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Race of a

Cardiologist with a Big Heart

Lifetime

on y an d em pa thy to pr ofe ssi Ne ph ro log ist br ing s en erg

10th Annual Golf Tournament Health Care Dream Team SUMMER 2019

Summer 2019 SAN JOAQUIN PHYSICIAN

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VOLUME 67, NUMBER 2 • JUNE 2019

14 18 22 26 32 SUMMER 2019

{FEATURES}

{DEPARTMENTS}

CARDIOLOGIST WITH A BIG HEART

44 IN THE NEWS 54 PRACTICE MANAGEMENT

10TH ANNUAL GOLF TOURNAMENT

56 PUBLIC HEALTH

HEALTH CARE DREAM TEAM

61 NEW MEMBERS

GROWING THE PHYSICIAN PIPELINE

62 IN MEMORIUM

RACE OF A LIFETIME

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PRESIDENT R. Grant Mellor, MD PRESIDENT-ELECT Richelle Marsigan, DO SECRETARY-TREASURER Hyma Jasti, MD BOARD MEMBERS Kismet Baldwin, MD, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Benjamin Morrison, MD, Raghunath Reddy, MD, John Zeiter, MD, Cyrus Buhari, DO, Nguyen Vo, MD

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

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

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD

CONTRIBUTING WRITERS R. Grant Mellor, MD, Jo Ann Kirby, George Khoury, MD, Gordon Arakawa, MD, PhD

MEDICAL EDUCATION PROGRAMS R. Grant Mellor PUBLIC HEALTH COMMITTEE Kismet Baldwin, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, 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.

James R. Halderman, MD, Grant Mellor, MD, Raissa Hill, DO, Ramin Manshadi, MD,

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD, Philip Edington, MD,

San Joaquin Physician Magazine

Steven Kmucha, MD

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

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MILLENIALS TO BOOMERS - DRYTOEYE MILLENIALS ALL GENERATIONS: MILLENIALS BOOMERS - DRYTOEYE MILLENIALS BOOMERS DRYTOEYE DRY -EYE BOOMERS - DRY EYE

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Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL

CATARACT SURGERY • GLAUCOMA CARE RETINAL •SERVICES EYELID SURGERY • LASIK • VISION EXAMS •• GLASSES CONTACTS Committed to continuously advancing vision careEXAMS andCARE providing compassionate patient care CATARACT SURGERY • GLAUCOMA RETINAL •SERVICES EYELID SURGERY • LASIK • VISION • •GLASSES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS GLASSES CONTACTS CATARACT SURGERY • GLAUCOMA CARE• RETINAL • EYELID SURGERY • LASIK • VISION EXAMS • •GLASSES •SERVICES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS • GLASSES • CONTACTS Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

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Joseph T. Zeiter, M.D.

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Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

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Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

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Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

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Richard John C.M. Canzano, Wong, M.D.

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eiter, M.D.

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Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

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Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

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John Harold C. Canzano, Hand, M.D. M.D.

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Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

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Steven LindaA.Hsu, Wood, O.D.O.D.

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Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Joseph Zeiter, M.D.

John Zeiter, M.D.

Richard Wong, M.D.

John Canzano, M.D.

Joseph Zeiter, Jr. , M.D.

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Peter Hetzner, O.D.

Linda Hsu, O.D.

tzner, O.D.

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Judith LindaA.Hsu, Prima, O.D. O.D.

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tzner, O.D.

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Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

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Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.

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tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

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Robert Dupree, O.D.

Over 50 years ofE. K.Pedersen, Vision Care Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Over 50 years ofE. K.Pedersen, Vision Care Over 50 years of Vision Care Over 50 years of Vision Care

Over 55 years of Vision Care

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Robert O.D. Robert Devinder E. Pedersen, K.call Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, Steven LindaA.Hsu, Wood, O.D. StevenE.A.Pedersen, Wood, please O.D. To refer AO.D.patient, To refer A patient, please call Robert O.D. Devinder Grewal, O.D. Robertplease Dupree, O.D. Jennifer ToPedersen, refer A patient, callPham, O.D. Ralph Miranda, O.D. To refer A patient, please call

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STOCKTON • LODI • MANTECA • TRACY • SONORA refer a patient, please call STOCKTON •To LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA

STOCKTON • LODI • MANTECA • TRACY • SONORA

www.zeitereye.com

SUMMER 2019

Robert Dupree,


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EXECUTIVE DIRECTOR’S REPORT

BUSY BEES I’m sure we all have heard the saying “busy people get things done.” Well, that has never resonated with me as much as it has this year. In what literally feels like the blink of an eye and a blur of activities, my daughter has graduated from high school and will be off to UCLA in the Fall. I miss her already, but am so excited for this next chapter in her life. Our sophomore son is so excited that we will be able to focus ALL of our time and energy on him.  Since the Spring Issue, Jessica, our Membership Coordinator has a added a new bundle of joy to her family and by the time you read this will be back in the office. Bodhi Anthony Peluso arrived March 9 weighing at 9lbs 2oz and 20 inches long. Welcome to the SJMS family Bodhi! LISA RICHMOND

Babies and graduations aside, Spring and Summer at SJMS always have us buzzing around with event preparation. It can be a bit chaotic at times with a small staff, but thankfully we have fun and our staff thrives under pressure. In April, our hard-working Decision Medicine interview committee consisting of facilitator Andrew Ochoa and volunteer physicians Drs. Khoury, Adubofour, Pang and Marasigan spent an entire Saturday screening 45 interviewees to select the elite 2019 Decision Medicine class. It is heartwarming that these very busy physicians are so passionate about this program, they are willing to spend part of their weekend with us. The final 24 are a diverse group of students who represent 16 San Joaquin High Schools in 5 different cities with an average GPA of 4.11. We cannot wait for this summer! Later in the Spring, we hosted our 10th Annual Golf Tournament benefitting The First Tee of San Joaquin and Decision Medicine. It was a beautiful day and great time was had by all. We appreciate everybody who came out to golf and the generous donations of our sponsors. As the demands on our physicians continue to rise, we realize the importance of an afternoon of relaxation and fellowship with friends and colleagues. Please see Dr. Khoury’s article and pictures from the event. Last, but certainly not least, we are excited to announce our 2019 Lifetime Achievement Award Recipient, Dr. Lawrence Frank and Young Physician Award Recipient, Dr. Sujeeth Punnam. We know you will enjoy reading the feature articles on both physicians. Please join us to honor them at our annual membership dinner on Sunday, June 9 at Stockton Golf & Country Club. More details in the enclosed advertisement. Have a wonderful summer!

Lisa Richmond

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A message from our President > R. Grant Mellor, MD

Safer in Stockton!

This is my eighth and final article as president, having had the unusual circumstance of serving two terms in office. It has been an interesting few years for medicine in our part of the Valley. We have seen expansion of medical education in the Stockton area, and plans laid for much further expansion at multiple institutions. A new local medical school sent its first 3rd and 4th year classes into our communities (and matched them all to residencies). We saw the separation of the County Coroner’s office from the Sheriff’s office, ensuring future independence of medical decision-making (and providing an example of why we need to maintain and strong and vigilant medical society). We clarified the mission of our highly-regarded Decision Program, and started a new program, Bridge of Medicine, to encourage local students to pursue medicine as a career. We strengthened our board, adding excellent new members, and creating a leadership development pipeline. Interest in board positions is at an all-time high, which is a great sign of the future of SJMS.

ABOUT THE AUTHOR ­ R. Grant Mellor, MD- Pediatrician and Chief of Professional Development, Central Valley Service Area, The Permanente Medical Group and current President of the San Joaquin Medical Society

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As a physician and especially a pediatrician, I’m interested in protecting children and families from vaccine-preventable disease. A recent report from the State of California detailed immunization rates by county. But first, some background. The San Joaquin Medical Society serves four counties: San Joaquin (population approximately 740,000), Amador (population approximately 37,000), Calaveras (population approximately 45,000), and Alpine (population approximately 1200). It’s generally accepted that any population needs a 90% to 95% immunization rate to create protective herd immunity. We have seen multiple measles outbreaks this year across our nation this year, usually associated with groups that have allowed herd immunity to fall substantially below the protective threshold.

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Last year, kindergartners who enrolled in California schools showed the following fully-immunized rates, by county: San Joaquin at 96.3%, Amador at 91.8%, Calaveras as 88.1%, and Alpine with too few for meaningful calculation. As you may know, there was a confirmed measles case in Valley Springs (in Calaveras County) a few months ago. Our populous neighboring counties on the valley floor are doing reasonably well: Sacramento county has a 93.5% rate, and Stanislaus County a 96% immunization rate. But, our neighboring Gold Country counties have concerning rates: Tuolumne County at 86.5%, and El Dorado at 89.6%. We all need to continue to promote vaccination as the best and safest way to prevent the many diseases that we know have been the scourge of humanity in the past and are waiting to return if immunization rates continue to drop. On a lighter note, when my patients ask about protecting their children from measles, I tell them to stay in Stockton, where they’ll be safer. They’re not used to hearing that!

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A Cardiologist with a Big Heart

BY JO ANN KIRBY

Dr. Sujeeth Punnam finds great satisfaction and even a DR. PUNNAM IS AN INNOVATOR AND

sense of fascination in the difference he is able to make in a patient’s life.

COLLABORATOR WHO CARES FOR HIS PATIENTS HERE IN THE VALLEY WHILE ALSO IMPROVING MEDICAL ACCESS AND EDUCATION BACK IN RURAL INDIA

“When a patient has a heart attack, within 30 minutes you can completely make them better and the patient will tell you, wow, I’m symptom free,” Punnam, an interventional cardiologist with Sutter Gould Cardiology in Stockton, said. From there, his goal is to collaborate with his patients and their primary physicians in improving their care, to educate them about disease management, and to promote a healthier lifestyle while encouraging each one to be compliant with their medical regimen.

