ReceptionsforChan

andGaramendi

Rozance,Sanghvion

HavingInfluence,BeingHeard

PGPMat

Work

Ruben:PromotingBetter

EyeCare

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FALL 2006

Ruben: Promoting Better Eye CareJames Ruben, MD, would just as soon stay out of politics. But he can’t take that chance, he says. The stakes are too high—for his patients, the public and the practice of medicine. A pediatric ophthalmologist and ocular motility specialist with TPMG in Sacramento/Roseville, Dr. Ruben has devoted his entire medical career to better eye care for children, not only through clinical practice, teaching and research, but also through tireless participation in the legislative arena.

“A lot of legislative decisions reflect the political clout of special interest groups,” he said. “It’s better to look at the whole picture and ask how we can spend our limited resources

most wisely for quality medical care. Politicians aren’t in a particularly good position to make those decisions—they are very busy, and the issues require in-depth analysis. I’d much prefer to see physicians resolving the issues based on

scientific evidence.”

“If you’re not at the table, you’re on the menu!”

Dr. Ruben examines Assemblyman Joe Coto, co-sponsor of ACR 145, at a glaucoma screening held at the State Capitol. Dipti Desai, a Certified Orthoptist at Sacramento/Roseville (not pictured) also participated in the screening.

…continued on page 2

Capitol Matters/Fall 2006�

ACR 145As vice president in charge of legisla-

tive affairs for the California Academy of Ophthalmology (CAO), Dr. Ruben practices what he preaches. Under his leadership, CAO sponsored ACR 145 (Nakanishi and Coto), which aims to review and revitalize Califor-nia’s vision screening and reporting require-ments for children entering first grade.

“Some special interest groups have been promoting mandatory comprehensive eye exams for children,” he said. “We think re-sources would be better used for screening as part of a well-baby check and then following up with those children who are found to have problems. The best way to approach this issue is by having a panel of experts look into it, which is what ACR 145 does.”

While state law requires children to have their vision evaluated when they enter school and at three-year intervals thereafter until the end of the eighth grade, there is no mecha-nism or money in the budget for tracking the results or ensuring that a child with a vision deficiency receives follow-up care.

Preventing Blindness“I got involved because vision screening

is so important,” Dr. Ruben said. “It is a very inexpensive way to prevent blindness. The Number One problem we are looking for in pediatric vision screening is amblyopia—where the brain doesn’t learn to see from one eye. Amblyopia affects three to five percent of the population and is the primary cause of monocular visual loss in people under 40. You can save loss of sight in a child’s eye with a relatively simple intervention, like an eye patch. In health care today, we spend a lot of money in areas that don’t give us a high yield, and we don’t pick the low-hanging fruit. Pedi-atric vision screening is picking the low-hang-ing fruit. The benefits of early intervention extend over the child’s entire lifetime.”

National InvolvementBesides his work for CAO, Dr. Ruben

has promoted vision screening at the national level by serving for four years as chair of the vision screening committee of the American Association of Pediatric Ophthalmology and Strabismus and as a member of the execu-tive committee of the American Academy of Pediatrics Section of Ophthalmology. He has also written and lectured on the cost-benefit impact of pediatric eye care.

“Every day I see kids who benefit from vision screening—or were missed,” he said. “This is an orphaned area because there is no pharmaceutical money in it. We have to attack the problem at every level.”

Coalition Building: Support Counts

It’s a fact of political life that resources tend to go to those who scream the loudest, Dr. Ruben said. “I tell my colleagues that the political process is unpleasant, but one thing is sure—if you’re not at the table, you are probably on the menu.”

That’s why he worked so hard to develop broad support for ACR 145, building a coali-tion of like-minded organizations, including Kaiser Permanente, the American Academy of Pediatrics and the California Academy of Ophthalmology. “I’ve discovered over the years that being scientifically correct is ir-relevant in the legislative arena,” he said. You can have the best argument scientifically, but your argument goes nowhere without politi-cal support.”

No surprise, then, that Dr. Ruben arrived at the state Capitol last June to testify on behalf of ACR 145 with ophthalmologist Thomas Kidwell, MD, an assistant physician-in-chief for Sacramento/Roseville and Edward Denz, OD, optometry chief for the North Valley, at his side. “It wasn’t so much what we said as the fact that all of us were there together to say it,” he explained. Their solidar-ity proved effective. “Many people signed on as co-authors,” Dr. Ruben said. ACR 145 became law on August 16, 2006.

