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Staying In

Rhythm

Ramin Manshadi’s On-Going Quest for AED Accessibility

Winter Issue 2011 WINTER 2011

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Open Wide...

With Confidence!

It’s Open Enrollment time for the San Joaquin Medical Society-sponsored Group Dental program. This plan is designed to help you, your family and your employees minimize the out-of-pocket expense of regular dental care. This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits that can save you money: • Annual Benefits of $2,000 per person for dental care, using network providers ($1,500 if you use non-network providers). • During Open Enrollment only, members may join as an individual or as a group with your employees.

Sponsored by:

• Low, calendar year deductible of $50 per person ($100 per calendar year maximum for families). • Pay no deductible on oral exams, x-rays and routine cleanings.

Remember, the open enrollment period is available once per year. To be eligible for coverage, applications must be received during the special open enrollment period ending on January 1, 2012. Call a Client Service Representative at 800-842-3761 for more information, a brochure and application. Or visit www.MarshAffinity.com/cmadownload.html to download an enrollment kit.

Underwritten by:

Administered by:

Underwritten by: (IL) - First Commonwealth Insurance Company, (MO) - First Commonwealth of Missouri, (IN) - First Commonwealth Limited Health Services Corporation, (MI) - First Commonwealth Inc., (CA) - Managed Dental Care, (TX) - Managed DentalGuard, Inc. (DHMO), (NJ) - Managed Dental Guard, Inc., (FL, NY) - The Guardian Life Insurance Company of America. All First Commonwealth, Managed DentalGuard, Inc. and Managed Dental Care entities referenced are wholly-owned subsidiaries of The Guardian Life Insurance Company of America. Products are not available in all states. Limitations and exclusions apply. Plan documents are the final arbiter of coverage. 51520 ©Seabury & Smith, Inc. 2011 • AR Ins. Lic. #245544 d/b/a in CA Seabury & Smith Insurance Program Management • 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • Member.Insurance@marsh.com • www.MarshAffinity.com • CA Ins. Lic. #0633005

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Volume 59, Number 4 • December 2011

{FEATURES}

22 36 45 60

STAYING IN RYTHM

Ramin Manshadi’s On-Going Quest for AED Accessibility

VISIONARY:

{DEPARTMENTS} 28 IN THE NEWS

New Faces and Announcements

Health Education

32 PRACTICE MANAGEMENT

LEGISLATIVE WRAP UP

34 MEDICAL HOME

Batten Down The Hatches

2011 CMA

House of Delegates Recap

6 Tips for Using Passwords to Protect Against Identity and Business Theft Patient Center Medical Care

54 MANAGING PROFESSIONAL RISK Safeguarding Data Forum

56 ANNUAL COMMUNITY HEALTH FORUM 68 NEW MEMBERS

ON THE COVER: Dr. Ramin Manshadi – photo by David Flatter

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Keep an eye out for the

Spring Issue

George M. Khoury, MD President Raissa Hill, DO President-Elect James Halderman, MD Past-President Thomas McKenzie, MD Secretary-Treasurer

March 2012

The Value of Membership 2.7 million and counting!

Board Members Lawrence R. Frank, MD Ramin Manshadi, MD Karen Furst, MD

2012 Buyers Guide

Moses Elam, MD Alan Kawaguchi, MD Kwabena Adubofour, MD

Peter Drummond, DO James J. Scillian, MD Kristin M. Bennett, MD

Medical Society Staff Michael Steenburgh Executive Director

SJMS Strategic Plan Unveiled

Debbie Pope Office Coordinator Gena Welch Membership Coordinator Committee Chairpersons MRAC F. Karl Gregorius, MD

Decision Medicine Kwabena Adubofour, MD

Ethics & Patient Relations to be appointed

Communications Moris Senegor, MD

Legislative Jasbir Gill, MD

Community Relations Joseph Serra, MD

Audit & Finance Marvin Primack, MD

Member Benefits Jasbir Gill, MD

Nominating Hosahalli Padmesh, MD

Membership to be appointed

Public Health Karen Furst, MD

Scholarship Loan Fund Eric Chapa, MD

NORCAP Council Thomas McKenzie, MD CMA House of Delegates Representatives Robin Wong, MD Patricia Hatton, MD

Lawrence R. Frank, MD James J. Scillian, MD Roland Hart, MD

James R. Halderman, MD Peter Oliver, MD

CMA House of Delegates Representatives - Alternates Kwabena Adubofour, MD

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Gabriel K. Tanson, MD

Ramin Manshadi, MD

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WINTER 2011

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SAN JOAQUIN PHYSICIAN

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MeSSAge MESSAGE>>executive ExecutiveDirector Director

2.7 Million Reasons “ Individually, we are to be a Member one drop, but together we are an ocean.”

Given the overall economic outlook many of our members are facing with shrinking reimbursements, tighter contracts, and rising practice costs, it comes as no surprise that I’m often asked to justify the cost of membership. Establishing an ROI on intangible services and benefits is not easy. I often begin citing all of the personal services we offer to our members and then move on to the long list of benefits we provide and generally focus in on the amazing advocacy work CMA provides each of you. It’s a compelling argument, but not thatSusan hear it. Thosealways words convincing were spokentobyallDr. Kaweski, San Diego County Medical Society’s new What would be compelling is if they heard from some of their own peers how president during her recent installation ceremony. She further “andyear united we must membership has benefitted them and their practice. Overstated, the past dozens of ourbe, especially in these tumultuous times” to which I couldn’t agree more. Th ese are diffi cult times members have called upon us for help with their reimbursement, legal and contracting for physicians andObviously the medicalI can’t community a whole. changes are happening challenges. discloseasthe details Far-reaching surrounding our involvement, but I can say at a break-neck pace in Washington, D.C., and at our own state capital. As that Dr. Kaweski so pride we take great in helping thosebethat we need solidarity amongstof ourSJMS/CMA ranks like never before. One voice may Ofeloquently all the states, services and benefits it and often ignored and no one notices, but when a chorus sings in harmony – it’s prettneed y hard to not taketimes membership, I honestly believe the value of it has been expressed to notice. us that we’ve saved their your direct access to these economic services at practice. Membership is oftthe en perceived as acost non-essential cost of doing business. Something CMA exceed annual of membership! Dealingyou withsign up for out of habit or peer pressure. Some see it as a duty, having joined early in their medical challenging practice career issues and never takenhours the opportunity become involved or seek any of our can take (if not days)toout of yourmore schedule and despite having theservices most it’s of justmembership not enough.because You need professional help with the right and socompetent sadly, neverstaff, trulysometimes see the value their own perception is skewed contacts the peopleofwho make a difference. average, 10-15from of our towards it beingtosomething littlecan or no value. NothingOn could be further themembers truth. call CMA’s Center for Economic Services for helpbenefi eachts,month. It may be anarray issueofwith a Membership not only provides you extensive personal but opens a wide rejected reimbursement, a new contract that needs to be reviewed, help with completing yet services to your practice managers and staff as a whole. Beyond that, we could fill several pages another form from CMS, or anything else you can imagine. with the extensive of services CMA as Services well. collected over 2.7 million dollars in Last year list alone, the Center forprovides Economic disputed claims for CMA members statewide. I don’t know specifically how much of that To truly appreciate have tobut experience or several at least members appreciatewho the extensive landed back inmembership, our membersyou pockets, I do knowit of personally called me place to thank us day because theirbehalf help resulted in significantand outcomes. lobbying taking every on your in both Sacramento D.C. For those all the benefits of SJMS/CMA I honestly membersOf who haveservices had to and call us and request assistancemembership, with a collection, billing,believe coding,the value of your direct access to these economic services at CMA exceed the annual contract or personnel issue, membership value is easy to comprehend and seldom enterscost of membership! their thoughts after help has been rendered. For those that have attended our annual House That means all of the other good stuff is icing on the cake. Our personal service to your of Delegates or yearly the capital for Legislative Day, value again securely reinforced practice staff andvisit thetomonthly Office Managers Forum, yourisannual directory, multiple because they see fi rst-hand the impact our unifi ed voice has in these arenas of thought. free CME breakfast seminars throughout the year, fun and entertaining social events, our personalized website with member access to Prescriber’s Letter, discounted programs with My hope is you have had the opportunity to seeNorcal first-hand value of your membership and Fitness 360, Crown Computer Services, and the MARSH Insurance are all available to you. And let’s not forget DocBookMD, our latest offering which is sweeping our feel positive about the contribution you’re making in the future of medicine by being a part of membership. something much bigger than yourself. Possibly even an ocean. Membership adds value to your practice, and equally important, adds your voice to the chorus of 35,000 California Physicians who are All the Best! represented in Sacramento and DC by the CMA. Your voice is needed and we welcome the opportunity to serve you. All the Best!

Mike Steenburgh Executive Director

Moris Senegor, MD Moris Senegor, Editor MD Editor Editorial Committee Editorial Committ ee Moris Senegor, MD Shiraz Buhari, MD MD Kwabena Adubofour, Kwabena Adubofour, MD Mike Steenburgh Robin Wong, MD Michael Steenburgh William West Managing Editor Managing Editor William@sjcms.org Sherry Roberts Creative Director Michael Steenburgh sherrylavonedesign.com Contributing Editor Contributing Writers Sherry Roberts Carmen Spradley Creative Director/Graphic Cheryl EnglandDesigner sherry@sjcms.org Tom Gehring William West Contributing Sources California Medical Association Contributing Sources California Medical Association Los Angeles County Medical Association Los Angeles County San DiegoMedical CountyAssociation Medical Society San Diego County Medical Society The San Joaquin Physician magazine is published quarterly by magazine the The San Joaquin Physician Sanis Joaquin Medical Society published quarterly by the San Joaquin Medical Society Suggestions, story ideas or completedstory storiesideas or Suggestions, writt en by current completed stories San Joaquin Medical Society written by current members San Joaquin Medical Society are welcome andmembers will be reviewed by the Editorial ee. are welcome andCommitt will be reviewed by the Editorial Committee. Please direct all inquiries and submissions to: Please direct all inquiries and submissions to: San Joaquin Physician Magazine 3031 W. MarchPhysician Lane, SuiteMagazine 222W San Joaquin 95219 3031Stockton, W. MarchCA Lane, Suite 222W Phone: 209-952-5299 Stockton, CA 95219 Fax: 209-952-5298 Phone: 209-952-5299 Email Address: gena@sjcms.org Fax: 209-952-5298 Email Address: gena@sjcms.org Medical Society Office Hours: MondaySociety through Friday Medical Office Hours: 8:00 AM to 5:00 PM Monday through Friday 8:00 AM to 5:00 PM

Mike Steenburgh Executive Director

66 SAN SANJOAQUIN JOAQUINPHYSICIAN PHYSICIAN

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MESSAGE > From The President

A New Plan Emerges for SJMS!

Our goal is to identify the issues for each of the various categories and groups of physicians, specific to their practice as well and general concerns we all face.

ABOUT THE AUTHOR Dr. George M. Khoury is President of the San Joaquin Medical Society and practices at Stockton Diagnostic Imaging as a Radiologist.

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This past October our board invested an entire Saturday with the task of developing a new Strategic Plan for the society. I would like to thank those board members for taking time from their families to spend the day working on behalf of the San Joaquin Medical Society members. The goal of this exercise (it actually encompasses several board meetings, the Saturday session itself, and several more discussions yet to come) was to evaluate what hadn’t been accomplished from the previous strategic plan developed in 2006 and to plot the next strategic plan, which includes a fresh vision and updated 3-5 year goals. Starting with the basic principle; we are physicians who chose the profession of medicine with the primary intent of serving our patients health and well fare to the best of our abilities. For the past couple of years the board has entertained discussions on how to make our medical society relevant to our physician members, and community at large. This evolved into the quest of making the SJMS a brand name that implies competency, caring, and knowledge. How to get this idea or message across to our community is where we started.

During the day long adventure we reminded ourselves of the mission of our society where we have been and where we want to be. We identified what we felt were the main goals to be achieved by 2015. These were: • Grow membership to achieve a 75% penetration amongst our counties’ physicians (at present we are 63%) • Be the recognized Voice of medicine in our community • Elevate the importance of our local issues at the state level and within the CMA. • Improve the health of our counties population. Why does membership always seem to be one of the primary goals? Since 1990 the number of licensed physicians in California has risen from 69,474 to over 100,000 as of a 2010 report. However the membership in CMA has decreased in that same period of time from 38% to 22%. The non-members of CMA include those who have never joined and those who were members

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San Joaquin Medical Society and CMA Members Enjoy: Vast CMA Resources:

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“My Membership provides me a Voice in Sacramento and Washington DC.” Thomas McKenzie, MD

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San Joaquin Medical Society Resources: • Online Prescriber’s Letter subscription • DocBookMD phone app • Annual Directory • Free CME Seminars • Cost Saving Benefits • Quarterly Publication • Website/Online Resources • Insurance Savings • Alliance Membership • Annual Social Events • Patient Referrals • Office Manager Forum and Practice Resources

