Spring 2017

NEUROSURGERY’S

CHANGING

TIDE

SJMS Holiday Party Physician Burnout New Laws 2017 Spring 2017

Credentialed. Customized. Committed.

When is the last time your advisor ran you a comprehensive Financial plan? Contact us today to schedule your complimentary review.

3555 Deer Park Drive, Suite 160 Stockton • 209.546.6100 641 Fulton Ave, Suite 200 Sacramento • 916.414.8282 Nick Salvetti, CFP , CRPC ®

®

THESALVETTIGROUP.COM

A.J. Salvetti, CFP®, CRPC®

Securities offered through Raymond James Financial Services Inc., Member FINRA/SIPC. The Salvetti Group is an independent firm.

Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, Certified Financial Planner™ and CFP® in the U.S.

VOLUME 65, NUMBER 1 • MARCH 2017

{FEATURES}

14 18 24 34 SPRING 2017

SJMS HOLIDAY PARTY

{DEPARTMENTS} 42 IN THE NEWS

PHYSICIAN BURNOUT

58 PUBLIC HEALTH

NEW LAWS 2017

NEUROSURGERY’S CHANGING TIDE

New faces and Announcements Improve Food Security to Help Reduce Obesity

56 PRACTICE MANAGEMENT:

Committed to Improving Quality Health Care

63 NEW MEMBERS 65 IN MEMORIAM

SAN JOAQUIN PHYSICIAN

3

PRESIDENT Kwabena Adubofour, MD PRESIDENT-ELECT Grant Mellor, MD PAST-PRESIDENT John Zeiter, MD SECRETARY-TREASURER George Savage, MD BOARD MEMBERS Raissa Hill, DO, Dan Vongtama, MD, Alvaro Garza, MD, MPH, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD

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

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Kwabena Adubofour, MD, Lisa Richmond MANAGING EDITOR Lisa Richmond

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

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS James Noonan, Kwabena Adubofour, MD, Alvaro Garza, MD, MPH, Daniel H. Kim, MPH, MCHES, David Jensen, MD

SCHOLARSHIP LOAN FUND Matthew Wetstein, PhD THE SAN JOAQUIN PHYSICIAN MAGAZINE

CMA HOUSE OF DELEGATES REPRESENTATIVES

is produced by the San Joaquin Medical Society

Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Roland Hart, MD,

SUGGESTIONS, story ideas or completed stories written

Grant Mellor, MD, Kwabena Adubofour, MD,

by current San Joaquin Medical Society members

Raissa Hill, DO, Ramin Manshadi, MD

are welcome and will be reviewed by the Editorial Committee.

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

4

SAN JOAQUIN PHYSICIAN

SPRING 2017

TAKING CARE OF BUSINESS Experience the benefits of working with an award-winning local community bank.

Build a relationship with experienced banking professionals who listen to your needs. Benefit from customized banking solutions and cutting-edge technology.

Your community bank

SPRING 2017

SAN JOAQUIN PHYSICIAN

5

EXECUTIVE DIRECTOR’S REPORT

2017 MEMBER SURVEY IS HERE! There has been a lot of excitement buzzing around SJMS. Our current Board of Directors is one of the most enthusiastic in recent history with innovative and exciting ideas! We have been using this energy to evaluate our current benefits and engagement opportunities for our members. It began with positive round table discussions and what we discovered amongst our board is that their priorities and interests are as diverse as our membership as a whole. Ultimately, we realized that in order to focus our valuable time and limited resources, we needed to take the pulse of our membership. This is where you come in! We need your feedback via the 2017 Membership Survey. We will be emailing it to all active members, for whom we have a valid email address, on Monday, March 6. Please be sure to check your spam folder just in case. We have also posted it online at www.sjcms.org and our brand NEW Facebook page.

LISA RICHMOND

We are excited to announce that the Public Health Committee is back, with 20 members meeting on a quarterly basis. This committee is a physician led, grassroots effort charged with the task of developing a plan for SJMS to help inform/educate the public, with attention to policymakers (elected, organizations, etc.), through advocacy for equal opportunities for better health for everyone.

Please call our office for more information.

With the seemingly constant increase in regulatory burdens coupled with increasing patient loads, it would make sense that many physicians are feeling overwhelmed. CMA has made physician burnout one of their priority issues this year and is offering a variety of resources in the form of webinars, articles and even a free “confidential assistance line.” This 24- hour phone service provides completely confidential doctor to doctor assistance to those struggling with depression, anxiety, stress, alcoholism and/or drug abuse. The first article (of many) on this topic is included in this issue.

As part of our local wellness initiative, we will be identifying and helping physicians create “interest groups.” The hope is that these groups and activities will create a sense of camaraderie and fellowship amongst physicians who have the same interests or hobbies and, ultimately, provide some degree of stress relief. The first, a cycling club, is being championed by Drs. Jensen and Senegor. Please read more from Dr. Jensen on page12 and be sure to tell us about your hobbies when you take the survey.

Finally, please save the date(s) for our 8th Annual Golf Tournament to benefit The First Tee of San Joaquin and SJMS’ own Decision Medicine Program on Sunday, April 30 at the lovely Stockton Golf and Country Club. See enclosed advertisement for more details. Our annual Young Physician and Lifetime Achievement Award Dinner will be held on Sunday, June 11. More information and invitations to follow!

All the best,

Lisa Richmond

6

SAN JOAQUIN PHYSICIAN

SPRING 2017

Sometimes You Just Need a Little Help.

EXCI

RAFFTING PRIZ LE E S

Eighth Annual Golf Tournament Join fellow San Joaquin Medical Society members and invited guests for a relaxing round of golf, BBQ lunch, dinner and after golf party. Exciting and generously donated raffle prizes you don’t want to miss. Plus an opportunity to benefit our local The First Tee of San Joaquin and SJMS’ Decision Medicine programs. Your hosts, Drs. Kwabena Adubofour, George Herron, Prasad Dighe and George Khoury are committed to making this an event to remember!

Sunday April 30, 2017 • Stockton Golf & Country Club • 4 Person Scramble $175 per golfer - Price includes green fees, golf cart, lunch, and entry into the raffle for a grand door prize (must be present to win) announced during the after golf dinner and party! New this year, invite a guest to join you for dinner! See registration form for details. $50 of every entry fee goes to The First Tee of San Joaquin program Hole Sponsorships benefit SJMS’ Decision Medicine Program

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

To sign up, please call the San Joaquin Medical Society office at 209-952-5299 SPRING 2017

Ei gh t h A n n u a l

SAN JOAQUIN PHYSICIAN

7

THE RIGHT DOC MAKES IT ALL BETTER.

We all want to make healthy choices. At Kaiser Permanente, you’ll get a wide selection of doctors to choose from. So you can find the one with the experience and the personality that best fits you and your needs. And if you ever change your needs or your mind, you can change your doctor at any time.

Visit kp.org today because together we thrive.

A message from our President > Kwabena O.M. Adubofour, MD, FACP

ZIP Code Impacts Your Patient’s Health More Than Genetic Code and You can do Something about it

“Physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction” Rudolph Virchow 1821-1902 I think that what Virchow was also attempting to do in the quote above was to get us to remember that, even though genetics can shape our proneness to certain diseases and can shape some clinical outcomes but so can other factors which may be more important:

ABOUT THE AUTHOR ­ Kwabena O.M. Adubofour, MD, FACP Medical Director, East Main Clinic and Stockton Diabetes Intervention Center and Current President of San Joaquin County Medical Society.

• S ocial determinants of health – which speaks to issues impacting income, poverty and inequality.

• S ocial environment – which deals with such issues as crime rates and the affluence of the neighborhood our patients call home.

• P hysical environment – the question here is what is the interplay of living in an environment with heavy industry, a neighborhood with no parks and no access to healthy foods and no walkable paths and health outcomes?

•T hese three factors should form the foundation for good and accountable public health. These same factors should form the basis of how we look at each patient and should inform what we do as a medical society outside the walls of our individual consulting rooms.

Geographic Information Systems and Data Generation: Technological advances in geographic information systems, including digital software, maps and longitudinal data sets on socioeconomic and environmental factors, can be used to describe multiple aspects of an individual’s community and environment. The use of electronic health records allows clinical data to be matched with environmental and other factors impacting the health of those we see in our clinics. This link has relevance to clinical care and research and should be driving our public health and disease prevention efforts1.

SPRING 2017

SAN JOAQUIN PHYSICIAN

9

A message from our President > Kwabena O.M. Adubofour, MD, FACP

Some Evidence: A set of maps created by the Robert wood Johnson Commission to build a Healthier America dramatically illustrates the impact of ZIP codes on longevity. Community members living only a few miles apart may have a 25year gap in life expectancy. This is not acceptable.

Here in California, the Building Healthy Communities is a 10 year, $1 billion comprehensive initiative launched by The California Endowment. The project aims to transform 14 of California’s communities most devastated by health inequities into places where all people have an opportunity to thrive2 . These efforts have been led by Anthony Iton, MD. His

is not non-compliance. We are part of the solution. We need clinicians willing to act locally in engaging policy makers and sharing information that may impact the future design and location of local factories.

The obese patient with type 2 diabetes who is experiencing difficulty in shedding weight cannot arbitrary be labelled as non-complaint. We are part of the solution. We need to act locally by informing policy makers about the link between the absence of parks and the high obesity prevalence, about the absence of good, well stocked grocery stores and high disease prevalence.

We have to be present, we have to be engaged in the deliberations of our We rank in the middle of the pack among other developed nations for city councils and town planning commissions. outcomes even though we outspend all the other nations. We need to We need to inform them about the fact that what is make changes globally but we can begin by acting locally. adversely impacting our patients and killing them work in this area has shown that every additional $12,500 in is not their genetic code but their ZIP code. household income buys one year of life expectancy. A visit to the California Endowment website allows one to compare life It is now time for us to use clinical-community data sets to expectancy by home address. make community-wide decisions in terms of public health, health promotion and disease prevention.

Not surprisingly, there is a disparity in disease prevalence by ZIP codes and it impacts every ethnicity locally in San Joaquin Here at the medical society, we aim to make a difference. We county. The difference is striking as you move northwards from need your help to be effective advocates. Our Public Health ZIP code 95206 to ZIP code 95219. It becomes fairly obvious Committee under the chairmanship of Alvaro Garza, MD, that individuals living in neighborhoods with limited parks needs you. We are planning for several initiatives to disrupt the and physical activity resources and living in food deserts have a detrimental impact of ZIP codes on the health and wellbeing higher prevalence of type 2 diabetes and other cardiovascular of the citizens of this county. Please think about becoming a ailments. The California Endowment website enables one to member of the various committees of the medical society. We compare life expectancy by home address/ZIP codes as well. are united in speaking with one voice in holding policy makers accountable for more green space and in the elimination of Clinicians as natural attorneys/advocates: food deserts and in reaching out to county residents to be more responsible when it comes to decisions concerning their health.

We spend a lot of money on healthcare in this country but unfortunately most of that money is devoted to non-disease prevention efforts. We rank in the middle of the pack among REF: 1 other developed nations for outcomes even though we Hirsch A, Schwartz BS: Why ZIP code may influence outspend all the other nations. We need to make changes health more than genetic code. http://www.newsweek. globally but we can begin by acting locally. com/ZIP-code-health-genetic code-514226 That asthmatic patient who is always in the emergency room may be living in a heavily polluted environment. The problem

10

SAN JOAQUIN PHYSICIAN

2

uilding Healthy Communities: http://www.

B calendow.org/building-healthy-communities/

SPRING 2017

Toni Brayer, MD Board of Governors

MIEC has just announced $11 Million in dividends* to be distributed to policyholders in 2017

MIEC continues to support policyholders and their communities!

MIEC has a dividend policy that is vastly superior to our competitors and we’ve never lost site of the medical associations who back our policyholders. Our mission: provide our policyholders and local medical communities with the exemplary service and support they deserve.

Added value: n No profit motive and low overhead n Local Claims office in Northern and Southern California n Supports organized medicine in California For more information or to apply: n www.miec.com n Call 800.227.4527 n Email questions to underwriting@miec.com * On premiums at $1/3 million limits. Future dividends cannot be guaranteed.

MIEC 6250 Claremont Avenue, Oakland, California 94618 • 800.227.4527 • www.miec.com SJMS_01.31.17 SPRING 2017

MIEC OwnedSAN byJOAQUIN the policyholders we protect.

PHYSICIAN 11

By David Jensen, MD

HOW ABOUT A

CYCLING GROUP? Dr. Kwabena Adubofour has asked Dr. Moris Senegor and me to consider organizing a cycling group within our Medical Society. As such, we are soliciting our members to determine if there is interest.

I have always enjoyed riding a bicycle. About seven years ago I took it to a higher level. I was involved with an early morning running group in our Brookside neighborhood that included Drs. John Canzano and Mario Sattah. I sarcastically refer to this group as a Think Tank because our discussions are mostly humorous and entertaining. Nothing too intellectual like you might expect with the Hoover Institute or similar organization. Anyway, the running group is also into road cycling. So to continue to hang with these hilarious people, I went all in with a custom fit carbon fiber road bike, clip-in pedals, loud spandex bike wear and everything else.

Our initial rides were around Woodbridge, Acampo and, Linden.

My first long ride was around Lake Camanche and over Pardee Dam, about 40 miles in the beautiful Sierra Nevada foothills. That was a lesson in the importance of continuous nutrition and hydration to prevent cramping.

