Summer 2023

Sequential pulses to a polyp ignited a

surgical fire

in the patient’s airway.

Surgical fires were among the 10 most common sentinel events reported by hospitals to the Joint Commission in 2021. *

If a sentinel event happens and a ProAssurance insured is involved, they have direct access to medical liability claims specialists and risk management consultants with experience navigating these types of malpractice claims.

We’ve seen the worst you can imagine and have the expertise to help reduce risk and ensure a vigorous defense from day one. The principle of fair treatment guides every action we take in defense of our physicians and healthcare providers.

PRESIDENT- Cyrus Buhari, DO PRESIDENT ELECT- Nguyen Vo, MD TREASURER- Neelesh Bangalore, MD

BOARD MEMBERS Stephen Tsang, MD, Maggie Park, MD, Sujeeth Punnam, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD, Raghunath Reddy, MD, Kinnari Parikh, MD, Inderpreet Dhillon, MD and Bhagya Nakka, MD

MEDICAL SOCIETY STAFF

EXECUTIVE DIRECTOR Lisa Richmond

MEMBERSHIP COORDINATOR Jessica Peluso

COMMITTEE CHAIRPERSONS

CMA AFFAIRS COMMITTEE Larry Frank, MD

DECISION MEDICINE Kwabena Adubofour, MD

MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD

PUBLIC HEALTH COMMITTEE Kelly Savage, DO SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

CMA HOUSE OF DELEGATES REPRESENTATIVES

Robin Wong, MD, Lawrence R. Frank, MD

James R. Halderman, MD, Raissa Hill, DO Richelle Marasigan, DO, Ramin Manshadi, MD

Kwabena Adubofour, MD, Philip Edington, MD Harpreet Singh, MD

SAN JOAQUIN PHYSICIAN MAGAZINE

EDITOR Lisa Richmond

EDITORIAL COMMITTEE Lisa Richmond, Raghunath Reddy, MD, Cyrus Buhari, DO

MANAGING EDITOR Lisa Richmond

CREATIVE DIRECTOR Sherry Lavone Design

CONTRIBUTING WRITERS Jo Ann Kirby, Cyrus Buhari, DO, Maggie Park, MD, Doreatia Hart, BSN, RN, PHN Barb Alberson, MPH

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

SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298

E-mail Address: lisa@sjcms.org

MEDICAL SOCIETY OFFICE HOURS:

Monday through Friday 8:30am-4:30pm

Closed for Lunch between 12pm-1pm

ANNUAL MEMBERSHIP DINNER

RUNS IN THE FAMILY

In the Winter 2014 issue of SJP, we surveyed and highlighted members with generations of physicians in their family. We weren’t surprised that so many children of physicians were inspired to become one themselves after witnessing such a noble profession firsthand. Now, close to 10 years later, we know that the article could use an update (note to self) as we are aware of many families adding physicians to their families and in some cases, to their practices. Nevertheless, when the nominating committee selected Dr. Robin Wong as its Lifetime Achievement Award recipient, it was the first time that a mother and son have both won the award. Dr. Wong’s mother, Dr. Dora Lee was president of SJMS in 1946, and in 2001 received the same award. Amazing! We know you will enjoy reading the features in this issue on Dr. Wong and our very deserving Young Physician Award recipient, Dr. Ajithkumar Puthillath of Stockton Hematology Oncology Medical Group.

SJMS has remained steadfast in its commitment to encouraging and assisting the bright, talented youth of our community to pursue a career in medicine. This year, the committee scored 100 applications before interviewing 45 students and ultimately selecting the final 24 in the class of 2023. A huge thank you to Drs. Hyma Jasti, Kwabena Adubofour, George Khoury, Marina Castillo, Kinnari Parikh and Alain Flores for their engagement in this process.

In the past several years, SJMS has worked hard to develop its board of directors. We are proud to have expanded representation from various modes of practice and geographic location in our service area. This year, due to our President-Elect Nguyen Vo moving, we are fortunate that President, Dr. Cyrus Buhari has agreed to serve one additional year in his current role. We’d like to thank Drs. Vo and Reddy for their service and welcome new board members, Drs. Sunny Philip and Ripudaman Munjual. The SJMS Board of Directors works for you; feedback and questions from members are always welcome. Please email Lisa@sjcms. org to get in touch.

Wishing a wonderful summer,

Lisa Richmond

Exceptional Care for Spina Bifida

The Spina Bifida Association designates only a select number of providers as a Clinic Care Partner, those that meet the highest standards of care and expertise. Not every state, not every region has one. But we do here at Shriners Children’s Northern California.

Our multidisciplinary team includes highly experienced specialists in rehabilitation medicine, orthopedics and urology, and our comprehensive care includes on-site orthotics. The Shriners Children’s system has the largest network of motion analysis centers in the world.

As a leader in multidisciplinary neuromuscular care, our spina bifida clinic treats the following:

Myelomeningocele

Myeloschisis

Meningocele

Lipomyelomeningocele

Tethered cord

Caudal regression syndrome/sacral agenesis

At Shriners Children’s, there are no barriers to care. Care is provided regardless of the family’s ability to pay or insurance status.

Hope Springs Eternal

The legislative season is in full effect. On April 19th, California Medical Association (CMA) and local medical societies stormed Sacramento with the intention of lending our voice to our state legislators. On the “hit-list” for our discussions were the commonsense reforms to the prior authorization process and the ridiculous cuts in Medi-Cal looming on the horizon. We are hoping for a successful 49th CMA Annual Legislative Advocacy Day. Hope springs eternal. I doubt Alexander Pope was referring to politicians listening to their constituents and stakeholders when he wrote An Essay on Man in 1730. Despite my cynicism I am confident that we succeeded in getting our point across to them.

ABOUT THE AUTHOR

Cyrus Fram Buhari, DO is the current president of the San Joaquin Medical Society and practices at the San Joaquin Cardiology Medical Group

California Senate Bill 598 seeks to overhaul the use of prior authorization given to plans in the Knox-Keene Health Care Service Plan Act of 1975. Yes, I said “1975.” In 2023 health plans seem to be using the prior authorization process in near punitive fashion to cut costs. The process is cumbersome and adds an extra layer of bureaucracy to the practice of medicine. I am not arguing that prior authorization has a role in identifying unnecessary tests and more cost-effective therapeutics. But these days the prior authorization process has been used to deny testing, more expensive but effective medications, and what is deemed appropriate care for patients by their physicians. It has morphed into a beast in and of itself whose purpose is to breathe a burden on physicians to cut cost. When last I checked, health plans in California tend to be profitable. Yet some of our stateof-the-art drugs in multiple subspecialties are routinely denied despite a very strong contemporary evidence base. SB598 is a big step in the right direction.

Additionally, we are fighting hard against cuts to the Medi-Cal program. As it is right now, practices that accept Medi-Cal are struggling. Both primary care and specialty practices alike accept very poor reimbursement as it is for taking care of these patients who often have multiple active comorbidities. We all treat and respect these patients as much as any in our respective practices. Yet while one side of the mouth says we need access for these patients to be expanded, the other says we are cutting your reimbursement. How then can anyone complain when practices stop taking patients? We will continue to fight for not only stopping cuts in reimbursement from these Federal and State agencies but for increases to get the reimbursement to an appropriate level in the year 2023. These patients need our care and these types of “not-so-brilliant” ideas of cost savings do not help

the number one goal of the program, which is to expand care to the underserved of our state and our community.

The prior authorization process needs reform and your San Joaquin Medical Society (SJMS) and CMA are on the front lines lobbying on behalf of our members. I purposely kept this quarter’s article short so as not to bore everyone. Please support your local Medical Society and CMA and stand with us in protecting the sanctity of the doctorpatient relationship, reducing the burdens on physicians to deliver care, and to increase physician reimbursements to levels that will encourage expansion of access to and delivery of the highest quality healthcare we can offer.

Physicians gather in Sacramento as champions for patients and the practice of medicine!

Hundreds of physicians, residents and medical students gathered in Sacramento on Wednesday, April 19, 2023, for the 49th annual California Medical Association (CMA) Legislative Advocacy Day.

This year’s event was by all accounts a wildly successful endeavor. CMA welcomed nearly 400 attendees, representing 45+ specialties and 24 component medical societies. Attendees participated in a total of 120 legislator meetings as champions for patients and the practice of medicine.

“I think it is so important to advocate for our patients,” said Quinn Lippman, M.D., an ob-gyn who attended advocacy day with her peers from the San Diego County Medical Society. “There’s the one-on-one care we give in our offices every day, but [it's important that we] take a step back and look at the broader picture of who has access to health care, how that care is being delivered, what medications patients have access to.”

Attendees received updates from CMA President Donaldo Hernandez, M.D., and CMA’s chief lobbyist Stuart Thompson about key health care issues before

the legislature this year. Attendees then lobbied their legislators in support of CMA's priority issues, including:

+ SB 598: Prior Authorization Reform, which would significantly reduce the administrative burden physicians must bear because of prior authorization.

+ AB 765: Truth in Advertising, which protects patients AND physicians against allied health professionals who use terminology to misrepresent themselves as physicians.

+ Medi-Cal: While we have made sure that all Californians have health care coverage, it is meaningless if they can’t see a provider or get regular, timely care outside of the emergency room. Access to care is the last leg of the stool that holds this safetynet program up and is the key to unlocking quality health care for all and reducing disparities.

