summer 2014

Summer 2014

PLUS: Western Health Care Leadership Academy 2014

San Joaquin Golf Event 2014 Photos and more!

Advocateand

Doctor,Teacher,Dr. Salamon:

Missionary,

2 SAN JOAQUIN PHYSICIAN SUMMER 2014

No matter where you are in life, SJMS Group Level Term Life Insurance benefits can be an affordable solution to help meet your family’s financial protection needs.

Mercer and SJMS leveraged the buying power of your fellow members to secure dependable and affordable life insurance benefits at competitive premiums from ReliaStar Life Insurance Company, a member of the Voya family of companies.

With quality life insurance benefits extended at competitive rates, you’ll rest easy knowing you’ve provided coverage for your loved ones through the Group 10-Year and 20-Year Level Term Life Plans.

As a member, you can conveniently help protect your family’s financial future with the Group 10-Year and 20-Year Level Term Life Plan. It features:

• Benefits up to $1,000,000

• Rates designed to be level for 10 or 20 full years*

• Benefit amounts that never change provided premiums are paid when due

67149 San Joaquin TL Ad (7/14)Full Size: 8.5” x 11” Bleed: Yes= 8.75”x11.25” Live: 7.5”x 10”Folds to: N/A Perf: N/AColors: 4C=(CMYK)Stock: N/A Postage: N/A Misc: N/AM

ERCE

R

A financial safety net for you—

and the ones you love

10- and 20-year level term life

See for Yourself: Get more information about your Group 10-Year and 20-Year Level Term Life Plans, including eligibility, benefits, premium rates, exclusions and limitations, and termination provisions by visiting www.CountyCMAMemberInsurance.com or by calling 800-842-3761.

67149 (7/14) Copyright 2014 Mercer LLC. All rights reserved.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • [email protected] • www.CountyCMAMemberInsurance.com

* The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days’ advance written notice.

The County Medical Associations and Societies/NORCAP/CMA receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

Sponsored by: Underwritten by:ReliaStar Life Insurance Company, a

member of the Voya family of companies.

SUMMER 2014 SAN JOAQUIN PHYSICIAN 3

{FEATURES}

36

1228

40

WESTERN HEALTH LEADERSHIP San Diego CA 2014

DR.SALAMON: A HEALER’S LIFELifetime Achievement Award Recipient

GOLF TOURNAMENTSJMS’ 5th Annual

DR.MARYROSE BAUTISTAOne Person HospiceYoung Physician Award

{DEPARTMENTS}20 MICRA Protect Access to Quality Health Care & Patient Privacy

22 IN THE NEWS New Faces and Announcements

50 PUBLIC HEALTH Measles: A Concern For International Travelers

54 PATIENT BEHAVIOR: The Key to Improving Patient Outcomes

65 NEW MEMBERS

Western Health Care Leadership 2014

Cover Photo by Dale Goff

VOLUME 62, NUMBER 2 • JUNE 2014

No matter where you are in life, SJMS Group Level Term Life Insurance benefits can be an affordable solution to help meet your family’s financial protection needs.

Mercer and SJMS leveraged the buying power of your fellow members to secure dependable and affordable life insurance benefits at competitive premiums from ReliaStar Life Insurance Company, a member of the Voya family of companies.

With quality life insurance benefits extended at competitive rates, you’ll rest easy knowing you’ve provided coverage for your loved ones through the Group 10-Year and 20-Year Level Term Life Plans.

As a member, you can conveniently help protect your family’s financial future with the Group 10-Year and 20-Year Level Term Life Plan. It features:

• Benefits up to $1,000,000

• Rates designed to be level for 10 or 20 full years*

• Benefit amounts that never change provided premiums are paid when due

67149 San Joaquin TL Ad (7/14)Full Size: 8.5” x 11” Bleed: Yes= 8.75”x11.25” Live: 7.5”x 10”Folds to: N/A Perf: N/AColors: 4C=(CMYK)Stock: N/A Postage: N/A Misc: N/AM

ERCE

R

A financial safety net for you—

and the ones you love

10- and 20-year level term life

See for Yourself: Get more information about your Group 10-Year and 20-Year Level Term Life Plans, including eligibility, benefits, premium rates, exclusions and limitations, and termination provisions by visiting www.CountyCMAMemberInsurance.com or by calling 800-842-3761.

67149 (7/14) Copyright 2014 Mercer LLC. All rights reserved.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • [email protected] • www.CountyCMAMemberInsurance.com

* The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days’ advance written notice.

The County Medical Associations and Societies/NORCAP/CMA receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

Sponsored by: Underwritten by:ReliaStar Life Insurance Company, a

member of the Voya family of companies.


MEDICAL SOCIETY STAFF

EXECUTIVE DIRECTOR Lisa Richmond

COMMUNITY PROJECT MANAGER Vanessa Armendariz

MEMBERSHIP COORDINATOR Jessica Peluso

COMMITTEE CHAIRPERSONS

MRAC F. Karl , Gregorius, MD

DECISION MEDICINE Kwabena Adubofour, MD

ETHICS & PATIENT RELATIONS to be appointed

LEGISLATIVE Jasbir Gill, MD

COMMUNITY RELATIONS Joseph Serra, MD

PUBLIC HEALTH Alvaro Garza, MD

SCHOLARSHIP LOAN FUND Janwyn Funamura, M.D.

NORCAP COUNCIL Thomas McKenzie, MD

CMA HOUSE OF DELEGATES REPRESENTATIVES

Robin Wong, MD, Lawrence R. Frank, MD,

James R. Halderman, MD, Patricia Hatton, MD,

James J. Scillian, MD, Peter Oliver, MD, Roland Hart, MD

Kwabena Adubofour, MD,

Gabriel K. Tanson, MD, Ramin Manshadi, MD

SAN JOAQUIN PHYSICIAN MAGAZINE

EDITOR Lisa Richmond

EDITORIAL COMMITTEE Thomas McKenzie, MD

Lisa Richmond, Mike Steenburgh

Vanessa Armendariz

MANAGING EDITOR Lisa Richmond

CREATIVE DIRECTOR Sherry Roberts

CONTRIBUTING WRITERS Vanessa Armendariz,

James Noonan, Steven E. Larson, M.D., MPH,

Amber Candido, M.A., Daniel Reimer, M.A.

Julie Vaishampayan, M.D., M.P.H

THE SAN JOAQUIN PHYSICIAN MAGAZINE

is produced by the San Joaquin Medical Society

SUGGESTIONS, story ideas or completed stories

written by current San Joaquin Medical Society

members are welcome and will be reviewed by

the Editorial Committee.

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

San Joaquin Physician Magazine

3031 W. March Lane, Suite 222W

Stockton, CA 95219

Phone: 209-952-5299 Fax: 209-952-5298

Email Address: [email protected]

MEDICAL SOCIETY OFFICE HOURS:

Monday through Friday 9:00 AM to 5:00 PM

Closed for Lunch between 12pm-1pm

PRESIDENT Thomas McKenzie, MD

PRESIDENT-ELECT Ramin Manshadi, MD

PAST-PRESIDENT Raissa Hill, DO

SECRETARY-TREASURER James J. Scillian, MD

BOARD MEMBERS Lawrence R. Frank, MD, Moses Elam, MD, Peter Drummond, DO, Dan Vongtama, MD, Alvaro Garza, MD,

Kwabena Adubofour, MD, Kristin M. Bennett, MD, Clyde Wong, MD, George Savage, MD, Parvinderjit Kaur, MD


• Fast, accurate claims payments• Free eReferrals, ePrescribing and online doctor-patient communications• Experienced RN case management for complex, time-intensive cases• Deep discounts on EPM and EHR solutions to help you meet the federal mandate• Easy preventive care and disease management reminders for patients• Extensive health resources that boost patient engagement• High consumer awareness that builds practice volume

At Hill Physicians, we continue to improve upon coordinated care, with remarkable results. We provide the tools and support that practices need to be financially successful and improve the coordinated care experience for their patients. Our advantages include:

That’s why 3,800 independent primary care physicians, specialists and healthcare professionals have joined Hill. Feel confident in the future of your practice and your patients by affiliating with Hill Physicians Medical Group.

Hill Physicians’ 3,800 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Easy Choice, Health Administrators (San Joaquin), Health Net, Humana, United Healthcare WEST and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt in.

San Tso, D.O.Hill Physicians provider since 2004.

Uses Ascender preventive care reminders, Hill inSite to review eClaims and eligibility and Hill EHR for a comprehensive solution to patient care, practice management and ePrescribing.

Confidence

For more about the advantages of affiliating, visit HillPhysicians.com/JoinUs.

The feeling you have when you are affiliated with Hill Physicians.

SQ_TSO_May.indd 1 5/1/2014 3:50:21 PM


LISA RICHMOND

MY FAVORITE TIME OF YEARYou may have heard that a trial attorney-sponsored ballot measure that aims to undermine the protections afforded to patients across California as part of the Medical Injury Compensation Reform Act (MICRA) has officially qualified for the November ballot. On Election Day, these trial attorneys will ask voters to weigh in on “The Troy and Alana Pack Patient Safety Act,” an initiative that was carelessly thrown together without any concern for taxpayer pocketbooks, privacy, patients or health care. CMA has joined a campaign coalition to oppose the measure, because it will be costly for consumers and taxpayers, endanger patient access to quality health care and jeopardize the privacy of our personal health information. The coalition is a diverse and growing group of trusted doctors, community health clinics, hospitals, family-planning organizations, local leaders, public safety officials, businesses and working men and women formed to oppose this costly, dangerous ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals. Please visit www.cmanet.org/micra for more information about how to get involved – it’s important that we have a unified, connected voice to defeat the ballot measure in November.

On a (much) lighter note, on May 4 we held the 5th Annual SJMS Golf Tournament to benefit the First Tee of San Joaquin and our Decision Medicine Program at Stockton Golf and Country Club. It was a beautiful day and great time was had by all. We appreciate everybody who took time out of their busy weekend to golf, and the generous donations of our sponsors. As the demands on our physicians continue to rise, we realize the importance of an afternoon of relaxation and fellowship with friends and colleagues. Please see Dr. Khoury’s article and pictures from the event.

