September 2014 by Fresno Madera Medical Society

Official Magazine of FRESNO COUNTY Fresno-Madera Medical Society KERN COUNTY Kern County Medical Society KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Medical Society TULARE COUNTY Tulare County Medical Society

Vital Signs

September 2014 â&#x20AC;˘ Vo V Vol. l. 36 No. 9

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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 September 2014 Vol. 36 – Number 9 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 CMA NEWS................................................................................................................................7 NEWS

AFFORDABLE HEALTHCARE ACT: Understanding the Grace Period for Subsidized Exchange Enrollees.......................................................................................8

HEALTHCARE NEWS................................................................................................................9

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

•C MA Covernance Technical Advisory Committee: Why Things Are Changing And What Will Be Proposed

• 2015 Coding Book News

• Walk With A Doc

• Upcoming Events

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

• Medical Missionary Journey: Part Two

• Membership News

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

• President’s Message

• Let Your Opinions Be Heard: FMMS Seeking 2015 Committee Participants

• Walk with a Doc

• In Memoriam: Edward Mosley, MD; Gilford Y. Wong, MD; Unaiza Hayat, MD

Doctors’ strike

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.

If Prop. 46 passes we go on strike! Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee SEPTEMBER 2014 / VITAL SIGNS

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EDITORIAL

Walk The Precinct Alan M. Birnbaum, MD Editor, Vital Signs

To defeat Proposition 46 on November 4, we need to walk the precinct. To win elections, successful candidates walk their precincts and meet their voters. They can buy all the television spots they want, purchase print ads to run every day, or use the mail, e-mail and social media, but nothing beats personal contact with the voter. Walk the precinct. As doctors with litigation-endangered practices, and on behalf of our patients whose access to care is threatened by Proposition 46, we must take the same attitude. Fortunately, as physicians we only need to walk figuratively. It is our patients who walk to us for care encounters of many types, giving us the opportunity to briefly, politely but effectively state the case against Proposition 46.

As physicians we only need to walk figuratively… It is our patients who walk to us…

We all know the reasons for “NO on 46.” The core issues are maintaining access to care; preventing further cost escalation and protection of privacy. You should already have well-written materials from CMA with specific point-by-point data and reasoning. Physicians themselves need no convincing. WE WILL VOTE come November 4. But even more critical for a victory REMAINS convincing NONphysician citizens who do not yet understand the initiative or who still remain uncommitted. We cannot remedy those who have already decided to vote yes. Avoid arguing with Proposition 46 proponents. Respect their view. Your time is better spent talking with the unconvinced.

Be confident, and keep in mind that the growing alliance against Proposition 46 is broad and strong. Make sure that your medical office prominently displays the “NO on 46” message. If you are not yet a CMA and FMMS member, NOW is the time to JOIN. Be ready to discuss maintenance of MICRA status quo with your patients, briefly and simply. Practice with your friends… practice with an eighth grader! Keep your message simple, but EFFECTIVE. Encourage those who already realize that “NO on 46” is the way, to get out and vote by mail or at the booth on Election Day. Walk the precinct. Author can be reached at Siriusguy@aol.com.

SEPTEMBER 2014 / 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:

New York Life Insurance Company New York, NY 10010 on Policy Form GMR

Mercer Health & benefits Insurance Services LLC • CA Ins. Lic. #0G39709 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com

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CMA NEWS We Need Your Help! Begin Securing “No” Votes for the November Election Physician advocates:

The campaign against the dangerous and deceptive Proposition 46 is

entering its final and most important stages, and we need your help to begin securing “NO” votes for the November election. As part of your roles as a campaign advocate, we’re asking that you begin the process of outreaching to your friends, families and colleagues to let them know how important it is that Prop. 46 is rejected by voters later this year. For the purposes of this undertaking, the campaign is asking that your outreach targets not be fellow physicians, but rather potential voters who likely have not been informed about the harmful effects that this initiative would have on our state. As a reminder, Prop. 46 threatens to increase costs, reduce access to care and compromise the personal privacy of millions of Californians. All of this so that trial lawyers will find it easier to sue doctors and hospitals, taking money out of the health care system and putting it into their own pockets. As you begin the process of seeking out potential “NO” votes, remember that you have a wealth of resources at your disposal at both www.NoOn46.com and www.cmanet.org/micra. If you require additional

patient brochures, “No on 46” buttons, posters or other material, please contact Yna Shimabukuro at yshimabukuro@cmanet.org. Using these resources, along with the message training you may have received, we’re asking that you secure at least 20 committed “NO” votes for the first phase of this undertaking. These names will be added to our list of committed contacts that we can count on to oppose Prop. 46 in November. You will find a tracking sheet here that enables you to record the name and ZIP code of the contacts from which you have secured a commitment for a “NO” vote. Please fill out this sheet with the relevant information and return it to Yna Shimabukuro by either fax at 916-444-5688 or email at yshimabukuro@cmanet.org. Again, I cannot stress enough how important the next few months will be to the future of our profession. We will win this fight, but we cannot do so alone, and each and every vote secured brings us one step closer to victory. Sincerely,

Richard Thorp, MD, FACP President, California Medical Association

INCREASED COSTS. LOSING YOUR DOCTOR. THREATENING YOUR PRIVACY.

