With the recent acquisition of NORCAL Group, ProAssurance is now the nation’s third largest medical professional insurance carrier with claims and risk management expertise in every major healthcare region.
Meet the new best-in-class, where the principle of fair treatment guides every action we take in defense of our medical professionals.
PRESIDENT- Cyrus Buhari, DO
PRESIDENT ELECT- Nguyen Vo, MD
TREASURER- Neelesh Bangalore, MD
BOARD MEMBERS Stephen Tsang, MD, Maggie Park, MD, Sujeeth Punnam, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD, Raghunath Reddy, MD, Kinnari Parikh, MD, Inderpreet Dhillon, MD and Bhagya Nakka, MD
MEDICAL SOCIETY STAFF
EXECUTIVE DIRECTOR Lisa Richmond
MEMBERSHIP COORDINATOR Jessica Peluso
COMMITTEE CHAIRPERSONS
CMA AFFAIRS COMMITTEE Larry Frank, MD
DECISION MEDICINE Kwabena Adubofour, MD
MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD
PUBLIC HEALTH COMMITTEE Maggie Park, MD
SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD
CMA HOUSE OF DELEGATES REPRESENTATIVES
Robin Wong, MD, Lawrence R. Frank, MD
James R. Halderman, MD, Raissa Hill, DO Richelle Marasigan, DO, Ramin Manshadi, MD
Kwabena Adubofour, MD, Philip Edington, MD Harpreet Singh, MD
SAN JOAQUIN PHYSICIAN MAGAZINE
EDITOR Lisa Richmond
EDITORIAL COMMITTEE Lisa Richmond, Raghunath Reddy, MD, Cyrus Buhari, DO
MANAGING EDITOR Lisa Richmond
CREATIVE DIRECTOR Sherry Lavone Design
CONTRIBUTING WRITERS Jo Ann Kirby, Cyrus Buhari, DO, Maggie Park, MD
THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society
SUGGESTIONS, story ideas 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 9:00am to 5:00pm Closed for Lunch between 12pm-1pm
See the world as it was meant to be seen.STOCKTON LODI MANTECA TRACY SONORA JACKSON LISA RICHMOND
This Spring officially marks my ten-year anniversary of working for SJMS! It’s unbelievable to think that when I started, I had two kids in elementary school and now they are both in college! I have been blessed to work with a diverse group of physicians, from every specialty and mode of practice, on important programs and initiatives in our community and statewide, including our flourishing pipeline programs, working in conjunction with the California Medical Association to ward off multiple attacks on MICRA, successfully adding more than one billion dollars in to Medi-Cal through Prop 56 and advocating to protect the profession of medicine and quality healthcare for patients. The last decade has been quite the ride and I’m looking forward to what is to come.
Over the years, we have learned about the variety of ways our members give back through donating their money, time, and talents. Whether it is volunteering in the medical clinic at St. Mary’s Dining Room, serving on the board of a local non-profit, fundraising, mentoring aspiring physicians or mission work abroad, there is such a vast array of opportunities. It’s all about identifying your passion and finding the right match! Experts say that giving to others can help protect your mental and physical health. It can reduce stress, combat depression, keep you mentally stimulated, and provide a sense of purpose. We are highlighting just a handful of inspiring examples in the feature story of this issue.
SJMS was proud to sponsor the San Joaquin County Women Physicians Holiday Party in December, graciously hosted by board member, Dr. Manreet Basra. The event was highly attended by women physicians in every stage of their career, residents through retired. Women tend to be master jugglers, always with many balls in the air at one time. They strive to provide excellent care to their patients, be present for their families and active in their community. The SJC Women Physician’s group exists to provide fellowship, support, and encouragement. Learn more about the history and enjoy pictures from the event on page
Finally, save the date for the annual Young Physician and Lifetime Achievement Award dinner scheduled for Sunday, June 4 at Stockton Golf & Country Club. More information coming soon.
Best wishes,
Lisa RichmondDoctors Hospital of Manteca began 60 years ago with the mission to provide the best care possible to Manteca. Today, we are a top employer in the community with over 500 employees and a staff of more than 180 physicians –many board-certified in their specialty.
From emergencies and screenings to surgical and procedural services, we deliver expertise and compassionate care close to home.
Doctors Hospital of Manteca offers:
• 24-Hour Emergency Care and Convenient Online Check-Ins
• 24/7 Critical Care Coverage Led by Intensivists
• Advanced Orthopedics for Knee and Hip
• Family Birthing Center
• Imaging Services, Including 3-D Mammography
• Surgical Services, Including Weight Loss Surgery
• Women’s Health
• Wound Care Center
To refer a patient, call (844) 632-5727 or visit DoctorsManteca.com
• Accredited as a Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®), a joint program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS)
• Designated as a Blue Distinction® Center+ for Bariatric Surgery
• Designated as a Blue Distinction® Center for Knee and Hip Replacement
• Recognized as a Certified Quality Breast Center of Excellence in the National Quality Measures for Breast Centers program
CA
Whether you believe that the future of medicine will be advancements in technology and Artificial Intelligence (AI) or good old-fashioned in-person doctor visits will change the way medicine is practiced in the future or not, access to care is paramount. There can be no healthcare delivery without healthcare access. Physicians have understood this for a century. We have stood shoulder to shoulder with the patients of our community advocating for more resources to improve the access to and delivery of high-quality patient care. Are we being heard? Winston Churchill’s famous statement, “Never let a good crisis go to waste,” seems to describe our government in great detail. I, on the other hand, am not willing to stand idly by and let our healthcare system go into crisis in the first place.
It seems that every article I write starts off gloomy and tries to end with some rallying-ofthe-troops closing. Sadly, this one is unlikely to be different. There are challenges ahead on every front and it seems like at times we are on the dirty end of the stick. I want all of you to remain upbeat and positive, however. As I have stated before… We are not alone. The San Joaquin Medical Society (SJMS) is our voice in the dark. With the Board of Directors’ leadership, alongside the California Medical Association (CMA), we are constantly engaging local, state, and federal politicians in advocacy for our physician members and for the medical community as a whole. SJMS and CMA worked hard to enshrine protections in MICRA and minimize potential disastrous legislation that would surely have been worse than compromise. Together, we have an agenda full of legislative advocacy for this year and the next. We are using every resource to try to stave off cuts to CMS reimbursements and to fight for increases.
ABOUT THE AUTHOR
Cyrus Fram Buhari, DO is the current president of the San Joaquin Medical Society and practices at the San Joaquin Cardiology Medical Group
As a physician in this community for over 10 years and having lived here all of my young and most of my adult life, I care too much about the medical staff and our patients to allow this system to descend into crisis. And I don’t need to ask any AI ChatBot to know that that is certainly what will happen when physician practices start to feel the Centers for Medicare and Medicaid Services (CMS) short-sighted cuts. In our community we
are familiar with physician early retirement, out-of -state migration, and burnout. It almost seems that physician shortages are what is wanted or needed by Governmental agencies and payers before any action is taken. When a physician decides to retire or move away, it is usually met with both happiness and sadness. While the physician now gets to experience the much-deserved retirement, they move on from those they have spent their lives caring for and patients lose a friend and advocate. Additionally, and most seriously, the overall access to care in the community is diminished, again. This is especially harmful to the community in the case of early retirement. Does CMS or Congress not understand any of this? I think we know the answer.
I want to always bring us back to the one thing that we have protected and that we should all hope never wavers or fractures… the doctor-patient relationship. No amount of AI can bring a patient or family comfort like a hug from their doctor. CMS’s failure to eliminate cuts and enact increases that are long overdue is both sad and less than smart (I’m trying to be tactful). We can be certain that forces are lining up to embrace any technology that they feel can replace physicians and reduce cost. So much money is being spent in technology and AI, it is mind blowing. If a fraction of that
money was spent on supporting physician practices in underserved communities like ours, we could practically eliminate most barriers to access and care. Technology and AI are welcome tools for us to deliver care. They are not and never will be cheaper substitutes for proven quality healthcare.
Despite the fact that I am a fan of technology in daily life and in healthcare, I believe that we as the physicians of this community will not stand for any substitute for human contact and the opportunity to be WITH our patients through hard times and good. We continue to deliver the best care at CMS’s discounted and inadequate reimbursement rates and will continue to do so until we no longer can afford to. This is because we will NEVER stop caring for our patients and their families.
