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VOLUME 68, NUMBER 4 • DECEMBER 2020
PICTURED ABOVE: CARDIAC CATH LAB TECHNOLOGIST NORMAN JONES, CARDIAC ELECTROPHYSIOLOGIST DR. RASHAAD CHOTHIA, AND ANESTHESIOLOGIST DR. VIVIAN KIM ARE READY TO BEGIN A CATHETER ABLATION PROCEDURE AT DAMERON HOSPITAL.
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9 PRESIDENT'S MESSAGE 12 IN THE NEWS 20 LEGISLATIVE WRAP-UP 30 20 YEARS FOR VISIONARY COUNCIL 39 FINDING HOPE 44 EMPLOYMENT LAW CHANGES 48 STATE TOBACCO TAX-FUNDED PROGRAM 50 PRACTICE NEWS AND RESOURCES 54 PUBLIC HEALTH UPDATE 58 NEW MEMBERS
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PRESIDENT Hyma Jasti, MD PRESIDENT ELECT Raghunath Reddy, MD TREASURER Cyrus Buhari, DO BOARD MEMBERS Sanjay Marwaha, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Philip Cheng, MD, Benjamin Morrison, MD, Maggie Park, MD, Nguyen Vo, MD, Sujeeth Punnam, MD, Richelle Marasigan, DO, John Zeiter, MD
MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Maria Rodriguez-Cook
SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Hyma Jasti, MD MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design
COMMITTEE CHAIRPERSONS
CONTRIBUTING WRITERS Hyma Jasti, MD, Jo Ann Kirby,
CMA AFFAIRS COMMITTEE Larry Frank, MD
Gwen Callaway, MPH, Maggie Park, MD, Nikki Chan,
DECISION MEDICINE Kwabena Adubofour, MD
Jamie M. Bossuat, Esq
MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD
CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD
THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.
James R. Halderman, MD, Raissa Hill, DO Richelle Marasigan, DO, Ramin Manshadi, MD
PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:
Kwabena Adubofour, MD, Philip Edington, MD
San Joaquin Physician Magazine
Harpreet Singh, MD
3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm
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EXECUTIVE DIRECTOR’S REPORT
IS IT OVER YET? To say that 2020 has been a challenge is the understatement of the century! It still seems surreal as I reflect to February when my sister and I flew to visit my daughter at college in Los Angeles. The first and last trip of the year. The flurry of events happening during an unprecedented pandemic has been overwhelming at times. Here we are nine months later, and the world still feels a bit upside down. We are grateful for the dedicated physicians, nurses and other healthcare workers in our community and across the country who stepped up without the blink of an eye to care for patients who were hospitalized with COVID-19; many (initially) did so without the proper PPE to keep themselves, patients and their families safe. They continue to be there for patients medically and emotionally, when they cannot have visitors. LISA RICHMOND
As with other small businesses, many of our physicians were sidelined, asked to temporarily close or reduce patient visits and procedures creating further hardship in an already difficult situation. But, as always, they have remained steadfast in their commitment to their patients and the safety of their community. Benjamin Franklin said “out of adversity, comes opportunity” and that has most certainly been the case. Years of barriers to telehealth were removed to allow physicians to care for patients remotely. We’ve all had to think outside the box and thus have seen unimaginable creativity and innovation. There has been no “business as usual this year.” This was evident when CMA, with the help of local medical societies, took on the huge logistical task of distributing millions of pieces of free PPE donated by the State of California to members and non-members alike. At SJMS our goal this year has been simply to help and support our members and their practices, however necessary. We understand the tremendous sacrifices that have been made and have never been prouder to represent physicians. As our local COVID-19 numbers rise, we pray the surge will not be as bad as predicted and look forward to a safe and effective vaccine. Although I wouldn’t wish to relive this crazy year, it has taught us all valuable lessons in slowing down, spending quality time with family and taking care of one another. We wish you health and happiness and look forward to 2021.
Happy Holidays,
Lisa Richmond
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A message from our President > Hyma Jasti, MD
Mental Wellbeing with COVID 19 Pandemic As we draw close to nearly a year of living in a pandemic, I continue to be in awe of our community’s inspiring strength. If you have not yet heard the outpouring of love to healthcare professionals, let me add my voice and say that I thank you for every day that you’ve woken up and gone to work, and every one of your sacrifices and contributions to patientcare. Your efforts and sacrifices are deeply appreciated and valued well in our community. It is a well-known piece of advice that children are meant to limit their screen time, but that is becoming nearly impossible with the widespread introduction of online schooling as a response to COVID-19. Studies are underway to see the impact of isolation and online schooling, and there is no surprise that social skills are off, as well as the possibility of increased mental health down the line. This applies to both anxiety and depressive symptoms. In adults, especially those of color who are experiencing other forms of trauma at the same time, this is compounded. In our practices, we should continue to take special care to identify and manage potential mental health concerns in our patients, especially in young adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers. We should provide the resources and opportunities for them to meet mental health providers at the appropriate time.
ABOUT THE AUTHOR Hyma Jasti, MD is the current president of San Joaquin Medical Society and the Chief of Adult & Family Medicine for the Central Valley Area for The Permanente Medical Group
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Among the many political changes this election season brought us is Oregon’s decriminalization of all drugs. This reminds me that, no matter any of our personal views, substance abuse is a physical and mental medical condition that can and should be treated. As mental issues skyrocket so will substance abuse, addiction, and overdosing. As we screen for these in our daily practice, remember to treat patients as you would for any other illness, with empathy and evidence-based science. Last but not least, take care of yourselves. Healthcare workers are another population that may suffer increased mental health consequences as a result of this current crisis. It is easy to work into the early hours of the morning answering emails, but it is also important to take an hour or two off, sit with your family, read a book, or sip cocoa by the fire. Though our travel continues to be severely limited, I wish all of you a restful holiday season, with a strong internet connection to make it to all your video family gatherings. Be safe.
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In The News
IN THE
NEWS Delegates Needed 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. The San Joaquin Medical Society is a member of District VI, along with Stanislaus, Merced-Mariposa, Fresno-Madera, Kern, Tulare-Kings and Tuolumne medical societies. Responsibilities include attending approximately 5 virtual district meetings and the annual House of Delegates conference in October. 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. St. Joseph's Cancer Institute and Community Medical Centers Awarded $110,000 to Help Fight Lung Cancer The American Cancer Society (ACS), National Football League (NFL) and San Francisco 49ers have awarded a grant to St. Joseph’s Cancer Institute and Community Medical Centers, addressing lung cancer mortality by increasing screenings and supporting smoking cessation efforts. The grant funding was made possible through ACS’s partnership with the NFL and the league’s Crucial Catch campaign. “St. Joseph’s Cancer Institute is excited to collaborate with Community Medical Centers, NFL and ACS to increase the early detection of Lung Cancer in our community. Lung cancer symptoms typically do not appear until the disease
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Providing staff, physicians, and patients with relevant & up to date information
has progressed to later stages and we would like to improve early detection through the Low Dose CT Lung Cancer Screening exam,” said Kathryn Langford, Cancer Institute Director. The grants are the latest in ACS’s Community Health Advocates implementing Nationwide Grants for Empowerment and Equity (CHANGE) program, which provides funding opportunities as part of the ACS’s commitment to reduce cancer disparities. Since 2009, the NFL’s Crucial Catch has raised more than $20 million in support of ACS. This program promotes health equity and addresses cancer early detection disparities through community-based cancer prevention programs that increase access to necessary cancer screenings. To learn more about St. Joseph’s Lung Cancer Screening Program, please visit StJosephsCares.org/LungScreening. St. Joseph’s Nationally Recognized With An ‘A’ For the Fall 2019 Leapfrog Hospital Safety Grade St. Joseph’s Medical Center was once again awarded an ‘A’ in fall 2020 Leapfrog Hospital Safety Grade, a national distinction recognizing St. Joseph’s achievements protecting patients from harm and providing safer health care. The Leapfrog Group is an independent national watchdog organization driven by employers and other purchasers of health care committed to improving health care quality and safety for consumers and purchasers. The Safety Grade assigns an ‘A’, ‘B’, ‘C’, ‘D’ or ‘F’ grade to all general hospitals
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across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care.
Hanadi Abou Dargham, MD
St. Joseph’s invites you to nominate physicians practicing humankindness at St. Joseph’s or in the community to receive recognition. Call 209.467.6486 or email Catherine. Swenson@dignityhealth.org for more information.
Christina Funghi, MD
Coming January 1st for MediCal Members: California State Pharmacy Carve-Out: MediCal Rx Health Plan of San Joaquin is proceeding full steam ahead to prepare both their members and providers for the January 1, 2021 effective date. HPSJ now has begun to roll out a provider awareness and education campaign. The goal is to generate clarity for HPSJ providers so that they are equipped to correctly engage with the State’s Medi-Cal Rx system from day one. The campaign is driven by recognition that providers are the lynchpin for both members’ uninterrupted health care and – now that the State will be assuming those substantial costs – avoiding pharmacy claims that by mistake land with HPSJ.
Masks for Public Schools in San Joaquin County – Update from Health Plan of San Joaquin (HPSJ) On October 20, the San Joaquin County Board of Supervisors approved the use of Timothy Bechtel, MD Shyh-Fang Cheng, MD up to $428,440 in CARES Act funds for Masks for Schools. In partnership with the San Joaquin County Health Care Services Agency and Recognizing Physicians with Humankindness in coordination with the San Joaquin Office of Education, Each quarter, St. Joseph’s Medical Center recognizes HPSJ ordered 304,000 masks, or twice the number of masks physicians in the community that go beyond clinical as students. The vendor estimates the delivery of masks in excellence to deliver healing with compassion and kindness, batches through the month of November. The Office of also known as humankindness. Most recently, Hanadi Education will distribute the masks to the 14 school districts Abou Dargham, MD, Internal/Family Medicine, Christina and 239 public schools in San Joaquin County by the end Funghi, MD, Pediatrics, Timothy Bechtel, MD, Surgery, of 2020. All involved parties view this as a step to help our and Shyh-Fang Cheng, MD, Neonatology were recognized schools safely reopen, along with other important factors by their patients and peers for going above and beyond and and considerations. displaying genuine kindness to their patients.
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In The News
IN THE
NEWS Health Careers Scholarships & Mentors: Health Plan of San Joaquin For the 2020/21 academic year, HPSJ awarded $77,000 in scholarships, including 17 $3,000 awards and 26 $1,000 awards, for 43 local students to attend various schools. These schools include Modesto Junior College, San Joaquin Delta College, University of the Pacific, CSU Stanislaus, CSU Chico, San Francisco State University, Santa Clara University, UC Berkeley, UC Davis, UC Los Angeles, UC San Diego, UC San Francisco, UC Santa Barbara, and UC Santa Cruz. Students were selected based on academic performance, interest in a career in health care, community service, and a commitment to return and serve our community. Beyond these important financial resources, certain awardees also have the benefit of a personal mentor from our professional HPSJ staff. Further, they are invited to attend quarterly networking check-ins. All 12 Decision Medicine student applicants from San Joaquin County Medical Society were awarded a scholarship of either $3,000 (HPSJ Health Careers Awardees) or $1,000 (HPSJ Extended Program Honorees). Local Convening on Post-Hospital Services Health Plan of San Joaquin organized and hosted the first Central Valley local convening to raise awareness of post-hospital resources and identify the options currently available for Medi-Cal beneficiaries. Among the approximately 70 organizations attending this online convening, 10 representatives, one from each type of specialty provider, presented a snapshot of their services in San Joaquin and Stanislaus counties. HPSJ Commission Chairman, Greg Diederich, presented on behalf of San Joaquin County Health Care Services Agency. With San
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Providing staff, physicians, and patients with relevant & up to date information
Joaquin and Stanislaus being Two-Plan counties, HPSJ and HealthNet both presented, and we co-branded the event. HPSJ has now gathered the profile information from participants in the Local Convening on Post-Hospital Services. The Long-Term Care Resource Booklet 2020 has now been sent digitally to each attendee and is posted on the plan website, www.hpsj.com/long-term-transition-webinar/. The Department of Health Care Services (DHCS) opened the door to this convening opportunity and has stated it is especially interested in local convening sessions in the Central Valley where the need and opportunities are greatest because of the COVID-19 surge on skilled nursing facilities. New Electrophysiology Lab program at Dameron Hospital Dameron Hospital’s new Electrophysiology (EP) Program offers comprehensive diagnostic and treatment options for all cardiac arrhythmias including atrial fibrillation (AFib), ventricular arrhythmias and other conditions requiring complex ablations in San Joaquin County under the leadership of Rashaad Chothia, MD, a board certified cardiologist, electrophysiologist and Dameron’s EP Program medical director. According to Dr. Chothia, each heartbeat is triggered by an electrical impulse in the upper right chamber of the heart. People with AFib have faulty signals that fire so rapidly that the upper chambers fibrillate instead of beating smoothly. These rapidly discharging triggers are called hot spots. To restore normal rhythm, these hot spots must be isolated. “We’re able to offer patients excellent options in treating their heart arrhythmias at Dameron’s EP lab,” says Dr.
