coastal medicine: summer 2015

Summer 2015 • V3 N2

Coastal MedicineThe magazine of the Santa Cruz County Medical Society

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Summer 2015 • COASTAL MEDICINE • 3

2015 Legislative Leadership Conference, Sacramento, CA. From left to right: SCCMS Legislative Chair & Governor - David Benjamin, MD; SCCMS HOD Delegate & Governor - John Pestaner, MD; CMA

Trustee & SCCMS Governor - Donaldo Hernandez, MD, and SCCMS Executive Director - Donna Jones Odryna.

Coastal MedicineThe magazine of the Santa Cruz County Medical Society

CONTENTSThe President’s Desk ........................................................................................................ 5

Membership News ........................................................................................................... 8

CruzMed Foundation Message ...................................................................................... 9

CMA Trustee Report ...................................................................................................... 11

Leadership Academy Recap ............................................................................................ 14

Executive Director’s Message .......................................................................................... 22

2015-2020 Strategic Vision / Calendar .......................................................................... 23

4 • COASTAL MEDICINE • Summer 2015

SANTA CRUZ COUNTYMEDICAL SOCIETY

SANTA CRUZ COUNTY BOARD OF GOVERNORS

PRESIDENT Brian Brunelli MDPAST-PRESIDENT Jeannine Rodems, MD

SECRETARY Christopher O’Grady, MDTREASURER Patrick Meehan, MD

GOVERNORS

John Christensen, MD; Melissa Gerlach, MDHoussein Hassani, MD; W. Richard Hencke, MD; Donaldo Hernandez, MD; Lisa Hernandez, MD;

Dawn Motyka, MD; John Pestaner, MD; Rosalind Shorenstein, MD; Jack Watson, MD

CMA HOUSE OF DELEGATES REPRESENTATIVES

John Christensen, MD; W. Richard Hencke, MD;Christopher O’Grady, MD; John Pestaner, MD

Jeannine Rodems, MD; Rosalind Shorenstein, MD; Jack R. Watson, MD

COMMUNITY ENGAGEMENT/PARTNERS

CMA Luther F. Cobb, MD, PresidentCRUZMED FOUNDATION Jeannine Rodems, MD, President

EMERGENCY MANAGEMENT COUNCIL Donna Odryna, SCCMS RepresentativeEMERGENCY MEDICAL CARE COMMISSION Marc Yellin, MD, SCCMS Representative

HEALTH IMPROVEMENT PARTNERSHIP Donna Odryna, Board MemberSCC MEDICAL RESERVE CORPS Jeff Terpstra, Advisory Board Chair

MEDICAL SOCIETY, FOUNDATION & RESERVE CORPS STAFF

EXECUTIVE DIRECTOR Donna J. OdrynaHEALTH EDUCATION PROGRAM SPECIALIST Heather Thomsen, PhD

MEMBERSHIP & OUTREACH MANAGER Paula SatarianoBOOKKEEPER Christie Hicks

ADMIN/OFFICE ASSISTANT Lauren CozzaSOCIAL MEDIA/MARKETING INTERN Dominic Tovar

POSTMASTER

Send address changes to:Coastal Medicine Magazine

1975 Soquel Dr #215Santa Cruz CA 95065-1821

Coastal Medicine magazine is produced by the Santa Cruz County Medical Society.

EDITORIAL REVIEW Brian Brunelli, MD; Jeannine Rodems, MD, and Donaldo Hernandez, MD

MANAGING EDITOR Donna Odryna

CONTRIBUTING WRITERS Brian Brunelli, MD; CMA staff; Donaldo Hernandez, MD; Jeannine Rodems, MD; Donna Odryna

COPY EDITOR/LAYOUT Lauren Cozza

OPINIONS expressed by authors are their own and not necessarily those of Coastal Medicine magazine or SCCMS. Coastal Medicine reserves the right to edit all contributions for clarity and length and to reject any material submitted in whole or in part. Acceptance of advertising in Coastal Medicine is no way constitutes approval or endorsement by SCCMS of products or services advertised. Coastal Medicine and SCCMS reserve the right to reject any advertising.

SUGGESTIONS, story ideas, or completed stories written by current Santa Cruz County Medical Society members are welcome and will be reviewed by the Editorial Committee.

DIRECT all inquiries, submissions, and advertising to:Coastal Medicine Magazine1975 Soquel Dr #215Santa Cruz CA 95065-1821Phone: (831) 479-7226Fax: (831) 479-7223E-mail: [email protected]

Copyright ©2015 Santa Cruz County Medical Society. All rights reserved. Reproduction in whole or in part without written permission is prohibited.

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Santa Cruz County


Dr. Brian Brunelli is the SCCMS President, serving 2014-2016. He is a Neurologist with the Palo Alto Medical Foundation Santa Cruz. Dr.

Brunelli is married and has two children.

Greetings. Aft er a wonderful summer and the start of the new school year, the Santa Cruz County Medical Society is rolling up its sleeves and getting back to work. Here are some of our accomplishments in the past year:

• We completed our biannual strategic retreat, leading to a streamlining in our board of governors and the structure of our administration. (See updated vision, goals, core values, and competencies highlighted by our chief executive Donna Odryna in her message).

• We were able to bring Wendell Potter, PhD to lecture on health insurance practices to maximize their profi t.

• We awarded Martina Nicholson, MD with the Santa Cruz County medicine lifetime achievement award.

• SCCMS and the CMA helped to defeat Proposition 46, which would have opened up California to massive increases in malpractice costs.

• Last, but not least, Congress, with the backing of SCCMS and the California Medical Association (CMA), fi nally repealed Locality 99, allowing Medicare payments in Santa Cruz to rise to levels commensurate with costs of practice.

In the coming year, the SCCMS will send a full delegation to the Annual California Medical Association’s House of Delegates, maximizing our infl uence on healthcare topics with local and national importance. Right now, the California legislature is debating the aid in dying bill Senate Bill 128, the “End of Life Option Act” sponsored by our district representative Senator Bill Monning and Senator Lois Wolk from District 3. SCCMS is part of that discussion.

What new issues do you think we should take on in Santa Cruz County? Can EMS safely navigate north and south on Hwy 1 during rush hour? Is “medical marijuana” really an issue that should involve physicians? How bad a problem is homelessness, chronic psychiatric disease, and drug abuse in Santa Cruz County and what role should local physicians play in health access in these regards? Is there enough primary care and specialty access in the county?

