Summer 2010

SUMMER 2010 SAN JOAQUIN PHYSICIAN 1SUMMER 2010 SAN JOAQUIN PHYSICIAN 1

Summer Issue 2010

Community Medical Centers REVIVES HISTORIC GLEASON HOUSE

2 SAN JOAQUIN PHYSICIAN SUMMER 2010

SUMMER 2010 SAN JOAQUIN PHYSICIAN 3


Volume 58, Number 2 • June 2010

{FeATUReS}

TAKINg STReeT MeDIcINe TO THe gLeASON HOUSe40

DR. STANLey cLARK 2010 Lifetime Achievement Recipient18

{DePARTMeNTS}

26 IN THe NeWS New faces and Announcements

34 cOMMUNITy INTeRNSHIP PROgRAM

38 MANAgINg PROFeSSIONAL RISK

46 MeMBeRSHIP BeNeFITS: CMA launches new monthly resource

57 DIABeTeS ReFeReNce gUIDe

68 HeALTHcARe HAPPeNINgS IN PIcTUReS

32 DR. RAMIN MANSHADI 2010 Young Physician Award

cMA STePS UP!An interview with Elizabeth McNeil52

oN THE CoVER: Community Medical Centers CEo Mike Kirkpatrick, Medical Director Thomas Mahoney, MD and Care Link Manager Randy Pinnelli, PA stand in front of the historic gleason House – soon to be the location of their twelfth clinic.


Helping doctors treat and

patients heal.The Advanced Imaging Center

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radiologists, comprehensive diagnostic services, and a

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High Field MRIBreast MRI

Digital X-ray (walk-in’s welcome)

(209) 333-7422Frank M. Hartwick, M.D.

Majid Majidian, M.D.R. Brandon Rankin, M.D.Grant W. Rogero, M.D.Roger P. Vincent, M.D.

Lawrence R. Frank, MD President

James Halderman, MD President-Elect

Robin Wong, MD Past-President

George Khoury, MD Secretary-Treasurer

Board Members

Shiraz Buhari, MD Moses Elam, MD Trinh Vu, MD Thomas McKenzie, MD John Olowoyeye, MD Anil K. Sain, MD Javad Jamshidi, MD Raissa Hill, MD Kristin M. Bennett, MD Jerry Soung, MD

Medical Society Staff

Michael Steenburgh Executive Director

Debbie Pope Office Coordinator

Gena Welch Membership Coordinator

Committee Chairpersons

MRAC Decision Medicine Ethics & Patient Relations F. Karl Gregorius, MD Kwabena Adubofour, MD to be appointed

Communications Legislative Community Relations Morris Senegor, MD Patricia Hatton, MD Joseph Serra, MD

Audit & Finance Member Benefits Nominating Marvin Primack, MD Jasbir Gill, MD Hosahalli Padmesh, MD

Membership Public Health Scholarship Loan Fund to be appointed Karen Furst, MD Eric Chapa, MD

NORCAP Council Sandon Saffier, MD

CMA House of Delegates Representatives

Shiraz Buhari, MD Lawrence R. Frank, MD James R. Halderman, MD Patricia Hatton, MD Francis Isidoro, MD Peter Oliver, MD James J. Scillian, MD Gabriel K. Tanson, MD Robin Wong, MD Peter Gierke, MD


At California Pacific Medical Center’s Heart Failure and Transplant Program we are committed to work-ing with referring physicians to provide compre-hensive patient care, focused on improved survival and quality of life for patients with advanced heart failure.

We are heart failure cardiologist Ernest Haeusslein, M.D. and cardiothoracic surgeons James Avery, M.D. and Glen Egrie, M.D. We would like to make an appointment to see you in your office. Why? We’d like the opportunity to acquaint you with our facilities, staff and advanced therapies, includ-ing destination therapy and “bridge to transplant.” We’d also like to review referral indicators to help identify your patients who may benefit from these advanced therapies.

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• ExpertevaluationandtreatmentofpatientswithNYHA functionalclassIII/IVheartfailureandAHA/ACCstagesC andDheartfailure.• Exceptionalexperience–withnearly400transplantsand 200ventricularassistdeviceimplantationssinceour programbegan.• Accesstothemostcurrentmechanicalassistdevices available:bothshort-termsystemsdesignedfortreatment ofcardiogenicshockandothersdesignedforlong-term left-and/orright-ventricularsupport.• Urgentoutpatientconsultationsandevaluationsofyour patients–within48hours.Wecanalsoaccommodate same-dayhospitaltransfers.• Anexperienced,highly-trainedcardiaccareteam,com- prisedofBoardcertified,fellowshiptrainedcardiologists, cardiovascularandthoracicsurgeons,physicianassistants, nursecoordinators,dieticians,licensedclinicalsocial workers,psychiatrists,financialcounselorsand rehabilitationspecialists.

Our program offers:

To schedule our visit to your office – or to refer a patient: 415-600-1051


Moris Senegor, MDEditor

Editorial Committ eeShiraz Buhari, MD

Kwabena Adubofour, MDRobin Wong, MD

William WestManaging Editor

[email protected]

Michael SteenburghContributing Editor

Sherry RobertsCreative Director/Graphic Designer

[email protected]

Contributing SourcesCalifornia Medical Association

Los Angeles County Medical Association

San Diego County Medical Society

Th e San Joaquin Physician magazine is published quarterly by the San Joaquin Medical Society

Suggestions, story ideas or completed storieswritt en by current

San Joaquin Medical Society members

are welcome and will be reviewed by the Editorial Committ ee.

Please direct all inquiries and submissions to:

San Joaquin Physician Magazine3031 W. March Lane, Suite 222W

Stockton, CA 95219Phone: 209-952-5299

Fax: 209-952-5298Email Address: [email protected]

Medical Society Offi ce Hours:Monday through Friday

8:00 AM to 5:00 PM

MeSSAge > executive Director

People Who Make the Difference Th is issue is really all about great people and their amazing accomplishments on behalf of our community, our medical society and, ultimately, all the people who receive medical help. In our community there is a network of organizations and caregivers that did not appear out of thin air, but was constructed by years of dedicated eff ort. Th at network is still being built. Within this Physician Magazine you can read about some of the architects of that health network.

During our General Membership Meeting and Dinner on June 27th, we will focus the evening on honoring Dr. Stanley Clark, our 2010 Lifetime Achievement Recipient. Att empting to complete a litt le research on Dr. Clark, I pulled his bulging membership fi le and discovered many interesting facts which are featured in our story on page 18. Th e fi le also contained a collection of photos chronicling his long career here in Stockton and every photo featured him sporting a diff erent bow tie, which struck me as symbolic of a man who was practical (long ties get in the way), humorous (a bow tie is whimsical), and possessing the dexterity of a fi ne orthopedic M.D. (bow ties require fi nesse to tie properly). Turns out that Dr. Clark is all of these things…and a lot more. We are very proud to honor him.

For the past two years the executive board has discussed the introduction of a new award meant to honor the stellar work being performed by so many of our younger physicians. Despite the common challenges of establishing their practices and starting and raising a family – many of our younger members fi nd the time and energy to contribute to a wide variety of civic, non-profi t, political, philanthropic and even teaching opportunities. For some, their motivation is a strong personal interest in a particular fi eld or project and for others it’s simply a deeply felt sense of purpose to give back. So, for the fi rst time in our 144 year history, we will bestow the new Young Physicians Award as well during our General Membership Dinner. Our fi rst recipient is Dr. Ramin Manshadi who somehow fi nds the time to contribute his expertise to a wide variety of causes. You will certainly enjoy reading more about him on page 32.

Th e wonderful work Community Medical Centers accomplishes is certainly no secret to our membership, but few may be aware of their Care Link program which is featured on page 40. You may also be surprised at the historical roots of CMC that are revealed in the story. Th is program is truly a shining light of our medical community and worthy of our support.

Lastly, I would like to honor someone who truly provides the “glue” that keeps the medical society together – our Offi ce Coordinator Debbie Pope. When I joined the society 3 years ago, and Gena Welch joined us a year later, Debbie provided us the foundational platform to work from and we’ve grown as a team. Well, Debbie just passed the 10 year milestone with us. She wears many hats and handles them all well. Th anks Debbie for your signifi cant contributions.

All the Best!

Mike SteenburghExecutive Director


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MeSSAge > From The President

ABOUT THE AUTHOR- Lawrence Frank, MD is the 2009-2010 President of San Joaquin Medical Soceity.

Health Care reform will take the medical profession to accomplish. Medical care by legislation is a failure, often adding expense and “busy work” with little return in improved health care.

Whither Health Care Reform?

A controversial piece of legislation that some see more as Medical Insurance Reform.

There is much to like in it. Recognizing the importance of our primary care providers, their Medicare payments will increase without decreasing payment to specialists. Recognizing that having medical insurance doesn’t equal access to care and the paucity of primary care providers, particularly acute in Central California, unused residency slots will be slotted for training primary care providers and general surgeons. The importance of preventive care in reducing health care expenses is recognized; Medicaid will now provide coverage as will Medicare without copays. The devil is in the details: what are “certain preventive services” and will reimbursement meet or exceed the costs (to physicians) to provide same? Many providers would say that MediCal payments (when/if ultimately received) are, um, parsimonious at best. The purpose of this legislation is

to improve health care access and reduce costs to the nation. But will this achieve its goal? How much health care “reform” can either third party payers, government or private, or providers affect? As physicians, the high percentage of our citizens who are illiterate (and thus unable to use printed health information), are obese and at risk of or have diabetes, who are hypertensive and eat a high salt diet, the lack of safe places (read parks) for children to exert themselves with play are worrisome. We are now appalled at children presenting with type 2 Diabetes, some so obese that gastric bypass surgery is now done on children as young as 12 years old. This is exacerbated when school budgets, slashed to the bone, reduce physical education. Those of us whose BMIs are higher than 26 know how difficult it is to lose weight once gained; few are those with the discipline to eat and exercise down to a healthy weight and keep it there. Some restaurants


now serve such huge portions that I would characterize their serving vessels not as plates but as troughs. Fast food restaurants have doubled the size of their hamburgers and french fried portions even before supersizing.2 In addition to “Big Pharma”, we now must deal with “Big Salt.”1 The Food Industry (Frito-Lay, ConAgra, PepsiCo, etc.) uses salt to make low quality food (some the lowest quality the FDA allows for human consumption) palatable. To significantly reduce salt content, they readily admit they would have to use higher quality and thus, more expensive, foods; of course the increased cost would be passed on to the consumer, a further hardship for the socioeconomically challenged. The food industry argues that reducing caloric intake by 100 calories daily would save more health care costs than reducing salt content, the same industry (including restaurants and fast food dispensers) that has increased serving sizes (see above). Health, a condition, and wellness (a term I used to abjure) is a process; these are dynamic and change as we age. A 12 year old with a BMI of 35 is doomed to a life shortened by illness. The coming decades will see health care costs soar because of this. Treating diabetes, hypertension, cardiac and vascular disease and renal failure is not prevention; it is managing a potentially preventable illness and is expensive. Cleveland Clinic’s CEO said we need to get out of the illness business and into the health

business. This is a daunting challenge and must start very early, as in before birth with readily available prenatal care. Genetic differences among different ethnicities can increase the risk of obesity and/or hypertension. These are exacerbated by the above noted. Cultural differences in food preferences must be addressed. As a medical student in New York City (40 years ago!), it was clear that expecting Puerto Rican patients to readily follow a diabetic diet acceptable to those of northern European descent was futile. The National Kidney Foundation website readily directs viewers to latino-friendly dietary information in Spanish; the American Diabetic Association’s Spanish information is more difficult to tease out. Guidance for Southeast Asians and Pacific Islanders still depends on volunteers within these communities. Finally, education and acculturation over one to two generations will be needed to alter some cultures that see obesity as a sign of wealth and prestige: you can afford lots of food. Socioeconomic factors are also in play. A study by our Public Health Department found fresh fruit and vegetable availability was the lowest in economically depressed parts of Stockton but all manner of processed foods (American “cheese”, tortilla and potato chips, Ding Dongs) were readily available and attractively displayed – this in the agricultural center of California. The weekly Farmers’

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Market is held in north Stockton; is there a way to bring the Farmers’ Market to southeast Stockton or can southeast Stockton be brought to the Farmers’ Market just as patrons are brought to the Asparagus Festival by bus? What can be done to make our parks safe enough for our children to play in them without the risk of injury or death from random drive by shootings? Until safety is assured, parents will insist on their children staying home where there major exercise involves thumb muscles only.

I haven’t even addressed smoking (don’t get me started). Thus, whereas much of the Health Care Reform legislation passed is commendable, actual health care reform cannot be legislated any more than can morality. Civil Rights legislation and Hate Crime laws haven’t changed everyone’s opinions about “the other.” Health Care reform will take the medical profession to accomplish. Medical care by legislation is a failure, often adding expense and “busy work” with little return in

improved health care. As physicians and as members of organized medicine, we must lead, educate, persuade, cajole and in all other manners drive the changes. We must, in humility, recognizing that we still don’t know everything, educate and convince our patients not only to improve their own health by appropriate lifestyle changes, but to serve as models for their children and grandchildren. We must start to figure out how to work locally to bring down the barriers to good health – much of which doesn’t depend on going to the doctor’s office. Can we convince local restaurants to reduce portions and can we convince their patrons of the health value of such changes? Can we make neighborhoods and parks safe and enjoyable and encourage our citizens to use them? Tilting at windmills? Perhaps. “Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure... than to rank with those poor spirits who neither enjoy nor suffer much, because they live in a gray twilight that knows not victory nor defeat.” –Theodore Roosevelt. Thank you for the opportunity to serve as your society’s President this past year. I have learned much.

