Vital Signs September 2012

September 2012 • Vol. 34 No. 9Official Magazine of

FRESNO COUNTYFresno-Madera Medical Society

KERN COUNTYKern County Medical Society

KINGS COUNTYKings County Medical Society

MADERA COUNTYFresno-Madera Medical Society

TULARE COUNTYTulare County Medical Society

September 2012 • VoVoV l. 34 No. 9

Vital SignsSee Inside:See Inside:

Health ReformHealth Reform

Pre-Existing Pre-Existing Coalition Insurance Coalition Insurance PlanPlan

A PrescriptionA Prescriptionfor Your Healthfor Your Health

See Inside:

Health Reform

Pre-Existing Coalition Insurance Plan

A Prescriptionfor Your Health

2 SEPTEMBER 2012 / V ITAL S IGNS

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VITAL S IGNS / SEPTEMBER 2012 3

Official Publication of

Fresno-Madera Medical Society

Kings County Medical Society

Kern County Medical Society

Tulare County Medical Society

September 2012Vol. 34 – Number 9

Editor, Prahalad Jajodia, MDManaging Editor, Carol Rau

Fresno-Madera Medical SocietyEditorial CommitteeVirgil M. Airola, MDJohn T. Bonner, MDHemant Dhingra, MDDavid N. Hadden, MDRoydon Steinke, MD

Kings RepresentativeTBD

Kern RepresentativeJohn L. Digges, MD

Tulare RepresentativeGail Locke

Vital Signs SubscriptionsSubscriptions to Vital Signs are$24 per year. Payment is due inadvance. Make checks payable tothe Fresno-Madera Medical Society.To subscribe, mail your check andsubscription request to: Vital Signs,Fresno-Madera Medi cal Society,PO Box 28337, Fresno, CA 93729-8337.

Advertising Contact:Display:

Annette Paxton,[email protected]

Classified:Carol Rau,

559-224-4224, ext. [email protected]

ContentsVitalSigns

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion piecesaccepted for publication do not necessarily reflect the opinion of the Medical Society. All medicalsocieties require authors to disclose any significant conflicts of interest in the text and/or footnotes ofsubmitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118.

EDITORIAL..................................................................................................................................5

NEWS

HEALTH REFORM:The Supreme Court’s Decision Doesn’t Change One Thing...............................6

LETTERS TO THE EDITOR.........................................................................................................7

iHEALTH NEWS .......................................................................................................................8

CALIFORNIA: Pre-Existing Coalition Insurance Plan ..................................................................10

A Prescription for Your Health ................................................................................................11

AIR QUALITY: Join Us and Support California’s Clean Air Leadership.........................................12

CLASSIFIEDS ...........................................................................................................................18

KERN COUNTY MEDICAL SOCIETY ............................................................................................13

• President’s Message

• New Members

TULARE COUNTY MEDICAL SOCIETY.........................................................................................14

• Congratulations Ronald Marconi, MD

• Save the Date September 23: Tulare County Medical Society 2012 Family Day

• TCMS has a New Website

FRESNO-MADERA MEDICAL SOCIETY .......................................................................................13

• President’s Message

• Continuing Education

Cover photography: Clovis Balloon Festival,by Joseph B. Hawkins, Jr., MD

Calling all photographers:Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee


EDITORIAL

Surviving in These Difficult Timesand Achieving Happiness

Prahalad B. Jajodia, MDEditor, Vital Signs

moment of your life. What this means is that even difficult timescan be filled with joy as you work your way through small

problem after small problem untilthe big problem isn’t so biganymore. And while we’re on thesubject, it’s worth rememberingthat you really do want at leastsome problems. It’s called beingalive, and it has a markedadvantage over the next bestalternative.

So, it’s time to man up and gettough. Ladies too. Every one of ushas done it before, and we can doit again. It’s time to be alert andaware and to learn what’s neededin order to survive in thisuncertain environment. And it’salso time to appreciate what wehave, and not spend our hours inmisery, pining for what we wish

were true rather than working to make sure it comes true. Tothose who are struggling, I assure you, the tough times will end.And when they’re over, your dreams will still be there, just asalive and vibrant as before. Maybe better. Sweeter for the effort.

And, as always, I urge you to stay healthy. It’s vital that youmake time for exercise, sleep, and good nutrition. There will bedays when you are David fighting Goliath. You don’t want to beso sleepy that you forget your sling, or so weak you can’t use it.And no matter what, make time for your loved ones. It willcharge you with energy and provide a tender reminder of what isimportant.

Peace, prosperity and happiness to you and yours.

Dr. Jajodia is a practicing gastroenterogist and liver specialist inFresno, CA. If you have any questions about this article, you canreach him at: (559) 431-8888 or email at [email protected].


Life is a challenge, and life is a joy. But in between those headytimes of being totally primed for challenge and later knowing thefullness and serenity of accomplishment laystretches where uncertainty and doubt canseep into a life and erode one’s sense of well-being, impinging upon our natural, God-given, state of happiness. Doubt about whatthe future may hold often times brings outthe best in people, causing them to makenecessary preparations for change; but othertimes it can be overwhelming and paralyzing.

All of us are aware that there may soon be dramatic and farreaching changes made in the way medical care is financed in theUnited States. Although it’s far from certain this will happen,just the thought of it has created a tsunami of worry washing overour profession. There’s a palpable pressure. There’s stress. Somefear the worst; perhaps rightly so. Others are more optimistic.And a third group are neither optimistic nor pessimistic; they arepreparing for any contingency as best they can.