Let us know the questions you think we should be addressing and tell us what you think about the current debates. We represent you – our members – and your voice needs to be heard.

All the Best,

Brian Brunelli, MD

THE PRESIDENT’S DESK

Mercer

NORCAL Mutual

Dignity Health Medical Group

Palo Alto Medical Foundation

Santa Cruz County


42 SAN JOAQUIN PHYSICIAN FALL 2015

CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions With implementation of the ICD-10 code set just around the corner, many physicians

have been understandably wary about the transition and the potential for payment

disruptions and claims processing errors that could interfere with patient care. Fortunately,

the California Medical Association (CMA) – working closely with the American Medical

Association (AMA) and other medical associations – has secured provisions that will ease

this transition, particularly for physicians in practices with limited resources.

Thanks to CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently

announced that it will provide a one-year grace period during which it will allow for

flexibility in the Medicare claims payment, auditing and quality reporting processes as

the medical community gains experience using the new ICD-10 code set. The ICD-10

implementation date of October 1, 2015, has not changed.

THE CHANGES ANNOUNCED INCLUDE:CLAIM DENIALS: Medicare review contractors will not deny claims based solely on the

specificity of the ICD-10 diagnosis code as long as a valid code from the right family of

codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10

coding mistakes during the grace period.

QUALITY REPORTING: Physicians also will not be penalized under the quality reporting

programs for errors related to the additional specificity of the ICD-10 diagnosis code,

again as long as a code from the correct family of codes is used.

ADVANCE PAYMENTS: If Medicare contractors are unable to process claims within

established time limits because of administrative problems, such as contractor system

malfunction or implementation problems, advance payment may be available to keep

resources flowing to physician practices.

ICD-10 COMMUNICATION CENTER: CMS will set up a communication center to monitor

the implementation of ICD-10 in an effort to quickly identify and resolve issues related to

the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive

and triage physician and provider issues.

For the latest ICD-10 news and updates, see CMA’s ICD-10 resource page at

www.cmanet.org/icd10.

CMA PUBLISHES

ICD-10 TRANSITION GUIDE

CMA has published the

“ICD-10 Transition Guide”

to help practices of all

sizes successfully make the

switch to the new ICD-10

coding system. The guide

will answer frequently asked

questions and includes

CMA’s “ICD-10 Transition

Preparation Checklist” to

help ensure the transition is

a smooth one. The guide is

free to members-only at

www.cmanet.org/icd10.

CMA reimbursement help line, (888) 401-5911 or [email protected]

Page 2 of 6

ICD-10 Transition Preparation ChecklistPrEParaTIon

☐ Awareness of effective date – Verify that all staff, including physicians, are aware of the ICD-10 change and the

implementation date.☐ Create a project team – In larger practices, create an ICD-10 project team to handle and oversee the transition. In

smaller practices, this may be an assigned individual or a few individuals.

☐ Create an action plan – To address the ICD-10 transition, assign tasks to members of the project team and

set deadlines for completion of each task assigned. Timelines of when to complete various tasks may differ

depending on the size of the practice. CMS has created detailed implementation timelines based on practice

size, which are available on their website at www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html (click

“Online ICD-10 implementation guide,” then under the blue “Start” tab, select your practice size).

☐ Create a budget – Estimate and secure budget (potential costs include updates to practice management

systems, new coding guides and superbills, staff training).

☐ Identify areas impacted by the transition – Discuss with all staff members how/where they use/see ICD-9 codes

(e.g., superbill, chart documentation, practice management system, coders, EHR, clearinghouse, etc.) to identify

how ICD-10 will affect your staff and processes.

• Run a report to identify your most frequently billed ICD-9 codes.

◊ Review the medical record documentation to determine whether the documentation would be sufficient

to select an ICD-10 code. ◊ This will help the practice identify the corresponding ICD-10 codes for training purposes, as well as help

the practice identify training opportunities.

☐ Talk to your vendors – Identify all of your vendors that will have an impact on the ICD-10 transition (practice

management system, EHR, clearinghouse, etc.) to discuss their readiness and timelines.

• When are they conducting testing with the practice and other vendors?

• What are their timelines for testing or implementation of any necessary upgrades?

• Are upgrades needed and if so, are there any costs associated with the upgrades (or is it included in your

maintenance price)?• Ensure your system(s) will have the ability to maintain both ICD-9 for dates of service through September

30, 2015, and ICD-10 codes for dates of service October 1, 2015, forward.

• Ask your vendor specifically about the number of text characters they allow for the ICD-10 description in the

system. Some of the text descriptions are extremely long so if the vendor can’t accommodate the full description,

start thinking about how you will modify so that all staff is clear on the description of the new ICD-10 code.

Reminder: Clearinghouses will not be able to crosswalk your ICD-9 codes to ICD-10 codes as there is not a

one-to-one crosswalk between the two code sets.

☐ Ensure system edits are updated – If your EHR and/or practice management systems contain billing edits based

on ICD-9 codes, work with your vendor to ensure these are updated.

☐ Identify internal work flow processes that need to be updated – Disease management registries, data collection

processes, data reporting processes, or other work flow processes may need to be updated.

☐ Schedule follow up meetings to evaluate preparation progress – Schedule reoccurring meetings with team

members involved in the transition to evaluate progress and identify potential problems.

CMA reimbursement help line, (888) 401-5911 or [email protected]

Page 1 of 6

GUIDEICD-10 Transition GuideWhat physicians need to know

On January 16, 2009, the Department of Health and Human Services (HHS) published a regulation requiring the

replacement of ICD-9 with ICD-10. Originally due to be implemented as of October 1, 2013, concerns regarding the

successful transition delayed implementation until October 1, 2015.

While the transition to ICD-10 has been criticized by some as unnecessary and costly, the arguments in support of

the transition are that ICD-9 has become outdated and fails to accurately reflect the complexities of 21st century

medicine. It is widely believed that the specificity of ICD-10 will meet the reporting needs of our modern health care

system while helping to identify diagnosis trends, improve quality and care management, and assist in the reporting

of the public health system.The California Medical Association (CMA) has developed a transition website, www.cmanet.org/icd10, that includes

important news articles and other ICD-10 transition information for physicians. CMA will also be hosting a number of

live training events to assist physicians with the transition.