1. The Hard Sell on Salt, The New York Times, vol CLIX, no. 55,056, p. 1, Sunday, May 30th, 2010.2. Childhood Obesity and Type 2 Diabetes, K. Adubofour, MD, 21st Annual Diabetes Symposium, Sutter Health, April 2010

MeSSAge > From The President


ABOUT THE AUTHOR- Moris Senegor, MD serves as the Chairperson of the Publications Committee for the San Joaquin Medical Society and Editor of its flagship publication the San Joaquin Physician.

What I did not realize, and now learned with the predicament of San Joaquin General is that government based institutions and services take their biggest hits late in a recession, because drops in tax revenues are one or two years behind.

From The editor < MeSSAge

Misfortune VS.

CalamityThoughts About The Predicament Of “County” Hospital

THE FAMOUS VICTORIAN PRIME MINISTER, Benjamin Disraeli, upon being asked the difference between calamity and misfortune quipped about his legendary rival, “if Gladstone fell into the Thames that would be a misfortune, and if anybody pulled him out, that I suppose would be a calamity.” I bet the esteemed members of the San Joaquin Board of Supervisors are privately feeling the same about their biggest problem: San Joaquin General Hospital, currently in the throes of a grand misfortune. They are the rescuers, and the consequences of salvation, to them, may seem worse than those of closure. The latter, now looming in the horizon, is a source of concern in our medical community, doctors and hospitals alike. Many have approached me – I happen to work both at San Joaquin General and other area hospitals – with questions about what I think is happening there, and my prognosis. They usually display fearful attitudes, seeming to anticipate a giant sewage leak into their emergency rooms, OR’s, and practices. Even a limited reduction of services at San Joaquin General such as neurotrauma (what

I provide) is being viewed with fear. Obviously the capacity of area hospitals to absorb displaced patients from San Joaquin General is being questioned by those who staff them. As with any enterprise in trouble, there is abundant finger pointing in various directions to blame for the predicament of San Joaquin General. Included are outside consultants (the Camden Group) who are viewed as strangers out to destroy cherished institutions in our community, and the hospital’s current administration who are viewed as incompetent. Perusal of letters to the Stockton Record Editor reveals a regular stream of writers bearing such accusations. Other culprits include the Board of Supervisors, a political body incapable of acting effectively as a Board of Trustees for the hospital, the San Joaquin Residency programs which are blamed for their inefficiency and cost, dragging down the finances of the hospital, and various employee unions viewed as intransigent, sucking up precious dollars by creating an atmosphere resistant to a lean workforce. Even though I partly practice at San Joaquin General, I am not sufficiently


embedded in the inner workings of the hospital to confirm whether any of the above is accurate. All I know is that the more a prominent medical enterprise gets in trouble, the more fingers arise, usually accompanied with loud mouths assigning blame. Other examples in my two decades in our community include the financial troubles of Omni IPA in the 1990’s, the demise of St. Dominick’s Hospital in Manteca, and various past crises that have afflicted Joaquin General. Over the years I have learned to keep my own fingers to myself, for I find them necessary in providing me with strokes needed to swim through the turbulent waters of modern medicine. When they point here and there, it is harder to keep afloat. However I do feel that the main factor responsible for the current, worst crisis of the hospital is the Great Recession of 2007- 2008. Not being an economist, I previously only knew the general outlines of events in a recession. For instance, stock markets recover early, while everyone is down in the dumps. I also knew that unemployment starts late in a recession and ends late, long after the recession is officially over. What I did not realize, and now learned with the predicament of San Joaquin General is that government based institutions and services take their biggest hits late in a recession, because drops in tax revenues are one or two years behind. Thus we now have headlines in our papers proclaiming disaster in the hospital, accompanied on the same pages with rosy outlooks about the general economy. In the near future some official body will declare that the Great Recession ended some time around the end of 2009 or early 2010. That’s about when San Joaquin General’s chronic troubles became potentially lethal. To be sure, as I indicated above, the hospital has been on the edge of a cliff for years. It has grappled with funding shortages with every small and large past downturn in the State economy. Its residency programs have been chronically on the brink of closure until a recent deftly organized rescue. Its specialty staffing has been what I call a “leaking boat”: every time administration plugs up a leak by filling an important specialty position another seems to open up elsewhere. San Joaquin administration has been in a chronic crisis mode for years. The decision to recruit the Camden Group, in part arose out of these old crises. No one expected the perfect financial storm that was to appear while turnaround efforts got under way. Drought in all the coffers supplying the hospital, especially the State with its Medical program, and the County, as of now still the rescuer of last resort, is now bringing the unthinkable to the fore. If you think San Joaquin General is unique in this regard, think

again. “Hospitals Under the Knife” proclaims a headline (Wall Street Journal, March 26, 2010). It turns out that the nation’s largest public hospital system, known as New York City’s Health and Hospital Corporation is facing a $ 1 billion deficit, and planning to lay off 2600 employees including doctors and nurses. This is a giant organization made of 24 provider entities, including 11 hospitals in 5 boroughs, some well known, such as Bellevue, Harlem and Bronx. Imagine 11 County Hospitals, all under one umbrella, all in trouble. It seems to dwarf the $20 million deficit hounding our Board of Supervisors, Mr. Cohen and Mr. Culbertson. Another hospital conglomerate in trouble, according to the article, is Miami’s Jackson Hospital System, four public hospitals in Dade County, facing a deficit of $ 226 million. In dollar amounts these giants certainly eclipse the trouble in our hometown, but then we are small compared to New York and Miami, and ours may very well be as

big as theirs, in proportion to population size. The Camden Group advocates that the hospital’s predicament be remedied either by making it a larger, more full-service entity (including diversified cardiac and oncology services currently not available), or shrink it to a more primary care and obstetrics oriented institution. The obvious path is the latter, since enlarging the hospital would require substantial capital, currently unavailable. I have met with Mr. Culbertson, whom I personally consider a well meaning man. I do not think he wants to carry a taint in his career of

being the one that killed San Joaquin General. He sounds optimistic that the hospital can survive in the long term as a shadow of its former self and intends to enact this vision. Therein lies the dilemma facing the Board of Supervisors. Weary of past deficits, I am certain they see continued survival of the hospital as a harbinger of “more of the same”. How long the County can continue subsidizing the hospital remains a delicate question for them. Ongoing financial drain in years to come promises slow and ongoing hurt. Closure on the other hand, is a one time, big wallop of political pain, with none afterwards. It is a bit like having a bunch of teeth extracted without anesthesia, but then none are left to cause future trouble. Would the continuing presence of San Joaquin General in our community be a “calamity” to our government? This question will haunt the Supervisors in the months to come.

MeSSAge > From The editor

“Drought in all the coffers supplying the hospital,

especially the State with its Medical program, and the County, as of now still the rescuer of last

resort, is now bringing the unthinkable to the fore.”

- Moris Senegor, MD


The 2010 Lifetime Achievement Award winner is Dr. Stanley Clark, Jr., an orthopaedist known for his wit and energy, his enthusiasm as a team doctor for University of the Pacific and various high schools, and his international medical trips. His beginnings may have foretold his vibrancy and

colorful career. For example, the place of his birth was determined by one of the most colorful figures of the early twentieth century, Pancho Villa. “My father was regular army who had run away from home at age 17 and enlisted,” Dr. Clark said. “He went into the medical corps. He was a ward sergeant, headed for dental school, went to Alaska to set up dental clinic, but Pancho Villa started shooting things up and he had to go to Texas. He eventually enrolled in officer candidate school and got his lieutenancy in the medical corps.” The Clark family ended up in San Antonio where Stanley A. Clark, Jr., was born in 1921. The peripatetic lifestyle of the Army brat was just beginning. There were adventures and close calls along the way. When he was two years old and living in Manila, an earthquake in Tokyo was so strong it flipped his grandmother’s rocking chair. In San Diego, he accidentally slammed his Chevy Roadster into a

telephone pole when he was 17-years old. But no cross-border conflict, tectonic slippage, or distracted driving deterred him from a lifetime of medical service in Stockton and around the globe.

Berkeley and Stanford Dr. Clark attended the University of California at Berkeley, graduating in 1942. Then he created for himself a Big Game ambivalence by enrolling in Stanford Medical School where he received and M.D. in 1946. He did orthopaedic residency at Fort Miley Veterans Hospital in San Francisco from 1948 to 1950. He served in the military from 1946 to 1948 and his final rank was Captain MC. “I met my wife-to-be, Carolyn in San Francisco,” said Dr. Clark. Carolyn also attended Stanford and earned a nursing degree. “All that I may have achieved would not have been possible without the support and driving energy of my loving wife of 63 years and the protection of our living God, Jesus Christ,” Dr. Clark said. He met Luis Arismendi in medical school in Stanford. Dr. Arismendi was headed to Stockton to join his father in law as a general surgeon. By way of this connection, Dr. Clark came to Stockton and partnered with Dr. Clarence Luckey in June of 1951. At the time there were three orthopedists in town, according to Dr. Clark. When Dr. Clark came to town the population was 90,000 and in the medical society had 90 physicians. Today there are more than 300,000 people in Stockton and its unincorporated suburbs. The medical society counts more than 700 members. Dr. Clark was President of the Medical Society for the 1969-1970 term. “I have many memories of Stan Clark from the 60s and the 70s,” Dr. Henry Zeiter said. “But I remember

Lifetime Achievement Award Winner:

Dr. Stanley ClarkBy William West

cOMMUNITy > Lifetime Achievement


him mostly from the monthly Medical Society get-togethers at the Dameron Annex Building on Lincoln Street. Stan, Dr. Chimiklis, and I were usually the last to leave. We closed all these parties at 11:00 pm. The young members now can’t even imagine what those monthly meetings were like. Stan was the life of those parties. He was always happy, smiling, and acidly sarcastic at times, all in good fun. I have never seen Stan morose or unfriendly, and he cared for everyone.” “He always maintained a good sense of humor,” Dr. Robert Hermann said via email. “He had a limerick for all occasions-although none of them can be repeated in mixed company.” “Stan Clark was the only doctor I knew in Stockton who had a bomb shelter at his house!” Dr. Joe Serra said. “I was in it. It was a real underground bomb shelter.” It was a very busy time for the young physician. Typical days began early. He was scrubbed and ready for 6:30 a.m. surgery, then off to the office to work through the day until 6:00 p.m. Often he would get called back or out to the emergency clinic was a very basic one in downtown Stockton. Patients were treated there for quite a while. There were no emergency rooms at the hospitals at that time in the 1950s. “My partner and I would go up into the foothills to do orthopedic surgery,” Dr. Clark said. “Itinerant surgery is frowned upon nowadays, but at that time there just weren’t very man orthopedic men around. We’d travel to San Andreas and Jackson. Ripon had a hospital at that time.” “We also spent time out at the County Hospital,” Dr. Clark said. “We were on staff and conduct grand rounds. We not only treated patients, we taught the residents.”

Carolyn Clark It was a busy time for Carolyn Clark as well. Carolyn Clark fostered newborns. At any time of the day or night, if she got a call to care for abandoned children, she responded. She took care of hundreds of babies before they were adopted. According to her

many friends and fans in the S.J. Medical Society’s Auxiliary, she received no compensation for her foster care labors. Carolyn was known as the flower lady for the Auxiliary. At their once a month lunches, she would bring flowers from her own garden. She was and is, by all accounts from a number of friends, a warm and wonderful lady and a perfect foil for Stan’s humor. Dr.Clark and Dr. Luckey were team physicians for the UOP football team during this time. “UOP put a lot of people into the pro ranks,” Dr.

Clark recalled. “Dick Bass went to the Los Angeles Rams after a 1000-yard-running year. We repaired his knees twice in college. More recently, people might remember Mike Merriweather, who went to the Vikings. We worked on his leg as well”. In association with the Orthopaedics Overseas Organization, Dr. Clark went to Malawi, in east Africa, for one month at a time 1989

through 1991, where he practiced orthopaedic

surgery and trained Malawians in orthopaedic techniques. Wife Carolyn, an R.N., conducted a survey of five Presbyterian Hospitals at the behest of the Presbyterian Central Office. In 1993 they traveled to India for a month to work in the Presbyterian hospital in Miraj, which is located in western central part of India. In 1994 they went to St. Lucia in the West Indies, also an Orthopaedic Overseas Organization operation, where they stayed for six weeks. He served from 1983-to-1986 and 1992-to-1995 as Chief of Surgery at St. Joseph’s Hospital (now St. Joseph’s Medical Center). “I had the opportunity to work with him while he served as Chair of the Department of Surgery at St. Joseph’s and I was Vice President for the Medical Staff,” Dr. Hermann said. “He very capably managed several difficult situations and was able to deal firmly and fairly with a few recalcitrant surgeons’ egos. Stan was a true gentleman and a highly respected Orthopaedic Surgeon, both by his patients and the medical community.”