Fear is the brutish cousin of worry. Send him packing. I usethe acronym FEAR (False Evidence Appearing Real) to put fearin its place. We create almost all of our fears our self – conjuringup horrible, gut-wrenching scenarios, each one more grim andmaddening inextricable than the last – and we ourselves providethe false evidence, making it up as we go along, and thenconvincing ourselves that it’s real! I say take control of yourmind, and dismiss those thoughts. When you do, the fear willdissolve into the harmless nothing that it is.

In the most basic sense, there are only two choices in life: tobe happy or to be unhappy. I choose to be happy… regardless ofwhat the future holds. One way I do this is by thinking of life inblocks. Our life is a huge block of time in which we live. Theyears are relatively large blocks, the days and hours smaller ones.Some blocks are easy to live through, others much more difficult.During the difficult blocks, we must be strong and determined.Sometimes when we’re in the middle of a very tough stretch, itseems like it will last forever. (Maybe you’re in one right now andknow this firsthand.) But don’t worry, it won’t last forever. It’sonly one block; one small block of your life. And thinking of itin this way can make it easier to handle, both emotionally and ina practical sense.

Do not let negative emotions prolong your time in a difficultblock. Worry, fear, frustration, dissatisfaction, and anger onlyextend your long and restless night in that dreary motel. Butpositive emotions such as passion, commitment, and an opennessto change will have you checking out in no time and moving onto a better future. You and only you are in charge of youremotions. Regardless of the circumstances, you’re the one whogets to decide whether you’re happy or unhappy every single

Prahalad B.Jajodia, MD

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I N S UR ANC E


the lack of science in such statements? Or, was Vital Signs givingspace to an esteemed past president of the Tulare Medical Societywithout thought to the content of a diatribe that is franklyoffensive to those who would promote health and healthylifestyles in the Central Valley.

On the chance that the truth lies in the last of thesepossibilities, I must respond… Does Dr. Stillwater feel he has abetter understanding of climate science than NOAA and themajority of climate scientists? If he does, does he believe thatburning fossil fuels and blowing cigar smoke to create “plantfood” is really a good idea for the health of valley residentsalready suffering with an excessive burden of asthma and chroniclung disease? A review of the Pub Med database searching“smoking and dementia” shows that almost every study since2000 has shown an increased risk of Alzheimer’s disease insmokers (not reduced as Dr. Stillwater suggests). On hisinsistence that concealed carry laws reduce the risk of violentcrime, I can find no supporting evidence in a Pub Med literaturereview. The only articles I can find show little effect or a slightincrease in violent crime with the institution of concealed carrypermits. One interesting study in Australia after the initiation ofstringent gun control laws showed a precipitous decrease in masshomicides and a reduction in all firearms deaths (an interestingfinding in light of recent events in Aurora, Colorado). PerhapsDr. Stillwater’s data comes from NRA pamphlets or gun-lobbywebsites.

If the intent of the Vital Signs editorial board was to inciteresponse from the health care community, I commend you. Ifhowever, your intent was to promote health in our communityand to inspire young physicians to join our ranks, I think youerred. We need to promote a rational dialog that moves ourcommunity towards better health and reduces morbidity andmortality. We should also be fostering a vibrant Society thatembraces evidence based health improvement strategies whichyoung physicians are anxious to join. By providing a mouthpiecefor opinion-based policy that says “this seems right to me” youtake our profession back fifty years or more. By printing Dr.Stillman’s diatribe you risk inciting the kind of idealogicbickering that divides much of the rest of our Society and is notneeded in our group.

– Alex Moir, MDFamily Medicine

Ref:1.) Inj Prev. 2005 Apr;11(2):77-83.2.) Inj Prev. 2006 Dec;12(6):365-72

Dear Editor,Kudos to the editor of Vital Signs for

publishing four articles about theenvironment that led to a spirited debate.

Vital Signs has, in my experience, a wideaudience beyond the medical societyincluding patients reading it doctors’ officer,lawmakers sharing it with their staff,members of the media, to mention a few andshould have a wider distribution.

The public listens to doctors because their vigilance providesinformation unavailable elsewhere. Letters to the Editors ofmajor newspapers are the second most read part of an editionbut – rarely publish more than five percent of the submissions.

A report by an alert doctor who reported on the efficacy ofthalidomide in the treatment of leprosy sparked ongoing researchfour decades after it was pulled off the markets because it causedbirth defects during pregnancy.

Another example is John Telles, MD, who as a member of astate air quality board reported that the organization was vettingimpaired by allowing a staff member to embellish hisqualifications. The tepid response and Doctor Telles resignationfrom that board leaves a dent in its credibility.

Hopefully, Vital Signs will expand the “Letter to the Editor”– Andre N. Minuth, MD

• • •

Dear Vital Signs Editors,I have to admit to loving irony and ironic

humor. Thus, I initially enjoyed thejuxtaposition of your editorial rant by Dr.Stillwater and the air quality article by Drs.Rubinstein and Sherriffs (discussing theirpurchase of an electric vehicle) in your July2012 issue. What a contrast! Dr. Stillwaterthrowing out angry denials of the risks ofglobal warming, handgun use, and cigar smoking; and Rubinsteinand Sherriffs modestly discussing the economic andenvironmental benefits of their Nissan Leaf. I smiled, and almostlaughed out loud. I returned to the articles a couple of times andsmiled again, but then I started to ponder the rationale forincluding Dr. Stillwater’s article. Was it an attempt to get aresponse from an apathetic crowd? Could it be that Dr. Stillwaterwas playing a hyperactive Steven Colbert, issuing a stream ofover-the-top, over-stated, right-wing talking points, just to show

L E T T E R T O T H E E D I T O R

Andre N.Minuth, MD

Alex Moir, MD


iHEALTH NEWSReprinted with permission from iHEALTHBeat

CMS PROPOSES NEW HARDSHIPEXEMPTIONS FOR E-RX PROGRAM

CMS has proposed two additional hardshipexemptions for its electronic prescribingincentive program, Health Data Manage -ment reports. The two new hardship exempt -ions are part of a proposed rule that wouldestablish the Medicare physician fee schedulefor 2013 (Goedert, Health Data Management, 8/2).

