Winter 2016

Page 1

California

FAMILY PHYSICIAN VO OL . 67 NO. 1 Wi nt e r 2016

THREE NEW LAWS WILL AFFECT YOUR PATIENTS AND YOUR PRACTICE

12

2015 MEMBER OF THE MONTH YEARBOOK

16

REMEMBERING WHY I AM A CAFP MEMBER

22

4 + 4 = 40: MAINTENANCE OF CERTIFICATION EQUALS LIFELONG LEARNING

26

CAFP Wins AAFP Leadership in State Government Advocacy Award!

From left to right: Adam Francis, Carla Kakutani, MD, Leah Newkirk and Jack Chou, MD.

Success. It’s what California’s ďŹ nest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT). As a physician-directed organization, we understand the realities of running a medical practice, and are committed to supporting you with a range of valuable programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.

Protect Your Online Reputation With CAP’s Free Physician’s Action Guide! The Physician’s Online Reputation Action Guide can help you build a strong and positive reputation. Learn how to: ; .$/52"(& 0"4*&.43 4/ 0/34 0/3*4*6& 2&6*&73 ; 002/02*"4&,8 2&30/.% 4/ .&("4*6& 2&6*&73 ; 04*-*9& 3/$*", -&%*" 4/ &34"#,*3) your credibility.

Request your free electronic or hard copy today!

800-356-5672 | CAPphysicians.com/ReputationPro

Physician – Full-time position for the Clovis facility. Current CA MD or DO license required; Board Certified/Board Eligible Family Practice or Internal Medicine; Current DEA; ACLS required; EMR exp. pref.; Excellent benefits package; Hiring in accord. with Indian Pref. Act. Please send CV to CVIH HR, 2740 Herndon Ave., Clovis, CA 93611 or email to hr@cvih.org Central Valley Indian Health, Inc. Argyros Health Center, La Quinta, CA

TM

ACHIEVE

extraordinary outcomes When you're part of Dignity Health, you'll be able to do more than just care for your patients. You’ll have the opportunity to develop and participate in health, education and wellness programs that will help improve the lives of people throughout your community...and beyond. If you want to achieve extraordinary outcomes, join us today.

OUTPATIENT FAMILY MEDICINE PHYSICIANS Northern and Southern California (Bakersfield, Grass Valley, Inland Empire, Merced, Redding, Sacramento, Santa Cruz, Stockton, Ventura & Woodland)

Practice Highlights: 6 /.*)*(3 1$.# ($)$-., .$0 ) clinical support 6 ) -. '$-# ",*1$)" ( $ ' ",*/+ OR an independent single specialty group practice 6 /'' .$( ) + ,. .$( +, .$ *+.$*)-

EISENHOWER MEDICAL ASSOCIATES Faculty, Family Medicine Residency Rancho Mirage, California Become an integral part of an exciting new residency program! Eisenhower Medical Center in Rancho Mirage, California recently welcomed its third class of residents and has a full 10-year ACGME accreditation. Eisenhower Medical Associates, Inc., a California Professional Corporation is seeking to enhance its team of employed physicians to serve as Family Medicine Residency faculty members for the Eisenhower Medical Center Residency Program. You will have in-patient and out-patient care responsibilities as well as precepting FM residents in the Eisenhower Center for Family Medicine. You will have protected time for curriculum management, resident advising, and scholarly work. Board certification in Family Medicine is required. An academic appointment will be confirmed from the Keck School of Medicine, University of Southern California and rank will depend upon experience and qualifications. Eisenhower Medical Associates seeks candidates whose experience, teaching, research, and community service has prepared them to contribute to our commitment to serving the Coachella Valley. Qualified applicants, including recent residency graduates, are encouraged to apply. Candidates should submit an electronic CV and statement of interest to Anne Montgomery, MD, MBA, Program Director, at amontgomery@emc.org with a copy to tdunn@emc.org. For questions or inquiry, please contact Patti Petersen, FM Residency Program Manager at ppetersen@emc.org or 760-773-4504.

6 $ ' */) .$*) '$") 1$.# *) *! the largest health systems in the nation and the largest hospital system in California 6 ' ,3 "/ , ). + ,$* ) excellent earning potential based on productivity model 6 .., .$0 *)/- -.,/ ./, 6 /))3 '$!*,)$ '* .$*)- 1$.# -3 - .* ) , ) $- * + & #* *- )" ' - ) ) $ "*

Please contact/send your CV to: Physician Recruitment providers@dignityhealth.org 888-599-7787 www.dignityhealth.org/physician-careers

ϭϹώϏ WÄ‚Ä?Ĺ?ÄŽÄ? ǀĞŜƾÄž Íť ^Ä‚Ĺś &ĆŒÄ‚ĹśÄ?Ĺ?Ć?Ä?Ž͕ Ä‚ĹŻĹ?ĨŽĆŒĹśĹ?Ä‚ ϾϰϭϏϾ Íť Ç Ç Ç Í˜ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? WĹšŽŜÄž ͞ϰϭϹͿ ϯϰϹͲϴϲϲϳ Íť &Ădž ͞ϰϭϹͿ ϯϰϹͲϴϲϲϴ Íť ͲžÄ‚Ĺ?ĹŻÍ— Ä?Ä‚ĨƉΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

ÄœÂŒÂŽÂ›ÂœČąÂŠÂ—Â?Čą ˜Š›Â?

�Šě

President :ĂLJ t͘ >ĞĞ͕ D ͕ DW,

^ĆľĆ?Ä‚Ĺś ,Ĺ˝Ĺ?ĞůĂŜĚ͕

President-Elect >ĞĞ ZĂůƉŚ͕ D

Executive Vice President

Ć?ŚŽĹ?ĞůĂŜĚΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? ĹŻĹŻĹ?Ć?ŽŜ Ä‚ĆľÄžĆŒ

Immediate Past President Ğů DĹ˝ĆŒĆŒĹ?Ć?Í• D

Associate Director, Communications and Publications

Speaker DĹ?Ä?ŚĞůůĞ YĆľĹ?Ĺ˝Ĺ?ƾĞ͕ D

:ÄžĆŒĆŒĹ? Ä‚Ç€Ĺ?Ć?Í• , W

Vice-Speaker >Ĺ?Ć?Ä‚ tÄ‚ĆŒÄšÍ• D Secretary/Treasurer tÄ‚ĹŻĆšÄžĆŒ DĹ?ĹŻĹŻĆ?Í• D

Ä‚Ä?Ä‚ĆľÄžĆŒÎ›ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

California FAMILY PHYSICIAN

LJŜƚŚĹ?Ä‚ <ÄžÄ‚ĆŒÍ• D Ĺ?ǀ͕ , W Senior Vice President

Quarterly publication of the California Academy of Family Physicians

Ä?ĹŹÄžÄ‚ĆŒÎ›ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? ŽĚLJ DĹ?ĆšÄ?ĹšÄžĹŻĆšĆŒÄžÄž

EĂƚŚĂŜ ,Ĺ?ĆšÇŒÄžĹľÄ‚ĹśÍ• D Í• Editor ĹŻĹŻĹ?Ć?ŽŜ Ä‚ĆľÄžĆŒÍ• Managing Editor

Ä?ĹľĹ?ĆšÄ?ĹšÄžĹŻĆšĆŒÄžÄžÎ›ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

ŽžžƾŜĹ?Ä?Ä‚ĆšĹ?ŽŜĆ? ŽžžĹ?ƚƚĞĞ͗ EĂƚŚĂŜ ,Ĺ?ĆšÇŒÄžĹľÄ‚ĹśÍ• D Í• Chair

Manager, Information, Technology and Foundation Programs

Ä?ĹšĹ?ŜĂLJĂ EÄ‚ĆŒÄ‚Ç‡Ä‚ĹśÄ‚Ĺś

Workforce Development Manager

Director, CME/CPD

ŊĚĂǀĹ?Ć?ΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? ĆŒĹ?Ä‚Ĺś ĞǀĹ?ŜĞ

Manager, Finance

Ä?ĚĞǀĹ?ŜĞΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

Ä‚ĹśÄ‚ĆŒÄ‚Ç‡Ä‚ĹśÄ‚ĹśÎ›ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? >ĞĂŚ EÄžÇ ĹŹĹ?ĆŒĹŹ Vice PresidentÍ• Health Policy ĹŻĹśÄžÇ ĹŹĹ?ĆŒĹŹÎ›ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

^ŚĞůůLJ ZĹ˝ÄšĆŒĹ?Ĺ?ƾĞĆ?Í• Í• & ,W

Executive Vice President ^ĆľĆ?Ä‚Ĺś ,Ĺ˝Ĺ?ĞůĂŜĚ͕

ĚĂž &ĆŒÄ‚ĹśÄ?Ĺ?Ć?

Foundation President ŜƚŚŽŜLJ ĹšŽŜĹ?Í• D

Ä‚ĨĆŒÄ‚ĹśÄ?Ĺ?Ć?ΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

ZĹ?Ä?ŚĂ ^Ä‚ĆŒÄ‚Ć?Ç Ä‚Ćš

DÄ‚ĆŒĹ?Ä‚ :ÄžŜŜĹ?ĹśĹ?Ć?

ĆŒĆ?Ä‚ĆŒÄ‚Ć?Ç Ä‚ĆšÎ›ĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

AAFP Delegates :ÄžĨĨ >ĆľĆšĹšÄžĆŒÍ• D Ä‚ĆŒĹŻÄ‚ <ĂŏƾƚĂŜĹ?Í• D AAFP Alternates Ä‚ĆŒŽů ,ĂǀĞŜĆ?Í• D :ĂLJ t͘ >ĞĞ͕ D Í• DW,

Deputy Director, Government Affairs

Manager, Membership

Deputy Executive Vice President

Ć?ĆŒĹ˝ÄšĆŒĹ?Ĺ?ƾĞĆ?ΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? Program Support Coordinator

žŊÄžŜŜĹ?ĹśĹ?Ć?ΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ? ^ŽŜĹ?Ä‚ <ĂŜƚĂŏ

Íť :ƾůĹ?Ä‚ ĹŻÄ‚ŜŏÍ• D Íť EĂƚŚĂŜ ,Ĺ?ĆšÇŒÄžĹľÄ‚ĹśÍ• D Íť :ÄžĨĨĆŒÄžÇ‡ >ĆľĆšĹšÄžĆŒÍ• D Íť :ĂLJ DŽŜĹ?Ĺ?Ä‚ĆŒÄšĹ˝Í• D Íť DĹ?Ä?ŚĞůůĞ YĆľĹ?Ĺ˝Ĺ?ƾĞ͕ D Íť ĹŻÄ?ÄžĆŒĆš ZĂLJ͕ D dŚĞ California Family Physician Ĺ?Ć? ƉƾÄ?ĹŻĹ?Ć?ŚĞĚ Ć‹ĆľÄ‚ĆŒĆšÄžĆŒĹŻÇ‡ Ä?LJ ƚŚĞ Ä‚ĹŻĹ?ĨŽĆŒĹśĹ?Ä‚ Ä?ĂĚĞžLJ ŽĨ &Ä‚ĹľĹ?ůLJ WŚLJĆ?Ĺ?Ä?Ĺ?Ä‚ĹśĆ?͘ KƉĹ?ĹśĹ?ŽŜĆ? Ä‚ĆŒÄž ƚŚŽĆ?Äž ŽĨ ƚŚĞ Ä‚ĆľĆšĹšĹ˝ĆŒĆ? ĂŜĚ ŜŽĆš ŜĞÄ?ÄžĆ?Ć?Ä‚ĆŒĹ?ůLJ ƚŚŽĆ?Äž ŽĨ ƚŚĞ žĞžÄ?ÄžĆŒĆ? ĂŜĚ Ć?ƚĂč ŽĨ ƚŚĞ &W͘ EŽŜͲžÄžĹľÄ?ÄžĆŒ Ć?ĆľÄ?Ć?Ä?ĆŒĹ?ƉĆ&#x;ŽŜĆ? Ä‚ĆŒÄž ΨϯϹ Ć‰ÄžĆŒ Ç‡ÄžÄ‚ĆŒÍ˜ Ä‚ĹŻĹŻ ϰϭϹͲϯϰϹͲϴϲϲϳ ƚŽ Ć?ĆľÄ?Ć?Ä?ĆŒĹ?Ä?Ğ͘

Manager, Medicall Practice Affairs

Ć?ŏĂŜƚĂŏΛĨÄ‚ĹľĹ?ůLJĚŽÄ?Ć?Í˜Ĺ˝ĆŒĹ?

CMA Delegation Ć?ĹšÄ?LJ tŽůĨĞ͕ D Í• DW,Í• DWW :ĂLJ t͘ >ĞĞ͕ D Í• DW, DÄ‚ĆŒĹ?Äž ZĂžĂĆ?Í• D DÄ‚ĆŒĹŹ ĆŒÄžĆ?Ć?ĹśÄžĆŒÍ• D sÄ‚Ĺś EĹ?ƾLJĞŜ͕ K &ĞůĹ?dž EƾŜĞnj͕ D Í• DW,

pcipublishing.com Created by Publishing Concepts, Inc. $AVID "ROWN 0RESIDENT s DBROWN PCIPUBLISHING COM For Advertising info contact -ICHELE 'ILBERT s EXT MGILBERT PCIPUBLISHING COM EDITION 17

>ŽŽŏĹ?ĹśĹ? ĨŽĆŒ Ä‚ ĹŠĹ˝Ä?Í? 'Ĺ˝ ƚŽ Ç Ç Ç Í˜ĨƉŊŽÄ?Ć?ŽŜůĹ?ĹśÄžÍ˜Ä?Žž Ç ĹšÄžĆŒÄž LJŽƾ Ä?ĂŜ͗ Íť Ć?ÄžÄ‚ĆŒÄ?Ĺš ĹŠĹ˝Ä?Ć? ĨŽĆŒ ĨĆŒÄžÄž Íť ƉŽĆ?Ćš Ä‚ ĆŒÄ Ć?ĆľĹľÄ Íť Ä?Äž Ç€Ĺ?Ć?Ĺ?Ä?ĹŻÄž ƚŽ ÄžĹľĆ‰ĹŻĹ˝Ç‡ÄžĆŒĆ? Íť ĆŒÄžÄ?ÄžĹ?ǀĞ ÄžͲžÄ‚Ĺ?ĹŻ Ä‚ĹŻÄžĆŒĆšĆ? ŽĨ ĹśÄžÇ ĹŠĹ˝Ä? ƉŽĆ?Ć&#x;ĹśĹ?Ć? YƾĞĆ?Ć&#x;ŽŜĆ?Í? Ä‚ĹŻĹŻ ϴϴϴͲϴϴϰͲϴώϰώĂŜĚ Ä‚ , >d,Äž Z Z^ ĆŒÄžĆ‰ĆŒÄžĆ?ĞŜƚĂĆ&#x;ǀĞ Ç Ĺ?ĹŻĹŻ ŚĞůƉ LJŽƾ͘

4

California Family Physician Winter 2016

12 Three New Laws Will Affect Your Patients and Your Practice

Adam Francis

14 Accelerating into Family Medicine

Ngabo Nzigira

18 Integrate Behavioral Health Services: It’s Time to Stop Cutting People off at the Head!

Elaine Skoch

22 Remembering Why I Am a CAFP Member

Leo Leer, MD

24 Don’t Miss These New Coding Opportunities with ICD-10-CM 26 4 + 4 = 40: Maintenance of Certification Equals Lifelong Learning

Mary Jean Sage Shelly Rodrigues, CAE, CHPH, FACEHP

28 Chronic Care Management: Reporting from the Trenches

Bill Zepf, MD

6

Editorial

Keeping Modern Medicine from Becoming a Winchester House

Nathan Hitzeman, MD

8

President’s Message

Balancing the Business and Busyness of Family Medicine

Jay W. Lee, MD, MPH

9

PCMH Corner

The Business Case for PCMH: Supporting Transformation and Value-Based Payment

10 Political Pulse

CAFP Protects Patient Safety and Access in 2015

16 Membership

2015 Member of the Month Yearbook

30 EVP’s Forum

CAFP Goals and FMAHealth Goals Well-Aligned

Leah Newkirk Carla Kakutani, MD

Susan Hogeland, CAE

For upcominŐ CD acƟǀiƟes ǀisit familydocs͘orŐͬcme California California Family Family Physician Physician Winter Fall 2016 ϮϬϭϰ

5

EDITORIAL

ȱ ȱ ĵ ǰȱ ȱ

Keeping Modern Medicine from Becoming a Winchester House /Ŷ ŵLJ ŵĞĚŝĐĂů ƉƌĂĐƟĐĞ͕ / ƐŽŵĞƟŵĞƐ ĨĞĞů ůŝŬĞ Ă ƌƵŶŶŝŶŐ ďĂĐŬ ŵŽƌĞ ƚŚĂŶ Ă ƋƵĂƌƚĞƌďĂĐŬ͕ ĚŽĚŐŝŶŐ ŚĞƌĞ ĂŶĚ ƚŚĞƌĞ ƚŽ ĂǀŽŝĚ ƉŽƉͲƵƉ ƚĂĐŬůĞƐ ďLJ ĞůĞĐƚƌŽŶŝĐ ŵĞĚŝĐĂů ƌĞĐŽƌĚƐ ; DZͿ͕ ƚŽdžŝĐ ƉƌŝŽƌͲ ĂƵƚŚŽƌŝnjĂƟŽŶ ŚĂŶĚŽīƐ ĨƌŽŵ ŵĞĚŝĐĂů ĂƐƐŝƐƚĂŶƚƐ͕ ĂŶĚ ƚŚĞ ŝŶĂŶĞ ƉůĂLJ ĂĐƟŽŶ ĨƌŽŵ ďŽĂƌĚ ĂŶĚ ĐĂƌĞ ĨĂĐŝůŝƟĞƐ ŽŶ ŵLJ ĞůĚĞƌůLJ ƉĂƟĞŶƚƐ ;Dƌ͘ :ŽŶĞƐ ůŽƐƚ ƚǁŽ ƉŽƵŶĚƐ͘ tŚĂƚ͛Ɛ ŽƵƌ ƉůĂŶ͍Ϳ͘ ŶĚ ŝĨ /͛ŵ ƚĂĐŬůĞĚ͕ ǁŝůů ŵLJ ĐŽŶĐƵƐƐŝŽŶ ďĞ ͞ŝŶŝƟĂů͕͟ ͞ƐƵďƐĞƋƵĞŶƚ͟ Žƌ ͞ƐĞƋƵĞůĂ͍͟ ,ĂǀĞ / ďĞĞŶ ƚĂĐŬůĞĚ ďĞĨŽƌĞ͍ / ƚŚŝŶŬ ƐŽ͘ / ĨŽƌŐĞƚ͘ dŚĞ ĞŶĚ njŽŶĞ ŽĨ ŵŽĚĞƌŶ ĚĂLJ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝƐ ƚŚĞ WĂƟĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ͘ dŚŝƐ ŝƐ ĂŶ ŝĚĞĂůŝnjĞĚ ŽĸĐĞ ŝŶ ǁŚŝĐŚ ůĞĐƚƌŽŶŝĐ DĞĚŝĐĂů ZĞĐŽƌĚƐ ; DZͿ ŝŶƚĞƌĨĂĐĞ ǁŝƚŚ ĞǀĞƌLJŽŶĞ͖ ĚƌĂŐŽŶƐ ƵŶĚĞƌƐƚĂŶĚ LJŽƵƌ ĞǀĞƌLJ ǁŽƌĚ͖ ƚĞĚŝŽƵƐ ƚĂƐŬƐ ĂƌĞ ĚĞůĞŐĂƚĞĚ ĂŶĚ ŐůĂĚůLJ ĐĂƌƌŝĞĚ ŽƵƚ͖ ŵĞĂŶŝŶŐĨƵů ŚĞĂůƚŚ ƌĞƉŽƌƚƐ ŽŶ LJŽƵƌ ƉĂƟĞŶƚ ƉĂŶĞů ŵĂƚĞƌŝĂůŝnjĞ ŝŶ ĨƌŽŶƚ ŽĨ LJŽƵ͖ ŵĞŶƚĂů ŚĞĂůƚŚ ĂŶĚ ƐŽĐŝĂů ǁŽƌŬĞƌƐ ďƵnjnj ĂƌŽƵŶĚ ůŝŬĞ ůŽďďLJŝƐƚƐ Ăƚ ƚŚĞ ĂƉŝƚŽů ĂŶĚ Ă ƚĞĂŵ ĂƉƉƌŽĂĐŚ ůĞĂĚƐ ƚŽ ƉĂƟĞŶƚ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ǁĞůůŶĞƐƐ͘ tĞ͛ǀĞ ĚĞĮŶŝƚĞůLJ ŵĂĚĞ ƐŽŵĞ ƐƚƌŝĚĞƐ ƚŽǁĂƌĚ W D,͕ ďƵƚ / ĐĂŶ͛ƚ ŚĞůƉ ďƵƚ ƚŚŝŶŬ ŽĨ ĂŶŽƚŚĞƌ ŚŽŵĞ͕ ƚŚĞ tŝŶĐŚĞƐƚĞƌ DLJƐƚĞƌLJ ,ŽƵƐĞ ŝŶ ^ĂŶ :ŽƐĞ͕ ŶĞĂƌ ǁŚĞƌĞ / ŐƌĞǁ ƵƉ͘

ŽĚĚŝƟĞƐ͘ ^ƚĂŝƌĐĂƐĞƐ ůĞĂĚŝŶŐ ƚŽ ŶŽǁŚĞƌĞ͕ ĚŽŽƌƐ ŝŶ ƚŚĞ ŇŽŽƌ͕ ĐĂďŝŶĞƚƐ ƚŚĂƚ ŽƉĞŶ ŽŶƚŽ ǁĂůůƐ͕ ŶĂƌƌŽǁ ŚĂůůǁĂLJƐ͕ ůŽǁ ĐĞŝůŝŶŐƐ ĂŶĚ ŐƌŽƵƉŝŶŐƐ ŽĨ ŝƚĞŵƐ ƚŚĂƚ ƌĞŇĞĐƚ DƌƐ͘ tŝŶĐŚĞƐƚĞƌ͛Ɛ ŽďƐĞƐƐŝŽŶ ǁŝƚŚ ƚŚĞ ŶƵŵďĞƌ ϭϯ͘ ,Žǁ ĚŽ ǁĞ ŬĞĞƉ ŽƵƌ W D, ĨƌŽŵ ďĞĐŽŵŝŶŐ Ă tŝŶĐŚĞƐƚĞƌ ,ŽƵƐĞ͍ Kƌ ŚĂƐ ŝƚ ĂůƌĞĂĚLJ ďĞĐŽŵĞ ŽŶĞ͍

¢ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ¢ȱ ¢ȱ ȱ ȱ ȱ ȱ ě ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ

tĞůů͕ ĞǀĞƌLJ ŚŽŵĞ ŶĞĞĚƐ Ă ŐŽŽĚ ĨŽƵŶĚĂƟŽŶ͕ ĂŶĚ ĞǀĞƌLJ ĐŽƵŶƚƌLJ ĂƌŽƵŶĚ ƚŚĞ ǁŽƌůĚ ǁŝƚŚ ĞīĞĐƟǀĞ ƵŶŝǀĞƌƐĂů ŚĞĂůƚŚ ĐĂƌĞ ŚĂƐ Ă ƐƚƌŽŶŐ ƉƌŝŵĂƌLJ ĐĂƌĞ ĨŽƵŶĚĂƟŽŶ͘ ĂĐŚ ŽĨ ƚŚĞƐĞ ĐŽƵŶƚƌŝĞƐ ŚĂƐ Ă ŐŽǀĞƌŶŵĞŶƚ ƚŚĂƚ ĞīĞĐƟǀĞůLJ ƐƵďƐŝĚŝnjĞƐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ͕ ƌĞŐƵůĂƚĞƐ ƉŚĂƌŵĂĐĞƵƟĐĂů ƉƌŝĐĞƐ ĂŶĚ ŵĞĚŝĐĂů ĚĞǀŝĐĞƐ ĂŶĚ ĐƵƌƚĂŝůƐ ŝŶƐƵƌĂŶĐĞ ƐŚĞŶĂŶŝŐĂŶƐ͘ KƵƌ ĐŽƵŶƚƌLJ͛Ɛ ŐŽǀĞƌŶŵĞŶƚ ŐŽĞƐ ƚŚƌŽƵŐŚ ĮƚƐ ĂŶĚ ƐƉƵƌƚƐ ŽĨ ŽŌĞŶ ǁĞůůͲŵĞĂŶŝŶŐ ĞīŽƌƚƐ ƚŚĂƚ ŝŶĞǀŝƚĂďůLJ ďĂĐŬĮƌĞ Žƌ ĂƌĞ ƚŽŽ ƐŵĂůů ƚŽ ŵĂŬĞ Ă ĚŝīĞƌĞŶĐĞ͘ tŚLJ ĚĞĐůŝŶĞ ŵLJ DĞĚŝĐĂƌĞ ƉĂƟĞŶƚ͛Ɛ ƚŚLJƌŽŝĚ ƐƟŵƵůĂƟŶŐ ŚŽƌŵŽŶĞ ŽƌĚĞƌĞĚ ĨŽƌ ĨĂƟŐƵĞ ďƵƚ ĂƉƉƌŽǀĞ ƚŚĂƚ ĮŌŚ ŶƵĐůĞĂƌ ŚĞĂƌƚ ƐĐĂŶ Žƌ ƚŚĂƚ ŵĂŐŶĞƟĐ ƌĞƐŽŶĂŶĐĞ ŝŵĂŐŝŶŐ ŽĨ ƚŚĞ ďƌĂŝŶ ƚŚĂƚ ǁŽŶ͛ƚ ĐŚĂŶŐĞ ŵĂŶĂŐĞŵĞŶƚ͍

&ŝƌĞĂƌŵƐ ŚĞŝƌĞƐƐ ^ĂƌĂŚ tŝŶĐŚĞƐƚĞƌ͕ ŐƌŝĞǀŝŶŐ ƚŚĞ ĚĞĂƚŚƐ ŽĨ ŚĞƌ ŚƵƐďĂŶĚ ĂŶĚ ŽŶůLJ ĐŚŝůĚ ʹ ŽŚ LJĞĂŚ͕ ĂŶĚ ƐŽŵĞ ϭϬϬ ŵŝůůŝŽŶ ĨŽůŬƐ ŬŝůůĞĚ ďLJ tŝŶĐŚĞƐƚĞƌ ƌŝŇĞƐ ŽǀĞƌ ƚŚĞ LJĞĂƌƐ ʹ ůŽƐƚ ŚĞƌ ƉŽƌĐŚ ůŝŐŚƚ ďƵƚ ďƵŝůƚ ĂŶĚ ĐŽŶƟŶƵŽƵƐůLJ ƌĞŶŽǀĂƚĞĚ ƚŚĞ ďŝnjĂƌƌĞ ϭϲϬͲƌŽŽŵ͕ Ϯϰ͕ϬϬϬͲƐƋƵĂƌĞ ĨŽŽƚ ŵĂŶƐŝŽŶ ďĞĨŽƌĞ ĚLJŝŶŐ ϯϴ LJĞĂƌƐ ůĂƚĞƌ ŝŶ ϭϵϮϮ͘ ^ŚĞ ĚŝĚ ƚŚŝƐ ŽŶ ƚŚĞ ĂĚǀŝĐĞ ŽĨ Ă ŽƐƚŽŶ ƐƉŝƌŝƚƵĂůŝƐƚ ǁŚŽ ƚŽůĚ ŚĞƌ ƚŚĂƚ ƚŚĞ ŽŶůLJ ǁĂLJ ƚŽ ĂƉƉĞĂƐĞ ƚŚĞ ƐƉŝƌŝƚƐ ƚŽƌŵĞŶƟŶŐ ŚĞƌ ǁĂƐ ƚŽ ďƵŝůĚ Ă ŚŽŵĞ ĂŶĚ ŶĞǀĞƌ ƐƚŽƉ ďƵŝůĚŝŶŐ ŝƚ͘ ; ĞƐƚ ĂĚǀŝĐĞ ĞǀĞƌ͊Ϳ

/ƚ ŝƐ ŝŶĨƵƌŝĂƟŶŐ ƚŽ ďĞ ƚŽůĚ ŶŽƚ ƚŽ ůĞĂǀĞ ƚŚĞ > ŶŝŐŚƚůŝŐŚƚ ŽŶ ŝŶ ŽŶĞ ƌŽŽŵ͕ ĂŶĚ ŚĂǀĞ ƚŚĞ ŐĂƐ ĮƌĞƉůĂĐĞ ďůĂnjŝŶŐ Ϯϰͬϳ ŝŶ ƚŚĞ ŽƚŚĞƌ͘ ůů ƐŚĞŶĂŶŝŐĂŶƐ ĂŶĚ ƉLJƌĂŵŝĚ ƐĐŚĞŵĞƐ ŵƵƐƚ ĐŽŵĞ ƚŽ ĂŶ ĞŶĚ͕ ŚŽǁĞǀĞƌ͘ dŚĞ ĞŶĚ ŝƐ ŝŶ ƐŝŐŚƚ͘ &W ĂŶĚ &W ĂƌĞ ƉƌŽŵŽƟŶŐ ŽƵƌ ŝŶƚĞƌĞƐƚƐ ĂŶĚ ŐĞƫŶŐ ŵŽƌĞ ŽĨ ĂŶ ĂƵĚŝĞŶĐĞ ǁŝƚŚ ĚĞĐŝƐŝŽŶ ŵĂŬĞƌƐ͘ ,ĞĂůƚŚ ĐĂƌĞ ŐŝĂŶƚƐ ĂƌĞ ƐƚĂƌƟŶŐ ƚŽ ƌĞŝŐŶ ŝŶ ƚŚĂƚ ϯϬ ƉĞƌĐĞŶƚ ĞƌǁŝĐŬŝĂŶ ǁĂƐƚĞ͘ dŚĞ ǁƌĞĐŬŝŶŐ ďĂůů ŝƐ ƉŽŝƐĞĚ ƚŽ ƐŚĂƩĞƌ ƐŽŵĞ ŽĨ ŵĞĚŝĐŝŶĞ͛Ɛ ĂƌƌĞŶƚ ƌŽŽŵƐ͘ tĞ ŶĞĞĚ ƚŽ ďĞ ƚŚĞ ĂƌĐŚŝƚĞĐƚƐ͕ ŚĂƌĚŚĂƚ ǁĞĂƌĞƌƐ͕ ŝŶƐƉĞĐƚŽƌƐ ĂŶĚ ŽĐĐƵƉĂŶƚƐ ŽĨ ƚŚŝƐ ŶĞǁ W D,͘

dŚĞ ƌĞƐƵůƚ ŝƐ Ă ŚŽƵƐĞ ƚŚĂƚ ŶŽǁ ŝƐ ƚŽƵƌĞĚ ĨŽƌ ŝƚƐ ĞŶĚůĞƐƐ ĚĞƐŝŐŶ

dŚŝƐ ŝƐƐƵĞ ŵĞĂŶƐ ďƵƐŝŶĞƐƐ͕ ĂŶĚ ƐŽ ĚŽ ǁĞ͊

6

California Family Physician Winter 2016

Save the Date! CAPG Annual Conference 2016 Sharing The Lessons of Innovative Payment Models Ă•Â˜iĂŠÂŁĂˆÂ‡ÂŁÂ™]ĂŠĂ“ä£ĂˆĂŠĂŠUĂŠĂŠ >˜VÂ…iĂƒĂŒiÀÊ Ă€>˜`ĂŠ Ăž>ĂŒĂŒ]ĂŠ->Â˜ĂŠ ˆi}Âœ]ĂŠ Taking risk is no longer just an option. The Medicare Access and CHIP Reauthorization Act of 2015—MACRA—is effectively making risk mandatory for physician organizations that want to y stayy in the g game. And where Medicare g goes, commercial p payers will follow. At our Annual Conference on knowledge and best practices from physician Conference, you’ll gain hands hands-on organizations who are thriving in both government and commercial risk arrangements, along with high-level insights on the political and legislative forecast for value-based care.