While it may be busy. this is my favorite time of year! We have just finished the Decision Medicine review process and have interviews scheduled! I continue to be so impressed with the high level, well rounded kids we have apply to this program. I can’t wait to meet them in person. If you would like more information about Decision Medicine or would like to participate as a physician mentor, please call me at the office at 952-5299. We are extremely proud of this program as we strive to “grow our own doctors.” Please visit www.decisionmedicine.com for more information about this exciting program.

Last, but certainly not least we are excited to announce our 2014 Lifetime Achievement Award Recipient, Dr. Peter Salamon and Young Physician Award Recipient Dr. MaryRose Bautista. You will find a wonderful feature on each physician towards the middle of this issue. Please join us to honor them at our annual membership dinner on Sunday June 22 at Brookside Golf and Country Club. More details in the enclosed advertisement.

I hope this summer allows you some much deserved relaxation and family time!

Best Wishes,

Lisa Richmond

STAFF REPORT

Letter From The Executive Director


MEDICAL GROUP, INC.GILL OBSTETRICS & GYNECOLOGY

DIPLOMATS OF THE AMERICAN BOARD OF OBSTETRICS & GYNECOLOGY

Whether you’re a young woman, having your first or fourth baby, goingthrough menopause, or beyond - our doctors will give you the special care

you deserve!

Health Care Just as Unique as You!

Advanced Care and Clinical Innovation

Experience Matters

Contrary to the popular book title, women are not from Venus!But women do have special health care needs and they varydepending on the stages of a woman’s life. At Gill Obstetrics &Gynecology, we offer clinical expertise and compassionate care togive our patients the best care for every stage of life.

Gill OB/GYN is the largest OB/GYN medical group in the county.Because of the vast capabilities of our physicians, most of ourpatients do not have to leave the area for care. Our specialtyphysicians include a full-time endocrinologist and the county’sONLY full-time Perinatologist specializing in high-riskpregnancies. We were the first to introduce minimally invasivesurgeries to the area and now we are offering robotic assistedgynecological surgery using the da Vinci Robot!

With Almost 60 Years of experience and roots dating back to 1953,Gill OB/GYN has a rich history of serving generations of womenthroughout San Joaquin County. We are proud to have deliveredover 85,000 healthy babies!

Robotic Assisted Gynecologic Surgery

Changing the Experience of Surgery for WomenGill OB/GYN is now Offering

• Less blood loss

• Less pain

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• Quicker recovery

PRENATAL & POSTPARTUM CARE • HIGH RISK PREGNANCY • INFERTILITY • INVITRO FERTILIZATION • GYNECOLOGYENDOMETRIOSIS - URINARY INCONTINENCE - OVARIAN CYSTIC DISORDER • LAPAROSCOPY - HYSTEROSCOPY

DIAGNOSIS & TREATMENT OF CERVICAL, UTERINE, OVARIAN CANCERS

Convenient locations to serve you.

Manteca Tracy1234 E. North St., Ste. 102, Manteca, CA 95336 • (209) 727-4912 530 W. Eaton Ave., Ste. C, Tracy, CA 95376 • (209) 727-4963 Galt (209) 251-2221

We accept most health insurance,including Medi-Cal

Maya Nambisan, M.D.Param K. Gill, M.D. Jasbir S. Gill, M.D. Maria Escalona, M.D. Thomas Streeter, M.D. Vincent P. Pennisi, M.D. Darrell R. Burns, M.D. Tonja Haris-Stansil, M.D. Kevin E. Rine, M.D. Linda Bouchard, M.D. Jacqualin Miller, D.O.

Jennifer Phung, M.D. David L. Eibling, M.D. Harjit Sud, M.D. John Kim, M.D. Philip D. Ross, M.D. R. Afiba Arthur, M.D. Catherine Mathis, M.D. Lynette Bird, R.N., B.S.N. Vicki Patterson-Lambert, R.N.P.C. Denise Morgan, M.S.N.-

999 S. Fairmont Ave., Ste. 225 & 230, Lodi, CA 95240 • (209) 642-76211617 N. California St. Ste. 2A, Stockton, CA 95204 • (209) 787-5204 (Evening hours available)

2509 W. March Lane, Ste. 250, Stockton, CA 95207 • (209) 787-5247

GILLOBGYN.COM

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We accept most health Insurance, Including Medi-Cal

Convenient locations to serve you.Stockton: 1617 N. California St. Ste. 2A, CA 95204 • (209) 466-8546 (Evening hours available)

2509 W. March Lane, Ste. 250, Stockton, CA 95207 • (209) 957-1000 Lodi: 999 S. Fairmont Ave., Ste. 225 & 230, Lodi, CA 95240 (209) 334-4924

Manteca: 1234 E. North St., Ste. 102, Manteca, CA 95336 • (209) 824-2202 Tracy: 530 W. Eaton Ave., Ste. C, Tracy, CA 95376 • (209) 229-8685 Galt: (209) 745-7473

GILLOBGYN.COM


Being a good doctor is about more than practicing good

medicine. It’s about preventing illness. Being proactive.

Taking the time to really listen. And giving our patients the

personalized care they deserve. So, to all doctors, we’d like

to say thanks. Because of you, a healthier life for everyone

is as normal as 98.6.

We believein 98.6degrees.

For more information, visit us online at kp.org/centralvalley


As I mentioned last June, not too many a Society president comes from Lodi!

I chose to use that responsibility to increase society membership and to

enhance the value of your membership to the Society and CM A . This

Medical Society is your input to the local, state,

and federal political systems which are very much deciding how you will practice medicine in the future years. We are blessed with an austere, capable staff headed by our Executive Director, Mrs. Lisa R ichmond.

Our interaction with the CM A

staff has been

consistently assisted by our past Executive Director, Mr. Michael Steenburgh. CM A remains extremely effective advocating for the House of Medicine in the state of California.

We have been successful in interacting with our political representatives at all levels, and plan to continue to do so. They need our input. As I mentioned in a prior article….if you don’t have a seat at the table.. . .you may be on the menu. In general, they truly respect factually documented, reasoned arguments in favor of improving the healthcare system for our patients and society as a whole. A ll of us need to consistently access the political system to advocate for the survival and sanctity of the doctor-patient relationship. We also have to demonstrate why this simple principle of medicine is also the most cost-effective for those paying the bills.

As all of you are aware, this last year has been another year of grinding

ABOUT THE AUTHOR Dr. Thomas McKenzie is President of the San Joaquin Medical Society and is an Orthopedic Surgeon practicing in Lodi.

Signing Off

A message from our President > Thomas McKenzie, MD

Thank you for the privilege and opportunity to represent you and serve as San Joaquin Medical Society President this year.

change for the House of Medicine. It was the best of times……. and the worst of times. For the most part, we are continuing to provide excellent care to our patients despite the multilayered systems of governmental, insurance, hospital bureaucracies interfering with the doctor-patient relationship.

But governmental, regulatory, and insurance bureaucracies continue to increase their unfunded demands. Monetary pressures continue unabated from all sides. EMRS, meaningful use dictates continue with ever increasing monetary punishment for noncompliance.

The House of Medicine remains under attack from all sides, at all levels. At the federal level the implementation of the A ffordable Care Act insurance exchange (Covered California) and beginning of care of these patients remains fraught with bureaucratic and insurance company misinformation, political grandstanding , and not a whole bunch of patient care. Meanwhile, all insurance premiums continue their inexorable rise.

At the state level…there is the constant attack on everything medicine has to offer. The scope of practice expansion bills by allied health professionals, nurse practitioners, optometrists, pharmacists will not be the last. The governor continues to pursue the path of less payment to physicians caring for those covered in the MediCal system.

But CM A lobbying efforts and effectiveness remain second to none. Our lobbyists headed by CM A Chief Executive Officer Dustin Corcoran, tirelessly advocate in our behalf. But the main event is coming on November 4, 2014 with Election Day……….and you better be ready for it. Ignorance is no excuse. As I am writing this article, the yet to be numbered proposition (proponents are calling it the “Troy and A lana Pack Patient Safety Act”) to increase the cap on California’s Medical Injury Compensation Reform Act (MICR A) is moving forward. The ballot

measure will have real impacts on patients across California – health care costs will soar, access to care will be eviscerated and personal privacy information may be jeopardized. This ballot measure will see a lot of media attention over the next 5 months and we all must do our part to successfully defend the current law.

Mr. Corcoran has assembled an experienced team to defeat this initiative, aggressively sought support from numerous organizations across the political spectrum, and pursued funding from all sources. The CM A and our county Society have tools to help us win the campaign

– so, visit w w w.cmanet.org/micra to get more information.

What about you? Have any of you said one word of this aggravated assault on medicine to any of your patients yet? Have you donated any money to CA LPAC for the defense and education of MICR A? If not, why not? We can all do more and do better. I strongly encourage you

to forward at least $100 for MICR A defense to the CM A .

If you truly understand the significance of this issue, you should be donating $1000! Please also check with MICR A resource page on CM A’s website frequently for updated information and tips on how to be involved – a coordinated effort is a must. More information can be found at w w w.cmanet.org/micra. Please sign up to be part of this effort today…..and send what you can as a check to the below address:

CA LPAC1201 J. Street, Ste 275Sacramento, CA 95814

I sincerely thank the entire San Joaquin Medical Society for the honor of serving as President this year. I leave this Society in the capable hands of Dr. Manshadi, and will work tirelessly to support him in the coming year.

Our collective professional future is on the line in November. It is all about MICR A .

United We Stand

A message from our President > Thomas McKenzie, MD

Mr. Corcoran has assembled an experienced

team to defeat this [MICRA] initiative, aggressively sought support from

numerous organizations across the political spectrum, and pursued funding from all

sources.

““

14-531 MRI Ad_SJ Physician_REPLACEMENT

Tuesday, February 04, 2014 1:06:35 PM


14-531 MRI Ad_SJ Physician_REPLACEMENT

Tuesday, February 04, 2014 1:06:35 PM

For 16 years, the California Medical Association hosted the California Health Care Leadership Academy, which earned a reputation as one of the West Coast’s premier health policy and leadership development conferences. This year, the 17th annual conference was rebranded the Western Health Care Leadership Conference and welcomed physicians and practice managers from many of the western states. This year’s conference – with more than 700 attendees – was a huge success. >>

2014

17TH ANNUAL

Among our high powered presenters was keynote speaker Hillary Rodham Clinton, Former Secretary of State and Former U.S. Senator from New York. Clinton, who addressed the attendees live via satellite, joined many other big-name thinkers and doers who shared strategies and resources for accelerating the shift to a more integrated, high performing and sustainable health care system. The conference examined the most significant challenges facing health care today and presented proven models and innovative approaches to transform health care delivery and business practices.

