Vital Signs September 2015

September 2015 • Vol. 37 No. 9

FRESNO COUNTY

KERN COUNTY

KINGS COUNTY

MADERA COUNTY

TULARE COUNTY

September 2015 • VoVV l. 37 No. 9

Vital SignsOfficial Magazine of

Fresno-Madera Medical Society

Kern County Medical Society

Kings County Medical Society

Fresno-Madera Medical Society

Tulare County Medical Society

See Inside:

Breakthroughs inAlzheimer’s Research

Staying Sane, Satisfiedand Effectivein Medicine and Life

Empowering Physicians

See Inside:

Breakthroughs inAlzheimer’s Research

Staying Sane, Satisfiedand Effectivein Medicine and Life

Empowering Physicians

Success.

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SEPTEMBER 2015 / VITAL SIGNS 3

Cover Photograph: “ California Drought Tomato” by JoAnn Ganduglia, RN

VitalSigns Contents

Official Publication ofFresno-Madera Medical SocietyKings County Medical SocietyKern County Medical SocietyTulare County Medical Society

September 2015Vol. 37 – Number 9

EditorAlan Birnbaum, MD

Managing EditorCarol Rau Yrulegui

Fresno-Madera Medical SocietyEditorial Board

Virgil M. Airola, MDHemant Dhingra, MDDavid N. Hadden, MDRoydon Steinke, MD

Kern RepresentativeJohn L. Digges, MD

Tulare RepresentativeFrancine Hipskind

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

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

Advertising Contact:Display:

Annette Paxton559-454-9331

[email protected]

Classified:Carol Rau Yrulegui

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

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

CLASSIFIED AD PLACEMENTMembers: 3 months/3 lines* free; there–after $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.

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

NEWS

CMA NEWS ............................................................................................................................7

35th ANNUAL CARDIOLOGY SYMPOSIUM .................................................................................4

HEALTHCARE NEWS ...............................................................................................................8

LEGISLATIVE OUTLOOK: Empowering Physicians .......................................................................9

ALZHEIMER’S: Research Breakthroughs ..................................................................................9

CLASSIFIEDS..........................................................................................................................15

TULARE COUNTy MEDICAL SOCIETy ......................................................................................10

• Size Matters in Science

• Medical Care in Tulare County

• Upcoming Events

• Walk With A Doc Program

FRESNO-MADERA MEDICAL SOCIETy .....................................................................................12

• President’s Message

• Staying Sane, Satisfied and Effective in Medicine and Life: General Society Meeting

KERN COUNTy MEDICAL SOCIETy ..........................................................................................14

• CMA House of Delegates Deadlines and Caucus Times

• Membership News

4 SEPTEMBER 2015 / VITAL SIGNS

SAVE THE DATE

35th ANNUAL CENTRAL VALLEy CARDIOLOGy SyMPOSIUM

November 7, 2015 Madera Municipal Golf Center

FEATURED TOPICS

• Update on Catheter Ablation for Atrial Fibrillation

• Approach to Patients with Ventricular Arrhythmias and Normal Heart

• Trans Catheter Aortic Valve Replacement 2015: Achievements and Challenges

• Assessment and Current Concepts in the Treatment of Hypertriglyceridemia

• Cardiomyopathy Update: Stress Induced, Drug Induced and Peripartum Cardiomyopathy

• Catheter Based Repair of Mitral Regurgitation, A.S.D.s and L.A.s

• Are PCSK9 Inhibitors the Next Breakthrough in the Cardiovascular Field?

> UPCOMING ••••••••••

65th ANNUAL yOSEMITE POSTGRADUATE INSTITUTE MARCH 18-20, 2016


EDITORIAL

What are YOU doing to bring balance to your life? While satisfaction from a successful professional practice remains the core of every physician’s world, a solid

family life and developing outside interests adds significant strata to a life well spent. All physicians need at least one avocation and contact with community members to complete their lives when out of the office or hospital.

As I peruse the Fresno-Madera Medical Society (FMMS) Pictorial Directory, I appreciate how some members achieve that balance. Areas I recognize include the arts, public policy advocacy, music, outdoor adventuring, horticulture, sports, aviation, astronomy, and religious leadership.

Stereotypically, physicians play golf, like Jeff Aoki, an active 17 handicap player at Fort Washington. But beyond playing golf, Dr. Aoki serves on his club’s Board of Directors, as its Human Resources chair. So, for our September 24 event (see page 13), and our Installation Gala November 13, his efforts will be part of their success.

On August 8, I attended a wonderful evening performance of opera and great Broadway songs, featuring a trio of Fresno physicians – baritones Don Gaede and Marshall Flam, as well as operatic tenor Harvey Edmonds, the latter for years a major organizational force behind the California Opera Association. Similarly at the Fresno Philharmonic, physicians provide much leadership, including J.D. Northway, Richard Mendoza, Varouj Altembarkian, David Hadden, James Prochazka and Nam Kim. Many of us remember the late surgeon and actor Steve Parks. What a guy… in Guys and Dolls and many other shows. Bill Podolsky plays clarinet in the Fresno Community Concert Band and in the Fresmer klezmer group. Guitarist Bob Calmes loves to learn new licks on his banjo, and I hear Judy Davis plays a mean set of drums with her band.