About Amblyopia (Lazy Eye)

• Affects 2-3 out of every  100 children (3% of children under the age of 6)

•Responsible for more monocular vision loss than all other causes combined (including trauma) in individuals under age 40

• Detectable during routine eye screening

• Leads to permanent  vision loss 

• Can be prevented and treated if detected early

Ruben continued from cover

�Capitol Matters/Fall 2006

The LegisLaTive Forum:WhaT iT is, WhaT iT Does

Many of the bills relating to health care that are proposed and de-bated in Sacramento started out as resolutions authored or evaluated by the California Medical Association’s (CMA) House of Delegates. But before the CMA takes a position, many of those resolutions are studied by the Legislative Forum, a group of Permanente physicians active in the CMA.

The Legislative Forum is a subset of the Very Large Group Practice Forum (VLGPF). All 4,200 Permanente physicians who belong to the CMA are members of the VLGPF. Members of the Legislative Forum are Permanente physicians who are active in CMA leadership through their county medical societies or specialty medical associations.

“The Legislative Forum brings together clinicians, elected repre-sentatives and physicians with regional leadership roles to coordinate the involvement of Permanente physicians in the CMA and other professional organizations,” said Sharon Levine, MD, associate execu-tive director, TPMG, who chairs the Legislative Forum.

Participating Early in the Process“By commenting and acting on CMA resolutions, the Legislative

Forum provides feedback before potential legislation is fully devel-oped,” said Amy Andersen, director, TPMG Government Affairs. “Since the stakes can be high when the Legislature gets involved in

health care issues, we need to take full advantage of every opportunity to par-ticipate early in the legis-lative process, to protect the Permanente approach to care delivery and the practice of medicine.”

Each year, the CMA House of Delegates considers more than 100 resolutions. The Legisla-tive Forum plays an important role in determining which might affect Permanente practice, and thinking through the implications.

Recently, for example, the Legislative Forum discussed resolutions related to:• Prohibiting balance billing and establishing a payment dispute

resolution process.

• Updating California’s blood safety laws.

• Making tests for rare diseases more available by relaxing laws regulating clinical reference labs.

“What it comes down to is supporting Permanente physicians’ involvement with ‘the House of Medicine’ at the state and county level and putting our expertise to work to promote good public policy,” Andersen concluded.

shaping poLicy For heaLTh care, pubLic saFeTy

Here are three examples of how TPMG physicians made significant contributions to help shape health policy in California this year.

Reporting Medical Errors SB 1301 (Alquist)

• Purpose: Tightens up accountability for medical errors in hospi-tals by listing 27 events that must be reported.

• Participation: Sharon Levine, MD, associate executive director, TPMG and Bernadette Loftus, MD, physician-in-chief, Santa Clara, supported Senator Elaine Alquist’s effort to sponsor the bill, and Michael Ralston, MD, director of Quality Demon-stration, TPMG, testified in hearings. TPMG legislative staff worked with Alquist to help draft the bill, testified on its behalf and successfully encouraged the California Hospital Association to support it.

• Status: Passed Legislature. Governor’s signature or veto pending.

Syndromic Surveillance AB 1956 (Horton)• Purpose: Pilots a uniform, statewide, Web-based, interactive

surveillance system for monitoring infectious diseases and informing health care providers.

• Participation: Eric Koscove, MD, chief, Emergency Department, Santa Clara, and David Witt, MD, former chief of infectious dis-eases for TPMG, advised Assemblywoman Shirley Horton about syndromic surveillance. TPMG legislative staff helped draft a bill, and Dr. Koscove testified on its behalf at Assembly hearings. Steven Wiesner, MD, chief, Occupational Health Department, Oakland, testified at Senate hearings.

• Status: Passed Legislature with bipartisan support. Governor’s signature or veto pending.

Vision Screening ACR 145 (Nakanishi and Coto)• Purpose: Establishes a blue-ribbon panel to study and recom-

mend improvements to state vision screening requirements for children entering first grade.

• Participation: James Ruben, MD, pediatric ophthalmologist and ocular motility specialist with TPMG in Sacramento/Roseville, Thomas Kidwell, MD, an assistant physician-in-chief for Sacra-mento/Roseville, and Edward Denz, OD, optometry chief for the North Valley, testified on behalf of the bill (story, p. 1).

