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Legislative Wrap Up Introducing SJMS Alliance Update Alzheimer Toolkit Winter 2017

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VOLUME 65, NUMBER 4 • DECEMBER 2017

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{FEATURES}

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MEET MACRA REQUIREMENTS

40 IN THE NEWS

LEGISLATIVE WRAP UP

48 ALLIANCE UPDATE

STRENGTHENING THE HOUSE OF MEDICINE

52 PRACTICE MANAGEMENT:

ALZHEIMER TOOLKIT

56 PUBLIC HEALTH

DIABETES PREVENTION PROGRAM

60 NEW MEMBERS

New faces and Announcements San Joaquin Medical Society Alliance Committed to Improving Quality Health Care Tips for Patients and Policymakers

63 IN MEMORIAM

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PRESIDENT R. Grant Mellor, MD PRESIDENT-ELECT George Savage, MD PAST-PRESIDENT Kwabena Adubofour, MD SECRETARY-TREASURER Dan Vongtama, MD BOARD MEMBERS Aliya Gessling, MD, Alvaro Garza, MD, MPH, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD, Richelle Marasigan, DO

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Grant Mellor MD, Lisa Richmond MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, MD CMA AFFAIRS COMMITTEE Larry Frank, MD PUBLIC HEALTH Alvaro Garza, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS R. Grant Mellor, MD, James Noonan, Alvaro Garza, MD, MPH

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

CMA HOUSE OF DELEGATES REPRESENTATIVES

is produced by the San Joaquin Medical Society

Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Grant Mellor, MD, Kwabena Adubofour, MD, Raissa Hill, DO,

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

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

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ALIGN WITH THE BEST Learn more at DrSteveHowell.com today.

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EXECUTIVE DIRECTOR’S REPORT

SEASON OF GRATITUDE I recently saw a quote by writer GK Chesterton that said, “when it comes to life, the critical thing is whether you take things for granted or take them with gratitude.” I never realized how true this was until I had children. As everyone warned it would, time is flying by at warp speed as I now have an 8th grader and junior in high school.

Sometimes it makes me sad as it feels like my life has become measured by how many short years left until they leave for college. So, I am trying to soak in and enjoy every minute and take it all with gratitude!

LISA RICHMOND

Professionally, I am grateful for my staff, our board of directors and all of physician members who work so hard for the betterment of the profession and improvement of the health of our community. At SJMS, we know that being a physician requires long hours and dedication, often at a personal sacrifice. Along those lines, we will be conducting “Gratitude Pop Ups” during the holidays this year. We will be “popping up” before medical staff meetings across San Joaquin County, with goodies, a smile and a huge THANK YOU to all of the wonderful physicians who practice medicine here. Follow us on Facebook to see where we are going next!

We often talk about advocacy as one of the intangible, yet most important, member benefits of joining SJMS/CMA. Each year a group of seven dedicated SJMS Delegates participate in the legislative process as they meet with hundreds of their peers from throughout California at the annual CMA House of Delegates Conference. They say that if you don’t have a seat at the table, you are on the menu, so we would like to invite you to the table! We are currently recruiting passionate leaders, who are interested in influencing policy and legislation, to serve as Alternate Delegates. Please read more about the HOD process and how to get involved in this issue’s feature article on page 32.

Finally, we hope to see you at our annual Holiday Party on Thursday, December 14, at Stockton Golf & Country Club as we enjoy fellowship with friends and colleagues and celebrate a year well done. I wish you all much laughter, joy, good cheer, and time with those who matter most. Thank you for the privilege of leading the society for another year.

Happy Holidays,

Lisa Richmond

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invites you to

Thursday | december 14 | 2017 Stockton Golf & Countr y Club

3800 Countr y Club Blvd | Stockton 95204 6pm–Cocktail Reception 7pm–Dinner $45–Physician Members & Guests $75–Non-Members Please make your reser vation before December 1 by calling SJMS at 209-952-5299

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

Growing Our Own Physicians

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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While the CMA works statewide to promote and protect our profession, The San Joaquin Medical Society is addressing a local concern of importance to the physicians and people of our community -- the current and impending physician shortage.

A recent study by the Healthforce Center at UCSF predicted that the Central Valley will experience a significant shortage of primary care physicians in the next fifteen years, despite a potential surplus in other nearby geographical areas. This is no surprise to local medical groups who struggle to attract physicians to join their practices, despite offering excellent compensation and practice opportunities.

The best long-term solution is to create an educational environment conducive to developing our own future pool of physicians. That’s why we support the Health Careers Academy, a Stockton high school devoted to training future health care professionals. That’s why the SJMS started the popular Decision Medicine summer program for high school students more than a decade ago. And it’s why we are forming the Medical School Admission Advisory Group (MSAAG) -- to give guidance to high school students, college students, and other members of the community who would like to go to medical school.

You can’t be a doctor without going to med school, and readers of this magazine know that getting in isn’t easy! The MSAAG aims to increase the odds for our local students, by providing them with expert guidance from high school, college and beyond. For example, we may advise taking advantage of the two “side doors” into medical school. One is the BS/ MD program, which grants automatic admission to medical school upon successful completion of undergraduate studies. Highly-qualified high school students who are sure they want to be physicians can take advantage of this.

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

There are approximately twenty programs in the nation to which a California high school student can apply. It’s a great deal for the right student, but is underutilized locally.

The other “side door” to medical school is the postbaccalaureate route. This is for qualified students who have not taken the pre-med route in their undergraduate education, and later decide that they want to pursue

medicine as a career. There are now many “post-bac” programs in the country, and many will offer a package of one intense year of pre-med courses, followed by admission to a linked U.S. medical school. (That’s how a 6th grade teacher came to write this article.) We would like to find and encourage qualified Central Valley neighbors to consider this route.

The “front door” to medical school is the traditional admissions route, and it is in many ways the toughest to navigate. It starts in May with the general application. Students Representing and must decide which medical schools Advising Area Physicians to apply to. Most choose about for Over 30 Years thirty schools. This is followed by Lawyers Who Solve the Legal Issues individual secondary applications, Confronting Physicians one for each school, each to be completed with its own set of Malm Fagundes LLP offers the strength and resources of attorneys and professional staff experienced in a range questions and required essays. of services. Our attorneys provide advice and counsel in medical malpractice litigation, business, real estate, and Finally comes the interview process personal needs of physician clients.

--- with a different format at each Joe Fagundes provides experienced, successful school. The MSAAG will be representation of physicians and other health care providers in defending malpractice suits, prepared to offer next year’s local protecting hospital privileges, and answering students advice at each step of the medical board inquiries. He also provides guidance and assistance in real estate and way. financial matters.

We would like to bring our Scott Malm advises physicians and their medical students back to the offices regarding business formation, employment and labor matters, community with residency and personal estate planning. programs. There are currently only three programs in our county, but by 2023 there may be three times that number. So, if we can get more of our students into medical school, more will have the opportunity to come home to train locally. If they train locally, they will practice locally!

It takes a long time to grow a doctor. That’s why we’re working We welcome the opportunity to hard on it now. If you’re interested speak with you regarding your in joining the Medical School legal needs during a confidential consultation. Visit our website at Admission Advisory Group, please malmfagundes.com and call us at contact Lisa Richmond at 209-870-7900.

Lisa@sjcms.org. We’ll have our first malmfagundes.com meeting in January 2018.

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Strong community partnerships lead to happier, healthier people

Celebrate Health Partnering today for a healthier tomorrow

With over 345,000 members and growing, 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.

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Five Best Practices to Meet MACRA Requirements by the End of the Year

BY KIM HATHAWAY, MSN, CPHRM, HEALTHCARE QUALITY AND RISK CONSULTANT, THE DOCTORS COMPANY

As the end of the third quarter of 2017 approaches, practices that have not yet developed their Medicare Access and CHIP Reauthorization Act (MACRA) plan face great urgency to complete their plan—and those who have started may be feeling overwhelmed.

Regardless of the reporting stage, these steps can help guide practices to succeed: 1. R eview past performance in quality measures such as the Physician Quality Reporting System (PQRS) or specialty measures that your practice has reported. These are strong indicators of how your practice will do in the future. Align activities and quality measures with what you are already doing in your practice and determine how to make capturing the needed data part of your team’s workflow. Ask for input from the frontline of your practice about the most efficient ways to collect the necessary data elements.

2. S tudy the specifications for measures you are reporting to better understand its value. For claims or registry reporting, go to Quality Payment Program website (https://qpp.cms.gov/about/resourcelibrary) and choose the appropriate file under “Documents and Downloads.” If you are reporting through your electronic health record (EHR), the vendor can be very helpful in choosing your measures.

3. M onitor your data on a weekly or bi-weekly basis. Compare the reports that you run in your office to those generated by your EHR or registry. Investigate any discrepancy so that it can be corrected now by coaching the team on documentation or timeliness of reporting.

4. Understand that the scoring process for the quality measures is very different than it was in PQRS. Under PQRS, if you reported the measure enough times, you received credit. And if you reported on one patient, you would get a pass. Under MIPS it is your performance rate that will be most important.

On top of the change in how much you report versus the performance rate, the scores will be determined based on national benchmarks, with the highest performing deciles receiving a greater point value.

5. Review the Quality Resource Utilization Report (QRUR) to fully understand how the practice performs in quality and cost.

Use the 2015 or 2016 QRUR (publishing fall 2017) to identify potential weaknesses and address them before cost returns as a scored category in 2019—because cost will carry a weight of 30 percent toward the MIPS composite score. There are no reporting requirements for the cost category in 2017. CMS will provide feedback on cost for the 2017 performance period, but it will not be counted in the final composite score for 2017 or 2018.

For help with interpreting the information on your QRUR, consult the CMS website regarding QRUR analysis and payment. You will find additional resources and links to the EIDM System and what to do if you believe your QRUR is not accurate.

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Our Vision for Creating a Campus Where Health and Healing Continues …

Groundbreaking Ceremony - L to R: Elbert Holman, Stockton Vice Mayor; Dr. Rishi Sikka, Sutter Health; Assemblymember Susan Eggman; Kevin Huber, President & CEO Grupe Commercial Company; Dr. Si France, CEO WelbeHealth; State Senator Kathleen Galgiani; and Jillian Simon, WelbeHealth.

We are excited to be working with WelbeHealth and Sutter Health. On October 25, 2017, a groundbreaking ceremony was held at University Park for their new facility designed to accommodate a Program of All-Inclusive Care for the Elderly (PACE), which will provide comprehensive medical and social services for the care of the elderly.

"This project perfectly aligns with our mission to provide a venue for needed services and skilled jobs in Mid-town Stockton. Employees within University Park have the opportunity to work in a healthy, park-like setting with state-of-the art buildings and technology. We are very excited to partner with WelbeHealth and Sutter Health on such an important project." – Kevin Huber

A Sanctuary in the City

Available For: Build-to-Suit • Ground Lease • Historic Remodel For more information: Dan Keyser (209) 473-6201 • dkeyser@grupe.com or visit us at universityparkstockton.com • 612 E. Magnolia Street, Stockton, CA 95202 16

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G N I R E V A UNW DEFENSE CMA’S 2017 LEGISLATIVE WRAP UP

BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT

Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it.” -MUHAMMAD ALI

In modern California politics, there is no more imposing figure than Governor Jerry Brown. Since his return to the Governor’s office, Brown and his administration have been able to develop and implement his policy agenda in a nearly flawless manner, overcoming every political obstacle in his way. Nowhere has Governor Brown’s dominance been more evident than in the crafting of the state budget.

