May 2013 â€˘ Vol. 35 No. 5
Official Magazine of FRESNO COUNTY Fresno-Madera F resno-Madera Medical Society KERN COUNTY Kern County Medical Society Kern KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Fresno-Madera Medical Society TULARE COUNTY Tulare T ulare County Medical Society
See Inside: May is Clean Air Month Act Now to Avoid Medicare Penalties Health Care Reform
We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.
SAN DIEGO ORANGE
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.
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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.
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M AY 2 0 1 3 / V I TA L S I G N S
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 MEDICARE: Act Now to Avoid Penalties in 2015........................................................................8 HEALTH CARE REFORM: Details Emerge About Health Provisions in Obama’s Budget Plan ...........9
May 2013 Vol. 35 – Number 5 Editor, Bonna Rogers-Neufeld, MD Managing Editor, Carol Rau
AIR QUALITY: Clean Air Month: Taking Positive Steps...............................................................12 The Connection Between Chronic Diseases and Dirty Air .....................................13 CLASSIFIEDS ...........................................................................................................................18 TULARE COUNTY MEDICAL SOCIETY.........................................................................................14
Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD John T. Bonner, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD
• May is National Asthma and Allergy Awareness Month KERN COUNTY MEDICAL SOCIETY ............................................................................................15 • President’s Message • Membership News FRESNO-MADERA MEDICAL SOCIETY .......................................................................................16 • President’s Message
Kern Representative John L. Digges, MD
• Walk With A Doc Dates Released
Tulare Representative Thelma Yeary
• Save the Date: FMMS Family Picnic – June 29
• Laennec Stethoscope Replica and History on Display
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.
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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 / M AY 2 0 1 3
Law OямГces of MICHAEL J. KHOURI MICHAEL J. KHOURI ATTORNEY AT LAW
. . .
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 www.khourilaw.com
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CMA NEWS NEW BREAST DENSITY NOTIFICATION LAW WENT INTO EFFECT APRIL 1
CMA ANNOUNCES 2013-14 SPONSORED LEGISLATION
On April 1, 2013, California’s new breast density law took effect,
lative focus for 2013 on increasing the numbers of physicians in the state and fighting the proposed 10 percent Medi-Cal provider rate reduction. These are the bills CMA will sponsor for 2013-14: UC Riverside Medical School (SB 21 and AB 27) – These bills would provide $15 million a year in funding for the recently accredited University of California Riverside School of Medicine. According to a 2010 report by the California Health Care Foundation, the Inland Empire has the lowest ratio of primary care physicians and specialists of any region in the state, with barely half of the recommended number. The UC Riverside School of Medicine is the first UC medical school accredited since the 1960s. GME Funding (SB 488) – This bill would augment the amount of graduate medical education (GME) funding that California receives in order to increase the number of resident physicians in California. Medi-Cal Cuts (SB 640) – This bill is the vehicle for a proposed rollback of the 10 percent Medi-Cal provider rate reduction contained in the 2011-12 state budget. CMA is building a coalition of different providers who have been impacted by the cuts or who, like CMA, are still in court over their implementation. This bill would both eliminate the retroactive cuts, as well as stop them going forward, helping to provide needed stability to the Medi-Cal system as the state prepares for full federal health reform implementation in 2014. Therapeutic Substance (AB 670) – This bill would close a loophole in the law that lets pharmacists receive financial incentives each time they recommend a therapeutic switch (a chemically different drug) from the drug prescribed by the physician. Physician Workforce: Medically-Underserved Communities (AB 1288) – This bill will serve to create additional residency slots across California and develop a stronger pipeline for physicians to serve in California’s medically-underserved communities. Employment of Physical Therapists (AB 1003) – Since 1990, the Physical Therapy Board of California has explicitly allowed physical therapy services to be provided by medical corporations. In 2010, the board rescinded this policy, threatening to disrupt the lives of hundreds of physical therapists who work for medical corporations, hospitals, home health care services and nursing care facilities. This bill will clarify existing law to explicitly authorize medical corporations to hire persons licensed under the Business and Professions Code, the Chiropractic Act or the Osteopathic Act. For more information, subscribe to CMA’s Legislative Hot List at www.cmanet.org/newsletters.
requiring health facilities that perform mammography to provide patients who have “heterogeneously dense breast or extremely dense breasts” with the following notice, in addition to the other findings of their mammogram: “Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer. This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.” The categorization of what constitutes dense breasts is based on the Breast Imaging Reporting and Data System established by the American College of Radiology and can be somewhat subjective. The new law does not create a new duty of care or legal obligations beyond the duty of the health facility performing the mammography to provide the notice. The California Medical Association (CMA), however, remains concerned that such a notice places physicians in the position of counseling patients regarding breast density when there are no medical guidelines or scientific data to help interpret the report or to determine what, if any, additional testing should be done for patients with dense breast tissue. While the intent of the law (SB 1538) is to give women more power and control over their health, CMA is concerned that it may impose undue cost burdens on the patient. Because high breast density is not currently by itself a risk factor for cancer in medical guidelines, in cases where prior authorization is required for additional screening, the tests may not be covered by their insurance. If a patient inquires about breast density after receiving the mandated notification, physicians should provide patients with information regarding breast density and discuss their lifetime personal risk of breast cancer and appropriate screening and diagnostic tools specific to their needs. A brochure to help patients understand breast density is available on the American College of Radiology website here. For more information, see CMA On-Call document #3112, “Cancer Information Requirements.” This document, available in CMA’s online health law library, is available free to members at www.cmanet.org/cma-on-call. Nonmembers can purchase this and other documents for $2 per page. Physicians can find information and guidelines on breast density on the American College of Radiology website (www.acr.org) and the California Academy of Family Physicians website (www.familydocs.org/practice-management-news). More information on breast cancer screening can be found on the American Congress of Obstetricians and Gynecologists website (www.acog.org).
