Central Valley Physicians Spring 2016 by Fresno Madera Medical Society

Spring 2016

Growing Local Physicians A Doctor’s Journey Comes Full Circle Public Health Update: Climate Change Fresno Madera Medical Society’s Latin Jazz Night

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CENTRAL VALLEY PHYSICIANS

Spring 2016

VOLUME 1, NUMBER 2 • SPRING 2016

Cover Photo by Nicole Butler

{FEATURES}

24 36

GROWING LOCAL PHYSICIANS

FRESNO MADERA MEDICAL SOCIETY’S JAZZ NIGHT

{DEPARTMENTS} 16 IN THE NEWS

A DOCTOR’S JOURNEY COMES FULL CIRCLE

22 CMA EDUCATION 38 PUBLIC HEALTH UPDATE:

Climate Change

43 HOBBIES AT A GLANCE 44 OFFICE MANAGER’S FORUM:

Spring 2016

New faces and Announcements

Committed to Improving Quality Health Care

CENTRAL VALLEY PHYSICIANS

Letter From The Executive Director

SPRING IS HERE, IN CASE YOU CAN’T HEAR IT IN MY VOICE. A doctor called the office last week and the first thing he asked was, “whose voice is on the welcome message?” He then followed with, “she needs to go NICOLE BUTLER see an allergist; she has allergies.” Well that voice is mine and yes, I have terrible allergies during the change of seasons. Spring is here, in case you can’t hear it in my voice, and Fresno Madera Medical Society is busy. We are on the tail-end of our enrollment season, and we are currently up about 8% in membership working towards the goal of 13%. In numbers, we need less than 100 members to join the medical society to reach our goal. We hosted the first of many physician socials of the year: Jazz Night at Arte Americas. With more than 100 attendees, it was a fun night with good music and great company. Two weeks ago we finished the 65th (yes, we have been doing this event for 65 years) Postgraduate Institute Conference in Yosemite. This year was a sell out and we are already working towards growing next year’s event to be even bigger. We also held our first of many Office Manager’s Forum luncheons. We had a full-house of administrators, office managers and even a doctor in attendance for lunch and a legal update in healthcare compliance. This spring we will be participating in California Medical Association’s 42nd Legislative Advocacy Day on April 13, 2016. We have several physicians, residents and FMMS Alliance members who will head to Sacramento to join about 400 others ready to lobby and speak to legislators about health care, medicine and treating patients. If you would like to join us please call me at (559) 224-4224. As we continue to work towards accomplishing our goals, we hope that you will take the time to attend one of our events and meet staff and board members of Fresno Madera Medical Society. By the end of spring, we hope to have met our membership goals so we can focus more on outreach and benefits for our members and on all of the summer events we have planned. It is going to be a great year! Thank you,

PRESIDENT Hemant Dhingra, MD PRESIDENT-ELECT Alan Kelton, MD VICE PRESIDENT Trilok Puniani, MD SECRETARY-TREASURER Cesar A. Vazquez, MD PAST-PRESIDENT A.M. Aminian, MD BOARD OF GOVERNORS Christine Almon, MD, Alan Birnbaum, MD, Jennifer Davies, MD, Joseph Duflot, MD, William Ebbeling, MD, Don Gaede, MD, David Hadden, MD, Christina Maser, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Katayoon Shahinfar, MD, Roydon Steinke, MD, Jessica Lee, MD CENTRAL VALLEY PHYSICIANS EDITOR Alan Birnbaum, MD MANAGING EDITORS Nicole Butler and Millie Thao EDITORIAL COMMITTEE Alan Birnbaum, MD - Chair, Don Gaede, MD - Associate Editor, Virgil Airola, MD, Hemant Dhingra, MD, Roydon Steinke, MD, Cesar Vazquez, MD, Nicole Butler, Millie Thao CREATIVE DIRECTOR www.sherrylavonedesign.com CONTRIBUTING WRITERS Alan Birnbaum, MD, Don Gaede, MD, Ravi Rao, MD, Alex Sherriffs, MD, Roydon Steinke, MD, Jennifer Seita, Millie Thao CONTRIBUTING PHOTOGRAPHERS Nicole Butler, Kelley Nelson CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: Central Valley Physicians 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720 Phone: 559-224-4224 • Fax: 559-224-0276 Email Address: nbutler@fmms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9 a.m. to 5 p.m. Closed from 12 to 1 p.m. MEDICAL SOCIETY STAFF Executive Director Nicole Butler Director, Communications and Physician Relations Millie Thao CMA HOUSE OF DELEGATES REPRESENTATIVES Hemant Dhingra, MD*, A.M. Aminian, MD, Patrick Golden, MD, Brent Kane, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Roydon Steinke, MD, Toussaint Streat, MD ALTERNATES Alan Kelton, MD*, Naeem Akhtar, MD, Praveen Buddiga, MD, William Carveth, MD, Trilok Puniani, MD, Swarnpal Sekhon, MD *Automatic Delegate

Nicole Butler Executive Director Fresno Madera Medical Society

CENTRAL VALLEY PHYSICIANS

Spring 2016

Loren I. Alving, MD Director of the UCSF Fresno Alzheimer & Memory Center

Please join us for an exclusive dinner and CME accredited program

“Managing Difficult Behaviors in the Elderly” This special program on managing difficult behaviors in dementia patients is brought to you by Oakmont of Fresno, the UCSF Memory and Alzheimer’s Center and the Fresno Madera Medical Society*. This program is designed for internists, family medicine physicians, and neurologists concerned with managing difficult behaviors in the elderly, including patients with dementia. Upon completion of this program, attendees will be able to: • discuss specific care • identify underlying causes of behavioral changes in the elderly examples and identify treatment options • treat behavioral problems in the elderly * Fresno Madera Medical Society (FMMS) is accredited by the Institute for Medical Quality/California Medical Association to provide continuing education for physicians. FMMS designates this live activity for a maximum of 1 hour of AMA PRA Category 1 credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Dzung Trinh, MD, FACP Geriatrician and head of Geriatric Medicine at Kaiser Fresno

Andrew Goddard, BMedSC, MB BS, FRANZCP, FAPA Professor and Vice-Chair in the Department of Psychiatry at UCSF, and serves as Chief of Psychiatry for UCSF Fresno

Wednesday, April 20th 6:00pm - 7:30pm Enjoy wine, cocktails and a delightful dinner prepared by our exceptional culinary team.

Kindly RSVP by April 18th to 559-475-9494, as space is limited.

5605 N. Gates Ave Fresno, CA 93722

559-475-9494

oakmontofresno.com RCFE #107206882

A message from our Editor > Alan M. Birnbaum, MD

Drug Prices Becoming Harder to Swallow

ABOUT THE AUTHOR Alan M. Birnbaum, MD, is Board Certified in Adult Neurology and is with Spruce Multispecialty Group. Dr. Birnbaum is currently Medical Director of the Saint Agnes Medical Center Stroke Program and a Board Member of Fresno Madera Medical Society.

CENTRAL VALLEY PHYSICIANS

As the United States struggles to support 18% of Gross National Product going to healthcare, physicians, patients and administrators grimace that nationally pharmacy costs now consume 16.7% of that. Such depletes dollars for physicians. Many see earnings stagnate as their cost of living rises. Similarly patients have dwindling dollars left after deeper deductibles and costlier co-pays. Indirect consequences spread widely. Underfunded higher education has become much more expensive. Young people face either a barrier to entrance or graduation not in a gown but instead a cloak of debt. Consider examples for drugs essential to my specialty of neurology. From your own practice likely you can supply more. Sometimes newer more expensive drugs CAN overall save money, even when ten times costly as earlier choices. If a patient suffers from deep venous thrombosis, DVT, $1400 for six months of a “novel oral anticoagulant,” a NOAC, the surcharge of $1200 over warfarin still can save the system money, because hospitalization for heparin bridging therapy, of perhaps $5000 can be avoided. The longer treatment continues however, for patients with recurrent DVT or pulmonary embolism, or those with atrial fibrillation,

paroxysmal or fixed, creating stroke risk, the greater the cost to the system. A sales representative for a leading NOAC, proudly shared with me her company’s data regarding “new start” cardiology patients requiring anticoagulation. Only 22% now get warfarin, related partly to patients’ preference for the convenience of no laboratory monitoring. Her NOAC now boasts a 52% market share of the remaining 78%. Yet how curious is it that despite “competition” among four similar products, ALL cost the system nearly $8 a day? One might query Presidential candidates why competitive capitalism today fails the healthcare consumer. Such outpatient drug issues can pale compared to medications for emergent hospital care. Recent price spikes for the infused drug, t-PA, “tissue plasminogen activator,” Activase, Alteplase/Genentech, for many years costing $2200 for a 100 mg vial but last wholesale price $8295, makes gold at only $4 for the same 0.1 gram look absolutely cheap! From its 1987 introduction at a price about ten times that of a streptokinase, its cost of stayed level as it entered everyday stroke care circa 1996 through 2002. During the last three years of its patent the price to hospitals rose

