fall 2014

Fall 2014

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Moris Senegor, M.D. - A Memoir of Love and Neurosurgery in San Francisco and more!

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FALL 2014 SAN JOAQUIN PHYSICIAN 3

{FEATURES}

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DOGMEATA Memoir of Moris Senegor, M.D.

MICRA: HAVE YOU JOINED THE FIGHT?An Overview of Prop. 46

DECISION MEDICINEHomegrown Physicians

{DEPARTMENTS}20 IN THE NEWS New Faces and Announcements

56 PUBLIC HEALTH Measles: A Concern For International Travelers

60 PRACTICE MANAGEMENT: The Key to Improving Patient Outcomes

63 NEW MEMBERS

Decision Medicine 2014

VOLUME 62, NUMBER 3 • SEPTEMBER 2014


MEDICAL SOCIETY STAFF

EXECUTIVE DIRECTOR Lisa Richmond

COMMUNITY PROJECT MANAGER Vanessa Armendariz

MEMBERSHIP COORDINATOR Jessica Peluso

COMMITTEE CHAIRPERSONS

MRAC F. Karl , Gregorius, MD

DECISION MEDICINE Kwabena Adubofour, MD

ETHICS & PATIENT RELATIONS to be appointed

LEGISLATIVE Jasbir Gill, MD

COMMUNITY RELATIONS Joseph Serra, MD

PUBLIC HEALTH Alvaro Garza, MD

SCHOLARSHIP LOAN FUND Janwyn Funamura, M.D.

NORCAP COUNCIL Thomas McKenzie, MD

CMA HOUSE OF DELEGATES REPRESENTATIVES

Robin Wong, MD, Lawrence R. Frank, MD,

James R. Halderman, MD, Patricia Hatton, MD,

James J. Scillian, MD, Peter Oliver, MD, Roland Hart, MD

Kwabena Adubofour, MD,

Gabriel K. Tanson, MD, Ramin Manshadi, MD

SAN JOAQUIN PHYSICIAN MAGAZINE

EDITOR Lisa Richmond

EDITORIAL COMMITTEE Ramin Manshadi,

Lisa Richmond, Mike Steenburgh

Vanessa Armendariz

MANAGING EDITOR Lisa Richmond

CREATIVE DIRECTOR Sherry Roberts

CONTRIBUTING WRITERS Vanessa Armendariz,

James Noonan, Julie Vaishampayan, M.D., M.P.H

THE SAN JOAQUIN PHYSICIAN MAGAZINE

is produced by the San Joaquin Medical Society

SUGGESTIONS, story ideas or completed stories

written by current San Joaquin Medical Society

members are welcome and will be reviewed by

the Editorial Committee.

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

San Joaquin Physician Magazine

3031 W. March Lane, Suite 222W

Stockton, CA 95219

Phone: 209-952-5299 Fax: 209-952-5298

Email Address: [email protected]

MEDICAL SOCIETY OFFICE HOURS:

Monday through Friday 9:00 AM to 5:00 PM

Closed for Lunch between 12pm-1pm

PRESIDENT Ramin Manshadi, MD

PRESIDENT-ELECT John Zeiter, MD

PAST-PRESIDENT Thomas McKenzie, MD

SECRETARY-TREASURER George Savage, MD

BOARD MEMBERS Raissa Hill, MD, Moses Elam, MD, Grant Mellor, MD, Dan Vongtama, MD, Alvaro Garza, MD, Kwabena

Adubofour, MD, Mohsen Saadat, DO, Clyde Wong, MD


LISA RICHMOND

RALLY THE TROOPS!It is essential that we rally the troops and unite for what is sure to be a highly watched battle against Prop 46. By the time you receive this issue in your mailbox, there will be less than 60 days left until Election Day. In order to defeat this misguided measure it is imperative that you educate yourself, your patients and our community. In fact, it is so important that we have dedicated the majority of this issue of San Joaquin Physician to the No on Prop 46 efforts. Please call our office with any questions or visit www.NoOn46.com.

Membership is often perceived as a non-essential cost of doing business. Some see it as an obligation, renew out of habit or peer pressure, but sadly never truly see the value of their membership. At SJMS and CMA we hope that through this fight, you will be able to truly appreciate the extensive lobbying and advocacy that takes place every day locally, in Sacramento and in Washington D.C. on your behalf. Furthermore, Membership not only provides you with personal benefits, but opens a wide array to services to your practice managers and staff as a whole. Please contact Jessica Peluso, Membership Coordinator with any questions or concerns.

We are also very proud of our community programs, such as Decision Medicine. This past summer marked the 12 year anniversary of Decision Medicine, a program which introduces 24 local high school students to the field of medicine through personal mentoring opportunities, behind the scenes access to our regional hospitals clinics and public health centers. We experienced record physician engagement this year! Thank you to our generous financial sponsors Health Plan of San Joaquin and Kaiser Permanente, local community partners and our member physicians for your continued support. These students are a bright spot in our summer and make us feel hopeful about the future of medicine in San Joaquin County.

Finally, please SAVE THE DATE for our annual Holiday Party on Sunday, December 14 at Brookside Golf & Country Club. It is always a nice time to gather with friends and colleagues as we celebrate the holiday season and hopefully a win against Prop 46!

All the Best,

Lisa Richmond

STAFF REPORT

Letter From The Executive Director


Jasbir S. Gill, M.D.

Catherine Mathis, M.D.

Darrell R. Burns, M.D.Thomas Streeter, M.D. Tonja Harris-Stansil, M.D.Tonja Harris-Stansil, M.D.Tonja Harris-Stansil, M.D.Param K. Gill, M.D. Vincent P. Pennisi, M.D. Kevin E. Rine, M.D.

John Kim, M.D. Lynette Bird, R.N., B.S.N.Lynette Bird, R.N., B.S.N. Vicki Patterson-Lambert, Vicki Patterson-Lambert, R.N.P.C. Denise Morgan, M.S.N. - N.P.Denise Morgan, M.S.N. - N.P.Denise Morgan, M.S.N. - N.P.Harjit Sud, M.D.Harjit Sud, M.D.

Linda Bouchard, M.D.

Jennifer Phung, M.D.Jennifer Phung, M.D. David L. Eibling M.D.David L. Eibling M.D. R. Afiba Arthur, M.D.R. Afiba Arthur, M.D. Jacqualin Miller, D.O.

Philip D. Ross, M.D. Philip D. Ross, M.D. Maria E. Escalona, M.D.

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It is with great pleasure to serve as the President of San Joaquin Medical Society in this tumultuous time. I would like

to thank all my colleagues for putting their trust in my ability

to lead this society in this coming year. My first and

foremost priority is to help educate and inform

my colleagues, patients, and friends about California’s Medical Injury Compensation Reform Act (MICR A) and the trial lawyer attempts to change

the successful law which will appear on

the November ballot, Proposition 46. . Despite our

modes of practice, specialty or

county affiliation – it is more important than ever that together, we unite as one voice to defeat this costly, dangerous measure that will impact all Californians. If at any time in our careers there is a need to unite, the time is now.

Prop 46 would have devastating effects on consumers, taxpayers, patients and the future of health care in our state. Because of this, we have dedicated this issue of San Joaquin Physician to help inform our colleagues. My motto this year is “Unity in Diversity” because first and foremost we are physicians and advocates for our patients and by standing together as one, we can defeat Prop 46.

We became physicians – entered this great profession – because of a deep desire to serve humanity, heal the sick and provide hope for the patients and families that enter our waiting rooms. We made the great pledge to “Prescribe regimens for

ABOUT THE AUTHOR Ramin Manshadi MD, FACC is President of the San Joaquin Medical Society and is Board-Certifi ed Cardiologist.

Serving You

A message from our President > Ramin Manshadi MD, FACC

I would like to thank all my colleagues for putting their trust in my ability to lead this society in this coming year.

FALL 2014

It is with great pleasure to serve as the President of San Joaquin Medical Society in this tumultuous time. I would like

to thank all my colleagues for putting their trust in my ability

to lead this society in this coming year. My first and

foremost priority is to help educate and inform

my colleagues, patients, and friends about California’s Medical Injury Compensation Reform Act (MICR A) and the trial lawyer attempts to change

the successful law which will appear on

the November ballot, Proposition 46. . Despite our

modes of practice, specialty or

ABOUT THE AUTHOR Ramin Manshadi MD, FACC is President of the San Joaquin Medical Society and is Board-Certifi ed Cardiologist.

Serving You I would like to thank all my colleagues for putting their trust in my ability

to lead this society in this coming year.

the good of patients according to my ability and my judgment and never do harm to anyone.”

As physicians, we are always looking for ways to increase patient safety, improve medical technology and better serve the patients we’ve dedicated our lives and careers to. Prop 46, despite what proponents may say, will do nothing to improve patient safety and is just a deceptive measure thrown together by trial lawyers without thought or concern about costs, access to care or patient privacy.

Prop 46 was written by trial lawyers for trial lawyers, and will take money directly out of the health care delivery system. If they get their way, medical lawsuits and payouts will skyrocket

and consumers, taxpayers and patients across the state will have to carry the burden of those increased costs. Additionally, If California’s medical liability cap goes up, people could also lose access to their trusted doctor as many physicians will be forced to leave California to practice in states where medical liability insurance is more affordable. What’s more is that that Prop 46 will force doctors and pharmacists to use a massive statewide database filled with Californians’ personal medical prescription information – the Controlled Utilization Review and Evaluation System (CUR ES). A mandate government will find impossible to implement, and a database with no increased security standards to protect the personal prescription information of so many patients.

If you’re reading this article, you’re already engaged and for that, we thank you for your continued efforts. In order to defeat Prop 46 in November, we must make our colleagues aware of the challenges before us between now and Election Day. It will take everyone’s dedication to educate patients about the real intentions of this misguided measure and so let us make it our goal to inform our peers that have not yet been aware of the implications Prop. 46 would have.

What can you do leading up to November 4? Please regularly visit the NoOn46.com for updates and current news

If you haven’t donated to the campaign, it’s easy, visit www.noon46.com and click “contributions.” This is not a time for us to let a few carry us through with their contributions. Every dollar counts and will help makes sure that the No on 46 campaign is able to communicate with patients – voters – about the real intentions of the

ballot measure.

