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Official Magazine of FRESNO COUNTY Fresno-Madera Medical Society KERN COUNTY Kern County Medical Society KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Medical Society TULARE COUNTY Tulare County Medical Society

See See Inside: Inside: Transfusion Transfusion Medicine Medicine Under Under the the ACA ACA iHealth iHealth News News Walk Walk With With A A Doc Doc

April 2013 • Vo Vol. ol. 35 No. 4

Vital Signs

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.



For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT). Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.


CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best. We invite you to join the nearly 12,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.


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Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society

Contents CMA NEWS ................................................................................................................................5 NEWS 2013 CMA Education Webinar Series .......................................................................................7 iHealth News ..........................................................................................................................9 CHAT WITH THE EDITOR ........................................................................................................11

April 2013 Vol. 35 – Number 4 Editor, Bonna Rogers-Neufeld, MD Managing Editor, Carol Rau Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD John T. Bonner, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD

BLOOD CENTER: Transfusion Medicine Under the Affordable Care Act ......................................12 AIR QUALITY: FMMS and Valley Physician Appointed to the California Air Resources Board and the San Joaquin Valley Air Pollution Control District ............13 CLASSIFIEDS ...........................................................................................................................18 FRESNO-MADERA MEDICAL SOCIETY .......................................................................................14 • President’s Message • Walk With A Doc Dates Released • Financial Education Seminar Series for FMMS Members KERN COUNTY MEDICAL SOCIETY ............................................................................................16

Kings Representative TBD Kern Representative John L. Digges, MD Tulare Representative Thelma Yeary

Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medical Society, PO Box 28337, Fresno, CA 937298337.

• Membership News TULARE COUNTY MEDICAL SOCIETY.........................................................................................17 • Healthcare Reform and California’s Changing Insurance Marketplace • Calling All Tulare County Medical Society Members • Brain Teaser

Cover photography: “Butterfly” by Ning Lin, OD, MD Equipment used: Canon EOS 40D with Canon 100mm lens Settings: 1/800ƒ/5ISO 400100 mm Canon 60D, 18-135mm lens, ASO 100, 1/200, F/8

Advertising Contact: Display: Annette Paxton, 559-454-9331

Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

Classified: Carol Rau, 559-224-4224, ext. 118

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion pieces accepted for publication do not necessarily reflect the opinion of the Medical Society. All medical societies require authors to disclose any significant conflicts of interest in the text and/or footnotes of submitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118. V I TA L S I G N S / A P R I L 2 0 1 3


CALIFORNIA COLON & RECTAL CANCER SCREENING CENTER CALIFORNIA GASTROENTEROLOGY ASSOCIATES Excellence in Digestive Disease Care for the Central Valley including: • Colon Rectal Cancer Screening • Peptic Ulcer Disease • Inflammatory Bowel Disease • Liver Diseases 7121 N. Whitney Avenue Fresno, CA 93720 (559) 299-9395 451 E Almond Avenue Suite 103 Madera, CA 93637 (559) 673-4000 Our Endoscopy Center is Naeem M. Akhtar MD • Jose C. Hernandez MD • Ambreen Khurshid MD and Mikhail Alper PA-C


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On March 8, the Center for Medicare & Medicaid Services (CMS) released guidance for provider billing under the Budget Control Act of 2011 or sequestration. According to CMS, the 2 percent Medicare cuts will be applied to fee-for-service (Part A and Part B) claims with dates-of-service or dates-of-discharge on or after April 1, 2013. The claims payment adjustment will be applied to all claims after determining coinsurance, any applicable deductible and any applicable Medicare secondary payment adjustments. Claims for durable medical equipment (DME), prosthetics, orthotics and supplies, including claims under the DME Competitive Bidding Program, will also be reduced by 2 percent for claims with dates-of-service on or after April 1, 2013. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare's payment to beneficiaries for unassigned claims is subject to the 2 percent reduction. CMS encourages Medicare physicians who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare's reimbursement. Across-the-board federal budget cuts were triggered on March 1, because Congress failed to come to an agreement on how to reduce the federal deficit. The 2 percent "sequestration" cuts to Medicare are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out to end last year's debt-ceiling crisis. The cuts are evenly split between defense spending – with spending on wars exempt – and discretionary domestic spending. Medicaid is exempt from the cuts. The mandatory Medicare cuts will result in a savings of $11 billion in 2013. For more information, see "Sequestration FAQ," available in CMA's online resource library at resource-library. Questions about reimbursement should be directed to your Medicare claims administration contractor. Contact: Michele Kelly, 213-226-0338 or


California Medical Association (CMA) Center for Legal Affairs announces the upcoming release of the updated California Physician's Legal Handbook (CPLH) for 2013. CPLH is the premier California health law publication with more than 4,500 pages and eight volumes of comprehensive legal information, including current laws, regulations and court decisions related to the practice of medicine. Preorder your copy by April 15 and save 10 percent. CPLH is updated annually by CMA attorneys to include the most recent changes in health law, including new and updated sections on the health benefits exchange, direct primary care models, medical staff alignment models, EHR meaningful use stage 2 and e-prescribing. Starting in 2013, CPLH is also available on a new subscription-only website. The new CPLH website,, features full search term capabilities using keywords, specific citations and court cases as well as the ability to save searches and easily email and download CPLH content. A CPLH website subscription comes with access for five individual users. (Additional users can be added for a nominal fee.) For more information, visit or call 800-7864262.