My second long ride was in the same location but this time all the way to Mokelumne Hill and back with Drs. Steve Eager, Roland Winter, Gary Murata and a couple of others. Immediately I knew I was in over my head. They were kind enough to wait for me periodically but I didn’t want to hold them up. At one point my chain

came off which caused further delay. Roland came back to check on me. He told the others that I was attacked by a flock of wild turkeys! We eventually made it to Mokelumne Hill for a rest stop. I returned safely by myself while the others continued riding.

Since then I have had countless memorable rides including one around Lake Tahoe, 3 century rides (100 miles) in Sonoma , Monterey, and the Berkeley hills to name a few, not to mention our beautiful country roads in San Joaquin County and the neighboring foothills. I also enjoy the American River Bike Trail in Sacramento.

Today’s road bikes are incredibly efficient and very fun to ride! Mountain bikes and hybrid bikes are other options. Some even come with electric motors if you think you might need assistance!

I have to thank the Think Tank for introducing me to this wonderful sport, as well as former St. Joseph’s COO Mike Ricks. I’m not an expert in the field but I might know enough to help any of you get started if you are interested.

I can also repair your flat tire!

CONTACT

me or Dr. Senegor (943-0305) if you are interested.

David Jensen, MD l Dr.David.Jensen@DignityHealth.org l 209 461-5338

12

SAN JOAQUIN PHYSICIAN

SPRING 2017

The 14th Annual Stockton Diabetes Seminar

FOSTERING EXCELLENCE IN

DIABETES CARE Target Audience: NURSES, PHARMACISTS, CDE’s and PHYSICIANS

This NO FEE SEMINAR for licensed professionals includes: • Free continental breakfast and lunch • Networking opportunities with healthcare providers engaged in innovative diabetes care

8:00am to 2:00pm

• Updates on recent and important advances in diabetes care

UNIVERSITY OF THE PACIFIC

• Free CME & CEU Credits

Saturday | March 11 | 2017

DeRosa Center | 3601 Pacific Avenue, Stockton 95211

REGISTRATION REQUIRED Please call the San Joaquin Medical Society at 209-952-5299

In lieu of a conference fee, we kindly ask that you donate two children’s books.

These books will be donated to Reach Out & Read San Joaquin® and HPSJ’s Little Free Library. By building on the unique relationship between parents and medical providers, these programs help families and communities encourage early literacy skills so children enter school prepared for success.

SUPPORTED BY: Health Plan of San Joaquin Dameron Hospital San Joaquin Diabetes Society Dignity Health St. Joseph’s Medical Center San Joaquin Medical Society

SPRING 2017

SAN JOAQUIN PHYSICIAN

13

ANNUAL HOLIDAY PARTY Honoring Outstanding Achievement in Medicine Award Recipient,

BENNET OMALU, MD

16

SAN JOAQUIN PHYSICIAN

SPRING 2017

SPRING 2017

SAN JOAQUIN PHYSICIAN

17

PHYSICIAN BURNOUT Being a physician is for many a calling. They are drawn to the practice of medicine, motivated by a deep-seated desire to help and heal. “Being a physician is not just something we ‘do,’ it is something we ‘are,’” says Ruth E. Haskins, MD, president of the California Medical Association. “What brings us joy, almost universally, is caring for patients.”

Yet 75 percent of California doctors are showing signs of burnout, according to a 2016 Physicians Foundation study.

This survey, conducted biennially since 2008, has consistently demonstrated that the professional morale of physicians is declining, due in large part to regulatory and paperwork burdens that limit the time physicians can spend with patients and a loss of clinical autonomy.

“We’d much rather have our hands on our patients than our hands on our keyboards,” says Dr. Haskins.

>>

PHYSICIAN BURNOUT

“At many practices, nurses and medical assistants were entrusted, while operating under physiciandesignated protocol, with filtering

ELECTRONIC AND PAPER INFORMATION THAT WOULD NORMALLY PASS TO PHYSICIANS.”

TO SEE THE FULL STUDY, GO TO annfammed.org/content/11/3/272.full

20

SAN JOAQUIN PHYSICIAN

So how can physicians gain control of the things that burn them out and reclaim the joy in their practices? A 2013 study published in the Annals of Family Medicine looked at high-functioning primary care practices that had put into place innovations to help mitigate physician burnout. The authors found that a shift from a physician-focused care model to a “shared-care” model, with a greater focus on clinical support staff and more frequent daily staff and physician communication, could decrease the amount of tedious work that needs to be done, resulting in more personal satisfaction for physicians.

While the study’s authors said that no single practice they studied had solved every issue for physicians, they did find unifying themes that created greater physician satisfaction: • P ractices that build stable, well-trained teams that work together every day and meet regularly to improve their work can create efficient work f lows and rewarding practice environments.

• S tandardized work f lows with higher levels of clinical support personnel can make practices less chaotic, save time and meet patients’ needs more quickly.

•T eamwork is facilitated by proximity of workstations and frequent forums for interaction. Thoughtful physical layout with co-location of staff and line of sight enhances communication.

• F ace-to face verbal communication is often more effective, efficient and enjoyable than circulating asynchronous electronic messaging.

Researchers found that the most successful practices at balancing work/life for physicians had instituted changes like these: •A ll patients received pre-visit planning that included lab tests. Lab tests were scheduled and performed several days in advance of the patient visit so that the results could be discussed. The pre-planning was done in conjunction with the physician by a medical assistant or nurse. In one practice, the medical assistant’s role was expanded to include medication review, agenda setting, form completion and closing care gaps.

• S ix of the practices entrusted support personnel to serve as a physician scribe for each patient visit. They captured the physician’s medical notes for the patient record, entered orders, prepared the after-visit summaries and reinforced the care plan with the patient.

• P rescription renewals were re-engineered so that stable prescriptions were renewed for a year during an annual comprehensive care visit. This prevented unnecessary interval handling of renewals.

•A t many practices, nurses and medical assistants were entrusted, while operating under physician-designated protocol, with filtering electronic and paper information that would normally pass to physicians. These “physician extenders” passed on only information that specifically required a physician’s level of expertise. The physician was kept up-todate verbally so nothing was lost between patient and physician. This decreased inbox work for physicians substantially and helped filter out normal laboratory results, prescription renewals and other requests that could be handled by delegates or well-trained assistants.

• S ome practices allowed time in their schedules for brief team meetings

SPRING 2017

throughout the day. In one large practice, physicians decided to colocate their work stations so they sat side by side with their nurses and medical assistants, allowing for an easy f low of information between physicians and team members.

CMA DOC: BRYAN BOHMAN, MD Palo Alto anesthesiologist helps launch groundbreaking Stanford WellMD program Burnout is an insidious psychological phenomenon consisting of two main elements: depersonalization and emotional exhaustion, says Dr. Bohman, who is Associate Chief Medical Officer at Stanford Hospital and Clinics and Interim Director of Stanford’s new WellMD Center.

Burnout impairs not only the physician’s ability to provide optimum care for patients, but it also can have a devastating impact on the physician’s personal life, as evidenced by physician suicide rates that are twice the national average. “We have unfortunately had tragic experiences with this among our own Stanford trainees and faculty colleagues over the past several years,” he “EMRs are perhaps the biggest pain point for says. our physicians. They need to be improved in Physicians are in terms of the end user. Connecting with patients many ways a highly is where physician satisfaction comes from. We privileged group, he said, but surely cannot do a good job if we spend most of our this does not justify time checking boxes.” – Bryan Bohman, MD exposing them to this shockingly high risk of burnout. Burnout is not a minor consideration and does not simply ref lect a sense of being “overworked and underpaid.”

One of Dr. Bohman’s primary areas of interest is the relationship between physician wellness and health care system performance. While serving as Chief of Staff at Stanford Hospital and Clinics he established a medical staff wellness committee to advocate for appropriate attention to physician wellness across Stanford. As chair of this committee for its first four years, he led the charge to measure and address Stanford physicians’ burnout levels as well as their professional fulfillment.

The result was the 2015 launch of the Stanford WellMD Center, aimed at improving the health and professional fulfillment of physicians. The program has been funded for five years by the Stanford School of Medicine, Stanford Health Care and Stanford Children’s Health.

It is Stanford’s goal to better equip the faculty, students and researchers to meet the challenges of clinical practice for physicians where increased productivity, lower costs, improved patient experience and better population health outcomes are now the norm, says Dr. Bohman.

SPRING 2017

IMPROVING PRACTICE WORKFLOWS KEY TO COMBATING PHYSICIAN BURNOUT Provider stress and burnout can have a significant impact on organizational productivity, morale, costs and the quality of care being delivered.

On the previous pages we looked at how "shared care" models can increase physicians' professional satisfaction and combat the epidemic of physician burnout.

One of the key takeaways is that improving workflows within the practice is a powerful antidote to burnout.

The American Medical Association's STEPS Forward™ collection includes a number of "Workflow and Process" educational modules that provide practical guidance on practice redesign to improve workflow, communication and practice culture. Continuing medical education credit can be earned from each module.

For more information, visit www.stepsforward.org.

SAN JOAQUIN PHYSICIAN

21

PHYSICIAN BURNOUT

“Studies show when physician wellness is ignored, THERE ARE

ALSO CONSEQUENCES FOR PATIENTS – medical errors are one such consequence. “

Statistics show that the professional well-being of U.S. physician workforce is threatened, with as many as 50 percent of academic physicians, and over 75 percent of trainees, showing symptoms of burnout in recent surveys, he said. “This extraordinary level of physician stress and burnout takes a toll not just on the affected individuals, but also has serious effects on the health of both patients and the entire organization.”

A 2013 survey of Stanford physicians found a significant portion (26 percent) reported one or more symptoms of burnout. The survey found that clinically focused faculty had higher burnout rates and lower professional fulfillment than research faculty or community physicians/adjunct faculty.

Another key finding from the Stanford survey was that burned out physicians leave Stanford at a rate twice that of those who do not suffer from burnout. “We need these physicians to stay at Stanford,” he said. “So it’s really important that we build a culture and a clinical practice environment that supports work life balance and the professional fulfillment of our people. That’s what will alleviate their burnout and keep them here despite the crazy housing prices on the Peninsula.”

The financial impact of attrition on Stanford Medicine is also steep— the combination of direct recruiting costs along with lost clinical revenue can easily exceed $1,000,000. That is in addition to the costs of reduced productivity and clinical quality associated with burnout.

EMRS DRIVING UP BURNOUT RATES

EMRs have become a crushing burden. Instead of just collecting clinical data, they have become billing tools, quality tools and the required data capture can impair physicians from connecting with their patients, he said.

“Connecting with patients is where physician satisfaction comes from.

We cannot do a good job if we spend most of our time checking boxes.

FREE CME: SIX STEPS TO IMPROVE PHYSICIAN RESILIENCY Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models— reduce the amount of time physicians spend delivering direct patient care. Physicians often experience burnout caused by demanding workloads, nights on call and other common stressors. Learning resiliency helps physicians have longer, more satisfying careers and reduces the risk of burnout.

The American Medical Association (AMA) STEPS Forward™ collection includes a module, “Improving Physician Resiliency,” that includes six ways to improve resiliency in a demanding practice environment and ways to prevent burnout. The module will help physicians identify tools and resources to increase

22

SAN JOAQUIN PHYSICIAN

resiliency, assess personal and professional contributors to stress, and identify and prioritize values in all aspects of their lives.

Launched by AMA in June 2015, STEPS Forward now includes 43 free interactive educational modules aimed at helping physicians redesign their medical practices to minimize stress and reignite professional fulfillment in their work. Continuing medical education (CME) credit can be earned from each module.

For more information, visit www.stepsforward.org.

SPRING 2017

CONFIDENTIAL ASSISTANCE

Asking for help is one of the most difficult and heroic things you can do. The Physicians' and Dentists' Confidential Assistance Line is here to help. This 24-hour phone service provides completely confidential doctor-to-doctor assistance.

This service is free and it will not result in any form of disciplinary action or referral to any disciplinary body. Our goal is to help, not to discipline.

Call: (650) 756-7787 (Northern California)

(213) 383-2691 (Southern California)

Improving our physicians’ experience with the EMR is a key goal.”

Accordingly, the WellMD program has allied with the Chief Medical Information Officer to search for solutions.

They are also working with administrative leadership in the two Stanford hospitals to build care processes that are more efficient and reliable. “We believe that physician wellness should be an explicit consideration in strategic and operational decision-making across Stanford Medicine,” said Dr. Bohman.

Studies show when physician wellness is ignored, there are also consequences for patients – medical errors are one such consequence. Depressed resident physicians made medication errors at six times the rate of residents who were not depressed and sleep-related impairment has also been shown to have direct impact on the quality of patient care in addition to being harmful to the affected physician’s psychological and physical well-being, said Dr. Bohman.

“We want to encourage a culture where the effects of the academic and clinical environment on physician health and professional fulfillment are seen by all as an essential consideration in creating the highest quality academic health care system,” he said.

AS PART OF THAT EFFORT, THE WELLMD PROGRAM HAS AMBITIOUS GOALS:

• E mbed wellness education and initiatives in medical student and trainee curricula; • I ntegrate support for physician wellness in leadership roles and responsibilities • P rovide access to child care and affordable housing for trainees and early career physicians;

SPRING 2017

• Find ways to make it more practical for physicians to participate in paternity leave, maternity leave, elder care and family leave; and • Establish space and venues to encourage professional interaction and wellness (including physician lounges, exercise opportunities and healthy food options).

These are just a few of the initiatives that the program plans to enact in its efforts to slow physician burnout at Stanford.