Participate in a Speaker’s Bureau session Sign up as a hospital coordinator to help educate your colleagues

Order materials to have available in your offices With rapid changes to the health care delivery system, we are all busy with the daily work of both seeing patients and adapting to new times. Ensuring that Prop. 46 is defeated is an important charge that we must dedicate our time to between now and Election Day. I am confident that with our voice and efforts united as one, we can!

A message from our President > Ramin Manshadi MD, FACC

Prop 46 was written by trial lawyers for trial lawyers, and will take money directly out of the health care delivery

system. If they get their way, medical lawsuits and payouts will skyrocket and

consumers, taxpayers and patients across the state will have to carry the burden of those increased costs.

““patients across the state will

“patients across the state will

have to carry the burden of those increased costs.

“have to carry the burden of those increased costs.

““Prop 46“Prop 46


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As a physician, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

That’s why the San Joaquin Medical Society sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company:

• Benefits not tied to a practice, giving you more flexibility with potential career changes

• Benefit payments that are 100% TAX-FREE when you pay premiums yourself

• High monthly benefits up to $10,000

• Protection in your medical specialty for the first 10 years of disability

With this critical protection, you’ll have one less thing to worry about until your return.

YOU WORK TO PROTECT YOUR PATIENTS.WE WORK TO PROTECT YOU. Learn more about this valuable plan today! Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at 800-842-3761.


D O G M E A TA Memoir of Love and Neurosurgery in San Francisco.

Moris Senegor, M.D.

Ambitious and cocky, a young neurosurgery resident left his hometown of Chicago for what became an unforgettable adventure in San Francisco, both exhilarating and disheartening, destined to irrevocably change his future. “Dogmeat” was the moniker he was given as apprentice to a famous—and famously intimidating—

neurosurgeon. Moris Senegor gives a disarmingly honest account of his “Dogmeat” days in the wards and operating rooms of UCSF.

He also vividly recounts how he fell in love with San Francisco and a woman he found there. His story is for both surgeons and anyone

ever beguiled by San Francisco.


Moris Senegor, M.D. > The Author of Dogmeat

Regular readers of San Joaquin Physician Magazine will recognize the name of Dr. Moris Senegor not only as one of the

area’s top neurosurgeons, but also as a longtime contributor and eventual editor of the medical society’s publication.

Now, Senegor has added another title to his lengthy resume – author. Earlier this year, Senegor worked with publisher Xlibris to produce his first full-length project, entitled “Dogmeat: A Memoir of Love and Neurosurgery in San Francisco.”

Senegor, who served as editor of San Joaquin Physician Magazine from 2000 to 2012, said he discovered his talent for writing in a somewhat unusual way.

“As I remember it, I submitted a rather nasty letter,” he said, recalling that his lean, stripped down style and penchant for choosing controversial subject matter was something that regular readers would later tell him they found refreshing.

As time went on, Senegor continued his contributions to the magazine, before eventually picking up a regular spot as a wine blogger with

S T O C K T O N N E U R O S U R G E O N A D D S ‘ A U T H O R ’ T O R E S U M E



the Stockton Record. Before long, the once-occasional writer suddenly found that turning out copy had suddenly become a major fixture in his life.

“It sort of became a side thing that started taking up more and more of my time,” he said.

As time went on, Senegor said that his long-standing desire to publish a full-length work began to grow, but that it wasn’t until a reading of Ernest Hemingway’s famous memoir “A Moveable Feast” that his ambitions as an author finally came to a head.

“That was a life changer,” he said, noting that Hemingway’s choice to focus upon his formative years as a young writer in Paris provided the inspiration for “Dogmeat’s” subject matter. Senegor explains that, as with Hemingway’s time in Paris, his six-month experience as a resident under world-renowned neurosurgeon Charles Wilson, M.D. in San Francisco is one that he looks back upon as one that helped make him the person he is today.

“It was the best and worst thing that I ever did in my life,” he said. “And it almost destroyed my career.”

Throughout the work, Senegor is able to candidly discuss his experiences in San Francisco, including a medical error made during his residency whose effects slowly began to bleed into the more personal aspects of his life.

“This is not at all about my accomplishments, this is about my weakness as a young doctor,” Senegor explains.

“Dogmeat,” which draws its name from a comment a fellow resident made early in the program about how Senegor would spend the next six months as Dr. Wilson’s “dogmeat,” also deals with Senegor’s love of both San Francisco, as well as a woman he met during his time in the city.

Using these three themes – neurosurgery, love and the city itself – Senegor weaves together three seemingly

independent storylines into one formative experience he believes has forever changed his life – both professional and private.

“It was like I was emptying something out that was inside of me,” he

said of the work.

“Dogmeat: A Memoir of Love and Neurosurgery in San Francisco” is available to order on Amazon, in both electronic and hardcopy, and well as in Barnes and Noble’s online store.

“ T H I S I S N O T A T A L L A B O U T M Y A C C O M P L I S H M E N T S , T H I S I S A B O U T M Y W E A K N E S S A S A

Y O U N G D O C T O R . ” - S E N E G O R

Moris Senegor, M.D. > The Author of Dogmeat


All young people can learn….FIND THE RIGHT PLACE!

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IN THENEWS

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

Kevin R. Hilton, MD, joins Lodi Health as sports medicine practitioner and orthopedic surgeon He practices sports medicine and orthopedic surger y at Lodi Health Physicians Vine Specialt y Care.

Dr. Hilton is board-certi f ied and fel lowship-trained in sports medicine and orthopedic surger y. He is a graduate of Universit y of K ansas School of Medicine and has a bachelor of science from Universit y of Cali fornia, Dav is.

Dr. Hilton completed a sports medicine fel lowship w ith Kerlan-Jobe Orthopedic Clinic in Los A ngeles, ser v ing as

a team physician for the Los A ngeles Lakers, Los A ngeles Dodgers and A naheim A ngels. He is an active member of the A merican Academy of Orthopedic Surgeons and the A merican Orthopedic Societ y for Sports Medicine. His interest and ex pertise include arthroscopic and reconstructive surger y of the k nee, shoulder, elbow and ank les, as wel l as adult reconstructive surger y (joint-replacement surger y) of the k nee, hip and shoulder.

Most recently, Dr. Hilton has been in private practice at Cali fornia Sports Medicine Orthopedic Surger y in Rosev i l le. His of f ice is now located at Lodi Health Physicians Vine Specialt y Care, 1235 W. Vine St . in Lodi, 209.334.8520. Dr. Hilton is accepting new patients and most insurance.

Lodi Health Joins Registry Group for Joint Replacement SurgeriesMore than 80,000 k nee and hip replacements surgeries are performed each year in Cali fornia. That number is ex pected to increase as more people remain active as they age. Lodi Health has a lways been committed to prov iding the highest qual it y care to its joint replacement patients and now takes the added step toward improv ing patient outcomes by joining the Cali fornia Joint Replacement Registr y (CJR R), an independent organization that col lects and reports patient and cl inical data about the outcomes of joint replacement procedures.

Lodi Health ’s involvement w ith the CJR R ref lects its mission to continuously improve qualit y and satisfaction for patients who have hip and k nee replacements.

“Patient registries for joint replacement procedures and other medical procedures and conditions have proven to be ef fective tools in improv ing patient outcomes and reducing complications that can occur both during and fol low ing surgical procedures,” said Lodi Health President and CEO Joseph Harrington. “In fact, in countries where registries have been created and used, rev ision rates have decreased signif icantly, resulting in better patient outcomes and reduced overal l cost of care.”

Lodi Health is a private, not for profit health system

In The News


Kevin R. Hilton, MD


founded in 1945. Visit the website at lodihealth.org. The CJR R was created to meet the need for objective, scientif ic information about the results of hip and k nee replacement surgeries. It col lects and incorporates direct feedback from patients about their pain and f unction before and af ter hip and k nee replacement surgeries. Visit CJR R’s website at w w w.caljrr.org.

St. Joseph’s Among Top 5 In State For Coronary Artery Bypass SurgeryConsumer Reports recently released its f irst-ever ratings of hospitals for heart surger y and St. Joseph ’s Medical Center made the l ist of the top f ive hospitals in the state for coronar y arter y by pass graf t surger y.

St . Joseph ’s received a stel lar rating of “above average” for coronar y arter y by pass graf t surger y and a sol id rating of “average” for aortic valve replacement. In total there were only seven hospitals in the state that received above average ratings in either coronar y arter y by pass, aortic valve replacement, or both.

The ratings were part of an in-depth article t it led “ Where should you go for heart surger y?” which examined data from more than 400 hospitals in the nation. Consumer Reports rated the hospitals based on information reported

to the Societ y of Thoracic Surgeons, which represents the gold standard in track ing hospital performance. R atings are determined by measuring factors such as patient sur v ival rates, complications, surgical technique, and medication management.

Of the just over 120 hospitals in Cali fornia, there were only 46 hospitals that agreed to release their data for public reporting to Consumer Reports.

“ We have a long-standing histor y of excel lence in cardiac care, and we are proud to be grow ing and continuing this legacy,” said Don Wiley, president/CEO of St . Joseph ’s Medical Center. “Our award w inning Heart Center attracts patients from throughout the state who are in search of top-

The American Cancer Society’s Annual ‘Making Strides Against Breast Cancer’ Walk Scheduled for October 11 in Stockton

On Saturday, October 11, The American Cancer Society is hosting its third annual Making Strides Against Breast Cancer at San Joaquin Delta College. The event is a 5k walk that honors survivors, provides information and raises funds for the Society’s breast cancer services as well as research toward preventing, curing and treating breast cancer.

These services include “Look Good, Feel Better,” which provides those undergoing treatment with free wigs and makeup tips and “Reach to Recover,” where newly diagnosed breast cancer patients are paired with survivors to help them

through their journey. Additionally, the Society funds groundbreaking research, which has led to advances such as Herceptin, Tamoxifen and the use of mammography as the standard in breast cancer detection.

Those interested can form teams or walk as individuals. Since there is no registration fee, participants are encouraged to fundraise. For more information please visit http://MakingStridesWalk.Org/Stockton, e-mail: [email protected] or call 209.941.2677.

In The News


IN THENEWS

In The News

of-the-l ine care, and that’s just what indiv iduals can ex pect to receive at our hospital .”

St . Joseph ’s Medical Center conducts over 4,000 cardiac procedures annual ly and has been ranked in the top 10% in the nation for cardiac surger y by CareChex . Additional ly, St . Joseph ’s is a designated STEMI Receiv ing Center for the treatment of heart attacks, surpassing national standards for opening a blocked arter y.