2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the for-profit health insurance industry and beginning in 2014 will provide health insurance to most of the nation’s uninsured. Under the ACA, two thirds of California’s uninsured will be covered by private insurance through a health insurance exchange purchasing pool. The exchange’s goal is to start pre-enrollment in October 2013. CMA has developed a new toolkit titled, CMA’s Got You Covered: A physician’s guide to Covered California. This toolkit will educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting. The toolkit is available free to members only at Contact: CMA's reimbursement help line, 888-401-5911 or

2013 Pricing

Website Print Print & Website

Nonmembers Before After 4/15 4/15 $445 $495 $878 $975 $985 $1,095

Members Before After 4/15 4/15 $355 $398 $715 $798 $805 $918

Physicians are reminded that most of the CPLH content is available FREE to members in CMA On-Call, CMA's online health law library, at


California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff. Reimbursement Help Line 888-401-5911 • One-on-one educational and reimbursement assistance to physician members and their staff Practice Empowerment • Tools and resources to empower physician practices • Seminars and toolkits for physicians and their staff Experienced Staff • Staffed by practice management experts with a combined experience of over 125 years in medical practice operations Need help? Contact CMA’s reimbursement experts at 888401-5911 or

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How Successful Is Your Practice? Let physician members know your practice is available for referrals Use Vital Signs to advertise your practice at special rates offered to member physicians. contact: Annette Paxton Vital Signs Advertising Representative (559) 454-9331


. . .

CRIMINAL DEFENSE PROFESSIONAL BOARD DISCIPLINE DEFENSE MEDICARE AND MEDI-CAL AUDIT AND FRAUD DEFENSE Former Deputy District Attorney Over 30 Years Experience Admitted in all California state and federal courts Telephone: (949) 336-2433; Cell: (949) 680-6332 4040 BARRANCA PARKWAY, SUITE 280 IRVINE, CALIFORNIA 92604


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CMA NEWS CMA Center for Economic Services

Education Series April 3: Strategic Planning From Vision to Action – A Self-Guided Process – Rachel Smith • 12:15-1:15pm Learn how simplified strategic planning and personal coaching can get you, your practice or your organization where you want to go. In this interactive webinar you will get to develop your own vision and strategic plan with tools to ensure you can walk away with immediate items, tools you can use again and how to obtain coaching support to implement the remaining steps of your plan.

April 9: CMS Quality Reporting Programs: What Physicians Need to Know and Do Now to Improve Care and Avoid Penalties – CMS • 12:15-1:45pm Presented by the Centers for Medicare & Medicaid Services (CMS), webinar attendees will understand the background and rationale for CMS incentives and payment adjustments that affect physicians, including the Physician Quality Reporting System (PQRS), the ePrescribing (eRx) Incentive Program, the Electronic Health Record (EHR) Incentive Program, and the new Value Modifier (VM) program; be able to define what actions they need to take to receive each incentive and avoid payment adjustments; and know where to go to obtain further information about CMS quality programs and stay abreast of future developments.

April 10: Preparing for EHR Implementation and Conversion David Ginsberg • 12:15-1:15pm Many EHR system implementations fail or stumble due to common mistakes made during implementation. This webinar will review common pitfalls, what you should insist your vendor provide (project plans, timelines), setting up files (order sets, pick lists, etc.), the importance of all stakeholder involvement, the danger of scanning paper charts, and resources to support you.

Webinars At-A-Glance Most webinars are FREE for CMA members, $99 for non-members. CMA members are eligible for special discounts on ICD-10-CM Training from AAPC

April 17: Valuing, Selling, Buying or Transitioning a Practice Debra Phairas • 12:15-1:15pm Considering retirement? Selling or wanting to buy a practice? Making this transition requires planning and sufficient time to accomplish this effectively for your patients, staff and family. California has a high cost of living, which makes it more difficult for physicians to sell, transition, start, or purchase a practice. Learn creative strategies to help you accomplish your goals. This seminar will discuss the options, including: bringing in an associate, recruiting or selling the practice. Included is the latest information on valuation methodology for selling, divorce or estate planning.

April 24: California’s Health Benefit Exchange: How it Will Impact Your Practice and Change Commercial Insurance Brett Johnson • 12:15-1:45pm Beginning in 2014, California’s private health insurance market will never look the same – individuals and small employers will be able to purchase health insurance coverage through the state’s health insurance exchange, now named Covered California. It is estimated that by the end of 2016, over one in five Californians will get their health insurance through the Exchange. Furthermore, with the selection of exchange plans occurring no later than April of 2013, payors are likely to begin reaching out to physicians regarding exchange products soon, if they have not already (e.g., Anthem Blue Cross and Blue Shield of California). In this presentation, you will learn more about California’s exchange and what it will mean for physicians. You will also gain an understanding of some of the risks and benefits of contracting to provide services to exchange enrollees. Questions? CMA Member Help Center: 800-786-4262 Please note: this calendar is subject to change. Visit for updates.

116th 6th A Annual n n ua l Ca California lifornia H Health eallth lth t h Ca C Care r e LLeadership eaders h i p Acade Academy my

May M ay 3 ay 311 - JJune une 2 2,, 2 2013 013 • P Planet l a n et H Hollywood, ol lyw lyw y wo o d , LLas as V Vegas e gas

Welcome to the era of health reform. Increasing demand for services. Intensifying pressure for cost and quality accountability. Small practices joining larger groups seeking safe harbor. Undercapitalized medical groups sinking. Hospitals and health plans acquiring practices in a “vertical integration” (consolidation?) of the health care market.

