Monday, June 18, 2018


CHOC Named One of the Safest Hospitals in the Nation by The Leapfrog Group

CHOC Children’s Hospital has once again been named a “Top Hospital” by The Leapfrog Group for providing the safest and highest quality health care services to patients.  CHOC is one of only nine children's hospitals in the nation—and the only one on the West Coast— to earn the prestigious distinction.  

"CHOC is committed to becoming the world's safest children's hospital. While this is a never-ending journey, being named as a Top Children's Hospital for the eighth time by the Leapfrog Group suggests we are on the right track. Leapfrog has always emphasized patient safety as the top priority, one with which our patients, families and partners would no doubt agree. It's a humbling honor, and serves as both encouragement and motivation to continue our efforts to provide the safest, highest quality care possible,” said Dr. James Cappon, chief quality officer, CHOC.

The selection of Top Hospitals is based on the results of the 2016 Leapfrog Hospital Survey. Performance across many areas of hospital care is considered in establishing the qualifications for the award, including infection rates and a hospital’s ability to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology

“Being acknowledged as a Top Hospital is an incredible feat achieved by less than three percent of hospitals nationwide,” said Leah Binder, president and CEO of The Leapfrog Group. “With this honor, CHOC has established its commitment to safer and higher quality care. Providing this level of care to patients requires motivation and drive from every team member. I congratulate CHOC’s board, staff and clinicians, whose efforts made this honor possible.”

To see the full list of institutions honored as 2016 Top Hospitals, please visit

6 OC Hospitals Receive "A" Rating for Safety

Six hospitals in the Orange County area, including Hoag Hospital Irvine, Hoag Memorial Hospital Presbyterian, Orange Coast Memorial Medical Center, Kaiser Foundation Hospital - Anaheim and Irvine, and UC Irvine, received an A rating from the Leapfrog Group, a national hospital safety organization, which recently released its annual safety ratings for 2016. 

Of the 2,633 hospitals evaluated nationally, 267 were in California. Eighty-one California hospitals received an A rating overall, and the state ranked 26 among the 47 states included in the rating.

Kaiser Permanente hospitals consistently post some of the highest scores.

“Kaiser Permanente is committed to patient safety. The ratings by the Leapfrog Group demonstrate that commitment and the trust we have earned from our patients and members, affirming that they are receiving the right care from a team of compassionate physicians, nurses, and care providers,” said Edward M. Ellison, MD, executive medical director, Southern California Permanente Medical Group. “Our emphasis on infection control and adherence to the safest surgical standards makes Kaiser Permanente hospitals in Southern California among the safest in the nation. 

“In the fast-changing healthcare landscape, patients should be aware that hospitals are not all equally competent at protecting them from injuries and infections. We believe everyone has the right to know which hospitals are the safest and encourage community members to call on their local hospitals to change, and on their elected officials to spur them to action. States that put a priority on safety have shown remarkable improvements.” said Leapfrog President and CEO Leah Binder in a statement.

The Leapfrog Group's safety assessments factor in several criteria from 30 categories, pooled together from various performance measures from sources such as the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention. These include rates of errors, injuries, accidents, and infections, according to the LA Times.

The Leapfrog Hospital Safety Grade is calculated by top patient safety experts and is peer reviewed, fully transparent and free to the public. A full description of the data and methodology used in determining grades is available at

MACRA Implementation: A Review of CMS’ Final Rule

WEBINAR:  November 30, 2016 | 12:15pm - 1:15pm

This webinar offers 1 free AMA PRA Category 1 Credit™ for CMA members. This webinar is also available to nonmembers for $99.*

This webinar will provide an overview of the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program, authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Our speaker will provide key details and dates you’ll need to know and information about how to prepare for the start of the program on January 1, 2017. We will also review key elements of the Merit Based Incentive Payment System (MIPS) pathway and provide a comparison to the other pathway in the program, Advanced Alternative Payment Models (APM). Finally, we will review the flexibilities clinicians have to pick how and when they begin this program during the 2017 transitional year, and review available resources currently available for clinicians seeking technical support.

Featured Presenter: Ashby Wolfe, M.D., MPP, MPH, is a board-certified family physician who currently serves as Chief Medical Officer for California, Arizona, Nevada, Hawaii and the Pacific Territories for CMS. Her focus is on implementation of the many facets of the Affordable Care Act and its role in providing access to high-quality care and improved health at a lower cost.