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Dameron Hospital Electrophysiology Lab Chothia. “We effectively diagnose the source of arrhythmias by conducting an electrophysiology study, which involves inserting specialized electrode catheters through a blood vessel into the heart chambers to record their electrical activity. This helps determine the source of the abnormal heartbeat and assess whether the patient needs an implantable device like a pacemaker or treatment with a catheter ablation procedure.” The catheter ablation procedure involves guiding a catheter into the heart to destroy or isolate the hot spots that are causing the abnormal heartbeat. In order to accomplish this, we use a 3-D mapping system to detail the heart’s anatomy in conjunction with live cardiac ultrasound imaging to position the catheters in the heart. Some of the catheters locate and record the source of abnormal signals. Once all of the sources are mapped, we use a specialized catheter that accurately delivers radiofrequency waves to create lesions that isolate the faulty electrical impulses and stop them from causing arrhythmias. One of the advantages of our approach is that in most cases, f luoroscopy is not required. We combine catheter contact force technology, 3-D mapping and advanced navigation capabilities to achieve optimal results for the patient.”
Dinesh Vyas, MD, MS, FACS Dinesh Vyas, MD, MS, FACS, joins Dameron Hospital as New General Surgeon Dinesh Vyas, MD, MS, FACS, has joined Dameron Hospital as its new full-time practicing general surgeon. With over 25 years of experience, Dr. Vyas is recognized as a world-acclaimed robotic surgeon, scientist, academic leader, and educator. He received his Masters of Surgery and MBBS from Rajasthan University in India, and served his residencies at Case Western Reserve University in Cleveland, OH, and the University of Pittsburgh in Pittsburgh, PA. Dr. Vyas also served as a research fellow at the Washington University School of Medicine in St. Louis, MO. He is board-certified with the American Board of Surgery and has more than 100 peer-reviewed publications and 200 invited talks with multiple patents in medical devices. His passion and accomplishments revolve around surgery, endoscopy, education, epidemiology, medical device innovation, global health, emergency medicine and healthcare management. Dr. Vyas specializes in advanced laparoscopic gastrointestinal surgery, advanced robotic colorectal surgery, image-guided surgery, endoscopic surgery, thyroid surgery, colonoscopies, adrenal surgeries, Hiatal hernias, complex hernias, breast surgery and trauma surgery. “Our patients receive a full consultation, which includes
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In The News
IN THE
NEWS
Providing staff, physicians, and patients with relevant & up to date information
education on the condition and treatment options,” continues Dr. Chothia. “It’s critical that patients are part of the decision-making process when moving forward with a treatment plan. Every patient and every condition is unique and we want to be sure we provide them with a solution that’s right for them.” Adventist Health Lodi Memorial Family Nurse Practitioner Laura Akahori, FNP-C, Returns to Hospital at Prenatal Clinics Adventist Health Lodi Memorial is pleased to announce board-certified family nurse practitioner Laura Akahori, FNP-C, has returned to the hospital at the prenatal clinics in Lodi and Galt. With more than 25 years of service in the hospital’s obstetrics department, Akahori has the depth and breadth of experience patients rely on for the highest quality care during their pregnancy. She provides prenatal exams and labs, family planning, plus pregnancy education, counseling and support. Inspired by her nurse mother, Akahori followed her into the
Laura Akahori, FNP-C
HAVE SOMETHING TO SHARE? 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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In The News
IN THE
NEWS profession and says, “I’ve always liked taking care of people and helping them learn about their care and options. We are all on this journey of life together, and I’m here to help my patients along the way.” Akahori earned her master’s degree in nursing from Sonoma State University and bachelor’s degree in nursing from California State University, Dominguez Hills. She is certified by the American Academy of Nurse Practitioners. Approachability is a hallmark of her care, and Akahori wants her patients to know, “Never be afraid to ask questions. Sometimes we both learn something from those questions.” Akahori is accepting new patients at the Adventist Health Lodi Memorial Prenatal Clinics in Lodi and Galt. The Lodi clinic is located at 2415 W. Vine St., Ste. 103. More information and appointments are available by calling 209-333-3030. The Galt clinic is located at 387 Civic Dr. More information and appointments are available by calling 209-745-6105. Newsweek Recognizes Adventist Health Lodi Memorial as a Best Maternity Care Hospital Adventist Health Lodi Memorial has been named to Newsweek’s 2020 list of Best Maternity Care Hospitals. The distinction recognizes facilities that have excelled in providing care to mothers, newborns and their families, as verified by the 2019 Leapfrog Hospital Survey. Best Maternity Care Hospitals is part of Newsweek’s Best Health Care series, powered by data from The Leapfrog Group. “At Adventist Health Lodi Memorial, providing a positive birthing experience – through advanced care with a neonatal
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intensive care unit (NICU) and a partnership with UC Davis Health – is something we strive to offer every expecting family,” said Daniel Wolcott, president of Adventist Health Lodi Memorial. “I am so proud of our OB team, who is dedicated to high reliability, patient safety and quality care.” “Best Maternity Care Hospitals showcases an elite group of hospitals from across the country,” said Nancy Cooper, Global Editor in Chief of Newsweek. “These facilities stand out for the care they provide to women and families, and for giving babies a strong start to life. Particularly in these uncertain times, we are honored to share this list of topranked facilities with Newsweek’s readership.” Hospitals named as a Best Maternity Care Hospital have fully met The Leapfrog Group’s standards for maternity care on evidence-based, nationally standardized metrics. This includes lower rates of early elective delivery, NTSV C-section, and episiotomy, as well as compliance with process measures including newborn bilirubin screening prior to discharge and blood clot prevention techniques for mothers delivering via C-section. Adventist Health Lodi Memorial welcomes Craig Garfolo to Wound and Hyperbaric Center Adventist Health is pleased to announce that board-certified podiatrist Dr. Craig Garfolo, DPM, FACPM, has joined Adventist Health Lodi Memorial Medical Office – Wound and Hyperbaric Center. Dr. Garfolo, DPM, FACPM, is a podiatric medicine specialist caring for wound care patients. Dr. Garfolo who has more than 35 years of experience, has
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amputations when necessary. Working at the wound center not only provides me another avenue to exercise my passion in a community I love, but also the privilege of working with such a great and dedicated team to help heal and save limbs,” Dr Garfolo said. Adventist Health Lodi Memorial’s wound center specializes in caring for those with diabetic foot ulcers, infections, foot surgeries, radiation wounds, vascular ulcers, post-operative wounds, pressure wounds and bed sores. Dr. Garfolo completed his residency at Southern California Podiatric Medical Center, LAC-USC Medical Center in Los Angeles. He earned a Master of Science and Doctor of Podiatric Medicine from California College of Podiatric Medicine in Oakland.
Craig Garfolo, DPM FACPM always had an interest in health and helping others achieve it. He says that his career has been extremely challenging but has also been extremely rewarding. “My practice has evolved over the years, and now my surgical focus is treating those with urgent foot problems, including diabetic-related, infections, wounds, and
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He has been married for over 33 years and has two adult children. In his spare time, he spends time with his family, outdoors, traveling and following professional sports. Dr. Garfolo is accepting patients at Adventist Health Lodi Memorial Medical Office – Wound and Hyperbaric Center, located at 2415 W. Vine St., Suite 106 in Lodi. For more information or schedule an appointment, please call 209-333-3066.
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CALIFORNIA’S COMPLETELY UNPREDICTABLE,
TOTALLY CHAOTIC LEGISLATIVE YEAR
As 2019 concluded, reasonable assumptions about 2020 began to emerge. The year was expected to be busy and more polarizing due to the presidential election occurring in November. Large-scale issue-based campaigns calling for new state programs supported by the expected state budget surplus were being announced. State legislators were finalizing their legislative packages. And lastly, the California Medical Association (CMA) was preparing to defeat yet another attempt to eliminate the cap on noneconomic damages incorporated in California’s longstanding professional liability reform law, the Medical Injury Compensation Reform Act (MICRA). In March, the world changed, and California politics and the legislative process went through an unprecedented transformation. On March 19 Governor Gavin Newsom issued the nation’s first statewide stay-at-home order in response to the arrival
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of the novel coronavirus (SARS-coV2) in California. All nonessential businesses, such as restaurants, entertainment centers/activities, etc., were immediately shut down until further notice. The State Legislature was forced to take multiple extended recesses, and all in-person lobbying was prohibited, leading to the cancellation of CMA’s annual Legislative Advocacy Day. The legislative process was completely upended. CMA staff worked diligently to adjust to ever-changing dynamics, as both houses of the Legislature scrambled to implement social distancing guidelines and condense their calendars. In the end, CMA successfully maintained state funding for physician services, defeated proposals to increase or add new administrative burdens onto physicians, and secured a number of Executive Orders to protect medical practices as they faced a pandemic unlike any seen in the past century.
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However, CMA did not escape the legislative session unscathed. The legislature passed, and the governor signed AB 890 (WOOD), which created two new classifications for nurse practitioners (NP). While this measure was passed into law, this matter is far from settled, as the fight to ensure patient safety now moves into the regulatory process. All of CMA’s advocacy centers have prioritized this issue, developed an action plan, and are coordinating with the American Medical Association (AMA) as well as various specialty associations to ensure the bill is implemented in a manner that protects patients and physician practices. BUDGET – ACCESS TO CARE California began this year with a strong economy, historic reserves and a projected surplus of $5.6 billion. Due to the COVID-19 pandemic, the state’s economy took a significant hit, which meant the Governor had to make several difficult decisions when revising his proposed budget in May. The Governor’s May Revision was a complete redrafting of the state budget proposal released on January 10, 2020. In January, the budget proposal increased our state’s investment in health care, which included growing California’s physician workforce. The May Budget Revision, however, sought to reverse course, proposing to cut Proposition 56 funding for increased physician reimbursements, reduce patient benefits in Medi-Cal and strike all investments seeking to expand the physician workforce. Through the budget process in the Legislature, CMA was able to protect: •
$1.2 BILLION in Proposition 56 (tobacco tax) funding, which provides supplemental payments for physician and dental services, family health services, developmental screenings, non-emergency medical transportation and value-based payments. This includes the continuation of all future cohorts of the Proposition 56 Physician and Dentist Loan Repayment Program (years 2-5 of the 5-year program).
•
$1.5 MILLION in General Fund monies to maintain the Proposition 56 Graduate Medical Education program at an ongoing total of $40 million.
•
$33.3 MILLION in ongoing General Fund monies for the continuation of the Song-Brown Healthcare Workforce Training Program.
•
THE EXPANSION OF POST-PARTUM MENTAL HEALTH SERVICES for individuals diagnosed with a maternal mental health condition.
