Winter 2022

Winter 2022

SERVING SAN JOAQUIN,

TUOLUMNE, ALPINE, AMADOR AND CALAVERAS COUNTY PHYSICIANS

151st House of Delegates Convenes Dr. Mansahdi elected to Board of Trustees Employment Legislative Update

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HEALTHCARE PROFESSIONALS

treated fairly With the recent acquisition of NORCAL Group, ProAssurance is now the nation’s third largest medical professional insurance carrier with claims and risk management expertise in every major healthcare region.

Meet the new best-in-class, where the principle of fair treatment guides every action we take in defense of our medical professionals.

For information regarding the NORCAL Group acquisition > > > 2

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ProAssurance.com

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VOLUME 70, NUMBER 4 • DECEMBER 2022

PICTURED ABOVE: HOUSE OF DELEGATES

9 A MESSAGE FROM OUR PRESIDENT

12 LAYING NEW FOUNDATIONS 14 ENROLLMENT IN MEDI-CAL MANAGED CARE PLANS

16 2 022 EMPLOYMENT LEGISLATIVE UPDATE

18 LEGISLATIVE WRAP UP 2022

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28 HOUSE OF DELEGATES 40 COMMUNITY CONNECTIONS

42 IN THE NEWS 50 RESIDENTS' REPORT 52 PRACTICE MANAGEMENT 56 PUBLIC HEALTH

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PRESIDENT- Cyrus Buhari, DO PRESIDENT ELECT- Nguyen Vo, MD TREASURER- Neelesh Bangalore, MD BOARD MEMBERS Stephen Tsang, MD, Maggie Park, MD, Sujeeth Punnam, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD, Raghunath Reddy, MD, Kinnari Parikh, MD, Inderpreet Dhillon, MD and Bhagya Nakka, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Raghunath Reddy, MD MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Jo Ann Kirby, Cyrus Buhari, DO, Leticia Garcia Castillo, MSN, RN, PHN, Maggie Park, MD, Jamie Bossuat, Nadeja M. Steager 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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SPONSORED BY

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EXECUTIVE DIRECTOR’S REPORT

THE VALUE OF ADVOCACY

Throughout my time at SJMS, I have heard many stories of physicians donating their time and talents to projects and organizations both in our community and abroad. We’d love to learn more about your passion projects for an upcoming article! What is so important to you, that you use what little “free” time you have, to make a difference, big or small? Please look for a survey that will be emailed in December; we may even highlight you in the article! Not sure we have your proper email address? Email me at Lisa@ sjcms.org.

LISA RICHMOND

We often talk about advocacy as one of the intangible, yet most important, benefits of joining SJMS/CMA. Each year a group of seven dedicated SJMS Delegates participate in the legislative process as they meet with hundreds of their peers from across street at the annual CMA House of Delegates Conference.

They say that if you don’t have a seat at the table, you are on the menu, so we would like to invite you to the table! We are currently recruiting passionate leaders, who are interested in influencing policy and legislation, to serve as Alternate Delegates. Please read more about the HOD process and how to get involved, as well as details on all 2022 healthcare legislation.

Speaking of member benefits, our Office Managers Forum (OMF) is back in person and will now be offered quarterly on the second Wednesdays of March, June, September, and December at Papapavlos in Lincoln Center.

The OMF empowers physicians and their practice managers with valuable tools and resources via expert led sessions from industry professionals.

Finally, we hope to see you at our annual Holiday Party on Thursday, December 15 at Stockton Golf & Country Club as we enjoy fellowship with friends and colleagues and celebrate a year well done. I wish you all much laughter, joy, good cheer, and time with those who matter most. Thank you for the privilege of leading the society for another year.

Happy Holidays,

Lisa Richmond

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Excellence in minimally invasive care.

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

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

Angiography for vascular malformation Balloon kypohoplasty for vertebral compression fractures Cryoablation for kidney cancer Pain management to treat nerve pain (pain blocks) Percutaneous transhepatic biliary drainage (PTBD) Peripheral arterial and venous disease Prostate artery embolization (PAE) Radioembolization for liver cancer (Y90) Uterine artery / uterine fibroid embolization (UAE / UFE)

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

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Closer to home + enhanced referrals = easier access to WORLD-CLASS CARE Offering added convenience for our referring providers From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-theminute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley.

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

Referring your patients to UC Davis Health care is easier than ever. Our physician referral liaisons are here to serve as direct lines of communication — helping to navigate and expedite referrals.

Our liaisons can help to: ■

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Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings, webinars, and share information about CME and other events Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs

Reach out to your local Physician Referral Liaison today: Joaquin Muñoz | 916-701-7161 | joamunoz@ucdavis.edu

Payam Saadai, M.D. Assistant Professor, Department of Surgery Specialties: Pediatric Surgery, Colorectal Surgery, Fetal Surgery, Minimally Invasive Surgery

Frank Ing, M.D., F.A.C.C., M.S.C.A.I., Chief, Division of Pediatric Cardiology, Codirector, UC Davis Pediatric Heart Center, Professor of Pediatrics Specialty: Pediatric Cardiology

referrals.ucdavis.edu 8

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A message from our President > Cyrus Fram Buhari, DO

We cannot afford to wait Every other year it seems as if we go through a political cycle. One party is up and the other party is down. It’s so sensational and vapid that many physicians such as myself try very hard to drown it out. But no matter which party is in power, it seems that the voices of physicians go unheard unless there is political gain from some legislative action. I am hopeful that this cycle will be different, but I am used to disappointment by now.

For years the physicians of our community have been delivering care to the people of our community at a discount while improving quality and outcomes. There has been no meaningful increase in reimbursement to primary care, specialty, or surgery that can even come close to matching inflation and the cost to deliver this care. Physician practices have long suffered financially under the burdens of the Affordable Care Act as well as draconian Centers for Medicare and Medicaid Services (CMS) cuts that only serve to punish physician practices and reduce access to care. I recognize that these cuts are made through some warped sense of maintaining budget neutrality in order to have the appearance that our legislators are efficient stewards of our tax dollars.

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

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However, despite this we see billions (if not trillions) of dollars being spent on our behalf that do not translate into improvement in the lives of the members of our community. No matter which party you support, or which party is in power, an immense amount of wasteful spending is in every single bill signed into law.

Would it be too inflammatory to suggest that for every dollar spent on foreign aid or the military, that a matching dollar be spent on healthcare for the patients of our community? Without impugning the motives of our elected leaders, I respectfully urge them to listen to and take an interest in our concerns.

CMS is poised to enact cuts in 2023 that will result in Medicare payment cuts to over 90% of medical practices. It seems both asinine and punitive at the same

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A message from our President > Cyrus Fram Buhari, DO

time. If the goals are to increase access to care, improve the quality of that care, and facilitate delivery of care to our community, then how can these cuts be seen as positive toward those ends? The cost of living has risen for us all and every physician practice that I am in touch with has given their employees cost of living increases to the extent that they can financially bear it.

California Medical Association and the San Joaquin Medical Society are working hard to lobby for the delay of these cuts in the CMS Physician Fee Schedule rule. If we can get our elected leaders to listen and act on this, it will be a start. But not only will these cuts send physicians into early retirement, they will serve as a negative incentive to move to underserved areas or areas where the cost of living is oppressive. Not only should these cuts be eliminated, but there should also

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be a push for increased reimbursement and a cost of living adjustment that matches inflation.

ANY reduction in payments to physicians from CMS (and insurers who will closely follow suit) will reduce access to care and result in harm to the patients of our community. I remain hopeful that common sense and compassion will prevail. We as physicians need to make our voices heard to elected leaders and to our patients whose precious votes they desire. The San Joaquin Medical Society has been speaking with a loud voice at both the local, state, and national level but we cannot push for these changes without the strong support of our membership. I urge all of you to push our friends and colleagues to renew their memberships and join us in the fight ahead. Thank you.

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BY NADEJA M . STE AGER

FOR IMPROVED YOUTH MENTAL HEALTH On November 1, 2022 the Community Health Leadership Council of San Joaquin County convened its 22nd Annual Community Health Forum, Youth Mental Health: Dismantling a Million Bricks. Recognizing and addressing the youth mental health crisis is of utmost importance as is ensuring access to quality mental health care services for those who need it is imperative.

The National Alliance on Mental Illness published in a recent article (APR. 19, 2022), “We are in a youth mental health crisis.

And the need to talk about and address this crisis is urgent.”

The Council was pleased to bring together this timely meeting of various diverse leaders representing hospitals, medical providers, health plans, community-based organizations, youth, local government, business, education and non-profits who are committed to unite and effectively address and collectively help resolve youth mental health issues.

“There is great need for us to urgently work to find new creative and collaborative solutions to improve mental health care workforce shortages, access to good mental health services for our youth most in need and leveraging resources to connect our youth

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with these services to address this growing crisis in our region,” Nadeja Steager, director of the Community Health Leadership Council said, “the youth are not only our future, they are our now”.

Our MC and Moderator for the day, Brian Jensen, Vice President of the Hospital Council of Northern and Central California began the days’ message with the bottom line up front.

“We need your help. Today is a Call To Action!” He went on to say, “behavioral health needs are real; anxiety, depression, substance use, suicide, these are all real things that kids are struggling with everyday”. The ask is that we all take inventory of what we bring to the table and such that we can combine to realize a significant improvement to our youth mental health and well-being.

Aside from being an honor, having Ms. Michelle Doty Cabrera, Executive Director, County Behavioral Health Directors Association of California as our keynote was very enlightening as she spoke of behavioral health being “much more than a medical model of physicians, medication and nurses rather an amalgam of a (child’s) environment, living conditions, societal factors like discrimination, as well as their ability to cope with those things”.

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She went further to touch upon the importance of all community partners from bottom to top working together to ensure mental health benefits, policy and funding are structured to connect with and help youth in the best way possible to enable them to overcome mental challenges.

We also heard from a unique panel of local experts “who have great experience, perspective and who are in the trenches addressing these challenges every day”, said Jensen. Fay Vieira, San Joaquin County Behavioral Health Services, Children and Youth Services, Sheri Coburn, San Joaquin County Office of Education, Comprehensive Health Programs, Dr. Paul Rains, St. Joseph’s Behavioral Health Center and Christine Noguera, Community Medical Centers covered some of the root of trauma and adverse childhood experiences that directly impact youth behavioral health, the mental health impact the healthcare workforce shortage is having and the current efforts to alleviate, as well as some of the current partnerships and projects to increase mental health programs and services with delivery models that meet the youth where they are

at in order to more readily care for those being impacted by mental health difficulties.

Brian Jensen closed with an invitation and exhortation. “I invite you and me to stand shoulder to shoulder and lift where we stand. There is something that each of us can do in this. Not one of us alone can shoulder the burden of fixing this problem but together there are things that each one can contribute to do just that. I am confident that we can make a better situation for our young people”.

CHLC M E M B E RS Dr. Lisa Aguilera-Lawrenson Superintendent/President

Alain Flores, MD Assistant Physician-in-Chief

Christine Noguera Chief Executive Officer

Zienna Blackwell Rodriquez Director

Matt Garber Assistant Director

Maria Pallavicini Provost/Executive Vice President for

Troy Brown Superintendent of Schools

Brian Jensen Vice President

Lisa Richmond Executive Director

Greg Diederich Agency Director

Sanjay Marwaha, MD Physician in Chief

San Joaquin Delta College

San Joaquin County Public Health Services

San Joaquin County Office of Education

San Joaquin County Health Care Services Agency

The Permanente Medical Group

San Joaquin County Health Care Services Agency

Hospital Council of Northern & Central California

The Permanente Medical Group

Brooke McCollough President

Adventist Health, Lodi Memorial Hospital

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Community Medical Centers

Academic Affairs University of the Pacific

San Joaquin Medical Society

Michael Schrader Chief Executive Officer

Health Plan of San Joaquin

Nadeja Steager Executive Director

Community Health Leadership Council, San Joaquin

Don Wiley President & Chief Executive Officer

Dignity Health, St. Joseph’s Medical Center

Betty Wilson Executive Director

Business Council of San Joaquin County

Chuck Winn, Board of Supervisor, District 4 San Joaquin County Board of Supervisors

Moses Zapien, Chief Executive Officer & President

San Joaquin Community Foundation

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Patients with Medicare and Medi-Cal: Enrollment in Medi-Cal Managed Care Plans

For your patients that have both Medicare and Medi-Cal (Medi-Medi), they will soon need to enroll in a Medi-Cal managed care plan. This change does NOT restrict their choice of Medicare providers, or their choice of Original Medicare vs.