The e-prescribing program required physicians to reportsubmitting at least 10 electronic prescriptions by June 30 toavoid Medicare reimbursement penalties. Those who did notreport at least 10 e-prescribing encounters or file for a hardshipexemption in time will face a 1.5% payment reduction for allMedicare claims in 2013 (iHealthBeat, 7/9).

The e-prescribing program allowed health care providers tofile for hardship exemptions if they:

• Were unable to e-prescribe because of certain laws orregulations (Health Data Management, 8/2);

• Generated fewer than 100 prescriptions during a six-monthreporting period;

• Practice in an area that has a limited number of pharmacieswith e-prescribing capabilities;

• Prescribe large volumes of narcotics; or

• Work in a rural area that has limitedaccess to high-speed Internet (Daly,Modern Physician, 8/3).

The new proposed rule would extend thee-prescribing hardship exemptions tocertain eligible professionals and grouppractices participating in the meaningful useprogram for the first time (Health DataManagement, 8/2). Under the 2009 federaleconomic stimulus package, health care

providers who demonstrate meaningful use of certified electronichealth record systems can qualify for Medicare and Medicaidincentive payments.

In the proposed rule, CMS wrote, “We have received feedbackfrom stakeholders requesting significant hardship exemptions fromapplication of the [e-prescribing] payment adjustment based onparticipation in the [meaningful use] incentive program, a programwhich requires a certain level of electronic prescribing activity.”

The agency added, “As a result of such feedback, we believethat in certain circumstances it may be a significant hardship foreligible professionals and group practices who are participants ofthe [meaningful use] incentive program to comply with thesuccessful electronic prescriber requirements of the [e-prescribing] incentive program” (Modern Physician, 8/3).

Therefore, the two new hardship exemptions would apply toeligible health care providers who:

Please see on iHealth News on page 9


iHEALTH NEWS• Attest to meaningful use during certain payment adjust ment

reporting periods for the e-prescribing program; or • Show their intent to adopt a certified EHR system by

registering for the meaningful use program (Health DataManagement, 8/2).

Read more: http://www.ihealthbeat.org/articles/2012/8/3/cms-p r o p o s e s - n e w - h a r d s h i p - e x e m p t i o n s - f o r - e r x -program.aspx#ixzz23T3rsiyi

FDA APPROVES INGESTIBLE ‘DIGITAL PILL’ TOMONITOR MEDICATION ADHERENCE

The FDA has approved an ingestible “digital pill” that features anembedded microchip to record medical information, PCWorld’s“Geek Tech” reports (Lee, “Geek Tech,” PCWorld, 8/1). Themicrochip is the first ingestible device approved by FDA(Maxmen, “News Blog,” Nature, 7/30).

The microchip, developed by Proteus Digital Health, is asilicon wafer that is about the size of a grain of sand and includestrace amounts of magnesium and copper. The device generateselectricity when it makes contact with the stomach’s digestivefluids and sends a signal to a patch on the patient’s skin (“GeekTech,” PCWorld, 8/1).

The disposable patch then can transmit information to ahealth care provider’s mobile phone application, including dataon:

• Time the pill is taken; • Heart rate; • Body position; and • Temperature (Armstrong Moore, CNET, 8/1).Eric Topol – director of the Scripps Translational Science

Institute in La Jolla, California — said the ingestible microchipcould address the problem of patients not following drug regimensconsistently, allowing doctors to “know when to rev up a patient’smedication adherence” (“News Blog,” Nature, 7/30).

FDA only has approved the use of the microchip in placebopills to test whether it works as intended. Proteus hopes toeventually integrate the microchip into prescription medicationsso the device can track patients’ drug adherence and vital signs(“Geek Tech,” PCWorld, 8/1).

George Savage, co-founder and CMO of Proteus, said thecompany hopes to embed the microchip in medications for long-term illnesses, such as drug-resistant tuberculosis, diabetes andchronic diseases (“News Blog,” Nature, 7/30).

Read more: http://www.ihealthbeat.org/articles/2012/8/3/fda-app rove s - inge s t i b l e -d i g i t a l - p i l l - t o -mon i t o r-med i ca t i on -adherence.aspx#ixzz23T5cEJd7

UNIVERSITY TO TAKE OVER DAILYMANAGEMENT OF CALIF. CANCER REGISTRY

The University of California-Davis Health System hasannounced that it will take over the day-to-day operations of theCalifornia Cancer Registry, the California Department of PublicHealth’s statewide cancer database and surveillance system,Modern Physician reports.

The registry contains information on four million cancer cases thathave been diagnosed in California since 1988. The data include:

• Patient demographics;

• Cancer type; and • Treatment and survival information.According to UC-Davis, researchers use the data to assess

geographic, ethnic and racial risk factors for cancer.Kenneth Kizer – director of UC-Davis’ new Institute for

Population Health Improvement – will oversee the operations ofthe registry. Kizer spearheaded the effort to create the registrywhen he served as director of the former California Departmentof Health Services from 1984 to 1991.