Can physicians control their own destiny – and the future of medical practice? Hear from experts and leaders of change and attend a comprehensive slate of practice management seminars and workshops to position your practice for success. Early-Bird and Multiple Registration Discounts Save up to $200 per person when you register before May 3!

Register Reg ister aatt 800.795.2262 or

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“When it comes to Meaningful Use, athenahealth did all the legwork… and then they made it easy for me to do.” –Dr. Reavis Eubanks

This is how Dr. Eubanks got paid for Meaningful Use.


fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an effective way to begin earning up to $44,000 in Medicare incentive payments. athenahealth helped Dr. Eubanks go from paper to payment in just six months. With guidance every step of the way and proven, cloud-based services.  f Best in KLAS EHR*  f Free coaching and attestation

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Visit or call 800.981.5085 *ambulatory segment for practices with 11-75 physicians *GZPVEPOUSFDFJWFUIF'FEFSBM4UJNVMVTSFJNCVSTFNFOUEPMMBSTGPSUIFmSTUZFBSZPVRVBMJGZ XFXJMM credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act Medicare reimbursement payments only. Additional terms, conditions, and limitations apply.


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Cloud-based practice management, EHR and care coordination services

iHEALTH NEWS Reprinted with permission from iHEALTHBeat


During the Healthcare Information and Management Systems Society (HIMSS) conference in March, CMS Administrator Marilyn Tavenner announced that CMS will not issue rules on Stage 3 of the meaningful use program until next year, AHA News reports (AHA News, 3/6). Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments. Instead of issuing Stage 3 rules this year, Tavenner said that CMS will focus on: • Implementing the Stage 2 final rules; and • Determining what requirements to include in Stage 3 of the meaningful use program (Robeznieks, Modern Healthcare, 3/6). Tavenner also confirmed that federal officials would not change the Oct. 1, 2014, implementation deadline for ICD-10 transaction codes (AHA News, 3/6). U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch from ICD-9 to ICD-10 code sets means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes (iHealthBeat, 3/4). National Coordinator for Health IT Farzad Mostashari delivered a keynote address at the HIMSS conference, saying that the U.S. has a broken health care system that "is failing everyone in health care and everyone we love." He said that more effective use of EHR systems, health data exchange tools and patient data could help improve the country's health care system. Mostashari also noted that allowing patients to access their health data will help drive patient engagement, saying, "No one should make a profit holding patient data hostage" (Sullivan, Government Health IT, 3/7). During the HIMSS conference, Carol Cain – senior director of clinical information services for the Kaiser Permanente Care Management Institute – said that Kaiser Permanente is leveraging large volumes of patient data as part of a massive analytics operation aimed at boosting care quality and reducing costs. Also at the HIMSS conference, Brad Putnam – executive director of HealthShare Montana, the statewide health information exchange – described lessons learned from implementing the exchange. Putnam said the three keys to the success of HealthShare Montana include becoming the market leader in providing: • Access to an accurate EHR; • A range of cost-effective identified and de-identified clinical analytical services; and • Advanced technology for patient-centered medical homes and accountable care organizations (Fratt, Clinical Innovation & Technology, 3/7). WALMART, SAM'S CLUB TO DEPLOY 2,500 SELF-SERVICE HEALTH KIOSKS

Self-service kiosks that aim to boost consumer health are being deployed in thousands of stores across the U.S., Kasier Health News

reports. Walmart and Sam's Club are scheduled to debut 2,500 of the kiosks developed by Duluth, Ga.-based SoloHealth. The kiosks will offer consumers access to various health tests, such as: • Blood pressure; • Eye sight; and • Obesity. The devices also can advise patients on: • Diet; • Locating a doctor; • Pain management; and • Vitamins. SoloHealth said it plans to update the kiosks so that they include smoking cessation tips, diabetes testing and programs for helping consumers enroll in health plans. Mark Savage, a senior attorney for Consumers Union, said the kiosks could pose privacy risks. He said, "You have a situation where a patient is voluntarily disclosing information, which means there is no privacy protection, generally," adding, "They may not know if the information is being kept and might be used weeks or years after." Stephen Kendig, chief commercial officer for SoloHealth, said that the firm is not considered a covered entity under HIPPA and therefore is not required to meet the law's privacy standards. Bart Foster, founder and CEO of SoloHealth, said that all personal data – except email addresses – obtained by the kiosks are aggregated and shared with SoloHealth sponsors without personal identifiers (Appleby, Kaiser Health News, 2/19).