Medicare Advantage. Medi-Medi patients can continue seeing their Medicare providers, regardless of which Medi-Cal plan they enroll in. Medicare providers do NOT need to enroll in Medi-Cal plans to see Medi-Medi patients.

The California Department of Health Care Services (DHCS) is making this change to make Medi-Cal coverage more consistent throughout the state – over 1.1 million patients with Medicare and Medi-Cal (over 70 percent) are already enrolled in a Medi-Cal managed care plan.

DHCS recently sent notices to Medi-Medi patients that need to choose a Medi-Cal plan. In San Joaquin County, Medi-Medi patients can choose either Health Net or Health Plan of San Joaquin for their Medi-Cal plan.

How should providers educate their front office and billing staff about this transition?

What should provider front office and billing staff tell MediMedi patients about this transition?

•M edicare providers do NOT have to join a Medi-Cal plan to continue billing Medicare.

•M edi-Medi patients can choose any Medi-Cal plan, even if their Medicare provider is not in the Medi-Cal plan.

• P rovider payment amounts will NOT change when a MediMedi patient joins a Medi-Cal plan.

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• Joining a Medi-Cal plan does NOT limit access to Medicare providers or change Medicare benefits.

• Joining a Medi-Cal plan does NOT impact patient choice of Original Medicare or Medicare Advantage.

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How will Medicare provider billing change when a MediMedi patient joins a Medi-Cal Plan?

• P roviders continue billing Medicare as usual.

• I n general, Medi-Cal Managed Care plans are responsible for all applicable Medicare deductibles and coinsurance for dual-eligible individuals, whether the provider is in or out of network, and should be billed appropriately.

Where is this enrollment change happening?

• F or people with both Medicare and Medi-Cal, Medi-Cal coverage will change to Medi-Cal managed care in the counties listed below. In all other counties, Medi-Cal is already provided through Medi-Cal managed care plans: •A lameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, El Dorado, Fresno, Glenn, Imperial, Inyo, Kern, Kings, Madera, Mariposa, Mono, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, Sierra, Stanislaus, Sutter, Tehama, Tuolumne, Tulare, and Yuba counties.

How do Medi-Medi patients choose a Medi-Cal plan?

• Medi-Cal plan choices depend on the county, and whether the patient is already in a Medicare Advantage plan. Patients can learn more by visiting the Health Care Options (HCO) website or calling 1-800-430-4263.

How do I find out more about this change?

• For more information, please visit this webpage at the California Department of Health Care Services: Statewide Medi-Cal Managed Care Enrollment for Dual Eligible Beneficiaries • Patient questions should be directed to DHCS Health Care Options at 1-800-430-4264, or the Health Care Options website.

• For additional questions from Medicare providers related to this transition, please email OMII@dhcs.ca.gov.

Julio Narvaez M.D. Andrew Chen M.D. Alan Nakanishi M.D. Pamela Tsuchiya M.D. On-Tat Lee M.D. Hana Rha O.D. Aamun Garcha O.D.

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2022 EMPLOYMENT LEGISLATIVE UPDATE By: Jamie M. Bossuat, Kroloff, Belcher, Smart, Perry & Christopherson As we have seen for the last several years, the legislative session this year resulted in a multitude of employment laws that employers should be aware of and implement in their workplaces. Below are a few that are likely to be most notable for medical practices:

Bereavement Leave The California Family Rights Act (CFRA) was expanded t o cover bereavement leave. Beginning January 1st, employers covered by the CFRA (those with 5 or more employees) must provide 5 days of unpaid leave following the death of an employee’s family member. As with the rest of the CFRA, “family member” is a spouse, child, parent, sibling, grandparent, grandchild, domestic partner, or parent-in-law. Employees must have been employed at least 30 days prior to the commencement of the leave. The days need not be taken consecutively, but must be taken within three months of the date of death. Employers can request documentation of the family member’s death.

Leave to Care for Designated Persons Both the CFRA and the California Paid Sick Leave law are amended to allow an employee to take an unpaid leave of absence to care for a “designated person” other than a family member as defined under the law. Employers may limit employees to one designated person per 12-month period. \ Pay Scale Posting Existing law requires employers to provide pay scale information to applicants after an applicant has completed an initial interview. A “pay scale” is the “salary or hourly wage range that the employer reasonably expects to pay for the position.” This

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requirement has been expanded. All employers must provide pay scale information to current employees for the employee’s current position. Additionally, employers with 15 or more employees must post the pay scale within any job posting and provide it to third parties engaged to announce or publish a job posting.

Non-Work Related Marijuana Usage The Fair Employment and Housing Act has been amended to prevent discrimination against employees or applicants based on their use of cannabis off the job and away from the workplace. Employers may still maintain drug and alcohol-free workplaces and prohibit employees from possessing, using, or being impaired by cannabis at work. This law does not apply to employees in the building and construction trades or positions that require applicant or employee testing as a matter of law.

Minimum Wage & Mileage Reimbursement Increases The statewide minimum wage will increase to $15.50 per hour for all employers, regardless of the number of employees, on January 1, 2023. The minimum salary threshold to maintain exempt status will increase to $64,480 annually. Additionally, the IRS mileage reimbursement rate increased to 62.5 cents per mile on July 1, 2022.

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YO U ’ R E M A D E F O R

You want to fill each day with more of what matters most. Adventist Health Lodi Memorial and Dameron Hospital are here to help you experience the health, wholeness and hope you need so you can embrace each moment. We do this through whole-person healthcare that’s convenient, connecting you with providers who understand you’re more than just a patient. We’re proud to be a partner on your journey to experience your best health — mind, body and spirit. Because we’re not just here to put more years in your life. We’re here to put more life in your years.

Learn more at AdventistHealthLodiMemorial.org

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2022 Legislative Wrap-Up

By Janice Rocco, CMA Chief of Staff In 2021, with emergency use authorization for COVID-19 vaccines, the hope was that the pandemic would end and life could go back to normal.

Instead, it wasn’t until 2022 that the state legislature began moving back to something resembling business as usual.

By Janice Rocco, CMA Chief of Staff

I

n 2021, with emergency use authorization for COVID-19 vaccines, the hope was that the pandemic would end and life could go back to normal. Instead, it wasn’t until 2022 that the state legislature began moving back to something resembling business as usual.

The state declaration of the COVID-19 State of Emergency remains in effect. The State Capitol is again open to the public, but even that has changed in ways that provide less access to legislators and their staff than was the case prior to the pandemic. The Capitol building is undergoing construction and legislators have moved their offices outside the Capitol.

Committee hearings are being conducted in person again, though often with a hybrid phone-in option. Separate from the legislature, public meetings held by state departments and commissions have begun shifting back to a hybrid approach, so that we can be back in person again. These changes mean that we have adjusted and found new ways that we, as advocates, communicate with legislators and their staff.

In California, we had five legislative seats become vacant during the year, which meant five special elections to fill them. By the time each of these races had concluded, a total of five new Democrats had been sworn into office. With these additions, Democrats continue to have a supermajority in both the Assembly and the Senate.

The closing of the 2021–2022 legislative session also brought with it the end of an era for a well-respected member of the legislature. Senator Richard Pan, M.D., spent 12 years serving California in the legislature by focusing on improving the state’s health care system, fighting for patients and the practice of medicine. Though Dr. Pan has many legislative accomplishments, we are particularly grateful for his leadership during the COVID-19 pandemic, where his expertise was critical to our state on a daily basis.

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HEALTH CARE REFORM

MICRA

As the legislative year began, AB 1400, the single payer health care coverage bill, was before the State Assembly for a vote. That bill died in the Assembly at the end of January, which then shifted the discussion to other health care reform measures. The Governor’s Office of Health Care Affordability proposal from 2021 was back for discussion and debate, with the California Medical Association (CMA) fighting to prevent this broad measure from becoming an administrative burden for physician practices.

When the year began, the expectation was that CMA’s focus in 2022 would be working to defeat the socalled “Fairness for Injured Patients Act” (FIPA) ballot initiative that had qualified for the November 2022 ballot. The ballot initiative, if it had passed, would have eviscerated the protections of California’s Medical Injury Compensation Reform Act (MICRA). After Californians Allied for Patient Protection (CAPP), led by CMA CEO Dustin Corcoran, negotiated a legislative deal with FIPA proponents, Assemblymember Eloise Gómez Reyes put that legislative deal into AB 35, the MICRA Modernization Act. Just 16 days later, Governor Newsom signed the bill into law and FIPA proponents removed their initiative from the ballot. This historic agreement prevented a costly ballot fight and ushered in a new and sustained era of stability around malpractice liability.

Ultimately, we were successful in getting physician practices with fewer than 25 physicians exempted from both the data submission requirements and the cost targets that the state will develop. Similarly, we fought to prevent independent practice associations (IPAs) from being included as a way to impose cost targets and data submission requirements on smaller physician groups, ultimately seeing them removed from the bill. We were also able to get the Newsom Administration to commit to include $200 million in the state budget for grants to assist physician practices with implementation of some of the provisions in Office of Health Care Affordability legislation, such as a shift to alternative payment models.

STATE BUDGET Another victory in the health care reform space was achieved via the 2022–23 state budget. Continuing California’s commitment to achieving universal health care access, the $308-billion budget includes a phasedin system to provide full scope Medi-Cal coverage to all income-eligible Californians regardless of age or documentation status by January 1, 2024. This makes California the first state in the nation to expand its Medicaid program to provide full benefits to all eligible individuals—a critical step in our shared goal of ensuring that every Californian has access to quality health care.

Many other CMA priorities and supported issues were addressed in the 2022–23 budget, including: a permanent extension of key Medi-Cal telehealth flexibilities implemented during the pandemic; full funding for the Prop. 56 Medi-Cal supplemental payments and graduate medical education funding programs; major investments in health care workforce development; $1.3 billion for health care worker retention pay; $700 million in equity and practice transformation payments; and $200 million for reproductive health and reproductive justice issues.

(For more details on the state budget, see cmadocs.org/ budget-22-23.)

MEDICAL BOARD CMA aggressively fought AB 2060 (Quirk), which would have created a public member majority on the Medical Board of California. We were able to kill this bill in its first house.

At the same time, CMA sponsored legislation— AB 1636

by Assemblymember Akilah Weber, M.D. —to preserve the integrity of the medical profession by ensuring physicians convicted of sexual assault with a patient lose their license with no ability for it to be reinstated. This bill removes the medical board’s discretion to give or reinstate the license of a physician or surgeon who lost their license due to sexual misconduct with a patient. This bill would also deny a physician’s and surgeon’s license to an applicant who has been or is required to register as a sex offender.

HEALTH IT CMA had three significant victories addressing health information technology issues. The passage of AB 852 (Wood) eliminates administrative burdens associated with complying with California’s electronic prescribing mandate. AB 32 (Aguiar-Curry) permanently ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, so that this reimbursement reform lasts beyond the public health emergency. Finally, SB 1419 (Becker) helps physicians comply with the new federal information blocking rule and protects patients’ sensitive medical information.

REPRODUCTIVE RIGHTS In June, the U.S. Supreme Court decision in Dobbs v.

Jackson Women’s Health caused shockwaves on a national

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scale, as access to reproductive health care services was stripped away from millions of Americans overnight.

CMA and other organizations had begun planning for this reality in late 2021 by forming the Future of Abortion Council to develop legislative and budget proposals to ensure that access to abortion care would not be denied in California once the court overturned Roe v. Wade.

This year, 15 reproductive health care bills were signed into law by Governor Newsom, including bills meant to strengthen protections for physicians and other health care providers from civil or criminal actions that could arise in other states if providers treat patients from outside California. Additionally, $200 million was included in the 2022–23 state budget to expand access to reproductive health care, including abortion.

ADMINISTRATIVE BURDENS CMA sponsored SB 250 (Pan) to reduce administrative burdens from health plans’ prior authorization requirements and ensure that patients get the care they need, when they need it. This bill was strongly opposed by the health plans and although it passed the Senate, it fell short in the Assembly Appropriations Committee.