Below are highlights from this year’s conference, which was April 11-13, 2014, at the San Diego Convention Center.

CLINTON URGES MOVE AWAY FROM FEE-FOR-SERVICE PAYMENT MODEL; SAYS CURRENT SYSTEM IS NOT SERVING PHYSICIANS, OR PATIENTS, WELL.

KEYNOTEFormer Secretary of State Hillary Rodham Clinton addressed the 700 physicians, practice managers, medical students and others at the Western Health Care Leadership Academy in San Diego.

Delivering the keynote address live via satellite, Secretary Clinton urged the California Medical Association to work with other like-minded organizations to help advance meaningful health care


delivery and payment reform, instead of continuing to “rejigger” a broken system.

“At some point, we have to move away from fee for service payment for medical care,” said Secretary Clinton. “It is not serving physicians well, or any other health care providers, and I don’t believe it’s serving patients well.”

Secretary Clinton told attendees that she shares physicians’ frustration with Congress’s inability to make any progress on fixing the current broken payment system. She said she would like to see more systemic reform so that physicians are fully reimbursed for everything that

goes into the care of patients. “It is deeply bothersome to me that it is still not accepted that a lot of what constitutes wellness—things that a physician can be promoting with his or her patients—should be reimbursed by Medicare,” Clinton said. “When a physician sits down with a patient and says ‘I’m going to give you a nutrition regimen. I’m going to have my nurse or my PA check in on you to make sure that you’re walking every day.’ These are all things that would keep that patient out of the operating room for a bypass or a stent or some other expensive intervention.”

“We’re never going to resolve the injustice, the unpredictability, the unfairness that unfortunately permeates the current system,” she said. “We need to move away from this very narrow approach to reimbursing physicians.”

“At some point, I hope we’re going to be able to take a look at the broad base of funding streams, both public and private, that go into funding health care–particularly physicians’ pay—and look more at who the patient is and what the doctor is providing that patient, instead of what the program is and how we can keep trying to put square pegs in a round hole.”


Secretary Clinton also held up California’s implementation of the Affordable Care Act as a model for the nation. “We’re going to be watching closely what happens in California. Seeing what works, and what doesn’t. States like California, intent on covering more citizens and fostering bold experimentation to improve outcomes and reduce costs, will not only lead the way, but help everyone else find the way.”

Secretary Clinton also urged all stakeholders to work together to keep pushing for improvements to the health care system. “The transparency called for under the Affordable Care act is going to reveal a lot of information. Some of it may be surprising. And some of it may even be quite troubling,” said Clinton. “But

for the first time, we’re going to see information. And everyone will be able to look at the same information. We can then try and figure out ‘Is there a problem that needs to be fixed?’”

The data collected under the Affordable Care act will, according to Clinton, will allow us to ask questions that will give us much better insight into how we can move towards a more efficient, quality driven health care system.

“I think this is a great opportunity, if we do it with that kind of open attitude of ‘let’s learn what works, let’s make this better.’ Let’s hear from physicians and nurses and pharmacists, you name it. Everyone come to the table. What do you think needs to be changed?”

STRANGE BEDFELLOWSDISCUSS FUTURE OF HEALTH CARE

Western HealthCare Leadership > 2014

Attendees also heard from a diverse panel of health care industry experts who discussed the changing dynamics of the health care marketplace and how we can work together to contain health care costs through innovation and integration.

“How do we offer something that is affordable to patients and still allow physicians to be financially whole? It’s a very fine needle we need to thread,” said panelist Paul Markovich, CEO of Blue Shield of California. According to Markovich, two key elements will be attracting younger, healthier patients into the risk pool and redefining “primary care.”

“If there’s a way for us to look at the scope of primary care more broadly, shift to a system where we can understand that it’s not just the services provided in the office,” said Markovich. “If we can understand it, manage it, and pay for it, we’ll be far more successful together.”


Markovich predicts that if we don’t get a handle on rising health care costs, we’ll end up with a single payer system. “We must all work together. Everyone is a cost center. Even me. Everyone is a part of the problem, and everyone needs to be a part of the solution.”

The panelists agreed that advances in technology and changing patient expectations are going to push the health care industry to think very differently than it does today. “Technology is a tool that we have not even begun to leverage to its real potential,” said Susan Turney, M.D., President and CEO of the Medical Group Management Association.

According to Craig Sammitt, M.D., President of DaVita Healthcare Partners, electronic health records will play a critical role. But in order to truly revolutionize health care, he says, “we need a single source of truth about our patients that

is secure and safe. We’re going to see an explosion of new apps and technologies to connect with people. But the single source of truth should always be the same.”

Integration is going to be key, agreed Dustin Corcoran, CEO of the California Medical Association. But he warned not to mistake consolidation for integration. “We have to find a way for small and medium practices to have that same level of integration [as large groups and hospitals] without consolidation and without driving prices up,” said Corcoran. “We need to find a way for small practices to bind together, share data, share analytics, so they can better coordinate care at a lower cost.”

On the closing day of the conference, Covered California Executive Director Peter Lee told attendees that he recognizes that the roll out of the Affordable Care Act (ACA) has been a “bumpy ride,” but that he looks forward to working with the physicians of California during this “new era” of health care.

“This is beginning the new era of health care – an era where health care is a right, not a privilege,” said Lee. “That is what will make the ACA truly historic.”

Lee urged the hundreds of physicians, practice managers and other health care stakeholders in attendance to remember that the ACA is the biggest change in health care since the launch of Medicare over 50 years go.

“If we go back 50 years ago, the launch of Medicare was not smooth, it was not without controversy, it was not without calls

COVERED CALIFORNIADIRECTOR LOOKS FORWARD TO “MAKING HISTORY”


for boycotts from some in the physician community,” said Lee. “And yet today, it’s something we all take for granted – the fact that we have a Medicare system to make sure that our seniors get access to high quality care.”

According to Lee, Covered California and the contracted health plans could have definitely benefited from another 6 months to a year of lead time, but such a delay would have also meant a delay in getting literally millions of people insured.

“We’re continuing to work to build and improve a system that we think is going to be here for many, many years to come, and I look forward to us working together to improve a system that will be historic in changing what health care is for California and the nation,” said Lee.

Lee admits that there is still a lot of work to do, particularly in the area of network adequacy.

“We’re going to be relying on the regulatory standards of network adequacy and see how those work – do we need to lean in and do more? That’s what we’re looking at right now,” said Lee. “We are looking to plans to keep updated their provider directory information. This is an area where, without a doubt, plans are stumbling. This is an area where the plans could have used more time and they doing fixes.”

Lee insists Covered California recognizes and takes to heart that the ACA is not just about coverage. It’s about getting people the care they need.

“We need to make sure that once people are covered, that people are actually getting care. Again, this isn’t about coverage, it’s about addressing disparities in care, about addressing wellness and prevention, and getting people the care they need.”

Part of this will be done by looking at claims data and using consumer surveys, says Lee. “We have in process a long-term set of analytics and methodologies to understand what consumers are really facing – looking at the clinical information on what care are people getting, and on a timely basis, are they getting the care as needed?”

Lee told attendees that Covered California will be

reviewing very substantial clinical analytics for all the care that is being provided to Covered California enrollees. Through the analytics, Lee hopes that we can ensure that the promise of coverage isn’t an empty one, and that patients’ needs are being met.

“This is a moving process, a process that we are learning and we appreciate learning from you what’s working and what’s not working,” said Lee. “But also we look forward in many ways to making history with you.”

SEE FLICKR FOR PHOTO COVERAGE OF 17TH ANNUAL LEADERSHIP ACADEMY

Visit the California Medical Association Flickr page at www.flickr.com/californiamedicalassociation to see the photographs from this year’s conference!

SAVE THE DATE 2015 WESTERN HEALTH CARE LEADERSHIP ACADEMY

Mark your calendars and plan to join us for the 18th Annual Western Health Care Leadership Academy, planned for May 29-31, 2015, at the Loews Hollywood Hotel. Additional information will be posted at www.westernleadershipacademy.com when available.Our keynote speaker will be Malcolm Gladwell, international bestselling author whose books have changed the way we think about sociological changes and the factors that contribute to high levels of success.

Western HealthCare Leadership > 2014



IN LESS THAN SIX MONTHS, on November 4, 2014, these trial lawyers will ask voters to weigh in on “The Troy and Alana Pack Patient Safety Act,” an initiative that was carelessly thrown together without any concern for taxpayer pocketbooks, privacy, patients or health care. If trial lawyers get their way, our state will be saddled with a costly threat to privacy that California simply cannot afford.

IF THIS MEASURE IS APPROVED by voters, malpractice lawsuits and payouts will skyrocket, adding “hundreds of millions of dollars” in new costs to state and local governments, according to an impartial analysis conducted by the state’s Legislative Analyst. Someone will have to pay, and that someone is providers, taxpayers and consumers.

THE CALIFORNIA MEDICAL ASSOCIATION (CMA) has joined a campaign coalition to oppose the measure, because it will be costly for consumers and taxpayers, endanger patient access to quality health care and jeopardize the privacy of our personal health information. This group, “Patients and Providers to Protect Access and Contain Health Costs,” is a diverse and growing coalition of trusted doctors, community health clinics, hospitals, family-planning organizations, local leaders, public safety officials, businesses, and working men and women formed to oppose this costly, dangerous ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals.

THIS MEASURE would also have devastating effects on access to care for patients everywhere, but especially in rural and already underserved areas. Community health care clinics like Planned Parenthood and the Central Valley Health Network are already warning that this measure will cause specialists like OB/GYNs to reduce or eliminate services to their patients. This measure could also cause doctors to leave the state, meaning thousands of Californians could lose access to their trusted doctors.

