June 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

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

CMA NEWS.............................................................................................................................6

ICD-10...................................................................................................................................8

June 2015 Vol. 37 – Number 6

Editor Alan Birnbaum, MD

Fresno-Madera Medical Society......................................................................................10

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 Kern Representative John L. Digges, MD Tulare Representative Francine Hipskind

HEALTHCARE REFORM............................................................................................................9

CLASSIFIEDS..........................................................................................................................15

• President’s Message

• 2015 FMMS Directory Updates

• ICD-10-CM Boot Camp

TULARE County Medical SocieTY.......................................................................................12

• Physician Advocacy

• 2016 Coding Book News

• Walk With A Doc

Kern County Medical Society...........................................................................................14

• President’s Message

• Membership Recap

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. 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: “ Graveyard Lake Sunrise” Ansel Adams Wilderness by Joseph Hawkins, MD

Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee JUNE 2015 / VITAL SIGNS

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EDITORIAL Gaining Power for Our Patients Alan M. Birnbaum, MD Editor, Vital Signs

While I appreciate praise for my Editorials, I also find value in contrary opinions, offering a different perspective on issues facing healthcare. A recent exchange of views with Stephen Wolfe, MD, a psychiatrist and Fresno Madera Medical Society member now retired to the Central Coast, raised two core issues: WHAT should our goals be as a medical community? How can individual physicians generate meaningful input? Responding to my May theme of the ‘workmen’s wages’ doctors are due, Dr. Wolfe notes, “Hard work is in the eye of the beholder,” definitions varying widely. Having worked decades in mental health he cautions further that “working harder” itself can create “stress/family related issues.” Similarly he observes that medical “quality at the top of delivery is superb, much less so below the top tiers, all the way down to appalling.” As to how change in the doctor-patient-nation equation may occur, “Where do you think that the power is going to be in coming up with attempted solutions? Probably not with the docs,” as matters now stand. “How have we been part of the problem? We can try to obstruct change or promote better change but change we must.” Dr. Wolfe calls for a much broader base of physician social and political involvement and input. Having relocated his family from the Central Valley’s unhealthy air, he notes, “I believe Dr. Aminian is still President? He certainly is a man who has worked hard at the social level to bring about change in the environmental cause of disease. Do the rest of us contribute in this way? In some way?” With that, Dr. Wolfe critiqued my May Editorial for not including even “one positive approach to local methodology.” I plead nolo contendere. With 700 words at best one can raise an alarm but hardly define a plan of action. Consider our continuing complex conundrum: • Patients need access without risk of bankruptcy, which the Affordable Care Act has NOT yet resolved. • Emergency Departments are drowning in non-urgent primary care; across the country; the percentage of their patients seen who truly need admission has dropped by nearly half. • Physicians must practice quality medicine, yet still be allowed to run their practices as a business that makes it worthwhile to remain in the medical profession. • In an era when governments decreasingly fund public education, the nation cannot continue to pay 17-18% of Gross National Product for healthcare. “Que sera sera, what will be will be;” may be a wonderful song but exactly opposite the theme that doctors need to sing. Interestingly, I found myself concurring with virtually all of Dr. Wolfe’s suggestions, which I shall paraphrase: • Broaden access to medical schools; increase the number of MD and DO graduates. • Specialists who best understand indications and contraindications for the tests they perform merit incentive for conferring with ordering doctors before funds get wasted as now happens to 30 cents on the dollar. • None of us mourn the passing of the illegible handwritten medical records, but we need EMR 2.0, with notes denser in current content and leaner in static history. • Seek patient feedback regarding the quality and completeness of care encounters. • Design any new offices for efficiency in care, rather than ego-boosting appearance. • Pay more attention to the health of our fellow physicians. • Make physicians central to practice systems reshaping, not abandoning such to businessmen and politicians. • Promote local medical societies as active parties in the continuing debate. • Individual doctors must write persuasive letters to their legislators, not just airing complaints, but offering potential solutions…and even consider running for office. Even more powerful can be specialty-specific political training and action. My American Academy of Neurology every May provides intensive training in its Palatucci Advocacy Leadership Forum, and every February-March organizes AAN On The Hill with actual visits to members of Congress. I plan to apply for the May 2016 PALF. All doctors should understand and accept parallel purpose to our profession. Day in and day out, we need to deliver compassionate, complete yet cost-efficient care. Year in and year out, we must engage political processes at local, state and federal levels for ourselves, our patients, and our nation. Author may be reached at Siriusguy @aol.com. JUNE 2015 / VITAL SIGNS

