February 2009

• Recommendations for Use of Influenza Antiviral Medications
• SCMA Board Reaffirms Position Statement on Sutter Proposal
• Physician Directory Set for Delivery
• Volunteer Needed for SCMA Health Careers Scholarship Committee
• Nominations Needed for SCMA Elections
• Local Health Groups Can Apply for PFMC Community Grants
• Meetings on Health Care Reform Set for Feb. 11 and 21
• Obama Community Discussion Group Recommends Finance Reform
• BBR Needs Blood Donations
• Medi-Cal Claims with Patient SSNs Will Be Denied as of Feb. 1
• Physicians Urged to Complete Balance Billing Survey on CMA Website
• CME Events at Sonoma Developmental Center

Recommendations for Use of Influenza Antiviral Medications

By Dep. Health Officer Mark Netherda, MD

Although influenza activity is low in Sonoma County andthroughout the United States to date, preliminary data from a limited number ofstates indicate that the prevalence of influenza A subtype (H1N1) virusresistant to the antiviral medication oseltamivir (Tamiflu) is high. Therefore,CDC is issuing interim recommendations for antiviral treatment andchemoprophylaxis of influenza during the current flu season.

When influenza A (H1N1) virus infection or exposure issuspected, zanamivir (Relenza) or a combination of oseltamivir and rimantadineare more appropriate options than oseltamivir alone. Most labs in SonomaCounty, including the Public Health Department, do not differentiate betweenspecific subtypes of Type A influenza virus (e.g., H1N1 vs. H3N2). The CDC willupdate their recommendations as more information is gained through furthertesting of more viral isolates across the United States.

Both (1) people providing medical care for patients with suspectedinfluenza and (2) people who are candidates for chemoprophylaxis againstinfluenza should consider the following:

Consider use of influenza tests that can distinguishinfluenza A from influenza B.

Patients testing positive for influenza B may be giveneither oseltamivir or zanamivir (no preference) if treatment is indicated.

People who are candidates for chemoprophylaxis should beprovided with medications most likely to be effective against the influenzavirus that is the cause of the outbreak, if known. Respiratory specimens fromill patients during institutional outbreaks should be obtained and sent fortesting to determine the type and subtype of influenza A viruses associatedwith the outbreak and to guide antiviral therapy decisions.

Zanamivir should be used when people requirechemoprophylaxis due to exposure to influenza A (H1N1) virus and considered foruse when subtyping of Influenza A is unavailable and local/regional data suggesta prevalence of H1N1 activity. Rimantadine can be used if zanamivir use iscontraindicated. People whose need for chemoprophylaxis is due to potentialexposure to a person with laboratory-confirmed influenza A (H3N2) or influenzaB should receive oseltamivir or zanamivir (no preference).

For complete recommendations, visitwww.cdc.gov/flu/professionals/antivirals/index.htm.

SCMA Board Reaffirms Position Statement on Sutter Proposal

In response to Sutter’s latest proposal to build a newhospital in Santa Rosa, the SCMA board of directors has reaffirmed an earlierposition statement that emphasizes access to care, support for community healthdirectives, and availability of physicians.

The statement says, in part, that SCMA’s paramount concernis to “ensure that patients will continue to have access to care and to theirphysicians. We continue to express concerns that short-term capacity needs willbe insufficient.”

SCMA’s position statement is among many comments that thecounty’s Department of Health Services is analyzing in response to Sutter’sproposal, including those received at public hearings on Jan. 13 and 14. DHSofficials are expected to report their findings to the Board of Supervisors inthe spring.

Physician Directory Set for Delivery

The annual Sonoma County Physician Directory published bySCMA is back from the printer and will be delivered to all members free ofcharge in the first week of February. This year’s directory includes detailedspecialty and contact information for SCMA members, along with alphabeticallistings and specialty indexes for virtually all physicians in Sonoma County.

Additional copies are $30 for members ($40 for nonmembers)and can be ordered at www.scma.org or by contacting Rachel Pandolfi at 525-4375or rpandolfi@scma.org.

Several dozen physicians have joined SCMA during the pastyear, bringing the latest membership count to 666, about two-thirds of thepracticing physicians in Sonoma County. For more information on joining SCMA,visit www.scma.org.

Volunteer Needed for SCMA Health Careers Scholarship Committee

SCMA needs a physician volunteer for its Health CareersScholarship Committee, which recommends recipients for scholarships and studentloans. The committee meets only twice a year at lunchtime.

Interested physicians should contact Cynthia Melody at525-4359 or cmelody@scma.org.

Nominations Needed for SCMA Elections

Nominations for the following SCMA positions are due by March 20:

*     SCMA president-elect

*     Individual SCMA board representatives from Healdsburg (1), Petaluma (1), and Santa Rosa (2)

*     Two CMA delegates

*     Two CMA alternate delegates

All positions require a three-year commitment, beginning July 1. Nominations can be e-mailed to cmelody@scma.org, faxed to 525-4328, or mailed to SCMA, 3033 Cleveland Ave. #104, Santa Rosa, CA 95403. Each nomination should include a brief statement about the nominee's qualifications.

For more details, contact Cynthia Melody at cmelody@scma.org or 525-4359.

Local Health Groups Can Apply for PFMC Community Grants

Nonprofit health organizationsin Sonoma County are encouraged to apply for Community Grants from the PacificFoundation for Medical Care. The grants, generally in the $10,000 range, areawarded twice a year by the nonprofit foundation to support local projects thatenhance health services.

The application deadline for thenext round of grants is April 1. For application materials, contact MarilynFlowers at 800-548-7677, Ext. 120, or mflowers@rhs.org. For more information,visit www.pfmc.org.

Meetings on Health Care Reform Set for Feb. 11 and 21

At least two meetings on healthcare reform will be held in Santa Rosa during February.

Newly elected county supervisorsShirlee Zane and Efren Carrillo will host a Feb. 11 forum on the role of countygovernment in health care delivery. The forum will be held from 6 to 8 p.m. atthe Veterans Building, 1351 Maple Ave. To RSVP, contactSonomaSolutions@seiu1021.info.