Legislative Advocacy Day attendees also enjoyed an engaging panel discussion from our keynote luncheon speakers, physician Assemblymembers Joaquin Arambula, M.D.; Jasmeet Bains, M.D.; and Akilah Weber, M.D.

To see all the photos from this year’s advocacy day, see our Flickr album at bit.ly/2023legday.

And the Golden Gavel Goes to….

The CMA Political Action Committee (CALPAC) concluded its three-week Golden Gavel contest in conjunction with Legislative Advocacy Day, with a fundraising total of just over $13,800. The $13,800 raised represents a historic record for fundraising at Legislative Advocacy Day.

CALPAC Chair Damodara Rajasekhar, M.D., is excited to congratulate the physicians of the San Bernardino County Medical Society as winners of the Golden Gavel – with the highest fundraising total of any medical society.

The Golden Gavel contest challenged physicians from each county medical society to make a new donation or upgrade their current level of giving to CALPAC. At the end

of the three-week contest period, the medical society that had the highest level of giving won the Golden Gavel. The contest has now taken place three times, with a different CMA component medical society winning each year.

Donations to CALPAC are crucial for supporting the campaigns of political candidates who share CMA’s health care policy vision. The importance of CALPAC’s work, the core of which is electing legislators and maintaining positive relationships thereafter, was on full display at CMA’s Legislative Advocacy Day.

CALPAC is excited to build on this success and physicians are encouraged to give to CALPAC in support of CMA’s advocacy efforts by visiting calpac.org/donate

See You Next Year!

We are grateful for the time everyone took out of their busy schedules to speak with legislators on the issues impacting the delivery of health care in California. Next year will mark CMA's 50th Legislative Advocacy Day. We hope to see you in Sacramento on April 10, 2024!

The Cures Act and Its Impact on Healthcare Providers

The 1996 Health Insurance Portability and Accountability Act (HIPAA) gave patients a right to view and request corrections to their medical records. In the intervening years, the widespread adoption of electronic health records (EHR), patient portals, and smartphone applications have led to an increase in patients accessing their medical records electronically. The digital evolution of the medical record has prompted a number of healthcare professionals and patient safety advocates to promote quicker access to information stored in the EHR.

The 21st Century Cures Act (Cures Act), passed by the U.S. Congress in 2015, provides new regulation on a variety of healthcare concerns including funding, research, access to new and experimental drugs, telehealth, and interoperability of health information technology (health IT). Authors of the Cures Act introduced a new phrase to the health care community related to the interoperability of health information technology: “information blocking.”

Information Blocking: Defined

Information blocking is defined by the Cures Act and paraphrased by HIT.gov as a practice by a health IT developer of certified health IT, a health information network (HIN), a health information exchange (HIE), or a healthcare provider that, except as required by law or specified by the Secretary of Health and Human Services as a reasonable and necessary activity, “is likely to interfere with the access, exchange, or use of electronic health information (EHI).”

While information blocking can occur when a healthcare provider intentionally restricts access to the patient’s medical record, it can also occur unintentionally as a byproduct of health IT.

Physicians and facilities, like patients, can also experience information blocking. For exam ple, information blocking can occur when a healthcare provider moves from one EHR to another, or when they try to access a patient’s medical record held by another provider. Information blocking can also happen when physicians try to connect EHRs to local information exchanges. *

However, simple interference with the access, exchange, or use of EHI, may not automatically constitute a violation of the Cures Act. To constitute a violation, actors, such as physicians, must have knowledge and intent to interfere with the access, exchange, or use of EHI. * Essentially, provisions within the Cures Act seek to discourage physicians and entities from knowingly interfering with or discouraging access to a patient’s EHI. Healthcare providers found to be engaging in the practice may be subject to monetary penalties or reimbursement disincentives from federal healthcare programs, like Medicare and Medicaid.

Open Notes: When to Share

The information blocking provisions of the Cures Act are often colloquially referred to as “open notes.” Healthcare providers who do not make clinical notes open and available for their patients are engaging in the practice of information blocking, unless one of the Cures Act’s regulatory exceptions applies.

The OpenNotes organization a group of clinicians and researchers committed to increasing patient access to their medical records advocates for the sharing of medical notes and believe it may improve accuracy and patient safety, improve medication adherence, foster stronger relationships and better engagement, improve chronic care management, support care partners, and promote efficiencies.

The Cures Act references eight types of clinical notes that must be made available to patients upon request, which include the following:

• Consultation note

• Discharge summary note

• Procedure note

• Progress note

• Imaging narrative

• Lab report narrative

• Pathology report narrative

• History and physical

Healthcare providers who do not make clinical notes open and available for their patients are engaging in the practice of information blocking unless one of the Cures Act’s regulatory exceptions applies.

Potential Violations of the Cures Act

The American Medical Association has provided examples of potential violations of the Cures Act including: *

• Formal restrictions: A healthcare provider or office policy requires staff to obtain a patient’s written consent before sharing any EHI with unaffiliated providers for treatment purposes.

• Technical limitations: A healthcare provider disables the use of an EHR capability that would enable staff to share EHI with users at other systems.

• Isolated interferences: A healthcare provider has the capability to provide same -day EHI access in a format requested by an unaffiliated provider or by their patient but takes several days to respond.

Cures Act Exceptions to Information Blocking

While providers may read the requirements of the Cures Act and believe them to be burdensome, the information blocking rule contains exceptions for flexibility in operation. Knowing how the Cures Act differs from HIPAA is also helpful to understanding the scope of the Act. HIPAA’s regulations affirmatively and specifically state what types of EHI can be shared with other providers, patients, and third parties. The Cures Act information-blocking rule directs the providers to release records to patients and other providers in nearly all instances where an exception does not exist.

Two categories of exceptions to information blocking within the Cures Act provide flexibility to healthcare providers and organizations without burdening them with administrative ri gidity.

• Category I involves not fulfilling requests for access. These exceptions include preventing harm to the patient or another, protection of health information privacy, protection of health information security, infeasibility, and health IT performance.

• Category II involves the procedures a healthcare provider uses for fulfilling requests. The exceptions in the procedures category include limitation in content and manner, reasonable fees, and licensing.

Risk Management Considerations

With enforcement provisions of the Cures Act expected to be announced in the near future, it is important to train staff in sound documentation practices to help manage risk. Be mindful of the following as more and more patients expect instant access to their medical records.

Documentation Practices

• Assume all notes will be read by the patient.

• Complete documentation in a timely manner.

• Avoid abbreviations that may be standard in the healthcare community, but not easily interpreted by the patient.

• Avoid the use of pejorative terms such as “malingering”; instead, use factual observations in the chart.

• Use plain language and focus on clarity, for the benefit of the patient as well as other healthcare providers.

• Avoid copying and pasting from other sources.

• Before documenting difficult situations, attempt a conversation with the patient or guardian first.

• Promote accurate and timely entries that support the appropriate standards of medical care.

• Reinforce the medical record is used as a key witness in legal proceedings.

Policies and Procedures

• Review, revise, and update current policies to include responding to requests.

• Know the exceptions and incorporate into organizational policies.

• Conduct regular assessments of medical record management and disclosure processes.

Compliance and Training

• Remain up-to-date on changes and applicability dates.

• Identify decision makers and document when an exception applies.

• Conduct proper and regular training to appropriate staff members.

Complaint Response

• Prepare for future internal or external investigations.

• Know how to respond and who to involve.

• Conduct quality improvement process regularly and make adjustments in processes as appropriate.

Conclusion

It is important to note that the Cures Act’s information blocking rule does not override existing state and federal rules protecting patient confidentiality. Compliance with state and federal laws that require patient consent before production of medical records would likely not constitute information blocking. For example, a state may require certain conditions be met before releasing certain classes of EHI, such as HIV status or adolescent mental health information. In these instances, physicians should not release that EHI without first obtaining consent from the patient. *

The compliance date for healthcare providers to meet the Cures Act information blocking requirements was April 5, 2021. As of October 6, 2022, healthcare providers are required to make the same information available on patient third-party applications to not be engaged in information blocking.

The good news for healthcare providers is that although the date for Cures Act compliance has passed, the final rule went into effect without applicable enforcement provisions, which means providers still have time to bring their EHR systems and procedures into compliance. With proper planning and training, healthcare providers should be able to implement minor procedural changes to comply with Cures Act requirements.

If you have questions about the Cures Act or information blocking, contact Risk Management at 844-223-9648 or email RiskAdvisor@ProAssurance.com .* American Medical Association. What Is Information Blocking?

Legal disclaimer: The information provided in this article offers risk management strategies and resource links. Guidance and recommendations contained in this article are not intended to determine the standard of care but are provided as risk management advice only. The ultimate judgment regarding the propriety of any me thod of care must be made by the healthcare professional. The information does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about this topic should be directed to an attorney.

Family Matters

Dr. Wong delivers decades of care to Stockton community

BY JO ANN KIRBY

It’s all about family for the 2023 recipient of the San Joaquin Medical Society’s Lifetime Achievement Award.