Plenty of changes to the program are coming, Dr. Bohman said. In 2017 the program will hire a new director and a new burnout survey of the school’s physicians has just been completed. “Based on national trends showing worsening of epidemic levels of physician burnout, and considering that our center is just starting its real work, I don’t expect to see our Stanford burnout levels improved from 2013. If it holds steady this time around, I would be very happy. But the status quo is truly unacceptable, and our longer term goal is to make a large dent in these numbers and to have a large impact on the lives of our physicians, our patients and all the members of our health care teams.”

LEARN MORE ABOUT THE STANFORD WELLMD PROGRAM

Visit http://wellmd.stanford.edu for more information.

California’s doctors aren’t just health care and medical experts.

They’re also community leaders, philanthropists, entrepreneurs and policymakers dedicated to ensuring that patients receive quality health care at an affordable cost. #CMAdocs showcases California physicians leading the charge to help their communities thrive. Visit www.cmanet.org/cmadocs.

SAN JOAQUIN PHYSICIAN

23

2017

NEW HEALTH LAWS

Significant new California laws of interest to physicians The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on health care coverage, drug prescribing, public health, and workers’ compensation issues. On the following pages you will find highlights of the most significant health laws of interest to physicians.

ADVERTISING AB 2744 (Gordon) – Healing arts: referrals

Provides that the payment or receipt of consideration for advertising, wherein a licensed healing arts practitioner offers or sells services through a third-party advertiser, does not constitute a referral of patients when the third-party advertiser does not itself recommend, endorse, or otherwise select a licensee. Requires that a licensee disclose in the advertisement that a consultation is required and that the purchaser will receive a refund if not eligible to receive the service. Specifies that these provisions do not apply to basic health care services or essential health benefits, as defined.

24

SAN JOAQUIN PHYSICIAN

CLINICAL TRIALS AB 1823 (Bonilla) – California Cancer Clinical Trials Program

Establishes the California Cancer Clinical Trials Program to increase patient access to eligible cancer clinical trials in underserved or disadvantaged communities and populations.

Requests the University of California (UC) to establish and designate an institute or office with the authority to solicit and receive funds from business, industry, foundations, and other private and federal sources for the purpose of administering the program. Establishes a five member board to administer the program. Authorizes the UC to use its own state source funds for oversight and administration of the program relating to the initial start-up costs of the program only, provided the UC is reimbursed

SPRING 2017

New Laws > 2017

from federal and private sources funds. Requires the program, on receipt of funds totaling $500,000, to establish the Cancer Clinical Trials Grant Program to increase patient access to cancer clinical trials in underserved or disadvantaged communities and populations.

that uses existing information, but which does not include prospective interaction with human subjects.

CONFIDENTIAL INFORMATION

Until January 1, 2024, authorizes a federally certified critical access hospital to employ physicians and surgeon or doctors of podiatric medicine and charge for professional services rendered by those medical professionals if the medical staff concur by an affirmative vote that the professional’s employment is in the best interest of the communities served by the hospital and the hospital does not direct or interfere with the professional judgment of a physician and surgeon, as specified. Requires the office, on or before July 1, 2023, to provide a report to the Legislature containing data on the impact of this authorization on federally certified critical access hospitals and their ability to recruit and retain physicians and surgeons, as specified.

AB 1671 (Gomez) – Confidential communications: disclosure

CMA Position: Support Makes it a crime for a person who unlawfully eavesdrops upon or records a confidential communication with a health care provider, to intentionally disclose or distribute the contents of the confidential communication in any manner, in any forum, including on Internet websites and social media, or for any purpose without the consent of all parties to the confidential communication unless specified conditions are met.

AB 2828 (Chau) – Personal information: privacy: breach

Requires any agency, person, or business that owns or licenses computerized data that includes personal information to disclose a breach of the security of the system to any California resident whose encrypted personal information was, or is reasonably believed to have been, acquired by an unauthorized person, if the encryption key or security credential was, or is reasonably believed to have been, acquired by an unauthorized person, and the entity that owns or licenses the encrypted information has a reasonable belief that the encryption key or security credential could render that personal information readable or useable.

SB 514 (Anderson) – California Health Benefit Exchange

Prohibits the California Health Benefit Exchange (Covered California) from disclosing personal information obtained from an application for health care coverage to a certified insurance agent or certified enrollment counselor without the consent of the applicant, unless the agent or counselor is assisting the applicant. Does not preclude Covered California from sharing information of current enrollees or applicants with the same counselor or insurance agent of record, as specified.

SB 1238 (Pan) – Inmates: biomedical data

CMA Position: Support Specifies that biomedical research does not include the accumulation of statistical data in the assessment of the effectiveness of non-experimental public health programs or treatment programs in which inmates routinely participate.

Authorizes records-based biomedical research involving inmates

SPRING 2017

CORPORATE BAR AB 2024 (Wood) – Critical access hospitals: employment

DRUG PRESCRIBING AND DISPENSING AB 1668 (Calderon) – Investigational drugs, biological products, and devices

Enacts the Right to Try Act authorizing the manufacturer of an investigational drug, biological product, or device that is not yet approved by the United States Food and Drug Administration (FDA) to make the investigational product available to an eligible patient with a serious or immediately life-threatening disease or condition, as specified, when that patient has considered all other treatment options currently approved by the FDA, has been unable to participate in a relevant clinical trial, and for whom the investigational drug has been recommended by the patient’s primary physician and a consulting physician. Authorizes, but does not require, a health plan to provide coverage for any investigational product made available pursuant to this law. Specifies other criteria and requirements for the use of investigational drugs.

AB 1748 (Mayes) – Pupils: pupil health: opioid antagonist

CMA Position: Support Authorizes a pharmacy to furnish naloxone hydrochloride or another opioid antagonist to a school district, county office of education, or charter school if certain conditions are met. Requires the school district, county office of education, or charter school to maintain records regarding the acquisition and disposition of naloxone hydrochloride or another opioid antagonist furnished by the pharmacy for a period of 3 years from the date the records were created. Authorizes the provision of emergency naloxone hydrochloride or another opioid antagonist to school nurses and trained personnel. Immunizes physicians for issuing a prescription

SAN JOAQUIN PHYSICIAN

25

26

SAN JOAQUIN PHYSICIAN

SPRING 2017

New Laws > 2017

or order for such purposes. This bill contains other related provisions and other existing laws.

SB 482 (Lara) – Controlled substances: CURES database

Requires a health care provider authorized to prescribe, order, administer, or furnish a controlled substance to consult the Controlled Substances Utilization Review and Evaluation System (CURES) prior to prescribing a Schedule II, III or IV drug to a patient for the first and at least once every four months thereafter if the substance remains part of the treatment of the patient. Provides exemptions under specified conditions. Authorizes a health care practitioner to provide a patient with a copy of the patient’s CURES patient activity report.

SJR 29 (Hernandez) – EpiPen: pricing.

Senate joint resolution measure to urge the U.S. Food and Drug Administration to reconsider its denial of approval for generic alternatives to the epinephrine auto-injector EpiPen and urge the U.S. Congress to investigate the impact that Mylan’s monopoly has had on the price hikes for EpiPen, and urges the Congress and President to take action to limit the unrestrained ability of drug manufacturers to increase prices based only on what the market can bear.

HEALTH CARE COVERAGE AB 72 (Bonta) – Health care coverage: out-of-network coverage

Requires a health care service plan, for contracts and health policies issued, amended, or renewed on or after July 1, 2017, to provide that if an enrollee or insured receives covered non-emergency services in a contracting health facility provided by a non-contracting individual health professional, that enrollee or insured would be required only to pay the “in-network cost-sharing amount” unless the enrollee or insured provides written consent that satisfies specified criteria. Establishes a payment rate which is the greater of the health care service plan or health insurer’s average contracted rate for commercial products, as specified, or 125 percent of the amount Medicare reimburses for the same or similar services.

Requires the establishment of an independent dispute resolution process for claims and claim disputes related to covered nonemergency services provided at a contracted health facility by a noncontracting individual health care professional. Requires the development of a standardized methodology for plans and insurers to use in determining the average contracted rate. Limits enrollee and insured cost sharing for these covered services to costs no than those incurred had the services been provided by a contracting health professional unless the enrollee provides advance written consent to use out-of-network benefits.

SPRING 2017

SB 10 (Lara) – Health care coverage: immigration status

CMA Position: Support Requires Covered California to apply to the United States Department of Health and Human Services for a Section 1332 waiver to allow persons who are not otherwise eligible to obtain coverage through the Exchange because of their immigration status to obtain coverage from Covered California. Requires Covered California, after the waiver is granted, to require an issuer that offers a qualified health plan in the individual market through the Exchange to concurrently offer a California qualified health benefit plan to these individuals.

SB 923 (Hernandez) – Health care coverage: cost-sharing changes

CMA Position: Support Prohibits a health care service plan contract or health insurance policy from changing the cost sharing design, as defined, during the plan or policy year, except when required by state or federal law. Applies to grandfathered health care service plan contracts and health insurance policies and non-grandfathered health plan contracts and health insurance policies in the individual and small group markets that are issued, amended, or renewed on or after January 1, 2017.

HEALTH CARE FACILITIES AND FINANCING SB 867 (Roth) – Emergency medical services

CMA Position: Co-sponsor Extends until January 1, 2027, provisions of the Maddy Emergency Medical Services (EMS) Fund, which authorizes each county to establish an emergency medical services fund for reimbursement of costs related to emergency medical services.

Extends provision that authorize each county to elect to levy an additional $2 penalty for deposit into the EMS Fund for every $10 of fines, penalties, and forfeitures collected for criminal offenses and requires 15 percent of those funds collected to be used as funding for pediatric trauma centers.

SB 1365 (Hernandez) – Hospitals

Requires a general acute care hospital, except as specified, to notify patients scheduled for a service in a hospital-based outpatient clinic, as defined, when that service is available in a nonhospital-based location that may cost less. Defines “hospitalbased outpatient clinic,” for purposes of this bill, as a department of a provider, as defined in specified provisions of federal regulations, that is not located on the campus of that provider.

SAN JOAQUIN PHYSICIAN

27

28

SAN JOAQUIN PHYSICIAN

SPRING 2017

New Laws > 2017

MEDI-CAL AB 635 (Atkins) – Medical interpretation services

CMA Position: Support Requires the Department of Health Care Services (DHCS) to work with stakeholders to conduct a study to identify current requirements for medical interpretation services as well as education, training, and licensure requirements, analyze other state Medicaid programs, and make recommendations on strategies that may be employed regarding the provision of medical interpretation services for Medi-Cal beneficiaries who are limited English proficient (LEP), in compliance with applicable state and federal requirements. Establishes a pilot project to improve medical interpretation services.

AB 1696 (Holden) – Medi-Cal: tobacco cessation services

CMA Position: Support Requires Medi-Cal to cover tobacco cessation services only to the extent that federal financial participation is available and not otherwise jeopardized. Requires that the tobacco cessation services covered under Medi-Cal be subject to utilization controls and include all intervention recommendations assigned a grade A or B by the United States Preventive Services Task Force. Specifies that beneficiaries who are covered under this bill shall not be required to receive a particular form of tobacco cessation service as a condition of receiving any form or tobacco cessation service. Requires the Department of Health Care Services to seek any federal approvals necessary to implement the provisions of this bill.

SB 586 (Hernandez) – Children’s services

CMA Position: Support Authorizes the Department of Health Care Services to establish a Whole Child Model program under which managed care plans served by county organized health system or Regional Health Authority in designated counties would provide California Children’s Services (CCS) to Medi-Cal eligible CCS children and youth. Limits number of managed care plans that are eligible to participate in the program.

PROFESSIONAL LICENSING AND DISCIPLINE AB 2745 (Holden) – Healing arts: licensing and certification

Specifies that a physician or surgeon licensee who is otherwise eligible for a license but is unable to practice some aspects of medicine safely due to a disability is authorized to receive the limited license if specified described conditions are met, including payment of the appropriate fee. Clarifies the

SPRING 2017

Medical Board of California’s authority to: revoke, suspend, or deny a license for licensees and applicants who are guilty of unprofessional conduct, expands the Board’s authority to request medical records of deceased patients, authorizes specified disciplinary actions for licensed midwives, research psychoanalysts, and certified polysomnographic technologists.

SB 1177 (Galgiani) – Physician and Surgeon Health and Wellness Program

CMA Position: Sponsor Authorizes the Medical Board of California (MBC) to establish a Physician and Surgeon Health and Wellness Program for the early identification and appropriate interventions to support a licensee in his or her rehabilitation from substance abuse and authorizes MBC to contract with an independent entity to administer the program. Requires program participants to enter into an individual agreement with the program that includes, among other things, a requirement to pay expenses related to treatment, monitoring, and laboratory tests, as provided.

SB 1261 (Stone) – Physicians and surgeons: residency fee exemption

Removes the requirement that a physician and surgeon reside in California in order to receive a license fee waiver, when the license is for the sole purpose of providing voluntary and unpaid services.

PUBLIC HEALTH AB 1639 (Maienschein) – Pupil health: The Eric Paredes Sudden Cardiac Arrest Prevention Act

CMA Position: Support Establishes the Eric Paredes Sudden Cardiac Arrest Prevention Act that would require the California Department of Education to make available specified guidelines and materials on sudden cardiac arrest and warning signs. Requires pupils and parents to sign an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs before athletic participation. Requires training of coaches, athletic trainers, or authorized persons. Requires coaches to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity and sets other requirements for action in the event a pupil experiences specified symptoms.