• Status: Bi-partisan support. No opposition. ACR 145 became law on August 16, 2006.

The VLGPF is 20% of CMA members.

POLICYMATTERS

Capitol Matters/Fall 2006�

commissioner WiTh a mission

Answering a newspaper ad may be an unusual way for a physician to land a position, but that is how Steve Sidney, MD, associate director for Clinical Research, Division of Research landed on the Alameda County Public Health Commission. “When I saw the ad announc-ing an opening on the commission, I contacted the supervisor for my district and interviewed with his chief of staff. We hit it off, and he appointed me,” Dr. Sidney said.

One of two physicians on the 25-member board, Dr. Sidney is completing his fifth year as its chairperson. He describes his participa-

tion as “contributing to the health and well-being of the greater community, in keeping with Permanente’s overall mission.”

The Alameda County Public Health Commission advises the county Board of Supervisors and Health Care Services Agency and advocates for programs supporting disease prevention and the promotion of good health. It is a forum for the exchange and dis-semination of information about public health in the community.

“One of the challenges with public health is that when it is done well it is invisible,” he said. “No one sees the preven-tion of a heart attack. This makes it harder to get people to pay atten-tion and fund the public health infrastructure to the degree needed.”

LeadershipUnder Dr. Sidney’s leadership, the Alameda County Public Health

Commission was instrumental in securing $3 million in Measure A funding for public health initiatives. (Measure A was a voter-approved tax to be spent on a broad range of health issues. It raised approxi-mately $100 million, most of which was earmarked for the Alameda

County Medical Center.) He is also spearheading a reorganization of the com-mission to improve its ef-fectiveness in working with the county Public Health Department.

“Alameda County has a big focus on lifestyle interventions. Kaiser Permanente’s HEAL initiative—Healthy Eating Active Living—di-rectly addresses health disparities in the county, which has a lot of poverty,” Dr. Sidney said. It is natural for him to gravitate to social de-terminants of health, given that his research focuses on cardiovascular epidemiology. It also reflects the way Permanente physicians approach their patients.

Dr. Sidney’s involvement on the commission has fostered a closer relationship between the Division of Research and the Alameda County Department of Public Health. “The leaders of the two orga-

nizations are talking about how we might share data that the county lacks. These data will allow the county to make more informed deci-sions, especially about understanding and addressing health dispari-ties,” he said.

Varied IssuesPublic boards—which exist at the state, county and local level—

address issues as varied as youth and senior care issues, law enforce-ment and human rights. Members typically are appointed by elected officials. Members can be chosen for their expertise or because they represent the population being served.

While subject matter expertise can be useful, Dr. Sidney believes the most important qualifications are a fundamental interest in the subject matter and a willingness to participate fully and actively.

“Permanente physicians are generous in their volunteer work, de-livering needed health care in the community,” Dr. Sidney concluded, “but the behind-the-scenes work done by commissions is equally satisfying and, if done right, will pay long-term dividends.”

“One of the challenges with public health is that

when it is done well it is invisible.”

Dr. Steve Sidney

�

(From left) Linda Okahara, Carol Quan, Norman Quan, MD, Oakland Medicine, Balaram Puligandla, MD, Oakland Pathology, Bill Longwell, MD, Oakland Medicine, and Shirley Longwell.

Insurance Commissioner John Garamendi (left) talks with Richard Isaacs, MD, PIC South Sacramento and TPMG Associate Executive Director Sharon Levine, MD.

Eric Lipsitt, MD (left), Assemblywoman Chan and Tim Batchelder, MD, Richmond PIC.

Capitol Matters/Fall 2006

chan recepTion

Assemblywoman Wilma Chan was the guest of honor at a reception co-hosted by Tim Batchelder, MD, Richmond physician-in-chief, Eric Lipsitt, MD, Oakland Internal Medicine and Pauline Fox, JD, at her home in Piedmont on July 19.

Chan, who chairs the Assembly Committee on Health, has represented Alameda, Oakland and Piedmont in the Legislature since 2000. She is involved with the California for Healthy Kids campaign to expand affordable health care coverage and received the 2004 Clinic Champion award from the California Primary Care Association. Her other legislative priorities include senior services, early childhood educa-tion, environmental health, job creation and economic development.