Prior to Governor Brown’s return and the passage of the majority-vote budget, the enactment of the state budget was a drawn-out clash of political wills—a battle of ideals and priorities. The governor would present his vision in January. The Legislature would take months re-shaping 18

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and re-focusing the governor’s budget proposal. Tense negotiations would yield significant legislative changes in the budget and a handful of gubernatorial line-item vetoes.

During his second tenure, Governor Brown has worked to deliver on-time budgets that do not significantly differ from his January proposals.

This year, the state budget process was more critical than ever to the California Medical Association (CMA). The November 2016 election yielded another ballot measure victory for CMA and public health advocates across the Golden State with the passage of Proposition 56. CMA took on Big Tobacco and passed Prop. 56, which increased

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the tax on tobacco products by $2 per pack and stipulated that the new tobacco tax funds should increase access by improving provider payments.

Despite being outspent, CMA and its partners in support of the measure got Prop. 56 passed overwhelmingly, providing an influx of new revenue to increase payments to Medi-Cal providers. Governor Brown, however, seeking to secure his legacy of fiscal prudence, sought to re-interpret the provisions of Prop. 56 to redirect the tobacco tax proceeds from Medi-Cal providers to the State General Fund.

In his January budget proposal, Governor Brown didn’t include a rate increase for Medi-Cal providers. While there was an initial thought that the Governor was utilizing this proposal as a negotiation tactic to help shape the overarching discussion of the architecture for the state budget, it quickly became apparent that the Governor did not intend to ever support a rate increase for Medi-Cal providers. Thus, the battle began!

The Governor’s intentions became more evident with the release of the Department of Finance’s May Revision. Just weeks before the constitutional deadline for the Legislature to pass the budget, the Governor doubled down on this earlier proposal and once again proposed no funding to support a Medi-Cal rate increase for providers.

Restoring Prop. 56 funds was CMA’s top budget priority, and we engaged the Legislature through earned media, digital advertising, grassroots outreach and direct advocacy.

CMA and its coalition partners, specifically the California Dental Association and Planned Parenthood, devoted the necessary resources to make sure that the Legislature followed the will of the voters and used the tobacco tax money to improve access to care in our state. CMA’s county

medical societies and individual physician members made calls, wrote letters and conducted in-person legislative lobbying visits. Our legislative champions, led by Senator Richard Pan, MD, and Assembly members Joaquin Arambula, MD, and Jim Wood, D.D.S., pushed both the State Senate and Assembly to reject the Governor’s budget.

The final budget, which Governor Brown signed, provides over $1 billion ($546 million in state funds, with a federal match) to improve provider payments, and nearly $750 million ($375 million in state funds, with a federal match) will be available to physicians.

This victory was a collective effort of the entire CMA. A budget team was assembled, comprised of members of the Centers for Government Relations, Health Policy, Strategic Communications and Political Operations. Working in concert, this team successfully pushed the budget as CMA’s top legislative priority.

Media coverage of the budget is always competitive, but the issue of Prop. 56 funding garnered a significant amount of attention, even among the sea of other budget fights, thanks to the persistence of the CMA Communications team. CMA’s Political Operations staff organized physicians and county medical society executives to engage in the fight, bringing the issue to the attention of their legislators at in-district meetings and to the Capitol on our Legislative Advocacy Day in April. The CMA Government Relations team, the face of the fight, came armed to each hearing and meeting with the expertise of the CMA Health Policy team.

Although this fight will no doubt play out again in some future years and we will need to be vigilant to ensure continued funding, this year’s budget success seals the intent of the voters and will provide relief for California’s shamefully low Medi-Cal reimbursement rates.

AN AGGRESSIVE LEGISLATIVE AGENDA

prescriptions. Our bill would improve privacy protections in the mandated use of CURES. To deal with how opioids are prescribed, Assembly member Joaquin Arambula, MD, introduced AB 1048, which allowed for partial fill of Schedule II prescriptions and removed the requirement for evaluating pain as the fifth vital sign. These changes will alleviate some of the pressure on physicians to prescribe and reduce the number of opioids given to patients.

CMA also successfully pushed a clean-up bill for last year’s AB 2883 (authored by the Committee on Insurance), a workers’ compensation bill that inadvertently created hundreds of thousands of dollars new, burdensome costs to physician practices. CMA’s

Amid the budget battle, the quotidian legislative work continued – as always. However, the routine was not without intensity. CMA this year pushed an aggressive legislative agenda through our package of sponsored bills, seeking to address a wide variety of our members’ issues.

Two of our sponsored bills this year pertained to different aspects of the opioid crisis. SB 641 (Lara), which was put on hold for further discussion in the 2018 legislative session, is a supplement to Senator Lara’s SB 482 from last session, requiring use of the Controlled Substance Utilization Review and Evaluation System (CURES) for Schedule II-IV controlled substance

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bill—SB 189 (Bradford)—completely exempted physician practices from the workers’ compensation coverage requirement established by AB 2883, provided they have health insurance coverage. SB 189 will dramatically reduce the administrative cost of running a medical practice.

Our highest profile legislative fight was over the Medical Board of California sunset review. This was the Legislature’s scheduled review of the medical board, during which it can make changes to the board’s policies and procedures and, crucially, extends the board past its “sunset” – that is, dissolution – date. What should have been an uneventful, perfunctory bill became a fight for CMA because of the inclusion of several provisions

eroding physicians’ rights. We secured amendments to remove harmful provisions from the bill, including ones that would have reestablished a cost recovery program for the board, provided the board with new authority to issue cease practice orders and required certain physicians to notify their patients of their probation status.

As ever with the two-year legislative cycle, the bulk of the first year’s work sets the stage for the second year’s.

Discussions will resume in January over a host of issues, and CMA is well positioned in those conversations to protect the interests of physicians and their patients. Our strength this year builds our strength for next year.

In Unity, Janus L. Norman

BELOW ARE DETAILS OF THE MAJOR BILLS THAT CMA FOLLOWED THIS YEAR.

CMA-SPONSORED LEGISLATION AB 315 (WOOD): PHARMACY BENEFIT MANAGER TRANSPARENCY This bill requires pharmacy benefit managers (PBMs) to obtain a license from the Department of Managed Health Care before conducting business in California and to renew the license on an annual basis. It also requires PBMs to make quarterly disclosures regarding information with respect to prescription product benefits specific to the purchaser for all retail, mail order, specialty, and compounded prescription products.

Status: Held on the Inactive File of the Senate.

AB 505 (CABALLERO): RESTORING TRUST IN MEDICAL BOARD PROBATION This bill would have prevented a physician or surgeon charged with certain serious allegations from entering into a stipulated settlement that included probation as one of the settlement terms.

Status: Held in the Senate Business, Profession, & Economic Development Committee.

AB 1048 (ARAMBULA): IMPROVED OPIOID MANAGEMENT This bill allows Schedule II controlled substances to be partially filled at the request of the patient or the prescriber. It also removes the requirement that hospitals assess pain as the 5th vital sign, retaining the assessment but providing hospitals the flexibility in determining the best approach. These provisions ensure that health care providers can provide appropriate medical care while reducing excess opioid supply.

Status: Signed by the Governor (Chapter 615, Statutes of 2017).

AB 1221 (GONZALEZ FLETCHER): RESPONSIBLE BEVERAGE SERVICE TRAINING PROGRAM This bill would require California bartenders, servers, and managers to receive responsible beverage service training (RBS) through a program that must be administered or approved by the Department of Alcoholic Beverage Control or offered by a training provider that has been accredited by an accreditation agency. AB 1221 seeks to help individuals who serve alcohol, to meet their statutory requirement not to serve obviously intoxicated patrons and minors and reduce drunk driving.

Status: Signed by the Governor (Chapter 847, Statutes of 2017).

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SB 189 (BRADFORD): WORKERS’ COMPENSATION FIX

SB 641 (LARA): PRIVATE PROTECTIONS FOR THE CURES DATABASE

This bill provides a clarification to AB 2883 (Insurance Committee, 2016), which had allowed shareholderemployees with at least a 15-percent ownership stake in a corporation to exempt themselves from coverage. SB 189 reduces the 15-percent ownership threshold to 10 percent and explicitly exempts physician owners of medical corporations from workers’ compensation requirements regardless of percentage of ownership, as long as they have health insurance coverage.

This bill clarifies that law enforcement must get a warrant to obtain information from the Controlled Substance Utilization Review and Evaluation System (CURES), which aligns the CURES privacy protections more closely with those provided a patient’s medical record.

Status: Signed by the Governor (Chapter 770, Statutes of 2017).

SB 457 (BATES): OUT-OF-HOSPITAL BIRTHS This is a comprehensive approach for California licensees assisting out-of-hospital births (MDs, CNMs, and LMs) to establish proper protocols, increase patient safety, and clarify the appropriate scope of practice for both CNMs and LMs assisting births outside a hospital. CMA is cosponsoring this legislation with ACOG.

Status: Held in the Senate Business, Profession, & Economic Development Committee.

Status: Held in the Assembly Public Safety Committee.

SB 647 (PAN): SILENT PPO AND HEALTH CARE PROVIDERS’ BILL OF RIGHTS In 2003, the Legislature enacted the Health Care Providers’ Bill of Rights, in part to ensure that third-party payers are automatically bound by the terms of the original health plan/provider contract. Recently, the appellate court decision in the UFCW & Employers Benefit Trust v. Sutter Health (2015) ruled that a third-party payer was not bound by the terms of the original health provider/ health plan contract even though that payer had benefitted from the lower provider rates in the contract. The UFCW case has undermined protections that were established by a CMA-sponsored bill. We will be working with the California Hospital Association, to sponsor legislation to re-establish the automatic binding of a third-party payer to the original health plan/provider contract.

Status: Held in the Senate Health Committee.

SUCCESSFULLY NEGOTIATED LEGISLATION AB 40 (SANTIAGO): CURES DATABASE: HEALTH INFORMATION TECHNOLOGY SYSTEM This bill would require the Department of Justice to make a patient’s Controlled Substance Utilization Review and Evaluation System (CURES) history of dispensed controlled substances available to a practitioner through either an online Internet Web portal or an authorized health information technology system. The bill would authorize an entity that operates a health information technology system to establish an integration with and submit queries to the CURES database, if the system entity can certify, among other requirements, that the data received from the CURES database will not be

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used for any purpose other than delivering the data to an authorized health care practitioner or performing data processing activities necessary to enable delivery, and that the system meets applicable patient privacy and information security requirements of state and federal law. The bill would also authorize the Department of Justice to require an entity operating a health information technology system that is requesting to establish an integration with the CURES database, to enter into a memorandum of understanding or other agreement setting forth terms and conditions with which the entity must comply.

Status: Signed by the Governor (Chapter 607, Statutes of 2017).

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AB 182 (WALDRON): HEROIN AND OPIOID PUBLIC EDUCATION This bill would require the Department of Public Health, until January 1, 2023, to develop, coordinate, implement, and oversee a comprehensive multicultural public awareness campaign, to be known as “Heroin and Opioid Public Education (HOPE),” upon appropriation by the Legislature or receipt of state or federal grant funding.

The bill would require the HOPE program to provide for the coordinated and widespread public dissemination of information that is designed to, among other things, describe the effects and warning signs of heroin use and opioid medication abuse, to better enable members of the public to determine when help is needed and identify pathways that are available for individuals to seek help. The bill would require the HOPE program to use appropriate media types as specified, employ a variety of complementary educational themes and messages that are tailored to appeal to different target audiences and use culturally and linguistically appropriate means.