To help physicians prepare for the transition, CMA has created this ICD-10 Transition Guide.

1. What is the ICD-10 transition date?ICD-9 will transition to ICD-10 effective October 1, 2015. Under ICD-9 there are approximately 14,000 codes, which

will transition to approximately 69,000 under ICD-10.

2. What will change on the transition date?

For dates of service on or after October 1, 2015, ICD-10 codes will be required on all claim transactions. However,

only a small percentage of the codes will be used by most providers.

3. What do I need to do to prepare?While preparations for ICD-10 should have already begun, practices should be focusing on addressing the transition

in the remaining months prior to conversion. Practices should immediately create a plan or checklist identifying key

areas that ICD-10 will impact in their practice. While ICD-10 will obviously impact the billing aspect of any practice,

the ramifications of this change will go far beyond just the coder or biller. Practices, including physicians, should be

aware of the increased medical record documentation that will need to occur in support of the specificity of new

ICD-10 diagnosis coding. To address these changes, additional training may be required for both physicians and

staff. In conjunction with documentation, practices need to consider whether their practice management system,

electronic health records (EHR) system, clearinghouse, billing office, etc. will be ready to accept the new ICD-10

format. Remember, practice management systems will be required to maintain previous ICD-9 information for dates of

service September 30, 2015, while incorporating new ICD-10 formats for dates of service October 1, 2015, forward.

CMA has created checklist to help practices prepare for a successful implementation.


FALL 2015 SAN JOAQUIN PHYSICIAN 43

2015 ICD-10-CM Code Set Boot Camps

For more information about CMA, please visit www.cmanet.org or call 800.786.4262

DISCOUNTED ICD-10 EDUCATION AND TRAINING FOR MEMBERS

Recognizing that health care providers need help with the transition, CMA, AMA and CMS are also working to make

sure physicians and other providers are ready for the October 1, 2015, transition to the new ICD-10 code sets.

CMA, in partnership with its local county medical societies and the California Medical Group Management

Association, is offering two-day ICD-10 code set seminars around the state. The two-day boot camps include 16

hours of intensive general ICD-10 code set training, along with hands-on coding exercises. To view the available

dates and locations, visit CMA’s ICD-10 event calendar at www.cmanet.org/aapc-icd10.

In addition to the two-day code set boot camps, CMA has negotiated deep discounts on other ICD-10 training

courses through AAPC. For details, visit www.cmanet.org/aapc.

CMS and AMA will also be offering webinars, educational articles and national

provider calls to help physicians and other health care providers prepare for

the transition. For more information, see CMS’s ICD-10 provider page at

www.cal.md/cms-icd10 and AMA’s ICD-10 web page at

www.cal.md/AMAICD10.

2015 ICD-10-CM Code Set Boot Camps

• ICD-10 format and structure

• Complete in-depth ICD-10 guidelines

• Nuances found in the new coding system, with coding tips

TRAINING FOCUSES ON:

Learn to code for ICD-10-Clinical Modification (ICD-10-CM) and prepare for the ICD-10 Proficiency Assessment. Training is led by a certified AAPC instructor and is provided onsite in a classroom format. Conducted over two days, attendees will receive 16 hours of intensive general ICD-10 code set training along with hands-on coding exercises.

• 16 CEUs

• AAPC ICD-10-CM Code Set Course Manual

• AAPC ICD-10-CM Code Set Draft Book

• AAPC Online ICD-10-CM Proficiency Assessment (Required for current AAPC CPCs to maintain their credential)

• Access to AAPC’s Online ICD-10-CM Assessment Training Course through December 31, 2015

WHAT’S INCLUDED:

• $399 for CMA members & members’ staff

• $499 for CA-MGMA members

• $599 for non-members*Comparable AAPC ICD-10 Boot Camp Costs $799

PRICING:

2015 ICD-10-CM Code Set Boot CampsCode Set Boot CampsCode Set Boot CampsCode Set Boot Camps

Save up to $400!

REGISTER: CALL (800) 786-4262 OR VISIT WWW.CMANET.ORG/AAPC-ICD10INFORMATION: CALL JULI REAVIS AT (916) 551-2046 OR EMAIL [email protected]

LOCATION/DATES

For more information about CMA, please visit:

www.cmanet.org

*Dates and locations subject to change. Please check www.cmanet.org/AAPC-ICD10 for updated information and new boot camps being added.

For more information about these and other CMA member discounted course offerings from

AAPC, please visit: www.cmanet.org/AAPC

Sacramento . . . .July 15-16

Roseville . . . . . August 4-5

Stockton . . . . August 10-11(French Camp)

Modesto . . . . August 12-13

Redding . . . . August 24-25

Eureka . . . . . August 26-27

Santa Maria . . . . . June 8-9

Fresno . . . . . . . June 15-16

Napa . . . . . . . . . June 18-19

Irvine . . . . . . . . June 23-24

San Diego . . . . June 25-26

San Jose . . June 30-July 1

Redlands . . . . . . . .July 7-8

Los Angeles . . . . . .July 8-9

Santa Rosa . . . . .July 13-14

Torrance . . . . . . .July 14-15

SIGN UP FOR ICD-10 NEWS ALERTS

The CMA website allows registered users to create custom

content alerts on the topics that are of interest to you. Once

signed up, you will be notified any time there is new content

posted in one of your areas, including ICD-10 issues. To

sign up, go to www.cmanet.org and visit your account

dashboard, click on “My Alerts,” then select “ICD-10.”


Welcome SCCMS/CMA Members

New Members

Retired Practices

Mark Goldin, M.D.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

Shilpa Gupta, D.O.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

Inemesit Newsome, M.D.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

Moira Petirs, M.D.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

Daniel Wasserman, M.D.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

After 44 years of practicing medicine in Santa Cruz, Dr. Bernard Hilberman retired on June 30, 2015. Though his practice is retired, he remains an

active member of the SCCMS. Congratulations and enjoy your well earned retirement!

Stephen Bhandarkar, M.D.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

D. Christopher Danish, D.O.CA Emergency Physicians1555 Soquel Dr Santa Cruz 95065462-7710

Are you a “best of class”

physician?Do you want to practice medicine in one of the most beautiful places in the U.S.?