UC-Davis’ IPHI said it plans to improve the registry’sinformation management tools to enable:

• Faster and more accurate data collection; and • Expanded access to more users in California (Robeznieks,

Modern Physician, 6/27).Read more: http://www.ihealthbeat.org/articles/2012/6/28/university-

t o - t a k e - o v e r - d a i l y - m a n a g e m e n t - o f - c a l i f - c a n c e r -registry.aspx#ixzz209DrUrgn

TRAVELERS TURN TO MOBILE HEALTH APPSTO MANAGE THEIR MEDICAL CONDITIONS

A growing number of mobile medical applications aim to helptravelers manage their medical conditions, the New York Timesreports.

Some mobile apps allow users to store their healthinformation before a trip in case of emergency. For example, theiPad app drawMD lets patients who have had surgery record theexact location of a device or bypass.

Other apps aim to help travelers find urgent care whileabroad. The Emergency Medical Center Locator app includesdata on 2,400 medical centers in 101 countries. The app uses aniPhone’s GPS to help users find the closest care center that hasbeen approved by a credentialing society like the AmericanCollege of Cardiology.

Several apps aim to help travelers manage chronic diseases,such as diabetes. Apps like Glucose Buddy and GluCoMo remindusers to track and record their blood sugar levels. Another app,Diabetes Manager, allows users to input various health measuresand offers advice on actions they could take to adhere to theirtreatment plan.

Other apps offer treatment guidance. For example, theRxmindMe Prescription/Medicine Reminder and Pill Trackerapp reminds users when to take their medications, and theEpocrates app helps users identify prescription drugs by askingquestions about a pill’s color, shape and markings.

In addition, some apps target physicians who might be calledon to provide unexpected medical assistance while traveling.The NeuroMind app leads doctors through a series of questionsto help them diagnose a patient who has had a head trauma or isunresponsive.

Paul Cerrato, a medical app reviewer and the editor ofInformationWeek Healthcare, recommends that patients who planto travel talk with their physicians to select the apps that are bestfor their situation (Weed, New York Times, 6/11).

Read more: http://www.ihealthbeat.org/articles/2012/6/13/travelers-t u rn - t o -mob i l e - h e a l t h - a pp s - t o -manag e - t h e i r-med i c a l -conditions.aspx#ixzz2099qtf91


C A L I F O RN I A

DO YOU HAVE UNINSURED PATIENTS?

It is a well-known fact that California has one of the highest ratesof uninsured residents inthe country. This is an on-going challenge forproviders. We need toeducate the public aboutPCIP and to enroll eligiblepeople into the program,thus decreasing the numberof uninsured Califor nians.This is where you can help by passing along information on PCIP toyour patients who can benefit from the program.

For patients who cannot obtain insurance due to pre-existingconditions, California’s Pre-Existing Condition Insurance Plan(PCIP), might be the answer to improving their health status.Part of the Affordable Care Act, individuals who have beendenied coverage because of pre-existing health conditions andhave been uninsured for at least six (6) months are potentiallyeligible for PCIP. Benefits

The program benefits include inpatient and outpatientservices, doctor visits, pharmacy benefits, behavioral health,preventive care, physical therapy, case and disease management,laboratory and imaging services, physical therapy, and more.

California Pre-Existing Condition Insurance Plan (PCIP)Costs

By law, premiums for PCIP can be no more than 100 percentof those charged to persons without pre-existing conditions onthe individual insurance market. Since PCIP does not rate up forany factors beyond age and area of residence, premiums may belower than those on the open market. In other words, PCIP is agood buy for your patients.

EligibilityOther eligibility requirements include that subscribes are US

citizens, nationals or lawfully present, California residents, and canprove their pre-existing conditions. Proof can be verified througha denial letter from an insurance carrier, health plan, or a letterfrom a licensed provider confirming the pre-existing condition.This is something specific that you or a licensed provider on yourstaff can do to assist your patients in their PCIP enrollment.

Enrollment into PCIP is a straight forward process involvinga four-page application. Application and customer service isprovided through a call center at 877-428-5060 and atwww.pcip.ca.gov. Assistance is also available from insuranceagents/brokers and certified application assistants.

Marketing MaterialsIf you would like to display PCIP materials (available in both

English and Spanish) or have additional questions contactPCIP’s outreach coordinator at 916-673-4692 or [email protected].

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A I R Q U A L I T Y

California’s leadership is saving lives through groundbreakingprograms that reduce harmful pollution from our air. Innovativeclean air programs are spurring the drive toclean energy, clean transportation and betterpublic health. While our state has madetremendous progress, too many Californiansstill breathe polluted air, and there is work tobe done to meet our clean air and climategoals.

As health and medical leaders, we seefirsthand the damages caused by air pollutionin California. Polluted air affects us all, butour children, the elderly andthose living with asthma andother respiratory conditionssuffer the most. Each year inCalifornia, over 9,000 die due tothe effects of unhealthy air,thousands more suffer fromasthma attacks, heart attacks andstrokes, while millions lose timeat work or school. Air pollutioncan cause reduced lung functionin children and limit breathingcapacity for a lifetime. The pricetag of polluted air adds up to $22billion each year in health,medical costs and other eco -nomic impacts. In addition to thecost of health emergencies,illnesses linked to polluted air places more pressure on alreadybusy hospitals and packed emergency rooms.