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His senior partner at Sutter Gould, Dr. John Olowoyeye, said the Central Valley is incredibly fortunate to have Punnam practicing medicine in Stockton and credited him with helping to usher in transcatheter aortic valve replacement for patients here. “It’s a great service for our patients because they no longer have to travel to Stanford or UCSF to have this done,” Olowoyeye said of TAVR, a minimally invasive way to replace diseased aortic valves and failed artificial aortic tissue values by going through a blood vessel in the groin instead of requiring open heart surgery. Punnam, he said, has a way of bringing out the best in those around him and is an extremely modest and humble doctor who is an innovator, inventor, researcher and a bit of an entrepreneur. “As a doctor, I try to put myself in my patient’s shoes,” said Punnam, who has a very warm and approachable bedside manner. “For the first visit, I will draw out graphically on a on a piece of paper what we have to do and why we have to do it. This is very reassuring to them.” He leads a charity made up of doctors from his home region who worked together to bring defibrillators to rural India. “Back home, if you can imagine, they don’t have

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defibrillators,” he said. “We raised funding and have equipped the ambulances in the entire province.” He’s also active in the Share Foundation, which makes medical education and innovations accessible electronically to rural areas in India, China and Indonesia. He even develops medical apps with other Stockton physicians. It is for these reasons that he is being honored as the San Joaquin Medical Society’s “Young Physician of the Year.’ Punnam attended Kakatiya Medical College in Warangal, India and he finished his internship and residency at Brookdale University Hospital in Brooklyn, New York, and Crozer Chester Medical Center in Upland, Pennsylvania. He completed an interventional cardiology fellowship at Michigan State. Board certified in cardiovascular diseases and clinical cardiac electrophysiology, he and his family moved to Stockton in 2010 after he considered positions in Oklahoma City and Tampa. Researching the options, he said the top news at the time was a foreclosure crisis and spiraling crime in Stockton, hurricanes in Florida and tornadoes in Oklahoma. “I lived in Brooklyn in 1999, Stockton in 2010 wasn’t going to be a problem,” he said with a laugh. “Stockton is great, it’s turned out to be a good fit for us.” He joined Dr. Olowoyeye’s practice, known as Delta Heart

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Clinic before they merged with Sutter in 2014. “Looking at the health care system, we wanted to focus on patient care and not be bogged down by the administrative part of things. At the time, Sutter had a huge primary care basis but they didn’t have cardiology,” he said of the growing cardiology group. “There is a lot of instant gratification in the profession. It’s a collaborative effort in medicine, that I like. You are keeping primary physicians in the loops and patients in the loop.” He is committed to helping educate the next generation of medical professionals and as such, mentors physician assistants from the University of the Pacific. He is also continually researching and learning about leading technological advances in his field to provide transformative care for his patients, traveling to Germany with his fellow doctors for a week to learn about catheter based aortic valve replacement so he could perform the procedure here in the Valley. He makes time to drive his 11-year-old daughter and 14-year-old son to school in the morning since evenings can run late for the busy cardiologist. “I enjoy going to Tahoe and Bear Valley to snowboard with my son and my daughter likes to write, so I try and encourage her,” he said,

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of the two children he is raising with his wife Aparna whom he has known since their youth. He is humbled to be named “Young Physician of the Year,” and feels like his career is still a work in progress. Ever the caring physician, he has some words of advice for those patients who are symptom free after a trip to the emergency room. “Don’t forget us,” he said. “I want to see you once a year, to remind you of a few things.”

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1 0 TH A N N U A L

GOLF TOURNAMENT By George Khoury, MD

10 annual annualSJMS SJMS Golf benefiting The First ofTee San of Joaquin TheThe 10th GolfTournament Tournament benefitting The Tee First San Joaquin SJMS’sDecision Decision Medicine waswas held held on Sunday, April 28 April at the 28 at the andand SJMS’s Medicineprogram program on Sunday, beautiful Brookside Country This annual eventevent is a great our beautiful Brookside CountryClub. Club. This annual is occasion a great for occasion for society and and its members, to work to with our larger providing in ourmedical medical society its members, work with community our largerincommunity opportunities to build and expand ourexpand youth’s aspirations and futures. providing opportunities to build and our youth’s aspirations and futures. th

daystarted started with barbecue lunch and Putting what anAnd TheThe day witha apregame pregame barbeque lunch and Contest. PuttingAnd Contest. exciting contest.contest. Three separate, somewhat difficult putting lanes with treacherous what an exciting Three separate, somewhat difficult putting lanes with curves and slopes as well as tiny sand bunkers. The winner this year is our treacherous curves and slopes as well as tiny sand bunkers. The winner this year colleague Gary Gary Nahl. It seems course too difficult for difficult last year’sfor putting is our colleague Nahl. It the seems thewas course was too last year’s contest champ Kwabena Adubofour. The weather was perfect as golfers enjoyed putting contest champ Kwabena Adubofour. The weather was perfect as golfers playingplaying on the perfectly using agreens simple scramble enjoyed on the manicured perfectly greens manicured using a format simpleand scramble ended with a delicious dinner and many happy raffle prize winners! format and ended with a delicious dinner and many happy raffle prize winners! I wouldlike like to to thank energetic, fully engaged committee who worked hardworked I would thankourour energetic, fully engaged committee who to to bring in 75 in golfers and plentiful prizes. We are very thankful to very Basel thankful hard bring 75 golfers and raffle plentiful raffle prizes. We are Karabala, owner of 209 Furniture for his donation of the grand prize gift to Basel Karabala, owner of 209 Furniture for his donation ofcertificate the grand for gift $1000! The committee appreciates everyone who sponsored and participated prize certificate for $1000! The committee appreciates everyone who in this event. are excitedin to this announce weare raised $3800totoannounce benefit Thethat we sponsored and We participated event.that We excited First$3800 Tee of San Joaquin and for Decision This will help fund our raised to benefit The $5400 First Tee of San Medicine. Joaquin and $5400 for Decision scholarship program for our Decision Medicine students towards their college Medicine. This will help fund our scholarship program for our Decision Medicine expenses. Hope totheir see you all next expenses. year! students towards college Hope to see you all next year!

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Win ners F i r st Pl ace Jim Nesbitt Justin Holcomb, Allan Corey Ryan Winther

M o st H onest Angelica Orino, Jr. Orino, PJ Banabaye

A Huge Thank You to Our Generous Sponsors! 209 Furniture BAC Community Bank Dameron Hospital Fairmont Rehabilitation Hospital Financial Center Credit Union Lawrence Frank, MD Lincoln Square Post-Acute Rehab Oak Valley Community Bank Sacramento Ear, Nose, and Throat San Joaquin Kidney Clinic Stockton Diagnostic Imaging Windsor of Stockton- Elmhaven and Hampton Care Centers Zeiter Eye Medical Group

C lo se st to Pi n Jim Nesbitt Kari Khoury

Lo ng D rive Lance Newton Kari Khoury

P ut ti ng Co ntest Gary Nahl, MD

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Golf Tournament Committee Cathy Ghan Donald Miller George Khoury, MD George Herron, MD Karen Amestoy Kwabena Adubofour, MD Lisa Richmond Prasad Dighe, MD Maria Rodriguez-Cook

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Health Care DREAM CMA’s economic advocates recoup 29 million on behalf of physician members

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By Tina Tedesco

TEAM

The physicians of California have a powerful ally when it comes to dealing with problematic payors—the California Medical Association (CMA) Center for Economic Services (CES). Staffed by practice management experts with a combined experience of more than 125 years in medical practice operations, the CES team has recovered $29 million on behalf of its physician members in the past 10 years. Each member of the CES team brings something unique to the table, allowing them to bounce ideas off each other when trying to help practices. “We are the dream team of health care,” said Mark Lane, CES Director of Publications and Resources. “There are few issues presented that we do not have experience dealing with in some capacity. We can also draw upon our vast network of contacts to find a resource or point person to help address almost any issue. No other organization, that I am aware of, can assist physicians or their practices on this level,” said Lane. Lane began his career as a claims processor for plans such as Blue Shield and Health Net. Before long, he had moved up to a position in provider relations, allowing him to get a unique vantage point on the relationship between physicians and payors.

Empowering Physician Practices CES also provides one-on-one practice management assistance to physician members and their staff on reimbursement, practice operations and contract related issues. The center’s goal is to empower physician practices by providing resources and guidance to improve the success of the practice. Assistance ranges from coaching and education to direct intervention with payors or regulators. “The ultimate goal is to empower practices to be able to advocate successfully for themselves,” said CES Vice President, Jodi Black. “Sometimes processes fail and that’s when we intervene on their behalf.” >>

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In 2018, CES recovered nearly $11 million on behalf of physician members, up from $3 million in 2017. One of the biggest success this year was getting Anthem to agree not to pursue a $4.2 million recoupment from a member practice. Anthem had notified the practice it was planning to recoup more than $4 million due to problems with the renewal of a fictitious name permit. CMA escalated the issue to the medical director at Anthem, highlighting that upon renewal, the medical board showed no lapse in the permit. As a result, Anthem agreed not to pursue the recoupment and agreed to release the approximately $600,000 in pending claims for payment. Another success story was getting Medicare to agree to reinstate billing privileges and release almost a million dollars in pending payments to another practice that had its billing privileges had been revoked when Medicare discovered an undisclosed criminal offense by an employee of the practice. CMA, AMA and Noridian, California’s Medicare Administrative Contractor, worked together to get the practice’s appeal reviewed within three days, rather than the normal 90 days as allowed by law, to help get the practice’s billing privileges reinstated and avoid overpayments dating back nine years.