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6 JUNE 2015 / VITAL SIGNS

SGR reform: new era in health care begins

The

California Medical Association (CMA), along with the American Medical Association and other health care organizations, has been fighting to end the SGR for 12 years. Without action by Congress, physicians faced a 21 percent cut in Medicare reimbursement the very next day. “H.R. 2 is an unprecedented display of bipartisanship on the SGR. After more than a decade of inaction, this is truly a historic moment,” said CMA President Luther F. Cobb, MD. “This legislation will substantially improve access to care for the 5 million California seniors and disabled patients, nearly 1 million military families on TriCare, and nearly 1 million uninsured children.“ CMA applauds this rare bipartisan achievement in a deeply divided Congress. CMA, the American Medical Association and more than 780 state and national physician organizations supported the bill. The policy was developed jointly on a bipartisan basis by the three House and Senate health committees. U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (DCA) are credited with negotiating the budget offsets to fund the final SGR bill. Major provisions of H.R. 2: • Repeals the SGR • Provides automatic, stable 0.5 percent updates each year for four years In 2019, physicians can choose to participate in one of two payment track options: • Maintains a fee-for-service track that simplifies and consolidates the existing quality reporting programs, reinstates large bonuses up to 9 percent and reduces current penalties • The alternative payment model track provides 5 percent bonus payments and allows physicians to develop the new models, such as primary care/specialty medical homes. • Physicians are also required to be involved in defining quality • $125 million in funding to help small practice physicians transition to the alternative models or quality reporting programs • Reinstates bundled payments for the 10-day and 90-day global surgical services • Provides total cost of care data to help physicians better manage their practices • Mandates interoperatibily of electronic health record systems The bill represents a significant improvement Continued on next page

CMA NEWS Continued from page 6 over the current Medicare program, which mandates penalties up to 13 percent in the coming years with no opportunities for payment updates or bonuses. This bill also consolidates the burdensome reporting programs and reinstates significant bonus payments. By repealing the SGR and providing annual updates, it provides stability to physician practices that allows for longer term planning. Significantly, it allows physicians to design new payment systems that work for themselves and patients instead of government bureaucrats and it mandates physician involvement in defining and developing quality measures. Moreover, once the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system at a lesser cost. The enormous cost of the SGR has been a barrier to making any improvements. The bill also extends the expiring Children’s Health Insurance Program for two years at the higher Affordable Care Act (ACA) funding levels. It covers nearly 1 million children in California who would otherwise lose their insurance. CHIP was formerly known as Healthy Families in California before it was folded into the Medi-Cal program. It also extends the moratorium on RAC audits of the hospital two-midnight rule, which helps hospitals and physicians. And, finally, it extends the National Health Service Corps and the ACA teaching health centers primary care residency training programs. Funding Sources: The Congressional Budget Office (CBO) estimated the cost of the bill would total $211 billion over 10 years and will not be fully offset with other funding sources. For 12 years, Congress has stopped the SGR payment cuts before they have taken effect; because of that, Speaker Boehner and Leader Pelosi concluded that any federal government savings would be phony and the cost to repeal SGR should be $0. Another $70 billion for the measure will come from deductibles for new MediGap policies starting in 2020. The top 2 percent of high-income seniors will see their premiums increase to 15 percent more for couples making $267,000 to $320,000, and 20 percent more for couples making more than $320,000 in retirement income. There will also be a $35 billion payment cuts to hospitals and other providing post-acute care services. This final cut does not apply to physicians. CMA thanks physicians for their extraordinary efforts to keep fighting to pass this monumental legislation. Fifty-two members out of 54 member California Congressional delegation supported physicians on this subject. Unity within the physician community helped achieve this stunning victory.