Status: Failed in the Senate Appropriations Committee.

AB 334 (COOPER): SEXUAL ASSAULT This bill would have set the time for commencement of any civil action for recovery of damages suffered as a result of sexual assault, to the later of within 10 years from the date of the last act, attempted act, or assault with intent to commit an act, of sexual assault by the defendant against the plaintiff or within 3 years from the date the plaintiff discovers or reasonably should have discovered that an injury or illness resulted from an act, attempted act, or assault with intent to commit an act, of sexual assault by the defendant against the plaintiff.

Status: Failed in the Senate Public Safety Committee.

AB 387 (THURMOND): MINIMUM WAGE: HEALTH PROFESSIONALS: INTERNS Current law requires the minimum wage for all industries to not be less than specified amounts to be increased from January 1, 2017, to January 1, 2022, inclusive, for employers employing 26 or more employees and from January 1, 2018, to January 1, 2023, inclusive, for employers employing 25 or fewer employees, except when the scheduled increases are temporarily suspended by the Governor, based on certain determinations.

Current law defines an employer for purposes of those 22

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provisions. This bill would have expanded the definition of “employer” for purposes of these provisions to include a person who directly or indirectly, or through an agent or any other person, employs or exercises control over the wages, hours, or working conditions of a person engaged in a period of supervised work experience to satisfy requirements for licensure, registration, or certification as an allied health professional.

Status: Failed in the Assembly.

AB 413 (EGGMAN): CONFIDENTIAL COMMUNICATIONS: DOMESTIC VIOLENCE This bill would allow a party to a confidential communication to record the communication for the purpose of obtaining evidence reasonably believed to relate to domestic violence and the evidence so obtained would not be rendered inadmissible in a prosecution against the perpetrator for domestic violence.

Status: Signed by the Governor (Chapter 191, Statutes of 2017).

AB 702 (LACKEY): DRIVING UNDER THE INFLUENCE: CHEMICAL TESTS When a person is convicted of violating specified drivingunder-the-influence (DUI) provisions, and at the time of the arrest leading to that conviction the person willfully refused a peace officer’s request to submit to, or willfully failed to complete, a specified chemical test, existing law requires a court to impose additional penalties. This bill would make it a crime for a person to willfully refuse to submit to, or willfully fail to complete, a breath test after being lawfully arrested for a violation of specified offenses.

Status: Failed in the Senate Appropriations Committee.

AB 715 (WOOD): WORKGROUP REVIEW OF OPIOID PAIN RELIEVER USE AND ABUSE This bill would require the Department of Public Health to convene a workgroup, comprised of members selected by the department, to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers for instances of acute, short-term pain.

Status: Vetoed by the Governor.

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AB 859 (EGGMAN): ELDERS AND DEPENDENT ADULTS: ABUSE OR NEGLECT The Elder Abuse and Dependent Adult Civil Protection Act, provides for the award of attorney’s fees and costs to, and the recovery of damages by, a plaintiff when it is proven by clear and convincing evidence that the defendant is liable for physical abuse or neglect, and the defendant has also been found guilty of recklessness, oppression, fraud, or malice in the commission of that abuse. This bill would instead apply a preponderance of the evidence standard to any claim brought against a residential care facility for the elderly or a skilled nursing facility for remedies sought pursuant to the above provisions, upon circumstances in which spoliation of evidence has been committed by the defendant.

Status: Vetoed by the Governor.

AB 1061 (GLORIA): VICTIM’S RESTITUTION This bill would update the administration of the Crime Victim Compensation Board. It would prohibit a suspected perpetrator of the crime for which compensation is sought from being an authorized representative for the purposes of filing a claim. The bill would provide an indefinite application period for certain crimes, including rape, as specified. The bill would add preparation for testimony as a condition the board may consider for extending the time for application.

Status: Failed in the Assembly Appropriations Committee.

AB 1116 (GRAYSON): PEER SUPPORT AND CRISIS REFERRAL SERVICES This bill would create the Peer Support and Crisis Referral Services Act, which would allow for the creation of “peer support teams” to provide counseling services to individuals who respond to critical incidents. These services would be available to physicians who provided emergency services who need mental health counseling or peer support.

Status: Failed on the Senate Inactive File.

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AB 1250 (JONES-SAWYER): COUNTIES: CONTRACTS FOR PERSONAL SERVICES This bill would have established specific standards for the use of personal service contracts by counties requiring the County Board of Supervisors to make a number of findings, before awarding a government service contract to a private third party, including non-profits. The bill does not apply to existing contracts and any extension or renewal of those contracts. Additionally, the bill does not apply to services that are expert in nature or to services where there are not sufficient number of county employees in the workforce to reasonably provide the service.

Status: Failed in Senate Rules Committee.

AB 1312 (GONZALEZ FLETCHER): SEXUAL ASSAULT VICTIMS: RIGHTS This bill would require a law enforcement authority or district attorney to also notify a sexual assault victim that he or she has the right to request to have a person of the same gender or opposite gender as the victim present in the room during any interview with a law enforcement official or district attorney, unless no such person is reasonably available. It would require that emergency contraception be provided to the victim for free. It would require law enforcement to develop and provide, and for medical personnel to provide, if available, a card with information on the rights of sexual assault victims. It would require the forensic medical examiner to allow the victim to shower or bathe, if facilities are available. It would establish a minimum time for law enforcement to store a rape kit or evidence from a sexual assault.

Status: Signed by the Governor (Chapter 692, Statutes of 2017).

AB 1316 (QUIRK): PUBLIC HEALTH: CHILDHOOD LEAD POISONING: PREVENTION This bill would change the definition of “lead poisoning” to include concentrations of lead in arterial or cord blood.

The bill would require that the regulations establishing a standard of care include the determination of risk factors for whether a child is at risk for lead poisoning be updated

by July 1, 2019 and would require the department, when determining those risk factors, to consider the most

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significant environmental risk factors. It would require the California Department of Public Health, to annually publish information regarding efforts to increase lead screening in children and efforts to reduce lead exposure.

Finally, it would require lead screening done pursuant to the screening regulations to be covered by insurance.

Status: Signed by the Governor (Chapter 507, Statutes of 2017).

AB 1560 (FRIEDMAN): NURSE PRACTITIONERS: CERTIFIED NURSEMIDWIVES: PHYSICIAN ASSISTANTS: PHYSICIAN AND SURGEON SUPERVISION The Physician Assistance Practice Act authorizes a physician assistant licensed by the Physician Assistant Board, to be eligible for employment or supervision by any physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California prohibiting that employment or supervision. The act prohibits a physician and surgeon from supervising more than 4 physician assistants at any one time. This bill would prohibit a physician and surgeon from supervising more than 12 nurse practitioners, certified-nurse midwives, and physician assistants at any one time.

Status: Failed on the Senate Inactive File.

AB 1650 (MAIENSCHEIN): EMERGENCY MEDICAL SERVICES: COMMUNITY PARAMEDICINE This bill would have, until January 1, 2022, created the Community Paramedic Program in the authority. The bill would have authorized the authority to authorize a local EMS agency that opts to participate in the program to provide specified services, such as case management services and linkage to nonemergency services for frequent EMS system users, through a local community paramedic program.

Status: Failed in the Assembly Appropriations Committee.

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AJR 19 (ARAMBULA): OPIOID AWARENESS AND DEPENDENCY PREVENTION This measure urges hospital-based pain management formularies, to consider the inclusion of a range of nonopioid alternatives and urges the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.

Status: Signed by the Governor (Chapter 208, Statutes of 2017).

SB 33 (DODD): ARBITRATION AGREEMENTS Existing law requires a court, on petition of a party to an arbitration agreement alleging (1) the existence of a written agreement to arbitrate a controversy and (2) that a party to the agreement refuses to arbitrate the controversy, to order the petitioner and the respondent to arbitrate the controversy if the court determines that an agreement to arbitrate exists, unless the court makes other determinations. This bill would add to these determinations instances in which a financial institution, as defined, is seeking to apply a written agreement to arbitrate, contained in a contract consented to by a consumer, to a purported contractual relationship with that consumer that was created by the petitioner fraudulently, without the consumer’s consent and by unlawfully using the consumer’s personal identifying information.

Status: Signed by the Governor (Chapter 480, Statutes of 2017).

SB 43 (HILL): ANTIMICROBIAL-RESISTANT INFECTION: REPORTING This bill would have required specified general acute care hospitals and clinical laboratories to submit a report to the California Department of Public Health, commencing July 1, 2019, and each July 1 thereafter, containing an antibiogram of the facility for the previous year. The bill would have required the Antimicrobial Stewardship and Resistance Subcommittee of the Healthcare Associated Infections Advisory Committee of the department, on or before January 1, 2019, to develop and recommend to the department the acceptable electronic format

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for the report and a method for the department to accurately estimate the number of deaths that result from antimicrobial resistant infections for specified types of antimicrobial infections. It would also require CDPH to annually publish information related to the number of antimicrobial-resistant infections and the estimated number of deaths.

Status: Failed in the Assembly Health Committee.

SB 199 (HERNANDEZ): THE CALIFORNIA HEALTH CARE COST, QUALITY, AND EQUITY ATLAS This bill would have required the Secretary of California Health and Human Services, in furtherance of the goal of creating the California Health Care Cost, Quality, and Equity Atlas, to convene an advisory committee composed of a broad spectrum of health care stakeholders and experts. The bill would require the secretary to charge the advisory committee with identifying the type of data, purpose of use, and entities and individuals that are required to report to, or that may have access to, a health care cost, quality, and equity atlas, and with developing a set of recommendations based on specified findings of the March 1, 2017 report.

Status: Failed in the Assembly Appropriations Committee.

SB 219 (WIENER): LONG-TERM CARE FACILITIES: RIGHTS OF RESIDENTS This bill would make it unlawful for any long-term care facility, to take specified actions wholly or partially on the basis of a person’s actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status, including refusing

to use a resident’s preferred name or pronoun and denying admission to a long-term care facility, transferring or refusing to transfer a resident within a facility or to another facility, or discharging or evicting a resident from a facility.

Status: Signed by the Governor (Chapter 483, Statutes of 2017).

SB 349 (LARA): CHRONIC DIALYSIS CLINICS: STAFFING REQUIREMENTS This bill would establish minimum staffing requirements for chronic dialysis clinics and establish a minimum transition time between patients receiving dialysis services at a treatment station. The bill would require chronic dialysis clinics to maintain certain information relating to the minimum staffing and minimum transition time requirements and provide that information, certified by the chief executive officer or administrator, to the department on a schedule and in a format specified by the department, but no less frequently than 4 times per year.

Status: Failed on the Assembly Inactive File.

SB 698 (HILL): DRIVING UNDER THE INFLUENCE: ALCOHOL AND MARIJUANA This bill would have, until January 1, 2021, made it a crime for a person who has between 0.04% and 0.07%, by weight, of alcohol in his or her blood and whose blood contains any controlled substance or 5 ng/ml or more of delta-9-tetrahydrocannabinol to drive a vehicle. The bill would have required a person to fail field sobriety tests to establish probable cause for a chemical test to test the person’s blood. The bill would have made a first violation punishable as an infraction and would have made subsequent violations punishable as a misdemeanor.

Status: Failed in the Senate Appropriations Committee.