Meet Your Advocates Jodi Black, Vice President Jodi is the Vice President of CMA’s Center for Economic Services. She has spent the past 14 years working through practice operational issues and advocating on behalf of members of CMA and its county medical societies. Prior to her time at CMA, Jodi spent 15 years working with a group of emergency physicians. “My team not only provides one-on-one assistance when needed, but we also work hard to educate and empower practices to be able to advocate successfully for themselves.””

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“This is money that would have likely gone unrecouped if we didn’t step in,” said Black, who has been with CMA for 14 years, building relationships with both physicians and payors on behalf of CMA. Prior to joining CMA, she spent 15 years working with a group of emergency physicians, a field she entered while still in college. She changed her major to health care administration because she believed in the cause so much. CES is constantly developing resources and tools to assist practices with new laws, including its monthly e-bulletin, CPR, webinars and phone conversations. These services are free to all members. “It feels great to help our doctors, so they can get back to work helping their patients,” said Juli Reavis, CES Associate Director, who focuses largely on helping physicians with California’s new out of network billing and payment law (AB 72). The law, which went into effect July 1, 2017, placed limits on what physicians can bill patients for using an out of network physician at in network facility. CES created more than 10 new resources to help practices succeed and comply with these new requirements.

You are Not Alone In 2018, CES assisted physicians and their office staff with more than 1200 calls from 682 different practices from 29 different component medical societies. Sixteen percent of those calls were from first time callers. Often, the only way CES finds out about an issue is by members contacting the call center. Typically, if an issue is affecting one practice, it’s impacting others. Small errors, sometimes on the part of the payor, sometimes on the part of the physician, can have a snowball effect. “Our goal is to take the noise out of the system so doctors can get back to treating patients,” said Black. “I always felt a need to help others and prevent pain and suffering wherever I could,” said Lane. “The role I serve at CMA, assisting physicians and their practice staff, has given me the opportunity to fulfill my mission. It’s the most rewarding role I have ever had in my 25 years of health care.”

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When do I call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help: Are your claims not being paid in a timely manner or according to your contract? Do you need assistance regarding the new law on payment and billing for outof-network services (AB 72)?

Are you receiving untimely requests for refunds or is a payor recouping money without first notifying you in writing of a refund request? Do you need assistance creating a business case as to why a payor should consider contracting/re-contracting with your practice? Do you need help with Medicarerelated issues?

Are you receiving unreasonable requests for medical records? Do you need help identifying common practice mistakes costing you money? Have you been presented with a managed care contract and you’re not sure if the terms are consistent with California law? Have you done everything you can to resolve an issue with a payor, including appealing, and have been unsuccessful?

Are your claims being denied after obtaining prior authorization?

Call CMA’s reimbursement helpline today at (888) 401-5911 and they will arm you with the knowledge you need to identify and fight unfair payment practices. Learn more about how CMA’s practice management experts can help you at cmadocs.org/ces.

Meet Your Advocates Cheryl Bradley, Physician Advocate Cheryl specializes in Medicare issues. Before joining CMA, Cheryl served as a provider outreach and education specialist for Noridian Healthcare Solutions, California’s Medicare contractor. She came to CMA with over seven years of Medicare experience. “Our goal is to empower CMA member physicians and their staffs to use tools and resources that increase their understanding of the health care topics at hand – and their bottom lines.” Mark Lane, Director of Publications and Resources For more than a decade and a half before joining the CMA team in 2010, Mark began his career as a claims processor for plans such as Blue Shield and Health Net. Before long, he had moved up to a position in provider relations, giving him a unique vantage point on the relationship between physicians and payors. “Communication really is the answer to a lot of payor issues. CMA has the contacts and the relationships to cut through the red tape and get things done.” Kris Marck, Physician Advocate Before joining CMA in 2011, Kris spent 23 years working on the payor side of the health care industry. This previous experience makes her a very effective and approachable advocate for physicians in need of reimbursement and contracting assistance. “Working with payors is challenging and the reimbursement process is complex. Don’t hesitate to call us. It’s easy to give the easy answer, but it’s difficult to go and find the right answer. We’ll get you the right answer.” SUMMER 2019

Juli Reavis, Physician Advocate Juli primarily focuses on helping members navigate the new AB 72 billing restrictions for out-of-network services at in-network facilities. “We are fighting to ensure that payors do not game the system to set artificially low physician payment rates. If you’re being negatively impacted by AB 72’s new billing and payment restrictions, call me. I can help.” Learn more at cmadocs.org/ab-72. Victoria Travis, Executive Assistant Victoria is often the first point of contact for practices in need of reimbursement assistance or practice management advice. “We hear from physicians on an array of payment issues, and we are here to help guide you, provide clarification and be a voice for you to help combat payment challenges.” Mitzi Young, Physician Advocate Mitzi has spent more than 20 years in health care settings, including county organized health programs, surgery centers and specialty health care practices, and brings a variety of skills suited to help CMA members tackle their practice management questions. “With over 125 years of practice management experience on the CES team, we can help medical practices work smarter, not harder.” The CES team can be reached at (888) 401-5911 or economicservices@cmadocs.org. Tina Tedesco is a freelance writer in Sacramento. SAN JOAQUIN PHYSICIAN

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Growing THE PHYSICIAN PIPELINE BY KATHERINE BOROSKI

A robust, diverse and well-trained workforce is essential to meeting the health care demands of all Californians. While California has made great strides since the passage of the Affordable Care Act in extending health insurance to millions of residents who were previously uninsured, our state is currently facing a critical physician shortage. California’s underserved communities are already facing a severe shortage of physicians, which will exponentially worsen as the population continues to grow, diversify and age. This will be further compounded as physicians move toward retirement faster than the replacement rate. This year, the California Medical Association’s (CMA) foundation, Physicians for a Healthy California (PHC), launched two new projects that will make real progress in growing and strengthening the physician pipeline to meet the demands of California’s growing patient population, with a focus on medically-underserved areas and populations. >>

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THE AFFORDABLE CARE ACT IN EXTENDING HEALTH INSURANCE TO MILLIONS OF RESIDENTS WHO WERE PREVIOUSLY UNINSURED.

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Funding Residents by Discipline 2018–19 Existing Positions

New Positions

Total

Family Medicine

14

29

43

Internal Medicine

14

19

33

OB/GYN

11

8

19

Pediatrics

22

11

33

Emergency Medicine

13

15

28

Totals

74

82

156

Discipline

CALMEDFORCE: GME GRANT PROGRAM PHC’s CalMedForce program is committed to growing a diverse physician workforce by supporting, incentivizing and expanding graduate medical education (GME) in California. The program was made possible by the Proposition 56 tobacco tax, which was sponsored in 2016 by CMA, the California Hospital Association and Service International Employees Union-United Healthcare Workers West. The University of California is the designated recipient of the funding and has contracted with PHC to administer the annual grants. “These CalMedForce grants will help California grow and strengthen the physician pipeline to meet the demands of our state’s growing and changing patient population,” said Lupe Alonzo-Diaz, MPAff, PHC president and CEO. In the inaugural cycle of CalMedForce in January 2019, PHC awarded $38 million to GME programs across the state to fund approximately 150 physician residents. In total, PHC received funding requests for nearly 600 residency positions from 131 residency programs, totaling more than $147 million!

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The 73 programs that received awards in the first cycle represent residency positions in both urban and rural areas. Programs that focus on medically-underserved areas and populations were given priority. Of the 156 residency positions funded, 74 are existing residency slots that could have been eliminated if not for this funding. Eighty-two of the positions funded are brand new – 60 of them in new residency programs and 22 at existing programs. “The demand for these funds is a clear indicator of the statewide need for this funding and an example of how the new tobacco tax will help improve access to care in California,” said Cathryn Nation, M.D, associate vice president for health sciences in the UC Office of the President. Every dollar invested into expanding residency slots in California is significant, considering one primary care resident can conduct approximately 600 patient visits per year.

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Applicants for CalMedForce Grant Cycle 2018–19 Number of Residency Programs Requested: 131

Total Funding Amount ($) Requested: $147,255,500

Awarded: 73

Awarded: $38,195,000

WHY IS GME FUNDING SO IMPORTANT? Sadly, California is a mass exporter of medical students. Every year, hundreds of graduating medical students do not find a residency slot in California to continue their training. “Inadequate funding for medical residency programs forces talented young doctors who want to stay and practice in California to train in other states,” said CMA President David H. Aizuss, M.D.

the areas where they train and remain there after their training to care for their communities. When Californiaeducated medical students leave to another state for a residency program, they often do not return. Overall, 54.2% of individuals who completed residency training from 2008-2017 are practicing in the state of where they trained. California ranks the highest of all states, with a 77.7% rate for in-state retention. We can grow our physician workforce by expanding the number of California residency positions.