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Through the budget process in the Legislature, CMA was able to protect $1.2 billion in Proposition 56 (tobacco tax) funding, which provides supplemental payments for physician and dental services, family health services, developmental screenings, nonemergency medical transportation and value-based payments. In addition, the revised budget proposal included a 47% increase to the Medical Board of California’s physician and surgeon licensing fee. Through CMA’s advocacy, the Legislature rejected that proposal. Still, the Legislature could revisit the discussion in 2021 when the Medical Board is subject to a review of all of its operations through the Sunset Review process. It is anticipated that the Medical Board will seek a license fee increase in the context of that process. SURPRISE BILLING – AB 72 FIX Since the implementation of AB 72 (Bonta) related to surprise billing, CMA has been working with the Legislature to mitigate the negative impacts on the physician community. This year, AB 2157 (WOOD) was introduced to address the issues surrounding the independent dispute resolution process (IDRP). Along with several specialty societies, CMA was able to secure amendments that allowed physicians to provide more substantial evidence to better defend their claims during an AB 72 payment dispute. Through CMA’s advocacy in the legislative process and with the Department of Managed Health Care (DMHC) directly, an IDRP determination has been in the physician’s favor, a first since the law became effective. However, our work on this issue does not end there. CMA continues to work with regulators and legislators to further ensure a process that is fair and accessible to any physician needing to use it. PUBLIC HEALTH Flavored tobacco products are often the entry point for young people who use tobacco. Over the last several years, a spike in e-cigarette use among the nation’s youth
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has been linked to targeted advertisements of flavored tobacco. Menthol cigarettes, sweet cigars, candy vapes and other flavored tobacco products serve one purpose: to mask tobacco’s harshness and get users hooked to a dangerous life-long addiction. In 2020, CMA combined forces with a large coalition of health care, youth and community organizations to support SB 793 (HILL), which prohibits tobacco retailers, or any tobacco retailers’ agents or employees, from selling, offering for sale, or possessing with the intent to sell or offer for sale, a flavored tobacco product or a tobacco product flavor enhancer. This ban includes e-cigarettes and vaping products, as well as traditional tobacco products. SB 793 crossed the legislative finish line and was quickly signed by Governor Newsom once it reached his desk. The new law will take effect on January 1, 2021. DECREASING ADMINISTRATIVE BURDENS CMA worked with ASSEMBLYMEMBER LORENA GONZALEZ ON AB 2257 to further address challenges for physician practices resulting from a bill passed last year (AB 5) that made significant changes to the definitions of independent contractors and employees, in an attempt to be consistent with the court decision in the Dynamex case. Last year, AB 5 included an exemption for physicians, but there continued to be a need to address business-to-business and referral agency arrangements. CMA successfully secured amendments to address those outstanding concerns, and the bill was signed into law. CMA also helped lead a coalition to defeat SB 977 (MONNING), which sought to expand the California Attorney General’s existing authority related to mergers and acquisitions in the health care industry. Although CMA policy supports governmental actions designed to ensure hospital market competition, this broadly drafted legislation established a wide definition of health care transactions, which included leasing and other medical contracting arrangements. SB 977 ultimately failed to move off the Assembly floor.
CMA worked with Senator Dr. Richard Pan to exempt independent medical practices from the mandate, and secured physician involvement in future rulemaking and guidance on this issue and supply chain sustainability.
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In addition to the above, CMA worked with multiple legislative offices to stop the creation of new administrative burdens related to the COVID-19 pandemic. AB 685 (REYES) requires employers to provide written notification within 24 hours to their employees if they were potentially exposed, at the workplace, to a person who has COVID-19. As this would have required physician practices to report this information daily, CMA secured amendments that exempted employees who conduct COVID-19 testing or screening or that provide direct care to individuals known to have tested positive for COVID-19. This approach balanced CMA’s support for notifying employees of possible exposure and protecting physician practices from being overburdened. Senator Richard Pan, M.D., introduced legislation requiring the state and health care employers to procure a stockpile of personal protective equipment (PPE) as a means of addressing future equipment shortages like the one experienced at the outset of the pandemic. As introduced, the bill would have created a significant burden on independent physician practices. CMA worked with Dr. Pan to exempt independent medical practices from the mandate, and secured physician involvement in future rulemaking and guidance on this issue and supply chain sustainability. IMPLEMENTING TELEHEALTH At the onset of the statewide public health emergency, CMA worked to build upon AB 744 (AGUIAR-CURRY, 2019), which required commercial health plans to implement payment parity for services provided via telehealth. An association-wide advocacy effort allowed CMA to secure widespread payor coverage across the entire health care system that required all commercial, Medi-Cal and workers’ compensation payors to immediately cover telehealth services at the same rate as in-person services. To achieve this outcome, CMA worked with each independent agency and department to ensure consistency between the DMHC and the Department of Health Care Services (DHCS) as well as the California Department of Insurance (CDI) and employers under the Department of Workers’ Compensation (DWC). Each agency continued to post updated guidance consistent with CMA’s input, and often referenced CMA’s sponsored telehealth legislation (AB 744) as their models. CMA also advocated for the Governor to waive existing laws requiring consent prior to providing telehealth services. During the COVID-19 state of emergency, these waivers ensure that no enforcement action would be authorized against covered health care providers providing telehealth services via remote communication technologies that may not fully comply with these privacy laws. CMA was successful in receiving these waivers at the state and federal levels.
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DECREASING LIABILITY FOR MEDICAL PRACTICES CMA worked with a coalition of health care and other business organizations to defeat AB 2570 (STONE). This bill would have exposed physicians and their practices to frivolous lawsuits, making it more difficult for physicians to maintain the viability of their practices. SCOPE OF PRACTICE As discussed earlier, ASSEMBLYMEMBER JIM WOOD’S AB 890 creates two new categories of nurse practitioners, who would be allowed to provide services without standardized procedures. Despite the fervent work of CMA, the AMA and numerous specialty societies, the bill passed the legislature and was enacted in law. The bill does not eliminate physician supervision and leaves room for interpretation regarding the role supervision can still play in the physician-NP relationship. It should also be noted that existing NPs are not impacted by AB 890 and must continue practicing under standardized procedures. In addition, the measure includes a delayed implementation of three years to allow for the completion of the regulatory process. A detailed factsheet on this bill can be found on the CMA website at cmadocs.org. Despite this setback, the fight to protect patient safety will now roll into the regulatory process. CMA will continue to work in tandem with AMA and our grassroots network to keep physicians engaged on this issue.
UNCERTAINTY CONTINUES Although the 2019-2020 legislative session has finally concluded, uncertainty continues. In November, a new fiscal outlook will reveal whether the state budget is still facing a multi-billion shortfall. December will provide an idea of whether the Legislature will reopen the Capitol and allow for in-person lobbying. The political process will continue to be uncertain. However, there will be a consistent truth among all the unpredictable chaos: CMA will always be in the midst of every critical political and legislative battle, utilizing our resources to advance an agenda that protects physician practices and empowers the physician voice. On the following pages, you will find details of the major bills that CMA followed this year. In unity,
Janus L. Norman CMA Senior Vice President Centers for Government Relations and Political Operations
CMA will always be in the midst of every critical political and legislative battle, utilizing our resources to advance an agenda that protects physician practices and empowers the physician voice. In other scope developments, CMA and the American College of Obstetricians and Gynecologists (ACOG) resolved a long-standing issue with the certified nursemidwives (CNM) through SB 1237 (DODD). This bill creates a framework for CNMs to perform certain functions within the scope of midwifery independently while maintaining a collaborative relationship with a physician and surgeon. The measure also includes a requirement for informed patient consent as well as patient outcome reporting requirements.
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PRIORITY BILLS
SUCCESSFULLY NEGOTIATED BILLS
AB 2157 (WOOD): HEALTH CARE COVERAGE: INDEPENDENT DISPUTE RESOLUTION PROCESS
AB 288 (CUNNINGHAM): CONSUMER PRIVACY: SOCIAL MEDIA COMPANIES
This bill codified fixes to the independent dispute resolution process under AB 72 (2015). Specifically, AB 2157 codifies a process by which all parties may submit confidential information to provide evidence for their claim in the IDRP that cannot be seen by the other party. Other provisions of the bill codify current regulations that the Department of Managed Health Care has already adopted because of CMA’s advocacy. Status: Signed by the Governor (Chapter 278, Statutes of 2020).
SB 483 (PAN): DEPARTMENT OF MOTOR VEHICLES: RECORDS: CONFIDENTIALITY This bill would add public health officers to the list of public officials and employees whose home addresses are prohibited from disclosure in the records of the Department of Motor Vehicles. However, existing law already affords public health officers the same level of privacy as other elected officials, when it comes to the disclosure of personal information. An existing program was identified that offers stronger protections than SB 483. The Safe at Home program, administered by the Secretary of State, shields the applicant’s home address from the public record. CMA advocated for the urgency of adding public health officials to the Safe at Home Program; Governor Newsom issued Executive Order N-80-20 to that effect. The order permits public health officials to participate in the Safe at Home address-confidentiality program, to reduce the kind of harassment many public health officials have been subject to in recent months. Status: Implemented through Executive Order.
SB 793 (HILL): FLAVORED TOBACCO PRODUCTS CMA and a large coalition of health care, youth and community organizations supported SB 793. The new law will take effect January 1, 2021, and will prohibit retail stores and vending machines in California from selling flavored tobacco products. Status: Signed by the Governor (Chapter 34, Statutes of 2020).
This bill would have allowed social media users to have their information permanently deleted by social media companies at their request. The definition used in the bill for “social media company” was broadly defined to include any entity providing electronic services and accounts; therefore CMA successfully negotiated an exemption for physicians and medical services to ensure they weren’t inadvertently captured under the legislation. Status: Failed in the Assembly Privacy and Consumer Protection Committee.
AB 1131 (GLORIA): MEDI-CAL: COMPREHENSIVE MEDICATION MANAGEMENT This bill would have established comprehensive medication management (CMM) services as a covered benefit under the Medi-Cal program, and would have required CMM services to include the development of a care plan in collaboration with the beneficiary and the beneficiary’s health care providers to address identified medication therapy problems. CMA collaborated with the author and sponsors to limit the instances when pharmacists can perform CMM, to if the physician refers the patient due to specific criteria outlined in the bill. Status: Failed in the Senate Appropriations Committee.
AB 1611 (CHIU): EMERGENCY HOSPITAL SERVICES: COSTS AB 1611 would have required a health care service plan contract or an insurance policy to provide that if an enrollee receives covered services from a non-contracted hospital, the enrollee or insured is prohibited from paying more than the same cost sharing that the enrollee would pay for the same covered services received from a contracting hospital. The bill would have also required a health care service plan or insurer to pay a non-contracted hospital for emergency services (excluding post-stabilization services) rendered to an enrollee pursuant to the reasonable and customary value of the services provided. CMA secured amendments that would have ensured that the provisions of the bill did not apply to physicians and surgeons. Status: Failed in the Senate Health Committee.
AB 1998 (LOW): DENTAL PRACTICE ACT: UNPROFESSIONAL CONDUCT This bill was introduced to ensure patient protections for
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dental patients receiving services through telehealth from direct-to-consumer orthodontic businesses. Initially, the language required an in-person exam by a treating dentist prior to a patient receiving orthodontic therapy. Given the specific focus on providing orthodontic therapy through telehealth, CMA worked with the California Dental Association on amendments to this legislation that attached protections to the orthodontic standard of care, rather than the method of delivery or technology, consistent with CMA telehealth advocacy on behalf of physicians. Status: Failed in Senate Business, Professions and Economic Development Committee.
AB 2014 (MAIENSCHEIN): MEDICAL MISCONDUCT: MISUSE OF SPERM, OVA, OR EMBRYOS: STATUTE OF LIMITATIONS AB 2014 would allow for prosecution, both civil and criminal, for crimes involving the unlawful use or implantation of sperm, ova, or embryos to be commenced within three years after the discovery of the offense. CMA secured amendments that remove the civil provisions of the bill and bring the statute of limitations in-line with MICRA to limit liability exposure. Status: Signed by the Governor (Chapter 244, Statutes of 2020).