Drought may have caused record-breaking year for West Nile virus activity in California

In 2014, California had the second-highest number of human cases of WNV since the virus first invaded California in 2003. In 2014, California recorded 801 cases of the potentially fatal disease. In 2005, CDPH detected 880 cases of WNV. It is possible that the ongoing drought contributed to West Nile virus activity by creating more limited sources of water for birds and mosquitoes, according to CDPH Director and State Health Officer Karen Smith, M.D. “As birds and mosquitoes sought water, they came into closer contact and amplified the virus, particularly in urban areas. The lack of water could have caused some sources of water to stagnate, making the water sources more attractive for mosquitoes to lay eggs,” said Dr. Smith.

Physicians should consider WNV in any person with a febrile or acute neurologic illness who has had recent exposure to mosquitoes, a blood transfusion or organ transplantation, especially during the summer months in areas where virus activity has been reported. The diagnosis should also be considered in any infant born to a mother infected with WNV during pregnancy or while breastfeeding. More information on WNV in pregnancy and breastfeeding is available here. All cases of WNV should be reported to local public health authorities in a timely manner. The incubation period for WNV is typically two to six days, but ranges from two to 14 days and can be several weeks in immunocompromised people. An estimated 70-80 percent of human WNV infections are subclinical or asymptomatic. Most symptomatic persons experience an acute systemic febrile illness that often includes headache, weakness, myalgia or arthralgia; gastrointestinal symptoms and a transient maculopapular rash also are commonly reported. Less than 1 percent of infected persons develop neuroinvasive disease, which typically manifests as meningitis, encephalitis or acute flaccid paralysis.

Board of Pharmacy approves regulations allowing pharmacists to furnish naloxone

The

California State Board of Pharmacy has approved emergency regulations allowing pharmacists to furnish naloxone hydrochloride without a prescription. The regulations went into effect on April 10, 2015. Naloxone is a medication used to counter the effects of opioid overdose by reversing central nervous system and respiratory system depression and hypotension. In 2014, AB 1535 (Bloom) authorized the furnishing of naloxone hydrochloride by pharmacists and required the Board of Pharmacy to develop these regulations and the Medical Board of California to approve them. Under the new regulations, naloxone hydrochloride is available by request or at the suggestion of a pharmacist. The regulations also incorporate many of the provisions that the California Medical Association (CMA) advocated for during the legislative and regulatory process by requiring that pharmacists dispensing naloxone complete an approved training program, provide training and informational resources to recipients, and ensuring that consultations to provide training on opioid prevention, recognition and administration of naloxone cannot waived by the recipient. Finally, the regulations require the pharmacist to notify the patient’s primary care provider if the patient provides consent. For more information, see On-Call document #3009, “Pharmacists.” On-Call documents are free to members in the CMA Resource Library. Nonmembers can purchase On-Call documents for $2 per page.

Health Law Library

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contains over 4,500 pages of medical-legal, regulatory, and reimbursement information. ON-CALL documents are free to members and can be found in CMA’s online resource library. Nonmembers can purchase medical-legal documents for $2 per page

JUNE 2015 / VITAL SIGNS

ICD-10 Five Facts About ICD-10 To help dispel some of the myths surrounding

ICD-10, the Centers for Medicare & Medicaid Services (CMS) recently talked with providers to identify common misperceptions about the transition to ICD-10. These five facts address some of the common questions and concerns CMS has heard about ICD-10: 1. The ICD-10 transition date is October 1, 2015. The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10. 2. You don’t have to use 68,000 codes. Your practice does not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes. 3. You will use a similar process to look up ICD-10 codes that you use with ICD-9. Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection. 4. Outpatient and office procedure codes aren’t changing. The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding. Your practice will continue to use CPT. 5. All Medicare fee-for-service providers have the opportunity to conduct testing with CMS before the ICD-10 transition. Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure you can submit claims with ICD-10 codes. During a special “acknowledgement testing” week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.