St. Joseph’s Medical Center is first in the Central Valley to use new technology for treatment of coronary artery diseaseSt. Joseph ’s Medical Center is the f irst in the Central Val ley to use the Diamondback 360® Coronar y Orbital Atherectomy System (OA S). This new technolog y is the f irst ev idence-based, safe treatment approved by the FDA for severely calcif ied coronar y lesions that can cause complications when treating Coronar y A rter y Disease (CA D), a l i fe-threatening condition.

“This revolutionar y technolog y w il l enhance the already excel lent care that patients receive at St . Joseph ’s Heart Center” said Donald J. Wiley, Hospital President and CEO. “ We are both proud and excited to be the f irst local hospital to of fer this new treatment.”

The Diamondback 360® Coronar y OA S, from Cardiovascular Systems,

Inc. , uses a patented combination of dif ferential sanding and centri f ugal force to reduce arterial calcium, which is present in nearly 40 percent of patients undergoing a percutaneous coronar y inter vention in the U. S.

The dev ice is an eccentrical ly mounted 1.25-mil l imeter diamond-coated crow n that sands away calcium in severely calcif ied coronar y arteries, enabling stent deployment. A s the crow n rotates and orbit increases, centri f ugal force presses the crow n against the lesion, reducing arterial calcium, while healthy tissue f lexes away.

St. Joseph’s Medical Center named practice Greenhealth Partner for change. St. Joseph’sFormally acknowledged for Environmentally Preferable Practices

St. Joseph ’s Medical Center was awarded the 2014 “Greenhealth Partner for Change” Award by Practice Greenhealth, the nation’s leading health care communit y that empowers its members to increase their ef f iciencies and env ironmental stewardship while improv ing patient safet y and care through tools, best practices and k nowledge.

This is the tenth year that St . Joseph ’s Medical Center has been recognized by Greenhealth. Each year, the hospital strives to achieve the highest level possible of env ironmental awareness and conser vation integration. St . Joseph ’s is San Joaquin Count y’s f irst “green certi f ied ” hospital by Green Team San Joaquin, an env ironmental program of the Greater Stockton Chamber of Commerce.

In F Y 2013 St. Joseph ’s recycled 64% of its overal l waste stream which equates to 865.48 tons of recycl ing. Additional ly, St . Joseph ’s has a

In The News

partnership w ith MedShare, which acts as a recycl ing and distribution center for surplus medical supplies and equipment.

Doctors Hospital Manteca Achieves “Comprehensive Status” in Weight Loss Surgery ProgramDoctors Hospital of Manteca is pleased to announce that our Weight Loss Surger y Program has earned “Comprehensive Status” from the Metabolic and Bariatric Surger y Accreditation and Qualit y Improvement Program (M BSAQIP). This is a meaningf ul achievement which ref lects the center’s abi l it y to perform al l weight loss procedure t y pes. This designation demonstrates our Weight Loss Surger y Program’s commitment to del ivering the highest qual it y care for bariatric surger y patients.

13th Annual Diabetes Conference With diabetes on the rise across A merica, this disease is impacting healthcare prov iders in al l discipl ines. Care for patients w ith any health condition is complicated by the added diagnosis of diabetes. With more and more people af fected by diabetes successf ul ly managing the disease is

now crit ical in any f ield of medicine. To address this grow ing need, the annual Diabetes Conference in San Joaquin Count y is coming back this year on November 1st . This w il l be the 13th annual seminar on “Fostering Excel lence in Diabetes Care”. With support from local hospitals, health plans and the San Joaquin Medical Societ y, the latest information on diabetes care is being made avai lable to local

physicians and other healthcare professionals. The event w il l be held at the Universit y Plaza Waterfront Hotel in Stockton from 8am to 2 pm, and 5 CM E credits w il l be prov ided. For more information or to register, please contact the San Joaquin Medical Societ y at 952-5299.

Four New Primary Care Physicians Join San Joaquin General Hospital ClinicsCarina Gonzalez , M.D. has joined San Joaquin General Hospital in French Camp practicing family medicine. Carina was born and raised in A rgentina and w il l assist in San Joaquin General Hospital ’s medical ser v ices to Spanish speak ing residents. Dr. Gonzalez received her medical degree from the Universit y National de Rosario (U NR) school of medicine near Buenos A ires A rgentina. She special ized in family medicine w ith a residency at Bel la Vista Hospital in Mayaquez, Puerto R ico. Dr. Gonzalez w il l perform family medical ser v ices through San Joaquin General Hospital ’s Primar y Medical Clinic.

Richard Slarve, M.D. a family medicine special ist has joined San Joaquin General Hospital to see patients in the Hospital ’s Primar y Care Medical Clinic. He ser ved as a physician in the U. S. A ir Force for 30 years. Dr. Slar ve received his medical degree from the Universit y of Los A ngeles (UCL A) School of Medicine. He conducted his residency in family medicine at the Universit y of Cali fornia Ir v ine. Dr. Slar ve looks for ward to the assisting the residents of San Joaquin Count y through the Hospital ’s family oriented cl inic care system. Dr. R ichard Slar ve joined San


Richard Slarve, M.D.

Samuel Ko, M.D.

Joaquin General Hospital in Februar y and can be contacted at the Hospital ’s Primar y Medical Clinic.

Ngoc Le, D.O. Early this year Dr. Ngoc Le joined San Joaquin General Hospital in French Camp practicing family medicine. Dr. Le received her medical degree from the Loma Linda Medical Center School of Medicine in Southern Cali fornia. Dr. Le did her family medicine residency at Wilson Memorial Hospital in New York . Ngoc Le is a lso f luent in speak ing Vietnamese. She is practicing family medical care through San Joaquin General Hospital ’s Primar y Medical Clinic.

Samuel Ko, M.D. A board certi f ied internal medicine prov ider has recently joined San Joaquin General Hospital in French Camp practicing in the Primar y Medical Clinic at San Joaquin General . Dr. Ko completed his medical internship Los A ngeles Count y-Universit y of Southern Cali fornia Medical Center. He continued his medical education w ith an internal medicine residency at Wyckoff Heights Medical Center, New York . Dr. Ko is active in primar y medical ser v ices through San Joaquin General Hospital ’s Primar y Medical Clinic. Dr. Samuel Ko is a lso f luent in the Burmese lang uage.

San Joaquin General Hospital is San Joaquin Count y’s only designation medical trauma center w ith emergency air transport ser v ices. The Hospital has a lso been recognized as a designated stroke receiv ing center and ranked by the Joint Commission in the top 20% of hospitals national ly for qualit y patient care.

Carina Gonzalez, M.D.

Ngoc Le, D.O.

In The News


In The News

“ As your MIEC Claims Representative, I will serve

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Senior Claims Representative Michael Anderson

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SJMS_06.17.14.indd 1 6/17/14 1:26 PM

GET THE FACTS

ABOUT PROP 46

Over the last several months, you may have read information about the Medical Injury Compensation Reform Act (MICRA) lawsuit initiative, Proposition 46, in the pages of this magazine, on your local

medical society’s website, in information from the California Medical Association (CMA) and likely from the hundreds of coalition partners that have all pledged to oppose the measure this November. On

November 4, 2014, voters will be asked to cast their ballots. In the final months, weeks and days leading up to Election Day, it will be our task as physicians to educate our patients, neighbors, friends and

families about the real intentions behind Prop. 46.

Have You Joined the Fight?


An Overview of Prop. 46 The measure is complex and contains three separate and distinct pieces that trial lawyer proponents have thrown together in an effort to mask their real intent – quadrupling non-economic damages in MICRA, pulling money directly out of the health care delivery system and putting it into their own pockets. The pieces voters will be asked to weigh in on are as follows:

A quadrupling of the non-economic damages limit on medical malpractice awards in California, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs, and cause many doctors and other medical care professionals to quit their practices or move to places with lower medical malpractice insurance premiums – reducing access to care in California.

An unfunded mandate that will require physicians, pharmacists and veterinarians to check a government run database before prescribing schedule II or III drugs. This piece in particular threatens patient privacy by requiring a massive expansion of the use of a personal prescription drug database.

Both a random and mandatory requirement to perform alcohol and drug testing on doctors, which was only added to this initiative to distract from the main purpose.

Let’s not be fooled – Prop. 46 uses alcohol and drug testing of doctors to disguise the real intent – to increase the limit on the amount of medical malpractice lawsuit awards.

Raising Health Care Costs I’ve been speaking about Prop. 46 for months now, and explaining to people how it was carelessly thrown together without concern for taxpayers’ pocketbooks, health care or privacy, but one question that comes up repeatedly is, “how will this increase health costs?”

We know that trial lawyers out to profit from medical lawsuits sloppily drafted Prop. 46 and it will result in higher health care costs for everyone. We’ll see money come directly out of the health care delivery system and straight into the pockets of the lawyers that stand to gain most.

These higher costs will be passed to every purchaser and provider of health care: state and local governments, employers, employees, consumers and taxpayers. That’s why such a broad coalition of group stands in solid opposition to Prop. 46.

According to California’s independent, non-partisan Legislative Analyst’s Office (LAO) Prop. 46 could increase costs for state and local governments by “several hundred million dollars annually.”

The LAO goes on to warn that “even a small percentage change in health care costs could have a significant effect on government health care spending.”But, how exactly?

State and local governments are hit with higher costs in two ways: They provide health care benefits for current and retired government employees;They also provide health care

NOON


services for low-income residents through Medi-Cal and other locally-run health care programs like community clinics and public hospitals.

Higher health care costs for state and local governments would reduce funding available for vital local services like police, fire, social services, parks and libraries, to name a few. If Prop. 46 passes, everyone will carry the burden of these increased costs.

While the LAO estimates costs to state and local governments, they aren’t the only ones who will pay for more lawsuits and higher payouts.

According to a study by California’s former Legislative Analyst, Prop. 46 will increase health care costs across all sectors by $9.9 billion annually, which translates to around $1,000/year in higher health costs for a family of four.

For many families across the state, that is a tough choice between groceries and health care – and one that we can’t afford to let happen.

Threatening Privacy Proposition 46 includes a provision that could significantly jeopardize the privacy of patients’ personal prescription medical information. The initiative forces doctors and pharmacists to use a massive statewide database, called CURES, which is filled with patient’s personal prescription drug information. Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands this ballot measure will place on it. In fact, in evaluating Prop. 46 the LAO noted, “Currently CURES does not have sufficient capacity to handle the higher level of use that is expected to occur when providers are required to register beginning in 2016.”