Spring 2016

to $3050, about 11.5% per annum, though relative to introduction Genentech. in 1987, the rise was 1.8%. Had Grinchtech simply continued Medicare years ago accepted the value of t-PA, and introduced incremental pricing at that reasonable rate, Activase would now cost a differential DRG payment to cover its cost. That meant that $3724. That price would be affordable, since new DRGs with higher hospitals would not unfairly bear the burden of this core drug. Yet hospital reimbursement introduced by CMS until recently covered the CMS reimbursement from 2006 to 2013 rose only about $891, the cost. from $11,173 to $12,064 by 2013, with no recent rises to cover sharp Alteplase generates a superior outcome for about one ischemic rises since late 2014. Now the increase in Activase cost over the last stroke patient in three, leaving one patient in eight with no residual two years means for that each case treated under DRG’s 61, 62 and at all. I have lived with these figures for two decades, providing rapid 63, for varying levels of complication, an hospital will LOSE around counseling of patients and families in Emergency Departments. $4000. Such does not take into account general pharmacy trends of At the same time, I have explained that around 60% of patients get recent years. Per Saint Agnes Medical Center Chief Financial Officer, no benefit. I do warn that three patients out of a hundred will end Michael Prusaitis’ numbers, such averaged 10.4% per year through up worse, from sICH, symptomatic hemorrhagic transformation, 2015, peaking at 22.1% in 2014. of an originally ischemic stroke. For one of those patients, death Ultimately manufacturer justification for price escalation rests in will result, So, Activase remains valuable, but to call it a “miracle” “Pharmacoeconomics,” which on brief investigation appears to be drug overstates its value. In jewelry terms, on the 24 karat scale well a small industry that attempts to calculate drug “value” relative to understood by the local leader in t-PA usage, my colleague of many improved life expectancy and life quality. A 2014 STROKE abstract years, jewelers’ son Harvey L. Edmonds, MD, with Activase we have an 8 karat treatment when “We take the pricing of our medicines very seriously and consider we really need 18 karat. Big Pharma expresses its own a variety of factors, including how well a medicine works and gilded vision. As Tara Iannuccillo how it compares to other treatments; how to ensure price doesn’t from Genentech Corporate Relations responded to recent prevent our medicines from getting to people who need them; questions: “We take the pricing and the amount of money we need to allow us to continue of our medicines very seriously and consider a variety of factors, discovering new medicines for people with serious diseases.” including how well a medicine works and how it compares to other treatments; how to ensure price doesn’t prevent our medicines from getting to people who need proclaims: “ r-tPA resulted in a gain of 0.39 quality-adjusted life years them; and the amount of money we need to allow us to continue (95% confidence range, 0.16–0.66) on average per patient and a discovering new medicines for people with serious diseases.” lifetime cost-saving of $25 000 (95% confidence range, −$42 500 to So, HOW do major pharmaceutical companies not just maintain −$11 000) compared with no r-tPA.” but even increase drug prices, after a patent has expired, as it did for Authoring such pieces are pharmaco-alchemists like Deepa Lalla, Alteplase in 2005? One factor has been mergers and consolidation, B.Pharm, PhD, one co-author of the above-quoted paper, who either reducing competition. For “niche” drugs, manufacturing startwork directly for Genentech and other Big Pharma, or establish their up costs discourage new vendors. Alteplase requires biological own consulting firms, such as her Palo Alto Outcomes Research, production. One cannot make it in a high school chemistry conduct calculations, then publish articles, including in STROKE, lab: It is synthesized using the complementary DNA or cDNA for to support drug price inflation. As Dr. Lalla’s website proclaims: natural human tissue-type plasminogen activator obtained from a “Every molecule has a unique value proposition and our strength is human Melanoma cell line. The manufacturing process involves the in identifying, quantifying and communicating this value to internal secretion of the enzyme Alteplase into the culture medium by an established and external audiences. We do this by combining deep technical mammalian cell line (Chinese Hamster Ovary cells) into which the cDNA knowledge with a strategic vision that lets us identify only the most for Alteplase has been genetically inserted. Fermentation is carried out compelling strategies and tactics.” in a nutrient medium containing the Antibiotic Gentamicin, 100 mg/L. Unfortunately, corporate rationalizations and Dr. Lalla’s “strategic However, the presence of the antibiotic is not detectable in the final product. vision” for her corporate clients clash with the limitations of what Likely the prospect of sharing an Alteplase market of perhaps 45,000 hospitals, patients and carriers can reasonably tolerate. One potential doses discourages any manufacturer who might compete against response at hospitals equipped for catheter-based interventions

Spring 2016

CENTRAL VALLEY PHYSICIANS

Hilton San Francisco Union Square

May 13 - 15, 2016

San Francisco, CA

Physicians, nurses, medical practice managers and all other health care industry professionals—Join us in the heart of San Francisco to prepare for changes affecting your profession, your practice and your economic future.

Health care power players will share strategies and resources for accelerating the shift to a more integrated, high performing and sustainable health care system. Speakers include Dr. Atul Gawande, distinguished surgeon, teacher and writer – named one of TIME magazine’s 100 most influential thinkers; Karl Rove, former Deputy Chief of Staff and Senior Advisor to President George W. Bush; and Donna Brazile, Al Gore campaign manager and Democratic National Committee Vice Chair.

800.795.2262 www.westernleadershipacademy.com 8

CENTRAL VALLEY PHYSICIANS

Spring 2016

A message from our Editor > Alan M. Birnbaum, MD

might be to omit that $8295 infusion of t-PA then based upon rapid combination brain imaging both CT and CTA, go directly to the use of stent retrievers in appropriate cases. Curiously European hospitals do not face this issue. Thanks to Andreas Heller, MD, one of the fine Saint Agnes intensivists who manage post-TPA patients, for searching the German language Web and determining that in Europe, a wholesaler for BoehringerInghelheim Actilyse at current exchange rates charges for two 50 mg vials $1631—20% of the US price! In the United Kingdom through the National Health Service their renowned Queen Square Hospital for neurological disorders pays just $1,232 for the same dose. Penetrance of thrombolytic treatment for stroke remains incomplete. Noted stroke neurologist David Tong, MD, from California Pacific Medical Center, advises me that generally

hospitals treat about 5% of ischemic stroke patients with t-PA, stroke centers better at 7-10%. Yet his group of stroke neurologists, both at its San Francisco “hub” and numerous California “spokes,” has demonstrated that with simplified SMART criteria, and good public education, a treatment rate of 25% is possible. So while t-PA doses now yearly used for this country’s 600,000 or so ischemic stroke patients approximate 45,000, the goal should be 150,000. Might we hope that Genentech, instead of spiking Alteplase’s price, would publicly partner with stroke neurologists to both expand thrombolytic treatment and endovascular stroke treatment as the more positive path to profit? Hopefully we can now start an effective public reaction in our country towards an equitably sustainable era of pharmacotherapeutics for all disorders.

In Memoriam Trevor David Glenn, MD

TREVOR DAVID GLENN, MD January 29, 1934 - March 10, 2016

Trevor D. Glenn, MD, age 82, of Fresno, CA, passed on Thursday, March 10, 2016, after a brave battle with Parkinson’s disease. Dr. Glenn graduated from Temple University School of Pharmacy and then continued to Thomas Jefferson Medical School in Philadelphia where he graduated with Honors. Throughout his career, Dr. Glenn held many prestigious positions which included,—but not limited to—serving as Deputy Medical Director at New Jersey State Hospital; Director of Fresno County Department of Mental Health; Director of Fresno County Department of Public/Mental Health; Professor, Department of Health Science, California State University, Fresno; Assistant Dean of Academic Affairs, Medical Education Program, University of California, San FranciscoFresno; private practice for over 30 years; as well as numerous leadership roles within the Veteran’s Administration Hospital of Fresno, CA. Dr. Glenn was a Fellow in the American College of Physicians and Surgeons, a Distinguished Life Fellow in the American Psychiatric Association, and a Fellow and Board of Regents elect, along with the position of Secretary General in the American College of Psychiatrists. In addition, Dr. Glenn was also presented with the prestigious Kaiser Award for Excellence in

Spring 2016

Teaching, University of California, San Francisco. Along with his extensive history of professional achievements and accolades, Trevor lived out his two-fold passion involving teaching the Word of God and serving our country’s veterans. Trevor and his loving wife, Madeline, both authored and taught numerous Bible studies for over 25 years. It was a divinely appointed partnership that brought the truth of God’s word to many people. In addition, Trevor had the privilege of conducting compensation and pension exams at the Veteran’s Administration Hospital of Fresno for veterans who suffered from service-related Post Traumatic Stress Disorder (PTSD). It was Trevor’s passion to honor those who served our country sacrificially. It is through Trevor’s teaching and serving that his legacy will live on. Trevor was an avid sports fan, and he and Madeline were members of the Bulldog Foundation and proud “Arena Builders” of the Save Mart Center in Fresno. In addition, Trevor was an honorary member of the Silver Hearts Club founded by his wife Madeline. He is survived by Madeline, his wife of 33 years; twin brother, James D. Glenn and his wife Lorraine; his two children, Trevor Glenn II and his wife Chrissie, and Susan Martyn and her husband Randy; four grandchildren; two great-grandchildren; along with nieces and nephews. In addition, Trevor is survived by the “children of his heart,” Michael Burns and his wife Tina, and Born. Dr. Trevor Glenn was a member of the Fresno Madera Medical Society for 44 years.

CENTRAL VALLEY PHYSICIANS

Guest Editorial > Ravi D. Rao, MD

Medicare Proposal

ABOUT THE AUTHOR Dr. Ravi D. Rao attended the All India Institute of Medical Sciences in New Delhi, India, where he completed his internship. He then did his Internal Medicine residency in Madison, Wisconsin, at the University of Wisconsin Hospital and Clinics in Madison. Subsequently, he stayed in the midwest, and went on to the Mayo Clinic, Rochester, MN, where he did his fellowship in Medical Oncology and Hematology. He then stayed on as an attending, and was an Assistant Professor in the Department of Oncology. He then moved to Fresno after several years, and has been in private practice in HematologyOncology of Fresno (now combined with cCARE). He specializes in a wide variety of solid tumors, in a busy clinical practice.