Dr. Gaede, beyond his mellifluous musical voice, also possesses a powerful public policy voice with his letters frequently published in the Fresno Bee, articulating especially his concerns for our environment. I admit to an occasional letter myself. Isn’t there an issue about which YOU should be writing? Joaquin Arambula does more than write letters, he’s running for the California Assembly District 31 seat with an excellent chance of winning in November 2016. California physicians need more of our own in the legislature.

Enjoying that environment and the majesty of our nearby Sierra Nevada, has been a tradition among Central Valley physicians. In our retired generation, we think of Michael Adams, Tom Eliason and Al Sorter, the latter who has been active in ski patrol at China Peak. Among those still practicing, Robert Crooks and Eric Hanson have felt the power of wild places on this continent and others.

Imaging the wilderness and our world’s wonders, local physicians have become skilled photographers. Dr. Hanson’s photos have been enjoyed by patients at Sierra Pacific Orthopedic Center, while Vital Signs has had its covers feature scenic shots by Joseph Hawkins, Robert Bernstein, Newton Seiden, Ning Ling, Don Gaede, David Slater and others.

Yet multiple activities are the norm for many physicians, including those serving in their spiritual community, like Harcharn Chann. Dr. Seiden currently serves on his temple’s Board of Directors, as does Ben Teitelbaum, and as did Mark Alson in the recent past. For some local physicians, life’s inspiration sees the heavens from another perspective. Melvin Helm has become an accomplished astro-imager and a major organizer of the Sierra Remote Observatory. Below the ionosphere fly pilots like Garry Sevel, who uses his Cessna 210 to support of local search and rescue efforts as well as Charles Touton with LIGA.

Traveling the troposphere would be local physicians who cycle including Bill Carveth, Bill Dominic, cardiologist John Telles and orthopedist son Conner Telles. Even I have a road bike with flat tires staring sadly at me. No doubt I have missed many tennis players, such as Sergio Ilic, not to mention marathoner Marty Rindahl, who also summitted Mt. Everest. Alex Sherriffs and Joan Rubinstein enjoy all outdoor activities.

Surely I have missed artists, though one artisan and musician to mention would be Carl Askren, mandolin player and maker and also an artisan of living wood, Mike Saul, whose exquisitely sculptured bonsai trees so many of us have enjoyed at public shows.

For the sake of your community and your own well-being, become and remain active beyond your practice. Plan to attend the Fresno-Madera Medical Society’s September 24 dinner program at Fort Washington Country Club, with speaker Linda Hawes Clever, MD, to further expand your life horizons.

Author may be reached at Siriusguy @aol.com.

Balance and the Complete Life

Alan M. Birnbaum, MDEditor, Vital Signs

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Please see CMA News on page 15

CMA NEWSCMS RELEASES PROPOSED 2016 MEDICARE PHySICIAN FEE SCHEDULE

The Centers for Medicare and Medicaid Services (CMS) recently released the 2016 proposed Medicare physician payment rule. The rule reflects the 0.5 percent increase in payment as of July 1, 2015, and the additional 0.5 percent increase in payment on January 1, 2016, recently adopted by Congress. Overall, Medicare will pay physicians nearly $700 million more in 2016 than they will have paid in 2015.

Most notable in the payment rule is CMS’ proposal to pay for advance care planning and end-of-life counseling. The fee schedule would establish two new codes to cover early conversations between patients and their physician about care options. These codes were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC). The codes include discussion before an illness progresses and during the course of treatment so patients can make decisions about appropriate treatment for their personal situation. One code would cover the first 30 minutes and the other would cover additional 30-minute blocks of time. AMA and the California Medical Association (CMA) have been pushing CMS to cover such services.

CMS is seeking comments on the 2019 implementation of the new Medicare payment systems recently adopted by Congress as part of the permanent repeal of the sustainable growth rate (SGR) formula. The agency also noted its strong support for promoting primary care services and is soliciting comments on potential coverage of collaborative care services and an expansion of the Comprehensive Primary Care initiative. The proposal also includes an expansion of payment for telehealth services mainly for in-home treatments for end-stage renal disease.

There are numerous changes to the relative values of services – many recommended by the AMA RUC. Most notably, payment for gastroenterology services will be reduced five percent, with colon and rectal surgery reduced by 1 percent. Organized medicine is fighting many of these changes.

Other notable provisions of the rule include:Myriad changes to the Accountable Care Organization Shared-Savings

program, the Physician Quality Reporting System (PQRS) and the value-based payment modifier, which will soon apply to all physicians who bill under a tax identification number.

CMS will no longer require physicians who opt out of the Medicare program to notify Medicare on an annual basis.

New appropriate use criteria for advanced diagnostic imaging mainly based on recommendations from the related specialty societies.

Some new exceptions to physician self-referral laws.The overall payment impact by specialty can be found on page 711 of the

rule. Please note that these payments do not account for adjustments made by PQRS, the value-based payment modifier or meaningful use.

CMS is also updating the Geographic Adjustment Factors for all localities nationwide. California will see increases of 0.1 to 0.3 percent. Please note that starting in 2017, California localities will move to Metropolitan Statistical Areas due to the CMA-sponsored geographic practice cost index legislation, with there will be larger payment increases to the urban counties currently within the “Rest of California” locality.