OPPOSED LEGISLATION AB 221 (GRAY): WORKERS’ COMPENSATION: LIABILITY FOR PAYMENT Current law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury. This bill would have provided that for claims of occupational disease or

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cumulative injury filed on or after January 1, 2018, the employee and the employer would have no liability for payment for medical treatment, unless one or more of certain conditions are satisfied, including, among others, that the treatment was authorized by the employer.

Status: Failed in the Assembly Insurance Committee.

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AB 320 (COOLEY): CHILD ADVOCACY CENTERS This bill would have authorized a county, in order to implement a multidisciplinary response to investigate reports involving child physical or sexual abuse, exploitation, or maltreatment, to use a Child Advocacy Center. The bill would have required a Child Advocacy Center to meet specified standards, including the use of representatives from specified disciplines and providing dedicated child-focused settings for interviews and other services. The bill would have authorized multidisciplinary team members to share with each other information in their possession concerning the child, the family of the child, and the person who is the subject of the abuse or neglect investigation.

Status: Failed in the Assembly Human Services Committee.

AB 595 (WOOD): HEALTH CARE SERVICE PLANS: MERGERS AND ACQUISITIONS This bill would have required specified entities that intend to merge with, consolidate, acquire, purchase, or control, directly or indirectly, a health care service plan doing business in this state to give notice to, and secure prior approval from, the Director of the Department of Managed Health Care. The bill would have required that entity to apply for licensure as a health care service plan.

The bill also would have required the department, prior to approval, conditional approval, or denial of the proposed agreement or transaction, to hold a public hearing on the proposal and make specified findings.

Status: Failed in the Assembly Appropriations Committee.

AB 700 (JONES-SAWYER): PUBLIC HEALTH: ALCOHOLISM OR DRUG ABUSE RECOVERY: SUBSTANCE USE DISORDER COUNSELING This bill would have established a career ladder for substance use disorder counseling to be maintained and updated by the State Department of Health Care Services. The bill would have established classifications for substance use disorder (SUD) counselor certification or registration to be implemented by the organizations that certify substance use disorder programs. The bill would

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have required any person who engages in the practice of SUD counseling to be certified by, or registered with, a certifying organization, unless specifically exempted.

The bill would establish additional standards for registrants and interns, as defined, and impose additional requirements on SUD counselors. The bill would have provided authority to the department to discipline a certificate holder or registrant. The bill would have authorized the department to implement these provisions by regulation.

Status: Failed in the Senate Health Committee.

AB 748 (TING): PEACE OFFICERS: VIDEO AND AUDIO RECORDINGS: DISCLOSURE This bill would allow a video or audio recording that relates to a matter of public concern because it depicts an incident involving a peace officer’s use of force, or is reasonably believed to involve a violation of law or agency policy by a peace officer, to be withheld for a maximum of 120 calendar days if disclosure would substantially impede an active investigation.

Status: Failed in the Senate Judiciary Committee.

AB 889 (STONE, MARK): SECRECY AGREEMENTS Current law generally permits the parties to a civil action to include, as a condition to a settlement, a provision requiring that information about the settlement or the underlying dispute be kept confidential; however, existing law prohibits a confidential settlement agreement in a civil action with a factual foundation establishing a cause of action for civil damages for an act that may be prosecuted as a felony sex offense. Existing law also establishes that flouting this prohibition is grounds for professional discipline for an attorney, and it requires the State Bar of California to investigate and take appropriate action in any case brought to its attention. This bill would have instead authorized but not required the State Bar to investigate these cases of attorney misconduct.

Status: Failed in the Assembly.

AB 937 (EGGMAN): HEALTH CARE DECISIONS: ORDER OF PRIORITY The Health Care Decisions Law provides for an individual’s use of a request regarding resuscitative WINTER 2017

measures, which is a written document, signed by an individual with capacity or a legally recognized health care decision maker for the individual, and the individual’s physician, that directs a health care provider regarding resuscitative measures for the individual. This bill would have provided that, to the extent of that conflict, the most recent order signed by the individual or instruction made by the individual is effective. The bill would have deemed a request regarding resuscitative measures signed by specified persons on behalf of the individual to be signed by the individual.

AB 1402 (ALLEN, TRAVIS): PROSTITUTION: MINORS This bill would have made the prohibitions on prostitution and related offenses applicable to a person under 18 years of age.

Status: Failed in the Assembly Public Safety Committee.

AB 1612 (BURKE): NURSING: CERTIFIED NURSE-MIDWIVES: SUPERVISION

This bill would have exempted from the Alcoholic Beverage Control Act the use of powdered alcohol as an ingredient in non-powdered products and the production, sale, or offering for sale or delivery, receipt, or purchasing for resale of powdered alcohol for use as an ingredient in non-powdered products.

This bill would have repealed the requirement that a certified nurse-midwife be under the supervision of a licensed physician and surgeon. The bill would authorize a certified nurse-midwife to consult, refer, or transfer care to a physician and surgeon as indicated by the health status of the patient and the resources and medical personnel available in the setting of care. The bill would provide that a certified nurse-midwife practices within a variety of settings, including, but not limited to, the home setting.

The bill would have specified that nurse-midwifery care emphasizes informed consent, preventive care, and early detection and referral of complications.

Status: Failed in the Assembly Governmental Organization Committee.

Status: Failed in the Assembly Appropriations Committee.

AB 1110 (BURKE): PUPIL HEALTH: EYE AND VISIONS EXAMINATIONS

ACR 8 (JONES-SAWYER): ADVERSE CHILDHOOD EXPERIENCES: POSTTRAUMATIC “STREET” DISORDER

Status: Failed in the Senate Health Committee.

AB 1054 (BROUGH): POWDERED ALCOHOL

This bill would have required, during the kindergarten year or upon first enrollment or entry at an elementary school, including a charter school, a pupil’s eyes and vision to be examined by a physician, optometrist, or ophthalmologist in accordance with specified provisions, unless the pupil’s parent or guardian submits a written waiver to the school or charter school. The bill would have required, in a pupil’s kindergarten year or upon first enrollment or entry at an elementary school that is not a charter school, the pupil’s vision to be appraised in accordance with the above-specified provisions only if the pupil’s parent or guardian fails to provide the results of the eye and vision examination.

Status: Failed in the Assembly Appropriations Committee.

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This measure would recognize post-traumatic “street” disorder as a mental health condition with growing implications for our state.

Status: Signed by the Governor (Chapter 139, Statutes of 2017).

SB 72 (MITCHELL): BUDGET ACT OF 2017 This bill included the Senate’s budget package, which would have allocated only $348 million in Proposition 56 funding to improve access to care, $150 million of which would have been for a high-need specialty access pool to provide rate increases for physicians that are tied to the Access Assessment study required by the Medi-Cal 2020 waiver, to network adequacy standards established by the new federal Medicaid rule, or to more closely align Medi-Cal rates with those in the Medicare program. The remaining Prop. 56 funding it his budget would have been

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allocated to the Medi-Cal program to support regular program growth as proposed by the Administration.

Additionally, this bill would have implemented the Administration’s proposal to allocate $50 million in Prop.

56 funding to the University of California (UC), while also cutting $50 million from the General Fund base, which would require the UC to use this funding for its base operation and not to increase graduate medical education opportunities for medical school graduates seeking to complete their residencies in California. Finally, this bill only allocated $6 million from the General Fund to the Office of Statewide Health Planning and Development for the Song-Brown program, rather than the full $33 million that the Governor had cut from the budget in his proposal.

Status: Failed in Senate Budget Committee.

SB 350 (GALGIANI): INCARCERATED PERSONS: HEALTH RECORDS

SB 538 (MONNING): HOSPITAL CONTRACTS This bill would have prohibited contracts between hospitals and contracting agents or health care service plans from containing certain provisions, including, but not limited to: setting payment rates or other terms for nonparticipating affiliates of the hospital; requiring the contracting agent or plan to keep the contract’s payment rates secret from any payor, as defined, that is or may become financially responsible for the payment; and requiring the contracting agent or plan to submit to arbitration, or any other alternative dispute resolution program, any claims or causes of action that arise under state or federal antitrust laws after those claims or causes of action arise, except as provided. The latest amendment required health plans and health insurers to be responsible for including and disclosing relevant terms of the provider contract with the third-party payor. The bill would make any prohibited contract provision void and unenforceable.

Current law authorizes a provider of health care or a health care service plan to disclose medical information when the information is disclosed to an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor, or other person or entity responsible for paying for health care services rendered to the patient, to the extent necessary to allow responsibility for payment to be determined and payment to be made. This bill would have additionally authorized the disclosure of information between a county correctional facility, a county medical facility, a state correctional facility, or a state hospital to ensure the continuity of health care of an inmate being transferred between those facilities.

Status: Failed in the Assembly Health Committee.

Status: Failed in the Senate Appropriations Committee.

SB 636 (BRADFORD): ADDICTION TREATMENT: ADVERTISING: PAYMENT

SB 419 (PORTANTINO): MEDICAL PRACTICE: PAIN MANAGEMENT

This bill would have prohibited a person, firm, partnership, association, or corporation, or an agent or employee thereof, from making payments for services that recommend any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary. The bill would also have prohibited a person, firm, partnership, association, or corporation, or an agent or employee thereof, from using runners, cappers, steerers, or other persons to procure clients, patients, or customers for any form of medical care or treatment provided by an alcoholrelated or narcotic-related program, facility, or dispensary.

This bill would have prohibited a person from prescribing oxycodone, by whatever official, common, usual, chemical, or trade name designated, to a patient under 21 years of age.

The bill would have made a violation of this prohibition subject to a civil penalty. The bill would also have authorized a patient who was prescribed oxycodone in violation of the prohibition, and who sustained economic loss or personal injury as a result of that violation, to bring a civil action to recover compensatory damages, reasonable attorney’s fees, and litigation.

Status: Failed in the Senate Business, Professions, and Economic Development Committee.

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SB 562 (LARA AND ATKINS): THE HEALTHY CALIFORNIA ACT This bill, the Healthy California Act, would have created the Healthy California program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.

Status: Failed in the Assembly.

Status: Failed in Senate Health Committee.

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SB 746 (PORTANTINO): PUPIL HEALTH: PHYSICAL EXAMINATIONS Current law authorizes a physician and surgeon or physician assistant to perform a physical examination that is required for a pupil to participate in an interscholastic athletic program of a school. This bill would have additionally authorized a doctor of chiropractic, naturopathic doctor, or nurse practitioner practicing in compliance with the respective laws governing their profession to perform that physical examination.

Status: Failed in Senate Education Committee.

submit reports pursuant to Business and Professions Code 805.1; change the adverse event reporting requirements for outpatient surgery settings, change the requirements for use of an expert witness in disciplinary cases; end, as of January 1, 2019, the requirement for concurrent engagement of investigators and prosecutors in medical board cases; extend the authorization of the Osteopathic Medical Board of California; make changes to continuing medical education for OMBC-licensed physicians, and make other changes to the medical-board’s administration.

Status: Signed by the Governor (Chapter 775, Statutes of 2017).

SB 790 (MCGUIRE): HEALTH CARE PROVIDERS: GIFTS AND BENEFITS This bill would prohibit pharmaceutical and device manufacturers from providing physicians anything of value and create new regulations that govern interactions between these companies and physicians.

Status: Failed on the Assembly Inactive File.

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STRENGTHENING THE HOUSE OF MEDICINE ORGANIZED MEDICINE – WHETHER AT THE LOCAL, STATE OR FEDERAL LEVEL – EXISTS LARGELY FOR THE PURPOSE OF BOLSTERING THE PHYSICIAN VOICE.

