Keeping You Connected

The SMLMA keeps you up to date on the latest news,
policy developments, and events


April 2010

Survey on Impact of Medicare Cuts

In cooperation with other Bay Area medical societies, SCMA is conducting the following survey about the potential impact of the pending 21.3% cut in fees to physicians in the Medicare fee-for-service (FFS) program (excludes Medicare HMOs). The Medicare FFS payment formula—known as the Medicare Sustainable Growth Rate (SGR)—triggers recurring cuts and has kept payment rates unchanged or lower since 2001. To help educate the public about the impact of Medicare cuts, we would appreciate your completion of this survey by April 14.

To complete the survey, print this e-mail, mark your answers, and fax back to SCMA at 525-4328. You may also respond by e-mail to Questions may be directed to SCMA at 525-4375. Thank you.

1.         Primary Medical Specialty: ___________________________________

2.         Practice Size:
         □ Solo/Small Group (1-4 physicians)
         □ Medium Group (5-150)
         □ Large Group (151-1000)

3.         Practice Setting:
         □ Office-Based
         □ Hospital-Based
         □ Other _______________________

4.         How many years have you been in the Medicare FFS Program?
         □ 2 years or less
         □ 2 to 10 years
         □ More than 10 years
         □ I do not participate because of:
         □ poor reimbursement
         □ not applicable to specialty/practice
         □ other: _____________________________

5.         Approximate percentage of your patients in the Medicare FFS program? ______

6.         Approximate percentage change (if any) in the number of Medicare FFS patients since 2001 (year of last substantive Medicare pay increase): _______

7.         The 21.3% pay cut will affect my Medicare FFS patients as follows (check all that apply):

         □ Will not reduce the # of existing patients I treat
         □ Will reduce time for treating existing patients
         □ Will reduce the # of existing patients I treat
         □ Will stop treating all existing patients
         □ Will not reduce the # of new patients I accept
         □ Will reduce the # of new patients I accept
         □ Will stop accepting new patients

8.         Congress’ failure to stop future pay cuts will affect my Medicare FFS patients as follows (check all that apply):

         □ Will not reduce the # of existing patients I treat
         □ Will reduce time for treating existing patients
         □ Will reduce the # of existing patients I treat
         □ Will stop treating all existing patients
         □ Will not reduce the # of new patients I accept
         □ Will reduce the # of new patients I accept
         □ Will stop accepting new patients

9.         I am willing to help make the public aware of the impact of Medicare’s payment policies (via press conferences, interviews with news reporters, etc.)
         □ Yes    No   (if yes, please complete below)

Name (optional):                   ___________________________________

Contact number (option

April 2010

Medicare rate cuts still pending, despite passage of health reform

The clock keeps ticking on Medicare rate reductions. Lost in the discussions over passage of health reform legislation is the fact that physicians are scheduled to get a 21% Medicare rate reduction by mid-April if Congress fails to act. The rate reductions, mandated by the sustainable growth rate (SGR) formula, were originally scheduled to take effect March 1. Congress postponed that deadline to April 1, and now Medicare has effectively extended the deadline another two weeks by asking carriers not to process claims with April service dates for 10 business days.

The net effect of these delays is that Congress will have to act immediately upon its return from recess on April 12. While both the House and Senate are expected to postpone the SGR cuts once again, the big question is whether they will do away with the SGR formula for good. The House did vote to repeal the SGR formula last fall, but the Senate has so far failed to act.

CMA and AMA are calling on all physicians and patients to help repeal the SGR formula once and for all. Please contact Sen. Dianne Feinstein, Sen. Barbara Boxer and your local House Representative and deliver a simple message: It’s time to repeal the SGR formula. As noted by AMA President Dr. James Rohack, “Congress’ failure to act on permanent repeal of the broken Medicare physician payment formula has put access to health care for seniors and military families in jeopardy.”

When contacting your representatives, give your name, specialty and practice location. Then tell your representative to stop the 21% cut and repeal the SGR formula once and for all. Contact information for your representatives appears below.

·       Sen. Feinstein - Click Here or use the AMA’s grassroots hotline at 800-833-6354.

·       Sen. Boxer - Click Here or use the AMA’s grassroots hotline at 800-833-6354.

·       House Representative - Click Here or use AMA’s grassroots hotline at 800-833-6354.

Please direct any feedback or questions from your representative to SCMA’s executive director, Cynthia Melody, at or 525-4375.

CMA has also prepared a flyer that you can use to get patients involved in the fight to protect Medicare. The flyer is available at



Details about health care reform posted on SCMA website

Two detailed CMA documents about health care reform have been posted on the SCMA website at The first, “Pros and cons of health care reform,” provides an overview of the benefits and shortcomings of the recently signed legislation. The second, “What CMA did for physicians in health care reform,” describes CMA’s many successful efforts to advocate on behalf of physicians and patients.