AMA and CMA are carefully analyzing the multitude of changes to the physician payment system and will be submitting extensive comments.

Contact: Elizabeth McNeil, 800-786-4262 or [email protected].

CMA UPDATES ICD-10 TRANSITION GUIDE

Will your practice be ready on Oct. 1, 2015?To help physicians prepare for the transition, the California Medical

Association (CMA) has updated its “ICD-10 Transition Guide,” which includes an ICD-10 transition preparation checklist. New information includes: new table indicating code categories that are expanded as well as those that are reduced under ICD-10; information on how payors will handle prior authorizations around the transition date; listing and links to CMA’s live ICD-10 training courses; information on the Centers for Medicare & Medicaid Services’ “grace period”; and a visual of the anatomy of ICD-10 code structure, among other changes.

For the latest news and information on the ICD-10 transition, see www.cmanet.org/icd10.

UPDATED PAyOR PROFILES NOW AVAILABLE

The California Medical Association’s (CMA) Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, United Healthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration, a description of the plan’s dispute resolution process and the name and contact numbers for medical directors, provider relations and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge.

LEGISLATIVE UPDATE:Six tobacco bills to be taken up during special session on health

Six bills aimed at saving lives and reducing the cost of tobacco-related diseases on California’s health system will be taken up during the Legislature’s second special session to address health care – a meeting ordered by Gov. Jerry Brown.

Some of the bills being proposed are the same as those introduced in the Capitol earlier this year, including bills to add e-cigarettes to the existing tobacco products definition and to increase the age of sale for tobacco products to 21. Other bills introduced would allow local jurisdictions to tax tobacco products and require all schools in the state to be tobacco-free.

CMA President Luther F. Cobb, MD, said the bills symbolize a “tremendous step forward for a healthier California” and that they will help to curb tobacco use in California’s youth.

Three out of every four kids who try cigarettes continue to smoke as adults, and half of those smokers will die from tobacco-related illnesses, according to American Cancer Society Action Network Vice President Jim Knox.Bills to expand nurse practitioners’, optometrists’ scope of practice stall in Assembly committee

A bill that would have allowed nurse practitioners (NP) to practice independently and prescribe drugs without physician oversight is finished, at least for the year.

Senate Bill 323 was voted down 8-4 on June 30 in the Assembly Business and Professions (B&P) Committee. The committee agreed to take it up again on July 14, but the bill was pulled from the hearing by its author, Senator Ed Hernandez (D-Azusa). The California Medical Association (CMA) and the California Academy of Family Physicians led the fight against SB 323.

Senator Hernandez also pulled a separate scope of practice bill, SB 622,


Please see Healthcare News on page 15

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BLUE SHIELD TO REPAy $82M

Blue Shield of California has to issue $82.8 million in rebates to consumers and small employers under an Affordable Care Act provision, the Los Angeles Times reports. The state’s other two largest insurers – Anthem Blue Cross and Kaiser Permanente – say they do not owe any refunds this year.

Under the ACA, insurers that do not spend at least 80% of premiums on medical care must issue refunds. According to the Times, Blue Shield last year spent 76.8% of premiums on medical care.

Blue Shield said it missed the 80% threshold in part because of enrollment uncertainty under the ACA. As a result, the insurer owes:

• $61.7 million to about 450,000 individual consumers, with an average rebate of $136; and

• $21.1 million to about 19,000 small businesses.

The insurer said letters and rebate checks will be sent to eligible consumers by Sept. 30.

Spokesperson Steve Shivinsky said, “It reflects a lot of the uncertainty in the marketplace we were entering into with the [ACA]” (Terhune, Los Angeles Times, 8/4).

CALIFORNIA’S AGING POPULATION COULD STRAIN HEALTH CARE SySTEM IN THE SAN JOAqUIN VALLEy

According to a report by the California HealthCare Foundation, California’s population of residents ages 65 or older is projected to more than double by 2040. As a result, that population’s demand for health care services will increase, but the effects will be disproportionate depending on service type and location.

In 2012, nearly two-thirds of seniors in California had at least two chronic conditions, and more than one-third had four or more chronic conditions. The report suggested that the presence of multiple chronic illnesses will increase aging Californians’ demand on the state’s health care system (CHCF report, August 2015).

As such, there could be a shortage of services, including:

• Home health care;• Long-term care; and• Skilled nursing and residential living facility

beds.However, seniors likely will have access to

enough acute care hospital beds (“Capitol Alert,” Sacramento Bee, 8/6). Specifically, the report noted that acute care use by seniors has fallen

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LEGISLATIVE OUTLOOK ALZHEIMER’S

A Refreshing Take On the Role of Pediatricians

What I Learned About Empowering the Politician Within

Anita Chadha, MD Resident, UCSF-Fresno

It was a bright, sunny and beautiful April, 2015 California morning. What became of that seemingly simple, coordinated day of appointments slowly transformed into a monumental and unforgettable experience for me.

Representing UCSF-Fresno Pediatrics Residency and the American Academy of Pediatrics, I, along with other Residents, took our first steps into the State Capitol at Sacramento, at California Medical Association’s (CMA) Annual Legislative Day. A day, wherein physicians from across the state are empowered to influence current legislation and lend their experiences toward improving patient care from a statewide level. As pediatric residents, we were honored to lobby and advocate for our future generations.