Palo Alto Medical Foundation (PAMF) has a full-time opportunity for a Board

Certified / Board Eligible Internal Medicine Physician to join our medical group in Santa Cruz, CA. PAMF physicians

are dedicated to excellence and patient-centered care.This is a great opportunity to join a well-established unique multispecialty practice, run by physicians, supporting a very collegial and collaborative work environment.

This is a shareholder track position which offers a very competitive salary

guarantee, plus incentive and a generous benefit package leading toward full

shareholdership following 24 months of employment.

Palo Alto Medical Foundation for Health Care, Research and Education is a

not-for-profit health care organization dedicated to enhancing the health of

nearly one million people in the Bay Area. Our two physician groups consist of 1,300

physicians practicing in primary care and more than 40 medical and surgical

specialties.

Please contact:Palo Alto Medical FoundationPhysician Recruitment DepartmentPhone: 650-934-3582Fax: [email protected]

No placement agencies, please.

EEO – Equal Employment Opportunity


I would like to thank those of you who attended and contributed to our fi rst annual “Cork and Cuisine Gala.” In a partnership between the CruzMed Foundation and the Santa Cruz County Medical Society (Society), the Gala recognizes the lifetime achievements and contributions of a local Society physician member with the Annual Excellence In Health Care Award, while also raising friends and funds to support the mission of the Foundation. Th e event was well attended, and we had wonderful feedback from everyone about the great wines, excellent food, and silent auction. Everyone truly enjoyed the evening! Th e “2016 Cork and Cuisine” is scheduled for Friday, June 3, 2016, so mark your calendars now and join us as we celebrate the lifetime achievements of a local physician.

Now into my second year as president of the CruzMed Foundation, we are continuing to focus our eff orts on our 3 priority areas – Preparedness, Pipeline, and Public Health. Th ese priorities serve as our Society’s commitment to both the profession and the community with physician-based funding and engagement here locally. Following are some highlights.

• Preparedness

We continue to support the mission and goals of the Medical Reserve Corps of Santa Cruz County. I am very pleased to introduce you to the newest member of the staff team – Paula Satariano, Manager of Membership and Outreach for both the Santa Cruz County Medical Society and Medical Reserve Corps (SCCMRC). She is working with the SCCMRC to develop a more self-suffi cient governing structure while supporting the community through the work of the SCCMRC. Please welcome Paula to our team!

• Pipeline

Th is fall we hope to award our fi rst scholarship for a UCSC student interested in pursuing medicine as a profession – thanks to your generous support. We will also continue our work with the MESA (Mathematics, Engineering, Science Achievement) program in the public schools to support their interest in the sciences. Th ank you to those physicians who contribute not only your treasure, but your time and expertise in fostering youth interest in health care during the MESA day events.

• Public Health

Th ere is exciting news related to the 5210+ Program and our commitment to reducing obesity in our community by 10% by 2020. We continue to serve as a partner with the United Way/Go For Health! Collaborative, which has approximately 150 local partners who share common ground goals and who work together to combat the obesity epidemic. Our current success would not be possible without the generosity of the Palo Alto Medical Foundation. Additionally, we are thankful to Whole Foods Market at both the Santa Cruz and Capitola stores for providing local and organic fresh fruits and vegetables weekly to the program at each of the participating schools.

Th anks to our phenomenal work of health education specialist, Heather Th omsen, PhD the program is showing early evidence amongst the elementary school students that they are retaining the key messages while having fun with the educational programming. Heather worked through this summer with camps at Vine Hill and Brook Knoll elementary schools as well as the Ben Lomond Quest program. Fift h grade students at seven elementary schools will be engaged in 5210+ curriculum activities during the current fall quarter. Th e good and bad news is that we have a wait list of local schools on standby to start the program. Some of these schools include several that have recently fallen out of the funding parameters for the Supplemental Nutritional Assistance Program Education (SNAP-Ed) programming, in some cases by just .06 percent. Th e need is very high. Th e current grant funding sunsets at the end of January and we are pursuing an ambitious 3-year, $450,000+ proposal to expand the reach and impact of the program. We are very pleased with the community response and interest in funding the program and hope to have funding partners in place in the next couple of months.

We greatly appreciate your support of and engagement in the work of the CruzMed Foundation. If you are interested in learning more about the programs of the Foundation, wish to volunteer or contribute, please contact our Executive Director Donna Odryna.

Sincerely,

Jeannine Rodems, MD

New Members

Dr. Jeannine Rodems is the President of CruzMed Foundation, and on the Board of the California As-sociation of Family Physicians. She recently opened her own Family Medicine practice in Santa Cruz.

She is married and has one child.

CRUZMED FOUNDATION MESSAGE


Dr. Donaldo Hernandez is a CMA Trustee, the Coastal Medicine Editorial Chair, and a Past President of SCCMS. He is in Internal Medicine and is a Hospitalist with the Palo Alto Medical Foundation.

Right to Die?You’ve worked hard all your life to provide a goodstandard of living for you and your family and KEEP yourcurrent lifestyle in retirement. But long-term care costscan get in the way.

If you develop a debilitating long-term condition, you may need long-term care.

Once you’re 65 years old, Medicare will help pay yourmedical costs. But Medicare does not pay full benefitsfor extended-care, assisted-care facilities, custodial careor nursing home facility expenses. If you need this typeof care, you could face big expenses:

• The national average cost of a year in a nursinghome is $87,600.*

• The 2014 median annual cost for an assisted-living,one-bedroom apartment with a private bath, or aprivate room with a private bath was $42,000.*

Many of us think Medicare is going to cover long-termcare expenses, but find the coverage very limited. That’swhy millions of responsible Americans help protect theirlifestyles with long-term care insurance. But finding theright protection isn’t easy. It’s tough to compare policieswith different benefits, features, limitations, costs,spouse coverage and more.

The Santa Cruz County Medical Society/CMA canhelp, with a special benefit for members: Long-TermCare Resources, a unique long-term care buying service.This program allows you to work with a long-term care insurance representative who will give you all theinformation about benefits and rates of different, highlyrated long-term care providers.

Call Long-Term Care Resources today to receive information at 800-616-8759, or visit www.myltcplan.com/sccms.