The data shows that most physicians set down roots in

CALHEALTHCARES: LOAN REPAYMENT PROGRAM Ample research demonstrates that the Medi-Cal system is struggling from persistent underfunding. As a result, California ranks among the lowest in the nation in payments to providers. These chronically low reimbursement rates have a direct effect on Medi-Cal patients’ ability to receive timely treatment from a physician. Compounding the problems is the fact that physicians often enter practice with hundreds of thousands of dollars

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in educational debt. This debt burden, coupled with low reimbursement rates, makes it unsustainable for many physician practices to take on a significant number of MediCal patients. In April 2019, the California Department of Health Care Services (DHCS) launched a new loan repayment program—CalHealthCares, which incentivizes physicians to provide care to Medi-Cal beneficiaries by repaying

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CalHealthCares Loan Repayment Funds Requested Total Applications Submitted: 1,276 | Total Funds Requested: $300,626,830

Physicians 928 | $212,275,967 Dentists 217 | $55,699,133 Practice Support Grants 14 | $3,328,511

Medical Students | 107

Dental Students | 10 Students 117 | $29,323,219

Total Applications | 1,276

educational debt up to $300,000 in exchange for a five-year service obligation. DHCS has contracted with PHC to administer the program. CalHealthCares was also made possible by Proposition 56, which provided a one-time allocation of $220 million for state loan repayment programs. The first round of applications for the new CalHealthCares statewide loan repayment program attracted more than 1,200 applications from physicians and dentists who agreed to see more of California’s 13 million Medi-Cal patients in exchange for repayment of their student loans. In all, requests totaled more than $300 million, reflecting tremendous interest in the five-year program. CalHealthCares expects to award approximately 125 physicians and 20 dentists in this first award cycle, to be announced by June 30.

Total Student Applications | 117

open to physicians who graduated from a residency program and/or completed a fellowship within the past five years (on or after January 1, 2014). There are no geographic limitations—providers may be located in any California county. With more than 13 million Californians relying on MediCal programs to provide basic and specialty care for serious diseases, the stakes are high. “The CalHealthCares program promises to have a real and immediate impact on access to care for Medi-Cal patients,” said Dr. Aizuss. “Especially for new enrollees, who often struggle to access to timely and quality care.” For more information about CalMedForce and CalHealthCares, visit the PHC website at phcdocs.org. Katherine Boroski is Senior Director of Communications at the California Medical Association. She can be reached at kboroski@cmadocs.org.

All awardees will be required to maintain a patient caseload of 30% or more Medi-Cal beneficiaries. The program is

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The One Thing Hackers Hope You Never Discover Imagine not being able to send or receive e-mail for days, possibly weeks. Don’t think this could happen because you have a reputable anti-virus software installed? If so, you’re operating on a false sense of security and hackers are praying that you keep thinking that way. Here’s why: Most business owners think that because they have anti-virus software installed and a software firewall, that their network is “secure.” Not so. One of the most common stunts hackers pull is breaking through a software firewall to hijack a server. Once they’re in, they use YOUR server to relay spam and other viruses to millions of users in a matter of seconds.

1. In no time flat, your company’s server and email gets “blacklisted”, which means the big email delivery hubs (like Comcast, Google, Verizon, etc.) flag ALL e-mails coming from your server as “dangerous” and won’t let them through; and on the net, you’re guilty until proven innocent, which means it could take days or weeks to get your name cleared. During that time, you are completely without e-mail.

2. Your patients, prospects and vendors start getting Viagra ads and invitations to XXX-rated web sites from your company. Not good. The absolute best way to make sure this never happens is to invest in a top-grade managed services provider. This investment is worth twenty times the cost in peace of mind and saved time.

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Race of a

Lifetime

pathy to profession Nephrologist brings energy and em

BY JOANN KIRBY

In his office, which is overflowing with stacks of medical journals, there is a sepia-toned photo of his grandfather hanging on the wall. “People said that when he walked into a room, his patients immediately felt better,” Dr. Lawrence Frank said of the German doctor, who died before he was born.

Dr. Frank has been racing around since he was informed via telegraph that

It’s safe to say that Frank, whose goal to become a physician was clear to him from the age of 5, would have made his grandfather immensely proud he inherited an empathetic attitude that sets patients immediately at ease.

he was accepted

Frank, who has served as medical director of the hemodialysis unit at San Joaquin General Hospital since 1979, is being honored with the “Lifetime Achievement Award” from the San Joaquin Medical Society.

Medicine.

to the New York University School of

It’s a distinction that both thrills and perplexes the kidney specialist. >>

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“I have no idea how I earned it,” he said, with a grin that reveals his trademark sense of humor hidden behind a seemingly gruff exterior. “There are doctors who go all over the world and save all these lives, and all I do is sit here.” Well, not exactly. An avid runner who has completed in marathons, including the famed Boston Marathon on its 100th anniversary, Dr. Frank has been racing around since he was informed via telegraph that he was accepted to the New York University School of Medicine. The Bronx native, a son of German immigrants who were in theater, attended Bronx High School of Science and New York University before graduating from NYU’s School of Medicine and interning at Lincoln Hospital, an affiliate of the Albert Einstein College of Medicine in New York. After completing his residency, he was awarded a fellowship in nephrology from UC San Diego. Serving his country as a medical officer during Vietnam sent him to Panama where he learned the finer art of jungle survival skills. “I learned to scuba dive there,” he said. “There were Cuna Indians there living in primitive huts and one day I spent the day with them. They liked me because I went back for seconds and thirds at meal time. When they take you out there, they throw you out of a helicopter and you had to swim to shore.” It was sink or swim at the county hospital. In 1979, his job at San Joaquin General began with news that his chief dialysis technician had quit. On that very hot Valley day 40 years ago this summer, he interviewed and subsequently hired Steve Schneider. “He and I hit it off right away and it’s been a privilege to know him and work with him,” Schneider said. “He is a dichotomy in that so many people who know him professionally know him as someone who has no patience for incompetence. And yes, that’s because as a patient he’s going to stick up for you, advocate for you and get you the best care. But if you get to know him personally, he’s a hilarious man with a contagious laugh and a great sense of humor. I don’t know of anyone more deserving of this honor.” Schneider considers it providence that he went to work for the kidney specialist because just three years later his own young son would need Frank’s care. “My six-year-old son was diagnosed with kidney disease and Larry had him medi-flighted to UCSF because they had a pediatric nephrology unit there,” said Schneider, who donated one of his kidneys to his son and now administers home

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dialysis treatment to him since that organ eventually gave out. “I feel like Larry saved his life and he’s been there for my son ever since.” At San Joaquin General, the doctor from Bronx would forge his career as the sole nephrologist caring for underserved patients in need of medical management, dialysis and transplant referral while at the same time guiding medical students and residents as part of the teaching faculty. In Stockton, he found a home, hobbies, and a forged an impressive career. It being a county hospital, he has worn many hats over the years. He has headed up infection control, served as president of the medical staff, been part of utilization review and sat on countless committees. “I never felt the urge to leave,” he said of San Joaquin General. “I don’t think I’d ever want to work anywhere else. It is still like a family here. It’s a tight group, we back each other up.” Schneider calls Frank a lifelong learner who is a voracious reader and researcher, to the benefit of the 170 patients he has on dialysis in the unit and the others he sees in the hospital.

"I don’t think I’d ever want to work anywhere else. It is still like a family here. It’s a tight group, we back each other up." - Dr. Lawrence Frank

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Please join us for the

ANNUAL MEMBERSHIP DINNER honoring our

2019 Lifetime Achievement Award Recipient

LAWRENCE FRANK, MD Young Physician Award Recipient Sujeeth Punnam, MD

SUNDAY JUNE 9, 2019 Cocktail Hour 6:00pm | Dinner 7:00pm

STOCKTON GOLF & COUNTRY CLUB 3800 Country Club Boulevard Stockton, California Member Physicians and Spouse/Guest $50 per person Non-Members and Invited Guests $75 per person

Additionally, we will honor the passing of the gavel from R. Grant Mellor, MD to Richelle Marasigan, DO

PREM IER LEVEL SPONSORS

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Frank’s respect for skill and competence in the medical profession prompted him to strike up a romance with a nurse named Karen whom he married in 2008. “I was slow to pop the question. She joined the Sundance Running Club in Stockton because I was in it. She was training for a half marathon,” he recalls, of the club he served as president and newsletter editor. “I had a fanny pack with snacks and the ring. She said yes.” His wife is very proud of him and thrilled to see him be honored by his peers. The couple have two sons and three dogs. Their son David has been in China for the past three years, teaching English to elementary classes. Their second son, Alex, will be graduating from high school. “Larry wants everyone to see him as a grumpy, rough, old cuss but he’s really very soft and caring,” his wife said. “I think the best picture of that at this time in our lives is how he interacts with our dogs - he gives our little dog Poppy a ride in

With the SJMS, he became politically active as a delegate to the CMA House of Delegates and remains politically motivated to improve health care.

SUMMER 2019

the car around the block every morning before going to work.” He is a member of many professional organizations, including the San Joaquin Medical Society, serving stints as president and on the board of directors. With the SJMS, he became politically active as a delegate to the CMA House of Delegates and remains politically motivated to improve health care. A major concern is regulations enacted by well-meaning people who aren’t in the field as well as the rising cost of attending med school, both of which he says puts a stranglehold on the profession. “Since I’ve been here, we have had some residents who owe $300,000 and $400,000 in student loan debt,” he said. “You have these young doctors coming out with a spouse and a family, they want to buy a house. Now more of them are employed than are having their own practice.” The Lifetime Achievement Award isn’t the end of the race for Frank. Professionally he shows no sign of slowing down. But physically, he’s taking part in a different sprint now. “I’m in a race to give 20 gallons of blood,” he said. “I’m at about 17 gallons. Eight donations to a gallon. They want me to give platelets.” Being a doctor is just in his blood.

