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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

Vital Signs

May Is Clean Air Month

See Inside: More Californians Have Access To Prescription Savings 2014: The Destruction of Private Practice Medicine What Physicians Need To Know About The Anthem Exchange Addendum

May 2014 • Vol. 36 No. 5

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


San Diego orange LoS angeLeS PaLo aLTo SacramenTo

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.


Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society May 2014 Vol. 36 – Number 5

Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD 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 Medi­ cal Society, PO Box 28337, Fresno, CA 93729-8337. Advertising Contact: Display: Annette Paxton, 559-454-9331 Classified: Carol Rau Yrulegui 559-224-4224, ext. 118

Contents EDITORIAL.................................................................................................................................5 CMA NEWS................................................................................................................................8 NEWS

MICRA UPDATE: Physicians Must Rally To Oppose Trial Lawyers On All Fronts...............................7

CMA NEWS: What Physicians Need to Know About the Anthem Exchange Addendum...................9

CMA EDUCATION SERIES.........................................................................................................9

AFFORDABLE HEALTHCARE ACT: Surviving the Third Month of Covered California.........................9

HEALTHCARE REFORM..........................................................................................................10

CLASSIFIEDS..........................................................................................................................19 TULARE County Medical SocieTY.......................................................................................11 • President’s Message

• Walk With A Doc

Kern County Medical Society...........................................................................................13

• More Californians Have Access To Prescription Savings

• Membership News

Fresno-Madera Medical Society......................................................................................14

• Save the Date: May 22 Multidisciplinary Approach to Recognizing & Treating Hyperparathyroidism

• Walk with a Doc

• Medical Managers Forum

• In Memoriam: Harold M. Price, MD

Cover Photograph: “  Childrens Hospital Central California” By Don Gaede, MD Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

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. MAY 2014 / VITAL SIGNS


You have to pay for workers’ compensation insurance. But...

YOU DON’T HAVE TO In California, rates for workers’ compensation insurance are soaring. In the second half of 2013, rates increased by an average of 8.7%.1 That’s after a 10% increase in the first half of 2013.2 Source: Workers Compensation Insurance Rating Bureau of California, amended_ppr_filing_complete.pdf


2 Source: Business Insurance, article/20130925/NEWS08/130929901


FMMS/KCMS/TCMS members, call 800-842-3761 to see if you can save!

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2014: The Destruction of Private Practice Medicine Michael W. Lynch, MD, FACP, DTM&H

On November 1st 2014, I will celebrate my 30th year in private practice in

Fresno. In addition to Internal Medicine (IM), I have had the opportunity to develop a subspecialty interest in Travel Medicine. It has been an adventure of privilege and exhilaration to build the practice and to be primarily responsible for the care of my patients. After completing college, four years of graduate studies, internship and residency, I was hungry to create something that belonged to me. I have no reservations about the choices I have made. I enjoy my practice and patients on a daily basis.

system including patients, doctors, and drug companies has little to do with their formulas for financial success. The idea of supporting and perpetuating quality has little to do with their decision-making. If they can forge alliances with the government If they and create a system to generate wealth, [insurance they are going to do that – and they have. companies]

I am writing this piece because of the importance of discussing with you, my colleagues, the ongoing revolution and the attack on private practice by the US Government, the State of California and the health insurance companies. The Affordable Care Act (ACA) is truly a Trojan horse. The pretense was to provide healthcare coverage to 32 plus million people who were denied health insurance in the US. In actuality it is a takeover of every element of healthcare and a relegation of physicians to a position where we have ultimate responsibility but with minimal authority. This is the definition of a dysfunctional system.

can forge

The ACA promised to put primary care physicians “in the driver’s seat,” but in truth the gear is stuck in reverse. Do I feel empowered? Do I have opportunity on the horizon? Not based upon what I see. Patients are prevented from keeping their insurance and keeping and/or choosing their doctors. I have longstanding friends and patients who now cannot find insurance coverage that will allow them to continue to see me as their physician. They are given no choices other than Covered California. Tell me, what truly is the role of government? The ACA redefines healthcare as one of the major social institutions of our country. The State of California and the federal government are committed to making the exchange work no matter what the expense or the ethics of the policies used to promote its success. It is as thought they have decided that “the means justifies the end.” I believe that neither the means nor the end is right for our country. If the ACA was equitable why have Congress as well as specific labor unions and corporations opted out? Why is there no mention of malpractice reform in this 2000+ page documents? Why are drug costs, including generics, currently accelerating at a precipitous rate? Why are insurance companies allowed to increase their premiums while increasing their deductibles? This is a sure way to increase profits, as less patients will be able to afford the deductible and visit their doctor. My office staff has been in contact with the Associate Director for the Center for Medical and Regulatory Policy for the CMA, Bret Johnson, JD. He advised that most of laws that determined the powers of Covered California were approved in 2010. Do you know what a health insurance company is? They are gamblers with the goal of creating wealth by stacking the odds in their favor. They do this by betting that there will be more money coming in than money going out. The alignment of proper incentives for each member of the healthcare