Many of us as physicians want the CURES database to work to help keep patients safe. Unfortunately, the provision in this ballot measure isn’t that simple.

Prop. 46 will force the CURES database to respond to tens of millions of inquiries each year– something the database simply cannot do in its current form or functionality. A non-functioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients.

Another concerning piece of this provision is that the massive ramp up of this database will significantly put at risk patients’ private medical information. Prop. 46 doesn’t contain any provisions or funding to upgrade the database with increased security standards to protect personal prescription information from government intrusion, hacking, theft or improper access by non-medical professionals.

The CURES database contains a record of every dispensed prescription of a Schedule II, III or IV substance and contains highly sensitive, personal and potentially stigmatizing details about a person’s health. It includes prescription information including medicines used to treat anxiety, insomnia, obesity, narcolepsy, drug detoxification, pain, epilepsy, conditions related to cancer and AIDS, asthma, chronic infection, and other sensitive medical conditions.

What’s more - the law gives the Department of Justice unfettered discretion to disclose confidential patient prescription information to any state, local, or federal public agencies for disciplinary, civil or criminal purposes.

There are literally hundreds of entities and thousands of individuals who work for those agencies that meet this definition - providing access to highly-personal and sensitive patient health information for non-medical reasons.

What Now? We’ve got a lot of work to do between now and Election Day. The proponents of Prop. 46 continue to mislead the public about the real intentions behind the measure – quadrupling the cap on non-economic damages in MICRA, which will result in higher health care costs for everyone.

For the future of medicine in California – and the nation – and for the safety of our patients, I ask you to get engaged in these last weeks and months. You can:

Donate to the campaign. It’s as simple as visiting NoOn46.com and clicking on “contribute.” Every dollar counts as we need to produce material to ensure voters understand the risks associated with Prop. 46

Order campaign material. We’ve got buttons, office posters, informational brochures, lab coat cards and more, all available at NoOn46.com. Simply click “Take Action” and “Get Campaign Material” and it will be sent directly to you.

Sign up to be a part of the campaign. As physicians, we see dozens of patients daily. Take the time to let them know about the dangers and real intent behind Prop. 46.

With the changing times in the health care delivery system, I know it can be tough to make the time for something else. The future of our profession depends on us here, and I urge you to commit to being involved through November 4 and beyond.

For all of your efforts until now and moving forward – thank you.

Sincerely,Lisa Richmond


The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s Trial Lawyers have launched an attack to

undermine MICRA and its protections and we need your help. Membership has never been so valuable!

savings of over $81,000

WAYS SJMS/CMA IS WORKING FOR YOU!

Are you an SJMS/CMA member?San Joaquin physicians are saving an average of $81,752 this year.

2013 SAN JOAQUIN MEDICAL SOCIETY MICRA SAVINGS CHART

San Joaquin Medical Society3031 West March Lane, Ste. 222W, Stockton, CA 95219Phone: (209) 952-5299 Fax: (209) 952-5298

* Medical Liability Monitor - Annual Rate Survey Issue, Vol. 38, No. 10, October 2013. Annual rates with limits of $1 million/$3 million.

General Surgery Internal Medicine OB/GYN Average (Non-Invasive)

San Joaquin County $28,147 $7,976 $36,865 $24,329

Connecticut $92,782 $34,700 $170,389 $99,290

District of Columbia $73,018 $24,010 $147,595 $81,541

New York $148,454 $35,883 $227,899 $137,412

CT-DC-NY Average $104,751 $31,531 $181,961 $106,081

MICRA Savings $76,604 $23,555 $145,096 $81,752

Increased costs

Losing your doctor

Threatening your privacy

By now, many of you are familiar with the MICRA lawsuit initiative that will appear on the November 4, 2014, ballot. Proposition 46 is being opposed by a coalition of doctors, community health clinics, Planned Parenthood Affiliates of California, local governments, working men and women, business groups, taxpayer groups, hospitals and educators, all of whom know that the measure will lead to more lawsuits and higher health care costs. What’s more, it will threaten personal privacy and jeopardize people’s access to their trusted doctors or clinics.

This information is intended to be useful for coalition members who are on the ground working to defeat Prop. 46. To that end, please also visit www.NoOn46.com for updated campaign information and to find out what you can do to join the efforts as an individual or organization.

No on Prop 46

Get Engaged!No on Prop 46

Get Engaged!

WHAT YOU CAN DOSIGN UP FORMALLY (AS AN ORGANIZATION, PRACTICE OR INDIVIDUAL) IN OPPOSITION TO THE CAMPAIGNVisit the campaign website at www.NoOn46.com to add your name to the growing list of groups and organizations opposing Prop. 46.

REQUEST A CMA STAFF MEMBER TO SPEAK TO YOUR GROUP, HOSPITAL OR SPECIALTY SOCIETYLet your local county medical society or CMA know and we can ensure you’re hearing from the right people about the most recent campaign updates.

PARTICIPATE IN MESSAGE/MEDIA TRAININGThe campaign is looking for physicians interested in taking on a more public role speaking to community groups about why this ballot measure should be defeated. Contact Molly Weedn at [email protected] for more information.

SPEAK TO YOUR COLLEAGUES, PATIENTS AND COMMUNITYUse the resources at NoOn46.com to talk to your colleagues, patients, friends and family. Don’t forget to speak to community members as well – groups such as Rotary, Kiwanis, Soroptimist and more provide great venues for presentations.

ORDER CAMPAIGN COLLATERALDownload the Order Form to receive office posters, English- and Spanish-language patient brochures, campaign buttons, message cards and more. You can also order directly online by visiting NoOn46.com

SPREAD THE MESSAGE ON SOCIAL MEDIAIf you’re active on social media, start by following the California Medical Association and No on Prop 46. Retweet and repost the information that is being put out to help spread the word about how dangerous and costly Prop. 46 will be for everyone. For questions about how to start a Twitter or Facebook account or how to engage with CMA, please contact Brooke Byrd at [email protected].

TwitterCMA: @cmaphysicians No on 46: @NoOn46

FacebookCMA: facebook.com/cmaphysicians No on 46: facebook.com/NoOn46


By now, many of you are familiar with the MICRA lawsuit initiative that will appear on the November 4, 2014, ballot. Proposition 46 is being opposed a coalition of doctors, community health clinics, Planned Parenthood Affiliates of California, local governments, working men and women, business groups, taxpayer groups, hospitals and educators, all of whom know that the measure will lead to more lawsuits and higher health care costs. What’s more, it will threaten personal privacy and jeopardize people’s access to their trusted doctors or clinics.

This information is intended to be useful for coalition members who are on the ground working to defeat Prop. 46. To that end, please also visit www.NoOn46.com for updated campaign information and to find out what you can do to join the efforts as an individual or organization.

How to Talk to Your PatientsProp 46 - A costly threat to people’s personal privacy Californians can’t afford.

TALKING TO YOUR PATIENTSCommunicating the No on 46 message to your patients will be critical to defeating the trial lawyers’ attacks on the medical profession. As a trusted medical expert, you are in a unique position to share how Prop 46 would truly affect all health care users and taxpayers. Please use the Frequently Asked Questions (FAQ) below to guide your conversation with patients.

WHAT WILL PROP. 46 DO?Prop 46 does three things:• Quadruples the limit on medical malpractice awards in California, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs, and cause many doctors and other medical care professionals to quit their practice or move to places with lower medical malpractice insurance premiums – reducing access to care.

• Threatens your privacy by requiring a massive expansion of a personal prescription drug database.

• Requires alcohol and drug testing of doctors, which was only added to this initiative to distract from the main purpose.

Proposition 46 uses alcohol and drug testing of doctors to disguise the real intent – to increase a limit on the amount of medical malpractice lawsuit awards. WHO OPPOSES PROP. 46?Thousands of organizations and individuals representing doctors, nurses, community clinics, local governments, labor unions, business groups, education groups, taxpayer groups, hospitals, community groups and many others oppose Prop. 46 because it will lead to more lawsuits, higher health care costs, threaten people’s access to their trusted doctor or clinic, and jeopardize people’s personal prescription drug information.

WHO SUPPORTS PROP. 46?One hundred percent of the reported contributions to pay for signature gathering to place this on the ballot in November 2014 came from trial lawyers and their allies.


HOW WILL PROP. 46 INCREASE HEALTH CARE COSTS?There is no question that more lawsuits against health care providers will increase costs, and someone has to pay. And that someone is consumers and taxpayers.

California’s former Legislative Analyst found Prop. 46 would increase health costs for consumers and the state by about $9.9 billion annually.

This translates to more than $1,000/year in higher health care costs for a family of four.

California’s current independent, non-partisan Legislative Analyst Office (LAO) said impacts to state and local governments (i.e. – taxpayers) would be “several hundred million dollars annually.”

In its evaluation, the LAO warned “even a small percentage change in health care costs could have a significant effect on government health care spending.”

HOW DOES THIS AFFECT TAXPAYERS?State and local governments pay for current and retired government employee health benefits and they provide

health care “safety net” services directly through Medi-Cal, state and county hospitals and community clinics, and other local programs.

If lawsuits increase and health care costs go up, state and local governments pay these out of the budgets they receive from taxpayers. Increased health costs to state and local governments could force cuts to other vital services like education, public safety and social safety net programs. Or, state and local governments may decide to make up that additional cost by raising revenues, and that will come from taxpayers.

WHAT ABOUT ACCESS TO HEALTH CARE? HOW WILL THAT BE AFFECTED BY PROP. 46?If California’s medical liability cap goes up, people could lose the ability to see their trusted doctors. Many community clinics operate on slim margins. Any

significant increase in their costs will force them to reduce or eliminate services for patients. Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable.

Respected community clinics, including Planned Parenthood, warn that specialists like OB-GYNs will have no choice but to reduce or eliminate vital services, especially for women and families in underserved areas.

WHY ARE COMMUNITY CLINICS SO STRONGLY OPPOSED TO PROP. 46? Community clinics, like Planned Parenthood Affiliates of California, Community Clinic Association of Los Angeles County, and the California Association of Rural Health Clinics and hundreds of others say Prop. 46 will raise costs that will cause specialists, like OBGYNs, to reduce or eliminate services

to their patients. Many clinics struggle financially, particularly community clinics that serve low-income, uninsured and rural patients. Anything that increases costs could jeopardize access to care for those patients most in need.