SCOPE OF PRACTICE Another big fight this year was CMA’s work with the California Academy of Eye Physicians and Surgeons to oppose AB 2236 (Low), which would have allowed optometrists to perform certain surgical procedures without the same training as ophthalmologists. This bill was hard-fought in the legislature and was the last bill to pass the Assembly before midnight on the final night of the legislation session, when it eventually received the 41st vote it needed for passage. Even though this bill narrowly made it out of the legislature, Governor Newsom heard from hundreds of physicians and vetoed it to protect patients, issuing a strong statement about the inadequacy of its training requirements.

LOOKING BACK AT A BUSY SESSION By the time the Governor’s bill final signing period for the 2021–22 legislative session ended, Governor Newsom had signed 997 bills into law and vetoed 169 bills.

On the following pages, you will find summaries of many of the key bills that CMA was involved with in 2022.

For more details on the major bills that CMA followed this year, visit cmadocs.org/legwrap2022. Subscribe to CMA’s free biweekly Newswire and stay informed on CMA’s legislative efforts and other issues critical to the practice of medicine at cmadocs.org/subscribe.

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The California Medical Association (CMA), working to empower physicians to lead and transform the health care system, recently welcomed Stuart Thompson, J.D., as its new Senior Vice President. In that role, he will lead the association’s government relations and political operations efforts.

“Stuart’s impressive record of success inside the halls of government and across California’s political landscape will be a great asset as we navigate rapid changes in our health care delivery system and look for opportunities to improve the health of all Californians by helping people get timely, high-quality care,” said CMA CEO Dustin Corcoran.

“We have a big year ahead of us and Stuart’s deep understanding of health care policy, and the legislative and regulatory agencies in California, will position CMA as an even greater force in the health care advocacy space.”

Thompson has over 15 years of legislative, government and legal experience in California, most recently serving as the Chief Deputy Legislative Secretary in Governor Gavin Newsom’s administration. Having already served as Associate Director of Government Relations at CMA for five years prior to joining the Newsom administration, Thompson’s wealth of experience advocating on behalf of physicians and the patients they serve makes him uniquely suited for the role.

“This is a pivotal time for health care in our state and I am thrilled to join CMA’s lobbying team to advance meaningful, measurable improvements in California’s health care delivery system,” said Thompson. “By bridging the gap between policymakers and medical professionals, we can achieve a health care system that delivers for all Californians.”

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Advanced Urology in Stockton If urological issues are keeping your patients from doing what they love, St. Joseph’s Medical Center is here to help. Our fellowship-trained urologists treat a wide variety of conditions, including those affecting the bladder, kidneys, prostate, and reproductive organs. Our specialists utilize the latest technologies available to treat the entire spectrum of cases, from the most common to the most complex.

Advanced treatment options include: • Robotic-assisted surgeries: • Prostatectomy • Nephrectomy • Cystectomy • Adrenalectomy • Bladder neck contracture • Pyeloplasty • Ureteral reimplant • Cystoscopy (visual scope inspection of the urethra) and bladder/prostate (in men) • Treatments for benign prostatic hyperplasia • Removal of kidney or prostate due to cancer • Removal of kidney stones • Anti-incontinence surgeries To learn more, visit dignityhealth.org/stockton/urology.

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SPONSORED BILLS AB 32 (AGUIAR-CURRY): TELEHEALTH

Status: Signed by Governor (Chapter 515, Statutes of 2022).

Assembly Bill 32 ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, adds flexibility for providers to enroll patients in certain Medi-Cal programs remotely, and requires the Department of Health Care Services to complete an evaluation to assess the benefits of telehealth in Medi-Cal

by July 2025.

AB 1636 (WEBER): PHYSICIAN LICENSURE OR REVOCATION – SEXUAL MISCONDUCT

Status: Signed by Governor (Chapter 453, Statutes of 2022).

Assembly Bill 1636, by Assemblymember Akilah Weber, M.D., protects patients and maintains confidence in the medical profession by ensuring physicians convicted of sexual misconduct have their license revoked and cannot acquire or have a license reinstated. This bill removes the Medical Board of California’s ability to give a license to or reinstate a physician who lost their license due to sexual misconduct with a patient.

AB 2055 (LOW): CONTROLLED SUBSTANCES – CURES DATABASE Status: Held in Assembly Appropriations Suspense Committee.

Assembly Bill 2055 would have rehoused the state’s prescription drug monitoring program – the Controlled Substance Utilization Review and Evaluation System (CURES) database – from the Department of Justice to the California State Board of Pharmacy. CURES should be managed with the primary goals of improving patient care and public health, and as such it should be administered by an entity whose mission and policies focus on the use of the database by health care providers and research experts.

AB 2098 (LOW): PHYSICIANS AND SURGEONS – UNPROFESSIONAL CONDUCT

Status: Signed by Governor (Chapter 938, Statutes of 2022).

Assembly Bill 2098 provides that the dissemination of misinformation or disinformation related to COVID-19 by a physician to their patient constitutes unprofessional conduct. The bill clarifies that the medical board may take action if a licensee provides misinformation that departs from the applicable standard of care or did so with malicious intent or the intent to mislead.

The governor issued a statement in conjunction with his signature on the bill, which read in part: “I am signing this

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bill because it is narrowly tailored to apply only to those egregious instances in which a licensee is acting with malicious intent or clearly deviating from the required standard of care while interacting directly with a patient under their care. To be clear, this bill does not apply to any speech outside of discussions directly related to COVID-19 treatment within a direct physician patient relationship.”

AB 2132 (VILLAPUDUA): TUITION FOR MEDICAL SERVICE PILOT PROGRAM

Status: Held in Assembly Higher Education Committee.

Assembly Bill 2132 would have created a pilot program, administered by the California Student Aid Commission, to identify and select individuals from diverse, underrepresented communities to fund their education from community college/undergraduate school through completion of their medical residency program.

The individual would have been required to commit to practicing in medically underserved areas after completing their residency program.

AB 2522 (GRAY): PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM

Status: Held in Senate Appropriations Committee.

Assembly Bill 2522 sought to create a dedicated loan repayment program for the state’s public health workforce.

There are currently no existing retention or recruitment loan repayment programs for non-licensed public health personnel.

SB 250 (PAN): HEALTH CARE COVERAGE

Status: Passed Senate. Held in Assembly Appropriations Committee.

Senate Bill 250 would have comprehensively reformed the prior authorization process by requiring that physicians be included in the development and updating of plan utilization management criteria; requiring plans to create a prior authorization exemption program that allows physicians who are practicing within the plan’s criteria 90% of the time to get a blanket exemption for one year from the plan’s prior authorization requirements; and giving a treating physician who does not have a prior authorization exemption the right to have an appeal of a denial be conducted by a physician in the same or similar specialty.

SB 1419 (BECKER): HEALTH INFORMATION

Status: Signed by Governor (Chapter 888, Statutes of 2022).

Senate Bill 1419 helps California physicians comply with the federal information blocking rule. In spring 2021, the federal 21st Century Cures Act final rule took effect.

That rule has had unintended consequences for patients and physicians regarding sensitive medical information.

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SB 1419 improves quality of care by guaranteeing that physicians and patients have all the information needed for integrated health care.

AB 852 (WOOD): ELECTRONIC PRESCRIBING

This bill provides patients with the right to receive results of their imaging scans in written or oral form, the same protection currently provided to lab results. It also provides enhanced protection for sensitive medical information, as defined by the Confidentiality of Medical Information Act.

Assembly Bill 852 gives physicians more flexibility in complying with California’s electronic prescribing mandate. This bill exempts low-volume prescribers (many of them retired or semi-retired physicians who maintain a license), prescribers in areas of natural disasters, and prescribers who are granted a waiver based on extraordinary circumstances. These new exceptions also track with exceptions in the Medicare program.

Additionally, this bill provides a framework for application programming interfaces by incorporating the requirements of the Interoperability and Patient Access final rule for state-regulated health plans and insurers.

CO-SPONSORED BILLS AB 1608 (GIPSON): COUNTY OFFICERS – CONSOLIDATION OF OFFICES

Status: Passed Assembly. Held on Senate Floor.

Assembly Bill 1608 would have eliminated the ability of a county board of supervisors to consolidate the offices of the sheriff and the coroner. The bill would have also required counties that currently consolidate those offices to separate the roles. The intent behind the bill was to retain physician autonomy and prevent forensic pathologists from being pressured to change their cause of death determinations due to pressure from a sheriff/coroner in order to reduce any indications of law enforcement misconduct.

PRIORITY SUPPORT BILLS AB 35 (REYES): CIVIL DAMAGES – MEDICAL MALPRACTICE

Status: Signed by Governor (Chapter 17, Statutes of 2022).

Assembly Bill 35, the MICRA Modernization Act, implements the compromise that was negotiated between CAPP and the proponents of the “Fairness for Injured Patients Act” ballot proposition. The bill extends the longterm predictability and sustainability of the state’s medical malpractice laws and settles a decades-long divide on the issue. After the bill was signed, FIPA proponents withdrew their ballot measure, avoiding a million-dollar fight.

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Status: Signed by Governor (Chapter 518, Statutes of 2022).

AB 1242 (BAUER-KAHAN, BONTA AND GARCIA): REPRODUCTIVE RIGHTS – PROTECTIONS FOR PATIENTS AND PROVIDERS

Status: Signed by Governor (Chapter 627, Statutes of 2022).

Assembly Bill 1242 protects those performing, aiding in the performance of or obtaining an abortion from arrest and prohibits law enforcement from cooperating with or providing information to those outside of California regarding lawful abortion. This bill went into effect immediately when it was signed into law on September 27, 2022.

AB 1666 (BAUER-KAHAN): ABORTION – CIVIL ACTIONS Status: Signed by Governor (Chapter 42, Statutes of 2022).

Assembly Bill 1666 enacts legal protections from civil and criminal liability for clinicians that provide abortions to patients who reside in other states with hostile abortion laws. These protections include precluding liability for any of the following “crimes” in other states: aiding or abetting in the inducing of an abortion; receiving or seeking an abortion; and performing and inducing an abortion. This bill went into effect immediately when it was signed into law on June 24, 2022.

AB 1797 (WEBER): IMMUNIZATION REGISTRY Status: Signed by Governor (Chapter 582, Statutes of 2022).

Assembly Bill 1797 requires health care providers and other agencies, including but not limited to, schools, childcare facilities, Women, Infants, and Children service providers, health care plans, foster care agencies, and county human services agencies to disclose immunization information to local health departments and the California Department of Public Health (CDPH). The data includes disclosure of a new data point related to a patient’s or client’s race and ethnicity. This bill was part of the legislature’s broader “vaccine work group” legislative package.

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AB 2223 (WICKS): REPRODUCTIVE HEALTH

Status: Signed by Governor (Chapter 629, Statutes of 2022).

Assembly Bill 2223 clarifies the law to prevent anyone in California from being investigated, prosecuted, or incarcerated for ending a pregnancy or experiencing pregnancy loss.

AB 2626 (CALDERON): MEDICAL BOARD OF CALIFORNIA – LICENSEE DISCIPLINE – ABORTION

SB 883 (ROTH): UMBILICAL CORD BLOOD COLLECTION PROGRAM

Status: Signed by Governor (Chapter 604, Statutes of 2022).

Senate Bill 883 extends the University of California’s Umbilical Cord Blood Collection Program through January 1, 2026. Stored umbilical cord blood is a lifesaving resource that is used to treat more than 80 diseases such as leukemia, lymphoma and immune deficiency.

SB 1473 (PAN): HEALTH CARE COVERAGE

Status: Signed by Governor (Chapter 565, Statutes of 2022).

Status: Signed by Governor (Chapter 545, Statutes of 2022).

Assembly Bill 2626 prevents state licensing boards from suspending or revoking the license of someone who performs an abortion in accordance with California law.

Additionally, the bill prohibits the boards from taking an adverse action against an applicant or licensee that was disciplined in another state for performing an abortion if the abortion met the applicable standard of care for the procedure in California.

Senate Bill 1473 requires health plans to cover COVID-19 therapeutics consistent with current law related to coverage of COVID-19 testing and vaccinations, which was signed into law in 2021 through CMA-sponsored SB 510 (Pan). Additional provisions of the bill extend coverage for out-of-network cost-sharing for COVID-19 testing and vaccination to six months after the federal public health emergency expires.

SB 866 (WIENER): MINORS – VACCINE CONSENT

Status: Passed Senate, but not taken up on Assembly Floor.

