Sunday, March 18, 2018


Medical Community Loses Richard F. Kammerman, M.D.

It is with great sadness that we announce that Richard F. Kammerman, M.D., past president of OCMA, passed away at St. Joseph Hospital on January 9, 2014.  He was 83.
Dr. Kammerman was board certified in family medicine.  He was a Clinical Professor of the UCI Department of Family Medicine. 
Dr. Kammerman was president of OCMA in 1991-92.  In 1997, he was named OCMA's Physician of the Year.  Even after he retired, Dr. Kammerman could be counted on to assist OCMA whenever he was needed.  He was a popular mentor in OCMA's "Speed Mentoring" program that OCMA organized for UCI medical students.  In recent years, Dr. Kammerman served on the Physicians of Excellence Selection Committee.  In addition, Dr. Kammerman founded and served as president of OCMA's Toastmasters Club (chapter 3773).  
Dr. Kammerman contributed countless hours to service and leadership positions within OCMA and other professional associations and hospitals since the early 1960's.  In addition to his work within OCMA, Dr. Kammerman served as president of the Orange County Chapter of the Academy of Family Physicians and served as a representative to the California State Academy of Family Physicians and the California Medical Association.  He served on the hospital staffs of St. Joseph Hospital, CHOC, and Western Medical Center, and was elected chair of the Family Medicine Department in each of these hospitals. 
Dr. Kammerman's greatest influence on the community has been the positive impact on the lives of the uninsured and under-insured in Orange County.  His tireless work and unwavering commitment to the poor resulted in the unprecedented launching of CalOptima, the county's Medi-Cal managed care organization.  He was involved with the program's design and was instrumental in forging the partnership among the county government, private physicians, hospitals and community clinics that continues to this day.
While serving as part of the UCI Volunteer Faculty, Dr. Kammerman was devoted to educating future physicians and volunteered many hours each week to mentor medical students. 
In a written statement, Dr. Ralph Clayman, dean of the UCI School of Medicine, said:  "A member of the School of Medicine Alumni Board since its inception, Dr. Kammerman had knowledge and appreciation of the roots and foundation of the School of Medicine and therefore was often looked to as a historian for the group.  As co-president in 2011, Dr. Kammerman helped reengage and reenergize the board. Dr. Kammerman received the Lauds & Laurels Distinguished Alumni Award for the UC Irvine School of Medicine in 2011 in recognition of the tremendous amount of time and energy he devoted to making the UC Irvine School of Medicine the great institution that it is today."
Dr. Kammerman volunteered his time and service to many groups and organizations, including the Discovery Science Center, the Santa Ana Junior Chamber of Commerce, and the Lions Club.  He received commendations for service from the Boy Scouts of America, the Orange County Board of Supervisors, the California State Senate, the California State Assembly, and the U.S. House of Representatives.
A few years ago, the UCI Department of Family Medicine created the Richard Kammerman, M.D. Award.  This award is presented each year to a volunteer faculty member in recognition of outstanding service to the department and the community.  Dr. Kammerman was the first recipient and the award has continued to be named in his honor in recognition of his service - displaying the characteristics that form the selection criteria for this honor. 
Richard F Kammerman, M.D. will be missed by his family, friends and the medical community at large.

CMA Develops Simple Tool to Identify Physician Participation Status in Exchange Plans

January 23, 2014

On January 1, 2014, Covered California began providing health coverage to more than 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so that they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted.

Even if you did not intentionally contract with any exchange plans, the California Medical Association (CMA) urges physicians to check their participation status. It is very possible that physicians may have been unknowingly opted into an exchange plan network due to the way that major insurance plans have structured their provider agreements.

If you've attempted to look up your exchange plan participation status on the Covered California website, you know that it's not a straightforward process. Because it is critical that physicians know what plans they are contracted with, CMA has created a quick and easy tool to look up your exchange plan participation status in just a few clicks.

The tool, available to members only, requires simply your first and last name and middle initial and it will tell you which plans list you as a contracting physician (as of September 2013, the most recent data released by Covered California). To access the tool, visit

Please note: You will be required to login with a member account. If you have not already activated your web account, visit If you need assistance activating your account, contact CMA's member service center at (800) 786-4262 or

For more information on Covered California, visit CMA’s exchange resource center at Physician members and their staff also have free access to CMA’s practice management experts at (888) 401-5911 or