Fortunately, California’s recently adopted clean energy; cleanvehicle and improved fuel standards will further spur progress tocleaner air, bring tremendous public health benefits and reducethe burden on our healthcare system. California must stay thecourse on these critical public health laws to meet our clean airand climate goals that will help generations of Californians tobreathe easier and live healthier lives.

Our health and medical organizations understand theimportance of our public health and with California achieving itsclean air goals. We pledge to support these goals by:

Join Us and Protect California’s Clean Air LeadershipPraveen Buddiga, MD FAAAAI

Edited by Michelle Garcia

1. Protecting California’s authority to set clean air standardsstrong enough to achieve near-term and long-termpollution reduction goals.

2. Educating the public and policymakers about key measuresto achieve healthy air goals.

3. Opposing and exposing efforts to weaken, delay orundermine California’s life-saving healthier standards.

California’s life-saving motor vehicle standards, dieselemission reduction programs, climate change programs (AB 32,energy efficiency, advanced clean cars, Low Carbon FuelStandard, SB 375 smart growth programs, etc.) have set us on apath for a healthier future. We support California’s clean airleadership because all Californians deserve to breathe clean,healthy air.

Contact Michelle Garcia, Air Quality Director for the Fresno-Madera Medical Society a project of the California MedicalAssociation Foundation by calling 559-824-5567 [email protected].

The campaign to Protect California’s Clean Air Leadershiphas been convened by the American Lung Association in California

JOIN THEFRESNO-MADERAMEDICALSOCIETY IN ITSSUPPORT OFTHIS YEAR’SAB32RESOLUTIONAT THE 2012CMA HOUSE OFDELEGATES.

PraveenBuddiga, MD

FAAAAI


Kern

2229 Q StreetBakersfield, CA 93301-2900

661-325-9025Fax 661-328-9372

website: www.kms.org

KCMS Officers

Joel R. Cohen, MDPresident

Wilbur Suesberry, MD President-elect

Noel Del Mundo, MDSecretary

Ronald L. Morton, MDTreasurer

Portia S. Choi, MD Immediate Past President

Board of DirectorsAlpha Anders, MDBrad Anderson, MD

Eric Boren, MDLawrence Cosner, MD

John Digges, MDJ. Michael Hewitt, MD

Calvin Kubo, MDMelissa Larsen, MDMark Nystrom, MDEdward Taylor, MD

CMA Delegates:Jennifer Abraham, MD

Eric Boren, MDJohn Digges, MD

Ronald Morton, MD

CMA Alternate Delegates:Lawrence Cosner, Jr., MD

Patrick Leung, MDMichelle Quiogue, MD

Staff:Sandi Palumbo, Executive Director

Kathy L. HughesMembership Secretary

“WEBUTATIONS”by Joel Cohen MD and Rebecca Cohen

Have you checked your Medical Board profile lately? The CMA wants you to know that the MedicalBoard requires that you list your address of record on their website. Most will advise that you placeyour address of record as a PO Box address, not your home address for privacy reasons. This is personalinformation.

But more importantly, do you know what your internet persona says about you? You may in fact besurprised at what you find…old addresses, public records including judgments and the like,compliments and complaints. Sometimes you may find that your most private and personalinformation such as cell phone numbers, home addresses, etc. are also on the web.

Just “googling” your name and city will reveal thousands of results. Some of these results arepertinent, others are not. The first three pages are typically the most important.

You may not be aware of other lesser known search engines that cache web pages that may behidden on the web. Also try engines such asspokeo.com, Peekyou.com, wink.com, andzabasearch.com . This is just scratching the surface... there are others.

Do you find the results to be fair, accurate, truthful, or even reflective of you or your business? Isthis information that you want publicly available?

The odds are the information, in some way, may look like all of the above. Dealing withinaccuracies can vary depending on the source, and sometimes this process is not only costly, but alsotime consuming. You can deal with inaccuracies by contacting each company directly, or by usingcommercial services, individual consultants, and law firms that specialize in reputation defense.Because some web services will pull information from other websites, then catalog it and make itavailable, correcting all of these inaccuracies may not be fool proof.

If you want to know what your “webutation” is, begin by looking yourself up. If you find there areinaccuracies, I’d recommend you start by consulting a professional to ensure that everything web

President’s Message

JOEL R. COHEN, MD

The following physicians’ names, etc. are being published in compliance with the KCMS Constitution& Bylaws. Board Certification will be listed only if the physician has been certified by a SpecialtyBoard recognized by the American Board of Medical Specialists, as approved by the AmericanMedical Association.

New MemberMEMBERSHIP INFORMATION

Oliver T. Phan, MD(Internal Medicine/Nephrology)Central Nephrology Medical Group5030 Office Park Dr., 93309-0612661-323-2847/ FAX: 323-2261Email: [email protected] Degree: U of Minnesota MedicalSchool 2007Internship/Residency: U Hospitals CaseMedical Center, OH 2007-2010Fellowship: Emory Hospitals & School ofMedicine, GA 2010-2012Board Certified: Internal Medicine 2010

Joel A. Lardizabal, MD(Cardiology/Internal Medicine)Central Cardiology Medical Group2901 Sillect Avenue Ste.100, 93308-6372661-323-8384 / FAX: 323-9326Email: [email protected] Degree: U of Philippines 2001Internship/Residency: Kern Medical Center2003-2006Fellowship: UCSF-Fresno 2008-2011 & U ofMiami 2011-2012Board Certified: Internal Medicine 2006 &Cardiology 2012