AB 2257 (GONZALEZ): WORKER CLASSIFICATION: EMPLOYEES AND INDEPENDENT CONTRACTORS: OCCUPATIONS: PROFESSIONAL SERVICES This bill, AB 2257 – previously AB 1850 – became the designated vehicle to clean-up last year’s AB 5, regarding Dynamex and independent contractors, acknowledging the need for additional clarifications to the now existing law. CMA received an exemption for physicians in last year’s Dynamex legislation (AB 5, Gonzalez). This year, CMA advocated for and secured language in this bill to better allow medical groups to continue contracting with other non-exempted medical provider practices. In particular, CMA received clean-up language in the physician exemption section from last year, as well as language better ensuring medical groups can utilize the existing business-tobusiness and referral agency exemptions in the bill. This bill included an urgency provision and has already been signed by the Governor; therefore these fixes are already in effect. Status: Signed by the Governor (Chapter 38, Statutes of 2020).
AB 2273 (BLOOM): PHYSICIANS AND SURGEONS: FOREIGN MEDICAL GRADUATES: SPECIAL FACULTY PERMITS
Medical Centers like Cedars-Sinai to apply for and receive Special Faculty Permits (SFP) for physicians with specialized expertise by allowing these academic medical centers to directly apply for an SFP without changing any state licensing requirements or allowing a non-licensed California physician to practice outside of the current special permit requirements. Status: Signed by the Governor (Chapter 280, Statutes of 2020).
AB 2276 (REYES): CHILDHOOD LEAD POISONING: SCREENING AND PREVENTION This bill seeks to improve blood lead screening for children enrolled in a Medi-Cal Managed Care Plan through increased accountability measures highlighted in a recent state audit. CMA obtained clarifying amendments to ensure the accountability rests squarely with the Medi-Cal Managed Care Plan and not physician practices. Status: Signed by the Governor (Chapter 216, Statutes of 2020).
AB 2300 (COOPER): CALIFORNIA YOUTH FOOTBALL ACT This bill would authorize a certified emergency medical technician, state-licensed paramedic, or higher-level licensed medical professional to provide prehospital emergency medical care or rescue services consistent with their certification or license during a football game. CMA worked with the author’s office to ensure that in cases where a player is removed from the game due to injury, they are not allowed to return unless evaluated by a licensed medical professional and receive written clearance to return to athletic activity. Status: Signed by the Governor (Chapter 49, Statutes of 2020).
AB 3092 (WICKS): SEXUAL ASSAULT AND OTHER SEXUAL MISCONDUCT: STATUTES OF LIMITATIONS ON CIVIL ACTIONS This bill specifies that a civil action may be brought against any person or entity who owed a duty of care to the plaintiff for committing sexual assault or other criminal sexual conduct. The bill would also revive sexual misconduct claims, brought by or on behalf of a patient who suffered sexual misconduct at a student health center. The author took CMA’s amendments to narrowly tailor the bill to apply to victims of James Heaps at the University of California, Los Angeles. Amendments also limited the provisions to the dates at which James Heaps worked at UCLA. Status: Signed by the Governor (Chapter 246, Statutes of 2020).
This bill streamlines the process for Independent Academic
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AB 3330 (CALDERON): DEPARTMENT OF CONSUMER AFFAIRS: BOARDS: LICENSEES: REGULATORY FEES This bill increased the CURES licensing fee to fund the implementation of recently passed legislation related to the program – AB 149, AB 528, AB 1750, AB 1753, and SB 482. The budget process deferred action on a proposed 133% CURES fee increase, but negotiations were rekindled on the item with mere weeks remaining in the legislative session. CMA staff engaged to ensure the increase required was reasonable and justified. Ultimately the fee was negotiated down to $11 for two years, and $9 ongoing. Status: Signed by the Governor (Chapter 359, Statutes of 2020).
SB 275 (PAN): HEALTH CARE AND ESSENTIAL WORKERS: PERSONAL PROTECTIVE EQUIPMENT In response to the current shortage of personal protective equipment, this legislation was introduced and initially focused around requiring stockpiles to mitigate such shortages during future emergencies. CMA strongly supports better PPE access and long-term solutions to efficiency focused supply chain management as the focus for necessary, but largely commoditized, products like masks, gowns and gloves. However, without that access and those solutions currently in place, CMA worked with the author and sponsor to make sure independent physician practices were explicitly removed from the health care employer and provider stockpile mandates in the bill. Status: Signed by the Governor (Chapter 301, Statutes of 2020).
SB 855 (WIENER): HEALTH COVERAGE: MENTAL HEALTH OR SUBSTANCE USE DISORDERS Require a health care service plan or health insurer, on and after January 1, 2021, to provide coverage for the diagnosis and medically necessary treatment of mental health and substance use disorders in the same manner as other medical conditions and not limit coverage to short-term or acute treatment. CMA secured amendments that removed the ability for class action lawsuits to be more easily brought by patients against physicians and plans, limited the ability of health plans to recoup money for services already paid for by the plans, and protected the ability of physicians to advocate on behalf of their patients when determining what is medically necessary during the course of a patient’s treatment. Status: Signed by the Governor (Chapter 151, Statutes of 2020).
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SB 1123 (CHANG): ELDER AND DEPENDENT ADULT ABUSE This bill brings parity for elder and dependent abuse in both the Penal Code and the Welfare and Institutions Code (WIC). Specifically, the Penal Code lacked definitions of physical, mental, and emotional abuse which were found in the WIC. CMA secured amendments that ensured the language that was added in the Penal Code was identical to that found in the WIC and did not inadvertently expose physicians to further liability. Status: Signed by the Governor (Chapter 247, Statutes of 2020).
SB 1237 (DODD): NURSE-MIDWIVES: SCOPE OF PRACTICE SB 1237 is a measure which allows certified nurse midwives to independently practice midwifery to the full extent of their license without removing the requirement for collaborative relationship between a certified midwife and a physician. CMA worked with ACOG, the California Nurse-Midwives Association, and Senator Dodd’s office to craft language which would appropriately define their scope without physician collaboration, how and when collaboration with a physician is necessary, and when it is necessary to transfer care to a physician. This bill maintains critical patient safeguards by requiring a certified nurse midwife have an established agreement in place with a physician (mutually agreed upon protocols and procedures) if they provide any services to patients which fall outside of the scope of midwifery. If they choose not to have an agreement with a physician, the midwife cannot provide those services and must transfer the care of the patient to a physician. Status: Signed by the Governor (Chapter 88, Statutes of 2020).
OPPOSED BILLS AB 503 (FLORA): GUN-FREE SCHOOL ZONE This bill would have allowed an individual who holds a concealed carry license to carry their firearm in a church, synagogue or other place of worship, and on the grounds of a public or private school with permission from the school. Status: Failed in the Assembly Public Safety Committee.
AB 780 (BROUGH): HEARING AID DISPENSERS: PRACTICE: CERUMEN MANAGEMENT: APPRENTICE LICENSE AB 780 sought to expand the scope of practice for hearing aid dispensers to include tympanometry and cerumen management. AB 780 also would have removed continuing education requirements and an exam related to
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tympanometry, created an “advanced practice certificate,” and added in supervision by a mentor or trainer. Status: Failed in the Assembly Appropriations Committee.
AB 888 (LOW): OPIOID PRESCRIPTIONS: INFORMATION: NONPHARMACOLOGICAL TREATMENTS FOR PAIN This bill would have required a prescriber to offer patients receiving opioids a referral to a non-pharmacological treatment provider such as a chiropractor or acupuncturist. AB 888 also sought to make prescribers obtain written, informed consent from patients receiving an opioid with specific informed consent language. Status: Failed in the Senate Business, Professions and Economic Development.
AB 890 (WOOD): NURSE PRACTITIONERS: SCOPE OF PRACTICE: PRACTICE WITHOUT STANDARDIZED PROCEDURES AB 890 created two new types of nurse practitioners who would be allowed to perform certain functions without standardized procedures. The law specifies the education, training, testing, regulatory and governance requirements for these new NPs, including the circumstances in which an NP must consult with or refer patients to a physician. Significant provisions of AB 890 are ambiguous, necessitating additional clarification and guidance from regulators. Though the law will be enacted in the fall of 2020, full implementation and training of these new categories of nurse practitioners will not happen until the required regulations and guidance are approved by state regulators. Status: Signed by the Governor (Chapter 265, Statutes of 2020).
AB 1909 (GONZALEZ): HEALING ARTS LICENSEES: VIRGINITY EXAMINATIONS OR TESTS This bill would have prohibited a healing arts licensee from performing an examination or test on a patient for the purpose of determining whether the patient is a virgin. The bill would have also made a violation of its provisions deemed as unprofessional conduct and grounds for disciplinary action by the licensing board for the healing arts licensee. Status: Failed in the Assembly Business and Professions Committee.
AB 1933 (MAIENSCHEIN): PUPIL HEALTH: SUDDEN CARDIAC ARREST: ATHLETIC ACTIVITIES
parent or guardian to request the administration of an electrocardiogram as part of the pupil’s evaluation for purposes of being permitted to return to participate in an athletic activity. CMA was negotiating amendments with the author when the bill was held in Committee. Status: Failed in the Assembly Education Committee.
AB 2204 (ARAMBULA): HEALTH CARE COVERAGE: SEXUALLY TRANSMITTED DISEASES AB 2204 would have required health plans and insurers, beginning January 1, 2021, to provide coverage for sexually transmitted disease testing and treatment at a contracting or noncontracting health facility at the same cost-sharing rate an enrollee or insured would pay for the same services received from a contracting health facility. Status: Failed in the Assembly Health Committee.
AB 2242 (LEVINE): MENTAL HEALTH SERVICES AB 2242 would have required a health care service plan or insurer to approve the provision of mental health services for enrollees under the plan who are detained for 72-hour treatment and evaluation. Additionally, the bill would have required that health plan to schedule an inpatient appointment for the patient within 48 hours of the patient’s release from detention and would have prohibited a noncontracting provider from billing the patient more than the cost-sharing amount the patient would pay to a contracting provider. CMA was negotiating amendments with the author when the bill was held in Committee. Status: Failed in the Assembly Health Committee.
AB 2417 (PATTERSON): MATERNAL MENTAL HEALTH: BEREAVED MOTHERS This bill would require that education and information to be made available to bereaved mothers. The bill would define a bereaved mother as one who has experienced a miscarriage, stillbirth, or fatal fetal diagnosis. CMA opposed the bill given the additional requirements placed on physicians who care for women in settings other than the hospital to develop a program. Patients who have difficulty with miscarriage are already screened for depression in the outpatient setting and referred for services. Additionally, this bill is similar to legislation that has been introduced throughout the country by the anti-abortion lobby as a strategy to potentially expand the definition of personhood to limit access to reproductive care. Status: Failed in the Assembly Health Committee.
This bill would have authorized a student or the student’s
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AB 2418 (PATTERSON): PERINATAL HOSPICE This bill sought to require the Department of Public Health to collect information regarding perinatal hospice and make it available to patients, providers, and hospitals. This is legislation that has been introduced throughout the country by the anti-abortion lobby as a strategy to potentially expand the definition of personhood to limit access to reproductive care. CMA opposed the bill given it would interfere with patient/physician communications concerning reproductive health care and go against CMA policy supporting continued patient access to reproductive health care (HOD 617a-00). Status: Failed in the Assembly Health Committee.
AB 2515 (NAZARIAN): CONTINUING MEDICAL EDUCATION: GERIATRIC MEDICINE This bill would take the current requirement in statute for general internists and family physicians who have a patient population of which 25% are 65 and older to complete at least 20% of all mandatory CME hours in a course related to geriatric medicine or the care of older patients and changes the percentage to at least 10% of patients who are 50 years of age and older. Status: Failed in the Assembly Business and Professions Committee.
AB 2570 (STONE, MARK): FALSE CLAIMS ACT This bill would have exposed physicians and their practices to all kinds of frivolous lawsuits by allowing the materiality of a false record or statement charge to “focus on” the potential effect (as opposed to the actual effect) of the false record or statement when the record or statement was made. The bill would also specify that that amount of damages that may be awarded include consequential damages. CMA, along with a coalition of health care and business organizations, stopped the bill in the Senate Judiciary Committee. Status: Failed in the Senate Judiciary Committee.