Dr. Robin Wong, a champion of family medicine, has cared for patients from cradle to grave in the footsteps of his late trailblazing mother, Dr. Dora Lee, who nurtured his interest in medicine before inviting him to join her practice. Today, more than four decades later, he still demonstrates that family matters as his wife and daughter work by his side along with loyal staff who seem more like kin. >>

The Lifetime Achievement Award recipient must demonstrate dedication, community involvement and leadership — qualities Dr. Kwabena Adubofour cited when nominating Dr. Wong, singling out his roles as past president of the San Joaquin Medical Society as well as a long-term board member and district delegate; his commitment to mentoring, his role in the health education of the local Chinese community, and his longevity as a primary care physician.

One of the rare doctors to still operate a solo practice, Dr. Wong’s old school paper charts for each of his patients belies a lifelong learner who works tirelessly to stay abreast of the latest in medicine so that he can handle the care of his patients until they are able to see a specialist, if needed.

“I might be the last family medicine physician in private practice who delivered babies,” he said at his California Street office, shelves upon shelves of those manila file folders visible past the front counter. “I miss delivering babies but right now I’m focused more on an aging population.”

At 74, Dr. Wong has no plans to immediately retire unless the key member of staff who runs the front office, Tina Zavala, beats him to it. Being a doctor is a dream job for Dr. Wong and the culmination of a pact he made with his childhood friend. It’s not so easy to hang up the stethoscope.

“My friendship with him is what inspired me to become a doctor. We got to go and visit his mother’s office on our way home from school. His mom, Dora Lee, was quite a woman. She was one of the first woman doctors in Stockton. We made a pact that we would become doctors then,” his friend Dr. Timothy Coates said. “Family physicians, we get taught that because of the family moniker, we should take care of

everyone in the family, and we get to know them and treat each one with respect. Robin does that very well. He’s honest, forthright, easy to understand and always does the right thing.”

That might be the Boy Scout in him. Along with his mother and his father, a well-known professional commercial photographer in Stockton, Scouting made a lasting impression. “What influenced me a lot when I grew up was scouting, Cub, Boy and Explorer. I was able to obtain the rank of Eagle Scout.” In addition to numerous Scouting

become a doctor. We got to go and visit his mother’s office on our way home from school. His mom, Dora Lee, was quite a woman. She was one of the first woman doctors in Stockton. We made a pact that we would become doctors then.”

DR.

awards, he grew into a young man who possessed a love of the outdoors, the ability to do things independently, and a knowledge of safety as well as first aid.

He would go on to earn his undergraduate degree at UC Berkeley and headed to medical school at Automous University of Guadalajara, graduating in 1975. “I then went to UC Irvine, which took three people per year for a fifth-year pathway, and that was a key moment in me being able to continue my education in the U.S. I think when I die, I’m going to donate some money to them,” he said, laughing. “You have to have

brains, but you also have to have luck.”

He came back to the Valley to do his residency and internship before starting work with his mother, who also invited Dr. Coates to come on board, as well.

He was awarded the degree of Fellow by the American Academy of Family Physicians in 1994. He served as chief of staff at St. Joseph’s Medical Center from January 2003 to December 2005 and as president of its community board from

“My friendship with him is what inspired me to

-

TIMOTHY COATES

July 2011 to July 2013. “Serving as chief of staff is challenging, you are overseeing doctors, attending so many meetings and also you have your own practice,” he said. During his tenure as with St. Joe’s, the hospital underwent a Joint Commission survey. “You want your hospital to be recognized for excellent quality and safety. It was an honor, and it was very challenging,” he said.

Together with his wife Clara, they share three children, Nicholas, Joel and Natalie, who is his accounts manager and certified medical coder/ biller for the office. Dr. Wong is a proud father and grandfather. He’s also immensely grateful for his wife. They are coming up on their 45th wedding anniversary. He met his her on a trip to Taiwan, when she was his tour guide at one of his tourist stops. “Later that afternoon in Taipei, I spotted her, and I told my friend that we needed to take her out to dinner,” he said. Natalie still marvels at their chance second encounter that day and calls it fate. Clara has been a steadfast and supportive partner at home and in the office, “taking care of all the things no one else wants to,” she said. What’s it like for Natalie working with dad? “He’s a good boss,” she says. “I’ve learned a lot from him from his interaction with patients. They have a lot of trust and confidence in him.” She is also impressed

with the lengths he goes to keep abreast of the latest medical breakthroughs — always learning so that he can help his patients. But most of all, she says what makes him a great doctor is that he takes time to listen to his patients.

In his spare time, he enjoys running and has competed in more than a half dozen marathons “It’s my peace time. I think about my patients. I think about what I need to do for the day,” he said. He loves traveling and dabbles in cooking. He has been an avid golfer and enjoyed skiing. At age 60, he and his daughter became scuba certified. But that hobby was short-lived. “I went a couple of times, but my wife said it’s too dangerous,” he said.

He enjoys hanging out with his three grandsons. Clearly, he would have enough to keep him occupied in retirement. But he feels like his patients still need him and he’s concerned about the shortage of physicians that continues to plague the area. He is a big champion of mentoring and is proud to have inspired a former patient to become a doctor.

The Lifetime Achievement Award will be presented to Dr. Wong on June 4, just 22 years after his mother received the same award.

DR . AJ BRINGS empathy TO CANCER FIGHT

BY JO ANN KIRBY

The Young Physician Award honors Dr. Ajithkumar Puthillath, an oncologist with Stockton Hematology Oncology Medical Group, who brings a frenetic energy coupled with true empathy in everything he accomplishes.

Dr. AJ, as he is affectionately known, was in his third month of residency when he started experiencing debilitating back pain, the kind that made him question everything. He was diagnosed with ankylosing spondylitis, an inflammatory arthritis that mainly affects the spine.

“I have to stay positive. It’s been transformative in that it brings a lot more empathy because I’ve experienced pain and a chronic health struggle,” he said. This makes him even more mindful as a physician to his cancer patients. “To be anyone’s doctor is a precious thing, he said. “Their confidence and trust are the most important factors.” >>

He graduated with a Bachelor of Medicine and Surgery from the University of Mysore in India and earned a master’s in public health administration from City University of New York. During his Internal Medicine residency at Michigan State University, he was honored as Resident of the Year. His wife encouraged him to go into oncology and she could not be more proud of the physician he has become. After he finished his fellowship at the prestigious Roswell Park Comprehensive Cancer Center in Buffalo, New York, he and his wife found a home in the Stockton community where he is part of a thriving practice. They have found Stockton to be a very welcoming place and the warmer climate is better for his joints.

“Cancer is such a challenging field but he gives his patients hope, he is very honest with them and never sugarcoats anything. He has a very good bedside manner,” Indu Mendon said of her husband, adding that she has seen how he interacts with cancer patients firsthand. “I lost my own aunt to ovarian cancer, and he helped her through the whole practice.”

She said he comes home very sad when he can’t save a patient but gains a lot of inspiration from his patients’ strength. “It gives

him great satisfaction when he can tell a patient that their cancer has gone into remission,” she said. “He tries to make the best decisions for his patients as if they were his own family.”

His own battle with AS means he battles fatigue and pain at times, but one would never know by the buoyancy he brings into a room. His wife, a special education teacher with Lincoln Unified School District, jokes that she threatens to sit down with his parents for an IEP — teacher talk for individual education plan — to discuss whether he might have a little hyperactivity issue because he is always in “rush mode.”

Dr. Prasad Dighe and Dr. Aminder Mehdi invited Dr. AJ to join their practice and he calls them “excellent mentors.” He says treating cancer is a “team effort” that includes everyone from the billing team to nurses. The practice has since grown into four locations with eight doctors.

“He is extremely bright and knowledgeable about the business aspects of running an oncology office,” Dr Dighe said. “It is because of him that we today are doing well as Stockton Hematology Oncology Medical Group not only in Stockton but also in Lodi, Tracy and Manteca.

“ He is extremely bright and knowledgeable about the business aspects of running an oncology office . It is because of him that we today are doing well as Stockton Hematology Oncology Medical Group not only in Stockton but also in Lodi, Tracy and Manteca." - DR. PRASAD DIGHE

He served as chief of staff at Lodi Memorial and is presently chairman of its Bioethics Committee. He is also the chair of St. Joseph Medical Center’s Breast Cancer Program, is a board member at Lodi Memorial and serves as director of SJMC’s Palliative Care Program. Recruiting doctors to San Joaquin County is a priority as well and to that end he is proud to be a faculty member for the Internal Medicine Training program at SJMC.

Dr. AJ splits his time between the Stockton and Lodi offices. “The doctors I joined are so great. It’s very small group that allows me to grow,” he said, in his office, which is brightly decorated by colorful artwork done by his wife and two daughters. “I owe a lot to my wife who has been steadfast in her support and confidence.”

It also allows him time to spend with his family. He and his wife have two daughters, Arya is 12 and Akshara is 8. The closeknit family enjoys travel to far-flung locations, even sampling sushi in Japan and learning more about the culture of that country. He is a fun-loving dad who loves Disneyland as much as his kids and he has also coached his daughter’s Science Olympiad team to victory.  A wine collector and self-described “foodie”, Dr. AJ is the person to ask about the best places to dine. He and his wife are very close to their parents and other family. Indu jokes that her mom calls more to talk to her son-in-law than her own daughter.

The Young Physician Award was a surprise to Dr. AJ, but his wife said its well deserved. The son of a mom who worked as an elementary school principal and father who worked in a factory, the importance of resilience, hard work and integrity were instilled in him from an early age.