8 JUNE 2015 / VITAL SIGNS

HEALTHCARE REFORM SENATE COMMITTEE SHINES LIGHT ON MEDICARE APPEALS CLAIMS BACKLOG

The Senate Finance Committee is calling for increased attention

to an accumulating backlog of Medicare appeals claims, The Hill reports (Ferris, The Hill, 4/28). According to Modern Healthcare, the Office of Medicare Hearings and Appeals’ current appeals backlog has reached more than 500,000 cases for the first three of five appeals claim levels. The time it takes for an appeal to be processed has increased from an average of about 95 days in fiscal year 2009 to a projected 547 days in FY 2015 (Dickson, Modern Healthcare, 4/28). During a committee hearing on Tuesday, OMHA officials said they are receiving a record amount of appeals and blamed a lack of resources for the backlog. According to The Hill, the office received 700,000 appeals claims in FY 2013, up from 60,000 claims that were submitted in FY 2011. Meanwhile, the number of employees working on such claims has remained at 60, according to Sen. Ron Wyden (D-Ore.). Wyden added, “It’s no wonder that the appeals system is buckling under its own weight” (The Hill, 4/28). Further, Wyden said the backlog has become so large that the office is no longer hearing new appeals cases (Modern Healthcare, 4/28). CMS could change the initial level of appeals to help streamline or avert access to following appeals levels, according to Sandy Coston, CEO of Medicare administrative contractor Diversified Service Options. For example, Coston said that contractors could triage claims that involve clinical decisions to second-level appeals, which are overseen by qualified independent contractors and often involve provider input. Thomas Naughton, senior vice president of the QIC Maximus Federal Services, suggested increased use of electronic records could help to reduce the backlog because QICs would no longer have to provide administrative law judges at OMHA with paper files. (Modern Healthcare, 4/28).

CMS RELEASES MEDICARE PART D PRESCRIPTION DRUG SPENDING DATA

The largest amount of spending – more than $2.5 billion – was on

Pfizer’s heartburn treatment Nexium, which was prescribed to about 1.5 million beneficiaries in 2013 (Thomas/Pear, New York Times, 4/30). The data show that brand-name drugs for common conditions, such as acid reflux and asthma, made up Medicare Part D’s three largest expenditures. The 10 most-common prescription drugs in 2013 all were generic (Adams, CQ HealthBeat, 4/30). Lisinopril, which is used for high blood pressure, was the most frequently prescribed drug, with about 36.9 million claims. The cholesterol drug simvastatin was the secondmost frequently prescribed drug, appearing on about 36.7 million claims (Herman, Modern Healthcare, 4/30). The data show that in total, Part D spent $103.7 billion on drugs. However, accounting for rebates from drugmakers, Part D spending was $69.7 billion in 2013 (Wall Street Journal, 4/30). Some of the drugs that were most costly to Part D in 2013 are or soon will be available as generics, according to the Times. For example, Nexium’s patent protection ended in 2014 and is now available in generic form (New York Times, 4/30). The Pharmaceutical Research and Manufacturers of America in

a statement said the data are “misleading,” given that insurers often negotiate rebates that can go as high as 20% to 30% for branded drugs (Wall Street Journal, 4/30). Further, American Medical Association President Robert Wah in a statement said the group is “troubled by the lack of context provided with the data that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn.” CMS officials also warned against drawing too many conclusions from the data (Neergaard, AP/Los Angeles Times, 4/30).