alliances with the government

So where are we going with health insurance in our state? With the implementation of Covered California there are only three options available in our Fresno area:

and create

1. A nthem Blue Cross, PPO and HMO

a system to

2. Blue Shield PPO


3. Kaiser

Blue Cross and Blue Shield hold the monopoly in the Valley. Under they are going their new plans they have reduced reimbursement to physicians by 30% to do that – and 10%, respectively. The Blues are and they have. promising physicians that the increase in patient volume will make up for the reduction in reimbursement. A physician can only see so many patients in a day and can only monitor so many mid level practitioners. Sufficient patient time is a must if physicians are going to respect patients’ individual needs as they use their skills to diagnosis and treat disease.


THERE IS NO DIFFERENCE BETWEEN THE EXCHANGE PRODUCTS AND PRIVATE INSURANCE PRODUCTS EXCEPT THE EXCHANGE IS SUBSIDISED BY THE GOVERNMENT AND BASED UPON THE INCOME OF THE POLICY HOLDERS. There are four different levels of coverage for Blue Cross and Blue Shield. The only difference is how much premium the patients pay and how much deductible they have. All individuals will have the same insurance. Consider that you decided to forgo purchasing a new car because you wanted better health insurance. It is already decided for you that you cannot have a better policy. Your wishes are irrelevant. The old Blue Cross/Blue Shield Group plans that utilize the old PPO networks and products are grandfathered in FOR NOW. Please see next page MAY 2014 / VITAL SIGNS


Editorial Continued from page 5 Every plan now must include benefits for the following categories even if they are not needed: 1. Ambulatory Patient Services. 2. Emergency Services. 3. Hospitalizations. 4. Maternity and newborn. 5. Mental Health, Substance Abuse Disorder Services including Behavioral Health Treatment. 6. Prescription drugs. 7. Rehabilitative Services and Devices. 8 Laboratory Services. 9.  Preventative Well Being Services and Chronic Disease Management. 10.  Pediatric Surgery including oral and vision care.

There are more acute problems associated with these new plans including: 1. Blue Cross and Blue Shield never clarified that the new plans have a limited number of providers. In fact the provider lists on their web sites are still not correct. Many of them displayed providers that are not contracted. 2. The lower reimbursement rates for Covered California PPO plans are provided with the concept that a provider will have a larger number of patients. Will the quality of care decrease with increasing volume and less time? The answer is obvious. 3. Will the level of service provided by physicians drop to a level to warrant a decreased reimbursement? 4. O verhead in most doctors’ offices runs between 40% and 60%. How can practices afford to continue in the private sector? 5. The current regulations will destroy private practice. 6. A ll negotiations between the State, Federal Government and insurance companies have occurred behind closed doors. 7.  Blue Cross, Blue Shield, Kaiser and Medicare are the dominant players in the Fresno market simply because there are no other choices. 8. With a narrow provider network, patients overflow is expected. Do you think that the patient would actually be able to receive the healthcare they are paying premiums for? Please see next page 6 MAY 2014 / VITAL SIGNS

MICRA UPDATE MICRA Signatures Submitted

Physicians Must Rally To Oppose Trial Lawyers On All Fronts Richard Thorp, MD President, California Medical Association


Watchdog, a front group for the Consumer Attorneys of California, submitted roughly 830,000 signatures to qualify a measure for the November ballot that would scrap key provisions California’s Medical Injury Compensation Reform Act (MICRA). The ballot measure is being floated under the guise of “consumer protection” when it is all about the bottom line for the state’s trial lawyers. Jamie Court, President of Consumer Watchdog, recently admitted in an interview with the Los Angeles Times that aspects of the ballot initiative – specifically those pertaining to physician drug testing – were added simply because they polled well and serve as the “ultimate sweetener.” This deceptive measure will raise health care costs for all Californians by lifting MICRA’s cap on non-economic damages, thus increasing lawsuits against health care providers and decreasing access to care for patients across the state. California’s physician community must join together and oppose this dangerous measure. This same trial lawyer group is also sponsoring candidates across the state in their bids for the state legislature. The California’s Political Action Committee (CALPAC) is working to defeat these candidates who would vote to change MICRA in the legislature. We need your support to continue to win at the ballot box and in the legislature.

Editorial Continued from page 6 9. T HERE IS NO LIABLITILY FOR THE INSURANCE COMPANIES OR FOR THE STATE AND/OR FEDERAL GOVERNMENT FOR MISRPRESENTING THE TRUTH OVER AND OVER AGAIN. There is a lawsuit currently in the Superior Court of the State of California, County of Los Angeles, sponsored by Edward Gaines, insurance broker and State Senator out of Rocklin. The lawsuit challenges whether Peter Lee, Executive Director of Covered California, has the right to prevent other insurance products from competing in the current market place. I am recommending the following: 1. Physician-representative organizations including the AMA, CMA, FMMS and subspecialty organizations must get the word out educating the public as well as our legislative representatives. 2. Educate physicians to the facts so they can make rational choices. Who determines what you are worth? Can you possibly survive financially? Should the government be able to control your insurance contracts, your business and every other aspect of your medical practice?