Don’t get left behind.

Registration opens end of January at capg.org/conference2016

Top Reasons Physicians Join MedLion 1. No coding, no claims. 2. Less paperwork, more autonomy. 3. Seamless integration with practice at no cost. 4. Guaranteed $50 per patient per month. 5. Being able to enjoy practicing medicine again.

MedLion is the nation’s largest DPC group. Join us today!

MedLion Direct Primary Care Is Expanding Its Provider Network Please contact Samantha at info@medlion.com or call 855.211.3223 to become a MedLion provider.

www.MedLion.com California Family Physician Winter 2016

7

PRESIDENT’S MESSAGE

¢ȱ ǯȱ ǰȱ ǰȱ

Balancing the Business and Busyness of Family Medicine >Ğƚ͛Ɛ ƚĂůŬ ĂďŽƵƚ ƚŚĞ ďƵƐLJŶĞƐƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ EŽ͕ ƚŚĂƚ͛Ɛ ŶŽƚ Ă ƚLJƉŽ͘ / ŵĞĂŶ ŝƚ͘ ,Žǁ ĚŝĚ ǁĞ Ăůů ŐĞƚ ƐŽ ďƵƐLJ͍ ŶĚ ǁŚĞŶ ĚŝĚ ĐĂƌŝŶŐ ĨŽƌ ƉĂƚŝĞŶƚƐ ƐŽŵĞƚŝŵĞƐ ďĞĐŽŵĞ ƐŽ ĨĂƌ ƌĞŵŽǀĞĚ ĨƌŽŵ ǁŚĂƚ ǁĞ ǁƌŽƚĞ ĂďŽƵƚ ŝŶ ŽƵƌ ƉĞƌƐŽŶĂů ƐƚĂƚĞŵĞŶƚƐ͍ DLJ ĚĞĂƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ĐŽůůĞĂŐƵĞƐ͕ ŝƚ ŝƐ ďĞĐĂƵƐĞ ŽĨ ƚŚĞ ďƵƐŝŶĞƐƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƚŚĂƚ ǁĞ ŚĂǀĞ ďĞĐŽŵĞ ƐŽ ďƵƐLJ͘ >ĞƐƚ LJŽƵ ƚŚŝŶŬ ŵLJ WƌĞƐŝĚĞŶƚ͛Ɛ ŵĞƐƐĂŐĞ ďĞĐŽŵĞƐ Ă ĚŝĂƚƌŝďĞ ĂďŽƵƚ ĚŝǀŽƌĐŝŶŐ ďƵƐŝŶĞƐƐ ĐŽŵƉůĞƚĞůLJ ĨƌŽŵ ŚĞĂůƚŚ ĐĂƌĞ͕ ďƌŝŶŐŝŶŐ ƵƐ ďĂĐŬ ƚŽ ƚŚĞ ĚĂLJƐ ŽĨ LJŽƌĞ ǁŚĞŶ ƉĂƚŝĞŶƚƐ ďĂƌƚĞƌĞĚ ĨŽƌ ŽƵƌ ĐĂƌĞ ;ƚŚŽƵŐŚ ƚŚĞƌĞ ŝƐ Ă ďĞĂƵƚŝĨƵů ƐŝŵƉůŝĐŝƚLJ ƚŽ ƚŚĂƚ ŵŽĚĞůͿ͕ / ǁŝůů ĂĐŬŶŽǁůĞĚŐĞ ƚŚĂƚ ŚĂǀŝŶŐ ƐŽŵĞ ďƵƐŝŶĞƐƐ ƐƚƌƵĐƚƵƌĞ ŵĂŬĞƐ ƐĞŶƐĞ͘ tĞ ŚĂǀĞ ƚŽ ďĞ ĂďůĞ ƚŽ ŬĞĞƉ ŽƵƌ ĚŽŽƌƐ ŽƉĞŶ ĂŶĚ ƚŚĞ ůŝŐŚƚƐ ŽŶ͘ tĞ ŚĂǀĞ ƚŽ ďĞ ĂďůĞ ƚŽ ƐƚŽĐŬ ŽƵƌ ĞdžĂŵ ƌŽŽŵƐ͘ tĞ ŚĂǀĞ ƚŽ ďĞ ĂďůĞ ƚŽ ƉĂLJ ŽƵƌ ƐƚĂĨĨ͘ tĞ ŚĂǀĞ ƚŽ ďĞ ĂďůĞ ƚŽ ŵĞĞƚ ŽƵƌ ďĂƐŝĐ DĂƐůŽǁŝĂŶ ŶĞĞĚƐ͕ ŝŶĐůƵĚŝŶŐ ĨŽŽĚ ĂŶĚ ƐŚĞůƚĞƌ͘ tĞ ŚĂǀĞ ƚŽ ďĞ ĂďůĞ ƚŽ ƉĂLJ ďĂĐŬ ŽƵƌ ƐƚƵĚĞŶƚ ůŽĂŶƐ͘ KŚ͕ ĂŶĚ ǁĞ ĂůƐŽ ŵŝŐŚƚ ǁĂŶƚ ƚŽ ůŝǀĞ Ă ůŝĨĞ͕ ƌĂŝƐĞ Ă ĨĂŵŝůLJ͕ ƚƌĂǀĞů͕ ĞƚĐ͘

/ƚ ŝƐ ƚŝŵĞ ĨŽƌ ƵƐ ƚŽ ƌŝƐĞ ƵƉ ĂŶĚ ďĞĐŽŵĞ ƚŚĞ ƉŚLJƐŝĐŝĂŶ ůĞĂĚĞƌƐ ŽƵƌ ƉĂƚŝĞŶƚƐ ŶĞĞĚ ƵƐ ƚŽ ďĞ͘ dŚĂƚ ŵĞĂŶƐ ǁĞ ŵƵƐƚ ďĞ Ă ŬĞLJ ƉĂƌƚ ŽĨ ƚŚĞ ƐŽůƵƚŝŽŶ ĨŽƌ ĂĐŚŝĞǀŝŶŐ dƌŝƉůĞ ŝŵ ;ďĞƚƚĞƌ ĐĂƌĞ͕ ďĞƚƚĞƌ ŚĞĂůƚŚ͕ ƌĞĂƐŽŶĂďůĞ ĐŽƐƚͿ͘ tŝƚŚ ƚŚĞ DĞĚŝĐĂƌĞ ĐĐĞƐƐ ĂŶĚ ,/W ZĞĂƵƚŚŽƌŝnjĂƚŝŽŶ Đƚ ;ĂŬĂ D Z Ϳ͕ ǁĞ ŚĂǀĞ Ă ĐŚĂŶĐĞ ƚŽ ďĞƚƚĞƌ ĚĞĨŝŶĞ ǁŚĂƚ ƉƌŝŵĂƌLJ ĐĂƌĞ ŵĞƚƌŝĐƐ ƚƌƵůLJ ŵĂƚƚĞƌ͗ ĐĂƌĞ ƚŚĂƚ ŝƐ ĂĐĐĞƐƐŝďůĞ͕ ĐŽŶƚŝŶƵŽƵƐ͕ ĐŽŵƉƌĞŚĞŶƐŝǀĞ͕ ĐŽŽƌĚŝŶĂƚĞĚ͕ ĂŶĚ ĨŽĐƵƐĞĚ ŽŶ ƚŚĞ ǁŚŽůĞ ƉĞƌƐŽŶͬƉŽƉƵůĂƚŝŽŶ͘ tĞ ŚĂǀĞ ƚŽ ĚĞŵĂŶĚ ƚŚĂƚ ƚŚĞ ďƵƐŝŶĞƐƐ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ďĞĐŽŵĞ ĂůŝŐŶĞĚ ǁŝƚŚ ƚŚĞƐĞ ǀĂůƵĞƐ ƐŽ ǁĞ ĐĂŶ ŵĂŬĞ ŚĞĂůƚŚ ƉƌŝŵĂƌLJ ŽŶĐĞ ĂŐĂŝŶ͘ KŶůLJ ƚŚĞŶ ǁŝůů ǁĞ ĂĐŚŝĞǀĞ ƚŚĞ ũŽLJ ŝŶ ƉƌĂĐƚŝĐĞ ŶĞĐĞƐƐĂƌLJ ƚŽ ĂĐŚŝĞǀĞ ƚŚĞ YƵĂĚƌƵƉůĞ ŝŵ͘

ȱ ȱ ȱ ȱ ȱ ¢ȱ ¢ ǰȱ¢ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ǯȱ ȱ¢ ȱ ȱ ȱ ȱ ǰȱ Ě ȱ ȱ¢ ȱ ¢ ǯ

dŚĂƚ ďĞŝŶŐ ƐĂŝĚ͕ ƚŚĞ ďƵƐŝŶĞƐƐ ŽĨ ŚĞĂůƚŚ ĐĂƌĞ ŚĂƐ ŐŽƚƚĞŶ ƐŽ ĐŽŵƉůŝĐĂƚĞĚ ƚŚĂƚ ƚŚĞ ĚĂLJƐ ŽĨ ƐŝŵƉůLJ ŚĂŶŐŝŶŐ LJŽƵƌ ŶĂŵĞ ŽŶ Ă ƐŚŝŶŐůĞ ĂƌĞ ŐŽŶĞ͘ dŚĞ ĂĚŵŝŶŝƐƚƌĂƚŝǀĞ ďƵƌĚĞŶ ŽĨ ĐĂƌŝŶŐ ĨŽƌ ƉĂƚŝĞŶƚƐ ŚĂƐ ďĞĐŽŵĞ ƵŶǁŝĞůĚůLJ͘ /Ŷ ĨĂĐƚ͕ ƚŚĞ ƐĞƌǀŝĐĞƐ ǁĞ ƉŚLJƐŝĐŝĂŶƐ ŐĞƚ ƉĂŝĚ ĨŽƌ ĂƌĞ ŶŽǁ ƌĞĨĞƌƌĞĚ ƚŽ ĂƐ Ă ͞ŵĞĚŝĐĂů ůŽƐƐ ƌĂƚŝŽ͟ ďLJ ŝŶƐƵƌĂŶĐĞ ĐŽŵƉĂŶŝĞƐ͘ dŚĞ ĂĚǀĞŶƚ ŽĨ ĞůĞĐƚƌŽŶŝĐ ŵĞĚŝĐĂů ƌĞĐŽƌĚƐ ŚĂƐ ŽŶůLJ ĂĐĐĞůĞƌĂƚĞĚ Žƌ ĂŵƉůŝĨŝĞĚ ;Žƌ ĂĐĐĞůĞƌĂƚĞĚ ΎĂŶĚΎ ĂŵƉůŝĨŝĞĚͿ ǁŚĂƚĞǀĞƌ ŝŶĞĨĨŝĐŝĞŶĐŝĞƐ ƚŚĞ ĚĞůŝǀĞƌLJ ƐLJƐƚĞŵ ŚĂĚ ƚŽ ďĞŐŝŶ ǁŝƚŚ͘ DĞĂŶǁŚŝůĞ͕ ǁĞ ŚĂǀĞ ŝŶĐƌĞĂƐŝŶŐ ƌĞƉŽƌƚŝŶŐ ďƵƌĚĞŶƐ ƚŽ ĚĞŵŽŶƐƚƌĂƚĞ ƚŚĞ ͞ƋƵĂůŝƚLJ͟ ŽĨ ĐĂƌĞ ǁĞ ƉƌŽǀŝĚĞ͘ ,Žǁ ĚŝĚ ƚŚĞ ƉƌĂĐƚŝĐĞ ŽĨ ŵĞĚŝĐŝŶĞ ďĞĐŽŵĞ ƐŽ ĨĂƌ ƌĞŵŽǀĞĚ ĨƌŽŵ ŽƵƌ ŝĚĞĂůƐ͍ tĞ ůĞƚ ŝƚ ďĞĐŽŵĞ ƚŚŝƐ ǁĂLJ͘ tĞ ĂďĚŝĐĂƚĞĚ ŽƵƌ ƌĞƐƉŽŶƐŝďŝůŝƚLJ ĨŽƌ ŚŽůĚŝŶŐ ƚŚĞ ƉĂƚŝĞŶƚͲĚŽĐƚŽƌ ƌĞůĂƚŝŽŶƐŚŝƉ Ăƚ ƚŚĞ ĐĞŶƚĞƌ ŽĨ ĐĂƌĞ͕ ďĞĐĂƵƐĞ ĚĂŵŵŝƚ͕ :ŝŵ͕ /͛ŵ Ă ĚŽĐƚŽƌ ŶŽƚ Ă ďƵƐŝŶĞƐƐ ;ǁŽͿŵĂŶ͘ ŶĚ ǁŚĞŶ ǁĞ͛ƌĞ ŶŽƚ Ăƚ ƚŚĞ ƚĂďůĞ͕ ǁĞ͛ƌĞ ŽŶ ƚŚĞ ŵĞŶƵ͘ /ƚ͛Ɛ ŶŽƚ ƚŽŽ ůĂƚĞ ƚŽ ŐƌĂď ŝƚ ďĂĐŬ͘

8

California Family Physician Winter 2016

Ɛ /͛ǀĞ ƚƌĂǀĞůĞĚ ƵƉ ĂŶĚ ĚŽǁŶ ŽƵƌ ƐƚĂƚĞ ƚŚŝƐ LJĞĂƌ ĂƐ LJŽƵƌ ƉƌĞƐŝĚĞŶƚ͕ /͛ǀĞ ŚĞĂƌĚ ĨƌŽŵ ŵĞŵďĞƌƐ ůŝŬĞ LJŽƵ ǁŚŽ ĂƌĞ ǁŽƌƌŝĞĚ ĂďŽƵƚ ƚŚĞ ŝŶĐƌĞĂƐŝŶŐ ĂĚŵŝŶŝƐƚƌĂƚŝǀĞ ďƵƌĚĞŶ ǁĞ Ăůů ĨĂĐĞ ƚŽ ĚĞůŝǀĞƌ ŚŝŐŚ ǀĂůƵĞ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ zŽƵƌ ĐĂĚĞŵLJ ŝƐ ĨŽĐƵƐĞĚ ŽŶ ŚĞůƉŝŶŐ LJŽƵ ŶĂǀŝŐĂƚĞ ƚŚĞƐĞ ƵŶĐĞƌƚĂŝŶ ƚŝŵĞƐ ƚŚƌŽƵŐŚ ŽƵƌ ƐƚƌĂƚĞŐŝĐ ǁŽƌŬ ŽŶ ƉĂLJŵĞŶƚ ƌĞĨŽƌŵ͕ ƉƌĂĐƚŝĐĞ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ͕ ǁŽƌŬĨŽƌĐĞ ĂŶĚ ũŽLJ ŝŶ ƉƌĂĐƚŝĐĞ͘ /ƚ ĐŽŶƚŝŶƵĞƐ ƚŽ ďĞ ŵLJ ŚŽŶŽƌ ĂŶĚ ƉƌŝǀŝůĞŐĞ ƚŽ ƌĞƉƌĞƐĞŶƚ LJŽƵ͕ ĂŶĚ / ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƚŚĞ ĚĂLJ Ăůů ŽĨ ƵƐ ĂƌĞ ĂďůĞ ƚŽ ŐĞƚ ďĂĐŬ ƚŽ ƚŚĞ ďƵƐŝŶĞƐƐ ŽĨ ĐĂƌŝŶŐ͘ /Ŷ ƚŚŝƐ ŝƐƐƵĞ ŽĨ ĂůŝĨŽƌŶŝĂ &ĂŵŝůLJ WŚLJƐŝĐŝĂŶ͕ LJŽƵ ǁŝůů ƌĞĂĚ ƐƚŽƌŝĞƐ ĂďŽƵƚ ƚŚĞ ďƵƐŝŶĞƐƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͘ Ɛ LJŽƵ ƌĞĂĚ ĂďŽƵƚ ƚŚĞ ďƵƐŝŶĞƐƐ͕ ƌĞĨůĞĐƚ ƵƉŽŶ LJŽƵƌ ďƵƐLJŶĞƐƐ͘ ,Žǁ ĐĂŶ ǁĞ ďĞƐƚ ĂůŝŐŶ ƚŚĞ ďƵƐŝŶĞƐƐ ŽĨ ŵĞĚŝĐŝŶĞ ǁŝƚŚ ŽƵƌ ǀĂůƵĞƐ͍ tŚĞŶ ĚŽ ǁĞ ƐĂLJ ĞŶŽƵŐŚ ŝƐ ĞŶŽƵŐŚ ĂŶĚ ĨŝŐŚƚ ďĂĐŬ ĂŐĂŝŶƐƚ ƚŚĞ ƐƚĂƚƵƐ ƋƵŽ ŝŶƐƚĞĂĚ ŽĨ ǁĂŝƚŝŶŐ ĨŽƌ ŽƚŚĞƌƐ ƚŽ ŐŝǀĞ ƵƐ ƚŚĞ ũŽLJ ǁĞ Ăŝŵ ĨŽƌ ŝŶ ŽƵƌ ĐůŝŶŝĐĂů ƉƌĂĐƚŝĐĞ͍ tŚĞŶ ĚŽ ǁĞ ƐĂLJ ŶŽ ŵŽƌĞ ŵĞĂŶŝŶŐůĞƐƐ ĂďƵƐĞ͍ tĞ ŵƵƐƚ ƐĞƚ ƚŚĂƚ ďĂƌ ŚŝŐŚ ĂŶĚ ǁĞ ŵƵƐƚ ĞdžƉĞĐƚ ƚŽ ƌĞĂĐŚ ŝƚ ƚŽŐĞƚŚĞƌ͘ /ƚ ŝƐ ŽŶůLJ ďLJ ŚĞůƉŝŶŐ ŽŶĞ ĂŶŽƚŚĞƌ ƌŝƐĞ ƵƉ ƚŚĂƚ ǁĞ ǁŝůů ďĞ ĂďůĞ ƚŽ ƌŝƐĞ ƵƉ ĞŶ ŵĂƐƐĞ ĂŶĚ ĐƌĞĂƚĞ ƚŚĞ &ŽƌĐĞ ŶĞĞĚĞĚ ƚŽ ŵĂŬĞ ƚŚĞ ƐLJƐƚĞŵ ĐŚĂŶŐĞ͘ /Ĩ LJŽƵ͛Ě ůŝŬĞ ƚŽ ƐŚĂƌĞ LJŽƵƌ ƐƚŽƌLJ ĂďŽƵƚ ƚŚĞ ďƵƐLJŶĞƐƐ ŽĨ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ͕ ƉůĞĂƐĞ ĐŽŶƚĂĐƚ &W ǀŝĂ ĞŵĂŝů ;ĐĂĨƉΛĨĂŵŝůLJĚŽĐ͘ŽƌŐͿ Žƌ ƉŽƐƚ Ă ĐŽŵŵĞŶƚ ŽŶ ŽƵƌ &ĂĐĞŬ ƉĂŐĞ ;ĨĂĐĞŬ͘ĐŽŵͬ ĨĂŵŝůLJĚŽĐƐͿ͘

ȱ ȱ

PCMH CORNER

The Business Case for PCMH: Supporting Transformation and Value-Based Payment &Žƌ ƐĞǀĞƌĂů LJĞĂƌƐ ŶŽǁ͕ ĂĚǀĂŶĐŝŶŐ ƚŚĞ WĂƚŝĞŶƚ ĞŶƚĞƌĞĚ DĞĚŝĐĂů ,ŽŵĞ ;W D,Ϳ ŵŽĚĞů ŚĂƐ ďĞĞŶ Ă ƐƚƌĂƚĞŐŝĐ ŐŽĂů ĨŽƌ &W͘ KǀĞƌ ƚŚĞƐĞ LJĞĂƌƐ͕ ĂůŝĨŽƌŶŝĂ͛Ɛ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĐŽŶƐŝƐƚĞŶƚůLJ ĞdžƉƌĞƐƐ ŝŶƚĞƌĞƐƚ ŝŶ ƉƌĂĐƚŝĐĞ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ ĂŶĚ W D,͕ ďƵƚ ũƵƐƚ ĂƐ ĐŽŶƐŝƐƚĞŶƚůLJ ĞdžƉƌĞƐƐ ĐŽŶĐĞƌŶ ĂďŽƵƚ ƚŚĞ ďƵƐŝŶĞƐƐ ŵŽĚĞů͘ /ŶĐƌĞĂƐĞĚ ĂĐĐĞƐƐ͕ ĚĂƚĂͲĚƌŝǀĞŶ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ƐƚƌĂƚĞŐŝĞƐ͕ ĐĂƌĞ ŵĂŶĂŐĞŵĞŶƚ ĨŽƌ ĐŚƌŽŶŝĐ ŝůůŶĞƐƐ͕ ƚĞĂŵͲďĂƐĞĚ ĐĂƌĞ͕ ĞŵƉĂŶĞůŵĞŶƚ ĂŶĚ ƉŽƉƵůĂƚŝŽŶ ŚĞĂůƚŚ ƌĞƋƵŝƌĞ ĂŶ ŝŶǀĞƐƚŵĞŶƚ ďLJ ŐƌŽƵƉƐ ĂŶĚ ƉƌĂĐƚŝĐĞƐ͘ dƌĂŶƐĨŽƌŵŝŶŐ ƚŽ ƚŚĞ W D, ŵŽĚĞů ĐĂŶ ƌĞƋƵŝƌĞ ĐŽĂĐŚŝŶŐ ĂŶĚ ĞĚƵĐĂƚŝŽŶ ĂŶĚ ĐĂŶ ƉŽƚĞŶƚŝĂůůLJ ƌĞƐƵůƚ ŝŶ Ă ƐŚŽƌƚͲƚĞƌŵ ůŽƐƐ ŽĨ ƉƌŽĚƵĐƚŝǀŝƚLJ ĂƐ ůĞĂĚĞƌƐŚŝƉ ĚĞǀŽƚĞƐ ƚŝŵĞ ƚŽ ƚŚĞ ĞĨĨŽƌƚ͘ dŚĞ ŵŽĚĞů ĐĂŶ ŝŶĐůƵĚĞ ŶĞǁ ƐƚĂĨĨ ƉŽƐŝƚŝŽŶƐ ĂŶĚ ƌĞƋƵŝƌĞ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚĞĐŚŶŽůŽŐLJ͕ ĂŶĚ ƋƵĞƐƚŝŽŶƐ ƌŝŐŚƚĨƵůůLJ ĂƌĞ ƌĂŝƐĞĚ ĂďŽƵƚ ǁŚĂƚ ŬŝŶĚ ŽĨ ƌĞƚƵƌŶ ŽŶ ŝŶǀĞƐƚŵĞŶƚ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂŶƚŝĐŝƉĂƚĞ͘ Ƶƚ ĂƐ LJŽƵ ǁŝůů ƌĞĂĚ͕ ŶĞǁ ŝŶĐĞŶƚŝǀĞƐ ĞdžŝƐƚ ĨŽƌ ƚƌĂŶƐĨŽƌŵŝŶŐ ƚŽ ƚŚĞ W D,͕ ĂŶĚ &W ŚĂƐ Ă ƚǁŽͲƉĂƌƚ ƌĞĐŽŵŵĞŶĚĂƚŝŽŶ ƚŽ ĂŶƐǁĞƌ ƚŚĞ ƉƌĂĐƚŝĐŝŶŐ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ͛Ɛ ƋƵĞƐƚŝŽŶƐ͗ ;ϭͿ ŝĚĞŶƚŝĨLJ ĂǀĂŝůĂďůĞ ƌĞƐŽƵƌĐĞƐ ƚŽ ƐƵƉƉŽƌƚ LJŽƵƌ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ ĂŶĚ ƚŚĞƌĞďLJ ƌĞĚƵĐĞ ƐŽŵĞ ŽĨ ƚŚĞ ͞ƐƚĂƌƚƵƉ͟ ĐŽƐƚƐ ƌĞƋƵŝƌĞĚ ŽĨ LJŽƵƌ ŐƌŽƵƉ Žƌ ƉƌĂĐƚŝĐĞ͖ ĂŶĚ ;ϮͿ ƉƌĞƉĂƌĞ ĨŽƌ Ă ĨƵƚƵƌĞ ŝŶ ǁŚŝĐŚ ƉŚLJƐŝĐŝĂŶƐ ĂƌĞ ƉĂŝĚ ĨŽƌ ǀĂůƵĞ ŶŽƚ ǀŽůƵŵĞ͘ Support for Transformation &W ĞŶĐŽƵƌĂŐĞƐ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ŝŶǀĞƐƚŝŐĂƚĞ ĂǀĂŝůĂďůĞ ƌĞƐŽƵƌĐĞƐ ƚŽ ƐƵƉƉŽƌƚ ƉƌĂĐƚŝĐĞ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ͘ ,ĞƌĞ ĂƌĞ ƐŽŵĞ ƉŽƚĞŶƚŝĂů ƐŽƵƌĐĞƐ ŽĨ ƐƵƉƉŽƌƚ ŝŶ ĂůŝĨŽƌŶŝĂ͗ TransforminŐ Clinical Practice /nitiatiǀe /Ŷ ƚŚĞ ĨĂůů ŽĨ ϮϬϭϱ͕ ƚŚĞ ĞŶƚĞƌ ĨŽƌ DĞĚŝĐĂƌĞ ĂŶĚ DĞĚŝĐĂŝĚ ^ĞƌǀŝĐĞƐ ; D^Ϳ /ŶŶŽǀĂƚŝŽŶ ĞŶƚĞƌ ĂŶŶŽƵŶĐĞĚ ŝƚ ǁĂƐ ĂǁĂƌĚŝŶŐ Ϯϵ ŐƌĂŶƚƐ ƚŽ WƌĂĐƚŝĐĞ dƌĂŶƐĨŽƌŵĂƚŝŽŶ EĞƚǁŽƌŬƐ ŝŶ ƚŚĞ dƌĂŶƐĨŽƌŵŝŶŐ ůŝŶŝĐĂů WƌĂĐƚŝĐĞ /ŶŝƚŝĂƚŝǀĞ ;d W/Ϳ͘ d W/ ŝƐ ĚĞƐŝŐŶĞĚ ƚŽ ŚĞůƉ ĐůŝŶŝĐŝĂŶƐ ĂĐŚŝĞǀĞ ůĂƌŐĞͲƐĐĂůĞ ŚĞĂůƚŚ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ ďLJ ƐƵƉƉŽƌƚŝŶŐ ŵŽƌĞ ƚŚĂŶ ϭϰϬ͕ϬϬϬ ĐůŝŶŝĐŝĂŶ ƉƌĂĐƚŝĐĞƐ ŽǀĞƌ ƚŚĞ ŶĞdžƚ ĨŽƵƌ LJĞĂƌƐ ŝŶ ƐŚĂƌŝŶŐ͕ ĂĚĂƉƚŝŶŐ ĂŶĚ ĨƵƌƚŚĞƌ ĚĞǀĞůŽƉŝŶŐ ĐŽŵƉƌĞŚĞŶƐŝǀĞ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ƐƚƌĂƚĞŐŝĞƐ͘ &ŝǀĞ ĂǁĂƌĚĞĞƐ Ăŝŵ ƚŽ ǁŽƌŬ ǁŝƚŚ ƉƌĂĐƚŝĐĞƐ ŝŶ ĂůŝĨŽƌŶŝĂ͗ >ŽĐĂů /ŶŝƚŝĂƚŝǀĞ ,ĞĂůƚŚ ƵƚŚŽƌŝƚLJ ŽĨ >ŽƐ ŶŐĞůĞƐ ŽƵŶƚLJ͕ EĂƚŝŽŶĂů ZƵƌĂů ĐĐŽƵŶƚĂďůĞ ĂƌĞ ŽŶƐŽƌƚŝƵŵ͕ WĂĐŝĨŝĐ ƵƐŝŶĞƐƐ 'ƌŽƵƉ ŽŶ ,ĞĂůƚŚ͕ ŚŝůĚƌĞŶ͛Ɛ ,ŽƐƉŝƚĂů ŽĨ KƌĂŶŐĞ ŽƵŶƚLJ ĂŶĚ s, ͬh, ůůŝĂŶĐĞ EĞǁĐŽ͕ /ŶĐ͘ MACRA dŚĞ DĞĚŝĐĂƌĞ ĐĐĞƐƐ ĂŶĚ ,/W ZĞĂƵƚŚŽƌŝnjĂƚŝŽŶ Đƚ ŽĨ ϮϬϭϱ ;D Z Ϳ ĂůůŽĐĂƚĞƐ ΨϭϬϬ ŵŝůůŝŽŶ ƚŽ ƐƵƉƉŽƌƚ ŽƌŐĂŶŝnjĂƚŝŽŶƐ