CENTRAL VALLEY PHYSICIANS

Here is what we can all agree on: to pay for that research. Medicare spending is increasing Medicare’s most recent attempt rapidly at an unsustainable rate. Drug (unveiled in March 2016) at reducing costs are amongst the most rapidly costs, puts the onus on oncology growing costs, and amongst these, practices. The current model of oncology drug costs are going up the paying oncologists for drugs using fastest. The divergence of opinion as a formula of drug price plus a small to what can be done about this starts percentage, is as such a reduced beyond these facts. version of a previous system where The two broad methods would be a higher percentage used to be paid. to (a) reduce payments to the drug With the previous reduction in the makers and hence reduce the overall ‘margin,’ many oncology practices bill, or to (b) act at the level of the had to give up practicing, reducing consumer (either the patient or physician) The most obvious solution, and of and make them use less of these expensive course the only solution that will work in drugs. the long run, is for Medicare to negotiate The most obvious solution, and of course down the costs of drugs. the only solution that will work in the long run, is for Medicare to negotiate access of patients to care (especially down the costs of drugs. There is little in rural areas). This occurred because justification for paying $100,000 a many drugs became ‘underwater,’ year for a drug that extends life by two such that treating patients with many months (as a true, but very typical standard drugs would lead to a loss example). Pharmaceutical companies (similar issues have led to ongoing consistently charge the American shortages of critical chemotherapy consumer much higher prices than drugs in the market now). As a result, elsewhere. They consistently produce this pushed many oncologists into high profits for their shareholders and the waiting arms of hospitals, where administrators, and spend more on they became employees. Hospitals, marketing than on research, all the can interestingly enough, both charge while claiming that the high prices are more, and also pay less, for the same justified by, and actually are needed, drugs. The cost of care in a hospital

Spring 2016

dominated market is higher than when this is done by an independent practice - by a lot. The underlying presumption that is driving the change is that somehow, given two equally effective drugs, oncologists are deliberately choosing

include new drugs that got added as new option? Am I to decide to indications (i.e., Nivolumab got recommend to the patient to stop antian indication for renal cell cancer, cancer therapy and to go onto hospice melanoma and lung cancer, but was care, if there was an alternate option counted only once in these numbers). that might work? We are ethically, In fact, the presence of competing morally and legally we are bound to drugs does not seem to want to make act in the best interest of the patient. anyone drop We took an oath. their price (i.e., Oncology practitioners have been Gleevec, made amongst the earliest to identify this How does Medicare expect us to not pick a by Novartis trend of high drug prices, and to new options if it can prolong survival/cure for CML, first criticize the current system. The approved in high cost of chemotherapy drugs someone, if it is available as new option? 2001 and at adversely effects oncology practices. that point, At a very basic human level, we end the more expensive drug to generate one of the most expensive drugs to up not treating some patients because profits. This premise, apart from enter the market, has remained just as they cannot afford the co-pay, etc. obviously implying malfeasance, is expensive, in totally false. First, this is very rare spite of having to find two similar drugs, and to be four other Of all the parties involved, medical able to pick one over the other based competitors). oncologists would most love to see drug costs merely on cost. Most decisions are Many made on toxicity/safety, scheduling new drugs go down. The current proposal by Medicare and mostly on effectiveness. Most are being will not achieve that goal. recently approved drugs (hence, approved for drugs that are under patent, and are end-of-themore expensive), were specifically line indication approved for as they were more (i.e., after all other therapies are These discussions and decisions are effective in treating cancer, than the exhausted). gut-wrenching. If a patient/insurance old comparators, so are more likely to In the first two months of 2016, I can company does not pay up for some be used. distinctly recall four patients whom reason, the financial impact upon I consciously the practice is enormous. One of and deliberately my partners had a patient whose chose to treat insurance company denied payment The current Medicare proposal is almost with such a new after $50,000 of drug was delivered, as certainly going to raise costs in the medium (and expensive it was deemed medically â&#x20AC;&#x2DC;unnecessary.â&#x20AC;&#x2122; drug), over a Of all the parties involved, medical to long term. All relevant oncology much cheaper oncologists would most love to see organizations have adamantly opposed the new alternative. drug costs go down. The current That cheaper proposal by Medicare will not achieve proposal, and it is imperative that Medicare option was â&#x20AC;&#x201C; that goal. The only way to do so administrators listen to what is being said. hospice. And would be to negotiate down the prices yes, hospice care of oncology drugs. The current is much cheaper Medicare proposal is almost certainly Secondly, almost all the drugs now than Nivolumab/Opdivo for stage IV going to raise costs in the medium being approved are being priced at lung cancer that has failed all other to long term. All relevant oncology $5,000 to $10,000 per month. In chemotherapy drugs. organizations have adamantly opposed 2015, 20 new drugs were approved, How does Medicare expect us to the new proposal, and it is imperative and in 2014, 10 new drugs were not pick a new options if it can prolong that Medicare administrators listen to approved. These numbers do not survival/cure someone, if it is available what is being said.

Spring 2016

CENTRAL VALLEY PHYSICIANS

Y

C  W

A REPORT ON WHAT IT TAKES TO MAKE A HEALTHY COMMUNITY

MAKING VALLEY HEALTHCARE CONCERNS HEARD

Going to the top

TO TACKLE OUR REGION’S CHALLENGES

The Valley faces unique health challenges—concentrated poverty, language barriers for 20% of residents, low education levels and higher than average rates of asthma, lung disease, diabetes and obesity—Community Medical Centers CEO Tim Joslin explained to Congress. To make it even more challenging, Joslin added, the Valley has one of the lowest doctor-to-population ratios in the state and far less than the recommended minimum of 60 doctors per 100,000 residents. Joslin went to Washington D.C. last summer to make the case for increased funding for physician training programs that could help bring more doctors to the Valley.

There are only 48 primary care physicians per 100,000 people in the central San Joaquin Valley compared to 85 doctors per 100,000 in the Bay Area

“If need is the measure, our region of the country should have more physicians per capita, not fewer. Graduate medical education is the key to solving this inequity,” Joslin testified before the House Ways and Means Committee during a hearing on rural healthcare. Commmunity CEO Tim Joslin (far left) urges Congress in July 2015 to reform federal funding for more doctors.

As the largest healthcare provider in the central San Joaquin Valley, Community has one-third of all the inpatient hospital discharges in the five county region and one of the busiest emergency departments in the state. Community could not provide this care without the help of the 300 medical residents and fellows from the University of California, San Francisco’s School of Medicine and the faculty doctors who supervise them, Joslin told the committee. “Our region’s population has increased by a third since 1997, yet our federally funded resident positions have remained at the 1997 level,” Joslin said. “This contributes to the disparity we see in the ratio of physicians to population.” SEE VIDEO OF JOSLIN’S TESTIMONY: cmc.news/congress

One Network. One Community.

Clovis Community Medical Center | Community Behavioral Health Center | Community Regional Medical Center | Fresno Heart & Surgical Hospital

WHAT HAPPENS WHEN A HOSPITAL NETWORK AND ITS COMMUNITY ARE CONNECTED? FIND OUT AT www.CommunityMedical.org

FRESNO MADERA MEDICAL SOCIETY MEMBERS ENJOY: Vast CMA Resources: • Contract Analysis

“My membership provides me a voice in Sacramento and Washington DC.” Thomas McKenzie, MD Member Since 1991

• Reimbursement Hotline • Legal Hotline • Legislative Hotline • HIPPA Compliance • Free Monthly Webinars on various topics • Extensive Online Resources including over 200 letters, agreements, forms, etc. • Plus – Free Legal Advice with CMA ON-CALL Documents

Fresno Madera Medical Society Resources: • Online Prescriber’s Letter subscription • DocBookMD phone app • Annual Directory • Free CME Seminars • Cost Saving Benefits • Quarterly Publication • Website/Online Resources • Insurance Savings • Alliance Membership • Annual Social Events • Patient Referrals • Office Manager Forum and Practice Resources

Your membership investment supports our advocacy efforts on your behalf in Sacramento and Washington DC.

For more information about membership please contact us (559) 224-4224 • www.fmms.org Spring 2016 CENTRAL 1040 E. Herndon Ave., Suite 101 • Fresno, CA 93720VALLEY PHYSICIANS 13

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NORCAL MUTUAL RISK MANAGEMENT INSIGHT

4 Tips To Help Lower Medical Liability Risk Review of NORCAL Mutual’s proprietary closed-claims data and field research1 reveals four main areas in which physicians can help lower risk levels by implementing effective risk management strategies.

Management of follow-up processes: Follow-up systems are important because physicians have a responsibility to ensure that patients are informed about their conditions and get needed care.

Generation of documentation: The purpose of the medical record is to communicate internally and externally about a patient’s health. In addition, in a medical malpractice lawsuit, the patient’s record will be used as evidence.

Management of medications: Two common medication management issues that have been discovered in office assessments have to do with proper prescribing practices and management of patients with chronic pain and opioid prescribing.

Communication with other health care providers: Gaps in communication between treating physicians can cause problems that jeopardize a patient’s well-being and provide the impetus for litigation.

RM Tip: Ensure that all clinical findings, test results, and consultant reports are reviewed and acted upon in a timely manner. RM Tip: Each patient’s chart should be an accurate account of the patient’s history and complaints, physical findings, diagnostic tests, diagnoses and medical care and treatment. Whether a record is paper-based or electronic, the documentation in it should show the patient’s active problems, data analyzed to understand the problems, and plans for further investigation and handling of the problems.

RM Tip: Create a policy and procedure for prescription refills describing: • Who in the office can refill prescriptions, create a drug order or transmit a refill to the pharmacy • The refill policy for weekend and evening requests • The process for writing prescriptions in such a way that quantities cannot be altered, particularly when scheduled drugs are involved • The preferred method of transmitting prescriptions Consider use of a therapeutic pain management agreement if indicated. RM Tip: If you refer patients to other physicians, have some mechanism in place to see that your referral recommendations are carried out and that the patient was seen by the consultant (or another physician of the patient’s choice). Your follow-up mechanism for referrals should also track your receipt and review of the consulting physician’s report.

Most of these risk management recommendations are not expensive or hard to put in place; most focus on setting up systems or protocols and then adhering to them. Taking some time to appraise and strengthen vulnerabilities in your practice or facility will help protect patients and may keep you from a malpractice suit or help you defend against one.

For the full report visit 4risktips.norcalmutual.com. 1. NORCAL Mutual closed claims study — associated issues in claims from July 2009 through June 2014 and NORCAL Mutual study of policyholder risk assessments from July 2009 through June 2011. Copyright ©2015 NORCAL Mutual Insurance Company. All rights reserved.

In The News

IN THE

NEWS

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

• FRESNO • UCSF Fresno Names Associate Dean Michael W. Peterson, MD, has been appointed Associate Dean of the UCSF Fresno Medical Education Program. Peterson has served as Interim Associate Dean since January 1, 2015. He has been Chief of Medicine at UCSF Fresno for 14 years, and he serves as Vice Chair in the Department of Medicine at UCSF.

Michael W. Peterson, MD

“I have every confidence that Dr. Peterson will lead UCSF Fresno with vision, vigor and commitment,” said Talmadge E. King Jr., MD, Dean of the UCSF School of Medicine and Vice Chancellor for Medical Affairs. “He will continue to be a trusted leader within the Department of Medicine and the school and will continue to extend UCSF’s mission in Fresno and the San Joaquin Valley.”