Please join your physician colleagues around California by I implore you contributing $150, $300, $500 or to donate to more to CALPAC. Visit https:// and login to make CALPAC – the your donation. state’s largest Your contribution to CALPAC physician run today will go directly to protecting MICRA and ensuring that all political action Californians have access to quality and committee – affordable health care. so it can We must reach every voter in California and educate them on continue its the dangers of losing our MICRA aggressive protections. efforts on Again, I implore you to donate $150, $300, $500 or more to CALPAC behalf of – the state’s largest physician run California political action committee – so it physicians. can continue its aggressive efforts on behalf of California physicians. Defeating the attacks on MICRA will be no small task, but together, I am confident we will be successful.

3. Promote a free market. What exists now is totally void of competition. The Blues have a total monopoly in the Valley. They fix your prices, but you the physician are legally unable of doing the same. 4. Support Edward Gaines, State Senator out of Rocklin and insurance broker in his lawsuit against the State of California. Call him at 916651-4001. 5. Feel free to talk to Barbara Cordova, my Office Supervisor at Spruce Multispecialty Group, 559-439-5757. She has been on the top of these issues and has given me supporting information. Horace Weinberg, MD, I appreciate your Editorial in the May 2014 issue of Vital Signs. You are right that there is no going back to “the way it was.” But we are where we are, and we need to confront the new realities of healthcare. We must be involved in the process, and we cannot continue to just sit back and observe. We are in the current situation because we have taken a back seat to the process. Whether you work at Kaiser, a private office setting, the VA, or a university-affiliated system we all are physicians, and the integrity of our profession is under attack. It is not just about us, it is about future generations of patients and doctors. We have no choice other than getting involved now. Author may be reached at



CMA NEWS Congress passes California Medicare GPCI fix, ICD-10 delay and SGR patch

On March 31, the U.S. Senate passed the “Protecting Access to Medicare

Act of 2014” bill to postpone for one year the 24 percent cut to Medicare physician payments as called for under the fatally flawed sustainable growth rate (SGR). The bill (H.R. 4302) was signed into law by the President on April 1. The bill, which already passed the U.S. House of Representatives last week, provides a 0.5 percent physician payment update through December 31, 2014, and then a 0 percent update until April 1, 2015. On a bright note, the patch bill does include the California Medicare locality update, known as the California geographic practice cost index (GPCI) fix. The long overdue GPCI fix will update California’s Medicare physician payment regions and raise payment levels for urban counties misclassified as rural, while holding remaining rural counties harmless from cuts. The bill also delays for one year the ICD-10 medical billing coding conversion, pushing the implementation date to October 1, 2015. The California Medical Association is waiting for guidance from the Centers for Medicare and Medicaid Services on how ICD-10 will ultimately be implemented. Watch for future news regarding ICD-10 implementation

CMA attends California Democratic, Republican Party Conventions to showcase health care efforts


California Medical Association (CMA) sent a large contingent of physicians, medical students and staff to the California Democratic


Party Convention in Los Angeles and the California Republican Party Convention in Burlingame. As the trial lawyers are major Democratic party financial contributors, our presence was critical to the ongoing battle over the Medical Injury Compensation Reform Act (MICRA). Joining the group of 3,000 California Democratic delegates and guests, CMA’s physicians and medical students, donning their crisp white lab coats, had a major presence. Roaming the halls, lining the backs of caucus rooms and speaking to delegates, CMA’s representatives were the talk of the convention. And, during the huge general session, students greeted hundreds of delegates with information regarding the trial lawyers’ ballot measure “sweetener” ploy. California Republicans have been consistent supporters of MICRA and other tort reform efforts, and this year is no different as we face the trial lawyers’ latest challenge. CMA’s representatives to the Republican convention not only spoke to the delegates about the critical importance of continuing to support MICRA, but also touched on many other health care issues facing physicians in Sacramento this legislative session.

Problems getting paid?


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) or economicservices@

CMA NEWS What Physicians Need to Know About the Anthem Exchange Addendum Anthem Blue Cross recently notified over 11,000 practices who are currently participating in its

