January 2015 by Fresno Madera Medical Society

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Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society January 2015 Vol. 37 – Number 1 Editor Alan Birnbaum, MD Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Board Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD Kern Representative John L. Digges, MD Tulare Representative Francine Hipskind Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medical Society, PO Box 28337, Fresno, CA 93729-8337.

Contents EDITORIAL.................................................................................................................................5 NEWS........................................................................................................................................6

FMMS Member Wins CMS’s Annual “Country Doctor” Award......................................................9

BLOOD BANK........................................................................................................................10

2015 Post Yosemite Institute................................................................................................10

CLASSIFIEDS..........................................................................................................................15 TULARE County Medical SocieTY.......................................................................................11

• President’s Message • George Tiss Award • Just Walk With A Doc

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

• KCMS Installation of Officers: January 16 • Membership News

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

• President’s Message • Physicians Honored With Community Service Awards • Medical Managers Network Forum

Advertising Contact: Display: Annette Paxton, 559-454-9331 apaxton@cvip.net Classified: Carol Rau Yrulegui 559-224-4224, ext. 118 csrau@fmms.org Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion pieces accepted for publication do not necessarily reflect the opinion of the Medical Society. All medical societies require authors to disclose any significant conflicts of interest in the text and/or footnotes of submitted materials. Questions regarding content should be directed to 559-2244224, ext. 118.

Cover Photograph: “ Badger Pass Yosemite Ski Area” by Ning Lin, OD, MD Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee Members: 3 months/3 lines* free; thereafter $20 for 30 words. NON-Members: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30. *Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

JANUARY 2015 / VITAL SIGNS

YOU WORK TO PROTECT YOUR PATIENTS. We work to protect you. AS A PHYSICIAN, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty. That’s why the Fresno-Madera, Kern and Tulare County Medical Societies/ CMA sponsor a Group Long-Term Disability program underwritten by New York Life Insurance Company: • Benefits not tied to a practice, giving you more flexibility with potential career changes • Benefit payments that are 100% TAX FREE — when you pay premiums yourself

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UNDERWRITTEN BY:

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OR SCAN TO LEARN MORE!

EDITORIAL

Let’s All Make Better Music Together Alan M. Birnbaum, MD Editor, Vital Signs

Health care in the United States often resembles a philharmonic orchestra without a conductor, individual players creating a cacophony as each plays to a dysharmonic beat. Can motivated physicians make better music? Nationwide, practitioner attitudes differ widely towards the overall system and particularly the Affordable Care Act on professional practice and patient health. Letters to the Editor in the December 12, 2014 Wall Street Journal featured 10 doctors’ contrasting attitudes and concerns. Three pairs of responses epitomize that cacophony of concept. Robert Murphy, MD, from Collegeville, Pennsylvania argued “Solo and small group private practice is already dead” so “doctors should embrace employment in integrated health systems.” In California, Janet Fuchs, PhD, of Beverly Hills felt that “The solution to increased doctor and patient satisfaction is opting out of the system entirely. Hang a shingle. Set a Delivering price list. Take cash.” medical In Gaffney, South Carolina, “small town family physician” Richard Ruffing, MD recalls that to just generate an “average primary-care salary,” he saw, as early as 1995, no choice care without save to “join a hospital system.” today’s As to the downside of physician employment, Jo Rummelhart, DDS, from Madison, financial Wisconsin relates that in Great Britain, with its National Health Service, “two-thirds of the physicians are unionized via the British Medical Association,” which made possible a carebarriers disruptive strike during mid-2012. merits the Robert W. Geist, MD, of St. Paul, Minnesota finds the patient to be “at risk” from greatest “payment reform doublespeak”, due to “conflict of interest” by rationing care. Yet at the same time in Des Moines, Iowa, Thomas A. Carlstrom, applauds typically much higher priority. A ACA deductibles and feels that applied uniformly, such de facto rationing would “greatly parallel reduce the total cost of medical care.” emphasis Locally the December 6, 2014 Fresno Bee featured reporter Barbara Anderson’s wellbalanced article about Exchange plan access obstacles despite ACA. She related particularly should be the erroneous practitioner rosters and also noted that most private practices can’t afford to protection accept substandard fees most such plans allow. Beyond that, Exchange Bronze and Silver from financial policies’ daunting deductibles create further barriers to care. What must physicians improve on our current conundrum? Delivering medical care risk. without today’s financial barriers merits the greatest priority. A parallel emphasis should be protection from financial risk. Care deferred today, due to cost, creates even greater costs tomorrow. If, as I have advocated, we nationally eliminate all deductibles in favor of graduated co-pays that start higher then drop as costs accrue to compensate for crude and cruel dollar barriers families now face, physicians will need to become even more involved in directing care, while ensuring patients know why we are making our decisions. For each procedure ordered, all of us need to ask what question the test would answer, as well as if the result will truly impact care. A prime example remains MRI scans for non-radiating spinal pain in patients whose exam shows no neurological disturbance. This is a situation where a reasonable physician can direct care on clinical grounds alone. Major opportunity also lies in regular medication reconciliation to maximize generic options and discard duplicating drugs. Such a cognitively-improved approach does require greater physician time. We must clearly document the work involved, and by individual and collective effort, we must insist on payment for our time. The current fee-for-service reimbursement schedules regressively discount time spent with patients. Instead, payment for revisits CPT 99213 through 99215 should more closely reflect time spent. Similarly, payment for new patient visits CPT 99203 through 99205 should become time linear. As well, we need a CPT 99206 for our most complex patients. At the same time, physicians paid by salary or capitation merit parallel incentives to promote quality. If the overall system becomes progressive enough to properly pay physicians for cognitive work, in turn we can create better music and better care at a lower cost for our patients. Author may be reached at Siriusguy @aol.com. JANUARY 2015 / VITAL SIGNS