CMS: PIONEER ACO PROGRAM SAVED NEARLY $400M OVER TWO YEARS

The Pioneer ACO program saved Medicare nearly $400 million in

spending over two years, according to data released by CMS, the Wall Street Journal reports (Beck, Wall Street Journal, 5/4). Under the Pioneer program, which launched in January 2012, participating providers contracted with CMS to meet quality targets and assume new risk when caring for a set population of Medicare beneficiaries; in exchange, they received additional financial incentives. The program was designed to reward early adopters of coordinated care models and offer the health industry an example of successful outcomes-based pay models. However, some participants took issue with the structure of the program. By last year, 10 of the original 32 Pioneer ACOs had dropped out of the program, with some moving into the Medicare Shared Savings Program (California Healthline, 10/9/14). According to the new data, which were published in the Journal of the American Medical Association, expenditures for Medicare beneficiaries receiving care through Pioneer ACOs increased slower than expenditures for non-ACO, fee-for-service beneficiaries in the program’s first two years (Wall Street Journal, 5/4). Specifically, the data show that CMS saved an estimated $385 million in the first two years of the Pioneer ACO program. Researchers found that the increase in expenditures from the 2010-2011 baseline for the average beneficiary aligned with a Pioneer ACO was $35.62 less in 2012 and $11.18 less in 2013 when compared with non-ACO, FFS beneficiaries. Overall, the slower spending growth generated about $280 million in savings in 2012 and $105 million in savings in 2013. Researchers attributed the slower expenditure growth primarily to decreases in inpatient utilizations among beneficiaries aligned with the ACO, as well as: • Decreases in office visits for primary care evaluation and management; and • Smaller increases in the number of tests, procedures, and imaging services. The researchers found no decrease in 30-day readmissions for ACO-aligned beneficiaries but they did note that the number for follow-up visits for discharged patients was higher for the ACO patients Meanwhile, beneficiaries in the ACOs reported higher satisfaction with clinician communication and timely care than other Medicare beneficiaries. The findings by independent actuaries means the Pioneer ACO program is the Affordable Care Act’s first alternative payment program to be certified to cut costs while improving quality. As a result, CMS is now authorized to begin rolling out elements of the program nationwide. JUNE 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 William Ebbeling, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Trilok Puniani, MD Ranjit Rajpal, MD George Saul, MD Roydon Steinke, MD Connor Telles, MD Cesar 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 Carol S. Yrulegui Interim Executive Director Doreen Chaparro Physician Liasion

10 JUNE 2015 / VITAL SIGNS

President’s Message It’s June, so we are already half way into this year.

This makes it a good time to reflect on our activities so far and also to again note what we hope to accomplish together for the rest of this term. Even though we’ve had a very challenging year; together, we have accomplished a lot. Most of my efforts have concentrated on restructuring the Fresno Madera Medical Society (FMMS), not only to build a strong foundation and organization, but also to be able to support all of our visions, hopes and goals. First on the list of priorities was to recruit a new director who would provide strong leadership for our Society. After an extensive search and with the assistance of CMA, we now have an Executive Director. She has an impressive background, including vast experience in the medical field spanning many years. She also has a strong desire to succeed and we look forward to her leadership and efforts in the months ahead. We welcome her to our Society as she starts her new job in midJune, and I will introduce her to you in more detail in my next article. We’ve also been working on our financial health and, so far, we have made progress. Even though we lost some sources of funding due to the economy, we hope that by cutting costs while at the same time increasing our membership, we can be in the best position to continue to achieve our goals. Educating the public about the role of the FMMS should be an important part of our efforts locally, statewide, nationally and internationally. Recently, I had the opportunity to meet with physician representatives from India who were in Fresno as part of a Vocational Training Team exchange offered by District 5230 of Rotary International. We discussed different ways of exchanging ideas to improve patient care. As a medical society, we must take stands on public health issues, and we must support any efforts that improve public health, access to care and the quality of care to our patients. We’ve recently done this on television, radio and news paper interviews. We must also preserve the integrity of the medical profession by preventing any intrusions to our field that would jeopardize that quality of patient care. Likewise, it is our duty and obligation to preserve the integrity and goals of the medical profession by both providing guidance and assistance to future generations of physicians and by mentoring young medical students and residents. This year we will provide a financial reward – the Steven Parks, MD Award –for one of the residents who showed particular leadership. In addition, as the president of the FMMS, I will be participating in the welcoming ceremonies for our incoming residents. To improve the quality of life for physicians, we are also working to re-create a resource for our overall wellbeing. To this end, we will soon form a “wellness coalition.” Currently we are in talks with all of the hospitals in our area, and we are looking forward to this being a joint effort amongst us all. Yes, we still have a lot more to do, but I am hopeful that by the end of the year we will have a strong organization with a strong foundation, a strong membership and the financial strength to do extensive patient advocacy, to take stands on public health issues, to mentor our young physicians and future physicians and to implement a resource to improve the quality of life of our physician members. Furthermore, I hope the general public will better understand what our Society is about, will better understand our contributions and will be keenly aware of our interest in our population’s health.