AB 1719 (Rodriguez) – Pupil instruction: cardiopulmonary resuscitation

CMA Position: Support Requires, commencing with the 2018-19 school year, the governing board of a school district or the governing body of a charter school that requires a course in health education

SAN JOAQUIN PHYSICIAN

29

• One mile Discovery Trail featuring commentary on architecture and points of historic interest

• Home to the University Park World Peace Rose Garden • Ninth World Peace Rose Garden in the world • A destination for visitors to embrace serenity & quiet reflection • Features Inspirational Messages of Peace from local students

• An educational hub for the greater community Preschool College

• 102-acres in the Historic Magnolia District in Stockton • Home to medical, educational, retail and commercial related uses

• Energy efficient new buildings • Close proximity to both St. Joseph's Hospital and Dameron Hospital

A Sanctuary in the City

Located on 102-acres, University Park is a safe, fully landscaped and beautifully maintained park with easy access to and from major freeways, local hospitals, the courthouse, city and county offices.

University Park is home to the University Park World Peace Rose Garden and several medical and educational facilities with 24 hour security, on site medical labs and child care programs. At University Park, you can step out of the office for a breath of fresh air, a quick walk and peace of mind.

For more information, please contact dkeyser@grupe.com Grant & Magnolia Streets • Stockton, CA 95202 • universityparkstockton.com 30

SAN JOAQUIN PHYSICIAN

SPRING 2017

New Laws > 2017

for graduation from high school to include instruction in performing compression-only cardiopulmonary resuscitation, as provided. Encourages those entities to provide to pupils general information on the use and importance of an automated external defibrillator. Expands existing immunities from civil liability related to this law.

AB 2439 (Nazarian) – HIV testing.

Creates a pilot project to be administered by the California Department of Public Health (CDPH) to assess and make recommendations regarding the effectiveness of the routine offering of a human immunodeficiency virus (HIV) test in the emergency department of a hospital. Requires participating hospitals to offer an HIV test to any patient in the hospital emergency department, collect specified information, and to report the information to CDPH. AB 2640 (Gipson) – Public health: HIV

Requires a medical care provider or person administering a test for human immunodeficiency virus (HIV) to provide patients who test negative for HIV infection, and are determined to be at high risk for HIV infection by the medical provider or person administering the test, with specified information and information about methods that prevent or reduce the risk of contracting HIV, including, but not limited to, pre-exposure prophylaxis and post-exposure prophylaxis, consistent federal guidelines.

SB 1095 (Pan) – Newborn screening program

CMA Position: Support Requires the California Department of Public Health to expand statewide screening of newborns to include screening for any disease that is detectable in blood samples as soon as practicable, but no later than two years after the disease is adopted by the federal Recommended Uniform Screening Panel (RUSP) or enactment of this bill, whichever is later.

SB 1408 (Allen) – Tissue donation

Deletes the prohibition in existing law on the transplantation of tissue from a donor with HIV and instead permits such transplantation if the physician and surgeon performing the transplantation has ensured that the organ from an individual who has been found reactive to HIV may be transplanted only into an individual who has been found reactive for HIV before receiving the organ and is either participating in clinical research approved by an institutional review board pursuant to federal requirements, or if the U.S. Secretary of Health and Human Services determines that participation in this clinical research is no longer warranted as a requirement for transplants, as specified.

REPRODUCTIVE ISSUES SB 999 (Pavley) – Health care coverage: contraceptives: annual supply

CMA Position: Support Requires a health care service plan or a health insurance policy to cover, and authorizes a pharmacist to dispense, up to a 12-month supply of FDA-approved, self-administered hormonal contraceptives when dispensed at one time for an enrollee or insured at one time by a provider, pharmacist, or at

JAMES SAFFIER, MD On-Site Medical Director Internal Medicine, Hospice & Palliative Care

Choose Hospice of San Joaquin • Family Satisfaction Survey scores rated higher than the State and National Averages • Only Hospice with a Hospice House in San Joaquin County • Pediatric Care Team (209) 957-3888 | www.hospicesj.org 3888 Pacific Ave. Stockton, CA 95204

SPRING 2017

SAN JOAQUIN PHYSICIAN

31

Use State-of-the-Art Lumivascular Technology to Treat Patients with Peripheral Artery Disease

LUMIVASCULAR TECHNOLOGY: TWO IS BETTER THAN ONE! • Enhanced technology allows physicians to treat patients with PAD in a minimally invasive way, resulting in quick recovery time • Ocelot maneuvers through totally blocked arteries in the legs using an integrated “camera” to see from inside the artery • Pantheris allows for removal of plaque with unprecedented precision using an innovative image-guided therapy

Dameron Hospital is the first hospital in Sacramento, San Joaquin and Stanislaus counties to provide its community with these state-of-the-art technologies.

Ocelot Pantheris

32

“With the lumivascular technology system, we now have the means to help patients with PAD get on the road to recovery and better health.These two state-of-the-art medical technologies are just two more ways Dameron is enhancing their treatment capabilities with a goal of bringing better outcomes to patients and empowering physicians in their practice.” –Dr. Daren Primack, Dameron Hospital Medical Director for Peripheral Vascular Program

SAN JOAQUIN PHYSICIAN

FOR MORE INFORMATION ABOUT LUMIVASCULAR TECHNOLOGY AT DAMERON HOSPITAL, Call Our Physician Outreach Liaison at 209-715-3618.

SPRING 2017

New Laws > 2017

a location licensed or authorized to dispense drugs or supplies.

Incorporates chaptering amendments for SB 253 (Monning).

TOBACCO SBX2 5 (Leno) – Electronic cigarettes

CMA Position: Co-sponsor Defines the term “smoking” for purposes of the Stop Tobacco Access to Kids Enforcement Act. Changes the definition under the law of “tobacco products” to include electronic devices, such as electronic cigarettes, that deliver nicotine or other vaporized liquids, and makes the furnishing of tobacco product to a minor a misdemeanor.

adopt regulations to provide employees with notice regarding access to medical treatment following the denial of a claim.

Increases the penalty assessments and require the posting of a list of claims administrators who are in violation of data reporting requirements. Revises and recasts provisions related to utilization review with regard to injuries occurring on or after January 1, 2018. Modernizes data collection in the workers’ compensation system and implements anti-fraud measures in the filing and collection of liens.

SBX2 7 (Hernandez) – Tobacco products: minimum legal age

CMA Position: Co-sponsor Extends the applicability of specified provisions of the Stop Tobacco Access to Kids Enforcement Act, including but not limited to provisions prohibiting the furnishing of tobacco products to, and the purchase of tobacco products by minors to persons under 21 years of age. Authorizes the California Department of Public Health to conduct random, onsite sting inspections of tobacco product retailers. Exempts active military personnel who is 18 years of age or older as confirmed by a military identification card.

WORKERS’ COMPENSATION AB 2503 (Obernolte) – Workers’ compensation: utilization review

CMA Position: Support Requires a physician providing treatment to an injured worker to send any requests for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity, according to rules adopted by the Administrative Director of the Division of Workers’ Compensation.

SB 1160 (Mendoza) – Workers’ compensation

A Professional Law Corporation

MICHAEL R. MORDAUNT PETER J. KELLY RICHARD J. SORDELLO, JR. CORINNE K. REYNOLDS STEPHANIE ROUNDY LORI A. REIHL MELISSA I. DOUGHERTY

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

PROCEEDINGS • PERSONAL INJURY LITIGATION

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

CMA Position: Co-sponsor Requires the Administrative Director of the Division of Workers’ Compensation to

SPRING 2017

SAN JOAQUIN PHYSICIAN

33

N

NEUROSURGERY’S

BY JAMES NOONAN

CHANGING

TIDE

MAJOR CHANGES HAVE COME TO NEUROSURGERY IN THE CENTRAL VALLEY REGION, WITH DR . MORIS SENEGOR TAKING THE REINS OF SAN JOAQUIN GENERAL HOSPITAL’S NEW NEUROSURGERY DIVISION.

A bit of serendipity, mixed with a lifelong dedication to one of medicine’s most demanding specialties, has brought major changes to how neurosurgical care is delivered in San Joaquin County.

In early 2017, San Joaquin General Hospital began the rollout of a dedicated neurosurgery

division, with long-time local provider Moris Senegor, MD coming on board as the division’s chief of neurosurgery. The new division will now be the county’s only neurosurgical provider.

This represents a major step toward San Joaquin General’s longstanding goal of Level II trauma center certification. >>

“In its entire history, there have only been six neurosurgeons in San Joaquin County. That’s very unusual for any community of our size.”

36

SAN JOAQUIN PHYSICIAN

For referring physicians and patients seeking neurosurgical care, the shift is one of tectonic proportions, but for those examining the details, the situation is one that has been slowly developing over the course of more than a quarter century.

Since 1991, Dr. Senegor has practiced alongside Dr. Karl Gregorius at their office on 2209 N. California Street in Stockton. Recently the majority of the neurosurgical care delivered by this pair has taken place at St. Joseph’s Hospital. Senegor and Gregorius also provided neurosurgical coverage for San Joaquin General Hospital between 1991 and 2013, but over time, their caseload gradually diminished.

As the years rolled on, services became more and more localized to the facilities at St. Joseph’s, and as recently as last year, the hospital was the county’s primary neurosurgery provider. This localization, Dr. Senegor explains, is the result of a longstanding shortage of neurosurgeons in the region.

“In its entire history, there have only been six neurosurgeons in San Joaquin County,” he says.

“That’s very unusual for any community of our size.”

From 2013 onward, San Joaquin General Hospital utilized locum tenens neurosurgeons for

SPRING 2017

their newly nascent trauma program while Drs. Gregorius and Senegor remained the county’s sole private practice neurosurgeons.

Roughly a decade ago, Gregorius and Senegor began planning for the inevitable.

“Last year, Dr. Gregorius, at age 75, decided to finally retire,” Senegor said, noting that efforts to recruit new neurosurgeons for St. Joseph’s were unsuccessful. “The bottom line is that, in 2016, it became pretty clear that, with Dr. Gregorius out of the picture and no new neurosurgeons coming in, I could not continue on there by myself.”

Meanwhile, staff at San Joaquin General Hospital had been steadily working to upgrade the facility’s trauma center certification, having earlier gained Level III designation. Regional trauma center designation has long been an aspiration of the hospital, one which Dr. Senegor was acutely aware.

“Creating a functioning trauma center for that hospital has been their holy grail,” he said.

The next rung on the trauma center designation ladder – Level II – would require, among other things, for San Joaquin General Hospital to have reliable, round-the-clock neurosurgery coverage, which created an appealing set of circumstances for both the hospital leadership and Dr. Senegor.

“I was seeking alternative solutions when San Joaquin General approached me,” Senegor said.

“They made me a proposal that I couldn’t refuse.

It was quite a creative idea on their part.”

In addition to the establishment of a new neurosurgery division, consisting of Dr. Senegor, Dr. Azeem Oladunjoye and Dr. Abbas Bahari, San Joaquin General’s proposal also called for the repurposing of Senegor and Gregorius’ existing office space on N. California Street as a multispecialty outreach facility, giving the French Camp hospital a larger foothold in the greater Stockton community.

“It is a way of extending to the medical heartbeat of the town,” Senegor said. “To me, that was a very innovative vision.”

With the Stockton office facility, San Joaquin General will have the ability to serve patients from the larger community in a variety of medical and surgical specialties, while also allowing Dr.

SPRING 2017

N

“This seemingly overnight change in neurosurgery is a major shift in our community.

The referring physician community is accustomed to private practice neurosurgery at St. Joseph’s. Suddenly, there’s no neurosurgery anywhere in San Joaquin County outside of San Joaquin General Hospital. For your average practicing doctor, this is a major change.”

SAN JOAQUIN PHYSICIAN

37

Neurosurgery > Changing Tide

Senegor to maintain his robust list of current patients.

Leadership at San Joaquin General Hospital echo Senegor’s sentiment, noting that the new neurosurgery division and satellite office are ways of better executing the hospital’s mission, that of providing excellent care to the greater San Joaquin region.

“For us, this is really an extension of what we do,” said David Culberson, chief executive officer for San Joaquin General

Hospital, noting that the neurosurgery division represents a major step in the hospital’s advancement toward level II trauma center designation.

While the new developments have been exciting for all parties involved, according to Senegor, the transition won’t be without its challenges.

“This seemingly overnight change in neurosurgery is a major shift in our community,” he said. “The referring physician community is accustomed to private practice neurosurgery at St. Joseph’s.

Suddenly, there’s no neurosurgery anywhere in San Joaquin County outside of San Joaquin General Hospital.

For your average practicing doctor, this is a major change.”

Challenges are also present within Lawyers Who Solve the Legal Issues the walls of San Joaquin General, he Confronting Physicians notes, with all of the logistical and staffing issues that come with building Malm Fagundes LLP offers the strength and resources of a new division from the ground up. The attorneys and professional staff experienced in a range of services. Our attorneys provide advice and counsel in neurosurgery division is also still in its medical malpractice litigation, business, real estate, and infancy, Drs. Senegor, Oladunjoye and personal needs of physician clients.

Bahari currently designated only as Joe Fagundes provides experienced, successful representation of physicians and other health care consultants to their emergency room. providers in defending malpractice suits, A more formal rollout of the protecting hospital privileges, and answering medical board inquiries. He also provides neurosurgery division is expected later guidance and assistance in real estate and in 2017, and when this happens, Senegor financial matters. says the number one priority will be Scott Malm advises physicians and their starting things off on the right foot. offices regarding business formation, employment and labor matters, “The number one focus will be to set and personal estate planning. the neurosurgery division on the right foundation,” he said. “Our aim is to make this an enduring program, and hopefully we’re successful in that aim.”

Despite its inherent challenges, the task is one at which Dr. Senegor looks toward with excitement, and something he now views as the final phase of an already impressive medical legacy.