We met with legislators who were preparing to vote on bills in the fields of Health and Education, bills whose effects would have direct bearings and repercussions on our communities. By partaking in willful discussions led by the firsthand experiences of multiple patient encounters, we as Central Valley physicians, advocated for the lives of our future newborns, adolescents and adult populations. The indescribable sentiments of pride, liberty of speech, and democracy lent itself to an inspiring experience that instilled in us an esteemed message – our voice can make a difference!

We marched headstrong and determined into our first appointment with Assemblyman Jim Patterson, in support of bill SB 277. This bill effectively eliminates the current personal belief exemption that exists for school entry vaccinations. As pediatricians we felt our duty to protect the lives of our patients, preserve the concept of herd immunity, and fight to eradicate once-fatal diseases which we now have FDA approved vaccinations for.

Our proceeding experiences that day served to reinforce an emerging notion that began evolving. As pediatric residents, we do have a voice! Our next appointment consolidated this notion following an in-depth discussion with representatives of Senator Andy Vidak. Not only did we reinforce our strong support for SB 277, but also merged our discussions with Tulare County Medical Society on other bills that were currently in the legislature, namely increasing reimbursement with Medi-Cal.

I would have to say the pinnacle of our day transpired during our contribution and participation in Senate hearings regarding AB 170. This bill inflicts an “opt-in” option for the California Newborn Screening, which currently screens for a subset of common metabolic and genetic diseases that may otherwise go unnoticed at birth. The immense livelihood and concepts of persuasion amongst a heated debate from our opposition, only invigorated and impressed upon me fortitude and determination to make a stance. The powerful enthusiasm and animation in that room confirmed our commitment to continue fighting for our children.

Walking away from the State Capitol that afternoon, I sensed a mounting inspiration and fervent desire to devote myself to pediatric advocacy. Prior to Legislative Day, I was blindly unaware of the direct impact our voices, experiences, and personal stories have on legislation..

The rewarding gratification that emerged following our lobbying efforts is indescribable and to put it bluntly – priceless. There indeed lies an imminent necessity for pediatricians to continue advocating for their patients, whether this be at a community, state, or federal level. CMA’s Legislative Day was an invaluable experience that every resident should partake in.

Breakthroughs In Alzheimer’s Research:

The Importance of Getting A Diagnosis and Support

For Patients

Stella De La Pena, DirectorAlzheimer’s Association

The Alzheimer’s Association International Conference (A AIC) is the world’s largest gathering of leading researchers from around the world focused on Alzheimer’s disease and other dementias. The following research breakthroughs were presented at A AIC’s annual conference held in Washington, DC in July 2015.

• Brain scans, memory testing and body fluids may hold the keys to understanding a person’s likelihood of developing Alzheimer’s.

• The research community is attacking Alzheimer’s disease from multiple angles, targeting the underlying causes and some of the most pernicious symptoms. These advances show a clear maturation of the field of research for Alzheimer’s and a hint at future possibilities of combination therapy.

• Women are disproportionately affected by Alzheimer’s. Almost two-thirds of American seniors living with Alzheimer’s are women. At age 65, women without Alzheimer’s have more than a one in six chance of developing Alzheimer’s during the remainder of their lives, compared with a one in 11 chance for men.

• Regular physical activity may reduce the risk of cognitive decline in Alzheimer’s disease and other dementias.

• While memory problems are common in the elderly, Alzheimer’s disease is a very specific neurological disease. It must be diagnosed before it can be successfully managed. Only 45% of people with Alzheimer’s disease or their caregivers report being told of their diagnosis. There are over five million people living with Alzheimer’s disease in California and it is the sixth leading cause of death.

The Alzheimer’s Association opened its doors in Fresno in August to offer education programs and support to those individuals, families and caregivers touched by the disease.

To partner with the Alzheimer’s Association to support your patients call the Helpline at 800-272-3900 or local office at 559-753-8200 and visit the Walk to End Alzheimer’s the morning of September 12, 2015, at Fresno State, Maple Mall, Fresno. For more information, please visit http://act.alz.org/fresno2015.


Tulare

3333 S. FairwayVisalia, CA 93277

559-627-2262Fax 559-734-0431

website: www.tcmsonline.org

Officers Monica Manga, MD, ABIM

PresidentVirinder Bhardwaj, MD

President-ElectRaman Verma, MD Secretary/TreasurerThomas Gray, MD

Past President

Board of Directors Anil K. Patel, MD

Jerry Jacobson, MD Pradeep Kamboj, MD

Matthew Kirkman, MD Christopher Rodarte, MD

Antonio Sanchez, MD

CMA Delegates Thomas Daglish, MD

Roger Haley, MD John Hipskind, MD

CMA Alternate Delegates Robert Allen, MD James Foxe, MD Mark Tetz, MD

Sixth District CMA Trustee Ralph Kingsford, MD

Staff Francine Hipskind Executive Director

Thelma Yeary Membership

Dana Ramos Administrative Assistant

Lydia Garcia Administrative Assistant

Size Matters in ScienceDavid Hewitt MD, Pathologist, Visalia

We get along in our daily lives reasonably well, in part because we’re accustomed to the scale of things. We can pick up small and large objects, maneuver around things well enough, and generally handle what comes our way, because we operate on the same scale as the things around us – at least the things that we deal with routinely. Moving away from that scale, to the very small or very large, can prove, well, uncomfortable. By the way, my arithmetic in this article may not be exact, but it’s in the general vicinity of correctness.