individual/exchange network of a contract addendum that will become effective July 1, 2014. The amendment only applies to physicians who are currently participating in the Anthem Blue Cross individual/exchange network. According to the notice, which was mailed on March 31, the addendum contains new regulatory requirements. While many provisions are requirements of Covered California, the California Medical Association (CMA) has concerns with certain provisions that appear to be beyond the scope of regulatory requirements. The new language in section 7 contains a broad requirement that physicians participate in any existing or future quality initiatives of Anthem or Covered California. While Covered California does require qualified health plans (QHPs) to report on a number of quality measures, CMA is concerned that this broad provision could require physicians to comply with overly burdensome and/or costly requirements in order to meet current or future quality program criteria. Additionally, there are no exceptions if a physician is unable to comply with or report various quality or other performance measures. Additionally, and of significant concern, the language in section 12 removes a participating physician’s ability to opt out of just the individual/exchange product without affecting the underlying Prudent Buyer contract, as is allowed currently. Effective July 1, the only option for physicians who wish to opt out of the individual/exchange product is to terminate the underlying Prudent Buyer PPO agreement. CMA has expressed our concerns to Blue Cross on these issues and is awaiting a response. One other provision of note is section 10, which allows Anthem to share providers’ contracted rates with Covered California. While Covered California does require QHPs to provide access to provider rates as of July 2014, CMA has expressed concern with Covered California about the intended uses of this data. Physicians do have the right to opt out of the exchange product without affecting the underlying Prudent Buyer PPO contract if Anthem receives notice before the effective date of the addendum, July 1, 2014. If you do not wish to participate in the individual/exchange product, you can opt out by providing 90 days written notice, which should be sent via certified mail with return receipt, to Anthem Blue Cross Prudent Buyer Plan Contract Processing, Attn: Individual/Exchange Contract Processing, Mail Station 8A, P.O. Box 4330, Woodland Hills, CA, 91365-4330. The notice must be received by Anthem by June 30. In addition to the addendum, the notice included an invitation to attend a webinar on Anthem’s exchange products. The webinars will be offered in late April and will cover how to confirm participation status, provider networks, plan names, enrollment periods, covered benefits, sample ID cards, risk adjustment and provider resources. Physicians are as always urged to carefully review and assess the impact any contract changes or addendums will have on their practices. Questions and concerns about the Anthem exchange addendum should be directed to the Anthem Blue Cross Network Relations at 855-238-0095 or To help physicians understand their rights when it comes to health plan contract amendments, CMA has published “Contract Amendments: An Action Guide for Physicians.” Additional guidance on negotiating and managing complex third-party payor agreements is also available in CMA’s contracting toolkit, “Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors.” Both are available free to members in CMA’s online resource library. Questions: CMA reimbursement help line, 888-401-5911 or


EDUCATION SERIES CMA Center for Economic Services Webinars At-A-Glance Most webinars are FREE for CMA members and their staff, $99 for non-members.

A Webinar Invitation for All Physicians and Their Staff

The California Medical Association (CMA) offers programs to educate physicians and staff on a range of practice management issues. Space is limited, so register soon.

May 14: Merging Practices – Strategies to Remain Independent Debra Phairas• 12:15-1:15p.m June 18: Power of the Pen: The Physician’s Responsibility in Prescribing and Referring for Medi-Cal Patients DHCS• 12:15-1:15p.m. Presented by Presented by the Department of Health Care Services (DHCS), this webinar will help you understand the importance of documentation, understand the physician’s role in prescribing, ordering and referring, and increase awareness of fraud and abuse in prescribing and referring.

July 2: HIPAA Breach Notification and California Requirements David Ginsberg• 12:15-1:15p.m. Every medical practice in California has obligations to report breaches of unsecured patient information. In some cases reporting must be made within 5 days to California authorities, and promptly for HIPAA compliance. This webinar will review and simplify these requirements. These webinars are hosted by the California Medical Association. You must register at least one hour prior to the event. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Help Line at 800786-4262. MAY 2014 / VITAL SIGNS


HEALTHCARE REFORM Newly Released Payment Data Could Be Misleading

Last month, CMS publicly released Medicare payment data for the first time since 1979, showing how the program paid out $77 billion to more than 880,000 health care providers in 2012. The data included information on payments made under Medicare Part B to all participating providers (California Healthline, 4/9). While some physicians said the step toward transparency was needed, they also criticized CMS for releasing the information without any additional context and before they could review it for accuracy. For example, some physicians noted that the payments do not equate to profits but instead cover treatment costs and staff wages while some physicians noted that they are listed as the billing physician for Medicare services for an entire practice, even though they did not order the services themselves (Grady/Fink, New York Times, 4/9). For example, according to the data, Mayo Clinic Laboratories Director Franklin Cockerill received $11,068,463 in Medicare reimbursements in 2012.. However, Cockerill is named as the billing physician for more than 23 million tests performed annually by Mayo Clinic physicians, a Mayo spokesperson explained. Mayo Medical Laboratories Marketing Administrator Andy Tofilon added that Cockerill receives a salary and, therefore, “has no financial stake in being included in all of these reports” (Washington Post, 4/9). The American Medical Association – which opposed the release – noted that patients could misuse or misinterpret the data. Lawyers Analyze New Medicare Payment Data To Detect Fraud