OVER THE NEXT FEW MONTHS, you’ll hear a lot of rhetoric from the proponents of the measure – but really, this is another example of special interest politics trying to fool the voters into thinking this is something that it’s not. Authors purposely added doctor drug testing to disguise their real intent behind the ballot measure: to increase lawsuits against health care providers, which will increase our health care costs and reduce access to quality health care. According to the Los Angeles Times: “The drug rules are in the initiative because they poll well, and the backers figure that’s the way to get the public to support the measure. ‘It’s the ultimate sweetener,’ says Jamie Court, the head of Consumer Watchdog.” (December 10, 2013)

THIS PROPOSAl also forces doctors and pharmacists to use a massive statewide database known as the Controlled Utilization Review and Evaluation System, or CURES, filled with Californians’ personal medical prescription information – a mandate our government will find impossible to implement, and a database with no increased security standards to protect your personal prescription information from hacking and theft. Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands this ballot measure will place on it. This ballot measure will force the CURES database to respond to tens of millions of inquiries each year– something the database simply cannot do in its current form or functionality. A non-functioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients. MOST CONCERNING, the massive ramp up of this database will significantly put patients’ private medical information at risk. The ballot measure contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from

You may have heard that the trial lawyer-sponsored ballot measure that aims to undermine the protections of the Medical Injury Compensation Reform Act (MICRA)

has officially qualified for the November ballot.

Increased Costs.Losing Trusted Doctors.Threatened Privacy. THAT’S WHAT HAPPENS WHEN LAWYERS PLAY DOCTOR


01648

Sutter Gould Medical Foundation is now offering Infusion Services at Stockton Medical Plaza and is accepting infusion patients.

The following infusion medications are available. •Actemra •Krystexxa •Rituxan •Benlstya •Orencia •Solumedrol •Boniva •Reclast •Tysabri •Gammagard •Remicade •Venofer •Infed

Patients receive personalized care in a comfortable environment.

WeARenOWOffeRInG infusion services

For more information or to refer patients, call (209)521-6097,ext.1508suttergould.org

MICRA > Protect Access

government intrusion, hacking, theft or improper access by non-medical professionals.

THE INITIATIVE is bad for patients, taxpayers and health care as a whole, and there has never been a greater need for physicians to band together and fight for our patients.

AS YOU CAN SEE, this initiative is fraught with problems and would prove detrimental to California’s health care system. I’m asking each of you to join the effort to defeat this costly threat to our state, and in doing so, protecting access to care and preventing higher costs for all California. Together, I’m sure we will be victorious.

AS WE FORGE AHEAD to Election Day, it is more important than ever to make sure we are speaking as a unified, coordinated voice. If you haven’t done so already, please visit CMA’s website at www.cmanet.org/micra for the latest information, handouts and to sign up as a campaign coordinator in your area. Please also visit the campaign website at www.stophigherhealthcarecosts.com to sign up to become an official opponent of this badly flawed measure. From the website you can: Sign up to add your name to the growing list of individuals and groups opposed to the MICRA ballot measure.

GET IMPORTANT FACTS, downloads and information that will help you spread the word about this costly measure

BE PART OF OUR OUTREACH TEAM. If you have direct patient contact, become part of our outreach team. Visit CMA’s MICRA resource page

to sign up as a campaign coordinator here.

PARTICIPATE IN MESSAGE/MEDIA TRAINING. The campaign is also looking for physicians interested in

taking on a more public role speaking to community groups about why this ballot measure should be defeated. Contact Molly Weedn at [email protected] for more information.

IN THENEWS

Providing staff, physicians and patients with relevant & up to date information

The Permanente Medical Group (TPMG) welcomes Dr. Greg MogelThe Permanente Medical Group (TPMG) would like to welcome Dr. Greg Mogel to Kaiser Permanente in the Central Valley. Dr. Mogel was appointed to the position of Chief of Radiology in January 2014. Prior to his appointment, he served as the Regional Radiology Department Chief for Kaiser Permanente’s Colorado Region. A Board-Certified Diagnostic Radiologist, Dr. Mogel came to Kaiser Permanente after a 10-year career at University of Southern California as Associate Professor of Radiology and Biomedical Engineering, preceded by active

duty military service in the U.S. Army Medical Corps. A passionate believer in the Kaiser Permanente model of

prevention and wellness, Dr. Mogel serves on several regional and national committees that work to improve the care we deliver to our members. He also sits on the board of Temple University’s College of Liberal Arts where he works to ensure that non-traditional, minority, and other under-represented groups can find an affordable, balanced, world-class education, bringing fresh perspectives to future generations of physicians and other healthcare providers. He graduated from the University of Pennsylvania School of Medicine in 1991.

Please join us in welcoming Dr. Greg Mogel to Kaiser Permanente’s Central Valley Area

The San Joaquin Medical Society endorses Health Careers Academy (HCA), which is a dependent Charter with SUSD. They will have their first graduating class next year in 2015. HCA has three areas of focus: providing students with a rigorous college prep curriculum, teaching specific health career technical skills and increase student’s sense of community awareness.

Could you use an extra hand at the office this summer? HCA is looking for summer job and internship opportunities to provide students with hands on learning outside the classroom. Each student will be carefully selected by Traci Miller, Principal and will have completed a college level course in Medical Terminology, First Aid, Health Occupations, Sports Medicine, Principals of Biomedical Science and Anatomy and Physiology. They are capable of performing a variety of tasks based on your need!

HCA students are very representative of the diverse patient population that makes up our local hospitals and doctors’ offices. Please join us in supporting the wonderful students of HCA! If you are interested in this opportunity or would like more information, please contact Traci Miller, Principal at HCA at 933-7360.

In The News

Dr. Mogel


FALL 2013 SAN JOAQUIN PHYSICIAN 23

14-790 SJ Physician SJMC Cardiac Ad

Thursday, April 24, 2014 12:12:06 PM

IN THENEWS

In The News

Doctors Hospital of Manteca Receives “A” in Patient Safety from The Leapfrog GroupDoctors Hospital of Manteca received the top grade from one of the nation’s leading patient safety advocacy organizations. The hospital received an “A” in The Leapfrog Group’s Spring 2014 Hospital Safety Score The Leapfrog Hospital Safety Score rating system is designed to give consumers information they can use to make the best healthcare decisions for themselves or a loved one.

“We are proud of Doctors Hospital of Manteca’s recent “A” grade, as we believe it recognizes our commitment to providing safe, quality healthcare to our patients,” said Nicholas Tejeda, CEO of Doctors Hospital of Manteca. We are committed to continually monitoring and improving the care we provide. Patient safety is the top focus for us--one that requires diligence with every patient, every day.”

San Joaquin General Launches New WebsiteA key component of San Joaquin General Hospital’s 2014 marketing program was the reconstruction of its website. SJ General has successfully produced a new patient-friendly web portal featuring an online communication network designed to meet the needs of today’s Central Valley resident. The new website now features a multi level communication platform that offers online communication with San Joaquin County patients and families of patients. The new site includes an extensive database featuring all of the practicing physicians at SJ General with physician photos, specialties and bios. The new site also features complete maps and diagrams of the many medical services on the SJGH campus, making patient and family visits a lot easier. It can be found at: www.sjgeneral.org.

The new site was designed to allow Central California residents an easy opportunity to select primary care and family medicine physicians. This site will make it easy for a new patient to find a physician of their choice in a specialty that will meet their specific needs. Expecting mothers will now find it much easier to select an OB/GYN of their choice. The new expanded website also features a complete list of the Hospital’s many services, maps and clinic locations saving much needed time in patient visits, as well as, emergency services.

San Joaquin General Hospital is also one of Central California’s leading teaching hospitals. The new website has updated its communication

of the Hospital’s residency programs for graduating medical students. The expanded communication pages now feature current information and enrollment in Family Medicine, Internal Medicine, General Surgery and Pharmacy residency programs. The new site officially went online in mid March and has been very well received by both patients, practicing physicians at SJGH and the entire clinical staff.

Collection Agency Pledges to Collect Health Care Debts with Dignity, Respect As local health care providers continue to develop patient-friendly billing and collection practices, one area collection agency is advancing the effort through its voluntary commitment to a new set of principles endorsed by ACA International, the Association of Credit and Collection Professionals (ACA).

C B Merchant Services, a collection agency based in Stockton has always complied with the federal Fair Debt Collection Practices Act (FDCPA) and other applicable laws and regulations, but has taken its commitment to professionalism a step further by pledging to uphold ACA’s “Health Care Collection, Servicing and Debt Purchasing Practices—Statement of Principles and Guidelines.” The Statement of Principles is a road map to help ACA members align their practices with the care-driven mission of their health care clients.

“Patients should always be treated with dignity and respect,” said Linda Guinn, President and CEO, C B Merchant Services. “Our health care clients expect us to represent them positively when we contact a patient regarding a past due bill. Yet collecting legitimate amounts due from those who have the ability to pay is crucial. We all benefit from a financially sound health care system, and in today’s environment, that increasingly depends on help from collection agencies like C B Merchant Services said Guinn.

The American Heart Association recently announced hiring Katie Malone as the new Heart Walk director for Stanislaus and San Joaquin counties. She will be responsible for handling event logistics and driving corporate and community involvement in the local Heart Walks to help raise funds for critical life-saving research and programs on heart disease and stroke in the San Joaquin valley and beyond. Malone previously served as private



IN THENEWS

In The News

event manager for The Reserve at Spanos Park where she booked and coordinated golf tournaments, weddings, parties and other events. She holds a bachelor’s degree in communications studies with a concentration in public relations from California State University, Sacramento, and a master’s degree in marketing from Capella University.

The San Joaquin Heart Walk is a fun, family-friendly 5k which celebrates those who have made lifestyle changes and encourages many more to take the pledge to live healthier lives while raising the dollars needed to fund life-saving research and initiatives in our local community. This year’s walk will be held at the University of the Pacific on Saturday,

September 6. For more information and to find out how to start a team, please visit www.SanJoaquinHeartWalk.org or call (209) 477-2683.

Sutter Tracy Community Hospital Honored With an “A” in Patient SafetyThe Hospital Safety Score is compiled under the guidance of the nation’s leading experts on patient safety and is administered by The Leapfrog Group (Leapfrog), an independent industry watchdog. The first and only hospital safety rating to be peer-reviewed in the Journal of Patient Safety, the Score is free to the public and designed to give consumers information they can use to protect themselves and their families when facing a hospital stay.