Small. Let’s start with the small. Now, I am not talking about small like a mouse, or a housefly, or a grain of sand. No, those are still in our size territory. Let’s move far down the scale, past bacteria and viruses, even past molecules, to the level of the atom, which is the basic unit of matter that still maintains the properties of that particular matter (an atom of gold is gold, and an atom of helium is helium).

Atoms range greatly in size; hydrogen is smallest, and uranium is just about the largest that one will find in nature, being roughly 240 times as massive as hydrogen and about four times the diameter of hydrogen. But even a very large atom is still very, very small. If you were to line up uranium atoms side by side, as close together as they can be, there would be about 70 million atoms per inch. Compare that to, say, English peas: 70 million average English peas would form a line something like 15,206,400 inches long – nearly 240 miles.

And that’s taking into account the entire uranium atom. If you really want to think aboutsmall, let’s move on to the nucleus of the atom. The nucleus is so small that it takes up less than half of a percent of the diameter of the atom. A crude model of a uranium atom might require a basketball, representing the nucleus, placed in a circle about 70 yards across (with 92 little grains of sand scattered around at various points in the circle representing the electrons). Most of the atom is empty space. The actual parts are unimaginably small.

Now, if you really want to think about small, we could move on to quarks, but that’s for another column.

Big. Now we consider the opposite end of things – the world of the really, really large. I don’t mean large like an elephant, or a building, or a mountain, or even a planet. Think bigger.

Our planet is about eight thousand miles through the middle. The Sun is more than 100 times as large through its middle and the sun could hold more than one million Earths inside it. But as stars go, the Sun is not particularly impressive. Let’s skip to the end on this one: The largest star that has been studied (at present, such study is limited to our own galaxy) is V Y Canis Majoris, in the constellation Canis Major (the Big Dog); it is more than 1500 times as large as our own star. Remember the English pea? If that’s the Earth, then the Sun is a twice a large as a basketball and V Y Canis Majoris is over half a mile across. That’s a big star.

But even that scale is nothing compared with distances between stars, and even less compared to distances between galaxies. Light takes about four one-hundredths of a second to go as far as the Earth is wide; it takes a little over eight minutes to go from the Sun to the Earth; and about two and a half hours to go as far as V Y Canis Majoris is across. (Again, a big star.)

But it takes light over four years to go from our sun to its nearest star (that means that it’s about four light-years away), and almost 4,000 years to go to the really big guy in Canis Major. And that’s all within our own galaxy. The next galaxy is over two and a half million light-years from us. In miles, that’s something like the number 15 followed by 19 zeroes. Now that’s really big.

Thinking about really small-scale or really large-scale things can make your head hurt. But being aware of the amazing scale of the universe is one of the beauties of science. For a fully mind-blowing, interactive video on the scale of the universe, visit http://www.htwins.net/scale2. Enjoy having your horizon broadened.

Send questions, comments, and suggestions for articles to [email protected].


Tulare

Medical Care in Tulare County

Deborah Jackson RN

Retirement: The dream finally realized. After a lifetime of careers and raising our family in the Washington DC National Capitol Area, my husband and I moved to our Tulare County home above the Camp Nelson area last summer. We recognized there would be many concerns and changes to address. A move from the East Coast to the West Coast, although exciting, can be overwhelming; new environment, new friends, new driver’s licenses, etc.

A priority for my husband and me was to find reliable, competent, medical care. With significant changes in medical insurance, we were concerned about medical coverage. We needed to set up appointments with a primary physician and specialists. While still in Northern Virginia, we asked our physicians for recommendations. Their reply; “You will have no problem finding good doctors in California... Everyone wants to work there.” This statement/consensus has been proven more than once.

In 2011, I began to experience symptoms of an inner ear condition while living in Northern Virginia. After retirement and our move to California, my symptoms continued to worsen. I was referred to Dr. Mark Reader, ENT, by my primary physician. After his thorough assessment and examination, he recognized that I had been diagnosed incorrectly in Northern Virginia. Dr. Reader accurately diagnosed my problem as BVH (Bilateral Vestibular Hypofunction), an irreversible condition of the vestibule of the ears. I was referred to Pro PT in Visalia and the expertise of physical therapist, Dr. Whitney Martinez. Her professional assessment concurred with Dr. Reader.

The combination of correct diagnosis and Physical Therapy has resulted in a significant amelioration in my symptoms. My ability to function independently with greater self-confidence has increased. To say thank you is inadequate when offered an accurate diagnosis and positive life changing services. I am grateful to Dr. Reader for the sense of confidence he generates to his patient and the sense of hope he offers through correct diagnosis and appropriate treatment. I deeply appreciate Dr. Reader’s commitment to his specialty. He brings current advances and knowledge to his practice.