;Ğ͘Ő͕͘ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ ŽƌŐĂŶŝnjĂƚŝŽŶƐ͕ ƌĞŐŝŽŶĂů ĞdžƚĞŶƐŝŽŶ ĐĞŶƚĞƌƐͿ ƚŚĂƚ ƉƌŽǀŝĚĞ ƚĞĐŚŶŝĐĂů ĂƐƐŝƐƚĂŶĐĞ ƚŽ ƉƌĂĐƚŝĐĞƐ ǁŝƚŚ ϭϱ Žƌ ĨĞǁĞƌ ĞůŝŐŝďůĞ ƉƌŽĨĞƐƐŝŽŶĂůƐ͘ WƌŝŽƌŝƚLJ ǁŝůů ďĞ ŐŝǀĞŶ ƚŽ ƉƌĂĐƚŝĐĞƐ ŝŶ ƌƵƌĂů ĂƌĞĂƐ͕ ŚĞĂůƚŚ ƉƌŽĨĞƐƐŝŽŶĂů ƐŚŽƌƚĂŐĞ ĂƌĞĂƐ ĂŶĚ ŵĞĚŝĐĂůůLJ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ͘ &W ŚĂƐ ƉƵƐŚĞĚ ŚĂƌĚ ĨŽƌ ƚŚĞ ĞĂƌůLJ ĚŝƐƚƌŝďƵƚŝŽŶ ŽĨ ƚŚĞƐĞ ŶĞĞĚĞĚ ĨƵŶĚƐ͘ &W ĚŽĞƐ ŶŽƚ LJĞƚ ŚĂǀĞ Ă ůŽƚ ŽĨ ŝŶĨŽƌŵĂƚŝŽŶ ĂďŽƵƚ ǁŚĞŶ ĂŶĚ ŚŽǁ ƚŚŝƐ ŵŽŶĞLJ ǁŝůů ďĞ ĚŝƐƚƌŝďƵƚĞĚ Žƌ ŚŽǁ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĐĂŶ ĂĐĐĞƐƐ ƚŚĞ ƚĞĐŚŶŝĐĂů ĂƐƐŝƐƚĂŶĐĞ͘ tĞ ĂŶƚŝĐŝƉĂƚĞ ƌĞŐƵůĂƚŝŽŶƐ ŝŶ ϮϬϭϲ ƚŚĂƚ ǁŝůů ƚĞůů ƵƐ ŵƵĐŚ ŵŽƌĞ͘ Commercial Insurers ŽŵŵĞƌĐŝĂů ŝŶƐƵƌĞƌƐ ƌĞƉŽƌƚ ƚŚĂƚ ƚŚĞLJ ĂƌĞ ƐƵƉƉŽƌƚŝŶŐ ƉƌĂĐƚŝĐĞ ƚƌĂŶƐĨŽƌŵĂƚŝŽŶ ŽĨ ŝŶͲŶĞƚǁŽƌŬ ƉƌŽǀŝĚĞƌƐ ŝŶ ĂůŝĨŽƌŶŝĂ ƚŚƌŽƵŐŚ ĐŽŶƐƵůƚŝŶŐ ƐĞƌǀŝĐĞƐ ĂŶĚ ŽƚŚĞƌ ƚĞĐŚŶŝĐĂů ĂƐƐŝƐƚĂŶĐĞ͕ ĂƐ ǁĞůů ĂƐ ƚŚƌŽƵŐŚ ƚŚĞ ŝŵƉƌŽǀĞĚ ĂǀĂŝůĂďŝůŝƚLJ ŽĨ ĚĂƚĂ ƚŚĂƚ ƐƵƉƉŽƌƚƐ ƋƵĂůŝƚLJ ŝŵƉƌŽǀĞŵĞŶƚ͘ &W ĞŶĐŽƵƌĂŐĞƐ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ĐŽŶƚĂĐƚ ĐŽŵŵĞƌĐŝĂů ŝŶƐƵƌĞƌƐ ǁŝƚŚ ǁŚŝĐŚ LJŽƵ ŚĂǀĞ ĐŽŶƚƌĂĐƚƐ͘ &ŝŶĚ ŽƵƚ ǁŚĂƚ ƚŚĞLJ ĂƌĞ ŽĨĨĞƌŝŶŐ ĂŶĚ ŵĂŬĞ ƵƐĞ ŽĨ ŝƚ͘ Value-Based Payment dŚĞ LJĞĂƌ ϮϬϭϱ ŵĂLJ ŐŽ ĚŽǁŶ ĂƐ Ă ƐĞĂ ĐŚĂŶŐĞ ŝŶ ƉĂLJŵĞŶƚ ĨŽƌ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ͘ dŚĞ LJĞĂƌ ďĞŐĂŶ ǁŝƚŚ ƚŚĞ ^ĞĐƌĞƚĂƌLJ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ ĂŶŶŽƵŶĐŝŶŐ ƚŚĂƚ ƚŚĞ DĞĚŝĐĂƌĞ ƉƌŽŐƌĂŵ ǁŽƵůĚ ŵŽǀĞ ŝŶ Ă ƋƵĂŶƚŝĨŝĂďůĞ ǁĂLJ ƚŽǁĂƌĚ ƉĂLJŝŶŐ ĨŽƌ ǀĂůƵĞ͘ dŚĞ D Z ůĂǁ ƉƵƚ ƚŚŽƐĞ ŐŽĂůƐ ŝŶƚŽ ƐƚĂƚƵƚĞ͗ D Z ĞƐƚĂďůŝƐŚĞƐ Ă DĞƌŝƚͲ ĂƐĞĚ /ŶĐĞŶƚŝǀĞ WĂLJŵĞŶƚ ^LJƐƚĞŵ ;D/W^Ϳ ƚŚĂƚ ĐŽŶƐŽůŝĚĂƚĞƐ ĞdžŝƐƚŝŶŐ DĞĚŝĐĂƌĞ ĨĞĞͲĨŽƌͲƐĞƌǀŝĐĞ ƉŚLJƐŝĐŝĂŶ ŝŶĐĞŶƚŝǀĞ ƉƌŽŐƌĂŵƐ͘ WŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚĞ D/W^ ƉƌŽŐƌĂŵ ǁŝůů ƌĞĐĞŝǀĞ ƉĂLJŵĞŶƚ ƵƉĚĂƚĞƐ ďĂƐĞĚ ŽŶ ƚŚĞŝƌ ƋƵĂůŝƚLJ͘ Ɛ ĂŶ ĂůƚĞƌŶĂƚŝǀĞ ƉĂLJŵĞŶƚ ƚƌĂĐŬ͕ D Z ĞƐƚĂďůŝƐŚĞƐ Ă ƉĂƚŚǁĂLJ ĨŽƌ ƉŚLJƐŝĐŝĂŶƐ ƚŽ ƉĂƌƚŝĐŝƉĂƚĞ ŝŶ ĂůƚĞƌŶĂƚŝǀĞ ƉĂLJŵĞŶƚ ŵŽĚĞůƐ ; WDƐͿ͕ ŝŶĐůƵĚŝŶŐ ƚŚĞ W D,͘ tĞ Ɛƚŝůů ŚĂǀĞ Ă ůŽŶŐ ǁĂLJ ƚŽ ŐŽ ŝŶ ƚĞƌŵƐ ŽĨ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ƚŚĞƐĞ ĐŚĂŶŐĞƐ ŝŶ ƚŚĞ DĞĚŝĐĂƌĞ ƉƌŽŐƌĂŵ ĂŶĚ ǁŚĞƚŚĞƌ ĂŶĚ ŚŽǁ ĐŽŵŵĞƌĐŝĂů ƉĂLJĞƌƐ ǁŝůů ĨŽůůŽǁ͘ Ɛ ŽĨ ƚŚŝƐ ǁƌŝƚŝŶŐ͕ ƉƌŽƉŽƐĞĚ ƌĞŐƵůĂƚŝŽŶƐ ŽŶ D/W^ ĂŶĚ WDƐ ĂƌĞ ĂŶƚŝĐŝƉĂƚĞĚ ŝŶ DĂƌĐŚ ϮϬϭϲ͘ tŚĂƚ ŝƐ ĐůĞĂƌ ŝƐ ƚŚĂƚ ŝŶĐƌĞĂƐŝŶŐůLJ͕ ƉĂLJŵĞŶƚ ǁŝůů ďĞ ƚŝĞĚ ƚŽ ǀĂůƵĞ͕ ŶŽƚ ǀŽůƵŵĞ͕ ĂŶĚ ƚŚĂƚ ŝŶ ƚŚĞ WD ƉƌŽŐƌĂŵ͕ ƉƌĂĐƚŝĐĞƐ ĨŝŶĂůůLJ ǁŝůů ďĞ ƉĂŝĚ ďŽŶƵƐĞƐ ĨŽƌ ďĞŝŶŐ Ă W D,͘ dŚĞ ďƵƐŝŶĞƐƐ ĐĂƐĞ ĨŽƌ W D, ũƵƐƚ ŐŽƚ ƐƚƌŽŶŐĞƌ͗ W D, ŝƐ LJŽƵƌ ǁĂLJ ŽĨ ŝŶĐƌĞĂƐŝŶŐ LJŽƵƌ ǀĂůƵĞ͘ Leah Newkirk is CAFP’s Vice President of Health Policy. California Family Physician Winter 2016

9

POLITICAL PULSE

ȱ ǰȱ ȱ

CAFP Protects Patient Safety and Access in 2015 &W ĨŽƵŐŚƚ ŚĂƌĚ ƚŽ ƉƌŽƚĞĐƚ ƉĂƟĞŶƚƐ ĂŶĚ ŝŵƉƌŽǀĞ ĂĐĐĞƐƐ ƚŽ ĐĂƌĞ ĚƵƌ ĐĂ ƵƌŝŶŐ Ő ƚŚ ƚŚĞ Ğ Įƌ ĮƌƐƚ Ɛƚ LJĞĂ ĞĂƌ ŽĨ ŽĨ ƚŚĞ ϮϬϭ ϬϭϱͲ ϱͲϭϲ ϭϲ >ĞŐ ĞŐŝƐ ŝƐůĂ ůĂƟǀ ƟǀĞĞ ^Ğ ^ĞƐƐ ƐƐŝŽ ŝŽŶ͘ Ŷ͘ dŚĞ 'ŽǀĞƌŶŽƌ ƐŝŐŶĞĚ ϭϵ ŽĨ ϮϮ &WͲƐƵƉƉŽƌƚĞĚ ďŝůůƐ ƚŚĂƚ ŵĂĚĞ ŝƚ ƚŽ ŚŝƐ ĚĞƐŬ͘ KƵƌ ƐŝŐŶĂƚƵƌĞ ůĞŐŝƐůĂƟǀĞ ĂĐŚŝĞǀĞŵĞŶƚ ƚŚŝƐ LJĞĂƌ ǁĂƐ ƚŚĞ ƉĂƐƐĂŐĞ ŽĨ ŽŶĞ ŽĨ ƚŚĞ ƐƚƌŽŶŐĞƐƚ ǀĂĐĐŝŶĂƟŽŶ ůĂǁƐ ŝŶ ƚŚĞ ĐŽƵŶƚƌLJ͕ SB 277 ;WĂŶͿ͘ dŚŝƐ ďŝůů ĂůůŽǁƐ ŽŶůLJ ƉŚLJƐŝĐŝĂŶͲŽƌĚĞƌĞĚ ŵĞĚŝĐĂů ĞdžĞŵƉƟŽŶƐ ƚŽ ƚŚĞ ĐŚŝůĚŚŽŽĚ ǀĂĐĐŝŶĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĨŽƌƌ ĂĚ ĨŽ ĂĚŵŝ ŵŝƩĂ ƩĂŶĐ ŶĐĞĞ ŝŶ ŝŶƚŽ ƚŽ ĂŶLJ ƉƵď ƵďůŝůŝĐĐ Žƌ Žƌ Ɖƌŝ ƌŝǀĂ ǀĂƚĞ ƚĞ ĚĂLJ ĐĂƌ ĂƌĞĞ͕ ĞůĞ ůĞŵĞ ŵĞŶƚĂƌLJ ƚ ƐĐŚŽŽů Žƌ ƐĞĐŽŶĚĂƌLJ ƐĐŚŽŽů͘ ^ŽŵĞ ŽĨ ƚŚĞ ŽƚŚĞƌ ƚŽƉ &WͲ ƐƵƉƉŽƌƚĞĚ ďŝůůƐ ƚŚĂƚ ďĞĐĂŵĞ ůĂǁ ŝŶĐůƵĚĞ͗ ͻ AB 187 ; ŽŶƚĂͿ ĞdžƚĞŶĚƐ ďLJ ŽŶĞ LJĞĂƌ ƚŚĞ ĚĂƚĞ ŽŶ ǁŚŝĐŚ ĂůŝĨŽƌŶŝĂ ŚŝůĚƌĞŶ͛Ɛ ^ĞƌǀŝĐĞƐ ĞŶƌŽůůĞĞƐ ĂƌĞ ƚƌĂŶƐŝƟŽŶĞĚ ŝŶƚŽ DĞĚŝͲ Ăů ŵĂŶĂŐĞĚ ĐĂƌĞ͕ ĂůůŽǁŝŶŐ ŵŽƌĞ ƟŵĞ ƚŽ ĞŶƐƵƌĞ Ă ƐƵĐĐĞƐƐĨƵů ƚƌĂŶƐŝƟŽŶ ĨŽƌ ƚŚŝƐ ǀƵůŶĞƌĂďůĞ ƉŽƉƵůĂƟŽŶ͘ ͻ AB 637 ; ĂŵƉŽƐͿ ĂůůŽǁƐ ŶƵƌƐĞ ƉƌĂĐƟƟŽŶĞƌƐ ĂŶĚ ƉŚLJƐŝĐŝĂŶ ĂƐƐŝƐƚĂŶƚƐ ƚŽ ƐŝŐŶ WŚLJƐŝĐŝĂŶ KƌĚĞƌƐ ĨŽƌ >ŝĨĞ ^ƵƐƚĂŝŶŝŶŐ dƌĞĂƚŵĞŶƚ ;WK>^dͿ ĨŽƌŵƐ͘ ͻ AB 679 ; ůůĞŶͿ ĞdžƚĞŶĚƐ ƚŚĞ ĚĂƚĞ ďLJ ǁŚŝĐŚ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ŵƵƐƚ ƌĞŐŝƐƚĞƌ ǁŝƚŚ ƚŚĞ ŽŶƚƌŽůůĞĚ ^ƵďƐƚĂŶĐĞ hƟůŝnjĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^LJƐƚĞŵ ; hZ ^Ϳ WƌĞƐĐƌŝƉƟŽŶ ƌƵŐ DŽŶŝƚŽƌŝŶŐ WƌŽŐƌĂŵ ďLJ Ɛŝdž ŵŽŶƚŚƐ͕ ĨƌŽŵ :ĂŶƵĂƌLJ ϭ͕ ϮϬϭϲ ƚŽ :ƵůLJ ϭ͕ ϮϬϭϲ͕

ͻ ͻ

ͻ

ďĞĐĂƵƐĞ ŽĨ ŽĨĨ ĚĞů ĞůĂLJ ĂLJƐ ŝŶ ŝŵƉ ŵƉ ƉƌŽ ƌŽǀŝ ǀŝŶŐ ŶŐ ƚŚĞ Ś hZ ^ ^ ŽƉĞĞƌĂ ƌĂƟŶ Ɵ Ő ƟŶ ĂŶĚ ĞŶ ŶƌŽ ƌ ůůůŵ ŵĞĞŶƚ ƐLJƐ LJ ƚĞĞŵ͘ ŵ͘ SB 4 ;>ĂĂƌĂĂͿ Ăů ĂůůŽ ůŽǁƐ ůŽ ǁƐ ƵŶĚŽĐ ǁƐ ŶĚ ĚŽĐ Ž Ƶŵ ƵŵĞŶ Ğ ƚĞ ĞŶ ƚĞĚ Ě ĐŚ ŚŝůĚ ŝůůĚƌ ĚƌĞŶ ĚƌĞŶ ĞŶ LJŽ ŽƵ ƵŶŐ ŶŐĞĞƌ Ğƌ ƚŚ ŚĂŶ ϭϵ ϵ ƚŽ Ž ĞŶ ŶƌƌŽů Ž ů ŝŶ ĨƵů Ƶůůů ƐĐĐŽƉ Ž Ğ DĞ Ğ DĞ DĞĚŝ ĚŝͲ Ěŝ Ͳ ĂĂů͘ Ͳ SB 19 ;tŽ t ůŬ ůŬͿͿ ĞƐ ĞƐƚĂ ƚĂĂďů ďůŝƐŚĞƐƐ Ă WK WK>^ >^^d d ĞZĞŐ ĞŐŐŝƐƐƚƌ ƚƌLJ LJ Wŝ LJ WŝůŽ ůŽƚƚ͘ ůŽ Ƶƌƌ Ƶƌƌ Ƶ ƌƌĞŶ ĞŶƚů ĞŶ ƚůLJ ƚů LJ ƚŚ LJ ƚŚĞĞ WK ƚŚ WK>^ >^d d ĨŽ ĨŽƌŵ ĨŽ ƌŵ ŝƐ Ɛ Ă ƉĂ ƉĂƉĞ ƉĞƌ ƉĞ ƌ ĚŽ ĚŽĐƵ ĚŽ ĐƵ ƵŵĞĞŶƚ Ŷ͕ ǁŚŝĐ ǁŚ ŝĐŚ ŝĐ Ś ŽŌ Ś ŽŌ ŽŌĞŶ ĞŶ ĐƌĞ ƌĞĂƚ ĂƚĞƐ Ăƚ ĞƐ Ă ďĂƌ Ăƌƌŝ ƌŝĞĞƌ ƌŝ Ğƌ ƚŽ ŝƚ Ž ŝƚƐƐ Ğī ĞīĞĐ ĞĐƟǀ ƟǀǀĞŶ ĞŶĞƐ ĞƐƐ͘ ĞƐ Ɛ͘ Ŷ ĞůĞĐ ĞĐƚƌ ƚƌŽŶ ŽŶŝĐ ŽŶ ŝĐ WK> K>^d ^d ƌĞŐŐŝƐ ŝ ƚƌLJ ǁŝ ǁ ůůů ŚĞů ĞůƉ Ɖ ĞŶƐƵ Ɖ ĞŶ ƐƵƌĞ ƌĞ ŝŵŵ ŵŵĞĚ ĞĚŝĂ ŝĂƚĞ ƚĞ ĂĐĐĞ ĂĐ ĐĞƐƐ ƐƐ ƚŽ Ž ǀŝ ǀŝƚĂ ƚĂů ůŵĞ ŵĞĚŝ ĚŝĐĂ ĐĂůů Žƌ ŽƌĚĞ ĚĞƌƐ ƌƐ ďLJ Ğŵ ĞŵĞƌ ĞƌŐĞŶĐLJ ŵĞĚŝĐĂů ƉĞĞƌƐ ƌ ŽŶŶĞ ŶĞů͘ů SB 792 ;DĞŶĚŽnjĂͿ ƌĞƋƵŝƌĞƐ ĚĂLJ ĐĂƌĞ ǁŽƌŬĞƌƐ ƚŽ ďĞ ǀĂĐĐŝŶĂƚĞĚ ĂŐĂŝŶƐƚ ŵĞĂƐůĞƐ͕ ƉĞƌƚƵƐƐŝƐ ĂŶĚ ŝŶŇƵĞŶnjĂ ƵŶůĞƐƐ ƚŚĞ ĞŵƉůŽLJĞĞ ĐĂŶŶŽƚ ďĞ ǀĂĐĐŝŶĂƚĞĚ ďĂƐĞĚ ŽŶ Ă ŵĞĚŝĐĂů ĐŽŶĚŝƟŽŶ͘

&W ĂůƐŽ ǁŽƌŬĞĚ ŚĂƌĚ ƚŽ ĚĞĨĞĂƚ Žƌ ĂŵĞŶĚ ŵŝƐŐƵŝĚĞĚ ůĞŐŝƐůĂƟŽŶ͕ ŝŶĐůƵĚŝŶŐ ĨŽƵƌ ŽǀĞƌƌĞĂĐŚŝŶŐ ƐĐŽƉĞ ŽĨ ƉƌĂĐƟĐĞ ĞdžƉĂŶƐŝŽŶ ďŝůůƐ ƚŚĂƚ &W ƐƵĐĐĞƐƐĨƵůůLJ ŚĂůƚĞĚ ;AB 1306 Ͳ EƵƌƐĞͲ DŝĚǁŝǀĞƐ͖ SB 323 Ͳ EƵƌƐĞ WƌĂĐƟƟŽŶĞƌƐ͖ SB 622 Ͳ KƉƚŽŵĞƚƌŝƐƚƐ ĂŶĚ SB 538 Ͳ EĂƚƵƌŽƉĂƚŚƐͿ͘ EŽƚ Ă ƐŝŶŐůĞ ďŝůů ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ƚŚĂƚ ǁŽƵůĚ ƚŚƌĞĂƚĞŶ ĐƵƌƌĞŶƚ ƉŚLJƐŝĐŝĂŶ ŵĂůƉƌĂĐƟĐĞ ůŝĂďŝůŝƚLJ ĂŶĚ ƚŚĞ DĞĚŝĐĂů /ŶũƵƌLJ ŽŵƉĞŶƐĂƟŽŶ ZĞĨŽƌŵ Đƚ ;D/ Z Ϳ ĂŌĞƌ ƚŚĞ ŚŝƐƚŽƌŝĐ ĚĞĨĞĂƚ ŽĨ WƌŽƉŽƐŝƟŽŶ ϰϲ ůĂƐƚ EŽǀĞŵďĞƌ͘

&W ƌĞĐĞŝǀĞĚ ƚŚĞ &W >ĞĂĚĞƌƐŚŝƉ ŝŶ ^ƚĂƚĞ 'ŽǀĞƌŶŵĞŶƚ ǁĂƌĚ Ăƚ ƚŚĞ ϮϬϭϱ ^ƚĂƚĞ >ĞŐŝƐůĂƟǀĞ ŽŶĨĞƌĞŶĐĞ͘ 10

California Family Physician Winter 2016

ƚ ƚŚĞ ƚ ŚĞ ŶĂƟ ĂƟŽŶ ŽŶĂů Ăů ůĞǀĞů Ğů͕ů͕ &W W ĂŶ ŶĚ Ě &&W &W W ƐĐ ƐĐĐŽƌ ƐĐŽƌ ŽƌĞĚ ĞĚ Ě Ă ďŝŐŐ ǁŝŶ ŝŶ ŝŶ ŽƵ Ƶƌƌ ĞīŽ Ğī ŽƌƌƚƐ ƚƐ ƚŽ ĨƵŶĚ ĨƵ ƵŶ ŶĚ Ě Ă ĐƌƵ ƌƵĐŝ ƵĐŝ ĐŝĂů Ă Ɖƌŝ Ăů ƌŝŵĂĂƌƌLJLJ ĐĂƌ ĂƌĞ Ğ ĨĞ Ĩ ĚĞĞƌĂ ƌĂů 'ƌƌĂĚ ƌĂů ĂĚƵĂ ĚƵĂ Ƶ ƚĞ ƚĞ DĞĚ ĚŝĐ ŝĐĂĂůů ŝĐĂ Ě ĚƵĐ ƵĐĂƟŽŶ ĂĂƟ ƟŽŶ Ž ;'D D Ϳ Ϳ ƉƌƌŽ ŽŐƌ Ő Ăŵ Ăŵ͕​͕ ĂƐ ǁĞů Ğůůů ĂƐƐ ŽƚŚĞƌ ƚŚ ŚĞĞƌƌ ŝŵƉ ŵƉŽƌ ŽƌƚĂĂŶ Ŷƚƚ Ɖƌŝ ƌŝŵĂ ŵĂƌLJ ƌ ĐĂĂƌĞ ƌĞ ƉƌƌŽ ŽŐƌĂŵ ĂŵƐ Ăŵ Ɛ ƐĞ ƐĞƚ ƚŽ Ž ůŽƐ Ž Ğ ĨƵ ĨƵ ƵŶĚŝŶŐ͘ ŶĚ Ě Ő͘ Ő ĞĐĂƵƐĞ ŽĨ ŽƵ ĞĐ ĞĐ Ƶƌ Ğī ĞīŽƌƌƚƐ Ğī ƚƐ͕ ƚƐ͕ ŚƵŶĚ ŚƵ ƵŶĚ ŶĚƌĞ ƌĞĚƐ ƌĞ Ğ ŽĨ Ĩ ŵŝ ŵŝůů ŝůůůůŝŽ ŽŶƐƐ ŽĨ Ĩ ĚŽ ĚŽ ŽůůĂƌ ůůůĂƌ Ă Ɛ ǁĞƌĞ ǁĞƌĞ ǁĞ ƌĞ ĂƉƉ ƉƉƌŽ ŽƉƌ ƉƌŝĂ ŝĂƚĞ ƚĞĚ Ě ĨŽƌ ĨŽ Žƌ Ž Žŵŵ ŵƵŶŝƚ ŝƚLJ LJ ,ĞĂůƚŚ ,Ğ ĂůƚƚŚ Ăů Ś ĞŶ ŶƚĞ ƚĞƌƐ ĞƌƐ ƌƐ͕​͕ ƚŚ ŚĞ EĂ EĂƟŽ ĂƟŽ ƟŽŶĂ ƟŽŶ ŶĂůů ,Ğ ŶĂů , ĂůůƚŚ Ś ^Ğƌǀŝ Ğƌǀŝ Ğƌ ǀŝĐĞ ŝĐĞ Đ Žƌ ŽƌƉƐ ƉƐ ;E, E, ,^ ^ Ϳ ĂŶ ŶĚ ƚƚŚ ŚĞĞ ddĞĞĂĐ ĂĐŚ ŚŝŶ Śŝ ŝŶŐ ,ĞĞĂĂůƚƚŚ ĞĞŶƚ ŶƚĞƌ ;d, d, ͿͿ Ɖƌŝ ƌŝŵĂ ŝŵĂ ŵĂƌLJ ƌLJ ĐĂƌƌĞĞ ƌĞƐŝŝĚĞŶĐ ĚĞĞŶĐ Ě ŶĐLJ LJ Ɖƌ ƉƌŽŐ ƉƌŽŐ Ž ƌĂĂŵ ŵ͘​͘ dŚĞĞ ǀĂ dŚ ǀĂƐƚ Ɛƚƚ ŵĂũũŽƌ Žƌƌŝƚ ŝƚƚLJ ŽĨĨ ƚŚĞĞ ϵϬ ŝƚLJ Ϭ ŵ ŵŝŝůůůůŝŽ ŝŽŶ Ŷ ǀǀŝŝƐŝ ƐŝƚƐ ƚƐƐ ƚŽ Ž Ž Ž Žŵŵ Žŵŵ ŵƵ ƵŶ Ŷŝƚ ŝƚLJ ƚLJ LJ ,Ğ ,ĞĂů ĂůƚŚ ĂůƚŚ Ăů ĞŶƚ Ğ ŶƚĞƌ Ŷƚ ĞĞƌƌƐ Ăƌ ĂƌĞ Ğ ĨŽ Žƌ Ɖ ƉƌƌŝŵĂƌ ĂƌƌLJ ŵĞ ĂƌLJ ŵ Ěŝ ĚŝĐĂ ĐĂĂů ĐĂ ĐĂƌĞ ĂƌĞ ƐĞƌƌǀŝ ǀŝĐĐĞĞĞƐ͘ Ɛ͘ dŚĞ Ɛ͘ ŚĞ E,^ ŚĞůƉƐ ďƌƌŝŶ ŶŐŐ ŚĞ Ś ĂůůƚŚ ĐĂƌĞĞ ƉƌŽĨ ƉƌŽĨ Ɖƌ ŽĨĞƐ ĞƐƐŝ ĞƐ ƐŝŽŶ Ɛŝ ŽŶĂů ŽŶ ĂůƐƐ ƚŽ Ăů Ž ĂƌĞĂƐ ƌĞĞĂƐ ǁŚĞƌĞ ƚŚĞLJ ĂƌĞ ŶĞ ŶĞĞĚ ŶĞ ĞĚĞĚ ĞĚ ĞĚ ŵŽƐƚƚ ďLJLJ Ɖƌ Ɖ Žǀ ŽǀŝĚ ŽǀŝĚ ŝĚŝŶ ŝŶŐ ŝŶ Ő ƐĐ Ő ƐĐŚŽ ƐĐ ŚŽůĂ ŚŽ ůĂƌƐ ůĂ ƌƐŚŝ ƌƐ ŚŝƉƐ ĂŶĚ ůŽĂŶ ƌĞƉĂ Śŝ Ɖ LJŵ LJŵĞŶ ĞŶƚƚ ŝŝŶ ĞdžĐŚĂ ĞŶ ŚĂŶŐŐĞ ĨŽ Žƌ Ă ĐŽ Đ ŵŵ ŵŝƚƚŵĞ ŵĞŶƚ ŽĨ ƐĞƌǀŝĐĞ ŝŶ ĂŶ ƵŶ ŶĚĞĞƌƐĞƌǀĞĚ ĐŽŵŵ ŵƵŶ ƵŶŝƚ ŝƚLJ͘ LJLJ͘​͘ dŚĞ Ś d, d, Ɖƌ ƉƌŽŐ ŽŐƌĂ ƌĂŵ ŵ Ğdž ĞdžƉĂ ƉĂŶĚ ŶĚƐƐ ƌĞ ƌĞƐŝ ƐŝĚĞ ĚĞŶĐ ĚĞ ŶĐLJ LJ ƚƌ ƚƌĂŝ ĂŝŶŝ ŶŝŶŐ ŶŐŐ ŝŶ ĐŽ ĐŽŵŵ ŵŵ ŵƵŶŝƚ ƵŶ ŶŝƚƚLJLJͲͲďĂĂƐĞ ƐĞĚ ĞĚ ƐĞƫŶŐƐ͕ ŝŶ ŝŶĐů ĐůƵĚ ƵĚŝŶ ŝŶŐ Ő Ɛŝ Ɛŝdž dž Ɖƌ ƉƌŽŐ ŽŐƌĂ ŽŐ ƌĂŵƐ ŵƐ ŝŶ Ăů ĂůŝĨŽƌŶŝĂ͘ ZĞ ZĞƐŝ ƐŝĚĞ Ɛŝ ĚĞŶƚ ĚĞ ŶƚƐ Ŷƚ Ɛ Ăƌ Ɛ ĂƌĞĞ ƚƌĂŝ ƚƌ ĂŝŶĞ ŶĞĚ Ě ŝŶ ŝ ĨĂŵ ŵŝůŝůLJ LJ ĂŶ ĂŶĚ Ě ŝŶ ŶƚĞĞƌŶĂů ŵĞĚŝĐŝŶ ŝ Ğ͕ ƉĞĚ ĞĚŝĂ ŝĂƚƌ ƚƌŝĐ ŝĐƐ͕ Ɛ͕ ŽďƐ ďƐƚĞ ƚĞƚƚƌŝĐ ƚĞ ƚƌŝĐƐƐ ĂŶĚ ŐLJLJŶĞ ŶĞĐŽ ĐŽůŽ ůŽŐLJ ŐLJ͕​͕ ƉƐ Ɖ LJĐ LJ Śŝ ŚŝĂƚƚƌLJ ĂŶĚ ŐĞŶĞƌĂů ĂŶĚ ƉĞĚŝĂƚƌ ƚƌŝĐ ƚƌ ŝĐ ĚĞŶ ĞŶƟƐ ƟƐƚƌ ƚLJ ƚŚƌŽƵŐŚ ƚŚ Ś ƚŚ ƚŚŝƐ ŝƐ ƉƌŽ ƌŽŐƌ ŐƌĂŵ Ăŵ͘​͘ /Ŷ ƌĞĐŽŐŶŝƟŽŶ ŽĨ ŽƵƌ ĞīŽƌƚƐ͕ ŝŶĐůƵĚŝŶŐ ŽƵƌ ƐƵĐĐĞƐƐĨƵů ƐƚƌĂƚĞŐLJ ŽĨ ǁŽƌŬŝŶŐ ǁŝƚŚ &W ƚŽ ĐŽŶǀŝŶĐĞ ϱϬ ŽŶŐƌĞƐƐŝŽŶĂů ZĞƉƌĞƐĞŶƚĂƟǀĞƐ ĨƌŽŵ ďŽƚŚ ƉĂƌƟĞƐ ƚŽ ƐŝŐŶ ŽŶƚŽ Ă ůĞƩĞƌ ƐƵƉƉŽƌƟŶŐ ƚŚĞ d, ƉƌŽŐƌĂŵ͕ &W ƌĞĐĞŝǀĞĚ &W͛Ɛ ϮϬϭϱ >ĞĂĚĞƌƐŚŝƉ ŝŶ ^ƚĂƚĞ 'ŽǀĞƌŶŵĞŶƚ ǁĂƌĚ͘ dŚŝƐ ŝƐ ƚŚĞ ƐĞĐŽŶĚ ĐŽŶƐĞĐƵƟǀĞ LJĞĂƌ &W ƌĞĐĞŝǀĞĚ ƚŚŝƐ ĂǁĂƌĚ ĨŽƌ ŽƵƌ ĂĚǀŽĐĂĐLJ ƉƌŽŐƌĂŵƐ͘ / ǁĂƐ ŚŽŶŽƌĞĚ