2015 FMMS Directory Updates CCFMG PHYSICIANS Mario Martinez, MD *FM 1041 Rose Ave. Selma / 891-6417

Christina Maser, MD *GS 7415 N. Cedar #102 Fresno / 435-6600

Nancy Parks, MD *GS 255 N. Herwaldt Dr. Fresno / 459-4090

Fresno-Madera

JUNE 2015 / VITAL SIGNS

Tulare

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

12 JUNE 2015 / VITAL SIGNS

Why Physician Advocacy Is Important John Hipskind, MD, FACEP

Legislative advocacy is important to physicians for a number of reasons. The primary one is that it allows a face-toface interaction with our state representatives who can exert a very real, either positive or negative, impact on our practice. The more time we take to get to know each other, the better the working relationship that can develop and the more likely they are to become friends of medicine. As evidence of fostering those relationships, shortly after our visit at the Capitol on April 14, Assemblyman Mathis’ office called TCMS and asked for an opinion on a Bill his office was looking to submit. The Bill being considered had to do with Neuropsychologists so TCMS member Dr. Richard Pantera volunteered to review, comment and recommend an opinion. This is clear evidence that physicians have credibility and our voices matter to our legislators. The keys to being an effective advocate for medicine was best summed up by Bob Hertzka, MD. He is a former president of CMA and a practicing anesthesiologist. First off, we need to respect our elected officials and their staff. Every action they take is scrutinized (and frequently distorted) by an often very judgmental and frequently hostile audience. Next, we need to respect our adversaries (well, maybe not certain hysteria-based celebrities when it comes to being the leader of the anti-vax movement). Ascribing evil motives to one’s opponents is a losing strategy. Many of our opponents do it (think Prop 46 attempt to repeal MICRA) and it backfires on them. Lastly, respect the truth. “I don’t know, but I can find out” goes a long way to cement your credibility with your representatives. The other (but more selfish) reason for taking an interest in advocacy is that it allows me to work alongside a number of highly motivated local physicians who are dedicated to improving the quality of all of our practices. Physicians like Drs. Daglish, Kingsford and others are colleagues we can all be proud of. They volunteer their time and passion to make our practices such that we can all be better physicians to our patients, our biggest advocate of all.

CMA – Legislative Day Kunal Sukhija MD, Emergency Medicine Resident

Thomas Jefferson wrote, “The care of human life and happiness, and not their destruction, is the first and only object

of good government.” Does this remind you of something? These words echo the sentiments of the Hippocratic Oath, so it’s not so unbelievable that the ultimate goals of both physicians and lawmakers are one and the same. My goal as an EM resident is, of course, to learn as much as possible. This includes learning how to effectively advocate for my patients at all levels – from the trauma bay to Capitol Hill. I was recently given the immense privilege of being the Tulare County Medical Society’s resident delegate to CMA’s 41st Legislative Advocacy Day. The CMA hosts this event yearly, and physicians at all levels and from all specialties are encouraged to gather in Sacramento to discuss local, state, and even nation-wide issues with our legislators. Removing personal vaccination exemptions for school-aged children (SB 277), increasing Medi-Cal reimbursement to Medicare levels (SB 243/AB366), and various aspects of scope of practice were among this year’s hot topics and are certainly issues common to all practitioners here in the Central Valley. I was given the incredible opportunity to share not only my stories, but the stories of countless patients I’ve seen with Senators Jean Fuller and Andy Vidak as well as Assemblymen Jim Patterson and Devon Mathis. I made sure they understood my views Continued on the next page