On Feb. 21, Dr. John Shearerwill moderate a discussion of single-payer plans from 3 to 4:30 p.m. at theGlaser Center, 547 Mendocino Ave. Panelists include Drs. Richard Quint andClaudia Chaufan. No RSVPs are required.

Obama Community Discussion Group Recommends Finance Reform

On Dec. 30, nearly 50 localphysicians and other health care leaders attended a Health Care CommunityDiscussion in Santa Rosa sponsored by the Obama-Biden Transition Project.According to a summary of the meeting provided by RCHC and Health Action, thegroup identified financing as the biggest problem in the health system.

“The health care financing modelis the underlying problem in the system,” the group concluded, “because it iswasteful, does not provide equal access to care, and does not reflect a valueof health care as a civil right equal to education and public safety.”

The group also recommendeduniversal coverage, medical homes, and increased emphasis on preventive care.Their recommendations, along with those from similar groups around the country,will be considered as part of a health care reform package to be unveiled bythe Obama Administration later this year.

BBR Needs Blood Donations

Blood Bank of the Redwoods’blood supply is being depleted by limited donations. They are in great need ofblood donors for all blood types.

Blood may be donated at the BBRoffice, 2324 Bethards Dr., Santa Rosa. The office is open from noon to 7 p.m.Monday to Thursday and 9 a.m. to 3 p.m. on Friday and Saturday.

Medi-Cal Claims with Patient SSNs Will Be Denied as of Feb. 1

Beginning on Feb. 1, physicianscan no longer bill Medi-Cal or the Child Health and Disability PreventionProgram using patients’ Social Security numbers as identifiers. All providersmust use the 14-character Medi-Cal identification number from recipients’Benefits Identification Cards (BIC) or paper ID cards when submitting claims.The ID number is located on the front of the card and consists of a 9-digitclient index number, a check digit, and a 4-digit issue date. (The issue dateis used to deactivate cards that have been reported as lost or stolen.)

The only exemption to this ruleis for Medicare crossover claims. Physicians may continue to bill Medicarecrossover claims using the recipient’s SSN/Medicare number as it appears on beneficiaries’Medicare identification cards.

Physicians are also urged to useMedi-Cal identification numbers when verifying eligibility or submittingtreatment authorization requests. In an emergency or in the event a Medi-Calpatient does not bring his or her BIC to an appointment, physicians may (withthe patient’s permission) use a SSN to verify eligibility via the Medi-CalEligibility Verification System.

Physicians Urged to Complete Balance Billing Survey on CMA Website

CMA is conducting a survey togauge the impact of the recent ban on balance billing by the California SupremeCourt and by the Department of Managed Health Care’s regulation definingbalance billing as an “unfair billing pattern.” CMA also is gathering evidenceconcerning other, broader industry practices by health insurers to underpay forout-of-network services.

The survey is located on thehome page of the CMA website at www.cmanet.org. Physicians are urged tocomplete the survey as fully as possible. The information will be used by CMAin its advocacy efforts and will not be used in a manner that reveals anyphysician’s identity.

To request a paper copy of thesurvey, contact Samantha Pellon at 916-551-2872 or spellon@cmanet.org.

CME Events at Sonoma Developmental Center

Two CME events will be held atthe Sonoma Developmental Center in February. Both are scheduled for McDougallHall from 1 to 2 p.m.

On Feb. 5, Drs. Ken Christensenand David Gray will discuss ICD-9 coding. On Feb. 26, Dr. Gopa Green willdiscuss renal osteodystrophy. For details, call JoAnne Rawles at 938-6419.

Charles Amezcua, MD
Anatomic & Clinical Pathology
401 Bicentennial Way
Santa Rosa 95403
393-4684 Fax 393-4291
Univ Southern California 1993

Santiago Centurion, MD
Dermatology
106 Lynch Creek Way #8
Petaluma 94954
763-6816 Fax 763-1730
New Jersey Med Sch 1999

Julie Clark, MD
Obstetrics & Gynecology*
1550A Professional Dr. #100
Petaluma 94954
792-2229 Fax 792-1072
Cornell Univ 2001

Randall Hrabko, MD
Dermatology*
6880 Palm Ave.
Sebastopol 95472
823-7628 Fax 823-1521
Univ Miami 1976

Daciana Iancu, MD
Internal Medicine
401 Bicentennial Way
Santa Rosa 95403
393-4104 Fax 393-4146
Univ North Carolina 1997

Francesca Manfredi, DO
Family Medicine
144 Stony Point Rd.
Santa Rosa 95401
521-4635 Fax 544-4626
Western Univ 2000

Margaret Marquez, MD
Internal Medicine*
Geriatric Medicine*
3559 Round Barn Blvd.
Santa Rosa 95403
571-3953 Fax 571-3941
UC Davis 1994

David Pastran, MD
Family Medicine
401 Bicentennial Way
Santa Rosa 95403
393-4300 Fax 393-4558
Univ Colorado 2003

Carina Quezada, MD
Pediatrics
3925 Old Redwood Hwy.
Santa Rosa 95403
393-4000 Fax 566-5292
Univ Southern California 1994

Mitchell Savitsky, MD
Emergency Medicine
401 Bicentennial Way
Santa Rosa 95403
393-4000 Fax 393-4741
George Washington Univ 1978

Regina Sullivan, MD
Obstetrics & Gynecology*
401 Bicentennial Way
Santa Rosa 95403
393-4696 Fax 393-4299
New Jersey Med Sch 1994

Michael Tsao, MD
Pediatrics
3925 Old Redwood Hwy.
Santa Rosa 95403
393-4000 Fax 566-5929
Northwestern Univ 2003

Jamie Weinstein, MD
Family Medicine
5900 State Farm Dr.
Rohnert Park 94928
206-3000 Fax 206-3042
Oregon Health Sciences Univ 2000