Participants should register at least one hour before the webinar. If you do not register an hour before the webinar start time, we cannot guarantee your attendance.

To register, click here

Contact: CMA Member Help Center (800) 786-4262 or

*The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council on Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The California Medical Association/Institute for Medical Quality (CMA/IMQ) designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Provider approved by the California Board of Registered Nursing, Provider Number CEP370, for 1 contact hours.

On-demand webinars are not available for CEU or CME credits.

Highlights from the OCMA Board of Directors meeting on November 10, 2016

By:  Darla S. Holland, M.D., President, OCMA

The OCMA Board of Directors met on Thursday, November 10.   The following highlights the major discussions and actions that took place at that meeting: 

The Resident Representative, Dr. Duy Nguyen, indicated that the Resident Physicians in Orange County are interested in Physician Wellness Programs geared toward physicians in training.  A resolution addressing burnout in Medical Students was discussed at the CMA Board of Trustees meeting in October.    The Board is very supportive of sponsoring and supporting such activities for the Medical Students and Residents in programs in Orange County.   
There was vigorous discussion about the CMA's role in the passage of Senate Bill 72.   Many hospital based physicians are affected by this legislation, slated to take effect on January 1, 2017.   A recommendation was made to have the Legislative Leadership Committee recommend language to be submitted through the Resolution process to the House of Delegates year round process.     
The Building Committee made a presentation recommending that OCMA purchase a building as leasing continues to deplete our reserves.   The principles guiding the building search involve the following priorities: 1) To have a location convenient for most members to access; 2) To invest in a manner that generates revenue for both operating expenses and special projects that and will grow to at least keep pace with inflation so that the value of the principle does not diminish over time; 3) To allow OCMA staff to function most of their time on activities that support the core mission of the organization.    These principles will be incorporated into the building search.   
The Physicians of Excellence Reception will be on January 25, 2017.

2016 Election Results are In


California Medical Associaiton: 2016 Election Results

ELECTION Night 2016:
One for the history books!

Once again, the California Medical Association took on tough fights and prevailed.

We won all of our statewide ballot measure endorsements, including three local initiatives in the Bay area.


MACRA before and after


Together, we voted to…


· Invest in Medi-Cal. (Yes on Prop. 56, 55 and 52)

· Save lives, reduce smoking rates and prevent thousands of children from starting in the first place. (Yes on Prop. 56)

· Triple the funding for California's anti-smoking programs. (Yes on Prop. 56)

· Provide more essential services like medical check-ups, immunizations, prescriptions and dental/vision care for 13 million low-income Californians, including seven million children. (Yes on Prop. 52)

· Prevent an increase in state prescription drug costs, as well as preserve patient access to medications. (No on Prop. 61)

· Protect public health and clarify the role of physicians in controlling and regulating the adult use of cannabis. (Yes on Prop. 64)

· Reduce sugar intake to prevent diabetes and obesity. (Yes on Measures V (San Francisco), HH (Oakland) and O1 (Albany))

· Break down barriers and removed outdated bilingual education mandates to better reflect California's diverse society. (Yes on Prop. 58)

· Ensure critical infrastructure projects – including hospitals and medical facilities – aren't subject to delays or loss of local control. (No on Prop. 53)

· Strengthen California's ability to prevent gun violence. (Yes on Prop. 63)


Voters made health care a priority



In the coming months, we'll work to ensure the new revenue reaches the communities most in need of access to health care and improved services.

Voters sent a clear signal that they are willing to support investments in public health andthat they are tired of Sacramento chronically underfunding health care. CMA's alignment with voters further demonstrates our strength and ability to fight for physicians throughout the state and in all modes of practice.

And on the national front – there are more questions than answers, but one thing is clear: we could be facing a major shake-up.

How will the next Congress and Trump's administration handle the Affordable Care Act? Rising drug prices? Health and Human Services secretary? Medicaid expansion? Mega-mergers?

Regardless of what comes next, CMA will continue to keep California's physicians in the driver's seat on health care policy. And we're working ahead to 2018 to ensure the next Governor reflects our values, including the protection of MICRA and investments in public health.

I want to thank each of you for your support and dedication to CMA. Your membership drives this organization to excellence. Together, we stand stronger.