An international group of researchers has created the most expansive map of human metabolism available, which they say functions like a Google map of the body, according to an analysis published in the journal Nature Biotechnology, Time reports. The interactive map – called "Recon 2" – was developed using data from published literature and existing models of metabolic processes. It includes 1,800 protein-coding genes. Recon 2 consolidates data on human metabolic functions and allows users to zoom in to a cellular level to see details or zoom out to get a broader perspective of different metabolic reactions that might be involved in a particular function. Researchers say that Recon 2 could have a number of medical applications, including tracing gene expression patterns to specific metabolic pathways, which could lead to more useful targets for drugs that intervene in such processes. They also are confident that Recon 2 could help expose the causes of some diseases – such as cancer and diabetes – and help aid in the development of treatments for such illnesses. Ines Thiele, a professor at the University of Iceland who helped develop the map, said, "Ultimately, I envision it being used to personalize diagnosis and treatment to meet the needs of individual patients." Thiele added, "In the future, this capability could enable doctors to develop virtual models of their patients' individual metabolic networks and identify the most efficacious treatment for various diseases" (Sifferlin, Time, 3/5)

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April 12-14, 2013 2013 YOSEMITE POSTGRADUATE INSTITUTE Yosemite National Park presented by

Information: or 559-224-4224x 118


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CHAT WITH THE EDITOR The Editor of Vital Signs recently sat down with George Strasser, Esq. an experienced health care attorney who practices law at Baker, Manock, & Jensen. In an ongoing series, selected topics will be discussed. If you have a question that relates to health care law, please submit it to the Editor.

Legal Tips About EMR Editor: Mr Strasser, in recent years we have seen the transition to electronic medical records which is now mandated by the government. What are the important issues a physician should consider with regards to EMR? Mr Strasser: Electronic medical records vary greatly from office to office and from hospital to hospital. Many physicians today have a hybrid system with paper and electronic records that overlap. Some information that is on paper doesn’t get on to the electronic record and vice versa. It can be difficult to piece together a chronology of what happened to a patient. Both electronic and paper records can be incomplete. For example, if a patient calls in with a message, or if the patient asks for and receives advice over the phone, that should be in the record somewhere. When there is an email exchange between doctor and patient, that information should also be in the patient’s chart. We find that some electronic records have a system where the Medical Assistant, or the Nurse, or the Doctor merely checks a box, or perhaps “unchecks” a box, when taking a history, or when noting a sign or symptom. Sometimes the information from the electronic record for the previous visit is automatically imported to the current visit. If a physician’s electronic records have the exact same vitals, lab results, patient complaints, and physical exam findings for three visits in a row, no one will believe the records. Nor should they. My favorite anecdote about this problem came from a Medicare billing investigator. There was an office note that mentioned that the patient was upset because he got a speeding ticket on the way to the appointment. The problem was that this same information was copied into the next eleven visits. As you know, medical records are reviewed in malpractice lawsuits, in Medical Board investigations, in peer review investigations, and in billing investigations. When a copy and paste situation arises, the burden is on the physician to explain the records. Another problem can arise when the physician doesn’t understand how a particular electronic record is closed, so that it cannot be further revised. If a change needs to be made in such a record, then the change must be made as a late entry. Some systems keep track of each and every entry, right down to the minute the entry was made. Some systems keep track of every time an electronic record is accessed. Plaintiff’s attorneys are well aware and look for discrepancies in the medical record. Another problem is “chart lore.” Imagine that a staff member imports a different patient’s history and incorrectly states that the patient had breast cancer ten years ago. Sometimes that information will get copied and repeated electronically over and over, and it can be very difficult to remove incorrect information. The bottom line is that it is imperative that a physician understand the electronic medical records system in place. Remember that electronic medical records from other sources may be incorrect. Finally, doctors must be willing to embrace newer and better technology including electronic medical records systems as they emerge.

George Strasser, Esq.


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Transfusion Medicine Under the Affordable Care Act Patrick Sadler, MD, Central California Blood Center

It has two parts; 10 titles; 2,462 pages and countless provisions, all geared to ensure that every American has access to quality, affordable health care. It is estimated to provide insurance coverage for an additional 32 million people while lowering health care costs. It is known as the Affordable Care Act, or ACA, the final, amended version of the comprehensive health care reform law enacted by Congress in March 2010. Given the ACA’s size and scope, it is not surprising that many U.S. residents are questioning how the law affects them, and those within the transfusion medicine and cellular therapy community are questioning how the law may influence the health care services they provide. The specific provisions of the law that concern transfusions and blood banking can be found throughout all 10 Titles of the ACA, but generally reflect three overarching themes: expanding health care coverage, improving the quality of health care and limiting health care costs. This article touches on the impact of health care reform on blood products, transfusion medicine and cellular therapy services, and the patients who are served by them. Expand Health Care: One of the ACA’s primary goals is to provide access to health insurance for all Americans. The Congressional Budget Office estimates that the ACA will expand insurance coverage to more than 95 percent of Americans. To bring uninsured people into the system, the ACA will provide many programs, including those listed in Table 1. Although some reforms have already begun, the rest are slated to roll out over four years and beyond, with most changes taking place by 2014. “The increase in the number of insured individuals is the most important part of ACA, not just for AABB members, but for the whole health care system,” said Theresa Wiegmann, JD, director, public policy, and special counsel for AABB (the organization formerly known as American Association of Blood Banks). “As more people come into the system, there are sure to be increases in health care services provided, including an increase in the number of transfusion and cellular therapy services.” To prepare for this increase, Wiegmann said that blood centers will need to continue what they have done successfully in the past: adjust supply to meet the demand and keep a careful eye on changing trends in health care so that they can recruit more donors as needed. But blood products will have to be utilized more effectively, too. College of American Pathologists Governor, and longtime AABB member, Richard Friedberg, MD, PhD, FCAP, believes this can be done partly by concentrating on treating patients, not just numbers such as lab values. “When we get more involved in treating patients, we can be sure that utilization is appropriate,” said Friedberg. Nonetheless, he foresees staffing problems, both at the technican and supervisory roles. “Even as we continue to control utilization, it won’t be enough to offset the increase in the insured population, especially as the elder population grows.”