ȱ ȱ ȱ ȱ ȱ¢ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ǯ ƚŽ ĂĐĐĞƉƚ ƚŚĞ Ăǁ Ă ĂƌĚ Ě ŽŶ ďĞŚ ŚĂůĨ ĂůůĨ Ĩ ŽĨĨ Ăů Ăůůů ŽĨĨ ŽƵƌ ĚĞĞĚ ĚŝĐĐĂƚ Ă ĞĚ ŵĞŵ ĞŵďĞ ď ƌƐ ďĞ ĂŶĚ Ě ƐƚƚĂī Ăƚ ī ƚ ƚŚ ƚŚĞ ϮϬϭϱ ϱ &W ^ƚĂƚ ĂƚĞ >Ğ > ŐŝŝƐůĂĂƟǀĞ ŽŶĨĞ ĨĞƌĞ ƌĞŶĐ ƌĞ ŶĐĐĞ ƚŚ ƚ ŝƐ ŝƐ EŽǀĞŵďĞƌ͕ ĂůŽŶŐ ǁŝƚŚ Ś &W ĞƉƵ ƉƵƚLJ ƚLJ ŝƌ ŝƌĞĐ Ğ ƚŽƌ ŽĨ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ ĚĂŵ &ƌĂŶĐŝƐ͕ &W sŝĐĞ WƌĞƐŝĚĞŶƚ ŽĨ ,ĞĂůƚŚ WŽůŝĐLJ >ĞĂŚ EĞǁŬŝƌŬ ĂŶĚ >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ ŵĞŵďĞƌ ĂŶĚ &W ŽĂƌĚ ŵĞŵďĞƌ :ĂĐŬ ŚŽƵ͕ D ͘ tĞ ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ĮŐŚƟŶŐ ŚĂƌĚ ĨŽƌ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ŝŶ ϮϬϭϲ͊ Dr. <akutani is Chair, CAFP LegislaƟve Aīairs CommiƩee.

Join our Family Practice Team in California! Redlands Family Clinic in Redlands, California, is growing and we are in need of an additional provider to join our team! This busy outpatient-only clinic features a Monday through Friday schedule, with hours between 8am and 5pm. There is no night or weekend call. The practice currently has 1 Physician and 2 NPs on staff. We are located 10 miles east of downtown San Bernardino. We are open to candidates that are looking for part-time and full-time opportunities. The right candidate must be BC or BE in Family Practice. Please apply for immediate consideration. To learn more about these or other Hospital Medicine opportunities, contact Valerie Patterson at 954.377.2963, Valerie_Patterson@teamhealth.com or visit www.teamhealth.com.

California Family Physician Winter 2016

11

ȱ

Three New Laws Will Affect Your Patients and Your Practice California’s New Law Limiting Vaccination Exemptions KŶĞ ŽĨ ŽƵƌ ƐŝŐŶĂƚƵƌĞ ůĞŐŝƐůĂƚŝǀĞ ĂĐŚŝĞǀĞŵĞŶƚƐ ƚŚŝƐ LJĞĂƌ ǁĂƐ ƚŚĞ ƐŝŐŶŝŶŐ ŽĨ ^ Ϯϳϳ ;WĂŶͿ͕ Ă ďŝůů ƚŚĂƚ ĞůŝŵŝŶĂƚĞƐ ƚŚĞ ƉĞƌƐŽŶĂů ďĞůŝĞĨ ĂŶĚ ƌĞůŝŐŝŽƵƐ ĞdžĞŵƉƚŝŽŶƐ ƚŽ ƐĐŚŽŽů ĂŶĚ ĚĂLJĐĂƌĞ ǀĂĐĐŝŶĞ ƌĞƋƵŝƌĞŵĞŶƚƐ͘ /Ĩ ƉĂƌĞŶƚƐ ĐŚŽŽƐĞ ŶŽƚ ƚŽ ǀĂĐĐŝŶĂƚĞ ĂŶĚ ƚŚĞ ĐŚŝůĚ ĚŽĞƐ ŶŽƚ ŚĂǀĞ Ă ŵĞĚŝĐĂů ĞdžĞŵƉƚŝŽŶ͕ ŚĞ Žƌ ƐŚĞ ĐĂŶ ĞŶƌŽůů ŝŶ Ă ƉƌŝǀĂƚĞ ŚŽŵĞͲƐĐŚŽŽůŝŶŐ ƉƌŽŐƌĂŵ Žƌ ƉĂƌƚŝĐŝƉĂƚĞ ŝŶ ŝŶĚĞƉĞŶĚĞŶƚ ƐƚƵĚLJ ƉƌŽũĞĐƚƐ ŽǀĞƌƐĞĞŶ ďLJ ƚŚĞ ƐĐŚŽŽů ĚŝƐƚƌŝĐƚ͕ ďƵƚ ĚŽ ŶŽƚ ŝŶĐůƵĚĞ ĐůĂƐƐƌŽŽŵ ƚŝŵĞ͘ dŚĞ ůĂǁ ĂůƐŽ ŝŶĐůƵĚĞƐ Ă ƉƌŽǀŝƐŝŽŶ ƚŚĂƚ ŐŝǀĞƐ ƵŶǀĂĐĐŝŶĂƚĞĚ ĐŚŝůĚƌĞŶ ǁŝƚŚ ĞdžŝƐƚŝŶŐ ŶŽŶͲŵĞĚŝĐĂů ĞdžĞŵƉƚŝŽŶƐ ŵŽƌĞ ƚŝŵĞ ƚŽ ĐŽŵƉůLJ ǁŝƚŚ ƚŚĞ ƌƵůĞ ďLJ ƌĞƋƵŝƌŝŶŐ ǀĂĐĐŝŶĞ ĐŚĞĐŬƐ ŽŶůLJ Ăƚ ƚŚĞ ƉƌĞƐĐŚŽŽů͕ ŬŝŶĚĞƌŐĂƌƚĞŶ ĂŶĚ ƐĞǀĞŶƚŚ ŐƌĂĚĞ ůĞǀĞůƐ͘ ĞĐĂƵƐĞ ƚŚĞ ŶĞǁ ůĂǁ ĂůůŽǁƐ ŽŶůLJ ƉŚLJƐŝĐŝĂŶͲŽƌĚĞƌĞĚ ŵĞĚŝĐĂů ĞdžĞŵƉƚŝŽŶƐ͕ ǁĞ ĂŶƚŝĐŝƉĂƚĞ ƚŚĂƚ ŽƵƌ ŵĞŵďĞƌƐ ǁŝůů ŚĞĂƌ ƋƵĞƐƚŝŽŶƐ ĂďŽƵƚ ƚŚĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĨƌŽŵ ƉĂƚŝĞŶƚƐ͘ &W ƚĞĂŵĞĚ ƵƉ ǁŝƚŚ ƚŚĞ ĂůŝĨŽƌŶŝĂ DĞĚŝĐĂů ƐƐŽĐŝĂƚŝŽŶ ĂŶĚ ƚŚĞ ĂůŝĨŽƌŶŝĂ ŚĂƉƚĞƌ ŽĨ ƚŚĞ ŵĞƌŝĐĂŶ ĐĂĚĞŵLJ ŽĨ WĞĚŝĂƚƌŝĐƐ ƚŽ ƉƌŽĚƵĐĞ Ă &ƌĞƋƵĞŶƚůLJ ƐŬĞĚ YƵĞƐƚŝŽŶƐ ŽĐƵŵĞŶƚ ƚŽ ŚĞůƉ ŐƵŝĚĞ ƉŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚĞ ůĂǁ͛Ɛ ŝŵƉůĞŵĞŶƚĂƚŝŽŶ͘ zŽƵ ĐĂŶ ĨŝŶĚ ƚŚĂƚ ĚŽĐƵŵĞŶƚ ŽŶ ŽƵƌ ǁĞďƐŝƚĞ͗ ǁǁǁ͘ĨĂŵŝůLJĚŽĐƐ͘ŽƌŐͬĨͬ^ Ϯϳϳ& Y͘W &͘ End of Life Option Act tŝƚŚ ƚŚĞ ƉĂƐƐĂŐĞ ŽĨ yϮͲϭϱ ; ŐŐŵĂŶͿ͕ ƚĞƌŵŝŶĂůůLJ ŝůů ĂůŝĨŽƌŶŝĂŶƐ ŵĂLJ ŽďƚĂŝŶ Ă ƉƌĞƐĐƌŝƉƚŝŽŶ ĨŽƌ ĂŶ ͞ĂŝĚͲŝŶͲĚLJŝŶŐ͟ ĚƌƵŐ͘ dŚĞ ƉƌĞƐĐƌŝƉƚŝŽŶ ĐĂŶ ŽŶůLJ ďĞ ŝƐƐƵĞĚ ĂĨƚĞƌ ĐĞƌƚĂŝŶ ĐŽŶĚŝƚŝŽŶƐ ĂƌĞ ŵĞƚ͕ ŝŶĐůƵĚŝŶŐ ͻ Ŷ ĂƚƚĞŶĚŝŶŐ ƉŚLJƐŝĐŝĂŶ ĚŝĂŐŶŽƐĞƐ ĂŶ ŝŶĐƵƌĂďůĞ ĂŶĚ ŝƌƌĞǀĞƌƐŝďůĞ ĚŝƐĞĂƐĞ ƚŚĂƚ ǁŝůů͕ ǁŝƚŚŝŶ ƌĞĂƐŽŶĂďůĞ ŵĞĚŝĐĂů ũƵĚŐŵĞŶƚ͕ ƌĞƐƵůƚ ŝŶ ĚĞĂƚŚ ǁŝƚŚŝŶ Ɛŝdž ŵŽŶƚŚƐ͖ ͻ ĐŽŶƐƵůƚŝŶŐ ƉŚLJƐŝĐŝĂŶ ĐŽŶĨŝƌŵƐ ƚŚĞ ƚĞƌŵŝŶĂů ĚŝĂŐŶŽƐŝƐ ĂŶĚ ƉĂƚŝĞŶƚ͛Ɛ ĐĂƉĂĐŝƚLJ ƚŽ ŵĂŬĞ ŵĞĚŝĐĂů ĚĞĐŝƐŝŽŶƐ͖ ͻ dŚĞ ĂƚƚĞŶĚŝŶŐ ƉŚLJƐŝĐŝĂŶ ƌĞĨĞƌƐ ƚŚĞ ƉĂƚŝĞŶƚ ƚŽ Ă ŵĞŶƚĂů ŚĞĂůƚŚ ƐƉĞĐŝĂůŝƐƚ͖ ͻ dŚĞ ƉĂƚŝĞŶƚ ŵĂŬĞƐ ƚǁŽ ŽƌĂů ƌĞƋƵĞƐƚƐ ĨŽƌ ƚŚĞ ŵĞĚŝĐĂƚŝŽŶ Ăƚ ůĞĂƐƚ ϭϱ ĚĂLJƐ ĂƉĂƌƚ ĂŶĚ ͻ ǁƌŝƚƚĞŶ ƌĞƋƵĞƐƚ ŝƐ ƐƵďŵŝƚƚĞĚ͕ ƐŝŐŶĞĚ ďLJ ƚǁŽ ǁŝƚŶĞƐƐĞƐ͘

12

California Family Physician Winter 2016

&W ĂĚŽƉƚĞĚ Ă EĞƵƚƌĂů ƉŽƐŝƚŝŽŶ ŽŶ ƚŚĞ ďŝůů͕ ŝŶ ƉĂƌƚ ďĞĐĂƵƐĞ ŽĨ ŽƵƌ ŵĞŵďĞƌƐ͛ ĚŝĨĨĞƌŝŶŐ ƉŽƐŝƚŝŽŶƐ ŽŶ ƚŚĞ ŝƐƐƵĞ͕ ĂŶĚ Ă ŶĞǁ͕ ŵŽƌĞ ŶƵĂŶĐĞĚ ƉŽůŝĐLJ ŽŶ ĞŶĚͲŽĨͲůŝĨĞ ĐĂƌĞ͘ tĞ ĂƌĞ ĚĞǀĞůŽƉŝŶŐ ĞĚƵĐĂƚŝŽŶĂů ĂŶĚ ŽƚŚĞƌ ŵĂƚĞƌŝĂů ƚŽ ŚĞůƉ ŐƵŝĚĞ ŽƵƌ ŵĞŵďĞƌƐ ƚŚƌŽƵŐŚ ƚŚĞ ŝŵƉůĞŵĞŶƚĂƚŝŽŶ ŽĨ ƚŚŝƐ ůĂǁ͘ Physician Network Directory Accuracy ^ ϭϯϳ ;,ĞƌŶĂŶĚĞnjͿ ǁŝůů ƌĞƋƵŝƌĞ ŚĞĂůƚŚ ƉůĂŶƐ ƚŽ ƉƵďůŝƐŚ ĂŶĚ ŵĂŝŶƚĂŝŶ ĂĐĐƵƌĂƚĞ ƉƌŽǀŝĚĞƌ ĚŝƌĞĐƚŽƌŝĞƐ ǁŝƚŚ ŝŶĨŽƌŵĂƚŝŽŶ ŽŶ ĐŽŶƚƌĂĐƚŝŶŐ ƉƌŽǀŝĚĞƌƐ ǁŚŽ ĚĞůŝǀĞƌ ŚĞĂůƚŚ ĐĂƌĞ ƐĞƌǀŝĐĞƐ ƚŽ ƚŚĞ ƉůĂŶƐ͛ ĞŶƌŽůůĞĞƐ͕ ŝŶĐůƵĚŝŶŐ ƚŚŽƐĞ ƚŚĂƚ ĂĐĐĞƉƚ ŶĞǁ ƉĂƚŝĞŶƚƐ͕ ďĞŐŝŶŶŝŶŐ :ƵůLJ ϭ͕ ϮϬϭϲ͘ dŚĞ ĚŝƌĞĐƚŽƌŝĞƐ ŵƵƐƚ ďĞ ĂǀĂŝůĂďůĞ ŽŶ ƚŚĞ ƉůĂŶƐ͛ ǁĞďƐŝƚĞƐ ǁŝƚŚŽƵƚ ĂŶLJ ƌĞƐƚƌŝĐƚŝŽŶƐ Žƌ ůŝŵŝƚĂƚŝŽŶƐ ĂŶĚ ĂůůŽǁ ƉƌŽǀŝĚĞƌ ƐĞĂƌĐŚĞƐ ďLJ ƐĞǀĞƌĂů͕ ŵĂŶĚĂƚŽƌLJ ĨŝůƚĞƌƐ͘ WůĂŶƐ ŵƵƐƚ ƵƉĚĂƚĞ ƚŚĞ ĚŝƌĞĐƚŽƌŝĞƐ Ăƚ ůĞĂƐƚ ǁĞĞŬůLJ͘ &W ŽƌŝŐŝŶĂůůLJ ƐƵƉƉŽƌƚĞĚ ƚŚĞ ďŝůů͕ ƵŶƚŝů ŝƚ ǁĂƐ ĂŵĞŶĚĞĚ ƚŽ ŝŶĐůƵĚĞ ŵŽƌĞ ďƵƌĚĞŶƐŽŵĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ŽŶ ƉƌŽǀŝĚĞƌƐ͘ &ŽƌƚƵŶĂƚĞůLJ͕ &W ƐĞĐƵƌĞĚ ĂŶ ŝŵƉŽƌƚĂŶƚ ĂŵĞŶĚŵĞŶƚ ďĞĨŽƌĞ ƚŚĞ ďŝůů ǁĂƐ ƐŝŐŶĞĚ ǁŚŝĐŚ ƐƚĂƚĞƐ ƚŚĂƚ ŝĨ ƚŚĞ ƉůĂŶ ĚĞůĂLJƐ Ă ƉĂLJŵĞŶƚ͕ ƚŚĞŶ ŝƚ ŵƵƐƚ ƌĞŝŵďƵƌƐĞ ƚŚĞ ĨƵůů ĂŵŽƵŶƚ ŽĨ ĂŶLJ ĚĞůĂLJĞĚ ƉĂLJŵĞŶƚ͗ ϭͿ ƚŚƌĞĞ ĚĂLJƐ ĨŽůůŽǁŝŶŐ ƚŚĞ ĚĂƚĞ ŽŶ ǁŚŝĐŚ ƚŚĞ ƉůĂŶ ƌĞĐĞŝǀĞƐ ƚŚĞ ŝŶĨŽƌŵĂƚŝŽŶ ƌĞƋƵŝƌĞĚ ĨƌŽŵ ƚŚĞ ƉŚLJƐŝĐŝĂŶ͖ Žƌ ϮͿ ŝĨ ƚŚĞ ƉŚLJƐŝĐŝĂŶ Žƌ ƉŚLJƐŝĐŝĂŶ ŐƌŽƵƉ ĨĂŝůƐ ĞŶƚŝƌĞůLJ ƚŽ ƉƌŽǀŝĚĞ ƚŚĞ ŝŶĨŽƌŵĂƚŝŽŶ͕ ƚŚĞ ĨƵůů ĂŵŽƵŶƚ ŵƵƐƚ ďĞ ƉĂŝĚ Ăƚ ƚŚĞ ĞŶĚ ŽĨ ŽŶĞ ĐĂůĞŶĚĂƌ ŵŽŶƚŚ͘ ŽŶƚƌĂĐƚƐ ďĞƚǁĞĞŶ ƉůĂŶƐ ĂŶĚ ƉƌŽǀŝĚĞƌƐ ǁŝůů ŶŽǁ ƌĞƋƵŝƌĞ͗ ͻ dŚĞ ƉƌŽǀŝĚĞƌ ƚŽ ŝŶĨŽƌŵ ƚŚĞ ƉůĂŶ ǁŝƚŚŝŶ ĨŝǀĞ ďƵƐŝŶĞƐƐ ĚĂLJƐ ǁŚĞŶ ƚŚĞ ƉƌŽǀŝĚĞƌ ŝƐ ŶŽƚ ĂĐĐĞƉƚŝŶŐ ŶĞǁ ƉĂƚŝĞŶƚƐ Žƌ͕ ŝĨ ƚŚĞ ƉƌŽǀŝĚĞƌ ŚĂĚ ƉƌĞǀŝŽƵƐůLJ ŶŽƚ ĂĐĐĞƉƚĞĚ ŶĞǁ ƉĂƚŝĞŶƚƐ͕ ƚŚĞ ƉƌŽǀŝĚĞƌ ŝƐ ĂĐĐĞƉƚŝŶŐ ŶĞǁ ƉĂƚŝĞŶƚƐ͘ ͻ dŚĞ ƉƌŽǀŝĚĞƌ ƚŽ ĚŝƌĞĐƚ ĂŶ ĞŶƌŽůůĞĞ Žƌ ƉŽƚĞŶƚŝĂů ĞŶƌŽůůĞĞ ƚŽ ƚŚĞ ƉůĂŶ ĨŽƌ ĂĚĚŝƚŝŽŶĂů ĂƐƐŝƐƚĂŶĐĞ ŝĨ ƚŚĂƚ ƉƌŽǀŝĚĞƌ ŝƐ ŶŽ ůŽŶŐĞƌ ĂĐĐĞƉƚŝŶŐ ŶĞǁ ƉĂƚŝĞŶƚƐ ĂŶĚ ƚŚĞ ĞŶƌŽůůĞĞ ŝƐ ƐĞĞŬŝŶŐ ƚŽ ďĞĐŽŵĞ Ă ƉĂƚŝĞŶƚ͘ dŚĞ ƉƌŽǀŝĚĞƌ ŵƵƐƚ ĂůƐŽ ƉƌŽǀŝĚĞ ŝŶĨŽƌŵĂƚŝŽŶ ƚŽ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ŽŶ ŚŽǁ ƚŽ ĐŽŶƚĂĐƚ ƚŚĞ ĞƉĂƌƚŵĞŶƚ ŽĨ DĂŶĂŐĞĚ ,ĞĂůƚŚ ĂƌĞ ; D, Ϳ Žƌ ĂůŝĨŽƌŶŝĂ ĞƉĂƌƚŵĞŶƚ ŽĨ /ŶƐƵƌĂŶĐĞ ; /Ϳ ƚŽ ƌĞƉŽƌƚ ĂŶLJ ŝŶĂĐĐƵƌĂĐLJ ǁŝƚŚ ƚŚĞ ƉůĂŶ͛Ɛ ĚŝƌĞĐƚŽƌLJ͘ ͻ dŚĞ ƉƌŽǀŝĚĞƌ ƚŽ ŐŝǀĞ ĂŶ ĂĨĨŝƌŵĂƚŝǀĞ ƌĞƐƉŽŶƐĞ ĂŶĚ

ͻ

ĐŽŶĨŝƌŵĂƚŝŽŶ ƚŚĂƚ ƚŚĞ ŝŶĨŽƌŵĂƚŝŽŶ ŝŶ ƚŚĞ ƉƌŽǀŝĚĞƌ ĚŝƌĞĐƚŽƌLJ ŝƐ ĂĐĐƵƌĂƚĞ͕ Žƌ ĐŚĂŶŐĞƐ ŝĨ ƚŚĞ ŝŶĨŽƌŵĂƚŝŽŶ ŝƐ ŝŶĂĐĐƵƌĂƚĞ͕ ƵƉŽŶ ƌĞĐĞŝǀŝŶŐ ŶŽƚŝĨŝĐĂƚŝŽŶ ĨƌŽŵ ƚŚĞ ƉůĂŶ ŽĨ ŝŶĨŽƌŵĂƚŝŽŶ ŝƚ ŚĂƐ ŝŶ ŝƚƐ ĚŝƌĞĐƚŽƌLJ͘ WůĂŶƐ ƚŽ ĂƚƚĞŵƉƚ ƚŽ ĐŽŶƚĂĐƚ Ă ĐŽŶƚƌĂĐƚĞĚ ƉƌŽǀŝĚĞƌ ŝŶ ǁƌŝƚŝŶŐ͕ ĞůĞĐƚƌŽŶŝĐĂůůLJ ĂŶĚ ďLJ ƚĞůĞƉŚŽŶĞ ƚŽ ĐŽŶĨŝƌŵ ǁŚĞƚŚĞƌ ƚŚĞ ƉƌŽǀŝĚĞƌ͛Ɛ ŝŶĨŽƌŵĂƚŝŽŶ ŝƐ ĐŽƌƌĞĐƚ Žƌ ƌĞƋƵŝƌĞƐ ƵƉĚĂƚĞƐ͘

A CHILD’S BRUISE … AN ACCIDENT OR SOMETHING MORE?

tŚŝůĞ ƚŚŝƐ ŶĞǁ ůĂǁ ŝƐ ŶŽƚ ŝĚĞĂů͕ ďĞŶĞĨŝƚƐ ƚŽ ƉŚLJƐŝĐŝĂŶƐ ĐĞƌƚĂŝŶůLJ ĂƌĞ ĐŽŶƚĂŝŶĞĚ ŝŶ ŝƚ͘ WůĂŶƐ ŵƵƐƚ ƐĞŶĚ ŝŶĨŽƌŵĂƚŝŽŶ ƚŽ ƉƌŽǀŝĚĞƌƐ͕ ŝŶĐůƵĚŝŶŐ Ă ůŝƐƚ ŽĨ ŶĞƚǁŽƌŬƐ ĂŶĚ ƉůĂŶ ƉƌŽĚƵĐƚƐ ƚŚĂƚ ŝŶĐůƵĚĞ ƚŚĞ ĐŽŶƚƌĂĐƚĞĚ ƉƌŽǀŝĚĞƌ Žƌ ƉƌŽǀŝĚĞƌ ŐƌŽƵƉ͘ dŚĞ ƉůĂŶƐ ĂƌĞ ƌĞƋƵŝƌĞĚ ƚŽ ĐƌĞĂƚĞ ĂŶ ŽŶůŝŶĞ ƉŽƌƚĂů ƚŚĂƚ ƉŚLJƐŝĐŝĂŶƐ ĐĂŶ ƵƐĞ ƚŽ ƵƉĚĂƚĞ ƚŚĞŝƌ ŝŶĨŽƌŵĂƚŝŽŶ Ăƚ ĂŶLJ ƚŝŵĞ ĂŶĚ ǁŝůů ƉƌŽǀŝĚĞ ĐŽŶĨŝƌŵĂƚŝŽŶ ƚŚĂƚ ƚŚĞ ƵƉĚĂƚĞ ǁĂƐ ƌĞĐĞŝǀĞĚ͘ Adam Francis is CAFP’s Deputy Director of Government ZelaƟons.