The physicians of Tulare County and their staff are friendly, compassionate, and competent. Their commitment to providing professional care is genuine. These are essential attributes when seeking the medical assistance of a physician. For us, especially as we have grown grow older, the relationship between us and our physician is one of collaboration, allowing for honest conversation and good listening. This leads to knowledgeable diagnosis and treatment. Our anxiety to find specialists was unfounded. My husband and I highly regard the excellent care we are receiving. The medical community of Tulare County compares (if one must compare) very favorably with Washington, D.C./National Capitol Area.

As a retired medical professional, R.N., I have had the personal opportunity to observe and experience the amazing medical care available in Tulare County. I offer heartfelt thanks to each physician and medical staff member from whom I have received care. Without reservation, I recommend the services and care of Dr. Mark Reader. I would with the same emphasis recommend the services of Dr. Whitney Martinez. Our move to Tulare County, California is one of the best decisions we have ever made.

Thank you for helping us to have a healthier and happier retirement! TULARE: Del Lago Park

Saturday, September 19, 2015Topic: 2nd Anniversary Registration: 8:00amWalk Time: 8:30am

Join us at the next Walk With A Doc to take a step toward a healthier you! All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness.

ANYONE CAN ATTEND!For more information, please contact

Tulare County Medical Society at(559) 627-2262

VISALIA: Riverway Sports Park,3611 N. Dinuba Blvd.

Saturday, September 12, 20158:00 to 9:00 am

Registration: 8:00am • Walk Time: 8:30am

Join us at the next Walk With A Doc to take a step toward a healthier you! All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness.

ANYONE CAN ATTEND!For more information, please contact

Tulare County Medical Society: 559-627-2262

VISALIA: Riverway Sports Park,3611 N. Dinuba Blvd.

Saturday, Sept. 12, 2015 • 8:00 to 9:00 am

TULARE: Del Lago ParkSaturday, September 19, 2015

Topic: 2nd Anniversary

Tulare County Medical Society Upcoming Events

TCMS FAMILy DAySunday, October 4, 2015McDermott Field House

DINNER MEETINGDr. Steven E. Larson, CMA President-Elect Thursday, October 29, 2015Visalia County Club

Details will follow by mail on the above events.

If you have any questions, please feel free to call the TCMS office at 559-627-2262 and ask to speak to Dana Ramos. You may also email her at [email protected].


Fresno-MaderaA.M. AMINIAN, MD

President’s MessageMEDICARE AND MEDICAID CELEBRATE 50 yEARS OF SERVICE

As doctors, we understand the importance of providing access to quality, affordable care to our patients. This year marks an important milestone in providing that access to our seniors, individuals who might otherwise be unable to afford care, and those that suffer from long term disabilities. Some 50 years ago, in fact on July 30, 1965, President Lyndon B. Johnson (LBJ) signed Medicare and Medicaid into law, changing the landscape of health care in America forever.

Moments after President Johnson signed the legislation into law, he presented the first Medicare card to former President Harry Truman who was then 81 years old and his wife, Bess Truman. In 1945, President Truman was the first president to suggest that a national health insurance program was needed. It took 20 more years and the work of three more presidents to develop the first national program designed to expand coverage and access.

Prior to this legislation, more than half of seniors were uninsured and in need of affordable health care, fearing that an illness or accident could cause major economic hardship for themselves and their families. Though Medicare and Medicaid started as basic insurance programs for Americans who didn’t have health insurance, they’ve changed over the years to provide more and more Americans with access to the quality and affordable health care they need and now almost all seniors are covered by one or both programs.

According to the Center for Medicare and Medicaid Services (CMS), the two programs combined cover 1 in 3 Americans (roughly 122 million people). More than 55 million Americans rely on Medicare to provide 23 types of preventative services, hospital stays, lab tests and critical supplies like wheelchairs, as well as prescription drugs. Medicaid provides comprehensive coverage to more than 70 million eligible children, pregnant women, low income adults and people living with disabilities. It covers essential services like annual check-ups, care for new and expecting mothers, and dental care for kids from low-income families.

In the Central Valley alone, Medicare and Medi-Cal (California’s name for Medicaid) have a major impact on the health care coverage of it’s residents. Of the roughly 125 million Americans benefitting from one of these two programs, 1.2 million of them are residents of the Central Valley, with close to a million low income children, adults and people with disabilities on Medi-Cal, and more than 250,000 seniors and disabled individuals on Medicare.

While there are many challenges ahead for both programs and public opinion has varied on them since being signed into law, politicians and lawmakers in both parties have continued to work together to keep Medicare and Medicaid viable. Look for more information later this summer as California legislators are working on the funding for Medi-Cal because of it’s substantial growth due to the implementation of the Affordable Care Act.

Interesting Facts from Center for Medicare and Medicaid Services• In 1965 the life expectancy for a male was 78.5 years and 83 years for a woman. In 2015 the average life expectancy

for a man is 84.3 years and 86.6 years for a woman.• 1.5 million doctors, health care providers and suppliers participate in the Medicare program nationwide.• Medicare was responsible for helping to desegregate hospitals after the Civil Rights Act went into effect. Hospitals

had to comply if they wanted to receive Medicare federal funding.• More than one third of all Medicare beneficiaries live with four or more chronic conditions.