Immediately following CMS’ release of Medicare payment data last week, lawyers who specialize in representing health care fraud whistleblowers began mining the information for possible indications of fraud, Reuters reports. Such lawyers focus on bringing cases against drugmakers and providers on behalf of employees who think other employees might be committing Medicare fraud (Baynes, Reuters, 4/14). According to Reuters, settlements resulting from whistleblower cases can be substantial, with the whistleblowers receiving up to 30% of the government’s recovered funds. Typically, lawyers receive about 40% of the whistleblower’s award. Patrick Burns, co-director of Taxpayers Against Fraud, said that he was contacted by a group of lawyers right after the release asking for his help accessing the data, which is available to the public online. Lawyers have said that the data could point to leads for new fraud allegations. According to Reuters, lawyers would still need to find clients who have inside knowledge of alleged fraud. Still, the data allow for employees who suspect fraud to now see whether their employers’ billing seems out of line with similar providers, according to Reuters (Reuters, 4/14). DOI Analysis: 43% of Medical Coverage Denial Appeals Are Successful

Patients who appeal the denial of health coverage for certain medical

services are successful about 43% of the time, according to an analysis of independent medical reviews by the California Department of Insurance, Capitol Public Radio’s “KXJZ News” reports (“KXJZ News” [1], Capital Public Radio, 4/1). The Affordable Care Act allows policyholders to appeal a denial of 10 MAY 2014 / VITAL SIGNS

health care services directly to the health plan and to a third party. Before the ACA, there was no consistent national process for appealing a denial of coverage for medical services (Bartolone, “KXJZ News” [2], Capitol Public Radio, 4/1). In 2001, California launched its Independent Medical Review program, an appeals process that allows California residents to challenge denials or delays of coverage by private health care insurers (Gorn, “Capitol Desk,” California Healthline, 2/3/12). IMR can overturn an insurer’s decision, in which case the insurer is required to immediately approve the patient’s health care service request. IMR also can approve an insurer’s denial of services. From 2001 to 2013, the DOI analysis found that after the state appeals process: • 2% of insurers’ decisions were withdrawn; • 43% of insurers’ decisions were overturned; and • 55% of insurers’ decisions were upheld (“KXJZ News” [1], Capital Public Radio, 4/1) Specifically, the analysis found that service denials were overturned in: • About 51% of Health Net cases; • About 52% of Blue Shield of California cases; • About 53% of Anthem Blue Cross cases; and • About 57% of Kaiser Permanent cases.

CIRM Offers Update on State’ Stem Cell Research Progress

At UC-Davis last month, the California Institute for Regenerative Medicine

gave an update on the state’s progress in stem cell research, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 4/1). California founded CIRM in 2004 after voters approved Proposition 71, which provided $3 billion to help stem cell researchers develop therapies for various conditions (California Healthline, 5/5/11). So far, more than 600 grants totaling about $1.9 billion have been awarded for stem cell research related to nearly 40 different diseases. An additional $500 million has been pledged or set aside for future projects. The agency has about $600 million left to award through 2017. After that, CIRM will need to look to private groups or another ballot measure to secure additional funding, the Business Journal reports. According to the Business Journal, nine of the first 14 research teams funded by CIRM have started to enroll patients in clinical trials or will begin doing so by the end of 2014. The trials will focus on finding treatments for diseases that include: blood disorders; degenerative eye disease; leukemia; sickle cell disease; solid tumor cancers; and Type 1 diabetes. Meanwhile, two research projects are already underway, according to CIRM staff. One program is focusing on test therapies for HIV/AIDS, while the other is studying treatment options for congestive heart failure (Sacramento Business Journal, 4/1).

AMA Report: U.S. Doctors Added $1.6T to Economy in 2012

U.S. physicians in 2012 contributed $1.6 trillion to the economy, and each doctor supported an average of about 13 jobs, according to an analysis released Wednesday by the American Medical Association. The analysis estimated that U.S. doctors supported more than 9.9 million jobs and paid more than $65 billion in local and state taxes. “AMA: Docs Add $1.6 Trillion to Economy” (Pittman, MedPage Today, 4/16).

Tulare Thomas Gray, MD

President’s Message The Hits Keep on Comin’