The Family Medicine Residency at KDHCD is currently seeking

2 positions

Associate Program Director and

Core Faculty Interested applicants should submit a CV to: Patti Egan - Medical Recruiter 2100 Powell Street Ste 900 Emeryville, CA 94608 Email: eganp@medamerica.com Phone: 510-350-2789

'R <RX .QRZ :KDW :KHQ +RZ WR 5HSRUW" 7DNH WKLV FRPSOLPHQWDU\ RQOLQH FRXUVH DQG x /HDUQ HVVHQWLDO VLJQV WKDW VKRXOG EH UHSRUWHG x (DUQ FRQWLQXLQJ HGXFDWLRQ FUHGLWV x 6KDUH ZLWK \RXU VWDII DQG FROOHDJXHV 3UH UHJLVWHU DW KWWS ZZZ LPT RUJ HGXFDWLRQ FDSUUF DVS[ California Family Physician Winter 2016

13

ȱ £ ȱ

Accelerating into Family Medicine /Ŷ ƚŚĞ ƐƵŵŵĞƌ ŽĨ ϮϬϭϯ / ǁĂƐ ƐŝƚƚŝŶŐ ŝŶ Ă ƐŵĂůů ŚƵŵŝĚ ƌŽŽŵ ŝŶ Ă ĐŽĂƐƚĂů ĂŐƌŝĐƵůƚƵƌĂů ƚŽǁŶ ŝŶ ĐƵĂĚŽƌ͕ Ă LJŽƵŶŐ ĐŽŵŵƵŶŝƚLJ ŚĞĂůƚŚ WĞĂĐĞ ŽƌƉƐ ǀŽůƵŶƚĞĞƌ ǁŽƌŬŝŶŐ ŽŶ ŚŝƐ ƉĞƌƐŽŶĂů ƐƚĂƚĞŵĞŶƚ ƚŽ ŐĞƚ ŝŶƚŽ ŵĞĚŝĐĂů ƐĐŚŽŽů͘ ĨĞǁ ŵŽŶƚŚƐ ůĂƚĞƌ / ƌĞĐĞŝǀĞĚ ŐŽŽĚ ŶĞǁƐ͕ ĂĐĐĞƉƚĂŶĐĞ ƚŽ h ĂǀŝƐ͕ ƐƉĞĐŝĨŝĐĂůůLJ ƚŚĞ ŶĞǁ ĂĐĐĞůĞƌĂƚĞĚ ŵĞĚŝĐĂů ƐĐŚŽŽů ĞdžƉĞƌŝĞŶĐĞ ŝŶƚŽ ƉƌŝŵĂƌLJ ĐĂƌĞ͘ / ŚĂĚ ǁŽƌŬĞĚ Ă LJĞĂƌ ŝŶ ĐƵĂĚŽƌ͕ ĂŶĚ ĂƐ / ƌĞĨůĞĐƚĞĚ ďĂĐŬ ŽŶ ƚŚĞ ƉĂƌƚƐ ŽĨ ƚŚĞ ǁŽƌŬ ƚŚĂƚ ďƌŽƵŐŚƚ ŵĞ ƚŚĞ ŵŽƐƚ ũŽLJ͕ ŝƚ ǁĂƐ ƚŚĞ ůŽŶŐ ƚĞƌŵ ƌĞůĂƚŝŽŶƐŚŝƉƐ / ŚĂĚ ďƵŝůƚ ĂŶĚ ƚƌLJŝŶŐ ƚŽ ƉƌŽŵŽƚĞ ŚĞĂůƚŚLJ ĐŽŵŵƵŶŝƚŝĞƐ͘ WƌŝŵĂƌLJ ĐĂƌĞ ĞŵďŽĚŝĞĚ ƚŚŝƐ͘ dŚĞ ĂĐĐĞůĞƌĂƚĞĚ ƉƌŽŐƌĂŵ ƐĐĂƌĞĚ ƚŚĞ ůŝǀŝŶŐ ĚĂLJůŝŐŚƚƐ ŽƵƚ ŽĨ ŵĞ ʹ ƐŽ ŵƵĐŚ ƚŽ ůĞĂƌŶ ŝŶ Ă ƐŚŽƌƚĞƌ ƚŝŵĞ͘ Ƶƚ ĂĨƚĞƌ Ă ƐŝƚͲĚŽǁŶ ǁŝƚŚ ŽŶĞ ŽĨ ŽƵƌ ĂƐƐŽĐŝĂƚĞ ĚĞĂŶƐ ŽĨ ĂĚŵŝƐƐŝŽŶ͕ ǁŚŽ ĐŽŶǀŝŶĐĞĚ ŵĞ ƚŽ ďĞ ďŽůĚ ĂŶĚ ƐƚŽƉ ĚŽƵďƚŝŶŐ ŵLJƐĞůĨ͕ / ƌĞĂůŝnjĞĚ ƚŚĂƚ ƚŚŝƐ ƉƌŽŐƌĂŵ ǁŽƵůĚ ĂůůŽǁ ŵĞ ƚŽ ŐĞƚ ŽƵƚ ƚŚĞƌĞ ǁŽƌŬŝŶŐ ƐŽŽŶĞƌ͕ Ăƚ ůĞƐƐ ĚĞďƚ͕ ĂŶĚ ŚĞůƉ ŵĞ ƐƚĂLJ ŝŶ ƚŚĞ ĂƌĞĂ ƚŚĂƚ / ǁĂŶƚĞĚ ƚŽ ƐĞƌǀĞ͘ /Ŷ ϮϬϭϰ / Śŝƚ ƚŚĞ ŐĂƐ ƉĞĚĂů ŽŶ ƚŚŝƐ ŶĞǁ ĂĐĐĞůĞƌĂƚĞĚ ƉƌŽŐƌĂŵ͘ ^Ž ŚĞƌĞ / Ăŵ͕ ĂůŽŶŐ ǁŝƚŚ ĨŝǀĞ ŽƚŚĞƌ ĐůĂƐƐŵĂƚĞƐ͕ ŚĂůĨǁĂLJ ƚŚƌŽƵŐŚ Ă ƋƵŝĐŬ ƚŚƌĞĞ LJĞĂƌƐ ĂŶĚ ƚŚĞŶ ŽŶ ƚŽ ƌĞƐŝĚĞŶĐLJ͘ dŚĞ ƚƌĂĐŬ ŝƐ ĐĂůůĞĚ ͲW ͕ Žƌ ĐĐĞůĞƌĂƚĞĚ ŽŵƉĞƚĞŶĐLJͲďĂƐĞĚ ĚƵĐĂƚŝŽŶ ŝŶ WƌŝŵĂƌLJ ĂƌĞ͘ dŚŝƐ ƉƌŽũĞĐƚ ƐƚĂƌƚĞĚ Ăƚ h ĂǀŝƐ ĂƐ ƉĂƌƚ ŽĨ Ă ůĂƌŐĞƌ ĐŽŶƐŽƌƚŝƵŵ ŽĨ ϭϭ ƉƌŽŐƌĂŵƐ ĨƵŶĚĞĚ ďLJ ĂŶ ŵĞƌŝĐĂŶ DĞĚŝĐĂů ƐƐŽĐŝĂƚŝŽŶ ; D Ϳ ƚƌĂŶƐĨŽƌŵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƚŝŽŶ ŐƌĂŶƚ͘ h ĂǀŝƐ ŚĂƐ ƉĂƌƚŶĞƌĞĚ ǁŝƚŚ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ ŝŶ ƚŚŝƐ ĞŶĚĞĂǀŽƌ͘ ͲW ͛Ɛ ůĞĂĚĞƌƐŚŝƉ ĂŶƐǁĞƌĞĚ ƚŚĞ ƋƵĞƐƚŝŽŶ͕ ͞,Žǁ ĚŽ ǁĞ ĂĚĚƌĞƐƐ ƚŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͍͟ KŶĞ ĂŶƐǁĞƌ ŝƐ͕ ͞>Ğƚ͛Ɛ ŐĞƚ ƚŚĞŵ ƚƌĂŝŶĞĚ ĨĂƐƚĞƌ ĂŶĚ ǁŽƌŬŝŶŐ ƐŽŽŶĞƌ͘͟ dŚŝƐ ĂůƐŽ ƌĞƋƵŝƌĞĚ Ă ĐŚĂŶŐĞ ƚŽ ƚŚĞ ůĂǁ ŽĨ ŚŽǁ ŵĞĚŝĐĂů ĚĞŐƌĞĞƐ ĂƌĞ ĂǁĂƌĚĞĚ ŝŶ ƚŚĞ ^ƚĂƚĞ ŽĨ ĂůŝĨŽƌŶŝĂ͘ dŚĂŶŬƐ ƚŽ ƚŚĞ ƐƵƉƉŽƌƚ ŽĨ ƚŚĞ D ͕ &W ĂŶĚ ƚŚĞ ůĞŐŝƐůĂƚƵƌĞ͕ ŵĞĚŝĐĂů ĚĞŐƌĞĞƐ ĂƌĞ ŶŽǁ ŐƌĂŶƚĞĚ ďĂƐĞĚ ŽŶ ƐƚƵĚĞŶƚƐ͛ ŵĞĞƚŝŶŐ ŶĂƚŝŽŶĂů ŐƌĂĚƵĂƚŝŽŶ ĐŽŵƉĞƚĞŶĐŝĞƐ ĨƌŽŵ ƚŚĞ >ŝĐĞŶƐŝŶŐ ŽŵŵŝƚƚĞĞ ŽĨ DĞĚŝĐĂů ĚƵĐĂƚŝŽŶ ƌĂƚŚĞƌ ƚŚĂŶ ďĞŝŶŐ ďĂƐĞĚ ŽŶ ƚŚĞ ƚŝŵĞ ŝƚ ƚŽŽŬ ƚŽ ĐŽŵƉůĞƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƚŝŽŶ͘ ^Ž ǁŚĂƚ ŚĂƐ ŵLJ ĞdžƉĞƌŝĞŶĐĞ ůŽŽŬĞĚ ůŝŬĞ ƐŽ ĨĂƌ͍ tĞůů͕ / ŚĂĚ Ă ƉƌŝŵĂƌLJ ĐĂƌĞ ŵĞŶƚŽƌ ĨƌŽŵ ƚŚĞ ďĞŐŝŶŶŝŶŐ͘ ƵƌŝŶŐ ŵLJ ĨŝƌƐƚ ƚǁŽ LJĞĂƌƐ͕ / ŚĂǀĞ ďĞĞŶ ĨŽƌŐŽŝŶŐ ŵLJ ƐƵŵŵĞƌ ďƌĞĂŬƐ͕ ďŽƚŚ ďĞĨŽƌĞ ƐƚĂƌƚŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ĂŶĚ ŝŶ ďĞƚǁĞĞŶ D^ϭ ĂŶĚ D^Ϯ LJĞĂƌ͘ / ĂůƐŽ ƚƌĂŝŶ ǁŝƚŚ Ă ĚŽĐƚŽƌ ŝŶ ŚŝƐ ŽƵƚƉĂƚŝĞŶƚ ĐůŝŶŝĐ ƚŚƌŽƵŐŚŽƵƚ

14

California Family Physician Winter 2016

ȱ £ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯ ƚŚĞ ƐĐŚŽŽů LJĞĂƌ Ă ĨĞǁ ŚĂůĨͲĚĂLJƐ ŽĨ ƚŚĞ ŵŽŶƚŚ͘ tĞ ĂůƐŽ ŚĂǀĞ ƐŽŵĞ ƐƉĞĐŝĂů ŐƌĂŶĚ ƌŽƵŶĚƐͲƐƚLJůĞ ĐůĂƐƐĞƐ͘ / ĐĂŶ ƐĂLJ / Ăŵ Ɛƚŝůů ǀĞƌLJ ŚĂƉƉLJ ǁŝƚŚ ŵLJ ĚĞĐŝƐŝŽŶ ƚŽ ĚŽ ƚŚŝƐ ƉƌŽŐƌĂŵ͘ ĞĐĂƵƐĞ ƚŚĞ ƉƌŽŐƌĂŵ ŝƐ ŚĞƌĞ ŝŶ ŵLJ ŚŽŵĞƚŽǁŶ͕ / ĂƐŬĞĚ ŵLJ ƐĐŚŽŽů ůĞĂĚĞƌƐŚŝƉ ŝĨ Ă <ĂŝƐĞƌ ĐůŝŶŝĐ ŝŶ ŵLJ ŶĞŝŐŚďŽƌŚŽŽĚ ŽĨ ƐŽƵƚŚ ^ĂĐƌĂŵĞŶƚŽ ǁŽƵůĚ ďĞ Ă ĨƵƚƵƌĞ ƉƌĂĐƚŝĐĞ ƉŽƐƐŝďŝůŝƚLJ͘ dŚĞLJ ĨŽƵŶĚ ŵĞ Ă ŵĞŶƚŽƌ ǁŚŽ ĐƵƌƌĞŶƚůLJ ǁŽƌŬƐ Ăƚ <ĂŝƐĞƌ͕ ǁŚŽ ƚƌĞĂƚƐ ƉĞŽƉůĞ ǁŚŽ ƐŚŽƉ Ăƚ ƐƚŽƌĞƐ Ăƚ ǁŚŝĐŚ / ƵƐĞĚ ƚŽ ƐŚŽƉ͕ ǁŚŽ ǁĞŶƚ ƚŽ ŚŝŐŚͬĞůĞŵĞŶƚĂƌLJ ƐĐŚŽŽůƐ ŵLJ ĨƌŝĞŶĚƐ ĂŶĚ ĨĂŵŝůLJ ǁĞŶƚ ƚŽ͕ ĂŶĚ ǁŚŽ ůŽŽŬƐ ůŝŬĞ ŵĞ͊ ,ĂǀŝŶŐ Ă ŐƌĞĂƚ ĚŽĐƚŽƌ ǁŚŽ ĂůƐŽ ŚĂƉƉĞŶƐ ƚŽ ďĞ ĨƌŝĐĂŶͲ ŵĞƌŝĐĂŶ ĂƐ ŵLJ ŵĞŶƚŽƌ ŽǀĞƌ ŵLJ ƚŚƌĞĞ LJĞĂƌƐ ŝŶ ŵĞĚŝĐĂů ƐĐŚŽŽů ŝƐ ƐŝŵƉůLJ ĂŵĂnjŝŶŐ͘ ŶƚĞƌŝŶŐ ϮϬϭϲ͕ ŵLJ D^ϯ LJĞĂƌ ǁŝůů ďĞ Ă ŶĞǁůLJͲĐƌĞĂƚĞĚ ƚĞŶͲ ŵŽŶƚŚ ůŽŶŐŝƚƵĚŝŶĂů ĞdžƉĞƌŝĞŶĐĞ ǁŝƚŚ Ăůů ƚŚĞ ƌĞƋƵŝƌĞĚ ƚŚŝƌĚ LJĞĂƌ ƌŽƚĂƚŝŽŶƐ ƉƌŝŵĂƌŝůLJ ǁŝƚŚŝŶ ƚŚĞ <ĂŝƐĞƌ ƐLJƐƚĞŵ͘ dŚĞ ĨŽƵƌƚŚ LJĞĂƌ͕ LJŽƵ ĂƐŬ͍ EŽŶĞ ŽĨ ƚŚĂƚ͕ ƚŚĂŶŬ LJŽƵ͕ /͛ůů ũƵƐƚ ďĞ ŽŶ ŵLJ ǁĂLJ ŝŶ ϮϬϭϳ͊ dŝŵĞ ŝƐ ƐĂǀĞĚ ďLJ ŐĞƚƚŝŶŐ ƌŝĚ ŽĨ ƚŚĞ ĂƉƉůŝĐĂƚŝŽŶͬ ŝŶƚĞƌǀŝĞǁ ƉƌŽĐĞƐƐ͘ ůů ŽĨ ƵƐ ĂĚŵŝƚƚĞĚ ŚĂǀĞ ĐŽŶĚŝƚŝŽŶĂů ĂĐĐĞƉƚĂŶĐĞƐ ;ǁĞ ŵƵƐƚ ƉĂƐƐ Ăůů ĞdžĂŵƐͿ ƚŽ Ă ĨĞǁ ƉĂƌƚŶĞƌ ŶŽƌƚŚĞƌŶ ĂůŝĨŽƌŶŝĂ ƌĞƐŝĚĞŶĐŝĞƐ ƚŚĂƚ ĂƌĞ ĂůƐŽ ĚĞĚŝĐĂƚĞĚ ƚŽ ĂĚĚƌĞƐƐŝŶŐ ƚŚĞ ĨƵŶĚĂŵĞŶƚĂů ƋƵĞƐƚŝŽŶ͕ ͞,Žǁ ĚŽ ǁĞ ĂĚĚƌĞƐƐ ƚŚĞ ƐŚŽƌƚĂŐĞ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͍͟ &Žƌ ƵƐ͕ ƚŚĂƚ ĂŶƐǁĞƌ Ő ŝƐ ͲW ͘ Ngabo Nzigira is a current MS2 at UC Davis, volunteers at the student run clinic Clinica TepaƟ, is co-Vice President of Student NaƟonal Medical AssociaƟon and is board member of the LaƟno Medical Student AssociaƟon.

! ! ## ! & ! " # " ! ! # ! ) , # ! " * & " ! ! "" !( ! # ! ! % !" # # ! % # $#$! , " # $ #" ! & # ! % ##" # ! # , # #& ! # # # ##"

(" #& ! . / " !% # ! # ! ' #! ! , " $ # " $ + ##" * " * * ! * # ', (" - * 472- (" #& ! " & ( " # $ # ! % $#"# ! # !#$ # " " # ( # ! $ #( # # ! , ! & # # #& ! * # # $! ("+ 692-5:3-:888 $! 0 ! ) (" ! !", ##" (" #& ! ' $" % #! # (" !$ # # !# #

California Family Physician Winter 2016

15

2015 Member of the Month Yearbook CAFP reŐularly hiŐhliŐhts the inspirinŐ stories of our members with the Member of the Month series. We celebrate the passion that drives them to success and share how they have put their vast knowledŐe and enthusiasm to work on behalf of their paƟents, students and community. Take a moment and meet our standout 2015 honorees who are usinŐ their voices and experience to advance the specialty:

JANUARY: The Champion

FEBRUARY: The Advocate

Nate Hitzeman, MD

Jennifer HasƟnŐs, MD

͞The most rewardinŐ thinŐ is hearinŐ from former students or residents with whom I’ve worked – either updaƟnŐ me on their proŐress or thankinŐ me for helpinŐ them on their medical journey. The teacher-student interacƟon is so rewardinŐ for me. When I was a student, I remember takinŐ notes from all the Őood aƩendinŐs and thinkinŐ, ͚I’m ŐoinŐ to try to Őlean the best from all these folks and be like them someday!”

"One of my best experiences has been cominŐ to an understandinŐ of the extraordinary journey of Őender, creaƟnŐ transŐender services and brinŐinŐ this understandinŐ to others. There have been so many other maŐical moments: brinŐinŐ the idea of an inteŐrated community health center to fruiƟon, brinŐinŐ behavioral health services to our Planned Parenthood health center and beinŐ part of the process to enŐaŐe mid-level clinicians to be aborƟon providers via academic and leŐislaƟve avenues."

MARCH: The Pioneer

APRIL: The Ambassador

Larry Shore, MD

Brent SuŐimoto, MD

“In 2007, I became interested in the PaƟent Centered Medical Home (PCMH) model. I went throuŐh a process of curiosity leadinŐ to confusion and then I was ulƟmately convinced that this is where I wanted to take my pracƟce. Now our PCMH is cominŐ up on our third anniversary. TakinŐ that project from concept to pitch to implementaƟon has been very saƟsfyinŐ. It is also, as a concept and pracƟce, riŐht at the heart of pracƟce and payment reform.”

“The breadth of family medicine, I think, is essenƟal to my joy in pracƟce, and brinŐs incredible experiences and Őrowth with every paƟent. It is important for me to be a member of CAFP and AAFP because it is my bias that I believe family medicine can save American health care. I am Őlad to have CAFP and AAFP as the voice for family medicine.”

MAY: The Innovator

JUNE: The Educator

Sharon Lin, DO

Candace Lawson, MD

“When I was the medical student representaƟve on the CAFP board, I accompanied CAFP on many trips to Sacramento to talk to leŐislators and staīers reŐardinŐ health care reform. I felt like I was doinŐ my civic duty, and that was an empowerinŐ feelinŐ. California is where a lot of innovaƟon comes from and we are leaders in health care reform. It’s an exciƟnŐ Ɵme and a Őood place to be. ”

“I make a diīerence by showinŐ up every work day eaŐer to do the work ahead of me despite bureaucracy and weird reŐulaƟons. I make a diīerence by teachinŐ residents and medical students to ensure that our physicians of the future will be equipped with the skills necessary to provide excellent paƟent care. PaƟence, compassion and a Őood sense of humor are key!”

16

California Family Physician Winter 2016

MEMBERSHIP

JULY: The Leader

AUGUST: The AcƟvist

Hobart Lee, MD

Elisabeth Wilson, MD,MPH

“It is vital to encouraŐe pipeline acƟviƟes and stay connected to medical students and residents throuŐh CAFP and AAFP. Advocacy for universal health care, PCMH transformaƟon, increasinŐ the family physician workforce and leadership opportuniƟes are extremely important. The educaƟon I Őet from CAFP and AAFP throuŐh live CME events, journals and online learninŐ is one of my main ways of stayinŐ current and evidenced-based in my medical knowledŐe and pracƟce.”

“Our students and residents are acƟvely enŐaŐed in addressinŐ the impact of discriminaƟon and bias on vulnerable communiƟes. Students at UCSF started the #WhiteCoats4BlackLives movement and our family medicine residents at San Francisco General Hospital are orŐanizinŐ discussions on police violence, Islamophobia and implicit bias. I truly believe that physicians are responsible for takinŐ acƟon on social jusƟce issues. It maƩers what we do and what we say, and I am honored to be part of this work.”

SEPTEMBER: The Mentor

OCTOBER: The RepresentaƟve

Mike WiƩe, MD

Shani Muhammad, MD

“A family physician should have respect for all paƟents and staī. Be a spectacular listener and learn from each paƟent and each encounter. Be kind, and have a sense of irony and an easy sense of humor. Never brinŐ a bad aƫtude to your workplace. Learn to be an eīecƟve and inclusive leader.”

“My best experience as a CAFP member thus far, undoubtedly, was beinŐ mentored by both Jay Lee and Jack Chou at AAFP’s NaƟonal Conference of ConsƟtuency Leaders. I successfully ran for Minority Co-Convener and havinŐ their support while I pracƟced my speech made a huŐe diīerence! The Įrst Ɵme I tried it, I was ŐrippinŐ the podium! By run-throuŐh number four, I was relaxed, poised and ready to win! It is wonderful to have mentors who are experienced, accessible and willinŐ to help.”

NOVEMBER: The Trailblazer

DECEMBER: The Visionary

Chris Flores, MD

Shannon Connolly, MD

“One of my biŐŐest achievements has been seƫnŐ up a successful “dream pracƟce” based on the lowoverhead, low-volume model. Ten years aŐo, many people said it couldn’t be done, but with hard work and creaƟvity, my wife and I have established a respected, fullspectrum medical home with passionately loyal paƟents and manaŐeable work-life balance. I have done house calls, hospital inpaƟent work, skilled nursinŐ home rounds, virtual oĸce visits and state-of-the-art diaŐnosis and manaŐement from a small oĸce.”

“BeinŐ in a brand new pracƟce, I feel very fortunate to be in a posiƟon where we can examine all of our systems and really think to ourselves, 'Is this the best way to do this͍'. It’s incredibly exciƟnŐ to build somethinŐ from the beŐinninŐ. NothinŐ is set in stone, so we have an opportunity to start with a vision and Őo from there. We are in a Őood posiƟon to really try to Őet thinŐs riŐht for our paƟents.” California Family Physician Winter 2016

17

ȱ

Integrate Behavioral Health Services: It’s Time to Stop Cutting People off at the Head! ZĞĐĞŶƚ ƌĞƐĞĂƌĐŚ ŝŶĚŝĐĂƚĞƐ ƚŚĂƚ ĂƐ ŵĂŶLJ ĂƐ ϳϬ ƉĞƌĐĞŶƚ ŽĨ ƉƌŝŵĂƌLJ ĐĂƌĞ ǀŝƐŝƚƐ ŚĂǀĞ ƉƐLJĐŚŽƐŽĐŝĂů ŝƐƐƵĞƐ ĐŽͲŽĐĐƵƌƌŝŶŐ ǁŝƚŚ Ă ƉŚLJƐŝĐĂů ĐŽŵƉůĂŝŶƚ͘ hƉ ƚŽ ϰϱ ƉĞƌĐĞŶƚ ŽĨ ŝŶĚŝǀŝĚƵĂůƐ ǁŚŽ ĚŝĞ ďLJ ƐƵŝĐŝĚĞ ŚĂǀĞ ǀŝƐŝƚĞĚ ƚŚĞŝƌ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉŚLJƐŝĐŝĂŶƐ ǁŝƚŚŝŶ Ă ŵŽŶƚŚ ŽĨ ƚŚĞŝƌ ĚĞĂƚŚƐ͘ ^ĞǀĞŶ ƉĞƌĐĞŶƚ ŽĨ Ăůů ǀŝƐŝƚƐ ƚŽ Ă ƉƌŝŵĂƌLJ ĐĂƌĞ ĚŽĐƚŽƌ ŶŽǁ ŝŶǀŽůǀĞ Ă ƉƌĞƐĐƌŝƉƚŝŽŶ ĨŽƌ ĂŶƚŝĚĞƉƌĞƐƐĂŶƚƐ͘ &ŽƵƌ ŽƵƚ ŽĨ ĨŝǀĞ ƉƌĞƐĐƌŝƉƚŝŽŶƐ ĨŽƌ ƉƐLJĐŚŽƚƌŽƉŝĐ ŵĞĚŝĐĂƚŝŽŶƐ ĂƌĞ ǁƌŝƚƚĞŶ ďLJ ƉƌŝŵĂƌLJ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͘ dŚĞ h^ WƌĞǀĞŶƚŝǀĞ ^ĞƌǀŝĐĞƐ dĂƐŬ &ŽƌĐĞ ;h^W^d&Ϳ ƌĞĐŽŵŵĞŶĚƐ ĚĞƉƌĞƐƐŝŽŶ ƐĐƌĞĞŶŝŶŐ ĨŽƌ ĂĚƵůƚƐ ƚŽ ŝŵƉƌŽǀĞ ĚĞƚĞĐƚŝŽŶ ĂŶĚ ƉĂƚŝĞŶƚ ŽƵƚĐŽŵĞƐ͕ ƉƌŽǀŝĚĞĚ ƚŚĂƚ ƐLJƐƚĞŵƐ ĂƌĞ ŝŶ ƉůĂĐĞ ƚŽ ĞŶƐƵƌĞ ĂĐĐƵƌĂƚĞ ĚŝĂŐŶŽƐŝƐ͕ ĞĨĨĞĐƚŝǀĞ ƚƌĞĂƚŵĞŶƚ ĂŶĚ ĂƉƉƌŽƉƌŝĂƚĞ ĨŽůůŽǁͲƵƉ͘ What are the leǀels of integration of behaǀioral health serǀices͍ ͻ ĂƐŝĐ ĐŽůůĂďŽƌĂƚŝŽŶ Ăƚ Ă ĚŝƐƚĂŶĐĞ ;ƌĞĨĞƌƌĂů ƚŽ Ă ƉƌŽǀŝĚĞƌ ŽƵƚƐŝĚĞ ƚŚĞ ƉƌĂĐƚŝĐĞͿ͘ ͻ ĂƐŝĐ ĐŽůůĂďŽƌĂƚŝŽŶ ŽŶͲƐŝƚĞ ǁŝƚŚ ŵŝŶŝŵĂů ŝŶƚĞŐƌĂƚŝŽŶ ;ĐŽͲůŽĐĂƚŝŽŶ͕ ƌĞĨĞƌƌĂůͲďĂƐĞĚͿ͘ ͻ ůŽƐĞ ĐŽůůĂďŽƌĂƚŝŽŶ ŽŶͲƐŝƚĞ ;ĐŽͲůŽĐĂƚŝŽŶͿ ;Ğ͘Ő͕͘ Ă ƉƌŝŵĂƌLJ ĐĂƌĞ ƐĞƚƚŝŶŐ ĞŵďĞĚĚŝŶŐ Ă ďĞŚĂǀŝŽƌĂů ŚĞĂůƚŚ ƉƌŽǀŝĚĞƌ ǁŝƚŚ ĨĂĐĞͲƚŽͲĨĂĐĞ ĐŽŵŵƵŶŝĐĂƚŝŽŶ ĂŵŽŶŐ ĐůŝŶŝĐŝĂŶƐ͖ ƉƌŽǀŝĚĞƌƐ ĂƌĞ ŵŽƐƚ ůŝŬĞůLJ ĨƌŽŵ ƚǁŽ ŽƌŐĂŶŝnjĂƚŝŽŶƐ ĂŶĚ ŚĂǀĞ ĚĞĐŝĚĞĚ ƚŽ ǁŽƌŬ ƚŽŐĞƚŚĞƌ ŝŶ ƚŚĞ ƐĂŵĞ ƐƉĂĐĞͿ͘ ͻ ůŽƐĞ ĐŽůůĂďŽƌĂƚŝŽŶ ĂƉƉƌŽĂĐŚŝŶŐ ĂŶ ŝŶƚĞŐƌĂƚĞĚ ƉƌĂĐƚŝĐĞ ;ƚĞĂŵͲďĂƐĞĚ ĐĂƌĞͿ͕ ĂŶĚ ĨƵůů ĐŽůůĂďŽƌĂƚŝŽŶ ŝŶ Ă ƚƌĂŶƐĨŽƌŵĞĚ ĨƵůůLJͲŝŶƚĞŐƌĂƚĞĚ ƐLJƐƚĞŵ ;ƐŝŶŐůĞ ŚĞĂůƚŚ ƐLJƐƚĞŵ ƚƌĞĂƚŝŶŐ ƚŚĞ ǁŚŽůĞ ƉĞƌƐŽŶ ǁŝƚŚ Ă ƐŚĂƌĞĚ ŵĞĚŝĐĂů ƌĞĐŽƌĚͿ͘ dŚĞ ŬĞLJƐ ƚŽ ƐƵĐĐĞƐƐ ŝŶ ĂŶLJ ƌĞĨĞƌƌĂů ƉƌŽĐĞƐƐ ĨŽƌ ďĞŚĂǀŝŽƌĂů ĐĂƌĞ ĂƌĞ ƚŚĞ ͞ǁĂƌŵ ŚĂŶĚͲŽĨĨ͟ ĨƌŽŵ Ă ƚƌƵƐƚĞĚ ŵĞĚŝĐĂů ƉƌŽǀŝĚĞƌ ǁŝƚŚ ǁŚŽŵ ƚŚĞ ƉĂƚŝĞŶƚ ŚĂƐ Ă ƌĞůĂƚŝŽŶƐŚŝƉ ƚŽ Ă ďĞŚĂǀŝŽƌĂů ŚĞĂůƚŚ ƉƌŽǀŝĚĞƌ ĂŶĚ ƚŚĞ ƚŝŵĞůŝŶĞƐƐ ǁŝƚŚ ǁŚŝĐŚ ƚŚĂƚ ŚĂŶĚͲŽĨĨ ŽĐĐƵƌƐ͘ ZĞƐĞĂƌĐŚ ŚĂƐ ĚĞŵŽŶƐƚƌĂƚĞĚ ƚŚĂƚ ƚŚĞ ŵŽƌĞ ƚŝŵĞ ƚŚĂƚ ĞůĂƉƐĞƐ ďĞƚǁĞĞŶ ƚŚĞ ƌĞĐŽŐŶŝƚŝŽŶ ŽĨ ďĞŚĂǀŝŽƌĂů ŚĞĂůƚŚ ŝƐƐƵĞƐ ĂŶĚ ƚŚĞ ĂĐƚƵĂů ƌĞĨĞƌƌĂů͕ ƚŚĞ ůĞƐƐ ůŝŬĞůLJ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ǁŝůů ĨŽůůŽǁ ƚŚƌŽƵŐŚ ĂŶĚ ĂƚƚĞŶĚ ƚŚĞ ƐĞƐƐŝŽŶ͘ Integration͗ Where to start͍ Understanding: ĞǀĞůŽƉ ĂŶ ŝŶĐƌĞĂƐĞĚ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ďĞŚĂǀŝŽƌĂů ŚĞĂůƚŚ ŝƐƐƵĞƐ ƚŚƌŽƵŐŚ ĞĚƵĐĂƚŝŽŶ ĂŶĚ ĐŽŶƐƵůƚĂƚŝŽŶ ĂŶĚ ĐŽŵŵŝƚŵĞŶƚ ƚŽ ǁŚŽůĞ ƉĞƌƐŽŶ ĐĂƌĞ͘ džƉůŽƌĞ ĐŽŵŵƵŶŝƚLJ 18