Senate Bill 866 would have allowed minors 15 years of age or older to consent to vaccines that the United States Food and Drug Administration and Advisory Committee on Immunization Practices have approved. Existing law allows minors 12 years of age or older to make certain medical decisions without parental consent, most notably as it relates to consenting to general medical care if the minor lives separately from their parents or legal guardians. Due to timing and vocal opposition, this legislation was not taken up for a vote on the Assembly floor.

SB 871 (PAN): PUBLIC HEALTH – IMMUNIZATIONS

Status: Held in Senate Health Committee.

Senate Bill 871 would have added the COVID-19 vaccine to the list of required vaccinations before a pupil can be admitted into any private or public elementary or secondary school, childcare center, day nursery, nursery, family day care home or development center. The bill also would also have removed the personal belief exemption for the COVID-19 vaccination. This bill was part of the legislature’s broader “vaccine work group” package of legislation.

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SCA 10 (ATKINS): REPRODUCTIVE FREEDOM

Status: Signed by Governor (Chapter 97, Statutes of 2022).

Senate Constitutional Amendment 10 creates a pathway for California to constitutionally protect an individual’s right to reproductive freedom and to obtain health services, including abortion and contraception. Approved with a two-thirds vote of the legislature, the provisions of this bill became Proposition 1 on the November 2022 ballot, which passed with an overwhelming margin of support.

PRIORITY OPPOSE BILLS AB 1278 (NAZARIAN): PHYSICIANS AND SURGEONS – PAYMENTS: DISCLOSURE: NOTICE

Status: Signed by Governor (Chapter 750, Statutes of 2022).

Assembly Bill 1278 requires physicians to provide each patient with a written or electronic notice about the federal Open Payments database at their initial office visit, and obtain a signature from the patient or a patient representative.

This bill was introduced in 2021 and originally would have required physicians to provide each patient with detailed information about the physician’s personal receipt of gifts or funds from pharmaceutical companies, device manufacturers, etc., as reported by those entities in the federal Open Payments database on an annual basis. CMA sought amendments, and the bill was narrowed to a onetime, general notice to patients about the existence of the Open Payments database.

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AB 1328 (IRWIN): CLINICAL LABORATORY TECHNOLOGY AND PHARMACISTS Status: Held on Senate Floor.

Assembly Bill 1328 would have created a scope infringement allowing pharmacists to order and perform over 1,400 Clinic Laboratory Improvement Amendmentsapproved tests, not limited to temperature, pulse and respiration. This bill would also have authorized a pharmacist to order and interpret any test results they ordered to “promote patient health.” CMA worked hard to seek amendments and ultimately stop the bill on the Senate Floor.

AB 1400 (KALRA): GUARANTEED HEALTH CARE FOR ALL Status: Held on Assembly Floor.

Assembly Bill 1400, the California Guaranteed Health Care for All Act, would have created the CalCare program to administer and provide universal single payer health care coverage and a health care cost control system in the state. The bill contained minimal details regarding the administration of such a program.

AB 1785 (DAVIES): CALIFORNIA PARENTS’ BILL OF RIGHTS ACT

Status: Held in Assembly Education Committee.

Assembly Bill 1785 attempted to create a “California Parents’ Bill of Rights” by making numerous technical and substantive amendments to various code sections. This bill would have undermined existing protections for health care decisions, and the resulting records, that a minor has a statutory right to make. In addition, the bill attempted to erode the ability of a school district to require certain immunizations.

AB 2060 (QUIRK): MEDICAL BOARD OF CALIFORNIA Status: Killed on Assembly Floor.

Assembly Bill 2060 sought to change the composition of the Medical Board of California to a public member majority and eliminate the licensee majority of the board’s disciplinary panels. This was the second consecutive legislative session that the Legislature sought this change to the board’s composition.

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AB 2080 (WOOD): HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT OF 2022 Status: Held in Senate Health Committee.

Assembly Bill 2080 would have required any medical group, hospital, hospital system, health care service plan or pharmacy benefit manager to provide written notice to the Attorney General (AG) at least 90 days before agreeing to a merger, acquisition or change in control with another health care entity if the transaction had a value of $15 million or more. The bill would authorize the AG to consent to, give conditional consent to, or not consent to the agreement, and if the AG did not consent to the agreement, the transaction would be stopped.

AB 2236 (LOW) OPTOMETRY: CERTIFICATION TO PERFORM ADVANCED PROCEDURES Status: Vetoed by Governor.

Assembly Bill 2236 would have authorized optometrists to perform laser and surgical procedures on a patient’s eye if they met minimal education and training requirements, including performing 43 procedures on live patients. The bill failed to adequately educate optometrists to develop clinical competency and judgment to identify, manage and mitigate complications during surgery to prevent permanent damage to patients’ eyes and eyesight.

Echoing CMA’s concerns, Governor Newsom vetoed the bill with a statement indicating: “I am not convinced that the education and training required is sufficient to prepare optometrists to perform the surgical procedures identified.

This bill would allow optometrists to perform advanced surgical procedures with less than one year of training. In comparison, physicians who perform these procedures must complete at least a three-year residency program.”

SB 920 (HURTADO): MEDICAL BOARD OF CALIFORNIA: INVESTIGATIONS: RECORD REQUESTS

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

Senate Bill 920 sought to erode privacy protections for both patients and physicians by allowing Medical Board of California investigators to inspect records prior to requesting a subpoena for the records in order to establish good cause for further investigation. This was the second consecutive legislative session that the Legislature sought this change.

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SB 1023 (HURTADO): HEALTH PROFESSIONS – TRAINING AND EDUCATION: BLUE RIBBON COMMISSION Status: Held in Assembly Health Committee.

Senate Bill 1023 sought to create a Blue-Ribbon Commission on Strengthening our Health System

by Transforming Medical Training and Education to Improve Patient Protection. The bill was a misguided effort to address broader concerns about the regulation of physicians and surgeons by the medical board. In particular, the bill sought to reconsider the evidentiary standard used in disciplinary cases. CMA was able to negotiate amendments with the author to refocus the bill on seeking information and reporting on methods to increase the number of diverse physicians entering the workforce, particularly in low-income and rural communities.

SB 1467 (KAMLAGER): MATERNAL MENTAL HEALTH

Status: Held in Senate Health Committee.

Senate Bill 1467 sought to ensure that all biological mothers are offered maternal mental health care services or are screened appropriately for maternal mental health conditions. CMA expressed concern that the term biological mother may exclude a population of people that may be pregnant or become pregnant.

CMA’s Council on Legislation took an oppose unless amended position and sought an amendment to change the term biological mother to birthing person. Instead, the bill failed to garner a hearing in its first committee.

ACA 11 (KALRA): TAXES TO FUND HEALTH CARE COVERAGE AND COST CONTROL Status: Held in Assembly Rules Committee.

Assembly Constitutional Amendment 11 was the companion funding mechanism for the single-payer health care system proposed under AB 1400 (Kalra, 2021), which the association took an oppose unless amended position on. ACA 11 would have raised the gross receipts tax, increased the employer and employee shares of the payroll tax, and increased the personal income tax on high earners.

This bill was never referred out of the Assembly Rules Committee.

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SUCCESSFULLY NEGOTIATED BILLS AB 1704 (CHEN): LIMITED PODIATRIC RADIOGRAPHY PERMITS

Status: Signed by Governor (Chapter 580, Statutes of 2022).

Assembly Bill 1704 adds health care professionals operating leg-only podiatric radiography equipment under the supervision of a licensed podiatrist to the list of individuals exempted from the existing requirements of state law regarding who is permitted to operate radiological equipment in California. It also tried to remove the CDPH Radiologic Health Branch’s authority to determine certification and move it to the Podiatric Medical Board of California. CMA was able to retain the certification authority within CDPH and provide more specificity related to the requirements to receive this permit.

AB 1809 (AGUIAR-CURRY): NURSING FACILITY RESIDENT INFORMED CONSENT PROTECTION ACT OF 2022 Status: Vetoed by Governor.

Assembly Bill 1809 would have required informed consent be given by a skilled nursing facility resident before being prescribed and administered any psychotherapeutic medication. Additionally, the prescribing physician could be charged with criminal battery for not obtaining the consent from the resident. CMA secured amendments to narrow the drugs affected by the bill, remove the charge of criminal battery from the bill and to require only the relevant information about the prescribed medication be given to the resident for consent purposes.

AB 1896 (QUIRK): GAMETE BANKS Status: Vetoed by Governor.

Assembly Bill 1896 would have added notification requirements to gamete banks. Specifically, this bill attempted to require gamete banks to notify clients of the risk of inbreeding and steps to mitigate that risk.

In addition, the banks would have been required to implement a secure process for tracking future sperm donations and sharing that information with other gamete banks. CMA staff successfully negotiated amendments that minimized this bill to being education-based only, while reducing the administrative burdens and liability risk that were originally part of the bill.

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AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

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designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE

Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES – ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

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WINTER 2022

House of Delegates

CMA ELECTS NEW OFFICERS AND ESTABLISHES POLICY ON MAJOR HEALTH CARE ISSUES The California Medical Association (CMA) recently convened its 151st annual House of Delegates (HOD) meeting in Los Angeles.

During the first in-person meeting of the HOD since the pandemic, more than 500 California physicians gathered to debate and establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine.

The association also installed its new officers, including new CMA President Donaldo Hernandez, M.D., an internist who is one of the longest-serving hospitalists in Santa Cruz County.

The major issues the delegates focused on this year were: Physician Workforce: Our state is facing a physician shortage that has reached crisis proportions, and the COVID pandemic has placed additional pressure on an already strained system. And, as California continues to grapple with longstanding workforce challenges, the Dobbs decision is creating new ones, particularly for medical students and residents in states that restrict or ban abortion services. The delegates discussed policies to expand and strengthen the physician workforce so that every patient has timely access to affordable, quality care.

Health Care Reform: In 2019, the Healthy California for All Commission was formed and charged with developing a plan to move our state toward a unified financing system for health care delivery. CMA’s commitment to universal access remains steadfast, but CMA strongly believes that the health care system must be funded in a way that is sustainable, so that health care coverage is not simply an empty promise and that all patients have equal access to quality care. The delegates discussed and debated a set of principles to ensure that any health care reforms will delivery highquality, affordable and evidence-based care to all.

Mental Health: Over the last five years, California has committed to investing billions of new dollars into improving mental health services for all Californians across all delivery systems. The scope of these investments is sweeping, and implementation of many of the initiatives, along with growing the state’s mental health workforce, will take years to accomplish. Delegates heard from Diana Ramos, M.D., the newly appointed California Surgeon General and longtime CMA member and delegate about California’s efforts to improve and expand mental health care.

You can view the final reports on each of these topics online at cmadocs.org/HOD. WINTER 2022

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Elections Santa Cruz Internist Donaldo Hernandez, M.D., Takes Office as CMA’s 154th President Santa Cruz internist and hospitalist Donaldo M. Hernandez M.D., FACP, was installed as CMA’s 154th president.

“As we emerge from the mire that was the pandemic, I think it’s clear that we cannot go back to the system that existed before the world shut down,” said Dr. Hernandez.

“Business as usual left too many behind, left too many gaps, and left too many of us asking, ‘Is this what I signed up for?’”

Dr. Hernandez has long been a tenacious agent for change, and as president his goal is to position CMA at the forefront of change and innovation.

“I believe that an energized and engaged physician community is the best path toward a reimagined and integrated care delivery system, insulated from political gamesmanship and special interests,” said Dr. Hernandez.

“A system that focuses on relationships – particularly the core relationship between patient and physician – is the solution for affordable and equitable care delivery.”

“Physicians are the only segment of the care delivery infrastructure that swore a sacred oath to uphold a values-based construct as we care for our fellow humans. Adherence to that oath positions us to truly lead the necessary transformation of health care. The path forward must be physician-led and patient-focused.”

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Born in Southern California, Dr. Hernandez received his undergraduate degree from the University of California, Berkeley; his medical degree from the University of California, San Diego; and completed his internal medicine residency, and a fellowship in general internal medicine at Harbor-UCLA Medical Center in Torrance.

Dr. Hernandez is one of the longest-serving hospitalists in Santa Cruz County and is currently a shareholder in the Palo Alto Medical Foundation, considered one of the highest quality hospital medicine programs in Central and Northern California.

Dr. Hernandez has been a member of CMA and the Santa Cruz County Medical Society (SCCMS) since 2003.