2015 Saint Agnes Women’s Club president Janelle Dunn, Sister Mary Clennon, director of the Holy Cross Center for Women, and Frank Beazley, Saint Agnes Medical Center vice president of Mission Integration Saint Agnes Women’s Club gifted $90,000 to Saint Agnes Holy Cross Center for Women The Saint Agnes Women’s Club gifted $90,000 to Saint Agnes Holy Cross Center for Women at the club’s annual Installation of Officers

HAVE SOMETHING TO SHARE? We welcome submissions to our In the News section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to nbutler@fmms.org one month prior to publication (June 1 for the Summer issue, September 1 for the Fall issue, and December 1 for the Winter issue).

CENTRAL VALLEY PHYSICIANS

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Luncheon in January. The Holy Cross Center for Women offers educational programs and respite for homeless and lowincome women and their children. The gift is a result of the club’s 2015 fundraising efforts through annual events such as Le Petit Tea, Happy Hour for Holy Cross, and the Fashion and Entertainment Event. Both Sister Mary Clennon, Director of the Holy Cross Center for Women, and Frank Beazley, Saint Agnes Medical Center Vice President of Mission Integration, accepted the donation on behalf of the Center. “We thank the Women’s Club for all the work they have done to accomplish this,” Sister Mary said. “It is wonderful for all the people we serve.”

Neurosurgical Oncology, and the opening of his academic and clinical neurosurgery practice location at the Fresno Cancer Center located at 7887 N. Cedar Avenue in Fresno, California. Dr. Perry, an Eagle Scout, earned his medical degree from Yale Medical School, and completed his general surgery internship, neurosurgical residency and neurooncology fellowship at the Johns Hopkins Medical Center. He is also fellowship trained in pediatric neurosurgery and served on faculty at UCSF as assistant professor and director of pediatric surgical epilepsy, and at the University of North Carolina, Chapel Hill, as associate professor and chief of pediatric neurosurgery. Dr. Perry is Board Certified in Neurological Surgery and is the Medical Director of Neurosurgical Oncology at the Fresno Cancer Center.

The donation helps fund the Center’s educational programs, such as six-week long summer programs for children and young people ages 4 to 17, and personal services for women and children including weekly distribution of clothing and diapers. The gift will also help the Center purchase three industrial-size washers to better accommodate the 2,900 loads of laundry done annually.

US Cancer Management Corporation is pleased to announce the appointment of Victor Perry, MD, as Medical Director of

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His surgical treatments will focus on patients 21 years old and younger.

Fresno Gastroenterology Welcomes Stephen Davis, MD

John Wiemann, MD, has joined the Fresno location of University Orthopaedic Associates

Fresno Cancer Center Welcomes Neurosurgeon Victor Perry, MD

Dr. Wiemann has received specific training and education in spine, hip, and sports orthopaedics.

Stephen Davis, MD

John Wiemann, MD

Victor Perry, MD

his fellowship in Pediatric Orthopaedics at Arnold Palmer Hospital for Children.

University Orthopaedic Associates announced that Pediatric Orthopaedic Surgeon John Wiemann, MD, has joined University Orthopaedic Associates located at 7235 N. First Street, Suite 103 in Fresno, California. Dr. Wiemann is board certified in Orthopaedic Surgery. He earned his medical degree from University of California, San Diego, and went on to complete his residency in Orthopaedic Surgery at University of New Mexico. He finished

Stephen Davis, MD, joined Fresno Gastroenterology on March 1, 2016. Dr. Davis is board certified with more than 35 years of experience. Prior to joining Fresno Gastroenterology, Dr. Davis was in private practice in Fresno since 1978. He completed his medical training at Valley Medical Center in Fresno, California. He received the honor of The Outstanding Intern of the Year in 1975 and The Best Resident Teaching Award in 1976. He was on the teaching faculty at UCSF Fresno from 1978 through 1981. Dr. Davis is an active member of the American College of Gastroenterology, American Society for Gastrointestinal Endoscopy, and the Fresno Madera Medical Society. His passions outside of medicine include sports, travel, and spending time with his family.

Saint Agnes Announces New Director of Wound Care, Hyperbaric Medicine & Amputation Prevention Judy Burden, RN, has joined Saint Agnes

CENTRAL VALLEY PHYSICIANS

In The News

IN THE

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

NEWS as Program Director for Wound Care, Hyperbaric Medicine & Amputation Prevention. Judy has worked in health care for 26 years and has been a nurse for 21 years. She previously worked as a PACU nurse for Fresno Heart & Surgical Hospital and before that was an administrator for outpatient dialysis center US Renal Care in Atwater, California. Judy holds an Associate of Science degree in nursing from Fresno City College. She decided to become a nurse at age six, when her father’s kidneys were failing. She saw how the nurses comforted her parents and knew she wanted to be like that one day.

Kids Day fundraising total, bringing the new record to a cool, eye-popping $600,000 The Kids Day partnership between Valley Children’s, The Fresno Bee and ABC30 set a new record before the bonus by raising $591,559 on March 8. That means The Fresno Bee will add another $8,441 to reach the new record total. The approximately 6,000 volunteers, who helped sell Kids Day editions for $1, was also a record turnout this year. “We are in awe of The Fresno Bee’s generosity, first to partner with us and ABC30 to make this event possible, and then to go above and beyond by making a generous donation to Kids Day,” said Vice President of Philanthropy and Chief Development Officer Rob Saroyan. “We are so proud and grateful for our partnership with The Bee and ABC30. I would also like to thank all the Valley Children’s physicians, staff, and volunteers who made this Kids Day the best yet in support of our patients.” Fresno Bee Publisher and President Tom Cullinan said the donation was the company’s way to show its appreciation and support for Valley Children’s. “Valley Children’s commitment to the healthcare services provided for all of the children in the region – without regard to their families’ ability to pay – is amazing and inspiring,” Cullinan told The Fresno Bee on Thursday. “We are very proud of our longstanding partnership

CENTRAL VALLEY PHYSICIANS

with Valley Children’s and ABC30 on this annual event. This is our way of showing our appreciation and thanks.”

Community Regional Opens First Cystic Fibrosis Program in the Valley Community Regional Medical Center has opened the only accredited adult and pediatric cystic fibrosis program between San Francisco and Los Angeles. UCSF Fresno recruited internal medicine specialist David Lee, MD, from Brown University to head the new clinic, which does newborn screening for the disease and treats patients from birth throughout their life. The UCSF Fresno Cystic Fibrosis Program takes a team approach to care with respiratory therapists, nutritionists, pulmonologists, gastroenterologists and social workers seeing each patient during checkups. As an accredited program, patients have access to local and national research on the disease. Dr. Lee says the number of cystic fibrosis patients in the Valley mirror the number of cystic fibrosis patients in San Francisco.

Busy Community Regional Medical Center Emergency Department treats its 1 millionth patient Shortly before the calendar turned to 2016, the one millionth patient was treated in Community Regional Medical Center’s emergency department. When the Table Mountain Rancheria Trauma Center opened in 2007, its football-field sized emergency department was the largest in California. It quickly became one of the busiest serving an average of 355 patients a day – 17 on average for trauma care.

Valley Fever Community Awareness Day On Friday April 8, 2016, from 4:30 to 7 p.m., the Health Sciences Research Institute at UC Merced is hosting a Valley Awareness Day to inform our community about the effects of the illness affecting many Fresno and greater Central Valley residents. The event will be held at 155 N. Fresno Street in the UCSF Fresno Center for Medical Education Building. This event is open to the public for free

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and will provide educational learning about Valley Fever and how to stay healthy. There will also be activities, refreshments, and a raffle. For more information, please email Erin Gaab at egaab@ucmerced.edu.

CONTINUING

MEDICAL

EDUCATION Saturday, April 16, 2016

VALLEY CHILDREN'S PEDIATRIC CLINICAL SYMPOSIUM BAKERSFIELD MEMORIAL HOSPITAL, BAKERSFIELD, CA For more information call 559-353-6621

Wednesday, April 20, 2016

Kenny Mai, MD

Soumyi Pai, MD

Saint Agnes Medical Providers Adds Two New Physicians Kenny Mai, MD, is board certified by the American Board of Orthopaedic Surgery. Dr. Mai has been treating Central Valley patients since 2008. With a special interest in total joint replacement, Dr. Mai’s surgical skills expand the scope of multidisciplinary care available from the team of multi-specialists at Saint Agnes Medical Providers. Dr. Mai earned his medical degree at Hahnemann School of Medicine in Philadelphia. He completed his surgical internship and orthopaedic residency at State University of New York at Stony Brook. He completed his adult joint reconstruction fellowship at Scripps Clinic in La Jolla, California. Soumyi Pai, MD, is a board certified general surgeon. Dr. Pai comes to Saint Agnes Medical Providers from the UCSF Fresno General Surgery Residency Program. She earned her medical degree at Government Medical College in Mysore, Karnataka, India, and completed her residency at St. John’s Medical College Hospital in Bangalore, Karnataka, India. Dr. Pai takes special interest in breast surgery, soft tissue surgery, endocrine surgery, and hand surgery. She is fluent in Hindi, Konkani, Kannada and Tamil. For more information, please call 559-450-7267 or visit www.SaintAgnesMedicalProviders.com.

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MANAGING DIFFICULT BEHAVIORS IN THE ELDERLY OAKMONT OF FRESNO, FRESNO, CA For more information, call 559-224-4224

Saturday, April 23, 2016

STATE OF THE HEART -SAINT AGNES MEDICAL CENTER CARDIOLOGY SYMPOSIUM 2016 SAINT AGNES MEDICAL CENTER, SHEHADEY PAVILION, FRESNO, CA For more information call 559-450-7566

Saturday, April 23, 2016

AIR POLLUTION & CLIMATE CHANGE SYMPOSIUM UCSF FRESNO CENTER FOR MEDICAL EDUCATION AND RESEARCH AUDITORIUM, FRESNO, CA For more information call 559-499-6421

May 18-20, 2016

HIGH SIERRA WILDERNESS & TRAVEL MEDICINE CONFERENCE PINES RESORT, BASS LAKE, CA For more information, call 415-476-4251

Saturday, May 21, 2016

STROKE CONFERENCE PART 1 KAISER PERMANENTE, FRESNO, CA For more information, call 559-448-3319

Saturday, June 25, 2016

(NOTE NEW DATE) NEPHROLOGY SYMPOSIUM CLOVIS VETERANS MEMORIAL, CLOVIS, CA For more information, call 559-224-4224

CENTRAL VALLEY PHYSICIANS

In The News

IN THE

NEWS

Providing physicians, office staff, and healthcare executives with relevant and up-to-date information

Saint Agnes Medical Center named Blue Distinction Center Saint Agnes has been named a Blue Distinction Center for Knee and Hip Replacement. This designation signifies that the healthcare facility met nationally established quality-focused criteria and demonstrated expertise in delivering specialty care safely and effectively. Hospitals awarded with Blue Distinction Specialty Care recognition by Blue Cross and Blue Shield companies have a proven track record for delivering better results than other facilities – including fewer complications and readmissions – based on nationally established quality measures, with input from expert physicians and medical organizations.