California Family Physician Winter 2016

ƌĞƐŽƵƌĐĞƐ ĂŶĚ ĂǀĂŝůĂďŝůŝƚLJ ŽĨ ƐĂŵĞ͘ ĞƚĞƌŵŝŶĞ ǁŚŝĐŚ ůĞǀĞů ŽĨ ŝŶƚĞŐƌĂƚŝŽŶ ǁŝůů ďĞƐƚ ŵĞĞƚ ƚŚĞ ŶĞĞĚƐ ŽĨ LJŽƵƌ ƉƌĂĐƚŝĐĞ ĂŶĚ LJŽƵƌ ƉĂƚŝĞŶƚƐ͘ Training: ǀĞƌLJŽŶĞ ŝŶ ƚŚĞ ƉƌĂĐƚŝĐĞ ŚĂƐ ƚŽ ŚĂǀĞ ĂŶ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ǁŚLJ ĂŶĚ ŚŽǁ ďĞŚĂǀŝŽƌĂůͬŵĞŶƚĂů ŚĞĂůƚŚ ĐĂƌĞ ŝƐ ďĞŝŶŐ ŝŶƚĞŐƌĂƚĞĚ ŝŶƚŽ ƚŚĞ ƉƌĂĐƚŝĐĞ͕ ǁŚĂƚ ƚŚĞŝƌ ƌŽůĞ ǁŝůů ďĞ ĂŶĚ ŚŽǁ ƐƵĐĐĞƐƐ ǁŝůů ďĞ ŵĞĂƐƵƌĞĚ͘ ŐŽŽĚ ŝŶƚƌŽĚƵĐƚŽƌLJ ĐůĂƐƐ ĨŽƌ ƐƵƉƉŽƌƚ ƐƚĂĨĨ ŝƐ Ă ĐŽƵƌƐĞ ĐĂůůĞĚ ͞DĞŶƚĂů ,ĞĂůƚŚ &ŝƌƐƚ ŝĚ͟ ǁŚŝĐŚ ŝƐ ƉƌŽǀŝĚĞĚ ŝŶ ŵĂŶLJ ĐŽŵŵƵŶŝƚŝĞƐ ĨŽƌ ŵŝŶŝŵĂů Žƌ ŶŽ ĐŚĂƌŐĞ͘ Identify Screening tools: ZĞƐĞĂƌĐŚ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƐĐƌĞĞŶŝŶŐ ƉƌĂĐƚŝĐĞƐ ĂŶĚ ƚŽŽůƐ͖ ĚĞǀĞůŽƉ ĂŶĚ ĂƉƉƌŽǀĞ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ ƐĐƌĞĞŶŝŶŐ ŐƵŝĚĞůŝŶĞƐ͘ Treatment: Ɛ ĂŶ ĞdžĂŵƉůĞ͕ ƚŚĞ ƵƐƵĂů ĐĂƌĞ ĨŽƌ ĚĞƉƌĞƐƐŝŽŶ ŝŶ ƚŚĞ ƉƌŝŵĂƌLJ ĐĂƌĞ ƐĞƚƚŝŶŐ ŚĂƐ ƌĞƐƵůƚĞĚ ŝŶ ŽŶůLJ ĂďŽƵƚ ŚĂůĨ ŽĨ ĚĞƉƌĞƐƐĞĚ ĂĚƵůƚƐ ďĞŝŶŐ ƚƌĞĂƚĞĚ ĂŶĚ ŽŶůLJ ϮϬͲϰϬ ƉĞƌĐĞŶƚ ƐŚŽǁŝŶŐ ƐƵďƐƚĂŶƚŝĂů ŝŵƉƌŽǀĞŵĞŶƚ ŽǀĞƌ ϭϮ ŵŽŶƚŚƐ͘ /Ŷ ĂĚĚŝƚŝŽŶ ƚŽ ŵĞĚŝĐĂƚŝŽŶƐ͕ ƚŚĞ ĨŽĐƵƐ ŽĨ ƚŚĞƌĂƉLJ ŵĂLJ ŶĞĞĚ ƚŽ ŝŶĐůƵĚĞ ůĞĂƌŶŝŶŐ ŚĞĂůƚŚŝĞƌ ďĞŚĂǀŝŽƌƐ ĂŶĚ ĐŽƉŝŶŐ ŵĞĐŚĂŶŝƐŵƐ͘ dŚĞ ĨŽĐƵƐ ŽĨ ƚŚĞƌĂƉLJ ŝŶ ĂŶ ŝŶƚĞŐƌĂƚĞĚ ƐĞƚƚŝŶŐ ŝƐ ůĂƌŐĞůLJ ƐŚŽƌƚͲƚĞƌŵ͕ ďƌŝĞĨ ŝŶƚĞƌǀĞŶƚŝŽŶƐ͘ /Ĩ ƉĂƚŝĞŶƚ ŶĞĞĚƐ ĞdžĐĞĞĚ ďƌŝĞĨ ŝŶƚĞƌǀĞŶƚŝŽŶ͕ ƌĞĨĞƌƌĂů ǁŽƵůĚ Ɛƚŝůů ďĞ ŵĂĚĞ ƚŽ Ă ƚŚĞƌĂƉŝƐƚ ǁŚŽ ƐĞĞƐ ƉĂƚŝĞŶƚƐ ŽŶ Ă ůŽŶŐͲƚĞƌŵ ďĂƐŝƐ͘

ȱ ¢ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱȃ ȱ Ȭ ěȄȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȭ ěȱ ǯ

&Ĺ˝ĆŒ Ć‰ĆŒÄ‚Ä?ĆšĹ?Ä?ÄžĆ? ĂŜĚ Ć‰ĆŒĹ˝Ç€Ĺ?ÄšÄžĆŒĆ? Ć‰Ä‚ĆŒĆšĹ?Ä?Ĺ?ƉĂƚĹ?ĹśĹ? Ĺ?Ĺś Ä?ĂƉĹ?ƚĂƚĞĚ ĞŜǀĹ?ĆŒŽŜžÄžĹśĆšĆ? ĂŜĚ Ĺ?ĹśĹ?ĆšĹ?Ä‚ĆšĹ?ǀĞĆ?Í• ƚŚĞ ĚĞǀĞůŽƉžĞŜƚ ŽĨ Ä?ĞŚĂǀĹ?Ĺ˝ĆŒÄ‚ĹŻ ŚĞĂůƚŚ Ć?ÄžĆŒÇ€Ĺ?Ä?ÄžĆ? Ä?Ä‚Ĺś ŚĞůƉ Ć?ĂǀĞ ÄšŽůůÄ‚ĆŒĆ? ĞǀĞŜ ĨŽĆŒ ƚŚĞ Ä?Ä‚ĆŒÄž ŽĨ žĞĚĹ?Ä?Ä‚ĹŻ Ä?ŽŜÄšĹ?ĆšĹ?ŽŜĆ?͘ tĹ˝ĆŒĹŹĹ?ĹśĹ? Ç Ĺ?ƚŚ ĂŜĚ ĆšĆŒÄžÄ‚ĆšĹ?ĹśĹ? LJŽƾĆŒ ƉĂƚĹ?ĞŜƚĆ? ĨĆŒŽž Ä‚ Ɖ ĹšŽůĹ?Ć?ĆšĹ?Ä? Ć‰ÄžĆŒĆ?ƉĞÄ?ĆšĹ?ǀĞ ĆŒÄžĆ?ƾůĆšĆ? Ĺ?Ĺś Ä?ÄžĆšĆšÄžĆŒ ŽƾĆšÄ?ŽžÄžĆ?Í• Ĺ?ĹśÄ?ĆŒÄžÄ‚Ć?ĞĚ Ć?Ä‚ĆšĹ?Ć?ĨÄ‚Ä?ĆšĹ?ŽŜ ĂŜĚ ĚĞÄ?ĆŒÄžÄ‚Ć?ĞĚ ŚĞĂůƚŚÄ?Ä‚ĆŒÄž Ä?Ĺ˝Ć?ĆšĆ?͘ References: Íť

>ĞǀĞLJ͕ DĹ?ĹŻĹŻÄžĆŒÍ• sÄžĆŒĹŻĹ˝Ĺ?Ĺś ĚĞ'ĆŒĆľÇ‡Í• ĎŽĎŹĎ­ĎŽÍ— ĞŚĂǀĹ?Ĺ˝ĆŒÄ‚ĹŻ ŚĞĂůƚŚ Ĺ?ŜƚĞĹ?ĆŒÄ‚ĆšĹ?ŽŜÍ— Ä‚Ĺś ÄžĆ?Ć?ĞŜƚĹ?Ä‚ĹŻ ĞůĞžĞŜƚ ŽĨ ƉŽƉƾůÄ‚ĆšĹ?ŽŜͲÄ?Ä‚Ć?ĞĚ ŚĞĂůƚŚÄ?Ä‚ĆŒÄž ĆŒÄžÄšÄžĆ?Ĺ?Ĺ?Ĺś dĆŒÄ‚ĹśĆ?ĹŻ ĞŚĂǀ DĞĚ͘ ĎŽĎŹĎ­ĎŽ ^ĞƉ͖ ώ͞ϯͿÍ— ϯϲϰʹϯϳϭ͘ WĆľÄ?ĹŻĹ?Ć?ŚĞĚ ŽŜůĹ?ŜĞ ĎŽĎŹĎ­ĎŽ :ƾů ώϲ͘ ĚŽĹ?Í— Ď­ĎŹÍ˜ϭϏϏϳ͏Ć?ϭϯϭϰώͲϏϭώͲϏϭϹώͲϹ Íť >ƾŽžÄ‚ : Í• DÄ‚ĆŒĆšĹ?Ĺś Í• WÄžÄ‚ĆŒĆ?ŽŜ :>͘ ŽŜƚĂÄ?Ćš Ç Ĺ?ƚŚ žĞŜƚĂů ŚĞĂůƚŚ ĂŜĚ Ć‰ĆŒĹ?ĹľÄ‚ĆŒÇ‡ Ä?Ä‚ĆŒÄž Ć‰ĆŒĹ˝Ç€Ĺ?ÄšÄžĆŒĆ? Ä?ÄžĨŽĆŒÄž Ć?ĆľĹ?Ä?Ĺ?ĚĞ͗ Ä‚ ĆŒÄžÇ€Ĺ?ÄžÇ Ĺ˝Ä¨ ƚŚĞ ĞǀĹ?ĚĞŜÄ?Ğ͘ Ĺľ : WĆ?LJÄ?ĹšĹ?Ä‚ĆšĆŒÇ‡Í˜ ĎŽĎŹĎŹĎŽÍ–ϭϹϾ͞ϲͿÍ—ϾϏϾʹϾϭϲ͘ Íť ,ĞĂůƚŚ ĨĨ ĆľĹ?ĆľĆ?Ćš ĎŽĎŹĎ­Ď­ ĎŻĎŹÍ—ϴϭϰϯϰͲϭϰϰώÍ– ĚŽĹ?Í—Ď­ĎŹÍ˜ϭϯϳϳ͏ŚůƚŚĂĨĨÍ˜ĎŽĎŹĎ­ĎŹÍ˜Ď­ĎŹĎŽĎ° Íť DÄ‚ĆŒĹŹ d>Í• >ĞǀĹ?Ćš <ZÍ• ĆľÄ?ĹŹ : ĂƚĂƉŽĹ?ŜƚĆ?Í— ƉĆ?LJÄ?ĹšĹ˝ĆšĆŒĹ˝Ć‰Ĺ?Ä? ÄšĆŒĆľĹ? Ć‰ĆŒÄžĆ?Ä?ĆŒĹ?ƉƚĹ?ŽŜĆ? Ä?LJ žĞĚĹ?Ä?Ä‚ĹŻ Ć?ƉĞÄ?Ĺ?Ä‚ĹŻĆšÇ‡Í˜ WĆ?LJÄ?ĹšĹ?Ä‚ĆšĆŒ ^ÄžĆŒÇ€Í˜ ώϏϏϾ͖ϲϏ͞ϾͿÍ—ϭϭϲϳ Íť h^W^d&͘ ŜŜ /ĹśĆšÄžĆŒĹś DĞĚ͘ ĎŽĎŹĎŹĎŽÍ–ϭϯϲÍ—ϳϲϏͲϲϰÍ– h^W^d&͘ ŜŜ /ĹśĆšÄžĆŒĹś DĞĚ͘ FAMILY MEDICINE/INTERNAL MEDICINE ώϏϏϾ͖ϭϹϭÍ—ϳϴϰͲϾώ Vista Community Clinic located in North San Diego County Íť ZĞǀĹ?ÄžÇ Ä‚ĹśÄš WĆŒĹ˝Ć‰Ĺ˝Ć?ĞĚ ^ĆšÄ‚ĹśÄšÄ‚ĆŒÄš dĂdžŽŜŽžÇ‡ ĨŽĆŒ >ĞǀĞůĆ? ŽĨ /ŜƚĞĹ?ĆŒÄ‚ĆšÄžÄš ,ĞĂůƚŚÄ?Ä‚ĆŒÄžÍ•Í&#x; Ć‰ĆŒÄžĆ‰Ä‚ĆŒÄžÄš ĨŽĆŒ ƚŚĞ EÄ‚ĆšĹ?ŽŜÄ‚ĹŻ ŽƾŜÄ?Ĺ?ĹŻ ŽĨ ŽžžƾŜĹ?ƚLJ ĞŚĂǀĹ?Ĺ˝ĆŒÄ‚ĹŻ ,ĞĂůƚŚÄ?Ä‚ĆŒÄžÍ• ŚƚƚƉ͗͏͏ Seeking: Full-time, part-time and per diem Family Medicine Physicians. Ç Ç Ç Í˜Ĺ?ŜƚĞĹ?ĆŒÄ‚ĆšĹ?ŽŜ͘Ć?ĂžŚĆ?Ă͘Ĺ?Ĺ˝Ç€ÍŹĆŒÄžĆ?ŽƾĆŒÄ?Ğ͏Ć?ĆšÄ‚ĹśÄšÄ‚ĆŒÄšͲĨĆŒÄ‚ĹľÄžÇ Ĺ˝ĆŒŏͲĨŽĆŒͲůĞǀĞůĆ?ͲŽĨͲ Ĺ?ŜƚĞĹ?ĆŒÄ‚ĆšÄžÄšͲŚĞĂůƚŚÄ?Ä‚ĆŒÄž Requirements: California license, DEA license, CPR certiďŹ cation and board certiďŹ ed in family medicine. Bilingual English/Spanish preferred. Elaine Skoch, PCMH-CCE is a CAFP consultant, board cerĆ&#x;ÄŽed Nurse ExecuĆ&#x;ve at the

advanced level and recognized as a PCMH Clinical Content Expert by the NaĆ&#x;onal CommiĆŠee for Yuality Assurance.

Contact c Us: Visitt our website at a ww www.vistacommunityclinic.org r Forward resume to hr@vistacommunityc t linic.org r or fax resume to 760-414-3702

Mountain Valleys Health Centers, Inc. is a great place to work and rural north eastern California is a great place to live. Whether raising a family, relaxing in seclusion or working your own ranch the communities we live in and serve are a great place to enjoy a little slower pace and a much higher quality of life. Mountain Valleys Health Centers offer numerous attractive employment opportunities for health care professionals. If you are a dedicated, mission driven health care professional or want to be part of the staff of a mission driven corporation, please consider joining our team. MVHC is currently recruiting for a full scope Family Practice physician which includes being on staff at the local rural hospital and, preferably, performing OB.

We offer generous compensation packages including: ‡ )XOO 0HGLFDO %HQHILWV 3DFNDJH ‡ 5HWLUHPHQW 3ODQ ‡ &RQWLQXLQJ (GXFDWLRQ ‡ 372 +ROLGD\V ‡ 1+6& /RDQ 5HSD\PHQW ‡ )7&$ 0DOSUDFWLFH ,QVXUDQFH

Interested Candidates Please Contact: Mountain Valleys Health Centers 'DYH -RQHV &(2 530-294-5114 djones@mtnvalleyhc.org California Family Physician Winter 2016

19

FAMILY MEDICINE CLINICAL FORUM APRIL 1ϲ-17, 201ϲ ͮ SAN FRANCISCO, CA

INSIGHT

INNOVATION

INSPIRATION

The Family Medicine Clinical Forum is the California Academy of Family Physicians’ largest CME event of the year. With 2ϴ sessions, oīering 2ϴн CME credits, with four pre-ͬpost-conference workshops available, the Forum is sure to be CAFP’s best meeƟng yet. The Family Medicine Clinical Forum is designed BY family physicians FOR family physicians and focuses on engaging family physicians in a refreshing, two-day conference.

Register by April 1, 201ϲ to save Ψ50 on Forum registraƟon! For more informaƟon and to register for the Forum, visit: www.familydocs.orgͬfamily-medicine-clinical-forum

#FMForum1ϲ INVEST IN THE FUTURE OF FAMILY MEDICINE WWW.CAFPFOUNDATION.ORG

The Core Co ontentt Review of Family y Mediciine Why Choose Corre Content Rev view? • CD and Online Ve V rsion ns availab a le for und der $200!! • Cost Eff ffective CME • Fo F r Fa F milly Phy h sicians by y Family l Ph hysiicians • Print Subsscrip ptio on alsso av a aila able • Discount for AA AAFP members • Money y back guarantee if you don n’t pass the Boarrd exam • Prov vides non-d dues revenue fo f r yo our State Chap a te er

North America’s most widely y-recog gniized prrogram for: • Fa F mily y Medicine CME • ABFM M Board Pre eparation • Selff-Evaluation n • Vi V sit ww ww. w CoreC Content.com • Call 888-343-C CORE (2673) • Email mail@ @CoreContent.com

California Family Physician Winter 2016

ȱ ǰȱ

Remembering Why I Am a CAFP Member FW ŚĂƐ ďĞĞŶ Ă ƉĂƌƚ ŽĨ ŵLJ ůŝĨĞ ƐŝŶĐĞ / ǁĂƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ŝŶ ƚŚĞ ϭϵϴϬƐ͘ ^ŚŽƌƚůLJ ĂĨƚĞƌ / ŵŽǀĞĚ ƚŽ ,ƵŵďŽůĚƚ ŽƵŶƚLJ ŝŶ ƚŚĞ ĞĂƌůLJ ϭϵϵϬƐ͕ ŵLJ ŝŶǀŽůǀĞŵĞŶƚ ŐƌĞǁ ƚŽ ƚŚĞ ƉŽŝŶƚ ǁŚĞƌĞ / ĨŽƵŶĚ ŵLJƐĞůĨ ŽŶ ƚŚĞ MĞĚŝĐĂů WƌĂĐƚŝĐĞ ĨĨĂŝƌƐ ŽŵŵŝƚƚĞĞ ĂŶĚ ŽŶ ƚŚĞ ŽĂƌĚ ŽĨ ŝƌĞĐƚŽƌƐ͘ tŚŝůĞ / ůŽǀĞĚ ůŝǀŝŶŐ ŝŶ ,ƵŵďŽůĚƚ ŽƵŶƚLJ͕ / ŵŝƐƐĞĚ ƚŚĞ ĞĂƐLJ ĂƐƐŽĐŝĂƚŝŽŶ ǁŝƚŚ ƐŽ ŵĂŶLJ ŽƚŚĞƌ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶƐ ĂƐ ŚĂĚ ďĞĞŶ ƚŚĞ ĐĂƐĞ ǁŚĞŶ / ůŝǀĞĚ ŝŶ ^ŽƵƚŚĞƌŶ ĂůŝĨŽƌŶŝĂ͘ dŽŽ͕ ƚŚŝƐ ǁĂƐ Ă ƉĞƌŝŽĚ ŽĨ ŐƌĞĂƚ ƚƵƌŵŽŝů ŝŶ ƚŚĞ ŵĞĚŝĐĂů ǁŽƌůĚ͕ ǁŝƚŚ ŚŽƐƉŝƚĂůƐ ďƵLJŝŶŐ ƉƌĂĐƚŝĐĞƐ͕ ůĂƌŐĞ ŐƌŽƵƉƐ ĨŽƌŵŝŶŐ͕ ƐŵĂůů ƉƌĂĐƚŝĐĞƐ ĨůŽƵŶĚĞƌŝŶŐ͙ĂŶĚ / ĨŽƵŶĚ ŝŶ FW Ă ĐŽŶŶĞĐƚŝŽŶ ƚŽ ďƌŝůůŝĂŶƚ ĂŶĚ ĞŶĞƌŐĞƚŝĐ ĐŽůůĞĂŐƵĞƐ ǁŚŽ ŝŶƐƉŝƌĞĚ ĂŶĚ ŵŽƚŝǀĂƚĞĚ ŵĞ ƚŽ ƐƚƌĞŶŐƚŚĞŶ ŵLJ ƉƌĂĐƚŝĐĞ͕ ĞdžƉĂŶĚ ŽƵƌ ƌĞĂĐŚ͕ ŝŵƉƌŽǀĞ ƉĂƚŝĞŶƚ ĐĂƌĞ ĂŶĚ ďƵŝůĚ Ă ƚƌƵĞ ŵĞĚŝĐĂů ŚŽŵĞ͘ ^ĂĚůLJ͕ ƚŚĞ ƌĞĂůŝƚLJ ŽĨ ůŝǀŝŶŐ ϮϱϬ ŵŝůĞƐ ŶŽƌƚŚ ŽĨ ƚŚĞ ĂLJ ƌĞĂ͕ ǁŝƚŚ ĞŝƚŚĞƌ Ă ǁŝůĚůLJ ĞdžƉĞŶƐŝǀĞ ĂŶĚ ƵŶƉƌĞĚŝĐƚĂďůĞ ĂŝƌƉůĂŶĞ ƚƌŝƉ Žƌ Ă ƐŝdžͲŚŽƵƌ ĚƌŝǀĞ ŝŶ ŵLJ ĨƵƚƵƌĞ ĂŶLJ ƚŝŵĞ / ǁĂŶƚĞĚ ƚŽ ĂƚƚĞŶĚ Ă ŵĞĞƚŝŶŐ ;ĚŽƵďůĞ ƚŚĞ ĞdžƉĞŶƐĞ ĂŶĚ ƚŚĞ ƚŝŵĞ ŝŶǀŽůǀĞĚ ĨŽƌ Ă ƚƌŝƉ ƚŽ ^ŽƵƚŚĞƌŶ ĂůŝĨŽƌŶŝĂͿ͕ ďĞŐĂŶ ƚŽ ĐĂƚĐŚ ƵƉ ǁŝƚŚ ŵĞ͕ ĂƐ ĚŝĚ ƚŚĞ ĚĂLJͲƚŽͲĚĂLJ ƐƚƌĞƐƐĞƐ ŽĨ ďƵĐŬŝŶŐ ƚŚĞ ůŽĐĂů ƚƌĞŶĚ ĂŶĚ ďĞŝŶŐ ƉĂƌƚ ŽĨ Ă ƐƵĐĐĞƐƐĨƵů͕ ƚŽƚĂůůLJ ƉƌŝǀĂƚĞ ƉƌĂĐƚŝĐĞ͘ EŽǁ͕ ŝƚ͛Ɛ ďĞĞŶ ŽǀĞƌ Ă

ĚĞĐĂĚĞ ƐŝŶĐĞ / ŚĂǀĞ ĂƚƚĞŶĚĞĚ Ă FW ŵĞĞƚŝŶŐ͕ ĂŶĚ ŝƚ͛Ɛ ďĞĞŶ ƚŚĂƚ ůŽŶŐ Ăƚ ůĞĂƐƚ ƐŝŶĐĞ / ǁĂƐ ŝŶǀŽůǀĞĚ ŝŶ ůĞĂĚĞƌƐŚŝƉ͘ tŚŝůĞ /͛ŵ FĂĐĞŬ ĨƌŝĞŶĚƐ ǁŝƚŚ ƐĞǀĞƌĂů ĚŽĐƐ ĂŶĚ ǁŝƚŚ ^ŚĞůůLJ RŽĚƌŝŐƵĞƐ ; FW ĞƉƵƚLJ džĞĐƵƚŝǀĞ sŝĐĞ WƌĞƐŝĚĞŶƚͿ ĂŶĚ ^ƵƐĂŶ ,ŽŐĞůĂŶĚ ; FW džĞĐƵƚŝǀĞ sŝĐĞ WƌĞƐŝĚĞŶƚͿ͕ /͛ǀĞ ŶŽƚ ŚĂĚ ƌĞĂů ĐŽŶƚĂĐƚ ǁŝƚŚ ĂŶLJŽŶĞ ĨƌŽŵ ƚŚĞ FW ƵŶƚŝů ƚŚŝƐ ǁĞĞŬ͕ ǁŚĞŶ :ĂLJ >ĞĞ͕ M ͕ MW,͕ ŽƵƌ ĐƵƌƌĞŶƚ FW ƉƌĞƐŝĚĞŶƚ͕ ĂŶĚ ^ƵƐĂŶ ďŽƚŚ ŵĂĚĞ ƚŚĞ ƚƌŝƉ ŶŽƌƚŚ ƚŽ ĂĚĚƌĞƐƐ ŽƵƌ ŵĞĚŝĐĂů ĐŽŵŵƵŶŝƚLJ ĂŶĚ ŵĞĞƚ ǁŝƚŚ ǀĂƌŝŽƵƐ ŵĞĚŝĐĂů ůĞĂĚĞƌƐ͘ FƌĂŶŬůLJ͕ / ĨŽƵŶĚ ƚŚĞ ĞdžƉĞƌŝĞŶĐĞ͕ ĨƌŽŵ Ă ǁŚŽůůLJ ƉĞƌƐŽŶĂů ƉĞƌƐƉĞĐƚŝǀĞ͕ ƚŽ ďĞ ƋƵŝƚĞ ƐƵƌƌĞĂů ĂŶĚ ďŝƚƚĞƌƐǁĞĞƚ͘ ƌ͘ >ĞĞ͛Ɛ ƉƌĞƐĞŶƚĂƚŝŽŶ ĂďŽƵƚ ŶĂǀŝŐĂƚŝŶŐ ƚŚĞ ŵŝŶĞĨŝĞůĚ ŽĨ ŽƵƌ ĐƵƌƌĞŶƚ ŚĞĂůƚŚĐĂƌĞ ƐLJƐƚĞŵ ĂŶĚ ŵĂŝŶƚĂŝŶŝŶŐ ĞŶũŽLJŵĞŶƚ ŝŶ ŽƵƌ ǁŽƌŬ ʹ ĨŽĐƵƐŝŶŐ ŽŶ ǁŚLJ ǁĞ ĚŽ ǁŚĂƚ ǁĞ ĚŽ ʹ ǁĂƐ ŝŶƐƉŝƌŝŶŐ͕ ďƌŝůůŝĂŶƚ ĂŶĚ ŵŽƚŝǀĂƚŝŽŶĂů͘ Ƶƚ ƚŚƌŽƵŐŚ ŝƚ Ăůů͕ / ǁĂƐ ŬŝĐŬŝŶŐ ŵLJƐĞůĨ ĨŽƌ ŵĂŬŝŶŐ ƐŽ ŵĂŶLJ ĞdžĐƵƐĞƐ ĨŽƌ ƐŽ ŵĂŶLJ LJĞĂƌƐ ĨŽƌ ŶŽƚ ŵĂŬŝŶŐ ƚŚĞ ĞĨĨŽƌƚ ƚŽ ƐƚĂLJ ĐŽŶŶĞĐƚĞĚ ǁŝƚŚ FW͘ / ĐŽƵůĚ ďĂƌĞůLJ ĂƉƉƌĞĐŝĂƚĞ ŚŝƐ ŐƌĞĂƚ ƚĂůŬ ǁŝƚŚ ƚŚĞ ŝŶŶĞƌ ĚŝĂůŽŐƵĞ ŽĨ ƌĞŐƌĞƚ ƌƵŶŶŝŶŐ ƚŚƌŽƵŐŚ ŵLJ ŚĞĂĚ͘