CMA NEWS UCSF Fresno Department of Internal Medicine Presents:

MEDICAL

UPDATE March 20 - 22, 2015

Humboldt physician installed as CMA’s 147th president

The California Medical Association (CMA) has installed Humboldt County physician Luther Cobb,

M.D., as its 147th president. He takes office on the heels of the momentous defeat of Proposition 46, a campaign in which doctors and health care providers across California rallied together to oppose the measure that ultimately failed 33-67 percent. “What a thrilling time to be assuming the role of CMA president,” said Dr. Cobb. “The health care community has stood tall in protecting our patients and their access to care and as we look ahead to the year in front of us, I am confident that we will continue to do so.” After attending Stanford Medical School, Dr. Cobb went onto do his residency at Stanford as well, taking a two year fellowship to study pancreatic islet transplantation for diabetes. He later joined the Stanford faculty and worked at the affiliated county hospital in Santa Clara County, Santa Clara Valley Medical Center. Dr. Cobb is a former chair of the CMA Council on Legislation and has served on the organization’s executive committee since 2006. He is also past president of the Humboldt-Del Norte County Medical Society. Dr. Cobb’s term as CMA president will run from November 2014 through October 2015.

Verifying your patients’ eligibility and benefits in 2015 may save your practice thousands of dollars

UCSF Fresno Center Auditorium 155 North Fresno St. Fresno, CA 93701 (corner of Divisidero & Fresno)

An educational program designed for internists, family practitioners, primary care physicians, and nurse practitioners who work in the primary care field. CME: 15 (applied for) Registration Fee: $195 Social events to include a trip to Yosemite and Blossom Trail tour.

For more information: Call 559-459-6299 or email vconingsby@fresno.ucsf.edu

6 JANUARY 2015 / VITAL SIGNS

With the new year soon upon us, physicians are urged to be diligent in verifying patients’ eligibility

and benefits to ensure that you will be paid for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations start over. With open enrollment there may also be changes to patients’ benefit plans, or they may even be insured through a new payor. The new year also brings a host of other challenges that could affect your ability to be paid: • Medicare patients can modify their enrollment choices from October 15 through December 7, allowing them to switch between Medicare fee-for-service and Medicare Advantage, or switch from one Advantage plan to another. Please see CMA News on page 7