To see how the Sutter Health hospitals’ score compares locally and nationally, and to access safety tips for patients and their loved ones, Katie Malone

San Joaquin County Health Care Services Agency Welcomes Dr. Alvaro Garza, MD, MPH as the New Public Health Officer

Dr. Alvaro Garza is San Joaquin County’s Public Health Officer with the Public Health Services Division of the Health Care Services Agency as of mid-March 2014.

He is a public health physician with local, state, national, and international practice and research experience since the mid-1980’s. His education includes a medical degree from the University of California, San Francisco, (UCSF) School of Medicine, pediatrics residency training at UC San Diego, and a master’s degree in public health from the San Diego State University, Graduate School of Public Health. He is board certified in pediatrics, did medical epidemiology training in the Epidemic Intelligence Service of the US Centers for Disease Control and Prevention, and is an adjunct faculty member at the UCSF School of Medicine.

His local experience includes health officer at San Benito County, deputy health officer at San Mateo County, and health officer at Stanislaus County. He presently serves on two statewide advisory committees for the California Department of Public Health: the California Office of Binational Border Health and the Office of Health Equity.

Having immigrated from Mexico at the age eight years old, Garza grew up in the San Diego area, is bilingual, bicultural, and binational, and has lived in the San Joaquin Valley for 18 years.


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visit the Hospital Safety Score website at www.hospitalsafetyscore.org. Consumers can also go to www.hospitalsafetyscore.org for a free download of the Hospital Safety Score app.

“This is the fifth consecutive Hospital Safety Score report in which Sutter Tracy Community Hospital has received an A grade. We are extremely focused on safety, and the scores ref lect the hard work our nurses, physicians and staff put in each day to make sure our patients receive quality care in a safe and professional environment.” ~ David Thompson, chief executive officer of Sutter Tracy Community Hospital

Lodi Health welcomes Dr. Phi Huynh and Dr. Naeem Rana

Lodi Health has welcomed two new physicians to its medical practices: Phi Huynh, MD, andNaeem Rana, MD.Dr. Huynh is f luent in English, German, French and Vietnamese. He practices at Lodi Health

Physicians Millsbridge Family Care, located at 1901 W. Kettleman Lane in Lodi. He is a graduate of

Westfalische Wilhelms-Universitat Munster in Germany. There, he was a

Doctoral candidate in the Department of Neurology, and he was awarded doctor medicinae (the

Ph.D. equivalent) in 1993. Dr. Huynh completed residencies at family practices in Greenville,

S.C., and Worcester, Mass. Since 2005, Dr. Huynh has practiced in Charlotte, N.C. at Northcoss

Medical Center and Carolina Family

Medicine and Urgent Care.

Dr. Rana is practicing at Lodi Health Physicians Fairmont Specialty

Care. Before joining Lodi

Health, Dr. Rana was a physician in Fresno, where his private practice specialized in consultative

Pulmonary and critical care medicine. Dr. Rana completed medical school at Rawalpindi

Medical School, University of the Punjab in Pakistan, and completed his residency in internal

medicine at St. Luke’s Hospital in St. Louis, Missouri. Dr. Rana’s offices are located at 845 S. Fairmont Avenue in Lodi.

Dr. Rana

Dr. Huynh


For as long as people can remember, maps have helped point us in the right direction.

Sometimes, however, these very same maps can guide us toward places – and experiences – that we might have otherwise missed.

This would be the case for Dr. Peter Salamon, who, after completing medical training that took him across both the nation and the globe, looked to a map to locate the city that would ultimately become his place in the world.

Stockton – the community in which he landed – would go on to benefit for decades.

In a way, it was an odd mix of fate and circumstance that brought Dr. Salamon out west. After attending medical school at the University of Michigan, he spent two years on active duty in the United States Navy, stationed both in Connecticut and aboard the Nuclear Submarine Thomas Jefferson. Hoping to moonlight at a local hospital while waiting to begin a residency at the University of Wisconsin after leaving the Navy, Dr. Salamon was required to fill out medical licensing forms for both states. Having always wanted to experience the West Coast, he opted to add a third set of forms to stack.

“I said, well, as long as I’m filling out these forms, I might as well fill them out for California,” he recalls.

After his residency, Dr. Salamon began a Fellowship in Children’s Orthopaedics at the Hospital for Sick Children in London, England. It was there that he decided that when it came time to return the United States, California would be his target.

After spending roughly six months at a position in Walnut Creek, Dr. Salamon would get word of an opening in Stockton, an opportunity – and place – which forced him to unfurl the map.

Doctor, Teacher, Missionary and Advocate

The

JOURNEYDr. Peter Salamon’s more than forty years as a practicing physician has seen him become something of a “physician of many hats,” yet his heart – and medical career – remains strongly rooted right here in Stockton.

By: James Noonan

of

Lifetime Achievement Award > Dr. Salamon


“I had no idea where Stockton was,” he said. “So, I looked it up on the map and thought, what the heck.”

In October of 1975, after medical training that had taken him from the Midwest, the East Coast and even as far abroad as England, Dr. Salamon began his practice at the Alpine Orthopaedic Medical Group in Stockton.

“I’ll have been in practice 39 years in

Stockton this fall,” he now recalls. “I never left”

Now, after nearly four decades of serving his community, the Central Valley region and the profession of medicine as a whole, Dr. Salamon is being honored with the San Joaquin Medical Society’s Lifetime Achievement Award.

“Needless to say, I was overwhelmed; especially when you think about the people who have received it in the past,” he said.

Over the nearly 40 years that Dr. Salamon has been seeing patients at Alpine Orthopaedic Medical Group, he has become a leader in the field of pediatric orthopedics, an expertise that has had a tremendous impact on health of the Stockton community. Colleagues of Dr. Salamon note that, often times, he is called upon to treat some of the most difficult problems in pediatric orthopedic surgery seen in the Central

“I’ll have been in practice 39 years

in Stockton this fall, I never left.”

-Dr. Salamon

Now, after nearly four decades of serving his community, the Central Valley region and the profession of medicine as a whole, Dr. Salamon is being honored with the San Joaquin Medical Society’s Lifetime Achievement Award.


Valley region, an obligation which he happily fulfills, regardless of the patient’s insurance status.

It was this very expertise that lead to an opportunity that would eventually became another major pillar in Dr. Salamon’s medical career.

In the early 1980s, a colleague by the name of Dr. George Rab, a professor of orthopedic surgery at the University of California, Davis, asked whether Dr. Salamon might be interested in joining the university’s faculty.

For Dr. Salamon, the offer was one he simply could not pass up.

“It was a very good opportunity for me,” he said, noting that the so-called

“teaching moments” often presented while practicing medicine have lead to some of the most cherished experiences of his long career.

Now, after serving as a professor of children’s orthopedic surgery at UC Davis for three decades, moments such as these have become a mainstay in Dr. Salamon’s career – something that has allowed him to build a tremendous legacy through the residents and students he has helped guide through their own medical training.

“It’s been a very rewarding 30 years for me,” he says.

In this time, Dr. Salamon has seen immense changes in health care, but

explains that the transfer of personal experience from one generation of physicians to the next still remains the foundation of a medical education.

“On one hand, the technology available to us has changed a great deal, but the teaching methods are largely the same,” he says.

As Dr. Salamon’s career progressed, this desire to both teach and practice continued to grow, ultimately leading him to, once again, unfurl a set of maps to help take on new, more distant, set of challenges.

About eight years ago, Dr. Salamon was invited by his associate Gary Murata to take part in a medical mission

Healer, teacher,

missionary and

advocate


to Liberia through an organization called Mercy Ships, a non-profit enterprise that seeks to provide medical care to developing counties through the use a self-contained hospital ship. The opportunity, though incredibly rewarding, left Dr. Salamon wanting more.

“It was missing something,” he said. “There was an opportunity to help patients, but not an opportunity to teach.”

From here, Dr. Salamon began seeking out other medical mission opportunities, specifically those that would allow him to interact with local physicians and share as much knowledge and expertise as possible.

“There are lots and lots of opportunities to do this,” he adds. “Every operation has a teaching aspect.”

In the subsequent years, Dr. Salamon has served on medical missions to countries such as Honduras, Costa Rica, Trinidad and Tobago, Bhutan, Vietnam, Thailand and Cambodia. This wide array of destinations has given him remarkable insight into a variety of conditions faced by his physician colleagues across the globe.

“There are always differences,” he said. “You may be doing things at a very different level depending on which county you are in.”

Additionally, by working through organizations such as Health Volunteers Overseas, CURE International, Operation Rainbow and the American Orthopaedic Foot & Ankle Society, Dr. Salamon has been able to interface with and educate international physicians, something that will hopefully address many of the untreated, or undertreated, medical conditions that he sees while treating patients abroad.

For Dr. Salamon, who also frequently travels the world recreationally with his

wife of 45 years, these medical missions are an opportunity to combine personal and professional passions.

“It melds pretty well,” he says. “I always try to leave something behind, not just take pictures.”

In addition to his practice in Stockton, his role as an educator at UC Davis and multiple medical missions, Dr. Salamon’s career is also highlighted by years of service to organized medicine, including a term as president of the San Joaquin County Medical Society during the 1980s. Dr. Salamon now looks back proudly on these years, noting



that many of the major issues faced by organized medicine today – including the defense of the state’s Medical Injury Compensation Reform Act, or MICRA – were also playing out during his time as president.

Yet another – and likely the most important – role assumed by Dr. Salamon during his career is that of a husband and a father.

In 1969, Dr. Salamon married his wife Susan, who he had met while the two were in Ann Arbor at the University of Michigan. In the years that followed, they gave birth to their son, Michael, and daughter, Sarah. Despite growing up in

California, both Michael and Sarah followed in their parents footsteps and attended the University of Michigan for their undergraduate education.

“That made them both third generation Michigan alumni,” he said, adding that his father had also received his education at Ann Arbor.

Eventually, both of the Salamons’ children went on to pursue careers as physicians, with Michael currently practicing as an orthopedist in Louisville, Kentucky and Sarah practicing as a pediatrician in Los Angeles.