Tulare Kings 2016 Coding Book News

It is that time again to start purchasing

Continued from page 12 regarding legislation that directly affects our patients and our ability to practice here in Tulare County. I’ve seen what we can accomplish when we focus our voice and speak as one (I hope nobody forgot the uphill battle that was Prop 46). While it’s encouraging to know that physicians have a voice within the legislative branch, it’s abundantly clear that it’s not loud enough. Inter-specialty squabbling, divided medical associations, and lone-wolf mentalities have allowed our collective voice to be muffled. My experience in Sacramento proved to me that we have a seat at the table, legislators are listening, and that it is our duty to ensure that patient and physician experience is the compass that steers the course of healthcare legislation. Rest assured, if we don’t take this opportunity, the laws will be made on our behalf by those who are not in the operating rooms, hospital wards, or clinics. And I can guarantee that we will not like the outcome.

coding books. Order your 2016 editions of CPT, ICD-10, and HCPCS through us. We are offering extraordinary discounted rates and free shipping directly to your office. Remember to order early to avoid delays in getting your books on time. Please coantact Dana Ramos to order or obtain more information: 559-7340393 or dramos@tkfmc.org.

Edmund Burke said “The only thing necessary for the triumph of evil is for good men to do nothing. I don’t know that those who oppose vaccination are evil. However, the debate in Sacramento was very heated, as Gov. Brown acknowledged in his address to the attendants at CMA Legislative Day in April. I was fortunate to hear his speech along with good men and women of TCMS. We advocated for worthy causes affecting the delivery of medicine and individual and public health for Californians, especially the Central Valley. Our group teamed up with pediatricians and residents from UCSF Fresno. Surprisingly, state senators, legislators, and their staff were very receptive to timely and accurate information. We fought for better physician reimbursement, innovations in healthcare delivery, public health through herd immunity, and increasing residency positions in California. I also had the opportunity to meet up with other medical students as we advocated for our profession and those we serve. I discovered that like the group of students and physicians I was with, the representatives chose their careers because they care about the people they serve too. How the government really works has always been a mystery to me. I found it is more about speaking up for what I believe in. I realized that I need to do just that. I enjoyed my experience overall and will definitely attend next year. Edmund Burke also said “those who don’t know history are destined to repeat it. I am determined to advocate for those who don’t understand history as I move into the future of medicine.

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

Physician Advocacy Will Goodrich ATSU-MS II

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581

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. ANYONE CAN ATTEND! For more information, please contact Tulare County Medical Society at (559) 627-2262 TULARE: Del Lago Park Saturday, June 20, 2015 Topic: HEALTHY KIDS Registration: 8:00am Walk Time: 8:30am VISALIA: Blain Park, 3101 S. Court St. Saturday, June 13, 2015 8:00 to 9:00 am

JUNE 2015 / VITAL SIGNS

Kern Michelle S. Quiogue, MD, FAAFP Department of Family Medicine Kaiser Permanente Kern County 2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org

President’s Message Did you know?

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

When you join KCMS-CMA you hire a powerful professional staff to protect the viability of your practice. By protecting your practice from legal, legislative, and regulatory intrusions, your membership lets you focus on what’s really important: your patients.

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

When should you call? • Are your claims not being paid in a timely manner? • Are you not being paid according to your contract? • Do you need help with Medicare related issues? vAre your claims being denied after obtaining prior authorization? • Are you receiving unreasonable requests for medical records or untimely requests for refunds? • Are you having difficulty obtaining fee schedules and/or payment rules? • Are your claims denied for timely filing? • Have you been presented with a managed care contract and you’re not sure if the terms are with California law? • Have you done everything you can to resolve an issue with a payor, including appealing?