BY JAMES NOONAN

HEALTH POLICY The California Medical Association’s House of Delegates provides members a direct voice in the organization that shapes statewide health policy Here in California, that voice, represented by the California Medical Association, has been responsible for some of the state’s major medical and public heath milestones, including the formation of the state’s health department, the creation and chartering of the state’s first medical schools, and more recently, safeguard that work to ensure that childhood vaccination rates in the state’s public schools remain at levels that will keep our citizens safe. Thanks to the organization’s system of governance,

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California physicians.

these actions were implemented under the guidance of medical professionals, but were also conceived of by physicians, the very men and women who have dedicated their lives to the health of California.>>

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This process, CMA’s House of Delegates, remains as relevant and impactful today as it has ever been.

“As physicians, we know that there are a variety of other entities that want to influence how we practice medicine. It’s become a reality of our profession,” said Dr. Larry Frank, chair of the District VI delegation to CMA’s House of Delegates. “The only way

Society, Tulare County Medical Society and Tuolumne County Medical Society.

During the House’s annual meeting, geographical delegations, specialty delegations and mode of practice forums gather to discuss and debate resolutions that have been submitted to the House, either by an CMA individual member, a county medical society, or some other body represented at the gathering.

Resolutions passed by a vote of the House have gone "If you're feeling badly about (something), on to direct CMA’s policy discussions and it's irritating you and you want to do in Sacramento, something about it, the House of Delegates and in some cases, is your way to go about doing it." have led to direct legislative or regulatory changes being written into DR. LARRY FRANK law.

“The House of to counteract, or stop that, is to be part of an Delegates is dealing the major issues currently organization with a process that can make facing California’s physicians, not only on the those changes. CMA is that organization, and regulatory and financial level, but also the it’s House of Delegates is that process.” major public issues seen in our state,” Frank As the CMA’s principle policy making said, noting that recent topics of discussion body, Frank explains, the House of Delegates have covered areas such as state and federal provides physicians with direct access to a reimbursement, opioids, legalized cannabis system that is responsible for shaping the and medically supervised injections sites.

CMA’s policy agenda for years to come.

In order for any action on these issues Through the House’s process of accepting, to take place, however, physicians must be reviewing and ultimately adopting member’s engaged in the process, either by submitting resolutions, it encourages participation from resolutions themselves, or serving as a a diverse spectrum of physicians, representing delegate or alternate during the House’s various specialties, modes of practice and annual meeting. geographical locations. The District VI “These days, most of the stresses and delegation, which Frank has chaired for past unpleasantness in practicing medicine comes several gatherings of the House, consists of from others telling us how we should be the San Joaquin County Medical Society, practicing, whether it be insurance companies, the Kern County Medical Society, the elected officials or someone else,” Frank said.

Kings County Medical Society, the Merced“If you’re feeling badly about that, and it’s Mariposa Medical Society, the Fresno-Madera irritating and you want to do something about Medical Society, the Stanislaus Medical it, the House of Delegates is the way to go

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about doing it.”

While the House of Delegates’ annual meeting, and its resolutions process, has always provided California physicians with a direct avenue to help shape the CMA’s policy agenda, a variety of recent changes have streamlined the House’s activities, allowing members to take action at any point throughout the year.

Under the new structure, the House of Delegates has shifted toward a more “year-round” system, allowing members to submit a resolution for consideration at any time throughout the year, which allows issues to receive consideration outside of the regularly scheduled annual meeting. Resolutions are reviewed quarterly

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Under the new structure, the House of Delegates has shifted toward a more “yearround” system, allowing members to submit a resolution for consideration at any time throughout the year.

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by CMA’s Speaker of the House, who reviews and vets the resolution before passing those that fall under the purview of the House of Delegates to the various delegations, who are able to then take action on them.

“It’s more or less an ongoing process now,” Frank said.

“Every quarter, we get together and put forth a report on the resolutions that have been submitted in the previous few months.”

Comparing the new structure to the past practices of the House of Delegates, in which resolutions were submitted en mass roughly two months before the House’s annual meeting, Frank points out that the two methods seek to reach the same, democratic outcome, using two extremely different means.

“It’s kind of like comparing boots you’d wear in the

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military to a pair of loafers,” he said. “They serve the same purpose, but take entirely different approaches.”

CMA’s new form of conducting the business of the House of Delegates also allows the organization to be significantly more nimble on issues of vital importance, particularly those that are subject to the increasingly volatile action in Washington D.C. and Sacramento.

One example in which the new structure would prove advantageous, Frank said, is the hypothetical repeal of the Affordable Care Act, and the question of what the CMA’s policy stance would be on the implementation of any replacement legislation.

“Under the previous structure, that discussion would only take place at the annual meeting,” he said. “Now, it could be taken up at any point throughout the year.”

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DELEGATES Lawrence Frank, MD Nephrology San Joaquin General Hospital

Ramin Manshadi, MD Cardiology Manshadi Heart Institute

Raissa Hill, DO Family Practice HT Family Physicians

R. Grant Mellor, MD Pediatrics Kaiser Permanente

The revised structure also allows delegates to lend an enhanced level of focus and attention to resolutions, given that they are coming across them in smaller groups, rather than being asked to view and digest all resolutions over the course of a two-day meeting.

“It’s a different way of doing things, and I think it’s a better way,” Frank said.

“There are so many issues that come up. This way, you have more time to really delve in.”

For those that would like more fully immerse themselves in this process, the District VI delegation is currently seeking both delegates and alternates.

In order to serve, interested physicians must be willing to review the quarterly reports and resolutions passed on by CMA’s Speaker of the House, attend between three and four teleconferences throughout the year, and be present during the annual two-day meeting of the House of Delegates, which typically takes place in October and alternates host location between Anaheim and Sacramento.

The reward for their involvement is the knowledge that they are taking a major step toward bettering their profession, and adding their weight to a physician voice that has helped shaped policy in the Golden State since its inception.

“Engagement in the process is vital,” Frank said. “Physicians are the ones who know these issues better than anyone, and creating solutions goes beyond affiliation with you county medical society of the CMA. We must be engaged in the process is we hope to see change.”

Ready to take action?

Robin Wong, MD Family Practice

James Halderman, MD Anesthesia Sutter Gould Medical Foundation

ALTERNATE Kwabena Adubofour, MD Internal Medicine East Main Clinic

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SUBMIT A RESOLUTION

If you have a resolution you would like to submit for next quarterly review, e-mail it to resolutions@cmanet.org.

Please read the guidelines for submission and formatting before submitting a resolution, available at www.cmanet.org. Resolutions that do not follow the guidelines will be rejected.

The resolution submission deadline for the first quarter of 2018 has already passed, but you can still submit resolutions for the second quarter until January 21, 2018.

BECOME A DELEGATE

Delegates and alternates are the cornerstone of the California Medical Association’s democratic process. Their actions can help shape not only CMA’s policy agenda, but statewide health policy that will go on to impact millions of Californians.

If you would like to be considered for the position of delegate or alternate, please contact Lisa Richmond, executive director of the San Joaquin County Medical Society, at Lisa@sjcms.org.

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

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Sometimes You Just Need a Little Help.

EXCI

RAFFTING PRIZ LE E S

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

Sunday April 29, 2018 • Brookside Country Club • 4 Person Scramble $175 per golfer - Price includes green fees, golf cart, lunch, after golf dinner and party! See registration form for details. $50 of every entry fee goes to The First Tee of San Joaquin program Hole Sponsorships benefit SJMS’ Decision Medicine Program

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

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

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In The News

IN THE

NEWS Center for Sight Welcomes Two New Physicians Dr. Nisreen Mesiwala Kothari was born and raised in Bloomfield Hills, MI. She completed her undergrad at the University of Michigan and was Nisreen Mesiwala Kothari, MD awarded the prestigious Dean’s Merit scholarship to attend the University of Michigan Medical School. She completed her ophthalmology residency at University of Pittsburgh and then a fellowship in Cornea and External diseases at the Tufts University in Boston, MA. Dr. Kothari specializes in cataract surgery, pterygium surgery, LASIK surgery and corneal transplants. She speaks English, Gujarati, and some Spanish.

Dr. Sarah Dehaybi was born and raised in Northern Arizona and completed her undergrad, Masters of Public Health and medical school degree at the University of Arizona and finished her Master’s in Public Health with an internship at the World Health Organization in Geneva, Switzerland.

She then went on to complete an internal medicine internship and ophthalmology residency at the University of Missouri, Kansas City.

Dr. Dehaybi manages ocular diseases including cataract, glaucoma, diabetic retinopathy, macular degeneration, and dry eye disease. She speaks English, some Spanish and some Arabic.

Sarah Dehaybi, MD

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

St. Joseph’s Offers New Approach for Hip Replacement St. Joseph’s Orthopedic Services is excited to be the first in our community to now offer the anterior approach for hip replacement. With this new innovative approach, the incision is made at the Jaspreet Sidu, DO front of the hip, as opposed to the traditional posterior approach, where the incision is made on the side. The anterior approach is an example of evolving surgical techniques designed to improve outcomes for patients.

“The hip joint and affected muscles are accessed differently with the anterior approach,” says orthopedic surgeon Jaspreet Sidhu, D.O. “As a result; studies are showing that for many patients, the benefits are less damage to major muscles, less post-operative pain, shorter hospital stays, and faster recovery.”

Dr. Sidhu practices at Alpine Medical Group and is on staff at St. Joseph’s Medical Center. He is a Fellowship trained orthopedic surgeon who specializes in anterior approach hip replacement, total knee replacement, and complex revision knee/hip replacement. To learn more about Dr. Sidhu visit alpineorthopaedic.com or call 209.948.3333.

To learn more about St. Joseph’s advanced orthopedic services, including robotic assisted knee-replacement, call our orthopedics patient navigator at 209.939.4517 or visit StJosephsCares.org/Ortho.

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St. Joseph’s Earns “A” Grade for Patient Safety by Leapfrog The Leapfrog Group, a national nonprofit health care ratings organization, recently released new Leapfrog Hospital Safety Grades. The Safety Grade assigns letter grades of A, B, C, D and F to hospitals nationwide based on their performance in preventing medical errors, infections and other harms. Dignity Health - St. Joseph’s Medical Center was one of 832 awarded an “A” for its commitment to keeping patients safe and meeting the highest safety standards in the U.S. “Patient care and safety are our top priories,” said Don Wiley, president and CEO of St. Joseph’s Medical Center. “Every day, our doctors, nurses, and other caregivers work together to improve care. Receiving this ‘A’ grade affirms our diligent work.”

Developed under the guidance of a Blue Ribbon National Expert Panel, the Leapfrog Hospital Safety Grade uses 27 measures of publicly available hospital safety data to assign A, B, C, D and F grades to more than 2,600 U.S. hospitals twice per year. It is calculated by patient safety experts, peer reviewed, fully transparent and free to the public.

“It takes consistent, unwavering dedication to patients to achieve the highest standards of patient safety. An ‘A’ Safety Grade recognizes hospitals for this accomplishment,” said Leah Binder, president and CEO of The Leapfrog Group. “We congratulate the clinicians, Board, management and staff of St. Joseph’s Medical Center for showing the country what it means to put patient safety first.”

TAVR Team St. Joseph’s TAVR Team Completes 50th Procedure The transcather aortic valve replacement (TAVR) team at St. Joseph’s Heart & Vascular Institute is proud to have reached a major milestone, recently completing their 50th TAVR procedure, bringing new hope and changing the lives of 50 patients who were suffering from severe aortic valve stenosis.