ƌ͘ >ĞĞƌ ƌĞĐŽŶŶĞĐƚĞĚ ǁŝƚŚ FW Ăƚ Ă ƌĞĐĞŶƚ ŵĞĞƟŶŐ ŚĞůĚ ŝŶ ,ƵŵďŽůĚƚ͕ ͘ WŝĐƚƵƌĞĚ ůĞŌ ƚŽ ƌŝŐŚƚ͗ ƌ͘ :ĂLJ t͘ >ĞĞ ; FW WƌĞƐŝĚĞŶƚͿ͕ ƌ͘ >ĞŽ >ĞĞƌ͕ WĞŶŶLJ FŝŐĂƐ ; džĞĐƵƟǀĞ ŝƌĞĐƚŽƌ ŽĨ ,ƵŵďŽůĚƚͲ Ğů EŽƌƚĞ MĞĚŝĐĂů ^ŽĐŝĞƚLJͿ ĂŶĚ FW ŵĞŵďĞƌ ƌ͘ ,Ăů 'ƌŽƚŬĞ͘ 22

California Family Physician Winter 2016

tŚĞŶ / ǁĂƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ͕ / ŚĂĚ ŝŶŝƚŝĂůůLJ ŝŶƚĞŶĚĞĚ ƚŽ ƚƌĂŝŶ ŝŶ Ă ŵƵĐŚ ŶĂƌƌŽǁĞƌ͕ ƌĞƐĞĂƌĐŚͲ ŽƌŝĞŶƚĞĚ ĂƌĞĂ ŽĨ ŵĞĚŝĐŝŶĞ͘ ,ŽǁĞǀĞƌ͕ / ĨŽƵŶĚ ƚŚĞ ĚĂLJͲƚŽͲĚĂLJ ĞdžƉĞƌŝĞŶĐĞ ǁŝƚŚ ŵĞŶƚŽƌƐ ĂŶĚ ĂƚƚĞŶĚŝŶŐ ƚŽ ďĞ ŝŶƚŝŵŝĚĂƚŝŶŐ͕ ŶŽƚ ƉĂƌƚŝĐƵůĂƌůLJ ƉĂƚŝĞŶƚͲĐĞŶƚĞƌĞĚ ĂŶĚ ŶŽƚ ǀĞƌLJ ĞŶĐŽƵƌĂŐŝŶŐ͕ ĞdžĐĞƉƚ ǁŚĞŶ ŝƚ ĐĂŵĞ ƚŽ ŝŶƚĞƌĂĐƚŝŽŶƐ ǁŝƚŚ ĨĂŵŝůLJ ƉŚLJƐŝĐŝĂŶ ƚĞĂĐŚĞƌƐ ĂŶĚ ŵĞŶƚŽƌƐ͘ dŚĞLJ ǁĞƌĞ ĐŽŵƉĞƚĞŶƚ͕ ďƌŝŐŚƚ͕ ǁĞůůͲƌŽƵŶĚĞĚ͕ ƌĞĂůůLJ ĐĂƌĞĚ ĂďŽƵƚ ƉĂƚŝĞŶƚƐ ĂŶĚ ƚŚĞLJ ǁĞƌĞ ŶŝĐĞ͊ / ǁĂƐ ƐŽůĚ͘ dŚĞ ŶĞdžƚ ƚŚŝŶŐ / ŬŶĞǁ / ǁĂƐ ŝŶƚĞƌǀŝĞǁŝŶŐ ŝŶ ĨĂŵŝůLJ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵƐ͘ ^ŚŽƌƚůLJ ƚŚĞƌĞĂĨƚĞƌ͕ Ϯϵ LJĞĂƌƐ ůĂƚĞƌ ƚŽ ďĞ ĞdžĂĐƚ͕ ŚĞƌĞ / Ăŵ͗ ƐŽƌƚ ŽĨ ďĂĐŬ Ăƚ ƚŚĞ ďĞŐŝŶŶŝŶŐ͕ ďĞŝŶŐ ƌĞŵŝŶĚĞĚ ŽĨ ǁŚLJ / ĐŚŽƐĞ ƚŚŝƐ ƉĂƚŚ ŝŶ ƚŚĞ ĨŝƌƐƚ ƉůĂĐĞ͘ ^Ž͕ ƚŚĂŶŬ LJŽƵ ƌ͘ >ĞĞ͘ dŚĂŶŬ LJŽƵ ^ƵƐĂŶ͕ ĂŶĚ ^ŚĞůůLJ͕ ĂŶĚ Ăůů ŽĨ ƚŚĞ FW ƐƚĂĨĨ͕ ĨŽƌ ĐĂƌƌLJŝŶŐ ƚŚĞ ƚŽƌĐŚ͊ Dr. Leer is an active CAFP member based in Eureka, CA.

Dedicated to providing learning and development opportunities, a path to partnership and a sustainable career. Discover a rewarding Hospitalist career with Sound Physicians today.

CURRENT CALIFORNIA OPPORTUNITIES IN: Apple Valley Crescent City Bakersfield Fairfield Glendale Grass Valley

Lancaster Salinas San Bernardino Sonoma Stockton

MED7 has been providing urgent care services in the Greater Sacramento area since 1987 Urgent care clinics are located in Roseville, Carmichael, Folsom & North Sacramento. All shifts 9am to 9pm. Full time is 13 shifts per month. We offer our full time physicians the following: full malpractice coverage, medical & dental coverage at no cost for the physician & any dependents, disability policy & we have a simple IRA you can contribute to with 3% matching. Part time is 6 to 8 shifts per month. There is no call. There is no tail coverage that needs to be purchased should you leave our employment. We have a single policy that continues on after you leave. If something were to arise here after you left our employment, you would be covered. For more information about MED7 and our clinics please visit our website: www.med7.com We offer an attractive compensation package. Contact Merl O’Brien,MD, at: (916) 791-1300, ext.111; or email CV to: sherry@med7atwork.com.

soundphysicians.com/cali

California Family Physician Winter 2016

23

¢ȱ ȱ

Don’t Miss These New Coding Opportunities with ICD-10-CM

^ŝŶĐĞ ƚŚĞ OĐƚŽďĞƌ ϭ͕ ϮϬϭϱ ŝŵƉůĞŵĞŶƚĂƟŽŶ ĚĂƚĞ͕ ŵŽƐƚ ƉƌĂĐƟĐĞƐ ŚĂǀĞ ŵĂĚĞ ƚŚĞ ƚƌĂŶƐŝƟŽŶ ƚŽ / ͲϭϬ ĂŶĚ ĂƌĞ ƐůŽǁůLJ ĨĂŵŝůŝĂƌŝnjŝŶŐ ƚŚĞŵƐĞůǀĞƐ ǁŝƚŚ ƚŚĞ ĞdžƉĂŶƐŝǀĞ ĐŽĚĞ ƐĞƚ͘ tŚŝůĞ / ͲϭϬ ĂůůŽǁƐ ĨŽƌ ŵƵĐŚ ŵŽƌĞ ƐƉĞĐŝĮĐ ĐŽĚŝŶŐ ǁŝƚŚŝŶ ĞǀĞƌLJ ƐƉĞĐŝĂůƚLJ͕ ƚǁŽ ƉƌĞǀŝŽƵƐůLJ ƵŶƚĂƉƉĞĚ ŽƉƉŽƌƚƵŶŝƟĞƐ ĨŽƌ / ͲϭϬ ƚŚĂƚ ĂƌĞ ƉĂƌƟĐƵůĂƌůLJ ŝŵƉŽƌƚĂŶƚ ĨŽƌ ŵĞĂƐƵƌŝŶŐ ƋƵĂůŝƚLJ ĐĂƌĞ ŝŶĐůƵĚĞ ĐŽĚŝŶŐ ĨŽƌ ŝŵŵƵŶŝnjĂƟŽŶƐ ĂŶĚ ĚŽƐĂŐĞ͘ ImmuninjaƟon and Under-immuninjaƟon tŝƚŚ Ă ƐŝŶŐůĞ ĐŽĚĞ͕ Ϯϯ͕ / ͲϭϬ ŵĂŬĞƐ ƌĞƉŽƌƟŶŐ ŽĨ ƌŽƵƟŶĞ ĂŶĚͬ Žƌ ƉƌŽƉŚLJůĂĐƟĐ ŝŵŵƵŶŝnjĂƟŽŶƐ ŵƵĐŚ ĞĂƐŝĞƌ ƌĞŐĂƌĚůĞƐƐ ŽĨ ƚŚĞ ƚLJƉĞ Žƌ ŶƵŵďĞƌ ŽĨ ǀĂĐĐŝŶĞƐ ŐŝǀĞŶ͘ dŚĞ ĐŽĚĞƐ ƌĞĐŽŐŶŝnjĞ ƚŚĂƚ ƚŚĞ ƚLJƉĞ ŽĨ ǀĂĐĐŝŶĞ ƌĞƉŽƌƚĞĚ ǁŝƚŚ Ă Wd Žƌ , W ^ ĐŽĚĞ ŐŝǀĞƐ ƐƵĸĐŝĞŶƚ ĚĞƚĂŝů ĂďŽƵƚ ƚŚĞ ƚLJƉĞ ŽĨ ŝŵŵƵŶŝnjĂƟŽŶ ŶĞĞĚĞĚ͘

ŶŽƚ ƚŽ ŝŵŵƵŶŝnjĞ͕ ŚŝƐƚŽƌLJ ŽĨ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ŚĂǀŝŶŐ ŚĂĚ ƚŚĞ ĚŝƐĞĂƐĞ ĂŶĚ ƌĞĨƵƐĂů ŽŶ ƚŚĞ ƉĂƌƚ ŽĨ Ă ĐĂƌĞŐŝǀĞƌ ƚŽ ŝŵŵƵŶŝnjĞ͘ FŝŶĂůůLJ͕ ƚŚĞ ƐƵďĐĂƚĞŐŽƌLJ Ϯϴ͘ϯ ĐĂŶ ďĞ ƵƐĞĚ ƚŽ ƌĞƉŽƌƚ ƵŶĚĞƌͲ ŝŵŵƵŶŝnjĂƟŽŶ ƐƚĂƚƵƐ ƐƵĐŚ ĂƐ ĚĞůŝŶƋƵĞŶƚ ŝŵŵƵŶŝnjĂƟŽŶ Žƌ ůĂƉƐĞĚ ŝŵŵƵŶŝnjĂƟŽŶ ƐƚĂƚƵƐ͘ FƌŽŵ Ă ƋƵĂůŝƚLJ ƐƚĂŶĚƉŽŝŶƚ͕ ǁŚĞŶ ŝŶĚŝĐĂƟŶŐ ǀĂĐĐŝŶĂƟŽŶƐ ĂŶĚ ǀĂĐĐŝŶĂƟŽŶ ƐƚĂƚƵƐ͕ ŝƚ ŝƐ ũƵƐƚ ĂƐ ŝŵƉŽƌƚĂŶƚ ĨŽƌ ƚŚĞ ƉƌŽǀŝĚĞƌ ƚŽ ƌĞƉŽƌƚ ĂŶĚ ĚŽĐƵŵĞŶƚ ĐƵƌƌĞŶƚ ŝŵŵƵŶŝnjĂƟŽŶƐ ĂƐ ŝƚ ŝƐ ƚŽ ƌĞƉŽƌƚ Ă ůĂƉƐĞĚ ƐƚĂƚƵƐ͘

Underdosing UŶĚĞƌĚŽƐŝŶŐ ŽĐĐƵƌƐ ǁŚĞŶ Ă ƉĂƟĞŶƚ ƚĂŬĞƐ ůĞƐƐ ŽĨ Ă ŵĞĚŝĐĂƟŽŶ ƚŚĂŶ ŝƐ ƉƌĞƐĐƌŝďĞĚ ďLJ ĞŝƚŚĞƌ ƚŚĞ ƉƌŽǀŝĚĞƌ Žƌ ƚŚĞ ŵĂŶƵĨĂĐƚƵƌĞƌ͘ UŶĚĞƌĚŽƐŝŶŐ ŽŌĞŶ ůĞĂĚƐ ƚŽ Ă ƌĞůĂƉƐĞ Žƌ ĞdžĂĐĞƌďĂƟŽŶ ŽĨ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ĐŽŶĚŝƟŽŶ͘ /Ĩ Ă ĚŝĂďĞƟĐ ƉĂƟĞŶƚ͕ ĨŽƌ ĞdžĂŵƉůĞ͕ ĚŽĞƐ ŶŽƚ ƚĂŬĞ ƚŚĞ ƉƌĞƐĐƌŝďĞĚ ĂŵŽƵŶƚ ŽĨ ŝŶƐƵůŝŶ͕ ŚĞ Žƌ ƐŚĞ ŵĂLJ ĞŶĚ ƵƉ ŝŶ /ŵŵƵŶŝnjĂƟŽŶ ƐƚĂƚƵƐ͕ ŚŽǁĞǀĞƌ͕ ŝƐ Ă ƐŝŐŶŝĮĐĂŶƚ ƉƵďůŝĐ ŚĞĂůƚŚ ŝƐƐƵĞ ƚŚĞ ĞŵĞƌŐĞŶĐLJ ƌŽŽŵ ǁŝƚŚ ďůƵƌƌĞĚ ǀŝƐŝŽŶ͕ ĨĂƟŐƵĞ ĂŶĚ ŚĞĂĚĂĐŚĞ ĂŶĚ / ͲϭϬͲ M ŚĂƐ ĂĚĚƌĞƐƐĞĚ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ĐŽůůĞĐƟŶŐ ƚŚŝƐ ĚƵĞ ƚŽ ŚLJƉĞƌŐůLJĐĞŵŝĂ͘ ŝŶĨŽƌŵĂƟŽŶ ďLJ ƉƌŽǀŝĚŝŶŐ ŵƵůƟƉůĞ ĐŽĚŝŶŐ ĞdžƉůĂŶĂƟŽŶƐ ĂƐ ƚŽ ǁŚLJ Ă ĐŚŝůĚ Žƌ ĂĚƵůƚ ŵŝŐŚƚ ŶŽƚ ŚĂǀĞ ďĞĞŶ ŝŵŵƵŶŝnjĞĚ͘ ĂƚĞŐŽƌLJ Ϯϴ͕ ,ĂǀŝŶŐ ĐŽĚĞƐ ƚŽ ƌĞƉŽƌƚ ƵŶĚĞƌĚŽƐŝŶŐ ƐŝƚƵĂƟŽŶƐ ŝƐ ŝŵƉŽƌƚĂŶƚ͕ ĨŽƌ ĞdžĂŵƉůĞ͕ ŝƐ ƵƐĞĚ ƚŽ ƌĞƉŽƌƚ ŝŵŵƵŶŝnjĂƟŽŶƐ ŶŽƚ ĐĂƌƌŝĞĚ ŽƵƚ ĂƐ Ă ĚĞĐůŝŶĞ ŝŶ Ă ƉĂƟĞŶƚ͛Ɛ ĐŽŶĚŝƟŽŶ ĐĂŶ ƌĂŝƐĞ ƋƵĂůŝƚLJ ŽĨ ĐĂƌĞ ĂŶĚ ƵŶĚĞƌͲŝŵŵƵŶŝnjĂƟŽŶ ƐƚĂƚƵƐ͘ dŚĞ ŵĂŶLJ ƐƵďͲĐůĂƐƐŝĮĐĂƟŽŶƐ ŝƐƐƵĞƐ͕ ǁŚŝĐŚ ĐĂŶ ƵůƟŵĂƚĞůLJ ĂīĞĐƚ ƌĞŝŵďƵƌƐĞŵĞŶƚ͘ dŚĞ ĂďŝůŝƚLJ ŽĨ ƚŚŝƐ ƉĂƌƟĐƵůĂƌ ĐĂƚĞŐŽƌLJ ĚĞƐĐƌŝďĞ ƚŚĞ ƌĞĂƐŽŶƐ ĨŽƌ ƐƵĐŚ ƚŽ ƌĞƉŽƌƚ ƵŶĚĞƌĚŽƐŝŶŐ ŚĞůƉƐ ĐůĂƌŝĨLJ ƚŚĂƚ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ĐƵƌƌĞŶƚ ĐŽŶƚƌĂŝŶĚŝĐĂƟŽŶƐ͕ ŝŶĐůƵĚŝŶŐ ĂĐƵƚĞ ŝůůŶĞƐƐ͕ ĐŚƌŽŶŝĐ ŝůůŶĞƐƐ͕ ĂŶ ƐƚĂƚĞ ŽĨ ƌĞůĂƉƐĞ Žƌ ĞdžĂĐĞƌďĂƟŽŶ ŝƐ ŶŽƚ ĚƵĞ ƚŽ ƚŚĞ ĨĂĐƚ ƚŚĂƚ ƚŚĞ ŝŵŵƵŶĞͲ ĐŽŵƉƌŽŵŝƐĞĚ ƐƚĂƚĞ͕ ĂůůĞƌŐLJ ƚŽ ǀĂĐĐŝŶĞ Žƌ ĐŽŵƉŽŶĞŶƚ͕ ƉƌŽǀŝĚĞƌ ĚŝĚ ŶŽƚ ƉƌĞƐĐƌŝďĞ Ă ǀŝĂďůĞ ĐŽƵƌƐĞ ŽĨ ƚƌĞĂƚŵĞŶƚ ʹ ďƵƚ ĞƚĐ͘ ^ƵďͲĐůĂƐƐŝĮĐĂƟŽŶƐ ŽĨ ƚŚŝƐ ĐĂƚĞŐŽƌLJ ĂůƐŽ ĂƌĞ ĂǀĂŝůĂďůĞ ƚŽ ƌĂƚŚĞƌ ƚŚĂƚ ƚŚĞ ƉĂƟĞŶƚ ĚŝĚ ŶŽƚ ĨŽůůŽǁ ƚŚĞ ƉƌĞƐĐƌŝďĞĚ ƌĞƉŽƌƚ ƐƵĐŚ ƚŚŝŶŐƐ ĂƐ Ă ƉĂƟĞŶƚ͛Ɛ ĚĞĐŝƐŝŽŶ Žƌ ƉĂƌĞŶƚ͛Ɛ ĚĞĐŝƐŝŽŶ ƚƌĞĂƚŵĞŶƚ ƉůĂŶ͘

24

California Family Physician Winter 2016

Faculty UŶĚĞƌĚŽƐŝŶŐ ƐŝƚƵĂƟŽŶƐ ĂƌĞ ƌĞƉŽƌƚĞĚ ǁŝƚŚ ĐŽĚĞƐ ĨƌŽŵ ƚŚĞ WŽŝƐŽŶŝŶŐ ďLJ͕ ĚǀĞƌƐĞ īĞĐƚƐ ŽĨ͕ ĂŶĚ UŶĚĞƌĚŽƐŝŶŐ ŽĨ ƌƵŐƐ͕ MĞĚŝĐĂŵĞŶƚƐ ĂŶĚ ŝŽůŽŐŝĐĂů ^ƵďƐƚĂŶĐĞƐ ;dϯϲͲdϱϬͿ ĐĂƚĞŐŽƌLJ ŽĨ / ͲϭϬͲ M͘ UŶĚĞƌĚŽƐŝŶŐ ƐŝƚƵĂƟŽŶƐ ĂƌĞ ĚŝīĞƌĞŶƟĂƚĞĚ ĨƌŽŵ ƉŽŝƐŽŶŝŶŐƐ ĂŶĚ ĂĚǀĞƌƐĞ ĞīĞĐƚƐ ďLJ ƚŚĞ ĂƐƐŝŐŶŵĞŶƚ ŽĨ Ă ĮŌŚ Žƌ ƐŝdžƚŚ ĐŚĂƌĂĐƚĞƌ ŽĨ ͞ϲ͘͟ ƐĞǀĞŶƚŚ ĐŚĂƌĂĐƚĞƌ ƚŽ ƌĞƉŽƌƚ ĞƉŝƐŽĚĞ ŽĨ ĐĂƌĞ ;ŝŶŝƟĂů͕ ƐƵďƐĞƋƵĞŶƚͿ ŵƵƐƚ ĂůƐŽ ďĞ ƵƐĞĚ͘ ^ŝŶĐĞ ƵŶĚĞƌĚŽƐŝŶŐ ƌĞƉƌĞƐĞŶƚƐ ŶŽŶͲ ĐŽŵƉůŝĂŶĐĞ ǁŝƚŚ ƉƌĞƐĐƌŝďĞĚ ƚƌĞĂƚŵĞŶƚ͕ / ͲϭϬ ĂůƐŽ ĐŽŶƚĂŝŶƐ ĐŽĚĞƐ ƚŚĂƚ ƌĞƉŽƌƚ ƐŽŵĞ ŽĨ ƚŚĞ ĐŽŵŵŽŶ ƵŶĚĞƌůLJŝŶŐ ƌĞĂƐŽŶƐ ĨŽƌ ŶŽŶͲ ĐŽŵƉůŝĂŶĐĞ ƐƵĐŚ ĂƐ͗ ͻ /ŶƚĞŶƟŽŶĂů UŶĚĞƌĚŽƐŝŶŐ ŽĨ MĞĚŝĐĂƟŽŶ RĞŐŝŵĞŶ ƵĞ ƚŽ FŝŶĂŶĐŝĂů ,ĂƌĚƐŚŝƉ ; ϵϭ͘ϭϮϬͿ ͻ UŶŝŶƚĞŶƟŽŶĂů UŶĚĞƌĚŽƐŝŶŐ ŽĨ MĞĚŝĐĂƟŽŶ RĞŐŝŵĞŶ ƵĞ ƚŽ ŐĞͲ RĞůĂƚĞĚ ĞďŝůŝƚLJ ; ϵϭ͘ϭϯϬͿ ͻ /ŶƚĞŶƟŽŶĂůͬUŶŝŶƚĞŶƟŽŶĂů UŶĚĞƌĚŽƐŝŶŐ ĨŽƌ OƚŚĞƌ RĞĂƐŽŶ ; ϵϭ͘ϭϮϴͬ ϵϭ͘ϭϯϴͿ ͻ UŶĚĞƌĚŽƐŝŶŐ ŽĨ MĞĚŝĐĂƟŽŶƐ EO^ ; ϵϭ͘ϭϰͿ

John Muir Health’s Family Medicine Residency Program, Walnut Creek, CA

John Muir Health is a nationally-recognized healthcare system that offers a full range of outpatient and inpatient services. We are proud to be launching our UCSF-Affiliated John Muir Health Family Medicine Residency Program in the San Francisco East Bay area. We are seeking a faculty member to help develop an innovative, dynamic, 8-8-8 unopposed, community-based program that is attentive to underserved patient populations. The successful candidate must be a board-certified family physician who is committed to educating future family physicians and passionate about excellence in education and clinical services. The selected individual will be responsible for administrative leadership support, direct clinical care and precepting. Contact: Lynn Eddleman, Residency Program Coordinator p: (925) 941-2674 f: (925) 296-9015 lynn.eddleman@johnmuirhealth.com

džƚĞƌŶĂů ĂƵƐĞ ŽĨ MŽƌďŝĚŝƚLJ ĐŽĚĞƐ ;zϲϯ͘ϲ͕ zϲϯ͘ϴ ʹ zϲϯ͘ϵͿ ĂƌĞ ĂůƐŽ ĂǀĂŝůĂďůĞ ƚŽ ƌĞƉŽƌƚ ƚŚĞ ĨĂĐƚ ƚŚĂƚ ƵŶĚĞƌĚŽƐŝŶŐ ŝƐ ĚƵĞ ƚŽ ŶŽŶͲ ĂĚŵŝŶŝƐƚƌĂƟŽŶ ŽĨ Ă ŶĞĐĞƐƐĂƌLJ ĚƌƵŐ Žƌ ĨĂŝůƵƌĞ ŝŶ ĚŽƐĂŐĞ ĚƵƌŝŶŐ ƐƵƌŐŝĐĂů ĂŶĚ ŵĞĚŝĐĂů ĐĂƌĞ͘ ŽĐƵŵĞŶƚĂƟŽŶ ŚĂƐ ďĞĞŶ ƚŽƵƚĞĚ ĂƐ ŽŶĞ ŽĨ ƚŚĞ ďŝŐŐĞƐƚ ĐŚĂůůĞŶŐĞƐ ǁŝƚŚ / ͲϭϬ͘ dŚĞ ŵŽƌĞ ƉƌĞĐŝƐĞ ƚŚĞ ĚĞƐĐƌŝƉƟŽŶ ŽĨ Ă ƉĂƟĞŶƚ͛Ɛ ĐŽŶĚŝƟŽŶ͕ ƚŚĞ ŵŽƌĞ ĚĞƚĂŝůĞĚ ƚŚĞ ĐŽĚĞ ĐŚŽŝĐĞ ĐĂŶ ďĞ͘ dŚĞ ŐŽĂů ŝƐ ƚŽ ŐŝǀĞ ĂŶ ĂĐĐƵƌĂƚĞ ĚĞƉŝĐƟŽŶ ŽĨ ƚŚĞ ƐLJŵƉƚŽŵƐ ƚŚĂƚ ůĞĂĚ ƚŽ ĚŝĂŐŶŽƐŝƐ ĂŶĚ ƚŚĞ ƚƌĞĂƚŵĞŶƚ ĐŽƵƌƐĞ ĐŚŽƐĞŶ ƚŽ ŵŽƐƚ ĞīĞĐƟǀĞůLJ ĐĂƌĞ ĨŽƌ ƚŚĞ ƉĂƟĞŶƚ͘ Ž ŶŽƚ ŵŝƐƐ ƚŚĞ ŽƉƉŽƌƚƵŶŝƚLJ ƚŽ ĚŽĐƵŵĞŶƚ ĂŶĚ ĐŽĚĞ ƚŚĞƐĞ ƚǁŽ ŶĞǁ ĐŽŶĐĞƉƚƐ ǁŝƚŚ / ͲϭϬͲ M͘ Mary Jean Sage has extensive experience in the health care Įeld spanning a period of more than 2Ϭ years during which Ɵme she has managed diverse groups of professionals in delivering paƟent care. A founding Principal and Senior Consultant with The Sage Associates, Mary Jean is a naƟonally-known speaker, consultant and educator.

The Petaluma Health Center (PHC) has opportunities for experienced, innovative physicians to join a dynamic team of over forty providers in Southern Sonoma County. PHC is a Federally Qualified Health Center (FQHC) located in Petaluma and Rohnert Park, CA and provides full spectrum comprehensive primary care including obstetrical care and mental health services to over 20,000 patients. Our health center is a leading innovator in integrative medicine, team based care, and technology. We are seeking bilingual English/Spanish physicians with a minimum of three years’ experience to provide care to a panel of patients. These positions allow for ample growth and leadership in a multitude of areas related to improvement of the patient care experience. Options for combined hospital medicine and obstetric call are available, as is the option of outpatient call (telephone call) only.