AB 2786 (NAZARIAN): HOSPITAL EMERGENCY DEPARTMENTS: HIV TESTING AB 2786 would have required the Department of Public Health to develop protocols for emergency departments to implement and would have required those departments to integrate an opt-out HIV testing program for their patients into their standard of care. This bill was held in the Assembly Health Committee. Status: Failed in the Assembly Health Committee.
AB 2801 (OBERNOLTE): SEARCH WARRANTS: SEXUALLY TRANSMITTED INFECTION TESTING This bill would have expanded the testing that a court may order of an accused individual to include testing of additional bodily fluids for any sexually transmitted disease. The bill would have also enabled a parent or guardian, if the victim is a minor, or an authorized representative of the victim to exercise the victim’s rights in terms of disclosure regarding sexually transmitted disease testing. Status: Failed in the Assembly Public Safety Committee.
AB 2817 (WOOD): OFFICE OF HEALTH CARE QUALITY AND AFFORDABILITY AB 2817 would have created the Office of Health Care Quality and Affordability to analyze the health care market for cost trends and drivers of spending and create a strategy to control health care costs, including through the use of growth targets the state and each sector and entity of the health care delivery system would need to comply with. The Office would also be given broad authority over data collection and analysis and mergers and acquisitions of all health care entities under its jurisdiction. The conversation around cost and affordability transferred over to the budget process where the fiscal realities of the state stopped the idea from moving forward. Status: Failed in the Assembly Health Committee.
AB 2830 (WOOD): HEALTH CARE PAYMENTS DATA PROGRAM This bill would have implemented a new expansive state program for the collection and analysis of health care cost, equity, and quality information. Due to the budgetary impacts of the bill, the conversation shifted to the budget process and was addressed in AB 80. The proposal adopted in the State budget was consistent with CMA policy on the collection of health care information and our position on the creation of the All-Payors Database. Status: Failed in the Senate Health Committee.
SB 201 (WIENER): MEDICAL PROCEDURES: TREATMENT OR INTERVENTION: SEX CHARACTERISTICS OF A MINOR SB 201 would have prohibited a physician from performing any treatment or procedure on the sex characteristics of an intersex minor until the minor patient provides informed consent to the physician. The bill makes an exception for any procedure or treatment that is deemed medically necessary, which is defined in such a way that cannot properly address the complexity of such cases. Status: Failed in the Senate Business, Professions and Economic Development Committee.
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SB 977 (MONNING): HEALTH CARE SYSTEM CONSOLIDATION: ATTORNEY GENERAL APPROVAL AND ENFORCEMENT To address concerns around health care consolidation and impacts on access and affordability, this bill expanded the Attorney General’s existing oversight authority related to mergers and acquisitions involving nonprofit entities. CMA policy supports governmental actions designed to assure hospital market competition and assure quality of care, including the authority to disapprove hospital mergers and acquisitions whenever such transactions are expected to have negative consequences on affordability and/or quality of care (HOD 617a-00). However, this legislation was drafted as an overbroad approach that would subject a vast array of healthcare transactions – including leasing and other physician contracting arrangements – subject to the AG’s approval. Enacting this legislation during a public health emergency and economic crisis would have only further restricted the additional flexibility and resources CMA is working to ensure for struggling physician practices. Status: Failed on the Assembly Floor.
SB 1084 (UMBERG): PHARMACY: DISPENSING: CONTROLLED SUBSTANCES This bill would have required a pharmacist who dispenses in solid oral dosage form a controlled substance in Schedule II or Schedule III of the federal Controlled Substances Act to dispense it in a lockable vial, provide an educational pamphlet on controlled substances, and, if the lockable vial uses an alphanumeric or other code, include the code in any patient notes in the database or other system used by the pharmacy in the dispensing of prescription drugs. The patient or patient’s legal guardian would choose the code. Status: Failed in the Senate Business, Professions and Economic Development Committee.
SB 1097 (DURAZO): MEDICAL SERVICES: CREDIT OR LOAN SB 1097 would have made it more difficult for physicians to arrange for loan options for patients after receiving medical services. CMA was negotiating amendments with the author when the bill was held in committee. Status: Failed in the Senate Business, Professions and Economic Development Committee.
SB 1252 (MOORLACH): ADVANCE HEALTH CARE DIRECTIVES: MENTAL HEALTH TREATMENT
Advance Health Care Directives, creating opportunity for an argument that mental health treatment is somehow not included under other sections of law that refer to health care generally. Status: Failed in the Senate Judiciary Committee.
SB 1265 (DAHLE): COMPREHENSIVE SEXUAL HEALTH EDUCATION AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION EDUCATION This bill would have required the sexual health education and HIV prevention instruction notice to parents and guardians of pupils and the written and audiovisual educational materials used in comprehensive sexual health education and HIV prevention education to be translated if certain conditions are met, as specified. Status: Failed in the Senate Education Committee.
SB 1394 (MORRELL): COMPREHENSIVE SEXUAL HEALTH EDUCATION AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION EDUCATION This bill would have authorized a school district to require active parental consent (“opt-in”) with a signature for any sexual health education and HIV prevention education for a pupil in a grade lower than grade 7. Status: Failed in the Senate Education Committee.
SB 1407 (MOORLACH): VACCINE INJURY: INFORMATIONAL MATERIALS This bill would have required the State Department of Public Health to develop and make available to licensed physicians and surgeons written materials identifying specified federal resources on vaccine warnings, injuries, and deaths. The bill would have also required a physician and surgeon to provide those materials to a child’s parent or guardian before or at an appointment at which a vaccine is to be administered. Status: Failed in the Senate Health Committee.
SCR 93 (MELENDEZ): STATE OF EMERGENCY: COVID-19: TERMINATION This resolution would have declared that the state of emergency proclaimed by the Governor on March 4, 2020, is at an end, thereby terminating the emergency powers granted to the Governor as a result of that proclamation. Status: Failed in the Senate Rules Committee.
This bill explicitly added mental health treatment to the definition of health care decisions for purposes of
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2020 MARKS
20 YEARS
for Visionary Council
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C O M M U N I T Y H E A LT H L E A D E R S H I P C O U N C I L M OV E S F O R WA R D W I T H R E S U LT S BY JO ANN KIRBY
As the Community Health Leadership Council marks 20 years of service to the community, it’s annual forum on October 13 celebrated the achievement virtually by inspiring and educating more than 500 attendees on the timely topic of health inequities — a key concern the state is requiring counties to address as they work to reopen their economies during the Covid-19 pandemic. The keynote address on structural racism by Dr. Camara Phyllis Jones, a family physician and epidemiologist, was just another example of how the council is at the forefront of addressing pressing issues as it continues to bring leaders from all corners of the community together in the common goal of building a healthier San Joaquin County. During their two decades, the council has taken its collective brain trust and produced positive outcomes that are making a real impact. “The initial goal of the Council was a simple one – to build a culture of trust among area healthcare leaders,” Lita Wallach, director of the Community Health Leadership Council since its inception, said. “This grew to include leaders in education and business. After its first Community Health Forum, leaders rolled up their sleeves to work on critical issues like physician shortages, and shortages in other much needed healthcare professions.” Out of the council, HealthForce Partners was conceived to address the shortage of healthcare workers and improve healthcare career pathways for local residents. “The tangible result of that was the collaboration of Dignity, Adventist Health and Delta College to add 20 new spots for nursing students,” said Daniel Wolcott, president of Adventist Health Lodi Memorial and a founding director of HealthForce Partners when it
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was created in 2018. Working together with Corwin Harper of Kaiser Permanente, Donald Wiley at St. Joseph’s and David Culberson of San Joaquin General has been a gratifying experience, he said. “We admitted 20 nursing students who are local and already employed locally. We are adding another 20 into the 2021 cohort,” Wolcott said of HealthForce Partners’ achievements. “We are taking local students who were already employed in our health industry and getting them admitted into nursing school. It’s one of the most exciting things we’ve done. They would not have started if it had been for HealthForce Partners, which wouldn’t have happened without the council.” Another breakthrough to come out of the council was unveiled in October when San Joaquin Delta College and Community Medical Centers partnered for the unveiling of a badly needed Student Health Center on the Stockton campus. On its first day, staffers administered flu shots at a drive-thru event to celebrate the grand opening. “Delta College serves around 26,000 students each year. Yet it has never had a health center on campus. One of the strongest requests I received from our students when I took on this role was to create a health center on campus,” Dr. Omid Pourzanjani, president of San Joaquin Delta College and a member of the Community Health Leadership Council, said. “Through my membership with the Council, the connection with CMC was established almost instantly, the partnership was built quickly, and the will to bring together a health center on Delta's campus was genuine. The new Delta College Health Center in partnership with CMC will provide medical, mental, and dental services to our students and their dependent children. We are extremely
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happy about this partnership.” Being on the council has resulted in other collaborative consequences by building a network for leaders in healthcare, business and education. “It’s a broad cross section that can have a big impact when you get those minds together around the table,” Wolcott said. From its inception in 2000, the council was formed as a San Joaquin County Health Care Services’ sponsored organization that originated under the direction of a member of the San Joaquin County Board of Supervisors. It is
spotlight on health disparity prompted some thoughtful questions. “Can we enhance medical outreach, education, provide mental health and social support to patients affected by COFIC19? Can we dispel myths about COVID-19 and build more community ownership and accountability to control the spread of the virus,” he asked. As the council moves forward into the next decade, it will do so without Wallach at the helm as she is retiring in June 2021. Greater Stockton Chamber of Commerce CEO Doug Wilhoit credits her drive and vision for taking the council to where it is today. Wallach expects “ A l t h o u g h t h e p a n d e m i c h a s t e m p o r a r i l y s h i f t e d o u r f o c u s , the leadership group it has also made the situation much worse for people in will continue to ever y demographic . Without a doubt, we need to get break new ground back to finding , creating , and suppor ting solutions to the and forge resultg rowi n g m e nt a l h e a lth a n d s u b s t a n ce u s e e p i d e m i c . C H LC oriented partnerships c an and will play a role in that ef for t." that continue to put the needs of the - BRIAN JENSEN, VICE PRESIDENT OF THE HOSPITAL COUNCIL community at the center of their work. One focus several organized to convene key community decision makers for members would like to spotlight is a concern the council was the purpose of identifying the most critical health challenges studying before the pandemic shifted priorities. and opportunities confronting San Joaquin County and the “The 2019 Community Health Forum centered on the Northern Central Valley through annual Community Health behavioral health crisis in our community, state and nation,” Forums and goal-specific community conversations. The topic Brian Jensen, vice president of the Hospital Council, said. of health disparities and systemic racism at its October forum, “Although the pandemic has temporarily shifted our focus, which was co-hosted by the Stockton chapter of the NAACP, it has also made the situation much worse for people in every was a timely topic since Governor Gavin Newsom introduced demographic. Without a doubt, we need to get back to finding, a health equity metric to California’s Covid-19 Blueprint for a creating, and supporting solutions to the growing mental Safer Economy. health and substance use epidemic. CHLC can and will play a “Each of us has a responsibility to keep the topics of role in that effort." health disparities and structural racism open. As a community, It’s a concern echoed by Wolcott at Lodi Memorial. “I’m we can create platforms of dialogue that leads to action. By hopefully optimistic,” Wolcott said of the council’s ability to this, we can ultimately change beliefs and behaviors,” Wallach brainstorm solutions on mental health issues in the future. said. “This forum moved us forward in understanding root Looking ahead, Wallach has no doubt the council will causes of health inequities. Health inequities causes are continue to make an impact. more than individuals making poor choices or poor behavior “The Council is more dynamic than ever. … Our patterns. The forum provided a provocative lens of historical partnerships will continue in main areas, including health discrimination and its relationship to health inequities. The equity, health access, medical training, healthcare workforce more we can discuss this in open forums, the more we can development, behavioral health and more,” she said. move towards a healthier community.” Dr. Alain Flores, an assistant physician-in-chief at The Permanent Medical Group in Stockton said the forum’s
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Lita Wallach,
Greg Diederich,
Director Community Health Leadership Council P.O. Box 1805 Woodbridge, CA 95258 209.210.8898 lita.wallachconsult@gmail.com
Director San Joaquin County Health Care Services P. O. Box 1020 Stockton, CA 95201 209.468.5610 gdiederich@sjchcs.org
Chuck Winn, CHLC Chair San Joaquin County Board of Supervisors, District 4 44 N. San Joaquin Street Stockton, CA 95202 209.468.3113 cwinn@sjgov.org
EARS Zienna Blackwell Rodriguez
David Culberson,
Director San Joaquin County Public Health Services 1601 E. Hazelton Avenue Stockton, CA 95205 209.468.3409 zrodriquez@sjcphs.org
Chief Executive Officer San Joaquin General Hospital P.O. Box 1020 Stockton, CA 95201 209.468.6600 dculberson@sjgh.org
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Alain Flores, MD Assistant Physician-in-Chief The Permanente Medical Group 7373 West Lane, Suite 289 Stockton, CA 95210 209.476.3558 Alain.G.Flores@kp.org
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Matt Garber,
Sanjay Marwaha, MD
Scott Neely, M.D., V.P.,
Assistant Director San Joaquin County Health Care Services P.O. Box 1020 Stockton, CA 95201 209.468.6672 mgarber@sjchcs.org
Physician-in-Chief The Permanente Medical Group 7373 West Lane, Suite 289 Stockton, CA 95210 209.476.3376 sanjay.marwaha@kp.org
Chief Medical Officer Dignity Health – St. Joseph’s Medical Center 1800 N. California Street Stockton, CA 95204 209.467.6486 Scott.Neely@dignityhealth.com
Brian Jensen,
20 YE
Vice President Hospital Council 1215 K Street, Suite 730 Sacramento, CA 95814 916.552.7564 bjensen@hospitalcouncil.net
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James Mousalimas
Christine Noguera,
Superintendent of Schools San Joaquin County Office of Education PO Box 213030, Stockton, CA 95213 209.468.9033 jmousalimas@sjcoe.net
Chief Executive Officer Community Medical Centers 7210 Murray Drive Stockton, CA 95210 559-960-7779 cnoguera@cmcenters.org
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Maria Pallavicini PhD
Lisa Richmond,
Nadeja Steager
Provost University of the Pacific 3601 Pacific Avenue Stockton, CA 95211 209.946.2222 mpallavicini@pacific.edu
Executive Director San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, CA 95219 209.952.5299 lisa@sjcms.org
San Joaquin County Health Care Services P. O. Box 1020 Stockton, CA 95201 209.468.5610 nsteager@sjchcs.org
EARS Omid Pourzanjani, PhD
Michael Schrader,
Christina Bastida-Gonzalez
Superintendent-President San Joaquin Delta College Stockton, CA 95209 209.954.5118 opourzanjani@deltacollege.edu
Chief Executive Officer Health Plan of San Joaquin 7751 S. Manthey Road French Camp, CA 95231 209.461.2211 mschrader@hpsj.com
Executive Director HealthForce Partners 56 S. Lincoln Street, 2nd Fl. Stockton, CA 95202 209. 623.9907 cbastida@healthforcepartners.net
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Supporting Health Care Workers Serving on the COVID-19 Front Lines The emotional stress of responding to patients during the COVID-19 pandemic puts the personal and emotional health of front line health care workers at exceptional risk. To provide relief and help alleviate burnout, the California Medical Association (CMA) Wellness Program (CMA Wellness) has launched the Care 4 Caregivers Now program, connecting front line caregivers with a trained peer coach offering remote and confidential sessions at no cost.