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St. Joseph’s is one of a select group of providers and the only hospital in San Joaquin County to offer TAVR, a minimally invasive procedure that treats aortic stenosis without requiring open chest surgery. TAVR uses a catheter to replace the heart valve instead of opening up the chest and completely removing the diseased valve. The valve used during TAVR is inserted within the diseased aortic valve.

Patients are evaluated by a multidisciplinary team at St. Joseph’s Valve Clinic, which specializes in treating patients with various stages of heart disease, from advanced procedures including TAVR, to disease management. Once a patient is referred to St. Joseph’s Valve Clinic a team of experienced physicians and staff develop a personalized plan of care.

To learn more about St. Joseph’s TAVR program, visit StJosephsCares.org/TAVR. St. Joseph’s Voted Best of San Joaquin by The Record’s Readers St. Joseph’s Medical Center was once again voted Best Hospital by The Record’s readers in the Best of San Joaquin 2017 poll. St. Joseph’s is honored to have consistently received this recognition since the recognition program’s inception.

In addition, St. Joseph’s Behavioral Health Center, which offers a wealth of inpatient and outpatient mental health services, was voted Best Mental Health Services in San Joaquin County.

Dr. Sundeep Tumber Named Chair of Department of Anesthesiology at Northern California Shriners Hospital Sundeep S. Tumber, D.O., has been named Chair of the Department of Anesthesiology at Shriners Hospitals for Children — Northern California. Dr. Tumber joined the anesthesiology team at the Northern California Shriners Hospital in August of 2005. He was drawn to the field of pediatric anesthesiology after he completed his rotation at the Shriners Hospital in Sacramento, as a senior anesthesiology resident at the University of California, Davis.

“I am honored to be part of a team focused Sundeep Tumber, MD

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In The News

IN THE

NEWS on the specialized needs of children. I find my job as a pediatric anesthesiologist to be extremely rewarding, and I am privileged to provide care for our patients,” said Dr. Tumber.

“I was immediately drawn to Shriners because of the mission, the children, and the opportunity to work with the wonderful medical staff. I enjoy interacting with the patients during the perioperative period and providing them a safe and comfortable anesthetic. I work with an excellent team of physicians, nurses, and technicians. We provide state-of-theart care to our children here at Shriners,” he added.

Dr. Tumber was born and raised in Yuba City, CA. He earned his undergraduate degree at UC Davis, where he focused on how nutrition affects health. He went on to earn his doctorate in Osteopathic Medicine at Midwestern University — Arizona College of Osteopathic Medicine.

Dr. Tumber obtained his subspecialty board certification in Pediatric Anesthesiology in 2013.

Board certified by the American Board of Anesthesiology, Dr. Tumber is a member of the American Society of Anesthesiology, the California Society of Anesthesiologists, the International Anesthesia Research Society, and the American Osteopathic Association.

Dr. Tumber’s colleagues in the Department of Anesthesiology include Adam Chao, MD, John K. Liu, MD, Casey Stondell, MD, Michael D. Matson, MD, Sam Tafoya, MD, and Geneva B. Young, MD San Joaquin General Hospital to Display Wall of Hope and Inspire Community to Donate Life Donor Network West and San Joaquin General Hospital (SJGH) in French Camp announced that the hospital will host the Wall of Hope, a 20-panel exhibit that features stories

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

Wall of Hope Announcement of members of the community affected by organ and tissue donation. The exhibit opens on October 30 and will remain on display for a month.

Donor Network West’s first Wall of Hope was installed at a Central Valley hospital in 2012. The campaign put northern California on the national spotlight when it won the 2013 Platinum Pinnacle Award for best overall community initiative. The Pinnacle Awards, given annually by Donate Life America, recognize programs successful in inspiring more people to register as organ, eye and tissue donors and establishing donation as a cultural norm.

The 2017 iteration of the exhibit once again includes stories and photos of donor families as well as organ and tissue transplant recipients and their families. Among them is the Zaragoza family of Manteca. Sixteen-year-old Matthew Zaragoza Van Gelderen died at SJGH from a head injury sustained during a Friday night high school football in 2005 and saved four lives through organ donation and healed countless others with his tissues. The Zaragoza family will share Matthew’s story at a special exhibit opening event at the hospital on October 30.

Donor Network West is the federally-designated organ

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procurement and tissue recovery agency for northern California and Nevada. The organization partners with 175 hospitals in its service area of 40 counties to carry out its mission of saving and healing lives.

“This partnership with San Joaquin General Hospital allows us to continue to highlight organ and tissue donation as a way to heal lives in the communities we serve,” says Sean Van Slyck, Chief Operating Officer of Donor Network West. “The support of the hospital’s leadership and staff is invaluable to make donation a reality.”

Nearly 600 people are waiting for an organ transplant in San Joaquin County. One organ donor can save the lives of up to eight people and a tissue donor can heal more than 75 others.

Anyone can register as a donor at DonorNetworkWest.org or at the DMV.

Expanding Integrated Healthcare WelbeHealth and Sutter Health Aim to Expand Integrated Healthcare Services to Senior sat University Park WelbeHealth and Sutter Health, joined by elected officials and community leaders, held a groundbreaking ceremony for a new facility designed to accommodate a Program of All-Inclusive Care for the Elderly (PACE). The event was held at University Park in the University Park World Peace Rose Garden in Stockton, California.

WelbeHealth and Sutter Health have applied to bring this important program to the Stockton and Modesto communities with the goal of expanding integrated healthcare services to seniors. They anticipate receiving final approval for opening in 2018.

The Stockton/Modesto area is the largest metropolitan region in California without PACE. On its website, the Center for Medicare and Medicaid services (CMS) describes the PACE program as follows: “The Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides comprehensive medical and social

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services that enable older adults to live in the community instead of a nursing home or other care facility.” The collaboration of WelbeHealth, Sutter Health and Grupe Commercial Company speaks of the alignment of the missions for all involved.

“Together this partnership will bring much-needed quality, value and compassionate care to the most frail, vulnerable seniors in the Stockton and Modesto areas, building on Sutter Health’s many years of PACE success in California. We look forward to an ongoing dialogue with healthcare providers and other community leaders over the next several months as we prepare to open,” said Si France, MD, WelbeHealth CEO. Kaiser Permanente upgrades surgery unit, receives state designation Surgery patients at Kaiser Permanente’s outpatient medical offices in Stockton will benefit from an enhanced service experience now that the California Department of Public Health has designated the operating room area as an Ambulatory Surgery Unit.

The new license allows the unit to expand the number of patients under sedation and perform Occupational Medicine surgeries. In addition, patients will be able to review quality and safety scores online, and compare them with other facilities across the country.

“This respected designation allows us to provide greater flexibility and convenience to our members,” said Corwin Harper, senior vice president and area manager for Kaiser Permanente in the Central Valley. “We are also pleased that members will now be able to use online tools to compare our Ambulatory Surgery Unit with others and learn more about the quality work we perform,” he added.

“Medical advances and new protocols are making outpatient surgery a more convenient, safer and popular choice for patients,” said Sanjay Marwaha, physician-in-chief for Kaiser Permanente in the Central Valley. “This license recognizes the high-quality care that our physicians, nurses and staff perform on a daily basis to provide our patients with successful outcomes.”

The unit, on the second floor at Stockton Medical Offices, was previously known as the Outpatient Surgical Procedures Department.

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In The News

IN THE

NEWS National Safe Sleep Hospital Certification Program Recognizes Adventist Health Lodi Memorial Adventist Health Lodi Memorial was recently recognized by the National Safe Sleep Hospital Certification Program as a “Gold Certified Safe Sleep Champion,” for their commitment to best practices and education on infant safe sleep. They are the first and only hospital in California to receive the title.

The National Safe Sleep Hospital Certification Program was created by Cribs for Kids®, a Pittsburgh- based organization dedicated to preventing infant, sleep-related deaths due to accidental suffocation. In addition to being Cribs for Kids® partners, Adventist Health Lodi Memorial was recognized for following the safe sleep guidelines recommended by the American Academy of Pediatrics (AAP), and providing training programs for parents, staff and the community.

Community outreach includes educating parents about best sleep and safety practices for their newborns.

“Sleep-Related Death (SRD) results in the loss of more than 3,500 infants every year in the U.S.,” said Michael

Available Space to Lease for Medical Office: For Medical office in Weber Ranch Professional park, 1801 East March Lane, Stockton, CA; call today at (209) 951-8830 or (209) 951-8395; 1367 sq. ft. fully finished ready to move in with 4 exam rooms, Doctor's Chamber with separate bath room. Manager's room, work station for MAs, Patient's bath room, storage room, and Reception (waiting room).

H. Goodstein, MD, neonatologist and medical director of research at Cribs for Kids®. “We know that consistent education can have a profound effect on infant mortality, and this program is designed to encourage safe sleep education and to recognize those hospitals that are taking an active role in reducing these preventable deaths.” This program is well-aligned with the Maternal Child Health Bureau’s vision of reducing infant mortality through the promotion of infant sleep safety as outlined in Infant Mortality CoIIN Initiative.

Thirty-six states have designated SIDS/SUID/SRD as their emphasis to reduce infant mortality.

“We are proud of this designation and all of the diligence and hard work by our staff that goes into receiving a certification of this level,” said Adventist Health Lodi Memorial President and CEO Daniel Wolcott. “As a health care provider, it is our responsibility to educate not only our patients, but our entire community, about an issue as important as infant safe sleep practices.”

HAVE SOMETHING TO SHARE? We welcome submissions to our In-the-News Section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to lisa@sjcms.org one month prior to publication (February 1st for the Fall issue, May 1st for the Fall issue, August 1st for the Fall issue and November 1st for the Fall issue).

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MEMBER BENEFITS AND RESOURCES

EMPOWERING PHY SICIANS

CMA gives me the sens e that I am not alone in the fight to protect my patients and ensure that they get the best and highest qu ality of care.

C. Freeman, M.D. Psychiatrist, Member Since 2006

YOUR PRACTICE

YOUR PROFESSION

YOUR VOICE

Access to practice management experts

Valuable tools and resources

Legislative advocacy

Free CME webinars

Legal support

Free reimbursement helpline

News and updates you need to know

Free access to the most comprehensive health law library

WE GET YOU

WE KEEP YOU UP-TO-DATE

WE ARE YOUR VOICE

Direct payor intervention

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www.cmanet.org/benefits

SAN JOAQUIN PHYSICIAN

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al uin Medic San Joaq e c n ia ll Societ y A

ALLIANCE UPDATE

BY NANCY SCHNEIDER Nancy Schneider serves as SJMS Alliance Chair, CFO of the CMA Alliance and Treasurer of the AMA Alliance

FOR MORE INFORMATION regarding membership or to receive the Alliance monthly newsletter via email, please contact Nancy Schneider at 2schneiders@comcast.net.

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San Joaquin Medical Society Alliance

The San Joaquin Medical Society Alliance formerly known as the Auxiliary – founded in 1931- originally a “ladies” group- now welcomes spouses and significant others. How times have changed! We would love to reach more medical families, but struggle with obtaining home addresses and emails, which will only be used to disseminate information and invite you to our activities. See below for highlights:

• Coffee- we meet at Toot Sweets, 4755 Quail Lakes Dr, 10 AM on the 10th of the month unless it falls on a weekend. We have coffee and have very interesting discussions on a variety of subjects.

It’s even better when babies attend!