CMA NEWS Continued from page 6 • The Covered California open enrollment period is November 15, 2014, through February 15, 2015. Existing exchange/mirror patients have the option to select a different plan and Covered California expects an additional 500,000 individuals will enroll in an exchange plan during 2015 open enrollment. Additionally, there will be some changes to exchange/mirror product names in 2015. Covered California notified all exchange plans that the product names must be the same for exchange and mirror products and that plans must also utilize a standard naming convention for all individual exchange/mirror products. The 2015 Covered California QHP naming convention is as follows: [carrier name] + [metal tier name] + [Actual Value] + [product type (e.g., EPO, HMO, PPO)] Example: Blue Shield Bronze 60 PPO California moved the remaining 25,000 seniors and persons with disabilities (SPDs) from fee-for service to managed care on December 1, 2014, in the following counties: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne and Yuba. Additionally, 30,000 patients who are dually eligible for Medicare and Medi-Cal in Los Angeles and Santa Clara counties will begin to transition from fee-for-service Medicare and Medi-Cal into managed care on January 1, 2015. Dual eligible enrollees will transition in these two counties over the next 12 months based on month of birth. Duals will also continue to transition based on month of birth in San Bernardino, Riverside and San Diego counties. The duals transition for Orange County is scheduled to begin in July. For more information on Duals, see CMA’s toolkit, “Cal MediConnect Physician FAQ – What you need to know about keeping your patients and billing for the dual eligible population,”available at www. cmanet.org/duals. Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit. And don’t forget that deductibles are typically based on the calendar year and will reset on January 1. Many of the exchange/mirror plans have high deductibles (e.g., $5,000 deductible on the Bronze plan), as do some employer-based plans. This reinforces the importance of verifying patient eligibility – particularly for exchange patients – each time they are seen. Best practice is to communicate with patients upon scheduling to remind them that their plan has a deductible that may be resetting on January 1 and, if that is the case, payment will be due at the time of service. If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice as your ability to collect can decrease significantly after the patient leaves the office. Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money.

Are you having problems with the new prescription drug prior authorization form?

A new law recently took effect that streamlines and standardizes the prior authorization process for prescription drugs for most patients with PPO products. The new law (SB 866) requires all insurers, health plans (and their

contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt. If they fail to do so, the requests will be deemed authorized. The new law does not expand the list of medications that require a prior authorization. The requirement for HMO products, including Anthem Blue Cross and Blue Shield of California, becomes effective on January 1, 2015. The regulation for Department of Insurance-regulated products, including all other PPOs and Blue Cross and Blue Shield Life & Health products, became effective on October 1, 2014. However, in an effort to avoid confusion for practices, many plans/insurers implemented the new form across most, if not all, of their product lines on October 1. The California Medical Association (CMA) is interested in hearing from practices that have experienced difficulties with the new form. If your practice has run into any problems with the form itself, integration into your EHR, submission of the form to the payor, multiple requests for medical records from the payor, delays in processing by the payor, etc., please contact CMA at 916-551-2061 or economicservices@cmanet.org to share your experience. For information on the new form and accompanying regulations, including a chart of the effective dates by payor and product, see the CMA physician FAQ , “A Physician’s Guide to Implementation of SB866: The new standardized prescription drug prior authorization form.” This document is available free to members.

CMA helps develop toolkit for physicians facing medical audits

Medical audits are disruptive to physician practices and often cause substantial financial hardship. However, physicians need to consider medical audits as a routine part of their businesses and plan accordingly. There are many actions that physicians can take to mitigate both the risk of being audited and the potential for adverse audit findings in the event of an audit, some of them quite simple. The California Medical Association worked with the Physicians Advocacy Institute and the American College of Emergency Physicians to develop a toolkit that contains practical tools for physicians facing medical audits. The toolkit provides information and tips to guide physicians in anticipating medical audits, responding to auditors’ requests for medical records and appealing erroneous audit findings. The toolkit also includes detailed information regarding the various types of governmental and private payer audits, appellate procedures and extrapolation methodologies used by some payers to calculate alleged overpayments. Contact: CMA legal information line, 800-786-4262 or legalinfo@ cmanet.org. Problems getting paid?

The

California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff. Reimbursement Help Line: 888-401-5911 or economicservices@ cmanet.org When to call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing, and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help. JANUARY 2015 / VITAL SIGNS

Don’t miss the opportunity to attend the 2015 winter cme symposium in Whistler, BC, Canada

Pursuit of Excellence

Annual Winter CME Symposium

February 25-28, 2015 • Wednesday – Saturday 2015 Winter Symposium Scheduled Speakers Stay tuned for more speakers to come.