Your efforts will lead to victory!

As part of your roles as a campaign advocate, we’re asking that you begin the process of outreaching to your friends, families and colleagues to let them know how important it is that Prop 46 is rejected by voters later this year. For the purposes of this undertaking, the campaign is asking that your outreach targets not be fellow physicians, but rather potential voters who likely have not been informed about the harmful effects that this initiative would have on our state. FIRST NAME

LAST NAME

ZIP CODE

Please fill out this sheet and return it to Yna Shimabukuro by either fax at (916) 444-5688 or email at yshimabukuro@cmanet.org. Paid for by No on 46 – Patients, Providers and Healthcare Insurers to Protect Access and Contain Health Costs, with major funding from the Cooperation of American Physicians Independent Expenditure Committee and the California Medical Association Physicians’ Issues Committee

www.NOON46.COM SEPTEMBER 2014 / VITAL SIGNS

AFFORDABLE HEALTHCARE ACT Understanding the Grace Period for Subsidized Exchange Enrollees Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the “grace period.” The first month of this grace period will be treated normally, and plans must pay for services rendered. In months two and three, however, the health plan may suspend payment for any services provided to these enrollees – and deny the claims if the enrollee’s coverage is terminated for non-payment of premiums at the end of the third month.

In California, health plans will be required to suspend a subsidized enrollee’s coverage if the enrollee has not paid his or her premiums for more than a month. The health plans also will generally be required to notify the enrollee’s physician that the enrollee has entered month two of the grace period. Below are answers to frequently asked questions about the Covered California grace period.

Covered California’s 3-Month Grace Period for Non-payment of Premiums 1st Month of Delinquency

2nd and 3rd Months of Delinquency

Terminated After 3 Months of Delinquency

• Normal payment of claims

• Eligibility verification should indicate inactive coverage

• Plan effectively treats this month as paid even if enrollee is eventually terminated for non-payment

• The plan has the option to suspend payment for claims on services performed until the enrollee pays the outstanding balance, and any providers submitting claims for these patients will not be paid until patient is current.

• Plan has the option to deny all claims for services performed in the 2nd & 3rd months of delinquency.

• No provider notification of the patient’s delinquency

• Certain providers are notified of patient’s grace period status within 15 days of month two.

• Providers may seek payment for denied claims from the patient. • Patient may then enroll in a different Exchange plan at next open enrollment despite the delinquency.

• If enrollee pays off the balance, providers’ claims are paid at that time and enrollee’s coverage is reinstated. Certain providers receive a notice of the enrollee’s reinstatement.

Frequently Asked Questions (FAQ) How will I know who gets the 3-month grace period? Insurance ID cards for exchange enrollees will have the Covered California logo on them, but they will not indicate whether the enrollee is subsidized. Current enrollment trends, however, predict that 85 percent of those with exchange coverage will be subsidized and receive the threemonth grace period. What are my options if a patient presents with inactive coverage on account of the grace period? Practices should have policies in place prior to March 2014, the earliest date that patients may begin entering month two of the grace period. Practices may, for example, require a patient to sign an agreement that they will be responsible for all unpaid charges and may request a payment up front. A practice, however, must consider its own circumstances and, for instance, to what extent applying its current policies on treating uninsured or self-pay patients may be suitable.

How will I know whether an exchange patient is in months two or three of the grace period? Practices should verify an exchange patient’s eligibility as near the time of service as possible. If the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive. Furthermore, within 15 days of entering month two of the grace period, the plan is required to notify the primary care provider (PCP) of record and any physicians who have submitted claims on the patient within the previous two months. Where can I go for more information on the grace period and exchange plans? CMA’s exchange resources page, www.cmanet.org/exchange, has a wealth of information for practices impacted by Covered California. There you will find an exchange contracting guide for practices, CMA’s Got You Covered: A physician’s guide to Covered California, as well as FAQs, on-demand webinars, and other helpful guides on various aspects of Covered California. Additionally, CMA members and their staff have free one-on-one access to CMA’s practice management experts through the CMA reimbursement helpline at 888-401-5911 or economicservices@ cmanet.org. We are happy to provide assistance on any questions about the exchange, other reimbursement issues, contracting, or general practice management issues.