Join me in support of SJMS and CMA in their efforts to advocate on behalf of physicians and physician practices. Cuts from CMS and other health plans must be fought with every ounce of our resolve for they will only reduce access to care. We owe it to our patients and our community. The financial solvency of physician practices is an essential aspect of healthcare access. I urge you to stay focused and stay with me in our fight ahead. Thank you.
Your patients are made for more celebrations. That’s why Adventist Health Lodi Memorial brings together everything you’d want to overcome cancer. We feature a team of specialty-trained, board-certified oncology experts. They use the most advanced diagnostics, including the latest in genetic testing, along with the most precise treatment tools, like the Elekta Versa HD and Align RT. We even offer a dedicated nurse navigator to guide each patient through every step of the treatment journey. And it’s all under one roof right here in Lodi, close to home.
Call our physician liaison to refer a patient. 209-546-6138. Or learn more at AdventistHealth.org/LodiCancerCare
The San Joaquin Women Physicians Group was the thoughtful idea of Dr. Dora Ames Lee. She was born in Arizona around 1914, graduating from UC San Francisco School of Medicine in 1937. At that time there were very few women in medicine; it appears there were about four in the class of 1940. Dr. Lee practiced medicine in Stockton from 1939 until she retired in 1981. Around 1982, it is believed, she began to gather with other “lady doctors” for lunch. This group of women, the first and second generation of female physicians
in a small city like Stockton, needed love, understanding and support from each other as they raised their children while balancing professional, religious, community and family responsibilities.
There are too many other members of the early group to mention, but they included Dr. Ingeburg Kultzen, Lodi’s first pediatrician, who moved here from Germany in 1956 and practiced for 42 years. Dr. Graciela Barzaga, who practiced physical medicine and rehabilitation for over 55 years, was also an early member. The group continued to grow, and by early 2000, the group of lady doctors included Dr. Norma Espiritu, Dr. Margarita Nosce, Dr. Helen Reyes, Dr. Harjit Sud, Dr. Patricia Hatton, Dr. Linh Nguyen and Dr. Carol Cahill. Currently there are more than 40 members.
“From these ‘lady doctors,’ I learned grace and dignity under pressure, and I marvel every time we meet at the shared bonds of understanding among diverse medical specialties, different religions, cultures and personalities,” said Linda Kawaguchi, who in 2005 took over the duty of organizing these gatherings. “We have grown from a small group of women singing holiday
carols at each other’s homes into a larger, sometimes boisterous, always warm and welcoming group of women who laugh and cry and tell stories together.”
These amazing women physicians come from near and far, some from Tracy, Manteca, Lodi, the East Bay and Elk Grove, some who have lived and practiced here for many decades. Some are relatively new to the area, while others are just starting their medical residency training here in Stockton.
Dr. Manreet Basra summed up the importance of this camaraderie. “This group makes one feel very accomplished in our lives, while keeping us grounded at the same time, as we all understand how tough it is to balance our professional and personal lives, especially while raising our kids to become well learned and responsible individuals.”
With no agenda, political or professional, the Women’s Physicians Group exists to “just be there for each other.” Other social opportunities do exist for networking, referrals, continuing medical education and volunteer work, but no other group is quite like this one.
The United States Congress passed their year-end omnibus legislation last week, which includes a Medicare physician payment cut of 2.5% in 2023. Physicians had been staring down cuts as much as 8.5%, but a nationwide advocacy campaign by the American Medical Association, California Medical Association (CMA) and more than 150 organizations representing over 1 million physicians helped stave off many of the reductions. However, physicians who care for Medicare patients and CMA are very
concerned about how the cut will impact patient access to care.
“Congress’ plan to cut Medicare demonstrates a lack of understanding of the access barriers already plaguing our health care system,” says CMA President Donaldo Hernandez, M.D. “Physicians are frustrated and demoralized because, at a moment when the entire health care system is stressed to its limits, both parties in Congress have decided to ‘thank’ physicians working on the frontlines with cuts that will have devastating impacts.” >>
This 2.5% cut, following two decades of flat payment rates with no inflationary updates, will cause irreparable harm to Medicare and our underserved communities. When adjusted for inflation, Medicare physician payments have dropped by 22% from 2001 to 2021. Physicians simply cannot afford to operate under the current payment system.
“Physicians and all health care providers are exhausted as California hospitals are at capacity and patients are experiencing long waits at overwhelmed emergency departments and urgent care centers, and even longer waits to see a primary care physician,” says Dr. Hernandez. “After three years of a difficult pandemic and 20 years of no Medicare inflation updates, many physicians are leaving Medicare and many others are choosing to retire early. As physicians, we want to continue to care for the families in our communities, but we cannot do that when Medicare no longer covers our costs to provide care and pay staff.”
CMA is urging Congress to return in 2023 and immediately get to work on a long-term overhaul of the Medicare payment system that includes an annual automatic inflation update, addresses budget neutrality, and provides more alternative payment model (APM) opportunities.
The omnibus budget deal also extends the Advanced APM
incentive payment at a reduced rate of 3.5% for one year and delays for one year a scheduled increase in patient and revenue requirements to qualify for incentives.
The omnibus legislation extends for two years all telehealth flexibilities provided during the COVID-19 pandemic and includes a massive funding package to improve access to mental health, maternal health and substance use disorder services. Additionally, the budget deal provides funding for 200 new graduate medical education residency positions, half of which will be dedicated to training more psychiatrists to meet the nation’s growing mental health crisis. It also addresses future pandemic preparedness and aggressively invests in improving medical supply chains and combating drug shortages. At CMA’s request, the legislation requires more contracts for urgent domestic manufacturing of antibiotics, which are currently in short supply.
Finally, the Biden Administration released two rules in December to streamline prior authorization processes for certain payors. CMA had been aggressively pushing for a legislative fix, which unanimously passed out of the U.S. House of Representatives in September and was hoped to be included in the year end omnibus package.
In Fall 2022, Brooke McCollough was named the new president of Adventist Health Lodi Memorial. She has the distinction of being one of our very own, born and raised in Lodi with deep roots in our community. Destined for a career in healthcare, Brooke’s early experiences began by working for her dad in his pharmacies in Lodi and Stockton. An avid athlete, she pursued her passion for competitive volleyball and swimming which began when she was attending Stockton’s Annunciation School and all the way through her completion of high school at St. Mary’s.
After pursuing her undergraduate degree in business at the University of Colorado, followed by an MBA in Health Industry Leadership from Regis University, Brooke realized that there really was no place like home, so she returned to the Central Valley and began her healthcare career as an intern and consultant with San Joaquin General Hospital in 2006. Of course, with her heart set on giving back to her hometown, she made the move to Lodi Memorial Hospital in 2007 and never left. Beginning as a quality analyst, Brooke’s personal drive and commitment to excellence led to a series of promotions to positions with broader leadership responsibilities in the areas of quality, accreditation, risk, licensing, physician services and most recently, as chief operating officer since 2018.
Brooke views her new role as the perfect opportunity to give back to the community that has given her so much. Her personal objectives align perfectly with Adventist Health’s mission of living God’s love by inspiring health, wholeness and hope. Her vision for the future includes strengthening the hospital’s relationships with the community to improve residents’ health and quality of life.
“Brooke’s focus on operational excellence and broad community connections will be great assets as we continue our positive momentum at the hospital and in San Joaquin County,” says Terri Day, who will continue to serve as CEO for both Adventist Health Lodi Memorial and Dameron Hospital, and remain involved in setting the strategic direction for those hospitals.
This is the kind of long-term commitment and support Lodi needs right now from its hospital to move forward as a community. And it’s clear that Brooke intends to see this through because she has already established her own personal roots in the area. She and her husband, Matt, live in Lodi and they have three children – a 7-year old son and 3-year old fraternal twins. As a family they love participating in sports activities and spending time outdoors, especially near the ocean.
At Shriners Children’s Northern California, we offer vertebral body tethering as an alternative to spinal fusion to correct idiopathic scoliosis. The tethering device is a braided, polyethylene cord attached with screws to the convex side of the scoliosis curve. It restricts growth on that side and allows growth on the other, resulting in curve correction as the patient grows.