David Holloway, MD, CPE, FAAFP

Chen-Tan “CT” Lin MD, FACP

Chief Medical Officer, Bend Memorial Clinic

CMIO, Colorado Health

"Hitchhiker's Guide to Physician Leadership Development: How We Engaged Physicians, Attacked Variation, and Lived to Tell About It"

“Giving Patients Access: Improving Both Patients & Physicians Lives.”

Neil E. Romanoff, M.D., MPH, FACP

Ms. Barbara Spurrier

Vice President for Medical Affairs Associate Chief Medical Officer, Medical Staff Affairs Chief Patient Safety Officer

Co-Founder & Administrative Director Center for Innovation, Mayo Clinic

“Delivering the Safest Care: What Will Go Wrong Next?”

“Health Care Innovation Strategies: Innovations to Deliver Safer More Efficient Care - Mayo Clinic Experience.”

Blair Childs

Senior Vice President of Public Affairs for Premier, Inc

Town Hall Meeting

“Updates from Washington D.C.: Issues Affecting Health Care & Physicians.”

Scott Wells

CEO of Santé Health System “Healthcare Reform: What are we doing about it? Progress Report.”

Scott Wells

SHF Executive Director

Tim Joslin, CEO

Community Medical Center

Patrick Rafferty, COO Stephen Walter, CFO Community Medical Center

Community Medical Center

For more information/details please contact:

Laurie Smith, CMC Manager of Physician Education lsmith@communitymedical.org 559-459-1777 or 2-1777 or 2-1775 Carin Stirrup, SHF Manager of Marketing & Medical Foundation Education cstirrup@santehealth.net 559-228-5441

Sponsored by

No tuition fees-plan to attend now 10 CME (Applied For)

LEARN MORE & REGISTER ONLINE

www.wintersymposium.com

Dr. Oscar Sablan, left, receiving his award from CMA President Richard Thorp, MD.

FMMS Member Oscar Sablan, MD Wins CMA’s Annual “Country Doctor” Award Honored at CMA’s House of Delegates meeting in San Diego December 5-7, 2014 More than 30 years ago, Oscar M. Sablan, MD, an internist, and his wife Marcia Sablan, MD, a family physician, decided to work in a rural area for three years to get their medical loans forgiven as part of the National Health Service Corp, a federal program to supply debt relief to newly graduated physicians who agree to work in underserved areas. The couple moved from tropical Hawaii, where Dr. Oscar Sablan was serving his integrated medicine residency at the Queen’ Hospital, Honolulu, to the dusty rural town of Firebaugh, 100 miles east of Fresno. The plan was for the couple to do their three-year service in rural Fresno County and then walk away with their debts forgiven. They started their practice on the corner of “O” and 9th streets and have been there ever since. In San Diego last month the California Medical Association (CMA) honored Dr. Sablan with the Frederick K.M. Plessner Memorial Award, an award given each year to recognize a California physician who best exemplifies the ethics and practice of a rural country practitioner. Dr. Oscar Sablan and his wife are the only full-time doctors in the tiny town of 7,800 and they are still treating many of the same families as when they arrived three decades ago. The whole town, from wealthy ranchers to migrant farm workers, relies on the couple. The Sablons have guided

Firebaugh families through pneumonias, accident, injuries, cancers and bypass surgeries to better health. As the Sablans built up their medical practice, they realized that they could only do so much in the exam room. So they turned to politics. Dr. Oscar Sablan has served on the local school board for close to 20 years and his wife has served as Firebaugh’s mayor for 10 years and has sat on the city council for over 30 years. In addition to practicing of medicine and community service in public positions, in 1981 the couple started the community’s annual free Christmas day dinner, which feeds 650 plus people every year. Dr. Oscar Sablan has also served as the Firebaugh-Las Deltas Unified School District team physician for all sports for 33 years. It is common knowledge that rural regions of California have long faced shortages of doctors. While small towns near Firebaugh struggle to hang onto doctors, Dr. Oscar Sablan’s long-standing commitment to the community makes him an exception. Learn more about Dr. Oscar Sablan by watching the CMA tribute video on YouTube. Congratulations Dr. Oscar Sablan!

