november/december 2012

Legislation

& Advocacy

PhysicianA publication of the San Mateo County Medical Association

San Mateo

County

November/December 2012

It’s Open Enrollment time for the San Mateo County Medical Association sponsored Group Dental program. This plan is designed to help you, your family and your

employees minimize the out-of-pocket expense of regular dental care.

This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits

that can save you money:

Annual Benefits of $2,000 per person for dental care, using network providers ($1,500 if you use non-network providers).

During Open Enrollment only, members may join as an individual or as a group with your employees.

Low, calendar year deductible of $50 per person ($100 per calendar year maximum for families).

Pay no deductible on oral exams, x-rays and routine cleanings.

Remember, the open enrollment period is available once per year. To be eligible for coverage, applications must be received during the special open enrollment period ending on

January 1, 2013.

Call a Client Service Representative at 800-842-3761 for more information. Or visit www.CountyCMAMemberInsurance.com to download a brochure and application.

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referenced are wholly-owned subsidiaries of The Guardian Life Insurance Company of America. Products are not available in all states. Limitations and exclusions apply. Plan documents are the final arbiter of coverage.

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Now that the election is over and the accompanying drama has died down, it’s time to examine what it all means for the practice of medicine and the healthcare industry. This issue of San Mateo County Physician aims to help, with an update on new healthcare-related legislation in California, a recap of resolutions put forth by CMA’s House

of Delegates, and a profi le of the state’s newest physician-congressmembers.

We are also sharing a contribution from the CMA Foundation on Chronic Obstructive Pulmonary Disease (COPD), a serious lung disease that is now the third leading cause of death in the U.S. More than 12 million people are currently diagnosed with COPD, and it is estimated that another 12 million may have COPD and not even know it.

The next issue of San Mateo County Physician will be out in January 2013. Until then, have a happy and healthy holiday season.

President’s Message .....................................................5

The Election Over, It’s Time for the Real Work to Begin.

Gregory Lukaszewicz, MD

Executive Report ...........................................................7

Collaborative Effort Reflects Savings for ACO.

Sue U. Malone

State Legislative Update ..............................................9

New Laws that May Affect Your Practice in 2013 and Beyond.

Jodi Hicks

House of Delegates 2012 ............................................ 11

CMA Delegates Set Policy at Annual Meeting.

CMA Staff

Two MDs Elected to Congress ...................................13

Physicans Dr. Raul Ruiz and Dr. Ami Bera defeat Republican incumbents.

SMCMA Staff

November is National COPD Awareness Month ......15

CMA Foundation Staff

SMCMA Docs Staff CSM’s Annual Health Fair .........15

SMCMA Staff

Membership Update and Index of Advertisers ........18

December/January 2012Volume I / No. 9

On the cover

“State Capitol Photo by Sally,” by Wikipedia Creative Commons user Svnana. Image licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

PhysicianA publication of the San Mateo County Medical Association

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SAN MATEO COUNTY PHYSICIAN | PAGE 5

Th e Election Over, It’s Time for the Real Work to Begin

PRESIDENT’S MESSAGE

GREGORY LUKASZEWICZ, MD

Now that the 2012 election is over, the real work needs to begin. In the first few days following this year’s election, there appears to be a conciliatory tone coming out of Washington as both Republicans and Democrats are expressing their willingness to work together in order to find common ground and to compromise in order to solve our nation’s most pressing problems, in particular the self-imposed “fiscal cliff”.

While the presidential election in particular shaped up to be a real conversation about the size and role of government, outwardly nothing has shifted dramatically, with the Democrats maintaining control of the White House and Senate and the Republicans the House. Though the temptation may be for one side or the other to interpret the election as a clear mandate for its particular vision, overall the election results point to an electorate that is fairly split down the middle and continues to disagree about which direction we should take as a nation. But if the current post-election tone is maintained by our political leaders, then it very well may be possible to

move beyond the current state of gridlock.

In fact, if approached constructively, the differences between the President and Speaker of the House in particular (as they will be the key figures in the coming debates and negotiations) may actually prove to be an advantage. Rather than lead from the far right or left, the two leaders can hopefully come to a compromise somewhere in the middle, which, though maybe not fully satisfying to anyone, can potentially offer something for most Americans. House Speaker John Boehner is already softening his position to some extent on the issue of taxes. He does appear to be willing to discuss increasing federal revenues by getting rid of tax loopholes rather than actually raising taxes. It is exactly this kind of loosening of one’s position that can eventually lead to an agreement.