The California Medical Association (CMA) has placed its legis-
URGENT: PROVIDERS WHO REFER, ORDER OR PRESCRIBE FOR MEDI-CAL BENEFICIARIES MUST ENROLL WITH DHCS
The Department of Health Care Services (DHCS) made changes in January to its Medi-Cal provider enrollment requirements as a result of the Patient Protection and Affordable Care Act (ACA). One of the changes now requires all providers who order, refer or prescribe (including but not limited to physicians, NPs, and PAs) be enrolled in the Medi-Cal program. Previously, providers needed to enroll only if they wished to furnish (and bill for) covered services for Medi-Cal beneficiaries. Please see CMA News on page 7 V I TA L S I G N S / M AY 2 0 1 3
“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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CMA NEWS Continued from page 5 If an ordering and/or referring provider (ORP) is not enrolled in Medi-Cal, the “filling providers” (for example, the pharmacy that is filling the patient’s prescription or the specialist you are referring a patient to for treatment) will not be paid. As a result, patients may not receive needed items or services if the “filling providers” refuse to accept orders or referrals from providers who are not enrolled in Medi-Cal. Although the new requirement took effect January 1, 2013, DHCS established a grace period to allow more providers to enroll before claims are denied. The grace period could end at any time, and ORP providers are encouraged to complete the enrollment process as soon as possible. ORP providers are providers who enroll for the sole purpose of ordering, referring or prescribing to covered beneficiaries and who do not directly submit claims for their services. Please note that this type of enrollment does not allow the Medi-Cal program to reimburse the ORP-only provider for services provided directly to Medi-Cal beneficiaries. Providers who are already enrolled in Medicare or Medi-Cal under their individual (type 1) National Provider Identifier (NPI) number do not also have to enroll as ORP providers. The providers that may be affected by this change include individual physicians or physicians employed by physician groups, federally qualified health centers, rural health clinics, critical access hospitals, the Department of Veterans Affairs, Department of Defense TRICARE program and the Public Health Service. For information, or to enroll as an ORP provider, visit the DHCS website. The ORP enrollment form is “DHCS 6129.” For questions regarding enrollment as an ORP provider, contact the DHCS Provider Enrollment Division at email@example.com or 916-323-1945.
CMA LEADERSHIP ACADEMY TO FOCUS ON FUTURE OF INDEPENDENT PRACTICE
The California Medical Association (CMA) will discuss the future of independent medical practice at the 16th Annual California Health Care Leadership Academy, which will be held in Las Vegas at the Planet Hollywood Resort and Casino May 31-June 2, 2013. The program, entitled “Increasing the Odds of Success,” will feature health futurist Jeff Goldsmith, Ph.D., who will speak about the pressures that independent medical practices face as hospital and health plans acquire physician practices at an accelerated pace in the wake of federal health system reform. Also offered will be practice management workshops designed to assist independent practices navigate health reform. The complete agenda for the conference is available and brochures will be mailed to all CMA members. Registration is open and can be completed online at www.caleadershipacademy.com or by calling 800-795-2262. Room reservations at Planet Hollywood Resort and Casino can be made through the link on the academy website or by calling 866-3171829 (mention the Leadership Academy to receive the discounted group rate). Contact: CMA Leadership Academy hotline, 800-795-2262 or firstname.lastname@example.org.
Education Series CMA Center for Economic Services
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
May 1: The Power of the Pen – The Physician’s Responsibility in Prescribing and Referring for Medi-Cal Patients DHCS • 12:15-1:15pm 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/referring, and increase awareness of fraud and abuse in prescribing and referring.
May 8: Time Management – How to Quickly Make Decisions on What Matters Most Rachel Smith • 12:15-1:15pm Learn how to value what matters most and achieve your goals by understanding what you are giving away and practicing simple tools to find solutions (not excuses) to get what matters most checked off the list. This interactive webinar will provide live one-on-one coaching to illustrate and use the techniques taught in this session.
May 15: Enforcement Provisions of the Medical Practice Act Medical Board • 12:15-1:15pm Presented by the Medical Board of California, this webinar will describe basic facts about physicians licensed by the Board, including residence, age and specialties. Additionally, learn about laws regarding the Medical Board’s enforcement program, including the factors that can get a physician into trouble (most common mistakes, complaints and actions); the process from complaint receipt to adjudication; and why there is a physician interview and the benefits to fully responding. The webinar will also cover the sunset review process and the issues that are being discussed at the legislative level to enhance the law for consumer protection.
May 16: Essentials for ICD-10-CM: Part 1 AAPC • 7:45-8:45am or 12:15-1:15pm Part 2 continued on May 23 and Part 3 continued on May 30 This three-part series gives your staff a high-level overview and fundamental knowledge of ICD-10. You’ll learn documentation challenges, the differences with ICD-9, and how ICD-10 will affect each business area of your practice.
May 22: Documentation & Coding Auditing: Lessons Learned AAPC • 7:45-8:45am or 12:15-1:15pm Documentation and coding are critical elements to both practice revenue as well as compliance. At a minimum your practice may be losing revenue due to improper coding or documentation. Worse, you may be exposing your practice to tremendous compliance and financial risk. During this 60-minute webinar, join expert auditors from AAPC Physician Services who will share lessons learned from having conducted over 75,000 audits.