JANUARY 2015 / VITAL SIGNS

BLOOD BANK

2015 Yosemite Postgraduate Institute March 27-29, 2015 Yosemite National Park

Topics include: n Depression n ADHD n Migraines n Epilepsy n Autoimmune Diseases n Wound Care n Cholesterol Guidelines n Atrial Fibrillation n Genetic Testing n HIV n ICD-10 Brochures will be mailed January 2015

America’s Blood Centers Facilitates Member Participation in Cerus IDE for Intercept Blood System Treatment of Ebola Convalescent Plasma Submitted by Patrick Sadler, MD, Central California Blood Center

The Food and Drug Administration recently accepted the Investigational Device Exemption (IDE)

sup-plement from Cerus to allow the processing of plasma from donors who have recovered from Ebola virus disease (EVD) using the Intercept Blood System to treat patients in the US with convalescent plasma, Cerus announced. The trial is being initiated with Emory University Hospital, Atlanta, Ga., and the University of Nebraska Medical Center, Omaha, Neb. America’s Blood Centers is participating in the IDE by ensuring that its member centers located in areas with potential donors can obtain their plasma by apheresis and ship it to Emory University Hospital. It will be treated with Intercept there, frozen, and stored for distribution to facilities treating EVD patients at need. This will reduce the need for individual emergency treatment Investigational New Drug (IND) applications, as have been used to date. It will also standardize data collection to maximize what can be learned about the safety and impact of convalescent plasma. Plasma collected from individuals who have recovered from EVD contains antibodies against the virus – antibodies that may be used to treat patients with acute Ebola infection. However, recovered patients – many of whom either are from Africa or were on extended missions in Africa – may carry undetected pathogens, like malaria, due to prior exposure in Africa, and/or may have received blood products during their illness that would require their deferral from donation according to cur-rent regulations and standards. Treating their donated blood with the Intercept pathogen re-duction process should mitigate such risk. As a first step to engage ABC member centers, using information available about the location of recovered patients who have already agreed to be plasma donors, ABC Chief Medical Officer Louis Katz, MD, will contact appropriately located member centers to assess their willingness to become investigators. Those centers will then be connected with the appropriate Cerus contacts to begin building an inventory of pathogen reduced convalescent plasma. Central internal review boards are reviewing study documents for approval, which will simplify and speed up the process of center enrollment in the study. At this time, FDA has approved the Intercept treatment only for liquid (never frozen) plasma, which is what will be shipped to Emory University Hospital for processing and storage. Cerus has collected data on the treatment of frozen plasma that will be submitted to FDA when it is appropriate to amend the IDE. Once the centers located where available donors live have been contacted, access to the study for other centers will become available to accommodate future new donors. ABC member blood centers may contact Dr. Katz at lkatz@americasblood.org for more information. (from ABC Newsletter, November 21, 2014)

Blood Community Aids in Gates Foundation Efforts to Speed Development of Potential Ebola Treatments

The Bill & Melinda Gates Foundation announced on Nov. 18 that it will support efforts

Information: csrau@fmms.org or 559-224-4224x 118.

10 JANUARY 2015 / VITAL SIGNS

in Guinea and other Ebola-affected countries to scale up the production and evaluation of convalescent plasma and other convalescent blood products as potential therapies for Ebola patients. The foundation has committed $5.7 million to launch the effort. The Gates Foundation is providing funding to Clinical Research Management, Inc. (ClinicalRM) and a broad array of private sector partners – including many in the blood community – to study Ebola convalescent plasma collected in accordance with a recent World Health Organization guidance. The convalescent plasma will be collected through mobile donation equipped with Haemonetics PCS2 plasma collection systems and the Cerus Intercept Blood System. Blood Centers of America is providing staffing for this project. For more information and a full listing of partners on this effort, visit http://bit.ly/1teNWWN.