January 2009

• Additional Palmetto Medicare Billing Seminar at SCMA on Jan. 30
• Physicians Invited to Health Care Community Discussion on Dec. 30
• Winter Issue of Sonoma Medicine Examines Children’s Health
• Physician Directory Scheduled for Delivery Later This Month
• County To Hold Public Meetings on Sutter Hospital Proposal
• Physicians Mentors Needed for Students in Health Care Program
• North County Healthcare Foundation Sets Sights on Physician Recruitment
• Medicare Participation Deadline is Dec. 31
• New CME Reporting Requirements
• Neonatal Resuscitation Renewal Program on Jan. 23
• Primary Care Conference at Yosemite Lodge on April 3 and 4
• Marsh Offers Health Insurance Assistance

Additional Palmetto Medicare Billing Seminar at SCMA on Jan. 30

Because of high demand, SCMA will host an additional free seminar on Medicare billing from noon to 2 p.m. on Friday, Jan. 30. Attendees need to bring their own lunch. The first seminar, scheduled for Jan. 26, is completely full.

The Jan. 30 seminar, to be held in SCMA’s office at 3033 Cleveland Ave. in Santa Rosa, will be conducted by Sandra Siddall, a provider outreach consultant for Palmetto GBA, the new Medicare administrator for California. She will address any Medicare billing topics of concern to attendees.

To reserve a spot and suggest topics, contact Rachel Pandolfi at rpandolfi@scma.org or 525-4375. Space is limited, so early reservations are recommended.

Physicians Invited to Health Care Community Discussion on Dec. 30

All local physicians are invited to attend a Health Care Community Discussion on Dec. 30 sponsored by President-elect Obama’s Healthcare Transition Team. The discussion will be held from noon to 2 p.m. in the Sonoma Community Room at the Redwood Credit Union, 3033 Cleveland Ave., Santa Rosa.

Space is limited, so RSVPs are required. Please RSVP by 9 a.m. on Dec. 30 to Donna Paul of the Redwood Community Health Coalition at dpaul@rchc.net or 542-7242.

A Participant Guide for the discussion is available on the SCMA website at www.scma.org/resources/. The guide includes an overview of health care problems, key points of Obama’s health care plan, questions to address at the discussion, and a participant survey.

For more information on the Obama health care plan, visit www.change.gov.

Winter Issue of Sonoma Medicine Examines Children’s Health

The Winter 2009 issue of Sonoma Medicine, due for mailingnext week, features several articles on children’s health by localpediatricians, family physicians and a child psychiatrist. Topics includeimmunizations, nutrition, mental health, autism and the recent Community NeedsAssessment on children’s health.

Physicians interested in submitting article proposals forfuture issues should contact the editor, Steve Osborn, at sosborn@scma.org or525-4325.

Physician Directory Scheduled for Delivery Later This Month

The 2009 edition of the SCMA Physician Directory, one of themost heavily used reference tools in local medical offices, is scheduled fordelivery later this month. This year’s directory includes a new section withdetailed information on SCMA members, along with specialty indexes that listalmost every physician in Sonoma County.

Each SCMA member receives one free copy of the directory.Additional copies cost $30 for SCMA members, $40 for nonmember physicians, and$55 for the general public. To purchase, contact Rachel Pandolfi at 525-4375 orrpandolfi@scma.org.

County To Hold Public Meetings on Sutter Hospital Proposal

Three public meetings onSutter’s proposal for a new hospital next to the Wells Fargo Center will beheld on Jan. 13 and 14. The meetings, conducted by the  Sonoma County Department of HealthServices, will include presentation of the proposal by Sutter officials,followed by public comments. The proposal has been posted to the SCMA websiteat www.scma.org/resources/.

All three meetings will be heldin the DHS Rotunda at 3313 Chanate Road in Santa Rosa. Meetings are scheduledfor:

Jan. 13: 3 to 5 p.m.

Jan. 14: 8 to 10 a.m.

Jan. 14: 3 to 5 p.m.

For more information, contactLynn Scuri, DHS administrative services officer, at 565-4417. 

Physicians Mentors Needed for Students in Health Care Program

Physician mentors are needed for students in the HealthcareWorkforce Development Program at Santa Rosa Junior College. This competitiveprogram enrolls bright bilingual students who are pursuing careers in healthcare. Physicians can help these students by offering:

Internships. Studentscan volunteer in physicians’ office for at least 20 hours per semester.

Mentoring.Establish one-on-one relationships with students to help them explore medicalcareers.

Job Shadowing. Allowstudents to shadow you as you work.

North County Healthcare Foundation Sets Sights on Physician Recruitment

The Healthcare Foundation ofNorthern Sonoma County, a nonprofit group associated with Healdsburg DistrictHospital, has prepared a strategic plan that calls for more physicianrecruitment, improved IT services at the hospital and physicians’ offices, andpurchase of digital mammography and radiology equipment.

The ambitious plan follows asuccessful fundraising drive that began in 2005 and has raised $14.2 million todate. Funds have been used to upgrade the emergency department, ICU and strokecenter at Healdsburg Hospital.

A public meeting on the planwill be held at the Healdsburg City Council chambers at 5 p.m. on Jan. 7.

Medicare Participation Deadline is Dec. 31

Physicians who wish to change their Medicare participation status for 2009 must do so by this Wednesday, Dec. 31. There are three choices: be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.

A participating provider must accept Medicare allowed charges as payment in full for all Medicare patients.

A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. Nonparticipating physician fees are 95 percent of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25 percent more than the amounts allowed in the participating physician fee schedule.

Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. Once you opt out, you cannot opt back in for two years.

For more information, see CMA ON-CALL document #0151, “Medicare Participation (and Nonparticipation) Options,” available at www.cmanet.org/. You can also contact Michele Kelly at 916-551-2862 or mkelly@cmanet.org.

New CME Reporting Requirements

New CME reporting requirementstake effect in 2009. Physicians will now be required to complete 50 CME hours duringevery two-year licensure period, rather than 100 hours every four years. CMEwill also be calculated based on the physician’s personal license renewal date(the last day of the month of your birthday), not the calendar year.

