consists of business and employment litigation and counseling.

May 11, 2022: 11:00AM to 1:00PM

Topic to Be Determined CMA PRACTICE RESOURCES CMA recoups $33 million on behalf of physician members In 2021, the California Medical Association (CMA) recovered nearly $3.2 million from payors on behalf of physician members. This is money that would have likely gone unrecouped if not for CMA’s direct intervention.

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That’s because Califor nia physicians have a powerful ally when it comes to dealing with problematic payors—CMA’s Center for Economic Services (CES). Staffed by practice management experts with a combined experience of more than 125 years in medical practice operations, the CES team has recovered over $33 million from payors on behalf of its physician members during the past 13 years.

CMA members can call on CMA’s practice management experts CMA recoups $33 million on behalf of physician members for free one-on-one help with contracting, billing and payment problems by contacting reimbursement helpline at (888) 401-5911 or economicservices@cmadocs.org.

Lear n more about how CMA’s practice management experts can help you at cmadocs. org/ces.

Anthem Blue Cross clarifies recent telehealth reimbursement policy update Anthem Blue Cross has clarified that for Califor nia providers, it will continue to reimburse telehealth services billed with either POS 02 or POS 10 at the in-office place of service rate, as currently required by the

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Califor nia Department of Managed Health Care (DMHC).

In its December 2021 Anthem Provider News, Anthem Blue Cross announced a reimbursement policy update, “Virtual Visits – professional and facility,” which indicated that telehealth services billed with place of service (POS) 02 (telehealth provided other than in patient’s home) or new POS 10 (telehealth provided in patient’s home) would be reimbursed at the non-office place of service rate. Because this new policy does not align with Califor nia’s telehealth parity requirements, the Califor nia Medical Association (CMA) asked Anthem to clarify whether the new policy applies to Califor nia physicians. Anthem agreed that this was an error and has issued a clarification notice.

The clarification issued by Anthem aligns with the DMHC all plan letter (APL) issued on September 4, 2020, which reminded DMHCregulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services, including telephonic visits, as they would for services provided in person. This APL confirmed that the prior APLs (20-009 and 20-013) remain in effect for the duration of Califor nia’s declared state of emergency or until further notice from DMHC, whichever is earlier.

For specific details about Anthem’s reimbursement policies, visit the anthem.com/ca website.

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2021 YEAR IN REVIEW The California Medical Association (CMA) was once again at the center of key state health care policy decisions and action. With CMA’s help, California helped set an example for the nation in vaccinating residents, even as we coped with the rise of the delta variant. In addition to our work on COVID-19, CMA won key victories for physicians in the state budget, helped increase funding for public health and continues to build our physician workforce to help deal with chronic shortages across the state.

COVID-19 Vaccines: CMA worked closely with the Newsom Administration to ensure all Californians had access to vaccines, providing mapping data and physician feedback to help the state build a distribution network that allowed community-based physicians to obtain vaccines for their patients.

CalVaxGrant: CMA helped establish and administer the CalVaxGrant program, which provided $40 million to physician practices to help offset the costs of obtaining, storing and administering COVID vaccines.

Justice, Equality, Diversity and Inclusion: CMA created new Standards for Cultural Linguistic Competency and Implicit Bias in continuing medical education.

Telehealth: CMA sponsored AB 457 (Santiago), which ensures patients can access telehealth services from their selected health care providers, rather than a third-party corporate telehealth provider.

Billing Disputes: CMA’s Center for Economic Services recouped more than $1 million from payors on behalf of physician members.

COVID-19 Payments: CMA sponsored SB 510 (Pan), which requires health insurers to cover the cost of COVID-19 tests and vaccine administration.

Vaping Tax: CMA helped pass an increase in the tax on e-cigarettes and vaping products to more closely mirror the taxes on other tobacco products. The bill also ensures future funding for physician workforce programs, such as the physician loan repayment program.

Physician Workforce: CMA successfully advocated to make permanent a portion of Prop. 56 tobacco funds to pay for physician loan repayment and graduate medical education.

State Budget: In the budget process, CMA helped ensure state policy conformed to federal tax law with regard to Paycheck Protection Program loans for physician practices and made permanent the Prop. 56 supplemental payments for Medi-Cal providers.

Visit cmadocs.org for more information.