May 29: Estate Planning After the Fiscal Cliff Mark Drobny, JD • 7:45-8:45am or 12:15-1:15pm Now that the exemption for estate taxes is $5.25 million, what do you need to do? Are annual gifting and 529 education funds no longer necessary? When are family limited partnerships still useful? Do AB trusts still make sense? Should you keep or cancel your life insurance policies? What are intentionally defective grantor trusts, and when do they make sense? If you already have an estate plan, or have done no estate planning, what do you need to do? Hosted by a California State Bar Certified Specialist in Estate Planning, Trust and Probate Law. V I TA L S I G N S / M AY 2 0 1 3
Act Now to Avoid Medicare Penalties in 2015 Over the past six years, the Centers for Medicare and Medicaid Services (CMS) has launched a number of initiatives that offer physicians the opportunity to increase their net revenue by participating in quality reporting programs. Until now, these programs have been voluntary and physicians have received bonuses for participating. That’s about to change. Failure to participate now means physicians could face significant penalties. The American Academy of Family Physicians estimates that participating in these initiatives in 2013, rather than waiting until 2014, could save a physician $19,000 in avoided penalties. To help physicians understand the bonuses and penalties associated with key Medicare initiatives, the California Medical Association (CMA) recently hosted a webinar for members, “Quality Reporting Programs: What Physicians Need to Know and Do Now to Improve Care and Avoid Penalties.” The webinar is now available for on-demand viewing in the CMA resource library at www.cmanet.org/webinars. During the webinar, CMS Region 9 Chief Medical Officer, Betsy L. Thompson, M.D., discusses about the major quality reporting and e-health incentive programs currently underway for eligible professionals. The session covers the basics of the Physician Quality Reporting System, the Medicare and Medicaid Electronic Health Records Incentive Programs, the Medicare EPrescribing Incentive Program and the new value-based payment modifier. The content is geared toward physicians, nurse practitioners and physician assistants and what they need to know, although other health care professionals and medical office may find the information useful, as well. If you are not already familiar with each of these programs, the time to learn about them is now. Below is a brief summary of the programs and key dates that were discussed in the CMA webinar. MEANINGFUL USE Meaningful use is the set of criteria on which physicians must report in order to receive federal incentive payments for EHR adoption under the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs. Meaningful use is also the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments and value-based purchasing. Bonuses: For the Medicare EHR incentive program, your cumulative payment amount depends on the first year of participation. Physicians who start participating in 2013 can receive up to $39,000; physicians who start in 2014, up to $24,000. The last year to begin participation in the Medicare EHR incentive program is 2014. For the Medicaid (Medi-Cal) incentive program, physicians can receive up to $63,750. Penalties: Physicians who do not demonstrate meaningful use by 2015 will be subject to Medicare payment penalties. These reductions increase from 1-2 percent of total Medicare charges in 2015, to 2 percent in 2016 and 3-5 percent in 2017 and beyond. Medicaid rates will not be adjusted for failure to achieve meaningful use.
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ELECTRONIC PRESCRIBING Medicare’s e-prescribing program provides incentive payments for physicians who e-prescribe and payment penalties for physicians who do not. Bonuses: This year is the last year to receive a bonus for eprescribing.To qualify for the 0.5 percent bonus in 2013, you must have successfully reported e-prescribing activity for at least 25 patient visits between January 1 and December 31, 2012. Penalties: Starting in 2012, physicians who did not electronically transmit their prescriptions became subject to payment penalties on all Medicare allowed charges. The penalty in 2013 is 1.5 percent, and in 2014, 2 percent.
PHYSICIAN QUALITY REPORTING SYSTEM The Physician Quality Reporting System (PQRS) is a voluntary quality reporting program that provides incentive payments to eligible professionals who report data on quality measures for services provided to Medicare beneficiaries. Bonuses: Physicians must report on three individual measures or one measures group to receive a 0.5 percent bonus. Physicians participating in a maintenance-of-certification program are eligible for an extra 0.5 percent bonus, for a total bonus of 1 percent. Penalties: The Affordable Care Act calls for PQRS payment penalties starting in 2015. In the 2012 Medicare Physician Fee Schedule, CMS announced that 2015 program penalties will be based on 2013 performance. Therefore, physicians who do not successfully report on at least one individual measure in 2013 or elect to participate in the administrative claims reporting option will receive a 1.5 percent payment penalty in 2015. The penalty goes up to 2 percent in 2016 and beyond.
VALUE-BASED PAYMENT MODIFIER PROGRAM The value-based payment modifier was mandated by Congress under the Affordable Care Act. It will adjust physician payment based on the quality and cost of the care they provide. It will take effect in 2015 using 2013 data for groups of 100 or more physicians. By 2017, this modifier will be implemented for all physicians. Bonuses: Participating physicians may receive bonuses based on their quality and cost scores. Penalties: Participating physicians may be penalized up to 1 percent based on their quality and cost scores. Physicians who choose not to participate will be docked 1 percent. Each of these programs has specific deadlines and reporting requirements, some of which are overlapping, and are not always simple to understand. CMA’s webinar will give physicians the information they need to successfully participate in each program. During the webinar, Dr. Thompson will help participants understand which programs they are eligible for, the associated incentives and penalties for each program, and the deadlines and requirements for participation. The on-demand webinar is available free to CMA members at www.cmanet.org/webinars. Nonmembers can purchase the webinar for $99. Contact: CMA’s member service center, 800-786-4262 or email@example.com.