CMA’s Institute for MedicalQuality’s CME Certification Program, now in its 32nd year, documents andverifies physician participation in approved postgraduate education and otherCME activities. IMQ has modified its processes to adapt to the new reportingrequirements. Reporting forms will now be mailed quarterly to physicians withlicense expiration dates in the following quarter.

Once a completed form has beenreceived by IMQ, the physician’s self-reported CME will be verified forcompliance with medical board requirements.

IMQ’s CME certification is $29for members, $49 for nonmembers. Physicians also can request that their CMEcertification information be other agencies for credentialing or membershiprenewal purposes, without additional charge.

For details, contact Paulette Richardsonat 415-882-3387 or prichardson@imq.org.

Neonatal Resuscitation Renewal Program on Jan. 23

A renewal program for neonatalresuscitation (NRP) will be held at Sutter Santa Rosa on Jan. 23. Allparticipants need to complete an online NRP evaluation at www.aap.org/nrp/before attending the class. The program counts for 3 hours of CME credit. Formore details, contact Karen Mack at mackkl@sutterhealth.org.

Primary Care Conference at Yosemite Lodge on April 3 and 4

A postgraduate institute forprimary care physicians will be held at Yosemite Lodge on April 3 and 4. Topicsinclude psychiatric challenges, the biology of aging, and cardiovasculardiseases. Includes 16 hours of CME credit. To register, contact the FresnoMadera Medical Society at info@fmmms.org or 559-224-4224.

Marsh Offers Health Insurance Assistance

Marsh, the endorsed healthinsurance broker and consultant for SCMA, offers several resources for members,including:

* No-obligation review of yourcurrent health plan.

* Access to a variety of healthplans from multiple insurers.

* Health savings accounts.

* Tools to help you stay currenton health and benefit issues.

For details, contact a Marshrepresentative at 800-842-3761.

Space to Sublet
Sublet space in small medical office near Memorial Hospital. Call 707-396-4763.

Medical Office Santa Rosa
Office in class "A" medical building at 1111 Sonoma Ave., Santa Rosa. Approx. 100 sq. ft., with sink. $795/mo., including utilities. Access to shared waiting room, reception area, kitchen, private restrooms. Handicap accessible. Ample parking. Contact Judy at 707-528-0911.

Wanted: Vintage Doctor’s Bag
Looking for a vintage doctor’s bag as a gift for my medical student son. If you have one that is in fairly good condition and you are willing to sell it, contact Cynthia Melody at cmelody@scma.org or 707-525-4359.

How to Submit an Ad
To submit a classified ad for News Briefs or Sonoma Medicine, contact Nan Perrott at nperrott@rhscommunications.com or 707-525-4226. The cost is one dollar per word.

December 2008

• Physicians need to request performance data by Dec. 16
• Pay SCMA dues by Dec. 31 to qualify for 5% discount
• More than 200 attend SCMA’s 150th Anniversary Celebration
• Palmetto GBA seminar at SCMA on Jan. 26
• Inpatient psychiatric care may return to Sonoma County
• Southwest Health Center acquires two more clinics
• Court upholds balance billing regulation--for now
• Influenza and pneumococcal vaccines pricing
• Operation Access needs physician volunteers
• Electronic health records seminar in SF on Dec. 16
• Online CME program offers advice on helping veterans
• Buck Institute hosts session on drugs and aging
• Dr. James Dawson and Dr. Dick Lose pass away

Physicians need to request performance data by Dec. 16

Physicians have until Dec. 16 to request the data used to determine their California Physician Performance Initiative (CPPI) “performance scores.” Payors such as Blue Cross or Blue Shield may soon be using these scores to determine pay-for-performance rates or to create tiered networks.

CPPI recently sent about 20,000 California physicians their performance scores on 15 quality measures based on claims data from Medicare and from United Health, Blue Cross, and Blue Shield PPOs. The letters do not contain the underlying data.

CMA has expressed serious concerns about the accuracy and integrity of the data used to establish these scores. In order to address CMA’s concerns and to improve the quality of the data, CPPI has created a reconsideration process that physicians should use to verify the data.

All physicians should request their data from CPPI and verify its accuracy. If you do not raise concerns now, payors will use the data in the future to adjust your reimbursements and change the flow of patients to your practice.

Step-by-step instructions for obtaining and reviewing your patient data are available at www.cmanet.org/cppi. After finishing the reconsideration process, you should also complete the online survey at the same address to tell CMA what, if anything, was wrong with your performance scores.

For more information, contact the CMA member help line at 800-786-4262.

Pay SCMA dues by Dec. 31 to qualify for 5% discount

SCMA members who pay their 2009 dues by Dec. 31 qualify for a 5% discount. Payments need to be at SCMA by Dec. 31; there is no grace period.

Invoices were mailed earlier this fall. If you need a copy of your invoice or have any dues questions, contact Rachel Pandolfi at rpandolfi@scma.org or 525-4375.

More than 200 attend SCMA’s 150th Anniversary Celebration

SCMA’s 150th anniversary celebration at the Vintner’s Inn on Nov. 11 drew more than 200 local physicians, spouses and community members, making it by far the best attended SCMA event in recent memory.

“The attendance spoke for itself,” said SCMA president-elect Dr. Richard Powers, noting that the event promoted collegiality among physicians and encouraged them to resume their role as community leaders.

SCMA has received many complimentary notes and e-mails about the event from physicians. “The food and the setting were terrific,” wrote former SCMA president Dr. Heather Furnas, “but best of all was the camaraderie of the Sonoma County physicians, the SCMA staff, and physician leaders from our CMA district. … It was a very special evening with an extraordinary group of people.”

“The whole spirit was reassuring,” observed another former SCMA president, Dr. Fred David. “Despite all the troubles with medicine, we get a lot of support from seeing our colleagues in a social setting.”

Complimentary copies of the 16-page commemorative program distributed at the event are still available. To get a copy, contact Cynthia Melody at cmelody@scma.org or 525-4359.