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WINTER 2011

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MESSAGE > From The President

but chose not to renew. The non-renewal retention amongst all membership classes not be aware of the latest Public Health reasons given by these physicians in a and groups. We generally lose 6% of our data that places San Joaquin County state wide survey are: Lack of perceived membership base each year, and despite in an abysmal last place compared benefit, dues were previously paid by we are growing by 6-8% per year, we could to all counties in California as well their group, the belief that the benefits do much better. as when compared to counties with are there regardless of whether they Our goal is to identify the issues for similar population and socio-economic join or not, Ethnic groups don’t feel each of the various categories and groups breakdown. For all the hard work you represented, academia doesn’t see the of physicians, specific to their practice all do in caring for our population, value. Solo practitioners, who epidemiologic data does not need organized medicine the bear this out. It turns out that most, are apathetic to the value it takes more than just the and benefits received for the physician - patient relationship Why does membership seemingly expensive annual fee. to solve these chronic disease always seem to be one of What is the cost to join the problems. It requires involving medical society (and jointly the family, neighborhood, the primary goals? the CMA), you might ask? community, schools, and local For most of our members, we government. The public health Since 1990 the number of pay $950 per year for both. If department and the medical licensed physicians in California you are politically savvy, you society have begun working has risen from 69,474 to over comprehend the need to support together to start a diabetes our Political Action Committee training plan for physician offices 100,000 as of a 2010 report. (CALPAC) and throw in (MA training) and developing However the membership in another $250 (sadly, less than a community support group 5% of our members contribute education and training project. CMA has decreased in that same anything to our PAC) for a total Additionally, we are working to period of time from 38% to 22%. annual cost of $1,200 or $100 establish a reproducible diabetic per month! management program in all of That’s not really overpriced our hospitals. By joining forces but rather a bargain. For those with various organizations such of you whose group pays for the Society as well and general concerns we all face. as SJ Public Health, the CMA Foundation and CMA dues you have no excuse not To achieve this we have targeted the and Health Plan of San Joaquin, we can to join and we greatly appreciate their following as a general course of action: extend the reach of our efforts and create commitment to supporting organized lasting projects which will impact our medicine. • Improve data integrity to learn who is community. The latest stats from CMA shows that out there and what they need For those of you who are interested in the age distribution of members is heavily participating in this noble effort we could weighted in later career stages: 13% are • Engage existing members & use your input and assistance. Here are under age 39, 44% fall between 40-55 yrs demonstrate value to encourage some concrete ideas we have discussed in old, and 43% are 56 yrs and older. The retention our retreat please feel free to send in your young physicians also include residents. ideas as well. Sadly, our local numbers don’t look much • Increase outreach to targeted physicians better and this is something our new plan Residents • Strengthen our Partnerships with Public will address. We need to get our younger Alpine, Calaveras, Amador Counties Health and related organizations physicians involved. Other important issues surrounding • Ethnic community physicians • Strengthen Partnerships with membership includes recruiting more community support groups addressing ethnic physicians to our membership and Our second Goal is to be the recognized chronic disease (Diabetes, Obesity, leadership, connecting more with our as the Voice of Medicine in our Hypertension, Asthma …) local SJGH Residents who are offered a community. We want to create a Brand: complimentary membership now while “The San Joaquin Medical Society”, • Recruit Physician Champion volunteers they complete their residency, reaching synonymous with care, integrity and to guide these groups. Preferably our entire market area which is all of San concern for public health and wellphysicians from within these ethnic based Joaquin, Calaveras, Alpine and Amador being. Some of you if not the majority of communities. counties, and improving our overall physicians in our four county region may • Encourage Physicians who enjoy

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MESSAGE > From The President

authoring health topics to publish in our community newspaper and on our WEBsite, and our magazine. Physicians who are able to author or translate such articles into alternative language newspapers are also needed. By 2015 we also want to be an established force in the CMA through our

Delegates and Presidents Forum. Having a large membership not only increases our voice but increases the capital with which the CMA and CALPAC can work on our behalf at the State and US capitols. This political voice will also be used in our County and City politics. Most of us are unaware of the paltry

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amount contributed to Political action committees by physicians. Nationwide on average physicians donate $1.00 per year compared to trial lawyers who contribute on average $1,000 per year. No wonder MICRA is attacked every year at the Capitol. For those of you who don’t know what MICRA is you are probably young enough to know how to Google it on your smart phone. For the rest of you, you have benefited from this law for the past 36 years since the mid 70’s. I refer you to the CMA ALERT special issue: “ MICRA Under Attack” March 2011. Your malpractice insurance costs are far less than almost anywhere else in the country, because of this law. Yes you can thank the CMA for this. You should log onto the CMA web-site some time and find out how many battles they are fighting for all California physicians, members or not at the State and Federal Level. The CMA is even arguing a case at the Supreme Court. Finally our Benchmarks we will be tracking are as follows: Membership penetration reaches 75% in 2015 Public Health Report Card is 57Th or better SJMS is instrumental in development of local HIE Politicians / elected – officials come to the SJMS before voting on legislation There probably are other issues that you may wish to bring to our attention and even participate in. Please don’t be shy. Let us know. It is time for all physicians regardless of our allegiances or groupings to join together as one voice. Help us make this Four County Medical society a proud place to belong to and have a useful, meaningful purpose for all.

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MESSAGE > From The Editor

Mozart For Sale

I recently visited Prague and Vienna, two Central European capitals which, among other attributes, are famous as Classical music centers in Europe.

“Leave it to Hollywood, the movie capital of the world, to devalue Vienna, the one time music capital of the world.” “After all isn’t touristy synonymous with “undignified”?”

ABOUT THE AUTHORMoris Senegor, MD serves as the Chairperson of the Publications Committee for the San Joaquin Medical Society and Editor of its flagship publication the San Joaquin Physician.

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Prague in particular is remembered for its appreciation of the adult Mozart at a time when Vienna, his hometown and the then Mecca of music shunned him. I came to these cities with the intention of hearing Classical music concerts in their original habitat.   In Prague, which I visited first, there were numerous street hawkers advertising concerts to tourists. I took up one such offer and attended a performance at the Spanish Synagogue, a stunningly ornate building with a large dome. The brochure given to me advertised Orff’s “Carmina Burana”, a cantata that requires a huge chorus, solo singers and full symphony orchestra, and Ravel’s “Bolero”, another piece for symphony orchestra. After purchasing a rather expensive ticket, I wondered how they would stage such a large group of performers in the building which I had already visited; it didn’t seem big enough, nor did it have a stage. My puzzle was solved soon enough. When the concert began I discovered that what I had actually purchased was a pops concert by a string quintet and a soprano performing only extracts from those advertised works, as well as other tidbits of popular Classical

Music. I realized I had been misled and felt a bit foolish for having wasted a precious evening on this, what seemed a superficial affair aimed at tourists.   The problem with the concert was not the musicians. The soprano and quintet at the Spanish Synagogue were as skillful in their craft as any I have seen. I have no doubt so are all others featured in such touristy concerts. What dismayed me was the superficial repackaging of the Classical material to make it palatable to the lowest common musical denominator with the goal of giving tourists a sampling as though it were the “real thing” . Commercially motivated and a somewhat phony replica as it was, the experience had a Las Vegas flavor.   A week later, when I arrived in Vienna the musical scene seemed to get worse. Concert peddling was extremely aggressive, with numerous 17th century costume-clad people surrounding bewildered tourists like flies in prime sightseeing spots like the Hofburg, Graben, Stephanplatz and others. Obviously working on commission, they persistently pitched to hapless foreigners and refused to let go until their prey purchased tickets. I listened to one such

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pitch at the entrance of the Lippizaner Horse show. It was for a 2 hour “Mozart Pops” repertoire at $70-120 per person. With Prague fresh in my mind I perused the brochure pushed into my hands. It was another superficial, touristy “Mozart pops” affair. I decided that I had experienced countless concerts of excellent quality back home in San Francisco and Stockton, and that my original intent of having the same experience in its native environment, now highjacked by these jackasses, was foolhardy. It took some effort to extract myself from the clutches of the dealer who had engaged me. From then on I ignored the swarm of Viennese concert vendors, trying to hide my annoyance as best as I could.   As my tour continued, I now came to recognize a phenomenon I labeled “Mozart for sale” all over the city. First there were the ubiquitous Mozart chocolate stores, as frequently encountered as fast food joints in the U.S. Then there were numerous Mozart themed souvenir shops, cafes, restaurants and other establishments, all adorned with the wigged, powdered portrait of the composer, or his silhouette. I saw a Mozart concert truck in front of the Albertina Museum, a popular modern art venue

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near the Hofburg Palace complex. It was the support truck for those pesky concert hawkers, indicative of how large an industry Mozart tourism had become in Vienna.   Interestingly there were no other such touristy sales for other giants of the Vienna music scene such as Beethoven, Schubert, Johann Strauss, Brahms, Mahler and more. “Why Mozart?”, I wondered. I can only surmise that it is the after effect of the Oscar winning movie Amadeus (1984). Leave it to Hollywood, the movie capital of the world, to devalue Vienna, the one-time music capital of the world.   I then wondered why these commercial touristy concerts and “Mozart for sale” bothered me so much. It was obviously because the phenomenon cheapened the legacy of great music, a major accomplishment of Western Civilization, and along with it, of Mozart, one of its most eloquent practitioners. It then occurred to me that here at home Mozart is also ubiquitous (although usually not sold by street hawkers), from countless Mozart Festivals, to Mozart packed repertoires of Opera and Symphony companies. His music is frequently featured because it draws crowds and sells tickets. Aren’t these

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MESSAGE > From The Editor

organizations also engaged in a profit motive of some sort? What’s so different between them and the “Mozart for sale” environment of Vienna. The answer came to me on the overseas flight home, when I had time to contemplate the issue. Those legitimate musical companies all over the world treat Mozart,

and for that matter all other composers they feature, with appropriate respect and dignity. It was the undignified nature of the pushy sales, of images of Mozart on mundane souvenirs, of overpriced tickets for overhyped concerts, of the touristy treatment afforded to the music which I found distasteful. After all isn’t “touristy” synonymous with “undignified”?

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Classical music is a professional endeavor. Its practitioners spend large chunks of their childhood and adolescence to master their craft. They practice with great care for excellence, and respect for their music and its creators. When their profession is diverted into less dignified venues rancid with profit motive, disrespectful of their craft, regardless of how skillful they are, their reputation gets tarnished. I am sure there are numerous respectable musical companies in Vienna. I should have researched them ahead of my trip and reserved tickets for their version of Mozart – or any other composer. Instead, like most tourists, I came face-to-face with the street vendors selling spoiled versions, and returned home with a contaminated image of Vienna, news of which I am now spreading by mouth and by means of this article. The lesson of “Mozart for sale” applies to all professionals, including us doctors. We can choose to run our practices like our local Stockton Symphony, an organization committed to excellence and quality, or the Mid Summer Mozart Festival of the Bay Area (with George Cleve as long time conductor), which treats the legacy of Mozart with the care it deserves. Or we can run our practices like the concert hawkers of Vienna and Prague, displaying a naked profit motive, unprofessional sales tactics, and superficiality in our craft. The music that emanates from both may sound the same, but the impression it leaves in the audience is bound to be different. It was shameful of the Viennese to ignore the adult Mozart in the late 1700’s. It is equally shameful for them to exploit his legacy in such an undignified manner three centuries later. It is a blemish on the reputation of this otherwise charming, historic city with a majestic imperial past. “Mozart for sale” is a lesson we should all heed as professionals.

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2011 AWARE Provider

Toolkit

CMA Foundation’s AWARE Provider Toolkit for the Cold and Flu Season

Carol A. Lee, Esq., President and CEO, CMA Foundation

CDC

Material

[1] CDC Flyers: Careful Antibiotic Use: Cough Illness in the WellAppearing Child; Acute Cough Illness (Acute Bronchitis) (English only).

[2] Careful Antibiotic Use: Pharyngitis in Children (English only).

[3] Healthcare providers know that antibiotics cure bacterial infections, not viral infections such as: Colds or flu; Most coughs and acute bronchitis; Sore throats not caused by strep; and Runny noses. But, some healthcare providers are still overprescribing antibiotics. We must continue educating the healthcare community, patients and the public about when antibiotics work and when they do not. To aid in these efforts, the California Medical Association (CMA) Foundation’s Alliance Working for Antibiotic Resistance Education (AWARE) project has developed the 2012 AWARE Provider Toolkit for the cold and flu season. AWARE supports physicians’ efforts to promote appropriate antibiotic use, decrease the incidence of antibiotic resistance and meet the HEDIS measures for the Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis as well as Appropriate Testing for Children with Pharyngitis. The 2012 AWARE Provider toolkit contains educational resources specifically for providers as well as resources to educate patients. The toolkit contains: 2012 Acute Respiratory Tract Infection Guideline Summary (Adult and Pediatric) - A synopsis of appropriate diagnosis and antibiotic treatment of the most common respiratory infections. Prescription Pad – Available in English and Spanish, this handout offers over-the-counter treatments that can help alleviate symptoms of colds. For more information about AWARE and additional materials regarding appropriate antibiotic use, please contact the CMA Foundation at (916) 779-6620 or by e-mail at aware@thecmafoundation.org. Visit www.aware.md for additional clinical resources and patient education materials.

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Patient Education Materials (offered in English and Spanish):

[4] Health Tips – This handout provides tips to stay healthy, promotes proper antibiotic use and encourages frequent handwashing.

[5] Bronchitis and Other Cough Illnesses – These adult and pediatric handouts contains useful home care options and prevention tips.

[6] I Choose…To Prevent Influenza! – These adult and pediatric handouts contain information on influenza, how to prevent influenza, and what to do should one get sick.

[7] Feel Better Soon… Without Antibiotics! – These adult and pediatric brochures identify common symptoms and remedies that can provide symptomatic relief.

[8] Medical Office Posters (offered in English and Spanish):

[9] Feel Better Soon… Without Antibiotics! – These adult and pediatric posters inform patients that viral infections cannot be treated with antibiotics.

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Dr. Ramin Manshadi seen here teaching the importance of emergency care and deďŹ brillators in our schools.