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Public Health

Update

Childhood Vaccinations— Our Superhero Moment COVID-19 VACCINATIONS FOR CHILDREN AGES 5-17

BY DANIEL KIM, MPH, MCHES, HEALTH PROMOTION PROGRAMS COORDINATOR Tens of millions of children ages 5 to 17 already get vaccinated to protect against other infectious diseases.

Physicians must help send an equally empowering message behind COVID-19 vaccination, according to Dr. Paul Offit, director of the Vaccine Education Center and physician of infectious diseases at Children’s Hospital of Philadelphia.

“We need to try and explain to the parent—and to the child—that this makes them superheroes. This makes them Superman,” said Dr. Offit. “Now the virus or bacteria can just bounce off them. We need to do the best we can to do that.”

Public Health Services developed its Vaccine Superheroes campaign to help bring this message home. This upbeat approach is one way to help ensure our youngsters are fully vaccinated. Yet, we are not where we need to be.

On January 12, 2022, the Associated Press reported a rate of only 17% for COVID-19 vaccination rates in U.S. children ages 5 to 11, just two months after the Pfizer vaccine was authorized for this age group. At the time, California was just under 19%, while San Joaquin County was around 9%. As of publication, San Joaquin County continues to lag behind the state average.

Despite the initial fall surge of elementary school vaccinations soon after the COVID-19 vaccine was made available to this age group, distrust, misinformation, and delays from the holidays and winter storms slowed the pace of vaccinations—concerning public health officials that this may help fuel the ongoing pandemic.

Additionally, recent surges from the spread of the highly

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contagious Delta and Omicron variants have resulted in increased COVID-19 hospitalization rates among children under age 18 not seen in past surges. Many have other conditions worsened by COVID-19 but are not sick enough to require intensive care.

Use this guidance—from the U.S. Centers for Disease Control and Prevention (CDC), the American Medical Association, and the American Academy of Pediatrics—to talk with parents about safe, effective COVID-19 vaccines for children:

Dr. Maggie Park, San Joaquin County Public Health Officer and pediatrician, recognizes the critical role that local pediatricians, family medicine practitioners, nurses, pharmacists, and other vaccine providers have to help parents and caregivers understand the importance of COVID-19 vaccinations. We all play a part in assuring them COVID-19 vaccines are safe and effective for their children.

•R emind parents, all children 5 years of age and older without contraindications should get a COVID-19 vaccine as soon as possible.

“Healthcare providers are the most trusted source of information when it comes to vaccines,” says Dr. Park. “To protect the over 76,000 children ages 5-11 in the county now eligible for the pediatric dose, our medical community needs to take the time to talk to parents and caregivers about COVID-19 vaccines for their children. Please listen to their questions and concerns and address them actively and with empathy.” She also notes providers can support parents to feel more confident about vaccinating their children while addressing any barriers to accessing COVID-19 vaccines.

•R efer parents to the V-Safe smartphone text message tool, that can monitor the safety of the vaccine for their children.

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• P repare to discuss COVID-19 vaccine safety, specifically its development and effectiveness through the clinical trials with thousands of children prior to its authorization.

•B e sure to address potential allergy concerns.

•K now potential vaccine side effects. Discuss the overall benefits of being vaccinated--the lower risk for COVID-19 infection outweighs the risk of adverse reactions. Side effects from the vaccine have been mild

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can be hospitalized and develop serious complications like multisystem inflammatory syndrome (MIS-C) or post-COVID complications known as long-COVID. • Share how vaccinations help keep kids in school and protect vulnerable family members and siblings not yet eligible.

• Offer the COVID-19 vaccine along with other scheduled immunizations. This helps those behind on or due for immunizations or at increased risk from vaccinepreventable diseases. Like adults, they must still get two shots at least three weeks apart for maximum protection—though the dosage is one-third the quantity given to teens and adults and packaged in different vials.

• Listen to parents’ questions with empathy. Ask openended questions to explore their concerns. Listen without judgment and use motivational interviewing techniques to identify the roots of hesitation or misunderstanding.

Acknowledge their emotions, so they know they’ve been heard.

for most 5- to 11-year-olds, including pain in the arm where they received the shot, fatigue, headache, chills, and muscle aches.

• E xplain how COVID-19 can be serious in children. They

• Finally, share that COVID-19 vaccines remain effective against the original virus and many of its variants.

Your expertise goes a long way to bridging the gap some parents might be feeling toward COVID-19 vaccinations for their children. As Dr. Park shared for her resolutions in this next year, “Stay strong, stay safe, stay energized.”

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