Table 1: Programs Extending Insurance Coverage PROGRAM WHO IS COVERED YEAR IT BECOMES EFFECTIVE Pre-Existing Uninsured Americans 2010 Condition Insurance Plan with preexisting conditions who have been uninsured for at least six months because of a preexisting condition Early Retiree People who retire 2010 Reinsurance betweenage 55 and 65 Program Affordable Insurance Individuals and small 2014 Exchanges businesses state-based insurance exchanges) will replace today’s small group and individual markets and offer competitive, affordable, standardized health packages Medicaid Eligibility Individuals and families 2010 Expansion with incomes up to 133 states can opt to percent of the federal receive funds to poverty level expand Medicaid eligibility

Promote Quality Health Care: The ACA includes many provisions to improve the quality of care provided to Americans. For example, all Americans will have coverage for preventive care – including screening for high cholesterol, diabetes, HIV and other sexually transmitted infections — at 100 percent under Medicare, Medicaid and private plans, with no copays or deductibles. In addition, the ACA has established a core set of benefits that must be covered under Medicaid plans and by insurers who participate in the state-based Affordable Insurance Exchanges that will replace today’s small group and individual markets. Among other services, the essential health benefits include coverage for wellness services and chronic disease management, laboratory services, ambulatory and emergency services, and hospitalization. Building on the trend to pay for performance, the ACA will create a physician value-based payment program to promote increased quality of care and offer financial incentives to hospitals to improve the quality of care. Limit Health Care Costs: Several of the ACA programs are designed not only to improve quality but also to contain costs. These reductions are achieved with several health care delivery system reforms. The reforms under Medicare are intended to reward the value of care, not the volume of care. The new payment incentives are designed to reduce waste, slow the growth of health care costs and improve health. Accountable Care Organizations, or ACOs, are organized groups of medical providers who are rewarded for providing high quality, affordable care over a sustained period of time. They enable hospitals and Please see Transfusion Medicine on page 15


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AIR QUALITY FMMS Physician Appointed to the California Air Resource Board and the San Joaquin Valley Air Pollution Control District Michelle Garcia, Air Quality Director

Alexander Sherriffs, MD, was confirmed last month by the State Senate to serve on the California Air Resources Board (CARB) and the San Joaquin Valley Air Pollution Control District (SJVAPCD). Due to his long-standing commitment to air quality issues in California, he was appointed and has been actively serving for the past year in both organizations. During the past year, Dr. Sherriffs has demonstrated his commitment to finding solutions to protect public health through cleaner air quality while carefully considering the impacts on the San Joaquin Valley’s economy. In addition to consistently fulfilling his commitments, he has inspired other physicians and advocates across the state with his ability to see the bigger picture when making sound and informed decisions. A report issued by the UCLA Center for Health Policy Research highlights the rising rates of asthma in California, an issue Dr. Sherriffs has worked tirelessly on. “We are pleased that the California Air Resources Board and the California State Senate understands the dedication Dr. Sherriffs has to these issues not just in the Central Valley, but across the state,” said Ranjit Rajpal, MD, president of the FresnoMadera Medical Society. “He will surely be an exceptional addition to both boards and lend a kind of experience and voice that will only help improve the state of our air quality policy.” In addition to his work on air quality, Dr. Sherriffs is a practicing physician in Fowler and has been an active member of the California Medical Association, FresnoMadera Medical Society (serving as president in 1999) and the California Academy of Family Physicians. Dr. Sherriffs was born in California. He earned his BA in History at Yale, his MD at University of California, Davis, and completed residency training in Family Medicine at Valley Medical Center, Fresno. He and his wife – Dr. Joan Rubinstein – volunteered with the United States Public

CARB Board Chairperson Mary Nichols swears in Dr. Alex Sherriffs on December 16, 2011.

Health Service and spent two years with the Indian Health Service in Kincheloe, Mich. They returned to California in 1983

to raise their two daughters and establish their practice in Fowler. Congratulations Dr. Sherriffs!

You said what to the Medical Board’s investigator? Physicians often come to us after they have been interviewed by a Medical Board investigator or after they have already provided a written description of their care. Did you know that a Medical Board investigator is a sworn peace officer, with a gun, and a badge, and the power to arrest you? When the Medical Board demands an explanation, seek help immediately. The attorneys at Baker, Manock & Jensen have helped many physicians through the maze that is a Medical Board investigation. We would be honored to help you.

George L. Strasser 5260 North Palm Avenue Fresno, CA 93704 559 432-5400

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Fresno-Madera RANJIT RAJPAL, MD Post Office Box 28337 Fresno, CA 93729-8337

President’s Message

1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276



Umuntu ngumuntu ngabantu. Motho ke motho ka batho. ‘a person is a person through other persons’ – Ubuntu, African Proverb