Dustin Corcoran

By the Numbers

$3 billion
per year in new federal matching funds for Medi-Cal to serve elderly and low-income Californians. (Yes on Prop. 52)

Up to
$2 billion
per year to improve access to health care services, including Medi-Cal, for low-income children and their families. (Yes on Prop. 55)

Up to
$1.7 billion
(plus $1 billion in federal matching funds) for Medi-Cal. (Yes on Prop. 56)

$1.5 billion
in costs for children's health coverage by FY2019-20. (Yes on Prop. 52)

$350 million
per year in support to state and local public hospitals. (Yes on Prop. 52)

$20 million
per year for public schools to enhance smoking cessation programs. (Yes on Prop. 56)

Over-diagnosing Over-diagnosis

By:  John G. West, M.D., Director of Surgery, Breastlink (   

A recent article in the L.A. Times by Melissa Healy casts doubt on the value of screening mammography.  Her article is based on publications by Dr. Gilbert Welch, who has been a long-time critic of mammographic screening.

    Dr. Welch’s premise for concluding that mammograms led to unnecessary treatments is based on his observation that screening leads to the detection of a large number of small breast cancers without a corresponding reduction in the number of advanced breast cancers.  His assumption is that many of these small cancers would not progress and cause harm.

   The logic behind these assumptions is open to question, because advanced cancers typically are found in underserved populations that have low levels of participation in screening programs.  In populations with high levels of screening, locally advanced cancers are uncommon (1).  

     Dr. Welch bases his conclusions on a study comparing breast cancer outcomes during two time periods.  First was 1977-1979 before screening was routine, and the second was 2000-2002 when screening was widespread. His data source is the SEER program (Surveillance, Epidemiology and End Results), which provides information on the size and stage of breast cancers at the time of diagnosis.  

   What is critically lacking in the SEER data is information on mammographic screening for individual patients.  The fundamental flaw in the study reported by Dr. Welch is that he had no idea which patients received a mammogram and which did not.  This lack of screening data undermines the credibility of his conclusions.

      Studies that have data on who was screened and who was not come to a much different conclusions.  One recent study from Canada evaluated a large group of women who participated in routine screening and found a 40% reduction in breast cancer mortality (1).  A recent autopsy study from Boston found that 65% of women who died of metastatic breast cancer never had a mammogram (2).

   It has also been observed that when screening is introduced into underserved populations, the percentage of advanced cancers drops and there is a corresponding rise in the number of early stage cancers (3).  This is a critical observation since survival with early detection is greater than 95% and survival with advanced cancer is in the range of 50-60%.

   Dr. Welch also states that the biggest harm from screening is over-diagnosis.  In other words, he asserts that screening leads to the detection of small cancers, that if left untreated, would not cause harm. 

     It is correct to point out that some small, low-grade cancers may take years before becoming life threatening.  Thus, older women who have a cancer that is only seen on the mammogram might “outlive” their cancer even without treatment. However, small but rapidly growing cancers in the elderly usually benefit from aggressive treatment. Treating physicians must adjust their treatments based on tumor biology.  

    For younger women, over-diagnosis is a non-issue.  Given time, small, non-aggressive cancers will progress.  Most will spread beyond the breast within a decade or less.  Once this spread has taken place, there is often the need for aggressive surgery and chemotherapy, and the chances for survival are markedly reduced.

   The irony of the case against mammographic screening is that it comes at a time when major progress is being made in early detection.  We now have technology, such as screening ultrasounds and screening MRIs, that can detect cancers not visible on mammograms.  Widespread adoption of advanced screening technology, particularly in high-risk women and women with dense breasts, has the potential to produce dramatic reductions in breast cancer mortality.

    Now is not the time to cut back on screening.  Now is the time to develop less expensive and more effective screening technology.  We must recognize that over-diagnosis is not the problem.  The problem is over-treatment.   Our goal must be to individualize patient care in a manner that maximizes benefits while avoiding the harm associated with over-treatment.

1.  Coldman A., Phillips N., Wilson C. et. al. “Pan-Canadian Study of Mammography Screening and Mortality From Breast Cancer,” Natl Cancer Inst  106 (July 2014):1-7.