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Staying In Rhythm

RAMIN MANSHADI’S ON­GOING QUEST FOR AED ACCESSIBILITY

By Carmen Spradley

Within his protracted struggle to make AEDs accessible to every area high schooler, Dr. Ramin Manshadi appears to have two psychological forces swirling around him. The first such force works against him: people’s tendency to assume that someone else will address a problem. In their 1968 study, “Bystander intervention in emergencies: diffusion of responsibility,” psychologists J.M. Darley and B. Latane invited participants into a lab, and told them they were taking part in a discussion of a sensitive nature, to be held over an intercom system. Actually, the intercom was a device to ensure that participants could not physically see each other. Once this blind discussion was underway, one discussion member---actually a part of the study team---would appear to have an epileptic seizure.  >>

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24 SAN JOAQUIN PHYSICIAN Photos by David Flatter

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The study team measured the length of time it took for participants to help. That the length of time varied was not surprising, but the reason for the variation was remarkable, and clear. The greater the number of people involved, the slower the response.   Perhaps there are too many people who could help in Manshadi’s efforts. Getting a device in a school is within the purview of any parent’s group, school administrator, medical group, or community service organization. And while some have stepped up---The Sacramento Kings, Dameron Hospital, St. Joseph’s Foundation and St. Jude’s comes to mind--why is the road to AED accessibility often so quiet?   Dr. Manshadi first began this mission in 2008. He brought many people together, and the result was the endowment of eight AEDs in area schools. Since then, however, the momentum has slowed, and Manshadi’s goal of reaching every high school in the county has not yet been reached. Many school sites have yet to implement the AEDs they’ve been given, a fact Manshadi attributes to a concern over liability.   His mission is now expanded to include a means of training school personnel and ensuring equipment maintenance. Manshadi’s talks with Cardiac Science, the company that invented the first fully automatic AED, are

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exploratory at this point, but he hopes they can lead to making those first donated AEDs truly ready for service. “So I am saying, why not offer to them this program, where the company offers training and monitoring for $290 a year? This takes the fear of litigation away.”   Dr. Manshadi hopes a new book he wrote will not only generate revenue for the AED program, but also revive momentum. He is exploring the idea of a charity golf tournament, and will offer his book as a catalyst for another round of public education with the Sacramento Kings. 

The idea of life and death stays with him. “Even when I was a child of five, life and death situations were a big issue to me,” Manshadi writes in his book, The Wisdom of Heart Health. “I’m convinced it began after my grandfather died when I was four...I always wanted to investigate why people ended up dying.”   But the notion persists that SCD in student athletics is too rare to justify the expense. In a September 22, 2011 article from the Boston Globe, a spokesman for the Massachusetts Interscholastic Athletic Association (which oversees most

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high school sports in that state) indicated that the MIAA does not support requiring defibrillator training for coaches in that state, claiming it would deter volunteers. “We’re concerned as anybody if a student-athlete collapses on the field and doesn’t get the proper care, but statistically it doesn’t happen very often,” he said. But where are these statistics? Dr. Manshadi points out that there is no registry for such cases. “People think this is a rare occurrence...but you hear about it often. I think it is more than people think. If there are ways to help that are so simple (such as a fully automatic AED) then why not help?” The American Heart Association reports that at least 250,000 Americans die each year of sudden cardiac arrest before they reach a hospital, and that SCA strikes people of all ages and all degrees of fitness, usually without warning. While it can take emergency personnel eight to 10 minutes to arrive on scene, the AHA states that, for every minute defibrillation is delayed, the likelihood of resuscitation decreases by seven to 10 percent. In a world of smoke detectors, burglar alarms and fire extinguishers, the idea that rarity is justification for passivity seems odd. It derails the desire to be there when one of our own--our children--needs us. In 2007, Representative Betty Sutton, D-OH, sponsored H.R. 4926, known otherwise as the HEARTS Act. After clearing the House in June of 2008, its progress slowed, then stopped completely, within the labyrinth of the Senate. The HEARTS Act would, if enacted, amend the Elementary and Secondary Act of 1965 to establish a national grant program for AEDs in schools. “If that happened, my job would be done,” Dr. Manshadi says. “But it seems to be blocked.” While the plaque builds along the halls of Congress, local people across the country take Dr. Manshadi’s approach, which is to “get it done.” In Newton, Massachusetts, a school’s decision to establish an AED program had an unexpected outcome. As the September 22, 2011 issue of The Globe reported: For Laura Geraghty, there’s no question

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defibrillators should be in every school and public place. After she collapsed in 2009 at Newton South High School, she discovered that the school’s decision, made just a few years earlier, changed everything. “If there hadn’t been an AED, I wouldn’t be here,’’ she said. Geraghty was driving a bus for specialeducation students when she began feeling ill and stopped at Newton South High, where she asked a teacher’s aide to get the school nurse. She collapsed, and for 57 minutes her heart did not beat on its own as school officials and then paramedics worked to revive her. “The thing that saved my life and saved me

better to say, as Dr. Manshadi and others have: Where there is a will, there is a way? It is a mantra that dates back to the mid-1600s, from George Herbert’s published collection of proverbs. The phrase originally declared, “To him that will, ways are not wanting.” The phrase changed to its present form in an 1822 magazine article, but it is significant that the idea it represents reaches back so far in time, and that it persists.  But what drives the will? Why has Dr. Manshadi not given up his odyssey? The question brings us to the second psychological force swirling around Dr. Manshadi as he wages his campaign: altruism and its physiological response. Could the doctor’s benevolent work allow him a personal benefit? The American Heart Association Through a series of 50 reports that at least 250,000 scientific studies, Stephen G. Post, Americans die each year of PhD, a professor of Bioethics at Case Western Reserve sudden cardiac arrest before University School of Medicine, they reach a hospital, and that saw indications that psychological SCA strikes people of all ages states like empathy can lower and all degrees of fitness, usually stress response and improve immunity. “Humans have evolved without warning. to be caring and helpful to those around us, largely to ensure our survival,” he says, pointing out that Darwin, in his “Descent of Man,” from brain damage was the immediate CPR mentions survival of the fittest only twice, but and defibrillation,’’ she said. Linda Walsh, references benevolence 99 times. director of health and human services for Two of Post’s studies seemed to show Newton, said it took years to get defibrillators that older adults who volunteer enjoy better in all of the city’s schools, but finally, just about health. Another found a 44% reduction in two years ago, there was enough funding to early death among those who volunteered a finish outfitting the elementary schools. lot---a greater effect than exercising four times It is easy to forget that our schools house a week, according to Post. more than lively youngsters. They also host One could question Post’s findings. faculty members, staff and parents of varying But they seem to mirror our individual ages and health levels. Even the smallest experiences. And even if one couldn’t say for school sees a great number of visitors each certain what percentage of good health could year, particularly for special events such as be gained for every benevolent act, don’t we back-to-school nights and school plays. intuitively know that, in helping others, we Schools are the common denominators help ourselves? And wouldn’t it be sublime within the community. So why aren’t we all if, in the quest to save the lives of others, the clamoring for AED accessibility? cardiologist is actually keeping his own heart Perhaps we convince ourselves that what beating? is difficult is, in fact, impossible---a leap of logic that would seem silly even to ourselves if we actually said it aloud. Wouldn’t it be

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COMMUNITY > news

IN THE

NEWS

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

St. Joseph’s Takes a Running Start Toward Improving the Health of our Community St. Joseph’s Medical Center employees, physicians, and administrators are all smiles at the finish of the inaugural St. Josephs Half Marathon & 5K that took place on Sunday, October 23, 2011. St. Joseph’s got involved as the title sponsor in this new event to reinforce the organization’s mission, which in part is to help improve the health status of the community it serves. St. Joseph’s is committed to this mission by providing an environment for healing and tools to support and encourage the healthy life styles that reduce or prevent disease. “As the leading healthcare organization in this community, we believe it is St. Joseph’s Improving the health of our community important to support local events that reflect the enthusiasm and health of our Sutter Tracy Community Hospital Earns residents,” said Michael Ricks, St. Joseph’s ‘Top Performer on Key Quality Measures’ Chief Operating Officer. “St. Joseph’s believes in a healthy San Recognition from The Joint Commission Joaquin County and we were proud to have our team of runners Tracy – Sutter Tracy Community Hospital, part of the Sutter and walkers out with others from our community to support this Health network of care today was named one of the nation’s top exciting event.”  performers on key quality measures by The Joint Commission, In addition to the new St. Joseph’s Half Marathon and 5K event, the leading accreditor of health care organizations in America. St. Joseph’s supports a wellness program geared toward its 2,400 Sutter Tracy Community Hospital was recognized by The Joint employees, which has gained recognition and designation as a Commission based on data reported about evidence-based clinical Fit-Friendly Company at the Platinum Level by the American processes that are shown to improve care for certain conditions, Heart Association, and has been awarded a Bronze and Silver including heart attack, heart failure, pneumonia, surgical care and Award from the former California Youth and Workplace Wellness children’s asthma. Task Force. St. Joseph’s also holds an annual 5K Fun Run/ Sutter Tracy Community Hospital is one of six Sutter Health Walk in January, open to the community. For more information affiliate hospitals in the only 405 U.S. hospitals and critical access on upcoming wellness events, please visit StJosephsCares.org/ hospitals earning the distinction of top performer on key quality Wellness. measures for attaining and sustaining excellence in accountability measure performance. Inclusion on the list is based on an aggregation of accountability measure data reported to The Joint Commission during the previous calendar year. For example, this first recognition program is based on data that were reported for 2010.

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news < COMMUNITY Lodi Memorial Hospital and Regent Surgical Health Announce two joint ventures with 17 surgeons. Lodi Outpatient-Surgical Center and the Endoscopy Center of Lodi Lodi Memorial Hospital and Regent Surgical Health, a surgerycenter management and development company that specializes in hospital/physician joint ventures, are pleased to announce a new partnership between Lodi Memorial Hospital, Regent Surgical Health and 17 area physicians. Two outpatient medical centers, Lodi Outpatient Surgical Center and the Endoscopy Center of Lodi, will now come under the umbrella of this joint venture. The facilities provide specialist surgeries for ear/nose/throat, endoscopy, general surgery, orthopedics, podiatry, ophthalmology and urology. “This relationship is important, not only to the partners, but to residents of the hospital’s five-county service area.” said Lodi Memorial Hospital President and CEO Joe Harrington “Our community is best served by local doctors, a local hospital and local resources. This new partnership strengthens the ability of Lodi Memorial and 17 specialty physicians to work together as our community readies for health reform. This is a win, win, win – for the hospital, physicians and our community.” Area urologist and Lodi Surgical Associates CEO Erick Albert, MD, adds, “We are happy to join Lodi Memorial Hospital in its mission to expand access to care to the 300,000 patients in the Lodi area. This partnership will enhance the ability to provide excellent care for area patients.” Lodi Memorial Hospital and Regent Surgical Health will retain 51 percent of the for-profit corporation’s shares, and the physicians will retain the remaining 49. Dameron Makes Hospital-Wide Effort To Recycle and Reduce Landfill Waste. Dameron Hospital, as one of the County’s largest employers, has been on a path of environmental consciousness both through its internal waste practices, as well as its 1,300 strong employee base. One example has been the Hospital’s ability to reduce carbon emissions by switching to a proactive in-hospital service utilizing reusable Sharps containers. This new step prevents a significant amount of cardboard and plastic annually from going to the landfill. Dameron launched the Sharps Management Service this year using Bio Systems reusable containers by Stericycle (NASDAQ: SRCL). Each reusable container keeps an average of 600 disposable sharps containers from going to the landfill. Whether hospitals use disposable or reusable sharps containers, regulated hospital medical waste must be properly segregated and disposed according to U.S. standard environmental and regulatory requirements. Disposable containers end up in landfills and contribute to the sizable carbon footprint made by the nation’s healthcare industry. The EPA is increasing its efforts to reduce carbon emissions across the U.S. as part of its goal to reduce greenhouse gas emissions 17% by 2012 from its 2009 baseline. Dameron has made a concerted effort to do its part in meeting these Federal guidelines. As hospitals begin to explore environmental best practices

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such as reducing waste and implementing sustainable waste management programs to minimize their footprints, “green teams” are seeking additional ways to improve their practices. Dameron is currently recycling clean cardboard shipping containers and mixed glass-plastic-aluminum containers. Also, the Hospital is recycling all e-waste such as electronic equipment, computer related devices, and batteries. One recent example of Dameron’s commitment to the environment is a hospital wide campaign in conjunction with the San Joaquin Valley Air Pollution Control District regarding the promotion of “E-Trip” ride sharing and other environmentally sensitive employee practices. On the subject of medical waste, a survey by Practice Greenhealth, with more than 700 hospital members, found 64% were implementing medical waste reduction programs. Yet few tools exist to specifically help measure a hospital’s environmental impact. The Stericycle Carbon Footprint Estimator1 tool which Dameron is involved with is designed to help U.S. hospitals determine the amount of plastic, cardboard and resulting CO2 emissions they are able to keep out of the environment by switching from disposable to reusable sharps containers. Mark Koenig, Director of ALRMS / Compliance & Safety Officer, at Dameron Hospital says: “With the Hospital’s employment of the Stericycle’s Sharps Management Service featuring Bio Systems reusable containers, our facility has significantly decreased its carbon footprint. By switching to reusable containers we stopped buying disposable containers. With thousands of patient visits a year, there are hundreds to thousands of pounds less plastic and cardboard going to our local landfills. Equally important is managing the regulatory compliance and avoiding additional operational costs since we implemented the program in late 2010.” Stericycle’s Sharps Management System using Bio Systems reusable containers have been in U.S. hospitals since 1986. Since that time, Stericycle practices have kept nearly 103 million disposable containers out of landfills. “The Stericycle program has proven very successful. Dameron Hospital will continue its efforts to explore and take advantage of opportunities that are environmentally responsible for San Joaquin County”, says Koenig. “As a community Hospital, this is what we do.” Sutter Health, Sutter Gould Medical Foundation and Sutter Tracy Community Hospital Contribute $25,000 to San Joaquin County Food Banks Sutter Gould Medical Foundation, Sutter Tracy Community Hospital and Sutter Health today announced donations totaling $25,000 to Tracy Interfaith Ministries and the Emergency Food Bank of San Joaquin County, two of the primary food banks serving needy residents in the Tracy, Stockton, and Lodi communities. The donations are a portion of a quarter-million-dollar donation by the Sutter Health network to 29 food banks throughout Northern California, which will help provide more than a million healthy meals to families in need. “Our employees see on a daily basis how many of our patients

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COMMUNITY > news

IN THE

NEWS

Dr. Singh

Dameron Hospital becomes Kid Friendly

and neighbors are struggling to afford healthy, regular meals in our current economic situation,” says David Thompson, CEO of Sutter Tracy Community Hospital. “We are proud to support the work our local food banks provide to those in need.” Food bank officials say that monetary donations help maximize the amount of food available for the hungry – in many instances, a $1 donation can translate to over $5 worth of distributed food. “We made this donation on behalf of our employees, physicians and dedicated volunteers in hopes that we can make this upcoming holiday season a little brighter for those in need,” said Paul DeChant, CEO of Sutter Gould Medical Foundation.