Vertebral body tethering has distinct advantages:
• More preservation of normal vertebral and disc structures
• Preservation of spinal motion with a potential for improved quality of life
• The operation can be performed endoscopically, allowing for faster recovery
Experts recommend that children with idiopathic scoliosis and a curvature of 20-25 degrees get a referral to a specialist, as these curves may progress.
Who is a candidate for vertebral body tethering?
• Thoracic or lumbar curves of 40-65 degrees.
• Age between 10 years and 15 years old, as the child must have adequate growth remaining (Sanders score of 2-5).
• Pronounced kyphosis is generally a contraindication.
At Shriners Children’s, there are no barriers to care. Care is provided regardless of the family’s ability to pay or insurance status
On December 15, 2022, members of the San Joaquin Medical Society were excited to celebrate the holidays with friends and colleagues. It was a festive event with comedy by Dr. Neelesh Bangalore, who kept everyone laughing.
Volunteering has helped revive a passion for medicine while injecting some much needed expertise, money, medical supplies and patient care into projects near and far for some very giving San Joaquin County physicians.
These medical professionals have found some unique and inspiring ways to share their talents in their limited spare time.
Whether it’s mentoring students, serving as a high school varsity team doctor, caring for cleft-palate surgery patients, collecting medical equipment for a village in India or teaching life- saving trauma surgery techniques in a warzone, our physicians are filling a great need.
Dr. Feroze Sidhwa, M.D., is a surgeon specializing in trauma and critical care. He serves as the program director for San Joaquin General Hospital’s general surgery department and is heading to back Ukraine for a two-week deployment in March with the International Medical Corps where he teaches courses in the fundamentals of Advanced Trauma Life Support to doctors there. It will be his second trip to the country that has been fighting a brutal invasion from Russia, which has killed tens of thousands while leaving even more with complex injuries.
“What I like to say about working abroad is that it recharges my moral batteries. The environment you go into and the people you meet, they are really surprised that you care enough to be there, and they are so grateful,” Dr. Sidwha said.
He has served on medical missions to Haiti, southern Zimbabwe and the Palestinian territories where he was shocked by the pain tolerance of a population numb to suffering. American trauma surgeons in urban cities plagued by gun violence have a vast amount of experience that can translate to the battlefield, said Dr. Sidwha. The war in Ukraine is creating an increasingly desperate situation where physicians from all specialties, who might not be accustomed to trauma care, are having to learn that every second counts when it comes to stopping the bleed.
“I was worried they might think who are these random people coming in here?
Dr. Punnam led effort to send
But when we finished the course, there was this older man who was probably the most experienced guy there and he hadn’t said anything during the entire course,” Dr. Sidhwa said of his last mission to Ukraine. “Then he got up and spoke, and he said he didn’t realize there is this whole world of stuff that needs to happen before the patient even gets to the operating room.”
Dr. Sidwha and other physicians who have served on medical missions said there is a certain kind of freedom in the experience. “Stop thinking of it as giving back and start thinking of it as the purest practice of medicine that exists. No insurance companies, no hospital admins, just you, whatever resources you can muster, and sick people to take care of,” he said. “It’s a very different environment.”
Pediatrician Janwyn Loy Funamura, M.D served on a dozen medical missions throughout her career, with nonprofits such as Alliance for Smiles. She helped provide pre- and post- operative care to patients undergoing cleft palate surgery, sometimes in
far-flung locations such as Ghana where it had been years since such repairs were available to the population. “Most of the patients were young, but sometimes there would be an older patient and they were able to communicate how they had lived with this their entire life,” she said of the transformative surgery a cleft palate repair can make. “ It was very eye opening to me.”
Most of her missions were spent in China, which sparked a desire in the fourth- generation Chinese-American to learn more about her family heritage. Recently retired, she’s looking into her family tree.
Sutter Health cardiologist, Dr Sujeeth R. Punnam helped doctors in India care for Covid patients when there was an acute supply shortage. He raised $500,000 and coordinated $3 million in care with the help of other Indian physicians in the U.S. to send help to underserved communities in India. “We needed about 1,500 (oxygen concentrators) and only 1,000 were available. I was able to motivate a group of people from all over the U.S. to source some,” Dr. Punman said. Those were shipped from SFO to India. “Then we delivered 100 ventilators and 100 high flow nasal canula machines to 48 hospitals in 18 states of India through AAPI. All these are nonprofit hospitals or government hospitals taking care of patients for free,” he said.
Some physicians find ways to help closer to home and are mentoring the next generation. Dr. Kelly Savage, an internist with Kaiser Permanente, has found guiding young people
“Stop thinking of it as giving back and start thinking of it as the purest practice of medicine that exists."
- DR. SIDHWADr. Janwyn Funamura meets patient in Ghana
gives her a new perspective on her calling as a doctor. As the incoming chair of Bridge to Medicine, the San Joaquin Medical Society’s program to help mentor high school and college students interested in medicine, she encourages more physicians to get involved, especially younger doctors who are more familiar with today’s path to medical school and beyond. “Students, especially those who don’t have any physicians in their family, can be very intimidated by doctors and the whole process,” she said. “I share my story and then they feel like they can do it.”
She also launched Student Athletes in Medicine at University of the Pacific. As a former college swimmer and water polo player, she knows the time demands these student athletes have. “We started this so we could help some of the athletes mainly because I know how it felt to be in season and not have time for much of anything. We would schedule volunteer opportunities and research possibilities for them in their off season,” she said.
At Saint Mary’s High School in Stockton, Dr. Roland Winter and his wife Kristin, were the major benefactors of a brand-new track and a treatment room. Dr. Winter, of Alpine Orthopaedic Medical Group; Spine Center, has served for more than 27 years as the school’s varsity football team doctor and helps conduct sports physicals at the campus for student athletes. “It’s fun interacting
with the kids. The young men on the football team are very respectful and it’s been great to get to know them and to interact with their families,” Winter, who is also vice-chair of the school’s board of trustees. “I do like giving back to the community and a lot of parents have told me they are glad I’m on the sidelines.”
Dr. Winter has been able to stabilize broken bones and has relocated dislocated joints. He, too, is glad he’s on the sidelines, especially when there are serious injuries such as one that happened some years ago when the son of the visiting team’s coach was playing and suffered a broken neck. “He couldn’t feel his arms and legs,” he said, adding that the player made a full recovery and was playing
baseball by spring.
Winter and his practice are also team doctors for athletics at University of the Pacific and Dr. Winter serves as the medical director for the university’s masters program in sports medicine. Other physicians are combining altruism with their fitness
routine. Dr. Vicente Santiago, a sleep specialist with Kaiser Permanente and a veteran of two dozen marathons, is running the Boston Marathon in a team of four runners while raising money for Wake Up Narcolepsy. ” I am following a training program that emphasizes running in hills and also progressively longer runs on weekends (because the) Boston Marathon has a hilly course,” he said. “My personal goal is $10,000 to help this great foundation which in turn helps patients locally and worldwide.”
Those who are on the receiving end from the generosity of our medical community say it doesn’t go unnoticed. “Our track was all torn up and we couldn’t even host our own track and field meets,” St. Mary’s Athletic Director Adam Lichter, said. “Their generosity is the reason we have a new track. We are unbelievably blessed by their support. Having Dr. Winter on the sidelines during football games alongside our trainer is so reassuring to our athletes. Football can be a violent sport and
“I do like giving back to the community and a lot of parents have told me they are glad I’m on the sidelines.”
- DR. WINTERDr. Feroze Sidhwa and Ukrainian Translator Dr. Roland Winter serves as team doctor
having him there to do an initial assessment along with our trainer is very comforting.”
Giving back to the community, whether near or far, can be a win-win and those who are going the extra mile say the need is great. But so are the rewards. “You can kind of get
burned out sometimes, especially during the pandemic,” Dr. Savage said. “It’s just been really refreshing to be around these young people. They are really intelligent, and they are very cool. I really want to help more underserved students who don’t have access to mentors.”
Do you worry about who will take care of your patients when you retire? Do you want a meaningful way to give back to your community? If so, look no further! SJMS is currently recruiting volunteers to join our Bridge to Medicine (BTM) committee. BTM guides high-achieving, high school and college students who are committed to pursuing a career in medicine, along their academic journey so that they have the best chance of being accepted to medical school and ultimately returning to practice in our community.