Questions: Call CMA’s reimbursement help line, 888-401-5911 or economicservices@cmanet.org.

8 SEPTEMBER 2014 / VITAL SIGNS

HEALTHCARE NEWS Anthem, Blue Shield Announce Development of Health Data Exchange

Two of California’s largest health insurers – Anthem Blue Cross and Blue

Shield of California – are partnering to create one of the largest health information exchanges in the U.S., the Wall Street Journal reports. The two companies are investing a total of $80 million to develop the not-for-profit database, which is expected to go live in November (Beck/ Wilde Mathews, Wall Street Journal, 8/5). Ultimately, the insurers hope Cal Index will be supported by subscriptions paid by participating health care providers, the Los Angeles Times reports (Logan/Pfeifer, Los Angeles Times, 8/4). When it launches, the data exchange will include the medical records of about nine million health plan members. Health plan members will be notified of this project and can opt out. The records will include data on: • Diagnoses; • Lab tests; • Physician and hospital visits; and • Procedures. The insurers expect hospitals, physicians and other insurers in the state eventually to contribute data to the system. Initially, patients will not be able to access their own data on the system, but Anthem and Blue Cross said that function will be added later (Wall Street Journal, 8/5). Anthem and Blue Cross officials said that Cal Index will comply with state and federal privacy regulations, and will use passwords and other encryption methods to protect data. Meanwhile, the health data exchange also could face challenges obtaining funding to stay in operation. According to the Journal, dozens of similar databases have shut down or consolidated “amid funding and logistical woes” (Wall Street Journal, 8/5).

Congress allows veterans to seek care outside VA system At the end of July, Congress sent a $17 billion landmark bill to President Obama that will help U.S. veterans avoid long waits for health care within the U.S. Department of Veterans Affairs (VA). There was overwhelming support in both the Senate (91-3) and House (unanimous) for the bill, which will provide $10 billion in emergency spending over the next three years to allow veterans to seek care from private doctors and other health professionals due to delays in the VA system. Veterans would have access to private doctors if they could not get an appointment with the VA within 30 days or if they live more than 40 miles from a VA clinic. The bill also includes $5 billion for hiring more VA doctors, nurses and other medical staff; and another $1.3 billion to open 27 new VA clinics across the country. The legislation also makes it easier to fire hospital administrators and senior VA executives for negligence or poor performance.

CMS temporarily takes Sunshine Act system offline

The Centers for Medicare and Medicaid (CMS) announced that the

verification system for financial interactions tracked under the Physician Payments Sunshine Act system has been taken offline temporarily because of physician complaints of inaccuracies. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other

gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database. CMS had opened the system for physicians to review and, if necessary, dispute the data reported by drug and device manufacturers on July 14, 2014, and the six week dispute period was supposed to remain open until August 27, 2014. According to CMS, for each day the Open Payments system is offline, CMS will extend the review and dispute deadline and the subsequent 15-day corrections period deadline accordingly. The California Medical Association will keep members up-to-date when the deadline dates are announced. CMS said physicians can still register with the CMS Enterprise Portal (the first step in signing up to review your data), despite the shutdown. They will not, however, be able to register for the Open Payments system (step two) until the system is brought back online. Physicians and authorized representatives can submit questions to the CMS Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is also available by calling 855-326-8366, Monday through Friday, from 7:30 a.m. to 6:30 p.m. Central time, excluding Federal holidays.

CMS To Delay Release of Some Physician Payment Records

When the CMS Open Payments System launches in September, about

one-third of the records will be withheld because of data inconsistencies, CMS announced Friday, ProPublica reports (Ornstein, ProPublica, 8/15). The Open Payments System, which is required under the Affordable Care Act’s Sunshine Act, aims to boost transparency by making public what payments health care providers have received from drugmakers and medical device manufactures. It has been scheduled to launch on Sept. 30 (California Healthline, 8/15). CMS said it has fixed errors within the system but added that doing so required removing large chunks of payment data (Al-Faruque [1], The Hill, 8/15). CMS said it will still make public on Sept. 30 details about provider payments made from Aug. 1, 2013, to Dec. 31, 2013, but the flawed data will not be released until June 2015 (ProPublica, 8/15).