“Frankly, I hadn’t envisioned doing something like this - medical staff leadership - at this point in my career,” We welcome the opportunity to he said. “This is a challenge, but it’s speak with you regarding your one that’s allowed me to stay in the legal needs during a confidential consultation. Visit our website at community in a different format.” malmfagundes.com and call us at

Representing and Advising Area Physicians for Over 30 Years

209-870-7900.

malmfagundes.com

38

SAN JOAQUIN PHYSICIAN

SPRING 2017

Your Care, At Home

Delivering the best care to your front door Lodi Health Home Health brings clients the care they need in the familiar surroundings of their home. When patients need to see a physician prior to or after a scheduled office visit, our staff can provide care based on their doctor’s orders. We have been providing in-home care for over 30 years to Lodi and the surrounding areas.

We offer: » Skilled nursing care » Medical-Social services » Medication reconciliation » Wound Care » Dietary education

» Occupational Therapy » Physical Therapy » Speech Therapy » IV Therapy

For more information and a complete list of services, call Lodi Health Home Health at 209.333.3131 SPRING 2017

SAN JOAQUIN PHYSICIAN

39

The

REMEDY for all your

Financial

NEEDS

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

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

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

209-948-6024

•

www.fccuburt.org Federally insured by the NCUA.

40

SAN JOAQUIN PHYSICIAN

SPRING 2017

CMAWINS BIG AT THE BALLOT BOX

CALIFORNIA VOTERS MADE HEALTH CARE A PRIORITY

ELECTION 2016

BY THE NUMBERS

Election Night 2016 was one for the history books. Once again, the California Medical Association (CMA) took on tough fights and prevailed. We won all of our statewide ballot measure endorsements, including three local initiatives in the Bay Area.

$3 BILLION per year in new federal matching funds for Medi-Cal to serve elderly and low-income Californians. (Yes on Prop. 52)

Together, we voted to: • Invest in Medi-Cal. (Yes on Prop. 56, 55 and 52) • Reduce smoking rates and prevent thousands of children from starting. (Yes on Prop. 56)

• Protect public health and clarify the role of physicians in controlling and regulating the adult use of cannabis. (Yes on Prop. 64)

UP TO $2 BILLION per year to improve access to health care services, including Medi-Cal, for low-income children and their families. (Yes on Prop. 55)

• Triple the funding for California’s antismoking programs. (Yes on Prop. 56)

• Reduce sugar intake to prevent diabetes and obesity. (Yes on Measures V (San Francisco), HH

• Provide more essential services like checkups, immunizations, prescriptions and dental/vision care for 13 million low-income Californians. (Yes on Prop. 52)

• Break down barriers and removed outdated bilingual education mandates. (Yes on Prop. 58)

UP TO $1.7 BILLION

• Ensure critical infrastructure projects – including hospitals and medical facilities – aren’t subject to delays or loss of local control. (No on Prop. 53)

(plus $1 billion in federal matching funds) for Medi-Cal. (Yes on Prop. 56)

• Strengthen California’s ability to prevent gun violence. (Yes on Prop. 63)

SAVINGS OF $1.5 BILLION

• Prevent an increase in state prescription drug costs, as well as preserve patient access to medications. (No on Prop. 61)

(Oakland) and O1 (Albany))

Looking ahead

in costs for children’s health coverage by FY 2019-20. (Yes on Prop. 52)

In the coming months, we’ll work to ensure the new revenue reaches the communities most in need of access to health care. Voters sent a clear signal that they are willing to support investments in public health and that they are tired of Sacramento chronically underfunding health care.

$350 MILLION

How will the next Congress and Trump’s administration handle the Affordable Care Act? Rising drug prices? Medicaid expansion? Mega-mergers? Regardless of what comes next, CMA will continue to keep California’s physicians in the driver’s seat on health care policy. And we’re working ahead to 2018 to ensure the next Governor reflects our values, including the protection of MICRA and investments in public health.

Join or renew your membership today!

www.cmanet.org/join

SPRING 2017 Questions? Contact our Member Service Center at (800) 786-4262 or memberservice@cmanet.org.

per year in support to state and local public hospitals. (Yes on Prop. 52)

$20 MILLION per year for public schools to enhance smoking cessation programs.

(Yes on Prop. 56) SAN JOAQUIN PHYSICIAN

41

In The News

IN THE

NEWS 2017 Membership Survey

SJMS is asking for your input to learn more about the needs and interests of our members. The survey should take no more than 7 minutes to complete, and the individual responses will be kept confidential. It is currently available online at www.sjcms.org and on our NEW San Joaquin Medical Society Facebook page. Additionally, it will be emailed to all members, for whom we have a valid email address, on Monday, March 6. Please keep an eye out for it and check your spam folder just in case. Your name will be entered to win one of two, $100 gift cards to Amazon!

Marvin Primack, MD, An HPSJ Founder, Leaving us on Firm Footing, Come What May

For 20 years, nearly since the launch of Health Plan of San Joaquin, Marvin Primack, MD, was a member of the Health Commission, the governing body of the not-forprofit established for and by the people of San Joaquin County. More than a Commission member, up to his February 2017 retirement from the Commission, he has been the unrelenting voice for fiduciary steadiness and the increasingly strong fiscal systems needed to keep pace with 21st century demands for a financially robust managed care Medicaid plan.

As HPSJ celebrated its 20th anniversary of delivering hands-on, high-touch quality health care for our diverse Central Valley communities, it was the financial foundation that Dr. Primack early-on established as his focus that gave HPSJ the footing to take advantage

42

SAN JOAQUIN PHYSICIAN

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

of increasing opportunities afforded by the growth of Medicaid (Medi-Cal in California).

As long-time chairman of the Finance Committee, he has described himself as “constantly asking Marvin Primack, MD questions.”

Thanks to all of those unrelenting questions, HPSJ has been well-positioned to adapt to an ever-uncertain health care financial landscape.

His leadership has substantially made possible HPSJ’s stewardship and resourcefulness, to the point where the not-for-profit is able to balance investments in health care while innovating ways to stretch every dollar and expand access through a strong provider network.

HPSJ annually distributes $1 Billion in state and federal revenues, has grown into a major regional economic driver, has a direct fiscal impact on the entire health care infrastructure, and serves over 346,000 members.

Through stints as a renowned anesthesiologist, first in a leading Detroit hospital, and later (famously sandwiched by multiple retirements), including for a quarter century

SPRING 2017

at St. Joseph’s Medical Center, followed by a year at Zeiter Eye Clinic, and then more years at Lodi Outpatient Surgical Center, Dr. Primack has had a gift for the kind of business models and financial structures that make it possible for doctors to achieve work/life balance along with financial security for their practices and families. His passion for medicine and his patients, combined with a practical, practiced eye on the financial discipline, are qualities he has brought to the Health Commission’s leadership and oversight of HPSJ. The now completely retired anesthesiologist, and constant traveler who, with his wife, Bune, has racked up visits to 134 countries, considers his greatest accomplishment, “my four children.” He also can count as part of his great accomplishments the over 190,000 children who currently are HPSJ members, and all who grew up stronger and healthier during the past 20 years, Dr. Primack’s advice for whatever is to come? Keep an eye on the finances and “keep a sharp pencil.”

HPSJ Contribution to Decision Medicine

Decision Medicine, a San Joaquin Medical Society (SJMS) Program, receives additional Health Plan of San Joaquin (HPSJ) Contribution after HPSJ-Sponsored Transgender Health Training

Health Plan of San Joaquin recently contributed $2,200 to the San Joaquin Medical Society’s Decision Medicine Program, as part of its ongoing support for Decision Medicine. The total amount was arrived at by contributing $100 for each of the 22 SJMS physician members who attended a special transgender health training presented in the fall by HPSJ.

SPRING 2017

At HPSJ’s recent staff meeting, SJMS’ Executive Director Lisa Richmond came to the HPSJ French Camp Community Room to be presented with the check for $2,200, before over 300 employees. Accepting the oversized version of the actual check, Lisa Richmond expressed her gratitude to HPSJ, a Premier Sponsor of Decision Medicine.

Local Cardiologist elected to serve as the President of Calif Chapter of American College of Cardiology.

Stockton’s Cardiologist Ramin Manshadi, MD, has been elected to serve as the President/Governor of California Chapter of American College of Cardiology. His term begins in March of 2018. Dr. Manshadi also has served as the president of San Joaquin Medical Society, and was the recipient of San Joaquin Medical Society’s first Young Physician Award in 2010.

Currently he serves as the Chair of the President’s Forum at CMA. He has a private practice in Stockton, and Ramin Manshadi, MD volunteers his time teaching as Associate Clinical Professor at UC Davis and Touro Medical Schools.

There is work to be done. Cardiovascular disease claims 1 million lives annually. A quarter of deaths are attributed to heart disease. His goal is to help fulfill the mission of American College of Cardiology: To advocate for quality cardiovascular care-through education, research promotion, development and application of standards, and guidelines - and to influence health care policy. These will help Cardiac patients live healthier and longer.

SAN JOAQUIN PHYSICIAN

43

In The News

IN THE

NEWS Doctors Hospital Manteca welcomes Orthopedic Surgeon, Jeffrey McGillicuddy, MD

Jeffrey McGillicuddy, MD, is part of the FCPP network, and is practicing Orthopedics and Sports Medicine in Manteca, CA. His education started with Stanford University School of Medicine. His residency in Orthopedics was at Montefiore/Albert Einstein in the Bronx, NY. He also finished a Sports Medicine Fellowship at Stanford University/S.O.A.R. where he treated athletes at the professional, university and junior college level.

Dr. McGillicuddy Jeffrey McGillicuddy, MD has been in practice since 1999, beginning in Roseville, CA. There he focused on sports medicine, arthroscopy and fractures. He’s also practiced in Coos Bay, OR and Winona, MN before arriving in Manteca in 2016. Dr. McGillicuddy is Board Certified in Orthopedics and subspecialty certified in Sports Medicine. He is now accepting new patients.

Doctors Hospital Manteca welcomes new Pulmonologist, Siraj Ahmed, MD

Dr Ahmed, a native of Ohio, completed undergraduate studies in biomedical engineering from wright state university, medical school from St. George’s university.

44

SAN JOAQUIN PHYSICIAN

He completed internal medicine training from Seton Hall University, New Jersey and pulmonary/ critical care / sleep medicine fellowship Siraj Ahmed, MD from Tulane university in New Orleans. He moved to Manteca after 15 years of private practice in Indiana.

“I’m excited to move to Manteca to build a private practice. “I’m looking forward to providing excellent medical care to San Joaquin county patients. Will be providing acute care at Doctors Hospital in Manteca and will be seeing patients in office as well.

Doctors Hospital of Manteca Opens New Rapid Care Area to Speed Treatment and Discharge of Emergent Patients

The new Rapid Care area that opened Wednesday in Doctors Hospital of Manteca’s Emergency Department (ED) is designed to shorten the time it takes for loweracuity patients to be evaluated, treated and released.

The new three-bed Rapid Care area will allow clinicians at the hospital, which is experiencing a significant increase in ED patient traffic, to see more emergent patients per hour. An admitting specialist and a nurse in the ED waiting room are available to make sure patients are directed

SPRING 2017

promptly to the appropriate level of care.

“We are currently receiving anywhere from 12 to 15 ambulances a day in our Emergency Department – up from 8 to 10 during the same time period last year,” said Brian Beenes, Emergency Services Director at Doctors Hospital of Manteca. “The new Rapid Care area not only provides more beds overall for emergent patients, it will also allow us to triage lower-acuity patients more effectively and potentially get them in and out of the hospital faster.”

The hospital has also hired additional staff to help during peak hours and alleviate some of the traffic in the ED. In November, Doctors Hospital of Manteca was awarded Advanced Certification as a Primary Stroke Center by the Joint Commission and the American Heart Association/American Stroke Association. “The addition of the Rapid Care area in our ED will also strengthen our ability to provide high-quality, advanced stroke care for our patients,” Beenes said.

and administered by the Children’s Hospital Association (CHA).

This exhibit communicates the hope, compassion and resilience shared by the children and families served by children’s hospitals and the expert health care providers who deliver that specialized care. From healthy kids to children with rare and complex medical conditions, the exhibit celebrates children’s hospitals’ commitment to the health of all children.

Serat’s photo was chosen from more than 180 photographs submitted by 40 children’s hospitals across the country by a distinguished panel of judges representing Parents magazine, The Exposure Group, National Geographic Kids, Positive Exposure, and the Children’s Hospitals Today editorial advisory group.

The judges selected the photograph depicting Catalina undergoing testing in the motion analysis laboratory for its excellent composition and ability to depict what really makes children’s hospitals unique.

The Children’s Hospitals Photo Exhibit will be on display to the general public the week of July 10, 2017 in the rotunda of the Russell Senate Building and in the foyer of the Rayburn House Building in Washington, D.C. July 17 and 18, 2017. In addition the exhibit will travel around the country for two years displaying at children’s hospitals and partnering organizations in support of a wide variety of outreach efforts and events.

San Joaquin Valley Air District Seeking Medical Professional Hearing Board Member

Shriners Hospitals for Children Photo

Shriners Hospitals for Children Photo Selected for National Children’s Hospitals Photo Exhibit

Photograph taken in Northern California Hospital’s Motion Analysis Lab A photograph by Shriners Hospitals for Children — Northern California photographer Julia Serat was selected for inclusion in the 2017 Children’s Hospitals Photo Exhibit, a national competition presented by HUGGIES®

SPRING 2017

The Air District’s Northern Region Hearing Board is seeking a Medical Professional to serve on its Hearing Board, which meets on the first Wednesday of every month at 10:00am for approximately one hour (as needed). A stipend is provided for each meeting attended.