• KERN • San Joaquin Community Hospital Achieves Distinguished Hospital Award San Joaquin Community Hospital (SJCH) announced that it has received the 2016 Distinguished Hospital Award for Clinical Excellence for the second year in a row. The distinction puts SJCH in the top five percent of more than 4,500 hospitals nationwide for its clinical performance. SJCH is the only Kern County hospital to have achieved this prestigious quality award. “At San Joaquin Community Hospital, our staff, leaders, and executive team come to work every day with one mindset: to exceed the expectations of the patients and families we serve,” said Douglas Duffield, SJCH President and CEO. “This award is further evidence that we are earning the loyalty of the people of Bakersfield and Kern County by providing high quality, compassionate health care to every patient, every time.” Patients treated at Healthgrades Distinguished Hospitals for Clinical Excellence had a 26.5% lower risk of dying, compared to all other

CENTRAL VALLEY PHYSICIANS

San Joaquin Community Hospital Achieves Distinguished Hospital Award hospitals. If all other hospitals performed at the level of Distinguished Hospitals for Clinical Excellence, 158,858 lives could potentially have been saved across the nation over the past three years. “Unfortunately, not all hospitals perform equally when it comes to clinical outcomes, so it’s important that consumers do their research in order to find the right care,” said Evan Marks, Chief Strategy Officer, Healthgrades. “We commend those hospitals that have achieved Healthgrades 2016 Distinguished Hospital Award for Clinical Excellence for demonstrating an unwavering commitment to high quality care to accomplish these results.” In addition, Healthgrades rates every hospital each year in the country across specific categories like heart, brain and spine, and critical care. A 1-star, 3-star, or 5-star rating is then assigned to each hospital in every category. For 2016, the nine hospitals in Kern County were awarded a total of 25 5-star quality awards. Of those 25, SJCH received 18 – or roughly 75 percent of all 5-star quality awards. SJCH’s 5-star awards include heart attack and heart failure, stroke, sepsis, pneumonia, COPD, and more.

Spring 2016

Governor appoints Bakersfield woman to health care post Governor Brown has appointed a Bakersfield woman as Director of Health Care Delivery Systems at the California Department of Health Care Services. Jacey Cooper, 33, had been Vice President at Meridian Healthcare Partners and Vice President of Administrative Services at Kern Medical since 2014.

• KINGS • Central Valley General Hospital Becomes Community Care For 27 years, the community has known the large three-story building on Douty Street as Central Valley General Hospital. On March 7, 2016, Adventist Health leaders and staff revealed the new name, as Adventist Health/Community Care.

Jacey Cooper

Cooper had been at Kern Medical for four years and held a variety of positions including Special Projects Manager and Executive Director of Managed Care. She was a Senior Project Manager at COPE Health Solutions from 2009 to 2010 and held several positions at Marsh ClearSight LLC from 2005 to 2009, including Quality Assurance Analyst and Product Manager.

The change comes following the transition of the Obstetrics Department from the hospital to the new Family Birth Center at Adventist Medical Center – Hanford on Mall Drive. The birth center is a $44 million state-of-the-art facility that focuses on patient experience. It features 11 private labor and delivery rooms, two surgery suites, a six-bed neonatal intensive care unit operated by Valley Children’s Healthcare, 16 postpartum rooms, a café, gift shop, and more.

Tehachapi Valley Health Care District Unanimously Votes to Move Forward with Adventist Health On Tuesday night, the Tehachapi Valley Health Care District (TVHD) unanimously voted to move forward with Adventist Health – the parent company of San Joaquin Community Hospital (SJCH) – to complete the construction of the community’s new hospital and operate the facility. During the meeting, details were provided about the definitive agreement between the two organizations, as well as the construction funding agreement and lease agreement. “We are more excited than ever at the prospect of providing the community of Tehachapi access to high-quality health care services,” said Douglas Duffield, SJCH President and CEO. “Over the last year, we’ve been working diligently to come to an agreement that would be beneficial for both Adventist Health and the Health District and we’re looking forward to the next phase of this project.” In early 2015, TVHD decided that they needed the support of a health system to finish the construction of a new hospital project and provide long-term health care stability for the Tehachapi community. In response, San Joaquin Community Hospital – with Adventist Health – submitted a formal response to the RFP request and was the only system chosen to move forward to the next phase, which formally concluded with the vote on Tuesday night. The next step will be for the community to vote on the agreement during the June 7 general election. If the ballot measure is passed by a majority, Adventist Health will take over operations of the current hospital and begin work to complete construction of the new facility.

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Central Valley General Hospital Becomes Community Care “This is not an ending, but a new adventure,” says Derrick Gruen, Vice President of Physician and Ambulatory Services for Adventist Health/ Central Valley Network. “We will continue to offer quality care at the Douty campus, but now our focus will be on expanding access to quality care for Hanford and the region.” Of the 108,000 visits the Hanford clinic received from Feb. 1, 2015, through Jan. 31, 2016, 45%— or nearly 49,000—came from out of town. Six clinic services remain at the campus, including Community Care – Hanford primary care, Behavioral Health, Dental, Family Medicine Residency, Healthy Beginnings, and Specialty.

CENTRAL VALLEY PHYSICIANS

WEBINARS

EDUCATION •

SEMINARS

•

PODCASTS

•

AND MORE

DID YOU KNOW? CMA offers free webinars to its members Through its robust webinar series, CMA gives physicians and their staff the opportunity to watch live presentations on important topics of interest and interact with practice management, legal and financial experts, to name a few, from the comfort of their homes or offices. The webinars are free to CMA members and members’ staff and provide the timely information needed to help run a successful medical practice. What’s more, all webinars are available on-demand immediately following the live airing, providing an ever-growing resource library accessible at any time.

APRIL

How to Reduce Overhead Expenses and Increase Profitability April 20, 2016 | 12:15pm - 1:15pm There are only three ways to realize increased net income: raise fees, increase productivity or decrease overhead. With managed care contracting difficulties, increased fees are hard to achieve. The doctor/ group may already be working at maximum capacity so this may not be an option. In California, practices have higher overhead costs than national norms. The only way to assure profitability is to control and reduce overhead expenses. This webinar will provide information on how to do just that in a way that works for your practice.

MAY

Contract Renegotiations: How to Get Past “No” with a Payor May 4, 2016 | 12:15pm - 1:15pm When submitting a request to renegotiate, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. However, many practices fail to present a business case, which often results in a quick reply from the payor indicating that they are not in a position to renegotiate at this time. This webinar will cover steps practices can take to build their best business case and identify the uniqueness of their practice to prevent the “auto-reply” and present a thoughtful renegotiation request.

MAY

California Healthcare Performance Initiative (CHPI) Physician Quality Rating Program: Navigating the Review and Corrections Process May 25, 2016 | 12:15pm - 1:15pm

Last year, through commercial and Medicare claims data, CHPI issued clinical quality ratings for 15,000 California physicians. CHPI is gearing up to publish its second cycle of physician quality scores later this year; physicians will soon begin receiving notices advising of their quality scores along with information on how to access the review and corrections portal to confirm or correct their data. This webinar will provide an overview of the CHPI quality rating project, along with step-by-step instructions on how physicians can review their data for accuracy before the quality scores are published.

PRESENTER: Debra Phairas is President of Practice & Liability Consultants, LLC, a nationally recognized firm specializing in practice management and malpractice prevention. Her background includes medical clinic administration and loss prevention management for NORCAL Mutual, a physician malpractice insurance carrier in Northern California.

PRESENTER: Kristine Marck is an Associate Director in CMA’s Center for Economic Services. With over 20 years of experience in the health care industry, she offers a unique perspective as well as a balance of working for and with physicians and a drive to assist them in difficult times.

PRESENTER: Emily London is a project manager at the Pacific Business Group on Health (PBGH), where she manages communications for the Multi-Payor Claims Database Project. She joined PBGH in 2012 to work on the Intensive Outpatient Care Program, a Medicare-funded initiative to improve care coordination for high-risk patients.

*Webinars are free for CMA members and their staff ($99 for non-members). CENTRAL VALLEY PHYSICIANS

Spring 2016

Do you know What, When and How to Report Child Abuse?

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Family Tree > Growing Local Physicians

We’ve all heard, “the apple doesn’t fall far from the tree.” For physicians of the Centr al Valley, this remains true. Physician parents have proudly planted the seed for their children to enter the same profession in which they have thrived. Story By l Millie Thao • Photography By l Nicole Butler and Kelley Nelson

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Spring 2016

CENTRAL VALLEY PHYSICIANS

John Telles, MD, and son Connor Telles, MD

Family Tree > Growing Local Physicians

At the young age of 12, he witnessed his father in action – administering a myelogram lumbar injection, and fainted. At the time, Matthew Simons, MD, didn’t think medicine was his calling. Little did he know, years later, that he would be following in his father’s footsteps. Robert Simons, MD, neurosurgeon at Saint Agnes Medical Providers in Fresno, California, said he never pushed his son to be a physician. Son Dr. Matthew Simons joined Sierra Pacific Orthopedics in Fresno, California, in September 2015, specializing in hip and knee reconstruction surgery. “He was very levelminded and let me come to the decision on my own,” said Dr. Matthew Simons. Dr. Matthew Simons studied anthropology and after graduation, he began his career with an Internet start-up company. It was then, he knew he wanted to do something more. He started taking pre-medical requirements and realized he had peaked an interest. He decided to continue his education and attended

Matthew Simons, MD, and father Robert Simons, MD

“Growing up, I watched my father provide compassionate care as a neurosurgeon, which inspired me to choose a career where I am able to help others. It is my greatest joy when a patient tells me that I have improved their quality of life and relieved their pain,” said Dr. Matthew Simons. medical school at University of Illinois. “Growing up, I watched my father provide compassionate care as a neurosurgeon, which inspired

CENTRAL VALLEY PHYSICIANS

me to choose a career where I am able to help others. It is my greatest joy when a patient tells me that I have improved their quality of life and relieved their pain,” said Dr.