SIGN UP TO RECEIVE COACHING If you are a health care worker in constant worry of COVID-19 infection, currently separated from your family, or facing any other emotional difficulty at this time, we invite you to schedule a confidential peer coaching session at no cost. +
Eligible caregivers include, physicians, physician assistants, nurses, nurse practitioners and respiratory therapists
+
There is no cost, and you may receive coaching for up to 30 days
+
Coaching sessions are confidential and conducted remotely via videoconference; access to a computer or smart phone is necessary
While not a substitute for therapy or medical care, your peer coach understands the rigors of the profession and can offer guidance, mentorship and emotional support. Coaches hold space to listen to your concerns. Their goal is to help you feel heard, understood and become more aware of your options.
VOLUNTEER TO BECOME A COACH Care 4 Caregivers Now provides physicians (M.D. and D.O.) and nurses, including those who are recently retired, the opportunity to lend their unique expertise during these unprecedented times. Coaching services are conducted remotely and not considered practicing medicine. All interested volunteers should have:
20 YE
+
Four hours for training, which includes on-demand videos and 90-minute live/small group training session
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Access to computer audio/video and sufficient broadband (CMA Wellness supplies a Zoom account)
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At least 4 hours/week for remote coaching and mastermind sessions to share best practices and receive ongoing support
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Passion for supporting fellow health care providers
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Compassion, empathy, patience and strong listening skills.
Sign up to receive coaching, or to volunteer as a coach at: Care4CaregiversNow.org.
cmadocs.org/care4caregivers
z
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CMAwellness@cmadocs.org (800) 241-2466 WINTER 2020
Don Wiley,
Betty Wilson
Daniel Wolcott,
Chief Executive Officer Dignity Health, St. Joseph’s Medical Center 1800 N. California Street Stockton, CA 95204 209.467.6312 dwiley@dignityhealth.org
Executive Director Business Council, Inc. 2800 W. March Lane, Suite 473 Stockton, CA 95219 209.956.3380 bwilson@bci-sjc.org
President and Chief Executive Officer Adventist Health, Lodi Memorial Hospital 975 S. Fairmont Lodi, CA 95241 209.339.7560 wolcotda@ah.org
EARS Doug Wilhoit,
David Evans,
Chief Executive Officer Greater Stockton Chamber of Commerce 445 W. Weber Avenue, Suite 220 Stockton, CA 95203 209.547.2770 doug@stocktonchamber.org
Dean CSU Stanislaus, College of Science One University Circle NHS 373 Turlock, CA 95382 209.667.3696 devans@csustan.edu
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The heroes among us. As valued partners and dedicated professionals, our health care providers and staff can be relied upon to do their best for our patients every day. But right now, as we manage COVID-19, our people are going above and beyond to ensure we meet the needs of our patients and the safety of our community. To all our providers and staff, for what you do today and every day, we thank you.
St. Joseph’s Medical Center I St. Joseph’s Behavioral Health Center I Mark Twain Medical Center Dignity Health Medical Foundation
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Finding Hope in the Midst of Challenges Nursing program in the Northern San Joaquin Valley brings hope and opportunities to local health facilities and community members BY: NIKKI CHAN
Healthcare facilities in Northern San Joaquin Valley (NSJV) have faced a challenge in growing their workforce. Local schools were educating and training certified Registered Nurses (RN). Healthcare facilities were hiring the new graduates but after gaining some experience, they were transitioning to locations outside of the NSJV area. Local facilities were facing high turnover rates, which resulted in financial and resource loss.
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“In the Central Valley, we tend to be a training ground. We train new graduates and within 6 months to a year, they leave our facilities, partly because they are not residents of our County. Our local facilities have shared these sentiments for years and pleaded that something be done to develop a program that would allow our local residents the opportunity to pursue careers in healthcare, thereby mitigating the perception of a revolving door when it comes to training new grads” said Dr. Anitra Williams, Director of Nursing Operations at Dignity Health, St. Joseph’s Medical Center. For educational partners like San Joaquin Delta College (SJDC), a regional community college, that has to abide by California Senate Bill No. 1393, it can be challenging toto prioritize local/regional candidates. CA Senate Bill 1393 “prohibits a community college district from excluding an applicant to a registered nursing program on the sole basis that the applicant is not a resident of that district or has not completed prerequisite courses in that district.” “With CA Senate Bill 1393, we can’t pick and admit people from just our region, we have our programs open to all applicants in California. Our RN program, usually has about 40% of local,” explained Julie Kay, Dean of Health Sciences at SJDC With the parameters of CA Senate Bill 1393, the employment selection pool of local-residing graduates is scarce. There is urgency for new and creative solutions to meet the regional workforce demand. According to a study from the University of California, San Francisco (UCSF) Healthforce Center, the total number of RNs in the San Joaquin Valley is predicted to decline between 2017 and 2030. the demand for RNs is projected to grow more than 35%. The study suggested that “the primary policy solution for large projected RN shortages is to increase the number of graduates from education programs in the region.”
Local healthcare facilities, education institutions, and workforce development agencies were getting weary and tired of going through the revolving door of students. In 2018, healthcare, education, and workforce development executives from the NSJV convened and strategized a new partnership to combat the shortage and create a long-term solution by launching HealthForce Partners (HFP). With this new innovative partnership, partners from across the sector worked together to identify healthcare workforce gaps, like the RN shortage, and developed new career pathways and programs to address them. Through this new collaborative partnership, Dr. Anitra Williams, Director of Nursing Operations at Dignity Health St. Joseph Medical Center, seized an opportunity to convene Julie Kay, Dean of Health Sciences at (SJDC), Lisa Lucchesi, Director of Health Science Division at (SJDC), Dr. Ginger Manns, Chief Nursing Officer at Community Medical Center, Dr. Debbie Tavernier, CSU Stanislaus, Aaron Mata, Principal at Health Careers Academy, and Valerie Fisher, Regional Director of California Healthcare Workforce Initiative. Calling themselves the “Make It Happen” Team, the group drafted a plan to help high school students enrolled at Stockton Unified School District’s Health Careers Academy (HCA) and incumbent workers at local healthcare facilities to make the transition into SJDC’s Associate Degree in Nursing (ADN) program. This new plan became the Helping People Elevate Program (HOPE). The HOPE high school pathway enables 22 High school students from, HCA, to leverage dual enrollment at SJDC to complete their Nursing prerequisites. Through dual enrollment, students enter Delta College’s ADN program as early as 2021. “After our orientation at HCA, several moms had tears in their eyes. Some came up to us and told us their story of how they weren’t able to finish high school and were currently 2-3 jobs to support their families,” said Dr. Williams. “They were in
tears with the mere thought that their child would have an opportunity at a nursing career before the age of 21. There was so much hope in that room. I knew that I wanted to do something with the word hope because that’s what I saw when I was speaking to these parents.”
and completed all prerequisites but I still couldn’t get into a RN program. I’m thinking what am I doing wrong? I did everything that they told me to do. I lost hope,” said Shazia.
After years of facing barriers in pursuing a nursing career, Shazia was accepted into the first HOPE Incumbent Worker Incumbent workers at the local facilities were also facing cohort. The cohort includes 25 students from local facilities challenges in starting their nursing education. Incumbent Lodi Adventist Memorial, Dignity Health St Joseph’s Medical worker, Shazia Begum, has been employed at Dignity Health Center, and Community Medical Centers. Students in the cohort have also been working at their respective facilities for “I didn’t know what I wanted to do in school. As a first-generation years but were also struggling student, I didn't have the support system to help me pursue to get into a local nursing program. higher education,” explained Shazia. “Being in the hospital and in my job position, and also having someone sick at home, made
“We have built a strong relationship with our local facilities. Because we are working with a special population and special partnership it allows us to let those students automatically enter the program. It gives the HOPE program students’ ability to come in without the competition,” explained Lucchesi.
me realize that nursing might be the best route for me.” St. Joseph’s Medical Center for 15 years. She began her healthcare career at 18 years old working as PBX Operator and currently works as a Float Pool Secretary in the Patient Care Support Department. Although Shazia enjoys her job, she felt that there was still something missing in her career path. “I didn’t know what I wanted to do in school. As a firstgeneration student, I didn't have the support system to help me pursue higher education,” explained Shazia. “Being in the hospital and in my job position, and also having someone sick at home, made me realize that nursing might be the best route for me.” But pursuing a nursing career was not easy. As she was looking into nursing programs, she ran into hurdles with transferring coursework. Some schools wouldn’t take class credit from other schools so she would have to retake classes. She also completed a Licensed Vocational Nursing (LVN) program. “I finished the LVN program. I turned in all my course credits
The incumbent worker cohort is expected to complete the ADN program in Spring 2021. For the local facilities, they are both able to grow their nursing staff and equip them with the knowledge of the mission and values of their organization. The HOPE Program has not only become a creative and innovative solution to address the nursing shortage in the NSJV area, it also provides an opportunity to elevate community members equitably and sustainably. For more information, contact HealthForce Partners at info@healthforcepartners.net.