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Amardeep K. Singh, MD, Joins St. Joseph’s Medical Staff Interventional Cardiologist St. Joseph’s Medical Center is pleased to announce the addition of Amardeep K. Singh, MD, to the hospital medical staff. Dr. Singh comes to the Stockton area with expertise and knowledge gained from an Interventional Cardiology Fellowship at the University of California, San Francisco, and a Cardiovascular Medicine Fellowship and Internal Medicine Residency at the University of Southern California. She obtained her medical degree at Saint George’s University, School of Medicine in the West Indies. “As a woman, I offer a unique perspective and diversity to the discipline and practice of cardiovascular medicine,” says

Singh. “I have a great love for the field of cardiovascular medicine and a passion for helping others live well.” In addition to general cardiology, Dr. Singh specializes in interventional cardiology. She has experience in performing procedures such as right heart catheterization, left heart catheterization via the femoral or radial artery, aortography, ventriculography, temporary pacemaker placement, percutaneous atrial septal defect closure, and coronary and bypass graft angiography, angioplasty and stenting. Dr. Singh has done extensive research in cardiovascular medicine and her name finds merit in several medical publications. Dr. Singh’s credentials include Board Certification in Echocardiography, Level II in Cardiac CT and Nuclear Medicine,

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ABIM Cardiovascular Board Certification and ABIM Internal Medicine Board Certification. She is fluent in Hindi, Punjabi, and Spanish, which allows for optimal communication with Stockton’s diverse patient population. The established group of cardiologists at Stockton Cardiology Medical Group is excited to welcome the fi rst female interventional cardiologists to their team of physicians. For more information or to schedule an appointment, please call Stockton Cardiology Medical Group: (209) 944-5750. Dameron Hospital Emergency Department Certified as “KidQualified” The Dameron Hospital ED is now “KidQualified”, according to local hospital officials. The ED, which treats over 10,000 children a year from the Stockton community, received this prestigious certification from Valley Emergency Physicians, the physician practice group providing emergency services to Dameron Hospital and to over 35 hospitals in California and around the country. Dameron Hospital is one of only two Valley Emergency Physician Hospitals to have received the designation. Dameron received the “Kid-Qualified” certification on November 3, 2011, after a rigorous confi rmation process requiring the ED to demonstrate availability of a multitude of pediatric services, as well as substantial quality and safety measures for children. The “Kid-Qualified” designation was bestowed on the hospital by Ronald Dieckmann, MD, Director of Pediatrics for Valley Emergency Physicians, in a ceremony at the hospital. “What this means for our community”, remarked ED Director Brad Reinke MD “is that Dameron is ready for kids and the unusual and sometimes difficult to treat conditions seen in children. We have all the ingredients to make their ED visit as pleasant, as efficient and as focused as possible. State wide initiatives are beginning to target child specific Emergency Department care and we wanted to be at the forefront of those changes”. Among the many innovations that the ED has recently implemented is a rapid triage technique to quickly identify more serious medical conditions as well as initiate lab and x-ray studies on arrival to expedite care. The Dameron ED has also initiated kid friendly methods of pain relief for conditions such as burns, fractures and bad cuts. The Dameron ED staff are now trained to administer potent pain killers through a special syringe that delivers the drug into the nose, without the need for a painful intramuscular injection or IV needle stick. Pain is a common reason for parents to bring children to the ED. “We are almost totally ‘ouchless’ now”, offered Ms. Cheri Shirey, the ED Nurse Director who helped lead the hospital campaign to become “Kid Qualified”.

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A Vacation with a Purpose

Volunteers Needed! Antigua, Guatemala! How would you like to make a difference in a child’s life and earn 16 hours Category 1 CME? We’re taking a group of physicians to Antigua February 6-13, 2010. Spouses and children welcome. The tour includes fantastic Antigua, Lake Atalan, and two days custom fitting children with disabilities in wheelchairs. Experts teach us how to adjust the chairs to the children. A week to remember. Please check out our website, www. wilderness-medicine.com. Scroll down to Guatemala Service Project CME Trip. Contact me for further information. Joseph.serra@sbcglobal.net.

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protect yourbusiness 6 TIPS ON HOW TO HANDLE YOUR PASSWORD

6 Tips for Using Passwords to Protect Against Identity and Business Theft A h, those pesky passwords. If you work in the corporate world or in an office, you have one for your PC/Network and, unless there is a password synchronization application that combines them, you probably have more than one for other applications. Add those to the ones that you have for your home Internet, your banking and other websites that require passwords, and before you know it you have a nightmare on your hands in trying to manage them.

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Part of the frustration has to do with the different requirements for password formatting. Some systems only require four characters, some require eight. Some need a combination of alpha and numeric characters and others do the same with the addition of a few capital letters thrown in for extra security. It can be positively maddening. The worst thing you can do with your passwords is to place them in a text document which can be accessed on the hard drive of your computer. Your files are vulnerable - even if you think they are not. If someone is intent on finding them, they can. Even if you place them into a password protected document, those can be cracked, too. Writing them down has its own vulnerabilities, too, and there are varying opinions on this practice. If you do write them down on a piece of paper, put the document in a locked location whether it is in your home or at work.

you are open to having every site that you have a password to being vulnerable to hackers to log on and steal your identity, money or destroy your reputation. Be obscure. Use a combination of letters, numbers, capital letters and special characters if possible. The more you do this, the more secure your passwords will become. Create an alphanumeric version of a term you can remember. Using this technique

your files unrestricted access to your PC. Password-protect your wireless home network. If you have a wireless home network, be sure to password protect it as well. Use the same principles above in order to secure your wireless network. This will prevent others from accessing your connection and using it maliciously to hack the personal or business PCs and laptops you and your family use at home. Finally, there are password programs that can help with this important task, but the best advice is to start with the tips above right away. Password software can be useful as an organizational tool, but it is no match for using sound methods to manage and make your passwords difficult to crack. Crown Enterprises offers Practices peace of mind by protecting and securing their data and technology. We invite your practice to receive a FR EE Network and Security Checkup. One of our Engineers will meet with you and/or your Office administrator to discuss your concerns and evaluate your network. You’ll know exactly where you stand from a technology perspective after this FR EE service if you are a San Joaquin Medical Society member.

Password-protect your PC Be sure to give your PC a password on power-up. This will help protect your files unrestricted access to your PC.

Here are 6 tips on how to handle your passwords: Make them complex. People who use easy to remember or short passwords are inviting disaster. Use a little imagination and pick a password that is very difficult to attach to your life. Stay away from birth dates, phone numbers, house numbers, or any other number that is associated with your life. Keep passwords unique. When you change your passwords, make them unique from each other. Do not use the same password on all of your sites. If you do, then

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the word “Spaceship” becomes “Sp@ce5h!p”. Change regularly. This is the singular tip that can save you if you do not heed any of the other tips. How often should you change your password? How secure do you want to be? The frequency with which you change your password will determine how secure you are from becoming a victim. The more often you change it, the better you are. The longer you leave it the same, the more vulnerable you become. Three months is a good cycle for a password, but certainly if you fear for the security of your identity, then a monthly change is not out of the question. Password-protect your PC. Be sure to give your PC a password on power-up. This will help protect

Call us today at (209) 390-4670. Article Contributor: Mark Williams, Owner of Crown Enterprises, a firm specializing in practice management.

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MEDICAL HOME Patient Center Medical Care

A movement to improve the quality of care provided in San Joaquin County

M

edical care in the United States has evolved a concept that is being embraced by leading primary care physician societies and physician organizations. This concept -- the Patient Centered Medical Home (PCMH) -- incorporates a personal physician in a team-based medical practice with whole person patient orientation, where integrated care, quality and safety are provided through enhanced access, with a payment mechanism that reflects this broader healthcare effort. As envisioned, the concept suggests that every patient will have a physician who will work with a team to coordinate and deliver needed care for all stages and ages of life, including acute care, chronic care, behavioral and mental health care, preventive services and end of life care. Amazing advances can be accomplished if the medical community works together to address all the varied needs a person has in their lifetime. The PCMH encourages the Primary Care Physician and their team to include patients, family and caregivers in addressing health care needs. This encourages and supports patients in self-management and self-care, and facilitates the sharing of complete and accurate information and communication that allows patients to make informed decisions regarding their health care. Special aspects of Patient Centered Medical Care include: • Respect of the patient’s wants, needs and preferences; seeing that patients have the information and support to make decisions and participate in their own care.

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• Support and encouragement of self-care and care management for the patient, their family and caregivers. • Design and implementation of care delivery efforts that proactively consider all care needs, including cultural and linguistic aspects • Consideration of pediatric and geriatric patients, as well as persons with special needs within all populations. In the Patient Centered Medical Home concept, the medical community becomes a real coordinated community working together to meet the needs of patients as they pass from infancy to young adulthood, middle life and geriatric care. It supports the natural progression to move from Primary Care Provider to Specialist to Hospital to Home Health Agencies to Skilled Nursing Care and Assisted Care to End of Life issues all within the health care services within the community and under the watchful eye of the primary care team. To bring this concept closer to home in San Joaquin County, Health Plan of San Joaquin has been awarded a grant for a local project charter, “Health Home Safety Net Partnership of San Joaquin County.” The project will promote the PCMH and development of a health care delivery process to support it. Participants in the partnership include Health Plan of San Joaquin, San Joaquin General Hospital, Community Medical Center and San Joaquin Behavioral Health. Working closely with the group will be

Health TeamWorks, a Colorado-based consultant with tremendous experience in helping organizations develop PCMH programs. The project includes the development of bidirectional integration in behavioral health/mental health and primary care settings. An initial focus will be toward patients with co-occurring diabetes and depression, with efforts to improve quality measures such as access, preventing avoidable ER visits, hospital admissions and readmissions. To achieve this goal, a combination of technology, learning collaborative, consultation, team work, coaching and community resources will be incorporated to facilitate delivery system re-design. The overarching project goal: Ensure that appropriate care is delivered to every patient every time they are seen. To achieve this goal a system of planned care is established that ensures that patients receive the right care at the right time from the right member of the care team. Health TeamWorks coaches will assist local providers in the project to apply process improvement, promote best practices, share information and monitor progress toward the goal. Health Plan of San Joaquin is excited to be a part of this special project, one of only six funded throughout the State, and look forward to the learning, as well as the potential lasting benefits in the medical community. Brenda S. Hill RN, COHN-S Quality Improvement Nurse / Case Manager Health Plan of San Joaquin

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K a i s e r S ch o ol of A l l ie d He a lt h S c ie n c e s op e n s a t C a l S t a t e S t a n i s l a u s i n S t o c k t on’s Un i ve r sit y Pa rk

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Visionary:

health education at the speed of business by William West

James Fitzgibbon had been head of Kaiser’s School of A llied Health Science for only two days when he read forecasts that plainly showed Kaiser needed more technicians than he could possibly train in the R ichmond based school. He had to do something. He needed to find a way to train more radiographers, sonographers, phlebotomists and other health workers or Kaiser wouldn’t be able to handle the f lood of patients that will inundate California and the nation in the next few years. He contacted the Mayo Clinic, which is an integrated health care system like Kaiser. What were they doing to solve the education problem? A fter a f light to Minnesota, Fitzgibbon learned how Mayo was partnering with local colleges. “They were very forthcoming and generous,” Fitzgibbon said. “We learned a lot.” >>

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E nt e r K r i s t e n Bi r t w h i s t le, a K a i s e r Me d ic a l A d m i n i s t r a t ion C on s u lt a nt , wh o kn e w wh a t F i t z gi b b on w a s t r y i n g to d o . Fitzgibbon found a lot of interest from educational institutions in the Bay Area, but actual creation of the programs bogged down in bureaucratic machinations. Things looked grim. >> She was also a fourth-generation Stocktonian. While attending the Community Health Forum

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in Stockton two years ago, she had a conversation with Phyllis Grupe, philanthropist and wife of developer Fritz Grupe who had been developing University Park where Cal State Stanislaus had a satellite campus. Phyllis suggested to K risten that perhaps Kaiser’s School of A llied Health Science might be interested in training students in Stockton. Ms. Birtwhistle contacted Hamid Shirvani, President of California State University Stanislaus. President Shirvani realized that partnering with Kaiser was a natural. Fitzgibbon examined various studies that showed a crying need for health workers in the Central Valley, which included Kaiser’s future needs. Fitzgibbon made the trek to speak to Fritz Grupe. He was armed with PowerPoint presentations and multiple charts. “Mr. Grupe stopped me and asked me what I was trying to do,” Fitzgibbon said. “I told him I was trying to create more educated health workers to meet an increasing need. Mr. Grupe asked me if the students would have jobs at the end of the process. I told him they would have very good jobs. He shook my hand and said ‘let’s do it’.” The partnership between CSUS, Kaiser and Grupe Company was born from a serendipitous conversation and because three organizations had visionary leaders.