Prior to joining the CMA Executive Committee as President-Elect, he was elected to two terms as SCCMS president, then served on the CMA Board of Trustees for 10 years, representing the geographically and ethnically diverse District 7, which includes Monterey, Santa Cruz, San Benito, Santa Clara and San Mateo counties.

He has also served since 2016 as chair of CMA’s Justice, Equity, Diversity and Inclusion Committee.

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House ofofDelegates Delegates House House of Delegates House of Delegates

Donaldo Hernandez, M.D., CMA President Donaldo Donaldo Hernandez, Hernandez, M.D., M.D., CMA CMA President President Donaldo Hernandez, M.D., CMA President

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Elections Redwood City ob-gyn Tanya Spirtos, M.D., Becomes CMA President-Elect Redwood City ob-gyn Tanya W. Spirtos, M.D., was named CMA president-elect. She will serve on the CMA Executive Committee in that role for one year before being installed as president at the conclusion of next year’s annual meeting.

Dr. Spirtos is a board-certified obstetriciangynecologist in full-time practice in a group of six physicians, now part of foundation model Packard Medical Group/Stanford Medicine. She is also on the active medical staff of El Camino Hospital and Sequoia Hospital.

Dr. Spirtos earned her undergraduate degree at the University of Chicago and her medical degree at Northwestern University Medical Center. She completed her residency at Los Angeles County Medical Center/University of Southern California and is a fellow of the American Congress of Obstetricians and Gynecologists.

She was a member of the Board of Trustees of Sequoia Hospital Systems from 2003-07 and served on the Community Board of Directors of Sequoia Hospital from 2007-15. She has also been an adjunct clinical faculty of Stanford University Medical School since 1995, with an academic appointment as adjunct clinical assistant professor from 2006-14.

and is a member of both the San Mateo County Medical Society and Santa Clara County Medical Association—the latter of which she served as president from 2005-06. She was elected to the CMA Board of Trustees in 2009 and continues to serve on the CMA delegation to the AMA. Since 2016, she has served on the CMA Executive Committee, first as vice speaker of the House of Delegates, then as speaker.

She lives with her husband, Elias Eleftheriades, in Redwood City, where they are both active in the Greek community and culture. Her children, Michael and Alexandra, born in 1989, have grown up surrounded by the practice and profession of medicine.

Alex is currently an ob-gyn resident at the University of Texas Southwestern Medical Center in Dallas; Mike is a practicing lawyer with Cleary Gottlieb Steen and Hamilton in New York City in the division of mergers and acquisitions.

Since 2010 she has served at the Arbor Free Clinic with Stanford medical students and has been recognized for exemplary contributions in teaching. Despite this—and her participation on various health boards—she receives 100% of her compensation from patient care.

Dr. Spirtos has been a member of the CMA and American Medical Association (AMA) since 1985,

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WINTER 2022

Elections Los Angeles Family Medicine Physician Jack Chou, M.D., Elected CMA Speaker of the House Los Angeles family physician Jack Chou, M.D., was elected the new speaker of the CMA House of Delegates. He previously served three years as vice speaker.

Dr. Chou has split his clinical time between primary care, urgent care and hospitalist duties at Kaiser Baldwin Park Medical Center since 1999. He has been the physician-in-charge for the Family Medicine Department at Kaiser Baldwin Park Medical Center, Family Medicine Medical Office Building since 2006. Dr. Chou became the Chief of Service of the Family Medicine Department in July 2018, overseeing five medical office locations.

Dr. Chou was raised in a small rural town in Taiwan and later earned his Bachelor of Science in biology from the University of Miami, Florida, and his medical degree from the University of Southern California. He completed his family medicine residency at Kaiser Permanente Woodland Hills.

Dr. Chou and his wife, Kathy, are proud parents of twin daughters, Sarah and Samantha, and son, Nathan. He spends most of his free time dedicated to traveling with his family as part of his children’s education.

Dr. Chou is a partner of the Southern California Permanente Medical Group (SCPMG) and is the Regional Chair for Health Information Management and Regional Co-Chair for Scanning Oversight Committee at SCPMG. Since medical school, Dr. Chou has embraced leadership at all levels – local, state and national. Dr. Chou has been a member of CMA and the Los Angeles County Medical Association (LACMA) since 1992 and he has been an AMA member since 1996.

Dr. Chou has served as a member of the CMA House of Delegates since 2001. He was elected to represent LACMA on the CMA Board of Trustees in 2010 and served on the CMA Council on Ethical Affairs from 2011 to 2016.

Dr. Chou is also active in his local, state and national specialty societies, including serving as president and speaker of the California Academy of Family Physicians Congress of Delegates.

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Elections San Francisco Dermatologist Lawrence Cheung, M.D., Elected CMA Vice-Speaker San Francisco physician Lawrence Cheung, M.D., was elected the new vice-speaker of the CMA House of Delegates.

Dr. Cheung has been a dermatologist in solo private practice for 17 years. As a part of his practice, Dr. Cheung conducts and serves as principal investigator for clinical trials. He also serves as a volunteer dermatology preceptor at St. Mary’s Medical Center in San Francisco.

Dr. Cheung has been a member of the CMA Board of Trustees since 2020, after having previously served as chair of the CMA House of Delegates District VIII Delegation and as a member of the CMA Council on Science and Public Health. He also previously served on the Board of Directors for San Francisco Health Plan as a mayoral-appointed San Francisco County Commissioner.

Dr. Cheung has been a member of CMA and the San Francisco Marin Medical Society since 2006. He is also a member of the American Medical Association, the American Academy of Dermatology and the American Society for Dermatological Surgery.

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Elections Elections Elections THE FULL 2022-2023 CMA EXECUTIVE COMMITTEE INCLUDES: THE THEFULL FULL2022-2023 2022-2023CMA CMAEXECUTIVE EXECUTIVECOMMITTEE COMMITTEEINCLUDES: INCLUDES:

Donaldo Donaldo Donaldo Hernandez, M.D. Hernandez, Hernandez, M.D. PresidentM.D. President President

Tanya Tanya Tanya Spirtos, M.D. Spirtos, Spirtos, M.D. M.D. President-Elect

President-Elect President-Elect

Jack Chou, M.D.

Jack Jack Chou, Chou, M.D. Speaker of theM.D. House Speaker Speaker of the of the House House

Shannon Shannon Shannon M.D. Udovic-Constant, Udovic-Constant, Udovic-Constant, M.D. M.D. Chair, Board of Trustees Chair, Chair, Board Board of Trustees of Trustees

Sergio R. Sergio Sergio R. R. Flores, M.D. Flores, Flores, M.D. M.D. Vice-Chair, Board of Trustees

Vice-Chair, Vice-Chair, Board Board of Trustees of Trustees

Lawrence Cheung, M.D. Robert E. Wailes, M.D. Lawrence Lawrence Cheung, Cheung, M.D. M.D. Robert Robert E. E. Wailes, Wailes, M.D. M.D. Vice-Speaker of the House Immediate Past President Vice-Speaker Vice-Speaker of the of the House House

Immediate Immediate Past Past President President

Awards Honors Awards and Honors Ferndale Physician Donald Baird, M.D., Ferndale FerndalePhysician PhysicianDonald DonaldBaird, Baird,M.D., M.D., Receives CMA’s Plessner Award Receives ReceivesCMA’s CMA’sPlessner PlessnerAward Award

Ferndale family physician Donald Baird, M.D., Ferndale Ferndale family family physician physician Donald Donald Baird, Baird, M.D., M.D., received CMA’s most prestigious award, the received received CMA’s CMA’s most most prestigious prestigious award, award, the the Frederick K.M. Plessner Memorial Award. The Frederick Frederick K.M. K.M. Plessner Plessner Memorial Memorial Award.

Award.

The The award honors the California physician who best award award honors honors the the California California physician physician who who best best exemplifies the ethics and practice of a rural exemplifies exemplifies the the ethics ethics and and practice practice of of a rural a rural country practitioner. country country practitioner. practitioner.

Dr. Baird has served indigent and underserved Dr.Dr. Baird Baird has has served served indigent indigent and and underserved underserved patients in Humboldt and Del Norte counties patients patients in in Humboldt Humboldt and and Del Del Norte Norte counties counties for 46 years. He has enjoyed a full-time practice forfor 4646 years. years.

HeHe has has enjoyed enjoyed a full-time a full-time practice practice in primary care, which once included OB and in in primary primary care, care, which which once once included included OB OB and and

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pediatrics, but is now primarily focused on pediatrics, pediatrics, but but is is now now primarily primarily focused focused onon adults with subspecialty interest in psychiatry adults adults with with subspecialty subspecialty interest interest in in psychiatry psychiatry including bipolar disorder, schizophrenia including including bipolar bipolar disorder, disorder, schizophrenia schizophrenia and autism. and and autism. autism.

“During multiple attempts at retirement I've “During “During multiple multiple attempts attempts atat retirement retirement I've I've done some volunteer work in the third world, done done some some volunteer volunteer work work in in the the third third world, world, which has been very rewarding, but I also which which has has been been very very rewarding, rewarding, but but I also I also realized we have our own needs right here in realized realized wewe have have our our own own needs needs right right here here in in this community,” said Dr. Baird. this this community,” community,” said said Dr.Dr. Baird.

Baird.

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Delegates to annual convention lend their voices to pressing issues

BY JO ANN KIRBY

Dr. Ramin Manshadi was elected by District VI to the Board of Trustees when the California Medical Association’s House of Delegates convened in Los Angeles on October 22nd and 23rd. He was one of seven local physicians serving as delegates among more than 500 delegates who represent nearly every specialty and region of the state. Other delegates from SJMS include Drs. Lawrence Frank, Raissa Hill, Robin Wong, Richelle Marasigan, Jim Halderman, Philip Edington, and resident, Dr. Annie Haji Datoo who were all there to discuss the most pressing issues facing the medical community.“Ultimately, the delegates from my district have put their trust in me to be their voice,” Dr. Manshadi, a cardiologist who has been practicing for the past 22 years in Stockton and Lodi, said of winning the election to the board of trustees. “I have to serve them well.”

The annual gathering gave Dr. Manshadi and our other delegates the chance to hold important conversations about the state of health care and they

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DR. R A MIN M A NSH A DI were able to identify top priorities by listening to others and sharing their own stories. On the official agenda were three critical issues: physician workforce, health care reform and mental health. The goal of the annual meeting is for the California Medical Association to form broad policy on the most important topics. To that end, the CMA solicited comments from members in advance to help guide the organization to

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

Today, we are a top employer in the community with over 500 employees and a staff of more than 180 physicians – many board-certified in their specialty.

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

Doctors Hospital of Manteca offers: • 24-Hour Emergency Care and Convenient Online Check-Ins • 24/7 Critical Care Coverage Led by Intensivists • Advanced Orthopedics for Knee and Hip • Family Birthing Center • Imaging Services, Including 3-D Mammography • Surgical Services, Including Weight Loss Surgery • Women’s Health • Wound Care Center

•

Accredited as a Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®), a joint program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) •

Designated as a Blue Distinction® Center+ for Bariatric Surgery

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Designated as a Blue Distinction® Center for Knee and Hip Replacement

•

Recognized as a Certified Quality Breast Center of Excellence in the National Quality Measures for Breast Centers program

To refer a patient, call (844) 632-5727 or visit DoctorsManteca.com 1205 E. North St. Manteca, CA 95336 38

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craft actionable reports for the 2022 session.

Not surprisingly, recruiting physicians to the Valley remains a pressing need and our delegates were more than happy to address the state of the physician workforce. “For example, Merced does not have experts in women’s health, and they have to send their patients to other cities,” Dr. Manshadi said. “We have increased our graduate medical program in the area, but we have to further our work on coming up with strategies to get the graduates to stay in the Central Valley.”

Dr. Frank, a nephrologist, has been serving as a delegate for 13 years and echoes the need for more doctors, citing a shortage of primary care physicians as did Dr. Marasigan, who specializes in family medicine. She said growing the physician workforce is one of the most important topics that was discussed at the convention. “It is important that CMA policy helps to address the need to protect the existing physician workforce and help it grow in a way that also supports the needs to California’s diverse population,” Dr. Marasigan, of HT Family Physicians, said.

Dr. Wong believes health care reform was a most pressing issue and he learned that “Despite multiple modes of medical practice, physician can work together to achieve the best care for their patients.”