Premiums are based in part on age.The longer you wait, the higheryour premium rate may be.

* Genworth 2014 Cost of Care Survey, February 2014, https://genworth.com/corporate/about-genworth/industry-expertise/cost- of-care.html, viewed 1/27/15

Call 800-616-8759 or visit www.myltcplan.com/sccms

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CMA TRUSTEE REPORTDr. Donaldo Hernandez is a CMA Trustee, the Coastal Medicine Editorial Chair, and a Past President

of SCCMS. He is in Internal Medicine and is a Hospitalist with the Palo Alto Medical Foundation.

Doubtless, absent living in a monastic cell for low these many months, news of the intensely reviewed and potentially contentious legislation coalescing under the provocatively colloquial title of “Right to Die” has been rising to the forefront of many conversations. At the center of the conversation is how we, as a society, respond to our fellow Californians as they transition from treatable maladies to terminal conditions. What started as a highly publicized statement by Brittany Maynard to terminate, what was for her a grueling struggle with Glioblastoma, opting to leave her Alamo, California home for Portland, Oregon as her life ebbed, has now grown into an intensifying conversation and renewed legislative eff ort to allow persons with terminal illness greater choice on how and when they die.

State Senator William Monning along with Senator Lois Wolk introduced to this years legislative calendar “Th e End of Life Options Act”, SB128. Th e goal of the proposed legislation is to give patients with the confi rmed diagnosis of a terminal illness the right to seek life-ending medication from their doctor.

Specifi cally, the bill would require that:• Th e medication be self-administered;• Th e patient is mentally competent;• Two physicians confi rm the prognosis that the patient has six months or less to live;• Th e patient’s physician discusses alternatives and additional treatment options;• Th e patient submits a written request and two oral requests made at least 15 days apart; and• Two witnesses attest to the request.• Th at Physicians and Pharmacists would be given legal immunity if opting to participate and • Th at objecting Physicians and Pharmacists would be able to opt out

Since 1997 Oregon’s Death with Dignity Act (DWDA) was passed and is oft en held up as an example and template for legalized physician-assisted suicide legislation in other states, including California. According to the Oregon Department of Human Services (ODHS), 105 terminally ill patients used that law to hasten their own deaths in 2014. Further quoting the ODHS, “since the law was passed in 1997, a total of 1,327 people have had DWDA prescriptions written and 859 patients have died from ingesting medications prescribed under the DWDA. Of the 155 patients for whom DWDA prescriptions were written during 2014, 94 (60.6%) ingested the medication with all 94 patients dying from the use of those medications. Th irty-seven of the 155 patients who received DWDA prescriptions during 2014 did not take the medications and subsequently died of other causes.” Previous attempts to address this sort of legislation in California have met strong opposition and been defeated due in part to objections from Organized Medicine and religious groups concerned that suicide was tantamount to an immoral act. Th ere were also other concerns raised that such laws create a slippery slope, one in which suicide becomes the norm, and patients are denied life-extending treatment by insurance companies that may have a mixed incentives to deny care such that they would rather the enrollee kill themselves, or are pressured to do so by evil-intentioned family relations who don’t want to spend the patients’ savings on end-of-life care.

Using the Brittany Maynard experience and polling that shows approximately 70% of Americans support physicians aid in dying for terminally ill patients “by some painless means,” advocates for some form of physician assisted death sensed an opportunity. Clearly, opinion within the state was changing with respect to patient choice when facing a terminal diagnosis. Proponents also cited the Oregon experience as an example of how the law could work. Th ey noted that since the enactment of the law, in the 859 patients that had opted for physician aid in dying utilizing medications prescribed under DWDA, there was no reported episodes of abuse save for a rare handful of minor administrative violations by physicians.

Continued on Page 12.

Right to Die?


The impetus for now seeking a legislative resolution for patient choice in this regard grew largely due to shifting opinion in the electorate while simultaneously acknowledging that the Oregon experience has been anything but abusive.

For over three decades, the California Medical Association has stood squarely in opposition to any form of physician involvement in the termination of a patient’s life. Long standing policy consistently opposed any physician aid-in-dying on grounds that it violates physicians’ ethical and moral obligations as healers to provide the best treatment possible. But debate within the house of Medicine persisted with the ethics of prohibition and admissibility hotly debated. Opposition cited that it was not ethically permissible because assist in dying ran directly counter current to the sworn duty of the physician to preserve life and to do no harm. But others argued that some form of assisted death was in keeping with long standing traditions on the grounds that the physician’s duty to alleviate suffering may, at times, make assisted death a rational choice for a sentient person who is choosing to escape unbearable suffering at the end of life stressing respect for individual autonomy. Advocates within the profession sought to recognize the right of competent people to choose the timing and manner of death in the face of a confirmed terminal illness.

After much debate and acknowledging the changing needs of patients, the California Medical Association (CMA) earlier this year amended its long-standing opposition to legislation like SB128 to adopt a position of neutrality. While not an outright endorsement, by adopting a neutral position CMA removed a nearly insurmountable obstacle to the passage of SB128. The new position on physician aid in dying also allowed CMA to have a place at the table to work with the sponsors and authors of the bill to ensure the measure includes adequate protections for patients and providers.

“I don’t think we have internally vetted an issue as hard as we did this one,” said Dr. Ted Mazer, speaker of the CMA House of Delegates as quoted in the Sacramento Bee. “If the state is going to go forward and the public wants to go that way, we needed to be at the table.”

Technological advances are extending patients’ lives but with that we have to embrace the reality that some people who survive also suffer. Pushing the envelope of care delivery, often extracts a sobering physical and emotional price, a price that many patients struggle to weigh within the treatment cost benefit analysis.

And yet this policy change does not reflect universal acceptance of the idea of helping to end lives. Much debate and concern remains within the House of Medicine and several groups of medical providers remain in opposition. Again Dr. Mazer pointed out, “There are lots of doctors who think doctors should not be in the position of ending life,” adding that he himself remained “on the fence” and continues to wrestle with the issue. Physicians’ opinion remains divided, but the majority of physicians believe you should either allow this and participate or be neutral and allow the physician and the patient to make the decision.”

Under the proposed provision, Doctors with ethical objections could still opt out and refuse to administer lethal drugs, a provision that Mazer called “critically important.” They would not need to inform patients about the option.