At the reception, 20 TPMG physicians, staff and guests had an opportunity to meet and speak with Chan one-on-one. She described her legislative style as one of “incremental improvement,” a practical response to the challenge of achieving the two-thirds majority vote needed on bills that require significant spending.

Chan recognized the leadership of Permanente physicians in imple-menting electronic medical records and in emphasizing the importance of prevention in health care delivery, particularly to children. She encouraged Permanente physicians to continue their engagement in the legislative process as experts and advocates for quality health care.

– Andy Huber, legislative analyst, TPMG Government Affairs

OUTREACHgaramenDi recepTion

In late February, more than 30 Perman-ente physicians and guests attended a recep-tion for California Insurance Commissioner John Garamendi at the Oakland home of Eric Lipsitt, MD, co-hosted by TPMG Executive Director and CEO Robert Pearl. MD. Gara-mendi applauded the innovations in technol-ogy that our organization has spearheaded and noted their potential to drive advances throughout the industry for the benefit of patient care and quality.

A lively dialogue at the reception touched on the various approaches now being con-sidered to expand access and affordability of health care coverage in California. Through-out his years in public service at the federal and state level, Garamendi has championed expanded access to care. He believes that our integrated health care program has much to contribute to the policy dialogue, particularly regarding the efficient delivery of quality health care.

– Amy Andersen, director, TPMG Government Affairs

�

at workPGPM

Who’sWho AT PGPMSteering CommitteeDavid Lerman, MD, JD, Chair Sharon Levine, MDEdward Ellison, MD Jack Rozance, MDVito Imbasciani, MD Suketu Sanghvi, MD StaffAmy Andersen Pauline Fox, JD Executive Director TreasurerCapitol Matters/Fall 2006

Dr. Rozance: Having Influence

“Our integrated group practice model is the highest quality, most efficient model in the state of California. Anything that promotes that model serves the state and all of us well. PGPM provides an avenue for spurring interest in what’s going on politically in our communities and, equally important, for influencing what’s going on. When we have direct contact with elected state officials and their staff members, it works very well. We are able to talk to them about Permanente medicine and hear their views about health care in California.

“Having a PAC and being visible helps us counteract erroneous information that other groups may put out. There really are powerful forces out there to which we can respond. It’s

important for physicians to be involved in the political issues around us, particu-larly those that impact our practice. A good first step is to contribute to PGPM. Money talks! We turn to the list of PGPM contributors to find people who might be

interested in coming to events where they can meet informally with legislators.

“We also need to encourage and sup-port physicians who want to run for elective office—they have great credibility. PGPM’s role in supporting knowledgeable candidates is particularly important, because we have lost legislators with health care expertise due to term limits. Through PGPM, we can also identify talented candidates in the local com-munity early on and help them move into the state arena.”

Why Support pGpM? Recalling the past and looking to the future, Steering Committee members Jack Rozance, MD, physician-in-chief, Sacramento and Suketu Sanghvi, MD, Ophthalmology, San Francisco, give their reasons for supporting Physicians for the Group Practice of Medicine (PGPM).

“Through PGPM, we can identify talented candidates in the local community early on and help them move into

the state arena.”

Dr. Sanghvi: Being Heard

“It’s worth harkening back to a time—not so long ago—when physicians in fee-for-service practice found our model of prepaid group practice to be so threatening that Per-manente physicians were shunned by the or-ganized medical establishment. Boy, has that situation changed! We are now very involved in organized medicine, and Permanente practice is a crucial part of the health care landscape. Under these new circumstances, it is essential for our voice to be heard, and PGPM helps us take part in the conversation.

“PGPM is helping us give legislators a deeper, more nuanced picture of Permanente practice and the Permanente medical groups. This matters, because even well-intentioned legislative changes can have unintended negative consequences for our model of care. When we walk into the room now, legislators see us as part of the solution and as a model for the nation.

“Permanente physicians have the clinical autonomy to practice medicine the way it is supposed to be practiced. We benefit from this special environment, and we have a vest-ed interest in keeping it going—for ourselves, for our communities and for our patients.

“Health policymakers know that the resources allocated to health care are limited. Because Permanente physicians are used to providing care both efficiently and effectively, our perspective is especially useful and im-portant to legislators. We’re good people, we know something about health care, and being part of the policy discussion is another way we can contribute to the community.”

Dr. SanghviDr. Rozance

�Capitol Matters/Fall 2006

WANT TO KNOW MORE?