“He never expected this, and he doesn’t do any of the things he does to get recognition,” she said. “It’s called karma. You do your best for the satisfaction of a job well done.”

Adventist Health Lodi Memorial and Dameron Hospital is home to the area’s specialty-trained, board certified heart and vascular experts. From preventive care to cardiac emergencies, our experienced team offers the advanced diagnostic and treatment options you want for yourself and your loved ones. We even feature specialists in electrophysiology, interventional cardiology and cardiac emergency care performing the safest, most effective procedures to heal the most complex conditions. No matter your condition, our team puts their hearts into keeping yours healthy.

Learn more about our team. Visit AdventistHealth.org/SanJoaquinHeartandStroke

IN THE NEWS

Zeiter Eye Medical Group, Inc. | Vision Is Our Passion

Another Dr. Zeiter is joining Zeiter Eye Medical Group. John Zeiter, Jr. grew up in Stockton, graduating as valedictorian from St. Mary’s High School in 2008. He then moved across the country to Dartmouth College for his undergraduate work in chemistry, finishing in 2012. He completed medical school in 2017 at Baylor College of Medicine in Houston, followed by four years of ophthalmology training at the Kresge Eye Institute in the Detroit Medical Center, graduating in 2022. Finally, Dr. John, Jr. completed a one-year fellowship in Glaucoma at the UCSF Medical Center. His glaucoma training included extensive medical, laser, and minimally invasive glaucoma surgery (MIGS) in addition to complex anterior segment glaucoma and cataract surgery. Dr. John Jr. and his wife, Amy, have two children, Liliana and Braden. Dr. John Jr.’s hobbies include skiing, rock climbing, hiking, biking, listening to classic rock, and playing video games. He is excited to join Zeiter Eye which has served the residents of San Joaquin County for more than 60 years providing the gift of sight.

John Zeiter, Jr., MD

Advances in Patient Blood Management at Shriners Children’s Northern California

Shriners Children’s Northern California has implemented a new approach to pediatric surgical blood transfusion, using a state-of-the-art viscoelastic testing device from a leading hematology instrument maker. This device, which uses ultrasound technology, is the first of its kind being used in a pediatric hospital in the United States. It allows the anesthesia team to identify specific blood components a patient needs during a surgical procedure, including fresh frozen plasma, platelets and fibrinogen. This is particularly important during surgeries with rapid blood loss, such as trauma, burns or scoliosis surgery. The results are available in just 10 minutes, providing a faster alternative to traditional lab testing which can take up to 45 minutes.

Prior to the implementation of this technology, blood

transfusion during surgeries with rapid blood loss was based on clinical signs and the use of pediatric massive transfusion protocols. But those protocols are not always precise and can lead to unnecessary blood component therapy.

By using the goal-directed viscoelastic testing, the team at Shriners Children’s Northern California is able to reduce the use of blood products and potentially lower transfusionrelated morbidity and mortality. Dr. Sundeep Tumber, chief of anesthesiology, and his team are currently working on publishing their results.

This is a significant advancement in pediatric surgical blood transfusion and demonstrates Shriners Children’s Northern California's commitment to innovation and patient-centered care.

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

Dameron Specialty Surgery Clinic transitions to Adventist Health Physicians Network

The Dameron Hospital Specialty Surgery Clinic became a part of the Adventist Health Physician Network (AHPN) in February, 2023.

Now operating under the business name of AHPN Stockton Surgical Specialties, its participating physicians provide general, cardiothoracic and colorectal surgical services and includes these local surgeons:

DeAndrea Sims, MD

Dr. Sims is a general surgeon practicing in Stockton, California. Originally from Guam, she attended medical school at Howard University of Medicine and completed her post graduate training in Stockton at San Joaquin General Hospital. She is proficient in several surgeries including treatment of benign and malignant breast disease, gallbladder, hernia, and intestine disorders.

Jennifer McNeil, MD

Dr. McNeil is a board-certified surgeon with expertise in colon and rectal surgeries with an emphasis on abdominal and anorectal disorders. Using laparoscopy and other minimally invasive procedures, she provides surgical treatment for colon and rectal cancer, inflammatory bowel disease (IBD), pelvic floor issues, fecal incontinence and more.

Osama Zahriya, MD

Dr. Zahriya is a board-certified general surgeon with experience in laparoscopic, scope and robotic surgery, treating common conditions such as hernias, gallbladder removal and colon resections. Originally from Michigan, Dr. Zahriya trained internationally before completing his residency in Detroit. He was first inspired to practice medicine by his father, who is also a general surgeon.

AHPN Stockton Surgical Specialties offices are located across the street from Dameron Hospital. The offices are open Monday through Friday from 8 a.m. to 4:30 p.m. The address is 530 West Acacia Street, Suite 1, Stockton, CA 95203.

For consultations, call the AHPN Surgical Specialties offices at 209-242-7098.

DeAndrea Sims, MD

Jennifer McNeil, MD

Osama Zahriya, MD

Enhanced referrals for WORLD-CLASS CARE , closer to home

Convenience for referring providers

From delicate robotic and catheter procedures to precision therapeutics, we’re proud to offer diagnostic and treatment options for adult and pediatric referring providers across Northern California and the Central Valley.

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

Our physician referral liaisons are here to help navigate referrals and:

■ Facilitate access to our secure EMR system, PhysicianConnect

■ Assist with UC Davis Health clinical trials and telemedicine

■ Keep you abreast of new services, providers and research programs

■ Arrange meetings and webinars, and share information about CME and events

Your local Physician Referral Liaison: Joaquin Muñoz | 916-701-7161 | joamunoz@ucdavis.edu

Marike Zwienenberg, M.D. Health Sciences Associate Clinical Professor Specialty: Pediatric Neurological Surgery

Kaiser Permanente Modesto and Manteca Medical Centers Recognized for Safe Patient Care

Cal Hospital Compare Patient Safety Honor Roll for 2023 recognizes hospitals with a strong culture of safety

Kaiser Permanente’s Modesto and Manteca Medical Centers are named to the Cal Hospital Compare 2023 Patient Safety Honor Roll for providing patients with safe care across dozens of measures.

The honor roll recognizes 82 of the state’s 347 adult, acute care hospitals. Kaiser Permanente Northern California had 14 hospitals on the honor roll – representing 17% of the hospitals recognized.

The Patient Safety Honor Roll uses objective, publicly available patient safety measures to evaluate hospitals across a variety of domains including hospital acquired infections, adverse patient safety events, sepsis management, patient experience, and Leapfrog Hospital Safety Grade.

Hospitals on the honor roll had to meet a rigorous threshold of performance by having at least two-thirds of measure results above the 50th percentile and no measure result below the 10th percentile and/or Leapfrog Hospital Safety Grade A for the past three reporting periods.

Doctors Hospital of Manteca Launches Program to Provide More Comfort for End-of-Life Patients

In collaboration with Bristol Hospice and its hospitalist physician partners, Doctors Hospital of Manteca has launched a new general inpatient care program for hospice patients.

The goal of the program is to provide compassionate, individualized care and relief of suffering and pain for patients with acute or chronic symptoms who are in need of end-of-life care.

“We are so pleased to offer this service to our patients who may need extra care at the end of their life. By allowing patients to stay at our hospital for care, instead of transferring to an outside facility, it is not only less stress on the patient, but on the family as well,” said Eleze Armstrong, CEO of Doctors Hospital of Manteca. “It is always incredibly rewarding to engage in these types of partnerships that allow us to empathetically meet the needs of our patients and families during a very vulnerable time.”

The hospice program at Doctors Hospital of Manteca provides patients with around-the-clock comfort care and time with their

families in a comfortable home-like setting. The hospital team provides expert medical care, pain management and emotional and spiritual support tailored to the patient’s needs and wishes.

Patients are accepted into the program at Doctors Hospital of Manteca through inpatient hospital care or those transported to the emergency department for a clinical need.

Manteca Physician Retires After Serving 50 Years

Doctors Hospital of Manteca held a special reception in March for Dr. Karl Wolf, who has retired after serving 50 years at the hospital. His family, friends and colleagues were there to help celebrate his retirement. He was also presented with certificates of recognition from Manteca Mayor Gary Singh and the Manteca Chamber of Commerce. Other speakers included DHM CEO Eleze Armstrong, DHM CNO Tina Burch, Dr. Anil Sain and Dr. Howard Miller. Approximately 80 people were in attendance.

Dr. Wolf also spoke at the reception and reflected on his time at the hospital. He said the people of Doctors Hospital of Manteca are what made his time at the hospital a privilege.

Dr. Wolf, who is a family medicine physician, started working at Doctors Hospital of Manteca in 1973 and dedicated himself to his patients, the hospital and our community right up until his retirement.

Dr. Karl Wolf retires after 50 years

IN THE NEWS

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

Dignity Health Awards More than $342,000 to Five Stockton Community Organizations

Dignity Health St. Joseph's Medical Center and St. Joseph’s Behavioral Health Center have jointly awarded $342,621 in grant funding to five local community-based organizations seeking to provide health and human services to residents most in need in San Joaquin County.

Grant funds are used to provide services to underserved populations, specifically in priority neighborhoods identified in the tri-annual Community Health Needs Assessment. Organizations that receive grant funding are working collaboratively to address identified needs and to identify sustainable ways to continue to deliver impactful community services for the most vulnerable San Joaquin County residents.