Other national topics such as abortion were also a topic of conversation among delegates in light of the recent Supreme Court decision in Roe vs. Wade. Ophthalmologist Philip Edington said one thing he took away from the convention is that the “CMA is proactive in addressing access to care and abortion rights.”

For Dr. Annie Haji Datoo, an internal medicine resident at St. Joseph Medical Center, serving as a delegate for the first time was an eye-opening experience that highlighted the necessity of getting involved. She was

impressed by the careful attention delegates paid to topics such as abortion and mental health. “There is a lot of unfinished business,” she said, adding that more medical students, residents and fellows should get participate in these conversations. “It is critical to involve every level of doctors in training. We do have a voice, let’s use it.”

Dr. Marasigan has been serving as a delegate for three years now and has found the experience worthy. “I wanted to be able to participate in the resolution process and represent our colleagues of District VI. I wanted to stay informed about current issues and preserve the voice of fellow physicians in the ever-changing health care system,” Dr. Marasigan said. “I have learned so much regarding the policy-making process and how important it is for the CMA’s House of Delegates to debate the various important issues that help shape the future of medicine for the best.”

Going forward as a member of the CMA’s board of trustees, Dr. Manshadi says that in addition to the growing the number of physicians in our area there are two other matters he would like to see addressed.

Dr. Manshadi said that the disproportionately high numbers of MediCal patients in the Valley makes it important to raise MediCal reimbursement rates to at least comparable to MediCare rates and he said that the strategies to mitigate health inequity are important.

“There will be many policies, rules, governance questions, and decisions that the board of trustees has to consider and work as a team to implement to maintain the integrity of physicians and their practices while simultaneously delivering quality care to our patients,” Dr. Manshadi said of his new role. “I hope to be an integral part of this team.”

DELEGATES Lawrence Frank, MD Nephrology San Joaquin General Hospital Ramin Manshadi, MD Cardiology Manshadi Heart Institute Raissa Hill, DO Family Practice HT Family Physicians Robin Wong, MD Family Practice James Halderman, MD Anesthesia Sutter Gould Medical Foundation Kwabena Adubofour, MD ** Internal Medicine East Main Clinic Harpreet Singh, MD ** Internal Medicine Sutter Gould Medical Foundation ALTERNATES Richelle Marasigan, DO Family Practice HT Family Physicians Philip Edington, MD Ophthalmology Center for Sight District VI Delegate to Resident Fellow Section Annie Haji Datoo, MD PG-Y3, Internal Medicine St. Joseph’s Medical Center **indicates not in attendance

GET IN VOLV ED! Delegates and alternates are the cornerstone of the

California Medical Association’s democratic process. Their actions can help shape not only CM A’s policy agenda, but statewide health policy that will go on to impact millions of Californians. The San Joaquin Medical Society is currently recruiting for the position of Alternate Delegate. This position requires 4-6 virtual meetings per year and attendance at the October House of Delegates conference.

District VI San Joaquin Medical Society Fresno Madera Medical Society Kern County Medical Society Merced Mariposa Medical Society Stanislaus Medical Society The Medical Society of Tulare & Kings Counties

For more information about the position and/or to be considered for the position of alternate delegate, please contact Lisa Richmond, at Lisa@sjcms.org.

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Community Connections San Joaquin Medical Society Alliance welcomes spouses of physicians

BY JO ANN KIRBY

Being new in town can be daunting. But the San Joaquin Medical Society Alliance is here to welcome the families of physicians, residents and medical students and ease their transition into San Joaquin County life. They offer friendship and social events while also advancing projects that help enhance the health of our community through projects and scholarships.

Since 1931, when the first meeting of what was then called

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the Woman’s Auxiliary was held, the group strived to get to know the spouses of our physicians. It’s been called the San Joaquin Medical Society Alliance since the mid-1990s and today, the group’s members want it known that they are still here with open arms.

“You have the knowledge of all these physicians and their families in this town, we have the knowledge of the community, which we are willing to share,” San Joaquin Medical Society

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President Nancy Schneider said of her efforts to shore up membership. “They might have something they can also impart to us as well.”

Membership in the Alliance has dwindled from its high of 250 to about three dozen.

Schneider said today’s busy lifestyles make it difficult for people to commit to the Alliance but she said carving out time would be well worth it. “Friendship is the biggest thing. You meet other people in the same situation. I met other physicians’ spouses when I first joined,” she said, recalling how she was introduced to the Alliance when her and her husband, Dr. Ed Schneider, came to Stockton so he could begin his career in family medicine.

Since its inception, the Alliance was a way for members to network on behalf of their physician spouses. “We were new to the area and my husband had opened a practice in the area and we wanted to get to know people and let people know what the practice offered,” said Debra Johnson, who was a member for over 20 years. “There was a tremendous need in the community for my husband’s specialty. At the time there were only two ear, nose and throat specialists in the area.”

New members have an instant repository of information should they want to know the best neighborhood to live in, a good preschool, where to shop and dine, or when youth sports signups take place.

Trisha Macko, whose husband is an orthopedist, remembers when she was younger and leaned on the wisdom of women in the Alliance when she was new to a town. She’s belonged to Alliances in three different states and found the San Joaquin Medical Society Alliance so helpful. “So, belonging to it personally for me … I met women older than I am who had been in the town for the long time and knew kind of the ins and out of Stockton,” she said. “It was very welcoming to have kind of an instant group right away.”

In addition to practical knowledge, the group has been very effective in its community health endeavors. Members raised awareness among young people to consider the medical profession with a Health Careers Day and grew a scholarship fund. They founded a program to offer babysitting courses. To this day, the Alliance aids the Child Abuse Prevention Council and other help organizations. In the past, they have advocated for vaccinations, immunizations, amblyopia testing, CPR training, hosted a nutrition puppet show, held a symposium on teen alcoholism, distributed information to educate against bullying and so much more.

Laurie Yeager has been a member of the Alliance for 31 years and was introduced to the group when she and her husband moved to Stockton so he could begin his practice. “I feel like the organization has changed somewhat through the years as more

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and more wives have busy careers of their own. Nevertheless, I would still encourage people to join the Alliance and create a vital community,” she said. “I enjoyed the opportunities to provide community service and education materials, to learn about the larger organization and legislative matters concerning medicine and also the fun times we had with dinners, holiday luncheons, the follies, etc. Most of all, as I mentioned, any time we can form new connections, develop meaningful friendships and make a newcomer feel less alone, it is a good thing.

The Alliance members were a wealth of information about everything in Stockton.”

These days, the Alliance has a book club that and they will be hosting an upcoming luncheon with a cooking demonstration.

They are collecting toiletries and socks for a local homeless shelter, peanut butter for the food bank, gathering new and gently used books for the Child Abuse Prevention Council and still funding a scholarship.

Finding new members is a challenge because with so many doctors joining big medical groups, the members have difficulty tracking down names and contact information of spouses.

In today’s economy, more spouses are working full-time and juggling child-care and their children’s activities, which makes it hard to commit to meetings. Schneider says it’s a problem not just unique to the Alliance.

“I’ve tried to make contact with all the residents at St. Joe’s.

The residents did like all the cookies we took them from Fizz Bakery on Doctor’s Day,” she said. “A lot of the organizations in town, it’s the same people involved.”

But the Alliance is still here as a welcome wagon of the best kind and hopes that the medical community well help spread the word to encourage membership.

Macko thinks there is still a need even though people have other things on their plate “It was important to me to connect to other people who knew what it was like to be married to a physician. Your husband is very, very busy,” she said. Macko, whose orthopedist husband is still working in his 60s, said her husband recently put her in touch with a young patient’s mother who has three children and is married to a physician in his residency. Macko said she has reached out to the young mother and made several connections.

Schneider, who is also president of the state Alliance, said she’s appointed a taskforce to study the membership challenge.

“We are getting tired. We need new, young leadership,” she said with a laugh.

In the meantime, she hopes to continue spreading the word about the Alliance and encourages potential members to learn more about joining by going online to https://www.sjcms.org/programs/sjms-alliance.aspx.

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In The News

IN THE

NEWS

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

Health District, the last independent health district in the United States, for 26 years.

Bassem Ghobrial, MD Introducing Bassem Ghobrial, MD Dr. Ghobrial is a board-certified general surgeon. After finishing his general surgery residency at San Joaquin General Hospital, he completed a 1-year fellowship in advanced colon and rectal/ minimally invasive surgery followed by a 1-year fellowship in a ACGME-accredited colon and rectal surgery fellowship at the Colon and Rectal Clinic of Orlando. Dr. Ghobrial has joined San Joaquin General Hospital as full-time faculty and is accepting referrals from local medical professionals at 468.6153.

New Public Health Building Dedicated to Jack Williams, MD The construction of the new San Joaquin County Public Health Services’ building has been complete. The office block has been dedicated to Dr. Jack J. Williams, Director of San Joaquin Local

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Dr. Williams was a member of SJMS/CMA for three decades and was president in 1979. He served on several committees, including Public Health, Rural Health, Migrant Health, and School Health during his tenure.

Jack Williams, MD

Nicole Friel, M.D., has been named the medical director of sports medicine at Shriners Children’s Northern California Dr. Friel has been a team physician for multiple high school and collegiate teams and she has worked with the Pittsburgh Penguins, Chicago White Sox and Chicago Bulls.

Dr. Friel has published on a range of topics, including the role of ACL injury in the development of post-traumatic knee osteoarthritis, trends in shoulder stabilization surgical technique and the treatment of fracture in patellar dislocation.

The sports medicine program at Shriners offers the full range of

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sports medicine treatments and rehabilitation.

Our surgeons offer some of the latest, innovative procedures, such as osteochondral allografts and the MACI procedure for cartilage repair.

We treat anterior Nicole Friel, M.D. cruciate ligament tears, Achilles tendon ruptures, discoid meniscus and acromioclavicular joint separation, among other sports-related conditions and injuries. Our sports medicine program has onsite occupational, physical and sports therapists.

in the footsteps of her father, Paul Manske, M.D., a recognized authority on tendon healing, who was director of hand surgery at Shriners Children’s St. Louis from 1973 to 2011.

To contact sports medicine at Northern California Shriners Hospital, call (916) 453-2191.

Take Claire Manske, M.D., and the study she reported on the best approach to brachial plexus birth injury surgery. She asked, what is the best surgical approach to repairing the suprascapular nerve and restore external shoulder rotation in a brachial plexus birth injury? Is it a nerve transfer or a nerve graft procedure?

Mary Claire Manske, M.D., has been named medical director of hand and upper extremity at Shriners Children’s Northern California.

Shriners Children’s orthopedics service takes care of patients with congenital anomalies, brachial plexus birth injuries and other conditions of the hands, arms and shoulders. The hospital has a pediatric hand fellowship program, one of just five such programs in the country and it is involved in many research endeavors, local and collaborative with other centers.

In becoming director of the hand program, Dr. Manske follows

Dr. Manske has published on topics including the use of botulinum toxin in brachial plexus birth injury to prevent contracture and buy time for healing and the best technique for supracapsular nerve repair in brachial plexus birth injury.

To contact the hand and upper extremity physicians at Shriners Children’s call (916) 453-2191.

Shriners Children’s Research Improves Brachial Plexus Birth Injury Surgery Shriners Children’s Northern California frequently has unique opportunities to impact clinical orthopedics given the sheer volume of patients it sees and its connections with other major pediatrics hospitals.

She used data from a large, multicenter database of experience at six major hospitals (J Bone Joint Surg. 2020;102:298-308).

Prior to her report, surgeons tended to prefer the nerve graft procedure or the nerve transfer, for reasons that the surgical procedure seemed cleaner and easier.

But she found that the nerve transfer procedure gave the patients a higher likelihood of recovering functional strength.

“This has definitely changed my clinical practice,” Dr. Manske said.

SHARE YOUR PASSION PROJECT! Each year our members spend many hours, donating their time and talents to projects and organizations both in our community and abroad. We’d love to learn more about your passion projects and may even highlight you in an article we are working on for next year. Please complete the survey that will be sent to your email in December. Not sure we have your proper email address? Email Lisa Richmond at Lisa@sjcms.org.

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And it has significantly advanced the care those little patients with the injury receive.