“It’s been very rewarding to see that my children have chosen a career in medicine,” he said. “I feel as though I a set a reasonable example, so that they, at least, didn’t run in the complete opposite direction.”

Despite the multiple “hats” worn by Dr. Salamon over his career, if you were to ask him what he does for a living, the simplicity and straightforwardness of his answer demonstrates that his heart – and career – will always be rooted in that place he found on that map many years ago.

“I take care of people here in Stockton,” he says.

With nearly forty years of experience now behind him, Dr. Salamon continues to find way to not only heal but also instruct those around him. Along the way, he recognizes that each one of these experiences has, in turn, helped shape him into the man, and physician, that he is today.

Whether it be in the classroom, some far away land on a distant continent or the Stockton offices where he has spent the majority of his long career, Dr. Peter Salamon hopes to continue healing, teaching and learning as long as he can.

“Medicine, in large part, is sharing experiences and learning from other people’s experience,” he said. “Part of medicine is always teaching and always learning. It never stops.”

You Have a ChoiceChoose Quality

(209) 957-3888www.hospicesj.org

James Saffier, MDOn-Site Medical Director

Hospice & Palliative CareInternal Medicine

Joint CommissionAccredited



MEMBERSHIP DINNER

SALAMON

YOUNG PHYSICIAN AWARD

Dr. MaryRose BAUTISTA

ADDITIONALLY, WE WILL HONOR THE PASSING OF

THE GAVEL FROM PRESIDENT THOMAS MCKENZIE, MD

TO PRESIDENT-ELECT RAMIN MANSHADI, MD

SUNDAY, JUNE 22

COCKTAIL RECEPTION 6:00PM / DINNER 7:00PM

BROOKSIDE COUNTRY CLUB

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MEMBER PHYSICIANS & SPOUSE/GUEST – $35 PER PERSON

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HONORING OUR 2014 LIFETIME ACHIEVEMENT AWARD RECIPIENT

IF YOU WOULD LIKE TO ATTEND THIS EVENT, PLEASE

CALL THE MEDICAL SOCIETY AT (209) 952-5299

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New Laws > 2014

36 SAN JOAQUIN PHYSICIAN SPRING 2014

Golf&Sunshine5TH ANNUAL You couldn’t

have asked for better weather for the 5th SJMS Golf Tournament benefitting The First Tee of San Joaquin and our own Decision Medicine. >>


New Laws > 2014

Thankfully, the rain took a day off. The golf course was impeccable and the greens were as tough as PGA standards. Thank you to Rich Howarth and staff at Stockton Golf and Country Club who made this a most successful tournament.

We had a great turn out with 80 players registered to play. We started the day with a putting contest. This got our mojo ready for the shotgun start.

Thanks to the Decision Medicine alumni volunteers, volunteers, our San Joaquin Medical Society staff Jessica and Vanessa and of course, our executive director Lisa Richmond. The registration process went smoothly and players were very generous with their money buying raffle tickets. We are happy to announce that we raised $4,050 to benefit The First Tee of San Joaquin and $4,500 for SJMS’ Decision Medicine program. >>


Golf and Sunshine > 2014

Donald Miller, Executive Director of The First Tee of San Joaquin and their Board Members did a wonderful job in helping the Medical Society Golf Committee in the planning of the tournament. We truly value the partnership

Thank you to all of our Hole Sponsors, Oak Val-ley Community Bank for sponsoring the beverage/snack carts and Josh Church for coming through (again) with so many wonderful prizes.

The game was played smoothly using a simple scramble format. This allowed everyone to help out their team mates during the 18 holes. There was plenty of drink and merriment. The lunch menu was tasty and the post-game Hour d’oeuvres were scrumptious and plentiful. Both snack carts were rounding the course frequently.

Help us make our 6th Annual tournament in 2015 a big and successful tournament. Keep an eye and ear out for the date.

Winners:1st Place:Josh Church, AJ Valentine, Lex Chandra , Gary Kiedrowski

2nd Place: Mark Richmond, Jesse Munoz, Jeff Navarro, Ted Sanford

3rd Place: Jeff Godwin, Javier Garcia, Mike Covey

Closet to the pin #8 Ladies – Isabel Calder (10’8”) Men – Jeff Navarro (11’ ½”)

Longest Drive # 16 Ladies – Kari Khoury Men – Josh Church

Putting Contest:Javier Garcia

1. Zeiter Eye Medical Group2. Lawrence Frank, MD3. Stockton Diagnostic Radiology & Ultrasound Medical Clinic4. Pacific Private Wealth Management, LLC5. Stull Financial Group6. Stonecreek Village7. Prabhjit S. Purewal, MD., Inc8. Teamsters Local Union No. 4399. Morpheus Anesthesia10. University of the Pacific11. Oak Valley Community Bank12. Mayaco13. Dignity Health Medical Group14. Neelesh Bangalore, MD15. Pat Withrow for Sheriff16. Stockton Hematology & Oncology17. Peter Garbeff, MD18. Gregory Bensch, MD

Thank you to our sponsors

Golf Tournament CommitteeGeorge Khoury, MD

Kwabena Adubofour, MD

Lisa Richmond, SJMS

Josh Church, Roger Dunn

Cathy Ghan, Oak Valley Community Bank

Donald Miller, The First Tee of San Joaquin


New Laws > 2014

ORTHOPEDIC EXCELLENCE

209-944-5550DameronHospital.org

Rated Best in Stockton Region for Joint Replacement in 2012.

Dameron Hospital’s award-winning orthopedic program includes community educational workshops, surgical and non-surgical treatment options, treatment of orthopedic injuries and trauma, and rehabilitation. Specializing in spine, hip, knee, shoulder, ankle and joint replacement, Dameron’s physicians, surgeons and nurses work together to minimize pain and shorten recovery time for each patient.

Get back to enjoying the ACTIVE YOU.


AWARD2014

YOUNG PHYSICIAN AWARD- DR. MARYROSE BAUTISTA

Dr. MaryRose Bautista, “One-Person Hospice”STORY BY VANESSA ARMENDARIZ l PHOTO BY DALE GOFF

2014YPA

At only nine years old, Dr. Bautista was forced to deal with one of the greatest challenges of her young

life when she lost her mother to cardiomyopathy. She is the youngest child of three siblings. Although

heartbreaking, this experience has left a lasting impression on the way Dr. Bautista practices medicine. Her

father originally attended medical school, but left in his last year to pursue degrees in Chemical and Industrial

Engineering. Dr. Bautista received her undergraduate degree from UC Davis, where she was initially interested

in Engineering. Ironically, she decided to apply and matriculate into UC Davis Medical School.

Warm, compassionate, dedicated, selfless and determined are all words that have been used to describe Dr. MaryRose Bautista. >>


Dr. Bautista met her husband, Dr. John Canzano in her last year of medical school during her two week Ophthalmology rotation. She reminisces on the day she met Dr.Canzano, claiming that he wasted no time in asking her out. “He is the love of my life. The rest is history.” After residency, Dr. Bautista worked at a private, consumer-run practice in Piedmont, California while her husband completed his fellowship training. After his retina fellowship training, Dr. Canzano followed his mentor, Dr. John Zeiter to work at his practice in Stockton, CA.

In 2002, Dr. Bautista became an internal medicine physician at the outpatient VA clinic in French Camp, CA. She has treated a diverse group of people ranging from wealthy patients in a consumer-driven practice to serving a population that is largely disadvantaged. Regardless of socioeconomic status, the VA clinic provides an atmosphere where Dr. Bautista can

treat all patients equally. Many of her patients are homeless,

disadvantaged, and/or suffer from psychological disorders. Despite their hardships, her patients make it a priority to visit her; even if it means having to save money for months to buy gas or a bus ticket. The majority of Dr. Bautista’s patients are male; some have criminal backgrounds and/or suffer from Post-Traumatic Stress Disorder and substance abuse. Despite being a beautiful, small framed woman, she has been able to assert herself and command the respect of this “tough” group of men. She says, “Perspective is crucial in life, health, and the pursuit of happiness. If my patients trust and believe in me, I can instill a perspective that could potentially improve and better their lives. My patients see me as family/friend/and doctor all rolled into one.”

Dr. Bautista’s commitment to the health of her patients stems largely from her desire to

Young Physician Award > Dr. Bautista


help prevent the type of loss she experienced as a child. She often wonders what measures could have been taken to prevent her mother’s death. “Loss at any age can either elevate or diminish you. Fortunately, I found strength in my mother’s illness at a young age and the perspective of loss continues to motivate me and infuse me with compassion.” While it is important to ask the right questions, Dr. Bautista finds it imperative to listen carefully to her patient’s answers and identify what might be left unspoken to make an accurate diagnosis. She prides herself on the relationship she builds with each patient and often makes personal phone calls to check on them. When not working at the clinic, Dr. Bautista volunteers at a local VA Stand Down, which focuses on serving patients that have been displaced from their homes and have lost access to needed services.

Although Dr. Bautista is dedicated to her patients, her family remains her top priority. She and Dr. Canzano have two beautiful children, Christopher, 10 and Alina, 8. As two physicians and parents of young children, one might wonder how Dr.Canzano and Dr.Bautista make time for both their career and their family. Dr. Bautista explains the balance in saying, “Dr. Zeiter runs a practice that fills a huge and vital medical need, but also one that allows my husband to be present for me and our children.” The Zeiter family has “adopted” them, making it easier to call Stockton her home.

Dr. John Zeiter nominated Dr. Bautista for the Young Physician Award, giving her the title of a “one-person hospice.” He has witnessed first-hand the generosity and compassion that she shows towards her friends, family, colleagues and patients. She is particularly compassionate towards patients and friends with terminal illnesses, making time to remain at their bedsides to offer support. He describes her beautifully saying, “I rarely see her do anything for herself, and she never seeks recognition for her volunteer medical care or community service. I

have never known a more intelligent and compassionate physician in my 20 years of practice.”

She balances her work and personal life by keeping them separate. “I explain to my patients that when I am in the room with them, they are my primary focus and the center of my reasoning and action. However, my family and friends always take precedence. There are many capable doctors in this world, but my children have only one mother. My patients respect that the compassion

I show to them is fueled and encouraged by the love I have for my family and friends.” This delicate balance allows Dr. Bautista to be active in her children’s lives. She frequently volunteers at her children’s elementary school helping with dissections through the Science Docent Program and also being the “potato lady” who serves potatoes at lunch.