HEALTH CARE REFORM Details Emerge About Health Provisions of Obama’s Budget Plan Additional details are emerging about the $3.77 trillion fiscal year 2014 budget blueprint that President Obama released, the New York Times reports. Obama’s plan aims to reduce the federal deficit by $229 billion from FY 2013 through a combination of tax hikes for higher-income individuals and targeted spending cuts over a decade (Calmes, New York Times, 4/10). Overall, the blueprint aims to reduce the federal deficit by $1.8 trillion over a decade, bringing the deficit to about $500 billion in 2016 and down to 1.7% of the economy by 2024 (California Healthline, 4/10). The proposal would replace the $1.2 trillion in across-the-board spending cuts under the sequester with other savings over the 10-year period. The sequester – which took effect March 1 – includes a two percent reduction to Medicare reimbursement rates for providers (New York Times, 4/10). Obama’s budget plan calls for $400 billion in health care savings. The bulk of the savings would come from reduced payments to health care providers, including hospitals, The Hill’s “Healthwatch” reports (Baker , “Healthwatch,” The Hill, 4/10). According to Politico, the hospital savings would be used to help the government cover “bad debt” (Haberkorn, Politico, 4/11). Medicare savings also would come from raising premiums for higher-income beneficiaries, which the budget plan estimates would save about $50 billion over the next decade. In total, Obama’s spending blueprint would cut about $68 billion from Medicare benefits. Meanwhile, the plan calls for nearly $150 billion in cuts for the pharmaceutical industry. Under this proposal, changes to Medicare payment rates for prescription drugs and new policies that would introduce low-cost generic drugs more quickly into the market would result in more than $6 billion in savings (Baker , “Healthwatch,” The Hill, 4/10). Please see Health Care Reform on page 10 V I TA L S I G N S / M AY 2 0 1 3
HEALTH CARE REFORM Continued from page 9 Obama’s budget blueprint also seeks increased funding for CMS and the Internal Revenue Service to help the agencies implement various portions of the Affordable Care Act, the Washington Times reports. The proposal requests $440 million for the IRS, which must process tax credits for the ACA’s health insurance exchanges and assess tax penalties under the law’s individual mandate (Howell, Washington Times, 4/10). Meanwhile, CMS’ budget would increase from $3.8 billion in FY 2012 to $5.2 billion, of which $1.5 billion would be allocated for the implementation of the ACA’s health insurance exchanges, which are scheduled to begin operating in 2014 (Politico, 4/11). Budget Plan Aims To Bolster Mental Health Services, Food and Drug Safety In addition, Obama’s FY 2014 budget proposal requests $130 million to expand mental health treatment and prevention services, CQ HealthBeat reports. Of that, about $55 million would be used to provide school officials with mental health “first aid” training to identify early warning signs of mental illness. The proposal also calls for $50 million to help train 5,000 counselors, psychologists and social workers to serve students and young adults, and $25 million for grants to help young people find and access mental health treatment programs. Meanwhile, the plan calls for a 21% boost in funding for FDA over its FY 2012 budget to $4.7 billion. Obama’s budget requests for NIH and CDC were significantly smaller. He is seeking $472
million for NIH – which includes extra funding for Alzheimer’s disease research – and $432 million for CDC (Reichard, CQ HealthBeat, 4/10). Other key parts of Obama’s FY 2014 budget proposal include provisions to: • Create a new category to health plans offered in the Federal Employees Health Benefit Program – called “self plus one” – that would allow same-sex couples to share a policy without violating the Defense of Marriage Act (Baker , “Healthwatch,” The Hill, 4/10); and • Increase funding for the Health Resources and Services Administration by $9 billion, including $2.4 billion for the Ryan White program to help individuals living with HIV/AIDS. Reactions to Obama’s FY 2014 Budget Proposal The plan promptly drew a mix of criticism and praise from lawmakers, industry officials and advocacy groups, and was dismissed by Republican leaders, who pledged to withhold their support for tax increases as part of a deficit-reduction deal, Politico reports. Chip Kahn, president of the Federation of American Hospitals, criticized the cuts to hospital payments saying, such proposals are “counterproductive” and “mask efforts to attack the true drivers of cost in the health care system and will make the task of finding a durable solution addressing Medicare’s fiscal viability even more difficult” (Haberkorn, Politico, 4/11). Continued on page 11
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HEALTH CARE REFORM Continued from page 10 In a statement, American Medical Association President Jeremy Lazarus said many of Obama’s proposals “align with many of the principles developed by the AMA and 110 other physician organizations on transitioning Medicare to include an array of accountable payment models” and praised the plan for seeking to boost funding to expand mental health services (American Medical Association release, 4/10). Meanwhile, AARP Executive Vice President Nancy LeaMond in a statement said that “prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs” (AARP release, 4/10). Read more: http://www.californiahealthline.org/articles/2013/ 4/11/details-emerge-about-health-provisions-of-obamas-budgetplan.aspx#ixzz2QYCSy9Xi
LAWMAKERS QUESTION ROLE OF NAVIGATORS IN HEALTH PLAN EXCHANGES
House Republicans have requested more details on the role that navigators will play in the Affordable Care Act’s health insurance exchanges, The Hill’s “RegWatch” reports (Hattem, “RegWatch,” The Hill, 4/12). The query follows the Obama administration’s announcement that $54 million in grants are now available for navigators in the 33 states that will have federally run or partnership exchanges (Norman, CQ HealthBeat, 4/12). Under the ACA, each exchange must have two certified navigators, one of which must be a not-for-profit. The navigators are expected to provide “fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process” (California Healthline, 4/10). In a letter to HHS Secretary Kathleen Sebelius, six GOP members of the House Energy and Commerce Committee posed seven questions “to assist the committee in understanding the role navigators will play” once the ACA is fully implemented, including how many will be deployed across the country (“RegWatch,” The Hill, 4/12). In addition, the lawmakers questioned where the funding for grants will come from and whether more money beyond the initial $54 million will be spent on the program in the future. They also asked how the money would be distributed among states and what role the navigators would play in states building their own exchanges. Further, the lawmakers requested copies of the application forms that navigators will be required to fill out, as well as documents relating to their pay. They asked which groups, individuals and others are entitled to be navigators, particularly whether insurance agents would be eligible. According to a proposed rule released earlier, navigators cannot receive compensation to sell health insurance. The lawmakers also wanted clarification on how navigators will be trained in enrollment processes, how they will be monitored and how their performance will be assessed.