HOW WILL PROP. 46 THREATEN PEOPLE’S PERSONAL PRIVACY?Prop. 46 forces doctors and pharmacists to use a massive statewide database filled with Californians’ personal medical prescription information. A mandate government will find impossible to implement, and a database with no increased security standards to protect personal prescription information from hacking and theft – none.


Increasing lawsuits is not the answer and will do absolutely nothing to improve

health care quality.

The physician community and all health care providers are always looking for ways to

improve patient safety.

But don’t be fooled by Prop 46.

Continued on page 36

Vote no46

Increased costs

Losing your doctor


www.NOOn46.com

Pull out poster

Vote noIncreased costs

Losing your doctor


www.NOOn46.comPaid for by No on 46 - Patients, Providers and Healthcare Insurers to Contain Health Costs, with major

funding from the Cooperative of American Physicians IE Committee and The Doctors Company


And who controls the database? The government – in an age when government already has too many tools for violating your privacy.

WHAT IS WRONG WITH THE PROVISION MANDATING USE OF THE CURES DATABASE? This database sounds simple, but

it’s not. While the CURES database is already in existence, Prop. 46 would require an immediate ramp up (the day after the election, on November 5, 2014), and will force the CURES database to respond to tens of millions of inquiries each year – something the database simply cannot do in its current form

or functionality.

In fact, in evaluating Prop. 46 the LAO noted, “Currently CURES does not have sufficient capacity to handle the higher level of use that is expected to occur when providers are required to register beginning in 2016.”

This poses two problems:• Jeopardizes patient access to their prescriptions. Prop. 46 will force the CURES database to respond to tens of millions of inquiries each year– something the database simply cannot do in its current form or functionality. A non-functioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients.

• Significantly puts at risk patients’ private medical information. Prop. 46 contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from government misuse, hacking, theft or improper access by non-medical professionals.

SHOULDN’T DOCTORS BE DRUG TESTED? The physician community and all health care providers are always looking for ways to improve patient safety. But don’t be fooled by Prop 46.

The drug testing provision was included for political, not policy reasons. The lawyers who wrote and funded getting Prop. 46 on the ballot have never gone to the state


JOIN US,

SAY NO TO PROP 46



Increased costs. Losing your doctor. Threatening your privacy.

Vote no 46A broad coalition of doctors, community health clinics, hospitals, local governments, public safety, business and labor opposes Proposition 46, which would make it easier

and more profi table for lawyers to sue doctors and hospitals.

Learn More At www.NOOn46.com

CALIFORNIA STATECONFERENCE OF THE

N A A C PCalifornia

Stronger Together

Have you joined the growing coalition opposed to Prop 46?

of CALIFORNIACalifornia PEOPLE

Paid for by No on 46 - Patients, Providers and Healthcare Insurers to Contain Health Costs, with major funding from the Cooperative of American Physicians IE Committee and The Doctors Company


legislature to propose drug testing of doctors. In fact, the consultant for Prop 46, Jamie Court, cynically told the LA Times on December 10, 2013, that drug testing of doctors was “the ultimate sweetener,” designed to deceive voters from the real reason behind the initiative, to make lawsuits easier and more lucrative for the lawyers who wrote and funded Prop 46.

ARE THE DRUG TESTING PROVISIONS IN PROP. 46 THE SAME AS WHAT THE FAA AND DEPARTMENT OF TRANSPORTATION REQUIRE OF PILOTS AND AIRLINE PERSONNEL? No. In fact, Prop. 46 cherry picks portions of the FAA procedure for pilots, but excludes other important provisions that ensure due process and fairness. For instance:Prop. 46 imposes a “presumption of negligence” immediately upon a positive test or if a physician is unable to take the test within the mandated 12 hour timeframe. This is not part of the FAA/Department of Transportation regulatory framework.

Anyone (disgruntled patient, co-worker, family member) could make a claim that a physician is impaired. In fact, Prop. 46 grants immunity to anyone who reports any information that “appears” to show that a physician “may” be impaired.

The FAA and Department of Transportation’s drug testing policies are designed to identify and respond to impairment that directly places passengers at risk. In contrast, Prop. 46 focuses on identifying and imposing sanctions

for physician substance use during an arbitrary time period, regardless of whether there is any evidence that it places patient safety at risk.

ARE PATIENTS ONLY ENTITLED TO $250,000 IN THE EVENT OF A MEDICAL LIABILITY CASE?No. MICRA was set up to ensure patients received fair compensation if they were injured. Under MICRA,

patients receive:• UNLIMITED economic damages for any and all past and future medical costs.

• UNLIMITED economic damages for lost wages and lifetime earning potential.

• UNLIMITED punitive damages - punishment awarded for malicious

You Have a ChoiceChoose Quality

(209) 957-3888www.hospicesj.org

James Saffier, MDOn-Site Medical Director

Hospice & Palliative CareInternal Medicine

(209) 957-3888www.hospicesj.orgwww.hospicesj.org

James Saffier, MDOn-Site Medical Director

Hospice & Palliative CareInternal Medicine

Joint CommissionAccredited


w w w . N o O n 4 6 . c o m

signup sheet

Protect Access to Quality Health Care and Patient Privacy – Oppose Prop. 46

YES! I/our organization/company would like to be listed as an official opponent of Proposition 46 - the ballot measure written by trial lawyers to make it easier and more profitable for lawyers to sue doctors and hospitals. Prop 46 will signifi-cantly increase health care costs, reduce patient access to care and jeopardize the privacy of our personal health informa-tion.

Please select a category (check one): Organization Company Individual

Company or Organization Name/Employer:

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Return this Form By email: [email protected]

By fax: (916) 442-3510

By mail: NO on 46, 1510 J Street, Suite 120, Sacramento, CA 95814

notes

11no on 46 campaign TOOLKITno on 46 campaign toolkit10



A Professional Law Corporation

MICHAEL R. MORDAUNT

PETER J. KELLY

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Our firm devotes its practice to civil litigation with decades of experience representing healthcare professionals in:

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Phone (209) 473-8732Fax (209) 957-9165

or willful misconduct.

• Up to $250,000 for speculative “non-economic” damages, often called pain and suffering.

The $250,000 cap reduces incentives to file meritless lawsuits, while at the same time ensures that legitimate claims can move forward.

WHAT ABOUT CHILDREN, SENIORS, AND LOW-INCOME CALIFORNIANS AND THE $250,000 MICRA CAP? Those who will be most hurt by Prop. 46 and the higher health care costs are the very people who are most vulnerable and least able to absorb higher costs: children, seniors, families and low-income Californians.

More lawsuits, like those that will result from Prop. 46, will increase costs for those who can least afford them. And it will reduce patient access to care.

The bottom line is that Prop. 46 will make it harder for all of California’s patients, including children, seniors, and low-income families to receive quality care.

That’s why groups like the American Academy of Pediatrics – California, California Children’s Hospital Association, Children’s Specialty Care Coalition and senior advocates like those at Curry Senior Center oppose this measure.

WON’T PROP. 46 HELP IMPROVE QUALITY BY HOLDING DOCTORS MORE ACCOUNTABLE? Even one medical error is too many and that’s why the entire health

care community is always looking for ways to improve patient safety. But don’t be fooled by this measure.

Increasing lawsuits is not the answer and will do absolutely nothing to improve health care quality. Worse, the resulting higher

health care costs will put health care services even more out of reach for people who already suffer from lack of access. Community clinics, rural practitioners and safety net providers are the most vulnerable to cost increases and could be forced to cut back services.


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4 CONVENIENT LOCATIONS TO SERVE YOU

Congratulations Dr. Mary Rose Bautista for winning the 2014 Young Physician Award

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From left to right, John C. Canzano, M.D., Bill Trezza, Bank of Agriculture & Commerce CEO and Mary Rose Bautista, M.D.

John Canzano, M.D. is an Ophthalmologist and partner at Zeiter Eye Medical Group in Stockton. Dr. Canzano completed his undergraduate work at Duke University and went on to Emory University School of Medicine in Atlanta, Georgia. He then finished his residency at the UC Davis Medical Center, where he is now an Assistant Professor of Ophthalmology. Dr. Canzano then went on to receive specialty train-ing in the field of retina at the Doheny Eye Institute at the University of Southern California. Dr. Canzano specializes in refractive, cataract, and vitreoretinal surgery. He is also dedicated to helping patients with diabetic eye disease and macular degeneration.

Mary Rose Bautista, M.D. specializes in internal medicine- the diagno-sis and treatment of disease, and has 16 years of experience. Dr. Bautista studied at the University of California, Davis School of Medicine and did her residency at Cedars-Sinai Medical Center in Los Angeles. She is currently working at the Veterans Affairs Clinic in French Camp and is affiliated with the Veterans Affairs Palo Alto Health Care System. Dr. Bautista mainly works with adults as a primary care physician. She focuses on understanding multiple diseases and conditions and how they affect people, including how various diseases and conditions in-teract with one another.

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DECISION MEDICINE

o Pooo PPPHomegrown PhysiciansA desire to help the less fortunate, being a recent immigrant, experiencing homelessness, battling an autoimmune disease, losing a mother to breast cancer; these are just a few reasons that this year’s Decision Medicine students are motivated to pursue a career in medicine.


DECISION MEDICINE

PPPPHomegrown PhysiciansBy: Vanessa Armendariz


This year marked the 12th year of the Decision Medicine Program, a program developed by local physicians Dr. Kwabena Adubofour

and Dr. George Khoury, to help alleviate the primary care physician shortage in San Joaquin County. The two-week program exposes high school students to the field of medicine through physician mentoring, tours of local hospitals, interactive activities, and state-of-the-art simulation labs.

As with every year, the application process was extremely selective. With over 110 qualified applicants, it was extremely difficult to choose only 24 students. The 2014 participants had an average GPA of 4.2 and represented 14 different high schools across 5 different cities in San Joaquin County. Throughout the two weeks,

the students were challenged physically and mentally as they were exposed to various specialties in medicine. The nine-hour days were balanced to include informational lectures from various hospital departments, question and answer sessions with physicians, residents, and medical students, as well as interactive hands-on activities. Seven of the students had the exciting opportunity of scrubbing in and viewing various surgeries including a Cholecystectomy, cataract surgery, a stomach tumor removal, rotator cuff surgery, carpal tunnel surgery, and more.