•B ook Club- a group meets once a month to discuss a book chosen by the host. In January, we will be discussing Tillie Lewis: The Tomato Queen by Kyle Elizabeth Woods. If you would like to join us please RSVP to 2schneiders@comcast.net •O pioid Brochures- addiction has become an epidemic and the AMA Alliance has produced an educational brochure on addiction and what to look for. They are good for schools, senior centers and just for your own personal information. We have lots of brochures, if you have an organization or school who would want some please contact me. The brochures are cobranded with AMAA and printed with a grant from the CMAA. •W estern States Regional meeting- every year one of the Western States (California, Colorado, Nevada, Arizona, Oregon and Utah) hosts a meeting. This year it is February 8-11,2018 in Las Vegas and will focus on “Mindfulness”.

Spouses are welcome, as activities are also planned for them. Check the AMAA website for more information or contact conference chair Jacqueline Lee at jlnguynlee@gmail.com

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•P hysician Burnout and the Opioid Epidemic are covered in each of the latest editions of the Physician Family magazine www.physicianfamilymedia.org. Each topic was covered in depth and available on the website. The magazine is a publication of the AMA Alliance and a benefit of AMA Alliance membership.

•D isaster fund- www.cmaalliance.com. Visit the state Alliance website for information on a disaster fund for physician families in the fire area in Sonoma/Napa. The state alliance is a 501c3.

•H elen Stein Memorial Nursing Scholarship- two scholarships are given each year for students of Delta College Nursing program. Donations may be sent to Delta College Financial Aid Office or to the Alliance. If mailed to the Alliance send attention Florence Kamigaki, 3849 Peninsula Court Stockton 95219 Checks should be made out to the Helen Stein Scholarship.

•T he Alliance at all three levels- local, state and national – main objective is the support of the physician family starting with the training years and into retirement.

•W e support the SJ Medical Society in their endeavors where we can either help with volunteers or financially.

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Gail Joseph, M.D.

FALL 2017

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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.

DECEMBER 13TH 2017: MEDICARE UPDATES 2017

11:00AM to 1:00PM

Join us for our annual Medicare Update workshop for physicians and office staff. This 2 hour seminar will cover relevant information about current, future and proposed changes for the coming year!

Cheryl Bradley~ Associate Director, CMA Center for Economic Services

JANUARY 10TH, 2018:

BEYOND MACRA, THE FUTURE OF HEALTHCARE

11:00AM to 1:00PM

Do not miss this exciting presentation on how to take your practice “Beyond MACRA.” We will discuss the larger picture of why preparing your practice for new payment models and incentive opportunities in the future are critical to success. Learn how to validate that focusing on efficient and effective outcomes driven care will bring you a return on your investment.

Irv Barnett, MBA, CMPE Founder Irv found his calling, completing a master’s program in health care administration. After years of university hospital administrative experience, he has successfully led both independent and hospital-based physician groups, optimizing their partnerships with local health systems. Irv’s particular areas of knowledge in the medical practice include; identifying key revenue generating opportunities, creating new workflows, benchmarking and optimizing revenue cycle controls and forging new governance partnerships between all stakeholders in the organization.

Irv’s goal, when working with a group of practices, is to do “whatever it takes” by helping the management team get the resources they need to succeed whether it’s branding, managing risk, strategic planning, or operational improvements.

FEBRUARY 14TH, 2018: THE PATIENT EXPERIENCE

11:00AM to 1:00PM

Welcome to the Age of Consumerism! The breakthroughs we’ve enjoyed from companies such as Amazon, Apple, Uber, YouTube, and Yelp have simplified our lives in countless ways; offering customers choice, information, speed, and a world-wide platform. It’s wonderful when

you’re the customer. It’s overwhelming when you’re the vendor.

For many years, healthcare was immune to this sweeping phenomenon, but not anymore. Customers, consumers, patients – people - now expect all businesses to operate like these pioneering companies. Even the government has gotten onboard and begun setting higher standards for hospitals and healthcare providers.

So how can you possibly match the uniquely important, complex, and intimate nature of healthcare with that of buying a pair of shoes online or ordering a ride downtown? The Patient Experience team from Hill Physicians Medical Group will help guide you in their upcoming presentation. You’ll learn why Patient Experience matters, how it is measured, and what you can do for your own practice. You’ll leave with specific tools and ideas you can use in your practice that afternoon. ~The Patient Experience team from Hill Physicians Medical Group

MARCH 14TH, 2018:

PRACTICE MANAGEMENT 101

11:00AM to 2:00PM

Join us and learn from the expert!

CMA’s Physician Advocate Mitzi Young will help you identify opportunities for increased revenue and teach you best practices for implementing effective policies, procedures and processes into your medical office.

Topics Covered: • Three Strategies for Better Financial Outcomes • Common Practice Mistakes Costing You Money • Managing Patient Scheduling • Improving Patient Experience • Monthly Reports Every Practice Should Review • Effectively Processing Denied Claims • Marketing Your Practice for Success • Questions Every Office Should Ask Yearly ~ Mitzi Young is the Physician Advocate, for the CMA, RCMA and SBCMS. Mitzi brings 25 years of experience and expertise in the health care industry. 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 operations and business manager for a specialty practices and for an ambulatory surgery center. 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

Alzheimer’s Association Launches Toolkit Information to Aid Providers with New Medicare Code

The Alzheimer’s Association has released a Cognitive Impairment Care Planning Toolkit for care providers.

This comprehensive resource provides critical information and best practices for physicians, nurse practitioners, and physician assistants to better provide necessary care planning for individuals with cognitive impairment including Alzheimer’s and other dementias — which is now covered by Medicare.

Following a dementia diagnosis, care planning is crucial to improving outcomes and maintaining quality of life for the diagnosed and their caregivers, as well as controlling costs and planning appropriately for the future. The new G0505

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Medicare code provides reimbursement for a clinical visit that results in a comprehensive care plan, allowing clinicians to develop a care plan and identify appropriate community support services that can contribute to a higher quality of life for those living with cognitive impairment.

The Cognitive Impairment Care Planning Toolkit was developed by the Alzheimer’s Association with input from other experts in the field. The toolkit, available at alz.org/careplanning, serves as a resource for clinicians to understand what the G0505 Medicare code covers, and to provide a wide variety of resources for the clinician to utilize in care planning sessions.

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A world without Alzheimer’s The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support, and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s. For more information, visit alz.org.

“For far too long, individuals were given a diagnosis and little (CMS) to pay for cognitive and functional assessments and else. We have worked with thousands of families who have care planning for patients with Alzheimer’s disease and other had a better experience living through dementia because they cognitive impairments. The decision, was supported by the had plans in place”, said Donna Beal, Alzheimer’s Association, Alzheimer’s Association and came following rapidly growing California Central Chapter, Vice President Program Services and Advocacy.

“Proper care planning results in fewer hospitalizations, fewer emergency room visits, and better management of medication — all of which improves the quality of life Today, an estimated 5.5 million Americans are living with the for both patients and caregivers, and helps disease, and that number could rise as high as 16 million by 2050. manage overall care costs.”

5.5 million

Through the release of the Toolkit, utilizing our wide chapter network, and engaging medical professionals, the Alzheimer’s Association is working to ensure that eligible care providers are aware not just of the new code, but also of the best way to conduct a proper evaluation and care planning session under the code.

Materials in the toolkit include: • Overview of the code; • E asy access to validated tools to assist with diagnosis, such as the Mini-Cog™ and the Dementia Severity Rating Scale; • Safety Assessment Guide; • Caregiver Profile Checklist; • End of Life Checklist; and • P atient and Caregiver Resources.

The Alzheimer’s Association and its sister organization the Alzheimer’s Impact Movement (AIM) played a critical role in the decision by the Centers for Medicare & Medicaid Services

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bipartisan support in Congress for the Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act (S. 857, H.R. 1559), legislation conceived by the Alzheimer’s Association. And, to ensure the success of the new code, the Alzheimer’s Association Expert Task Force provided information and suggestions on its content and use to CMS. The Alzheimer’s Association Expert Task Force, comprised of a diverse group of experts from across the country that are currently providing care for individuals with Alzheimer’s and other dementias, also provided input on the Toolkit.

Today, an estimated 5.5 million Americans are living with the disease, and that number could rise as high as 16 million by 2050. What’s more, over 85 percent of people with Alzheimer’s and other dementias have one or more other chronic conditions, such as diabetes or heart disease. Care planning is critical for coordinating care and managing chronic conditions.

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Public Health

Update

From Health Tips for Patients to Well-Being Equity Tips for Policymakers Alvaro Garza, MD, MPH

Clinicians often encourage their patients to stay healthy with tips like ‘don’t smoke’, ‘eat a healthy diet’, ‘exercise regularly’, ‘drink in moderation’ and ‘practice safe sex’, among many others. But, more and more, health care professionals are realizing that, for many people and for whole communities, multiple barriers and obstacles prevent them from acting on such advice.

Understanding this and to help their patients’ ability to act on the health tips, some physicians might like to advise their patients to ‘don’t be poor’, ‘live near good supermarkets with affordable fresh produce’, ‘live in a safe neighborhood with parks close by’, ‘work in a rewarding job with good compensation’, and ‘have wealthy parents’. Of course, even if they were to give such advice, they’re not much able to assist their patients realize these “upstream” tips.

It’s intuitive and well known that our social and physical environments shape the choices available to us and thus influence our health outcomes. Health research has determined the most important factors that drive the health outcomes of death and disease, and they can be grouped. Social and economic factors account for about 40%, health behavior factors account for about 30%, clinical care access and quality factors account for about 20%, and physical environment factors account for

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about 10% of a community’s health (see graphic for example). Finally, social policies and programs shape most of those factors. Our risk behaviors are strongly influenced by social inequities, like racism,

sexism, classism, and by inequitable living conditions, like housing, neighborhoods, employment, and transportation.

To get to thriving and flourishing people and communities, we must

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consider more than health outcomes. Well-being includes positive emotional responses, satisfaction in various domains, and happiness. The research literature has found that flourishing people report the fewest limitations of activities of daily living, the fewest missed days of work, and the healthiest psychosocial functioning, with low levels of helplessness, clearly defined life goals, high levels of resilience, and high levels of intimacy. Health, then, is an important determinant of well-being. And, well-being is associated with positive outcomes for people, organizations (public and private), and populations.

So, how do we get to better health and well-being for residents and communities?

Physicians and the Medical Society should take every opportunity to raise awareness about and advocate for health and well-being equity in all policies. Health professionals are generally well respected and credible, and advocacy is a key means of promoting favorable policy changes. We must urge and encourage our policymakers to act on ensuring policies that allow opportunities for people and communities to take action for better health and well-being. Through such policies, we help enable and empower our patients and communities to make the healthy choices be the easy choices by creating the circumstances and opportunities in which they’re available.

Here, some best health and well-being equity tips for policymakers: do all you can to ensure that local, state, and

national policies provide for equal and fair opportunities for everyone, every day, everywhere a) for quality education and job training, b) for living wages, c) for quality affordable housing, d) for affordable health care insurance, e) for linguistically and culturally competent quality health care, f) for safe community spaces for regular physical activity, g) for healthy affordable food, h) for healthy physical environments and, above all, always favor and protect people’s health and well-being over profits.

This remainder includes a personal note.