HPSJ Announces $15 Million Investment to Locally Address Homelessness Health Plan of San Joaquin (HPSJ), the local health plan that serves more than 400,000 Medi-Cal beneficiaries in San Joaquin and Stanislaus Counties, has announced a $15 million investment to reduce and prevent homelessness across the community. Through this investment, HPSJ will partner to help fund the construction of shelters and permanent supportive housing units for those experiencing homelessness in cities that include Stockton, Tracy, and Modesto. Additionally, HPSJ’s investment will support innovative street medicine programs that position health care providers to directly deliver care outdoors to individuals who are experiencing homelessness. “This investment, unanimously and enthusiastically approved by our governing Commission, will allow HPSJ and our partners to better meet the needs of our most vulnerable members while addressing challenges related to homelessness in our community,” says HPSJ’s Chief Executive Officer, Michael Schrader. “HPSJ has proudly served the Central Valley for more than 25 years,” Schrader continues, “and we are strong in our commitment to improve the health of our community through collaboration on the launch of these new housing and homelessness initiatives.”

Health Plan of San Joaquin Steps in as DHCS Sunsets the Value Based Payments Program (VBP) Providers have an opportunity to receive additional reimbursements for delivering to HPSJ members preventive care services such as mammograms, well child visits for age-appropriate testing and immunizations, prenatal and postpartum care, blood lead screening, diabetes and persistent asthma care, and much more. From July 1, 2022-June 30, 2023, HPSJ will continue to reimburse the VBP program that DHCS discontinued. The extended VBP program continues at the sole discretion of HPSJ, which requests claims be submitted in a timely manner. For more about the VBP program, including the continuing measures along with billing and diagnosis codes and updates, bookmark www.hpsj.com/value-based-payments/.

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Enhancing Access to Quality Health Care – Diversity, Equity and Inclusion Health Plan of San Joaquin’s (HPSJ) Cultural and Linguistics team recently implemented video remote interpreting (VRI) and over-the-phone interpretation (OPI) services with two Federal Qualified Health Centers (FQHCs) – Community Medical Centers (CMC) and Stanislaus County Health Services – plus FQHC look-alike San Joaquin Health Centers (previously San Joaquin County Clinics). A combined 168,366 HPSJ members now have access to VRI and OPI as well as American Sign Language services through these HPSJ provider partners, increasing language access by 33% at CMC where there are 101,129 HPSJ members.

Breast Cancer Screening Pilot with Community Medical Centers (CMC) Health Plan of San Joaquin (HPSJ) and Federally Qualified Health Centers (FQHCs) staff are in regular contact through the Provider Partnership Program (PPP) to develop best practices that remove members’ barriers to care and improve their health outcomes. In a recent meeting, HPSJ’s Community Medical Centers (CMC) partners mentioned they wanted help with their Breast Cancer Screening rates. Together they developed a pilot project. HPSJ staff drafted a template letter for CMC to send, with a completed mammography work order, up to 300 of its 4,200 HPSJ patients eligible for Breast Cancer Screening. Together, HPSJ and CMC want to make it as easy as possible for a patient to obtain their order, then go to the location of their choice and at a time convenient for them. HPSJ and their CMC partners believe sending a completed copy of the mammogram order directly to the HPSJ patient can be a practical step to removing a barrier for the patient to get their important breast cancer screening. If all 300 patients in the pilot receive breast cancer screenings, CMC can increase their current testing rates by 7%. If successful, in 2023 HPSJ will recommend this pilot as a Best Practice to other FQHCs and participants in the PPP program.

Tenet Hospitals Earn Honor Roll Award for Maternity Care Doctors Medical Center, Doctors Hospital of Manteca and Emanuel Medical Center have all received the 2022 Honor Roll Award for Maternity Care from the California Health and Human Services (CHHS) Agency, Hospital Quality Institute and Cal Hospital Compare.

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In The News

IN THE

NEWS 108 hospitals have been recognized on the 2022 Maternity Honor Roll. These hospitals met or surpassed the statewide target aimed at reducing births via cesarean section (C-section) in first-time mothers with low-risk pregnancies.

In 2015, the CHHS Agency began recognizing hospitals that meet the statewide target of C-sections for low-risk births through its Maternity Honor Roll. This year’s award reflects calendar year 2021 hospital discharge and birth certificate data from California hospitals that offer maternity services and participate in the California Maternal Quality Care Collaborative’s Maternal Data Center.

Providing staff, physicians, and patients with relevant & up to date information personnel qualifications, adequacy of facility equipment, quality control procedures and quality assurance programs are assessed. The findings are reported to the ACR Committee on Accreditation, which subsequently provides the practice with a comprehensive report that can be used for continuous practice improvement.

Every year, more than 400,000 babies are born in California and childbirth is the No. 1 reason for hospitalization in the U.S. and California.

Doctors Hospital of Manteca Earns Breast MRI Accreditation Doctors Hospital of Manteca has been awarded a three-year term of accreditation in breast magnetic resonance imaging (MRI) as the result of a recent review by the American College of Radiology (ACR).

MRI of the breast, when used with mammography and breast ultrasound, can be a very useful diagnostic tool. Recent research has found that MRI can locate some small breast lesions sometimes not seen by mammography. It can also help detect breast cancer in women with breast implants and in younger women who tend to have dense breast tissue.

The ACR gold seal of accreditation represents the highest level of image quality and patient safety. It is awarded only to facilities meeting ACR Practice Parameters and Technical Standards after a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field. Image quality,

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2,500 Robotic Surgeries Manteca Physician Celebrates 2,500 Robotic Surgeries Antonio Coirin, M.D., general and bariatric surgeon at Doctors Hospital of Manteca, hit a special milestone in his career. Dr. Coirin has now performed 2,500 robotic surgeries on the da Vinci Surgical System. He celebrated the milestone with the team at Doctors Hospital of Manteca. Congratulations, Dr. Coirin.

Dr. Coirin has been practicing in the Central Valley for more than 30 years. He is a proctor for the da Vinci Surgical System and trains surgeons locally and across the country in general and bariatric surgery.

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to an underserved population that would be denied elective surgery based on size. The results of the team’s retrospective review demonstrated that High BMI Weight Loss Surgery can be safely performed at a small community hospital with a specialized team and dedicated equipment for patients of size.

Annual Service Awards Doctors Hospital of Manteca Employees Recognized at Annual Service Awards Doctors Hospital of Manteca is proud to celebrate milestone service awards every year for its employees. The hospital recently recognized more than 30 employees for their service, ranging from 5 years to 30 years.

“I would like to extend a heartfelt thank you and congratulations to this years’ service award recipients. This is such a special opportunity for us to recognize our employees for their invaluable contributions to Doctors Hospital of Manteca and their many years of service,” said Eleze Armstrong, CEO of Doctors Hospital of Manteca. “We have team members who are celebrating 20, 25 and 30 years of service. What a wonderful testament to the dedication of our employees and their longstanding commitment to making sure we provide quality, compassionate care in the communities we serve.”

Magy Cortes (Lab Supervisor) and Terri Locke-Barton (Registration Associate) were both recognized for 30 years of service. Magy was hired on April 6, 1992, and Terri was hired on July 6, 1992.

Doctors Hospital of Manteca Bariatrics Team Presents at ACS Safety Conference The bariatrics team at Doctors Hospital of Manteca had the special honor of presenting during this year’s American College of Surgeons (ACS) Quality and Safety Conference, which was held in Chicago. The team was 1 of only 13 from across the country selected to present.

Congratulations to Erin Bashaw and Amy Briggs for their incredible work on this project. Their research was selected for the virtual poster session because the hospital has created a unique surgical service line that promotes access to care and demonstrates high quality outcomes while promoting health

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St. Joseph’s Medical Center Receives $480K Grant St. Joseph’s Medical Center Receives $480K Grant from Local Foundation St. Joseph’s Medical Center (SJMC) received a $480K grant from The Antone E. & Marie F. Raymus Foundation to fund pediatric related equipment. This grant will cover the cost of a neonatal transport isolette, five fetal monitors and carts, and five handheld ultrasounds. SJMC is proud of the partnership it has formed with the Raymus Foundation, and the impact it is having across several departments for our youngest community members.

Pathways Community HUB Launched in San Joaquin County to Address Health Disparities in Underserved Populations In August, the Community Foundation of San Joaquin, Dignity Health - St. Joseph’s Medical Center, and partners announced a new partnership with Pathways Community HUB InstituteSM (PCHI) to address barriers to health experienced by so many

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individuals and families in San Joaquin County, including lack of housing, employment, or inadequate access to certain medical and behavioral health services. PCHI is a national nonprofit that partners with hospitals, clinics, health plans, community-based organizations, and community health Tammy Shaff workers (CHW) to identify socially disadvantaged patients and connect them to appropriate providers and services. Using an outcome-based payment approach, CHWs work with individuals to help remove physical and socioeconomic barriers to achieve optimal health.

Nearly 100 first responders attended, with Chaplains from the Spiritual Services Department performing the blessings for the first responders and their respective rigs. In addition to the blessing, each first responder received lunch and a token to show appreciation from SJMC.

Kaiser Permanente Medicare Health Plan in California Among the Nation’s Best Kaiser Permanente’s Medicare health plan in California is consistently among the highest performing in the nation for clinical care and patient experience Kaiser Permanente’s Medicare health plan in California is once again among the nation’s best for providing high-quality, seamless care, and outstanding service to its Medicare health plan members.

The Kaiser Permanente Medicare health plan in California received 5 out of 5 stars, the highest rating possible, according to the Centers for Medicare & Medicaid Services (CMS) annual Star Quality Ratings for 2023.

This is the 12th straight year Kaiser Permanente’s Medicare health plan in California has been rated 5 out of 5 stars.

“Kaiser Permanente is proud to be consistently rated among the best in the nation for providing high-quality care and service to our Medicare health plan members - and all of our members - throughout Northern California,” said Carrie Owen Plietz, FACHE, president of Kaiser Permanente’s Northern California region. “This 5-star rating reflects the unwavering commitment of our physicians, care teams and staff to keeping our members leading healthy and productive lives.”

Blessing of the Rigs St. Joseph’s Medical Center Holds Blessing of the Rigs for Local First Responders Dignity Health St. Joseph’s Medical Center (SJMC) held their inaugural Blessing of the Rigs event on Friday, October 28, 2022, National First Responders Day. SJMC offered a county-wide invitation to all city and county fire, police, sheriff and highway patrol departments, and county ambulance companies to attend. Festivities entailed a drive-thru interfaith blessing of the vehicles and first responders, which also included canine units and motorcycles.

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The CMS Medicare Part C (health plan) and Part D (drug plan) 5-Star Quality Rating system is designed to help people compare health and drug plans based on quality and performance. Plans that receive 5 out of 5 stars in the annual ratings are recognized as excellent. Plans that receive 4 out of 5 stars are above average.

Every year, CMS rates all Medicare Advantage health plans (Parts C and D) on multiple facets of care and service, including chronic conditions management, health maintenance, patient experience, customer service, and pharmacy services. Kaiser Permanente’s star ratings demonstrate the value of our integrated health care delivery system, which brings a myriad of services together, in many cases all under one roof, and puts our patients at the center of care.

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REIMBURSEMENT HELP: Members receive one-onone assistance from CMA’s reimbursement experts, who have recouped $33 million from payors on behalf of CMA physicians in the past 12 years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.

COVID-19: CMA understands that many physician practices are struggling in the wake of the COVID-19 outbreak. We are working closely with state and federal lawmakers to ensure physician practices remain viable, and that physician networks remain robust amid the financial uncertainty created by the COVID-19 crisis.

TELEHEALTH: Telehealth services have proven to be a critical tool for physicians so they can safely provide care to those who need it during the COVID-19 public health emergency. CMA has worked to ensure that government agencies understand the regulatory flexibilities necessary so that physicians can continue serving patients during the COVID-19 pandemic. From telehealth flexibility and payment parity, to waivers on privacy and security requirements to expedite the incorporation of telehealth into practice workflows, CMA has been at the table making sure policymakers understand the needs of physicians and their patients.

PHYSICIAN WELL-BEING: CMA believes physician

“The value that CMA brings to physician practices cannot be understated.

Membership is not a cost to my practice – it is an investment. I couldn’t run my practice without it.”

Tom McKenzie, M.D. Member since 1991

well-being and professional fulfillment are critical factors in maintaining patient access to quality care, and we must address this challenge at the organizational and systemic level. CMA’s Wellness Program launched Care 4 Caregivers Now in March 2020 to provide physicians with one-on-one emotional support from trained medical professionals in a safe, confidential and non-judgmental space.