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Theodore Nassar, MD, and son Peter Nassar, MD

“Dad would come home in the middle of the night and we thought we’d be in so much trouble for staying up late. Instead, he would come through the door with a big smile on his face saying, ‘It’s a boy!’ He has the best attitude and that inadvertently encouraged me to become a doctor,” said Dr. Peter Nassar.

Matthew Simons. “As soon as he knew he wanted to go into medicine, I brought him to meet physicians in the community to support him and help him explore different specialties,” said Dr. Robert Simons. After meeting physicians at Sierra Pacific Orthopedics, Dr. Matthew Simons knew he wanted to join. He made a commitment to the group at the end of his residency. After completing his fellowship, he returned to the Central Valley, where he felt had there was a need for his specialty

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in adult reconstruction and joint replacement surgery. He says he chose to specialize in orthopedics because he enjoys correcting injuries and watching his patients bounce back to a healthy state. Every Tuesday father and son cross paths in the hospital hallways between operating rooms when they both have surgical block time. “My dad has such a great reputation and has continued to have a long career. The nursing staff know him well which has given them good faith in me,” said Dr.

CENTRAL VALLEY PHYSICIANS

Family Tree > Growing Local Physicians

Matthew Simons. “His hardworking nature has been a good example for me.” Dr. Matthew Simons and his wife have two young boys, ages 5 and 2. He says he plans to take his father’s level-headed approach and see if medicine interests them. “I’m proud to see him following in my footsteps,” said Dr. Robert Simons.

California. For two years, he was the only OB/ GYN in Madera – which meant he couldn’t take vacation and was always on call. Every child born in Madera during that two year period was most likely delivered by Dr. Theodore Nassar. “I remember staying up until 3 a.m., playing video games with my brother,” said Peter Nassar, MD. “Dad would come home in the middle of the night and we thought we’d be in so much trouble for staying up late. Instead, he “I wanted to come back to the Valley. I wanted to come would come through the home,” said Dr. Peter Nassar. “I would have been a fool to go door with a big smile on his face saying, ‘It’s a boy!’ away and not come back and practice medicine with my dad.” He has the best attitude and that inadvertently encouraged me to become a doctor.” In 1978, Theodore Nassar, MD, was recruited Dr. Peter Nassar knew he wanted to be a from upstate New York to become the first physician since as far back as he could remember. obstetrician and gynecologist in Madera, At first, his goal was to become a pediatric cardiac surgeon. He doesn’t remember why or where he even heard the term. What he vividly remembers from Assisted Living • Memory Care visiting his father’s medical office, is staring at a Doppler on the desk and being intrigued by the different medical instruments. And there began Dr. Peter Nassar’s future in medicine. “I was so proud of him,” said Dr. Theodore Resident focused care that you will be proud to recommend. Nassar. “I taught him all of my old medical Personalized care plan • Incontinence Program school tricks, like using Medication management including injections • Purposeful activity programs mnemonics.” Like his Nurse on-site 7 days a week • Diabetic Wellness Program father, Dr. Peter Nassar decided to specialize 5605 N Gates Ave • Fresno, CA 93722 in obstetrics and 559-682-3114 gynecology. oakmontoffresno.com “I wanted to come back to the Valley. I RCFE #107206882

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Spring 2016

wanted to come home,” said Dr. Peter Nassar. “I would have been a fool to go away and not come back and practice medicine with my dad.” After completing his residency with the UCSF Fresno Medical Education Program in 2004, Dr. Peter Nassar joined his father’s practice Nassar Women’s Care in Madera, California. He says working with his father gave him a large amount of confidence, knowing that he could do any surgery and his father would be there to help guide him through any difficult situations. “I would tell my patients, we have 38 years of experience between the two of us. Little did they know, my dad had 37 years of experience and I had one.” Dr. Theodore Nassar said he has also learned a lot from practicing with his son. He has learned more about laparoscopies, hysteroscopies and Essures – which are all newer gynecologic procedures. Dr. Peter Nassar now practices with Saint Agnes Medical Providers in Fresno, California, but continues to work with his father in Madera once a week. Not only do they share professions, father John Telles, MD, and son Connor Telles, MD, also share a backyard, chicken coop and vegetable garden – they are next door neighbors. Dr. John Telles specializes in cardiovascular disease with The Heart Group in Fresno, California. “It is rewarding to have a son who shares similar interests with you,” said Dr. John Telles. “It’s been pretty amazing to see him evolve as a physician and surgeon.” Dr. Connor Telles describes his journey to medicine as the “easy hard way out.” It was an easy choice to follow

Spring 2016

Throughout the Centr al Valley, there are a number of physicians that have followed in the family tr adition of pr acticing medicine. This listing is not all encompassing. Please let us know for future publications of anyone we may have missed.

Naeem Akhtar, MD (gastroenterology) and Hengameh Akhtar, MD’s (pediatrics) daughter Shahrzad Akhtar, MD (neurology)

Jose Luis Bautista, MD (internal medicine) and son Juan Bautista, MD (internal medicine)

Lee Copeland, MD (internal medicine) and son Greg Copeland, DO (family pr actice)

Patrick Ginn, MD (gastroenterology) and daughter Michaela Ginn, MD (internal medicine)

Orlando Habibe, MD (internal medicine) and sons Alex Habibe, MD (internal medicine) and Michael Habibe, MD (emergency medicine)

John Harold Hanson, MD (gener al surgery) and Harriet Hanson, MD’s (pediatrics) son Eric Hanson, MD (orthopedics)

William Holmes, MD (internal medicine) and son Jonathan Holmes, MD (gener al surgery) and daughter-in-law Amie Holmes, MD (obstetrics and gynecology)

Maciej Kopacz, MD (anesthesiology) and daughter Sharon Kopacz, MD (obstetrics and gynecology)

CENTRAL VALLEY PHYSICIANS

Family Tree > Growing Local Physicians

Fariborz Naeni, MD (orthopedics) and son Pedr am Naeni, DO (gener al surgery)

Ronald Nelson, MD (cardiology) and son John Nelson, MD (cardiology)

Alfred Peters, MD (obstetrics and gynecology) and daughter Kristen Kroeker, MD (obstetrics and gynecology)

Krish R ajani, MD (neonatology) and son Anand R ajani, MD (neonatology)

H.R. Reddy, MD (cardiology) and Pooja Reddy, MD’s (internal medicine resident at UCSF Fresno) son H.K. Reddy (cardiology fellows at UCSF Fresno)

James Roth, DO (internal medicine) and brother Timothy Roth, DO (internal medicine)

Gary Storey, MD (urology) and daughter Leslie Storey, MD (dermatology)

Daniel Suchy, MD (pulmonology) and daughter Michelle Suchy, MD (anesthesiology)

Carlos Sueldo, MD (infertility and reproductive medicine) and daughter Carolina Sueldo, MD (infertility and reproductive medicine)

Rolando Young, MD (neurology) and son Oniel Oscar Young, DO (obstetrics and gynecology)

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suit in his father’s profession, but it couldn’t be accomplished without hard work. He remembers wanting to be a physician after the fourth or fifth grade when he says academics clicked for him. In high school, his plan was to become either an engineer or physician, which progressed into an approach that he describes as the medical application of engineering orthopedic trauma and spine surgery. “My father led by example,” said Dr. Connor Telles. “His office and the hospital were a sacred place.”

“It is rewarding to have a son who shares similar interests with you,” said Dr. John Telles. “It’s been pretty amazing to see him evolve as a physician and surgeon.” After completing medical school and orthopedic surgery residency at Yale University, Dr. Connor Telles went on to complete a spine surgery fellowship at Stanford University Medical Center. Four years ago, after completing his training, like his father thirty years before him, he chose to come home to the Central Valley to practice medicine. He specializes in diseases of the cervical thoracic and lumbar spine, including degenerative conditions, tumors and trauma. Patients of Dr. Connor Telles tell him that they remember him rounding with his father at a very young age. “Growing up in the Central Valley, I am able to serve a lot of people and family members of people I know. We share personal histories,” said Dr. Connor Telles. Dr. Connor Telles says he has learned

Spring 2016

commitment to his patients from his father’s example, an art that is often lost. Dr. John Telles admits he has also learned a few new techniques from his son – like writing down a diagnosis and key terms on a notecard for patients to take home with them to discuss with family and guide their inevitable Google search. The Telles have found it helps patients remember what they have discussed. Dr. John Telles confesses he has to learn more about balance from his son – to be able to enjoy his time away from work. With their unique living arrangement as next door neighbors, the two often catch up on their driveways as they pull in after a long day of work. With their busy schedules Dr. Connor Telles often jokes that it is “a race to see who can get home last.” Living close, their wives help Robert Julian III, DDS, MD, Robert Julian, MD, and Christopher Julian, MD each other on the home front, and Dr. Father Robert Julian, MD, Connor Telles is grateful his and sons Christopher Julian, two children, ages 4 and 3, have MD, and Robert Julian III, an opportunity to have a close DDS, MD, are all surgeons that and daily relationship with practice in Fresno, California. their grandparents. Urologists Dr. Robert Julian and Dr. Christopher Julian

Spring 2016

both practice together at Urology Associates of Central California. Dr. Robert Julian III is an oral and maxillofacial surgeon and serves as the director of residency training of oral and maxillofacial surgery

CENTRAL VALLEY PHYSICIANS

Walk with a Doc Take a Step Towards Better Health Walk with a Doc is a FREE walking program for anyone who is interested in taking steps to improve their heart health. Each walk is hosted by a friendly, local physician. In addition to numerous health benefits received just by walking, you will also get the chance to talk with a doc.

FRESNO

MADERA

BAKERSFIELD

Where: San Joaquin River Parkway & Trust 11605 Old Friant Rd Fresno, CA 93730 When: 3rd Saturday Time: 8:30 am Dates for Fresno April 16 May 21 June 18 July 16 August 20 September 17 October 15 November 19 December 17

Where: Lions Town & Country Park- Pavilion 2300 Howard Rd Madera, CA 93637 When: 1st Saturday Time: 8:30 am Dates for Madera April 2 May 7 June 4 July 2 August 6 September 3 October 1 November 5 December 3

Where: The Park at River Walk 11298 Stockdale Hwy Bakersﬁeld, CA 93313 Time: 8 am Dates for Bakersﬁeld June 25 September 3 November 19

CENTRAL VALLEY PHYSICIANS

Join us for Walk with a Doc For more information or questions, please call (559) 224-4224 or visit www.fmms.org.