The MICRA fight is on. Unless you have been living in a cave, you are aware that the trial lawyer supported group, Consumer Watchdog, obtained the 800,000 signatures required to place an initiative on the ballot in November to challenge the MICRA cap. CMA and TCMS are part of Californians Allied for Patient Protection (CAPP), a coalition of medical groups, hospitals, health insurers, trade groups and California employers aligned to counter the offensive (and it really will be offensive) taking place by the lawyers. Three things are needed from you. 1) E  ducate yourself and your patients about the misleading purpose of the initiative. It does not protect patients; it protects lawyers’ incomes. It will decrease access to and increase the cost of health care in California. (www. 2) B  ecome a public proponent of MICRA. Sign the commitment card at the CMA website ( issues-and-advocacy/cmas-top-issues/micra) 3) Make a contribution. The campaign against this initiative will be very Help us at expensive. It is projected to be one of the most expensive initiative battles the Tulare in state history. And if we do not prevail, it will be much more costly to County Medical practice in our beautiful state. Open your checkbook and, to paraphrase Tammany Hall, “donate early, donate often.” (, keep and-advocacy/cmas-top-issues/micra) you informed Speaking of donating. April was National Donate Life Month. The CMA about events encourages MDs to discuss organ donation with patients. Twenty-one thousand patients are currently on the donor list in California and eighteen patients a day and legislative die waiting for a transplant in the state. People of color are a disproportionately issues that large number of those waiting for organs (38% Latino, 18% Asian, 13% Black). will affect Success rates are higher when organs are matched between members of the same ethnic group. While the demand is higher, lack of awareness regarding the your practice. need for and benefits of organ donation make the donor pool smaller. Consider Share a educating patients about the need for organ donation and adding your name current email to the list. Information is available at the Donate Life California website, www. address so you Did you hear the collective sigh of relief when the Senate passed the can receive Protecting Access to Medicare Act of 2014 last week? In a one line addition at the reminders end of the bill, implementation of ICD-10 was delayed another year. Everyone involved, physicians, coders, billing companies and hospitals felt relief from the of upcoming trepidation over the looming October start date. Even the consultants who are events. exorbitantly charging for advice must have been happy. They have another year to benefit from our fear. For the seventeenth time since 2003 the bill also delayed a permanent fix to the Sustainable Growth Rate (SGR) (boo) but prevented a 24% cut to the payments to doctors for treating Medicare patients (yea). A 0.5% physician payment update to Medicare reimbursement is effective through December 31, 2014, not to extend into 2015. Unfortunately, although there was agreement on the need to revise the SGR, Congress was unable to agree on a funding source that would provide for permanent Medicare payment reform. The same legislation fixed the California geographic practice cost index (GCPI) for fourteen California counties. This increases payments from Medicare to physicians in counties that have gone from rural to urban in the Metropolitan Statistical Areas (MSA). (Yea). Tulare, Kings, Kern and Fresno were not included in the ‘upgrade.’ (Boo). On the bright side, our base rate from Medicare cannot go lower than it is currently set. One advantage to being at the bottom of the well, you cannot go any lower. Speaking of implementing legislation. While Congress was obfuscating funding sources, CMS was moving to release physician Medicare payment data. As I write, information covering $77 billion of Medicare Part B payments to physicians in 2012 including physicians’ provider IDs, charges, patient volumes and reimbursements from Medicare Please see next page

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: Officers Thomas Gray, MD President Monica Manga, MD President-Elect Virinder Bhardwaj, MD Secretary/Treasurer Steve Cantrell, MD Past President Board of Directors Anil K. Patel, MD Carlos Dominguez, MD Pradeep Kamboj, MD Christopher Rodarte, MD Antonio Sanchez, MD Raman Verma, MD CMA Delegates Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates Robert Allen, MD James Foxe, MD Mark Tetz, MD Sixth District CMA Trustee Ralph Kingsford, MD Staff Francine Hipskind Executive Director Thelma Yeary Executive Assistant Dana Ramos Administrative Assistant



Tulare President Continued from page 11 will be made available for 550,000 doctors. The AMA had delayed release of the information with an injunction that lasted for 33 years until it was lifted last May by a federal judge. The public interest served is to “shed light on Medicare fraud, waste and abuse.” Physicians are concerned that this information can be misinterpreted by the public and add confusion and misperceptions regarding treatment and physician utilization. But now, after a 33 year delay, it is out there. Help us at the Tulare County Medical Society, keep you informed about events and legislative issues that will affect your practice. Share a current email address so you can receive reminders of upcoming events, like the Wine Tasting May 9. Call TCMS at 559-627-2262. Share your thinking with us. I also want to remind you about the interest TCMS has in physician wellness. A Physician’s Assistance Program is sponsored by the Foundation for Medical Care and the Tulare County Medical Society. It offers counseling support for member and non-member physicians practicing in Kings and Tulare counties and their spouses. Up to six sessions with a professional counselor are billed to the Foundation for Medical Care. For information about the benefits or services call the Medical Society at 559-6272262. There is no need to give your name. The program is completely confidential. After writings like this it is on my speed dial. Enjoy the Wine Tasting. You will need it. Author may be reached at thomasgray@cep. com.

We share important information with TCMS current members. Email us at: to be added to the list.


Tulare County Medical Society presents

Join us at the next Walk With A Doc to take a step toward a healthier you! All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness. TULARE Del Lago Park, Tulare, CA Saturday, May 17, 2014 and Saturday, June 28, 2014 8:00am to 9:00am VISALIA Riverway Sports Park, Visalia, CA Saturday, May 10, 2014 and Saturday, June 14, 2014 8:00am to 9:00am Who can attend: ANYONE For more information, please contact Tulare County Medical Society at (559) 627-2262