As of this writing, the “fiscal cliff” is the most pressing issue facing our national leaders. Stemming from the stalemate during the debt ceiling crisis of 2011, the Budget Control Act of 2011 called for a potential combination of

severe budgetary cuts (termed sequestrations) and dramatic tax increases that would be put in place unless the Joint Select Committee on Deficit Reduction was able to come to an agreement that would begin to reduce the nation’s debt by $1.2 trillion over ten years, which as we know it did not. However, most economists are in agreement that such extreme measures would push the country further back into recession, so both parties currently appear very motivated to prevent this. More importantly, the drastic budget cuts will have the most dramatic effects on our most vulnerable citizens who area already struggling to get by during these intensely difficult times.

What do the election results mean. and what does the upcoming legislative season hold in store for physicians? First, with the re-election of President Obama and a democratically-controlled Senate, the Affordable Care Act (ACA) will most likely not be overturned or abolished. Still, one can envision certain aspects of the ACA being changed or overturned by the Congress. In addition, the Republican-controlled House can

6 SAN MATEO COUNTY PHYSICIAN | NOVEMBER/DECEMBER 2012

still attempt to withhold funding for the ACA, though this is very unlikely.

Since the overall structure of the ACA can be considered the law of the land, it will be important for physicians and organized medicine to focus on those aspects with which we are fundamentally opposed. One such issue is the Independent Payment Advisory Board, which will be a 15-member panel of unelected members with a mandate to control health care inflation by essentially restricting or limiting reimbursements. As physicians we may have very little if any control over the Board’s decisions because of this lack of accountability. The American Medical Association has actively been advocating for the abolition of the IPAB.

The second major issue that many physicians will face concerns Medicare reimbursement rates and in particular the sustainable growth rate (SGR). The SGR has been delayed on a temporary basis on multiple occasions. It is scheduled to go into effect January 1st, 2013 with a 26.5 percent reduction in Medicare reimbursements (though leaders of the GOP Doctors Caucus are confident that the lame duck Congress will approve another one-year freeze). Repealing the SGR at this point would cost the federal government roughly $270 -300 billion over ten years (the “doc fix”). However, the fiscal cliff includes full implementation of the SGR plus an additional two percent cut to all Medicare payments as part of the set of sequestrations unless action is taken to prevent our going over the cliff. Both the fiscal cliff and the SGR need to be addressed directly or else many physicians will be facing a major crisis in terms of maintaining their practices and continuing to provide adequate access for Medicare patients.

There is a great deal at stake in the coming months for our country, for our most vulnerable citizens who will be hardest hit by severe budget cuts, and for physicians. Let us hope that our re-elected and newly-elected leaders are up to the task of working together and finding compromise solutions that avoid these draconian measures and prevent us from “falling off the fiscal cliff”.

President’s Message: The Election Over, It’s Time for the Real Work to Begincontinued

NOVEMBER/DECEMBER 2012 | SAN MATEO COUNTY PHYSICIAN 7

EXECUTIVE REPORT

Collaborative Effort Reflects Savings for ACO

SUE U. MALONE

Alternative payment and delivery models in the private sector are popping up all over the country to test how best to change the prevailing fee-for-service reimbursement method and get better value for dollars spent. These models include patient-centered medical homes, in which a personal physician coordinates a team of people to provide comprehensive and integrated care; bundled payments, which reimburse multiple providers for clinically defi ned episodes of care; and accountable care organizations (ACO), which are alliances of physicians, hospitals, and other providers that agree to be accountable for the quality, cost, and overall care of a defi ned group of patients.

In case you missed it, there was an interesting article in the September issue of Health Affairs that discussed a pilot project of Blue Shield of California, CalPERS, Dignity Health and Hill Physicians, who developed an alternative payment and delivery model for reducing spending and improving health care quality. The group set out four goals for its ACO: 1) to deliver cost savings and a premium credit to CalPERS by reducing the growth in the cost of health care from 10 percent to 0 percent in the fi rst year; 2) to increase enrollment by attracting new public agencies to contract with CalPERS and increase enrollment for the partners; 3) to maintain or improve the quality of health care; and 4) to create a sustainable model.

Although the partners started talking about collaboration in 2007, it was not until 2010 that the pilot was launched in the greater Sacramento area. All 41,000 members of the pilot were already assigned to Hill Physicians, and 70-75 percent of their members’ spending for services in health care facilities was through Dignity Health (formerly Catholic Healthcare West).