County HIV, STD and family planning clinics to close

Patients who receive HIV, STD and family planning services from county clinics will soon have to seek care elsewhere. On March 30, the Sonoma County Board of Supervisors approved a Department of Health Services plan to eliminate those clinics, thereby saving about $1 million per year. The department’s revenues have declined by $27 million since 2007 and are expected to decline an additional $9.8 million during the 2010-11 fiscal year.

In a March 31 memo to local providers, Public Health Officer Dr. Mary Maddux-González noted that the clinics were originally established at a time when few providers were offering services for HIV and STD. With the subsequent growth of community health clinics, need for the county’s disease-focused clinics has diminished. As stated in Maddux’s memo, “Public Health will cease providing these clinical services given the increase in local primary care infrastructure where patients can be linked to a medical home with the full array of prevention-focused primary care services for their health care needs.”

The STD and family planning clinics, which serve about 60 patients per week, will close on April 2. The HIV clinic, which serves 550 patients, will close on June 30. Because of the complexities of county employment, projected layoffs amount to 20.17 full-time equivalents at most, including 1.3 FTE of physician time.


New CMA leader to attend SCMA reception on May 20

Dustin Corcoran, the new chief executive of the California Medical Association, will be the featured guest at the SCMA wine & cheese reception on Thursday evening, May 20. This annual event, to be held this year at Landmark Vineyards in Kenwood, offers a unique opportunity to gather with your colleagues in an informal setting. A variety of fine wines, cheeses and hors d’oeuvres will be served.

Corcoran, who has worked for CMA since 1998, became the association’s head lobbyist in 2004, serving as the main spokesperson for organized medicine in the state Legislature. He brings an outstanding track record for skilled advocacy to his new role as CEO. He will be available at the reception to answer members’ questions and discuss CMA activities.

The reception is free for SCMA members and their spouse or guest. The cost for nonmember physicians is $35. To RSVP, contact Rachel Pandolfi at 525-4375 or


Dr. Jeff Sugarman nominated as SCMA president-elect

Dr. Jeff Sugarman, a Santa Rosa dermatologist, has been nominated as president-elect of SCMA. He will be joined on the SCMA election ballot by two nominees for the board of directors, Drs. Jan Sonander and Peter Sybert, and five nominees for the CMA delegation: Drs. Dan Lightfoot, Don Van Giesen, Clinton Lane, Katherine McNally and Richard Powers.

SCMA members will vote on the nominees in May. For more information, contact Cynthia Melody at or 525-4375.



Sonoma Medicine is finalist for major award

Sonoma Medicine is a finalist for the annual Maggie awards presented by the Western Publishing Association, a nonprofit group devoted to publications in the western United States. The annual Maggie competition draws entries from throughout the West, including major magazines from Los Angeles and San Francisco. Sonoma Medicine is one of five finalists in the “quarterlies” category. The awards will be announced on May 7.

The Spring issue of Sonoma Medicine, to be mailed to all SCMA members in early April, focuses on breathing, with articles by local experts on nicotine addiction, asthma, sleep apnea, nasal congestion and breathing exercises. Other articles examine antibiotics, dental surgery, medical care in Afghanistan, legal excess, and the family medicine residency.

Each SCMA member receives one free subscription to Sonoma Medicine. Nonmembers can subscribe for just $19.80 per year by completing the subscription form at Article proposals are welcome at any time and should be submitted to the editor, Steve Osborn, at


RSVPs needed for April 27 Legislative Day in Sacramento

Local physicians interested in attending CMA’s free Legislative Leadership Conference in Sacramento on April 27 should RSVP by April 2. SCMA will be renting a van to travel to Sacramento, so reservations are requested.

The annual conference, which last year drew more than 400 physicians and CMA Alliance members, allows doctors to meet with legislators and express their views on pending health legislation. Appointments for SCMA members have been arranged with Assemblymembers Noreen Evans and Jared Huffman and with Sen. Mark Leno and an aide to Sen. Pat Wiggins.

The conference also includes a morning session featuring speakers from across the political spectrum. This year’s presenters include Assembly Speaker John Perez, Speaker Emeritus Robert Herzberg, CMA President Dr. J. Brennan Cassidy, and CMA’s new chief executive, Dustin Corcoran.

To RSVP, contact Rachel Pandolfi at 525-4375 or


State expands scope of practice for nonphysicians

Despite continued opposition from CMA, the California Office of Administrative Law has removed requirements that physicians be involved in critical health care activities in hospitals, such as patient admissions, medical examinations and patient transfers. Instead, new regulations will allow these activities to be performed by a “licensed health care provider acting within the scope of his or her licensure.”