Event photos will soon be posted on the SCMA website at www.scma.org.

Palmetto GBA seminar at SCMA on Jan. 26

Palmetto GBA, the new Medicare administrator for California,will be conducting a free seminar on Medicare billing at SCMA from noon to 2p.m. on Monday, Jan. 26. Attendees need to bring their own lunch.

The seminar will be conducted by Sandra Siddall, a provideroutreach consultant for Palmetto. She noted, “We realize that during thetransition period, many physicians have encountered numerous problems [withMedicare billing].” She will address any billing topics of concern toattendees.

To reserve a spot and suggest topics, contact RachelPandolfi at rpandolfi@scma.org or 525-4375. Space is limited, so early reservationsare recommended.

Inpatient psychiatric care may return to Sonoma County

Inpatient psychiatric care,which has been unavailable in Sonoma County since last spring, may return earlynext year, depending on the outcome of negotiations between several interestedparties.

Drs. Daniel Marrin and JimBerger--owners of the Fulton Road general acute care facility in Santa Rosaclosed by Memorial Hospital earlier this year--are negotiating with twopsychiatric hospital groups that want to reopen the facility. A third companyhas also expressed interest, as has the Joint Powers Authority (JPA) thatrepresents the county’s district hospitals.

Negotiations are complex becauseMarrin and Berger also own a general acute care facility on Sotoyome, acrossfrom Memorial Hospital. Under one scenario, the Fulton facility would be soldto a psychiatric group for inpatient psychiatric care, and the JPA wouldacquire the Sotoyome building for general acute care, possibly establishing anew Santa Rosa hospital district.

“It now costs $3 million to $5million per bed to build a new general acute care hospital,” said Marrin,noting that the Fulton and Sotoyome facilities already have 138 beds, and thatdemand for acute care is likely to increase as the population ages.

If the Fulton Road facility isused for psychiatric care, Sonoma County Mental Health would contract for beds,along with Kaiser and other providers. “Our average daily need is approximately8 to 10 beds, sometimes higher,” said Art Ewart, the county’s mental healthdirector. “This would solve virtually all the needs for psychiatric inpatientcare for adults.”

Further complicatingnegotiations is the possible sale of a portion of the Fulton Road property tothe Southwest Community Health Center, which would construct a 50,000 squarefoot facility to house the Santa Rosa Family Medicine Residency.

Southwest Health Center acquires two more clinics

Southwest Community Health Center has acquired the SantaRosa Homeless Clinic (formerly the Santa Rosa Free Clinic) and the RoselandChildren’s Health Center. Both clinics were threatened with closure because of risingcosts, decreased funding and increasing patient loads.

 “It is verydifficult for these smaller clinics to be financially sustainable in today’shealth care environment,” said SCHC CEO Naomi Fuchs. “Bringing these clinicsinto the SCHC organization will improve access, strengthen programs, andprovide financial sustainability. It is the right thing to do.”

Court upholds balance billing regulation--for now

The Sacramento Superior Courthas determined that the Department of Managed Health Care’s “balance billing”regulation is valid, but only insofar as it seeks to define balance billing asan unfair billing pattern. The court did not address whether the DMHC canenforce the regulation against providers, despite DMHC’s public assertions thatthis regulation “prohibits” balance billing. The DMHC, however, has indicatedthat it intends to take enforcement action against providers who balance bill.

CMA attorneys are reviewing theruling to determine the best strategy for an immediate appeal. They are alsoexploring separate litigation avenues to challenge the DMHC’s authority toprohibit balance billing or take any enforcement action based on thisregulation. 

Influenza and pneumococcal vaccines pricing

The Medicare Part B paymentallowance limits for influenza and pneumococcal vaccines are 95% of the AverageWholesale Price, except where the vaccine is furnished in a hospital outpatientdepartment. In those situations, payment for the vaccine is based on reasonablecost.

Annual Part B deductible andcoinsurance amounts do not apply for the influenza virus and the pneumococcalvaccinations. All physicians, non-physician practitioners and suppliers whoadminister these vaccinations must take assignment on the claim for thevaccine.

The prices below reflect thepayment allowance for the listed CPT codes when the vaccines are furnishedoutside the hospital outpatient department:
* CPT 90655: $16.879
* CPT 90656: $18.198
* CPT 90657: $6.609
* CPT 90658: $13.218
* CPT 90660: $22.316

Operation Access needs physician volunteers

Operation Access, a nonprofit organization that works with hospitals to provide elective outpatient surgeries and procedures to the uninsured, needs physician volunteers. The hospital waives all expenses and covers professional liability and malpractice insurance for physicians and other medical staff who volunteer. Participating hospitals include Petaluma Valley, Memorial and Kaiser Santa Rosa.

To volunteer, contact Daniel Rabkin at daniel@operationaccess.org or 415-733-0004.

Electronic health records seminar in SF on Dec. 16

A seminar on electronic health records sponsored by the Healthcare Information and Management Systems Society will be held in San Francisco on Tuesday afternoon, Dec. 16. Topics include the current state of EHR systems and EHR usage among hospitals, physician offices, insurance companies and patients.

Tickets cost $55. To register, visit www.nocalhimss.org.

Online CME program offers advice on helping veterans

Physicians can receive CME credit for accessing www.joiningforcesonline.org, a Web-based series of half-hour television programs that explore the medical, psychological and social issues that confront returning veterans and their families. The series is of particular benefit to doctors who are unfamiliar with the injuries, visible and invisible, that may be present in veterans.

Buck Institute hosts session on drugs and aging

A free public session onpharmacological and non-pharmacological intervention in aging will be held at theBuck Institute in Novato on Tuesday morning, Dec. 9. Topics include drugindustry targeting of aging as a disease and use of yoga techniques assustainable health care. Reservations are required; phone 415-209-2030.

Dr. James Dawson and Dr. Dick Lose pass away

Two longtime SCMA members, Drs.James Dawson and Dick Lose, died in November.