This pilot effort, orchestrated by Blue Shield, adopted an approach to effectively align incentives amongst health plan and provider partners by using a global budget with shared risk layered on top existing payment mechanisms. A global per member per month target amount for the cost of health care was established without changing the underlying payment mechanisms to physicians and hospitals. All partners had a fi nancial stake in ensuring that expenses did not exceed the target. If costs were to exceed the target at the end of the year, then the partners would each write off those expenses. If the expenses were below the target, then the partners would share in the savings. All the partners agreed to share savings as well as risks for each category of health care service within the per member per month target.

The fi rst hurdle the coalition encountered was establishing mutual trust amongst the partners. Blue Shield has to convince Dignity Health and Hill Physicians that the health plan was genuinely interested in sharing risk, not merely shifting it. All the

partners were accustomed to bargaining fi ercely with each other over the payment rates.

Among the strategies that emerged from this integrated framework was a review that focused on chronically ill patients, especially the 5,000 who accounted for 75 percent of total health care costs in the population for the pilot ACO. The partners also classifi ed hospital cases to identify heavy users and to establish benchmarks for improved care. The global per member per month target superseded the underlying capitation payment methodology for Hill and the fee-for-service payment methodology for Dignity Health.

Because all the partners had both upside and downside fi nancial risk for total health care expenditures, they had a powerful incentive to help each other.

Now two years have passed and the partners’ experience to date suggests that a global budget approach can gain wide acceptance from providers eager to make changes that can yield savings and improvements in clinical care. Both year one and year two showed positive results.

Blue Shield now has eight ACOs across California that use global budgets.

If you are not a subscriber to Health Affairs and would like a copy of this article, call SMCMA.


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Healthcare Labor Law


AB 2109: Communicable Disease: Immunization Exemption

Author: Dr. Richard Pan (D-Sacramento)

CMA Position: Sponsor

California is one of 20 states that allows for the broad use of the personal belief exemption (PBEs) from immunizations that are required for children to enter school. In

California, obtaining a personal belief exemption is simple—parents are only required to sign their name to a two-sentence standard exemption statement on the back of the California School Immunization Record or provide a signed written statement. Over the past decade, the number of parents choosing to exempt their children from school immunization requirements has increased signifi cantly, leading to more school children left vulnerable to preventable diseases. Parents have the right to make choices about immunizing their children; however, these choices should not be based on misinformation or lack of information. AB 2109 requires a parent or guardian seeking a personal belief exemption for their child to obtain a document signed by themselves and a licensed health care practitioner. The document will state that the health care practitioner has informed the parent or guardian of the benefi ts and risks of the immunization, as well as the health risks of the diseases that a child could contract if left unvaccinated.

Status: Enrolled and sent to Governor. Signed into law September 30, 2012. Goes into effect January 1, 2014.

* * *

SB 1524: Nursing

Author: Dr. Ed Hernandez (D-West Covina)

CMA Position: Watch

This bill deletes the statutory requirement that nurse practitioners complete at least six months of physician and surgeon supervised experience in the furnishing or ordering of drugs and a course in pharmacology covering the drugs that

will be furnished. The author contends this statute is antiquated and was put into place before there was any signifi cant training in pharmacology. He contends the proper training and proper education now exists and the six month requirement only delays employment of new advanced practice registered nurses (APRN). However, not everyone’s experience and education is equal and should be dealt with on a case-by-case basis. CMA recommended amendments, which the author accepted, that clarifi ed that the physician may include a six-month supervised experience (or longer) requirement in the standardized protocol between the physician and the APRN.


* * *

SB 1538: Health care: Mammograms

Author: Joe Simitian (D-San Mateo)

CMA Position: Neutral

This bill would require physicians to notify mammography patients with highly dense breasts about the density of their breast tissue. This issue has been debated within the house of medicine for nearly two years, but physician advocates were able to secure amendments to the bill that allowed both CMA as well as ACOG District IX to take neutral positions.

Status: Enrolled and sent to Governor. Signed into law September 22, 2012. Goes into effect April 1, 2013.

State Legislative Update

New laws that may affect your practice in 2013 and beyond


AB 589: Medical School Scholarships

Author: Henry D. Perea (D-Fresno)

CMA Position: Sponsor

Prior CMA sponsored legislation provided $1,000,000 per year in funding for the Steve Thompson Loan Repayment Program, which gives physicians up to $105,000 in loan repayment if they agree to practice in an underserved area for at least three years. This bill mirrors the loan repayment program and would create the Steve Thompson Scholarship Program, which would provide scholarships to medical students who agree to practice in one of California’s medically underserved areas upon completion of residency.