Tulare MONICA MANGA, MD, ABIM

President’s Message As the 2014 year closed out of its’ final days, it is clear to me that I have lived many years, that battles are becoming more frequent and harder to fight. I was not alone. As physicians we confronted a very difficult battle. We stayed together, and demonstrated once more that the physician perspective of serving as the consumer advocate in the move of patient safety is now as valid as many years ago. In 1975, the Malpractice Insurance Compensation Reform Act (MICRA) was passed. This year we had Proposition 46, whose official title was Drug and Alcohol testing for doctors. The focus was to increase the non economic cap of malpractice suits. But, let’s go back. What is Proposition 46? If I remember correctly, the first to talk about such, was Euclid, and it basically described how to draw a square from a given straight line. A square, a parallelogram whose all angles are right. Well, we were never given a straight line. The objective of the new proposition 46 was definitely not one. The ultimate goal was to increase the cap of non economical damages, and the actual translation of this was to increase compensation for trial lawyers. This was accompanied by measures with no clear mechanism of performance and great deal of disruption in patient care: impose mandatory drug testing for physicians, requirements to use the electronic Controlled Substance Utilization Review and Evaluation System (C.U.R.E.S) database, prior to prescribing a schedule II or III controlled substance. Our already, under served community was at higher risk of losing and decreasing access to care. No, this is not what I see as a straight line, therefore at the end, no square was constructed, and we could not see any right angles. We succeeded, however were left with the sensation that we will be confronting opposers of MICRA; and will need to continue educating our community about its’ value. This year The Affordable Care Act (ACA) took full effect. ACA impacted the number of patients seen and the reimbursement received by physicians, making cost control a top priority. Despite the focus on making health care more affordable, the costs to treat patients could escalate in 2015. The fee for service payment seems irrelevant and outdated within the new system. Care models have been created and started to be implemented, being now more consumer centered. Team based care will reduce redundancy and lower operating costs. This is an opportunity, we have to take advantage to redesign our practices, utilizing technology to monitor quality, to communicate effectively among care givers, and engage patients in their care. Evidence based medicine leading to standardization can help health care providers to deliver highly personalized customer experience at a competitive price. 2015 already has started to show new challenges: Implementation of the ICD-10 coding system, Meaningful Use Stage 2, and the Physician Quality Reporting System (PQRS). The transition from ICD-9 to ICD-10 will result in substantial challenges due to changes in the code structure, rules and number of codes. ICD-10 will impact physician documentation requirements in both the office, and hospital settings. The idea is to make understandable the severity, risk comorbidities and causation to justify assessment and treatment planned. Meaningful Use Stage 2 has proven difficult due to the number of processes, departments and IT systems impacted. While still an achievable goal, it brings new responsibilities to hospitals and physicians. The intention is to increase health information exchange between providers, and promote patient engagement by giving patients secure on line access to their health information. We are slowly transitioning out of fee for service into a system that rewards for quality while controlling cost. PQRS aims to give physicians a nudge, via incentive payments and penalties, in preparation for future pay for performance measures. Beginning 2015, eligible professionals, who have unsatisfactory reporting or non participation, will be subjected to 1.5% penalty. In the coming years, we will need to take up the charge and lead the health care delivery system in US, being able to control spending in the face of expensive new innovations and an aging society that requires more medical care and services. We need to stay together, and now more than ever we need to continue to build a strong relationship among physicians.

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

JANUARY 2015 / VITAL SIGNS

Tulare

Visalia Medical Clinic welcomes... CARDIOLOGIST

Ashkan Attaran, MD • University of Cincinnati School of Medicine • Internal medicine internship and residency, USC • Fellowship in cardiology, Georgia Regents University • Board certified, American Board of Internal Medicine

GENERAL SURGEON

Ammon Rasmussen, MD • Ohio State University College of Medicine • Internship and residency, Mount Carmel General Surgery Program, Ohio • Board certified, American Board of Surgery

Now accepting referrals

Visalia Medical Clinic

VMChealth.com • 5400 W. Hillsdale • 739-2000

2014 George Tiss Award Recipient Awarded Posthumously Charles Ayers, MD

Dr. Ayers was instrumental in establishing the specialty of Emergency Medicine at Kaweah Delta and was the original California Emergency Physician Emergency Department Medical Director. As Director, he initiated the Peer Review and Continuous Quality Improvement processes still used in the hospital today. He served as the early proponent of ACLS education throughout the Valley and worked as an ACLS instructor and Affiliate Faculty of the America Heart Association. Two generations of physicians owe their professional and personal development to Charlie. He was an inveterate student, always open to learning the latest medical advances from the trained colleagues he recruited to Visalia. As a close colleague of Dr. Tiss, they worked tirelessly for their patient well-being and shared interest in the well-being of children. Together they created an environment of collegiality in the medical community. Both men left gaping holes in the lives of their patients, colleagues and the community.