She strives to share her experiences and what she has learned at work with her children. She teaches them that “the gifts of intelligence and strength mean nothing if you don’t share them with others.” She was fortunate enough to have received a solid education and training and she believes that her “knowledge of medicine should be shared freely and generously.” Dr. Bautista has found a rewarding system which empowers her to be the wife, mother, and physician that she strives to be each day.

Young Physician Award > Dr. Bautista

I rarely see her do anything for herself, and she never seeks recognition

for her volunteer medical care or community service. I have never known a more intelligent and

compassionate physician in my 20 years of practice.”

Lodi Memorial Hospital Acute Physical Rehabilitation (APR)Twenty-three years of specialized, inpatient rehabilitation services for stroke, brain-injury, spinal-cord-injury, multiple-trauma and patients with other neurological conditions

�e county’s only acute, inpatient physical-rehabilitation program, featuring:

Emphasis on safe and independent transition home Coordinated physical, occupational, speech and

recreational-therapy sessions, three hours daily State-of-the-art technology for neurologic training 24-hour care by rehabilitation-trained, experienced nurses Daily physician visits Outdoor areas for rehabilitation and recreational activities Private rooms and room-service meals for patients and

their family members

Lodi Memorial Hospital Acute Physical Rehabilitation Ramnik Clair, MD, Medical Director209/712-7905 Tel209/333-3082 Fax975 S. Fairmont Ave., Lodi, CA 95240 www.lodihealth.org

APR outcomes for 2013 Lodi Memorial NationFunctional Independent Measurement (FIM) 32 29Average stay in hospital 13 days 16 daysReturn to home 86% 72%

Lodi Health’s team of physical rehabilitation experts.

Medical directorRamnik Clair, MD


HEALTH BENEFIT EXCHANGE RESOURCES FOR PHYSICIANS

See CMA's exchange resources page for information on exchange plan contracting, patient enrollment and eligibility, and more!

WWW.CMANET.ORG/EXCHANGE


When San Joaquin Medical Society/CMA members apply for up to $1,000,000 of 10 or 20-year Level Term Life insurance coverage underwritten by ReliaStar Life Insurance Company, a member of the Voya family of companies, they get a few things non-members don’t.

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*The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the policy with 60 days advance written notice. Underwritten by ReliaStar Life Insurance Company. Home Office: Mpls, MN Policy form LP08GP.

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Public Health Update

MEASLES A CONCERN FOR INTERNATIONAL TRAVELERS

Measles is an acute viral infectious disease, rarely seen in the United States today. While physicians practicing in the 1960’s diagnosed measles routinely, many younger physicians have never seen a case. References to measles can be found from as early as the 7th century. The disease was described by the Persian physician Rhazes in the 10th century as “more dreaded than smallpox.” Currently in California, measles is a growing health concern related to international travel. The latest report from the California Department of Public Health confirmed 51 measles

cases in the first quarter of this year; compared with just four reported by this time last year. Measles remains a common, serious and highly contagious disease in many parts of the world, including the Philippines, India and other areas in Europe, Asia, the Pacific, and Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), each year, measles infects about 20 million people and kills about 164,000 people worldwide, primarily children. Anyone traveling overseas may be exposed to measles and could become ill if they have never had measles or have not been

REPORT AND TEST SUSPECTED CASES

Call SJCPHS at (209) 468-3822 (after hours (209) 468-6000) immediately to report suspected cases. Do not wait for laboratory confirmation. Collect specimens as soon as possible for expedited testing by the Public Health Laboratory (PHL) rather than a commercial laboratory.


Public Health Update

properly vaccinated. Measles can come into the U.S. easily through infected visitors or through those returning to the U.S. from international travel. Infected individuals can spread the disease and spark outbreaks among pockets of unvaccinated people in the U.S., including infants and young children.

The most effective way to prevent measles is by vaccination. Vaccination confers protective immunity in >99% of people appropriately vaccinated with 2 doses of MMR. Early clinician identification of disease with timely institution of appropriate infection control and post-exposure prophylaxis of susceptible exposed individuals prevents spread and is crucial for measles control.

Clinical Features The incubation period of measles, from exposure to prodrome, averages 10–12 days; from exposure to rash onset averages 14 days. The prodrome is charac terized by fever, which increases in stepwise fashion, often peaking as high as 103°–105°F. This is followed by the onset of cough, coryza (runny nose), or conjunctivitis. The prodrome lasts 2–4 days.

Koplik spots, a rash (enanthem) present on mucous membranes, are considered to be pathognomonic for measles. These occur 1–2 days before the rash to 1–2 days after the rash, and appear as punctate blue-white spots on

the bright red background of the buccal mucosa.

The measles rash is a maculopapular eruption that usually lasts 5–6 days. It begins at the hairline, then involves the face and upper neck. During the next 3 days, the rash gradu-ally proceeds downward and outward, reaching the hands and feet. The maculopapular lesions are generally discrete, but may become confluent,

particularly on the upper body. Initially, lesions blanch with fingertip pressure. By 3–4 days, most do not blanch with pressure. Fine desquamation occurs over more severely involved areas. The rash fades in the same order that it appears, from head to extremities. Complications

Approximately 30% of reported measles cases have one or more complications. Complications of

Top: Evidence also shows that early initiation of ART can reduced risk for transmission of HIV to uninfected sexual partners, thereby reducing the incidence of new infections in the community.


Public Health Updatemeasles are more common among children younger than 5 years of age and adults 20 years of age and older. The most commonly reported complications are diarrhea (8%), otitis media (7%), pneumonia (6%), and encephalitis (0.1%). Death from measles occurs in approximately 0.2% of the cases; the most common causes of death are pneumonia in children and acute encephalitis in adults.

Subacute sclerosing panencephalitis (SSPE) is a rare, fatal degen erative central nervous system disease believed to be due to persistent measles virus infection of the brain. The onset of SSPE is insidious, beginning on average 7 years after measles infection, with progressive deterioration of behavior and intellect, followed by ataxia, myoclonic seizures, and eventually death.

Infection ControlWhen a suspect measles case is identified, mask and isolate the person immediately in an airborne infection isolation room if available; otherwise, place in a private room with the door closed. Do not use a regular exam room for at least 2 hours after the suspected case has left the room. Healthcare workers who enter the room should have documented immunity (2 doses MMR or laboratory evidence of immunity by measles IgG); regardless of immune status, they should use a N95 respirator or higher level of protection. Limit movement and transport of the patient for tests; if essential, mask the patient and notify receiving location of the patient’s suspected diagnosis. Note the staff and patients who were in area during the time the suspect measles patient was present and for 2 hours after the patient left. For additional guidance: http://www.cdph.ca.gov/HealthInfo/discond/Documents/

CDPHHCFacilityICRecsforSuspectMeaslesPatients.pdf. Vaccination - AdultsAll persons born during or after 1957 should be vaccinated with 2 doses of MMR unless they have laboratory evidence of immunity by measles IgG. Groups that are at increased risk for measles include health care workers, international travelers, women of childbearing age, and students in college or trade school. Measles circulates in most regions of the world outside of North and South America. Californians with measles in recent years have reported travel to the Philippines, Germany, France, England, India, China, among other destinations.

Vaccination – Infants and Young ChildrenMMR vaccine is routinely given at 12 months of age and 4-6 years of age. Infants aged 6 months through 11 months traveling to countries where measles is circulating should be given a single dose of MMR prior to travel. Any dose of measles-containing vaccine given before 12 months of age should not be counted as part of the series. Children vaccinated with measles-containing vaccine before 12 months of age should be revaccinated with two doses of MMR vaccine, the first of which should be administered when the child is at least 12 months of age.

Human behavior is a major contributor to the current rise in costs of health care. Research has shown that 25 cents of every health care dollar is spent on the treatment of disabilities that result from changeable behaviors (e.g., dieting, exercise, and smoking).

PATIENT BEHAVIOR:

THE KEY TO IMPROVING PATIENT OUTCOMESAUTHORS: AMBER CANDIDO, M.A. AND DANIEL REIMER, M.A.

1 Understanding the reasons patients engage in unhealthy behavior, or do not engage in health behaviors is important for addressing these issues. The reasons can be examined in terms of the consequences that typically follow a given response. Recall, for example, the last time you shared a funny story with a group of friends or colleagues. What type of response immediately followed the punch line? If the response provided was laughter, it is probable that the tendency to repeat the story in the future was “reinforced.” Meaning, following the laughter, you became more likely to repeat the story in a future, similar situation.

In the behavioral literature, the term “reinforcer” describes a consequence that 1) follows a given response and 2) increases the probability that the response will recur in the future. By incorporating this principle and application techniques into a medical practice, physicians around the world may be able to improve the outcomes of various diseases affected by health behaviors. This increase in improved health outcomes will then lead to decreased health care costs and increased patient satisfaction. There are many different strategies to use, but a few of the most common and convenient to implement are discussed below.

TOKEN ECONOMIESToken economies—where patients are rewarded with points or “tokens” for reaching pre-set goals—have been used to improve human behavior in a variety of populations, including those that monitor: psychiatric patients, medical patients, alcoholics, drug addicts, nursing-home residents and persons with a variety of developmental disabilities. 2 In a token economy, patients first determine daily or weekly goals (e.g., exercising for 45 minutes a day). Then, patients receive a token, check a box, or log this information into their phone, each time the goal is met. Once the patient reaches a pre-set number of tokens, they can exchange those tokens for a reward they enjoy, like dessert or a massage.