Status: Enrolled and sent to Governor. Signed into law Signed into law September 17, 2012.

AB 1533: International Medical Graduates Author: Holly Mitchell(D-Los Angeles)

CMA Position: Support

This bill would allow the UCLA International Medical Graduate program to create a fi ve-year pilot for participants to engage in physician- supervised patient care activities, as part of an approved and supervised clinical clerkship/rotation at UCLA. With this legislation, UCLA International Medical Graduates would receive valuable clinical learning opportunities and not be at risk for disciplinary action by the Medical Board of California. In light of California’s physician supply crisis, this bill would have a more immediate impact toward increasing the amount of licensed physicians that could practice in the state.

Status: Enrolled and sent to Governor. Signed into law July 25, 2012.

* * *

AB 1453: Essential Health Benefi ts

Author: Bill Monning (D-Carmel)

SB 951: Essential Health Benefi ts

Author: Dr. Ed Hernandez (D-West Covina)


These two bills, which are virtually identical, would establish a set of essential health benefi ts (EHBs) that insurers and health plans in California’s Health Benefi t Exchange will be required to cover. This pair of bills would adopt the Kaiser small group HMO as the state’s EHB benchmark.


AB 1761: Deceptive Marketing

Author: John A. Perez (D-Los Angeles)


This bill would prohibit deceptive marketing by outlawing “copy cats” from representing themselves as part of the California Health Benefi t Exchange.

Status: Enrolled and sent to Governor Signed into law September 30, 2012. Goes into effect January 1, 2014.

* * *

AB 1846: CO-OPs

Author: Richard Gordon(D-Menlo Park)

CMA Position: Watch

This bill authorizes Insurance Commissioner to issue a certifi cate of authority to Consumer Operated and Oriented Plans (CO-OPs). The Affordable Care Act calls for the creation of the CO-OPs, which are private, consumer-governed, non-profi t health insurance plans that will be operated by its community benefi ciaries (consumers, providers and employers).

Status: Enrolled and sent to Governor Signed into law September 30, 2012. Goes into effect January 1, 2013.

State Legislative Update

This article was excerpted from “One Must Imagine Sisyphus Happy: The California Medical Association’s 2012 Legislative Wrap-Up,” by Jodi Hicks. For the full report and more information about the CMA, please visit www.cmanet.org.


Revised Blood Donor Deferral Criteria

(Resolution 108-12)

The delegates expressed support for the use of rational, scientifi cally-based deferral periods for blood donations, applied based on level of risk rather than on sexual orientation.

* * *

Awareness and Prevention of Bullying

(Resolution 113-12)

The delegates called on CMA to support awareness and prevention of bullying in all its forms and to support the development of family, school and community programs and referral services for victims and perpetrators of bullying.

* * *

AB 32 and California’s Clean Air Leadership

(Resolution 117-12)

The delegates voted that CMA should support implementation of the California Global Warming Solutions Act of 2006, which protects the health of Californians from climate change.

Safer Furniture Flammability Standards

(Resolution 125-12)

The delegates asked that CMA endorse a revision of the California TB 117 furniture fl ammability standards, which would not require harmful fl ame retardants yet provide more effective fi re safety using barrier technology and fl ame-resistant fabric covers.

* * *

Support for Amending the Affordable Care Act

(Resolution 201-12)

The delegates directed CMA to support amending the Affordable Care Act to address issues of concern to the practice of medicine.

* * *

Dual eligible monitoring and reporting

(Resolution 208-12)

This resolution directs CMA to collect data from its membership regarding diffi culties with the planned transition of dual eligibles to managed care plans and to report the fi ndings to the California Department of Health Care Services, the California Department of Managed Health Care and the federal Centers for Medicare & Medicaid Services.

House of Delegates 2012

CMA delegates set policy at annual meeting

More than 700 California physicians convened in Sacramento October 13-15 for the 2012 House of Delegates (HOD), the annual meeting of the California Medical Association (CMA). Each year, physicians from all 53 California counties, representing all modes of practice, meet to discuss issues related to health care policy, medicine and patient care and to elect CMA offi cers. More than 120 resolutions were introduced and debated in reference committees on Saturday, October 13, 2012. Over the next two days, the complete house met again to debate and vote on reference committee recommendations. A total of 97 resolutions were adopted. The following are summaries of some of the resolutions that were adopted as policy.