FMMS Officers Ranjit Rajpal, MD President Prahalad Jajodia, MD President Elect A.M. Aminian, MD Vice President Hemant Dhingra, MD Secretary/Treasurer Sergio Ilic, MD Past President Board of Governors S.P. Dhillon, MD Ujagger-Singh Dhillon, MD William Ebbeling, MD Babak Eghbalieh, MD Ahmad Emami, MD Anna Marie Gonzalez, MD David Hadden, MD S. Nam Kim, MD Constantine Michas, MD Trilok Puniani, MD Khalid Rauf, MD Mohammad Sheikh, MD CMA Delegates FMMS President A.M. Aminian, MD John Bonner, MD Michael Gen, MD Brent Kane, MD Kevin Luu, MD Andre Minuth, MD Shazia Maghal, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-elect Praveen Buddiga, MD Surinder P. Dhillon, MD Don H. Gaede, MD Peter T. Nassar, MD Trilok Puniani, MD Oscar Sablan, MD Dalpinder Sandu, MD Mickey Sachdeva, MD CMA YPS Delegate Paul J. Grewall, MD CMA YPS Alternate Yuk-Yuen Leung, MD CMA Trustee District VI Virgil Airola, MD Staff: Sandi Palumbo Executive Director


Service lies at the heart and foundation of medicine. It is the defining hallmark and calling of our craft and it embodies our enduring commitment to our patients and the remarkable communities of California’s Central Valley. Our mission in FMMS and CMA, as organizations of physicians and caregivers, is grounded in the principles and practice of engaged public service. Fulfilling this ongoing mission and commitment to service will require a unique synergy of both our individual and collective leadership capacities. Each one of us, in the medical community and beyond, must play an “DO NOT GO integral leadership role to advance our cause of creating a more just, WHERE THE PATH equitable, sustainable and healthful world. The African philosophy of Ubuntu, or ‘humanness’, describes a way MAY LEAD, of seeing, living and being with others in mutual respect, harmony and GO INSTEAD compassion; where the well-being of every human being is intimately WHERE THERE IS bound relationally, as individuals and communities existing in complex webs and networks of interconnected relationships. NO PATH AND Through a great deal of introspection on these ideas, I have come to LEAVE A TRAIL.” realize what leadership and engaged public service means to me and on what I envision it should mean for our Medical Society. If we are to be sincere in the pursuit of our mission to enhance the health and well-being of our Valley communities, then we must challenge ourselves to re-imagine our own preconceived notions of leadership. We must take leadership for the healthcare of our patients and also empower them to take leadership for their own health and wellness. We must embrace an intersectional approach to medicine and public health which seeks to understand and interrogate the complex relationships between the health of our communities, our food systems, our schools, and the health of our planet. Each of us must challenge ourselves to imagine holistic approaches and visions for a healthy and empowered Central Valley, vibrant with clean soil, air and water for our children and for the generations to follow. We must inspire and be inspired to envision ourselves and our patients as active agents of transformation and re-vitalization in the health of our beautiful Central Valley. We must embrace this spirit of Ubuntu – of our common shared humanity, to cultivate a cosmopolitan ethic and culture of leadership activated through education and engaged public service. Indeed, the future health of our Valley is inextricably intertwined with the leadership decisions we must make today. And so, in the spirit of Ralph Waldo Emerson, the great American poet and Transcendentalist who embraced the numerous opportunities for leadership and public service he encountered in his own time, I call on all of you, “Do not go where the path may lead, go instead where there is no path and leave a trail.” Dr. Rajpal can be reached at

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Fresno-Madera Fresno-Madera Medical Society to Host Free Community Health Walks


Transfusion Medicine

COMMUNITY OUTREACH PROGRAM 'Walk with a Doc’ strives to encourage healthy physical activity in people of all ages and reverse the consequences of a sedentary lifestyle in order to improve their health and well-being.

ENCOURAGE YOUR PATIENTS TO PARTICIPATE! 2013 SATURDAY DATES: • APRIL 27 • MAY 25 • JUNE 29 9:00-10:00am • Registration at 8:30am Woodward Regional Park WHO CAN ATTEND: Participation is open to anyone interested in taking steps to improve their health. EACH WALK IS LED BY LOCAL PHYSICIANS In addition to the health benefits of walking, you will receive: • Healthy Snacks • Healthy Lifestyle Tips/Resources • Chance to Talk with a Doc NOW RECRUTING PHYSICIAN VOLUNTEER WALKERS Contact the Medical Society at 559-224-4224, ext. 114 Find us on Facebook: Fresno-Madera Medical Society

Financial Education Seminar Series for FMMS Members The third in this year’s Financial Education Seminars offered as a benefit to FMMS members and their guests, through a partnership with Central Valley Physician Benefits, will be hosted by Eric Van Valkenburg, CLU, ChFC® and Amy NuttallZwaan, CRPC®, CSNA, Financial Consultants with Central Valley Physician Benefits. The seminar topic is: “Estate Planning,” and will be presented by Robert Wright, Esq., Wright & Wright Attorneys at Law, Inc. Due to demand and interest, this will be a repeat of February’s seminar, as there have been many tax law changes impacting estate plans. The presentation will include a discussion of: • January 1, 2013 Changes to Federal Estate and Gift Tax Law – the new “Fiscal Cliff” tax legislation; • The Income Tax Trap for Married Couples with Living Trusts, and how to fix it; • Non-financial reasons to have an estate plan, or update an existing one; • Why so many estate plans won't work as they are intended; • What happens to your assets if you are disabled for an extended period; • How to reduce the chance your heirs will lose their inheritance, due to divorce, lawsuits or estate tax Wednesday, April 24, 2013 at 6 pm • Village Conference Center 265 E. River Park Circle, #260, Fresno, CA 93720 (four-story building, corner of N. Friant Rd. and N. Fresno St.) (Note: Different location. The seminar will not be held at the FMMS office) Space is limited! Reserve your spot by contacting: Central Valley Physician Benefits: 559-492-9592 or info@medicalsocietybenefits. com. A light meal will be available. Eric Van Valkenburg and Amy Nuttall-Zwaan are Registered Representatives with and securities offered through LPL Financial. Member FINRA/SIPC.