DEA makes tramadol a Schedule IV drug

Effective August 18, 2014, tramadol will be classified as a Schedule IV drug, according to a rule recently published by the U.S. Drug Enforcement Agency (DEA). The drug had been a non-controlled substance under federal law for almost 20 years. According to the DEA, the abuse of tramadol products has increased over the last several years, with it being used as a substitute for other opioids such as hydrocodone. Tramadol is a centrally acting synthetic opioid analgesic used in the management of moderate to moderately severe pain in adults. Tramadol is a novel analgesic having both opiate agonist activity and monoamine reuptake inhibition that contribute to its analgesic efficacy. Tramadol was first approved by the U.S. Food and Drug Administration (FDA) in 1995 under the trade name ULTRAM. Subsequently, the FDA approved generic, combination and extended release tramadol products. Tramadol is manufactured and distributed in various forms including tablets, capsules and liquid. The final rule imposes the regulatory controls and administrative, civil and criminal sanctions applicable to schedule IV controlled substances on persons who handle (manufacture, distribute, dispense, import, export, engage in research, conduct instructional activities with, or possess) or propose to handle tramadol. Please see next page SEPTEMBER 2014 / VITAL SIGNS

HEALTHCARE NEWS Continued from page 9 Physicians should be aware of the following: • The change becomes effective on Monday, August 18, 2014. After that, all regulatory requirements applicable to schedule IV controlled substances will apply to tramadol. This includes specific rules relating to storage, recordkeeping, inventory, disposal and prescribing. • Every DEA registrant who possesses any quantity of tramadol on August 18 must take an inventory of all stocks of tramadol on hand. • In order to prescribe tramadol on or after August 18, 2014, prescribers will have to be registered with the DEA to prescribe Schedule IV substances. • A ny unfilled prescriptions/refills for tramadol after August 18 will have to follow Controlled Substances Act rules governing Schedule IV substances, and some patients may need new prescriptions.

IOM Report Calls for Changes to Graduate Medical Education Funding

An expert panel of the Institute of Medicine proposed an overhaul of the way the U.S. funds physician training, Kaiser Health News reports (Rovner, Kaiser Health News, 7/29). The panel was led by former CMS administrators Donald Berwick and Gail Wilensky. Although some residency slots are paid for by states and other sponsors, most are federally funded by Medicare or Medicaid. In 2012, Medicare paid $9.7 billion for physician training, while Medicaid paid $3.9 billion. In addition, the Department of Veterans Affairs contributed about $1.4 billion, and HHS’ Health Resources and Services Administration contributed about $500 million. Even though funding largely is paid for by the federal government, new doctors “have no obligation to practice in specialties and geographic areas where they are needed or to accept Medicare or Medicaid patients once Governor Signs Bill to Complete they enter practice,” according to the IOM report. Medical School Under Four Years The panel concluded that simply increasing the number of residency positions would not address issues related to geographic and specialty Gov. Jerry Brown (D) signed a bill (AB 1838) that will allow students distribution. Medicare’s graduate medical education funds are enrolled in accredited medical school programs in California to become disproportionally awarded to New York, New Jersey and Massachusetts physicians in less than four years, the Sacramento Business Journal reports (Robeznieks, Modern Healthcare, 7/29). (Robertson, Sacramento Business Journal, 7/18). Specifically, the IOM report outlines five ways to reform the payment An accelerated pilot program already is underway at the UC-Davis system for physician training: School of Medicine in conjunction with Kaiser Permanente, and the first six participants began classes in June, the Journal reports. • Keep aggregate GME support at the existing level with yearly According to the Journal, only medical students who demonstrate high adjustments for inflation, but transition toward performance-based levels of scientific and medical understanding will be eligible for accelerated payments, ensure accountability, incent innovation and phase out the programs. existing payment system for Medicare; • Create an HHS GME Policy Council similar to the Medicare Payment Advisory Commission, which would direct policy for geographic distribution and specialty configuration of the doctor workforce; • Establish one GME Medicare fund that would be split 90-10 between operations and innovation, with reforms gradually growing innovation to 30% of the fund; • Direct funding to GME-sponsoring organizations based on a per-resident FRESNO KERN amount with geographic adjustments FAMILY MEDICINE FACULTY FAMILY MEDICINE FACULTY while implementing performance-based payments; and Clinica Sierra Vista is seeking a Board Clinica Sierra Vista is seeking a Board Certified Family Medicine Physician to • Keep Medicaid funding for GME at each Certified Family Medicine Physician to serve as faculty for the Rio Bravo Family serve as faculty for the Sierra Vista Family state’s discretion, but improve transparency Medicine Residency Program. Full and Medicine Residency Program. Full and and accountability with reforms similar to part-time teaching positions available! part-time teaching positions available! those implemented for Medicare funding Make a difference in the lives of new Make a difference in the lives of new physicians and join our faculty! Inpatient physicians and join our faculty! Inpatient (Modern Healthcare, 7/29).

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Implementing the recommendations would require action from Congress. The Association of American Medical Colleges said the proposal would amount to a 35% reduction in funding for teaching hospitals, which AAMC President Darrell Kirch said would “threaten the world’s best training programs for health professionals and jeopardize patients, particularly those who are the most medically vulnerable” (Kaiser Health News, 7/29).