IMQ's Stepping Up to Leadership earlybird pricing ends January 31

Earlybird pricing for the Institute for Medical Quality (IMQ) Stepping Up to Leadership conference ends January 31. Sponsored by IMQ and the PACE Program at UC San Diego, Stepping Up to Leadership is an interactive training course that helps physicians learn best practices and creative approaches for resolving common problems encountered as a medical staff officer or department or committee chair. Through small-group interactive teaching modalities, the course gives both experienced and new physician leaders the opportunity to gain practical knowledge and skills, and to learn the tools and techniques that are essential to effectively lead a medical staff. This is an event for the entire leadership team.The program addresses:

  • What it takes to be a successful leader;
  • Aligning medical staff & hospital interests;
  • Effective communication;
  • Challenges to on‐call panels, credentialing;
  • Disruptive professionals, impaired individuals;
  • Physician well being committees;
  • Using quality measures to enhance outcomes;
  • Legal considerations

The 2014 Stepping Up to Leadership program will take place March 6-8 at the Loews Coronado Bay Hotel in San Diego. A generous grant from the Physicians Foundation allows IMQ and PACE to offer Stepping Up to Leadership at prices as low as $595. Take part in an interactive learning environment led by expert faculty who engage participants through self‐assessments, Q&A, role playing & case studies.

Register now at

Physician Advocate Tip of the Month - Surviving the first month of Covered California

January Tip:

On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more than 400,000 patients statewide. It is critical that physicians and their staff know what to expect. 

In an effort to proactively arm physician practices with important information during the first month of the exchange, the California Medical Association has prepared the resource "Surviving the first month of the exchange" tip sheet. 

Receiving practice management guidance from Mitzi is a FREE OCMA member benefit!

Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs: 

Mitzi Young
Physician Advocate, CMA Center for Economic Services

Local charity reports on recent volunteer medical mission to Vietnam

The second volunteer medical mission of the year undertaken by Arpan Global and its large cadre of supporters was October 5-12, 2013, to the Thai Hoa Hospital in Cao Lanh Vietnam (the Dong Thap province). This hospital lies to the south of Ho Chi Minh City by about a 3-hour bus drive in a very rural area.  It is a tropical area, lush with green vegetation and abundant rice fields.  The people are warm, friendly, eager to practice any English they know, curious about the rest of the world, and willing to help in any way possible for whatever reason.  Their hospitality was heartfelt and their kind and gentle words and actions clearly came from the heart.

The Thai Hoa Hospital is a relatively new, private hospital built specifically to serve a large catchment area in the Don Thap province and is located in fairly close proximity to the older public hospital.  The first floor contains the outpatient clinic areas, radiology, pharmacy, emergency treatment and waiting areas.  Upstairs is the labor and delivery units, postpartum, the nursery (which includes three isolettes and a ventilator for premature babies), and the pediatrics ward.  The third floor holds the operating rooms (including one dedicated for cesarean sections), recovery room, and the general wards.  The facility is clean, modern, and there is a real sense of pride of ownership among those who work there.

This was one of the largest mission teams that Arpan Global has assembled, with 52 dedicated individuals making their way to the other side of the planet in order to participate.  The range of medical and healthcare services represented was quite wide:  

  • Anesthesiology
  • Pediatrics, including neonatology
  • Internal Medicine, including cardiology
  • Radiology, including ultrasonography
  • Surgery, including plastics, GI, urology, orthopedics, ENT
  • Obstetrics and Gynecology
  • Dentistry
  • Nursing
  • Occupational therapy
  • Pharmacology
  • Social worker

Even nonmedical experts were present, willing and able to do whatever they could to help with patient flow and even patient care when possible.  

While the hospital isimpressive for its modernity, it attracts a patient population that can be limited in size.  The outpatient sites serviced by the team were another story.  Patients in local towns and villages lined up for the chance to get a lottery ticket to be seen by the visiting medical team and they were there early in the morning, ready and willing to wait all day if necessary.  Triage desks were set up at each site with local volunteers from Cao Lanh serving as translators.  Vital signs were taken and after the concerns of the patient were ascertained, they were directed to an available medical team for evaluation, diagnosis and treatment.  (If specific specialty needs were identified, they were sent to the experts on site).   A space for occupational and physical therapy was created at each site, as was an impromptu pharmacy and dispensary.  The dental area was extremely popular and often the last to finish each day.  After several of these day-long outpatient visits, it became clear that hypertension (often severe and completely uncontrolled), osteoarthritis, chronic low back pain, and lack of oral hygiene were among the preeminent and common complaints in the general population. 

Trips to orphanages along with visits to government sponsored homes for disabled children and the elderly homeless were also part of the itinerary.  Arpan Global was able to donate a water filter, washer and dryer, and a computer to some of these facilities.  A day-long trip to a shelter for women and girls who had been victims of human trafficking highlighted the impact that desperate levels of poverty and lack of vocational skill sets play in enabling trafficking to occur. 