Continued from page 12 doctors to work together to manage and coordinate care for a share of the savings they achieve for Medicare. “Part of what the ACA is trying to do is control Medicare spending through measures that also improve quality” said Wiegmann. “Efforts to encourage ACOs and discourage errors and rehospitalization aim to control costs and improve patient care,” Wiegmann explained. “Bundled Payment” pilot programs provide bundled payments for entire episodes of care – rather than paying separately for each service – to encourage increased collaboration among hospitals, doctors and post-acute care providers to improve coordination of patient care. These and other efforts to reduce costs are likely just a starting point. Pay for Reform: In order to pay for significant expansions to Medicaid and other federal health care programs, additional resources are needed beyond the cost-cutting programs mentioned previously. Some of these revenue drivers will have a particular impact on AABB members, such as the medical device excise tax. The medical device excise tax is a 2.3 percent tax on the sale price of medical devices sold by manufacturers or importers. Because of concerns about the potential impact of the medical device tax on blood centers, AABB is urging the Internal Revenue Service to interpret the scope of the tax to exclude certain devices that blood centers purchase. “We want to make sure that the way a medical device is defined doesn’t inappropriately include some high volume supplies that blood centers buy, like reagents for blood testing and socalled combination products,” said Wiegmann. Please see Transfusion on page 18

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Kings 2013 KCMS Membership Directory

2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website:

KCMS Officers Wilbur Suesberry, MD President Alpha J. Anders, MD President-elect Eric J. Boren, MD Secretary Ronald L. Morton, MD Treasurer Joel R. Cohen, MD Immediate Past President Board of Directors Bradford A. Anderson, MD Lawrence N. Cosner, MD John L. Digges, MD J. Michael Hewitt, MD Susan S. Hyun, MD Melissa A. Larsen, MD Mark L. Nystrom, MD Sameer Gupta, MD Edward W. Taylor, MD CMA Delegates: Jennifer Abraham, MD John Digges, MD Ronald Morton, MD CMA Alternate Delegates: Lawrence Cosner, Jr., MD Staff: Sandi Palumbo, Executive Director Kathy L. Hughes Administrative Assistant


The 2013 KCMS Membership Directory is here! If you need additional copies, please use the Order Form listed on page 7 of the directory. Supply is limited, so hurry and place your order. Listed below are Changes/Corrections/Deletions that need to be made to your copy. CHANGES/CORRECTIONS BRECHNER, Theresa – 923 Lilly Court, Nipomo, CA 93444-6627 (pg.37) CARTMELL, Alan – GILL, Zora – HO, Sze – Remove Email address HOSPITALS IN KERN COUNTY (Hospital Index Tab) San Joaquin Hospital, 2615 Chester Avenue, 93301 Interim President: Scott Reiner LUKASZCZYK, Thomas – 2615 Chester Avenue, 93301-2014 PETERSON, Ronald – 2615 Chester Avenue, 93301-2014 REILLY, Thomas – 2615 Chester Avenue, 93301-2014 SCHMIDT, Kevin – 2615 Chester Avenue, 93301-2014 SRIVASTAVA, Pramod – TOBIAS, Joshua – 2615 Chester Avenue, 93301-2014 WEN, Thomas – Remove email address ZIOMEK, John – 2615 Chester Avenue, 93301-2014

DELETIONS (Also remove from “Membership By Specialty List” & “All Kern County Physicians” section.) LARSEN, Melissa MILLER, Gregg NEWBOLD, Shanna SEIBLY, John (Deceased pg.39) VANSONNENBERG, Eric

Membership Recap MARCH 2013 Active.............................................................................................264 Resident Active Members .................................................................2 Active/65+/1-20hr .............................................................................4 Active/Hship/1/2 Hship.....................................................................0 Government Employed......................................................................5 Multiple memberships........................................................................1 Retired..............................................................................................59 Total ..............................................................................................335 New members, pending dues .............................................................0 New members, pending application ..................................................0 Total Members..............................................................................335

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PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 KCMS Officers Jeffrey W. Csiszar, MD President Vacant President-elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President Board of Directors Bradley Beard, MD James E. Dean, MD Thomas S. Enloe, Jr., MD Ying-Chien Lee, MD Uriel Limjoco, MD Michael MacLein, MD Kenny Mai, MD CMA Delegates: Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

Tulare Healthcare Reform and California’s Changing Insurance Marketplace TUESDAY, APRIL 30, 2013 Registration: 6:00 p.m. • Program to begin at 6:30 p.m. Who should attend: Physicians, Office Managers and Administrators Speaker: Mark Lane, Associate Director, CMA’s Center of Economic Services Topics focused on will include: • What is a Health Information Exchange and how will it affect our practice? • What is a “Qualified Health Plan?” • How to contract with one of the Exchange plans? • What issues should I be aware of in the Exchange? • Updates on critical payor issues • What CMA resources are available to me? Please contact Dana Ramos if you are interested in attending via phone at 559-734-0393 or via e-mail at

Calling All Tulare County Medical Society Members VISALIA UNIFIED HIGH SCHOOLS NEED YOU!