Please see Kern President on page 18

14 SEPTEMBER 2012 / V ITAL S IGNS14 SEPTEMBER 2012 / V ITAL S IGNS

3333 S. FairwayVisalia, CA 93277

559-627-2262Fax 559-734-0431

website: www.tcmsonline.org

TCMS OfficersGaurang Pandya, MD

President

Steve Cantrell, MDPresident-elect

Thomas Gray, MDSecretary/Treasurer

Steve Carstens, DOImmediate Past President

Board of DirectorsVirinder Bhardwaj, MDCarlos Dominguez, MD

Parul Gupta, MDMonica Manga, MD

Christopher Rodarte, MDH. Charles Wolf, MD

CMA Delegates:Thomas Daglish, MD

Roger Haley, MDJohn Hipskind, MD

CMA Alternate Delegates:Robert Allen, MD

Ralph Kingsford, MD Mark Tetz, MD

Sixth District CMA TrusteeJames Foxe, MD

Sixth District CMA AlternateThomas Daglish, MD

Staff:Steve M. BeargeonExecutive Director

Francine HipskindProvider Relations

Gail LockePhysician Advocate

Thelma YearyExecutive Assistant

Tulare

Congratulations Ronald Marconi, MD2012 CMA FREDERICK K.M. PLESSNER MEMORIAL AWARD RECIPIENT

On behalf of the entire staff and physician members of the Tulare CountyMedical Society and California Medical Association it is an honor and privilegeto congratulate Ronald Marconi, MD as the recipient of the 2012 Frederick K.M.Plessner Memorial Award. This highly prestigious annual award honors a CMAmember physician residing and practicing in California who best exemplifies thepractice and ethics of a rural practitioner.

Dr. Ronald Marconi, MD has relentlessly supported the rural community ofVisalia in immense ways and has touched and improved the lives of numerouspeople in our community. From decades of active practice, serving to start theGood Samaritan Center, helping our schools with sports physicals and a local high school footballteam physician, as Director of our local rehabilitation hospital and as medical consultant for theCentral Valley Regional Center, he successfully exemplifies a rural practitioner in both ethics andpractice.

Dr. Ronald Marconi is the most deserving of this prestigious memorial award. Countless residentsof our rural community will forever be grateful to this humble caregiver. As Dr. Marconi’s daughtersaid on behalf of her family during his recent semi-retirement celebration, “Dr. Marconi is a man whohas taken that which is most humble and ordinary and elevated it into the realm of the extraordinary.”We genuinely believe many other people in our community have the identical sentiments about Dr.Ronald Marconi.

Please join us in offering sincere and heartfelt congratulations to Ronald Marconi, MD, who willreceive this highly deserved recognition at the CMA House of Delegates in Sacramento on Saturday,October 13, 2012.

SAVE THE DATE!Tulare County Medical Society

“Family Day 2012”at Adventure Park, Visalia

Sunday, September 2311 am-3 pm

Buffet lunch

Bumper Boats

Miniature Golf

Family Race Track

Arcade Games and

Laser Tag, too!

Please Plan to Join Us!(Invitations will be mailed soon)

RonaldMarconi, MD

VITAL S IGNS / SEPTEMBER 2012 15VITAL S IGNS / SEPTEMBER 2012 15

PO Box 1029Hanford, CA 93230

559-582-0310Fax 559-582-3581

KCMS Officers

Theresa P. Poindexter, MDPresident

Jeffrey W. Csiszar, MDPresident-elect

Mario Deguchi, MDSecretary Treasurer

Mario Deguchi, MDPast President

Board of DirectorsBradley Beard, MDJames E. Dean, MDLaura Howard, MD

Ying-Chien Lee, MDBo Lundy, MD

Michael MacLein, MDKenny Mai, MD

CMA Delegates:Jeffrey W. Csiszar, MD

Thomas S. Enloe, Jr., MDTheresa P. Poindexter, MD

CMA Alternate Delegates:Laura L. Howard, MD

Staff:Marilyn Rush

Executive Secretary

Tulare Kings


Post Office Box 28337Fresno, CA 93729-8337

1040 E. Herndon Ave #101Fresno, CA 93720

559-224-4224Fax 559-224-0276

website: www.fmms.org

FMMS Officers

Sergio Ilic, MDPresident

Ranjit Rajpal, MDPresident Elect

Prahalad Jajodia, MDVice President

Stewart Mason, MDSecretary/Treasurer

Oscar Sablan, MDPast President

Board of GovernorsA.M. Aminian, MD

Hemant Dhingra, MDUjagger-Singh Dhillon, MD

William Ebbeling, MDBabak Eghbalieh, MDAhmad Emami, MDDavid Hadden, MDS. Nam Kim, MD

Constantine Michas, MDKhalid Rauf, MD

Rohit Sundrani, MDMohammad Sheikh, MD

CMA DelegatesFMMS President

A.M. Aminian, MDJohn Bonner, MDAdam Brant, MDMichael Gen, MDBrent Kane, MDKevin Luu, MD

Andre Minuth, MDRoydon Steinke, MDToussaint Streat, MD

CMA Alternate DelegatesFMMS President-electDon H. Gaede, MD

Prahalad Jajodia, MDPeter T. Nassar, MDTrilok Puniani, MD

Dalpinder Sandu, MDSalma Simjee, MDSteven Stoltz, MDRajeev Verma, MD

CMA YPS DelegatePaul J. Grewall, MD

CMA YPS AlternateYuk-Yuen Leung, MD

CMA Trustee District VIVirgil Airola, MD

Staff:Sandi Palumbo

Executive Director

President’s Message

SERGIO D. ILIC, MD

It is interesting to continue to read about the Health Care reform act, especially after it was upheld bythe Supreme Court this summer. If we listen to the Republicans, they say if it is not repealed, the sky isgoing to fall. If we listen to the Democrats, there is nothing better than this law, short of going to heaven.Most of the time, the truth falls somewhere in between. There are going to be benefits we are not awareof at this time, and there will be unforeseen, long-term bad consequences. Some people believe thereform act will be repealed if the Republicans gain a majority of both houses and the presidency, but mygut feeling is that it’s not going to happen. I believe the Act will be modified, and hopefully for the better.