Applicants must reside in Merced, Stanislaus, or San Joaquin counties. For more information or to receive an application, contact Michelle Franco, Deputy Clerk of the Boards, at (559) 230-6038 or michelle.franco@valleyair. org. More information is available here: http://www.valleyair.org/Board_meetings/HB/ PublicNoticeofHBVacancie-030414.pdf

SAN JOAQUIN PHYSICIAN

45

In The News

IN THE

NEWS San Joaquin General Hospital Adding New Hospital Wing

San Joaquin General Hospital will be breaking ground March 10th on its new 34,000 square foot acute care wing.

The new two story acute care building will be constructed to the South and connect directly to the main Hospital.

The new hospital wing’s first floor will feature a fully modernized 23 bed Neonatal intensive care unit. The second floor will contain 20 upgraded medical/surgical beds and will accommodate patients in modern private rooms. The new facility will increase the Hospital’s ability to maintain cleanliness and offer a higher level of patient privacy. The new addition will also feature upgraded security, a new nurse call system with state-of-the-art communication technology.

The project is officially titled: Phase 2 Acute Care Patient Wing expansion. The Office of Statewide Health Planning and Development (OSHPD) approved the initial Phase 2 expansion architectural plans on February 9, 2016. The Sacramento firm of Otto Construction has been awarded the contract to construct the building, along with the firms of AECOM managing the construction phases with Hammel Green and Abrahamson managing administration and planning. A completion date for the entire project is set for July of 2018. The entire project has been budgeted for $34,698,000 and has been approved by the San Joaquin Board of Supervisors.

The new wing will function as a modern replacement for some of the Hospital’s services, which are still being provided in the original brick “tower building” constructed in 1934. The historic tower will remain on-site for some administration, record storage and other duties

46

SAN JOAQUIN PHYSICIAN

as determined in the future. The new acute care wing will function as another positive step for the Hospital to advance from a level III trauma center to a level II trauma center in the foreseeable future. The new 20 medical/ surgical beds will provide growth capacity for the trauma center, additional capacity for Medicare and PPO patients and allow for increased inpatient surgeries including orthopedics and neurosurgery.

Lodi Health achieves national accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

Patients seeking surgical treatment for obesity and its related conditions have a high-quality choice for receiving treatment at a nationally accredited program that meets the highest standards for patient safety and quality of care in the greater Lodi area.

Lodi Health today announced that it has earned certification as a Center of Excellence in Metabolic and Bariatric Surgery.

This prestigious accreditation is granted through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

SPRING 2017

(MBSAQIP®), a joint program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS). At Lodi Memorial, the most common weight-loss surgeries are the gastric bypass and vertical sleeve.

The MBSAQIP standards ensure that bariatric surgical patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. Ruby Gatschet, MD, Metabolic and Bariatric Surgery Director at Lodi Health, says the accredited center offers preoperative and postoperative care designed specifically for obese patients.

“This accreditation shows Lodi Health’s dedication and commitment to our patients and their families, from the initial planning stages of weight loss to educational opportunities and support groups afterward that lead to continued success,” Gatschet said. “Our patients can be confident in our program’s ability to deliver consistent, effective and evidenced-based care with every surgery.”

Lodi Health’s commitment to quality care begins with appropriately trained staff and surgeons who participate in meetings throughout the year to review its outcomes.

Lodi Health’s surgeons, who specialize in bariatric surgery, seek continuous improvement to enhance the structure, process and outcomes of the center.

To earn the MBSAQIP designation, Lodi Health met essential criteria for staffing, training and facility infrastructure and protocols for care, ensuring its ability to support patients with obesity. The center also participates in a national data registry that yields semiannual reports on the quality of its processes and outcomes, identifying opportunities for continuous quality improvement.

through multiple initiatives, including the recent electronic health record system conversion. He also played an integral role in Lodi Health’s affiliation with Adventist Health.

As VP of Operations, Whitney will continue to oversee business Jason Whitney development, marketing, public relations, food services and IT. In addition, he will manage facilities and environmental services and coordinate our long-term planning.

“I am pleased Jason has taken on this new role,” Daniel Wolcott said. “Throughout the past year he has proven to be an exemplary leader and an extremely valuable member of the executive team. His healthcare and business development experience, combined with his passion for ensuring we are providing nothing less than excellent patient-centered care, will enable him to help us grow the organization and the number of people we serve.”

Whitney has a bachelor’s degree from Pacific Union College in Angwin, Calif. and Master of Business Administration with an emphasis in finance and strategic management from the University of California, Davis. He and his wife Jenny and their three children reside in Lodi and are active in the community.

Jason Whitney appointed Lodi Health’s Vice President of Operations

The Maternal Child department at Lodi Memorial Hospital recently received a total score of 93 out of 100 for data submitted in 2015 for the Centers for Disease Control and Prevention (CDC)’s maternity Practices in Infant Nutrition and Care (mPINC) survey. The report highlights the hard work and commitment of Lodi Memorial as a birthing facility working to support best practices for breastfeeding.

The mPINC survey is a national, voluntary survey of infant feeding practices in maternity care settings.

Lodi Memorial Hospital was among 2,582 facilities

Jason Whitney has been promoted to Vice President of Operations at Lodi Health. In this role, Whitney will oversee the organization’s master planning process and play a large role in the strategic operating plan. He will continue to serve as a member of the executive leadership team and report to President and CEO Daniel Wolcott.

Whitney joined Lodi Health in November of 2015 as Assistant Vice President of Business Development and Integration and has successfully lead the organization

SPRING 2017

Lodi Health Receives Standout Score for Maternity Care

SAN JOAQUIN PHYSICIAN

47

48

SAN JOAQUIN PHYSICIAN

SPRING 2017

In The News

nationwide to participate. Scores were recently released in a benchmark report stating that Lodi Memorial performed better than 88 percent of other hospitals of similar size in the nation in measures of infant feeding care practices, policies and staffing expectations. Lodi Memorial’s score of 93 exceeds the state score of 85, and the national average mPINC score of 79.

Lodi Memorial earned perfect scores (100 percent) for labor-and-delivery care, breastfeeding assistance, mother-infant contact, staff training and structural and organizational aspects of care delivery. In 2014, Lodi Memorial Hospital earned its Baby-Friendly designation, which promotes these best practices in infant care, including breastfeeding education, a focus on skin-to-skin contact and rooming in – the practice of keeping mother and child together in the same room throughout their hospital stay. Lodi Memorial also has a weekly support group for breastfeeding moms to continue support once they are discharged.

New Dameron Ambulatory Care Center Physician

Devinder K. Makker, MD, is now practicing at the Dameron Hospital Ambulatory Care Center (ACC) at 530 West Acacia Street. Dr. Makker has been practicing in San Joaquin County for over 28 years which includes solo practice, medical group practice and serving as a staff physician for companies such as Apple, Cisco and Gallo.

A winner of numerous patient satisfaction awards, Dr. Makker is board-certified with the American Board of Family Practice and the American Board of Acute Rehab and Long-term Care. He is a graduate of Pandit Bhagwat Dayal Sharma Medical College in India, and Devinder Makker, MD served his residency at the University of Texas Health Science Center in San Antonio, Texas. He also holds an associate fellowship in integrative medicine from

SPRING 2017

the University of Arizona, and has a medical acupuncture degree from the University of California, Los Angeles.

Dr. Makker has a vast amount of training and expertise in integrative medicine.

Dameron receives 2017 Healthgrades 5-Star Quality Rating for Knee Replacements

Dameron Hospital has received the highest quality rating for total knee replacements from Healthgrades. This achievement was announced in a release on Healthgrades. com and in the Healthgrades 2017 Report to the Nation.

“This latest recognition from Healthgrades validates the clinical excellence of our care, particularly in the area of orthopedics,” said Lorraine P. Auerbach, Dameron Hospital President and Chief Executive Officer. “With our 5-Star ratings for total knee replacements and back surgeries, we are one step closer to our goal of delivering world-class health care to the people in our community.

Through ongoing collaboration with our physician partners, we expect to see similar results in all of our medical and surgical specialties.”

“Receiving a Healthgrades 5-Star rating for another of our orthopedic surgical services is an acknowledgement of how well our physicians and the hospital nursing and support staff are working together as a team in the best interests of our patients,” said Dameron Hospital Vice President of Medical Affairs and Chief Medical Officer Brad Reinke, MD. “Everyone understands what they need to do and openly communicates with each other to deliver a seamless patient care experience with excellent clinical outcomes.”

Dameron Hospital Names New Vice President of Nursing Services and Chief Nursing Officer

Dameron Hospital has announced the promotion of Denise J. Hair, RN, MSN, to vice president of nursing services and chief nursing officer (CNO). In this role, Hair will provide administrative leadership and operational oversight for Dameron Hospital’s provision of nursing care to patients and responsibility for the development, management and ongoing leadership of the Nursing Division, Staff Development, and Quality departments.

SAN JOAQUIN PHYSICIAN

49

In The News

IN THE

NEWS She is also responsible for the long-range planning of nursing services to ensure that Dameron continues to meet its commitment to the community for quality of care, well into the future.

“We are delighted that Denise agreed to serve in this critical role as the Denise J. Hair, RN, MSN executive leader of our nursing services,” said Lorraine P. Auerbach, Dameron Hospital President and Chief Executive Officer. “She has more than proven herself as an effective leader in her previous roles as assistant CNO and most recently as our interim CNO for the past two months. She is a forward thinker and has consistently demonstrated the creativity, influence and attention to detail that we will need in order to move Dameron’s quality and service agenda forward.”

St. Joseph’s Medical Center Recognizes Steven Goldberg, MD, and Richard Goldman, MD, as 2016 Physician Champions

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

50

SAN JOAQUIN PHYSICIAN

improvement through innovation. This year’s awardees are Steven Goldberg, MD, for Physician Champion of Community and Richard Goldman, MD, for Physician Champion of Quality.

Dr. Goldberg has contributed greatly Steven Goldberg, MD to the community by supporting education of residents and medical students in San Joaquin County.

Dr. Goldberg is known for his commitment to promoting both the most up-to-date medical care for the community as well as the education of our future physicians.

Dr. Goldman Richard Goldman, MD champions quality and compassionate care through his work to promote palliative care for our most severely ill patients. Dr. Goldman is known for his compassion and for his ability to communicate with patients and their families in an honest and caring manner.

SPRING 2017

St. Joseph’s Receives Governor’s Environmental and Economic Leadership Award

St. Joseph’s Medical Center is honored to be one of twelve California organizations to receive the state’s highest environmental honor, the Governor’s Environmental and Economic Leadership Award (GEELA).

Established in 1993, GEELA is awarded to individuals, organizations and businesses that have demonstrated exceptional leadership and made notable, voluntary contributions to conserving California’s precious resources, protecting and enhancing our environment, building public-private partnerships and strengthening the state’s economy.

St. Joseph’s ecology program was honored in the waste reduction category. The program focuses on waste reduction and includes an on-site laundry for reusable medical garments, which has diverted more than 7 million pounds of landfill waste. The hospital also has a 33,000 square-foot garden that contributes an average of 200 pounds of produce per week that is donated to local shelters. That’s the equivalent of distributing 377,000 meals per year.

St. Joseph’s has a long legacy of environmental stewardship. In addition to being a GEELA recipient, St. Joseph’s was also named a Practice Greenhealth Partner for Change, and is also the first hospital in the state to be recognized as a Certified Green Business.

St. Joseph’s Opens New Emergency Room Wing

To meet the growing needs of the community, St. Joseph’s Medical Center recently repurposed 8,000 sq. feet of existing space to expand their Emergency Room by almost 60%, adding an additional 24 new treatment spaces. The $8 million expansion project began in summer 2016 and the new wing opened in January. This new Emergency Department wing will enhance St. Joseph’s SuperTrack process, which helps reduce wait times for patients with minor illnesses and injuries, getting them home faster and freeing up resources and space to care for and admit patients faster and more efficiently.

SPRING 2017

Impella Mobile Learning Lab Brought to St. Joseph’s Medical Center

St. Joseph’s Medical Center recently participated in the exclusive Abiomed Mobile Learning Lab program. The Mobile Learning Lab is a highly interactive, facilitated learning experience that was brought directly to the hospital with the goal of training hospital staff on the Impella® heart pump, one of the newest, minimally invasive heart support and recovery technologies.

The Mobile Learning Lab offered cardiologists, nurses and catherization lab staff at St. Joseph’s a unique opportunity to learn about the Impella platform and how these heart pumps can best be used for those patients in critical need of cardiac support. The Mobile Learning Lab contained various Impella simulators, animations and key information, which were all presented by a team of Abiomed trainers.

The Impella is manufactured by Abiomed, Inc. Impella, the world’s smallest heart pump, is a percutaneous (through the skin) heart pump that offers hemodynamic support for patients during certain heart procedures – essentially assisting the pumping function of the heart.

Dignity Health Medical Group - Stockton Receives Patient Experience Award

Dignity Health Medical Group – Stockton was recently recognized for providing exceptional patient care by Avatar Solutions (now known as Press Ganey), a leading provider of patient experience surveys. Highlighting their consistent dedication to providing a high-quality patient experience, Dignity Health Medical Group – Stockton was honored for “Exceeding Patient Expectations” based on their performance in patient surveys.

Avatar Solutions’ annual patient experience awards honor significant accomplishments in patient satisfaction as well as innovation in health care settings. Dignity Health Medical Group - Stockton, along with six additional Dignity Health Medical Foundation groups are repeat Avatar patient experience award winners.