With the new position articulated and the a few new protections added at the request of CMA in place, SB128 made it’s way through the usual Senatorial wrangling and passed the upper house and was sent to the Assembly. Appearing as it was heading to passage in the Assembly, continued opposition grew resulting in the legislation being tabled in the regular session. When California last took up an aid-in-dying measure, the medical industry was not the only powerful institution helping to ultimately defeat the bill. Religious groups protested as well, with the California Catholic Conference remaining steadfast in their opposition. Several Southern California Democrats on the health committee were lobbied heavily by the Catholic Archdiocese of Los Angeles to oppose the bill. Even from their pulpits within their Sunday sermons, members of the Catholic clergy expressed their doubts over the ethics and wisdom of this measure. At the end of the day, the Co-sponsors didn’t have enough support from members of the Assembly Health Committee to advance the bill to the Assembly floor during the regular session.

Assembly members like Lorena Gonzalez (D-San Diego) whose mother died in 2007 after a long battle with breast cancer expressed concerns largely based on her personal experiences in dealing with a loved one facing terminal illness. She was quoted: “I’m uncomfortable based on the impact this will have on poor people in a health care system that cuts corners in the name of costs, and I’m uncomfortable with the way suicide could be viewed across society, not just the terminally ill.”

Proponents, including Assembly member Mark Stone continued to push for passage this year and the Assembly entered in to a Special Legislative Session in order to continue to persuade concerned members that the time was ripe to attempt to pass the legislation. Titled for the special session as ABX2-15, it included the same provisional language as a Senate measure.

However, Governor Brown expressed a dim view of this special session, expressing frustration with the timing. Brown administration spokesperson Deborah Hoffman said the special session is not the right time to consider such legislation. Hoffman said lawmakers instead should reconsider such a measure next year. Now with the Governors stated position, doubt has arisen with respect to his signing of any such law this year. If the Governor were to veto the bill, proponents vow to continue the conversation, meaning it would most likely head to a ballot measure in the coming election cycle.

On Friday September 4th, the Assembly special finance committee advanced ABX2-15 sending it to the full Assembly for vote. As of this writing, the State Assembly passed an amended bill, which will sunset in 10 years, at which time lawmakers could review how the law worked and decide whether to grant an extension. As of this writing, the bill has moved the desk of Governor Brown, a former Jesuit seminarian, for his signature, which is by no means certain…

But in a larger sense, what is hopefully a long overdue byproduct of all this activity is a more focused examination of how we, as a society discuss the subject of choice and medical futility, and in a larger sense, how we culturally approach death. Much as we seem to try, death cannot be excised from our collective experience much less our culture. So often Physicians are trapped between being asked to “Do everything” despite having a clear notion of the futility of intervening and “End the pitiless suffering”. And while advance-planning conversations are critical to providing care roadmaps for individual patients, as is so frequently the case, the journey is rarely black and white. The rhetoric is scathing. Terms like “barbaric” and “cruel” are employed to describe treatments that are clearly subjective in the value the individual patient may derive. It has become clear that medical and technological advances continue to provide patients with ever expanding treatment possibilities, including patients with advanced disease.


But in a larger sense, what is hopefully a long overdue byproduct of all this activity is a more focused examination of how we, as a society discuss the subject of choice and medical futility, and in a larger sense, how we culturally approach death. Much as we seem to try, death cannot be excised from our collective experience much less our culture. So often Physicians are trapped between being asked to “Do everything” despite having a clear notion of the futility of intervening and “End the pitiless suffering”. And while advance-planning conversations are critical to providing care roadmaps for individual patients, as is so frequently the case, the journey is rarely black and white. The rhetoric is scathing. Terms like “barbaric” and “cruel” are employed to describe treatments that are clearly subjective in the value the individual patient may derive. It has become clear that medical and technological advances continue to provide patients with ever expanding treatment possibilities, including patients with advanced disease.

The wide range of available options can unfortunately lead to confusion and misunderstanding, potentially resulting in inflated expectation and often postponing complex end-of-life conversations and decisions. Regrettably patients, patient’s families, and physicians may derive very different conclusions about which treatments are best to pursue, which are futile, and what reasonable goals of therapy look like. Improvements in medical care often retard the course of the illness and can improve quality of life, but with the inevitable advancement of illness continued life-prolonging interventions invariably impose increasing toll and offer diminishing returns, often without clear a transition point in the cost benefit analysis.

Emotionally we’d like to believe in miracles, but rationally we regularly struggle acknowledging we are mortal, frail and will pass. As we’ve seen advances in the science of care, questions regarding prognosis, accurate expectations, and potential quality of life become more

difficult and vague even for highly skilled and experienced providers. And if legislators try to codify futility, they will find that they will be behind an ever-moving horizon, one that changes with the ever changing advances of science and technology along with the continued graying of the American populace. There are no absolutes save one, that we all will some day die. As we celebrate patient autonomy we also need to remember that at the end of the day, we are on the journey with them. Our function is human to human; pausing and listening to their needs, their fears, their values, and their beliefs in simple terms, having a conversation about our shared humanity including our transience and mortality. Perhaps it is within that authentic interaction that we can embody the objective that we cure sometimes, relieve often, and comfort always. •

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The 2015 Western Health Care Leadership Academy

was held in sunny Hollywood at the end of May, bringing

Tinseltown a little star power of its own.


Western Health Care Leadership Academy

brings star speakers,

hundreds of physicians to Hollywood

The 18th annual event drew more than 570 participants, with guest speakers

including bestselling author Professor Dave Logan; Congressman Ami Bera, M.D.;

Pulitzer Prize-winning author Siddhartha Mukherjee, M.D.; Congressman Michael

Burgess, M.D.; and New York Times bestselling author Malcolm Gladwell. >>


Western Health Care Leadership Academy - 2015


Malcolm Gladwell talks problem solving

Bestselling author Malcolm Gladwell spent his talk illustrating the difference between two conflicting

types of problems: mysteries and puzzles.

The first keynote speaker, New York Times bestselling author Malcolm Gladwell, told attendees that being a good physician often requires being a good “mystery solver.”

Puzzles and mysteries are two different types of problems, Gladwell said—a distinction first articulated in 2007 by national security expert Gregory Treverton.