The committee meets approximately every other month at SJMS and consists of physicians (working & retired), alliance members and even a local professor. Most importantly, you don’t need to be an expert! We have committee members with a wide array of skill sets and resources, so you are never alone. For more information please contact Lisa Richmond at 952-5299 or Lisa@sjcms.org
Thirty qualified University of the Pacific seniors will be guaranteed admission to the medical school at Touro University California each year under a new partnership between the two institutions.
Pacific students who meet the GPA and standardized test requirements will earn automatic admission to the College of Osteopathic Medicine on Touro’s Vallejo campus. Osteopathic medicine is a holistic approach to medical care in which the entire patient is treated rather than just symptoms.
“This is a tremendous opportunity for our students seeking a career in medicine by providing a clear pathway to medical school,” said Maria Pallavicini, provost and executive vice president of Academic Affairs. “This partnership also will greatly impact the region by training a diverse group of highly qualified students who are likely to stay in the area and fill the growing need for physicians.”
The United States could see a shortage of up to 124,000 physicians by 2034, according to a report from the Association of American Medical Colleges. The existing shortage of primary care clinicians is especially high in California’s Central Valley. Pacific’s diverse student body (36% identify as Asian and 25% Hispanic) also can help meet the need for physicians from
underserved communities. Research has shown students from underserved communities are more likely to work in those areas.
“I'm very excited about the opportunity to partner with University of the Pacific to help build a more diverse physician workforce,” said Tami Hendriksz, dean of the College of Osteopathic Medicine and chief academic officer at Touro. “The alignment of our missions makes this partnership an ideal way to creatively address the projected physician shortages in our communities. The team at University of the Pacific has been great to work with, and I look forward to our continued collaboration.”
To qualify for the guaranteed admission program, Pacific students must have earned science and cumulative GPAs of 3.5 or better, attained a Medical College Admissions Test (MCAT) score of at least 505 and completed 100 hours of volunteering with osteopathic physicians, primary care clinics or underserved communities, among other criteria. Students do not need to be in a specific major.
Pacific students also will be guaranteed admission to two other programs at Touro under the new partnership agreement:
• Master of Public Health (10 students annually), which trains students to be leaders in research, education and policymaking.
• Master of Science in Medical Health Sciences (10 students annually). The one-year program makes students stronger candidates for medical school and opens the door for other healthcare-related opportunities
The California Medical Association (CMA) will host its 49th annual Legislative Advocacy Day in Sacramento on Wednesday, April 19, 2023. Attendees will have the opportunity to meet with legislators on priority health care issues. The meetings will be scheduled and coordinated by your local county medical societies.
This unique event is free of charge to all SJMS/CMA physician members, residents and medical students. Plan to join your colleagues as they prepare to lobby their legislative leaders and serve as champions for the house of medicine!
Set April 19 aside to become an advocate for your patients and colleagues! Register now at https://www.cmadocs.org/eventinfo/sessionaltcd/LEGDAY23/t/legislative-advocacy-day to register or email SJMS at Jessica@sjcms.org!
Registered attendees will also receive webinar training on legislation and policy affecting the practice of medicine on March 29.
• Are practicing in an area affected by natural disaster, officially declared disaster or emergency zone
• Are granted a waiver based on other extraordinary circumstances
To claim the exemption, physicians must register with the California Board of Pharmacy. This will allow allow pharmacists to confirm that a physician is exempt from the requirement.
Since California’s e-prescribing mandate originally took effect in January 2022, it has proven to be a costly burden for low volume prescribers, many of whom are retired or semi-retired physicians who maintain a license. E-prescribing software often comes with a monthly subscription cost, and for providers who write only a handful of prescriptions a year, the software can cost upwards of $20 per prescription. This bill aligns California law with federal regulations and will ease this burden at a time when physicians are still reeling from the effects of the COVID-19 pandemic.
Low volume prescribers and health care practitioners that meet certain criteria can now request an exemption from California’s e-prescribing mandate, under a new law (AB 852) strongly supported by the California Medical Association (CMA).
Under the new law, physicians are exempt from the e-prescribing mandate if they meet one of the following criteria:
• Issue 100 prescriptions or less in a year
Shriners Children’s Northern California has become the first children’s hospital in the West and only the second in the nation to become a verified Level 1 Specialty Children’s Surgery Center – Musculoskeletal from the American College of Surgeons’ Children’s Surgery Verification Program.
“This is more than acknowledgement of excellence in pediatric orthopedic care; it is a well-deserved recognition of our highly talented clinical professionals and support staff who provide exceptional quality multidisciplinary care to every patient, every day,” Michelle James, M.D., chief of orthopedic surgery at the hospital told staff.
Providing staff, physicians, and patients with relevant & up to date information
The Children’s Surgery Verification (CSV) Quality Improvement Program was launched by the American College of Surgeons in 2017. Published reports have shown verification to be associated with lower levels of narcotics administration, reduced surgical wait times and shorter hospital stays.
The verification is granted only after an extensive review of hospital structure, processes, and outcomes conducted by a team of reviewers that includes pediatric surgeons, anesthesiologists, and nurses.
Health Plan of San Joaquin (HPSJ) celebrated freshmen at Health Careers Academy (Stockton) with the annual presentation of scrubs for each student. HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD, said: “Each student has been selected to join Health Careers Academy and begin in earnest their journey into the healthcare field. We ask them to put their best foot forward and use their time well, with support from school leaders, faculty, their peers, and the community. These are our community’s future physicians, nurses, pharmacists, psychologists, therapists, data analysts and more. Ultimately, we want each student to feel supported by their community which is eager to have them back to practice locally and to mitigate the current healthcare workforce shortage.”
Dignity Health St. Joseph’s Medical Center (SJMC) has reached the milestone of completing 400 transcatheter aortic valve replacement (TAVR) procedures, led by Dr. Richard Waters, TAVR team cardiologist. TAVR is a minimally invasive procedure that focuses on replacing a thickened aortic valve that has difficulties fully opening, due to either aortic valve stenosis or aortic valve regurgitation, both of which cause reduced blood flow from the heart to the rest of the body. "We are pleased to be able to provide this effective and less invasive aortic valve replacement option to members of our community and offer an advanced level of cardiac care close to home,” said Dr. Richard Waters.
St. Joseph’s Medical Center offers comprehensive interventional radiology (IR) services to treat many conditions that once required surgery. By utilizing minimally invasive techniques, IR procedures generally result in decreased risks, less pain, and shorter recovery times for patients when compared to traditional surgery. Whether your patients are experiencing back pain, chronic kidney disease, heart and vascular conditions, cancer, or men’s or women’s health issues, IR treatments are available to address many health concerns.
St. Joseph’s interventional radiologists have a wealth of experience and expertise in leading-edge, minimally invasive procedures. Featured services and treatments include:
• Angiography for vascular malformation
• Balloon kypohoplasty for vertebral compression fractures
• Cryoablation for kidney cancer
• Pain management to treat nerve pain (pain blocks)
• Percutaneous transhepatic biliary drainage (PTBD)
• Peripheral arterial and venous disease
• Prostate artery embolization (PAE)
• Radioembolization for liver cancer (Y90)
• Uterine artery / uterine fibroid embolization (UAE / UFE)
For more information, visit dignityhealth.org/stockton/IR or call IR scheduling at (209) 467-6323.
Please help spread the word to those you serve – Health Plan of San Joaquin (HPSJ) wants to reward members for getting their annual checkups and routine exams. myRewards member incentive program is one of HPSJ’s many innovative quality improvement strategies. Preventive care is often overlooked in the daily lives of many members who face other challenges and have unmet needs. HPSJ’s goal is to increase the value of preventive care and decrease the barriers in receiving care. HPSJ members are encouraged to visit their doctor and stay up to date with their health exams and checkups. This year members can get rewards for going in for the following:
Women’s health
• Prenatal care in first trimester OR within 42 days of enrollment
• Postpartum visit between 7 and 84 days after delivery
+Depression Screening
• Prenatal Immunization series
Chronic disease
• Diabetes care: A1C
Well-child visits and immunizations
• 6 Well care for baby: 0 to 15 months
• 2 Well care for baby: 0 to 30 months
• Annual Well-child visits: 3 to 21 years of age
• Lead screening
• Immunizations for Adolescents
• Full Series: 1 dose of meningococcal vaccine, 1 Tdap vaccine and the complete human papillomavirus vaccine (HPV) series by their 13th birthday)
• Immunizations for Children- Pediatricians know all the details so parents/guardians just need to keep up with their well-child visits and follow their provider’s recommendations.