Tulare CMA Governance Technical Advisory Committee (GTAC):

Why Things Are Changing And What Will Be Proposed James Foxe, MD, GTAC Member

To understand what purpose of the GTAC and the results that are being presented, one must

understand where the CMA is and why the idea to form the GTAC even came to discussion. The question of relevance of the House of Delegates (HOD) has been raised multiple times within recent history. Over the last 20 years, attendance has dropped from 1200 to 700 delegates despite increases in representation. Resolutions have dropped from 150 to 100 over time. The HOD has voted to shorten the duration twice and generally discussion is limited to 15 minutes per item. This has left many people frustrated that we spend large amounts of time on items that are not important to many and little time on the major issues dealing with the House of Medicine as a whole. In 2011, Dustin Corcoran, CEO of the California Medical Association (CMA) , brought in an expert on Activity Based Accounting. Ultimately the costs of governance for the CMA as a whole were pegged at $5,106,413 for 2012. Of that the HOD cost $1,101,914 and the BOT $1,725,206 with sections forums and other subsidiary groups making the rest of the total. This does not include the opportunity costs of physicians and Component Societies to attend the HOD and Board of Trustee (BOT) meetings. Thus the Governance Technical Advisory Committee was formed. Al Gelders and I, represented District 6 on the committee since its inception. Very quickly the idea of a shortened HOD focusing on a few important items 4-5 per year (determined by input from all sources to the Speaker) gained favor. In order to accomplish this, the groundwork for year round input was laid with revision of the standing committees and councils to be able to function as reference committees on an ongoing basis. The trial last year of an online reference committee was the first step towards that goal. As envisioned by the GTAC , authors could submit their resolutions at any time of the year. The resolution would be referred to a standing committee which would then do the work of the reference committee and invite online commentary. Once that process was done, then the issue would go to the BOT which could then act on the issue in a timelier manner than current procedures allow. The second phase of the reform was voted on at the House last year which mandated what the TAC wanted do as well, namely, reduce the size of the BOT. Currently at 55 members plus, it is not an easy body to function well and is actually more costly than the HOD. In order to reduce the size, the representation ratios needed to be reworked. This brought up the disparity between the numbers of members represented by a single trustee. In order to address this issue the idea of redistricting arose. The County Medical Executive’s generally agreed as long as counties remained whole. After trying to balance membership and look at geographic considerations, the proposals circulated proved to be largely unpopular with the affected counties. Thus the GTAC decided to abandon the concept of redistricting to reduce the size of the board. It then recommended to the Board of Trustees at their July meeting, modification of the entitlement formula. Thus each of 11 districts will get one trustee and an additional trustee for each full 2500 regular active members. It should be noted that this results in Districts 5 and 8 having about 800 members and one trustee while Districts 2, 4 and 10 have 1800 or more members and one trustee as well. The concept of at-large trustee seats was abandoned. The GTAC was firm on the elimination of Organized Medical Staff Section (OMSS) and Specialty delegation seats while the Mode of Practice Fora would have one trustee for 4,000 members and two trustees for 8,000 or more. District 12 would be eliminated and treated like other sections for representation purposes (i.e. one trustee and two delegates). With this the BOT can be reduced to 29 down from over 55. Of note is that this includes the five officers of CMA who are elected by the HOD and do not represent any district directly. These proposals were presented last month to the Board but I do not know if they were changed dramatically by the Board or if they will be presented pretty much as outlined to the HOD in December. To accomplish all of these changes Bylaws will need to be changed and considered at the next HOD. The proposal is certainly somewhat controversial as there can be some downside issues, such as decreased grassroots participation and diminished leadership training for future CMA leaders. I think overall the pluses outweigh the negatives. As a practical matter commentary is needed before consideration at the House, as wordsmithing and ad hoc modifications of the proposals and necessary Bylaws changes on the floor will lead to chaos and contradictions that will take years to resolve. Be aware that the changes will take place slowly as the HOD is scheduled until 2016 and Board members will fulfill their elected terms before those deleted positions take effect. If anyone has questions, I or, Ralph Kingsford, Virgil Airola or Al Gelders, Trustees from District Six should be able to help you understand more of this major change proposed for CMA.

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org Officers Thomas Gray, MD President Monica Manga, MD President-Elect Virinder Bhardwaj, MD Secretary/Treasurer Steve Cantrell, MD Past President Board of Directors Anil K. Patel, MD Carlos Dominguez, MD Pradeep Kamboj, MD Christopher Rodarte, MD Antonio Sanchez, MD Raman Verma, 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 Executive Assistant Dana Ramos Administrative Assistant

Author can be reached at jwf@hotmail.com. SEPTEMBER 2014 / VITAL SIGNS

Tulare Kings 2015 Coding Book News

It is that time again to start purchasing

coding books. Order your 2015 editions of CPT, ICD-9, ICD-10, and HCPCS through us. We are offering extraordinary discounted rates and free shipping directly to your office. Please contact Dana Ramos, Provider Relations to order or obtain more information: 559-734-0393 or dramos@ tkfmc.org.