“All that I may have achieved would not have been possible

without the support and driving energy of my loving wife of 63 years and the protection of our

living God, Jesus Christ.” - Dr. Stanley Clark


Please join us for the

Annual Membership Dinnerhonoring our 2010 Lifetime Award Recipent

Dr. Stanley Clarkand our

2010 Young Physician Award Recipient,

Dr. Ramin Manshadi

SunDAY, June 27, 2010Cocktail Reception 6:00pm – Dinner 7:00pm

Stockton Country Club3800 Country Club Boulevard • Stockton, California

Additionally, we will honor the passing of the gavel from President Lawrence Frank, MD to President-elect James Halderman, MD

Premier SPonSor

gold SPonSorS

Silver SPonSor

bronze SPonSor

Member Physicians and Spouse/Guest $35 per person

non-Members and Invited Guests

$60 per person

Call in your reservation to Gena at the

Medical Society: (209) 952-5299


cOMMUNITy > Healthy Families Program


A Healthy Plan for San JoaquinWhen it comes to health, many people have a trusted community physician, a neighborhood pharmacist and a favored area hospital. With so much of healthcare being local, why wouldn’t somebody want a local health plan that works closely with these providers in coordinating that care? Th at was the thinking in 1994 when San Joaquin County decided to develop its own community health plan -- Health Plan of San Joaquin. Now, over 15 years later, HPSJ, as it’s commonly called, has reached a membership of 100,000 area residents through a focus on customer service, quality, and community involvement. Health Plan of San Joaquin was initially launched to serve local families in the State Medi-Cal Program, providing health benefi ts for low income and vulnerable families. Since its inception, HPSJ has expanded to serve more Central Valley residents. In addition to being the leading health plan among San Joaquin County Medi-Cal participants, HPSJ is now the largest health plan in the area serving children through the State’s Healthy Families Program. In 2009, Health Plan of San Joaquin began off ering AIM (Access for Infants and Mothers), a health coverage program for uninsured or underinsured women who are pregnant. “Th ere’s no question that being local has had a positive impact on our success,” said David Hurst, the Health Plan’s vice president of marketing. “For members, the idea of being served by a plan that is highly visible in the community and easily accessible is unique. We’re able to be involved with our members in a more direct way because we’re right here.” Some high touch eff orts to work with members include personal case management, face to face customer service, community outreach and a special member advisory committ ee that provides feedback and suggestions to the Health Plan regarding its programs. Hurst notes that many of HPSJ’s eff orts to engage with members are particularly tailored to the community. “We’ve developed health improvement programs that allow us to work with trusted community agencies, schools, churches, non-profi ts

and other trusted organizations that serve our clients to promote preventive care, wellness, the importance of health coverage for families,” said Hurst. Beyond customer service, the Health Plan’s commitment to quality extends to the health services members receive. Quality measurements among health plans have placed HPSJ among the highest in the state in areas such as immunizations and well child exams. HPSJ has emphasized preventive care for members by developing an incentive program that rewards members for gett ing appropriate care with gift cards for adults and movie tickets for kids.

HPSJ’s focus on access has resulted in an expansive physician and provider network, including nearly 200 primary care physicians and over 600 area specialists. HPSJ is also the only plan participating in the Medi-Cal and the Healthy Families Programs with

relationships with all hospitals in San Joaquin County. Beyond the benefi ts and services provided to members, the Health Plan also places a priority on investing in community health initiatives. In 2009, the Health Plan provided $150,000 in grants to community-based organizations for their health programs focused on access to healthcare, nutrition and physical activity and other key community needs. HPSJ also launched the Health Careers Scholarship Program, providing funds to graduating high school students that plan to pursue health professions and brings those skills back to San Joaquin County. HPSJ’s success in San Joaquin County and unique model as a community health plan prompted its expansion to Stanislaus County (Healthy Families and AIM) and Merced County (Healthy Families). Health Plan of San Joaquin is headquartered with offi ces in French Camp, providing easy access for members, providers and the community from all points of region. For information about the Health Plan or coverage programs that may be available for uninsured community residents, call 1-888-936-PLAN.


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Independent But Not Alone.

Hill Physicians’ 3,500 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Health Administrators (San Joaquin), Health Net, PacifiCare and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt-in.

Independence and strength are not mutually exclusive. Practices affiliated with Hill Physicians Medical Group retain independence while enjoying the strength that comes from being part of a large, well-integrated network of physicians. Hill’s advantages include:

• Fast, accurate claims payments

• Free electronic communication capabilities via RelayHealth

• RN case management for complex, time-intensive cases

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• Preventive care and disease management reminders for patients

• High consumer awareness that attracts patients

That’s why 3,500 independent primary care physicians, specialists and healthcare professionals have made Hill Physicians Medical Group one of the country’s leading Independent Physician Associations. Get more for your practice with Hill.

Get more information about Hill Physicians at www.HillPhysicians.com/Providers or contact: San Joaquin area: Paula Friend, regional director, (209) 762-5002, [email protected]

Sacramento area: Doug Robertson, regional director, (916) 286-7048, [email protected] Bay area: Jennifer Willson, regional director, (925) 327-6759, [email protected]

Steven Wall, M.D.Hill Physicians provider since 2004.Uses Hill inSite, Hill EHR, Ascender andRelayHealth for eClaims processing, electronichealth records, practice management,preventive care reminders and secure onlinecommunications with patients.

Your health. It’s our mission.

San Joaquin Physician (Dr. Wall).indd 1 2/3/10 9:22:02 AM


IN THENeWS

cOMMUNITy > news

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

Hill Physicians Begins Serving San Joaquin Medi-cal RecipientsHill Physicians Medical Group began providing care to San Joaquin’s Medi-Cal recipients on April 1, 2010. The arrangement also brings the doctors of San Joaquin General Hospital into the Hill Physicians provider network for Medi-Cal enrollees.“We’re very pleased,” says Paula Friend, regional director for Hill

Physicians in San Joaquin. “Medi-Cal is an important safety net for people and now we and our colleagues at San Joaquin General Hospital can work together to help provide care to people who rely on Medi-Cal in our community.”Combined, there will be 195 primary care doctors and specialists from Hill Physicians’ San Joaquin provider network and San Joaquin General Hospital available to Medi-Cal enrollees through Anthem Blue Cross. Medi-Cal recipients have the option of selecting coverage and providers through Anthem Blue Cross or Health Plan of San Joaquin, the two Medi-Cal managed plans contracted with the State’s Department of Health Care Services. Anthem Blue Cross is transitioning from a direct contracting arrangement in favor of a medical group or independent physician association model, which is expected to place more emphasis on primary care and prevention. Hill Physicians is one of the groups selected by Anthem to provide those services and more than 132 doctors from Hill’s local network chose to participate. Another 63 doctors from San Joaquin General Hospital are joining Hill Physicians Medical Group in order to serve Anthem Blue Cross local Medi-Cal beneficiaries.“I’m glad that a medical group as well-respected as Hill Physicians is caring for Medi-Cal members in our community,” says Dr. Robert Abatecola, a family medicine practitioner with San Joaquin General Hospital. “Some Medi-Cal enrollees have complex medical situations and Hill brings resources in patient education, preventive care and case management that go far beyond what an individual physician can offer.” Hill Physicians Medical Group is nationally recognized for its expertise in managed healthcare, and was awarded “Elite” status by the California Association of Physician Groups in 2009 – its highest designation. Hill Physicians began serving Medi-Cal members in Sacramento in late 2008 and plans to begin doing so in San Francisco later this year.“We’re committed to serving Medi-Cal members, “says David Culberson, director of San Joaquin General Hospital. “Our clinics and community medical centers now can serve more people through this affiliation with Hill Physicians.” San Joaquin General Hospital operates 30 outpatient clinics, many of which recently have been updated, and has developed a Hospital Master Plan that will revamp the hospital campus. Many Medi-Cal beneficiaries will receive letters letting them know that they will become Hill Physicians members through

get to Know cMA’s New ceO Dustin corcoran

golf, shyness, marriage, Bob Dylan and the future of cMA…what do they all have in

common? They define cMA’s new ceO, Dustin corcoran. For the full story, watch cMA’s nine

minute video now posted on youTube. To find it, simply search for Dustin corcoran or go to www.sjcms.org and the link is on our “About Us” Page.


news < cOMMUNITy

Anthem Blue Cross. The change does not impact Medi-Cal enrollees who receive services through Health Plan of San Joaquin._______________________________________

Dr. yao Joins Lodi Vine clinic - Neurologist Weiping Yao, MD, joins the Lodi Memorial Community Clinic - Vine in May. This specialty-medicine practice is also home to Frank Huang, MD, an endocrinologist. Dr. Yao graduated from Sun Yat-Sen University of Medical Sciences, in China, in 1983. The Lodi Memorial Community Clinic - Vine is located at 1235 W. Vine St., Ste. 22, in Lodi. Current patients can call for appointments, and new patients are welcomed with a physician’s referral. Most insurances are accepted. Call 334-8520 to schedule an appointment.________________________

Surgeon Peter Tuxen, MD, Joins St. Joseph’s Medical group - St. Joseph’s Medical Group of Stockton is pleased to welcome surgeon Peter A. Tuxen, MD, to their medical group of Family Practitioners, Internal Medicine Specialists, Pediatricians, and General Medicine Practitioners. Dr. Tuxen has joined St. Joseph’s Medical Group, but will remain in his current office located at 1805 N. California Street, Suite 409, here in Stockton. A surgeon in the Stockton area since 1977, Dr. Tuxen is a prominent leader in his field. Dr. Tuxen is a member of the Surgical Committees at St. Joseph’s Medical Center, as well as at Dameron Hospital, and is also a member of the Tumor Board and the Surgery Quality Assurance Committee at St. Joseph’s. He is the Chairman of the Surgery Department and a member of the Tissue and Transfer Committee at Dameron. During his tenure, Dr. Tuxen has held numerous medical staff committee positions, including a term as President of the Medical Staff at St. Joseph’s. Dr. Tuxen is a positive role model for colleagues and dedicated to providing top quality care to his patients. “I connect with my patients on a very personal level,” says Dr. Tuxen. “They share things with me they don’t share with other people because we’re talking about very private and personal aspects of their health. I enjoy getting to know them and using my 30 years of surgery experience to improve their health.”

Dr. Peter Tuxen attended the University of Colorado, in Boulder, CO, and completed his residency at San Joaquin General Hospital. Board Certified by the American Board of General Surgery, the American Board of Colon and Rectal Surgery and the Drug Enforcement Agency, Dr. Tuxen is a member of the American College of Surgeons, the American Society of Colon and Rectal Surgeons, the San Joaquin Medical Society, the California Medical Society, the Northwest Society of Colon and

Rectal Surgeons, and the Northern California Society of Colon and Rectal Surgeons. Dr. Tuxen has been a member of the medical staff at St. Joseph’s Medical Center since 1977.________________________

St. Joseph’s Women’s Imaging center continues Services in Mobile Mammography UnitOn Sunday, March 28, 2010, St. Joseph’s Women’s Imaging Center, located at 2320 N. California Street, Stockton, was destroyed by a fire. Fortunately, all of the patient records were recovered and relocated to St Joseph’s Medical Center.Continuing their commitment to serving patients and providing the highest quality mammography and breast imaging, St. Joseph’s Women’s Imaging Services has been temporarily relocated to the St. Joseph’s Mobile Mammography Unit (MMU), at 542 McCloud Ave., adjacent to the hospital. St. Joseph’s Mobile Mammography Unit is a fully accredited and licensed digital mammography unit that routinely travels throughout Northern California, serving women who do not have access to mammography services.

The same technicians and radiologists who perform and read the mammograms

for the Women’s Imaging Center will continue to provide services through the MMU. St. Joseph’s is in the process of developing a new north Stockton location to re-locate the Women’s Imaging Center in the Fall. For questions and/or appointment scheduling information, please call (209) 466-5028._______________________________________

Susan McDonald, MD, Appointed Vice President of Medical Affairs for St. Joseph’s Medical center - Susan McDonald, MD has been appointed to Vice President of Medical Affairs (VPMA) for St. Joseph’s Medical Center, Stockton. As VPMA, Dr. McDonald

Dr. yao Joins

Surgeon Peter Tuxen, MD


IN THENeWS

cOMMUNITy > news

will work closely with the entire medical staff to advance clinical and patient safety strategies and directly oversees the facility’s medical directors and medical staff office. Dr. McDonald has been a member of St. Joseph’s medical staff for almost three years as an Anesthesiologist with Stockton Anesthesia Medical Group, Inc. (SAMGI). In addition to her full time position as the VPMA, Dr. McDonald will continue to provide anesthesia in a limited capacity. During her tenure on the medical staff at St. Joseph’s, Dr. McDonald served as the Chairperson of the Anesthesia Quality Committee, the IRB, and championed efforts such as the medical center’s procedural sedation policy, exsanguinations protocol, and the implementation of the OB epidural program. Prior to SAMGI, Dr. McDonald worked at Virginia Mason Medical Center in Seattle, Washington, for 11 years.Dr. McDonald received her medical education at the University of Pennsylvania and is Board Certified, Diplomate Status, in Anesthesiology. ________________________

Sutter Tracy’s New High-Tech MRI Helps Doctors get the Full PictureDetecting tumors, blood clots, weak blood vessels and other problems inside the body is faster and easier than ever with Sutter Tracy Community Hospital’s new state-of-the-art magnetic resonance imaging