Tulare County Medical Society presents

Join us at the next Walk With A Doc to take a step toward a healthier you! All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness. TULARE: Del Lago Park Saturday, January 17, 2015 8:30am to 9:30am VISALIA: Riverway Sports Park Saturday, January 10, 2015 8:00am to 9:00am Anyone can attend! For more information, please contact Tulare County Medical Society at (559) 627-2262

12 JANUARY 2015 / VITAL SIGNS

Kern Kings You are cordially invited to attend the 2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org Officers Michelle S. Quiogue, MD President Vipul R. Dev, MD President-Elect Eric J. Boren, MD Secretary Bradford A. Anderson, MD Treasurer Alpha J. Anders, MD Past President Board of Directors Alberto Acevedo, MD William J. Farr, MD Susan S. Hyun, MD Kristopher L. Lyon, MD Betsy Matkovic, MD Mark L. Nystrom, MD Eric A. Peck, MD Edward W. Taylor, III, MD Linda P. Veneman, MD CMA Delegates Jennifer Abraham, MD Lawrence N. Cosner, Jr., MD Vipul Dev, MD John Digges, MD

Kern County Medical Society 2015 Installation of Officers and the KCMS Presidential Inauguration of

Michelle S. Quiogue, MD and

KCMS Alliance President Friday, January 16, 2015 6:00pm Social Hour 7:00pm Dinner 8:00pm Program

The Bell Tower Club

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 Officers Jeffrey W. Csiszar, MD President Vacant President-Elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President Board of Directors Bradley Beard, MD Jacqueline G. DeCastro, MD Thomas S. Enloe, Jr., MD Michael MacLean, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

1200 Truxtun Avenue, Bakersfield $45 per person RSVP Deadline Monday, January 12, 2015 khughes@kms.com 661-325-9025

CMA Alternate Delegate Sarah Assem, MD CMA YPS Delegate Cyrus R. Moon, MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

December 2014 Membership Recap Active........................................................249 Resident Active Members...............15 Active/65+/1-20hr.................................4 Active/Hship/1/2Hship....................0 Government Employed.......................4 Multiple Memberships........................1 Retired........................................................6 3 Total....................................................... 336

New Members (Pending Dues)........................................2 New Members (App Pending).......0 Total Members..............................338

JANUARY 2015 / VITAL SIGNS

Fresno-Madera A.M. AMINIAN, MD

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

14 JANUARY 2015 / VITAL SIGNS

President’s Message MY Bucket List for 2015

When I first came to Fresno in 1986, it was understood that unless you belonged to the Medical Society, you were

not able to effectively practice medicine with all the required privileges. It is unfortunate that throughout the years we have seen the weakening of organized medicine and the Medical Society both in membership and status. The recent elections with the defeat of Proposition 46 proved to all of us that unless we are united, we will not be able to control our destiny and enjoy our profession. We must continue on this path. These events and other efforts to erode our profession will continue to happen in one way or another. What keeps intruders from controlling our practices is not only by being united but also by making sure our patients’ satisfaction levels are as high as possible. Patients are increasingly unhappy, as they have lost the freedom of choice. Within the past decade we are being told more and more how to practice and what to prescribe. While many of us older, established physicians resent this intrusion, our new generations of physicians really don’t know any difference, are hesitant to tackle new challenges and consequently, most look forward to a sheltered job. While we must continually educate ourselves through CMEs, we must also mentor medical students and residents so they too can understand these issues and join in our vision, hopes and goals. During my presidency of the Fresno-Madera Medical Society, I intend is to facilitate the re-uniting of our profession and bring all of us back together to achieve our common goals. We need to rekindle our congenial and professional relationships in order to effectively work with our health partners and colleagues to promote patients’ advocacy and increase access to care. I also hope to have our members partake in more active roles related to Public Health issues, like our Walk With a Doc program. What better role model and inspiration can we be to our patients and community by getting out once a month to walk and promote a healthy life style? In addition, we also need to put more efforts into improving the quality of life of physicians. Although our membership consists of many modes of practice, at the end of the day, we all can use help and guidance on how to balance our daily lives. I look forward to hearing and working with each and every member of our medical community to achieve these goals. I can be reached at president@fmms.org.

FMMS presidentelect installed The Fresno-Madera Medical Society held its Annual Installation and Awards Banquet on November 8 at Fort Washington Country Club. A grand time was felt by all who attended the festivities, which included honoring the 2014 Community Service Award recipients, recognizing FMMS’ out-going president Prahalad Jojodia, MD and installing FMMS’ 2015 president, A.M. Aminian, MD.