The regulations also allow each facility to decide who can do what under a welter of competing advice from 30 licensing boards. CMA believes differing practices among facilities will cause confusion, thus endangering patients and inviting expensive and unnecessary lawsuits.

Portions of the regulations that would have weakened medical staff self-governance and mandated that clinical psychologists be granted medical staff membership in private hospitals were removed because of opposition from CMA and the Psychiatric Association.

CMA remains concerned about the impact of these regulations on patient care and is exploring all appropriate avenues to seek relief. The regulations take effect on April 2.


CMA offers free subscriptions to practice-management newsletter

CMA is offering free subscriptions to a new monthly publication, “CMA Practice Resources.” The first issue, to be published later this month, is filled with tips and tools to help physicians and their office staff improve practice efficiency and viability. Physicians, office managers, administrators and billing staff can subscribe by visiting



By SCMA Legal Counsel Larry McLaughlin

A medical office manager called me recently to say that one of their patient’s attorneys had accused her of breaking the law.

The patient was the plaintiff in an injury lawsuit, and the office manager had received a subpoena for records from the defense attorney in Los Angeles, with the date for compliance prominently displayed. Reasoning that it would take a while for mail to reach L.A., the office manager mailed the records early.

The patient’s attorney subsequently called the office manager to say that he objected to the records being released and planned on going to court to oppose the release. It was too late, however, because the office manager had already mailed the records. That was when the unhappy attorney accused her of breaking the law.

Errors in complying with subpoenas are actually a fairly common occurrence. Subpoenas are often confusing, and I advise physicians and staff receiving them to call me for advice. In this case the subpoena had the standard warning under the compliance date: “Do not release the requested records prior to the date and time stated above.” This warning language is often missed.

Sometimes when the requesting attorney uses a copy service to receive the records, the service will call the physician's office to demand an early release. Physicians and staff, however, should be aware that the law prohibits early release of records unless specifically waived by the patient. In the case described above, the office manager should have called the defense attorney’s office to ascertain how they planned to receive the records.

There are many other rules pertaining to subpoenas. SCMA physicians and staff are encouraged to contact me whenever you receive a subpoena, so I can walk you through the process. I can be reached at 707-579-4523 or



SCMA President Dr. Richard Powers has received the “Sonoma Family Physician of the Year” award from the California Academy of Family Physicians.

“Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth,” a book published last year by Santa Rosa pediatrician Dr. Mark Sloan, is one of five finalists in the “creative nonfiction” category for the 2010 Northern California Book Awards. Other finalists in that category include books by well-known Bay Area authors Michael Chabon and Dave Eggers. The awards will be announced April 18 at the San Francisco Public Library.

St. Joseph Health System honored 17 SCMA physicians as “top docs,” based on post-discharge patient survey results from 2009. The honorees for Petaluma Valley Hospital were Drs. James Leoni, Jonathan Choe, Mark Northfield and Stephen Steady. For Santa Rosa Memorial Hospital, the honorees were Drs. Kent Yinger, James Steele, Douglas Green, Thomas Degenhardt, Michael Grafe, Larry Marianella, Mark Schakel, Jon-Michael Castelli, Mark Homicz, Masis Babajanian, Douglas Jicha, Robert James and Patrick Coleman.



Palm Drive Hospital has hired Richard Robinson as its new CEO. A native of Modesto, Robinson was most recently CEO of Women’s & Children’s Hospital, an 84-bed facility in Louisiana. Although Robinson serves at the will of the Palm Drive Health Care District Board, he is actually an employee of Brim Healthcare, a nationwide management and consulting firm that has helped Palm Drive emerge from bankruptcy. The hospital is expected to be profitable this year.

Santa Rosa Memorial Hospital has renewed its Level II Trauma Center designation with Sonoma County. The renewal will last at least until 2018, with an option to extend the designation to 2022. Since receiving the designation in 2000, the trauma center has treated an average of 1,450 patients per year with serious or life-threatening injuries. “Memorial Hospital has consistently maintained the highest level of service,” said Sonoma County DHS Director Rita Scardacci. “This designation continues to make trauma care available to our community and the region.”

St. Joseph Health System has opened North County Hospice, a new hospice facility in Healdsburg. The medical director is Dr. Gary Johanson, a palliative medicine specialist in Sonoma County for the past three decades. The site is St. Joseph’s third hospice facility in the county, along with Memorial Hospice and Hospice of Petaluma.



A free weekly support group for patients with chronic illness will begin at Palm Drive Hospital on April 6. The meetings, which run from 2 to 3:30 p.m., will be facilitated by David Murphy, PhD, a psychologist specializing in management of chronic conditions. No advance registration is necessary. For more details, contact Dr. Murphy at 566-7026.