What are we trying to accomplish? Basically to deliver health insurance at an affordable cost, to asmany people as we can, while decreases the costs of health care. Can this be done and still preserve thefreedom of choice and improve the delivery of care while at the same time not jeopardizing innovation,new technology and the development of new drugs that are more effective, safer and less costly? I believethey can be achieved, but it’ll require our politicians to put the wellbeing of the country ahead of partypolitics and have open discussions on what is best for our patients and our profession.

Moving on to other topics – the monthly financial seminars for our members started up again inAugust and have had excellent responses from participants. The topic is repeated on the last Wednesdayand Thursday evenings, so there is no excuse not to attend. The topics are geared to novices like internsand residents, (basics of investing) all the way through retirement, (estate planning, social security andMedicare) for us older physicians. Please visit the FMMS website at www.fmms.org or the Central ValleyPhysician Benefits’ (CVPB) site at www.medicalsocietybenefits.com for more information about theseminars and what other money-saving benefits are being offered to our membership.

In addition, CVPB is presenting quarterly “Economic Forums.” These forums, held at a localrestaurant, provide great information by financial advisors and managers of mutual funds and largepension funds etc. who address topics of current interests. On August 2, the presentation was on the“Yale University Endowment Fund” and how they have managed to do so well in these uncertaineconomic times. I wish more of you would attend. A lot can be learned from them. Next up is ”How theelection result will impact your savings, investments, retirement plan etc.” Should be very interesting.

Speaking about global warming, Dr. Richard Muller, a professor of Physics at UC Berkeley and oneof the main scientists that didn’t believe in human-based climate warming, changed his position 180degrees after being commissioned to study the problem by the Charles Koch Family Foundation. TheFoundation typically supports prominent deniers of global warming. Dr. Muller now believes that theevidence is so strong, he came out openly with his results – to the chagrin of the sponsors of his research.

Fresno-Madera

2012 Educational Series for FMMS MembersSEPTEMBER 26 & 27, 2012: “ESTATE PLANNING BASICS” presented by Eric Van Valkenburg, CLU, CHFC and Amy Nuttall-Zwaan, CRPC, CSNA, FinancialConsultants with Central Valley Physician Benefits, with guest speaker: Robert S. Wright, Esq.

The same presentation is presented on both evenings and will include:• Financial, non-financial and tax reasons to have an estate plan or update an existing one• Why so many estate plans won’t work as they are intended• Federal Estate Tax avoidance strategies and how the unpredictability of tax law impacts existing plans• What happens to your assets if you are incapacitated for an extended period of time• How to reduce the chance your heirs will lose their inheritanceSeminars are held at the Medical Society offices, 1040 E. Herndon Ave. #101. (NE corner of

First/Herndon). Space is limited, so please RSVP as to which night you would like to attend by contactingthe Medical Society at 559-224-4224, ext. 118 or at [email protected]. A light meal will be available.

Future topics: Oct. 24 & 25: Financial Planning Basics – Nov. 28 & 29: Understanding Society Security BenefitsEric Van Valkenburg and Amy Nuttall-Zwaan are Registered Representatives with and securities offered through LPL Financial.

Member FINRA/SIPC

General Society New Member Social& & Invite family, colleagues andInvite family, colleagues and friends for an evening of: friends for an evening of:• WINE TASTING • DINNER

• DANCE • DOOR PRIZES

• FUN and LAUGHS MUST BE 21 YEARS OF AGE OR OLDER

…an evening you don’t want to miss!…an evening you don’t want to miss!

WednesdaySeptember 12, 2012

ApCalWine Tasting & Visitors Center

32749 AVENUE 7MADERA, CA

just west of Highway 99

6:30 Wine Tasting7:00 Buffet Dinner

7:15 Business MeetingReport on Nominations and

Add’l Nominations from floor

7:45 Music & Dancing$20 member

$40 guest

Rock to the sounds of

“Sound Affects”“Sound Affects”DR. JUDY DAVIS

on the drums!

Enclosed is my check #:______ Charge my: r MasterCard r Visa

C/Card #: ________| ________| ________| ________|

Exp Date: Billing Zip Code:

Name on card:

Signature:

Total Amount: Expiration Date:

FMMS member:

Guest (s) name:

Phone: Today’s Date:

Email:

Reserve: ____ # of tickets @ $20/member

____ # of tickets @ $40/guest

RESERVATION FORM – Please respond by September 5, 2012 Phone 224-4224 x112 • Fax 224-0276

NEW MEMBERSin attendance are

eligible for aSPECIAL PRIZE

DRAWING!


Fresno-Madera

Certified Medical CoderNOW ENROLLING

(CMC)®

Information & Registration:Sheryl Tatarian

559.224.4224 [email protected]

In today’s complex environment, certified coders are in high demand. More physicians need Certified Medical Coders who are capable of understanding the complexities of the reimbursement process. Improve the financial health of your practice. Your skills will help guard against improper claim submissions and contribute to a higher rate of paid claims for the practice. REQUIRED MATERIALS TO BRING: CPT, ICD-9-CM Volumes 1&2, HCPCS Manual and Medical Dictionary.