• Full Series: 4 DTaP; three polio (IPV); 1 measles, mumps and rubella (MMR); 3 haemophilus
influenza type B (HiB); 3 hepatitis B (HepB), 1 chicken pox (VZV); 4 pneumococcal conjugate
(PCV); one hepatitis A (HepA); series of rotavirus (RV); and 2 influenza (flu) vaccines by the 2nd birthday
• Fluoride Varnish Application once per year up to 6 years of age
Prevention:
• Flu shots
• Colorectal cancer screening
• Cervical cancer screening
• Breast cancer screening/mammogram
Please encourage those you serve to learn more at www.hpsj.com/myrewards.
Dignity Health St. Joseph’s Medical Center (SJMC) held their annual Adopt-a-Family toy drive on December 15th, with over 1,500 toys and 13 bikes collected for local children. Through collaborating with nonprofits such as Child Abuse Prevention Council, Human Services Agency, and Stockton Homeless Shelter, the toys were distributed to the community prior to Christmas. “We are delighted to continue our Adopt-a-Family tradition and are thankful for our generous employees who make the holidays special for so many children in San Joaquin County,” said President and CEO Donald J. Wiley. “I am humbled by the contributions this year and am grateful that we are able to give back to our community during the holiday season.”
rates for 31 of the most common conditions and procedures at nearly 4,500 hospitals across the country to identify the topperforming hospitals.
Doctors Hospital of Manteca has received a grant from the California Bridge Program (CA Bridge) to place substance use navigators in its emergency department to help patients battling substance use disorders.
On Saturday, January 28th St. Joseph’s held its 14th annual Fun Run/Walk for Wellness, presented by Pacific Homecare Services. With the generous support of the community and the nearly 600 participants, funds raised will assist St. Joseph’s Cancer Institute with purchasing a Trident HD Breast Imaging System. This technology will enable St. Joseph’s to image breast specimens in the operating room, which will let the surgeon know immediately if they removed all the tissue necessary.
Substance use navigators (SUN) are a vital part of successful treatment for substance use disorders, working both in the hospital and the community to connect people to treatment.
SUNs enhance access to around-the-clock treatment for patients. This model allows the navigators to be the frontline for initiating treatment. The best outcomes occur when patients start and are retained in long-term recovery treatment with medications. When patients in opioid withdrawal come seeking medical care, including for reasons not related to opioid use, they will be offered medication, such as buprenorphine, to ease severe symptoms of withdrawal and begin maintenance treatment. They will then be connected with treatment resources within the community.
St. Joseph’s Medical Center (SJMC) has been named one of America’s 250 Best Hospitals according to new research released by Healthgrades, the leading marketplace connecting doctors and patients. This achievement puts SJMC in the top 5% of hospitals nationwide for overall clinical performance across the most common conditions and procedures. Healthgrades evaluated patient mortality and complication
Studies have shown that initiating treatment and providing medication designed for addiction treatment are more likely to result in patients remaining in care and having better long-term outcomes than those who are given referral information alone.
Doctors Hospital of Manteca celebrated a special milestone on Friday, Nov. 4, 2022. If you’ve been to the hospital, chances are pretty high that you’ve met Ali Movasagh. Ali runs Coffee Klatch, his coffee cart just off the hospital’s main entrance. Nov. 4, 2022, marked his 18th anniversary of serving delicious coffee, drinks and treats at Doctors Hospital of Manteca.
The entire team at Doctors Hospital of Manteca would like to thank Ali for 18 amazing years of warm smiles, friendly waves and the best customer service around.
Doctors Hospital of Manteca is proud to announce the installation of a new digital radiographic and fluoroscopic suite located in the Diagnostic Imaging Department. This is a replacement of the previous fluoroscopic room.
This newer technology provides improved quality imaging at a lower radiation dose to patients. With increased
table weight limits and the ability to lower the table to 26 inches, patients can move on and off the table more safely and efficiently.
Adventist Health Lodi Memorial is thrilled to welcome Dr. Karim Zahriya, a board-certified general surgeon with over 30 years of experience specializing in abdominal surgery and advanced laparoscopic surgery. Dr. Zahriya has extensive experience in thyroid, breast, gallbladder, and colon surgery. He also has expertise in managing thyroid disease and performing biopsies, ablation, hemorrhoid and minor surgical procedures. Dr. Zahriya has been conducting medical research since 1990 which includes gastrointestinal and cardiac conditions and inspired by his strong desire to help people regain their health and enjoy a fulfilling life. As a San Jose native, he completed his undergraduate and graduate studies at San Jose State and his medical school and residency in Michigan.
Dr. Zahriya is excited to serve the San Joaquin County community.
Pediatrician Dr. Issa is a board-certified pediatric doctor with more than 10 years of experience caring for children. After attending medical school at Al-quds University in Jerusalem, she completed her pediatrics medical training at West Virginia University.
Dr. Issa now serves the community through pediatric care including sick visits, well child checkups, immunizations and more. Her experience allows her to treat a multitude of pediatric conditions, such as respiratory problems, asthma, behavioral problems, ADHD, and other common illnesses. She proudly serves children ranging from newborns to 18 years of age and is fluent in both English and Arabic.
Dr. Issa was inspired to practice medicine by watching the doctors who helped her family members throughout her life. She states, “I love my work because I help children get over illness, help parents take care of their children and make a positive impact in a child’s life.”
Dr. Sara Edwards, a University of California San Francisco orthopedic surgeon, visited Adventist Health Lodi Memorial on December 20, 2022 to observe and learn an innovative orthopedic shoulder replacement surgery technique that utilizes
a GPS-computer guidance system for precision.
Dr. Edwards observed Dr. Jaicharan Iyengar, a nationallyrecognized specialist in orthopedic surgery with focus on treatment of the shoulder and elbow. He is the founder of the Stockton Shoulder Institute at Alpine Orthopaedics and has performed more than 300 GPS-guided shoulder replacements since 2017. Dr. Iyengar regularly performs these procedures at Adventist Health Lodi Memorial, which is one of a limited number of medical centers in Northern California that offers this state-of-the-art surgical procedure.
Due to narrow bone windows within the shoulder, replacement outcomes are highly sensitive to accurate placement of components. This shoulder navigation technology, however, mitigates the challenges that often come with placement. According to Exactech, its GPS technology “connects the preoperative plan with real-time intraoperative instrument guidance and verifies implant placement.” Essentially, surgeons
utilize a pre-planning software to accurately plan the procedure and select implants for the patient’s specific anatomy. The software then works alongside the GPS in the operating room, directing the surgeon in real time.
“It is exciting to have Dr. Edwards join us here for an educational exchange,” said Dr. Iyengar. “UCSF has one of the best orthopedic programs in the country and she is one of their outstanding sports medicine specialists. I was delighted to share some of my minimally invasive surgical techniques with her.”
Dr. Edwards and Dr. Iyengar are both members of the Columbia Shoulder Society, which is an alumni group for surgeons who completed their fellowship training at Columbia University in New York, which is the oldest shoulder fellowship in the country.
Dr. Iyengar is a board-certified orthopedic surgeon specializing in shoulder and elbow surgery and sports medicine injuries. He is the founder of the Stockton Shoulder institute at Alpine Orthopaedics and earned his medical degree from the University of California San Francisco, where he also completed his internship and residency. Dr. Iyengar has served as the Head Team Physician to the Stockton Ports baseball team and the University of Pacific Tigers collegiate athletics program since 2013.
Dr. Edwards is an associate professor of orthopedic surgery at the UCSF School of Medicine. She is a practicing and Shoulder and Sports Medicine Specialist seeing patients at the UCSF Orthopaedic Institute in San Francisco, and the UCSF Berkeley Outpatient Center. She is a Team Physician at the University of San Francisco, City College of San Francisco and the Oakland Ballet.
To promote better health outcomes and preventive services, the DHCS requires Medi-Cal plans to report annually on a set of quality measures associated with children’s preventive services, women’s health preventive services, chronic medical conditions, and behavioral health conditions.