Dr. Dawson, who belonged to SCMAand CMA for more than 50 years, was 88. Originally a general practitioner inPetaluma and Forestville, he became an attending physician at Sonoma StateHospital in the 1960s. He then completed residencies in psychiatry andneurology and served as the facility’s chief of professional education.

Dr. Lose was a family physicianin Sonoma for many years. He served as president of the Sonoma County chapterof the American Academy of Family Physicians and as chief of staff at SonomaValley Hospital. He was 84.

Guy Delorefice, MD
Internal Medicine*
401 Bicentennial Way
Santa Rosa 95403
393-4733 Fax 393-4556
guydhunter@aol.com
Creighton Univ 1996

Mark Hurd, MD
Anesthesiology*
837 Fifth St. 2nd Floor
Santa Rosa 95404
522-1800 Fax 524-4687
jmahurd007@comcast.net
Tulane Univ 1986

Amita Kachru, MD
Obstetrics & Gynecology
500 Doyle Park Dr. #103
Santa Rosa 95405
579-1102 Fax 579-1386
akachru@gmail.com
Michigan State Coll 2004

Phi-Nga Le, MD
Internal Medicine*
Pediatrics*
401 Bicentennial Way
Santa Rosa 95403
393-4150 Fax 393-4298
phi.n.le@kp.org
Creighton Univ 1992

Yasmin Nibbe, MD
Internal Medicine*
Pediatrics*
401 Bicentennial Way
Santa Rosa 95403
393-4300 fax 393-4558
yasmin.k.nibbe@kp.org
Chicago Med Sch 2001

Rudy Santos, MD
Internal Medicine*
1165 Montgomery Dr.
Santa Rosa 95405
547-5437 Fax 547-5430
rudy510s@hotmail.com
St. George Univ 1997

Jerome Smith, MD
Pediatrics*
430 W. Napa St. #F
Sonoma 95476
939-6070 Fax 939-6077
jsmith@svchc.org
George Washington Univ 1997

* board certified

MEDICAL OFFICE SANTA ROSA
Office in class "A" medical building at 1111 Sonoma Ave., SantaRosa. Approx. 100 sq. ft., with sink. $795/mo., including utilities. Access toshared waiting room, reception area, kitchen, private restrooms. Handicapaccessible. Ample parking. Contact Judy at 707-528-0911.

MEDICAL OFFICE SONOMA
Suite available: Perkins Medical Center, Sonoma. 1800+/- sq ft. $2890/mo.707-996-4519.

To submit a classified ad forNews Briefs or Sonoma Medicine, contact Nan Perrott atnperrott@rhscommunications.com or 707-525-4226. The cost is one dollar perword.

November 2008

• Still time to RSVP for 150th Anniversary Celebration
• SCMA endorses new Medicare payment option
• Dr. Ian Hoffman wins “Article of the Year” award
• SCMA website continues to grow
• Dr. Thomas McCarthy dies at 60
• Supervisors approve residency consortium; one hurdle left
• Physicians can still get paper EOMBs from Medicare
• Balance billing regs apply to care provided on or after 10/15
• CMA House adopts resolution to ban smoking in casinos
• Free diabetes podcasts available from CDC
• NORCAL applications available in writable PDF format
• Health care conference in Santa Rosa on Nov. 12
• Dr. Stacey Kerr publishes book on hospital homebirths
• Dr. Allan Bernstein writes headache booklet for Krames

Still time to RSVP for 150th Anniversary Celebration

Tickets are still available for SCMA’s 150th AnniversaryCelebration on Tuesday evening, Nov. 11. The tickets are FREE to active andretired SCMA members, and $75 for spouses or guests. General admission is $95.

The event will be held at the Vintner’s Inn, 4350 BarnesRd., Santa Rosa, starting at 6 p.m. To RSVP or to purchase tickets, e-mailscma@scma.org or call 525-4359. Credit card payments can be accepted over thephone.

Major sponsors of this historic occasion include KaiserPermanente, NORCAL, Sutter Medical Foundation North Bay, and Sutter MedicalGroup of the Redwoods. Additional sponsorship is being provided by CMA, themedical societies of CMA District 10, Marsh, Pacific Foundation  for Medical Care, Redwood Regional MedicalGroup, Sonoma County Department of Health Services, St. Joseph Health System,and about a dozen other local health organizations and businesses.

On Oct. 23, the SCMA Alliance presented SCMA with an Allieaward for “Outstanding Contribution to the Community.” And on Nov. 4, theSonoma County Board of Supervisors will issue a proclamation recognizing SCMAfor its 150 years of service.

SCMA endorses new Medicare payment option

In response to a Medicare study of various options forrevising its payment localities, SCMA has endorsed Option 3, which wouldseparate high-cost metropolitan statistical areas (MSAs) from statewidelocalities.

In an Oct. 26 letter to Medicare, SCMA President Dr. KirkPappas and former president Dr. Brad Drexler noted that “none of the otheroptions adequately address payment inequities and will therefore not have anadequate effect on patient access to physicians.”

Medicare is accepting comments about the study, entitled “Reviewof Alternative GPCI Payment Locality Structures,” until Nov. 3. The study canbe downloaded at http://www.cms.hhs.gov/PhysicianFeeSched/downloads/ReviewOfAltGPCIs.pdf.Comments should be sent to MPFS@cms.hhs.gov.

Dr. Ian Hoffman wins “Article of the Year” award

Dr. Ian Hoffman, a residentphysician in the Santa Rosa Family Medicine Residency, has won the Article ofthe Year award from SCMA for “The Devil’s in the Details,” which appeared inthe Spring 2008 issue of Sonoma Medicine.

Hoffman’s article provides aneye-opening look at the influence of drug-company detailers who regularly visitphysicians’ offices, offering free samples and other gifts. He concludes, “Thelong-ingrained and widely accepted practice of interacting with pharmaceuticalrepresentatives will be a hard habit to break. As physicians, the question wemust answer now is whether conditions are right for us to move away from the ‘freelunch’ on our own, or do we need regulatory laws to break us of the habit?”