Post Office Box 28337 Fresno, CA 93729-8337

1040 E. Herndon Ave #101 Fresno, CA 93720

559-224-4224 Fax 559-224-0276

website: www.fmms.org

Officers A.M. Aminian, MD

PresidentHemant Dhingra, MD

President-ElectAhmad Emami, MD

Vice PresidentAlan Kelton, MD

Secretary/TreasurerPrahalad Jajodia, MD

Past President

Board of Governors Alan Birnbaum, MD

William Ebbeling, MD David Hadden, MD

Joseph B. Hawkins, MD Sergio Ilic, MD

Trilok Puniani, MD Ranjit Rajpal, MDGeorge Saul, MD

Roydon Steinke, MD Connor Telles, MD Cesar Vazquez, MD

CMA Delegates FMMS President Don Gaede, MD Brent Kane, MD

Brent Lanier, MD Andre Minuth, MD Ranjit Rajpal, MD Oscar Sablan, MD

Roydon Steinke, MD Toussaint Streat, MD

CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD

Trilok Puniani, MD

CMA Trustee District VI Virgil Airola, MD

Staff Nicole Butler

Executive Director

IN 1945, PRESIDENT TRUMAN WAS THE FIRST PRESIDENT TO SUGGEST THAT A NATIONAL HEALTH INSURANCE PROGRAM WAS NEEDED.


Fresno-Madera


PO Box 1029 Hanford, CA 93230

559-582-0310

Officers Jeffrey W. Csiszar, MD

PresidentVacant

President-ElectMario Deguchi, MD

Secretary TreasurerTheresa P. Poindexter, MD

Past President

Board of Directors Bradley Beard, MD

Jacqueline G. DeCastro, MD Thomas S. Enloe, Jr., MD Michael MacLean, MD

Kenny Mai, MD

CMA Delegate Ying-Chien Lee, MD

Staff Marilyn Rush

Executive Secretary

CMA House of Delegates Deadlines and Caucus TimesListed below are dates of importance for the upcoming CMA Annual Session being held October 16-18, 2015 at the Disneyland Hotel, Anaheim, CA. Please be sure to mark your calendars!

• September 18, 2015: Resolutions, Reports and Staff Analyses posted to CMA website (opportunity for virtual testimony begins)

• September 23, 2015: KCMS Delegation Meeting, 6pm, KCMS office• October 2, 2015: Deadline for submission of online testimony on

CMA website prior to virtual reference committee deliberations • October 9, 2015: Reference Committee Reports posted on CMA

website• October 15, 2015: Pre-House Meetings – Disneyland Hotel

• Board of Trustees • Organized Medical Staff Section Annual Assembly • Young Physicians Section Annual Assembly • Ethnic Medical Organization Section Annual Assembly • Mode of Practice Forum Annual Meetings • House Rules Committee

• October 16, 2015: Caucuses will meet at 10:00am-1:30pm• October 17, 2015: Caucuses will meet at 11:00am-12:30pm Additional information is available by contacting the KCMS office at

661-325-9025.

Kern Kings

2229 Q Street Bakersfield, CA 93301-2900

661-325-9025 Fax 661-328-9372

website: www.kms.org

Officers Michelle S. Quiogue, MD

PresidentVipul R. Dev, MD

President-ElectEric J. Boren, MD

SecretaryBradford A. Anderson, MD

TreasurerAlpha J. Anders, MD

Past President

Board of Directors Alberto Acevedo, MD

William J. Farr, MD Susan S. Hyun, MD

Kristopher L. Lyon, MD Betsy Matkovic, MD

Mark L. Nystrom, MD Eric A. Peck, MD

Edward W. Taylor, III, MD

CMA Delegates Jennifer Abraham, MD

Lawrence N. Cosner, Jr., MD Vipul Dev, MD

John Digges, MD

CMA Alternate Delegate Sarah Assem, MD

CMA YPS Delegate Cyrus R. Moon, MD

StaffKathy L. Hughes

Administrative Assistant

Membership NewsMEET THE NEW KCMS MEMBERS: The following physicians’ names, etc. are being published in accordance with KCMS Bylaws. Board Certification will be listed only if the physician has been certified by a Specialty Board recognized by the American Board of Medical Specialists as approved by the AMA.

Active ...........................................................240Resident Active Members .................. 32Active/65+/1-20hr ....................................4Active/Hship/1/2Hship .......................0Government Employed ..........................3Multiple Memberships ...........................1

Retired ...........................................................63Total ...........................................................343New Members (Pending Dues) .........1New Members (App Pending) ..........0Total Members .................................344

Maheep S. Birdi, MD (Neurology)3008 Sillect Ave., Ste. 100, 93308-6360661-432-7851 / FAX: [email protected] Medical Degree: Gov’t. Medical Clg., India 1996Internship/Residency: Westchester Med. Center, NY 2010-2014Fellowship: Westchester Med. Center, NY 2014-2015