According to the theory, puzzles occur when there is not enough information to solve a problem. Mysteries, on the other hand, arise when there is more than enough

information. Tackling a mystery thus becomes a matter of sifting through the abundance of data, rather than uncovering new information to reach a conclusion.

“This is a crucial distinction because we live in a world [where] most of our institutions and most of our disciplines and most of our expectations and regulations and such are set up on the expectation that what we face are puzzles,” Gladwell said. “And [Treverton] says, ‘look, we don’t face puzzles anymore. The signature problems of the modern world are all

mysteries.’”Gladwell applied the distinction to

historical events, stating that the Cold War was a puzzle propelled by a general lack of information, but the 9/11 attacks were a mystery that occurred in the wake of information overload.

However, the distinction can also be applied to medicine, he said.

In past generations, a doctor was a collector of information. Now, a doctor has to be an analyst of information.

Modern physicians must take a different approach to solving the information-laden problems of


today, and that requires good judgment and understanding, he explained.

In other words, it requires being a good mystery solver.

“Now here’s the question,” Gladwell said, looking over the crowd of physicians. “Does the world treat you as puzzle solvers, or does it treat you as mystery solvers?”

Gladwell added that the physician’s role today is “infinitely more complicated” and demands more than checking boxes and solving algorithms. So does the doctor-patient relationship, he said.

“We, and by ‘we’ I mean all patients, are terrified,” Gladwell said. “We’re entering a world we don’t understand, that is full of all kinds of questions we didn’t know existed four or five years ago. We want to walk into an office and have someone talk to us and look us in the eye and reassure us and give us guidance and understanding and nurturing and support.”

Gladwell’s presentation drew rapt attention throughout his 40-minute segment and received high praise from those who attended the Western Health Care Leadership Academy, an event spearheaded by the California Medical Association.

In the end, he emphasized the need for physicians to stand up for themselves and say that the nature of their profession has changed.

“You need to stand up to the world and say, ‘we’re not dealing with a puzzle anymore,’” Gladwell said. “We’re dealing with a mystery.”

“We, and by ‘we’ I mean all patients, are terrified. We’re entering a

world we don’t understand, that is full of all kinds of questions we

didn’t know existed four or five years ago. We want to walk into

an office and have someone talk to us and look us in the eye and

reassure us and give us guidance and understanding and nurturing

and support.” - Malcolm Gladwell



Attendees hear cancer presentation from Pulitzer Prize-Winning author Siddhartha Mukherjee, M.D.

Discoveries about cancer have led to a better understanding of the enigmatic disease, but according to

Pulitzer Prize-winning author Dr. Mukherjee, that understanding is merely the tip of the iceberg.

Siddhartha Mukherjee, M.D., an acclaimed hematologist and oncologist, touched on what he called the three realizations of cancer before leaving the audience to ponder the question: “What does our theory of cancer tell us today?”

“There is no other human disease that we know of that has this level of diversity and complexity,” he said, standing in front of the Ray Dolby Ballroom at the Loews Hollywood

Hotel. “Every patient’s cancer is his or her own cancer.”

Cancer is one of the oldest diseases known to man, despite some contemporary beliefs that it is mostly derived from present-day sources, Dr. Mukherjee said. It is one of the major problems of this century, and innovation in every aspect of cancer medicine is desperately needed to help fight the disease.

Deciphering cancer physiology, in

particular, is also vital to understanding the ailment, he said.

“We will not move through the barrier of cost, of care, of any of the barriers that currently surround cancer medicine unless we complete this project,” Dr. Mukherjee stated.

Dr. Mukherjee noted that there have been three revelations regarding cancer through the course of history. The first was that cancer is a disease of the cells, but eventually scientists discovered


that it is also a disease of genes and genomes — that is, it also involves multiple genes.These insights have been critical to understanding the nature of cancer, he explained.

But again, more effort needs to be made to understand its physiology. Dr. Mukherjee said it is the current and next generations who will need to helm this imperative project.

“It is the job of our generation to figure out how to make sense of the entire physiology, and by physiology I mean the human being that has cancer, his or her interactions with his or her particular environments, his or her particular exposures, and then deliver a complete new system of cancer medicine,” he said.

Dr. Mukherjee is the author of the 2010 Pulitzer Prize-winning book The Emperor of All Maladies: A Biography of Cancer, which was also the basis for a Ken Burns-produced documentary that aired on PBS earlier this year.

“We will not move through the barrier of cost,

of care, of any of the barriers that currently

surround cancer medicine unless we complete

this project.” - Siddhartha Mukherjee, M.D.


Save the date:

2016 Western Health Care Leadership Academy to feature Karl Rove and Donna Brazile

Check your calendar

and save the date for the

2016 Western Health Care

Leadership Academy, to

be held in San Francisco

May 13-15, 2016, at the

Hilton Union Square.

The opening session will

feature a preview of the

2016 presidential election

and its impacts on health

care. Speakers for this

session include Karl Rove,

former Deputy Chief of

Staff and Senior Advisor

to President George W.

Bush, and Donna Brazile,

Al Gore’s campaign

manager and Democratic

National Committee Vice

Chair.

Physicians and nurses,

medical practice

managers and other

health care professionals

will find this program

will help you prepare for

changes affecting your

profession, your practice

and your economic

future. Stay tuned for

more information.

www.westernleadershipacademy.com


Three things you may not know about Dr. Le:1. She is a native Vietnamese speaker.2. She is learning to swim and surf.3. She loves to travel.

We're happy to announce that Dr. Doan Le has joined us at

Dignity Health Medical Group Dominican. She will be treating

children with her expertise in pediatrics (and kindness). Call

831-476-3000 or visit dignityhealth.org/doctor to book

an appointment.

15-DignityHealth-001 CoastalMedicineFinal.indd 2 6/2/15 2:10 PM

Donna Odryna is the Executive Director of

the Santa Cruz County Medical Society and its affi liated organizations, CruzMed Foundation

and Santa Cruz County Medical Reserve Corps.

Th e summer of 2015 has been a time of change here at the Medical Society & CruzMed Foundation. As Board President Dr. Brunelli mentioned in his comments on page 5, your Board of Governors adopted a new strategic plan this summer and with it has come a retooling of our business practices and priorities. For your information the SCCMS revised mission statement, new vision statement, core values, competencies, and strategic goals are outlined in the chart on page 23.