The full text of Hoffman’sarticle appears on the SCMA website at http://www.scma.org/magazine/articles/?articleid=77.

SCMA website continues to grow

SCMA continues to add newmaterial its newly revised website at http://www.scma.org. Launched in October,the site includes a full list of member benefits, current and past issues ofSonoma Medicine, and a variety of resources for physicians. Credit card paymentcapabilities and an online directory of SCMA physicians are also in the works.

Suggestions for improving thewebsite should be sent to Steve Osborn at sosborn@scma.org or 525-4325.

Dr. Thomas McCarthy dies at 60

Dr. Thomas McCarthy, an ob/gynwho practiced in Santa Rosa for 26 years, died of brain cancer on Oct. 28. Hewas just 60 years old.

Dr. Cheryl Kellert, McCarthy’slongtime partner at Santa Rosa Ob/Gyn Medical Group, remembered him as anastute diagnostician and an excellent teacher. “As a partner,” she recalled,“he put his personal needs only after the group’s needs. He was a real teamplayer.”

McCarthy was well known in thecommunity for his dual role as doctor and as pastor at the Hope Chapel, achurch he founded in 1989. In a 1997 article for Sonoma County Physician (nowSonoma Medicine), he wrote, “The roles of pastor and physician work hand inhand. … While I do not actively evangelize patients in my practice, I do try tohelp them understand the non-physical roots of their problems and encouragethem to seek solutions other than antidepressants.”

Dr. Thomas Garrett, one ofMcCarthy’s former partners, remembered that, “The staff loved him. He wasalways up; he had a great sense of humor. He was respected by his colleagues inother specialties, and he saw the big picture.”

McCarthy’s death comes justweeks before his former practice is scheduled to close. “The heart of our groupdied when he got ill,” said Kellert. “He went into medicine because it’s aprofession and a calling, not because it’s a job.”

Services will be held in thePerson Theater in the Wells Fargo Center for the Arts at 2 p.m. on Friday, Nov.7.

Supervisors approve residency consortium; one hurdle left

Nearing the end of a longprocess, the Sonoma County Board of Supervisors has approved a deal transferringcontrol of the Santa Rosa Family Medicine Residency from Sutter Health to aconsortium of local health providers, including Sutter, Kaiser, Memorial, theSouthwest Health Center, the Dept. of Health Services and UCSF.

The deal, in the works since2007, must still be approved by the Accreditation Council for Graduate MedicalEducation, probably in early 2009. Once that happens, the consortium will takeover the program, and resident physicians will receive training not only atSutter, but also at Kaiser, Memorial and Southwest.

“The consortium structure willnot only provide a broader base of financial support, but will also offer aricher, more diverse learning experience for physicians,” said Sutter CEO MikeCohill. Sutter will contribute more than $4 million annually to the consortium,with Kaiser providing an additional $2.7 million per year.

Physicians can still get paper EOMBs from Medicare

Medicare payment problems continue to plague doctors’offices across California. In the most recent glitch, some physicians beganreceiving Medicare checks without an attached Explanation of Medicare Benefits(EOMB) because Medicare mistakenly switched those physicians to “electronicremittance advice (ERA) only” status.

Physicians who want to keepreceiving EOMBs should submit a letter to Medicare via CMA. Simply download thesample letter on the SCMA website at http://www.scma.org/i/userimages/Medicare_EOMB_request.pdf.Complete the letter with your specific information, then fax to Frank Navarroat 916-551-2046. The letter can also be used to request copies of EOMBs notincluded with previous payments.

Physicians can expect to beginreceiving paper EOMBs within three days from the date CMA receives their faxedrequest. For further details, contact Frank Navarro at fnavarro@cmanet.org or916-551-2046.

For other Medicare paymentproblems, call CMA toll-free at 800-786-4262 or visit the “Resources” sectionof the SCMA website at http://www.scma.org.

Balance billing regs apply to care provided on or after 10/15

Despite the vigorous efforts oforganized medicine, the Department of Managed Health Care (DMHC) regulationthat prohibits “balance billing” of HMO patients for out-of-network emergencyservices took effect on Oct. 15.

DMHC has indicated that theprohibition applies only to services provided on or after the regulation’seffective date. Bills sent after Oct. 15 for services provided before Oct. 15are not affected.

For more information, see CMA’sBalance Billing Advocacy Toolkit available to members only athttp://www.cmanet.org/member. CMA published the toolkit to help physicians dealwith the uncertainty caused by this regulation and to answer any questions theyhave about their rights and responsibilities.

CMA and a coalition of providergroups have filed a lawsuit against DMHC arguing that the regulation isunlawful and unenforceable because DMHC lacks the authority to regulatedoctors. The lawsuit also alleges that the regulation violates the intent ofthe Knox Keene Act, which is to ensure that HMOs provide adequate physiciannetworks to provide care for their enrollees.

For more detail, contactSamantha Pellon at 916-551-2872 or spellon@cmanet.org.

CMA House adopts resolution to ban smoking in casinos

The CMA House of Delegates hasadopted a resolution to support legislation mandating smoke-free gaming venuesas a prerequisite for issuing or renewing gaming licenses. The resolution byformer SCMA president Dr. Brad Drexler was one of many approved by the House atits annual meeting in Sacramento in early October. Other resolutions addressedprescription data mining, tax deductions for uncompensated care, and physicianstaffing of retail health clinics.

For a complete list ofresolutions, visit http://cmanet.org/member.

Free diabetes podcasts available from CDC

A series of 10 podcasts titled“Clinical Diabetes Management” is now available for free download from the CDCwebsite. The podcasts feature interviews with pharmacists, podiatrists, optometristsand dentists on preventing diabetes complications and working as part of thediabetes care team. The podcasts promote a team approach to comprehensivediabetes care and provide simple care recommendations to clinicians aboutmaking cross-disciplinary referrals.

The podcasts cover periodontaldisease, preventing vision loss, living with vision loss, preventingamputation, and the pharmacist's role in diabetes, among other topics. Toaccess the podcasts, visit http://www.cdc.gov/podcasts and search for “ClinicalDiabetes Management.”