WELCOME KMC RESIDENT PHySICIAN MEMBERSHisham J. Abukamleh, MD (IM) Verna L. Marquez, MD (FM)Kiran Agarwal, MD (IM) Olga Meave, MD (FM)Jasmeet K. Bains, MD (FM) Aarushi R. Parekh, MD (IM)Arlenis Barroso-Perez, MD (FM) Rhett Anthony B. Pelaez, Jr., MD (FM)Sabina R. Bera, MD (PSY) Ashley Pirozzi, MD (PSY)Julia L. Canders, MD (OBG) Omar Salamanca, MD (FM)Hassan Chahine, MD (IM) Ritam Sidhu, MD (IM)Shelly Gupta, MD (IM) Sukhpreet Sidhu, MD (IM)Samantha C. Madziarski, MD (PSY) Sarayu Vasan, MD (PSY)

JULy MEMBERSHIP RECAP


TULARE

KERN

CLASSIFIEDSFRESNO

. ANNOUNCEMENT Fresno Gastroenterology welcomes board-cer-tified physician Dr. John Abdulian and nurse prac-titioner Marcella Nole. Referrals appreciated by calling 559-323-8200 or faxing to: 559-323-9200.Digestive Disease Consultants, Patrick Ginn, MD & Kevin Kodama, MD, are proud to announce the association of Soo. Y. Kim, MD, Pradnya Mi-troo, MD & Sandeep Sekhon, MD, effective Sept. 1, 2015. New patients being accepted for Sept., 2015. Appointments by referral only. Call office at 559-440-0450 or FAX to 559-440-0461.

. FOR LEASE / RENT Medical office space, 1,331sf. Many new exterior improvements. 1046 E. Shields. Call Shannon at 559-999-6165 or [email protected]. Beautiful, remodeled 3,500sf. home in NW Fres-no cul de sac. Pool, fruit trees, large gardens on approx. 1/3 acre. Clovis West school district. Available mid-August, 2015 for one year. $2700 per month. Call Lynn 559-930-4213 or Hani 559-930-6406.

. FOR LEASE / RENT / SALE Prime location medical offices, across the street from Visalia Medical Clinic. 2,200sf. 5601 W. Hillsdale Ave. Visalia. Call 559-786-0512.

. FOR SALE Well established, turnkey medical weight loss clinic. Over 300 active patients and thousands to build from. Cash business with bariatric computer system. Finance with ProMed Financial. Contact Susan at [email protected].

CMA News Continued from page 7

Healthcare News Continued from page 9

that would have allowed optometrists to perform an array of supplementary procedures with little additional training. That measure would have permitted optometrists to perform scalpel surgeries, laser surgeries and intraocular injections. It was pulled on July 14 for the second time this month, ending its run in this year’s legislative session. CMA partnered with the California Academy of Eye Physicians and Surgeons along with a robust coalition, including local county medical societies, to warn lawmakers and the public about the dangers of this bill.

Lowering certification standards and oversight puts the safety and health of patients at risk. This was the case a few years ago when eight veterans suffered “significant” vision loss, and another 23 suffered progressive vision loss, after optometrists at the Palo Alto Veterans Affairs Health Care System ignored requirements to refer glaucoma patients so their treatment could be monitored by ophthalmologists.

Organizations voicing their opposition to SB 323 at the hearing included the California Academy of Eye Physicians and Surgeons, the Medical Board of California, California Psychiatric Association, California Orthopaedic Association, California Society of Dermatology and Dermatologic Surgery, and the California Society of Anesthesiologists, in addition to CMA.

PROBLEMS GETTING PAID?

The California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff.

Reimbursement Help Line: 888-401-5911 or [email protected] When to call CMA? CMA members can call on CMA’s practice management experts for free

one-on-one help with contracting, billing, and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help.

• Are your claims not being paid in a timely manner?• Are you not being paid according to your contract?• Are your claims being denied after obtaining prior authorization or verifying eligibility?• Are you receiving unreasonable requests for medical records or untimely requests for refunds?• Are you having difficulty obtaining fee schedules and/or payment rules?• Are your claims denied for timely filing?• Have you been presented with a managed care contract and you’re not sure if the terms are

consistent with California law?• Have you done everything you can to resolve an issue with a payor, including appealing, and have

been unsuccessful in getting the payor to resolve the issue?

since 2008, and acute care days could decrease by 15% by 2040 if those trends continue. However, acute care days could increase by as much as 50% in that time if current use rates remain unchanged.

Meanwhile, the report projected that senior population growth and health care utilization increases will vary by region. For example, individuals ages 65 and older in 2010:

Accounted for 10% of the population of the Inland Empire, which includes Riverside and San Bernardino counties, and is projected to account for 20% by 2040; and

Accounted for 10% of the population of San Joaquin Valley, and is projected to grow to 16% by 2040.

The report estimated that the Inland Empire and San Joaquin Valley will barely have enough acute care beds to meet demand if such trends continue (CHCF report, August 2015).

California’s nursing home population is likely to grow because of an expected increase in seniors with “self-care limitations.” Specifically, the report noted that more than 106,000 Californians will need nursing home care in 2030, up by 16% from 2012.

According to the report, the expected aging population growth will require additional resources and providers that include geriatricians, medical assistants, nurses, nurse practitioners; and physician assistants (HealthyCal, 8/6).

© 2015 NORCAL Mutual Insurance Company. * Based on 2014 data.

Proud to be endorsed by the Fresno-Madera, Kern, Kings and Tulare Counties Medical Societies

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Vital Signs September 2015