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But there was one more critical element that ignited the project.   “There are people who have vision,” said Fritz Grupe, CEO and Founder of The Grupe Company, “ but they don’t know how to execute. Vision is useless unless the visionaries can make it happen.” “No one of us could do this on our own,” said President Shirvani. “We are living in a peculiar time. It is a kind of strange time. First, we are in the most severe economic recession. A lso, this is a time when knowledge-based economy is the key. And a time when there is less support for higher education. A lso, a time where there is a high demand for health care workers.” How did President Shirvani make this happen where other educational leaders could not? “From my heart I tell you that it is commitment. You must be committed. As an architect you don’t just draw the blueprint, you make sure everything gets done properly. You follow up and follow up,” President Shirvani said. “President Shirvani cut through mountains of red tape at CSUS,” Fitzgibbon said. “He was originally trained as an architect, but he is a kind of a fighting architect. He has a blueprint in one hand and some kind of club in the other---” “A T-square,” Dr. Shirvani offered. There is palpable excitement because the partnership brings hope to a region that is hungry for good news about jobs, education and health care. “When you look at Sacramento or Washington, D.C., there isn’t a lot of confidence that they can get things done,” said Grupe. “This

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P r e sid e nt S h i r v a n i c u t t h r ou g h mou nt a i n s of re d t a p e a t C SUS . . . endeavor is probably unique in the nation and could be a pilot program.” In a few short years, California is projected to be a million persons short in skilled health care workers, according to Kevin Huber, President of Grupe Commercial, a division of Grupe Company that oversees the development of University Park and a million-square-feet of other properties. “Estimates of training capacity right now are 625,000,” Huber said. “So there is a shortfall of

about 375,000 workers, half of which will be needed right here in the Central Valley.” Part of the need will come from the new Department of Corrections medical clinic in Stockton, which will employ 2400 people, including an unspecified number of clinical technicians like phlebotomists, sonographers, and radiographers. A new VA clinic will also be built in Stockton. And if the A ffordable Care Act remains law of the land, thousands more will enter the health care system in the Central Valley.

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“ M a n y of ou t g r a d u a t e s e v e n t u a l ly c om e b a c k t o work for K a i s e r, e ve n i f t h e y d on’t d o s o u p on g r a d u a t ion . . . ”

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A tour of several Kaiser classrooms and training labs in the Cal State Stanislaus buildings showed modern state-of-the-art equipment so radiographers, sonographers, and phlebotomists could move to the workplace seamlessly. The equipment they train on, made by all the top manufacturers, is the equipment they will find in the clinical setting of hospitals.  Grupe put $150,000 into updating the labs and classrooms. Grupe has invested $40 million in transforming University Park from a state mental hospital into a beautiful 100-acre campus with room to grow under the stately trees in mid-town Stockton. Immediately north of the campus is St. Joseph’s Medical Center, part of Catholic Healthcare West. “We are reaching out to St. Joseph’s and other hospitals as clinical sites for our students,” said Dr. C. Darryl Jones, Medical Director of the Kaiser School of A llied Health Sciences. “We are actually limited to a certain number of students because we have only a limited universe of clinical sites. It is important that we produce the very best, most highly trained graduates. Clinical experience is critical.” Two-thirds of Kaiser’s graduates will work for Kaiser, but others will opt for hospitals or other clinical jobs that are closer to where they live, which may not include Kaiser. “Many of out graduates eventually come back to work for Kaiser, even if they don’t do so upon graduation,” Dr. Jones said. “Kaiser is a very good place to practice medicine.” Making University Park an even more attractive location for Kaiser is the presence of the Health Careers Academy, a charter high school under the Stockton Unified School

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District auspices. A fter visiting the school, Dr. Shirvani and Fitzgibbon spoke glowingly about the maturity and motivation of the students. “It is part of my job to visit many high schools,” Dr. Shirvani said. “And I have never seen such a diverse, focused group. They didn’t want to let us leave.” “They were hungry; that’s the best word I can come up with,” said Fitzgibbon. “When the first class from the academy graduates they can come right here to further their education in health care,” said Dr. Shirvani. “We are also offering right away a Bachelor of Science degree to go along with these certificate programs in radiography, sonography, and phlebotomy. That is first and foremost very good for the future of the student. They can earn money right away and further their education as they go, perhaps getting a degree in Medical Informatics or Public Health.” “Not only that,” said Dr. Jones, “ but in 2015 these certificated positions will require an A A degree and we think soon after it will require a bachelor. We want to be ready now. The mandates for education aren’t retroactive, so if you have been a radiographer for 15 years you won’t have to get the degree, but part of what we are doing is planning ahead and also we want the very best most educated graduates.” The prospects for good jobs are extremely rosy. The certificate programs cost in the neighborhood of $10,000 to $12,000 and initial salaries range from $20,000 to $40,000, depending on which program

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is taken and where the graduate works. “We have a responsibility to produce an educated health care workforce because that is the need in California and the Central Valley. This was a way to get it done. The idea is innovative. A ll of us in education and health care have a shortage of funds,” Shirvani said. “Costs are going up. The answer is partnership.” When Kaiser Permanente came along it made sense to join together the largest educational

third element. Mr. Grupe and Mr. Huber from Grupe Company were always supporters and worked very hard to develop this University Park. The high school Health Careers Academy is here because of their efforts.” A lso, Located in University Park is a pre-school and Pittman Elementary School. “One of our visions was to make this a center of education,” Huber said of University Park. “We have a preschool, Pittman Elementary, the Health Careers Academy,

“ Not on l y t h a t ,” s a id D r. Jon e s , “ bu t i n 2 0 15 t h e s e c e r t i f ic a t e d p o sit ion s w i l l r e q u i r e a n A A d e g r e e a n d we t h i n k s o o n a f te r i t wi l l re qu i re a b a c h e l o r...” system in California with the largest health care system, according to Shirvani. CSUS had a ten-year relationship with Kaiser on their Turlock campus. Kaiser had supported them financially and with internship opportunities for their undergrads. Many CSUS employees use Kaiser as their health care provider. The relationship was established and the Stockton campus as a site for Kaiser’s School A llied Health Sciences was a logical extension. “As the discussion went further,” Shirvani said, “We realized that Dr. Jones had a grand vision of the Kaiser School of A llied Health and we have a vision for our Stockton center and we married them together. Then there was a

and now Kaiser A llied Health School. You could literally start in pre-school and get your whole education right here in University Park.” “From a broader perspective,” said Grupe, “if you look at Sacramento or Washington, D.C., today, are you confident that they will get anything done? If you ask A mericans if they are optimistic or pessimistic, they are more in the pessimistic stance. Here we have leadership coming together that is different. Dr. Shirvani and Kaiser are visionary and we think Grupe is too.  No one could do this alone. Put us together and this is an incredible partnership.”

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2011 LEGISLATIVE WRAP-UP:

Batten Down the

Hatches

By: Jodi Hicks

Vice President, Government Relations

W

e weathered a storm this year, plain and simple. In a year fraught with budget woes, redistricting chaos and an unpredictable new Administration, the California Medical Association (CMA) overcame enormous shifts in the legislative and political landscapes. In what is becoming more and more common with each election, this Legislature was nearly one third newly-elected members. We were faced with tackling the huge task of both getting to know new legislators and educating them on our complex issues. As for the year in politics, it was a new year, new governor. Well, not exactly new… Returning to the office he left 28 years ago, a reinvented Jerry Brown began his third term as governor. And while he is certainly not new to leading the state of California, this selfdescribed wiser and more experienced governor was anything but predictable. Early indicators of Brown’s leadership style were highlighted in his no-frills inauguration. Even before he was sworn in, Brown’s handlers were unable to say with any certainty which post-inaugural events he would be at and when. One of the larger union organizations hosted a popular event dubbed The Peoples Inauguration Party on the Capitol lawn immediately after the swearing in ceremony, complete with free hot dogs and sandwiches. People waited in line for food and a chance to hear the new Governor speak, but in the first of many surprises to come, the Governor and his wife, Anne Gust Brown, stopped by for a few hot dogs and walked right past the tent and microphones.

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A short while later, he showed up impromptu to an unadvertised party and made a public speech to the small crowd. Brown seems to enjoy surprises, or he doesn’t like to be predictable, or both. And then came the budget. Because of recently passed ballot measures, the Legislature can pass a majority budget, but still needs a two-thirds vote for revenue increases. Throughout the year, Brown made a determined effort to close the budget gap by proposing tax increases be put on the ballot. Time and again, negotiations with Republican leadership broke down, despite the dismal outlook for the state. In March, Brown signed a budget attempting to close a $26 billion dollar deficit by slashing services for the sick and elderly, including $1.7 billion in Medi-Cal services. This year, CMA was able to protect Maddy funds from being eliminated in this round of cuts, and continues to fight the Medi-Cal cuts, which require a federal waiver. In June, the Legislature passed a rare, ontime budget that was described as not perfect, but Plan B. But it was not without political drama, including a historic budget-veto, legislative pay freezes and a physical skirmish on the f loor of the State Assembly. The brush-up began when a Republican legislator likened the Democratic budget to a Tony Soprano insurance scheme. A proud Italian Democratic legislator took offense, and after a few exchanges another legislator rushed to the confrontation and the two had to be held back by their colleagues. Despite the heated debates, the Legislature passed a budget the following night. But in a surprise to almost everyone in Sacramento, Brown treated the legislative deal to a swift veto the next morning, calling the budget unbalanced. Having passed the deadline, and now without pay, Legislators scrambled. Two weeks later deals were made and Brown signed the spending plan without fanfare. This

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was the first- budget passed by simple majority, but not without a bit of turmoil and unpredictable weather. The budget was not the only strife of the year, though. In California’s first ever attempt at politics-free drawing of districts, a citizens commission was charged with drawing maps without taking into account incumbents or partisanship. There were winners and losers in this process. Some legislators are now running for open seats in Congress while others find themselves drawn into districts with other sitting legislators.

he began to understand the dangers in turning physicians into employees without any employee protections. The author split with his sponsors, and took all of CMA’s suggested amendments in Health Committee. In what would be the most confusing committee hearing to date, the sponsors quickly opposed and killed their own bill. And we battled the physical therapists, again. They wanted direct access to patients, again. And we opposed it, again. We tried to clear up an ambiguity in law that questions whether medical

This year, CMA was able to protect Maddy funds

from being eliminated in this round of cuts, and continues to fight the Medi-Cal cuts, which require a federal waiver.

The experiment has left many politicians f lailing wildly in the wind as they attempt to move into another open seat or prepare for an election to hold on to their political lives. While the district lines are final, the fallout is still being calculated. With lawmakers worrying about their paychecks and their jobs, there were still laws to be passed. Even with a large sector of the Legislature being newcomers, many of the contentious issues of the year were reminiscent of years’ past. We fought and won corporate bar, again. This year’s bill had the same sponsor and same author as last year, but a slightly different outcome. After many of the same negotiations and same messaging around the dangers of corporate control over physicians, we reached a break-through with the author. As Chair of the Labor Committee,

corporations can hire physical therapists as employees, they opposed. We killed their bill, they killed ours. What was most interesting about these events was the lack of debate about the issue of scope expansion, or whether or not medical corporations should be allowed to employ physical therapists. The discussion seemed to be around compromise, specifically whether or not CMA should compromise. After all, they wanted something, we wanted something and some politicians thought the logical solution was to give something to each, or more accurately, not allow CMA to get one without giving up the other irrespective of the policy merits. SB 923 (Walters) would have allowed physical therapists to directly access patients without a diagnosis from a physician.

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The bill passed out of committee with one Senator giving a courtesy vote with a promise to hold the bill in Appropriations if the bill was not worked out. The bill was then held in Appropriations. Then came AB 783 (Hayashi), which would clarify the legal ambiguity, so that physical therapists, along with other physician extenders such as psychologists, nurses, physician assistants and podiatrists, can continue to work within the legal boundaries of medical corporations as they have for decades. Committee members commented that they wanted to see the issue of direct

Steinberg authored SB 543, which stated simply that the physical therapy board could not, for one year, discipline physical therapists solely on the basis of their employment. That was Senator Steinberg’s version of a compromise, which passed and is currently awaiting the governor’s signature. On a better note, MICR A was never introduced this year. There were rumors, even clear indicators, but in the end there was no bill that directly attacked MICR A. There were, however, three bills introduced by the consumer attorneys

With a new Legislature and Administration in place,

CMA made sure to introduce bills dealing with such important issues as physician

workforce, protecting MICRA , and adequate physician reimbursement rates.

access worked out before voting on this issue, or even combine the two issues. To be safe though, the chair and vice-chair of the committee stated they would write letters to the Physical Therapy Board of California asking it to not act on the issue of physical therapist employment until the Legislature had more time to opine. And if the lawmakers were not frustrating enough, then came the physical therapy board. Ignoring the committee’s request, the board began the process of investigating and potentially disciplining physical therapists on the basis of their employment. At this point, there wasn’t much time left in the legislative session for a solution, but it was clear that if the Legislature failed to act, the board would continue pushing forward. In an end-ofsession maneuver, President pro tempore

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that bit around the edges. All three were opposed by CMA. One was amended to remove all offensive content and the other two died along the way. With a new Legislature and Administration in place, CMA made sure to introduce bills dealing with such important issues as physician workforce, protecting MICR A, and adequate physician reimbursement rates. We continue to be at the forefront of discussions surrounding health care reform implementation and public health. The year was filled with tumultuous events and treacherous winding roads, but CMA captured decisive victories for physicians. The year ended without changes to the ban on the corporate practice of medicine, MICR A or scope of practice. The storm has calmed, but it will be

back. There will be new elections as politicians adjust to their new district lines and bills we defeated will surely be back next year. The state’s fiscal crisis remains – so much so that former Speaker Willie Brown recently wrote in the San Francisco Chronicle that [Governor] Brown is on the brink—and legislators are becoming concerned because they don't think he knows it. There is no way to wrap up this legislative year without highlighting the efforts of our team. While there were many twists and turns, our great group of advocates shifted, adapted and worked together to end the year successfully protecting physicians. The team has weathered this last storm, and is stronger for it. And most importantly we are ready for the next season, whatever it brings. Below are details on the major bills that CMA followed this year. Please feel free to contact any of us at CMA with questions. Stay tuned for information about Governor Brown’s actions on CMA-followed legislation.

CMA SPONSOR ED LEGISLATION AB 589 (Perea): Medical School Scholarships Prior CMA sponsored legislation provided $1,000,000 per year in funding for the Steve Thompson Loan Repayment Program, which gives physicians up to $105,000 in loan repayment if they agree to practice in an underserved area for at least 3 years. This bill mirrors the loan repayment program and would create the Steve Thompson Scholarship Program, which would provide scholarships to medical students who agree to practice in one of California’s medically underserved areas upon completion of residency. Status: Held on Senate Suspense File due to lack of specific non-state funding. Two year bill.