Here’s your chance to volunteer for a great cause!

MAY 7, 2013 • 12:00-3:00PM

Once again the Tulare County Medical Society is assisting the high schools in the Visalia Unified School District to provide annual sports physicals for athletes. In the past many of you have graciously agreed to participate in the event and we would like to ask you to do so again. We have scheduled two days of physicals with two high schools each day. For more information, or to volunteer for this meaningful project, please contact: Thelma Yeary, TCMS at 559-627-2262 or

Schools on this date: • Mt. Whitney High School • Redwood High School

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website:

TCMS Officers Steve Cantrell, MD President Thomas Gray, MD President-elect Monica Manga, MD Secretary/Treasurer Gaurang Pandya, MD Immediate Past President Board of Directors Virinder Bhardwaj, MD Carlos Dominguez, MD Pradeep Kamboj, MD Christopher Rodarte, MD Antonio Sanchez, MD Raman Verma, MD

MAY 14, 2013 • 12:00-3:00PM Schools on this date: • Golden West High School • El Diamante High School

CMA Delegates: Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates: Robert Allen, MD Ralph Kingsford, MD Mark Tetz, MD


Test your knowledge of some common health topic acronyms. Match the Acronym with the correct definition (answers on the bottom). ACA = Accountable A) A set of government-regulated and standardized health care plans in the United States, from which individuals may purchase health insurCare Act ance eligible for federal subsidies. All exchanges must be fully certified HIX = Health and operational by January 1, 2014, under federal law (Wikipedia 3/13) Insurance B) Refers to the process of reliable and interoperable electronic healthExchange related information sharing conducted in a manner that protects the HIE = Health confidentiality, privacy, and security of the information (, Information 3/13) Exchange RHC = Rural Health C) These are “safety net” providers such as community health centers, public Clinic housing centers, outpatient health programs funded by the Indian Health FQHC = Federally Service, and programs serving migrants and the homeless (, 3/13) Qualified D) A law enacted in 1977 allowing for these to operate to address an Health inadequate supply of physicians serving Medicare patients in rural areas Centers and to increase the utilization of non-physician practitioners such as nurse practitioners and physician assistants in rural areas (,3/13) E) Also known as the PPACA (Patient Protection and Affordable Care Act) Together with the Health Care and Education Reconciliation Act, it represents the most significant government expansion and regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. (Wikipedia 3/13)

Sixth District CMA Trustee James Foxe, MD Staff: Steve M. Beargeon Executive Director Francine Hipskind Provider Relations Thelma Yeary Executive Assistant Dana Ramos Administrative Assistant


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Answers: 1.) E, 2.) A, 3.) B, 4.) D, 5.) C

CLASSIFIEDS MEMBERS: 3 months/3 lines* free; thereafter $20 for 30 words. NON-MEMBERS: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30. *Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118. FRESNO/MADERA

ANNOUNCEMENT Dr. Ahmad Emani announces his Man of the Year campaign benefiting the Leukemia & Lymphoma Society. Tax-deductible donations to his campaign can be made at: www.mwoy-org/pages/cca/fresno13/aemani University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Call 559-320-0580.

FOR RENT / LEASE Medical office spaces: 1,000sf up to 2,500sf at NE. corner First/Herndon and NW corner First & Bullard starting at $1 psf++ by owner. Call 559-449-7668 or 559284-2625.

PHYSICIAN WANTED LQMG Medical Group is seeking Board Certified, Internal Medicine physicians to join its group. Call 559-450-5703. Camarena Health seeking FP/IM physician for Oakhurst facility. Requires CA physician license. Contact Dir. of HR at 559-6644158; or fax resume to 559-675-5224. TULARE

AVAILABLE Nanny available for your children. Dr. Stanic’s wife, Katarina, knows a right person for your home. Contact: Call Sequoia Dental Office; 559-635-7186, ask for Katrina or (indicate NANNY) under subject)

Transfusion Medicine Continued from page 15 Opportunities Abound: Although some of the ACA’s specific provisions introduce novel programs, its focus on improving the quality of care while controlling costs is familiar to the transfusion medicine and cellular therapy community, as highlighted in programs like Patient Blood Management, or PBM. Through PBM, AABB members are implementing measures to ensure patients are transfused only when clinically necessary. Earlier this year AABB issued a clinical practice guideline restrictive of red blood cell transfusion strategies for certain patients1. In general, the AABB Guideline makes three recommendations: adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients; adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less; and considering symptoms as well as hemoglobin concentration during transfusion decisions. “There is a real opportunity for those who understand blood in the health care system to get directly involved with oversight and resource utilization for the evolving coordinated care organizations,” said Friedberg. “A key tenet of tomorrow’s care will be to control costs and utilization… not necessarily to deny care, but to ensure care is appropriate. It’s the right thing to do and good medicine. There is a real opportunity to help the system improve quality and efficiency.” Author can be reached at: References 1 Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Annals of Internal Medicine. 2012;157(1):49-58 Source: ‘Transfusion Medicine under the Afford able Care Act’, by Alia Bucciarelli. AABB News September 2012


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“When I found out how much money I could save ($1,650) on the sponsored workers’ compensation program, I joined CMA. The savings paid for my membership and then some. Now I have access to everything CMA offers.” Nicholas Thanos, M.D. CMA Member


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Vital Signs April 2013  

April 2013 * Vol. 35 No. 4

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