Are You Overpaying for Workers’ Comp Insurance? Rates for workers’ compensation insurance in California have been on a sharp upward trend lately. In the second half of 2013, for instance, rates increased by an average of 8.7%[1]. That’s after a 10% increase in the first half of 2013 [2]. The spike has left many physicians wondering if they’re paying too much for workers’ compensation coverage. And in today’s competitive healthcare environment, physicians need every edge they can get to ensure the profitability of their practices. Fortunately, there’s a fast, easy way to check rates on workers’ compensation insurance. Just call 800-842-3761 to compare your current policy with workers’ compensation insurance available through the Societies. FMMS/KCMS/TCMS understands the unique needs and challenges of its members. That’s why they sponsor highquality workers’ compensation coverage – at highly competitive rates. To ensure outstanding service to its members, FMMS/KCMS/TCMS has selected Mercer Health & Benefits Insurance Services LLC, to administer this program. As the world’s leading insurance broker, Mercer has the resources and expertise members need. Call a Mercer Client Advisor at 800842-3761 for your free, no-obligation quote. [1] Source: Workers Compensation Insurance Rating Bureau of California, http:// ppr_ filing _complete.pdf [2] Source: Business Insurance, https://www. NEWS08/130929901

Mercer Health & Benefits Insurance Services LLC CA Ins. Lic. #0G39709 65443/66831 (5/14) Copyright 2014 Mercer LLC All rights reserved. 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761

Kern Kings More Californians Have Access To Prescription Savings 2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: Officers Alpha J. Anders, MD President Michelle S. Quiogue, MD President-Elect Eric J. Boren, MD Secretary Bradford A. Anderson, MD Treasurer Wilbur Suesberry, MD Past President Board of Directors Alberto Acevedo, MD Lawrence N. Cosner, Jr., MD Vipul R. Dev, MD John L. Digges, MD Susan S. Hyun, MD Kristopher L. Lyon, MD Ronald Morton, MD Mark L. Nystrom, MD Edward W. Taylor, III, MD CMA Delegates Jennifer Abraham, MD Vipul Dev, MD John Digges, MD Lawrence N. Cosner, Jr., MD CMA Alternate Delegate Joseph H. Chang, MD CMA YPS Representive Joseph H. Chang, MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

Statewide Prescription Assistance Program Offers a Prescription to High Healthcare Costs

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581

The Centers for Disease Control reports that Americans spend more on

Officers Jeffrey W. Csiszar, MD President Vacant President-Elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President

prescription drugs than people in any other country: some $45 billion in out-of-pocket dollars in the last year alone. With that in mind, the California Rx Card is reminding physicians that their patients who aren’t insured or who take prescription drugs that aren’t covered by their health insurance plans, can use the California Rx Card to obtain discounts of up to 80 percent off the retail price for brand and generic FDA-approved medications. California Rx Card has been working closely with clinics and hospitals around the state to distribute free discount prescription cards to all Californians so that all residents will have access to this free program. California Rx Card was launched to help the uninsured and underinsured residents afford their prescription medications. The program can also be used by people that have health insurance coverage with no prescription benefits, which is common in many health savings accounts (HSA) and high deductible health plans. Another unique component of the program is their preferred pharmacy option. California Rx Card has chosen CVS/pharmacy as their preferred pharmacy so that residents who don’t have access to a computer and can’t obtain a hard card, can visit any CVS/pharmacy to have their prescriptions processed through California Rx Card. Residents can simply reference “California Rx Card” to have their prescription processed through the program. California Rx Card is accepted at over 56,000 participating regional and national pharmacies. California Rx Card has helped residents save over $242 million since its inception in October 2007. You can help by encouraging your patients to print a free California Rx Card at California Rx Card is also available as an app for iPhone and Android. You can search “Free Rx iCard” in the app store. Any physicians who are interested in ordering free cards for their clinic/hospital can email Edward Brown, Program Director, at

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 Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

2014 KCMS Membership Directory Available

Copies of the 2014 KCMS Membership Directory are available at the KCMS Office. The cost is $10 for members and $40 for non-members. If you need additional copies, call the KCMS Office and place your order. Orders for 1-5 can be mailed – all others must be picked up. All orders must be paid for in advance or at time of pickup. Supply is limited, so place your order now!

April 2014 Membership Recap Active.........................................................253 Resident Active Members...................2 Active/65+/1-20hr..................................4 Active/Hship/1/2Hship.....................0 Government Employed........................4 Multiple Memberships.........................1

Retired.........................................................62 Total.........................................................326 New Members (Pending Dues).........................................0 New Members (App Pending)........0 Total Members...............................326 MAY 2014 / VITAL SIGNS


Fresno-Madera Medical Society Presents Awards at Regional Science Fair The 61st Annual Central California Regional Science, Mathematics & Engineering Fair was held in March at the