Tulare County Medical Society presents

Tulare County Medical Society Upcoming Events Transform Your Front Desk Thursday, November 13, 2014 1:00 to 4:00 p.m. Focus of training to be for front office staff on the following: • Communication skills • Importance of collecting Co-pays • HIPAA compliance & confidentiality • Short-notice appointments

Chart Auditing for Physician Services This class is a five-day class. November 13, 2014 9:00 a.m. to 12:00 p.m

Certified Medical Coder Course and Exam This class is a five-day class. November 14, 21, Dec. 5, 12, & 15, 2014 8:30 a.m. to 4:30 p.m. (one hour lunch break)

TCMS Family Day Sunday, September 14, 2014 McDermott Field House

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, Tulare, CA Saturday, September 27, 2014 8:00am to 9:00am VISALIA Riverway Sports Park, Visalia, CA Saturday, September 13, 2014 8:00am to 9:00am Who can attend: ANYONE For more information, please contact Tulare County Medical Society at (559) 627-2262

12 SEPTEMBER 2014 / VITAL SIGNS

Details will follow by mail on all of the above events. If you have any questions, please feel free to call the Tulare County Medical Society office at 559-734-0393 and ask to speak to Dana Ramos. You may also email her at DRamos@tkfmc.org .

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 James E. Dean, MD Thomas S. Enloe, Jr., MD Ying-Chien Lee, MD Uriel Limjoco, MD Michael MacLein, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

Kern Guest Editorial

Medical Missionary Journey Thomas R. Larwood, MD with Portia Choi, MD PART II Married near the end of medical school, my wife, Pat, and I soon talked with representatives of the Mission Board. They had need at that time of someone with my credentials in India or South Korea. If we were to go to India, the children would go to boarding school a thousand miles away. If we went to Korea, we could teach them at home or at an English-speaking school not far away, after a year in Korean primary school. The choice was easy. We would go to Korea. There followed one year of internship at L.A. County Hospital and a year of General Practice residency at Kern General Hospital (now Kern Medical Center). New missionaries usually learn the language of the country in the field but with the armistice still uneasy and Seoul only 38 miles from the Demilitarized Zone, an alternative was thought to be better. We were sent instead to the Yale Institute of Far Eastern Languages, which we attended for a school year. We headed for Korea aboard ship from San Francisco, with our two small boys in September 1954. We stopped in Tokyo to have proper papers signed by the U.S. Armed Forces to enter Korea and landed in South Korea at Pusan harbor, which is at the southeastern tip of the Korean peninsula. From Pusan our family traveled by train to Seoul, the capital of South Korea. In Seoul we lived on a hill in the ground floor of a two-story typical 1900 Midwest home. There was a coal furnace in the basement, along with a large concrete cistern which filled with water, when there was enough city water pressure to reach it. When there happened to be electricity the water was pumped up to the 50 gallon drums hooked up in the attic, giving us water pressure. In 1954 and 1955, our primary job was learning the Korean language. To keep my hand in medicine, I worked one day a week in the Foreign Clinic at Severance Hospital, to which I bicycled a mile or two each way. The hospital was an old building across from the main railroad station, which had been badly shot up as the North Koreans swept south in June of 1950 and again as the American and United Nations forces came north a few months later during the war. The hospital had also received considerable damage. Editorial Note: Dr. Tom Larwood contracted polio in September 1955. The trials for the polio vaccine were in its third stage with the vaccine being tested among persons in Atlanta, Chicago and Los Angeles that year. The next year, the polio vaccine was approved for mass vaccination of millions. Currently, Dr. Larwood is a prominent medical champion working with a multi-disciplinary team towards the development of a vaccine against coccidiodomycosis (valley fever), another illness that is affecting the lives and causing disability and death among those living in Kern County and many areas of the Southwest. This article was first printed in the Levan Humanities Review, Volume 2, Issue 1 (2014) and is available online by Googling Levan Humanities Review. Authors can be reached at trlarwood@bak.rr.com or ssportia@aol.com.