This year we experienced a record level of engagement from our member physicians and actually had more mentors than students! The program has evolved significantly since its inception due to the continued

Left to right: A visual timeline of Decision Medicine events

Decision Medicine > 2014

TEAM IMPACT CENTER: Team Building Activities • Icebreaker Activities

ST. JOSEPH’S MEDICAL CENTER: CPR Training & CertificationHOSPITAL TOUR: -Catheterization Lab -Maternity/OB -Operating Room

-Oncology -Radiology -Simulation Lab


support from our financial partners, Health Plan of San Joaquin and Kaiser Permanente, community partners, and dedicated physicians. The goal of the program and its reputation caught the eye of various media outlets and was subsequently featured on local news channels KCRA and Fox40 News as well as in the Modesto Bee and The Record newspapers.

Although the program is only two weeks in duration, the San Joaquin Medical Society

commits to serving as a resource to the students throughout their journey to pursuing a career in medicine. The goal of the program has always been to expose high achieving students to the field of medicine in hopes that they return to practice in San

PHYSICIAN SHADOWING: PHYSICIAN SHADOWING: -Internal Medicine -Family Medicine -Pediatrics

-Orthopedics -Ophthalmology -Radiology -Cardiology -OBGYN Oncology -General Surgery KAISER PERMANENTE: Question & Answer Session With Health care Professionals

HOSPITAL TOUR: -Pathology -Radiology -Simulation Birth -Catheterization Lab -Operating Room

UC DAVIS MEDICAL SCHOOL & SHRINER’S CHILDREN’S HOSPITAL: Patient History Workshop • Simulation Lab

Discussion Panel with Medical Students Medical Play With Children at Shriners Hospital

Tour of Shriners Hospital


SAN JOAQUIN GENERAL HOSPITAL: Hematology Lecture

Forensic Pathology Presentation Blood Typing Activity • HOSPITAL TOUR:

-Core Lab -Pathology -Information Technology

Joaquin County. This was reiterated throughout the program and reinforced at the concluding celebration banquet.

Our keynote speaker this year, Dr. Michael Rehbein of Kaiser Permanente, delivered an inspirational address to the aspiring physicians and their families that resonated with everyone in the room. He quoted theologian Frederick Buechner, saying, “Your vocation is where your greatest passion meets the world’s greatest need.” One of our greatest needs in San Joaquin County is to address the health issues and disparities within our community and one of the ways to do that is by having dedicated physicians who are passionate towards serving the community in which they grew up.

Some of the students will be the first in their families to attend college and many of them have not had previous exposure to the medical field. This program enables students to talk with a diverse group of physicians that may have similar backgrounds, whether they went to high school locally,

P

Kathy LaoYear in Decision Medicine: 2003

High school: Franklin High School

Undergraduate College: UC Berkeley

Medical school: Touro University Nevada

Field of Medicine: Family Medicine,

Doctor of Osteopathic Medicine (D.O.)

Did Decision Medicine have an impact on your life and desire to pursue medicine? If so, how?

Yes, definitely! When you grow up in an underserved community, you may not think that a career in medicine is an obtainable goal. Decision Medicine supported and encouraged me to believe in myself. It also showed me that there is a need for more diversity among healthcare professionals to better suit the needs of growing minority populations in California.Are you interested in coming back to San Joaquin County to practice medicine?Of course! In fact, I have a Family Medicine rotation scheduled at the San Joaquin General Hospital later this year.What was your most memorable experience from the Decision Medicine program?I loved being able to see the daily routines for doctors in different medical specialties. One day we worked with forensic pathologists, another day we worked with pediatricians...there was always something new for us to experience.

DAMERON HOSPITAL: Hematology Lecture

Forensic Pathology PresentationBlood Typing Activity • HOSPITAL TOUR:

-Core Lab -Pathology -Information Technology

FIRST-AID TRAINING AND COLLEGE WORKSHOP: First-Aid Training & Certification

COLLEGE WORKSHOP: -Financial Aid-Scholarships -Applying to College

-Summer Programs


Lodi Memorial Hospital Acute Physical Rehabilitation (APR)Twenty-three years of specialized, inpatient rehabilitation services for stroke, brain-injury, spinal-cord-injury, multiple-trauma and patients with other neurological conditions

�e county’s only acute, inpatient physical-rehabilitation program, featuring:

Emphasis on safe and independent transition home Coordinated physical, occupational, speech and

recreational-therapy sessions, three hours daily State-of-the-art technology for neurologic training 24-hour care by rehabilitation-trained, experienced nurses Daily physician visits Outdoor areas for rehabilitation and recreational activities Private rooms and room-service meals for patients and

their family members

Lodi Memorial Hospital Acute Physical Rehabilitation Ramnik Clair, MD, Medical Director209/712-7905 Tel209/333-3082 Fax975 S. Fairmont Ave., Lodi, CA 95240 www.lodihealth.org

APR outcomes for 2013 Lodi Memorial NationFunctional Independent Measurement (FIM) 32 29Average stay in hospital 13 days 16 daysReturn to home 86% 72%

Lodi Health’s team of physical rehabilitation experts.

Medical directorRamnik Clair, MD

oare an underrepresented minority, were from a low socioeconomic background, or overcame various life obstacles. These connections and mentoring opportunities are often life-changing and truly valuable to the students because it shows that our medical community is invested in their future.

For the first time, we held a white coat ceremony, where Dr.Adubofour and Dr.Khoury robed the students in front of their families, mentor physicians, and community partners. The traditional white coat ceremony often marks the transition from pre-

Rajeev SharmaYear in Decision Medicine: 2004

High school: Franklin High School

Undergraduate College: UCLA

Medical school: 3rd year at Our Lady of Fatima (OLFU) School of

Medicine

Field of Medicine: Internal Medicine, Doctor of Medicine (M.D.)

Did Decision Medicine have an impact on your life and desire to pursue medicine? If so, how?

Decision medicine had a huge impact on my life and desire to pursue medicine. I still vividly remember being given the wonderful opportunity to visit doctors, clinics and hospitals around the San Joaquin County. Decision Medicine opened my eyes to the different areas and specialties of medicine. More importantly, I was fortunate to spend one on one time with many of the doctors and healthcare workers in my community and saw the amount of dedication, commitment and passion involved in the practice of medicine. By the end of the program I knew a career in medicine had been firmly rooted.

Are you interested in coming back to San Joaquin County to practice medicine?Of course! I am very interested in coming back to San Joaquin County to practice medicine in the future. I would be honored to learn and work with many of the doctors in our community. After Decision Medicine I was inspired by the enthusiasm and passion of many of the doctors I came across. Practicing medicine in this community and inspiring other young adults to pursue medicine would be an amazing experience for me in the future.

What was your most memorable experience from the Decision Medicine program? My most memorable experience from Decision Medicine was visiting the UC Davis medical school anatomy lab. It was my first time seeing a cadaver. I remember not being as frightened as I anticipated but instead had a keen interest for learning more. Little did I know it wouldn’t be my last anatomy lecture.

CALIFORNIA PACIFIC MEDICAL CENTERS, SF: HOSPITAL TOUR: -Simulation Neonatal Intensive

Care Emergency -Pathology -Radiology PRESENTATIONS BY PHYSICIANS:-Neurologist -Pediatrician -Radiology

Pig Heart Dissection • Cardiac Catheterization Demonstration



COMMUNITY MEDICAL CENTERS & ST. MARY’S DINING HALL:

Gleason House Tour • Channel Medical Center Tour Tour of St. Mary’s Interfaith Center

Community Service Project



clinical to clinical health sciences. In this case, the ceremony reinforced the idea that we believe that each of the students have the capability of accomplishing their dream of becoming a physician.

San Joaquin Medical Society and Health Plan of San Joaquin Awards First College ScholarshipThis year, the San Joaquin Medical Society and Health Plan of San Joaquin partnered to provide the Decision Medicine/ HPSJ Health Careers Scholarship to one Decision Medicine alumnus in the amount of $2,500. Although all of the applicants were impressive, the application review committee selected 2013 alumnus Francisco Langarica as this year’s scholarship recipient.

Francisco ranked 9 out of 437 students at Franklin High School. One of the things that set Francisco apart from the others was his success despite extenuating circumstances. Being raised in a single-parent household and experiencing homelessness did not stop Francisco from pursuing his goals. Instead of letting the challenges defeat him, Francisco pushed himself to strive for more. He is extremely independent and self-motivating, taking the initiative to enroll himself in the International Baccalaureate Program, which requires students to take the most rigorous courses available.

With a GPA of 4.29, it is difficult to imagine that Francisco had time to participate in other activities. Although Francisco excelled academically, he mastered his time management skills and was involved in a myriad of activities including sports, community service organizations, and academic societies. He served as Treasurer of the National Honor Society, Vice President of Key Club, and

Continued on page 55


New Laws > 2014

209-944-5550DameronHospital.org

Dameron Hospital’s award-winning orthopedic program includes community educational workshops,

surgical and non-surgical treatment options, treatment of orthopedic injuries and trauma, and rehabilitation.

Specializing in spine, hip, knee, shoulder, ankle and joint replacement, Dameron’s physicians, surgeons and

nurses work together to minimize pain and shorten recovery time for each patient.

Get back to enjoying the ACTIVE YOU.

Rated Best in Stockton Region for Joint Replacement in 2012.

ORTHOPEDIC EXCELLENCE


HEALTH BENEFIT EXCHANGE RESOURCES FOR PHYSICIANS

See CMA's exchange resources page for information on exchange plan contracting, patient enrollment and eligibility, and more!

WWW.CMANET.ORG/EXCHANGE



the Events Coordinator of the Youth Advisory Board at the University of the Pacific. He won a 1st place medal in Astronomy and a 3rd place medal in Anatomy and Physiology out of 24 high schools in the regional Science Olympiad competition. He served as Captain of the tennis team and won the Athletic Award, medallion, varsity letter, and “Most Improved” plaque for both Water Polo and Swimming. He embodies the meaning of being a well-rounded student and was extremely deserving of the scholarship.