Longtime Director of Medical Staff Retires from Doctors Hospital of Manteca

Longtime Director of Medical Staff Services, Marla Terrell, has retired after serving 37 years at Doctors Hospital of Manteca. Marla served the hospital and community since 1986.

Doctors Hospital of Manteca held a celebration for Marla to wish her all the best in her well-earned retirement, and to extend its deepest gratitude to Marla for her commitment and incredible contributions to the hospital for so many years. Her attention to detail, consistency and hard work played a vital role in making sure the hospital’s Medical Staff Services operated smoothly.

Thank you to Marla for her service to Doctors Hospital of Manteca and our community for nearly four decades.

Since the Community Health Improvement Grants Program’s inception in 1990, St. Joseph’s has distributed nearly $4 million in grant funding to deserving nonprofit community benefit organizations. This year’s recipients include Boys & Girls Clubs at Sierra Vista, Emergency Food Bank of Stockton, St. Mary’s Dining Room, The Edible Schoolyard Project Stockton, and Trust for Public Land.

Marla Terrell retires after 37 years

Dignity Health Awards Grants

St. Joseph’s Medical Center Named One of the Top 50 Cardiovascular Hospitals in the Nation

Dignity Health St. Joseph’s Medical Center has been recognized as one of the nation’s 50 Top Cardiovascular Hospitals™ according to an independent quality analysis provided by PINC AI™ and reported by Fortune. To select top performers, an objective, independent, quantitative research analysis was performed using publicly available data measuring cardiac care in the United States. The PINC AI™ 50 Top Cardiovascular Hospitals™ program focuses on short-term, acute care, nonfederal U.S. hospitals that treat a broad spectrum of cardiology patients. SJMC’s Morrissey Family Heart and Vascular Institute received five stars in acute myocardial infarction, heart failure, and coronary artery bypass graft.

San Joaquin County to offer the WATCHMAN FLX device, which is the world’s most studied and implanted left atrial appendage closure (LAAC) device. This advanced procedure is led by SJMC's left atrial appendage occlusion (LAAO) team, consisting of Dr. M. Basra, Dr. R. Chothia, Dr. W. Chien and Dr. U. Sandhu.

St. Joseph’s Cancer Institute Unveils New Technology in Cancer Treatment Options

St. Joseph’s Cancer Institute and St. Joseph’s Foundation of San Joaquin are excited to unveil the TrueBeam Linear Accelerator,

St. Joseph’s Medical Center Celebrates 100th Successful Implantation of Most Advanced AFIB Technology

Dignity Health St. Joseph’s Medical Center has reached the milestone of completing its 100th WATCHMAN FLX™ case. The WATCHMAN FLX device reduces the risk of stroke and is an alternative to the lifelong use of blood thinners for people with Atrial Fibrillation not caused by a heart valve problem, also known as nonvalvular AF. St. Joseph’s is the first hospital in

TruBeam Linear Accelerator

SJMC's LAAO Team

the most advanced technology available to help fight cancer. This new linear accelerator combines imaging, beam delivery and sophisticated motion management to accurately and precisely target tumors with speed. The linear accelerator provides breakthrough tools that allow our radiation oncology team to treat more challenging cancers, such as pancreatic, paraspinal, lung, liver, breast, brain and prostate. This precision also allows for higher doses of radiation, given in less time, and with less impact on healthy tissue.

The linear accelerator is part of a larger $9.2 million project at the St. Joseph’s Cancer Institute, which consists of designing and building the linear accelerator vault, the TrueBeam equipment, and the specialty software. The project also includes ADA upgrades to patient dressing rooms and nursing stations in the Cancer Institute.

St. Joseph's Newest Training Tool

St. Joseph’s Medical Center welcomes the newest addition to their simulation family, SIM Baby. The medical center already has SIM Adult, SIM Junior, and SIM Preemie to provide ongoing training and development to staff and resident physicians. Clinical scenarios through a full life cycle allow physicians, nurses, respiratory therapists, resident physicians and other healthcare professionals at St. Joseph’s the ability to learn and sharpen their skills without patient harm. The SIM Baby, donated through the St. Joseph’s Foundation of San Joaquin, is housed in the Pediatrics Unit. The addition of the SIM Baby demonstrates St. Joseph’s dedication to training and development of their staff.

NOT PROFIT

Your trusted local non-profit serving Stanislaus, San Joaquin, Merced and surrounding counties since 1979.

NOT ALL HOSPICES ARE THE SAME. Make sure to ask for Community Hospice, the longest standing accredited Medicare and Medi-cal certified hospice, palliative and health services organization.

health support services

Children’s Grief Support School based and Camp Erin® of the Central Valley Community Education Hope Chest Thrift Stores

St. Joseph's SIM Baby

HealthCare. Better Together.

Doctors Hospital of Manteca began over 60 years ago with the mission to provide the best care possible to Manteca.

From emergencies and screenings to surgical and procedural services, we deliver quality healthcare and compassionate care close to home.

Doctors Hospital of Manteca offers:

• 24-Hour Emergency Care and Convenient Online Check-Ins

• 24/7 Critical Care Coverage Led by Intensivists

• Advanced Orthopedics for Knee and Hip

• Weight Loss Surgery Center of Excellence

• Imaging Services, Including Open MRI and PET/CT

• Surgical Services

• Women’s Health, Including 3-D Mammography

• Wound Care Center

To refer a patient, call (844) 632-5727 or visit DoctorsManteca.com

RESID ENTS' REPORT

A PLACE FOR ALL NEWS

HIGHLIGHTING RESIDENTS AND GRADUATE MEDICAL EDUCATION

ABDUL ALIM, MD ACCEPTED INTO THE GRAYKEN FELLOWSHIP IN ADDICTION MEDICINE AT BOSTON MEDICAL CENTER IN BOSTON, MA

The NEW Resident’s Report is dedicated to all the good news related to our hard-working residents training at San Joaquin General Hospital and St. Joseph’s Medical Center. Please email your submissions, written in third person with accompanying photo to Lisa@sjcms.org.

Coming from a third world country where Opioid Opium is taking many lives.  Witnessing many tragedies on a personal and professional level as well as lack of trained healthcare force in the area of addiction medicine it became an ongoing inspiring force. After Immigration to the U.S. and practicing (first as an ED nurse, and later as a resident), he noticed higher than Average prevalence of SUDs and addiction among an already underserved population.  Dr. Alim feel s this is his call to go out, get equipped with the required skillset in addiction medicine and return back to the valley and give back to the community that he believes he owes a lot.  His hope and plan is to return and start

an inpatient addiction consult service at San Joaquin General Hospital where he can treat SUDs among our inpatient populations and be a part of educating a new generation of young physicians to treat addiction as a chronic medical condition.

ALEJANDRO CASTELLANOS, MD ACCEPTED INTO FELLOWSHIP IN ADDICTION MEDICINE AT UCSF

Dr. Castellanos chose the FM SJGH Residency Program to help the Latinx community get easier access to medical care by being a Spanish speaking provider that understands their socioeconomical status. During his training he noticed that his community is greatly affected by substance use disorders (SUD) and the resources available to them are limited. The healthcare barriers and stigma surrounding mental health conditions and SUD are preventing this population from seeking medical services. “It’s time to help close the health care gap for our community” said Dr. Castellanos.

David grew up in the Stockton and started his college education at San Joaquin Delta College before transferring to UC Merced to complete his bachelor’s degree. He attended UC Davis School of Medicine with a focus on health care in the Central Valley and returned to the area to complete his Family Medicine residency at San Joaquin General Hospital. Post residency David will work with Community Medical Centers in Stockton and continue his passion for underserved populations with an emphasis on homeless health care and community outreach.

Surgical

Stanford Medical Center

Surgical Critical Care

NYU Langone Hospital

Surgical

Brigham

Pulmonary

Management and Critical Care

University of Texas Medical Branch

DAVID ARAIZA, MD JOINS COMMUNITY MEDICAL CENTER

NITASHA SHARMA, MD

Critical Care

and Young Women’s Hospital, Boston

SAMY MALIKBENDJEMIL, MD

Critical Care

AKHILA SURE, MD

KENNY KUMAR, MD

SJGH RESIDENTS PRESENT AT THE NATIONAL ACP MEETING

Despite their focus on providing quality health care amid their hectic schedules at SJGH, Internal Medicine residents remain true to furthering their medical education. SJGH residents Sara Suliman, Nikhil Gupta, Michael Purviance, Olamide Fasanya, Syed Rahman, Rick Hsu, Shivani Naidu and Jonathan Valeriote were selected to present their posters at the ACP Northern California Chapter meeting at Stanford University in October 2022. Sara Suliman and Jae Keum were selected to present at the National ACP Meeting in San Diego in April 2023.

Excellence in minimally invasive care.

St. Joseph’s Medical Center offers comprehensive interventional radiology (IR) services to treat many conditions that once required surgery. By utilizing minimally invasive techniques, IR procedures generally result in decreased risks, less pain, and shorter recovery times for patients when compared to traditional surgery. Whether your patients are experiencing back pain, chronic kidney disease, heart and vascular conditions, cancer, or men’s or women’s health issues, IR treatments are available to address many health concerns.