The National Academy of Medicine’s Culture of Health program (nam.edu/cultureofhealth) is a multi-year collaborative effort to identify strategies to create and sustain conditions that support equitable good health nationwide. In the summer of 2017, their Visualize Health Equity nationwide community art project (nam.edu/visualizehealthequity) called for submissions from artists of all kinds to illustrate what health equity looks, sounds, and feels like to them. Being an occasional poet, I submitted a bilingual poem about what I observe and believe many Latinos experience in the San Joaquin Valley. I titled it “Tri-Bi in the ‘Land of Opportunity’; where the bi-lingual, bi-cultural, bi-national demand equity in all policies”. It was selected to appear in their pop-up and online gallery and I was invited to attend their upcoming meeting. I share most of it here; Spanish words italicized.

Donde esta la oportunidad en este ‘pais de oportunidad’?

Who gets the opportunities in this “land of opportunities”?

Full of resources está la sociedad.

Policies don’t favor sharing para llegar a la equidad.

Me dicen que ahora, I’m losing my vision, Por no poder atender to diabetes, my condition.

A more liveable wage nos deben pagar.

So only this junk food podemos comprar.

I am a young mother, con hijo muy sano.

Can’t get health insurance, though I work todo el año.

Solo los ricos can afford care.

Y para nosotros? They do not care.

Mis hijos con asma, from so dirty, the air.

With only this farmwork, no nos podemos mover.

We don’t find oportunidades In these malditas y pobres vecindades

Soy yo el anciano. In clinic, no hay de mi gente.

To help interpret my ills, forzado a traer un adolescente.

El english, por no poderlo hablar, The doctors no me quieren tratar.

I am an injured immigrant indocumentado, I can recover well, con mi gente a mi lado.

Las politicas injustas keep families apart.

Les tenemos que integrar a little bit more heart.

I am a college student, tratando de mejorar mi vida.

Please give me information. No quiero oir que tengo SIDA. Todos queremos equidad in education.

Nos ayudará to improve our situation.

I love my two countries, la vida loca de dos paises.

This has been and is our life, en ambos estan nuestras raices.

Tri-bi’s want and demand justicia y oportunidad, for a better vida y sociedad con equidad.

Soy yo el campesino, I don’t understand what I hear: Para infección de TB, I’ll take medicines for a year?

Porque no hay justicia for those who work farms?

Todos merecemos to work free from harms.

Thank you for all you do for the health and well-being of all our residents.

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National diabetes prevention programs make big strides Without intervention, 15 to 30 percent of your patients with prediabetes will progress to type 2 diabetes within five years. Translation: Over the next five years, a typical large clinical practice could experience a 32 percent increase in the number of patients with diabetes.

Are you still unsure about engaging with a diabetes prevention program (DPP) to prevent type 2 diabetes in your patients? Study results recently published in Diabetes Care, a journal of the American Diabetes Association, may encourage you to reconsider.

The study examined the first four years of the National Diabetes Prevention Program (NDPP) and how effective structured lifestyle change programs were for participants diagnosed with prediabetes or at high risk for type 2

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diabetes. The program goal is to have participants lose a minimum of 5 percent body weight in six months, with an additional six months of maintenance.

A 2002 DPP study serves as the yardstick to measure participants’ progress. That study showed that adults ages 18 and older at high risk for diabetes who lost 5 to 7 percent of their body weight experienced a 58 percent risk reduction for type 2 diabetes. Those 60 years and older experienced a 71 percent reduction.

Early results reveal that National DPP participants experienced a higher percentage of body weight loss overall and a moderate increase in physical activity, which help lower their risk for type 2 diabetes.

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Proof is in the numbers Researchers used data from nearly 15,000 adults at high risk for type 2 diabetes. All were enrolled in yearlong Centers for Disease Control and Prevention-recognized DPPs across 220 organizations in 40 states and the District of Columbia.

Participants attended a series of sessions with trained lifestyle coaches who offered incremental feedback on how to optimize behavioral changes.

Examination of the data concluded that the higher percentage of weight loss and improved physical activity could be attributed to greater duration and intensity of session attendance.

Successful participants attended at least 17 sessions and met the minimum goal of 150 minutes of moderate to vigorous physical activity each week. Overall, nearly 36 percent achieved the 5 percent weight loss goal.

Weight loss generally increased as the number of sessions attended increased. For every additional session participants attended and every 30 minutes of activity reported, they lost an average of 0.31 percent of body weight.

Study results indicate that participation in NDPPs across a large number of delivery organizations proves successful.

National DPPs ease clinical burden of prediabetes Since prediabetes is a reversible condition, the National DPP is an evidence-based tool that can help your patients lower their risk of developing type 2 diabetes, reducing the likelihood of illness, use of medication to control the disease and medical expense associated with the disease.

“Those with diabetes are 100 percent more likely to develop hypertension, 80 percent more likely to be hospitalized for heart attack and 70 percent more likely to die from heart disease or stroke,” said Ruth Haskins, M.D., past president of the California Medical Association (CMA).

Three years after program completion the clinical impact of the National DPP includes: • 15 fewer new cases of diabetes • 8 fewer patients using anti-hypertensive medication • 4 fewer patients using anti-lipid medication Participation in this lifestyle change program after a

three-year follow-up was also nearly twice as effective as metformin showing a 31 percent risk reduction.

In addition to the health benefits to patients, the Centers for Medicare and Medicaid Services also acknowledged that the NDPP model offers cost savings and better quality patient care.

According to the American Diabetes Association, estimated direct medical costs for diabetes in 2012 was $176 billion. However savings for Medicare are estimated to be $2,650 per Medicare beneficiary that participates in a National DPP. “By working with a National DPP, physicians have ready access to a program designed to prevent and/or delay type 2 diabetes, can offer better care with an evidence-based program and can produce better outcomes that lower costs,” said Dr. Haskins.

Additional Resources

CMA has partnered with the American Medical Association to raise awareness of prediabetes resources, help providers connect their patients to CDC-recognized Diabetes Prevention Programs, and allow patients to take charge of their health.

For more ways to connect with and educate your patients, visit the California Medical Association (CMA) diabetes prevention web page at www.cmanet.org/diabetesprevention.

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New Members

13 NEW

SJMS MEMBERS THIS FALL!

...and even more on the way.

Michael Balduzzi, MD

Bao Vue, MD

Lydia Kim, MD

Allergy Immunology

OB/GYN

Dermatology

4628 Georgetown Place Stockton, CA 95207

7373 West Lane Stockton, CA 95210 AT Still University - Missouri

7373 West Lane Stockton, CA 95210 University of Wisconsin Medical School

Sarabjit Gill, MD Pediatrics

Terry Vien, MD

7373 West Lane Stockton, CA 95210 St. Petersburg State Medical Academy - I. I. Mechnikov

Anesthesiology 7373 West Lane Stockton, CA 95210 Western University of Health Sciences

Adesuwa Obasuyi, MD

Kamal Pradhan, MD

Child and Adolescent Psychiatry

Pediatrics

7373 West Lane Stockton, CA 95210 Northeastern Ohio University College of Medicine

7373 West Lane Stockton, CA 95210 Kolkata Medical College and Hospital

Nilima Bangalore Prasanna Kumar, MD

Vibha Joshi, MD

Internal Medicine

7373 West Lane Stockton, CA 95210 St. George’s University School of Medicine

2185 West Grantline Road Tracy, CA 95377 Bangalore University, Bangalore Medical College

OB/GYN

Yu Yu Shu, MD Anesthesiology 7373 West Lane Stockton, CA 95210 University of Wisconsin Medical School

Sai Aquisap, D.O. Family Practice 7373 West Lane Stockton, CA 95210 Touro University College of Osteopathic Medicine

Farhad Yazdi, D.O. Family Practice 1721 W Yosemite Ave Manteca, CA 95337 New York College of Osteo Medicine of NY Inst of Tech

Melissa Silverman, MD General Practice

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Introducing the San Joaquin Medical Society MemberCard!

As part of your membership with San Joaquin Medical Society you will receive quality discounts on dining, attractions and more with the brand new SJMS Membercard!

• Enjoy discounts on dining at more than a dozen local restaurants.

• Save when visiting participating area attractions and wineries!

DIRECTORY RSHIP OF MEMBE BENEFITS

• Earn reward points at over 11,000 online retailers nationwide.

Merchants honoring the SJMS MemberCard: • Midgley’s Public House • Papapavlo’s Bistro & Bar • Ben Mackie Fitness • Mettler Family Vineyards • ...and many more!

Plus gain access to the MemberCard Mobile App available for both Android and iPhone devices. The App allows you to find available discounts, map to participating businesses and WINTER redeem benefits directly on your phone!

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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 Institute CMA CAN HELP! March 24 - 26, 2017 I’VE RECOVERED

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 •CMA Do you members. have questions about Covered California?

• Do you need help with Medicare-related issues?

CMA’s Center for Economic Services is staffed by practice management experts with a combined experience of over 125 years in medical practice •operations.

Are you not Our being paidisaccording to your contract? goal to empower physician practices by providing resources and guidance to •improve Are you receiving untimely requests for refunds or is a the success of your practice.

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

payor recouping money from your check without

• 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, 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.

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

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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SAN JOAQUIN PHYSICIAN

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In Memoriam

In Memoriam Agostino Puccinelli, MD

AGOSTINO PUCCINELLI, MD March 26, 1930 - October 30, 2017

Pursuing his childhood dream to be a doctor, Agostino attended Creighton Medical School in Nebraska where he met his wife, Nellie Katherine.

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Agostino Puccinelli, MD, age 87, of Stockton, California, passed away Monday, October 30, 2017. At the time of his death, Agostino’s children surrounded his bedside at St. Joseph’s Hospital.

Agostino was born on March 26, 1930, in Los Angeles to Dante and Santina Puccinelli.

Dante immigrated from Italy to the United States in 1918. He married Santina in 1929 and had two children, Agostino and Donna.

Agostino spent his childhood attending private Catholic schools and supporting his father at his Italian grocery store called Europa’s. Agostino attended Sacred Heart Elementary School, Cathedral High School and earned an undergraduate degree from Loyola University in Los Angeles.

Pursuing his childhood dream to be a doctor, Agostino attended Creighton Medical School in Nebraska where he met his wife, Nellie Katherine. Soon after graduation from Medical school, Agostino traveled back to Los Angeles, married Nellie Katherine, and began a family while serving three years as a Captain and physician in the United States Air Force.

In 1961, Agostino moved his young family to Stockton, California, and opened up a private family practice where he served as a family physician and general surgeon for over 40 years. He was a member

of the San Joaquin Medical Society for 56 years. Agostino and Nellie Katherine continued to grow their family to eight children — five sons and three daughters.

They supported their children in everything they pursued, putting all eight of their children through college.

Agostino was a devout Catholic, caring family doctor, a devoted husband to his wife of 61 years, and loving father to his eight children, twenty-one grandchildren and one great grandchild. If he wasn’t caring for his patients at the office, hospital or rest homes, he was playing football, baseball, or badminton in the backyard with his children.

He was a loyal Notre Dame football fan and always maintained his love and loyalty to the Los Angeles Dodgers.

In addition to his wife, Nellie Katherine, he is survived by his sister Donna (Evan) Whitworth of Manhattan Beach, sons Michael (Kristin) Puccinelli of Sacramento, Robert (Carolyn) Puccinelli of Stockton, Daniel (Sue) Puccinelli of San Clemente, Stephen Puccinelli of Elk Grove, Brian (Meg) Puccinelli of Rolling Hills Estates, daughters Ann (Tony) Correnti of Playa del Rey, Kathleen (Joey) Raspo of Vernalis, and Lisa Puccinelli of Stockton. He was also survived by 21 grandchildren and one great granddaughter.

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