(MRI) system. The high resolution, three-dimensional images produced by the MRI let physicians view the body’s organs and tissues at many different angles

painlessly and quickly without using radiation. The $2 million MRI system from General Electric is the best in its class

and the only MRI in the area equipped with a separate, more comfortable table dedicated to breast MRI. The new MRI is the latest addition to Sutter Tracy’s line of high tech services, which includes digital X-ray and mammography, advanced computed tomography (CT), and stereotactic breast biopsy. “MRI technology has advanced tremendously over the past few years producing higher resolution images in less time. With this new MRI, we can make faster, more accurate diagnoses which will lead to better treatments and outcomes for patients,” said T. Tejpal Singh, medical director for Sutter Tracy Imaging Services. “The new MRI can image the breast, which we couldn’t do with our old MRI so we had to refer those patients to facilities

outside of Tracy. Now our patients can receive the care they need close to home. The new unit also produces much improved images of abdominal organs and blood vessels.” Women at high risk of developing breast cancer are among those to benefit most from the new MRI, added Dr. Singh. While mammography is still the screening tool of choice for most women, research shows that MRI is better at detecting breast cancer than mammography alone in certain women at high risk for breast

cancer – i.e. those with a strong family history of breast cancer or a genetic mutation that predisposes them to the disease. Sutter Tracy’s new MRI is also equipped with computer-aided detection (CAD), a system of hardware and software applied to breast MRI images. The system works like an “additional pair of eyes” and helps radiologists to more quickly and accurately determine the size and location of cancers found on breast MRI. The top-of-the-line MRI is capable of many other advanced applications as well, including

magnetic resonance angiography (MRA). MRA provides a non-invasive alternative for diagnosing damaged blood vessels in the brain following a stroke or circulatory problems in the legs, arms and organs such as the kidney. The new MRI isn’t the only change patients will notice. Sutter Tracy moved their MRI suite to a new larger building closer to the hospital to provide greater convenience for patients and their loved ones. Unlike the previous location, the new MRI suite has its own beautifully decorated waiting area and private changing room. “We put a lot of effort into improving the patient’s experience as well as upgrading our equipment,” said David Bowlsby, Sutter Tracy Imaging Services manager. “The larger space, big windows

Susan McDonald, MD,


cOMMUNITy > news

and special touches make visiting the MRI suite much more pleasant and comfortable for everyone involved. It’s all part of Sutter Tracy’s effort provide the community with the best health care services possible.”________________________

A Message from SJ Public HealthPHS needs a volunteer Obstetrician to participate on the Fetal-Infant Mortality Review (FIMR) Team. The Team reviews deaths of infants <1 year old, with particular attention to deaths occurring among African-Americans. The Obstetrician would greatly benefit the Team by providing information on risk factors related to adverse fetal outcomes as well as medical background on prenatal care, labor, and delivery. Meetings occur every other even month (except December) at St. Joseph’s Cancer Center. Lunch is provided. Next two meetings: June 24 and August 26 from 12:00-1:30 PM. PHS also needs a volunteer Pediatrician to participate on the Child Death Review Team. The Team reviews deaths of children <18 years old. The Pediatrician would play a vital role on this Team by providing medical information on child development, childhood diseases, and injuries. Meetings are held on the 3rd Thursday of every month at the Sheriff ’s Office in French Camp. Each Team Member receives cases to review 1-2 weeks in advance of a meeting. If a Member is unable to attend a certain meeting, s/he only has to let the coordinator know. Interested physicians can contact Dr. Wendi Dick, Assistant Health Officer, at (209) 468-3859 or [email protected]

________________________

St. Joseph’s Medical center Receives National Award for environmental excellence St. Joseph’s Medical Center has

received the highest environmental achievement award presented by Practice Greenhealth, a national membership organization for health care facilities committed to environmentally responsible operations. St. Joseph’s was named a member of the Environmental Leadership Circle, Practice Greenhealth’s most prestigious award. These competitive awards are given within the healthcare sector to institutions for outstanding programs to reduce the facility’s environmental footprint. “All of our members are committed to improving health care’s environmental performance, but there is an illustrious group of facilities setting the highest standards,” said Practice Greenhealth Executive Director Bob Jarboe. “They are the best of the best, the recipients of our top award. St. Joseph’s Medical Center has introduced extensive environmental strategies into health care and is committed to achieving further improvements.”

The Environmental Leadership Circle recognizes healthcare facilities that exemplify environmental excellence and are setting the highest standards for environmental practices in health care. Award winners are chosen by the Practice Greenhealth award review team from the top Partner for Change applicants. To be considered, facilities must meet the criteria for the mercury-free award, recycle at least 25 percent of their total waste stream, have implemented numerous other innovative pollution prevention programs, and are leaders in their community. This is the fifth consecutive year that St. Joseph’s Medical Center has attained the Environmental Leadership Status. St. Joseph’s has been part of the Environmental Leadership Circle since its inception in 2007. Each year, the hospital strives to achieve the highest level possible of environmental awareness and conservation integration. The many recycling programs ongoing


at St. Joseph’s include green waste, batt eries, cans, bott les, wood pallets, hospital products such as blue wrap and shrink wrap, baby bott les and energy effi cient laundry washers. “We take pride in being an environmental leader within the health industry and are dedicated to continuously striving to improve our environmental performance,” said John Kendle, St. Joseph’s Director of Operations, Support and Services. “Th e Environmental Leadership Circle is only going to get more crowded as more health care facilities make a commitment to reduce the health and environmental impacts associated with health delivery.” St. Joseph’s Medical Center has also implemented the use of 100% post-consumer waste recycled paper for the entire hospital, reusable isolation gowns, reusable sharps containers, and initiated onsite vermicomposting for wet kitchen scraps. St. Joseph’s has also begun a partnership with MedShare, which acts as a recycling and distribution center for surplus medical supplies and equipment. Th ey redistribute donated product to healthcare facilities in our community and in economically developing countries that have litt le or no medical resources.________________________

cMA Alert: New Physician Signage Regulations Take effect June 27California physicians will soon be required to inform their patients that they are licensed by the Medical Board of California, and to provide patients with the board’s contact information.Despite CMA objections, the Offi ce of Administrative Law recently approved these regulations, which are intended to let consumers know where to go for information on or with complaints about California medical doctors. CMA believes these regulations are an unnecessary administrative burden as state law already requires physicians to post their medical license or wear

a name tag indicating their licensing status. Th e new regulations, which take eff ect June 27, 2010, require physicians to provide this notice by one of three methods:1. Prominently posting a sign in an area of their offi ces that is conspicuous to patients, in at least 48-point type in Arial font. 2. Including the notice in a writt en statement, signed and dated by the patient or patient’s representative, and kept in that patient’s fi le, stating the patient understands the physician is licensed and regulated by the board. 3. Including the notice in a statement on lett erhead, discharge instructions, or other document given to a patient or the patient’s representative; the notice must be placed immediately above the patient’s signature line in at least 14-point type. Regardless of which method you choose, the notice must read as follows: “NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322, www.mbc.

ca.gov.”According to the medical board, physicians, not facilities, are responsible for compliance with this regulation. In group sett ings, only one sign must be posted (should that option be chosen), but it must be posted in a location where it can be seen by all patients.Although CMA strongly supports patient access to information about a physician’s education, training, and other qualifi cations, we believe that it would be more useful to provide patients with specifi c information about the education and training of their physicians. To that end, CMA is cosponsoring a “truth in advertising” bill along with the California Society of Plastic Surgeons. Our bill would require all health care practitioners to display their educational degree, license type and status, and board certifi cation on either their nametag or in their offi ces, to help patients bett er understand the credentials of a health care practitioner prior to receiving treatment.

San Joaquin Medical Society members can

call our office to request a FRee laminated sign for your office.

you may also visit our website to download a PDF sign,

sample letters and additional information on this important

topic.


Young Physician Award Winner:

Dr. Ramin ManshadiBy William West


Dr. Ramin Manshadi is the first recipient of the Young Physician Award from the San Joaquin Medical Society. The forty-

four-year-old interventional cardiologist was chosen because he of his dedication to high standards of patient care and innovative techniques, his engagement in professional organizations, and his community involvement. An example of patient care and innovation is the case of the Stockton woman who now lives because a heart pump circulates her blood. When the then 59-year-old woman experienced acute heart failure after suffering from chronic heart failure, her blood pressure plummeted toward zero. She was in cardiogenic shock. She was past Class 4 heart failure. Dr. Manshadi referred her to the Heart Failure/Transplant Program at California Pacific Medical Center in San Francisco , a hospital authorized to use an experimental heart pump that is small enough to be portable. The machine is known as a left ventricular assist device or LVAD. Because Dr. Manshadi pushed hard on behalf of his patient, he found a way for her to survive. Another example is a nearly 80-year-old man who received a defibrillator-pacemaker implant that wirelessly transmits heart function data to an internet site that Dr. Manshadi can monitor. The man lives in the foothills and this data stream enables Dr. Manshadi to get critical feedback, especially when the patient has an episode of distress. The technology, which at the time it was implanted by Dr. Manshadi was the first in this area, allows correlation of heart function data to symptoms. In addition to a busy private practice, he finds the time and energy to serve as an Associate Clinical Professor at UC Davis and a Clinical Professor at the UOP

School of Pharmacy. “I try to balance my private practice with teaching and also the American College of Cardiology’s California chapter,” said Dr. Manshadi. “I think each activity helps me to be a better doctor and take better care of my patients.” He has a special interest in Sudden Cardiac Death in athletes. On the bookshelves in his Pacific Avenue office are photos of Dr. Manshadi with former 49er quarterback, Joe Montana and with Sacramento Kings general manager Geoff Petrie. He has worked to increase

awareness of the symptoms that may indicate increased risk for SCD in athletes. In collaboration with Dameron Hospital, he has donated defibs to all the high schools in Stockton . He has helped find donors for defibrillators in local schools and his goal is to place them in every school in California . He just completed an agreement with the St. Joseph ’s Foundation to partner in the defibrillator effort. Also, he just finished a PSA video with the Sacramento Kings Coaches and players that is found at the HYPERLINK “http://Kings.com” \t “_blank” Kings.com website. SCD is a condition in which the heart stops abruptly without warning. This is usually caused by ventricular fibrillation, which is an abnormality in the heart’s electrical system and will result in death if not treated immediately. “Most SCD is caused by hidden heart problems that are not recognized by coaches or staff,” Dr. Manshadi said.

Heart abnormalities could be detected through a physical examination that includes standardized medical history questions and an electrocardiogram (EKG). The EKG should be given by a cardiologist or internist. An abnormal reading could signal a problem that would require follow-up. “I believe genuine interest in people is the key to all these things that I do,” Dr. Manshadi said. “If you are more a businessman physician than truly interested in helping people, the involvements in groups won’t work. One

must be more altruistically motivated.” Dr. Manshadi has offered free clinics for the uninsured. He has provided full Thanksgiving meals for eight families. Dr. Manshadi was born in Israel and his family moved to the United States in 1978 from Iran , thankfully missing the 1979 Iranian fundamentalist revolution. He is a Baha’i, a faith not well-regarded by the

Iranian government. His faith is a guiding light in his

professional and personal life. The doctor earned a B.S .in Physiology, University of California , Davis ; a M.S. in Physiology, University of Health Sciences/ Chicago Medical School, 1991; a M.D., University of Illinois at Chicago Health Sciences Center He is certified with the American Board of Interventional Cardiology, American Board of Nuclear Cardiology, American Board of Internal Medicine, and the American Board of Cardiology He has been a national speaker for pharmaceutical companies including Pfizer, GlaxoSmithKline, and Merck. Manshadi was voted Top Interventional Cardiologist 2007 by Castle Connelly ; America’s Top Cardiologist 2006-2007 by the Consumers Research Council, and Future Leader Award by American College of Cardiology California Chapter.

“I believe genuine interest in people is the key to all these things that I

do,” Dr. Manshadi said. “If you are more a businessman physician than truly interested in helping people, the involvements in groups won’t

work. One must be more altruistically motivated.” -Dr. Manshadi


Re-Launch of Community Internship ProgramPopular program led by Dr. Joe Serra sets dates in September

cOMMUNITy SeRVIce > internship program

In today’s health care environment of spiraling costs, confusion, criticism, litigation, and misunderstanding, health professionals must respond to medical consumers’ concerns by establishing ongoing and open communications. These communications must flow both ways if we are to resolve conflicts and devise constructive methods of containing costs without sacrificing patient care. Our Mini-Internship Program is an effort to achieve these ends by exposing the humane concerns of physicians through firsthand experience for interns. It also gives physicians input from a broad spectrum of community representatives as well which many find helpful in running their practice. It is for these reasons, that the medical society, through the persistence of Dr. Joe Serra who serves as the Community Relations Chair, is re-launching this popular program and already has several interested community leaders committed to participate. Interns will once again be invited from business, politics, media, labor, clergy, education, law, and the insurance industry, patient advocacy, or social service agencies, legislative, judicial, and regulatory organizations as in the past. This first program will take place during the week of September 13 – 17, 2010 with participants spending half a day in each one-on-one placement with physicians, rotating through a minimum of two assignments during the three-day project with the option of adding additional half days with other physician(s) to include more assignments. Interns are encouraged to ask questions and comment freely during their visits with physicians. In 2011, we plan to expand the program to twice a year to include as many people as possible in these small group experiences. Participating physicians represent the gamut of medical fields, from primary care (family and internal medicine,

Quick Facts!PROgRAM DATeS:

Orientation Meeting – Monday, September 13

6:00pm Stockton golf and country club

Shadowing Days – Tuesday- Thursday, September 14 – 16

Participants choose 2-3 half day sessions

Dinner Presentation – Thursday, September 16

6:30pm Stockton golf and country club

APPLIcATION PROceSS:

Further information and Application is available online at www.sjcms.org or call our office to request material be mailed at 952-5299

Participation is limited for this unique program.


pediatrics and obstetrics/gynecology), through emergency medicine, surgery, and a host of specialties. As with past schedules, the program consists of a reception at the Society offices to give the participants and the physicians an opportunity to get to know one another. The next two or three days provides participants one-on-one experiences to observe side by side activities of the physicians as they see patients, conduct surgery or other procedures. The last activity includes a dinner with all of the participants and physicians to share their experiences and discuss the outcome. Every year this joint dinner includes a robust discussion of the value of the experiences and how it will help participants in their role to share their positive experiences through their individual profession. Physicians also shared the perceptions they had gained of how valuable the experiences seemed to be to them and the participants with whom they interacted.