Patient Behavior > Improving Patient Outcomes

Although effective with adults, token economies can be especially useful with children who have been diagnosed with chronic conditions. For example, despite advances in pharmacological treatments, hospitalization and mortality rates among children with asthma are on the rise. One explanation is medication non-adherence, which ranges from 17-90% for children with Asthma.3 A recent behavioral psychology study combined the use of education and token economy systems to improve children’s levels of medication adherence and pulmonary functioning. Education included one, one-hour session with educational videos & written handouts about pulmonary functioning, asthma pathophysiology, medications, triggers, and management. For each token economy, children earned and lost tokens for taking or missing their asthma medications. Once a specified amount of tokens were earned, they were exchanged for a list of desired privileges. Following the intervention, children demonstrated increased medication adherence and, as a result, enhanced overall pulmonary functioning. Shaping

One way to enhance a token economic system is to incorporate the intervention technique known as shaping. Shaping is a method of reinforcing successive approximations—or smaller progressive steps—toward the development of a targeted behavior (response). As an example, consider the individual working to meet a set fitness goal (e.g., walking on a treadmill for an hour without a break). While working towards the goal, a care provider (or friend) may administer tokens for successive approximations along the way (e.g., the first day walking for 20 minutes without a break, the next day 30 minutes, etc.). By providing tokens for successive approximations over an extended period of time, the individual is more likely to continue with their exercise regimen and, ideally, experience the health benefits associated with the continuation of this routine.


The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice. Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership coordinator, at [email protected] or call (209) 952-5299.

Free to SJMS/CMA Members!practice manager

resources


In a few recent behavioral psychology studies, the combined use of shaping and token economic procedures have been shown to effectively reduce smoking among adolescences.4,5 In one study, shaping procedures were created and monitored through a web-based contingency management program where individuals were expected to provide video recordings of breath CO samples three times per day. Tokens were earned and could be exchanged for monetary rewards (gift cards) for incremental reductions in breath CO. Through this program, cigarette smoking was reduced, and, because the program was completed at home, it was believed to be more effective than one which requires travel: there is less response effort on both the part of the individual and the care provider who is monitoring the progress.

VISUAL REPRESENTATIONS OF DATAVisually tracking individual performance has been utilized in a variety of work and educational settings, particularly with respect to goal setting.6 The act of visually representing data involves tracking important medical measures over time with the individual’s data graphically represented as an effective form of visual feedback. Such visual representations allow patients to 1) easily review their medical measures and 2) be held accountable for their actions (or inactions) via an additional person monitoring their progress (e.g., a physician, care provider, or friend). This type of intervention can be useful in targeting several areas of behavioral health, including: diet regulation, exercise performance, blood pressure and/or heart rate monitoring, smoking cessation, etc. Physicians interested in monitoring the performance (or omission of) target behavior(s) can use visual representations of data to set and track collaborative patient goals. Goal progression can then be monitored in a variety of ways ranging from the old “pen-and-paper” method to the use of Smart Phone applications available to us at our fingertips. Using either method, patients can track, monitor, and upload their progress to track their results in real time. Early studies of electronic weight loss aids suggest that allowing individuals to construct their own regimen on their phone or computer could be key to reversing a variety of behavioral health-related epidemics (e.g., obesity). Such affordable, accessible tools may radically change the way we conceive of and administer health care, potentially saving the system billions of dollars in the process. For example, David H. Freedman, a consulting editor for John Hopkins Medicine International, describes an iPhone application called “Lose it” that allows users to track their eating and physical activity simply by holding their phones up to a food package’s bar

code, or by tapping the screen a few times at the start and end of a walk. This data is used to provide clear, graphic feedback on a user’s daily progress—“you might see at a glance that having a dessert will send your numbers into the red, but after you walk for 20 minutes, you’ll go back into the green.”7 Additionally, Behavioral Psychologist Matt Normand (University of the Pacific) is currently working to identify precise methods to track patient caloric intake and expenditure by, for example, collecting receipts for food purchases, providing checklists to record what is eaten, and measuring physical activity using tools such as pedometers. He then provides patients with visual representations of their behavior over time.

CONCLUSION:The science of behavior change has much to offer to health care professionals. Through the use of behavioral principles and technologies, small adjustments in behavior and lifestyle can be changed and maintained for the purpose of preventative care. Weight loss regimens can be designed to aid with the obesity epidemic; medication adherence interventions can be targeted in patients of all ages; cigarette smoking can be reduced for the prevention of associated cancers; the list of possibilities is truly endless. Targeting incremental behavior change in at-risk populations can help with the prevention or reduction to the severity of the disease before they become dangerous to the patient, time-consuming for the physician, and costly for the overall health care system. Physicians and other health care professionals do not have to create and customize behavioral health care interventions on their own; there are multiple strategies to integrate these concepts into medical practice. Health care technology has developed substantially in the last decade, making tracking health behaviors easy and affordable. Many providers are also beginning to develop collaborative relationships with behavioral health institutions or professionals who are experts in developing and implementing the strategies previously discussed. These collaborations are mutually beneficial, with physicians receiving expertise, support and cost-savings and behavioral health professionals receiving access to new populations of patients. Rapid changes to healthcare policy are requiring shifts in traditional healthcare practices. The changes will require creative solutions to some of medicine’s most systemic problems. The abovementioned techniques are examples of a few small changes physicians can make to address these issues.


Physicians need to be especially careful when managing chronic pain with opioid medications. Medical practices often seek risk management advice when they suspect a patient is misusing prescription medications, is not complying with treatment, or when the patient is making unreasonable demands for more opioids. If a patient suffers harm as a result of opioid medication use, a physician may find himself the target of a lawsuit alleging negligent treatment of chronic pain. The following tips may help

physicians and office staff

members increase patient safety

and lower liability exposure

related to these factors. >>

Risk Management, PMSLIC Insurance Company and the NORCAL Group

Jane Mock, Risk Management Specialist

Managing the Risks of Treating

Chronic Pain

with Opioids

MANAGING PROFESSIONAL RISK

PRACTICE MANAGEMENT

TREATING CHRONIC PAIN WITH OPIOIDS

Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL Mutual insureds. To learn more, visit www.norcalmutual.com/cme.

NORCAL

N


HOW DOES THE MANAGEMENT OF OPIOIDS CREATE POTENTIAL LIABILITY? Claims against physicians for negligent treatment and/or management of opioid medications frequently arise from the following: · Prescribing opioids without performing any diagnostic examinations · Prescribing an excessive quantity of opioids · Prescribing additional narcotics when not indicated · Failing to consider, screen for, or suspect narcotic addiction, and failing to refer the patient for treatment of drug addiction · Negligent monitoring · Failing to consult or refer to a pain specialist

IS THE STORY CLEAR? The physician might think that he or she has managed a patient’s pain appropriately, but if the medical record documentation does not ref lect that, defense of care is difficult. Examples of poor documentation include:

· No indication that the treating physician reviewed the patients prior medical records or studies · No physical exam results · No quantitative assessments of the patients pain · No indication that the treating physician discussed the risk of opioid addiction · No pain medication agreement · No evidence of assessment of effectiveness of the pain medications · No rationale for the physicians medication choices · No copies of narcotic prescriptions

RISK MANAGEMENT TIPS Clinicians can avoid reaching a point of crisis by applying a risk management approach to treating chronic pain.

Perform and document a

comprehensive history and

physical examination of the

patient.

· Complete all indicated diagnostic exams and tests. · Use an objective, comprehensive pain assessment tool. · Evaluate the patient for his or her risks of abusing medication. · Request copies of prior medical records.

Base the treatment plan on the

patient’s individual needs.

· Document differential diagnoses. · Consider and try both pharmacologic and non-pharmacologic pain treatments. · Manage patient expectations and educate patients about physical dependence, tolerance, and addiction.

Document this discussion, as well

as a plan of action to address

physical dependence.

· Document clinical decision making and rationale for one treatment choice over another. · Have patient sign a pain management agreement, if indicated.

Re-evaluate and document

the patient’s level of pain and

response to treatment at each

visit.

· Consider having the patient keep a pain diary. · Note the effectiveness and patient compliance with various treatment

Norcal > Treating Chronic Pain with Opioids


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As a member of the San Joaquin Medical Association, you’re privy to an exclusive bene�t—Financial Center Credit Union membership for you and your sta� !

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As a member of the San Joaquin Medical Association, you’re privy to an exclusive bene�t—Financial Center Credit Union membership for you and your sta� !

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modalities · Document the patients response, changes to the treatment plan, and your clinical rationale. · Document the name of the drug, dose, frequency with which the patient has been taking the medication; reported effectiveness; and the impact on the patient’s daily activities. · Communicate with other providers who are treating the patient. · Strongly consider utilizing your states prescription drug monitoring program · Utilize and refer to specialists when appropriate. · Be familiar with local resources that can provide assistance (e.g., pain clinics, teaching hospitals). · Obtain second opinions when indicated. · When choosing not to pursue clarification of a symptom or complaint, document the rationale.

Be aware of signs of drug abuse or

misuse.

· Set limits with patients; consider using a therapeutic pain medication agreement. · Do not provide narcotic refills unless the patient comes in for re-assessment.

· Evaluate the appropriateness of the requests in light of the prescription provided. · If you suspect substance abuse, carefully document details of the situation and discussions with the patient in the patient’s medical record.

Monitor the patient’s non-

compliance.

· Enforce the pain management agreement, when indicated. · Document the patients action or inaction that led to termination or discontinuation of pain medications and rationale for the decision.

· Contact your medical professional liability insurers risk management department for guidance relating to terminating a patient from the practice.

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Norcal > Treating Chronic Pain with Opioids


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12 NEW MEMBERS IN THE PAST 60 DAYS!

...and even more on the way.

Saleha Ahmed, M.D. Internal Medicine2505 W Hammer Ln Stockton, CA 95209(209) 468-6380

Craig Bobson, M.D. Family Medicine1140 Norman Dr, Ste 1 Manteca, CA 95336(209) 825-7748

Manavjyot Heer, M.D. Hospitalist2151 Grant Line Rd Tracy, CA 95377(209) 833-2367

Rupinder Singh, M.D. Internal Medicine 2505 W Hammer LnStockton, CA 95209(209) 524-1211

Duc Cung Nguyen, M.D. General Surgery 473 W Eaton AveTracy, CA 95376(209) 833-3320

Mary Rose Bautista, M.D. Internal Medicine7777 Freedom Road French Camp, CA 95231(209) 946-3400

Saadia Khan, M.D. Family Practice 7210 Murray Drive Stockton, CA 95210

John Mast, M.D. General Surgery473 W Eaton Ave Tracy, CA 95376(209) 833-3320

Robert Petty, M.D. Family Practice768 Mountain Ranch Rd San Andreas, CA 95249(209) 754-3521

Vikrant Moharir, M.D. Internal Medicine 768 Mountain Ranch Rd San Andreas, CA 95249 (209) 754-3521

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