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AB 655 (Hayashi): Peer Review In California, there is no general legal duty to share peer review information among hospitals, or between hospitals and peer review bodies. AB 655 would allow for a reasonable peer review sharing agreement between peer review bodies maintain the confidentiality of peer review information and protect the public health. Status: Signed by the governor. AB 783 (Hayashi): Professional Corporations—Licensed Physical Therapists and Occupational Therapists Since 1990, the Physical Therapy Board of California has explicitly allowed physical therapy services to be provided by a medical corporation. On November 3, 2010, the board rescinded this policy, threatening to disrupt the lives of physical therapists who are happily and legally employed by medical corporations. It also threatens to disrupt the care of our members’ patients and their patients’ continuity of care. AB 783 would ensure that licensed physical and occupational therapists may continue to be employed by medical, podiatric and chiropractic corporations, a practice which has been the norm for over two decades. (New temporary fix proposed in SB 543, see below.) Status: Held in Senate Business and Professions Committee. Two year bill. SB 543 (Steinberg and Price): Business and Professions— Regulatory Boards Because AB 783 was held in committee, CMA, along with Senator Steinberg and others, worked to find an agreement from both sides while we find a more comprehensive solution. The Physical Therapy Practice Act authorizes the Physical Therapy Board of California to license and regulate physical therapists, including the suspending and revoking licenses. This bill would, until January

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1, 2013, prohibit the board from taking disciplinary action against a licensee for providing physical therapy services as a professional employee of a medical corporation, podiatric medical corporation or chiropractic corporation. Status: Signed by the governor. SB 347 (Rubio): Postsecondary Education—Graduate Medical Education Payments (Medi-Cal) SB 347 would augment the amount in graduate medical education (GME) funding that California receives in order to increase the number of resident physicians in California. Currently, under fee-for-service Medi-Cal, hospitals are reimbursed for GME costs through separate direct payment. The average Medicaid GME payment per hospital is about $1.52 million. California does not make any GME payments under MediCal managed care—either as a direct payment to teaching programs or through inclusion in capitation rates to Managed Care Organizations. This bill would recalculate Medi-Cal managed care rates and carve out GME payments. Status: Held in Senate Health Committee. Two year bill.

CMA OPPOSED LEGISLATION SB 173 (Simitian): Health Care Coverage—Mammograms This bill would require physicians to notify mammography patients with highly dense breasts about the density of their breast tissue and the possibility that they may require additional imaging services (including ultrasound or MRI). This bill would create both practical and legal problems for physicians. Because the scope of who must receive the notice is so broad, women will be "scared" into thinking they need these expensive additional screenings when it isn’t at all warranted, leading to increased costs and pressures on a physician’s practice.

Moreover, because the grading of the condition that may/may not lead to their receipt of the prescribed notice is subjective in nature, the absence of the notice could lead to lawsuits against doctors if a patient is later diagnosed with breast cancer. Although density is an emerging issue in mammography and the fight against breast cancer, the science is still out on this matter and no definitive protocols have been developed by the industry yet in response to this condition. Finally, the only supportable portion of the bill, that guaranteeing that carriers pay for these screenings should they be necessary was taken out of the bill. As a result, this bill drives up fear and demand for unnecessary and expensive screening procedures, at a time when our focus should be on obtaining regular mammography for age-appropriate women. Author moved language to SB 791. Language from this bill was moved from SB 173, which was held on the Assembly Suspense file. This bill would require, under specified circumstances, a health facility at which a mammography examination is performed to include in the summary of the written report sent to the patient a specified notice on breast density. Status: Vetoed by the governor. AB 52 (Feuer): Rate Regulation AB 52 would require insurers to obtain prior approval from the Department of Managed Health Care or the Department of Insurance before increasing or decreasing in health care premiums, copayments or deductibles. While CMA is very concerned about the effect of skyrocketing premiums on individuals and small businesses, a full rate regulation scheme could give insurance companies an excuse to further squeeze dollars out of health care delivery. Rate-setting in health care is bad precedent and this type of rate oversight would be politically motivated. Arbitrary premium caps would not lead to sacrifice by the plans/insurers and could

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merely be passed down to physicians, leading to lower provider reimbursement, less time with patients and more barriers to care. Instead, CMA believes we should enforce rate review and new medical loss ratios standards and invest in meaningful ways to bring down health costs, such as medical homes, electronic medical records, chronic disease management and increasing Medi-Cal and Medicare reimbursement rates. Status: Held in Senate Appropriations Committee at the author’s request. Two year bill. AB 824 (Chesbro): Rural hospitals— physician services This bill would erode the ban on the corporate practice of medicine by allowing rural hospitals to employ physicians. Specifically, through year 2022, a rural hospital would be allowed to hire up to 10 physicians, without the participation of the medical staff in the hiring process, and would allow them to exceed that number with permission from the Medical Board of California. Status: Failed to meet committee deadline. Two year bill. AB 926 (Hayashi): Physicians and Surgeons: Direct Employment This bill would serve as the vehicle for any compromise between CMA and the California Hospital Association related to the corporate bar. This bill would reenact the pilot project to allow all qualified district hospitals to employ physicians by extending the sunset to 2022, allow for not more than 50 physicians to be hired, and require the Medical Board of California to report to the legislature on the effectiveness of the project. This bill goes far beyond the balance that was made in the original pilot project between the limited, direct employment of physicians by a hospital and patient health/physician autonomy to make decisions in the best interest of patient safety. Specifically, CMA should work with the author on

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amendments to have the bill apply to rural areas only and limit the amount of physicians that can be hired. Status: Corporate bar placeholder bill not used in 2011 legislative year. SB 920 (Hernandez): Optometry SB 920 was introduced by Senator Ed Hernandez to amend the Optometry Practice Act. Senator Hernandez previously authored legislation that has resulted in regulations to allow optometrists to treat Glaucoma, a ruling that is being challenged in court. Status: Failed to meet committee deadline. Two year bill.

interest of the patient. SB 924 would dismiss this long standing requirement of a diagnosis and allow physical therapists to perform treatment without knowledge of what they are treating. Status: Failed to meet committee deadline. Two year bill. SB 558 (Simitian): Elder and Dependent Adults Abuse or Neglect –Damages SB 558 would change the standards of proof for elder abuse to a preponderance of evidence. By filing a claim for relief under the Act, plaintiff ’s attorneys are able to circumvent the limits on non-economic

SB 924 would substantially expand the scope of practice for physical therapists in

California by allowing them to evaluate and treat patients for up to 30 days without a previous diagnosis from a licensed physician

SB 924 (Walters): Physical Therapists: Direct Access to Services SB 924 would substantially expand the scope of practice for physical therapists in California by allowing them to evaluate and treat patients for up to 30 days without a previous diagnosis from a licensed physician. Current law does not specifically address physical therapy treatment without referral, but the law does prohibit therapists from making medical diagnoses. A 1965 Attorney General Opinion on this proposed ambiguity found that prior diagnosis by a medical provider was necessary before physical therapy treatment may commence. This interpretation has since guided the scope of practice for physical therapists in California and is does so in the best

damages and attorney’s fees provided to health care providers under the Medical Injury Compensation Reform Act (MICR A). This bill was opposed by CMA and CAPP. Status: Held in Assembly Appropriations Committee. Two year bill. AB 1062 (Dickinson): Arbitration and Appeals AB 1062 would weaken the enforcement of arbitration agreements by prohibiting an appeal when a lower court refuses to enforce an agreement. Arbitration is an important MICR A component, and the bill was opposed by CMA and CAPP. Status: Died on the Senate Floor. Two year bill.

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CMA BILLS OF INTER EST AB 1360 (Swanson): Physicians and Surgeonsâ&#x20AC;&#x201D;Employment (Support) As amended, CMA is in support of this bill. In contrast to this author's corporate bar bill last year, which CMA killed (AB 646), CMA successfully brokered a compromise in AB 1360. This bill would create an expanded pilot program to allow eligible district hospitals throughout the state to hire up to 5 physicians. Similar to the original pilot program, the medical staff at the hospital would have to concur with the hospital administration's decision to hire prior to the employment of each physician. Status: Failed to meet committee deadline. Two year bill. SB 866 (Hernandez): Prior Authorization Standardized Form (Support) This bill would dramatically streamline and improve the prior authorization process for prescription drugs. The bill would require all plans, all insurers and physicians to use a standardized form when requesting prior authorization for prescription drug benefits. If a health plan or insurer fails to accept the prior authorization form or fails to respond to a physician within 48 hours, the bill would deem the prior authorization request granted. The bill would require the Department of Managed Health Care and the Department of Insurance to jointly develop the form with stakeholder input. The form cannot exceed two pages and must be electronically available and electronically transmissible. Status: Signed by the governor. AB 369 (Huffman): Step Therapy Reform (Support) This bill would limit a health plan's or health insurer's ability to use to step therapy or "fail first" protocols for the

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treatment of pain. The bill would require that the duration of any step therapy or fail first protocol be determined by the prescribing physician and would prohibit a health plan or health insurer from requiring that a patient try and fail on more than two pain medications before allowing the patient access to other pain medication prescribed by the physician. This bill would still allows step therapy to be used, but closes loopholes and puts the medical decisions back in the doctor's hands so the patient can get the right medication in a timely fashion.

value of the denied benefits. Status: Signed by the governor.

SB 155 (Evans): Maternity Coverage (Support) This bill, cosponsored by the American Congress of Obstetricians and Gynecologists and Kaiser Permanente, would close a loophole exploited by health insurance companies in order to sell cheap, "subprime" non-comprehensive health insurance that lacks maternity coverage. This bill would bring two bodies of law into conformity by requiring all individual and group health insurance policies regulated under the Department of Insurance to cover maternity services, while HMOs regulated by the Department of Managed AB 1059 seeks to ensure Health Care are already required to meet these standards. This that enforcement actions by the bill would ensure fair, affordable access to maternity coverage in Department of Managed Health health care benefits, regardless Care (DMHC) make physicians of the type of plan offered. It was split into two separate bills, SB and enrollees whole 222 and AB 210. Status: Bill was split into two different legislative vehicles. Updates on each bill below.

Status: Held in Assembly Appropriations Committee. Two year bill. AB 1059 (Huffman): Health Plan Penalties (Support) This bill seeks to ensure that enforcement actions by the Department of Managed Health Care (DMHC) make physicians and enrollees whole. Where the DMHC has found that an HMO has underpaid a physician, the bill would require the administrative penalty amount to, at a minimum, equal the amount of the underpayment plus interest. The enforcement action would also have to ensure that the physician and enrollee are compensated by the HMO for the full amount of the underpayment or financial

SB 222 (Evans): Maternity Services (Support) This bill would require every individual health insurance policy to provide coverage for maternity services for all insured covered under the policy. This bill would become operative only if AB 210 is also enacted. Status: Signed by the governor. AB 210 (Hernandez): Maternity Services (Support) This bill would require every group health insurance policy to provide coverage for maternity services for all insured covered under the policy. This bill would become operative only if SB 222 is also enacted. Status: Signed by the governor.

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SB 100 (Price): Outpatient Surgery Settings (Support) This bill would improve the ability of accrediting agencies and the Medical Board of California to work together to ensure that the care provided in outpatient surgery settings is top notch and that any bad actors are immediately identified and remediated or disciplined. The bill would increase transparency about the accreditation status of these facilities to inform patients, improves the inspection and investigation processes in the event a complaint is received, requires emergency protocols to be in place if there are

physician to discuss the matter with the parent. Status: Signed by the governor. AB 584 (Fong) Workers' Compensation: Utilization Review (Support) This bill would require that physicians performing "utilization review" (UR) in California’s workers' compensation cases be licensed by the Medical Board of California. Currently, many carriers hire out-of-state physicians to perform UR. Because these physicians do not understand the nuances of California law

CMA policy supports legislation to

allow patients 12 through 17 years of age to obtain vaccines to prevent sexually

transmitted infections without parental

consent if it is not possible for the physician to discuss the matter with the parent serious complications or side effects from surgery and protects against accreditation shopping. This is a balanced and reasonable bill that closes gaps and adds important safeguards to provide even more protection to patients. Status: Signed by the governor. AB 499 (Atkins) Minor Consent for Prevention of STIs (Support) Current law allows minors to consent to treatment of sexually transmitted infections (STIs), but not to preventative care for STIs. This is a barrier to minors seeking the HPV vaccine and other methods of prevention of STIs who cannot or will not obtain parental consent. This bill would allow a minor who is 12 years of age or older to consent to medical care related to the prevention of a sexually transmitted disease. CM A policy supports legislation to allow patients 12 through 17 years of age to obtain vaccines to prevent sexually transmitted infections without parental consent if it is not possible for the

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and our workers' compensation system, in many cases they end up inappropriately modifying, delaying or even denying treatment requests from the primarytreating, California doctor seeing the injured worker. Moreover, this also leads to increased lien filings for payment by doctors due to these complications and delays, adding unnecessary costs and workload to the system. Finally, the medical board has stated that UR is the practice of medicine, but since these physicians are not licensed in California, they cannot be held accountable for their actions to delay or deny treatment under California law. This bill is similar to AB 933 (Fong) of 2010, which CM A supported. Status: Vetoed by the governor. SB 336 (Lieu): Emergency Room Crowding (Support) This measure would require every licensed general acute care hospital to assess the condition of its emergency department (ED), using a crowding score, every four or

eight hours, and to develop and implement capacity protocols for overcrowding. California EDs are dangerously overcrowded and have reached a crisis level, ranking last in the nation in the number of emergency rooms available to its residents (6 for every one million people). This bill— sponsored by the California College of the American Chapter of Emergency Physicians (CalACEP) —would help to address this overcrowding and is similar to AB 2153 (Lieu) of 2010, which CM A supported. Status: Held in Assembly Appropriations Committee. Two year bill. SB 863 (Lieu): Workers' Compensation—Liens (Support) This bill is an effort to address the increasing number of medical payment liens being filed in the California workers' compensation system. In January of 2011, the Commission on Health and Safety and Workers' Compensation published a report on this subject that outlined a number of policy recommendations. This bill is crafted based on some of those recommendations, the primary one being to reduce the amount of time allowed to file a lien. This would help to stem the increasing practice of third-party entities buying up physicians’ workers' comp accounts receivables and filing new liens on them, even when the claims are 10 or more years old. CM A supports this bill as a means of securing efficiencies in the system without unduly hindering a physician’s ability to file a lien, a critical last resort for obtaining payment. Status: Held in Assembly Appropriations Committee. Two year bill. SB 923 (De Leon): Workers' Compensation—Official Medical Fee Schedule (Oppose Unless Amended) This bill would require the Administrative Director (AD) of the Division of Workers' Compensation to adopt a physician services fee schedule based on the Medicare system, the Resource-Based Relative Value Scale (RBRVS) by July 1, 2012. Under current law, the AD has the authority to do this based on the requirement to regularly update the physician fee schedule. However, past efforts to do so—as recently as mid2010—resulted in significant payment cuts to various physician specialties, in some cases as much as a 40 percent reduction. Although this bill previously