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LIVE WITHOUT LIMITS

DAMERON HOSPITAL’S BARIATRIC WEIGHT LOSS PROGRAM

EXCELLENCE IN WEIGHT LOSS SURGERY

Sign up for a free monthly seminar: 209-944-5550 | Dameronhospital.org 38

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Partnering today for a healthier tomorrow

With nearly 345,000 members, Health Plan of San Joaquin continues to build relationships with health care providers, resource agencies, and local businesses to deliver on our mission to improve wellness throughout the communities we serve.

Strong community partnerships lead to happier, healthier people. 888.936.PLAN (7526) TTY/TDD 711 | www.hpsj.com SUMMER 2019

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A COMMUNITY BUILT ON

COLLABORATION Doctors Hospital of Manteca is excited to introduce a first-of-its-kind resource for physicians and patients in Manteca: the da Vinci Xi robot. Local access to roboticassisted surgery techniques provides doctors the ability to offer helpful benefits for treating a range of conditions with less invasive surgery, shorter hospital stays, faster recovery times and less scarring. To learn more about the program, call (209) 988-2283. 40

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YOU ARE OUR MOST POWERFUL

ADVOCATE By Katherine Boroski, Senior Director of Strategic Communications, California Medical Association

Critical issues affecting today’s physicians are being decided in the legislative arena at a fast and furious pace. Health care reform, medical liability, and scope of practice are just a few of the vital issues being debated and voted on by elected officials in Sacramento. The California Medical Association (CMA) has some of the best lobbyists, lawyers, and other advocates in the Capitol, but the most powerful weapon in advancing the cause of physicians and their patients is you. Hearing from a physician with experience on the front lines of medicine can make all the difference for a legislator facing a complicated health care issue. That is why grassroots advocacy is so important.

WHAT IS GRASSROOTS ADVOCACY? Grassroots advocacy is a “bottom up” approach to social change that utilizes real physicians from the community to shape public policy. Grassroots advocacy harnesses the power of effective one-on-one relationships multiplied over and over until a critical mass of support effectuates the desired change. Effective advocacy is about communication and relationships. Advocacy must be an ongoing commitment and priority. Relationship building is essential and starts with persistence and repetition. Below are tips on how you can become an effective grassroots advocate on behalf of the physicians and patients of California. >>

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RECOGNIZE YOUR POWER: You are the

BE THE RESOURCE: Serve as an advocate on

subject matter expert on how health care issues impact your community. When it comes to matters of health, you are the specialist and the lawmaker is a generalist. Legislators don’t need to know everything you know about a particular issue – they just need to know enough to be convinced to take action.

behalf of the physician community and your patients by offering your expertise and experience.

ENGAGE POLICYMAKERS AND MAINTAIN RELATIONSHIPS: Get to know your elected officials by meeting with them and attending events in the community and at the Capitol. Educate them about your issues and ask to be added to their mailing or e-mail lists for upcoming events. Volunteer for campaigns, attend fundraisers and participate on advisory committees.

TELL YOUR STORY: Tell policymakers your stories to illustrate the entire picture. There is power in sharing the realities of your profession.

SHARE AND AMPLIFY ON SOCIAL MEDIA: Increase public awareness by promoting your legislative advocacy on social media. If you meet with an elected official, post and tag photos on social media and promote with key groups and media.

CONNECTING WITH YOUR ELECTED OFFICIAL THROUGH SOCIAL MEDIA Social media is an excellent platform to communicate with your elected officials, especially Twitter. The key is to “tag” the elected official(s) you’re addressing using their official Twitter account. Keep in mind that many elected officials may have both a campaign Twitter account and an “official” Twitter account – the latter is preferred.

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With Twitter, you have only 140 characters to convey your message, plus an image or link. Try writing out your full message first, then review with a critical eye and pare down accordingly. Always keep it professional, even if you’re tweeting your opposition to a legislator’s bill.

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CMA IS HERE TO HELP AVAILABLE RESOURCES

•C  MA’s Legislative Hot List provides a summary and the status of CMA-sponsored bills, as well as the progress of other significant legislation. •R  eal-time call to action alerts for legislative priorities. • S ample letters for advocating positions on legislation/ regulations. • S ample telephone call scripts for calling Capitol offices to voice positions on legislative bills/issues. OTHER WAYS TO GET INVOLVED

•T  ext DocLobby to 52886 to sign up for text alerts and you

Most legislation can be viewed as either solving a problem – or creating one, depending on which side you stand. When tweeting in support of something, or to encourage a vote for something, make sure you’re stating WHY (i.e., the problem) and what you want the legislator to DO about it (i.e., the solution). Keep in mind that a legislator may not be familiar with all the bill numbers in a session, especially if they’re not the ones introducing that legislation. Any reference to legislation should be #hashtagged, with a very short description of the bill after. SUMMER 2019

will immediately be notified when we need you to take action. • Participate in CMA’s Legislative Advocacy Day, which is held annually in April. This year’s Legislative Advocacy Day is April 24, at the Sacramento Convention Center. • Become a CMA social media ambassador. • Represent CMA by participating in media interviews for television, radio, newspapers and podcasts. • Author op-eds to educate the public on health policy issues. • Become featured as one of our #CMAdocs. • Follow @doclobby on Twitter.

LEARN MORE AT cmadocs.org/grassroots.

For example: As a practicing physician, I know how critical vaccinations are to prevent the spread of disease. @DrPanMD, vote YES on #SB277 #vaccine bill. You can also sigh up for the CMA Social Media Ambassador program, which provides training, advice and content to help keep your colleagues and other medical professionals informed, connected and engaged. SAN JOAQUIN PHYSICIAN

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In The News

IN THE

NEWS

Katherine Gonzales Adventist Health Lodi Memorial Names Community Integration Leader Adventist Health Lodi Memorial has announced the appointment of Katherine Gonzales as the organization’s community integration manager. This new role stems out of Adventist Health’s commitment to transform the health and health status of our communities. This work began in 2018 when the hospital board established its Mission Integration Committee. Board member and chair of the Mission

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

Integration Committee, Bill Cummins, Founding Pastor of Bear Creek Community Church, has assembled a list of community leaders to spearhead this important expansion of our mission. One of the first recommendations that the Mission Integration Committee made was to hire a leader to assist the hospital in this important work. “Our board has assisted me in integrating into our community. With the addition of Kat, we will be able to further extend the influence of our mission,” Wolcott said. “Our mission calls us to transform the health and health status of our community.” Gonzales will be a major partner with Wolcott in the local business community, including involvement in the San Joaquin County Community Health Assessment work group, Lodi Area Chamber of Commerce Vision 2020 Health Value Action Team and Economic Development Committee, the Healthy Lodi initiative, Lodi Homeless Committee, Healthforce Partners — San Joaquin County’s health workforce coalition, San Joaquin Business Council’s education committee and our several other community well-being initiatives. Gonzales will be a connection between Adventist Health and the community it serves, and act as resource to the health system for other local leaders. Adventist Health Lodi Memorial Ranks in Top 10 percent of National Inpatient Rehabilitation Facilities Adventist Health Lodi Memorial is proud to announce that its Acute Physical Rehabilitation program ranked in the top 10 percent of 868 inpatient rehabilitation facilities (IRF) that qualified to be ranked in the IRF database of Uniform Data

SUMMER 2019


Rehabilitation Facility Prospective Payment System (IRF PPS). The goal of the PEM Report Card is to recognize high-performing facilities for their delivery of quality patient care that is effective, efficient, timely, and patient-centered.

Healthcare Leaders Program System for Medical Rehabilitation (UDSMR) in 2018. Lodi Memorial has been in the top 10 percent for 10 consecutive years. “I am incredibly proud of the great care provided by our acute rehabilitation team of physicians and clinical specialists who strive for great patient outcomes,” said Daniel Wolcott, president of Adventist Health Lodi Memorial. “This ranking validates once again the sophisticated level of care and genuine compassion our patients feel when they receive care in our program. The rankings were determined by using UDSMR’s program evaluation model (PEM), a case mix-adjusted and severity-adjusted tool that provides facilities with a composite performance score and percentile ranking drawn from nearly three-quarters of all IRFs in the country. UDSMR’s PEM Report Card uses the indicators of efficiency and effectiveness contained in the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), the Centers for Medicare and Medicaid Services’ reporting tool for the Inpatient

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High school students get surgery experience in Adventist Health Lodi Memorial’s Healthcare Leaders Program At Adventist Health Lodi Memorial, 18 students from Lodi-area high schools got a 360-view of the innerworkings of a hospital. Memorial. The Student HealthCare Leaders Program is a 10-week program where they learn about every aspect of running a hospital. “It’s been an amazing experience,” said Jaime Edwards, the hospital’s Business Development Director. “They tell us it’s making a different in their lives and helping them to understand where they want to go in their careers.” Recently, the students participated in surgery night, spending two hours between three operating rooms, where they practiced sutures with general surgeon Dr. Tom Fahey and learning about orthopedic surgery with Dr. Kevin Hilton. The students graduated from the 10-week program on May 9. A new Student Healthcare Leaders program will begin in the fall. Lodi and Stockton-area students who are interested in participating can apply on the hospital website at AdventistHealthLodiMemorial.org. A. Claire Watkins, MD, joins Dameron Hospital as New Cardiothoracic Surgeon A. Claire Watkins, MD, has joined Dameron Hospital as a new cardiothoracic surgeon under the Stanford Cardiac Surgery Program. She received her medical degree from the University of Tennessee College of Medicine in Memphis, Tennessee, and received her master’s degree in Clinical Research from the University of Maryland School of Medicine in Baltimore, Maryland. Dr. Watkins served her cardiothoracic surgery residency at the University of Maryland Medical Center in Baltimore, Maryland, and held two fellowships abroad; one in interventional radiology at the Auckland City Hospital in New Zealand, and the other in vascular surgery at the Hospital

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In The News

IN THE

NEWS

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

Marie Lannelongue in France. She also holds a license in fluoroscopy and is a member of the American Board of Thoracic Surgery. Dr. Watkins brings with her many years of professional experience, concentrating in the areas of endovascular aortic surgery, structural heart intervention, coronary surgery, heart valve surgery, aortic surgery, and cases involving peripheral vascular disease.

from the Osaka University Graduate School of Medicine. Dr. Shudo also completed two surgery residencies in Osaka, Japan – one at Osaka University, and the other at the Osaka General Prefectural Hospital. He served cardiovascular surgery fellowships at the Osaka Rosai Hospital and the Osaka University Hospital, as well as cardiovascular surgery research fellowships with Yasuhiro Shudo the Osaka University Graduate School of Medicine, the University of Pennsylvania and Stanford University. Dr. Shudo is a member of many professional societies, including the Japan Surgical Society, the Japanese Association for Thoracic Surgery, the Japanese Society for Cardiovascular Surgery, and the Japanese College of Cardiology. He is also on multiple editorial boards and a published author in several professional medical journals.