Kaiser Permanente’s Northern and Southern California MediCal health plans were the only plans among more than two dozen in the state that achieved established quality levels for more than 90% of the measures.
“Kaiser Permanente is committed to improving the health of our members and communities we serve by providing care and coverage to those who otherwise couldn’t afford health care,” said Carrie Owen Plietz, FACHE, president of Kaiser Permanente’s Northern California region. “We are proud to be recognized for the quality care we provide as we focus on improving the overall health of our communities.”
Kaiser Permanente is also the only Medicare health plan in California to receive a 5-star rating, according to the Centers for Medicare & Medicaid Services’ 2023 Medicare Star Ratings.
Kaiser Permanente Northern California’s Medi-Cal health plan is the highest rated in the state for quality care, according to a December 2022 report from the state’s Department of Health Care Services (DHCS).
Medi-Cal is California’s Medicaid health care program, which covers a variety of medical services for children and adults with limited income and resources.
“We are pleased to be rated among the highest in the state for delivering high-quality and equitable clinical care to patients in every community we serve,” said Richard S. Isaacs, MD, FACS, chief executive officer and executive director of The Permanente Medical Group. “And we’ll continue to focus our efforts on further improving quality, access and service for all the patients who have entrusted us with their health and well-being.”
Last year, Kaiser Permanente Northern California received a 5-star rating for providing quality clinical care and behavioral and mental health care in the annual Health Care Quality Report Card from California’s Office of the Patient Advocate (OPA) and was the only health plan in the state to receive a 5-star “Summary Quality Rating” from Covered California — the state’s marketplace for the Affordable Care Act.
From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-theminute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley.
Your referred patients benefit from shorter drives, less traffic, affordable lodging, and more. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.
Referring your patients to UC Davis Health care is easier than ever. Our physician referral liaisons are here to serve as direct lines of communication — helping to navigate and expedite referrals.
Our liaisons can help to:
■ Facilitate access to our secure EMR system, PhysicianConnect
■ Arrange meetings, webinars, and share information about CME and other events
■ Assist with UC Davis Health clinical trials and telemedicine
■ Keep you abreast of new services, providers and research programs
Reach out to your local Physician Referral Liaison today: Joaquin Muñoz | 916-701-7161 | joamunoz@ucdavis.edu
Payam Saadai, M.D. Assistant Professor, Department of Surgery Specialties: Pediatric Surgery, Colorectal Surgery, Fetal Surgery, Minimally Invasive Surgery
Dr. Kwabena Adubofour, the Assistant Program Director at SJMC Internal Medicine Residency, and the IM Residency were one of the awardees for ABIM’s Building Trust Grant. They will implement DEI principles by using didactic education and experiential opportunities to enhance understanding of the relationship between social determinants of health and the importance of health equity.
The
Dr. Adubofour and the residents have partnered with three local CBOs (NAACP, El Concilio, and APSARA) and McKinley Elementary School for the project. A learning round table with patients is being coordinated with El Concilio to measure community members’ trust in their healthcare providers. A cultural competency and sensitivity curriculum will be introduced to increase their awareness of the beliefs, values and biases they bring to patient encounters, and improve their ability to interact effectively with individuals different from themselves.
NEW Resident’s Report is dedicated to all the good news related to our hard-working residents training at San Joaquin General Hospital and St. Joseph’s Medical Center. Please email your submissions, written in third person with accompanying photo to Lisa@sjcms.org.
The Office Managers Forum empowers physicians and their practice manager staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. This quarterly forum is normally held on the second Wednesday of March, June, September and December at Papapavlo's.
Registration is required!
If you don’t receive an invitation via E-Mail, please email Jessica@sjcms.org
March 8th, 2023: 11:00AM to 1:00PM
Jamie Bossuat, a shareholder and employment lawyer at Kroloff will present an update on the most pressing issues in employment law and will offer practical suggestions for reducing liability. Issues will include recent changes in wage and hour requirements, updates to leave of absence laws, and current litigation trends.
June 14th, 2023: 11:00AM to 1:00PM
This presentation focuses on how to improve patient experience, which begins with understanding the difference between patient satisfaction and patient experience. Presented by one of CMA’s practice management experts, Mitzi will discuss what has happened to service in a medical practice, how to improve the patient experience, having transparency with your patients, and effectively communicating, connecting, and building trust with patients and their family members.
Speaker: Mitzi Young is the Associate Director, Practice Strategy for the California Medical Association, Center for Economic Services. Mitzi brings over 29 years of experience in the health care industry. In Mitzi’s current role, her focus is Practice Management and Operations. She focuses on the day-to-day operations of CMA’s member practices. Mitzi recommends areas of improvement within a physician practice to achieve financial health, education, staff morale, and development of new internal systems. Mitzi presents seminars on practice management and health care regulations.
Mitzi started her career working for a third-party administrator as a claim and eligibility processor for San Bernardino County hospital’s medically indigent adult program. She went on to further her education and worked as an operations and business manager for specialty practices and for ambulatory surgery centers overseeing all personnel and
business operations. She brings with her a vast knowledge of medical billing and collections, contracting, accreditation, and personnel and business management. She understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of providers on succeeding in the ever-changing challenges of the healthcare landscape.
UHC delays Designated Diagnostic Provider program in CA until Jan. 1, 2022
Beginning on January 27, 2023, organizations that submit information to, or look up information in, the Medi-Cal provider portal will be required complete a one-time validation of their contact information.
After that date, the first time you log into Medi-Cal provider website’s Transaction Services using a submitter ID, a one-time web form will pop up that must be filled out to continue. Submitters will be required to validate their address, phone number and organization’s authorized contact person.
Once this is complete, access will be granted to Transaction Services as usual. This updated information will be used to mail an organization token to all submitters, allowing them to register for access to the new Medi-Cal Provider Portal.
Physicians should be aware that once this form is submitted, you will not be able to access the web form again. If for some reason it was input incorrectly, you will need to call the Medi-Cal service center at (800) 5415555 to update your information.
The California Department of Health Care Services (DHCS) recently announced the list of drugs that will require prior-authorization (PA) under Phase II Wave 2 of the Medi-Cal Rx transition, which is scheduled to start on February 24, 2023.
Phase II, Wave 2 will reinstate PA requirements for 46 additional standard therapeutic classes, including medical supplies, for new start prescriptions for beneficiaries 22 years of age and older. “New starts” are defined as new therapies or medications not previously prescribed to the beneficiary during the 15-month lookback period.
Phase II, Wave 2 will complete the reinstatement of PA requirements for new start prescriptions for beneficiaries 22 years of age and older. Medi-Cal Rx will continue to utilize PA and claims data to allow for grandfathering
of previously approved PAs until Phase III of Reinstatement, as announced in the alert.
New start prescriptions for pediatric patients 21 years of age and under continue to be excluded to prevent additional administrative obligations for providers of specialty pediatric services who have been significantly impacted by the transition to Medi-Cal Rx.
For an overview of the remaining phases of the MediCal Rx transition plan, see the DHCS Medi-Cal Rx Reinstatement Spotlight.
DHCS will also be holding Phase II reinstatement webinars via Zoom every Friday at 12 p.m. No registration is required. This month’s webinar will provide information specific to Phase II, Wave 2, including reinstatement of PA requirements for beneficiaries 22 years of age and older and submission of PAs in advance of the retirement of the transition policy.
To receive the latest news, alerts and bulletins on MediCal Rx, including the Reinstatement Spotlight published each Friday, sign up for the subscription service.
For questions, please contact the Medi-Cal Rx Customer Service Center at (800) 977-2273, available 24 hours a day, 365 days a year, or email MediCalRxEducationOutreach@magellanhealth.com.
• 30-Day Countdown – Reinstatement of Prior Authorization Requirements for 39 Drug Classes; https://medi-calrx.dhcs.ca.gov/cms/medicalrx/staticassets/documents/provider/bulletins/2022.12_A_PA_ Reinstatement_39_STCs_30-Day_Countdown.pdf
• Medi-Cal Rx Reinstatement of Prior Authorizations and Retirement of the Transition Policy: Phases II, III, and IV presentation; https://medi-calrx.dhcs.ca.gov/ cms/medicalrx/static-assets/documents/educationand-outreach/Slidedeck_PA_Reinstatement_and_ Transition_Policy_Retirement_Phases_II_III_IV.pdf
• Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services from Managed Care to Fee-for-Service
Frequently Asked Questions; https://medi-calrx.dhcs. ca.gov/cms/medicalrx/static-assets/documents/faq/ Medi-Cal_Rx_Transitioning_Medi-Cal_Pharmacy_ Services_from_Managed_Care_to_FFS_FAQs.pdf
As part of its year-end omnibus budget deal, Congress extended the Advanced Alternative Payment Model (APM) incentive payment for one additional year.