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This is NOT Reaching

Meaningful Use! contained language that ensured such reductions didn’t occur, this language was removed during the bill’s hearing in Senate Labor Committee at the request of the California Labor Federation. CM A supported the prior version of SB 923 as an assurance of sufficient payment during this policy transition, but now may need to change position as there is new risk to sufficient payment. Moreover, the ground rules (or billing rules) are not dealt with in this bill in any way, but significantly impact payment to physicians. We are working on language to offer to the author to address this concern. Status: Suspended in Assembly Appropriations Committee. Two year bill. AB 1000 (Perea): Health Care Coverage—Cancer Treatment (Support) This bill would help ensure that cancer patients are not denied the most appropriate and effective treatment by putting costs above care. According to the author, there are significantly greater patient out-of-pocket costs for oral cancer therapies covered under the pharmacy benefit than IV therapies covered under the medical benefit. These out-of-pocket costs become a de facto denial of access, which, in a study by Prime Therapeutics, resulted in 1 in 6 patients not receiving treatment solely due to cost. Therefore, patient access to potentially the only lifesaving cancer therapy available to them is restricted. Status: Held in Assembly Appropriations Committee. Two year bill. AB 378 (Solorio): Workers' Compensation—Pharmacy Products (Watch) This bill is meant to address a recent spike in prescriptions for and costs associated with compounded pharmaceutical products in the workers’ compensation system. In the past few years, the amount carriers have paid annually for these products have gone up over fourfold, with no legitimate clinical justification. It has been argued by the cosponsors of the bill—a coalition of labor, businesses, and insurance companies—that the same "bad actor" physicians who were profiteering from drug repackaging scams have now refocused on compounds. As a result, the author of this measure has in the past proposed utilization

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constraints to prevent unnecessary use of compounds, but CM A was able to kill that effort in the legislature. The new effort, as contained in AB 378, would curtail the amount payable for compounded drugs in workers’ comp cases in order to remove the incentive to overbill that currently exists in the system due to a lack of price controls for these products. The bill would also take a utilization approach to solving the problem, by adding "pharmacy goods" to the list of products and services in existing state law that a physician is barred from self-referring for. The final version of this bill contains compromise language negotiated by CM A that would limit reimbursement for physiciandispensed products to a level that would cover a physician practice’s costs to dispense them, but won’t provide an unreasonable financial incentive to prescribe and dispense them. This was done by allowing a physician office to be reimbursed for compounds at 300% of the Documented Paid Cost to the office, capped at a margin of $20. When the author and supporters agreed to take this amendment, CM A took a Neutral position on the bill. Status: Signed by the governor. SB 850 (Leno): Medical recordsConfidential Information (Watch) SB 850 purports to reduce medical errors. The information provided by the consumer attorneys stated many EHR software systems have design f laws that can cause serious errors if left uncorrected. In some situations, health care providers have taken advantage of these design f laws to cover-up errors by modifying or deleting earlier entries. SB 850 would ensure the accuracy, integrity and efficiency of electronic health records in order to achieve the ultimate goal of reducing medical errors. This was clearly introduced in order to highlight a particular case in which physicians were accused of fraudulently changing the patient’s electronic medical records. CM A opposes the bill, stating it is unnecessary and there are already laws in place to address fraud. After many discussions with the author, the bill was amended to merely ref lect federal requirements related to EHR systems. In this form, CM A went neutral on the bill. Status: Signed by the governor.

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Managing

Professional Risk Safeguarding Data What is the worst computer problem you need to prepare for? Is it arriving at the office to find your server doesn’t boot?

By Fran Cain Information Technology Department NORCAL Mutual Insurance Company and the NORCAL Group

Is it finding that a friend’s computer was compromised by a virus which your computer now has? Is it the power going out in the middle of the day? Or maybe you just downloaded the latest Microsoft updates and your software stopped working. These are all serious problems, and the threats are seemingly endless. Risks need to be mitigated by backing up your systems; using up-to-date operating system software, antivirus and anti-spyware software; and having reliable batteries in your Uninterruptible Power Supplies. But arguably the worst computer problem you could face would be compromised data. If data containing personally identifiable patient information (also known as Protected Health Information) leaves your possession and you know it—or, in the view of regulators, you should have known it—you will be subject to notification and reporting requirements under state and federal law (including but not limited to HIPAA). In other words, you must not keep this security breach hidden under the rug. But when you notify patients that confidential information about them and their medical conditions has been taken and could be misused, your reputation may suffer considerable damage. We will discuss some of the ways data can be compromised, how to guard against this happening, and how to respond if it happens despite best practices.

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There are many ways data can be compromised. One of the simplest is for a staff member to make a copy of data. While it has always been possible for staff to easily photocopy records in paper form, digitized data can be copied in huge quantities. It would be quite conspicuous to copy 1,000 patient files on a photocopier, but it would take only moments using a computer, and it’s possible no one would ever notice. Duplication of data is difficult to control. Mitigation begins with strong written policies that clearly notify staff that data should only be copied for specific, approved purposes, and with proper processes in place to safeguard security and privacy. For example, staff may copy medical records to removable media (e.g., USB flash drives, CDs or DVDs) in response to patient requests. Consequences for failure to follow policy, up to and including termination, must be outlined. (Read on for more information on removable media.) Another way data can be compromised is if the computer sends data across an unencrypted (undisguised) Internet connection. Data flowing across a network can be intercepted by eavesdroppers. Always look for indications that Secure Socket Layer (SSL) is being used when connecting to sites on the Internet for business purposes, such as banking. This is indicated by a gold padlock in Internet Explorer, or a grey padlock in other browsers. There are dozens of web browsers, so familiarize yourself with the SSL graphic in the address line of the web browser you use. Mitigation also requires using a good antivirus software product and keeping the virus signatures updated daily (virus signatures are like fingerprints that can be used to detect and identify specific viruses). You need to keep computer operating systems and software up-to-date and patched (problems repaired) on a regular basis (at least monthly). For computers running Windows, each time Microsoft issues security updates for operating systems and/ or programs all computers in the network or accessing the network should be updated. Avoid using wireless connections to communicate confidential patient information unless you are certain you are using current encryption methods (currently WPA or WPA2), and institute strong written policies about this. (Policies regarding use of

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antivirus software and regular updates must be in place even if Macintosh computers are used instead of Windows computers. While Windows computers are at much higher risk, any computer can become infected with a virus.) If you use laptops in your practice, staff members need to be advised to avoid storing patient data on the hard drive (that is, on the C drive or in My Documents, etc.). If the laptop is lost or stolen, the password can be easily hacked, and any data on the local hard drive can become accessible. This is one case in which you must contact ALL of your patients to notify them that their data has been stolen. (It is strongly advised that you seek assistance from your professional liability insurance carrier in the event that protected health information or other patient data is stolen or compromised in any way.) One excellent way to mitigate the damage when a laptop is stolen or lost is to use disc encryption on all laptop hard drives. A few years ago, the idea of encrypting hard drives struck fear into the I.T. community. Doing so slowed down the system and made it difficult to recover data if the computer crashed. While it is still true that it is tricky to recover data when the computer crashes, it is not necessarily impossible, and new encryption software does not noticeably slow down the computer. In fact, once your laptop is encrypted, chances are good that you will never even notice that your data is encrypted. The encryption software runs quietly in the background, and automatically decrypts data for e-mailing, exporting or copying. If the encrypted laptop is stolen, the data cannot be accessed—and no letters need to be sent to patients or anyone else. The peace of mind that comes from knowing this is worth the tradeoff of any inconvenience. Encryption software can be configured to encrypt not only hard drives, but also removable media, such as USB flash drives. USB flash drives are a headache to IT security personnel. As mentioned earlier, staff can easily steal data by copying to a USB flash drive. Automatic encryption when copying to an external device, such as a USB flash drive, makes it more difficult to steal data. If the miniature drive is dropped, lost or stolen, the data on it cannot be read by another computer. (Note: Before attempting to

encrypt any hard discs on your own, or even with the help of a consultant, be sure to back up all existing data to reliable media.) When copying a medical record to removable media for a patient, the encryption feature should be disabled. While raising awareness of the many serious threats to data, this article merely scratches the surface of the subject. NORCAL Mutual Insurance Company provides extensive information to assist you in understanding information risks and formulating appropriate policies and procedures. You have online access to this information through your MyNORCAL account (access is at www.norcalmutual. com). You also have full access to a wealth of state-specific information through the DataShield™ Learning Center, also located in MyNORCAL under the Risk Solutions tab. For example, you will find detailed sample policies which can easily be adapted to your practice, sample newsletters, up-to-date information on compliance, and training materials. If you already have a MyNORCAL account, go to the DataShield™ Learning Center and check out the Top Ten Cyber Security Tips under Training / Training Bulletin. Here are some additional free online articles if you would like to learn more about data security: http://www.ama-assn.org/resources/doc/psa/ hipaa-phi-encryption.pdf — A good overview, including helpful graphics and additional resources. http://www.brighthub.com/computing/smbsecurity/articles/61722.aspx — More insight into security breaches. http://en.wikipedia.org/wiki/Man-in-themiddle_attack — Discusses eavesdropping or “man-in-the-middle” attacks. Copyright 2011 NORCAL Mutual Insurance Company. All rights reserved. This material is intended for reproduction in the publications of NORCAL-approved brokers and sponsoring medical societies that have been granted prior written permission. No part of this publication may be otherwise reproduced, edited or modified without the prior written permission of NORCAL. For permission requests, contact: Jo Townson, CME Supervisor, at (800) 652-1051, ext. 2270.

SAN JOAQUIN PHYSICIAN

55


10 ANNUAL TH

COMMUNITY HEALTH FORUM

{

Kaiser CEO heralds quality and cost reduction

{

Dr. Robert M. Pearl, CEO of the Kaiser Permanente Medical Group, told more than 100 local health care leaders that health care delivery must transform from a balky 19th century system of piecemeal methods to a 21st century model that relies on technology for coordination and cost-cutting. by

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William West

WINTER 2011


It

must transform from a fee-for-service system to a pre-paid system. It must change to a system of disease prevention based on research and best practices. Dr. Moses Elam, Physician in Chief for the Central Valley region of The Permanente Medical Group, introduced Dr. Pearl. “Dr. Pearl was selected as CEO of The Permanente Medical Group in 1998,” Dr. Elam said. “He is also the CEO and President of the Mid-Atlantic region. Dr. Pearl believes cooperation between physicians in an integrated delivery system can increase quality of care and lower costs.” During a comprehensive review of the current health care

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system and the necessity for improving it, Dr. Pearl spoke about Kaiser’s experiences with system changes. Among other things, Dr. Pearl teaches classes in strategic thinking and strategic change as a Stanford faculty member. “Our health care costs are higher than they should be,” Dr. Pearl said. “Kaiser is lower cost than its competition and we have 10 physicians applying for every one position that comes open, but we don’t claim to have all the answers and we always strive to get better.” Kaiser spends $100 million on research each year. They have studied ways to provide quality care at lower costs and found that the two goals are synergistic, not competitive. For example, Dr. Pearl spoke about sepsis.

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“The most common cause of death in patients admitted to the hospital is sepsis,” Dr. Pearl said. “Only two percent of patients have sepsis as a diagnosis when admitted, yet one out of six will die from sepsis. A couple of Kaiser physicians studied this. Once you have sepsis you are very, very sick. It infects your whole body. Your chances aren’t good. So, these researchers found that there are warning signs that indicate you may develop sepsis. It isn’t a 100 percent certainty that the warning symptoms will mean sepsis, but if you treat a large population with the warning signs, you save lives and eliminate a lot of sepsis cases. You treat with antibiotics and f luids and you reduce mortality 40 percent. You also lower costs. Treating a patient with sepsis is expensive.” “Reduce mortality 40 percent. Better outcomes. Lower costs.” He also said that electronic records must be put in place with ‘meaningful use’, not just applied as a billing system. It must help a health care team know all the patients’ records. By using electronic health records data, like that used to analyze sepsis, treatments can be improved for everyone. All privacy safeguards need to be in place, but the data translates to better care at lower cost. Dr. Pearl indicated that the Affordable Care Act included opportunities to improve care and lower costs. If the ACA is repealed or the Supreme Court declares the financing method of requiring insurance unconstitutional, other systems would have to come into play. But health cost inf lation is unsustainable. More and more

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employers are dropping coverage. “The medical exchanges in the legislation may work, they are interesting in concept,” Dr. Pearl said. Dr. Pearl consulted on the crafting of the ACA. He told a story of accompanying a senator who had to go to the senate chambers to vote. The senator wanted to continue his conversation with Dr. Pearl about health care systems. The senator was about to vote on a trillion dollar stimulus bill. He told Dr. Pearl that it would pass and it would save the nation’s economy for a couple of years, but that unless they got a handle on the cost of health care that there wasn’t enough money to keep the country healthy and prosperous. “Together we can solve the problem, but we must work together,” Dr. Pearl said. Later, in a private interview, he indicated that Kaiser is always looking at the possibility of building a hospital in San Joaquin County, but there are no plans at the present time. After Dr. Pearl’s presentation, a panel moderated by Scott Seamons, Regional Vice President, Hospital Council of Northern and Central California, offered their viewpoints on local health care issues. The panel consisted of Joseph Harrington, CEO, Lodi Memorial Hospital; Dale Bishop, MD, Medical Director, Health Plan of San Joaquin; Paul DeChant, MD, MBA, CEO, Sutter Gould Medical Foundation, Judith Buethe, Owner, Buethe Communications, Lou Stillwell, Senior Vice President, Sahargun Mechanical. Ken Vogel, Supervisor, District 4, closed the meeting.