The group requested that answers to their queries be submitted by the end of April. Read more: http://www.californiahealthline.org/articles/ 2013/4/15/lawmakers-question-role-of-navigators-in-healthplan-exchanges.aspx#ixzz2QYDRVo3c
LOOPHOLE COULD ALLOW INSURERS TO AVOID ACA MANDATES THROUGH 2014
health insurers are planning to let millions of U.S. residents renew their current coverage to avoid new requirements under the Affordable Care Act, a move that critics say could temporarily derail efforts to reform the insurance market, the Los Angeles Times reports. Although it is widely believed that all health insurers must immediately comply with the ACA beginning in 2014, a loophole in the law allows insurers to extend existing coverage through the end of 2014 without following the new rules. For example, insurers could focus on renewing younger and healthier beneficiaries, thereby withholding them from the broader insurance pool in 2014, which could lead to higher costs for sicker and older populations in government health insurance exchanges. In addition, observers say that insurers might rush to enroll more people in individual policies before December so that they then can extend those policies through next year. Christine Monahan, a senior analyst at the Georgetown University Health Policy Institute, said, “This could undermine the [ACA], and it opens the door for exacerbating potential rate shock in the exchanges.” The strategy could affect millions of people who will purchase health coverage through government exchanges or who buy their own insurance. However, it will not affect those with employersponsored health plans, according to the Times. UnitedHealth Group, the largest U.S. insurer, said it still is determining how to move forward. WellPoint has said its renewal policies will vary by state, while Kaiser Permanente said it will not renew policies beyond Jan. 1, 2014, in California and in most other states where it offers coverage (Terhune, Los Angeles Times, 4/2). Read more: http://www.californiahealthline.org/articles/ 2013/4/3/loophole-could-allow-insurers-to-avoid-aca-mandatesthrough-2014.aspx#ixzz2QY9lZMkf
EXPERTS FORECAST TREND OF STATE HOSPITAL CLOSURES UNDER ACA
say that they expect several small- and mid-sized California hospitals to close amid implementation of the Affordable Care Act, the Los Angeles Times reports. PHC Hospital Closures Officials with Pacific Health Corporation said they are closing four hospitals in part because of legal costs associated with federal allegations that the facilities recruited homeless patients and provided them with unnecessary health care services in an effort to defraud Medicare and Medi-Cal, California’s Medicaid program (Terhune, Los Angeles Times, 4/3). Please see Health Care Reform on page 18 V I TA L S I G N S / M AY 2 0 1 3
AIR QUALITY Clean Air Month: Taking Positive Steps Dr. Praveen Buddiga
With May being Clean Air & Asthma Awareness Month, what better time to educate yourself and your patients on how to improve the air quality both in and out of your home. Supported by the American Lung Association and a wide number of health organizations, Clean Air Month educates people about the impact clean air can have on their lives. This observance also encourages people to take positive steps to help improve air quality. Clean Air Month: Taking Positive Steps • The Clean Air Act came into force in 1970. This Act has been successful in reducing air quality related health conditions and premature death. • Clean Air Month is a time for many states to celebrate the impact the Clean Air Act has had on the way people think about the environment and on the overall health of its people. • Clean Air Month is recognized in many states across America. Events are held throughout the month of May to promote awareness. These have included ‘Bike To Work Days’ and ‘Share A Car Days’. Some states offer Air Management Programs and timely reporting on state and federal air quality issues. You can help! Get involved and educate your patients. We can all make a difference. So what exactly is clean air? Clean air is air, which has a natural balance of gases such as oxygen, nitrogen and carbon dioxide. Clean air does not contain pollutants or allergens. Clean air does not harm the environment, nor is it a cause or trigger of health problems. So what are the consequences of dirty air? Poor quality air can harm the environment and affects us all. Toxic air pollution is linked to serious conditions such as cancer, heart attacks, onset of new asthma and chronic bronchitis. Air pollution can exacerbate pre-existing conditions such as asthma. Air pollution can also harm the environment. The burning of fossil fuels (often for transport or electricity generation) releases high levels of sulfur dioxide and nitrogen oxide into the atmosphere. These gases react with other gases and water to create rain, which is acidic. Pollutants that affect clean air & the environment include: • Acid Rain • Ozone • Toxic Air Pollution • Lead • Sulfur Dioxide • Particulate Soot • Carbon Monoxide If you’re not sure where to begin, here are some tips to help get started.
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In the home: Get some fresh air! Create a cross breeze by opening a few windows and running your AC or HEPA fans. Start by checking your local news station or newspaper to find out what the air quality forecast is as well as what the allergy forecast is for your community each day. Or you can visit www.valleyair.org and get an app! This will help you determine if you want to open your windows or run your AC. Clean house! Vacuuming and dusting once a week can remove allergens that not only aggravate your allergies but those that trigger asthma attacks and other breathing problems. Don’t forget to wash your bedding each week as well. Pillows, mattresses and bedding are harbors for dust mites. Wash in hot water and use high heat to control this trigger. In the yard: Check Before You Burn! Fireplace smoke is not only an irritant but a pollutant. The San Joaquin Valley Air Pollution Control District (SJVAPCD) can tell you which days are best for using your fireplace. Switch to a gas BBQ’er! Charcoal BBQ’s send a lot of smoke into the air and sprays like insect repellent can irritate those with breathing problems. Even the presence of mosquitoes could be considered an air quality issue. Switch to electric powered lawn equipment! Did you know the SJVAPCD has incentive programs to help you make the switch? Mowing the lawn can aggravate allergies, asthma and other breathing problems. So try to do it when sensitive (children, elderly and those with lung illnesses) folks aren’t around. If you are not a fan of electric powered equipment you can always go back to the push mower. Leaf blowers create a huge health hazard. Try to use a good old fashion rake and ask your gardener to help. Beyond the home: Spare the Air and Health Air Living! There are plenty of things you can do to help clean our air. Idling and moving vehicles (your car, school buses, semi-trucks, etc.) creates a lot of pollution. The SJVAPCD estimates that 80% of our pollution comes from vehicles. So try to take the bus, carpool, walk or bike if you can. Tune in and Tune Up! Keep your car tuned up. Old vehicles and non-smog checked vehicles create a lot of pollution. Check for Tune in and Tune Up events in your community. Incentives are provided to help get your car cleaned up. Visit www.valleyair.org for: • Air Quality Forecast • Real Time Air Advisory Network • Check Before You Burn • Healthy Air Living • E-trip • Air Alerts
AIR QUALITY The Connection Between Chronic Diseases and Dirty Air Michelle Garcia, Air Quality Director