Thank you, Healthcare Heroes! TEAMWORK During this season of thanks and giving, we are especially grateful for the compassionate care our team of health care professionals gives to our community all year long. Doctors Hospital of Manteca began 60 years ago with the mission to provide the best care possible to Manteca. Today, we are the largest private employer in the community with nearly 550 employees and a staff of more than 180 physicians that make us A Community Built on Care.
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The
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Financial
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As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff ! In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money. Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.
209-948-6024
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Key Employment Law
BY: JAMIE M. BOSSUAT, ESQ.
Changes to Be Aware of for 2021
California employment laws are always changing, but employers in 2021 will face some significant changes and challenges ranging from COVID-19 safety and notification requirements to expansion of the California Family Rights Act. This article addresses a few key changes that employers should prepare for.
COVID-19 Requirements Cal/OSHA and OSHA have begun citing employers for COVID-19 safety violations. They have issued a total of more than $2.5 million in penalties through the end of October. To prevent citations and penalties, employers should have a written Injury and Illness Prevention Plan in place and should have a specific COVID-19 safety plan in place that employees have been trained on and that complies with both state and local guidelines. Also, California law now has very strict notification requirements for a COVID-19 exposure in the workplace. Employers must provide written notice to all employees who may have been exposed within one business day. This notice must also include notice of COVID-19 related benefits and the company’s anti-discrimination, anti-harassment, and anti-retaliation policies and the company’s disinfection protocols and safety plan. Due to the short-timeframe for providing notice it is recommended that employers consult counsel and have a plan in place to respond to a COVID-19 exposure and have draft notices ready to be distributed quickly.
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Sexual Harassment Training All employees must have completed a compliant sexual harassment training by January 1, 2021. Supervisory employees must receive 2 hours of training and nonsupervisory employees must receive 1 hour of training.
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California Family Rights Act Expansion California has significantly expanded the California Family Rights Act, which provides employees the opportunity to take up to 12 weeks of job-protected leave for their own serious health condition, the serious health condition of a family member, or a birth or foster or adoption placement. The law, which previously only applied to employers with 50 or more employees now applies to all employers with more than 5 employees. The definition of “family member” has also expanded. All employers must update their employee handbooks to reflect this change and should familiarize themselves with the requirements of the CFRA so that they are prepared to implement the new law at the beginning of the year.
Minimum Wage Increase Also, employers should keep in mind that the minimum wage increases each year in California. For 2021, the minimum wage will be $13.00 per hour for employers with 25 employees or less and $14.00 per hour for employers with 26 employees or more. This also increases the salary threshold for exempt employees who fall under the professional, administrative, or executive exemptions. The salary minimums will be $54,080 for employers with 25 employees or less and $58,240 for employers with 26 employees or more.
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Strong community partnerships lead to happier, healthier people
Congratulations to our 2020 HPSJ Health Career Scholarship Recipients! Making a positive difference in the Central Valley
Health Plan of San Joaquin (HPSJ) continues to support our community and help develop future local healthcare workforce through scholarships and mentors. HPSJ awarded $77,000 in scholarships for the 2020/21 academic year, including 17 $3,000 awards and 26 $1,000 awards to 43 local students to pursue medical careers. Student winners also have the benefit of a personal mentor from our professional HPSJ staff. HPSJ remains committed to expanding access to health care by encouraging our local students to return to our community. For a full list of the HCSP winners 2020, visit:
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State Tobacco Tax-Funded Program Awards $38.14 Million to Expand California’s Health Care Workforce 101 awardees will help address physician shortage, increase access to care Largest CalMedForce applicant pool, so far, with over $95M requested Physicians for a Healthy California (PHC) announced more than $38 million in CalMedForce awards across the state to support medical training and residency programs and help grow the physician workforce. The third round of CalMedForce funding, released by PHC and generated by the voter-approved Proposition 56 tobacco tax in 2016, will support 202 residency positions in 101 graduate medical education (GME) programs at hospitals and clinics, with an emphasis on those serving medically underserved groups and communities. This cycle represented the largest applicant pool: 541 residents and 122 applications requesting over $95 million in funding.
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The California Future Health Workforce Commission estimated that California will need 4,700 additional primary care clinicians by 2025 and approximately 4,100 more by 2030 to meet demand. PHC, in partnership with the University of California (UC), established the CalMedForce grant program to help address California’s looming physician shortage because medical school graduates must continue training in an accredited, specialty-specific GME residency program to obtain a medical license and care for patients independently. “CalMedForce continues to demonstrate the high demand and need for GME opportunities,” said Lupe Alonzo-Diaz, MPA, PHC president and CEO. “The lack of sufficient residency spots contributes to California’s physician shortage and limits the number of new doctors entering the workforce. With COVID 19 impacting life for the foreseeable future, programs like CalMedForce are even more essential to protect access to care for all Californians.”
The UC is the designated recipient of Proposition 56 funding and has contracted with PHC to administer CalMedForce. All accredited residency programs in the state that meet guidelines are eligible to apply for funding. Of this year’s CalMedForce awardees, approximately 14% of GME programs are sponsored by the University. To date, CalMedForce has released over $114 million for 261 awards to 121 GME programs across California to retain and expand GME programs in primary care (family medicine, internal medicine, pediatrics, and obstetrics and gynecology) and emergency medicine. However, even with the additional funding, the shortage of California residency programs poses an ongoing challenge for expanding the physician workforce. “We understand the vital statewide need for this program and the funding it provides to support California’s future physicians,” said Cathryn Nation, M.D., Vice President for Health Sciences at UC Office of the President. “The annual demand for funding ref lects the importance of this program and its focus on the needs of medically underserved groups and communities".
San Joaquin County Residency Programs Awarded
Amount
San Joaquin General Hospital Family Medicine . . . . . . . . . . . . . . . . . . . . $150,000.00 San Joaquin General Hospital Internal Medicine . . . . . . . . . . . . . . . . . . . $150,000.00 St. Joseph’s Medical Center Emergency Medicine . . . . . . . . . . . . . . . $1,125,000.00 St. Joseph’s Medical Center Family Medicine . . . . . . . . . . . . . . . . . . . . $675,000.00 St. Joseph’s Medical Center Internal Medicine. . . . . . . . . . . . . . . . . . . . $675,000.00 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,775,000.00
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Practice News and Resources Free to SJMS/CMA Members!
The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. For the time being, we will be offering Zoom Meetings until we can get back to meeting in person. This monthly forum is held on the second Wednesday of the month. Registration is required! If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org for the Zoom call info!
December 9th, 2020: 11:00AM to 1:00PM
“MEDICARE UPDATES” Join us for a virtual Medical Updates seminar that will cover relevant information about current, future and proposed changes for the coming year! Presented by Cheryl Bradley- Associate Director, CMA Center for Economic Services
January 9th, 2021: 12:00PM to 1:00PM
“2021 Employment Law Update” This webinar, presented by Jamie Bossuat, a shareholder and employment lawyer at Kroloff, will address the key changes that employers should be aware of in 2021. The presentation will cover all aspects of employment law, including the following major updates: include mandatory Employee Handbook updates, COVID-19 reporting requirements, and how to implement the expansion of the California Family Rights Act that will apply to employers with 5 or more employees beginning in 2021.
CMA PRACTICE RESOURCES
Ask the Expert: Is telehealth payment parity ending soon? Over the past few months, the California Medical Association (CMA) has received a number of inquiries from physician practices concer ned that the requirement to reimburse providers at in-office rates for telehealth services, including telephonic visits, may be
ending. However, according to guidance from Califor nia regulators, payors are required to continue with telehealth payment parity. On September 4, 2020, the Califor nia Department of Managed Health Care (DMHC) issued an all plan letter (APL) reminding DMHC-regulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services, including telephonic visits, as they would for services provided in person. This APL clarified that the prior APLs issued (20-009 and 20-013) remain in effect for the duration of Califor nia’s declared state of emergency or until further notice from DMHC, whichever is earlier. The APL also clarified that these requirements apply to delegated entities to the extent the health plan delegated the services impacted by these APLs. On March 30, 2020, the California Department of Insurance (CDI) issued guidance requiring CDI-regulated insurance companies to reimburse providers at the same rate for telehealth services as they would for services provided in person. Insurers were also required to reimburse a service provided telephonically at the same rate as services provided via video. These requirements are effective throughout the declared COVID-19 state of emergency. CMA has also heard from several practices that some payors aren’t reimbursing for the telephone services CPT codes, 9944199443. It’s important to note that while the regulators’ guidance requires payors to reimburse telehealth services, including telephonic visits, at the same rates as in person E/M office visits, such as CPT 99201-99205 and 99211-99215, the guidance does not
and patient interactions. The webinar series is open to all providers and will have an emphasis on the use of telehealth in Medi-Cal. For more information or to register, visit cmadocs.org/ telehealth-webinars.
Anthem Blue Cross introduces new narrow network for 2021
require payors to reimburse for the telephone services codes, CPT 99441-99443. Practices are encouraged to document thoroughly as though the visit had occurred in person and consider which in-person E/M office visit codes are appropriate to bill. For more information, see CMA’s COVID-19 Telehealth Toolkit for Medical Practices. This toolkit is currently available for free to all physicians as part of CMA’s ongoing support for physicians during the public health emergency. CMA has also produced a 12-part webinar series – Telehealth for Small and Medium Sized Practices – covering all aspects of implementing telehealth in a medical practice – selecting a platform, reimbursement rules
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Anthem Blue Cross has begun marketing a new, narrow “high performance” network for 2021. The Anthem High Performance/Blue High Performance Network (Blue HPN®) is part of a national network of Blue High Performance networks being created in collaboration with the Blue Cross Blue Shield Association. The new narrow network of physicians is a subset of its broader Anthem Prudent Buyer PPO network and will be utilized for its EPO (Exclusive Provider Organization) product line. While specific criteria for physician participation in the Blue HPN are unspecified, Anthem’s notice states that the Blue HPN is designed to focused on improved health outcomes and affordability of care for national employer groups. Anthem’s Blue HPN will be available in six metropolitan service areas located in the following Northern and Southern Califor nia areas.
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• • • • • •
Sacramento-Roseville-Arden-Arcade San Francisco-Oakland-Hayward San Jose-Sunnyvale-Santa Clara Los Angeles-Long Beach-Anaheim San Diego-Carlsbad Riverside-San Bernardino-Ontario
Anthem recently issued notices automatically opting-in providers who have been selected to participate in the Blue HPN. According to the notices, issued by Anthem on October 6, the terms of each physician’s underlying commercial PPO contract will apply to the new Blue HPN network. On or prior to January 1, 2021, provider directories will be updated to reflect providers participating in the new Blue HPN. Blue HPN patients will be issued new ID cards reflecting Blue HPN in a suitcase on the front of the card, signifying access to Blue HPN providers. Similar to other EPO narrow network plans, services rendered by non-Blue HPN providers are limited to only urgent and emergent care.
Physicians who are unsure whether or not they will be part of Blue HPN or those who have general questions about the program can contact Anthem Contract Support at CAContractSupport@Anthem.com.