The medical society was truly honored to have the opportunity to provide a scholarship to a Decision Medicine alumnus who represents everything that our program stands for. Francisco participated in Decision Medicine in 2013 and it was the words from Dr.Kwabena Adubofour that made Francisco realize that his educational dream was an attainable goal. Francisco notes, “He told me his story and how he overcame all odds to become a physician. He told me how he studied in Ghana and how difficult it was there. This taught me that if someone with hardly any resources in a third world country can make it as a physician

then certainly I can make it as a physician in a developed country with resources.”

Francisco will continue his pursuit to becoming a physician this fall at University of California-San Diego where he plans to major in General Biology and minor in Chicano Studies. He has committed to

coming back to practice medicine in Stockton. He explains, “I grew up in Stockton and have so many

memories here; some good, some bad; and I would hate to just walk away from my city. By practicing in San Joaquin County, I hope to build a stronger and safer environment.”

Helping Families Cherish LifeAseraCare Hospice® provides quality, compassionate care when you need it most. Our family-centered, holistic approach ensures that the needs and wishes of our patients and their families are met when faced with life-limiting illness.

Our services include: • Physician managed care • Admissions 24 hours a day, seven days a week • End-of-life decision making assistance • Special veterans recognition

Rated above average by CalQualityCare.org

AseraCare Hospice–Stockton2529 W. March Lane, Ste. 101Stockton, CA 95207209-474-8349www.AseraCare.com

For more information, contact us today.

This facility welcomes all persons in need of its services and does not discriminate on the basis of age, disability, race, color, national origin, ancestry, religion, gender, sexual orientation or source of payment. AHS-10269-13

“He told me his story and how he overcame all odds to become a physician. He told me how he studied in Ghana and how difficult it was there. This taught me that if someone with hardly any resources in a third world country can make it as a physician then certainly I can make it as a physician in a developed country with resources.”

56 SAN JOAQUIN PHYSICIAN FALL 201456 SAN JOAQUIN PHYSICIAN FALL 2014

Public Health Update

Influenza, 2014-2015The single best way to prevent influenza (flu) and its complications is annual vaccination.

The U.S. Centers for Disease Control and Prevention (CDC) and the CDC Advisory Committee on Immunization Practices (ACIP) recommend routine annual influenza vaccination for all persons aged ≥ 6 months who do not have contraindications. There are an increasing number of choices regarding flu vaccines. How do you know which one is the best one for your patients? For you and your family?

Influenza, the Virus(es)First, some background on influenza viruses and patterns of circulation. There are three types of influenza, named A, B, and C. Influenza C rarely causes human infections and will not be discussed further. Influenza A is divided into subtypes based on glycoproteins of the influenza virus membrane, namely hemagglutinin (H; there are 18 known H subtypes) and neuraminidase (N; 11 known subtypes). For the past 26 years, differing strains of A (H1N1) and A (H3N2) subtypes have

WHAT ARE THE SYMPTOMS OF FLU?high temperaturecold sweats, shiversheadacheaching jointaching limbsfatiguefeeling utterly exhaustedgastro-intestinal symptoms, such as nausea, vomiting, and diarrhea, are much more common among children than adults

http://www.medicalnewstoday.com/articles/15107.php

FALL 2014 SAN JOAQUIN PHYSICIAN 57FALL 2014 SAN JOAQUIN PHYSICIAN 57

Public Health Update

circulated each flu season. Influenza B viruses are not divided into subtypes, but are further broken down into different strains. Strains are classified as arising from either the Victoria or Yamagata lineage. For the past 12 years, influenza B strains from both lineages have been circulating each season.

Influenza, the Vaccine(s)Influenza A virus was first isolated in 1933, followed shortly by the discovery of influenza B in 1940. In 1938, Jonas Salk and Thomas Francis developed the first vaccine against flu viruses. This first inactivated bivalent flu (A & B) vaccine was licensed in 1945. Initial vaccines were whole killed viral vaccines. Current injectable flu vaccines are subunit vaccines, containing only part of the influenza virus. These subunit vaccines have less associated fever and local reactions compared to the whole killed viral vaccines.Since 1978, flu vaccines have provided coverage for three strains (trivalent vaccines), two A strains (H1N1 and H3N2) and one B strain. Last year, the first quadrivalent flu vaccines were approved, increasing coverage to four strains (quadrivalent vaccines): two A strains (H1N1 and H3N2) and two B strains (both Victoria and Yamagata lineage).

The trivalent flu vaccine for the 2014-2015 season protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus of the Yamagata lineage. The following trivalent flu vaccines are available:

1. Standard dose trivalent shots that are manufactured using virus grown in eggs (the “classic” flu shot). These are approved for people ages 6 months and older. There are different brands of this type of vaccine, and each is approved for

different ages (Afluria, Fluarix, FluLaval, Fluvirin, Fluzone).

2. A standard dose trivalent shot containing virus grown in cell culture, which is approved for people 18 and older. While grown in cell culture,

58 SAN JOAQUIN PHYSICIAN FALL 201458 SAN JOAQUIN PHYSICIAN FALL 2014

Public Health Updatethe seed virus for vaccine production was passed through chicken eggs. There is only one brand of this type of vaccine (Flucelvax).

3. A standard dose trivalent shot that is produced egg-free, approved for people 18 through 49 years of age. This vaccine is manufactured using recombinant technology (does not use the influenza virus or chicken eggs in the manufacturing process). There is only one brand of this type of vaccine (FluBlok).

4. A high-dose trivalent shot, approved for people 65 and older. It has four times the amount of antigen compared to the standard dose, and is intended to solicit a better immune response in older patients. There is only one brand of this type of vaccine (Fluzone High-Dose).

5. A standard dose intradermal trivalent shot, which is injected into the dermis instead of the muscle and uses a much smaller needle than for the regular flu shot, approved for people 18 through 64 years of age. This is a good alternative vaccine for a person who does not want an IM injection and does not qualify for the nasal spray vaccine. The patient should be counseled that there will be a greater local reaction at the vaccine site than with an IM flu shot. There is only one brand of this type of vaccine (Fluzone Intradermal).

The quadrivalent flu vaccine adds a second influenza B strain to the trivalent vaccine, protecting against two influenza A viruses and two influenza B viruses. Because both strains of the

B virus have been circulating each year, using a quadrivalent flu vaccine provides broader protection against influenza. The following quadrivalent flu vaccines are available:

1. A standard dose quadrivalent shot; as with the trivalent shot, manufactured using virus grown in eggs. These are approved for people ages 6 months and older. There are different brands of this type of vaccine, and each is approved for different ages (Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent).

2. A standard dose quadrivalent flu vaccine, given as a nasal spray, approved for healthy, non-pregnant people 2 through 49 years of age. A review of available studies suggests that this vaccine provides better protection than the flu shot in children 2-8 years of age. This is the preferred vaccine for all healthy children 2-8 years of age (FluMist Quadrivalent).

Remember that flu vaccination should begin soon after vaccine becomes available, ideally by October. However, as long as flu viruses are circulating, vaccination should continue to be offered throughout the flu season, even in January or later.

Annual flu vaccination is the single best way to prevent flu-related morbidity and mortality. Please continue to advise everyone to also wash hands regularly and often (hand hygiene), cough or sneeze into their arm (respiratory hygiene), and stay home when ill, away from others. Thank you for all you do every day to protect the health of our county residents.

FALL 2014 SAN JOAQUIN PHYSICIAN 59FALL 2014 SAN JOAQUIN PHYSICIAN 59

Table of vaccine formulations and age-groups for which approved:

VACCINE FORMULATION PATIENT AGE

6 - 23 months 2 - 17 years 18 – 49 years 50 – 64 years ≥ 65 years

Inactivated Influenza Vaccine, Trivalent (IIV3), Standard dose IM(≥ 6 months) + + + + +

Inactivated Influenza Vaccine, Quadrivalent (IIV4), Standard dose IM(≥ 6 months) + + + + +

Live Attenuated Influenza Vaccine, Quadrivalent (LAIV4), + +Standard dose Nasal Spray Healthy Healthy(2-49 years) Not Pregnant Not Pregnant Recombinant Influenza Vaccine, Trivalent (RIV3) Standard dose IM(18-49 years) + Inactivated Influenza Vaccine, Trivalent (IIV3), Standard dose Intradermal(18-64 years) + + Inactivated Influenza Vaccine, Trivalent (IIV3), High dose IM(≥ 65 years) +

The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice. Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership coordinator, at [email protected] or call (209) 952-5299.

Free to SJMS/CMA Members!practice manager

resources

SEPTEMBER 10TH, 2014: “NO ON PROP 46”11:00AM to 1:00PM

The campaign against the dangerous and deceptive Proposition 46 is entering its final most important stages, and we need your help to begin securing “NO” votes for the November election. As a reminder, Prop 46 threatens to increase costs, reduce access to care and compromise the personal privacy of millions of Californians.

We will win this fight, but we cannot do so alone, and each and every vote secured brings us one step closer to victory. Mike Steenburgh The Vice President of Component Relations and Marketing and Executive Director of CMA’s subsidiary, Component Medical Society Services.

OCTOBER 8TH, 2014: “COVERED CALIFORNIA 2015: WHAT YOUR HEALTHCARE TEAM NEEDS TO KNOW”11:00AM to 1:00PM

The CMA Foundation, through a grant from Covered California, is providing physicians and health care teams educational opportunities to learn more about Covered California and the impact on physician practices.

Timely information regarding: • Updated 2015 Enrollment Information• Identifying Qualified Health Plans within the Exchange

• Newly Updated Enrollment Demographics• Practice Management Tips

Presentations will also touch on the importance of understanding the changes taking place in the individual health insurance market; consumer cost sharing responsibilities; determination of premium assistance; physician status in the exchange market; and more information physicians need to know to get ready for Year Two of Covered California.

Lisa O’Connell is a Physician Educator for the Alameda-Contra Costa and Santa Clara regions.

NOVEMBER 12TH, 2014: TBD11:00AM TO 1:00PM

DECEMBER 10TH, 2014: “MEDICARE UPDATE 2015”

11:00AM TO 1:00PMJoin us for our annual Medicare Update workshop for physicians and office staff. This 2 hour seminar will cover relevant information about current, future and proposed changes for the coming year.

Michele Kelly, Associate Director, CMA’s Center for Economic Services, provides one-on-one assistance to physician members and their staff on reimbursement and practice operations issues. Assistance ranges from coaching and education, to direct intervention with payors or regulators.