One of the outcomes of the last session held in 2004 was an entertaining article in The Stockton Record written by participant/writer Gilbert as she covered her time with Orthopedic Surgeon Dr. Mikaelian and Radiologist Dr. Khoury and how it related to her profession. In a thank you note to Dr. Serra she wrote, “I feel honored

to have been asked and can’t tell you how much I value the experience.” She went on to write that “It was a fascinating, mesmerizing experience to see Dr. Mikaelian perform arthroscopic surgery. I will never forget the images and process that I witnessed. And after looking at film with Dr. Khoury, I understand why my doctor has never bothered to actually show me my own

MRI films. These doctors were wonderful teachers, kind,

patient, thorough, and I learned a lot.” She wrapped up her note by writing, “This Program was a wonderful experience, and I appreciate all you did to make it possible.”

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RISK MANAgeMeNT > medical records

Managing Professional RiskMaking Changes to a Medical Record: Corrections vs. AlterationsBy Mary-Lynn Ryan, Risk Management, NORCAL Mutual Insurance Company and the NORCAL Group

Appropriate, consistent and accurate medical record documentation promotes quality patient care by providing a comprehensive patient history and facilitating continuity of care among different members of the healthcare team. The medical record is also the best evidence of care provided, should that care ever be questioned in medical liability litigation. Physicians can preserve the medical record’s effectiveness as a patient care tool and as a defense tool by resisting the temptation to inappropriately change the record. Whereas appropriately executed corrections are a relatively benign aspect of documentation, medical record alterations can cast doubt on the physician’s credibility and make an otherwise defensible case one that has to be settled. Defining Alterations: When a physician receives notice of a lawsuit and goes back to the medical record to “clarify” certain points for the purpose of aiding the defense of the claim, it is an alteration. Medical record alterations are considered a deliberate misrepresentation of facts. When an alteration is discovered during medical liability litigation it seriously impacts

the ability to defend the claim. Additionally, many medical liability policies exclude coverage for claims in which the medical record was altered, which means the physician may end up paying for a judgment and defense costs out of pocket. Defining Corrections: When a physician changes a patient’s medical record during the normal course of treatment, before the issue of a claim or lawsuit arises, it is a correction. Corrections are acceptable, provided the changes are made appropriately.

Tips for Appropriate Medical Record Correction

Develop a medical records correction policy that incorporates the following recommendations:Mark the original (erroneous) entry through with a single line. Do not obscure the entry with correction fluid or ink. Do not attempt to write the intended number or word on top of the erroneous one(s) (i.e., “write over”). Sign, date and time the new (correct) entry.


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Never “back date” an entry to the medical record.If appropriate, direct the reader’s attention from the original, erroneous entry to the corrected entry, especially if it is not readily apparent that the subsequent entry is a correction.After a corrected entry has been added, never physically remove or erase an erroneous entry from the patient’s chart. The earlier (erroneous) entry may have been relied upon by other members of the healthcare team. To physically remove it would therefore falsely represent the integrity of the record.Develop policies and procedures that address making an addendum (or late entry). Write a note as an addendum if there is a need to write an entry in the record that is not contemporaneous with the finding or treatment being described. Place this addendum entry chronologically in the record, based on when it is being entered in the record. At the beginning of the addendum, explain to what the addendum refers. Sign, date and time the addendum entry.

Electronic Health Records

Users of electronic health record (EHR) systems should not be able to make changes to a computerized record indiscriminately or anonymously. When medical practices select an EHR system, they should ensure that once information is entered it cannot be removed. Although many software vendors claim that information cannot be removed or altered, practices should perform due diligence to confirm vendors’ security claims. In a properly functioning EHR system, any changes to the medical record must be made as addendums and dated appropriately so that later they cannot be construed as alterations.

Conclusion

Physicians should never place themselves in the position of having to defend a medical record alteration. There is almost always a price to pay, and the price can be high.

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.


In the early 1960s, S.J. Medical Society members Dr. Robert Browne and Dr. Virgil Gianelli voluntarily provided health care to those who had none—migrant farm workers and their

families. Their pioneering outreach spawned a wave of other medical and dental volunteers. Within a decade that volunteerism led to Community Medical Centers with eleven clinics. Today, CMC provides Care Link, a group who visit farms, shelters, and homeless on the streets. Care

Link / CMC will open their twelfth clinic in the former home of a Stockton legend: Edna Gleason.

TAKING STREET MEDICINE TO

THE GLEASON

HOUSE

By William West l Pictured: Randy Pinelli and Angie Carlos tend to a street person.


Edna Gleason, born in 1886 in Stockton, fed the hungry and homeless from the backyard of her house on South San Joaquin Street. In the basement she kept powdered milk that the needy could access through a small door in the back of the house. She kept a separate bank account for cash assistance to the impoverished. Soon, her historic house will be the home to a medical clinic for the needy of today. The Gleason House Medical Clinic is a collaborative effort of the Care Link - Community Medical Centers’ “Health Care for the Homeless” program and the Gospel Center Rescue Mission (GCRM). “Through their clinics, distributed throughout the county, Community Medical Centers provide much needed primary care access to the growing underserved population in our community,” said Dr. Dale Bishop, the Medical Director of the Health Plan of San Joaquin. “The Gleason House program, in particular, targets care to those with the greatest needs and most challenging access issues in this population.”

Community Medical Centers began in the 1960’s as a volunteer effort of the San Joaquin Medical Society to help migrant farm workers. The volunteer doctors drove to the fields to offer medical care, food, and clothing.

Dr. Robert Browne, a family practitioner, and Dr. Virgil Gianelli began the outreach to migrant worker campsites. They worked from the trunks of their cars. This became the local Migrant Farm Workers program and eventually the CMC. Both doctors were Stockton natives.“Gianelli never forgot his roots,” said Browne, according to a press release from the

SJMS in 2004 when Dr. Browne received the Lifetime Achievement Award. “He grew up on Wilson Way and he was really dedicated to taking care of disadvantaged people. In those days, there were no clinics for migrant farm workers. Most of them lived in tents in Linden. We used to go to the tents, sometimes churches. We even set up a clinic at the Linden Fire Department.” In 1967, with federal and state funding, the SJMS developed

cOVeR STORy > gleason house

Community Medical Centers fi rst trailer provided care in remote places and at jobsites – circa 1967.

Dr. Robert Browne, a family practitioner, and Dr. Virgil Gianelli began the outreach to migrant worker campsites. They worked from the trunks of their cars. This became the local Migrant Farm Workers program and eventually the CMC. Both doctors were Stockton natives.“Gianelli never forgot his roots,” said Browne, according to a press release from the

SJMS in 2004 when Dr. Browne

“The number of patients we serve has continued to grow at a steady rate with

marked increases over the past fi ve years—more recently in response to

persons who have lost their employment and insurance,” Mike Kirkpatrick


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44 SAN JOAQUIN PHYSICIAN WINTER 200944 SAN JOAQUIN PHYSICIAN

Mrs. Gleason, who was

the first woman on the

Stockton city council,

was a self-taught

pharmacist who passed the state-licensing

exam and then had to fight licensing board

to be certified. Reportedly, a month after she

received the license, her husband (a pharmacist)

died. She eventually owned several pharmacies

in Stockton. She served as president of the

California Pharmaceutical Association in 1933

and 1934.

Though she died childless in 1963, there are still

those who remember her.

“Griselda Olivas, who is with the Care Van at

St. Joseph’s, grew up next door to Mrs. Gleason

and still remembers her,” said Angie Carlos, an

outreach worker for Care Link, while standing

inside the Gleason House during a recent tour.

“Griselda was just a little kid and would sneak

into Mrs. Gleason beautiful backyard. It was lush.

She got in trouble one day for sneaking in.”

“The more you learn about the Gleason House

and Edna Gleason, the more you start to feel the

cohesion of the whole community,” said Randy

Pinelli, Homeless Health Care Services Director.

“For example, the UOP pharmacy school was

advised at

its inception

by Edna

Gleason.”

Gleason Park,

not far from

her house,

was dedicated

to her in 1975.

two clinical facilities and a mobile clinic. Now, CMC has eleven clinics in San Joaquin, Solano, and Yolo counties.Sometime in 2010 the renovated Gleason House is scheduled to open as the CMC’s twelfth medical clinic for the homeless and impoverished. “The Gleason House Homeless Clinic has been a work in process,” Mike Kirkpatrick, CEO of Community Medical Centers said. “We first began to seek funding to develop it over eight years ago. Requests were denied by the Bureau of Primary Health Care for three years in a row and we then began to look at special congressional appropriations. Three years later we were successful in obtaining some funds to begin the renovation project, but were short the total needed.”As part of the American Recovery and Reinvestment Act, additional funding was obtained but not enough to cover all the renovation costs. “Since then,” Mr. Kirkpatrick said, “we have partnered with the Gospel Rescue Mission to apply for Community Development Block Grant funds, which were recently approved by the City of Stockton and the County—so almost a decade of perseverance has finally made the project feasible.” “Services will be targeted to homeless individuals and families in the Stockton area who are housed in shelters or living under bridges,” Mr. Kirkpatrick said, “This is much the way we started our clinic program in 1965 when we served Migrant Farm Workers along the ditch banks and in the orchards near Linden.” CMC serves over 69,000 individuals each year with primary medical care including Family Practice, Pediatrics, Internal Medicine, and OB/GYN physicians—about 35 Full time physicians, 10 mid-level practitioners (who work for the organization), and 2.5 FTE OB/GYNs under contract through San Joaquin County. The total employee group is 365. “We offer evening, Saturday, and holiday hours at most locations, in addition to our regular daytime hours,” Mr. Kirkpatrick said. “Physicians are on call for after-hours coverage and in-patient care is coordinated in San Joaquin County with San Joaquin General. Of our patient population, 60% are Medi-Cal, 30% are uninsured who pay for services discounted on a sliding fee scale, and the remainder include some State and local contracts, Medicare, and private insurance. Over 70% of our service activity occurs in San Joaquin County.” The largest segments of CMC’s patient population are children and adults to age 30. Second largest is 30 to 60 years old and about 5% over 60. Ninety percent of patients are below 200% of federal poverty guidelines. “The number of patients we serve has continued to grow at a steady rate with marked increases over the past fi ve years—more recently in response to persons who have lost their employment and insurance,” Mr. Kirkpatrick said. Community Medical Centers is appreciative of the community support it has received over the years,” Mr. Kirkpatrick said, “and thanks the physician members of the San Joaquin Medical Society and our hospitals for the cooperative partnerships we have developed to assure a strong safety-net is available to the uninsured and under-insured populations.”

WINTER 2009 SAN JOAQUIN PHYSICIAN 45fALL 2009 SAN JOAQUIN PHYSICIAN 45SAN JOAQUINSAN JOAQUINSAN JOAQUIN PHYSICIAN PHYSICIAN PHYSICIAN 454545

CARE LINK FACTS:In 2001 Care Link – CMC’s Health Care for the Homeless Program received $250,000 in Federal support and began providing services with an initial goal of providing care for 1,000 homeless individuals annually. Since its inception Care Link has consistently provided no-cost health care for more than 1,500 homeless individuals annually (with a single year high of over 1,700 users) and provided nearly 5,000 patient encounters per year. In 2007 CMC served 7707 migrant and seasonal farm workers, 1823 homeless and 179 HIV/AIDS patients (2007 UDS Report).

Within the county the problem of homelessness is most acute in the Stockton area. A 1989 study by Mendelson and Associates found that there were 3,000 homeless persons in San Joaquin County with 90 percent in the Stockton area. Since this report was prepared over 16 years ago, the number has undoubtedly grown. CMC counted approximately 1823 homeless persons among its user population in 2007, including those served at homeless shelters, and at various street outreach efforts.


Membership > Benefi ts

yOUR OFFIce MANAgeR ADVOcATe HAS THe ANSWeRS

OFFICE MANAGERS FORUM: Join Gena Welch each month at Valley Brew for a lively seminar attended by dozens of other offi ce managers who enjoy a complimentary lunch and some great networking as well. For more info or next month’s topic, call Gena at 952-5299 to be added to our guest list. Every second Wednesday from 11:00 - 1:00

BRIeFLy NOTeDREPoRT UNfAIR PAYMENT PRACTICES

CMA fights Blue Shield Policy on Consultations

CMA Has New

Consultation Code guide

Calculating Interest on Claims

Medicare Payment Cuts

geNA WeLcHMeMBeRSHIP cOORDINATOR

(209) [email protected]

cMA LAUNcHeS NeW MONTHLy ReSOURce FOR PRAcTIce MANAgeRS

The maiden issue of CMA Practice Resources (CPR) was launched this past April and now is available on a monthly basis. Our normal Q & A section features material from the May CPR Bulletin so you can see the quality of material provided in this new resource. The free monthly e-mail bulletin from the reimbursement experts in CMA’s Center for Economic Services is full of tips and tools to help physicians and their staff improve practice efficiency and viability. If you or your staff would like to subscribe, you can do so at http://www.cmanet.org/news/cpr or go to our own website at www.sjcms.org and you will find the subscription links there as well (There is also a pdf subscription form attached, if you would prefer to print/fax.) If you have any questions or comments, contact San Joaquin Medical Society’s Gena Welch, Membership Coordinator at (209) 952-5299 or for specific questions about the CMA’s new CPR Bulletin, contact Aileen Wetzel, at (916) 551-2037 or [email protected].