By the end of the week, the team had seen over 800 patients, performed 125 dental procedures, several complex medical procedures, and many diagnostic procedures, allowing for appropriate treatment and intervention to begin for those patients.  More importantly, the team members felt like they had made a difference in the lives of people and the only issue of concern was the feeling that they wanted to do more.   Vietnam has been called Asia’s ‘comeback kid’ economically and while many are feeling the success, there still remains a great need for modernization and improvement in the health care system.  Arpan Global is proud to have had the opportunity to make its own contribution towards meeting that need in its own way.

For more information please contact Sudeep Kukreja, MD at (714) 585-1920

Vietnam mission team, Arpan Global Charities

Physician Advocate Tip of the Month - Don't miss out on your ACA Medi-Cal Payment Increase!

December Tip

Don't miss out on your ACA Medi-Cal Payment Increase!

Attesting is easy, so visit and complete the ACA Self Attestation Form before 12/31/2013. Physicians must attest individually. Checks are currently being distributed to those who have attested!

Medi-Cal Resource:

Over the past year, there have been a number of changes for Medi-Cal patients and for the physicians who treat them with more to come in 2014. Be sure to review CMA's new Medi-Cal Survival Toolkit available for free at (members only).


The deadline to avoid a 1.5% fee schedule penalty in 2015 is fast approaching. There is still time to report at least one valid individual measure via claims for dates of service in 2013. There are many measures that only need to be reported once per reporting period (January 1 through December 31, 2013) that meet the requirement.  
The 2013 Physician Quality Reporting System (PQRS) Implementation Guide is a good place to start to identify any measure that might pertain to your practice. The 2013 PQRS Individual Claims Registry Measure Specification Supporting Documents provides the specifications that must be met in order to report the measure (frequency of reporting, procedure codes, diagnosis codes, and reporting measure code(s)). Remember, you cannot go back and add a measure code to claims already submitted.

Receiving practice management guidance from Mitzi is a FREE OCMA member benefit!
Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs: 
Mitzi Young
Physician Advocate, CMA Center for Economic Services

ALERT: Legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance & the House Ways and Means Committees

Bipartisan House-Senate Medicare payment reform legislation passes out of committee; Congress includes 3 month patch to stop the 25% SGR cuts in budget deal

The Orange County Medical Association (OCMA) and California Medical Association (CMA) are pleased that legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance Committee and the House Ways and Means Committee yesterday, December 12, 2013. 
The Senate Finance Committee and the House Ways and Means Committee this week unveiled revised legislative proposals to repeal the Medicare sustainable growth rate (SGR) and establish a new payment system. Both committees have said that they expect to "mark-up" (pass out of committee) the legislation on Thursday, December 12.  The changes they have made since the initial October "discussion draft" are all positive and address most of the issues raised by the California Medical Association (CMA).
Yesterday's committee votes came just before Congress recesses for the holiday, pushing any further action into 2014. Congress has also included a three-month SGR patch-with a 0.5 percent payment raise-as part of the federal budget agreement, which will give lawmakers a little more time to finalize the long-term Medicare payment reforms. The bills are being passed out of Committee without funding sources. When lawmakers return in January, they will begin to marry the funding sources to the Medicare payment overhaul legislation.   
"With the drastically reduced price tag of $116 billion, Congress must seize the opportunity to set Medicare on a more stable course for current and future generations of physicians and patients," says CMA President Richard Thorp, M.D. "While the bill still needs work, CMA supports moving the bills through committee to continue to move the process forward. This is the most progress Congress has made on Medicare physician payment reform in a decade and we need to keep the momentum going."  
The revised proposals will first and foremost eliminate the badly broken SGR formula that has plagued policymakers and physicians for more than a decade. The legislation also establishes two payment tracks. A fee-for-service payment track coupled with a streamlined reporting program, called the Value Based Performance Program. The bill provides substantial physicians bonuses up to 12 percent. It also includes penalties. (However, existing law includes 8-9 percent penalties for non-participation next year without any bonus potential.)
The second payment track allows physicians to work with the Centers for Medicare and Medicaid Services (CMS) to establish alternative payment models, such as medical homes, that will provide 5 percent bonus payments. To help small practices transition to these models, they have provided a transition period and up to $125 million in funding assistance. The legislation also requires CMS to ensure that the new payment systems work for small practices as well as surgeons/specialists and primary care. 