Advanced APMs are one track of the Center for Medicare and Medicaid Services (CMS) Quality Payment Program, which offers incentives for meeting participation thresholds based on levels of payments or patients through Advanced APMs.
The California Medical Association (CMA) had advocated for this extension as part of the negotiations around the omnibus legislation. CMA also continues to advocate for a greater variety of and improvement to voluntary APMs and Accountable Care Organizations so more physicians have the opportunity to participate.
The extended availability of the Advanced APM incentive payment will allow eligible clinicians who are Qualifying APM Participants (QPs) for the 2023 QP performance period to receive a 3.5% (down from 5%) APM incentive payment in the 2025 payment year. Without this change, there would have been a one-year gap with no statutory incentives for participating in the program in the 2025 payment year.
In addition, the participation threshold for becoming a QP will remain frozen: Clinicians must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an Advanced APM Entity during the QP performance period.
Clinicians who are QPs for 2023 performance period will not need to do anything to receive their payments in 2025, unless the Center for Medicare & Medicaid Services (CMS) is unable to verify their Medicare billing information. QPs who do not receive their payments after initial disbursements are made will be able to check a public notice to see if they need to verify their Medicare billing information.
To learn more about the Advanced APM, visit qpp.cms. gov/apms/advanced-apms.
The California Medical Association (CMA) joined the American Medical Association (AMA) and more than 100 leading medical societies to voice support for the meaningful prior authorization reforms proposed by the Centers for Medicare and Medicaid Services (CMS) that will increase access to medically necessary care.
CMA and the physician groups sent a joint letter to CMS Administrator Chiquita Brooks-LaSure lauding the agency for incorporating the feedback of physicians and other stakeholders into the proposed rule and urged CMS to finalize the rule, which includes the following provisions:
Medicare Advantage (MA) plans may only use prior authorization to confirm diagnoses or other medical criteria and ensure the medical necessity of services.
MA beneficiaries must have access to the same items and services as they would under traditional Medicare. When no applicable coverage rule exists under traditional Medicare, plans must use current evidence from widely used treatment guidelines or clinical literature for internal clinical coverage criteria, which must then be made publicly available.
MA plans must establish a Utilization Management Committee to review their clinical coverage criteria and ensure consistency with traditional Medicare guidelines.
MA plans cannot deny care ordered by a contracted physician based on a particular provider type or setting unless medical necessity criteria are not met.
MA plans’ prior authorization approvals must remain valid for the duration of the course of treatment.
MA plans must provide beneficiaries with a 90-day transition period where a PA would remain valid for any ongoing course of treatment when beneficiaries change plans or enter MA.
After PA approval, MA plans cannot retroactively deny coverage for a lack of medical necessity.
Prior authorization has been a longstanding obstacle to patients receiving easily accessible care, and there has been ample evidence of this in Medicare Advantage plans:
AMA’s most recent survey on prior authorization found that 93 percent of physicians reported care delays while waiting for health insurers to authorize necessary care.
A review conducted by the Inspector General of the U.S. Department of Health and Human Services (HHS) found that Medicare Advantage Organizations improperly denied 13 percent of the prior authorization requests and 18 percent of payment requests.
A Kaiser Family Foundation analysis found that, in 2021, Medicare Advantage plans wholly or partially denied 2 million of 35 million requests (about 6%). Of the 11 percent of denials that were appealed, 82 percent were partially or fully overturned.
CMA is encouraging physicians who have been frustrated with administrative headaches and their impact on your patients to share their stories. Visit www.cmadocs.org/priorauth to add your voice to help reform the prior authorization process to ensure that patients receive the care they need — when they need it.
CMA saw unprecedented grassroots physician engagement, with nearly 4,000 messages sent to policymakers. These physician voices were key in helping to defeat AB 2060 (public member majority on Medical Board of California) and AB 2236 (allowing optometrists to perform surgical procedures).
CMA helped administer both the KidsVaxGrant ($22+ million) and COVID-19 Test to Treat Equity Grant ($59 million) programs, providing critical funding for community pediatric vaccinators, public health systems and community health centers.
CMA saw rapid membership growth among community health centers, resulting in an expansion of our mode of practice forums and House of Delegates representation.
CMA helped secure $1.3 billion in the state budget to provide retention bonuses for many of California’s physicians and other health care workers to stabilize the health care workforce.
CMA successfully advocated for full-scope Medi-Cal coverage for all income-eligible Californians by January 1, 2024, making California the first state to expand its Medicaid program to provide full benefits to all eligible individuals regardless of age or documentation status.
CMA completed its 28th Virtual Grand Rounds webinar, providing critical COVID-19 continuing medical education to over 13,000 attendees while expanding topics to include other public health concerns such as long COVID, monkeypox and wildfire smoke.
In a year where the world was starting to return to “normal,” the California Medical Association (CMA) seized the opportunity to make big gains for physician practices in several areas, from modernizing crucial malpractice legislation, preserving reproductive rights and encouraging grassroots engagement. This year’s achievements include:
Facing another statewide ballot proposition that would have effectively eliminated MICRA’s cap on non-economic damages, CMA and Californians Allied for Patient Protection seized an opportunity to end one of the longest running political battles in California. The legislative deal (AB 35), which modernizes MICRA while preserving its underlying principles, has ushered in a new and sustained era of stability around malpractice liability.
After the Supreme Court’s Dobbs decision, CMA worked with the Future of Abortion Council to protect and expand access to reproductive health care in California, leading to 15 bills signed into law, $200 million in the state budget and the passage of Prop. 1 to enshrine abortion rights into California’s constitution.
CMA member Jasmeet Bains, M.D., joined the California Assembly as its third physician legislator, while incumbent assemblymembers Joaquin Arambula, M.D., and Akilah Weber, M.D., were re-elected. At the federal level, representatives Ami Bera, M.D., and Raul Ruiz, M.D., were re-elected to Congress. CMA also saw its ballot measure positions reflected in election results, including the rejection of Prop. 29 (dialysis clinic requirements) and passage of Prop. 31 (ban on flavored tobacco).
The U.S. Department of Education overhauled the Public Service Loan Forgiveness Program, including the specific fix that CMA advocated for that will allow all eligible California physicians to receive loan forgiveness.
CMA recouped more than $1 million this year (nearly $40 million over 14 years) on behalf of physician members through direct payor interventions. CMA also stopped Cigna’s burdensome modifier 25 policy.
CMA achieved significant victories on health information technology issues by extending the COVID telehealth waivers into 2023; permanently extending key Medi-Cal telehealth payment parity; eliminating e-prescribing burdens (AB 852); and helping physicians comply with the new federal information blocking rule while protecting patients’ sensitive medical information (SB 1419).
San Joaquin County Public Health Laboratory (SJCPHL) is a state and federal certified CLIA diagnostic and ELAP accredited high complexity laboratory. The SJCPHL is an essential bridge between the local community and public health, providing testing for our health department programs, local hospitals, correctional facilities, county clinics, health departments from other counties, and more. With so many PH laboratories closing, and regionalization becoming the new norm, how does a PH Laboratory remain viable in the current economic climate? The SJCPHL in Stockton has managed to embrace the traditional role of a Public Health Lab while still looking ahead by incorporating new technologies and “lab friendly” instrumentation.
In November 2022, the laboratory transitioned to a new state of the art facility with approximately 4,800 square feet on the same campus at 1601 E. Hazelton.
In 2022 SJCPHL performed approximately 30,000 tests from a diversified test menu including:
• Special Bacteriology: Reference level testing to isolate and identify organisms responsible for: Botulism, Plague, Cholera and Typhoid, and for Campylobacter, Shigella, E. coli 0157:H7 and Salmonella. Clearance
testing for Salmonella, Shigella and Shiga Toxin producing organisms. Clearance testing allows Health Departments to determine when it is safe for the ill individuals to return to a daycare, school, or workplace.