5 CONSECUTIVE THURSDAYS: September 13, 20, 27 October 4, 118:30am - 4:30pm each day

$875 per personincludes CMC certification exam Continental Breakfast & Lunch

LIMITED SPACE! CLASS IS FILLING UP QUICKLY!

1040 E Herndon Ave #101NE corner at First StreetFresno, CA 93720


Classifieds

MEDICAL OFFICES

Gar McIndoe (661) 631-3808David Williams (661) 631-3816Jason Alexander (661) 631-3818

FOR LEASE2701 16th St. – 2,400

2031 17th Street – 1,776 sf.4817 Centennial Plaza Way – 2,370 rsf.Crown Pointe Phase II – 2,000-9,277 rsf.

3115 Latte Lane – 5,637 rsf.3115 Latte Lane – 2,660-2,925 sf.

Meridian Professional Center – 1,740-9,260 rsf.4000 Physicians Blvd – 5,883 rsf.

2204 “Q” Street – 3,200 rsf.3941 San Dimas Street – 3,959 rsf.

4040 San Dimas St. – 2,035 rsf.9300 Stockdale Hwy. – 3,743 - 5,378 rsf.9330 Stockdale Hwy. – 1,500-7,700 rsf.

SUB-LEASE4100 Truxtun Ave. – Can Be Split

Medical Records & OfficesSprinklered – 4,764 usf.

Adm. & Billing – 6,613 rsf.FOR SALE

Crown Pointe Phase II – 2,000-9,277 rsf.Meridian Professional Center – 1,740-9,260 rsf.

9900 Stockdale Hwy. – 2,000-6,000 rsf.

Naeem Akhtar, MD, Ambreen Khurshid,MD and Mikhail Alper, PA-C at CaliforniaGastroenterology Associates arepleased to welcome Carlos C. Hernandez,MD to their practice. For appts. Call 559-299-9395University Psychiatry Clinic: A slidingfee scale clinic operated by the UCSFFresno Dept. of Psychiatry at CRMC M-F8am-5 pm. Call 559-320-0580.

Medical office space. 850-3,500 sf atValley Medical Plaza at Herndon, nearSAMC. Rates starting at $1 sf, no triple net.Tenant improvements available. Call Brianat 559-281-1500.

ANNOUNCEMENT

FOR RENT / LEASE

MEMBERS: 3 months/3 lines* free; thereafter $20 for 30 words.NON-MEMBERS: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30.*Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word.Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

3,400 sq.ft. spaceSuitable for a Physical Therapy or

Individual practice; may be divided & remodeled to suit

Excellent parking andclose to St. Agnes Medical Center

Carl Abercrombie559-227-4658

c: 559-970-9035Jim Abercrombie

530-626-0321

Professional/Medical Office for LeaseCambridge Court

6335 N. Fresno Street, Fresno

NEWLYREMODELED1,200sq.ft. officewith fiveexam rooms

FRESNO/MADERA

TULARE

KERN

5 rm. office space, 1 mile off Hwy 99 in SWBakersfield in 112,000 sf. neighborhoodcenter anchored by InShape City Fitness.Underserved area in need of healthcareprofessionals. Other spaces available. CallBalmeet at 661-717-8383.

Cardiology practice in Bakersfield closingSept. 15. All office furnishing, supplies andequipment for sale. Call for specifics andarrangement: 661-323-5976.

FOR RENT / LEASE

FOR SALE

1,800 sf. medical space in Porterville inprime location w/ ample parking. AvailableFT or PT, brand new, 5 private exam rms.Contact Casey, 559-784-4925.

FT opening for MD in busy practice inVisalia. Offering full benefit package andmore. Contact Rhonda: 559-627-2333 [email protected].

PHYSICIAN/PROVIDED WANTED

FOR RENT / LEASE

related accurately reflects you, especiallyas your online reputation is just asimportant as your in-person reputation.Keep in mind, that it may change fromone day to the next, so this is not a do itonce and forget it proposition; you mustlook at your “webutation” on a regularbasis.

Just like correcting inaccuracies onyour credit report, the sooner you identifya problem, the easier it is to correct. Alongthese lines, have you checked your creditreport recently?

Kern President

Continued from page 14How Successful IsYour Practice?

Let physician membersknow your practice

is availablefor referrals

Use Vital Signs to advertiseyour practice at special ratesoffered to member physicians.

contact:Annette Paxton

Vital SignsAdvertising Representative

(559) 454-9331

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thing to worry about until your return.

SPONSORED BY:

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VITAL SIGNSPost Office Box 28337Fresno, California 93729-8337

HAVE YOU MOVED?Please notify your medical society ofyour new address and phone number.

PRSRT STDU.S. Postage PAIDFresno, CAPermit No. 30

CALL 1-800-652-1051 OR VISIT NORCALMUTUAL.COMProud to be endorsed by the Fresno-Madera Medical Society and the Kern, Kings and Tulare County Medical Societies

Our numbers add up to great claims support for your practice.

* Physicians Insurers Association of America Risk Management Review: 2011 Edition. **Jena et al. Research Letter, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. Archives of Internal Medicine. May 14, 2012.

88 NO INDEMNITY

REGIONAL CLAIMSOFFICES

YEARS “A” RATED BY A.M. BEST29

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Documents

Vital Signs September 2012