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Public Health
Update
Twindemic: COVID-19 and Seasonal Influenza BY GWEN CALLAWAY, MPH AND MAGGIE PARK, MD
All health care professionals know that as the weather begins to turn cooler it is time to recommend that patients receive their annual inf luenza vaccine. As preventative measures go, it is one of the most effective strategies in the public health playbook for reducing illness, hospitalizations, and deaths across all age groups during the winter months. However, this year we have the added burden of COVID-19. We are already seeing a wintertime surge in COVID-19 cases which will only increase as the season progresses. Inf luenza cases are also starting to appear across California paving the way for a viral “twindemic�. Twindemic is the term that experts and pundits alike have settled on to describe the dual threat of a heavy inf luenza season and simultaneous increase in COVID-19 cases during fall and winter. Add to the mix strained healthcare supply chains, general pandemic fatigue from the public, as well as beleaguered and exhausted hospital staff and it is easy to see why the next few months have so many so worried. Each year during seasonal inf luenza the hospitals and their ICUs fill with inf luenza patients. Already this season, with the number of COVID-19 cases in the community surging, the hospitals in San Joaquin County are starting to fill up, including the ICUs. As
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f lu season progresses, if a majority of people do not get vaccinated against inf luenza, this twindemic will overwhelm hospital resources. We already know that inf luenza and COVID-19 share many clinical symptoms so the best way to differentiate them is to order tests for both diseases. Some laboratories are acquiring a multiplex test that can test for both inf luenza and COVID-19 at the same time. If this is not available within your health system, continue to order the two separate tests. Since inf luenza cases are already being detected within the state, it is time to start ordering both tests on symptomatic patients. Current CDC guidance indicates that those who are concerned about exposure to confirmed COVID-19 cases, but are asymptomatic, should be tested for COVID-19 alone. There are generally two types of COVID-19 tests available: viral and antibody. At this time, antibody tests are unreliable as a way to diagnose disease or to determine current immunity to disease since the immunity granted by infection and recovery is not well understood. There are still many unanswered questions about the nature and extent of the immunity, therefore it cannot be assumed that a positive antibody test means that a patient is immune from COVID-19. However, it can be useful in determining whether an individual was infected
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there are two types of diagnostic tests – molecular tests, such as RT-PCR tests, that detect the virus’s genetic material, and antigen tests that detect specific proteins from the virus.
infections. Antibodies can take several days or weeks to develop after you have an infection and may stay in your blood for several weeks or more after recovery. Because of this, antibody tests should not be used to diagnose COVID-19. At this time researchers do not know if the presence of antibodies means that you are immune to COVID-19 in the future.
MOLECULAR TEST
ANTIGEN TEST
ANTIBODY TEST
Also known as…
Diagnostic test, viral test, molecular test, nucleic acid amplification test (NAAT), RT-PCR test, LAMP test
Diagnostic test
Serological test, serology blood test, serology test
How the sample is taken…
Nasopharyngeal (the part of the throat behind the nose), nasal or throat swab (most tests)
Nasal or nasopharyngeal swab (most tests)
Finger stick or blood draw
Some may be very fast (15 – 30 minutes), depending on the test
Same day (many locations)
Saliva (a few tests) How long it takes to get results…
Same day (some locations)
Is another test needed…
This test is typically highly accurate and usually does not need to be repeated.
Positive results are usually highly accurate, but false positives can happen, especially in areas where very few people have the virus. Negative results may need to be confirmed with a molecular test.
Sometimes a second antibody test is needed for accurate results.
What it shows…
Diagnoses active coronavirus infection
Diagnoses active coronavirus infection
Shows if you’ve been infected by coronavirus in the past
What it can’t do…
Show if you ever had COVID-19 or were infected with the virus that causes COVID-19 in the past
Antigen tests are more likely to miss an active COVID-19 infection compared to molecular tests. Your health care provider may order a molecular test if your antigen test shows a negative result but you have symptoms of COVID-19.
Diagnose COVID-19 at the time of the test or show that you do not have COVID-19.
or up to a week (longer in some locations with many tests)
www.fda.gov
(Fig.1: FDA)
even if they never showed symptoms. PCR (molecular test) and antigen tests are currently recommended to diagnose acute infection in symptomatic patients. Only PCR should be used for testing asymptomatic patients, such as close contacts of confirmed cases. Antigen tests are less sensitive than PCR tests, but they have similar specificity. Antigen tests perform best in symptomatic patients within seven days of their symptom onset, when the viral load is thought to be highest. If a patient is strongly suspected of having a COVID-19 infection receives a negative result on an initial antigen test, repeat testing using a PCR test should be considered. (Fig.1: FDA) With never-ending news coverage of COVID-19 case surges throughout the country, a twindemic seems all but inevitable. However, this is not the case. Despite the fact that inf luenza season is well on its way, it is not too late to be vaccinated. In San Joaquin County, f lu season typically runs from the end of October to the beginning of May. One
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1
or 1-3 days
October 2020
of the best things you can do is to encourage your patients - and their entire family - to receive a f lu shot as soon as possible. Recent data from the California Department of Public Health (CDPH) shows that the number of people getting a f lu shot has greatly decreased this season. This is exactly the opposite of what is needed now. To protect the patients and their families and help prevent hospitals from becoming overwhelmed, it is important that most people in our community receive a f lu vaccine as soon as possible. As a provider, contact your patients now and advise them of the importance of getting a f lu shot and encourage it for their whole family as well. Whether you are seeing them in person, virtually, or telephonically, be prepared to address questions, hesitancy, or misconceptions they may have about the f lu vaccine, particularly this year. Reassure them that this is the same seasonal f lu shot that is available every year. Remind them that there will be a separate vaccine for COVID-19. Situations change rapidly in an emergency and at the
SAN JOAQUIN PHYSICIAN
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(Fig. 2: CDC)
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time of this writing, the two frontrunning COVID-19 vaccines, from Pfizer and Moderna, have both released promising initial efficacy data. They are each expected to apply for and receive Emergency Use Authorization (EUA) from the FDA in order to enable quick rollout to the population. The first doses are projected to arrive at the end of 2020 for those identified in Phase 1A of vaccine distribution. Generally, this includes groups like healthcare providers, first responders, and long-term care facilities and will be narrowed down within each county individually based on the amount of vaccine actually allocated and the number of individuals at highest risk. There most likely will not be sufficient supply available for the general public until well into 2021. More information about planning for the COVID-19 vaccine can be found on the CDPH website: https://www.cdph.ca.gov/Programs/CID/ DCDC/Pages/COVID-19/COVID-19Vaccine.aspx. Once the COVID-19 vaccine does become readily available it will be more important than ever to address safety concerns and misconceptions. Widespread uptake is necessary if we are to achieve herd immunity and return to some semblance of normal life. Though data so far is promising, we cannot afford to erode trust in traditionally highly credible public health institutions. Any vaccine that becomes available will be reviewed and approved by a panel of top health experts before distribution in California. Informational resources for the public are currently being developed at every level about the COVID-19 vaccine. In particular, it is important for marginalized populations that there be transparency at every step. Continue to look for updates from CDPH and San Joaquin County Public Health Services as well as from federal sources like the FDA and the CDC. In the meantime, continue to reinforce the best way to combat both seasonal inf luenza and COVID-19 with your patients: wash your hands, stay 6 feet apart, stay home when sick, don’t gather with those outside your household, and wear a mask correctly. As a community, we can work together to keep each other safe and do our part to mitigate the effects of a twindemic. (Fig. 2: CDC)
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PPE Relief The California Medical Association and the California Office of Emergency Services distributed more than $80 million worth of personal protective equipment (PPE) free to nearly 15,000 practices in California.*
40,570
36 Events
Physicians Served
Over 15 Days
Boxes Distributed
15,800
in person
PPE Distributed
15 Million
Examination Gloves
40 Million Pieces
6,700
9,100
by mail
1.4 Million
700,000
Isolation Gowns
Bottles of Sanitizer
6.5 Million
1.5 Million
15 Million
N95 Respirators
Face Shields
Surgical Masks
Value of PPE Distributed
Items per Box 1,600 Nitrile Examination Gloves 800 Surgical Masks 320 N95 Respirators 90 Isolation Gowns 40 Face Shields
Practices Reached
15,000
Per Box
$5,000 Total
$80.6 Million Volunteers
Over 1,000
*Distribution is ongoing and these numbers are accurate as of September 1, 2020.
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15 NEW
SJMS MEMBERS THIS FALL!
...and even more on the way. Chirag Sheth, M.D.
Elyas Parsa, M.D.
Bayan Aghdasi, M.D.
Internal Medicine
Family Practice
Orthopaedic Surgery
445 W Eaton
500 West Hospital Rd.
2545 W Hammer Ln
Tracy, CA 95376
French Camp, CA 95231
Stockton, CA 95209
C.U. Shah Medical College, 2009
(209) 468-6768
(209) 948-1641
Midwestern University, 2009
Loyola University - Stritch School of Medicine, 2013
Dilpreet Kaur, M.D.
Juan Chiriboga Hurtado, M.D.
Neurology
Family Practice
Mahboob Ali, M.D.
445 W Eaton
500 West Hospital Rd.
Cardiology
Stockton, CA 95209
French Camp, CA 95231
1801 E March Ln
(209) 954-3370
(209) 468-6841
Stockton, CA 95209
Ross University School of Medicine,
Pontifical Catholic University of
(209) 951-9884
2005
Ecuador, 2009
Chandka Medical Coll University of
Manuel De La Cruz, M.D.
Robert Assibey, M.D.
Sind, 2002
Family Practice
Pei-Chuan Bellor-Yeh, M.D.
Pediatrics
500 West Hospital Rd.
Family Practice
518 West Eaton Avenue
French Camp, CA 95231
2505 W Hammer Ln
Tracy, CA 95376
(209) 468-7102
Stockton, CA 95209
(209) 833-2228
Ross University School of Medicine,
(209) 957-7050
Fac of Medical & Surg-University of
2017
Michigan State University College of
Santo Tomas, 1980
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SAN JOAQUIN PHYSICIAN
Human Med, 2017
WINTER 2020
Sukalpa Chowdhury, M.D.
Arpit Patel, D.O.
Family Practice
Family Practice
165 St Dominics Dr #201
2505 W Hammer Ln
Manteca, CA 95337
Stockton, CA 95209
(209) 823-2345
(209) 957-7050
Bankura Sammilani Medical Coll Calcutta U, 2009
Philadelphia College of Osteopathic Medicine, 2010
Karla Guerrero-Hall, M.D.
Nimmie Singh, D.O.
Obstetrics
Urgent Care
445 W Eaton Ave
445 W Eaton Ave
Tracy, CA 95376
Tracy, CA 95376
(209) 835-0100
(209) 830-4075
University of Illinois College of Medicine, 2016
Touro University College of Osteopathic Medicine
Gayathri Devi Kalva, M.D.
Maryam Zaman, M.D.
Internal Medicine
Family Practice
999 S Fairmont Ave #130
445 W Eaton Ave
Lodi, CA 95240
Tracy, CA 95376
(209) 366-2001
(209) 832-0535
Kurnool Medical Coll Sri Venkatesvara University, 2010
St Georges University School of Medicine, 2017
an affiliate of
We’re delivering the same comprehensive medical and social care to seniors – remotely, in their homes. THOUGH THE WORLD HAS CHANGED, our commitment to the health and well-being of our participants has never been stronger. We’ve rapidly shifted to a model of care we’re calling HomePACE, deploying 4G LTE tablets to all participants to help them stay connected to our medical team and stay engaged through games and social activities. When in-person care is required, it’s done by a single caregiver in the home whenever possible, minimizing potential exposures to Covid-19. We continue to enroll new participants, helping keep seniors healthy and thriving while also physically distanced to prevent the spread of the virus. For more information about our program, visit stocktonpace.com.
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SAN JOAQUIN PHYSICIAN
59
San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568 RETURN SERVICE REQUESTED
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San Joaquin Medical Society Member Benefits • Complimentary Security and Risk Assessment of your IT Infrastructure (valued at $500) • Compromised Credential Report from the Dark Web • 10% Discount of Monthly Managed Services for 1 Year (valued at a maximum of $5,000) • 6 Months Free Hosting of VoIP Phone System / Free Licensing for 3 years / 20% Off Set-up and On-boarding (valued at a maximum of $2500) • Waived Set-up Fee (valued at $1,000 - $2,000 – user # dependent) Call Shari Peck @ 209-423-2760 or email shari@ce-technology.com