Yasuhiro Shudo, MD, joins Dameron Hospital as New Cardiothoracic Surgeon Also joining Dameron Hospital as one of the cardiothoracic surgeons with the Stanford Cardiac Surgery Program is Yasuhiro Shudo, MD. He received his medical degree from Osaka University Medical School in Osaka, Japan, followed by his Ph.D.

Reminder from Health Plan of San Joaquin –State-Required Fraud, Waste, and Abuse Training Coming this Summer Health Plan of San Joaquin, as a licensed health care services plan regulated by the Department of Managed Health Care (DMHC) and contracted with the Department of Health Care

A. Claire Watkins

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Services (DHCS), is committed to protecting members, its network of providers, and public interests by preventing, detecting, investigating, correcting, and reporting Fraud, Waste, and Abuse (FWA). Unfortunately, FWA in health care is prevalent and expensive. Although there are no precise measures, it is estimated FWA in government health care services programs costs taxpayers billions of dollars every year. Not only is this a waste of funds, it can also effect HPSJ member safety, and access, and cause care issues.  In accordance with regulations, HPSJ requires that all network providers complete or attest to the completion of training in the fundamentals of health care FWA prevention, detection, and correction. The annual FWA training will be available this summer. Health Plan of San Joaquin asks that all San Joaquin county providers make sure to carve out time to complete this very important training. HPSJ will alert providers when the HPSJ training and attestation forms are available on www.hpsj.com/providers/. Cactus Application Manager introduced by Health Plan of San Joaquin The HPSJ Provider Network Credentialing Department is GOING GREEN with Cactus Provider Management Platform, a robust and comprehensive software solution. Cactus provides automated credentialing that offers cloudbased access, speeds up processes, tightens security, improves workflow, and reduces paper burden. What are the benefits? • Simplify and Streamline - Application Manager eliminates the complicated and error-prone process of gathering data from providers. Provider information will be entered on the application and will not need to be transcribed by the credentialing staff. This should reduce entry errors. •A  utomated Processes - Existing providers are notified when they are due for recredentialing. HPSJ can set automatic reminders and receive email alerts when a provider completes an application. •M  ore to come from HPSJ as they get closer to implementation, anticipated for this summer. Breast Health Initiative – New from Health Plan of San Joaquin If detected in the earliest stages, the five-year survival rate for breast cancer is 98%. For the past several years, Health Plan of San Joaquin has seen the number of women getting a breast

SUMMER 2019

cancer screening remain alarmingly low. To find out what was preventing them from going in for a screening, in 2018 HPSJ surveyed 169 HPSJ members. Knowing all too well that prevention is key, it was important to find out how the public, providers and their health plan could support women in being screened. Methodology Based on HEDIS gap reports, HPSJ focused on ZIP codes that had the most women living in them still needing a screening. Those ZIP codes were 95206 and 95210 in San Joaquin County and 95351, 95354, and 95350 in Stanislaus County. Here is a top-level summary of what the health plan learned in 2018. Question 1: Do you know how to schedule a mammogram? Answer: 87% said yes Question 2: Have you had your mammogram this year? Answer: 71% said no Question 3: Where do you get your preventative health information? Answers: Including – • PCP • Internet • Clinic • Friends • Caretaker • I do not get information Question 4: How would you like to receive screening reminders? Answers: Out of 169 responses – 1. Text (58) 2. Postcard (60) 3. Letter (16) 4. Email (11) 5. Phone Call (6) Question 5: What has prevented you from getting a screening? Answer: Top 7 responses – 1. Scared/afraid to know if something is wrong 2. PCP said “I did not need one” – or never mentioned that I needed

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In The News

IN THE

NEWS 3. I have small breasts 4. No family history 5. Had a painful experience in the past so don’t want to have another one 6. No caretaker for myself or my family member 7. My appointment was too far out HPSJ is addressing these disparities by launching a year-long, culturally and linguistically sensitive campaign to provide education to the community in San Joaquin and Stanislaus counties about the importance of getting a mammogram. We have begun to provide Community Advisory Committeetested education pieces to PCPs and their clinical staff to help remind their patients to get screened and pinpoint appropriate ages for these screenings. HPSJ also has established a web page for ongoing support and information, at https://www.hpsj.com/breast-cancer/ Tips for a timely conversation with a patient – ✓ Talk about early prevention ✓ Discuss the importance of follow ups ✓ Discuss the importance of having a mammogram done regularly and on time each year ✓ Talk about what age women should have a mammogram done ✓ Talk about how often a mammogram is needed ✓ Talk about family history and the importance of getting a screening and when to get it Physicians Featured on "Hello Healthy Podcast" Series Dignity Health recently launched the "Hello Healthy Podcast", an audio series featuring expert physicians from the central

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

valley, speaking on an array of health related topics. The first physicians from Stockton to be featured include Jaicharan Iyengar, MD, Gaurav Singh, MD, Scott Neeley, MD, Philip Cheng, MD, and Gurtej Malhi, MD. Those seeking information on shoulder pain, lung cancer, care for the critically ill, neonatal intensive care and advanced gastrointestinal procedures can tune in to the "Hello Healthy Podcast" to hear the latest information from trusted sources. The podcasts are available at StJosephsCares.org and also on several podcast platforms including Apple Podcasts, Spotify, iHeart Radio and Stitcher. St. Joseph’s Launches Pediatric Hospitalist Program This summer, St. Joseph’s Medical Center will be expanding the level of care available to pediatric patients in our community through the introduction of a new Pediatric Hospitalist Program. Pediatric specialists will be onsite 24 hours a day, providing specialized care to patients, and reducing the need for pediatric patients to be transferred outside of our community for care. The new Pediatric Hospitalist Program will also help to ensure continuity of care for patients, keeping local pediatricians connected to their patients. In addition to

SUMMER 2019


the Pediatric Hospitalist Program, St. Joseph’s also has an OB Hospitalist Program and a 24-hour Intensivist Program. St. Joseph’s Honored for Environmental Achievements St. Joseph’s Medical Center is proud to have received the Partner for Change Award from Practice Greenhealth, the nation’s leading organization dedicated to environmental sustainability in health care. “The care of our common home is integral to our mission at St. Joseph’s, to the health of our community and our world,” said Sister Abby Newton, OP, Vice President of Mission Integration. The Partner for Change Award recognizes health care facilities that continuously improve and expand upon programs to eliminate mercury, reduce and recycle waste, source products sustainably, and more. Winning

Denise Ammon, MD

Edward Cahill, MD

Recognizing Physicians with Humankindness Each quarter, St. Joseph’s Medical Center recognizes physicians in the community that go beyond clinical excellence to deliver healing with compassion and kindness, also known as humankindness. Most recently, Denise Ammon, MD, Cyrus Buhari, MD, AJ Puthillath, MD, and Edward Cahill, MD were recognized by their patients and

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facilities must demonstrate that they are recycling at least 15 percent of their total waste, have reduced regulated medical waste, are on track to eliminate mercury, and have developed successful sustainability programs in many areas. St. Joseph’s recent environmental achievements include diverting over 77,500 lbs of plastic from landfills, using 11,937 lbs of reprocessed medical devices, and recycling over 183,500 lbs of cardboard and 12,700 lbs of mixed recycling waste. The award is one of Practice Greenhealth’s Environmental Excellence Awards given to honor health care’s achievements in sustainability. The award was formally presented at the Environmental Excellence Awards Gala on May 9 in Nashville during CleanMed, the premier national conference for leaders in health care sustainability.

AJ Puthillath, MD

Cyrus Buhari, MD

peers for going above and beyond and displaying genuine kindness to their patients. St. Joseph’s invites you to nominate physicians practicing humankindness at St. Joseph’s or in the community to receive recognition. Call 209.467.6486 or email Catherine.Swenson@ dignityhealth.org for more information.