SAN JOAQUIN PHYSICIAN

51

In The News

IN THE

NEWS St. Joseph’s Offers Stanford University’s Compassion Cultivation Training™

St. Joseph’s Medical Center recently began Compassion Cultivation Training for physicians and nurses, with more than 30 local physicians registered to participate.

Compassion Cultivation Training (CCT) is an 8-week educational program designed by Stanford University’s Center for Compassion and Altruism Research and Education (CCARE).

“The primary focus of this course is the development of a healthy and compassionate attitude towards self – which in turn is the foundational requirement for promoting a compassionate attitude towards others,” says Scott Neeley, MD, St. Joseph’s Chief Medical Officer. “We are very pleased to offer this program to support physician wellness.”

Preliminary research suggests that Compassion Cultivation Training (CCT) can support one’s own happiness and well-being by reducing stress, anxiety and depression, increasing self-compassion and self-care, and enhancing awareness of our connections with others.

The CCT protocol combines contemplative practices with current psychology and scientific research to help caregivers lead a more resilient, compassionate life.

Through instruction, mindfulness, daily guided practices & exercises, and in-class interaction, participants learn how to train their minds to develop qualities & skills that help them relate and act toward others—and themselves, with compassion and kindness, which can greatly reduce distress in difficult situations and can be a profound personal resource for resilience and well-being.

52

SAN JOAQUIN PHYSICIAN

GCRM Check Presentation

Expansion of Recuperative Care Program at Gospel Center Rescue Mission (GCRM) Receives $75,000 Boost from Health Plan of San Joaquin (HPSJ)

Health Plan of San Joaquin (HPSJ) considers the reduction of hospital readmissions to be a key measure of how it’s doing when it comes to the health, and even long-term survival, of their members who have been hospitalized. HPSJ care teams actively partner with network hospitals. The result is their members are experiencing fewer return hospital stays, and they are recovering faster, more fully and more comfortably at home with their loved ones.

Unfortunately, HPSJ members who are homeless have no such ready port for recovery. Gospel Center Rescue Mission, at its Stockton location, offers just such a harbor through its recuperative care program, giving homeless individuals a safe place to rest while completing their medical recovery after being released from hospitals throughout the county. GCRM is the only non-profit

SPRING 2017

program of its kind in San Joaquin County. They provide 24-hour shelter beds for people who are too well to be in the hospital, but too sick to recuperate on the streets.

“The level of care provided is equal to what would be reasonably expected from a family member to a typical patient coming home after hospitalization,” said GCRM CEO Wayne Richardson.

HPSJ has contributed $75,000 to help GCRM meet its April 2017 deadline for expansion of their Recuperative Care Program facility. To learn more about this important program, as well as the fundraising campaign with local hospital partners, contact CEO Wayne Richardson through the non-profit’s website, www.gcrms.org.

Palliative Care Planning Grant Received from California Healthcare Foundation

Health Plan of San Joaquin (HPSJ) has received a $30,000 California Healthcare Foundation (CHCF) planning grant to meet the challenges of providing palliative care, described by CHCF as a “whole person approach to enhancing quality of life for patients with serious illnesses.”

“We now are working with local partners and foundation staff to develop a collaborative community approach that can provide our members with integrated, high quality care that improves the life of Lakshmi Dhanvanthari, MD patients and their families who are facing severe or life-threatening conditions,” said HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD. HPSJ Provider Network Team: A New Business Model

To complement HPSJ’s growing network of providers and practitioners, they now integrate contracting and services sides in a multidisciplined, fully cross-functional team.

This allows them to support the full range of provider

SPRING 2017

interests where HPSJ has a role to play, from provider’s business operations (e.g., streamlined claims payments), to helping them improve their levels of health care for HPSJ members, including Disease Management (DM) programs to supplement care for patients with chronic conditions such as diabetes, heart health and asthma.

According HPSJ Provider Network Vice President Pamela Newman: “We are better positioned to partner with providers and to identify where practice gaps may exist. Then, we can collaborate on ways extra support from HPSJ could provide timely, leveraged help with these gaps, for example special training to support their patients on a transgender journey, or providing preventative care training and resources to improve the oral health of children, including over 190,000 of HPSJ’s youngest members.”

Available Space to Lease for Medical Office:

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

California Medical Association’s 43rd Legislative Advocacy Day

CMA will host its annual Legislative Advocacy Day on Tuesday, April 18. The conference will be held at the Sheraton Grand in Sacramento. This is a unique event for California physicians and is free of charge to all SJMS/ CMA members. Please plan to join more than 400 physicians, medical students and CMA Alliance members who will be traveling to Sacramento to lobby their legislative leaders as champions for medicine and their patients. You may register by simply calling our office at 209-952-5299.

SAN JOAQUIN PHYSICIAN

53

Fortunately, there’s the Manteca Wound Center.

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

For more information, please call the Manteca Wound Center today.

A Department of Doctors Hospital of Manteca

(209) 823-7190 54

SAN JOAQUIN PHYSICIAN

SPRING 2017

SPRING 2017

SAN JOAQUIN PHYSICIAN

55

practice manager Free to SJMS/CMA Members!

resources

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

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

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

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

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

MARCH 8TH 2017:

“NEW CALIFORNIA HEALTH LAWS AND LEGISLATIVE UPDATE” 11:00AM to 1:00PM

CMA legal counsel will present an overview of new state laws enacted in 2016 that impact physician practices.

Lisa Matsubara is Legal Counsel in CMA’s Center for Legal Affairs. Lisa focuses on privacy and security, HIT and scope of practice issues. She also manages legal publications and staffs the legal information line. Lisa is licensed to practice in California and Hawaii and is a member of the California Society for Healthcare Attorneys and the American Society of Medical Association Counsel.

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

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

Advocacy at Work patholog Services additional with the Dep 2 for Economic to require for certain surgical 2 Center Urgent CMA survey response requeste Aetna Aetna tobe requir Meet Your d paide additional accreditatio 2 tices perk Lane 3 to Mar prac Aetna e: er 2, erroneou n1,requir 201 ements orain order to be paid for Advocat in ord k sly terminates providers from 3 Californi ctive August both Clinical Lab certai a network y at Wor n surgic that, effe altopatho be CMA Advocac vices logy ser-the Col3 requested vices physicians Docume be required Document, Docume s from edited with ey respnt,onse ntly notified Aetna idernt a recerecently y testing will certified and accr Urgent surv Aetn 3 3 physicia inates prov patholog United Healthca that,IA) fficenotified effective August 1, forming tsns(CL neously termre announces extension of HIPAA ing in-o in-office with the 2012,con form practice sistent Amendgymen testing will s perAetna erro5010 enforcem t patholo 3 ge isClinical toryImp rovemen Improve (CAP). be required network ent be both ment Amendm ists P as an thetochan 4 tory olog nt Laboraents that CaliforniaWhat’s a COHS? s (CLIA) Path ume ion of CA certified and accredit lege ofAm ericann Pathologists America recognit Aetna claim ument, Doc ed the olog of HIPAA lege of nt, Doc Col-y test physicians, (CAP). Services (CMS) l anatomwith ic path tophysicia DocumeSave In aa lette the Date unces extension 4 4 letterr to icaid pita In Aetna re anno -hos claimsforthat e &ns,Med non Centers for 4 icar the change Act lthca Med Medicar is now to avoid the 2013 consiste tion United Hea for e & nt with the ters implemend Services (CMS) recognit organiza e-prescribing pen-4 Cen nMedicai approve atioorganiza altyrcement d accredit s withas the ioncern ation of CAP accredit 5010 enfo an l certification for non-hospital ed con 45 approved ing. has voicanatomi S? forgydua patholo a COH Updates testAssociation to explain thec need organizaWhat’sPayor n ical ing. atio The Med Californ ia nia Medical Associat Aetna d accredit Health plan provider Califor ibing pen 5 iond has society voiced tation The has aske newslett an appsrove of this policy Save the Date andasked ers escr P asconcern with cy has specialty thea implem 2013 e-pr poliand 55 and enAetna e CA A tion avoid the explain tion. n of this Althoug theifica tatio need may recogniztoCLI h CMS cert for dual mayS recogniz Further- , CM aAct now to 5 ices.certifica e CAPa as an Aapprove ing serv ough CM tion,tion CMS . Alth does not requirerequirea both ation organiza CAP -accredit aalty ology testd accredit CLIA certifica S does not bothin-o accreditation 5 obtain the ffice path tion and accredit a specialty ns to tion, CMto perform CMA ates orm patholo in-office society physicia CAP, the to perf gyof Payor Updresources expressededit testing ng toCMA ations with services. sletters ability concern ordi obtaining Further, new the When youprov of Acc accr the ider a. ess ability see with this icon, that of physicia proc cerns tion prior to the to obtainition th plan osed bynsAetn ally, the there Heal the CAP deadline imp are additional resourc means ressed con accreditaimposed exp line Add by s.

Aetna. dead es tion availAccordi day the processprio ng to CAP, able free to Californ r to ely 90 approxim thes.accredita-is working closepractice ately ia Medical Assotion takes 90mat roxi days. Additio ly for app a seconda ciation (CMA) membe nally, CMA ry accredit takescan the process e, obtainin be very cost rs at the CMA website be very this issuof n can g r state and tion processation edit costly atio To access any of for practice In addition .

Aetna s.on ral othe accr to ry thesesresources, their contact with nda tact with rce A) and seve visitns http://w r conAetna a seco on this ly with the mea resounet.org/ issue,(AM to thei Americaition CMA is working ciation ces., that CMAww.cma icon Associat details. close- Gaul, senior In addn Medicalan ion Asso (AMA) and see this specialty medical Medical s availfurtherother for several societies resource stateTam When you Am.eric Stay tuneds.for andmy tuneddetails. the Stay contact further with additional Medical AssoPractice can ly etie r are . s with e soci question lette site ther al-LegCalifornia s about the letter Medic ut the medical CMA web network manage to ns abocan contact Librar specialty 4. Gaul, seniormlane@cmanet.org Tammy r at Aetna questio5-6604.

-660 able free A)almem bersyat the s, visit at (215)77 with )775 or s 1 tice Contact: CMA Prac (Form a at (215 resource reimbur erly(CM ) 401-591 CMA ciation sement at Aetn these ll) agerhelp line, (888) 401-591 line,1(888 any ofOn-Ca In this ces. or mlane@cmanet.o access ion, you will network manA reimbursement help org/ Topublicat rg references to cmanet.find “medical-legal” ://www. docume h Contact: CM May 2012

APRIL 12TH 2017:

“BEYOND MACRA : PREPARING FOR THE FUTURE OF HEALTHCARE” 11:00AM to 1:00PM

Creating value encompasses much more than reimbursement, and is an organizational imperative across all points of the health care system. MACRA introduces a process, but the future of healthcare will depend on a broader vision of profitability, better outcomes, enhanced patient engagement and provider satisfaction. This session takes the focus to a higher level of readiness for the future challenges in our industry.

May 2012

In this issue:

http

ing wit

nd Update on two Anthe ss issues pe m Blue Blue Cro pendingCa the Department of Mana o AnCross themissues with re tw ged Health Update on ged Health ManaCare

Medical Association’s nts. The California (CMA) online medical library contains over -legal 4,500 pages of medical legal, regulatory, and reimbursement informatMedical-legal docume ion. nts are free to membe and can be found rences to DMHC claims audit in CMA’s online will find refers library, http://www.cma Health ion, you resource California Asl previously reported licat The net.org/ pub Managed with nts. -library. medical-lega resource this , on ume NonmemIn 2012 artment of bers s, e can l-leg al” doc Care (DMHC) ordered Jan. 12,aud purchas it the Departm ent of2Manage e medical the Dep A) onlin dica -legal (CM ments for “me d Health provider claim docu-of medical12, 201 $2 per claimsBlue CrossontoJan. page. ociation’s interest, HCAnthem es reprocess reproces

al Library Medical-Leg A On-Call) CM (Formerly

ent of the Departm

to dating back DMto 2007. reported, s provider Medical Ass s over 4,500 pag nt information. e Cross claims, with The order is As previously Anthem Blu burseme ry contain

Objectives: Improving financial performance Managing data driven clinical processes Engaging the patient in the care workflow Aligning provider and staff activity with the practice Irv Barnett, MBA – Founder. Irv has been in health care management since 1986. He spent the last 19 years serving physicians throughout California. He has served as the President of California MGMA and has been a featured speaker at meetings around the country. Providing exceptional leadership around value-driven practice management techniques, Irv helps practices prepare for the future!

MAY 10TH, 2017:

“BENCHMARKING YOUR PRACTICE – CURRENT TOOLS TO ANALYZE PRODUCTIVITY” 11:00AM to 1:00PM Details to follow.

Presented by: Debra Phairas, President Practice & Liability Consultants, LLC www.practiceconsultants.net

s health plan

bers based on 2008 DMHC red reim libra largest HC) orde audits CMA Center free to mem in California. These e (DM latory, and the seven above the threshl, regu Econom its of plans Car to 200of7.the seven largest audits found legafor uments are audhealth ic Servic urce ts

back s of claim8 DMHC reso es ngviolation men 1201 J Street, #200, legal doc old allowed under Californ A’s online 200 payments above claim pay Sacramento, Medicalofthe interest,iadati -library. d on in CM95814 law at economicservices@cman seven r isallbase health plans. be found CA net.

As a result, DMHCThe orde d violations healthreshorg/resource l docuth plans. and can et.org • 916/551 cma -2061 assessed adminis audits foun lega n ww. ://w medicallibrary, http purchase bers can e.