St. Joseph’s interventional radiologists have a wealth of experience and expertise in leading-edge, minimally invasive procedures. Featured services and treatments include:

• Angiography for vascular malformation

• Balloon kypohoplasty for vertebral compression fractures

• Cryoablation for kidney cancer

• Pain management to treat nerve pain (pain blocks)

• Percutaneous transhepatic biliary drainage (PTBD)

• Peripheral arterial and venous disease

• Prostate artery embolization (PAE)

• Radioembolization for liver cancer (Y90)

• Uterine artery / uterine fibroid embolization (UAE / UFE)

For more information, visit dignityhealth.org/stockton/IR or call IR scheduling at (209) 467-6323.

Practice News and Resources

Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their practice manager staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. This quarterly forum is normally held on the second Wednesday of March, June, September and December at Papapavlo's.

Registration is required!

If you don’t receive an invitation via E-Mail, please email Jessica@sjcms.org

June 14th, 2023: 11:00AM to 1:00PM

“Customer Service: Improving the Patient Experience by Seeing it Through Their Eyes”

This presentation focuses on how to improve patient experience, which begins with understanding the difference between patient satisfaction and patient experience. Presented by one of CMA’s practice management experts, Mitzi will discuss what has happened to service in a medical practice, how to improve the patient experience, having transparency with your patients, and effectively communicating, connecting, and building trust with patients and their family members.

Speaker: Mitzi Young is the Associate Director, Practice Strategy for the California Medical Association, Center for Economic Services. Mitzi brings over 29 years of experience in the health care industry. In Mitzi’s current role, her focus is Practice Management and Operations. She focuses on the dayto-day operations of CMA’s member practices. Mitzi recommends areas of improvement within a physician practice to achieve financial health, education, staff morale, and development of new internal systems. Mitzi presents seminars on practice management and health care regulations.

Mitzi started her career working for a third-party administrator as a claim and eligibility processor for San Bernardino County hospital’s medically indigent adult program. She went on to further her education and worked as an operations and business manager for specialty practices and for ambulatory surgery centers overseeing all personnel and business operations. She brings with her a vast knowledge of medical billing and collections, contracting, accreditation, and personnel and business management. She understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of providers on succeeding in the ever-changing challenges of the healthcare landscape.

September 13th, 2023: 11:00AM to 1:00PM

Learn from HPSJ staff and public health partners how to engage HPSJ members in your practice for lead testing, oral health fluoride varnish application, childhood immunizations and more. Additionally, the staff will present information regarding the transition to the new payment system, transportation for members and share claims updates.

CMA PRACTICE RESOURCES

REMINDER: MEDI-CAL’S ANNUAL TWO-WEEK CHECKWRITE DELAY BEGINS JUNE 22

The California Department of Health Care Services (DHCS) recently announced the details of its annual “checkwrite” delay. DHCS will delay certain payments for two weeks in June so that those claims are paid out of the 2023-2024 fiscal year budget. This checkwrite delay will impact providers who render services through Medi-Cal funded programs.

Medi-Cal fee-for-service payments scheduled with a warrant date of June 22, 2023, will be held until July 6, 2023. Payments to the following programs will be held during this time period:

• Medi-Cal

o Child Health and Disability Prevention (CHDP)

o Family Planning, Access, Care and Treatment (Family PACT)

• Abortion

Medi-Cal funded fee-for-service payments scheduled for June 29, 2023, will be held until July 6, 2023. Payments to the following programs will be held during this time period:

“Health Plan of San JoaquinHow to sell prevention to your patients + Tips to help your practice succeed.”

• Abortion

• State-Only California Children’s Services

• State-Only Genetically Handicapped Persons Program

• Medi-Cal

o CHDP

o Family PACT

Payments made to the Every Woman Counts (EWC) program will be excluded from the hold.

CIGNA TEMPORARILY DELAYS MODIFIER 25 POLICY; AGREES NOT TO ENFORCE FOR CERTAIN LINES OF BUSINESS

As a result of advocacy by the California Medical Association (CMA) and other state specialty societies, Cigna has again delayed implementation of its policy requiring the submission of medical records for all Evaluation and Management (E/M) claims billed with CPT 99212-99215 and modifier 25 when a minor procedure is billed. The policy, originally scheduled to become effective May 25, will be delayed until June 11.

Cigna has advised CMA that the policy, when implemented, will not apply to fully-insured products regulated by the California Department of Managed Health Care or the California Department of Insurance (also referred to as CHC-CA and CHLIC). For these products, Cigna will continue to allow reimbursement when modifier 25 is appropriately billed with an E&M code without the need to submit medical records.

Unfortunately, Cigna’s large population of selffunded, Administrative Service Only business in California – representing over 70% of the total lives in the state – will remain subject to the modifier 25 policy.

CMA has stressed to Cigna and regulators that there is no reliable means to identify which patients have a fully insured vs. self-funded product so practices can know whether the policy applies. Absent clear identification of the product type for each patient, the exemption for fully insured products is meaningless.

CMA continues to discuss their concerns with Cigna, advocating for a more collaborative approach to identify alternative methodologies for cost containment that do not bluntly penalize physicians using the modifier appropriately.

Practices with questions or concerns are encouraged to contact Cigna Customer Service at (800) 88Cigna (882-4462).

Practices can also contact CMA at (888) 401-5911 or economicservices@cmadocs.org.

DEA EXTENDS TELEHEALTH FLEXIBILITIES FOR CONTROLLED SUBSTANCES

The ability to prescribe controlled substances based on telehealth patient visits was set to expire when the federal COVID-19 public health emergency ends on Thursday, May 11, 2023. The U.S. Drug Enforcement Administration (DEA) recently issued two proposed rules establishing new post COVID PHE policies for controlled substance prescriptions based on telehealth visits, one for buprenorphine and one for other controlled substances.

After receiving a backlash of opposition from the California Medical Association (CMA) and others in organized medicine, and more than 38,000 letters, DEA has issued a temporary rule that will extend the same policies that have been in place during the COVID-19 public health emergency for an additional 6 months, until November 11, 2023.

There will also be an additional one-year grace period for pre-existing telemedicine relationships. That means, if a patient and a practitioner have established a telemedicine relationship on or before November 11, 2023, the same telemedicine flexibilities that have governed the relationship to that point are permitted until November 11, 2024.

According to DEA, the goal of this temporary rule is to ensure a smooth transition for physicians and patients who have come to rely on the availability of telemedicine for controlled medication prescriptions, and allow adequate time for providers to come into compliance with any new standards or safeguards that DEA promulgates in the final rules.

CMA applauds this extension, which will allow patients to continue to receive safe and effective care via telemedicine. CMA submitted comments on the proposed regulations, urging DEA to ensure that any new rules will not limit access for our most vulnerable patients.

LETTER FROM OUR PRESIDENT

Reflecting on the challenges and opportunities faced by California physicians in 2022, it’s clear that perseverance and resilience were key themes.

As the world took steps toward a return to normal, the COVID-19 pandemic remained a formidable force. Compounded by seasonal influenza and increased respiratory syncytial virus (RSV) cases, much of 2022 mirrored early conditions in the pandemic, with overburdened hospital systems, high demand for medical attention and a shortage of health care workers.

The “tripledemic” last fall and the continued social fallout of the previous three years our members faced was the tip of the iceberg regarding obstacles that continue to erode physician autonomy, refute expertise and disrupt our sense of community. Continued bureaucracy and a challenging regulatory environment have only added to the burden on our medical professionals.

Many physicians I know have been able to weather over three years of pandemic-related challenges because of what brought them to the job in the first place: caring for patients. But when physicians are prevented from spending time helping their patients, that’s when they question whether it’s worth sticking it out.

The good news is that in 2022, CMA and its members were able to build a foundation through a long-sought victory on the modernization of the Medical Injury Compensation Reform Act (MICRA). That win will allow us to focus our energy and efforts on providing every resident in our state, access to high quality and equitable care, from physicians operating in stable and sustainable practice environments.

We are already working to create a health care system that truly serves those it was designed to help, and by putting the needs of physicians and patients first, we will create safer and healthier communities.

Further, in 2022, CMA successfully advocated for investments and policies to help members facing demanding workloads and hardships, including retention bonuses and adding California physicians to the federal Public Loan Forgiveness Program.

We also preserved many telehealth gains implemented during the pandemic, expanded fullscope Medi-Cal coverage to Californians regardless of immigration status, and secured substantial funding for vaccinations and COVID-19 testing.

None of this would have been possible without the collective strength of our physician members. Thank you for staying engaged during historically challenging times and for your continued efforts to keep your patients and communities healthy and thriving.

Donaldo Hernandez, M.D. President

LETTER FROM OUR CEO

For over a century and a half, CMA has worked tirelessly to improve health care for all Californians and ensure high-quality care for patients throughout the state.

At the beginning of 2022, as the pandemic entered its third year, CMA faced many uncertainties, including a statewide initiative set to appear on the November 2022 ballot that would have effectively eliminated MICRA’s cap on non-economic damages. If passed, the initiative would have brought catastrophic disruption to the health care system. Although California physicians were confronting unparalleled changes in the health care system caused by the pandemic, they were resolute in their fight against the initiative and CMA was able to quickly mount an effective opposition.