The Institute for Medical Quality is offering a one-day training program for new medical staff leaders in Irvine on Tuesday, April 13. The program, which costs $405 for CMA members and $445 for nonmembers, features sessions on the role of medical staff leaders, how to run effective meetings, and tips for staying accredited and licensed. To register, visit or call Leslie Iacopi at 415-882-5167.

Dr. Allan Bernstein will present a free lecture, “New Research on Memory Disorders,” at 2 p.m. on April 23 at Primrose, 2080 Guerneville Rd., Santa Rosa. Bernstein, former chief of neurology at Kaiser Santa Rosa, is an internationally known researcher and educator. Reservations for his lecture are required because of limited space. To reserve a spot, call 578-8360.

The Garden Tour, an annual fund-raiser sponsored by the SCMA Alliance and Foundation, will be held in Windsor on May 14 and 15. Six local families will open their private gardens for self-guided tours. Two homes will also be open for viewing. Funds raised by the tour will be donated to the Santa Rosa Community Health Centers and the Windsor branch of the Alliance Medical Center. Tickets are $40, and lunches will be available for purchase at the Windsor Golf Course. Raffle tickets for local restaurants will be sold as well. To purchase tickets, visit or call Janet Shane at 578-4537.

Easter Seals Northern California is sponsoring an all-day Physician Symposium on Saturday, May 15, at the Petaluma Community Center. The topic is developmental and behavioral screening in primary care. Presenters include Dr. Barbara Bennett, a professor of pediatrics at UCSF, and Dr. Maria Pilar Bernal, chief of autism spectrum disorder services at Kaiser Permanente. The symposium offers 5.75 hours of CME. To register, visit or contact Cindy Fasano at 415-382-7450 or



Dr. Gertrude Van Steyn, a pioneering woman physician who practiced in Santa Rosa from 1939 to 1981, died in March at the age of 95. Born in Holland, she grew up on a farm in Sebastopol and rode horseback to high school in Santa Rosa. She attended UC Berkeley and received her DO from the College of Osteopathic Physicians and Surgeons in Los Angeles.

After completing an internship at Los Angeles County Hospital, Van Steyn joined Dr. Caroline Weber in Santa Rosa, at a time when women physicians were quite rare. In an interview published in Sonoma Medicine in 1993, Van Steyn noted that some doctors at that time “had very strong feelings against both a woman and an osteopath.” As an example, she described an appendix case she had at the old General Hospital in Santa Rosa where she was not allowed to assist on her own patient.

In the 1940s, Van Steyn established her own practice, eventually building an office on Cherry Street in 1954. She practiced solo there until 1979, when she was joined by Dr. Gary Greensweig. She was famous around town for working long hours and not taking appointments. In the Sonoma Medicine interview, she noted, “When I’d get there in the morning, there would be a big line-up, and we’d take them in turn. Nobody griped or objected. They were taken in turn, whether they were poor or rich.”

After retiring in 1981, Van Steyn tended to her 14-acre property south of Santa Rosa. She raised sheep, horses and other livestock, and she fed many wild animals as well. She also traveled extensively. “I’m interested in the historical pioneer trails of the Western settlers,” she said in the interview. “I have followed many of them.”



Veronica Jordan, MD, Family Medicine, 3320 Chanate Rd., Santa Rosa 95404, 547-2220, Fax 303-3318, UC San Francisco 2007

Gian Nhan, MD, Anesthesiology*, Pain Medicine, 1739 Fourth St., Santa Rosa 95404, 528-6331, Fax 538-2154, Loma Linda Univ 1994

Renee Theisen, MD, Emergency Medicine*, 401 Bicentennial Way, Santa Rosa 95403, 393-4800, Fax 393-4741, Univ Michigan 2005

* board certified



Medical billing/reimbursement specialist
Out-source, save money. Coding, RAC review, EHR, credentialing services.

Office space
Small suite available for reasonable rent. Three exam rooms, southeast Santa Rosa. Call Connie, 707-525-0211.

Office to share in Novato
165 Rowland Way #303. Medical office to share with urologist. 2100 sq ft. Three exam rooms. One small conference room. Rent completely negotiable dependent on level of service use and overhead. Contact Dr. Peter Bretan, 415-892-0904 or

How to submit a classified ad
To submit a classified ad for SCMA News Briefs or Sonoma Medicine, contact Nan Perrott at or 707-525-4226. The cost is one dollar per word.



The Sonoma County Medical Association, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. Founded in 1858, SCMA is affiliated with the California Medical Association and the American Medical Association.

© SCMA 2010
3033 Cleveland Ave. #104
Santa Rosa, CA 95403



You are receiving SCMA News Briefs because you are a physician or an affiliated medical professional in Sonoma County. If you wish to unsubscribe, contact Steve Osborn at or 707-525-4325.


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