Nonmem $2 per pag ments for

s to pay

plan seve providers the money Thesetrative fines,law at allthe required required the onstrate ifornia. plans Calwere pays, ifornia ivetofine inthey owed and trat mandat ed ssed plans dem that plans under Cal adminis demonstrate dated that of 5 old allowed • Page 1 DMHC asse d and man

ic Services for Economento, CA 95814 1 CMA Center Sacram -206 et, #200, • 916/551

2012 owe As a result, they wereCPR • May 2012 • Page 1 of 5 CPR • May the money providers

1201 J Stre rvices@cmanet.org economicse

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

SUBSCRIBE NOW

Sign up now for a free subscription to our e-mail bulletin, at www.cmanet.org/news/cpr

Public Health

Update

Improve Food Security to Help Reduce Obesity (and other adverse health outcomes)

Alvaro Garza, MD, MPH and Daniel H Kim, MPH, MCHES Nearly 110,000 San Joaquin County residents (about 16% of population and 27% of children) are food-insecure. This insecurity means limited access to adequate food and nutrition due to cost and remoteness to food stores and/or other resources. These residents are at increased risk for overweight/

58

SAN JOAQUIN PHYSICIAN

obesity and chronic diseases such as diabetes, heart disease, and hypertension, as well as depression. Recent surveys show that about 48% of county adults have pre-diabetes and about 14% have diabetes. Food-insecure children are at higher risk for developmental problems and poor health. Besides these

SPRING 2017

impacts on individuals and families, societal costs include lost economic productivity, poor educational outcomes resulting from hunger, charity support, and avoidable health care costs.

Nationwide, these health care costs are estimated at over $130 billion per year. Addressing hunger and food insecurity in our communities also presents an opportunity for hospital savings by helping reduce readmissions and improve patient outcomes.

Compared to higher-income neighborhoods, the physical environment where food-insecure residents live often includes unsafe streets and parks and higher proportions of unhealthy food outlets such as convenience stores and fastfood restaurants, and little to no access to quality, affordable produce found in supermarkets and farmers markets.

Often, small corner markets that provide grab-and-go convenience may be a singular source of “food” to meet hunger needs. Areas that have a lack of healthy food retailers and where residents have limited means of travel to healthier grocery stores (more than a mile in urban settings) are termed food deserts. Neighborhoods with an overabundance of unhealthy food sources to healthy ones are termed food swamps.

The Refresh San Joaquin healthy retail project has a focus on improving the retail environment in these food deserts and swamps through enhancing access to healthy foods and beverages and reducing unhealthy advertising and promotions that influence purchasing behavior. Studies show that such store interventions can increase sales and consumption of produce and improve customer access to healthy products.

Store improvements include increasing the availability of fresh fruits and vegetables for sale, installing refrigerated storage or displays to keep produce and perishable foods fresh and readily visible, cleaning up the store or improving lighting to provide a better sense of organization and safety to customers, and adjusting product placements so that healthier foods and beverages are conveniently and prominently displayed. Educating customers and proper marketing of the healthy retail increases awareness and encourages healthy choices. Other strategies involve the community and include encouraging local food production from community and school gardens that can be sold in healthy food outlets and establishing an Adopt-a-Store program in which community organizations partner with store owners to conduct outreach to local residents.

Health care practitioners can play a significant role in identifying food-insecure children and families and referring them to services. While a majority of food-insecure families have incomes under the maximum income eligibility for child nutrition programs, about 30% of food-insecure households are above this level, indicating that poverty may not be the sole

SPRING 2017

SCREENING FOR FOOD INSECURITY

factor associated Within the p ast 12 months with food we worried , whether our insecurity. Based food would run o ut before w e g ot on research money to b uy more. evidence to (yes or no) screen and Within the p ast identify need, food we boug 12 months, the ht just didn’ in 2015, the t last and we didn’ t have mone y to American get more. (yes or no) Academy of Pediatrics Source: AAP Policy State ment: Promot Security for ing Food All Children, recommended Dec 2015. two foodsecurity screening questions be made of all families with children: (a) Within the past 12 months, we worried whether our food would run out before we got money to buy more (yes or no), and (b) within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more (yes or no). When a need is identified, referrals can be made by first consulting 211 San Joaquin (www.211sj.org) that has information on, and links to, resources like food pantries, home-delivered meals, and soup kitchens. In addition, it has information on, and links to, food expense assistance like CalFresh (Food Stamps/SNAP) and WIC (Women, Infants, and Children nutrition program). The Emergency Food Bank (www.stocktonfoodbank.org) and its Mobile Farmers Market are also excellent resources.

Practitioners can also help improve food security and reduce obesity by advocating for changes in the ‘upstream’ factors and policies that impact health outcomes (as in the figure). In addition to healthier food, many communities need to provide more opportunities for safer everyday physical activity for everyone; city and county policies and programs that foster walkable communities and green space can help ensure that. Improving community socioeconomic factors such as ensuring quality education, market wage jobs, and safe secure housing for all are positively associated with reduced obesity and a better quality and length of life. One recent and special upstream policy change that will help reduce obesity in children deserves mention and congratulations. During the summer of 2016, the City of Stockton passed an ordinance requiring restaurants that sell children’s meals that include a beverage to make the default beverage water, sparkling water, or flavored water without added sweeteners, or milk or milk alternatives. Our continuing advocacy for all upstream improvements is critical for our community health.

SAN JOAQUIN PHYSICIAN

59

Your leadership has reinforced HPSJ's stewardship and resourcefulness, as we balance investments in high-touch, quality health care with our continuous focus on expanding access throughout our region.

Marvin Primack, MD As you retire after 20 years of guiding the HPSJ Health Commission, our team thanks you for helping to improve access to quality care for our diverse communities and over 346,000 members.

60

Continuously improving the health of our community.

SAN JOAQUIN PHYSICIAN

SPRING 2017

Gill Obstetrics & Gynecology

THE VALLEY’S LEADER IN ROBOTIC SURGERY FOR WOMEN VOTED #1 BEST OB/GYN PRACTICE IN SAN JOAQUIN COUNTY!

Proud to be the First Medical Group Offering Single Site Robotic Surgery in the Valley Highly Skilled Minimally Invasive Surgical Team

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

Robotic Assisted Gynecologic Surgery

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

We are pleased to announce the association of

Alecia N. Russell, D.O.

David J. Russell, D.O.

Ofelia G. Ortiz, M.D.

Gail R. Joseph, M.D.

Kimberley E. Fillmore, M.D.

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

Param K. Gill, M.D.

Vincent P. Pennisi, M.D.

Jasbir S. Gill, M.D.

Harjit Sud, M.D.

Thomas Streeter, M.D.

David L. Eibling M.D.

Maya Nambisan, M.D.

Linda Colliflower, RNC, NP

Darrell R. Burns, M.D.

William Colliflower, M.D.

Tonja Harris-Stansil, M.D.

Catherine Mathis, M.D.

Linda Bouchard, M.D.

Jacqualin Miller, D.O.

Maria E. Escalona, M.D.

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

Eugenia L. Hurlbut, D.O.

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

Philip D. Ross, M.D.

Convenient locations to serve you

Stockton: 1617 N. California St., Ste. 2A – Ph. (209) 466-8546 • 2509 W. March Lane, Ste. 250 - Ph. (209) 957-1000 Lodi: 999 S. Fairmont Ave., Ste. 225 & 230 – Ph. (209) 334-4924 • Galt: (209) 745-7473 Jackson: 817 Court St., Ste. 8, Jackson, CA 95642 – Ph. (209) 223-1031 Manteca: 1234 E. North St., Ste. 102 – Ph. (209) 824-2202

WE ACCEPT MOST HEALTH INSURANCE, INCLUDING MEDI-CAL • GILLOBGYN.COM

Kayla D. Mapps, M.D.

Chikanele E. Okorie, M.D.

eMR implementation can be hard.

let us make it easy.

CROWN ENTERPRISES IS A LOCAL FULL SERVICE INFORMATION TECHNOLOGY COMPANY SPECIALIZING IN PROVIDING MEDICAL PRACTICES:

• Certified EMR/PM software selection • Reaching Meaningful Use for Federal Stimulus Money Funding • Hardware Installation and Repair • Business Continuity & Disaster Recovery • HIPPA/HiTech Regulatory Compliance • Network and Systems Security • Local Affordable Flat Fee IT Support

We guide our clients through every critical step and our process ensures improved operational efficiencies, quality of care, and increased practice profits.

Call us today for a complimentary consultation at (209) 390-4670 62

SAN JOAQUIN PHYSICIAN

SPRING 2017

New Members

10 NEW

SJMS MEMBERS THIS SPRING!

...and even more on the way.

Sai Gollapudi, MD

Michael Borges, MD

Venkata Emani, MD

2505 W Hammer Lane Stockton, CA 95209 Guntur Medical College

University of Southern California School of Medicine

Richard Camacho, M.D

1148 Norman Dr., Ste 2 Manteca, CA 95336 (209) 239-7852 Guntur Medical College, Andhra University

De La Salle University College of Medicine

Dorcas Yao, MD

Family Medicine

Kusum Lata, MD

Interventional Cardiology 1801 E. March Lane Stockton, CA 95209 (209) 951-9884 Govt. Stanley Medical College, Chennai India

Thwe Shein, MD Infectious Disease

2505 W. Hammer Lane Stockton, CA 95209 Institute of Medicine I

Anita Bai Xue, MD Anesthesiology

2151 W. Grant Line Road Tracy, CA 95377 Medical College of Wisconsin

SPRING 2017

Anesthesiology

Internal Medicine

Nancy Nelson, MD Psychiatry

1212 N. California Street Stockton, CA 95202 (209) 468-8700 University Tel Aviv, Sackler School of Medicine

Cardiology

Radiology

7751 S. Manthey Road French Camp, CA 95231 (209) 469-8399 University of Pennsylvania

Puneet Grewal, MD Internal Medicine

530 W. Eaton Avenue, Ste. K Tracy, CA 95376 (209) 835-4232 Baba Raghav Das Medical College, Gorakhpur University

SAN JOAQUIN PHYSICIAN

63

Do you know What, When and How to Report Child Abuse?

FREE ONLINE COURSE! Course developed by the Child Abuse Prevention Center









Approved for 1.25 AMA PRA Category 1 Credits™ Approved for 1.25 CE credits

ALL healthcare providers (MD, DO, RN, PhD, LCSW, MSW) are encouraged to take this valuable course! 



Course available 24/7

Course can be offered in a group training using a single log-in.

Contact Leslie Iacopi at (415) 882-5167 for more details.

Register NOW at: http://www.imq.org/education/caprrc.aspx 64

SAN JOAQUIN PHYSICIAN

SPRING 2017

In Memoriam

In Memoriam Lawrence Hildebrand, MD

LAWRENCE HILDEBRAND, MD October 16, 1934- December 26, 2016

He actively pursued his favorite sports, skiing, bicycling and hiking until he was eighty years old. Larry is survived by Ann, his wife of 52 years, his two children and four much loved grandchildren.

SPRING 2017

Surrounded by his family Lawrence passed away peacefully at the age of 82. He was born in Morden, Manitoba, Canada on October 16, 1934 to Adolf and Elizabeth Hildebrand. His education began in a one room school house and continued to University of Manitoba where he was awarded a Doctor of Medicine degree in 1960. He went on to specialize in Urology at the University of Minnesota, achieving his Board Certification and Fellowship in American College of Surgeons in 1967. Fresh from his residency Dr. Hildebrand came to Stockton to join Dr. Frank Roach and Dr. Robert Evert at Maple Street Urology. He gave his heart and soul to the care of his patients for thirty-nine years.

He never once regretted the move to Stockton. He and his

family have loved this area from the start.

After his retirement in 2006 he most enjoyed working in his garden and tending to his Compost Pile.

He actively pursued his favorite sports, skiing, bicycling and hiking until he was eighty years old. Larry is survived by Ann, his wife of 52 years, his two children and four much loved grandchildren. Alison, with her husband Barry Whittle, have raised her children, Zachary Asborno and Megan Ann DeVore. Steve and his wife Gabriella are the parents of Isabella and Aidan. Of his ten siblings Larry is only survived by his younger brother Arnold of Red Deer, Alberta.

The family is grateful to Dr. Steven L. Goldberg, Dr. S. Richard Goldman and Hospice of San Joaquin for their excellent compassionate care and for guiding us through the difficult time.

SAN JOAQUIN PHYSICIAN

65

Fresno Madera Medical Society

66th Annual Yosemite Postgraduate Institute March 24 - 26, 2017

Registration is now open - Call (559) 224-4224 ext. 118 for more information or visit www.FMMS.org

STOCKTON MRI & Molecular Imaging Medical Center, Inc. 2320 N. California Street • Stockton, CA 95204 PHONE 209-466-2000 • Fax 209-466-2600 w w w. s to c k to n m r i . co m

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

All Board Certified Radiologists with fellowship: Javad Jamshidi, MD Francis Isidoro, MD Brian Morrow, MD

The Fastest 128 Multislice High Resolution CT in community practice:

Siemens Somatom Definition AS+ (128) SPRING 2017

SAN JOAQUIN PHYSICIAN

67

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

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

N O R C A L

G R OU P

OF

COM PANI ES

MEDICAL PROFESSIONAL LIABILITY INSURANCE

PHYSICIANS DESERVE Offering top-tier educational resources essential to reducing risk, providing versatile coverage solutions to safeguard your practice and serving as a staunch advocate on behalf of the medical community.

Talk to an agent/broker about NORCAL Mutual today.

NORCALMUTUAL.COM | 844.4NORCAL

© 2016 NORCAL Mutual Insurance Company

nm5001