California Family Physician Winter 2016

25

¢ȱ ǰȱ ǰȱ ǰȱ

4 + 4 = 40: Maintenance of Certification Equals Lifelong Learning tŚĂƚ͍ ϰ н ϰ ĐĂŶŶŽƚ с ϰϬ͊ UŶůĞƐƐ ƐŽŵĞ ƌĞĂůůLJ ŶĞǁ ŵĂƚŚ ŝƐ ĐŽŵŝŶŐ ŝŶƚŽ ƉůĂLJ ŚĞƌĞ͘ >Ğƚ ŵĞ ĞdžƉůĂŝŶ ŚŽǁ ƚŚŽƐĞ ŽĨ ƵƐ ŝŶ ƚŚĞ ǁŽƌůĚ ŽĨ ŽŶƟŶƵŝŶŐ MĞĚŝĐŝŶĞ ĚƵĐĂƟŽŶ ; M Ϳͬ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ ; W Ϳ ĐĂŵĞ ƵƉ ǁŝƚŚ ƚŚŝƐ ĞƋƵĂƟŽŶ͘ MĞĚŝĐĂů ƐĐŚŽŽů ƚĞĂĐŚĞƌƐ ŐŽƚ LJŽƵ ĨŽƌ ĨŽƵƌ LJĞĂƌƐ ĂŶĚ LJŽƵƌ ƌĞƐŝĚĞŶĐLJ ĚŝƌĞĐƚŽƌƐ ĂŶĚ ĨĂĐƵůƚLJ ŚĂĚ ƚŚĞŝƌ ƐŚŽƚ ĨŽƌ ƚŚƌĞĞͲƚŽͲĨŽƵƌ LJĞĂƌƐ͕ ďƵƚ M ͬ W ŐĞƚƐ ƚŚĞ ŶĞdžƚ ϰϬ LJĞĂƌƐ ŽĨ LJŽƵƌ ŵĞĚŝĐĂů ƉƌĂĐƟĐŝŶŐ ůŝǀĞƐ͊ dŚŽƐĞ ϰϬ LJĞĂƌƐ ĂƌĞ ƚŚĞ LJĞĂƌƐ ŽĨ M ͕ W ĂŶĚ MĂŝŶƚĞŶĂŶĐĞ ŽĨ ĞƌƟĮĐĂƟŽŶ ;MO Ϳ ĨŽƌ FĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ;M ͲFWͿ͘ M ĂŶĚ M ͲFW ĂƌĞ ƚŚĞ ƌŽĂĚ ƚŽ ůŝĨĞůŽŶŐ ůĞĂƌŶŝŶŐ͖ ƚŚĞLJ ŵĞĞƚ ƚŚĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĨŽƌ ŽŶŐŽŝŶŐ ĐĂĚĞŵLJ ŵĞŵďĞƌƐŚŝƉ͕ ďŽĂƌĚ ĐĞƌƟĮĐĂƟŽŶ͕ ĨĞůůŽǁƐŚŝƉ͕ ƐƚĂƚĞ ůŝĐĞŶƐƵƌĞ͕ ŚŽƐƉŝƚĂů ĐƌĞĚĞŶƟĂůŝŶŐ͕ ĂŶĚ ŵŽƌĞ͘ FŽƌƚƵŶĂƚĞůLJ͕ ƚŚĞ ĂůŝĨŽƌŶŝĂ ĐĂĚĞŵLJ ŽĨ FĂŵŝůLJ WŚLJƐŝĐŝĂŶƐ ; FWͿ ŝƐ ŚĞƌĞ ƚŽ ĂƐƐŝƐƚ LJŽƵ ŝŶ ŵĞĞƟŶŐ Ăůů ŽĨ ƚŚĞŵ͘ The Back Story: /Ŷ ƚŚĞ ĞĂƌůLJ ϮϬϬϬƐ͕ ƚŚĞ ŵĞƌŝĐĂŶ ŽĂƌĚ ŽĨ MĞĚŝĐĂů ^ƉĞĐŝĂůƟĞƐ ; M^Ϳ ĚĞƐŝŐŶĞĚ Ă ƉƌŽĐĞƐƐ ĐĂůůĞĚ MĂŝŶƚĞŶĂŶĐĞ ŽĨ ĞƌƟĮĐĂƟŽŶ͕ ĂŶĚ ĞĂĐŚ ƐƉĞĐŝĂůƚLJ ďŽĂƌĚ ĂŐƌĞĞĚ ƚŽ ĂĚŚĞƌĞ ƚŽ Ă ƐĞƚ ƐƚƌƵĐƚƵƌĞ ƚŽ ĚĞǀĞůŽƉ ƚŚĞŝƌ ŝŶĚŝǀŝĚƵĂů ƉƌŽŐƌĂŵƐ͘ /Ŷ ϮϬϬϯ M ͲFW͕ ƉƌŽǀŝĚĞĚ ďLJ ƚŚĞ ŵĞƌŝĐĂŶ ŽĂƌĚ ŽĨ FĂŵŝůLJ MĞĚŝĐŝŶĞ ; FMͿ͕ ůĂƵŶĐŚĞĚ ĂƐ Ă ŵĞĂŶƐ ŽĨ ĐŽŶƟŶƵĂů ĂƐƐĞƐƐŵĞŶƚ ĨŽƌ ŝƉůŽŵĂƚƐ͘ MĂŝŶƚĞŶĂŶĐĞ ŽĨ ĞƌƟĮĐĂƟŽŶ M ͲFW ƐƚƌƵĐƚƵƌĞ ĐŽŶƐŝƐƚƐ ŽĨ ĨŽƵƌ ĐŽŵƉŽŶĞŶƚƐ͕ ĞĂĐŚ ĚĞƐŝŐŶĞĚ ƚŽ ĂƐƐĞƐƐ ŝŵƉŽƌƚĂŶƚ ƉŚLJƐŝĐŝĂŶ ĐŚĂƌĂĐƚĞƌŝƐƟĐƐ͗ ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ ;WĂƌƚ /Ϳ͕ ƐĞůĨͲĂƐƐĞƐƐŵĞŶƚ ĂŶĚ ůŝĨĞůŽŶŐ ůĞĂƌŶŝŶŐ ;WĂƌƚ //Ϳ͕ ĐŽŐŶŝƟǀĞ ĞdžƉĞƌƟƐĞ ;WĂƌƚ ///Ϳ͕ ĂŶĚ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ƉƌĂĐƟĐĞ ;WĂƌƚ /sͿ͘ ůƚŚŽƵŐŚ ƚŚĞƐĞ ĞůĞŵĞŶƚƐ ĂƌĞ ƐŝŵŝůĂƌ ƚŽ ĂŶĚ ĐŽŶƐŝƐƚĞŶƚ ǁŝƚŚ ƚŚĞ FM͛Ɛ ůŽŶŐͲƐƚĂŶĚŝŶŐ ƌĞĐĞƌƟĮĐĂƟŽŶ ƉƌŽŐƌĂŵ͕ ƚŚĞ FM ƉƌŽĐĞƐƐ ƐƚƌĞƐƐĞƐ ƚŚĞ ŝŵƉŽƌƚĂŶĐĞ ŽĨ ŽŶŐŽŝŶŐ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ĂĐƟǀŝƟĞƐ ƚŚĂƚ ĞǀĂůƵĂƚĞ ĂŶĚ ĞŶĐŽƵƌĂŐĞ ĐůŝŶŝĐĂů ĞdžĐĞůůĞŶĐĞ ĂŶĚ ďĞŶĞĮƚ ďŽƚŚ ƉŚLJƐŝĐŝĂŶƐ ĂŶĚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͘ ^ŝŶĐĞ ϮϬϭϭ͕ ƐƵĐĐĞƐƐĨƵů ĐĂŶĚŝĚĂƚĞƐ ŽĨ ƚŚĞ ĞƌƟĮĐĂƟŽŶ Žƌ RĞĐĞƌƟĮĐĂƟŽŶ ĞdžĂŵŝŶĂƟŽŶ ƌĞĐĞŝǀĞĚ Ă ĐĞƌƟĮĐĂƚĞ ĨƌŽŵ ƚŚĞ FM ǁŚŝĐŚ ƌĞƋƵŝƌĞƐ ĐŽŶƟŶƵĞĚ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ƚŚĞ M ͲFW ƉƌŽŐƌĂŵ ŝŶ ŽƌĚĞƌ ƚŽ ŵĂŝŶƚĂŝŶ ĐĞƌƟĮĐĂƟŽŶ͘ dŚĞ M ͲFW ƉƌŽĐĞƐƐ ŚĂƐ ďĞĞŶ ƐĞĐƟŽŶĞĚ ŝŶƚŽ ƚŚƌĞĞͲLJĞĂƌ ƐƚĂŐĞƐ ǁŝƚŚ ƐƉĞĐŝĮĐ ƌĞƋƵŝƌĞŵĞŶƚƐ ƚŚĂƚ ŵƵƐƚ ďĞ ƐƵĐĐĞƐƐĨƵůůLJ ĐŽŵƉůĞƚĞĚ ďLJ ƚŚĞ ĞŶĚ ŽĨ ĞĂĐŚ ƐƚĂŐĞ͘ ĞŐŝŶŶŝŶŐ ǁŝƚŚ ƚŚŽƐĞ ƉŚLJƐŝĐŝĂŶƐ ǁŚŽ ĐĞƌƟĮĞĚ Žƌ ƌĞĐĞƌƟĮĞĚ ŝŶ ϮϬϭϭ͕ ƚŚĞ M ͲFW ĞdžĂŵ ǁŝůů ďĞ ǀĂůŝĚ ĨŽƌ ϭϬ LJĞĂƌƐ ĂŶĚ ŵĂLJ ďĞ ƚĂŬĞŶ ĂŐĂŝŶ ĂŶLJƟŵĞ ĚƵƌŝŶŐ ƚŚĞ ƚĞŶͲLJĞĂƌ ĐLJĐůĞ͕ ƚŚƵƐ ͞ƵŶůŝŶŬŝŶŐ͟ ƚŚĞ ĞdžĂŵŝŶĂƟŽŶ ĨƌŽŵ ƚŚĞ M ͲFW ĐLJĐůĞ͘

26

California Family Physician Winter 2016

The Big Three: ϮϬϭϭ ŵĂƌŬĞĚ Ă ƌĞƋƵŝƌĞŵĞŶƚ ŽĨ ϱϬ ƉŽŝŶƚƐ ĨŽƌ ĞĂĐŚ ƚŚƌĞĞͲLJĞĂƌ ƐƚĂŐĞ͕ ĂŶĚ ƚŚĞ M ƌĞƋƵŝƌĞŵĞŶƚƐ ĂƌĞ ĐĂůĐƵůĂƚĞĚ ĨŽƌ ƚŚĞ ƚŚƌĞĞͲ LJĞĂƌ ƐƚĂŐĞ ƌĂƚŚĞƌ ƚŚĂŶ ŽǀĞƌ ƚŚĞ ůĂƐƚ Ɛŝdž LJĞĂƌƐ ŝŵŵĞĚŝĂƚĞůLJ ƉƌĞĐĞĚŝŶŐ ƚŚĞ ĞdžĂŵŝŶĂƟŽŶ͘ dŚĞ FM ĂƐƐŝŐŶƐ ƉŽŝŶƚƐ ĨŽƌ ĞĂĐŚ WĂƌƚ // ĂŶĚ WĂƌƚ /s ŵŽĚƵůĞ͘ ƵƌƌĞŶƚůLJ Ă ^ĞůĨ ƐƐĞƐƐŵĞŶƚ MŽĚƵůĞ WĂƌƚ // ŵŽĚƵůĞ ĞĂƌŶƐ ϭϱ ƉŽŝŶƚƐ ĂŶĚ Ă WĂƌƚ /s ŵŽĚƵůĞ ĞĂƌŶƐ ϮϬ ƉŽŝŶƚƐ͕ ŵĞĂŶŝŶŐ ƚŚĞ ƐĂŵĞ ƉƌŽĐĞƐƐ ŽĨ ĐŽŵƉůĞƟŶŐ ƚŚƌĞĞ ŵŽĚƵůĞƐ Ăƚ ĞĂĐŚ ƐƚĂŐĞ ǁŝůů ŵĞĞƚ ƚŚĞ ϱϬͲƉŽŝŶƚ ƌĞƋƵŝƌĞŵĞŶƚ͘ So͕ Where Does CAFP Fit into the 40͍ FW͛Ɛ W ŽŵŵŝƩĞĞ ŝƐ ĚĞǀŽƚĞĚ ƚŽ ĂƐƐŝƐƟŶŐ ĐĂĚĞŵLJ ŵĞŵďĞƌƐ ŝŶ ŵĞĞƟŶŐ ƚŚĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ĨŽƌ M ͲFW ĂŶĚ ƉƌŽŵŽƟŶŐ ůŝĨĞůŽŶŐ ůĞĂƌŶŝŶŐ͘ tĞ͛ƌĞ ĂĐƟǀĞůLJ ĞŶŐĂŐĞĚ ŝŶ ƉƌŽǀŝĚŝŶŐ M ĐƌĞĚŝƚƐ ǀŝĂ ƚŚĞ FĂŵŝůLJ MĞĚŝĐŝŶĞ ůŝŶŝĐĂů FŽƌƵŵ ;FŽƌƵŵͿ͕ ůů MĞŵďĞƌ ĚǀŽĐĂĐLJ MĞĞƟŶŐ͕ FĂŵŝůLJ MĞĚŝĐŝŶĞ ^Ƶŵŵŝƚ͕ ĐŚĂƉƚĞƌ ŵĞĞƟŶŐƐ͕ ǁĞďŝŶĂƌƐ ĂŶĚ ŵŽƌĞ͘ ƚ ƚŚĞ ϮϬϭϲ FŽƌƵŵ LJŽƵ ĐĂŶ ĞĂƌŶ ŵŽƌĞ ƚŚĂŶ Ϯϴ ƉƌĞƐĐƌŝďĞĚ ĐƌĞĚŝƚƐ ĂůŽŶĞ͊ tĞ͛ǀĞ ƌĞĐĞŶƚůLJ ůĂƵŶĐŚĞĚ ŽƵƌ M ͲFW RŽĂĚƚƌŝƉ ƐĞƌŝĞƐ͘ FW ŝƐ ďƌŝŶŐŝŶŐ 'ƌŽƵƉƐ ^ MƐ ƚŽ LJŽƵ ʹ Ăƚ LJŽƵƌ ůŽĐĂů ĐŚĂƉƚĞƌ͕ ƌĞƐŝĚĞŶĐLJ ƉƌŽŐƌĂŵ ĂŶĚ ŽƚŚĞƌ ůŽĐĂƟŽŶƐ͘ OƵƌ ĮƌƐƚ ƐƚŽƉ ǁĂƐ Ăƚ ƚŚĞ ŶŶĞŶďĞƌŐ ĞŶƚĞƌ ŝŶ WĂůŵ ^ƉƌŝŶŐƐ ŽŶ ĞĐĞŵďĞƌ ϱ ĂŶĚ ǁĞ ŚŽƉĞ ƚŽ ƐĐŚĞĚƵůĞ Ăƚ ůĞĂƐƚ ĨŽƵƌ ŵŽƌĞ ƐƚŽƉƐ ŝŶ ϮϬϭϲ͘ /Ŷ ĂŶ ĞīŽƌƚ ƚŽ ŵĞĞƚ LJŽƵƌ ŶĞĞĚƐ͕ FW ŚĂƐ ĨŽƌŐĞĚ Ă ƉĂƌƚŶĞƌƐŚŝƉ ǁŝƚŚ ƚŚĞ /ŶƚĞƌƐƚĂƚĞ WŽƐƚŐƌĂĚƵĂƚĞ MĞĚŝĐĂů ƐƐŽĐŝĂƟŽŶ ƚŽ ůĂƵŶĐŚ ŽƵƌ ŽǁŶ WĂƌƚ /s ĂĐƟǀŝƟĞƐ͘ dŚĞ ĮƌƐƚ WĂƌƚ /s ĂĐƟǀŝƚLJ ŝƐ Ă ƉŝůŽƚ ƉƌŽũĞĐƚ ŝŶ ŚƌŽŶŝĐ <ŝĚŶĞLJ ŝƐĞĂƐĞ͕ ǁŝƚŚ Ă ĨŽůůŽǁͲƵƉ ŵŽĚƵůĞ ŝŶ ŚƌŽŶŝĐ WĂŝŶ MĂŶĂŐĞŵĞŶƚ͘ dŚĞ ŶĞdžƚ WĂƌƚ /s ŵŽĚƵůĞ͕ ǁŚŝĐŚ ůĂƵŶĐŚĞƐ Ăƚ ƚŚĞ ϮϬϭϲ FŽƌƵŵ͕ ƚĂĐŬůĞƐ ĞŶĚͲŽĨͲůŝĨĞ ĂŶĚ ƉĂůůŝĂƟǀĞ ĐĂƌĞ͘ OƵƌ ŐŽĂů ŝƐ ƚŽ ĐƌĞĂƚĞ ĨŽƌ ĞĂĐŚ FW ŵĞŵďĞƌ Ă ůŝĨĞůŽŶŐ ůĞĂƌŶŝŶŐ ũŽƵƌŶĞLJ ƚŚĂƚ ǁĞĂǀĞƐ ůŝǀĞ ĂŶĚ ĞŶĚƵƌŝŶŐ ĂĐƟǀŝƟĞƐ ƚŽŐĞƚŚĞƌ ǁŝƚŚ ^ M^ ĂŶĚ WĂƌƚ /s ŝŵƉƌŽǀĞŵĞŶƚ͕ ǁŝƚŚ ƐƚŽƉƐ Ăƚ ƚĞĂĐŚŝŶŐ ĂŶĚ ƉƌĞĐĞƉƟŶŐ͕ ƐŝŐŚƚƐĞĞŝŶŐ Ăƚ ƉĞƌƐŽŶĂů ĂŶĚ ƉƌĂĐƟĐĞ ƌĞŇĞĐƟŽŶ ĂŶĚ ƵůƟŵĂƚĞůLJ ĂƌƌŝǀŝŶŐ Ăƚ Ă ƐƉĞĐƚĂĐƵůĂƌ ϰϬ LJĞĂƌƐ ŽĨ ĐŽŶƟŶƵŝŶŐ Ɖ ƉƌŽĨĞƐƐŝŽŶĂů ĚĞǀĞůŽƉŵĞŶƚ͊ Shelly Rodrigues, CAE, CHPH, FACEHP is CAFP’s Deputy Executive Vice President.

“I am so proud of the leadership of our professional organization. When I look at the current healthcare landscape and the tremendous uphill battles that we face, I am grateful that the CAFP and AAFP are out there, advocating for family physicians and their patients. Our collective voice as a profession is made so much stronger by the CAFP and AAFP.” WHY EARLY CAREER PHYSICIANS SHOULD BE CAFP MEMBERS 1. Enjoy opportuniƟes to grow your professional network with like-minded family physicians and healthcare leaders at local chapter and statewide events such as the All Member Advocacy MeeƟng and Family Medicine Clinical Forum. 2. Use our career development resources, including informaƟon on entering pracƟce and contract negoƟaƟon, through the CAFP’s online PracƟce Resource Center. 3. Stay up to date on vital health care issues, on vital health care issues aīecƟng California family physicians and their paƟents with such publicaƟons California Family Physician, Academy in AcƟon, PracƟce Management News and the LegislaƟve Update. 4. Wrotect paƟents͛ through such puďlic health advocacy eīorts in Sacramento and Washington as the recent eīort CAFP spearheaded to eliminate the personal and religious exempƟons for childhood immunizaƟons in California – a major public health victory. 5. dake advantage of leadership development opportuniƟes by joining CAFP commiƩees, legislaƟve training, our CME Leaders’ InsƟtute and more.

Shannon Connolly, MD New Physician Director, CAFP Board of Directors President-Elect, Los Angeles Academy of Family Physicians

PRACTICE WHAT YOU BELIEVE The future of health care is happening today at Kaiser Permanente Southern California. By pursuing new breakthroughs, promoting proactive care and employing innovative technologies, we’re giving our physicians the tools they need to create a healthier tomorrow. As part of our practice, you’ll be working in a progressive environment that encourages cross-specialty collaboration, professional autonomy and work-life balance. If you want to work at the forefront of our industry, consider the following opportunities:

BC/BE FAMILY MEDICINE & URGENT CARE PHYSICIANS Openings in Southern California Full-time and per diem opportunities are available in locations throughout Southern California. At SCPMG, you'll enjoy the amazing recreational activities, spectacular natural scenery and exceptional climate our area is known for, along with an excellent salary/benefits package and stability in today's rapidly changing health care environment. For consideration or to apply, visit our website at http://physiciancareers.kp.org/scal. For questions or additional information, please contact Bettina Virtusio: (877) 608-0044 or email Bettina.X.Virtusio@kp.org. Visa sponsorship not available. We are an AAP/EEO employer. http://physiciancareers.kp.org/scal Southern California Permanente Medical Group

FAMILY PRACTICE MD/DO Open Door Community Health Centers in coastal Northern California is seeking 3 full-time Family Practice MD/DO’s for our clinics in Crescent City, Eureka and McKinleyville. We offer competitive salary and benefits, including health insurance, malpractice insurance, pension plan, vacation/holiday pay, CEU time/stipend, and loan repayment options. Requires CA license, Board Certification, DEA, EMR experience. Visit www.opendoorhealth.com to learn about us, then come live, work and play on the stunning northern California Coast! California Family Physician Winter 2016

27

’••ȹ Ž™�ǰȹ

Chronic Care Management: Reporting from the Trenches dhe ŇaÄ?Ä?ergasĆ&#x;ng reality of procedureͲÄ?ased compensaĆ&#x;on in medicine is that one can Ä?ill more for an ingrown toenail procedure than for a level four oĸce visit on a challenging paĆ&#x;ent with a lengthy proÄ?lem list͘ that is more, we all share those days when the last visit is completed only to encounter a long list of phone calls, emails, reÄŽlls, prior authoriÇŒaĆ&#x;ons and paperwork ahead of us͘ dhe lack of any compensaĆ&#x;on for those edžtra hours can Ä?e diĸcult to stomach͘ ut waitÍŠ /n rides the charging stallion of MedicareÍ›s new hronic are Management Íž MÍż program, designed to compensate physicians for the care of compledž paĆ&#x;ents͘ are we hope for sunnier trails aheadÍ? Several months ago, my oĸce group of eight family doctors agreed to Ä?e one of the pilot sites for M enrollment͘ thile some arĆ&#x;cles on the new M program dangle hopes of ΨϭϏϏ,ĎŹĎŹĎŹĐ˝ annual payments to primary care providers, our collecĆ&#x;ve goal was at least to get to ingrown-toenail-levelsof-compensaĆ&#x;on improvement when taking care of our sickest paĆ&#x;ents͘1 MedicareÍ›s reĆ‹uirement for M enrollment is at least two chronic health condiĆ&#x;ons which place the paĆ&#x;ent at higher risk for decompensaĆ&#x;on, decline or death͘1 /t was fairly easy for us to idenĆ&#x;fy the paĆ&#x;ents who would Ć‹ualify͘ te use an lectronic ,ealth Record Íž ,RÍż, so we looked for those chronically ill Medicare paĆ&#x;ents who had mulĆ&#x;ple phone calls, emails or other paperwork encounters͘ Our organiÇŒaĆ&#x;on prepared several documents for providers and paĆ&#x;ents to review, which covered MedicareÍ›s reĆ‹uirements for enrollment and Ä?illing in the M program͘ dhese, along with helpful documents prepared Ä?y Family PracĆ&#x;ce Managementt ÍžFWMÍż, ran more than seven pages long͘2 'oing over this informaĆ&#x;on Ć‹uickly with paĆ&#x;ents was Ć‹uite diĸcult Í´ on top of the usual diaÄ?etes, hypertension, Ä?ack pain and depression issues that needed to Ä?e handled͘ / eventually honed my spiel down to the following pointsÍ— “Aren’t you relieved when you can reach your doctor by phone or email and don’t need to come to the oĸce to handle small issues?â€?

28

California Family Physician Winter 2016

“Do you realize that your insurance only pays for medical bills when you are seen at the office? We want to have plenty of nurses and medical assistants available so we can handle your phone calls and emails effectively 24/7, and the insurance payments from the CCM program will help us do this.� “Like every Medicare bill, your insurance will pay the majority of the cost, but there is still a share of the bill that may come to you. Your Medigap insurance will likely cover your $8 monthly co-pay, but I can’t guarantee that, since this is a new program, and we are still learning how it works.� After a bit of practice ironing out the kinks, it took me just a few minutes to go over those essentials of the program, and I only had a few patients who declined. After the enrollment paperwork, we then spent time going over the individualized care plan that is the heart of the CCM program. After a flurry of extra work for three months, we had enrolled our sickest patients. Although I am not a fulltime clinician, I imagine one who is might enroll at least 90 participants. Not every patient will accumulate the 20 minutes of CCM work each month needed for billing, but if two-thirds do, then a full-time doc will bill $42 x 60 x 12 = $30,240 in a year. This income supports needed practice resources, and some portion might find its way to our paychecks. A word of caution: before thinking your daily stack of phone calls, emails and refills might finally generate some compensation – my organization has recently informed me that Medicare Advantage (HMO) programs have decided to stop paying for CCM codes as of 2016, and who knows what other insurers will follow suit. One step forward, one step back! Bill Zepf, MD is a physician working in the small university town of Davis, California and is a faculty member of the Sutter Family Medicine Residency Program.

California C Calif lif iforniia FFamily amilily Ph Phy Physician h sici i ian Wi W Winter nter 2016

29

ȱ ǰȱ ȱ

EXECUTIVE VICE PRESIDENT’S FORUM

CAFP Goals and FMAHealth Goals Well-Aligned FW͛s 2Ϭ1ϲͲ1ϴ Strategic Wlan focuses on the ,oly drinity of family medicine͗ Wayment Reform, WracƟce dransformaƟon and torkforce evelopment, and recently our oard added a fourth goal͗ :Oz͘ dhese goals͛ success is interdependent and they align perfectly with those of Family Medicine for merica͛s ,ealth ;FM ,ealthͿ, the ĮveͲyear proũect kicked oī in late 2Ϭ1ϰ ďy the merican cademy and other family medicine organinjaƟons͘ tant to increase the pipeline for family medicine͍ nsure payment reŇects the true value primary care ďrings to paƟents͖ transform pracƟces so they emphasinje paƟent centeredness and relaƟonships and family physicians achieve workͲlife ďalance͘ tant pracƟces to transform to the WaƟent entered Medical ,ome ;W M,Ϳ model of care͍ W z for such enhanced services and train adeƋuate numďers of family physicians to meet demand͘ tant valueͲďased payment that recogninjes the ďreadth and depth of what family physicians do for paƟents and the ďeneĮt to their care͍ Support and encourage transformaƟon of pracƟces to the new model and ensure family physicians, wellͲtrained in that new model, can Įnd opportunity in such pracƟces͘ nd round and round we go͘ dhe phrase ͞if you ďuild it, he will come͟ was coined in the 1ϵϴϵ movie, Field of reams͘ /t has ďeen adapted ďy many to͗ ͞/f you ďuild it, they will come͘͟ /n the coming three years, as in the past three, one of our goals will ďe to help our memďers ďuild ͞it͟ ;the W M, or other advanced primary care modelsͿ and get W / for ͞it͘͟ dhe paƟentͲcentered model must ďe supported Įnancially while it is ďuilt and aŌerward͘ /n the movie, the farmer played ďy <evin ostner faced Įnancial ruin ďecause he turned cropͲgrowing land into a ďaseďall diamond͘ s the farmer and his family decline to sell their land to avoid that ruin, a long line of cars approaches, cars Įlled with patrons willing to pay to watch ďaseďall͘ ,is dream comes true and the farm is saved͘ FW hoped that our dream that insurers would recogninje and pay for the WaƟent entered Medical ,ome in alifornia would come true, ďut, to date, we have found otherwise͘

30

California Family Physician Winter 2016

Many early adopƟng family physicians ďuilt the medical home, ďut valueͲďased payment has lagged far ďehind adopƟon of the model͘ /n our state, capitated payment within managed care is the catchͲall͘ tithout improving payment for the enhanced care services, most insurers have simply declared their capitated payments already include such services͘ FW wants to see insurers lined up to pay for W M, services ũust as the patrons in /owa lined up in their cars to see ďall played on ostner͛s Įeld͊ espite the reference to the ,oly drinity in the opening sentence, FW doesn͛t work miracles͘ te can͛t ũust wave our hands and eīect the changes we advocate͘ te must work in concert with the FW and others to achieve our goals͘ FW sice Wresident of dvocacy, WracƟce dvancement and Wolicy, Shawn MarƟn, wrote in a recent ďlog of hearing for the Įrst Ɵme aďout ͞whacking the t ͟ ʹ the ͞work aŌer clinic͟ Ɵme that contriďutes so much to physician ďurnͲout͘ Removing administraƟve ďurdens that add no value to care is a priority of ďoth FW and FW͘ Our very own Wresident, :ay t͘ >ee, M , MW,, used that ͞whack the t ͟ phrase at the postͲ ongress of elegates seminar FW held in enver on payment reform for chapter leaders and edžecuƟves͘ dhe purpose of the seminar was to inform us aďout how FW is gearing up to help family physicians with implementaƟon of M R , the Medicare ccess and ,/W uthorinjaƟon ct of 2Ϭ1ϱ͘ From commenƟng on regulaƟons to implement M R to developing edžtensive resources to help memďers cope in the new world of M/WS ;MeritͲďased /ncenƟve Wayment SystemͿ and WMs ; lternaƟve Wayment ModelsͿ and WFWMs ;WhysicianͲfocused Wayment ModelͿ under M R , FW and FW will ďe there for you͘ te͛re waiƟng for a liƩle dust to seƩle so we know edžactly with what we͛re dealing ʹ then we͛re going to come at it with a vengeance to ensure you have the knowledge and tools to make the ďest decisions for you and your pracƟce in the new valueͲďased health care world͘ So, that͛s it͗ Wayment Reform͘ WracƟce dransformaƟon͘ torkforce evelopment͘ nd :Oz͘ te͛d love your thoughts͘

Healthcare is changing. Are you ready for a change? Consider Corizon Health - the nation’s leader in Correctional Healthcare. Join our team of professionals and experience the many rewards of working with an organization that truly values its healthcare providers. 8F DVSSFOUMZ IBWF PQQPSUVOJUJFT BWBJMBCMF GPS 1SJNBSZ $BSF 1IZTJDJBOT

΄ ΄ ΄

'SFTOP $PVOUZ +BJM 'SFTOP $" 4BOUB 3JUB $PVOUZ +BJM %VCMJO $" 4BOUB #BSCBSB $PVOUZ +BJM 4BOUB #BSCBSB $"

΄ ΄ ΄ ΄ ΄

Excellent compensation, including malpractice coverage No overheads, no billing issues Minimal on-call Medical/dental benefits, 401K Full time, part time, PRN and locums

Corizon Heath offers the opportunity to practice medicine without the normal practice worries! Work with industry leaders in an emerging clinical specialty with complex pathological challenges and opportunities for career advancement.

If you are interested please send your resume to:

Dee Thandi Dee.thandi@corizonhealth.com T: 800.893.2118 F: 866.303.2728

Over 500 facilities in 29 states. 35 years of innovation and expertise.

Visit corizonjobs.com to see all opportunities.

CALIFORNIA ACADEMY OF FAMILY PHYSICIANS FOUNDATION 1520 PACIFIC AVE SAN FRANCISCO, CA 94109 -2627

Presorted Standard U.S. POSTAGE PAID

Little Rock, AR Permit No. 2437

MIEC Belongs to Our Policyholders!

Toni Brayer, MD Board of Governors

Philosophy is Important In 2016 MIEC will be the only MPLI carrier distributing dividends in California. It’s time to join the company whose philosophy puts policyholder-owners first. MIEC has never lost sight of its original mission, always putting policyholders (doctors like you) first. For 40 years, MIEC has been steadfast in our protection of California physicians with conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services; we’ve partnered with policyholders to keep premiums low. Added value: profit motive and low overhead Q Dividends for a TEN year average savings of 31.4%* Q No

For more information or to apply: Q www.miec.com Q Call 800.227.4527 Q Email questions to underwriting@miec.com * On premiums at $1/3 million limits. Future dividends cannot be guaranteed.

MIEC 6250 Claremont Avenue, Oakland, California 94618 s 800-227-4527 s www.miec.com 32

California Family Physician Winter 2016

CalFamPhy_ad_12.21.15

MIEC Owned by the policyholders we protect.

Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.