Post Office Box 28337 Fresno, CA 93729-8337 1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: Officers Prahalad Jajodia, MD President A.M. Aminian, MD President-Elect Hemant Dhingra, MD Vice President Ahmad Emami, MD Secretary/Treasurer Ranjit Rajpal, MD Past President Board of Governors Alan Birnbaum, MD S.P. Dhillon, MD William Ebbeling, MD Anna Marie Gonzalez, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Alan Kelton, MC Constantine Michas, MD Trilok Puniani, MD Khalid Rauf, MD Roydon Steinke, MD CMA Delegates FMMS President Don Gaede, MD Michael Gen, MD Brent Kane, MD Brent Lanier, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD Praveen Buddiga, MD Surinder P. Dhillon, MD Trilok Puniani, MD Oscar Sablan, MD CMA Trustee District VI Virgil Airola, MD Staff Sandi Palumbo Executive Director


Fresno County Fairgrounds. The event provides an educational experience and stimulates young people’s interest in science, mathematics, computer, technology and engineering. It also provides for public recognition for their work. In addition to the regular panel of judges for the entire event, independent judges who represent government, professional and service organizations also judge and present awards within their specific areas. The FMMS sponsors awards related to medicine. FMMS thanks this year’s judges – UCSF-Fresno Residents: Drs. Anjani Kolahi, Teda Arunrut and Sara Higginson. This year’s winners and their projects are: Junior Division: • 1st place: Andrea Bogle; School: Granite Ridge Title: “Does a New Toothbrush Affect Gum Health?” • 2nd place: Isella Manzo / Kaylee Van Flue; School: American Union Title: “Keep Your Hands Clean” Senior Division: • 1st place: Nick Mah / Yousef Joseph; School: Clovis WestHigh School, Title: “Approach Studies to Subdermal Alternative to Determination of Blood Blucose Levels” • 2nd place: Julia Blanco; School: Clovis West High School Title: “The Effect of Video Games on Blood Pressure” Congratulations to all!

Is Your Office Manager Attending Medical Managers’ Forum Meetings? All it takes is a current and active email address. Contact Doreen at or 559-224-4224 ext. 112 to sign up! Medical Managers’ Forum provides a platform for medical managers and medical office staff to share specific needs and solutions based on their office experiences. The group also provides solution resources through seminars and workshops during the year. Membership is open to staff members of FMMS members’ offices and facilities. The group meets on an at-needed basis.

Next meeting TBA

The Fresno-Madera Medical Society welcomes new staff member: Doreen Chaparro.

Doreen will serve as the Physician Liaison/Peer Review Coordinator and will oversee the Medical Managers’ Forum. See above for her contact information.

Fresno-Madera SAVE THE DATE

­­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.

Multidisciplinary Approach to Recognizing and Treating Hyperparathyroidism


May 22, 2014 • 6pm-8pm featuring: Aron Gould-Simon, MD Radiologist Saima Crockett, MD Endocrinologist Christina Maser, MD Surgeon Fresno-Madera Medical Society Office 1040 E. Herndon Ave. #101 1.5 CME hours. Information: 559-224-4224, ext. 118 or


Fresno-Madera Medical Society presents

Just Walk! Walk with a Doc ‘Walk with a Doc’ strives to encourage healthy physical activity in people of all ages and reverse the consequences of a sedentary lifestyle. WHO CAN ATTEND: Participation is open to anyone interested in taking steps to improve their health.

Fresno Gastroenterology welcomes boardcertified physicians Dr. Paul Hanchett and Dr. Vivek Mittal. Referrals appreciated. Call 559323-8200 or Fax: referral to 559-323-9200. University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Call 559-3200580. FOR LEASE Office space at Chestnut/Herndon. Build to suit. 1,200 sf. Call 559-287-3279. PHYSICIAN WANTED Full or part time physician for Family Medicine office in Fresno. Good salary. Optional ownership in the future. Call Krystyna at 559-970-9191. Full or Part time physician wanted for local occupational medicine clinic to perform physicals on new hires. Call Su Rosenthal at 559-287-0172 or


HAROLD M. PRICE, MD 37-year member

Harold Price, MD, a retired pathologist, died March 17, 2014 at the age of 83. Dr. Price was born in Chicago in 1930. He received his medical degree from the University of Southern California School of Medicine in 1957 and completed his residency at the University Hospitals of Cleveland and a post fellowship at the Brain Research Institute at the University of California, Los Angeles . After serving in the US Army from 1962-1967, Dr. Price became Chief of Surgical Pathology at Magee Women’s Hospital in Pittsburgh and practiced at Cedars-Sinai Medical Center in Los Angeles. He moved to Fresno in 1976 and was Director of Pathology at Valley Medical Center. Dr. Price’s extensive background in the field of electron microscopy led to the acquisition of the first electron microscope in the Fresno area. Dr. Price is survived by his wife, four children and five grandchildren.


Woodward Regional Park Sunset View Shelter Registration 7:15am Walk Event 7:30am-8:30am May 31 June 28 July26


Town & Country Park Pavilion Area Registration 7:15am Walk Event 7:30am-8:30am May 3 June 7 July 12 FURTHER INFORMATION Fresno-Madera Medical Society (559) 224-4224, ext. 110 or at

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Vital Signs May 2014  

May 2014 Vol. 36 No. 5

Vital Signs May 2014  

May 2014 Vol. 36 No. 5