House of Delegates 2012

Electronic Prescribing and EHR Payment Reductions

(Resolution 214-12)

The delegates voted to oppose fi nancial penalties by any payor for physicians who do not adopt health information technology, such as electronic medical records and electronic prescribing.

Health Care Equality for Same-Sex Household Members

(Resolution 505-12)

The delegates unanimously voted to recognize that denying civil marriage contributes to poorer health outcomes for gay and lesbian individuals, couples and their families. The resolution also calls on CMA to support measures providing same-sex households with the same rights and privileges to health care, health insurance and survivor benefi ts afforded to opposite sex households.

* * *

Pharmacist’s Substitution of Physician Prescriptions

(Resolution 507-12)

The delegates asked that CMA consider legislation to make it illegal for pharmacists to receive fi nancial incentives to substitute a physician’s prescription.

* * *

Increasing Utilization of POLST Orders

(Resolution 512-12)

The delegates approved a resolution that calls on CMA to support awareness and use of Physicians Orders for Life-Sustaining Treatment (POLST) forms by physicians in all

appropriate instances where medical services are provided to patients at the end of life.

* * *

HIPAA and Medical Record Accessibility

(Resolution 606-12)

The delegates asked CMA to support a study on the extent to which HIPAA laws impede the timely transfer of medical information necessary for the appropriate coordination of care.

Helping Physicians Improve Their Health

(Resolution 610-12)

The delegates voted to encourage all physicians and physicians-in-training to properly manage their own physical and mental health and to serve as exemplars of healthy behaviors.

* * *

The complete and fi nal actions of the 2012 House of Delegates are available to CMA members at www.cmanet.org/hod under “Documents.”

SMCMA Delegates to the

CMA House of Delegates

John HoffLeslie Kim

Steve KmuchaBetty Lee

Gregory LukaszewiczVincent MasonJames Missett

Barry ObersteinRobert ReisfeldAmita Saxena

William TatomerDirk S. Baumann

Chair

Th e delegates called on CMA to support awareness and prevention of bullying in all its

forms.


Two MDs Elected to Congress

Amongst the newly elected members of the 113th Congress at November 13’s Congressional orientation were two doctors from California, both Democrats. In the 36th Congressional District in Coachella Valley, emergency physician Raul Ruiz ousted Republican incumbent Mary Bono Mack in a contentious election that gained national attention.

Dr. Ruiz, 40, was born in Coachella to farmworker parents. In his teens, he appealed to local businesses to help finance his education, promising to come back and serve the community as physician. True to his word, he returned to Coachella in 2007 after earning three degrees from Harvard— a Medical Doctorate, a Masters in Public Policy and a Masters in Public Health—and became an emergency physician at Eisenhower Medical Center, the Coachella Valley’s only nonprofit hospital. He is also the founder and director of the Coachella Valley Healthcare initiative, which aims to improve healthcare access for the medically indigent population of the Coachella Valley.

Historically, the 36th Congressional District, which includes most of central and eastern Riverside County, has been considered a “red” district based on voter registration numbers. Incumbent Mary Bono Mack, a moderate Republican, has served since 1998 when she filled the seat vacated by her husband, Sonny Bono, who was killed in a skiing accident. She was re-elected continuously until she

was defeated by Ruiz by a margin of just over one percent.Pundits say that Bono Mack’s stronghold on the district was weakened by Ruiz’s ability to connect with the growing Latino population and tremendous grassroots support from his hometown.

Ruiz has vowed to fight what he considers partisan gridlock in Washington and to work to create jobs, invest in education and renewable energy, and bring down the costs of health care. “I will always protect Social Security and Medicare from attempts to slash the guaranteed benefits California seniors have paid for and planned on,” stated Raul on his campaign website. “The best way to save Medicare is to reduce healthcare costs by allowing Medicare to negotiate with drug companies for lower prices and use electronic record keeping to eliminate expensive duplicate tests.”

Meanwhile, in another close race, in suburban Sacramento’s 7th Congressional District, Elk Grove physician Ami Bera has ousted incumbent Republican Dan Lungren, who had held the seat since 2005. Having lost to Lungren in 2010 by seven percentage points, Bera benefitted this election from redistricting that gave Democrats and edge and increased support from former President Bill Clinton, major nonprofit environmental groups, and liberal super PACs.

Dr. Bera, 47, was born in La Palma, California to parents who had immigrated to the U.S. in the 1950s.