EXPERT GUIDANCE: Staffed by experts with a combined experience of over 125 years in medical practice operations, CMA’s Center for Economic Services empowers physicians by providing resources and guidance to improve the success of their medical practices. Whether it’s identifying and fighting unfair payment practices, improving the efficiency of your practice, or guiding physicians through the contract evaluation and negotiation process, CMA has tools and resources to help.

QUESTIONS? CMA’s live-person call center is available Monday through Friday during business hours at (800) 786-4262 or via live chat at cmadocs.org.

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RESID

ENTS' REPORT A PLACE FOR ALL NEWS HIGHLIGHTING RESIDENTS AND GRADUATE MEDICAL EDUCATION Annie Haji-Datoo, MD PG-Y3, Internal Medicine, St. Joseph’s Medical Center District VI Delegate, Resident Fellow Section, CMA House of Delegates

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The NEW Resident’s Report is dedicated to all the good news related to our hard-working residents training at San Joaquin General Hospital and St. Joseph’s Medical Center.

Please email your submissions, written in third person with accompanying photo to Lisa@sjcms.org.

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For Dr. Annie Haji-Datoo, serving as a delegate for the first time was an eye-opening experience that highlighted the necessity of getting involved. She was impressed by the careful attention delegates paid to topics such as abortion and mental health. “There is a lot of unfinished business,” she said, adding that more medical students, residents and fellows should get participate in these conversations. “It is critical to involve every level of doctors in training. We do have a voice, let’s use it.”

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NEW CONNECTIONS WITH SJGH SJGH Family Medicine Residency Program added an exciting new twist to our biannual resident retreat by incorporating community outreach to the day. Part of the group of residents and attendings created something special for the children at Mary Graham while the other part of the group served a meal next to our recently established weekly outreach pop up clinic downtown. The day was spent increasing the connection within the program and also with the community.

SJMC RESIDENT PRESENTS POSTER AT THE AMERICAN COLLEGE OF GASTROENTEROLOGY CONFERENCE Dr. Jessie Wang, SJMC IMRP PGY-2, presented her poster Esophagobronchial Fistula after a Laparoscopic Partial Fundoplication, Mimicking as emphysema at the American College of Gastroenterology Conference in October.

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Practice News and Resources Free to SJMS/CMA Members!

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

Registration is required!

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

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December 14, 2022: 11:00AM to 1:00PM

“Medicare Changes 2023 and Beyond”

This presentation will provide your practice with an overview of the policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective for Calendar Year 2023 and beyond.

Join us as we discuss: • Telehealth Services • Updates to Other Evaluation and Management (E/M) Visits • Behavioral Health Services • CY 2023 Quality Payment Program • Noridian Compliance • Other Medicare Part B issues You will walk away with the resources to help you maneuver regulatory and procedural challenges that impact your practice.

Target Audience: Physicians, billers, office managers/practice administrators Presenter: Cheryl Bradley, Associate Director, CMA Center for Economic Services Chery has over 25 years’ experience in the Medicare Program and has held a variety of responsibilities including Education and Training Specialist, Medical Review Analyst, and has worked with providers in virtually all specialties across all the CA Medicare contractors. Cheryl is a credentialed instructor known for speaking at conferences, state associations, and for numerous organizations. She provides problem solving assistance to CMA member physicians on a number of healthcare issues. She is skillful at using humor to help providers navigate this difficult program.

March 8, 2023: 11:00AM to 1:00PM

“2023 Employment Law Updates”

Jamie Bossuat, a shareholder and employment lawyer at Kroloff will present an update on the most pressing issues in employment law and will offer practical suggestions for reducing liability. Issues will include recent changes in wage and hour requirements, updates to leave of absence laws, and current litigation trends.

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CMA PRACTICE RESOURCES LAST DAY TO CHANGE YOUR MEDICARE PARTICIPATION STATUS FOR 2023 IS DECEMBER 31

UHC delays Designated Diagnostic Provider program in CA until Jan. 1, 2022 It’s that time of year again—time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31,2022 to make changes for the 2023 participation year. The effective date for any changes made will be January 1, 2023.

In making the decision for the 2023 participation year, physicians should be aware that the Centers for Medicare and Medicaid Services (CMS) recently released the final rule and policies for next year. The fee schedule has not been released yet.

As always, physicians have three choices regarding Medicare: Be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.

Details on each of the three participations options are as follows: A participating physician must accept Medicareallowed charges as payment in full for all Medicare patients. A participating provider receives 5% more reimbursement than a non-participating provider.

A non-participating provider can make assignment decisions on a case-by-case basis and bill patients for more than the Medicare allowance for unassigned claims. Non-participating physician fees are 95% of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25% more than the amounts allowed in the participating physician fee schedule (which equates to 15% of the non-participating fees).

Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare›s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. As a result of the Medicare Access and CHIP Reauthorization Action of 2015 (MACRA), validated opt-out affidavits signed on or after June 16, 2015, will automatically renew two years after the effective date.

Physicians who want to change their participation

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status for 2023 must submit a signed Medicare Participating Physician or Supplier Agreement (CMS-460) to Noridian, California’s Medicare contractor, postmarked by December 31, 2022. The participation agreement will automatically renew each year. However, if there is a name or EIN (tax identification number) change, you will need to complete a new participation agreement.

There is also information on physicians’ Medicare participation options in the California

health-law-library. Nonmembers can purchase documents for $2 per page.

MEDI-CAL RADS WILL NO LONGER BE MAILED DUE TO SUPPLY CHAIN ISSUES

Recently, the California Department of Health Care Services (DHCS) announced that Medi-Cal will no longer mail Remittance Advice Details (RADs), Electronic Fund Transfer (EFT) statements or No Pay documents. According to DHCS, this change was necessitated due to supply chain issues. However, DHCS has clarified that it will continue printing documents until its supply is exhausted.

KROLOFF.COM Providers who have not yet transitioned to PDF RADs (which includes the embedded financial summary information) are strongly encouraged to do so at this time. To sign up for PDF RADs:

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When it comes right down to it, there’s really no such thing as a small legal matter when it sits on YOUR desk. Time to call the firm that always has your best interest in mind.

Log in to your Medi-Cal account on the Medi-Cal Providers website under the Transactions tab.

Click on the “Other” tab Click on the “Remittance Advice Detail (RAD)” link Once enrolled, the PDF RAD and Medi-Cal Financial Summary are accessible on under the Transaction Services page.

To access the transaction, providers must have a signed Medi-Cal Point of Service Network/Internet Agreement form on file.

For any questions regarding PDF RAD access, contact the Medi-Cal Telephone Service Center at (800) 5415555.

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Medical Association (CMA) health law library: #7209, “Medicare Participation (and 54 SANdocument JOAQUIN PHYSICIAN Nonparticipation) Options.” Health law library documents are free to members at cmadocs.org/

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Public Health

Update

Addressing Latent TB Infections to Eliminate TB LETICIA GARCIA CASTILLO, MSN, RN, PHN MAGGIE PARK, MD

Background

Tuberculosis (TB) has affected humans for centuries, and yet it is still one of the leading causes of death due to infectious disease in the world. TB is caused by the bacterium Mycobacterium tuberculosis. Infection occurs when a person inhales droplet nuclei containing tubercle bacilli that reach the alveoli of the lungs. There, the bacilli multiply and may spread through the bloodstream to more distant tissues and organs. In some people, the tubercle bacilli overcome the immune system and multiply further, resulting in progression to active TB disease. In most people, macrophages ingest and encapsulate the bacilli forming a granuloma, that keeps the bacilli contained and under control. At this point, a latent TB infection (LTBI) has been established and may be detected by a tuberculin skin test or an interferon-gamma release assay (IGRA).

Persons with LTBI are infected with M.tuberculosis, but they do not have TB disease. They usually have a positive TST or IGRA, but they have a normal chest x-ray and are not symptomatic nor infectious. Individuals with LTBI and no risk factors have a 5%-10% lifetime risk of progressing to active disease. Risk factors, such as immunosuppression or diabetes, significantly increase that risk of progression.

A person can live with LTBI for years or decades before it progresses to active disease.

LTBI is the primary cause of TB disease in California. In 2021, California reported 1,750 new active TB cases. Of

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those, 87% were from LTBI progressing to active disease, 10% from recent transmission and 3% from importation (being sick at arrival). It is estimated that more than 2 million Californians have LTBI. Of those, only an estimated 20% are aware of the diagnosis and only 12% get treated for LTBI. LTBI treatment stops TB infection from progressing to disease. It is also much less costly to test and treat an individual with LTBI than for TB disease. So why aren’t more people with LTBI getting treated? San Joaquin County Public Health Services (PHS) hopes to better understand the issue.

What PHS is doing

In 2021, San Joaquin County (SJC) reported 41 new active TB cases, a case rate of 5.2 per 100,000. The county TB rate has typically been slightly higher than the state rate. SJC also a history of large concurrent multiyear TB outbreaks. In 2020, SJC’s TB death rate was 17.4%, compared to 10.7% for California (figure 1).

Traditionally, PHS TB Control has focused on case management of active TB patients, contact investigations and outbreak management. In May of this year, the program started a new project focused on LTBI. Public health nurses and communicable disease investigators began making phone calls to SJC residents who had a positive IGRA in the past 12 months. There were 1900 positive IGRA lab reports received in 2021. The goal was to get a better idea

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about the treatment status of these individuals and provide education to those that may have not started treatment.

To date, over 500 calls have been made and 367 clients have answered the call. Of those 367 clients, 204 (37%) had not started LTBI treatment (figure 2).

Surprisingly, most of them stated that the reason they had not started treatment was because the ordering provider had not informed them of the positive results even though for many it had been several months since the test was completed. PHS provided these clients with education on TB and advised them to follow up with the ordering provider for treatment.

Most clients stated they were interested in LTBI treatment and would follow up with their provider.

PHS is working closely with the CDPH TB Control Branch to conduct more outreach and education to our community providers. Addressing LTBI is a priority to disrupt TB transmission. We must find and treat LTBI to prevent progression to disease. Primary care providers, civil surgeons, and community health clinics play a key role in the elimination of TB because they often provide care to populations at risk.

Recommendations for Community Providers

PHS asks that community providers evaluate and treat LTBI using the following 4 steps:

Step 1: Identify patients at risk for TB infection.

Use the California TB Risk Assessment to identify patients for LTBI testing. TB risk factors for infection include birth, travel, or residence in a country with an elevated TB rate, immunosuppression, and being a close contact to someone with infectious TB.

Isoniazid and Rifapentine weekly x 12 weeks OR Rifampin daily x 4 months. If a rifamycin-based regimen is not an option (due to drug resistance or intolerance), use Isoniazid daily x 9 months.

Resources for Healthcare Providers

Step 2: Test patients for TB infection. An IGRA is preferred

Latent Tuberculosis Infection Guidance for Preventing Tuberculosis in California https://ctca.org/wp-content/uploads/LTBI-Guidelines-62019-Revision-FINAL.pdf

Step 3: Evaluate for active TB disease. If the IGRA is

CDC Latent Tuberculosis Infection Resources https://www.cdc.gov/tb/publications/ltbi/ltbiresources.htm

over TST for non-U.S.-born persons >2years old.

positive, evaluate for active disease with a TB symptom screen, physical exam, and chest x-ray. Do not treat for LTBI until TB disease is excluded.

Step 4: Treat for LTBI. Use a short-course LTBI treatment regimen whenever possible. Preferred short course regimens:

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PHS no longer has a public health clinic and does not provide treatment.

For TB questions, call San Joaquin County TB Control at (209) 468-3828.

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San Joaquin Medical Society Member Only Benefits • Complimentary Dark Web Compromise Credential Report ✓ Over 11 billion accounts have been compromised – Has yours?

• Complimentary Phone System Assessment ✓ Is your phone bill higher than you would like? Does your phone system allow you to work from anywhere?

• Complimentary Security and Risk Assessment ✓ Have you conducted your Risk Assessment yet?

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San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568

PRSRT STD. U.S. POSTAGE

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Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

With over 400,000 members, Health Plan of San Joaquin continuously works to improve the health of our community by partnering with providers, resource agencies and local businesses to deliver on our mission.

Community • Partnership 60

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Join our network: www.hpsj.com/provider • 888.936.PLAN (7526)

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