RePORT UNFAIR PAyMeNT PRAcTIceSCMA is fighting on your behalf to curb abusive practices by third party payors. Our goal is to not only enact meaningful laws, but to make sure that these laws are enforced by state regulators. Unfair payment practices include, but are not limited to:Improper denial or delay in payment of a claimFailure to acknowledge receipt of a claimUnderpaymentDispute resolution difficultiesUntimely requests for refundsUnilateral contract amendments

Note: Physicians should first appeal all unfair payment practices through the payor’s Provider Dispute Resolution (PDR) process and allow at least 45 working days for the dispute to be resolved. If the plan fails to resolve the issue, physicians should file a formal complaint with the appropriate regulator.

TAKe AcTIONStep 1 – Identify the regulator.The Department of Managed Health Care (DMHC) regulates HMOs, as well as Anthem Blue Cross PPO and Blue Shield PPO. For a full list of health plans regulated by DMHC, see http://wpso.dmhc.ca.gov/hpsearch/viewall.aspx.

The California Department of Insurance (DOI) regulates most PPOs. For a list of insurers regulated by DOI, see http://insurance.ca.gov/0100-consumers/hcpcarriers.cfm.

For information on filing a complaint against self-insured ERISA plans, see CMA On-Call #1022, “ERISA Plans.” For workers’ compensation plans, see #1929, “Treating Physicians: Payment for Treatment.”

Step 2 – Prepare your complaint.Gather documentation, including copies of your claims, EOBs, appeals, and any responses received from the payor.

Step 3 – File your complaint.Complaints about DMHC regulated health plans must be filed through the agency’s online portal, http://www.dmhc.ca.gov/providers/clm/clm_comp.aspx.

To submit a complaint about a DOI regulated insurer, download and complete a Health Care Provider Request for Assistance (HCPRA) for each affected claim.

(http://www.insurance.ca.gov/0100-consumers/upload/RFAHPRFA.pdf)

Step 4 – Notify CMA.Members are encouraged to send CMA a copy of their complaint to help with our advocacy efforts. (CMA, Attn: Economic Services, 1201 J Street, Ste 200, Sacramento CA 95814 or fax 916/551-2027.)

TIP: Encourage your patients to also report unfair practices to the appropriate regulator.

CMA RESOURCES: CMA On-Call documents #1051, “Physician Complaints About Managed Care Plans,” and #1049, “Patient Complaints About Managed Care Plans,” #0122, “ERISA Plans,” and #1929, “Treating Physicians: Payment for Treatment.” Need assistance filing a formal complaint? CMA’s reimbursement specialists can help. Call CMA’s reimbursement help line at 888/401-5911 or e-mail [email protected].

cMA ADVOcAcy ReSULTS IN ReVISeD BLUe SHIeLD POLIcy ON FReQUeNcy OF cONSULTATIONSThe staff at Plastic Surgery Associates in Redding recently contacted CMA after receiving a notice from Blue Shield about a change to their payment policy on consultation codes. Specifically, Blue Shield announced it would reimburse for only one consultation code within a 12 month period when performed by the same physician or another physician of the same specialty within the same practice. CMA learned that Blue Shield’s edits only review the first 3 digits of the ICD-9 code. Thus, subsequent claims submitted within a 12 month period by the same practice with the same first three digits of the ICD-9 code would automatically be denied per the new policy, even if the claim was for subsequent consultative services on a separate or different part of the body.

For example, if a patient was referred for a consultation on a suspicious mole on her neck, the physician would bill a consultation code. But if the patient was referred back for another consultation for a suspicious mole on a different part of the body, the first 3 digits in the diagnosis code could be the same. For example, 173.4 is

CMA is fighting on your behalf to curb abusive practices by third party payors. Our goal is to not only enact meaningful laws, but to make sure that these laws are enforced by state regulators. Unfair

Note: Physicians should first appeal all unfair payment practices through the payor’s Provider Dispute Resolution (PDR) process and allow at least 45 working days for the dispute to be resolved. If the plan fails to resolve the issue, physicians should

regulates HMOs, as well as Anthem Blue Cross PPO and

The California Department of Insurance (DOI) regulates most PPOs. For a list of insurers regulated by DOI, see http://insurance.

For information on filing a complaint against self-insured ERISA

CMA RESOURCES:CMA On-Call documents #1051, “Physician Complaints About

malignant neoplasm of the skin on the scalp and neck, 173.7 is lower limb, 173.0 is the lip, etc. Blue Shield’s system would inappropriately deny the second visit based on only the first three digits of the ICD-9 code. To address this issue, Blue Shield has extended the edits to the first four digits of the ICD-9 code. The updated policy will be implemented in Blue Shield’s May release, scheduled for May 25, 2010.

TIP: Health plans and insurers are required to fully disclose complete fee schedules and payment rules to contracting physicians (28 C.C.R. §1300.71(o), Business & Professions Code §511.4, Insurance Code §10133.6.)

Best Practice: Obtain and review the payment policies for each contracted payor to ensure that your practice can administratively comply with each policy.

CMA RESOURCES: CMA On-Call document #1070, “Managed Care Contractual Protections.” Is a contracted payor not reimbursing claims according to their own payment policies? Members are urged to contact CMA’s Center for Economic Services at 888/401-5911 or [email protected].

WHIcH LAWS APPLy? Throughout this bulletin, CMA On-Call documents, and other CMA resources, you will see various laws referenced. Knox-Keene plans include licensed HMOs and their contracting medical groups/IPAs, Anthem Blue Cross of California PPO and Blue Shield of California PPO. These plans are governed by the Health & Safety Code and are regulated by the Department of Managed Health Care. PPOs and other insurers, including Blue Cross and Blue Shield life and health PPOs, are governed by the Insurance Code and are regulated by the Department of Insurance. Self funded ERISA plans and Medicare are governed by federal law and workers’ compensation plans must adhere to the Labor Code. cMA PUBLISHeS cONSULTATION cODe BILLINg gUIDeS As you are aware, Medicare is no longer recognizing inpatient and outpatient consultation codes. Effective January 1, 2010, physicians must instead bill using E&M codes from the Office and Other Outpatient Services, Initial Hospital Care, and Initial Nursing Facility sections of the 2010 CPT.

CMA has published a Medicare consultation code billing guide to provide some clarity on this understandably confusing and complex issue. CMA has also published a Managed Care Consultation Code Quick Reference Guide, which details which major payors in California will be changing their own payment policies as a result of this change.

CMA RESOURCE: CMA’s consultation code billing guides are available to members-only at www.cmanet.org/ces. If you have any additional questions about these new rules, call CMA’s reimbursement help line, 888/401- 5911 or e-mail [email protected]. cMA ADVOcAcy AT WORK “We wanted to take this time to express our gratitude to CMA and their staff on all the help and hand holding that was readily available to us through our stressful times. Because of CMA we were able to clear up our A/R’s from an HMO product line that refused to pay our doctors for the services rendered to our patients. CMA staff stuck by us through mounds of paperwork to get us paid for what was rightfully owed to our doctors. Thank you so much. It is such a relief knowing that CMA and their wonderful staff are available to assist us through any questions and concerns.”– Jane Kim, Office Manager for CMA MembersDrs. David A. Thompson and Lance J. Lee

ASK THe exPeRT: INTeReST cALcULATIONS Question: If a payor does not pay my claim within the statutory timeframe, how do I calculate interest due? Answer: Interest is calculated beginning with the first calendar day after the 30 or 45 working day period has elapsed.

Example: Contracted rate is $325.84.

Determine the interest rate. In this example it is a PPO claim, so interest is 10 percent per year.Determine amount not paid – in this example it is $325.84Multiply amount not paid by the interest percent per annum: $325.84 x .10 = $32.58/year.Divide interest due in a year by 365 days to get the daily interest due: $32.58/365 days = $.089/day.Determine the number of days the payment is late. Remember, the clock starts ticking from the 31st (or 46th) working day from the day the payor received a clean claim.Multiply the daily interest due by the number of days the payment is late to get the interest due - $.089 x 237 days = $21.09.

Membership > Benefits

UPCoMINg offICE MANAgERS foRUMS

June 9 – Health Plan of San JoaquinHere about the latest developments from HPSJgerri Casillas Nunez, SupervisorState Sponsored ProgramsLinda Reynolds, Provider Services Manager

July 14 – Taking Charge: Evaluating Relationships and Preparing for Negotiations – A focus on Payor ContractingAileen WetzelAssociate Director,Center for Economic ServicesCalifornia Medical Association

August 11 – Minimizing the financial Hit!Making every dollar count in this difficult economic period.Irv Barnett, Sr. Manager HealthcareMoss Adams, LLP

September 8 –Top Ten HR Topics!What you may not know about employment but should.Melissa Irwin, SPHRSenior ConsultantTPo HR Management

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Remember – if the issue is with a Knox-Keene plan that fails to automatically include interest due on a claim, they must pay a $10.00 per claim penalty in addition to the interest due.

Ask the Expert: Payor SolvencyQuestion: One of my contracted payors has stopped paying claims. I am concerned that the payor may be experiencing financial difficulty. What should I do?

Answer: One of the symptoms that a health plan, IPA or other payor is having financial difficulties is a failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory timeframes but does not release the checks in a timely manner. If you are experiencing repeated payment delays you should investigate the financial health of the payor.

CMA RESOURCE: To help CMA members monitor the financial health of their contracted payors, CMA has put together a Payor Solvency Checklist, which includes helpful information as well as options available to the practice.

MeDIcARe PAyMeNT cUTS STOPPeD – FOR NOWOn April 16, the President signed H.R. 4851, the Continuing Extension Act of 2010, retroactively reversing the 21.3 percent Medicare physician payment cut that took effect on April 1 and extending 2009 payment rates through the end of May. The Centers for Medicare and Medicaid Services (CMS) had instructed contractors to hold physician claims for 10 business days to minimize administrative complications and cash flow disruptions and allow Congress time to retroactively stop the cut before physician payments were affected. California’s Medicare contractor,

Palmetto, informed CMA that it did not pay any claims under the reduced fee schedule and that claims are being released for April dates of service. Claims will be processed one to two days at a time, starting with the oldest claims, until all claims that exceed the 14-day payment floor hold are released.

PROBLeMS geTTINg PAID?CMA’s Center for Economic Services (CES) provides direct reimbursement assistance to CMA physician members and their office staff.

Reimbursement Help Line 888/401-5911One-on-one educational and reimbursement assistance to physician members and their staffPractice EmpowermentTools and resources to empower physician practicesSeminars and toolkits for physicians and their staffExperienced StaffStaffed by practice management experts with a combined experience of over 125 years in medical practice operations

To access our reimbursement advocates, your physician must be a CMA member. For membership information, contact CMA Member Services at 800/786-4CMA (4262) or [email protected].

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Membership > Benefi ts

SUMMER 2010 SAN JOAQUIN PHYSICIAN 5151 SAN JOAQUIN PHYSICIAN fALL 2009

Kevin E. Rine, MD

GILL OBSTETRICS & GYNECOLOGYBOARD CERTIFIED OB/GYN • MEMBER OF THE AMERICAN SOCIETY OF LASERS IN MEDICINE

MEDICAL GROUP, INC.

75,000 HEALTHY BABIES DELIVERED

With 50 years of experience and roots dating back to 1953, Gill Obstetrics has a rich history of serving generations of women throughout San Joaquin County. We offer clinical

expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that

we put our patients’ needs fi rst.

After all… each woman's needs are unique and you deserve special care!

PRENATAL & POSTPARTUM CAREHIGH RISK PREGNANCY

INFERTILITY, INVITRO FERTILIZATIONGYNECOLOGY

ENDOMETRIOSISURINARY INCONTINENCE

OVARIAN CYSTIC DISORDERLAPAROSCOPY

HYSTEROSCOPYDIAGNOSIS & TREATMENT OF CERVICAL,

UTERINE & OVARIAN CANCERS

Stockton 10200 Trinity Parkway, Ste. 206 – Ph. (209) 957-1000Stockton 1617 N. California St., Ste. 2-A – Ph. (209) 466-8546Stockton 435 E. Harding Way – Ph. (209) 464-4796

Stockton 2509 W. March Ln., Ste. 250 – Ph. (209) 957-1000Lodi 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924Manteca 1234 E. North St., Ste. 102 – Ph. (209) 824-2202

visit our website at www.gillobgyn.com

Peter G. Hickox, M.D.

Charnpal S. Mangat, M.D.

Thomas Streeter, M.D.

Denise Morgan, M.S.N. - N.P.

Meena Shankar, M.D.

Harjit Sud, M.D.

Beth Fragilde, R.N., C.N.P

Jasbir S. Gill, M.D.