Spring 2016

Family Tree > Growing Local Physicians

at UCSF Fresno. “When they were little, they thought everyone’s dad were doctors,” said Dr. Robert Julian. He says he would take his sons golfing with him often – a hobby they continue to enjoy together today. From a young age they were surrounded by other physicians on the green and admired their lifestyles.

and brother share a specialty and practice, Dr. Robert Julian III shares something especially unique with his father – his name. He says, “Not only is it confusing for patients that we are both Dr. Julian, but we are both Dr. Robert Julian.” He jokes, “Patients of my dad will tell me, ‘Your father is so great, what happened to you?’” Both sons have children and are waiting to see if any will continue the Julian legacy in everyone’s dad were medicine.

“When they were little, they thought doctors,” said Dr. Robert Julian.

Dr. Christopher Julian remembers wanting to become a physician beginning in the third grade. Dr. Robert Julian III didn’t plan on becoming a physician until later in life when he realized he had a passion for science. He went to dental school before INC. deciding he would A REGISTRY & PLACEMENT FIRM become a surgeon, just like his father. Dr. Robert Julian and Dr. Christopher Julian have a special Nurse Practitioners ~ Physician Assistants opportunity to work closely together in the same practice. They say they spend more time together in surgery than elsewhere. “We have a great professional Locum Tenens ~ Permanent Placement relationship, but also get to have fun,” Voice: 800-919-9141 or 805-641-9141 said Dr. Christopher FAX: 805-641-9143 Julian. “There is a lot of comradery from tzweig@tracyzweig.com being family.” www.tracyzweig.com Although his father

Tracy Zweig Associates Physicians

Spring 2016

CENTRAL VALLEY PHYSICIANS

Borton Petrini, LLP Bakersﬁeld Business Ticke c o n f e r e n c e goi ts are ng fast!

Saturday, October 8, 2016 CSUB Campus 8 a.m. to 10 p.m.

Over 40 nationally known speakers & entertainers including:

Dr. Ben Carson

Rick Perry

Bobby Jindal

Bill Richardson

Kevin McCarthy

Herman Cain

Ann Romney

Sheriff Joe Arpaio

Laura Ingraham

Hugh Hewitt

Col. Allen West

Ann Coulter

Earvin “Magic” Johnson

Diane Keaton

Vicki Lawrence

Lou Holtz

Chubby Checker

Cal Thomas

Antonio Villaraigosa

James Carville

Over 15 separate venues including the Main Tent, Business Tent, “How-To” Tent, Ice Cream Pavilion, Beer & Wine Garden, Sports Tent, Olympic Pavilion, Farmers Market, Stars & Stripes Arcade, amusement rides, honkey-tonk, picnic & concert stage & more. Concludes with evening picnic, concert starring legend Chubby Checker & firework spectacular. For more information on ticket purchases call (661) 371-2204 or visit www.bakersfieldbusinessconference.com

Dr. Thomas > A Doctor’s Journey Comes Full Circle

A Doctor’s Journey Comes

Full Circle

Thomas W. Thomas, MD, in surgery

Story By Jennifer Seita

As a 19-year-old, Thomas W. Thomas, MD, fell in love with the people and culture of Brazil while serving on a mission for the Church of Jesus Christ of Latter-Day Saints. This summer, 41 years later, he will return to same Brazilian city of Sao Paulo to serve as Mission President, taking a leave of absence from his thriving orthopedic practice. Thomas was selected by his church to serve as Mission President, which is a commitment of three years. “This is not something you can apply for,” said Thomas. “I was not

CENTRAL VALLEY PHYSICIANS

expecting this call, nor did I position myself for this in any way. But the church called and asked if I would go.” When asked how long it took to make the decision to go, Dr. Thomas said, “about five seconds.” “I have a very strong faith and I am committed to serving,” Thomas said. Originally from Ogden, Utah, Thomas grew up in the Mormon Church. Like many young Mormon men, Thomas went on a 2-year mission at age 19. “It was such a privilege to go to Brazil as a young man,” said Thomas. “I

Spring 2016

fell in love with the country and the people. of absence, they completely embraced his The people were so warm and caring and decision. “I’ve been blessed to work with easy to love, and they loved us back.” He the best group in the world,” Thomas said. also found his passion for service, which led “The way we work together is better than to his decision to practice medicine. anywhere else I have ever been or seen. As Mission President, Dr. Thomas’ They have been 100% supportive of me. No responsibilities will be two-fold. He will one has questioned my decision or tried to serve as a missionary for the church, talk me out of it.” preaching and teaching. Secondly, he Over 4,000 letters have gone out to his will serve in an patients, letting administrative role them know about overseeing around his departure. “Every 200 19-year-old day I hear people say, missionaries in the ‘Can’t you wait?’” he area. “My job will be said jokingly. “But to train them, make for the most part, sure they are eating my patients have well, dressing well been supportive and writing home to and positive.” So mom,” said Thomas. supportive, that “Like a surrogate many have opted to parent while they put their surgeries are away.” on hold until Dr. Dr. Thomas Thomas returns. For has six children those that don’t want Ellen Thomas, and seven to wait, they will Thomas Thomas, MD, and daughter Emily Thomas grandchildren. Four be shifted to other of his children are doctors in the group. grown adults, one “We have a premier is in college, and group of doctors his youngest daughter, Emily, 16, will join here; the best in the country,” said Thomas. him and his wife, Ellen, in Brazil. She has “Patients will get the best of care with any decided to finish her last year of high school of us.” in Brazil and move with her family. “It will Dr. Thomas’ last day in the office will be a sacrifice for her,” Thomas said. “But she be May 10 and he and his family will leave has a sense of adventure and she is entirely Fresno for Salt Lake City, Utah on June 22. committed to going.” There, he will have a three day training and Dr. Thomas will also be pressing pause then will arrive in Brazil June 28. on his successful orthopedic practice. He “Orthopedics has been a blessing beyond practices general orthopedic surgery at compare,” said Thomas. “There is no Sierra Pacific Orthopedics where he has field of medicine where there are so many been a member since 2000. Sierra Pacific opportunities for positive reinforcement. Orthopedics is one of the largest and most Every day people are so grateful to walk utilized orthopedic specialty providers in again, to move their shoulder again. I have the San Joaquin Valley, with experts in the the best job in the world. In three years I treatment of virtually every bone and joint want to come back, but I’m prepared for in the body. Thomas has been practicing for anything to happen. I just know no matter over 25 years and has many loyal patients. what God will take care of me. He always When Thomas first told the team at has.” Sierra Pacific Orthopedics about his leave

Spring 2016

As Mission President, Dr. Thomas’ responsibilities will be two-fold. He will serve as a missionary for the church, preaching and teaching. Secondly, he will serve in an administrative role overseeing around 200 19-year-old missionaries in the area.

CENTRAL VALLEY PHYSICIANS

Public Health

Update

Don Gaede, MD, practices Internal and Vascular Medicine in Fresno. Alex Sherriffs, MD, practices Family Medicine in Fowler, and serves on the governing boards of the San Joaquin Valley Air District, and on the California Air Resources Board.

The two authors pose with their electric cars and Beta, Dr. Sherriffs’ dog.

Climate Change:

Threats and Opportunities for Our Valley Story by Don Gaede, MD, and Alex Sherriffs, MD

“Climate change is the biggest global health threat of the 21st century.” This statement was not written by some radical environmental group, but by one of the oldest and most prestigious medical journals in the world—The Lancet. The article continues, “Effects of climate change on health will affect most populations in the next decades, and put the lives and wellbeing of billions of people at increased risk.” It concludes, “We call for a public health movement that frames the threat of climate change for human kind as a health issue.”

CENTRAL VALLEY PHYSICIANS

Spring 2016

Since that time, many other medical organizations have echoed The Lancet’s concerns: A 2014 CDC report stated that “Climate change threatens human health and wellbeing in many ways, including impacts from increased extreme weather events, wildfire, decreased air quality, and illnesses transmitted by food, water, and diseases carriers such as mosquitoes and ticks.” Climate change is predicted to cause significant health problems for us in the Central Valley. It will likely worsen our air quality—already rated as one of the worst in the country. Higher atmospheric temperatures will increase ozone concentrations. Smoke from more frequent forest fires will likely elevate fine particulate matter concentrations. The allergy season will lengthen, as plants produce pollen earlier and longer. Declining snow pack in the Sierras and more extreme El Niño/La Niña events may exacerbate existing water shortages for our patients. Finally, increasing healthcare costs due to these climate effects will be borne by all of us. We congratulate the Fresno Madera Medical Society board for passing a resolution that outlined the threats that climate change poses to our health in the Central Valley, and called for action on this issue. We challenge other component medical societies to join this effort. What can we do to minimize our carbon footprints? There are many things we can do, large and small, but most important is to start doing something. Our cars. Transportation is the biggest source of greenhouse gases, so our choices here have a huge impact. When it is time to get a new car, first consider whether a plug-in electric can meet your range needs. Nissan Leaf, Chevy Spark, Tesla, Mitsubishi, Fiat, Ford, and BMW are a few of the choices available in the valley. You can immediately decrease your reliance on fossil fuels by 50%, transferring all your commute miles to plug-in electric. California is well on the way to putting one million battery electric cars on our roads by 2025. If an electric car would not work for you, look to a plug-in hybrid like the Volt. Typically it turns all the commute miles to electric, reserving the infernal combustion engine for longer trips. Replacing your current 25 mpg vehicle with a 50 mpg

Spring 2016

hybrid is another way to cut our reliance on fossil fuels. The current low gas prices are not going to last forever. Our homes. Can you install solar for electricity generation? How about solar water heating? We can cite plenty of cases where the PG&E bill is less than $10 a year now. Our offices. Lights, AC and heating, and water use are the big three. We can save real money and energy with

LED lighting, paying more attention to the thermostat, and what it is doing when there is no one in the office. Go to greenbusinessca.org to learn about the advantages of becoming a green certified business. Our health care institutions. Some are actively pursuing strategies to decrease their carbon footprint and have committees (at Community Regional Medical Centers) and even a designated Green Officer (at Dignity Health). Find out what commitment your hospital or clinic system has made, support it, and figure out how to get the ship moving even faster in the right direction. As a portion of the entire community, health care institutions throw a significant carbon footprint. Our government policies. This may be the most important point. Let those running for office know you care deeply about climate change, and the human contribution to climate change. You want to know what policies they will be supporting to speed our success in lowering green house gas production. This is a short and incomplete list of the many things we can do about climate change. Do them all if you can, but most importantly, do something—anything—to modify your carbon footprint. Get started, and then take the next step.