• Examinations for sexually transmitted diseases including Chlamydia, Gonorrhea, Trichomonas, HIV, Herpes, and Syphilis
• HIV viral load testing to monitor the level of HIV virus in a patient’s blood.
• HCV viral Load testing to monitor the level of Hepatitis C virus (HCV) in a patient’s blood.
• Full Mycology Laboratory.
• Parasite testing for suspected blood parasites that cause diseases like Malaria, Babesiosis and others. Performing testing for intestinal parasites like Giardia, Entamoeba histolytica, Cryptosporidium and others.
• TB isolation and identification using DNA probes and rapid methods for Mycobacterium tuberculosis. We also perform susceptibility testing for Mycobacterium tuberculosis with results that aid physicians in determining the most efficient drug regimen for the patient. SJCPHL can offer our Quantiferon Assay to detect latent Mycobacterium tuberculosis infections.
• Molecular tests for Norovirus, Enterovirus, Flavivirus, Influenza, Herpes, Measles, Mumps, Gonorrhea, Chlamydia, Shiga toxin, Bordetella pertussis as well as a molecular assay for respiratory viruses with multiple organism targets.
• Comprehensive COVID-19 (SARS-CoV-2) testing including high-throughput PCR, serology, and surveillance on the suspect variants using Whole Genome Sequencing (WGS).
• Testing animals for Rabies. Unlike a Clinical Laboratory, one unique aspect of a Public Health Laboratory is the ability to perform Rabies testing. Timely testing of animals suspected of having Rabies is important for quick administration of prophylaxis, if needed, to save a person from unnecessary treatment and to provide them peace of mind.
• Food poisoning examinations looking for organisms such as Staphylococcus, Salmonella, Listeria, and other organisms that contaminate food products.
• Environmental Testing including microbiological analysis of drinking water (also available to the public), labor camp water and dairy water.
SJPHL serves as the Laboratory Response Network (LRN) Reference Laboratory for San Joaquin as well as the counties of Alpine, Amador, Calaveras, Mariposa, Mono, Stanislaus, and Tuolumne. The LRN B is an integrated network of public health laboratories that can respond to bioterrorism threats, emerging/re-emerging infectious diseases, antibiotic resistant agents, and other public health emergencies. SJCPHL has a dedicated BSL3 suite equipped with specialized equipment and highly trained staff to rule-out suspect Bioterrorism agents such as Anthrax, Plague, Mpox, Tularemia, Brucella, Burkholderia, and Ricin. The BSL3 lab provides high-level containment and enhanced safety features. During the COVID-19 pandemic and Mpox outbreaks, SJCPHL was one of the diagnostic labs providing localized testing and provided guidance to the local sentinel laboratories and health departments within the catchment area.
SJCPHL has recently expanded the laboratory information feature by adding a user-friendly web portal application free of charge to clients. This modernization allows for faster turnaround times, reduces manual data entry errors and improves efficiency. The portal does require a brief training session so please contact the Lab for details. Phone: 209-4683460 or email: phlcopiaoutreach@sjcphs.org
SJCPHL works with groups within Public Health Services (PHS), our other health partners in San Joaquin County, and our health partners in the other counties we proudly serve. This includes:
• Working closely with physicians, nurses, and Environmental Health specialists to facilitate the diagnosis and control of infectious disease. We offer technical consultation for specimen collection, shipping and packaging, microbiological techniques and procedures, laboratory safety, quality assurance and epidemiology.
• Providing packaging and shipping training for both
Category A, Infectious Substances and Category B, Biological Substances to the sentinel laboratories in our catchment area.
• Hosting the Public Health Microbiologist Training Program, the LabAspire Assistant director fellowship and a Public Health rotation for the future Clinical Laboratory Scientists trainees from our local hospitals.
A powerful tool for public health
SJCPHL participates in several surveillance programs such as the National Respiratory and Enteric Virus Surveillance System (NREVSS). With timely collection of data, we can monitor disease circulation patterns and changes in disease occurrence (outbreaks), and can guide public health action.
Whole Genome Sequencing: Our COVID-19 (SARS-CoV-2) as well as bacterial WGS testing will expand with a high throughput instrument from Clear Lab Dx. This new user friendly instrument will allow us to analyze cases with quick turnaround time and generate a genetic fingerprint of the bacteria or virus from the patient. This will enable the health department to find clusters of disease that represent unrecognized outbreaks.
MALDI-TOF: Identification of bacteria and fungi by traditional methods can be a time consuming and complex task. Emerging technology like the Matrix-Assisted Laser Desorption/ionization TimeOf-Flight (MALDI-TOF) found on our new Bruker MALDI Biotyper system will allow our laboratory to identify organisms more quickly and efficiently, especially Mycobacteria species, therefore guiding treatment options.
Carbapenem-resistant Enterobacterales: Carbapenem-resistant (CRE) are strains of bacteria that are resistant to an antibiotic class (carpabenem) used to treat severe infections. SJCPHL will soon bring on the Cepheid Carbapenemase Resistance Molecular Test (Xpert Carba-R) to our Cepheid instrument. Performing this assay in house will reduce result turn-around time, direct patient treatment and help prevent the spread of these drug-resistant organisms in our community.
Contributors:
H. Kaur, Public Health Laboratory Director
S. Stewart, Supervising Public Microbiologist
S. Hazari, Supervising Public Microbiologist
M. Paniagua Alexander, Senior Public Health Microbiologist
R. Patel, Senior Public Health Microbiologist
J. Bernal, Senior Public Health Microbiologist
With heart rhythm disorders, the sooner the diagnosis, the more treatment options available. But some cases don’t come with noticeable symptoms. That’s why it’s important to have your patients check their heart health regularly.
St. Joseph’s Medical Center treats patients with persistent or permanent atrial fibrillation (AFib) who have difficult-to-treat conditions or those who continue to be symptomatic. We provide a multidisciplinary evaluation by electrophysiologists, cardiologists and surgeons who work together with patients to determine the best therapy to enhance their quality of life. Our heart experts specialize in many different types of ablation techniques to treat atrial fibrillation, including, advanced therapies such as WATCHMAN and epicardial/endocardial ablations, minimally invasive catheter ablation, and surgical options.
AFib therapy is aimed at reducing patients’ risk of stroke, relieving symptoms and preventing further weakening of the heart. Let’s take care of our patients’ heart today.
Learn more at dignityhealth.org/stockton/heart.
Dominic Pennisi, MD
Internal Medicine
1503 E March Lane, Ste A
Stockton, CA 95210
American University of Antigua College of Medicine
Elizabeth Phung-Heart, MD
Cardiology
2800 N California Street, Ste 14A
Stockton, CA 95204
Ripudaman Munjal, MD
Nephrology
1801 E. March Lane, Ste B265
Stockton, CA 95210
Shri Ram Murti Smarak Institute of Medical Sciences
Hanadi Abou Dargham, MD
Family Practice
2102 N California St
Stockton, CA 95204
Lebanesa University Faculty of Medical Sciences
Shilpa Malik, MD
Otorhinolaryngology
1503 E March Lane, Ste A
Stockton, CA 95210
University of Toledo College of Medicine
Shiva Khalili, MD
Obstetrics and Gynecology
7373 West Lane
Stockton, CA 95210
Lorestan University of Medical Sciences School of Medicine
Andrea Leung, MD
Obstetrics and Gynecology
7373 West Lane
Stockton, CA 95210
Jefferson Medical College of Thomas Jefferson U
Khaingthazin San, MD
Endocrinology, Diabetes and Metabolism
7373 West Lane
Stockton, CA 95210
University of Medicine 1
Yangon
Kyaw San, MD
Internal Medicine
7373 West Lane
Stockton, CA 95210
University of Yangon Institute of Medicine II
9 NEW SJMS MEMBERS THIS WINTER!
...and even more on the way.
San Joaquin Medical Society
3031 W. March Lane, Suite 222W
Stockton, California 95219-6568
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With over 400,000 members, Health Plan of San Joaquin continuously works to improve the health of our community by partnering with providers, community agencies who provide community supports services, and local businesses to deliver on our mission.
Learn more about the major transformation taking place – California’s Advancing and Innovating Medi-Cal (CalAIM) Initiative – and find out how we can partner to improve health access.
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