With the help of a strong coalition – composed of health care providers, hospitals, community clinics, advocates, labor groups and others – CMA successfully worked to secure a landmark agreement that removed the dangerous initiative from the ballot, while preserving the principles of MICRA and stabilizing malpractice liability costs for decades to come.

2022 also saw CMA using lessons learned during the pandemic to advocate for policy victories. We fought to expand full-scope Medi-Cal coverage to all Californians, made telehealth a permanent option and secured funding to retain valuable health care workers.

While many of these policy wins are significant on their own, they won’t be fully realized without removing barriers that continue to limit health care access for millions of Californians. That is why CMA is already looking ahead to the future and getting to work to improve Medi-Cal reimbursement rates, which haven’t seen a funding increase in decades.

In the legislature, 2022 marked the end of one era and the beginning of another, as Senator Richard Pan, M.D., ended his term in office and Assemblymember Jasmeet Bains, M.D., began hers.

Dr. Pan’s tenure was marked with many accomplishments, and we remain particularly grateful for his leadership navigating health care policy as chair of the Senate Health Committee, as well as his work to improve vaccine rates throughout our state. Time magazine named Dr. Pan a national “vaccine hero,” and we certainly agree.

We are thrilled that Dr. Bains is starting in the legislature in 2023, joining fellow physician Assemblymembers Akilah Weber, M.D., and Joaquin Arambula, M.D. As a family physician from the Central Valley and the state’s first Sikh lawmaker, Dr. Bains will be a much-needed voice.

CMA remains committed to empowering physicians to create a fair and equitable health care system for all patients. By ending the attacks on MICRA, we are already using our collective energy and resources toward making positive changes in the state’s health care delivery system.

The staff at CMA are always honored to support physicians and the practice of medicine – and we look forward to all that we can accomplish together in 2023 and beyond.

Dustin Corcoran Chief Executive Officer

2022 YEAR IN REVIEW

2022 YEAR IN REVIEW

2022 ACCOMPLISHMENTS

Grassroots Engagement

Grassroots Engagement

Member Participation Makes CMA the Most Effective Advocacy Organization

CMA saw unprecedented grassroots physician engagement, with nearly 4,000 messages sent to policymakers. These physician voices were key in helping to defeat AB 2060 (public member majority on Medical Board of California) and AB 2236 (allowing optometrists to perform surgical procedures).

In a year where the world was starting to return to “normal,” the California Medical Association (CMA) seized the opportunity to make big gains for physician practices in several areas, from modernizing crucial malpractice legislation, preserving reproductive rights and encouraging grassroots engagement. This year’s achievements include:

CMA saw unprecedented grassroots physician engagement, with nearly 4,000 messages sent to policymakers. These physician voices were key in helping to defeat AB 2060 (public member majority on Medical Board of California) and AB 2236 (allowing optometrists to perform surgical procedures).

The California Medical Association (CMA) is proud to advocate on behalf of its nearly 50,000 physician members by supporting pragmatic and forward-looking policies that keep patients and communities healthy and thriving.

For more than a century and a half, CMA has been honored to work with physicians to make meaningful improvements to our health care system and facilitate the timely, accessible, and affordable delivery of care.

Public Health Funding

Public Health Funding

CMA helped administer both the KidsVaxGrant ($22+ million) and COVID-19 Test to Treat Equity Grant ($59 million) programs, providing critical funding for community pediatric vaccinators, public health systems and community health centers.

CMA helped administer both the KidsVaxGrant ($22+ million) and COVID-19 Test to Treat Equity Grant ($59 million) programs, providing critical funding for community pediatric vaccinators, public health systems and community health centers.

MICRA Modernization

CMA was able to garner significant victories in 2022. Keep reading to learn more about CMA’s key advocacy accomplishments in 2022.

Reducing Cumbersome Administrative Burdens

Facing another statewide ballot proposition that would have effectively eliminated MICRA’s cap on non-economic damages, CMA and Californians Allied for Patient Protection seized an opportunity to end one of the longest running political battles in California. The legislative deal (AB 35), which modernizes MICRA while preserving its underlying principles, has ushered in a new and sustained era of stability around malpractice liability.

CMA has long made it a top priority to free physicians from administrative burdens so they can spend more time caring for their patients. In 2022, this included:

Community Health Centers

Community Health Centers

+ Enabling physicians to spend less time dealing with burdensome bureaucracy by:

Reproductive Rights

CMA saw rapid membership growth among community health centers, resulting in an expansion of our mode of practice forums and House of Delegates representation.

CMA saw rapid membership growth among community health centers, resulting in an expansion of our mode of practice forums and House of Delegates representation.

After the Supreme Court’s Dobbs decision, CMA worked with the Future of Abortion Council to protect and expand access to reproductive health care in California, leading to 15 bills signed into law, $200 million in the state budget and the passage of Prop. 1 to enshrine abortion rights into California’s constitution.

■ Defeating legislation that would have subjected physician practices to a burdensome approval process for changes in governance and mergers, acquisitions, and partnerships with other health care entities

■ Granting physicians more flexibility in complying with California’s electronic prescribing mandate

Election Victories

Retention Payments

Retention Payments

Expanding and Preserving Health IT Innovation

CMA helped secure $1.3 billion in the state budget to provide retention bonuses for many of California’s physicians and other health care workers to stabilize the health care workforce.

CMA helped secure $1.3 billion in the state budget to provide retention bonuses for many of California’s physicians and other health care workers to stabilize the health care workforce.

CMA member Jasmeet Bains, M.D., joined the California Assembly as its third physician legislator, while incumbent assemblymembers Joaquin Arambula, M.D., and Akilah Weber, M.D., were re-elected. At the federal level, representatives Ami Bera, M.D., and Raul Ruiz, M.D., were re-elected to Congress. CMA also saw its ballot measure positions reflected in election results, including the rejection of Prop. 29 (dialysis clinic requirements) and passage of Prop. 31 (ban on flavored tobacco).

The public health emergency enabled rapid and broad expansion of digital health tools, such as telehealth. CMA preserved and built on these gains by:

+ Fighting to add flexibility for providers to enroll patients in certain Medi-Cal programs remotely

Universal Health Care

Universal Health Care

+ Helping physicians comply with the new federal information blocking rule and protect patients’ sensitive medical information

Federal Loan Forgiveness

CMA successfully advocated for full-scope Medi-Cal coverage for all income-eligible Californians by January 1, 2024, making California the first state to expand its Medicaid program to provide full benefits to all eligible individuals regardless of age or documentation status.

CMA successfully advocated for full-scope Medi-Cal coverage for all income-eligible Californians by January 1, 2024, making California the first state to expand its Medicaid program to provide full benefits to all eligible individuals regardless of age or documentation status.

+ Successfully pushing to extend COVID-19 telehealth waivers into 2023

Billing and Burdens

The U.S. Department of Education overhauled the Public Service Loan Forgiveness Program, including the specific fix that CMA advocated for that will allow all eligible California physicians to receive loan forgiveness.

Protecting Reproductive Health Access

Virtual Grand Rounds

Virtual Grand Rounds

CMA recouped more than $1 million this year (nearly $40 million over 14 years) on behalf of physician members through direct payor interventions. CMA also stopped Cigna’s burdensome modifier 25 policy.

In 2022, the Supreme Court’s Dobbs v. Jackson decision sent shockwaves around the country as long-established reproductive rights were suddenly eroded. California, which has a long history of protecting and defending reproductive rights, fought back by bolstering protections for reproductive health access. In 2022, CMA continued that fight by:

CMA completed its 29th Virtual Grand Rounds webinar, providing critical COVID-19 continuing medical education to nearly 13,500 attendees while expanding topics to include other public health concerns such as long COVID, monkeypox and wildfire smoke.

CMA completed its 29th Virtual Grand Rounds webinar, providing critical COVID-19 continuing medical education to nearly 13,500 attendees while expanding topics to include other public health concerns such as long COVID, monkeypox and wildfire smoke.

Health IT

+ Successfully fighting for $200 million in the state budget to expand access to reproductive health care, including abortion, including $40 million for uncompensated care reimbursement to providers of reproductive health services

+ Supporting the passage of the statewide ballot initiative, Proposition 1, which enshrined abortion and contraceptives access into the state constitution

Visit cmadocs.org/year-in-review

CMA achieved significant victories on health information technology issues by extending the COVID telehealth waivers into 2023; permanently extending key Medi-Cal telehealth payment parity; eliminating e-prescribing burdens (AB 852); and helping physicians comply with the new federal information blocking rule while protecting patients’ sensitive medical information (SB 1419).