2.  Webb M.L., Cady B., Michaelson J.S. et. al. “A Failure Analysis of Invasive Breast Cancer: Most Deaths From Disease Occur in Women Not Regularly Screened,” Cancer  120 (Sept. 2014): 2839-2846.

3.  Epidemiologic Study from Orange Co. California:  Making mammographic screening available to the underserved Hispanic population.  

Message from Nikan Khatibi, D.O., OCMA Legislative Committee Co-Chair

Nikan Khatibi, D.O., Co-Chair of the OCMA Legislative Committee, recorded a brief synopsis of what physicians need to know for the upcoming election.  He addresses the elections for the first and third districts of the Orange County Board of Supervisors, two CMA-supported propositions and the Presidential election.  We encourage you to watch and listen to the video and VOTE on November 8, 2016. 

2016 California Ballot Propositions: Where Does OCMA/CMA Stand?

CMA’s Board of Trustees: Positions on November 2016 Ballot Measures


Prop. 52: California Medi-Cal Hospital Reimbursement Initiative 
Position: CMA Supports (
Prop. 52 would lock in hospital fees to allow the state to draw down federal health care funds. It would add language to the California Constitution requiring voter approval of changes to the hospital fee program. This will prevent diversion of the funds from the original intended purpose of supporting hospital care to Medi-Cal patients and paying for health care for low-income children.


Prop. 53: California Public Vote on Bonds Initiative 
Position: CMA Opposes (
Prop. 53 would require voter approval before the state could issue more than $2 billion in public infrastructure bonds that would require an increase in taxes or fees for repayment. This initiative could impact medical care by curtailing the ability of the State of California and local government entities to build or rebuild major infrastructure projects.


Prop. 55: California Children’s Education and Health Care Protection Act of 2016
Position: CMA Supports (
Prop. 55 would extend the current income tax rates on the wealthiest two percent of Californians – singles earning more than $250,000 and couples earning more than $500,000 a year – for 12 years. Funding would provide local school districts the money needed to hire teachers and reduce class sizes and improve access to health care services for low-income children so they can stay healthy and thrive.


Prop. 56: California Healthcare, Research and Prevention Tobacco Tax Act of 2016
Position: CMA Supports (
Prop. 56 – supported by a broad alliance of physicians, health care advocates, educators and others – would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack. Designed as a user fee on cigarettes and other tobacco products, the majority of the money would be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products.


Prop. 58: The Language Education Acquisition and Readiness Now (LEARN) Initiative
Position: CMA Supports (
Prop. 58 would give local school districts and their academic staff the option of providing bilingual education. California needs a well-prepared and educated health care workforce that reflects our diverse society. Prop. 58 would break down barriers by removing outdated mandates, helping physicians provide the best patient care for all Californians.


Prop. 61: Drug Price Standards Initiative
Position: CMA Opposes (
Prop. 61 would prevent certain state agencies from entering into contracts for the purchase of prescription drugs unless the price paid is the same as or lower than the special discounts provided to the U.S. Department of Veterans Affairs. The measure could result in the invalidation of existing agreements between the state and pharmaceutical companies that already provide significant discounts to the state.


Prop. 63: Safety for All Act of 2016
Position: CMA Supports (
Prop. 63 would prohibit the possession of large-capacity ammunition magazines and would require most individuals to pass a background check and obtain authorization from the California Department of Justice to purchase ammunition. CMA supports Prop. 63 to ensure our communities are safe and healthy places to live.


Prop. 64: Adult Use of Marijuana Act
Position: CMA Supports (
Prop. 64 would regulate and control the cultivation and use of non-medical cannabis. The proposal would generate up to $1 billion in taxes for state and local governments, according to a fiscal analysis of the proposal. CMA believes that the most effective way to protect public health is to tightly control, track and regulate cannabis, as well as comprehensively research and educate the public on its health impacts.


Prop. 56: CA Healthcare, Research and Prevention Tobacco Tax Act of 2016


The California Healthcare, Research and Prevention Tobacco Tax Act of 2016 – supported by a broad alliance of physicians, health care advocates, educators and others – would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack. The majority of the money from the initiative’s user fee on cigarettes and other tobacco products, including e-cigarettes containing nicotine, will be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products.