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In The News

C B Merchant Services Announces Chairman of the Board C B Merchant Services (CBMS) is pleased to announce that Mahala Burns (Cort Co.) has been elected chairman of the board of directors. F. Joe Dietrich, IV (Dietrich Insurance) will serve as vice chairman, Robert Kavanaugh (Financial Consultant) will serve as secretary , Ray McCray (City of Tracy & Financial Consultant) will serve as the chief financial

officer and David Vaccarezza will serve as past chairman. New board members include Justin Redman (F&M Bank) and Giovanni Trinchera (Bank of Stockton) . Linda Guinn continues as CEO/President. Headquartered in Stockton, CA, C B Merchant Services is a leading provider of professional accounts receivable management/ debt collection, billing and eviction services. Established in 1917, CBMS is the oldest and largest, mutual benefit, not for profit collection agency in California, and possibly the United States. Golden State Urology Announces Dr. Prithipal Sethi’s Designation on Uroloft Center of Excellence Golden State Urology today announced that Dr. Prithipal Sethi has been designated as a UroLift Center of Excellence. The designation recognizes that Dr. Sethi has achieved a high level of training and experience with the URoLift System and demonstrated a commitment to exemplary care for men suffering from symptoms associated with Benign Prostatic Hyperplasia (BPH). “With the UroLIft System, symptoms of BPH can be treated with a state-of-the-art system that provides rapid improvement of symptoms with the ability to wean off long-term medications. The minimally invasive therapy is definitely on its way to becoming the new standard of care for BPH.” Said Dr. Sethi. Nearly 40 million men in the United States are affected by BPH, not to be confused with prostate cancer, BPH occurs when the prostate gland that surround the male urethra becomes enlarged with advancing age and begins to obstruct the urinary system. Symptoms of BPH often include interrupted sleep and urinary problems, and can cause loss of productivity, depression and decreased quality of life.

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SUMMER 2019


Complete Women’s Health Care VOTED BEST OB/GYN PRACTICE IN SAN JOAQUIN COUNTY!

Over 90,000 Healthy Babies Delivered • Gill OB/GYN is the Leading OB/GYN Practice in SJ County • Expertly Trained Physicians and Staff • 65 Years of Experience • Specializing in High Risk Pregnancy • Leading the Way with Minimally Invasive Robotic Assisted Surgery

HEALTHCARE JUST AS UNIQUE AS YOU! Complete Pregnancy Care • High Risk Pregnancy • Infertility • Gynecology • Endometriosis • Urinary Incontinence Ovarian Cystic Disorder • Laparoscopy • Hysteroscopy Diagnosis & Treatment Of Cervical, Uterine, Ovarian Cancers • Robotic Surgery

Advanced Non-Invasive Aesthetic Services BioTE Bioidentical Hormone Replacement Therapy

Hydrafacial, Vampire Face Lift & Breast Lift

SUMMER 2019

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practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice.

CALIFORNIA MEDICAL ASSOCIATION

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

Fresno Madera MedicalPAID? Society TROUBLE GETTING 66th Annual Yosemite Postgraduate Do not ignore Medicare revalidation requests,Institute or CMA CAN HELP! March 24 - 26, 2017 I’VE RECOVERED your billing privileges will be deactivated. Practice Management: Tip of the Month

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

70,000

$

In the past nine years, CMA’s Center for • Are your claims being denied after obtaining prior • Do you have questions about the new law on payment Economic Services has recovered over authorization? from my payors using and billing for out of network services (Assembly Bill 72)? CMA’s Center for $15.5 million from payors on behalf of Economic Services •Noridian, Do you members. have questions about Coveredcontractor California? for California, • Do you need help with Medicare-related CMA Medicare’s administrative continues to deactivate providers issues? for not responding to for Medicare revalidation resulting in a gap in billing privileges and lost revenue for CMA’s Center Economic Services notices, is staffed by

•physicians. Are your claims not being paid in a timelynotices manner? • Have you been presented with a managed care Noridian sends revalidation practice management experts with a combinedvia email two or three months prior to the revalidation due contract and you’re not sure if the terms are

experience of only overreceive 125 years in medical practice date. You will a paper revalidation notice if the email is returned as undeliverable.

•operations. Are you not Our being paidisaccording to your contract? goal to empower physician

For more by information, visit cmadocs.org/tips. practices providing resources and guidance to •improve Are you receiving untimely requests for refunds or is a the success of your practice. payor recouping money from your check without

consistent with California law?

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

Assistance ranges coaching andrequest? education to first notifying you infrom writing of a refund Registration is now open direct intervention with payors or regulators.

Trouble Getting Paid? CMA Can ext. Help! Call (559) 224-4224 118 for more information or visit economicservices@cmadocs.org. www.FMMS.org Call (800) 786-4262 or email

Access to CMA’s reimbursement experts is a FREE, members-only benefit. help? Call 786-4262 or email economicservices@cmanet.org. CMANeed members can call on (800) CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

• Do you have questions about the new law on payment and billing for out of network services (Assembly Bill 72)?

• Are your claims being denied after obtaining prior authorization?

• Do you have questions about Covered California?

• Do you need help with Medicare-related issues?

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

• Have you been presented with a managed care contract and you’re not sure if the terms are

• Are you not being paid according to your contract? • Are you receiving untimely requests for refunds or is a payor recouping money from your check without

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

first notifying you in writing of a refund request?

Access to CMA’s reimbursement experts is a FREE, members-only benefit. Need help? Call (800) 786-4262 or email economicservices@cmanet.org.

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SUMMER 2019


The 16th Annual Stockton

DIABETES Fostering Excellence in Diabetes Care

SEMINAR

Target Audience: Nurses, Pharmacists, CDE’s, Dieticians, NPs, PAs and Physicians

Saturday, July 20, 2019 8 am to 2 pm

UNIVERSITY OF THE PACIFIC

DeRosa Center | 3601 Pacific Avenue, Stockton 95211

REGISTRATION REQUIRED To register, please email Sjmc-education-secretaries@dignityhealth.org or call 209.467.6331. Topics include: 1. What would you do? Instructive Diabetes Case Reports 2. Update on DKA 3. Cardiac Disease in Diabetes 4. Societal Implications of the Epidemic of Pre-diabetes 5. Newer Agents in T2DM Pharmacotherapy 6. Improving Patient-Physician Communication in Diabetes Care

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. SUMMER 2019

This no fee seminar for licensed professionals includes: • Free continental breakfast and lunch • Networking opportunities with healthcare providers engaged in innovative diabetes care • Updates on recent and important advances in diabetes care • Free CME & CEU Credits

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

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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.


JUNE 12TH, 2019: 11:00AM TO 1:00PM

“BEST PRACTICES FOR CONTRACTINGSTRATEGIES” This presentation provides best practice strategies and valuable resources to consider when contemplating a new contract, contract renegotiation or developing a strategy for future payor negotiations. Developing a strong contracting strategy can optimize the outcomes when presenting your “Business Case” to the payor and help avoid the quick “not interested” payor response. Topics covered: • CMA’s contracting resources: toolkits, legal resources, health plan details, template letters and worksheets • Strategies when creating the best “Business Case” for your practice • Post negotiation organization of your contracts from paper to scanned on-line references Bring your contracting questions and be prepared to delve into developing the best strategy for your practice’s contracting future. Kristine Marck, Associate Director in CMA’s Center for Economic Services. After over 25 years in the health/managed care industry, she has a balance of working for and with

physicians and a drive to assist them in these difficult times. Her extensive experience offers her a unique perspective and a number of encounters to draw from. Her distilled skills focus her advocacy in the areas on managed care contracting, MediCal stakeholder activities and liaison work with varied health plans, IPAs and Medical Groups.

JULY 10TH, 2019:

“NO MEETING DUE TO FACILITATING OUR DECISION MEDICINE PROGRAM” For more information on our Decision Medicine Program, please visit our website at decisionmedicine.com. We are looking for new Doctors who would be willing to host a student in their office on July 17th and/ or July 24th from 9:00AM-2:30PM. If you are interested, please contact Jessica@sjcms.org or call 209-952-5299!

AUGUST 8TH, 2019: 11:00AM TO 1:00PM

“TBD”


Public Health

Update

Measles in 2019 By Gordon Arakawa MD, PhD

Measles has arrived ‌ again. As of April 2019, there are over 700 reported cases of measles in the U.S. According to the Centers for Disease Control (CDC), this is the greatest number of cases reported in the U.S. in the last quarter century. Brief History Symptoms attributed to measles were first described by the Persian physician Rhazes in 900 CE. In 1492, Europeans first brought measles to the Americas. The first reported measles outbreak occurred in Colonial America in 1657. Prior to the modern measles vaccine era, roughly 8 million children died each year worldwide. Since the introduction of a measles vaccine in 1963 and establishment of routine vaccination schedules, deaths from

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measles have declined dramatically. In 1978, the CDC set a goal to eliminate measles from the U.S. In 2000, the CDC declared that measles was eliminated (defined as the absence of continuous disease transmission for greater than 12 months) in the US. However, over the past two years the number of measles cases worldwide has been steadily increasing. The World Health Organization (WHO) indicates that reported cases of measles worldwide have risen by over 400% during the first three months of 2019.

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Measles Cases in U.S. 1400

?

Number of MEASLES CASES

1200 1000 800 600 400 200

0

2016

2017

Figure 1

2018 YEAR

2019

2020

Figure 1 Plot of number of measles cases in the US from 2015-2019. So far this year, there has been a sharp increase in the number of measles cases in the U.S.

Herd Immunity Measles is amongst the world’s most contagious diseases. The infectivity of a particular disease is measured by its basic reproduction number or Ro value. The Ro value is defined as the average number of people that an infected individual will infect while he or she is contagious, assuming that everyone in the population is susceptible. If a disease has an Ro of greater than one, meaning that an infected person can spread the disease to more than one individual, that disease is likely to become an epidemic. If a disease has an Ro less than or equal to one, the disease is unlikely to cause an epidemic. It has been established that the Ro of measles is approximately 18; this means a person infected by measles can easily spread the disease to eighteen vulnerable persons. How can we ameliorate this situation? Vaccinations. Vaccinations are administered so that a person can develop immunity to a particular disease. If, in a group of 18 individuals,

SUMMER 2019

17 are vaccinated and the entire group is exposed to a person infected with measles, only the unvaccinated person would be vulnerable. The term “herd immunity” was coined from such analysis - the idea that even people who cannot be vaccinated can still be protected by those who are vaccinated. So, the answer is simple: in order to prevent measles outbreaks, ensure that an adequate number of persons are vaccinated.