I’d like to formally welcome Paula Satariano, the newest member of the Medical Society and CruzMed Foundation team (pictured on the right), she is our Manager of Membership & Outreach. Paula worked for us more than two years ago on a special grant project funded by the Santa Cruz County Health Services Agency for the Medical Reserve Corps. She then worked for the Peace Corps in Moldova for two years, as a Health Education Specialist with a focus on youth projects to advocate for health and social justice while analyzing the health needs among youth to create health education teaching resources. She is looking forward to meeting each of our members and assisting them in getting the greatest benefi t from their membership.

Finally, I wanted to thank the SCCMS Board of Governors for their leadership and ongoing service to the House of Medicine. Under their leadership, the Medical Society in Santa Cruz County is stronger than ever. Your elected Governors are eff ective advocates for all members locally, in Sacramento, and in Washington DC. So I invite you to reach out to your colleagues and let them know your concerns and interest so we can continue to be your voice when it matters most.

Warmest Regards,

Donna Jones Odryna


EXECUTIVE DIRECTOR’S MESSAGE

!

Mission&Core%Purpose%–%Why%We%Exist!%

Physicians!of!Santa!Cruz!County!improving!and!advocating!for!the!Health!of!the!

community!and!well!being!of!physicians!through!the!science!and!art!of!medicine.!

Vision&Where%We’re%Going!%

We!are!the!preeminent!professional!association!providing!leadership!and!guidance!on!issues!of!

healthcare!delivery!in!Santa!Cruz!County.!

Core&Values&What%We%Stand%For%

Protection!of!the!patient>physician!relationship!

Protection!of!the!profession!of!medicine!

Healthy!Communities!The!well!being!of!physicians!

Access!to!quality!health!for!all!people!Community!Service!

Trust,!integrity,!honesty,!transparency,!and!innovation!

Core&Competencies&Organizational%Strategic%

Strengths!%

Advocacy!Leadership!

Collaborations/Partnerships!Political!Relations!

Information>Sharing!Education!

Communication!

Goals&In%The%Next%Year%we%will…%

1. Grow!membership!2. Be!fiscally!and!economically!responsible!3. Advocate!for!the!profession,!quality!patient!care,!and!

access!for!all!4. Have!great!influence!with!local!healthcare!

organizations!and!coalitions!by!increasing!SCCMS!representation,!engagement,!and!involvement!in!community!works!

5. Increase!social!media,!marketing,!and!communications!activities!and!promote!member>only!benefits!

6. Generate!unrestricted!revenue!by!supporting!and!partnering!with!the!CruzMed!Foundation!in!support!of!its!overhead!and!operations!

201572020&Santa&Cruz&County&Medical&Society&Strategic&Visioning&&


SCCMS Board of Governor (BOG) Meetings• November 19, 2015 • March 24, 2016• January 28, 2016 • May 26, 2016

CMA Board of Trustees (BOT) Meeting• 2015 BOT – October 15, 2015 (Anaheim)

CMA House of Delegates (HOD)Th e delegates meet once a year to establish CMA policies on key issues that aff ect the practice of medicine, from medical ethics to critical matters of public health. Each year the HOD debates and takes action on more than 100 resolutions, each of them authored by members like you. For more details, visit www.cmanet.org/about/cma-governance/house-of-delegates.• 2015 HOD – October 16-18, 2015 (Anaheim)

Western Health Care Leadership AcademyTh e Leadership Academy is the West Coast’s premier opportunity for physicians, practice managers and other health care leaders to learn about leading-edge trends and developments in the rapidly changing health care marketplace, to access information and tools to help ensure the viability of medical practice, and to acquire the leadership skills needed to successfully manage change. For more information, visit www.westernleadershipacademy.com.• 2016 – May 13-15, 2016 (Hilton Hotel, San Francisco)

SCCMS Excellence In Health Care Awards /Cork & Cuisine Gala DinnerJoin us for an evening of celebration as we honor the 2015 Physi-cian of the Year. • June 3, 2016 (Santa Cruz)

Key Dates Calendar

Coastal MedicineTh e magazine of the Santa Cruz County Medical Society

1975 Soquel Drive, #215Santa Cruz, CA 95065-1821

180 Howard Street • Suite 210 • San Francisco, CA 94105

T 415.882.5151 F 415.882.5149 W imq.org

YOUR PARTICIPATION CAN MAKE A DIFFERENCE!

IMQ is looking for physicians who may be interested in becoming surveyors for any of the following IMQ programs:• Ambulatory Care Review Program• Continuing Medical Education Accreditation Program• Corrections and Detentions Health Care Program• Peer Review Consultants• Medical Staff Services Consultants• Panelists for Judicial Review Panels

The general qualifi cations for an IMQ surveyor are:1. CMA membership is required (or other state medical association) for MDs2. Meaningful involvement in a related program3. Active in medicine4. Peer recommendations5. A letter of recommendation from the county medical society

The qualities sought in an IMQ surveyor are excellent communication skills, diplomacy, effi ciency, fairness, fl exibility, good judgment, reliability, ability to present ideas in a constructive and positive manner, and enthusiasm for learning.

Ambulatory Surveys (with certain exceptions) require a full day on site along with pre survey document review and post survey report completion.

CME Surveys range from a few hours to a half day plus travel time. There also is pre survey document review and post survey report completion.

Corrections Surveys require from one to three days and utilize one physician working on a team of two to four surveyors depending upon size and complexity of the facility.

Peer Review Consultations require two physicians. On-site peer review, an objective review of one or more physicians’ clinical practices require one day on site. Off site clinical case review of patient care will utilize two or more physicians to review three to fi ve cases and complete a report on their fi ndings. The custom designed educational programs for medical staff s utilize one to two physicians on site for one half day to a full day of instruction depending on the topics requested.

Judicial Review Panels require fi ve physicians (of which three will be chosen to sit on the panelfollowing voir dire) for generally fi ve to seven days. The candidates must not be currently or formerlyemployed by the State of California.

For more information, please call Tim Dolan at (415) 882-5173 or e-mail: [email protected] visit our website at www.imq.org. We look forward to welcoming you to IMQ!

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U.S. Postage

PAIDSan Dimas, CAPermit No. 410

coastal medicine: summer 2015

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