“Sadly, we see tobacco’s deadly and costly toll every day in our hospitals and clinics. Cancer and other tobacco-related diseases kill more people than car accidents, murder, suicide, alcohol, illegal drugs and AIDS combined,” said Steven Larson, M.D., MPH, president of the California Medical Association (CMA). “The heart of this initiative is simple: Taxing tobacco saves lives by getting people to quit or never start smoking. The only people who will pay are those who smoke. If you don’t smoke, you don’t pay.”


California taxpayers pay $3.5 billion annually to treat cancer and other tobacco-related diseases through Medi-Cal. A user fee on cigarettes is a matter of fairness – it shifts the fiscal burden to smokers for these medical programs, smoking prevention and research.


The tobacco tax will also prevent a new generation of kids from taking up a deadly, addictive habit. Despite years of progress in education and research about the dangers of tobacco, nearly 17,000 California kids get hooked on smoking every year; one-third of them will eventually die from tobacco-related illnesses.


Prop. 56 is backed by a coalition that includes CMA, the American Cancer Society Cancer Action Network, American Lung Association in California, American Heart Association, California Dental Association, the California Hospital Association, SEIU California, Blue Shield of California and philanthropist Tom Steyer.


Connect with the campaign


Prop 55: CA Children’s Education and Health Care Protection Act of 2016


The California Children’s Education and Health Care Protection Act of 2016 will extend the temporary income tax provisions of Proposition 30 for 12 years. Prop. 55 will extend the current income tax rates on the wealthiest two percent of Californians – singles earning more than $250,000 and couples earning more than $500,000 a year.


This initiative will maintain the current tax rates on the wealthiest Californians to prevent billions of dollars in funding cuts for public education and vital health care services. This measure will generate $8 -11 billion per year, and provide up to $2 billion annually to improve access to health care for low-income children and their families. 


California Governor Jerry Brown supported and campaigned for the passage of Proposition 30 in 2012 to increase taxes to prevent $6 billion cuts to the education budget for California state schools. The measure was approved by California voters by a margin of 55 to 45 percent.


Funding from this vital measure will provide local school districts the money they need to hire good teachers and reduce class sizes for our students. And it will improve access to health care services for the low-income children so they can stay healthy and thrive. Budget forecasts show that unless we extend these taxes on the wealthy, in the first year alone our public schools will face nearly $5 billion in cuts, and our state budget will face a nearly $3 billion deficit.


“Doctors and other health care providers across the state are supporting this initiative because it will provide critical funds to improve access to health care for low-income children and their families,”  said CMA President-Elect Ruth Haskins, M.D. “This initiative will help our state provide the care vulnerable kids need to stay healthy and thrive.”


The initiative also ensures strict accountability and transparency so that all the money goes where it matters the most – directly to the classroom, not towards administrative costs.


Prop. 55 is backed by a coalition that includes CMA, the California Hospital Association, Association of California Health Districts, California Academy of Family Physicians, California Dental Association, Health Access California and Blue Shield of California.


Connect with the campaign


Physicians Must Post Non-Discrimination Statements by October 16 2016

The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) recently finalized new nondiscrimination rules intended to advance health equity and reduce health care disparities. Under the rule, which implements section 1557 of the Affordable Care Act, individuals are protected from discrimination in health care on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping. This new rule is the first federal civil rights law to broadly prohibit discrimination on the basis of sex in federally funded health programs. It also includes important protections for individuals with disabilities and enhances language assistance for people with limited English proficiency.

This rule applies to those who provide or administer health-related services or insurance coverage and receive "federal financial assistance." Federal financial assistance includes Medicare, Children's Health Insurance Program, Medicaid, meaningful use payments, HHS grants, Centers for Medicare and Medicaid Services gain-sharing demonstration projects, federal premium and cost-sharing subsidies, etc.

The rule does not apply to physicians who participate only in Medicare Part B, unless they are also receiving meaningful use incentive payments.

Covered physicians must comply with the following requirements:
Post a notice of nondiscrimination and taglines in the top 15 languages spoken by individuals with limited English proficiency
Develop and implement a language access plan
Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)
Submit an assurance of compliance form to OCR

Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against physicians in federal court.
To assist with implementation, OCR has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rule, factsheets on key provisions and a list of frequently asked questions.

The California Medical Association (CMA) has sought guidance from the California Department of Health Care Services to determine what languages California physicians must post for the nondiscrimination notice. As additional information becomes available, CMA will provide more detailed instructions about how physicians may comply with this rule.

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