Vijaya Bansal, M.D.

Param K. Gill, M.D.

Vijaya Bansal, M.D.

Lynette Bird, R.N., B.S.N.

Vincent P. Pennisi, M.D.

Patricia A. Hatton, M.D

Catherine Mathis, M.D.

Darrell R. Burns, M.D.

Ramneet K. Mangat, M.D.

Madhavi Ravipati, M.D.

Vicki Patterson-Lambert, R.N.P.C.

Madhavi Ravipati, M.D.Madhavi Ravipati, M.D.

Linda Bouchard, M.D.

Jennifer Phung

GILL OBSTETRICS & GYNECOLOGYBOARD CERTIFIED OB/GYN • MEMBER OF THE AMERICAN SOCIETY OF LASERS IN MEDICINE

MEDICAL GROUP, INC.

75,000 HEALTHY BABIES DELIVERED

With 50 years of experience and roots dating back to 1953, Gill Obstetrics has a rich history of serving generations of women throughout San Joaquin County. We offer clinical

expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that

we put our patients’ needs fi rst.

After all… each woman's needs are unique and you deserve special care!

PRENATAL & POSTPARTUM CAREHIGH RISK PREGNANCY

INFERTILITY, INVITRO FERTILIZATIONGYNECOLOGY

ENDOMETRIOSISURINARY INCONTINENCE

OVARIAN CYSTIC DISORDERLAPAROSCOPY

HYSTEROSCOPYDIAGNOSIS & TREATMENT OF CERVICAL,

UTERINE & OVARIAN CANCERS

Stockton 10200 Trinity Parkway, Ste. 206 – Ph. (209) 957-1000Stockton 1617 N. California St., Ste. 2-A – Ph. (209) 466-8546Stockton 435 E. Harding Way – Ph. (209) 464-4796

Stockton 2509 W. March Ln., Ste. 250 – Ph. (209) 957-1000Lodi 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924Manteca 1234 E. North St., Ste. 102 – Ph. (209) 824-2202

visit our website at www.gillobgyn.com

Peter G. Hickox, M.D.

Charnpal S. Mangat, M.D.

Thomas Streeter, M.D.

Denise Morgan, M.S.N. - N.P.

Meena Shankar, M.D.

Harjit Sud, M.D.

Beth Fragilde, R.N., C.N.P

Jasbir S. Gill, M.D.

Vijaya Bansal, M.D.

Param K. Gill, M.D.

Vijaya Bansal, M.D.

Lynette Bird, R.N., B.S.N.

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NOTE FROM SDCMS: Carefully note the references to CMA vs. AMA in Elizabeth McNeil’s comments and the ways CMA is better able to address California-specific issues than is AMA, especially due to the different constituent members. Elizabeth and CMA have been at the forefront of educating federal legislators and White House aides in the truth behind the Dartmouth Atlas studies and the inappropriate use of the studies by rural states to reallocate funds away from California. Without CMA’s efforts on this front, we stood to lose much more in coming years!

San Diego Physician: Tell us how you got started at CMA.

Elizabeth McNeil: I actually started my career on Capitol Hill working as a legislative assistant to several members of Congress. After I left Washington, DC — almost 20 years ago now — I came to California and have been working for CMA ever since. For years CMA had been doing some federal lobbying, but not to the extent that it needed to. We realized that, because of our unique circumstances here in California and the enormous impact federal issues have on our doctors and how they practice medicine, we differed from a lot of the other states and from AMA on different issues.

SDP: Can you give us an example?

McNeil: There are some issues where AMA can’t help California’s doctors — when we have, for example, geographic

fights between the states, which was the central theme this year. The president and his budget staff focused in on the Dartmouth studies that show wide disparities in Medicare spending across the country. For instance, in Los Angeles and Miami-Dade, Florida, we spend four times as much as other regions to provide the same care to senior patients. Many analysts believe it is inefficient delivery of care, and they have used the Dartmouth studies as a way to curb runaway healthcare costs. The Midwest and Northwest rural states that spend less than California operationalized it into legislation. The rural state proposal would have rewarded the states that spend less than the national average, and doctors in California, for example, who spend above the national average, would have had their reimbursements cut significantly. So that was the proposal put before Congress in an environment of cost containment and no new Medicare revenue. We spent our entire year fighting this fight, and AMA couldn’t enter the fray because they have states who are winners and states who are losers, and they couldn’t get in the middle of it. CMA had to be engaged in Washington, DC, ensuring that the bills were amended to account for California’s socioeconomic differences (income, racial and ethnic diversity, insurance status), health status differences, and our geographic differences in practice costs. As we know from numerous studies, including MedPAC, if researchers account for these other factors, the geographic variation in spending between states goes way down. Had the other states prevailed, we would have had up to 22 percent in payment cuts in California.

CMA Steps up Where AMA Can’t: An Interview With CMA’s Vice President for Federal Government RelationsReprinted from San Diego County Medical Society

cMA ADVOcAcy > Health Reform


SDP: What would you say to physicians who are angry with AMA right now with respect to health reform?

McNeil: It’s easy to stand on the outside and criticize AMA on healthcare reform, saying they should have gotten more for the docs. A lot of physicians are upset that AMA didn’t stand up and fight for the right to privately contract, for example. Private contracting is an uphill battle with Congress. It’s an issue that will take several years and a lot of work to take hold. I think AMA did the right thing in supporting expansion of coverage to the uninsured and all of the reforms on the for-profit insurance industry, which has been a part of CMA’s agenda for decades. Could AMA have done more to leverage Congress and their support for getting more on the physician payment side? Yes, they could have, and that’s what’s frustrating and lacking in this bill — that’s the unfinished business of health reform [see page 36]. However, physicians also need to understand that the health reform bill was more about reigning in escalating healthcare costs than it was about covering the uninsured. It was a tough environment. There was enormous pressure to contain costs in the Medicare program. Compared to the other providers — health plans, hospitals, pharma, nursing homes, and home health — physicians did not receive deep payment cuts. However, other than primary care, we were not given appropriate updates, and physicians are rightfully angry and frustrated. The Medicare SGR needs to be eliminated. That’s a huge start to getting us on the path of stable updates. But the incentives in our payment systems need to be completely realigned. CMA physicians did an incredible job of educating our congressional delegation, particularly those House Democratic leaders that included $450 billion in physician payment fixes in the House bill to provide coverage and access to doctors. I think AMA was right in their support of the House bill, but, unfortunately, we ended up with the Senate bill, which wasn’t nearly as good for doctors. I think we all should have been stronger in our opposition to the Senate bill. CMA tried to be very outspoken about the Senate bill. But AMA has a lot of commitments from the White House, the House leadership, and, to some extent, the Senate leadership, to address the physician payment issues, to stop the 21 percent SGR cut and repeal the SGR payment formula, and to weaken the impact of the independent Medicare board on physicians. CMA is working on these issues as well as including the California GPCI fix in the SGR bill this year. We expect a bill by June. I think our CMA leadership did a better job of nuancing our position on what we supported and what we didn’t. We were very strong in our opposition to the Senate bill. I think we did a better job of pointing out to our physician members where we had problems and what we wanted fixed. AMA did some important things for physicians, but they didn’t do


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a good job of involving the grassroots. CMA and San Diego have fantastic physician advocates who have been most effective. However, I think we have no idea the wrath that would have fallen upon physicians from the public and from Congress if physicians once again were standing in the way of low-income people who need health insurance. I think it’s something that we had to play very carefully.Medicine wanted to be relevant to the conversation and a partner at the table in the negotiations. If we had said hell no like the insurance industry finally did, we would have been left out of the room like they were, and you saw how the Obama Administration went after them with full force. I think if medicine had come out with a single oppose position, it would have been very harmful to our future success in achieving our legislative goals and on implementation of reform. And there are good things in this bill for physicians. So you have to be firm about what you oppose, but you also have to let Congress know that you want to be part of the solution. Whether it’s legislative or clinical, physicians are always looking for the solutions, rather than being part of the problem.

SDP: Any last words?

McNeil: This bill is a mixed bag for doctors. It’s great that we’ve covered a lot of uninsured patients and that we’re

going to reform the insurance industry. The primary care investments are significant. The fact that we’ve covered 80 percent of Californians is no small feat to be overlooked — we have to keep our perspective on that. It isn’t the way I would have done it. It isn’t the way most physicians would have done it. But I think we all need to move forward at this point and focus on improving it.There are a lot of important battles to be fought on SGR and reform implementation, and physicians have got to stay united. They’ve got to stay engaged in this battle; it’s probably more important than ever to speak out about access to doctors. And the implementation … boy, the devil’s in the details on this. It’s going to be an enormous amount of work, and that’s really where this bill will be won or lost for the doctors and the patients.I urge physicians not to get discouraged. Half of our doctors support this bill and the other half are very discouraged. For those who are discouraged, I encourage you to remain engaged, to stay in the fight because there’s still a lot to be gained here. The unfinished business agenda is important. We have to explore new payment and delivery models, realign incentives, and let physicians practice medicine. And as physicians, whether we agree or disagree, we will only prevail if we fight together — AMA, states, counties, and specialties.

cMA ADVOcAcy > Health Reform


Membership < MeDIcAL SOcIeTy

Tawanda Adeshina, MDFamily PracticeKaiser Permanente7373 West LaneStockton, CA 95210Offi ce: (209) 476-2080Meharry Medical College: 2002

Usman AliInternal MedicineSan Joaquin General Hospital500 W Hospital RoadFrench Camp, CA 95231Offi ce: (209) 468-6624Fiji Medical School: 1978

Mehrdad Amirhamzeh, MDPathology1805 N California, Ste 407Stockton, CA 95204Offi ce: (209)408-8338Medical College of Wisconsin: 1990

Sanjeev Bansal, MDFamily MedicineSutter Gould Medical Foundation2545 W Hammer LaneStockton, CA 95209Offi ce: (209)956-1552Government Medical College: 1999

Ramesh DharawatInternal MedicineSan Joaquin General Hospital500 W Hospital RoadFrench Camp, CA 95231Offi ce: (209) 468-6624Shivaji University Miraj Medical College: 1977

Daniel Dietrich, MDRadiologyValley MRI & Family Medical Imaging Center546 E Pine StreetStockton, CA 95204Offi ce: (209) 467-1000Uniformed Services University of Health Sciences: 1998

Jon Eck, MDOccupational Medicine3663 E Arch Road, Ste 400Stockton, CA 9515Offi ce: (209)943-2202St Louis University School of Medicine: 1988

Eric Larson, MDFamily MedicineKaiser Permanente7373 West LaneStockton, CA 95210Offi ce: (209)476-2181University of California School of Medicine – Davis: 2001

Colleen Lennard-LoveOtolaryngologySutter Gould Medical Foundation2545 W Hammer LaneStockton, CA 95209Offi ce: (209)830-4062Hahnemann University School of Medicine: 1995

Linath Lim, MDInternal MedicineSutter Gould Medical Foundation2505 W Hammer LaneStockton, CA 95209Medical College of Pennsylvania: 1993

Arturo MacasinagRadiologySutter Gould Medical Foundation2505 W Hammer LaneStockton, CA 95209Offi ce: (209)524-1211University of Santo Tomas: 1971

Jeffrey McDavit, MDPathologySt Joseph’s Medical Center1800 N California StreetStockton, CA 95204Offi ce: (209)461-5340University of Southern California School of Medicine: 2003

Susan McDonald, MDAnesthesiologySt Joseph’s Medical Center1800 N California StreetStockton, CA 95204Offi ce: (209)467-6552University of Pennsylvania School of Medicine: 1995

John Newman, MDFamily MedicineKaiser Permanente

7373 West LaneStockton, CA 95210Meharry Medical College: 1976

Ma Padero, MDInternal MedicineKaiser Permanente1721 W Yosemite AvenueManteca, CA 95337Offi ce: (209)824-5088Xavier University: 1987

Charles Stillman, DORadiologyValley MRI & Family Medical Imaging Center546 E Pine StreetStockton, CA 95204Offi ce: (209)467-1000Kirkville College of Osteopathic Medicine: 1995

Priya Swamy, DOInternal MedicineSutter Gould Medical Foundation2505 W Hammer LaneStockton, CA 95209Offi ce: (209)549-3370Touro University College of Osteopathic Medicine: 2006

Leila Yasrebi, MDPediatricsKaiser Permanente7373 West LaneStockton, CA 95209Offi ce: (209)476-5725Ross University School of Medicine: 2000

You-Tan Yeh, MDInternal MedicineSutter Gould Medical Foundation2505 W Hammer LaneStockton, CA 95209Offi ce: (209)549-3370Medical College of Wisconsin: 2006

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Diabetes and Cardiovascular Disease: New Comprehensive Reference Guide for CliniciansBy Carol A. Lee, Esq., President and CEO, CMA Foundation

THE CALIFORNIA MEDICAL ASSOCIATION (CMA) Foundation will soon release the 2009/2010 Diabetes and Cardiovascular Disease Reference Guide. The Guide aims to support clinicians’ management of diabetes-related, cardiovascular complications. The idea for this guide was in part generated from clinicians in San Joaquin County who participated in the CMA Foundation’s Advancing Practice Excellence in Diabetes pilot project.

Diabetes and Cardiovascular Disease Reference Guide ContentsThe Guide will be updated annually and include: Guidelines supporting the screening and diagnosis of type 2 diabetes, dyslipidemia and hypertension.Approaches to the clinical management of type 2 diabetes and its related cardiovascular complications.Strategies for preventing and more effectively managing type 2 diabetes complications.Strategies for effective communications with patients.Educational resources for physicians, other health care professionals and patients with diabetes.