+ Partnering with the Future of Abortion Council to help get 15 bills signed into law

2022 ACCOMPLISHMENTS CONT.

+ Protecting reproductive health providers and their patients by supporting legislation that:

■ Prevents state licensing boards from suspending or revoking the license of someone who legally performs an abortion

■ Protects those performing, aiding in the performing, or obtaining of an abortion from arrest

■ Enacts legal protections from civil and criminal liability for clinicians that provide abortions to patients who reside in other states

■ Prevents state licensing boards from suspending or revoking the license of someone who performs an abortion in accordance with state law

Preserving Physician Practice Standards

CMA protected the safety of patients and preserved the quality of health care by pushing back against reckless scope of practice changes. This included:

+ Defeating legislation that would have allowed optometrists to perform certain surgical procedures without the same training as ophthalmologists

+ Stopping a bill that would have allowed pharmacists to order and perform more than 1,400 Clinic Laboratory Improvement Amendments-approved tests and interpret any test they ordered to “promote patient health”

Physician Workforce and Pipeline

CMA strives to retain our life-saving physicians in the practice of medicine and train and recruit the next generation of physicians who will meet California’s future health care needs. In 2022, CMA:

+ Successfully fought for full funding for Proposition 56 (Tobacco Tax) Medi-Cal supplemental payments and graduate medical education (GME) programs

+ Successfully advocated for a change to the federal Public Service Loan Forgiveness program that will allow all eligible California physicians to receive loan forgiveness

+ Secured state funding for the following:

■ $1.3 billion for hospital health care worker retention pay, including physicians

■ $700 million in equity and practice transformation payments to better meet the needs of the Medi-Cal population and help practices as the Office of Health Care Affordability begins operating

CASE STUDY: MICRA: A SUSTAINED ERA OF STABILITY

Challenge:

In 2022, California’s physicians were up against yet another expensive statewide ballot proposition battle that threatened to destroy current protections against frivolous litigation and drive-up health care costs.

Solution:

CMA worked with Californians Allied for Patient Protection, the Consumer Attorneys of California, and Nick Rowley—author and primary funder of the ballot measure—to end a decades-long political battle and usher in a new era of stability in malpractice liability. The opposing sides of the ballot measure campaign set aside their differences and discovered points of agreement. They understood that this was a once-in-a-lifetime chance to safeguard California’s health care delivery system and the rights of injured patients. The result is a deal that promotes stable, affordable access to health care and stabilizes medical liability.

Outcome:

Following a bipartisan and nearly unanimous vote by the state Legislature, Governor Newsom signed the landmark agreement into law (AB 35), and in doing so finalized an achievement few thought was possible. As part of the agreement reflected in AB 35, proponents of the so-called Fairness for Injured Patients Act removed the initiative from the ballot.

Through AB 35, we have:

+ Ensured the predictability and affordability of medical liability insurance rates for decades to come, while providing a fair and reasonable increase to limits on non-economic damages.

+ Protected our health care delivery system from out-of-control medical litigation and runaway costs.

+ Preserved the underlying principles of MICRA, including:

■ Advance notice of a claim

■ One-year statute of limitations to file a case

■ Option of binding arbitration

■ Early offer of proof for making punitive damage allegations

■ Allowing other sources of compensation to be considered in award determinations

+ Established new discovery and evidentiary protections for all pre-litigation expressions of sympathy, regret, or benevolence, including statements of fault, by a health care provider to an injured patient or their family after an unforeseen outcome without fear that such statements or gestures will be used against them.

Public Health Update

Street Medicine San Joaquin

Engaging and Addressing Medical and Social Needs

DOREATIA HART, BSN, RN, PHN • BARB ALBERSON, MPH • MAGGIE PARK, MD

Background

Street Medicine began in the 1980’s as a health discipline to address the alarming rate of unmet health care needs on the streets. Street Medicine is a whole person care approach that provides health and social services that specifically address the unique needs and circumstances of the unsheltered homeless community. These services are delivered directly to them in their own environment utilizing a highly skilled multidisciplinary team. Visiting people in their own environment facilitates necessary relationships and trust building for a highly vulnerable and socially marginalized population. This practice has been shown to decrease overutilization of local emergency rooms and

addresses illnesses/infections before reaching advanced stages. Through assertive, coordinated, and collaborative enhanced care management, Street Medicine can be the beginning process in achieving higher levels of medical, mental health, and social care. (Street Medicine Institute, 2023)

Street Medicine San Joaquin

San Joaquin County Public Health Services’ Whole Person Care Program, in collaboration with San Joaquin Health Centers and Behavioral Health Services, will launch Street Medicine San Joaquin in Spring 2023. Street Medicine San Joaquin will provide direct care on the streets to meet homeless unhoused individuals where they are in their own environment and on their own terms. Street Medicine San Joaquin will utilize the SJ Health Medical Mobile Unit “Moby” to assist with addressing health care priorities as well as social conditions that have an impact on health. In collaboration with San Joaquin Health Centers, Public Health, and Behavioral Health, street services will include medical care (urgent/primary), enhanced care management, navigation of social and support services, rapid

syphilis and HIV testing, initial syphilis treatment, TB testing (blood draw), and health education. The program will start providing services in Stockton and will do a landscape study to identify the highest need areas across the county. Several days before an event takes place, Community Health Outreach Workers (CHOWs) from Whole Person Care and SJ Health will visit the area to identify what needs to be addressed by the Street Medicine team.

While considering the whole person when evaluating the need for care, the Street Medicine San Joaquin team will consist of a Nurse Practitioner, Medical Interns, Registered Nurses, Public Health Nurses, Social Workers, and Outreach Workers. The team will engage clients on a weekly basis in their environment, to ensure they are linked to medical services and social support as well as assistance with Medi-Cal enrollment. The team will also focus on assisting the clients with maintaining care and linkage to support services such as housing & shelter resources, assistance with obtaining an ID, food stamps, transportation assistance options, mental health support resources, etc., providing education around daily living activities, medication adherence, and crisis management. Engaging with individuals

this often should promote relationship building and trust which will ultimately open up opportunities to empower and address immediate needs.

In response to the alarming opiod crisis here in San Joaquin County, Street Medicine San Joaquin will also be distributing Naloxone and providing education on its use with the goal of decreasing opiod overdose and death among the unhoused homeless community. Naloxone is an FDA-approved medication that can save a person’s life when administered during an opioid overdose. For Naloxone to be effective during an opiod overdose, it must be in the right hands at the right time and administered within minutes of life-threatening symptoms such as stopped or slowed breathing. Street Medicine San Joaquin will encourage and offer addiction resources as well as distribute Naloxone kits as needed within the community to bolster San Joaquin County Public Health Services’ efforts to combat the opiod crisis.

Street Medicine San Joaquin’s mission is to care for the whole person…bringing immediate mental and health care to the people!

In Memoriam

ROBERT HERMANN, MD

1930-2023

Bob was born to Max and Alice Hermann in Milwaukee, Wisconsin on March 20, 1930. He peacefully passed at his assisted care residence on February 17, 2023. Bob graduated from Marquette University Medical College of Wisconsin in Milwaukee, where he met his wife Greta Gullekson, RN. They were married on June 27, 1953. After graduating medical school Bob served in the U.S Army Medical Corps, serving in Spokane, WA, Fort Sam Houston, TX and abroad in South Korea.

After he resigned his commission in Fort Benning GA in 1964, they moved to Stockton. Bob joined Delta Orthopedics and later co-founded Alpine Orthopedic Medical Group, practicing as an orthopedic surgeon in Stockton for 30 years. Bob was also chairman of the physician's quality-improvement lead team; team leader of the total joint-replacement clinical pathway team; and instructor for physicians in St. Josephs Regional Health System, where he has trained more than 70 doctors. He also conducted presentations at state conferences on quality improvement. As a California Medical Association surveyor, he took a leadership role in joint commission accreditation of health organizations and assisted St. Josephs in passing two accreditation surveys.

Bob retired in December of 1995. He was awarded the first Presidents Award for Quality by Edward G. Schroeder,

president, and chief executive officer of St. Josephs Regional Health System in January of 1996. After retirement from his orthopedic practice, Bob served for several years as Vice President for Medical Services at St Joseph's Hospital, directing medical staff activities. He was a devoted member of St. Michael's Parish in Stockton. He served as reader during church services and was member of the church council for 3 years.

Bob is survived by his son Mark (Sandy) Hermann, daughter Anne (Michael) Nickerson, son John Hermann, son Paul (Diana) Hermann and son James (Jennifer) Hermann. He is also survived by eight grandchildren and nine great grandchildren.

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SJMS MEMBERS THIS

Gautami Agastya, MD Internal Medicine

652 West 11th Street, Suite 137

Tracy, CA 95376

Gandhi Medical college, 1991

Jasmine Singh, MD Psychiatry

2216 N California Street, Suite A

Stockton, CA 95204

Touro University College of Osteopathic Medicine, 2016

Richard Camacho, MD Internal Medicine

1805 N California St., Ste 406

Stockton, CA 95204

Emilio Aguinaldo College of Medicine, 1999

Jennifer Jose, MD Internal Medicine

2505 W Hammer Ln

Stockton, CA 95209

Medical College Trivandrum Kerala University, 2015

Uyiosa Aimiuwu, MD

Emergency Medicine

1205 E North St

Manteca, CA 95336

University of Benin College of Medical School, 2007

Arashdeep Goraya, MD Hospitalist

1205 E North St

Manteca, CA 95336

Armed Forces Medical College, University of Pune, 2006

Trevor Wilson, MD

Emergency Medicine

500 West Hospital Road

French Camp, CA 95231

University of Medicine 1 Yangon

Navmoon Singh Mann, MD Psychiatry

3031 W March Ln, Suite 134

Stockton, CA 95219

Kasturba Medical College, 2011

SPRING!

...and even more on the way.

Your MCL patients may need to take action to keep their coverage. If your patients receive a large yellow packet in the mail requesting more information, urge them to respond in a timely manner to avoid loss of coverage.

Your Medi-Cal patients can go online now and verify or update their contact information and report other changes.