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Figure 2a and 2b Figure 2 shows a diagram of a hypothetical disease with an R0 of 10. In Figure 2a, the vaccination rate against the disease is 50%. The diseased patient interacts with ten individuals, five of whom are vaccinated against the disease. The disease spreads to the five unvaccinated persons. Each of the five new cases of the disease becomes a nidus for additional cases as each interacts with a population with a 50% vaccination rate. Result: high probability of an outbreak. In Figure 2b, the vaccination rate against the disease is 90%. The diseased patient interacts with ten individuals, nine of whom are vaccinated against the disease. The disease then spreads to the single unvaccinated person. This new case then become a nidus for a single case as he/she interacts with a population with a 90% vaccination rate. Result: low probability of an outbreak. Loss of Herd Immunity How did we transition from a world in which measles is “eliminated� in many countries to one in which measles outbreaks are common? There must be a loss of herd immunity. An appropriate analogy involves a castle fighting off invaders. As long as the castle wall is intact, the invaders cannot enter the castle. However, if part of the wall is taken down, the invaders have a chance to enter the castle. The loss of herd immunity can be explained by a decrease in measles vaccination rates. Worldwide, the

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decrease in vaccinations is attributed to two main factors: vaccine inaccessibility and vaccination hesitancy. Vaccine inaccessibility is seen in very poor countries which suffer from a general lack of resources. Madagascar is an example of a country with an impacted health sector and a 58% measles vaccination rate in 2017. Vaccine inaccessibility is also seen in strife-ridden countries where war and political instability make it impossible to sustain a competent vaccination program. South Sudan, with a 20% measles vaccination rate in 2017, is a prime example of a country in which recent wars have

SUMMER 2019


decimated the country’s healthcare infrastructure. It should be noted that South Sudan’s measles vaccination rate has dramatically improved following a joint UNICEF/WHO mass measles vaccination campaign in December 2018. There is another major influence affecting vaccination rates in countries not burdened by poverty or strife: vaccination hesitancy. Because of vaccine hesitancy, or a reluctance to be vaccinated, individuals are opting out of routine vaccinations. The reasons for such hesitancy are complex. There remains the fear of a link between childhood vaccinations and autism. In some groups, religious beliefs play a role in the negative view of vaccines. The safety of vaccine preparations has been challenged. There have been arguments put forth about exercising parental rights to choose whether or not to vaccinate their children. Some also believe that acquiring diseases naturally without protection from vaccinations provides the best health outcomes. For these many reasons, there is a widespread decrease in childhood vaccinations across the globe. For example, Ukraine, Serbia, France, Greece and Italy are European countries in which confidence in vaccinations has waned and the number of measles cases has risen over the past few years. In the Philippines, there has been a general lack of public trust in government vaccine programs and, as a result, a precipitous fall in the rates of childhood vaccinations for diseases including measles. Until there is a reversal in this trend of decreasing vaccinations rates throughout the world, the number of worldwide measles cases and outbreaks will continue to grow. Take Action How can we address this crisis? We cannot wait for the world to raise its measles vaccination rates. We cannot stop incoming travel from or travel to countries in which measles is endemic. We must ensure our measles vaccination rates remain above 95%. Furthermore, the vaccination rate of 95% must be as uniform as possible. There should be no “pockets” or areas of vaccination rates below 95%. Imagine a community with an overall vaccination rate of 96%. However, let’s assume there is a pocket, say a school, in this community with a vaccination rate of less than 70%. If this school population were exposed to person infected with measles, an outbreak at the school is likely. We can confirm immunity to measles. The CDC considers one protected from measles if an individual has written documentation of at least one of the following:

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1. R  eceived two doses of measles containing vaccine (e.g. MMR) AND you are: a. A school aged child (grades K-12)

b. A n adult, especially one who will be in a high-risk setting for measles transmission (e.g. students in college/university, healthcare personnel and international travelers)

2. R  eceived one dose of measles containing vaccine AND you are: a. A Pre-K aged child 3. Confirmed prior measles infection 4. Confirmed immunity to measles 5. Born before 1957 Confirmation of immunity to measles and vaccinations are extremely important for those who travel by air. Of course, those at greatest risk are those who travel to and from countries in which measles is endemic. However, even those who fly domestically in the US can be at risk for measles infection if they spend time in international hubs or take a flight with an international traveler infected by measles. Due to the increased risk of acquiring measles when traveling overseas, the CDC recommends that infants between 6 months and one year old should be given a dose of MMR prior to travel. It should be noted that full protection from measles infection develops four weeks after immunization. Yes, the threat of measles is now ever-present. Talk to your patients about the safety and efficacy of the measles vaccine (MMR). Explain to your patients the need for vaccinations in order to protect themselves, their family and community. If the vaccination rate remains high enough, then the threat of measles outbreaks in our county, state and country will be kept at bay, regardless of the vaccination situation in the remainder of the world. For more information contact: TB/CD Program of San Joaquin County Public Health Services 209 468 3822 CDC link to Measles, Mumps, Rubella Vaccine page: https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

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The

REMEDY for all your

Financial

NEEDS

As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff ! In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money. Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.

209-948-6024

www.fccuburt.org Federally insured by the NCUA.

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SAN JOAQUIN PHYSICIAN

SUMMER 2019


9 NEW

SJMS MEMBERS THIS SPRING!

...and even more on the way.

La Toya Luces, M.D.

Mitali Parmar, M.D.

Deepa Perumal, M.D.

7373 West Lane Stockton, CA 95210 (209) 735-4176 Howard University College of Medicine

500 W Hospital Rd French Camp, CA 95231 (209) 468-6000 Northwestern University Feinberg School of Medicine

2185 W Grant Line Road Tracy, CA 95377 (209) 735-4176 Sri Decaraj Urs Medical College

OB/GYN

Emergency Medicine

Marie Currie, M.D

Suseela Kumar, M.D.

530 W Acacia St. Ste 23 Stockton, CA 94203 (209) 242-7098 Dalhousie University Faulty of Medicine

7373 West Lane Stockton, CA 95210 (209) 731-4176 Medical College Thiruvananthapuram

Cardiothoracic Surgery

Internal Medicine

Joseph Izzo, M.D.

Phong Ngo, M.D.

500 W Hospital Rd French Camp, CA 95231 (209) 468-6000 Robert Wood Johnson Medical School

7373 West Lane Stockton, CA 95210 (209) 735-4176 St. George’s University School of Medicine

Emergency Medicine

SUMMER 2019

Occupational Medicine

General Medicine

Shampa Sarkar, M.D. Psychiatry

1305 Tommydon St. Stockton, CA 95210 (209) 735-4176 R.G. Kar Medical College

Swati Pathak, M.D. Internal Medicine

165 St. Dominics Dr. #201 Manteca, CA 95337 (209) 524-1211 Baba Farid University of Health Sciences

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In Memoriam

In Memoriam PRABHJIT SINGH PUREWAL, MD May 4, 1958 - April 7, 2019

Dr. Prabhjit Singh Purewal passed away suddenly at the age of 60. He was born in New Delhi, India, to Gurdan Kaur and Surinder Singh Purewal. Prabhjit attended St. Xavier's high school and the Armed Forces Medical College in Pune, India. He was an outstanding track and field athlete and held several Indian national records in long distance running. After moving to the United States, he completed his residency at the Long Island Jewish Medical Center and a fellowship in Hematology at Stanford University. Dr. Purewal moved his family to Stockton in 1994 to start his private practice. He made the front page of the Stockton Record the following year by performing the first bone marrow transplant in the city. 

practice moved to Manteca, where it remained until his passing. Dr. Purewal was a member of the San Joaquin Medical Society and the California Medical Association for 21 years. Dr. Purewal was an avid golfer and wine enthusiast, partnering in PureCru Wines. Nearly every weekend was spent in Napa or Carmel, where his vast network of friends continued to grow exponentially. He will be forever remembered as the most gracious host, and the most devoted father.  Dr. Purewal is survived by his three children, Paramveer, Tarunveer, and Heer; his father Surinder Singh; his sister Amardeep Kumar; and countless patients who credit him for saving their lives. 

He would later start the St. Teresa Comprehensive Cancer Center in honor of his time spent working at Mother Teresa's leprosy center in India. His

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INNOVATIVE MEDICAL SOLUTIONS IN A MULTICULTURAL WORLD Experience the difference with JRivera Associates. Expect exceptional service of on-site, telephonic, and video remote interpretation as well as written translation at reasonable rates. Many health plans cover linguistic services in compliance with regulatory requirements of providing Limited English Proficient (LEP) patients with professional interpreters and written translated materials. JRivera Associates is a team dedicated to providing physicians and their practices with the tools and technology to inform, empower and embrace communication to those who need it most...your patients. CALL US TODAY AT 209-405-0951 FOR A FREE INTRODUCTORY INTERPRETATION/TRANSLATION SERVICE!

Medical Interpretation and Translation | Over 47 languages to support your patients

JRIVERA ASSOCIATES 139 S. GUILD AVENUE SUMMER 2019 CA 95240 LODI,

P: 209-405-0951 E: SERVICES@JRIVA.COM W: WWW.JRIVA.COM

SAN JOAQUIN PHYSICIAN

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