CMA Center for Economic Services

1201 J Street, #200, Sacramento, CA 95814

[email protected] • 916/551-2061

In this issue:

Aetna to require additional accreditation require-

ments in order to be paid for certain surgical 1

May 2012

Medical-Legal Library

(Formerly CMA On-Call)

In this publication, you will find references to

“medical-legal” documents. The California

Medical Association’s (CMA) online medical-legal

library contains over 4,500 pages of medical-

legal, regulatory, and reimbursement information.

Medical-legal documents are free to members

and can be found in CMA’s online resource

library, http://www.cmanet.org/resource-library.

Nonmembers can purchase medical-legal docu-

ments for $2 per page.

CMA resourcesWhen you see this icon, that means

there are additional resources avail-

able free to California Medical Asso-

ciation (CMA) members at the CMA website.

To access any of these resources, visit

http://www.cmanet.org/ces.

CPR • May 2012 • Page 1 of 5

CMA Practice Resources (CPR) is a free monthly bulletin from the

California Medical Association’s Center for Economic Services. This bulletin is

full of tips and tools to help physicians and their office staff improve practice

efficiency and viability.

SUBSCRIBE TO CPR OR ANY OTHER CMA NEWSLETTERS: To stay up to date, sign

up for free subscriptions at www.cmanet.org/newsletters.

SPREAD THE WORD: Please forward this bulletin to your coworkers and colleagues.

Aetna to require additional accreditation requirements

in order to be paid for certain surgical pathology ser-

Aetna recently notified physicians that, effective August 1, 2012, practices per-

forming in-office pathology testing will be required to be both Clinical Labora-

tory Improvement Amendments (CLIA) certified and accredited with the Col-

lege of American Pathologists (CAP).

In a letter to physicians, Aetna claims that the change is consistent with the

Centers for Medicare & Medicaid Services (CMS) recognition of CAP as an

approved accreditation organization for non-hospital anatomic pathology test-

The California Medical Association has voiced concerns with the implemen-

tation of this policy and has asked Aetna to explain the need for dual certifica-

tion. Although CMS may recognize CAP as an approved accreditation organiza-

tion, CMS does not require both a CLIA certification and a specialty society

accreditation to perform in-office pathology testing services. Further, CMA

expressed concerns with the ability of physicians to obtain the CAP accredita-

tion prior to the deadline imposed by Aetna. According to CAP, the accredita-

tion process takes approximately 90 days. Additionally, the process of obtaining

a secondary accreditation can be very costly for practices.

In addition to their contact with Aetna on this issue, CMA is working close-

ly with the American Medical Association (AMA) and several other state and

specialty medical societies. Stay tuned for further details.

Practices with questions about the letter can contact Tammy Gaul, senior

network manager at Aetna at (215)775-6604.

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

Update on two Anthem Blue Cross issues pending with

the Department of Managed Health Care

DMHC claims audit

As previously reported, on Jan. 12, 2012 the Department of Managed Health

Care (DMHC) ordered Anthem Blue Cross to reprocess provider claims, with

interest, dating back to 2007.

The order is based on 2008 DMHC audits of the seven largest health plans

in California. These audits found violations of claim payments above the thresh-

old allowed under California law at all seven health plans.

As a result, DMHC assessed administrative fines, required the plans to pay

providers the money they were owed and mandated that plans demonstrate

ARE YOU READING CPR?

CPR contains the latest in Practice Management Resources, Updates and Information.

CMA Practice Resources (CPR)

is a free monthly e-mail bulletin

from CMA’s Center for Economic

Services. This bulletin is full of

tips and tools to help physicians

and their office staff improve

practice efficiency and viability.

SUBSCRIBE NOWSign up now for a free subscription to our

e-mail bulletin, at www.cmanet.org/news/cpr

CMA Center for Economic Services

1201 J Street, #200, Sacramento, CA 95814

[email protected] • 916/551-2061

In this issue:

Aetna to require additional accreditation require-

ments in order to be paid for certain surgical 1

May 2012

Medical-Legal Library

(Formerly CMA On-Call)

In this publication, you will find references to

“medical-legal” documents. The California

Medical Association’s (CMA) online medical-legal

library contains over 4,500 pages of medical-

legal, regulatory, and reimbursement information.

Medical-legal documents are free to members

and can be found in CMA’s online resource

library, http://www.cmanet.org/resource-library.

Nonmembers can purchase medical-legal docu-

ments for $2 per page.

CMA resourcesWhen you see this icon, that means

there are additional resources avail-

able free to California Medical Asso-

ciation (CMA) members at the CMA website.

To access any of these resources, visit

http://www.cmanet.org/ces.


CMA Practice Resources (CPR) is a free monthly bulletin from the

California Medical Association’s Center for Economic Services. This bulletin is

full of tips and tools to help physicians and their office staff improve practice

efficiency and viability.

SUBSCRIBE TO CPR OR ANY OTHER CMA NEWSLETTERS: To stay up to date, sign

up for free subscriptions at www.cmanet.org/newsletters.

SPREAD THE WORD: Please forward this bulletin to your coworkers and colleagues.

Aetna to require additional accreditation requirements



in order to be paid for certain surgical pathology ser

Aetna recently notified physicians that, effective August 1, 2012, practices per-

forming in-office pathology testing will be required to be both Clinical Labora-

tory Improvement Amendments (CLIA) certified and accredited with the Col-

lege of American Pathologists (CAP).

In a letter to physicians, Aetna claims that the change is consistent with the

Centers for Medicare & Medicaid Services (CMS) recognition of CAP as an

approved accreditation organization for non-hospital anatomic pathology test-

The California Medical Association has voiced concerns with the implemen-

tation of this policy and has asked Aetna to explain the need for dual certifica-

tion. Although CMS may recognize CAP as an approved accreditation organiza-

tion, CMS does not require both a CLIA certification and a specialty society

accreditation to perform in-office pathology testing services. Further, CMA

expressed concerns with the ability of physicians to obtain the CAP accredita-

tion prior to the deadline imposed by Aetna. According to CAP, the accredita-

tion process takes approximately 90 days. Additionally, the process of obtaining

a secondary accreditation can be very costly for practices.

In addition to their contact with Aetna on this issue, CMA is working close-

ly with the American Medical Association (AMA) and several other state and

specialty medical societies. Stay tuned for further details.

Practices with questions about the letter can contact Tammy Gaul, senior

network manager at Aetna at (215)775-6604.

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

Update on two Anthem Blue Cross issues pending with

the Department of Managed Health Care

DMHC claims audit

As previously reported, on Jan. 12, 2012 the Department of Managed Health

Care (DMHC) ordered Anthem Blue Cross to reprocess provider claims, with

interest, dating back to 2007.

The order is based on 2008 DMHC audits of the seven largest health plans

in California. These audits found violations of claim payments above the thresh-

old allowed under California law at all seven health plans.

As a result, DMHC assessed administrative fines, required the plans to pay

providers the money they were owed and mandated that plans demonstrate CMA Center for Economic Services1201 J Street, #200, Sacramento, CA [email protected] • 916/551-2061

In this issue:Aetna to require additional accreditation require-ments in order to be paid for certain surgical pathology services

1Update on two Anthem Blue Cross issues pending with the Department of Managed Health Care 1Meet Your CMA Center for Economic Services Advocate: Mark Lane 2CMA Advocacy at Work 2Urgent survey response requested 3Aetna erroneously terminates providers from California network

3Document, Document, Document 3United Healthcare announces extension of HIPAA 5010 enforcement 4What’s a COHS? 4Save the Date 4Act now to avoid the 2013 e-prescribing pen-alty 5Payor Updates 5Health plan provider newsletters 5

May 2012

Medical-Legal Library (Formerly CMA On-Call)In this publication, you will find references to “medical-legal” documents. The California Medical Association’s (CMA) online medical-legal library contains over 4,500 pages of medical-legal, regulatory, and reimbursement information.Medical-legal documents are free to members and can be found in CMA’s online resource library, http://www.cmanet.org/resource-library. Nonmembers can purchase medical-legal docu-ments for $2 per page.

CMA resourcesWhen you see this icon, that means there are additional resources avail-able free to California Medical Asso-ciation (CMA) members at the CMA website. To access any of these resources, visit http://www.cmanet.org/ces.


CMA Practice Resources (CPR) is a free monthly bulletin from theCalifornia Medical Association’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.SUBSCRIBE TO CPR OR ANY OTHER CMA NEWSLETTERS: To stay up to date, sign up for free subscriptions at www.cmanet.org/newsletters.SPREAD THE WORD: Please forward this bulletin to your coworkers and colleagues.

Aetna to require additional accreditation requirements in order to be paid for certain surgical pathology ser-vicesAetna recently notified physicians that, effective August 1, 2012, practices per-forming in-office pathology testing will be required to be both Clinical Labora-tory Improvement Amendments (CLIA) certified and accredited with the Col-lege of American Pathologists (CAP). In a letter to physicians, Aetna claims that the change is consistent with the Centers for Medicare & Medicaid Services (CMS) recognition of CAP as an approved accreditation organization for non-hospital anatomic pathology test-ing.

The California Medical Association has voiced concerns with the implemen-tation of this policy and has asked Aetna to explain the need for dual certifica-tion. Although CMS may recognize CAP as an approved accreditation organiza-tion, CMS does not require both a CLIA certification and a specialty society accreditation to perform in-office pathology testing services. Further, CMA expressed concerns with the ability of physicians to obtain the CAP accredita-tion prior to the deadline imposed by Aetna. According to CAP, the accredita-tion process takes approximately 90 days. Additionally, the process of obtaining a secondary accreditation can be very costly for practices. In addition to their contact with Aetna on this issue, CMA is working close-ly with the American Medical Association (AMA) and several other state and specialty medical societies. Stay tuned for further details. Practices with questions about the letter can contact Tammy Gaul, senior network manager at Aetna at (215)775-6604.Contact: CMA reimbursement help line, (888) 401-5911 or [email protected]

Update on two Anthem Blue Cross issues pending with the Department of Managed Health CareDMHC claims auditAs previously reported, on Jan. 12, 2012 the Department of Managed Health Care (DMHC) ordered Anthem Blue Cross to reprocess provider claims, with interest, dating back to 2007. The order is based on 2008 DMHC audits of the seven largest health plans in California. These audits found violations of claim payments above the thresh-old allowed under California law at all seven health plans. As a result, DMHC assessed administrative fines, required the plans to pay providers the money they were owed and mandated that plans demonstrate

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