CENTRAL VALLEY PHYSICIANS

Spring 2016

CENTRAL VALLEY PHYSICIANS

SAVE THE DATE MAY 26, 2016

HEALTHCARE CEO FORUM May 26, 2016 at 6 pm

Fort Washington Golf & Country Club 10272 N Millbrook Ave, Fresno, CA 93730 For more infomation call (559) 224-4224

CENTRAL VALLEY PHYSICIANS

Spring 2016

Hobbies > At a Glance

Hobbies

McTeague, A Tale of San Francisco by Benjamin Franklin (Frank) Norris Book Reviewed by: Roydon Steinke, MD, Obstetrician and Gynecologist in Fresno, California Fresno Madera Medical Society Member, 36 years

hy would one want to read a book—a novel at that—that was written over 100 years ago? In McTeague, Frank Norris tells a story that has many themes that are apropos to today’s world, in particular to health professionals. Issues such as professional training, quality of care, licensure, continuing education, professional organizations, family pressure, burnout, and changes in occupation are topics depicted in this book. McTeague is a man who lives in San Francisco in the 1800s and achieves some dental acumen by doing an apprenticeship. Then he practices dentistry. He is married to a very demanding and avaricious woman. Concerns about public safety and quality of dental care in California led to the development of professional standards and licensure with which he was unable to comply.

Spring 2016

He resorted to practice without a license, met with disciplinary action, and spiraled into tragedy. The story was made into a very accurate four-hour silent movie called “Greed” by Eric von Stroheim in 1924. It is considered by many as one of the top ten films ever made.

His death is intriguing in that his wife was one of the first people to be operated on in San Francisco for acute appendicitis and survive. Frank Norris developed acute appendicitis one year later. The diagnosis and surgery were delayed and he succumbed to postoperative peritonitis in 1902.

Frank Norris, a journalist, was an excellent storyteller who wrote 12 novels. Blix tells a story of a young couple in San Francisco who in their interaction utilize the transportation of the period and visit many of the city’s sites. The imagery is brilliant. Another novel, Octopus, is an excellent fictitious representation of the Mussel Slough massacre on Avenue 14, twelve miles north of Hanford, California. In it he displays his progressive ambitions with a declaration that the red tide will take over!

CENTRAL VALLEY PHYSICIANS

Office Manager’s Forum Free to FMMS/CMA Members!

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 Fresno Madera Medical Society (FMMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. FMMS 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. 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 ($20 thereafter). Registration required.

For more information, contact Millie Thao, Director of Communications and Physician Relations, 559-224-4224 Ext. 112 or milliethao@fmms.org.

Fresno-Madera MEDICAL

SOCIETY

New Members

APRIL 27, 2016

Time: Noon to 1:30 p.m. Location: TBD GETTING PAID: A PHYSICIANS GUIDE TO TAKING CHARGE OF ACCOUNTS RECEIVABLE Mark Lane, Associate Director CMA Center for Economic Services Mark Lane has 18 years of experience that allowed him to understand the needs and positions of both Physicians and Payors, making him an ideal candidate to educate providers on overcoming the ever changing challenges of the healthcare landscape.

MAY 18, 2016

Time: Noon to 1:30 p.m. Location: TBD CONTRACT RENEGOTIATION: HOW TO GET PAST “NO” WITH A PAYOR Kristine Marck, Associate Director CMA Center for Economic Services After over 25 years in the health/managed care industry, she has a balance of working for and with physicians and a drive to assist them in these difficult times. Her extensive experience offers her a unique perspective and a number of encounters to draw from. Her distilled skills focus her advocacy in the areas on managed care contracting, Medi-Cal stakeholder activities and liaison work with varied health plans, IPAs and Medical Groups.

JUNE 22, 2016

Time: Noon to 1:30 p.m. Location: TBD MARKETING 101: ADVERTISING, PR AND SOCIAL MEDIA FOR YOUR MEDICAL PRACTICE Jan Edwards, Founder Jan Edwards Marketing Jan Edwards, has more than ten years of experience in marketing. She serves as Development and Marketing Director of the Central California Women’s Conference and is responsible for development of funds, marketing and communications. Jan also teaches public relations and advertising classes in the Mass Communication and Journalism department at Fresno State. She is the sales adviser for The Collegian, an award-winning, student-run newspaper.

ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.

from the is thly bulletin This bulletin is a free mon nomic Services. practice Eco ces (CPR) staff improve tice Resour ciation’s Center for their office CMA Prac Medical Asso help physicians and California CMA Practice to , sign

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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.

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If there are additional topics that would like us to cover please contact Millie Thao at 559-224-4224 Ext. 112 or milliethao@fmms.org.

In The News

CLASSIFIEDS If you'd to submit a listing to our Classifieds or purchase an ad, please call 559-224-4224.

FOR LEASE/RENT

Medical office space, 1331 square feet. Many new exterior improvements. 1046 and 1060 E. Shields Ave. Contact Shannon Mar, 559-999-6165 or smar@guarantee.com.

Medical office space available, 1200 square feet, 3 exam rooms, lab space, waiting room with reception area, private office, and storage. 1095 E. Warner, Suite 102 Fresno. Near Saint Agnes call 559-905-9233 for more information.

Central California Available Medical Office BAKERSFIELD - David A Williams, Jason Alexander & Cameron Mahoney For Sale 2725 16th Street - Surgery Center 820 34th Street - Âą33,000 sf Lease 820 34th Street - 20,298 sf 9330 Stockdale Hwy. - 2,665 sf 2019 21st - 2,856 sf 3535 San Dimas - up to 12,000 sf 3941 San Dimas #103 - 3,759 sf 3850 Riverlakes Drive - 3,355 sf FRESNO - Bobby Fena, Michael Schuh & Beau Plumlee For Sale 2377 W. Cleveland - 5,832 sf For Lease 560 E. Herndon - up to 15,247 sf 1360 E. Herndon - 16,475 rsf 10000 Stockdale Hwy #102 - Bakersfield, CA 93311 - 661 631 3800 www.colliers.com/bakersfield 7485 N. Palm Avenue #110 - Fresno, CA 93711 - 559 221 1271 www.colliers.com/fresno

CENTRAL VALLEY PHYSICIANS

Kern County Medical Society Dinner & Presentation Wednesday, April 6, 2016 at 6 pm Please join us for dinner and Financial Education presented by Edward Jones & Mission Bank. This event is FREE to Physicians and Medical Managers Wool Growers Restaurant 620 E 19th Street Bakersfield, CA 93305 R.S.V.P. 661-325-9025 or fwinslow@kms.org

Spring 2016

Join Fresno Madera Medical Society for Legislative Advocacy Day in Sacramento APRIL 13, 2016 CALIFORNIA MEDICAL ASSOCIATION 42nd ANNUAL LEGISLATIVE LEADERSHIP CONFERENCE Wednesday, April 13, 2016 • Sheraton Grand Sacramento

Attendees will have the opportunity go to the Capitol throughout the day to meet with legislators on health care issues. The meetings will be scheduled and coordinated by local county medical societies. This is a unique event for California physicians and is free of charge to all CMA members. Plan to join more than 400 physicians, medical students and CMA Alliance members who will be coming to Sacramento to lobby their legislative leaders as champions for medicine and their patients. Tentative Agenda Sheraton Grand Ballroom - 1230 J Street, Sacramento, CA 8 am Registration/Continental Breakfast 9 am CMA Welcome and Remarks - Steven E. Larson, MD, President, CMA - Dustin Corcoran, Chief Executive Officer, CMA 9:30 am Meetings with Legislative Offices (State Capitol) 10:30 am Tobacco Tax Press Conference (State Capitol) 11:30 am Buffet Lunch (Sheraton Grand) 12:30 pm Keynote – Assembly Republican Leader Chad Mayes 1 pm Political Panel – Save Lives California 1:30 pm Meetings with Legislative Offices (scheduled by county medical societies)

Fresno Madera Medical Society will be coordinating transportation and arranging meetings with representatives for the event. For more information or to register, please contact Millie Thao at milliethao@fmms.org or call (559) 224-4224 or Yna Shimabukuro, CMA Government Relations at 916.444.5532 or yshimabukuro@cmanet.org.

Fresno Madera Medical Society 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720

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Permit No. 30 Fresno, CA

State of the Heart SAINT AGNES CARDIOLOGY SYMPOSIUM 2016 Saturday, April 23 • 8 a.m.-2 p.m. Saint Agnes Medical Center, Shehadey Pavilion 1303 East Herndon Avenue • Fresno, California This symposium focuses on cardiovascular disease management and emerging paradigms in treating coronary and structural heart disease. It will address practice gaps in disease management and provide education to improve patient outcomes.

Speakers Paradigms of Revascularization for Chronic Coronary Artery Disease Verghese Mathew, MD, FACC, FSCAI Consultant, Division of Cardiovascular Diseases and Department of Radiology Professor of Medicine, Mayo Clinic College of Medicine Protected PCI: Treating Complex Coronary Artery Disease in 2016 Anthony A. Hilliard, MD Assistant Professor of Medicine Director, Adult Cardiovascular Lab Loma Linda University International Heart Institute Invasive Management of Intractable Angina Gurpreet S. Sandhu MD, PhD Director, Dr. Earl Wood Cardiac Cath Lab, Mayo Clinic Transcatheter Mitral Valve Therapies Oluseun O. Alli, MD Assistant Professor of Medicine University of Alabama at Birmingham School of Medicine

Preregistration is required • No charge Please register online at www.samc.com. Registration must be received by April 16, 2016, to be guaranteed a participant syllabus. If you have questions or problems registering online, email medicaleducation@samc.com or call (559) 450-7566. Registration at the door is dependent on space availability. TM

5 AMA PRA Category 1 Credits to be awarded