2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org Officers Alpha J. Anders, MD President Michelle S. Quiogue, MD President-Elect Eric J. Boren, MD Secretary Bradford A. Anderson, MD Treasurer Wilbur Suesberry, MD Past President Board of Directors Alberto Acevedo, MD Lawrence N. Cosner, Jr., MD Vipul R. Dev, MD John L. Digges, MD Susan S. Hyun, MD Kristopher L. Lyon, MD Ronald Morton, MD Mark L. Nystrom, MD Edward W. Taylor, III, MD CMA Delegates Jennifer Abraham, MD Vipul Dev, MD John Digges, MD Lawrence N. Cosner, Jr., MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

July 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........................................................................................................62 Total........................................................................................................335 New Members (Pending Dues)........................................................................................0 New Members (App Pending).......................................................0 Total Members..............................................................................335

SEPTEMBER 2014 / VITALâ&#x20AC;&#x2C6;SIGNS

Fresno-Madera PRAHALAD JAJODIA, 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 Prahalad Jajodia, MD President A.M. Aminian, MD President-Elect Hemant Dhingra, MD Vice President Ahmad Emami, MD Secretary/Treasurer Ranjit Rajpal, MD Past President Board of Governors Alan Birnbaum, MD S.P. Dhillon, MD William Ebbeling, MD Anna Marie Gonzalez, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Alan Kelton, MC Constantine Michas, MD Trilok Puniani, MD Khalid Rauf, MD Roydon Steinke, MD CMA Delegates FMMS President Don Gaede, MD Michael Gen, MD Brent Kane, MD Brent Lanier, MD Kevin Luu, MD Andre Minuth, 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 Oscar Sablan, MD CMA Trustee District VI Virgil Airola, MD Staff Sandi Palumbo Executive Director

14 SEPTEMBER 2014 / VITAL SIGNS

President’s Message It’s Official: NO on 46 Campaign

On November 4, 2014, voters will be asked to weigh in on Proposition 46, a costly ballot measure that will make it

easier and more profitable for lawyers to sue doctors, community health clinics and hospitals, resulting in billions in increased health care costs annually. Prop. 46 is being disguised by the trial lawyer sponsors as a measure that will “increase patient safety” but we know it’s really just about seeking change to a current law that will allow proponents to file more medical lawsuits against health care providers. California’s non partisan Legislative Analyst has taken a close look at Prop. 46 and concluded that it could increase state and local government health care costs by “hundreds of millions of dollars annually.” We know that these increased costs would reduce funding available for vital state and local government services like police, fire, social services, parks, libraries, and the list goes on. As physicians, it is our job to provide care and protect our patients – but Prop. 46 does just the opposite. Taxpayers across the state will be on the hook for hundreds of millions of dollars in increased state and local government costs each year and could lose critical state and locally-provided services that so many count on. An independent study estimates that this proposition will increase health care costs across all sectors by almost $10 billion annually. How does that affect patients throughout California? It translates to about $1,000 per year in higher health care costs for a family of four. For many families, that’s the difference between being able to afford groceries or health care each month. If you haven’t signed up to oppose Prop. 46, please visit NoOn46.com and join the coalition today – the price to our patients is too great to risk it. If you haven’t signed a “No On Prop 46 Commitment Card” or pledged to be a coordinator at your hospital, visit cmanet.org/micra and sign up today. As we forge ahead to Election Day, I ask each of you reading this to take action and get involved in the No on Prop. 46 campaign. To find out more information about the issue and how you can help educate your colleagues, patients and neighbors, visit NoOn46.com today.

Let Your Opinions Be Heard FMMS Seeking Participants for 2015 Committees

FMMS’s committees are essential tools for accomplishing organizational goals. Through reports and actionrecommendations to the FMMS Board of Governors, committees provide important input to guide the governance, goals, programs and activities of the Society. Committees are where most of FMMS’s “action” takes place. Committee participation is voluntary and open to interested members. Committee appointments are made annually by the incoming president, with approval by the Board of Governors. Permanent and Ad Hoc Committees include: • Continuing Medical Education (CME): Meets as needed • Editorial: Meets as needed • Legislative: Meets as needed • Medical Review and Advisory (MRAC): Meets quarterly • Nominations: Meets as needed • Professional Relations: Meets as needed to investigate disputes Names need to be submitted by September 15, 2014. Contact the Society offices at 559-224-4224x118 or csrau@fmms.org or spalumbo@fmms.org.