The legislation meets many of CMA's long-standing goals for Medicare reform, including:

  • Repeal of the SGR;
  • Automatic payment updates before the new models begin;
  • Incentives to participate in new payment models (5 percent bonus);
  • A phase-in period and funding assistance to help small practices transition to new payment models;
  • Retention of a fee-for-service program;
  • Elimination of the current penalties and a consolidation of the current quality reporting programs (Physician Quality Reporting Program-PQRS, EHR Meaningful Use, and the Value Modifier) into a single program with a substantial new bonus pool; 
  • Improvements to the Value Modifier;  
  • Payment for complex chronic care management;
  • Timely data feedback for physicians;
  • Ensures that physicians develop the quality measures and are widely consulted on the new payment programs;
  • Update for the Medicare physician payment localities (California GPCI fix).

In response to CMA's comments, the committees made the following additional improvements:

  • Provides increased funding assistance ($125 million) to ALL small practices, not just rural and HPSA practices;
  • Allows a longer time-frame for physicians to prepare to participate in the new models;
  • Gives special consideration to small practices when developing the clinical improvement activities,  the value modifier methodology and the alternative payment models;
  • Requires the fee-for-service value-based program to reduce administrative burden on physicians and gives credit for improvement rather than just meeting a benchmark;
  • Ensures the Value Modifier will be cost and risk-adjusted;
  • Requires CMS to develop models that are attainable for specialists and surgeons, as well as primary care physicians, and small practices; 
  • Allows physicians to partially qualify for the new alternative payment models;
  • Expands the "total cost of care" data available to physicians to help physicians more efficiently manage their practices;
  • A study to examine total Medicare program cost savings (Part A, Part B and Part D) achieved by physicians.
  • Allows physicians to report data on the group level, including virtual groups, to improve the accuracy of the data.
  • Improvements to the Relative Value Unit process; 
  • Ensures that any practice guidelines or payment policies do not establish a standard of care for medical liability actions.

In a last-minute change, the Ways and Means bill now provides a stabilizing 0.5 percent automatic update each year for three years until the new payment models begin. The Ways and Means bill also includes the California geographic payment locality update ("GPCI fix"), which would transition the outdated payment localities to the current and regularly updated metropolitan statistical areas used to calculate payments to hospitals. This transition would take place over 6 years and guarantees that rural counties are not negatively impacted by the change. This GPCI fix would provide an additional $400 million to California physicians over 10 years.

The Senate Finance Committee bill does not, however include an automatic payment update in the first three years. The Senate Chairmen want to wait until the Congressional Budget Office scores the legislation and they negotiate funding sources before adding any payment updates. The Senate bill also does not include the California GPCI fix, as the committee has stated it wants to keep state-specific issues out of the committee mark-up. However, both Senate Finance Committee Chairman Max Baucus and Ranking Member Orrin Hatch have pledged to address the CMA GPCI issue during the January negotiations.  

The Doctors Company Risk Tip: Medical Clearance Does Not Clear the Patient or Physician of Risks

“Medical clearance” is when a surgeon requests clearance from an assessing physician before performing surgery on a patient. Cardiac risk is the number one reason to request medical clearance, but other risks that call for medical clearance include congestive heart failure, pulmonary embolism, anticoagulation, obesity, and high blood pressure. 

Anticoagulants, for example, are often an issue in surgical claims. If the patient is taking anticoagulants, the surgeon and the physician should agree on the best approach for that specific patient. They may discuss changes in medical management that should be made to decrease risk. If they believe the patient is at risk from a respiratory perspective, the focus may be on early mobilization, incentive spirometry, and respiratory treatment.

To avoid malpractice risks, consider the following tips when dealing with medical clearance:

  • Determine which patients need medical clearance. The surgeon should assess the type of surgery and its associated risks and the health of the patient. Healthy patients with no underlying conditions who are undergoing fairly low-risk procedures don’t routinely need medical clearance. 
  • Provide appropriate information. Problems can arise when the surgeon does not provide enough information to the assessing physician about the surgery being proposed. The surgeon should provide information to the assessing physician about the type of surgery, how long it will take, what kind of anesthesia is anticipated, how long the patient will be immobile, what is involved in rehabilitation, and what the recovery period looks like. The assessing physician should take that information into consideration, along with exam results and knowledge of the patient, to determine if the patient is at increased risk.
  • Develop a plan to mitigate risks. The surgeon and the assessing physician should work together to determine the steps to take to mitigate risk preoperatively, intraoperatively, and postoperatively. For example, they should agree about which medications to stop preoperatively and which to continue. 

There is no standard medical clearance process. Physicians should be aware of when a medical clearance would be indicated and have a good process to ensure it’s done.