CMA Delegates Jennifer Abraham, MD Lawrence N. Cosner, Jr., MD Vipul Dev, MD John Digges, MD CMA Alternate Delegate Sarah Assem, MD CMA YPS Delegate Cyrus R. Moon, MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

The Center for Economic Ser¬vices (CES), founded in 1999, provides members with one-on-one assistance for billing, contracting and payment problems that may arise. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials by payors to assisting with contract analysis during negotiations. Access to CES’s practice management experts is reserved exclusively for members. Assistance from CES can range from education on how to increase a practice’s efficiency to direct intervention with payors or regulators.

consistent

If you answer “yes” to any of the above questions, it might be time to call for help. I encourage you to call the reimbursement helpline today at (888) 401-5911 and they’ll arm you with the knowledge you need to identify and fight unfair payment practices. CES also provides physicians and their staff with access to CMA Practice Resources, a monthly bulletin offering tips for improving practice efficiency and viability. To sign up for a free subscription, visit www.cmanet. org/newsletters. For practice management tools, newsletters and other online assistance, visit www.cmanet.org/ces.

BENefits at your fingertips Activate your CMA web account today at www.cmanet.org CMA staff ready to serve you by calling (800) 786-4262

May 2015 Membership Recap Active....................................................................................................241 Resident Active Members...........................................................14 Active/65+/1-20hr.............................................................................4 Active/Hship/1/2Hship................................................................0 Government Employed...................................................................3 Multiple Memberships....................................................................1 Retired....................................................................................................63 Total....................................................................................................326 New Members (Pending Dues)..................................................0 New Members (App Pending)...................................................0 Total Members..........................................................................326

KCMS Membership Directory Is Now Available at the KCMS Office:

KCMS Member Physicians, $10 Non-Members, $40 14 JUNE 2015 / VITAL SIGNS

CLASSIFIEDS Q STREET PLAZA 3550 Q Street, Bakersfield

MEDICAL OFFICES FOR LEASE OR SALE • From 1,233 to 30,000 sq. ft. • Within walking distance to Bakersfield Memoral Hospital • 16 office condominiums • New modern exterior

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. FRESNO ANNOUNCEMENT

. University Psychiatry Associates: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC, M-F 8am-5pm. Call 559-320-0580. PHYSICIAN WANTED . On-site urologist seeking FM/IM physician to collaborate wellness programs and referral resources in addition to sexual health/urology practice. Office space available to share in N/E Fresno at 7005 N. Milburn. Call Shelby at 559-277-3963

R Shai Gordon (661) 472-0750

LIC#01780691

Shai@creativerealtymm.com CREATIVE REALTY MARKETING & MORTGAGE

FOR LEASE / RENT / SALE

Prime location medical offices, across the street from Visalia Medical Clinic. 2200 sf. 5601 W. Hillsdale Ave. Visalia. Call 559-786-0512 Office space in prime medical location at 220 S. Akers St. , Visalia. Perfect for primary care or allergy specialist to open practice in vacated allergist office. Call Shelby at 559-277-3963.

KERN

• Attractive Rates • Professionally Managed

TULARE

FOR SALE

Place your next classified here! Vital Signs has over 1,300 monthly readers. Reach physicans just like YOU with your need or want.

1880s Victorian office building, corner lot next to Cancer Center & San Joaquin Hosp. 1200 sf, off-street parking; wheel chair ramp; lobby; secretarial area; 3 offices; conference rm; kitchen; basement; alarm; storage building. $450,000 OBO, 1402 26th St. Bakersfield. Call Don 661327-2367 or Mike 661-747-4553. Well established, turnkey medical weight loss clinic. Over 300 active patients and thousands to build from. Cash business with bariatric computer system. Finance with ProMed Financial. Contact Susan at wtloss4sale@yahoo.com.

BAKERSFIELD FOR LEASE Crown Pointe Phase III – 2,000 to 20,000 sf 9330 Stockdale Hwy – 2,655 sf 1150 Lerdo Hwy – 1,766 to 3,793 sf 2019 21st Street – 2,856 sf 3941 San Dimas Street – 3,959 sf 2731 H Street – 1,375 sf 513 W. Columbus St – 2,550 sf 2501 H St – 2,602 sf FOR SALE 513 W. Columbus St – 2,550 sf LAND 517-519 W. Columbus – Build to Suit - 3,725 sf JUNE 2015 / VITAL SIGNS

VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337 HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

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