Fresno-Madera

CLASSIFIEDS Edward Mosley, MD, JD 58-year member

Edward Mosley, MD a retired internist, passed

Fresno-Madera Medical Society PHYSICIANS: Looking for ways to: • Add more physical activity to your lifestyle? • Be a role model and inspiration to your patients and your community? • Spend more time with your family and friends? Consider volunteering ONE HOUR every month or two in the Fresno-Madera Medical Society’s: WALK WITH A DOC Program This walking program is risk free and requires no preparation. Physicians just need to: SPEND A SATURDAY MORNING: •P resenting a 2-3-minute presentation on the health benefits of walking from the perspective of your specialty • Leading a 45-50 minute walk around Woodward Park in Fresno or Town & County Park in Madera • Answering potential questions from the walkers Encourage patients to take steps to improve their health

FRESNO: SEPTEMBER 27

Woodward Regional Park Sunset View Shelter Registration 7:15am Walk Event 7:30am-8:30am

MADERA: SEPTEMBER 7

Town & Country Park Pavilion Area Registration 7:15am Walk Event 7:30am-8:30am

Ready to Volunteer? For a schedule of dates and times Call the FMMS office: 559-224-4224x110 or send email to receptionist@fmms.org

Find us on Facebook: Fresno-Madera Medical Society

www.facebook.com/pages/Fresno-MaderaMedical Society/107731015917068

away June 13, 2014, at the age of 90. Dr. Mosley , born in Chicago in 1924, received his medical degree from Meherry Medical College in 1948 and completed his internship and residency at Harlem Hospital, NY and the Veterans Administration Hospital, Tuskegee, AL. He served in the US Army as a medical officer at Korea Army Hospital. Dr. Mosley began his private practice in Fresno in 1956. He created the Westview Convalescent Hospital in west Fresno and founded the West Fresno Health Care Coalition (now the West Fresno Family Resource Center). After leaving private practice in 1976, Dr. Mosley served as a consultant for Social Security Disability Evaluation until 1995. From 1971-1983, Dr. Mosley was elected and served as a Board of Trustee to the State Center Community College District. In 1981, he received his law degree from San Joaquin School of Law, specializing in medical malpractice and worked as a Workers Comp. consultant. Dr. Mosley fully retired in 2003. He is survived by his wife, five children, nine grandchildren and two great-grandchildren.

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 ANNOUNCEMENTS Fresno Gastroenterology welcomes boardcertified physicians Dr. Paul Hanchett and Dr. Vivek Mittal. Referrals appreciated. Call 559323-8200 or Fax: referral to 559-323-9200. University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Call 559-3200580. FOR LEASE Medical office. 1000sf, up to 2500sf at NE corner First/Herndon & NW corner First/Bullard; starting at $1 psf++ by owner. Call 559-824-9966 or 559930-4297. Office space at Chestnut/Herndon. Build to suit. 1200 sf. Call 559-287-3279. PHYSICIAN WANTED . 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.

Gilford Y. Wong, MD 58-year member

Gilford Wong, MD, a retired pediatrician, died

August 9, 2014 at the age of 88. Dr. Wong was born in China in 1926. After serving in the US Navy from 1944-1946, he received his medical degree from the University of Oregon School of Medicine in 1952 and completed his internship and residency at Highland Alameda County Hospital, Oakland, and Children’s Hospital, Berkeley. He began his private practice in Fresno in 1956 as the first board certified Chinese pediatrician in the area. In 1973, Dr. Wong became the first Medical Consultant for the Fresno office of the California State Department of Social Services Disability Evaluation Division – where he worked until his retirement in 1988. Dr. Wong is survived by his wife, three children and five grandchildren.

Unaiza Hayat, MD 5-year member

Unaiza Hayat, MD, an internist, passed away

August 10, 2014, at the age of 47. Dr. Hayat received her medical degree from the University of Maryland School of Medicine in 1995 and completed her residency and internship trainings at UCSF-Fresno in 2000. She co-founded avecinia wellness center in Fresno where she served as the CEO and Medical Director. Dr. Hayat is survived by her parents and three siblings.

Gar McIndoe (661) 631-3808 David Williams (661) 631-3816 Jason Alexander (661) 631-3818

MEDICAL OFFICES FOR LEASE 8327 Brimhall – 1,629 rsf. 8327 Brimhall – 2,288 rsf. Crown Pointe Phase II – 2,000-9,277 rsf. 3115 Latte Lane – 5,637 rsf. 3115 Latte Lane – 2,660-2,925 rsf. 1150-1160 Lerdo Hwy, Shafter 1,766 to 3,793 sf. 9300 Stockdale Hwy. – 16,618 sf. 9330 Stockdale Hwy. – 5,754 rsf. 9900 Stockdale Hwy. – 2,085 sf. 500 Old River Rd. #185 – 3,071 sf. SUB-LEASE 4100 Truxtun Ave. – Adm. & Billing – 6,613 rsf. FOR SALE 3015 Calloway – 1,465-10,318 sf. 4939 Calloway #103 – 1,827 sf. Crown Pointe Phase II – 2,000-9,277 rsf.

SEPTEMBER 2014 / VITAL SIGNS

VITALâ&#x20AC;&#x2C6;SIGNS Post Office Box 28337 Fresno, California 93729-8337

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

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