Outdoor air pollution is caused by small particles and ground level ozone that comes from car exhaust, smoke, road dust and factory emissions. Outdoor air quality is also affected by pollen from plants, crops and weeds. Particle pollution can be high any time of year and are higher near busy roads and where people burn wood. When inhaled, outdoor pollutants and pollen can aggravate the lungs, and can lead to chest pain, coughing, digestive problems, dizziness, fever, lethargy, sneezing, shortness of breath, throat irritation and watery eyes. Outdoor air pollution and pollen may also worsen chronic respiratory diseases, such as asthma. Two key air pollutants can affect asthma and other respiratory illnesses such as chronic obstructive pulmonary disease, bronchitis, emphysema, etc. One is ozone. The other is particle pollution (found in haze, smoke, and dust). When ozone and particle pollution are in the air, adults and children with asthma are more likely to have symptoms begin up to a day after they have been outdoors in polluted air. Air pollution can make people more sensitive to asthma triggers, like mold and dust mites. According to the California State University Fullerton Study (2008) the San Joaquin Valley is exposed to life-threatening pollutants on a regular basis. The cost of air pollution in the San Joaquin Valley is more than $1,600 per person per year, or $6 billion to the region’s economy, according to the researchers. Exposure to air pollution causes premature death, hospitalizations and respiratory symptoms, limiting a person’s normal daily activity and increasing school absences and loss of workdays, said the researchers. The cost reflects the impact these health problems have on the economy. Each year, the life- and health-threatening levels of pollution cause the following adverse health effects: • Premature deaths among those ages 30 and older: 3,812 • Premature deaths in infants: 13 • New cases of adult onset chronic bronchitis: 1,950 • Days of reduced activity in adults: 3,517,720 • Hospital admissions: 2,760 • Asthma attacks: 141,370 • Days of school absence: 1,259,840 • Cases of acute bronchitis in children: 16,110 • Lost days of work: 466,880 • Days of respiratory symptoms in children: 2,078,300 • Emergency room visits: 2,800
You can take steps to help educate your patients about the harmful effects of air pollution. Simple messaging such as: • Obtain current information about your local air quality in order to know where and when air pollution may be bad. • Ozone is often worst on hot summer days, especially in the afternoons and early evenings. • Therefore, outdoor physical activity should be planned . • Physical activity is important to staying healthy you just need to plan accordingly. • Particle pollution can be bad any time of year, even in winter. It can be especially bad when the weather is calm, allowing air pollution to build up. • Air pollution is worse near busy roads, during rush hour (school drop off and pick up times) and around factories. • Smoke in the air from wood stoves, fireplaces, wildfires and burning (vegetation, agriculture waste, garbage, etc.) make the air unhealthy to breathe. Author can be contacted at firstname.lastname@example.org. Resources: Air quality and health: • Fresno-Madera Medical Society (FREE educational brochures for patients written by physicians (What your doctor wants you to know about air pollution.) • Department of Public Health Fresno County at http://www.co.fresno.ca.us/DivisionPage.aspx?id=976 • Central Valley Air Quality Coalition (a coalition of over 70 community organizations working on air quality issues in the Valley) at http://www.calcleanair.org • EPA’s AIRNow website at www.epa.gov/airnow • Call 1-800-490-9198 to request free EPA brochures on: Ozone and Your Health, Particle Pollution and Your Health, and Air Quality. • Centers for Disease Control and Prevention (CDC) Web site at www.cdc.gov/asthma 1. http://www.epa.gov 2. http://calstate.fullerton.edu/news/2008/091-air-pollution-study.html Dirty Air Costs California Economy $28 Billion Annually, California State University Fullerton, November 12, 2008: No. 091.
For further FMMS Air Quality Program information, visit www.fmms.org.
V I TA L S I G N S / M AY 2 0 1 3
Tulare May is National Asthma and Allergy Awareness Month A.M. Aminian, MD, Medical Director, Allergy Institute
EXERCISE-INDUCED ASTHMA: HOW IT MAY AFFECT YOU 3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org
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 CMA Delegates: Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates: Robert Allen, MD Ralph Kingsford, MD Mark Tetz, MD 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
Jane Doe, 40, does not suffer from asthma, but when she was a teenager on the High School competitive swim team, she knew something was wrong. After six hours of intense outdoor exercise in the pool every day, she began to wheeze and cough; but when she was out of the pool, she no longer experienced any symptoms. Jane was suffering from exercise-induced asthma (EIA). Exercise-induced asthma (EIA) is a condition of respiratory difficulty that is triggered by aerobic exercise and lasts several minutes. Symptoms of EIA may resemble those of allergic asthma, or they may be much vaguer and go unrecognized, resulting in probable underreporting of the disease. Typically, the individual will experience breathing difficulty within 5-20 minutes after beginning aerobic exercise. Symptoms may include wheezing, a tightening of the chest, coughing, and even chest pain. Other symptoms may include prolonged shortness of breath, often beginning 5-10 minutes after brief exercise. EIA is experienced by approximately 12-15 percent of the population. Approximately 90 percent of asthmatics in general and 35-45 percent of people with allergic rhinitis (nasal membrane inflammation due to allergen exposure) experience EIA. Because EIA is not necessarily linked to normal asthma triggers, exercise can induce an asthma attack even in people who have no other triggers and do not experience asthma under any other circumstances. People with exercise-induced asthma are believed to be more than usually sensitive to changes in the temperature and humidity of the air. For example, when you are at rest, you breathe through your nose, which serves to warm and humidify the air you breathe in to make it more like the air in your lungs. But when you exercise, you breathe through your mouth and the air that hits your lungs is colder and drier. The contrast between the warm air in the lungs and the cold inhaled air can trigger a bronchial spasm. In addition to mouth-breathing, air pollutants, high pollen counts, and viral respiratory tract infections can also increase the severity of wheezing with exercise. Certain sports and their environments predispose individuals with asthma to experience EIA. Sports played in cold and dry environments usually result in more symptom manifestation for athletes with this condition. On the other hand, when the environment is warm and humid, the incidence and severity of EIA decreases. Specifically, when the attack is triggered, the airways begin to swell and secrete large amounts of mucus, which can partially block and obstruct the airways. It becomes difficult to exhale. In extreme cases, hives or anaphylaxis, a life-threatening condition, can occur. Young people, because they tend to be more active, are more likely prone to EIA and often deny their symptoms due to peer pressure, embarrassment, fear of losing their position on the team, or misinterpreting their symptoms as normal post-exercise fatigue. Exercise is important to lung development, heart health, physical fitness, and weight management. Exercise-induced asthma should not be used as an excuse to avoid exercise or participating in athletics. Almost all people with EIA should be able to exercise to their full ability. With proper diagnosis and treatment, anyone should be able to enjoy the benefits of an exercise program without experiencing asthma symptoms. Author can be reached at: email@example.com.