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C CMA delegates set policy on organ donation, Medi-Cal funding, health care workforce issues, and more Hundreds of California physicians convened in Anaheim this past weekend for the 2011 House of Delegates, the annual meeting of the California Medical Association (CMA). Each year, physicians from all 53 California counties, representing all modes of practice, meet to discuss issues related to health care policy, medicine and patient care, and to elect CMA officers. The following are summaries of some of the resolutions that the House adopted as policy. Visa restrictions and health care provider shortage areas (Resolution 606a-11): The delegates asked CMA to advocate for the expansion of the J-1 Visa program beyond 30 slots; and that visa waivers should be granted for six years initially and that

2011 CMA House of Delegates

Recap

preference should be given to physicians serving in rural and underserved areas. Hospital foundation ownership of medical groups (Resolution 207a-11): The delegates directed CMA to advocate for stronger regulatory enforcement of California â&#x20AC;&#x2DC;s ban on the corporate practice of medicine. Generic versus brand medications (Resolution 504-11): The delegates asked CMA to oppose the profit-motivated removal of generic medications from the market in favor of much more expensive brand products. Presumed consent for organ donation (Resolution 509a-11): The delegates asked CMA to study and develop new policy recommendations for relieving the organ donor shortage, including presumed consent. Legal prohibition of circumcision (Resolution 106-11): The delegates directed CMA to oppose any attempt to legally prohibit male infant circumcision and to refer this for national action.>>


Regulation of electronic cigarettes (Resolution 113-11): The delegates voted to support the prohibition of the use of electronic cigarettes and other nicotine delivery devices not approved by the FDA as smoking cessation aids in places where smoking is prohibited by law, and to support requiring a tobacco permit for the sale of electronic cigarettes and other nicotine delivery devices not approved by the FDA as smoking cessation aids. Medi-Cal enrollment at point of care (Resolution 204a-11): The delegates voted that CMA support allowing eligible uninsured patients to enroll in public health programs at the time they receive care. Effect of Medi-Cal funding cuts on access to care (Resolution 205a-11): The delegates asked CMA to request that the Centers for Medicare & Medicaid

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Services require the State of California to provide independently verified studies and data comparing access to physician services by Medicaid and commercially insured patients in California since state cutbacks. Coverage of contraception as health insurance benefit (Resolution 403-11): The delegates directed CMA to support coverage, without copayments, of all FDAapproved contraception methods and sterilization as a mandated health benefit of all health plans. The rest of the actions of the 2011 House of Delegates are available to members at http://www.cmanet.org/ hod. Click on the â&#x20AC;&#x153;documentsâ&#x20AC;? tab. San Diego family physician elected CMA president

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San Diego family physician James T. Hay, M. D., took over as the California Medical Association’s 144th president at the close of the association’s annual House of Delegates on Monday in Anaheim. In his address to the nearly 1,000 physicians in attendance, Dr. Hay challenged the members to set out to recreate the health care marketplace “like the tech industry does.” Rather than waiting for someone to pay us for our products and services under the new health care system, he said, physicians need to be active in its creation. Physicians need to set big goals, he said. It’s time to think about the end point – a better profession, a more secure economic environment, a healthier and safer public – we need to design a way to get there. But to get there, he cautioned, physicians must stop “fighting each other for pieces of a dwindling market,” and to think about enacting plans that enhance the

marketplace for patients and clinicians. Physicians know a lot about what would improve care for patients and produce cost savings, he said. For example, if we can coordinate care better and make it possible for patients to receive “treatment at home rather than in a hospital or skilled nursing facility,” this would save money and help patients.  “If patient care and safety were improved this way,” we might be able to “capture 25 percent of the market dollars rather than the 19 percent we currently own.”  “We have met the enemy and he is us,” Dr. Hay said quoting Walter Crawford’s satirical cartoon character Pogo. Then he challenged CMA’s members to stop thinking like victims. “If we have the power to create our own problems, we certainly have the power to fix them.” A native of Philadelphia, Dr. Hay, has practiced in the north county area of San Diego since 1978, when he founded North

Coast Family Medical Group. He received his medical degree from Jefferson Medical College in Philadelphia and his B.A. from Duke University in North Carolina. He completed his residency at Naval Hospital, Camp Pendleton, and is board-certified by the American Board of Family Medicine. Dr. Hay is a member of the San Diego County Medical Society (SDCMS) and the California Academy of Family Practice. He also has a long history of involvement in organized medicine at the local, state and national level. He is past president of SDCMS and the SDCMS Foundation and has been on the Board of Trustees of the California Medical Association (CMA) since 1994. He has been a member of CMA’s House of Delegates (HOD) since 1986, serving as vice speaker and speaker of the HOD from 2003 to 2009, and is currently concluding a one-year term as CMA president elect. He has served as a member of the Board

California Medical Association Political Action Committee CALPAC needs your help to support candidates and legislators who understand and embrace medicine’s agenda.

Fighting for you!

Our top priorities are: 1. Protect MICRA 2. Preserve the ban on the corporate practice of medicine 3. Provide solutions to our physician shortage crisis!

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of the San Diego and Imperial County Red Cross for six years and on the board of 211 San Diego for four years. Since 1977, he has received the AMA Physicians Recognition Award, which is given to physicians who demonstrate a commitment to patient care through continuing medical education. Dr. Hay is active in local and state political action and enjoys running, travel and great restaurants. Dr. Hay and his wife, Tricia, have two grown children and four grandchildren. View the video on YouTube at http:// www.youtube.com/cmaphysicians. Also serving on CMA’s 2011-2012 Executive Committee are: Immediate Past President James

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Hinsdale, M.D., a San Jose trauma surgeon; President-Elect Paul Phinney, M.D., a general pediatrician at Kaiser Permanente Medical Group in Sacramento; Speaker of the House Luther Cobb, M.D., a surgeon in Humboldt County; Vice Speaker of the House Ted Mazer, M.D., a San Diego an ear, nose and throat specialist; Chair of the Board of Trustees, Steve Larson, M.D., an internist and infectious diseases consultant in Riverside County; and Vice Chair of the Board of Trustees, David Aizuss, M.D., a Los Angeles ophthalmologist.

Riverside physician Steven E. Larson, M.D., elected chair of the CMA Board of Trustees Steven E. Larson, M.D., was elected chair of the California Medical Association (CMA) Board of Trustees this past weekend at the association’s annual House of Delegates meeting in Anaheim. Dr. Larson is the current CEO and chairman of the board of Riverside Medical Clinic, a multi-specialty medical group. He has been affiliated with the clinic since 1980. He is an assistant clinical professor of medicine at Loma Linda University School of Medicine and a clinical professor of biomedical sciences at University of California at Riverside. His medical staff appointments include Riverside Community Hospital, Parkview Community Hospital and Riverside County Regional Medical Center. Dr. Larson earned his medical degree from the Medical College of Wisconsin, Milwaukee, WI, graduating in 1975. He completed his residency in internal medicine in 1978 and a fellowship in infectious diseases in 1980, both at the Medical College of Wisconsin Affiliated Hospital in Milwaukee. He earned a master’s degree in public health from Loma Linda University in 1988. He is board certified in both internal medicine and infectious diseases. Dr. Larson also serves as a delegate to the American Medical Association (AMA), representing Riverside and San Bernardino physicians. In addition to membership in the Riverside County Medical Association, CMA and AMA, Dr. Larson is a member of the Medical Group Managers Association, the Infectious Disease Society of America, the Southern California Infectious Disease Society and the American College of Physicians. In his spare time, Dr. Larson enjoys mountain climbing and traveling with his wife, Catherine Larson, M.D., an internal medicine physician at Riverside Medical Clinic. They have three children.

WINTER 2011


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Performance art and swing band are big hits at the CMA Crystal Gala Approximately 500 California Medical Association (CMA) members attended the 15th Annual President’s Reception and Crystal Awards Gala last Sunday in

Anaheim, during the association’s annual House of Delegates meeting. The evening began with sparkling wine by Sonoma vintner Gloria Ferrer as members in black tie were whisked by shuttle from the Disneyland Hotel, where the meeting was

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being held, to the nearby Marriot for a jampacked evening of food and entertainment. Honored at the black tie affair were incoming CMA President James T. Hay, M.D., and the recipients of the CMA Foundation Leadership Awards, Roseville physician Colonel Darryl C. Hunter, M.D., and the San Diego County Medical Society Foundation. Highlights of the evening included Sacramento’s nationally known performance artist, David Garibaldi. Set to the musical “mashups” of DJ Joseph One, Garibaldi, whose live action painting finds him hurtling through the air, created portraits of Michael Jackson, Bob Dylan and Albert Einstein. He also painted the CMA logo. An auction of the artwork following his performance netted the CMA Foundation $18,500. Attendees were also entertained by legendary swing band Big Bad Voodoo Daddy, who packed the dance f loor. Guests were served classic Napa Valley wines including Plump Jack Winery Merlot and Cade Winery Sauvignon Blanc. An after party at House of Blues in Downtown Disney was well attended with approximately 165 members closing down the house. Proceeds from the Gala go to support the CMA Foundation’s work linking physicians and their communities to raise awareness about important public health issues.

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Rebecca Arthur, MD Obstetrics & Gynecology • P Gill OB/GYN Medical Group 999 S Fairmont Ave, Ste 225-230 Lodi, CA 95240 Office: (209) 334-4924 • Meharry Medical School: 2005

Alina Haq, MD Hospitalist • Sutter Gould Medical Foundation 600 Coffee Road Modesto, CA 95355 Office: (209) 524-1211 • University of Medicine & Pharmacy: 2002

Victoria Hsu, MD Ophthalmology • Central Valley Eye 36 W Yokuts Ave Stockton, CA 95207 Office: (209) 952-3700 • Loma Linda University: 2005

Tijpal Randhawa, MD Cardiovascular Disease • Pacific Heart & Vascular Medical Group 1081 W March Lane, D400 Stockton, CA 95210 Office: (209) 464-3615 • Ross University: 2001

Amardeep Singh, MD Cardiology • Stockton Cardiology 415 E Harding Way, Ste D Stockton, CA 95204 Office: (209) 944-5750 • University of Southern California: 2004

Yu-Yea Tzeng, MD Obstetrics & Gynecology • Kaiser Permanente 1721 W Yosemite Ave Manteca, CA 95337 Office: (209) 476-825-3555 • University of Miami: 1995

Sharon Wong, MD Internal Medicine • Kaiser Permanente 1721 W Yosemite Ave Manteca, CA 95337 Office: (209) 476-825-3555 • Guangzhou Medical College: 1984

Dulce Balmadrid, MD Pediatrics • Kaiser Permanente Group 7373 West Lane Stockton, CA 95210 Office: (209) 476-3300 • University of the Philippines: 1997

Sheila Saguinsin, MD Pediatrics • Kaiser Permanente 7373 West Lane Stockton, CA 95210 Far Eastern University: 200

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WINTER 2011


Dena Gu, MD General Surgery Kaiser Permanente 7373 West Lane Stockton, CA 95210 Temple Medical School: 2006 Antonio Saqueton, MD General Practice 4538 Augustus Court Stockton, CA 95207 Fac of Medical & Surg-University of Santo Tomas: 1964 Yu-Yea Tzeng, MD Obstetrics & Gynecology • Kaiser Permanente 1721 W Yosemite Ave Manteca, CA 95337 Office: (209) 476-825-3555 University of Miami: 1995

Residents Janessa Peralta, MD Pediatrics • Kaiser Permanente 1721 W Yosemite Ave Manteca, CA 95337 University of the Philippines: 1997

Waseem Aslam, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Punjah Medical College: 2006 Elizabeth Beal, DO Family Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Touro University: 2011

Inderpreet Dhillon, MD Psychiatry • Kaiser Permanente 7373 West Lane Stockton, CA 95210 Office: (209) 476-5188 National Medical University: 2002

Kavitha Bysani, MD Internal Medicine • San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Langaraya Medical College: 2006 Anthony Chau, MD Surgery San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 University of California School of Medicine - Los Angeles: 2011

Deborah Colina, MD Emergency Medicine • St Joseph’s Medical Center 1800 N California St Stockton, CA 95204 Office: (209) 467-6444 University of California School of Medicine - San Francisco: 2005

WINTER 2011

Amr El-Sergany, MD Surgery San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231

Office: (209) 468-6822 University of Florida: 2010 Shahin Foroutan, MD Surgery San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 University of Vermont College of Medicine: 2010 Richard Jordan, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 University of California School of Medicine - Los Angeles: 2001 Alexander Kurjatko, MD Surgery San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 St. George University: 2011 Kiki Lwin, MD Family Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Institure of Medicine I: 2007 Patrick Manookian, MD Surgery San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6620 UC San Diego School of Medicine: 2008 Pamir Mateen, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Universidad Central del Este: 2010 Jithu Mathew, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 992-9108 TD Medical College: 2008

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Samer Othman, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 St George’s University School of Medicine: 2009

French Camp, CA 95231 Office: (209) 468-6822 Government Medical College: 2009 Vishwa Sheth, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Saurashtra Medical School: 2009

Meena Pannu, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 St George’s University School of Medicine: 2010

Chirag Sheth, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 C.U. Shah Medical College: 2009

Belma Sadikovia, MD Neurology San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 University of California-Davis: 2009

Cindy Tang, MD Family Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Ross University School of Medicine: 2010

Maninder Sanghera, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road

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Angela Tran, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 St George’s University School of Medicine: 2011 Zabihullah Wardak, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 St George’s University School of Medicine: 2005 Sultan Yusufzai, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6822 Ross University: 2011

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