For more free resources ondiabetes prevention and control, visit http://www.ndep.nih.gov.

NORCAL applications available in writable PDF format

All applications andquestionnaires on the NORCAL website have been converted to writable PDFformat. Applicants can download the forms to their computers and complete themonline. There is no need to fill them out by hand, which was previously theonly option.

To download an application,visit http://www.norcalmutual.com/resources/applications.php.

Health care conference in Santa Rosa on Nov. 12

A health care conferencesponsored by the North Bay Business Journal will be held on Wednesday morning,Nov. 12, at the Hyatt Vineyard Creek Hotel in Santa Rosa. The featured speakeris Dr. David Greenberg, a vice president at the Buck Institute, who willdiscuss regenerative medicine, diseases in aging, and the latest stem-cellresearch. His speech will be followed by panel discussions on health caredelivery and health insurance.

Tickets are $45 per person. Toregister, contact Linda Perkins by Nov. 7 at 521-5265 or events@busjrnl.com.

Dr. Stacey Kerr publishes book on hospital homebirths

Santa Rosa family physician andPress Democrat columnist Dr. Stacey Kerr has just published “Homebirth in theHospital” a 224-page book on integrative childbirth. The book features storiesof 15 women who had integrative childbirths in a hospital setting. Published bySentient Publications, the book is available at local bookstores or at http://www.homebirthinthehospital.com.

Dr. Allan Bernstein writes headache booklet for Krames

Dr. Allan Bernstein, a SantaRosa neurologist and headache specialist, did all the science writing for a newpatient guide to headaches from Krames, a leading publisher of patienteducation materials. The 16-page booklet, now in its third edition, will beused in doctors’ offices throughout the country.

Stephen Banks, MD
Radiation Oncology*
3555 Round Barn Cir.
Santa Rosa 95403
522-6875 Fax 576-0445
sbanks@rrmginc.com
Stanford Univ 1993

John Chan, MD
Obstetrics & Gynecology*
Gynecologic Oncology*
100 Brookwood Ave.
Santa Rosa 95404
576-7557 Fax 576-7786
chanjohn@obgyn.ucsf.edu
UC Los Angeles 1995

Lee-may Chen, MD
Obstetrics & Gynecology*
Gynecologic Oncology*
100 Brookwood Ave.
Santa Rosa 95404
576-7557 Fax 576-7786
Lee-may.chen@ucsfmedctr.org
Univ Michigan 1992

Thomas Duckett, MD
Urology*
500 Doyle Park Dr. #303
Santa Rosa 95405
575-1833 Fax 575-1892
duckett@sutterhealth.org
Loyola Univ 1995

Alvaris Duffis Jr., MD
Diagnostic Radiology
401 Bicentennial Way
Santa Rosa 95403
393-3452 Fax 553-3589
alvaris.w.duffis@kp.org
Univ Pennsylvania 1984

Gabriel Flaxman, MD
Family Medicine
3320 Chanate Rd.
Santa Rosa 95404
547-2220 Fax 303-3187
flaxmeg@sutterhealth.org
Drexler Univ 2008

Henry Flores, MD
Surgery*
451 March Ave. #B
Healdsburg 95448
433-8844 Fax 433-8836
floreshc@sutterhealth.org
Univ Minnesota 1994

Stephen Fuette, MD
Emergency Medicine*
401 Bicentennial Way
Santa Rosa 95403
393-4000 Fax 393-4741
stephandreb@aol.com
Univ Southern California 1999

Catherine Hurley, MD
Family Medicine
3320 Chanate Rd.
Santa Rosa 95404
547-2220 Fax 303-3187
hurleyc@sutterhealth.org
Jefferson Med Coll 2008

Bonnie Kneibler, MD
Family Medicine*
8465 Old Redwood Hwy. #320
Windsor 95492
838-6685 Fax 838-6686
kneiblb@sutterhealth.org
Rush Med Coll 1982

Lisa Kremer, MD
Rheumatology*
Internal Medicine*
4725A Hoen Ave.
Santa Rosa 95405
576-3322 Fax 576-3323
kremerl@sutterhealth.org
Univ Minnesota 1989

Elizabeth Martinez-Augustin, DO
Internal Medicine*
Geriatric Medicine*
401 Bicentennial Way, MOB West #110
Santa Rosa 95403
393-3062 Fax 393-4389
lizmartinezdo@yahoo.com
Western Univ Health Sciences 1999

Anabel Ruiz, MD
Family Medicine
3320 Chanate Rd.
Santa Rosa 95404
547-2220 Fax 303-3187
ruiza4@sutterhealth.org
Johns Hopkins Univ 2008

Libby Schaefer, MD
Family Medicine
3320 Chanate Rd.
Santa Rosa 95404
547-2220 Fax 303-3187
schaefe@sutterhealth.org
Harvard Med Sch 2008

Adrienne Silver, MD
Pediatrics*
3975 Old Redwood Hwy.
Santa Rosa 95403
566-5271 Fax 566-5292
adrienne.m.silver@kp.org
Univ Colorado 1996

David Suchard, MD
Occupational Medicine*
Medical Toxicology
Environmental Medicine
1260 N. Dutton Ave. #244
Santa Rosa 95401
546-2880 Fax 546-2828
dsuchard@sonic.net
UC San Francisco 1992

Barbara Turner, MD
Family Medicine*
8465 Old Redwood Hwy. #320
Windsor 95492
838-6685 Fax 838-6686
turnerb2@sutterhealth.org
UC Irvine 1987

* board certified

MEDICAL OFFICE SPACE
Suite available: Perkins Medical Center, Sonoma. 1800+/- sq ft. $2890/mo.707-996-4519.

HOW TO SUBMIT A CLASSIFIED AD
To submit a classified ad for News Briefs or Sonoma Medicine, contact NanPerrott at nperrott@rhscommunications.com or 707-525-4226. The cost is onedollar per word.