After graduating from UC-Irvine, he served as chief medical officer for Sacramento County, then joined the University of California, Davis, Medical School as a clinical professor and associate dean in 2004. Currently, he is a real estate investor and landlord with eleven rental properties.

While Lungren heartily defeated Bera in the June primary by a margin of almost 12%, but at the end of the night on election day, they were within a few hundred points of each other (Bera leading) The Associated Press did not call the election for Bera until November 15, at which time he was leading by 2.2 percent.

About Medicare, Dr. Bera state on his campaign website, “As a physician who has worked at every level of the health care system and a candidate for Congress, I bring a unique perspective to the Medicare discussion. The Republican plan to dismantle and privatize Medicare—recently passed by the House of Representatives and supported by Congressman Dan Lungren—is a disastrous example of this.”

Both the 36th and 7th Congressional Districts were targeted by the Democratic Congressional Campaign Committee’s “Red to Blue” initiative, which identifies and offers financial and other assistance to top Democratic campaigns across the country in order to create a Democratic majority.

Stated CMA President Paul R. Phinney, MD, “Increasing the physician voice in Congress will undoubtedly improve the system in ways that help to ensure patients have access to high quality, compassionate care.”

Dr. Raul Ruiz

Dr. Ami Bera


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SMCMA Docs Staff CSM’s Annual Health Fair

Known by many names, Chronic Obstructive Pulmonary Disease (COPD) is a serious lung disease that is now the third leading cause of death in the United States. It is one of the nation’s largest health care concerns and is severely under-diagnosed and undertreated, according to the COPD Foundation. More than 12 million people are currently diagnosed with COPD, and it is estimated that another 12 million may have COPD but not realize it; and according to the Centers for Disease Control (CDC), in 2005, COPD caused an estimated 126,005 U.S. deaths in people older than 25 years.

Prevention of COPD begins with reducing or eliminating smoking initiation among teens and young adults and encouraging cessation among current smokers. Approximately 75 percent of COPD cases are attributed to cigarette smoking. You can take an active role in talking to your patients about smoking cessation and provide them with resources to help them. A referral to the California Smokers Helpline website at: http://www.nobutts.org/Information/p.shtml or call: 1-800-NO-BUTTS, where they will be provided with a live person to counsel them on cessation options.

Although tobacco use is a key factor in the development and progression of COPD, asthma, exposure to air pollutants in the home and workplace, as well as genetic factors and respiratory infections also play a role. Some of those occupational exposures

are to chemical fumes, gases, vapors and dust. If your patient works with this type of lung irritant, suggest they talk to their supervisor about the best ways to protect themselves, such as wearing a mask.

A simple Spirometry test can be used to measure pulmonary function and detect COPD in current and former smokers aged 45 years and older, and anyone with breathing problems due to environmental exposure to smoke or occupational pollutants.

By taking steps now and talking with your patient about smoking cessation, treatment options, and symptoms such as coughing or wheezing, many of these conditions can be treated with medications. IF your patients have respiratory infections, they should be treated with antibiotics, if appropriate. Antibiotics are not recommended except for use in the treatment of bacterial infections.

COPD Resources

For more information,visit www.aware.md. Click the “Patients & Consumers,” tab, then select “Patient & Consumer Education Materials.”

The COPD Foundation has a guide for diagnosing and managing COPD at www.copdfoundation.org.

November is National COPD Awareness Month

The College of San Mateo held its semiannual student health fair on October 30 and 31, and the San Mateo County Medical Association was invited to participate.

We put out a call for volunteers, and three SMCMA members offered to help staff our “Ask the Doctor” Booth: Dr. Jamila Champs and Dr. Ron Tempesta (pictured), both infectious disease doctors at Kaiser Permanente in South San Francisco; and Joann Blessing-Moore, MD, an allergy doctor practicing in San Mateo.

SMCMA’s Whitney Wood also provided information about Hep B Free San Mateo. While most of the students who stopped by were young enough to have been fully vaccinated against hepatitis B, many had older relatives at friends who were potentially at risk and were glad to learn of the programs free screening clinics in San Mateo County.

Approximately 500 CSM students visited the health fair, which featured low-cost flu shots, free glucose screenings, reiki and accupressure demonstrations, and information on health topics affecting college-

age people, including safe sex and birth control, substance abuse prevention, and eating disorders. “The participants really appreciated the tremendous variety of services and information that was available to them,” said Sharon Bartels, RN, CSM’s Health Services Coordinator.