The Tulare County Medical Society and Visalia Unified School District would like to extend our gratitude to all physician, non-physician medical personnel and medical students who volunteered this year for the annual high school physicals. Watch for the article, coming soon, in the Visalia Times Delta for the names of all volunteers. We would not be able to keep this wonderful program available to our local students without the generous help of our volunteers. You have once again made this program a success!
M AY 2 0 1 3 / V I TA L S I G N S
Presidentâ€™s Message DOCTORS AND INDEPENDENCE 2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org
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 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
PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581
Wilbur Suesberry, MD President, Kern County Medical Society Doctors are prominent members of any community. Luke, one of the twelve disciples, was a physician who was thought to have written Acts, the Letters to the Apostles. As a specialist in Otolaryngology, I came to practice in the Central Valley where I was able to have a solo practice. But it is getting harder and harder these days. I am losing my independence. Since the Institute of Medicine (IOM) document, the practice of medicine has been controlled by large organizations. There are the health maintenance organizations (HMO), the Preferred Provider Organizations (PPO) and the Independent Physicians Associations (IPA.) These organizations are also cutting rates and so is Medi-Cal, which is constantly cutting reimbursements. There was recently though, an increase in reimbursement, which is a good turn of events. However, it was for the primary care provider and not for the specialist. It also seems that those who review claims for medical services rendered, first review the claims to deny them. It is the minutiae that results in a denial, such as the reversal of numbers, rather than to look whether the rest of the identifying information could correctly identify the provider or the patient in order to approve the claim. In addition, the various insurance plans have different claim forms and instructions. There may be ways to improve an on-going problem. For example, I am requested to evaluate patients for hearing loss. Initially, the HMO would not authorize an audiogram. This occurred frequently and was frustrating, even for the patients. A patient sometimes had to travel over 50 miles for an evaluation with me. However, how could I accurately evaluate the patient without an audiogram? My solution was to communicate with the administrator of the plan, and now it has been arranged for pre-authorization for an audiogram to my office for evaluation of hearing loss. The practice of medicine is at a crisis now. Within crisis, there can be opportunities. That is the challenge, to find and act on the opportunities at this time. Author can be reached at firstname.lastname@example.org.
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
Membership Recap MARCH 2013 Active.............................................................................................264 Resident Active Members .................................................................2 Active/65+/1-20hr .............................................................................4 Active/Hship/1/2 Hship.....................................................................0 Government Employed......................................................................6 Multiple memberships........................................................................1 Retired..............................................................................................59 Total ..............................................................................................336 New members, pending dues .............................................................0 New members, pending application ..................................................0 Total Members..............................................................................336 V I TA L S I G N S / M AY 2 0 1 3
Fresno-Madera RANJIT RAJPAL, MD Post Office Box 28337 Fresno, CA 93729-8337
1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: www.fmms.org 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
IMPLICATIONS OF NEW MODIFIED HIPAA RULES FOR PATIENTS AND PHYSICIANS
Protecting the privacy rights of our patients is of paramount importance towards maintaining the integrity and trust, which distinguish patient-physicians relationships. One of our primary responsibilities as caregivers is to ensure the security and confidentiality of the personal health information (PHI) of patients, both as a matter of duty and obligation, and as mandated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Earlier this year, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights announced a final omnibus rule outlining a series of new modifications to enhance the efficacy of the existing HIPAA Privacy, Security and Enforcement Rules, as stipulated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted in conjunction with the American Recovery and Reinvestment Act of 2009 (ARRA) and the Genetic Information Nondiscrimination Act of 2008 (GINA). The new rules are designed specifically to provide patients and their families with greater privacy protections and legal mechanisms pertaining to the use and disclosure of their electronic and paper medical records and other vital personal health information. These modifications enable a patient to exert more control in the ways their PHI is managed and disclosed. For instance, an individual can now request a copy of their EMR in an electronic format. When a patient pays by cash, they now have the ability to instruct their caregiver not to divulge details of their treatment to their health plan. The rule makes it easier for parents and guardians to authorize the dissemination of proof of immunization of their children to schools. It also expedites a patient’s ability to authorize or restrict the use of their PHI for research and sets strict limits and safeguards on how PHI is utilized and disclosed for fundraising and marketing enterprises. It strictly prohibits the sale of an individual’s PHI without their consent and authorization. As a corollary, the rule provides the HHS and other regulatory agencies with greater enforcement powers and capabilities. Physicians and others in the medical community must take substantive steps to adjust and comply with the stricter privacy mandates to ensure the security of their patients’ PHI. Within the previous arrangement, the HIPAA Privacy and Security Rules were directed primarily towards covered entities such as health plans and health care providers. When the new modifications take effect, the HIPAA Rules will extend and apply to business associates of covered entities – essentially any firm or subcontractor, which manages patient data. Medical practices will now be required to assume legal culpability, and will be subject to federal enforcement measures for privacy breaches caused by business associates. The new penalties for noncompliance and violations of patient privacy rights have also risen significantly under the new rule, with a new maximum fine of $1.5 million per violation, depending on the severity of the privacy breach. Also, in order to comply with the Breach Notification protocols of the HITECH Act, medical practices will be required to report any incident involving a breach or compromise of confidential health data directly to HHS, after conducting potential risk assessments. Covered entities and business associates must comply with the new rule by September 23, 2013, and they have one extra year from that date to restructure current business agreements in order to meet federal requirement standards. What this entails for us as physicians is that we will need to take proactive steps to protect our practices and secure the privacy rights of our patients by making sure that our practices are prepared for the compliance requirements of the new HIPAA Rules. Be sure to revise your existing notices of privacy practices and place them in prominent and accessible places in your offices and on your practice website, so your patients are well informed and knowledgeable about their privacy rights and protections. In addition, it is imperative for each of us to conduct comprehensive and vigorous security risk assessments in our medical practices to ensure that confidential patient data is protected. Our patients and their families put great faith and trust in us to fulfill this vital obligation, and so, we must do whatever it takes to meet their needs and uphold their rights under the law. Dr. Rajpal can be reached at email@example.com.