Where’s the money? PAC, campaign and lobbying spending: http://cal-access.ss.ca.gov

What are the rules?Campaign finance, lobbying and conflict of interest laws: http://www.fppc.ca.gov

Who represents you and info on bills you may be interested in?http://leginfo.ca.gov/

PLEASE CONTR IBUTE TODAY ! Your contribution to PGPM will help secure the future of Per-manente medicine, promote high quality practice, and protect our patients in the years ahead. All contributions to PGPM are voluntary.* Please contribute today!

Maximum Individual Contribution for 2006: $5,600

Payroll Deduction: You can contribute through TPMG’s payroll deduction program. Your annual commitment will be deducted in monthly installments from your payroll check. To sign up, call Amy Andersen at 510-708-4472 or send e-mail to pgpm@pgpm.com.**

Personal Check: Send a personal check payable to PGPM to:Physicians for the Group Practice of Medicine1714 Franklin Street, #100-179Oakland, CA 94612

PGPM ON THE CAMPA IGN TRA I L• April – David Lerman, MD, JD, SCPMG general counsel, and

Vito Imbasciani, MD, SCPMG Government Relations, participated in an event supporting former Assemblyman George Nakano (D-Torrence) in his campaign for State Senate.

• June – Marvin Singleton, MD, Stockton, helped organize a campaign event for Assemblyman Greg Aghazarian (R-Stockton) and attended a re-election event for Assemblyman Alan Nakanishi, MD (R-Lodi).

• August – Sharon Levine, MD, TPMG associate executive director, Roman Kownacki, MD, Richmond Physical Medicine, Suketu Sanghvi, MD, San Francisco Ophthalmology, and Amy Andersen, TPMG director of Government Affairs, attended a luncheon for Insurance Commissioner Garamendi to support his candidacy for Lieutenant Governor.

Number of CandidatesPGPMSupported in 2006 Elections

76PGPM BY THE NUMBERS

Percentageof Winning

Races in 2006 Primary

Elections

ContributionsMade to Elections,

January to July 2006

$111,500Donations Received,

January to July 2006

$154,531

86%

pGpM at-a-Glance

TPMG and SCPMG established Physicians for the Practice of Group Medicine (PGPM) in 1999 as a political action committee (PAC) to:• Increase the visibility and influence of Permanente physicians in

Sacramento. • Channel political and financial support to candidates for state and

local office in California who share the values of group medical practices and support the interests of TPMG and SCPMG physicians and their patients.

• Help group practice physicians understand and participate in the political process.

Decisions about which candidates to support are made by the PGPM Steering Committee in consultation with Permanente colleagues. PGPM is a nonpartisan organization that: • Supports candidates for state and local office based on their merits.• Files information on its fundraising and contributions with the

California Secretary of State. This information is available at http://cal-access.ss.ca.gov

* Contributions to PGPM are not tax deductible. PGPM is required by law to file the names and employers of individuals who contribute $100 or more annually to the PAC. FPPC Filer I.D. #992303.

**This private telephone line and e-mail address must be used for inquiries regarding political contributions. No resources (including e-mail, telephones or facilities) of any Section 501(c)(3) organization (including Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals) may be used for or in connection with political fundraising.

http://cal-access.ss.ca.govhttp://www.fppc.ca.govmailto:pgpm@pgpm.com.*

FALL 2006

Presort Standard

U.S. Postage PAID

Oakland, CA Permit No. 1097

In ThIs Issue…Ruben: Promoting Better Eye Care 1Legislative Forum: Coordinating with the CMA 3Shaping Policy for Health Care, Public Safety 3Sidney: County Commissioner with a Mission 4Receptions – Chan, Garamendi 5Rozance, Sanghvi on Having Influence, Being Heard 6PGPM at Work 7

Reception for Supervisor Fiona M

a October 5, 2006

Legislative Forum

October 24

CMA House of Delegates

October 27-30

Legislative Forum

December 5

Reception for Senator Elaine Alqu

ist TBA 2007

Reception for Senator Tom Torlak

son TBA 2007

For more information about upcom

ing events, call 510-708-4472

Upcoming Events

The Permanente Medical Group1950 Franklin StreetOakland, CA 94612

Ruben: Promoting Better Eye Care The Legislative Forum: What It Is, What It DoesShaping Policy for Health Care, Public Safety Commissioner with a missionGaramendi ReceptionChan ReceptionPGPM at WorkUpcoming Events