Developing the Diabetes and Cardiovascular Disease Reference GuideIn late 2009, several participating physicians in the CMA Foundation’s Advancing Practice Excellence in Diabetes projects’

Quality Collaborative expressed the need for resources that better linked diabetes with cardiovascular disease. They shared with

Foundation staff that during visits with their diabetic patients, they actively discussed hypertension,

high cholesterol and other issues related to cardiovascular disease. Many felt overwhelmed

by the daunting task of addressing diabetes and its cardiovascular complications.

The CMA Foundation took action and convened an expert panel of physicians and

other health care professionals to develop this comprehensive Guide. More than

30 experts engaged in developing the Guide, including representatives

from the: American College of Cardiology, American Association

of Clinical Endocrinologists, National Medical Association, American College of Physicians,

California Department of Healthcare Services, California Diabetes

Program, California Diabetes Coalition and representatives from a number of health plans and other

provider organizations.

Diabetes & Cardiovascular Disease Prevalence: Nationally & LocallyNearly half of all adults in the US have one chronic condition associated with an increased risk of cardiovascular disease. According to the Centers for Disease Control and Prevention, 45% of individuals 20 years of age and older have hypercholesterolemia, hypertension, or diabetes. In fact, the major complication of diabetes and the leading cause of death among

diabetes guide < PRAcTIce ReSOURceS


patients with diabetes is cardiovascular disease. San Joaquin County ranks 48th out of 58 counties for the percent of county residents 18 and older with diabetes, as reported by the California Diabetes Program. This translates to 9.2% of residents diagnosed with diabetes compared to 7% of statewide. 65.2% have been diagnosed with high blood pressure, much higher than the state average of 61.5%, designating San Joaquin County as 35th out of 58 counties statewide. The impact of diabetes is especially visible among San Joaquin County’s Latino and African American population. Among those diagnosed with diabetes, 63.6% of Whites and 66.2% of Latinos were reported to have high blood pressure and 32.5% of Whites, 48.7% of African Americans reported having high cholesterol.

Local Level Intervention: Advancing Practice Excellence in DiabetesIn 2006, the CMA Foundation began the first phase of its diabetes

improvement project, Advancing Practice Excellence in Diabetes, to improve the quality of diabetes care provided in solo and small group practices in California. The overarching goals were to 1) decrease the prevalence of type 2 diabetes; and 2) reduce the racial and ethnic health disparities associated with type 2 diabetes. San Joaquin County was one of three geographic regions selected for participation due to its diverse patient and physician population, including a strong presence of Southeast Asian patients. Six practices from this region participated in the pilot and were comprised primarily of solo physicians with four to seven medical and front office staff. The Health Plan of San Joaquin and the San Joaquin Medical Society were strong partners in this pilot.

Some key practice and clinical improvements from the San Joaquin pilot are highlighted below.

Practice-Level ImprovementsSystems Changes Activity

Prepared and Proactive 1. Team

Daily huddles between office managers and physicians to 1. map out the day’s schedule Regular monthly staff meetings to improve overall 2. communicationPatient outreach and follow up care led by medical 3. assistant to ensure comprehensive careIn-chart reminders (e.g. pre-filled lab slips, printed visit 4. planners) to support the physician in completing all necessary care measures

Delivery System Design2. Use of linguistically and culturally appropriate patient 5. education materials to improve patient knowledge

Decision Support3. Adoption of a combined diabetes and cardiovascular 6. disease visit flow sheet

Registry Use4. Adoption of an electronic registry for point of care and 7. population management

Clinical Improvements

Indicator May 2007 December 2008

HbA1c screening (at least once per year)1. 70% 92%

HbA1c at goal (<7%)2. 21% 40%

LDL screening (at least once per year)3. 70% 90%

LDL at goal (<=100 mg/dL)4. 34% 50%

HDL screening (at least once per year)5. 75% 91%

HDL at goal (>35 mg/dL)6. 50% 73%

Cholesterol screening (at least once per year)7. 70% 90%

Cholesterol at goal (200 mg/dL)8. 46% 65%

PRAcTIce ReSOURceS > Diabetes guide


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Looking AheadThe CMA Foundation is moving forward with broadening the Advancing Practice Excellence in Diabetes project to a multi-year, statewide quality improvement project. The project will continue to address the diabetes and cardiovascular disease link, address healthcare disparities, and target solo and small group practices. The project will initiate work in the areas of patient self

management and medication adherence, while also partnering with Medi-Cal Managed Care Plans to provide local level, quality improvement support to practices. With a focus on achieving quality standards and providing training opportunities for clinicians and their staff, the project will help solo and small group practices prepare for health care reform changes on the horizon. The CMA Foundation will continue to engage the support of

clinician champions in San Joaquin County to support this statewide project.

The CMA Foundation’s Diabetes and Cardiovascular Disease Reference Guide will soon be available on the Advancing Practice Excellence in Diabetes Project section ofwww.thecmafoundation.org. For more information on the Guide or to see how you can participate in our next phase of the Advancing Practice Excellence in Diabetes project, please contact Senely Navarrete, MPH, Project Director, at (916) 779-6638 or [email protected].

PRAcTIce ReSOURceS > Diabetes guide

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Health Plan of San Joaquin Honors Local Health career’s Scholarship AwardessHealth Plan of San Joaquin is honoring graduating high school seniors who received academic scholarships from the Health Careers Scholarship Program. Thirteen local high school students from San Joaquin County were awarded scholarships for $2,500 and $1,000 totaling nearly $30,000 in awards.

Brandon Chan, Bear Creek High SchoolJames Cwick, Ripon High SchoolHarbir Dhillon, Lodi High SchoolDerek Leale, Tokay High SchoolLisa Lim, Cesar Chavez High SchoolJonathan Parra, Cesar Chavez High SchoolPriyank Patel, Lodi High SchoolVanessa Sanchez, East Union High SchoolKor Vang, Bear Creek High SchoolSamuel Walker, Tokay High School

Dianna Zavala, Lodi High School

Those who received $1,000 include:Kaylee Blankenship, Lodi High SchoolBerenice Carlon, Merrill F. West High SchoolMany of the scholarship recipients are first-generation college students. The majority will be attending colleges in California, including University of the Pacific, University of California campuses, and Stanford University.

Health Plan of San Joaquin’s Health Careers Scholarship Program was established to provide scholarships to students based upon their interest in pursuing a career in the healthcare industry. The 2010 cycle is the second academic year that the scholarships were awarded, and over 30 applications were received. ”There are many and varied opportunities for students seeking health careers in San Joaquin County. Regionally, we are experiencing both a high burden of illness and shortages of medical professionals, particularly primary care physicians, medical technologists, therapists, and nurses. Health Plan’s academic scholarships are a positive strategy to encourage the next generation of talented local students to consider careers in health and medicine,” said Dale Bishop, M.D., medical director for Health Plan of San Joaquin. He said the goal for establishing this scholarship program was to create a channel that can bring talented

students back to join the health-care workforce in San Joaquin County. Jonathan Parra, a Cesar Chavez High School senior who received a $2,500 award, said “this scholarship has encouraged me to continue my education and forwards my interest to return to San Joaquin as a medical professional. I see a need for bilingual doctors in the San Joaquin area to connect with patients directly and fulfill their needs." Parra will be studying pre-med health sciences at the University of California, Davis. The Health Careers Scholarship that Parra received from Health Plan will help him buy books and study materials and will assist with his tuition.More than 30 applications were received from students who have shown promise and interest in pursuing higher education in the health-care industry. Those who received $2,500 include:


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San Joaquin Medical Society Resources: • Annual Directory • CMA Member Seminars • Cost Saving Benefits• Quarterly Publication • Website/Online Resources • Insurance Savings• Alliance Membership • Annual Social Events • Patient Referrals• Office Manager Forum and Practice Resources

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San Joaquin Medical Society &Health Plan of San JoaquinPresent: The EHR Best Practice Series™Learn Best Practices for Selecting, Implementing, and Optimizing an Electronic Health Record (EHR) SystemWith the introduction of the HITECH Stimulus Act, 2010 is the year to fully adopt an EHR system. How do you plan for a successful EHR implementation? What level of “Meaningful Use” deployment is required to receive incentives? There are more than 250 EHR vendors in the market, how do you determine which EHR product meets Stimulus requirements and is the best fit for your practice and budget?

Maxwell IT, the producer of the EHR Best Practice Series™ is a nationally recognized EHR consulting company that provides education, self-help resources and vendor analysis through state medical associations. The seminars are designed to be vendor-neutral in content and are free or discounted for members and staff.

Basic Course ScheduleMarch 30, 2010 | 6:00pm – 8:30pmSeptember 21, 2010 | 6:00pm – 8:30pm Cost: Free for all physicians and office staff. Light snacks & beverages will be available during seminar.

Health Plan San Joaquin • Community Room 7751 South Manthey Road • French Camp, CA 95231

DISCLAIMER:Maxwell IT Company – the lead host of the EHR Best Practice Series™ - would like to thank the sponsors, medical associations and regional hospitalsparticipating to make the events possible. This is a vendor-neutral education program. All supporting medical associations, participating hospitals, and Maxwell IT Company are not affiliated with the participating sponsors, nor do they endorse any specific medical record system or related product or service in conjunction with these programs.© 2010 Maxwell IT Company. All rights reserved. EHR Best Practice Series is a trademark of Maxwell IT Company.

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Best Practices for EHR Selection & Implementation TOPICS WILL INCLUDE:EHR101 - Lessons Learned from a Practice Implementation• Provide a real-life perspective of what it takes to implement an EHR• Discuss short and long-term benefits (ROI) and change management issues• Provide an overview of an EHR system applied to the daily routine of a physician and administrator

Best Practices for Selection and Implementation• Present an overview of recommended selection criteria and methodology to identify potential vendors• Learn to build a five year budget model that calculates all direct and indirect costs associated with purchase, as well as cost savings• Learn how to effectively compare vendors

Workshop / Selection Handbook• Experience EHR technology first hand• Speak to experts directly about your specific requirements and experiences• Network with other physicians and administrators beginning the same process• Attendees will receive an EHR Selection Handbook - a planning kit to help kick-start your path to a successful EHR selection and implementation

66 SAN JOAQUIN PHYSICIAN SPRINg 2010

SPRINg 2010 SAN JOAQUIN PHYSICIAN 67

South Wing Dedication May 8, 2010

Top Photo: Key players in designing and building the South Wing on the second floor balcony of the new South Wing.

Right photo above: Joe Harrington, president and CEO, Lodi Memorial Hospital; Cecil Dillon, chair, Lodi Memorial Hospital Association Board of Directors; Param Gill, MD, board member, Lodi Memorial Hospital Association Board of Directors; Joe Handel, president, Lodi Memorial Hospital Foundation Board of Directors.

Left photo: A view of the health fair in the new Healing Garden from the second floor of the South Wing.

CMA Legislative Day at the Capital - Drs. Jim Scillian, Pat Hatton, President Lawrence Frank, Executive Director Mike Steenburgh and Alliance members Jeanne Siu and Nancy Schneider met with Assemblyman Bill Berryhill in addition to other key representatives.

SJMS Alliance Installation Lunch - Mary Bock was installed as the 2010-2011 Alliance President by California Alliance Past President Debbi Ricks of Santa CLara. SJMS Alliance Past President Jeanne Siu was also reconized.

H E A LT H C A R E H A P P E N I N G S


Community Center for the Blind Annual Health & Wellness FairApril 10, 2010

Patient Pavilion OpeningMarch 19, 2010

Top left photo: Ribbon Cutting hosted by the Stockton Chamber of Commerce. Top right photo: David Jensen, MD, and Jim Acosta enjoy the event.Second row, right photo: St. Joseph’s Medical Center CEO Don Wiley addresses the standing room only crowd.Bottom left photo: The hospitals new elevated and sweeping corridor is seen above the large crowd that attended the festivities.

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Bottom right photo: Alisa Kamigaki, Mas Kamigaki, MD, and Florence Kamigaki are pictured in the new spacious lobby of the Patients Pavilion.

Top left photo: all attendees to the fair were invited to have their names translated into braille as a keepsake. Center left photo: The entire event was cosponsored by the Stockton Lions Club. SJMS member and Lions member, Dr. Eric Chapa provided free health screenings as well.Second row, right photo: Kaplan students provided help all day with various tasks including blood pressure checks and even handing out fresh fruit donated by the Food Bank.Bottom left photo: St. Joseph’s Medical Centers Care Van provided excellent resources to those attending. Bottom right photo: Attendees enjoyed meeting Blind Center staff members.

HEALTHCARE HAPPENINGS is now a regular feature in San Joaquin Physician Magazine and requests your photo submissions for publication consideration. All photos must be submitted as JPG files electronically and contain appropriate captions.

Email your submissions to [email protected]


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Your reputation matters. Period.

interestMutual

Some insurers cap their defense costs or take them from your coverage limits.

NORCAL Mutual does not. We are committed to protecting you regardless of the cost.

There is no cap on the value of the reputation you’ve earned.

Call NORCAL Mutual today at 800.652.1051. Or, visit www.norcalmutual.com.

NORCAL Mutual is proud to be endorsed by the San Joaquin Medical Societyas the preferred medical professional liability insurer for its members.

Summer 2010

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Transcript of Summer 2010