Many thanks for our physician volunteers. CSM’s next student Health Fair is being planned for Wednesday, March 27, 2013, and SMCMA has been asked to participate.


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Ensuring faster physician payment

The American Medical Association is proud to work with the San Mateo County Medical Association to educate physician practices on how to streamline their claims process. Getting billing information quicker—and paid faster—is a prescription for efficiency. The AMA and the SMCMA support physicians in your practice, in the state house and in the courthouse. Working together with the SMCMA, the AMA will continue to make a difference.

Be a part of it. ama-assn.org/go/memberadvocate

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Donald J. Palmisano, MD, JD, FACSBoard of Governors, The Doctors CompanyFormer President, American Medical Association

We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company.

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this

starts with patient safety. In fact, we have the largest Department of Patient Safety/Risk

Management of any medical malpractice insurer. And, local physician advisory boards

across the country. Why do we go this far? Because sometimes the best way to look out

for the doctor is to start with the patient. To learn more about our medical malpractice

insurance program, call The Doctors Insurance Agency at (415) 506-3030 or (800) 553-9293.

You can also visit us at www.doctorsagency.com.


Gregory C. Lukaszewicz, M.D. ............................. PresidentAmita Saxena, M.D. ..................................... President-ElectVincent Mason, M.D ............................. Secretary-TreasurerJohn D. Hoff, M.D ...................... .Immediate Past President

Editorial Committee

Sue U. Malone ......................................... Executive Director Shannon Goecke ......................................... Managing Editor

Article Submission

Members are always encouraged to submit articles, commentary and Letters to the Editor. Email your submission to the SMCMA Editorial Committee at [email protected] for consideration for publication in San Mateo County Physician.

Editorial and Advertising Offi ces

777 Mariners Island Boulevard, Suite 100San Mateo, California 94404Tel (650) 312-1663 | Fax (650) [email protected] | www.smcma.org

© Copyright 2012 San Mateo County Medical Association

Raymond Gaeta, M.D.Russ Granich, M.D.Edward Koo, M.D.C.J. Kunnappilly, M.D.Michael Norris, M.D.

Michael O’Holleran, M.D.Irwin Shelub, M.D.Chris Threatt, M.D. Kristen Willison, M.D.

2011-2012 Offi cers & Board of Directors

Russ Granich, M.D., ChairSharon Clark, M.D.Edward G. Morhauser, M.D

Gurpreet K. Padam, M.D.Michael Stevens, M.D

David Goldschmid, M.D. ..................................CMA TrusteeScott A. Morrow ........ Health Offi cer, County of San MateoDirk Baumann, M.D ...................... AMA Alternate Delegate

Index of Advertisers

American Medical Association..................................... 17The Doctors Company ................................................. 17Hinshaw, Marsh, Still and Hinshaw. .............................. 8The Magnolia of Millbrae. ............................................ 14Marsh. ................................................ Inside Front CoverNORCAL Mutal Insurance Company Outside Back CoverOffi ce Space for Rent: Foster City Medical Pavilion .... 16Pillsbury & Levinson LLP. ............................................... 4Sutter Community Connect. .......................................... 6Tracy Zweig Associates. .............................................. 16

Advertising in San Mateo County Phsyician is a great way to reach out to the San Mateo County medical community. We offer a variety of display ads, in black & white and full color. Design assistance is also available. Classifi ed ads begin at $40 (for up to fi ve lines) for members and $75 for non-members.

Please contact Shannon Goecke, Managing Editor, at (650) 312-1663 or [email protected] to get started.

Advertising Opportunities

Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.

Acceptance and publication of advertising in San Mateo County Physician does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised. SMCMA reserves the right to reject any advertising.

Legal Information

PhysicianSan Mateo

County

New SMCMA Members

Andrea Durant/EMS. San Francisco

Lewis Hou/NSRedwood City

Priya Jagannathan/IMRedwood City

Ahalya Joisha/GERRedwood City

Eugene Kim/FMRedwood City

Alice Kwan/*EMS. San Francisco

Jin Lee/FMRedwood City

Jennifer Lin/IM Redwood City

Adrianne Lona/CHPRedwood City

Sapan Mody/OMRedwood City

Priti Patel, M.D./IMS. San Francisco

Scott Peak, M.D./ONRedwood City

Richard Tanner, M.D./IMRedwood City

Daniel Teng, M.D./FMRedwood City

Wendy Smith/OTO, HNSS. San Francisco

HBsAg test Anti-HBs test

Websites for further information: http://www.cdc.gov/hepatitis/HBV/TestingChronic.htm

“Without concerted action, thousands more Americans will die each yearfrom liver cancer or liver failure related to [hepatitis B].”

Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C2010 Institute of Medicine Report

Hepatitis B: A Vital Signfor Asian Americans

Check the boxes for

1 in 12Asian and Pacific

Islanders is living with chronic hepatitis B.

Most became infected at birth or early

childhood.

2 of 3 are unaware of their

infection because they have not yet been

tested. Most have no symptoms and even

their liver enzymes could be normal.

1 in 4will die from liver

cancer or liver disease without long term

medical care.

A public service announcement fromhttp://liver.stanford.edu

People of Asian/Pacific Islander(API) descent have the highest prevalence of chronic hepatitis B (CHB) in the United States. In fact, CHB is 100 times more common in Asian Americans than in non-Asian Americans. And a majority of them most likely acquired the hepatitis B virus (HBV) during childhood, currently show no symptoms, and are unaware of their infection. This is alarming because chronic carriers of HBV have a risk of liver cancer 100 times higher than the general population.

Please join San Mateo Hep B Free (smhepbfree.org) in their local effort to raise awareness of CHB risk and initiate screening among our API patients.

CHB can be reliably diagnosed with a simple and inexpensive blood test (for HBsAg and Anti-HBs markers), which will detect an active infection and assess immune status. Subsequent vaccination of appropriate patients who have not been exposed to HBV is >95% effective at preventing HBV Infection. And for those who need it, effective treatment is available, which might help improve the condition of the liver.

As physicians who serve patients of Asian descent, we are in a position to reduce the impact of CHB on their lives. Your help, along with that of your office staff, is crucial to this effort. Please contact Whitney Wood at [email protected] to find out how you can get involved. Together, we can help reduce the impact of CHB in our community. Thank you for your help.

Is solo or small group practice viable for the future?

• How to survive and thrive with savvy management and marketing

• Is the “concierge” model right for me?

Merger Mania – Should you merge with others?

• Single Specialty or Multi-Specialty—pros & cons • Can merging reduce expenses/increase net

income, maintain independence, increase contracting power to remain in private practice?

• Will merging position the group for future acquisition?

Joining a Foundation, University Affiliation or Hospital Outpatient Clinic

• How will tangible assets be valued?• Will goodwill or intangible asset value be included?

How will it be valued?• How many years should the contract be

guaranteed?• Compensation models including base salary and

$ per WorkRVU• What will it be like being an employee?• What if I want to leave?

Presenter Debra Phairas, President of Practice & Liability Consultants, LLC, is an experienced consultant who has advised physicians in making these critical transitions including shoring up solo/small groups, merging practices, consulting on being acquired and negotiating compensation for physicians. She has worked with more than 1,600 practices since 1985.

WHEN: Wednesday, January 30, 2013 Appetizers: 6:00 P.M. Program: 6:30-745 P.M.

WHERE: San Mateo County Medical Association 777 Mariners Island Blvd., Suite 100 San Mateo

COST: $99

SIGNUP: Please visit wwww.smcma.org/event or contact Shannon Goecke at (650) 312-1663/[email protected]. Payment accepted via check or credit card (Visa/Mastercard/Discover).

SMCMA SEMINAR - JANUARY 30, 2013OWNER VS. EMPLOYEE MD? WHAT IS YOUR STRATEGY FOR THE FUTURE?

There are many practice opportunities for physicians to consider for the future. Will you remain in solo practice? Merge with others to form a bigger single specialty, multi-specialty group or ACO? Join a Foundation or University Affiliation? This workshop will present a balanced discussion of options and issues for physicians to consider before making these important practice decisions. Topics Include:

777 Mariners Island BoulevardSuite 100San Mateo, California 94404

ADDRESS SERVICE REQUESTED

To improve patient safety, you need to stay on top of best practices. That’s why, as shown by the 2011 numbers

above, we provide you the risk management advice you need, when and how you want it. It’s why we provide

industry-leading CME online and through Claims Rx, our monthly publication based on closed claims. And why

we tailor solutions to help with your specific risk issues. The results include 98% policyholder retention, the

highest-level CME accreditation and reduced risk for you.

Our passion protectsyour practice

CALL 877-453-4486 OR VISIT NORCALMUTUAL.COM

Proud to be endorsed by the San Mateo County Medical Association

22,689

november/december 2012

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