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Fresno-Madera Laennec Stethoscope Replica and History on Display Robert Peters, MD
Through the efforts of Dr. V. Roy Smith, the new cochairman of the Historical Committee and Dr. David Hadden, a replica of a 1840 wood and ivory Laennec type Monaural Stethoscope has been prepared and placed on display in the lobby of the Society’s office. Dr. Hadden generously made this family heirloom available for the model making and offers the observation that his physician great great grandfather used the instrument extensively in the Irish homeland, probably during the famine years. Rene Thophile The technical assistance for the model was provided Hyascinthe Laennec by Chuck Smith of the Sequoia Woodturners. 1781-1826 Rene Theophile-Hyascinthe Laennec, 1781-1826, was a French chest physician and pathologist who first recognized in 1816 the amplification of body sounds when heard through a wooden tube. He named and described the sounds, correlating them with the pathology seen at post mortem. In his first volume in 1819, he described his findings, and revised and refined them in a final volume in 1826. At the time of his death also in 1826 from tuberculosis, he was a professor of Medical Science. His work also led to the still-used term, Laennec’s Cirrhosis for the alcohol-related disease. Though slow to be adopted, his work was followed in 1855 by the Cammann Binaural model, which continued to be refined in many ways until todays evolution to the current 1961 Littmann model in common use.
Model of Laennec Type Monaural Stethoscope, approx 1840 now on display in the Fresno-Madera Medical Society Offices.
Laennec’s First Stethoscope 1816
Cammann 1855 Binaural Stethoscope, brass and wood with woven varnished tubes
Save the Date: Fresno-Madera Medical Society Family Picnic
Fresno-Madera Medical Society to Host Free Community Health Walks
WALK WITH A DOC 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: • MAY 25 • JUNE 29 7:30-8:30am Registration at 7:15am 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 http://www.facebook.com/pages/FresnoMadera-Medical-Society/107731015917068
Saturday, June 29, 2013, 10am-3pm Woodward Park V I TA L S I G N S / M AY 2 0 1 3
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, 559224-4224, Ext. 118. FRESNO/MADERA join its group. Call 559-450-5703. ANNOUNCEMENT Camarena Health seeking FP/IM physician Dr. Ahmad Emami announces his Man of for Oakhurst facility. Requires CA physician the Year campaign benefiting the Leukemia license. Contact Dir. of HR at 559-664& Lymphoma Society. Tax-deductible dona- 4158; firstname.lastname@example.org or fax tions to his campaign can be made at: resume to 559-675-5224. www.mwoy.org/pages/cca/fresno13@aem ami. TULARE University Psychiatry Clinic: A sliding fee AVAILABLE scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Nanny available for your children. Dr. Call 559-320-0580. Stanic’s wife, Katarina, knows a right person for your home. Contact: Call Sequoia PHYSICIAN WANTED Dental Office; 559-635-7186, ask for LQMG Medical Group is seeking Board Katrina or email@example.com (indicate Certified, Internal Medicine physicians to NANNY) under subject)
Health Care Reform Continued from page 11 The U.S. attorney for central California said, “As a result of this illegal conduct, Medicare and [Medi-Cal] made nearly $16 million in improper payments to the PHC hospitals.” PHC agreed to pay $16.5 million to settle the allegations (California Healthline, 8/27/12). On Wednesday, PHC closed the emergency departments of: • Bellflower Medical Center; • Los Angeles Metropolitan Medical Center; and • Newport Specialty Hospital. Officials said the rest of the hospitals’ services will cease after all patients are transferred to other facilities (AP/Sacramento Bee, 4/2). Last month, PHC announced the closure of Anaheim General Hospital. Growing Trend of Hospital Closures According to the Times, although PHC’s action stems from the fraud case, experts expect many state hospitals to close over the next decade. Experts say that insurers increasingly are excluding certain hospitals and forming smaller networks of health care providers to help curb rising health care costs. Smalland mid-sized hospitals do not have the negotiating clout or resources of larger hospitals and health systems to join such networks, the Times reports. 18
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In addition, smaller hospitals are struggling under new ACA-related funding cuts and penalties for patient readmissions. Jim Lott, executive vice president of the Hospital Association of Southern California, said, “There were circumstances unique to [PHC] that precipitated” its hospital closures, adding, “Having said that, we are forecasting for hospital closures because of the changes brought about by the implementation of Obamacare.” He said that about 40 hospitals in the state could close over the next five to 10 years, which would represent nearly 10% of hospitals statewide (Los Angeles Times, 4/3). Read more: http://www.californiahealth line.org/articles/2013/ 4/4/experts-forecasttrend-of-state-hospital-closures-underaca.aspx#ixzz2QYAcZblJ
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V I TA L S I G N S / M AY 2 0 1 3
VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337 HAVE YOU MOVED? Please notify your medical society of your new address and phone number.
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