Fresno-Madera

CLASSIFIEDS

Physicians Honored With Community Service Awards

Paul Madsen, MD – Lifetime Community Service Award During his active and semi-retirement years, Dr. Madsen has served as an example of dedication to residents, patients and the community by his devoted involvement in education and training of Ob/Gyn physicians for over 50 years. He continues to provide residents with his clinical skills and friendly demeanor, providing them with examples that all can attempt to emulate. The exemplary care Dr. Madsen has showed toward his patients and his joy of teaching, which has inspired generations of trainees and colleagues - earned him this recognition. Charles Touton, MD – Special Project Service Award Since the late 1980s years, Dr. Touton, while carrying on his own private practice, has participated in the Central San Joaquin Chapter of LIGA – the Flying Doctors of Mercy, a group of health care professionals that fly down to Mexico monthly or semi-monthly to provide free healthcare to those patients who have no other access to medical services. Dr. Touton has not only provided his clinical services during these trips, but he also provided some of the transportation for the people and medical supplies to get to Mexico by piloting his own airplane. Dr. Touton’s dedication as a physician and humanitarian for the past several years earned him this recognition Edward Mosley, MD – Lifetime Community Service: awarded posthumously During Dr. Mosley’s long and distinguished career as an internist, he served the people of this community as a physician, educator and public servant. His service included: founder of the Westview Convalescent Hospital in West Fresno and founder of the West Fresno Health Care Coalition, an elected member of the State Center Community College Board and appointments to the California Electoral College and Blue Ribbon Commission for Master Plan Education. As a 58-year member of the Fresno-Madera Medical Society, Dr. Mosley passed away on June 13, 2014 at the age of 90. Mrs. Marian Mosley, Dr. Mosley’s wife, accepted the award on his behalf. Congratulations to all!

m u r o f k r o netw

See page 2 for ad placement guidelines.

FRESNO FOR RENT / SALE

Medical start-up space available. Located in an established dental office. Rent negotiable; up to 5 rooms to choose from. Call Staphanie at 559229-6249. Medical Office, 2000 sf; Professional Building on Saint Agnes Medical Center campus, North side, 1313 E. Herndon. Call 559-696-0816.

PHYSICIAN WANTED

Part time physician for Fresno area radiology facility to oversee contrast studies, 2 days per week, 4-7 hrs. per day. Retired physicians welcome. Contact Ed at 559-765-7988 Hospitalist physician needed in Fresno. Send resume/CV to Community Hospitalist Medical Group, 1180 E. Shaw, Fresno, CA 93710. Spruce Multispecialty Group of Fresno, committed to the private practice of medicine, is recruiting a BE/BC IM, Rheumatology or Pulmonary specialist. Contact Rathin at 559-289-9518 or tharathin@gmail.com. TULARE .

FOR LEASE / RENT / SALE

Prime location for medical offices, across the street from Visalia Medical Clinic. 2200sf. 5601 W. Hillsdale Ave., Visalia. Call 559-786-0512. Class ‘A’ Medical Space • Visalia • 8,190 sf, all/part, available for lease/purchase. Across the street from Kaweah Delta Hospital. Call 559804-7419 or 804-7421. See ad on page 12 for pictures/details.

of the

LUNCH & LEARN

JANUARY 22, 2015 • 12 to 1pm for Fresno-Madera Medical Society Members’ Medical Staff

Update of Controlled Substances: Rescheduling of Hydrocodone Combination Products Presented by:

Vinnie Valderos Agent, Fresno Office, Drug Enforcement Administration, Dept. of Justice

Discussion to include: • Determination to Transfer Hydrocodone to Schedule II • Legal Authority • Background • Clarification of Affected Drugs and Substances

Fresno-Madera Medical Society offices 1040 E. Herndon Suite #101 BROWN-BAG LUNCH: Beverages & dessert provided No charge to attend; due to space limitations, no more than two (2) people per office may attend. Must RSVP by Wednesday, January 21 to: Doreen Chaparro at dchaparro@fmms.org or 559-224-4224x 112

JANUARY 2015 / VITAL SIGNS

VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337

PRSRT STD U.S. Postage PAID Fresno, CA Permit No. 30

HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

Proud to be endorsed by the Fresno-Madera, Kern, Kings and Tulare County Medical Societies

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