Medical clearance is a misnomer because it implies that the patient is cleared and there are no risks. No patient is free of risk when undergoing a procedure. The goals of the assessment are to determine the level of risk and to identify opportunities to mitigate risk—with the surgeon and the assessing physician working in concert. The decision about whether to proceed with the operation belongs to the surgeon and the patient.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit

Competition Opens for Young Physicians Patient Safety Award

Medical Students and Residents Encouraged to Submit Essays for $5,000 Awards

Napa, California—November 18, 2013
—Entries are now being accepted for the 2014 Young Physicians Patient Safety Award, The Doctors Company Foundation announced today. Medical students and residents are eligible to compete for six $5,000 awards. Winners will also receive travel to the Association of American Medical College’s Integrating Quality meeting in Chicago June 12–13, 2014, where the awards will be presented.

Entrants must be third- or fourth-year medical students or first-year residents who were in a hospital setting as of June 2013. Entrants must submit a 500- to 1,000-word essay describing an instructional patient safety event they experienced during a clinical rotation that resulted in a personal transformation. Essays are due by 5:00 PM (ET) on Monday, February 3, 2014. Online entry forms are available at

The contest is sponsored by The Doctors Company Foundation in partnership with the Lucian Leape Institute at the National Patient Safety Foundation (NPSF). Entries will be judged by a panel selected by the NPSF.

“One of the missions of our Foundation is to support patient safety education for healthcare professionals,” said Leona Egeland Siadek, the Foundation’s executive director. “The Young Physicians Patient Safety Award is a key to this mission. These essays bring to the forefront the importance of making the culture of safety an integral part of the culture of medicine.” 

Past winning essays can be read at

About The Doctors Company Foundation
The Doctors Company Foundation was created in 2008 by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer. The purpose of the Foundation is to support patient safety education for healthcare professionals, patient safety research with clinically useful applications, and medical professional liability research. In this context, patient safety is defined as a healthcare discipline that minimizes the incidence and impact of adverse events by redesigning systems and processes using human factors principles to reduce errors.

Contact: Alina Gomez, agomez@the

Prescription Drug Abuse – What to Look For

By Ann Whitehead, JD, RN
Vice President of Risk Management & Patient Safety Cooperative of American Physicians, Inc.

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic. A staggering statistic from the National Drug Abuse Institute reveals prescription drugs are the second most abused drug, behind marijuana, by seniors in high school. The CDC finds overdoses from prescription painkillers resulted in more deaths in 2010 than heroin and cocaine combined.1

Prescription drug abuse affects all age, race, gender, and socioeconomic classes. Here are two examples: the patient on an antidepressant prescribed by his psychiatrist was also taking a narcotic prescribed by an orthopedist. In a drug-induced haze, the man threw himself down a flight of stairs, breaking his neck; or the 83-year-old patient who recently came to the office for morphine who later tested positive for cocaine. Both patients create liability and treatment issues for their physicians. 

Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription opioid painkillers. The U.S. Drug Enforcement Administration (DEA) and the California Department of Justice are aggressively prosecuting individuals who prescribe opioids illegally and those who operate “pill mills.” Physicians face challenges when trying to spot the patient who may be abusing prescription drugs or possibly improperly sharing them with others. The following are some suspicious behaviors that may raise the red flag. 

The patient may:

• Refuse to grant permission to obtain old records or communicate with previous physicians.
• Demonstrate reluctance to undergo comprehensive histories, physical examinations, or diagnostic testing, especially urine drug screenings.
• Request specific drugs (often because of the higher resale value of brand names).
• Profess multiple allergies to recommended medications.
• Resist certain treatment options.
• Threaten doctors or display anger during visits.
• Consistently target appointments at the end of the day or during off hours.
• Repeatedly lose prescriptions.
• Request escalation in dosages.
• Demonstrate noncompliance with prescription instructions.

A helpful tool for physicians is the “Opioid Overdose Toolkit: Information for Prescribers” recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).2 This guide offers tips on safe prescribing and preventing opioid overdose including: assessment, state drug monitoring programs, medication selection, prescription writing tips, use of naloxone, and deciding when to stop opioid.

Lastly, if you get a call from the DEA or local law enforcement, contact the CAP Hotline for assistance.

For more information about CAP, or to request additional information or risk management publications, please contact us at:, or call 800-356-5672. You can also visit our website at:

1 Centers for Disease Control and Prevention (CDC). CDC grand rounds: Prescription drug overdoses – A U.S. epidemic. MMWR Morb Mortal Wkly Rep.2012; 61(1):10-13.
2 Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Toolkit” Information for Prescribers. HHS Publication No. (SMA) 13-4742. Rockville, MD: Substance Abuse and Mental Health Administration, 2013.

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