Monday, August 20, 2018


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· Break down barriers and removed outdated bilingual education mandates to better reflect California's diverse society.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.

County of Orange Health Care Agency Mycobacterium Facts for Parents

The County of Orange Health Care Agency released the following fact sheet on Mycobacterium  abscessus infections.

County of Orange Health Care Agency Mycobacterium Facts for Parents

President's Report: Highlights from the August 18, 2016 OCMA Board of Directors Meeting

Liaison Reports: 

AMA: three topics were highlighted: 

1. An AMA Interim Meeting is slated for November 12-15. 
2. Communication about the status of MACRA was provided, indicating that the rules are still in the draft phase and that the AMA continues to work with CMS to make sure that all practice types and sizes are provided the flexibility to be successful in the new program. In a comment letter to CMS, 
the AMA outlined a number of recommendations to help these physicians success under MACRA. 

• Increase the low volume threshold to exempt more physicians. 
• Compare practices to their peers rather than larger or more advanced entities. 
• Lower reporting burdens for small, rural and similarly situated practices. 
• Provide education, training and technical assistance to small practices. 
• Allow participation in virtual groups as soon as possible. 

3. The steps that the Stanford surgical residency program leadership took to address the underlying issues affecting resident health were discussed. Their leadership took these after the tragic suicide of one of the physicians from that program, highlighting the need to address physician wellness and burnout in both physicians in training and practice. 

CMA: two major topics were brought forward: 

1. The priorities for the 2016 House of Delegates were recommended and approved and include 

Burnout (Actionable Report and Education Session) 
Opioids (Actionable Report and Education Session) 
ACA Changes Under 1332 Waiver (HOD 203-15) (Actionable Report) 
MACRA (Actionable Report and Education Session) 
Recertification / Maintenance of Certification (Actionable Report and Education Session) 
Development of a 5-Year Public Health Plan (Actionable Report) 

2. The Dues structure was revised to change discounts for new members as well as negotiated group memberships. 

OCMA Financials: 

OCMA has a healthy balance sheet. 
The Revised OCMA Budget was approved to reflect changes needed following the sale of the building. 

Physician Recognition Programs Committee Report: 

The partner to publish and celebrate the 2017 Physicians of Excellence will be Orange Coast Magazine. 
The time line once again involves summer nominations, applications, and selection with an anticipated celebration to take place in January. 
The celebration is slated to be held at Pirch in Costa Mesa. 
Physicians from the Physicians of Excellence program should be featured on the cover of Orange Coast Magazine’s January Edition. 

House of Delegates Report: 

Two resolutions were put forward from our delegation and both were supported by the delegation. 
Dr. Ted Mazer, speaker of the House of Delegates, will be joining the Delegation on its meeting scheduled for October 5 at 6:30 pm. to discuss how the Council reports and the resolution process will be coordinated. 

Services Committee Report

An addition to the OCMA Preferred Business Partner Policy was discussed and approved. A clause was added to state that “The products and services are not clinical, scientific, or research-oriented and the company is not a direct provider of patient care.” 
Should there be questions about whether or not a company might be considered a “patient care” company, it would be referred to the Board for vetting. 

Legislative Committee: 

Drs. Khatibi and Ramos announced that OCMA will be hosting a fundraiser at the OCMA Conference Center for Senator Lou Correa on September 8, 2016 at 6:00 pm. Senator Correa is running for the Congressional seat vacated by Loretta Sanchez who is running for the US Senate. Senator Correa’s wife is an Obstetrician/Gynecologist and he has long been a friend of the House of Medicine. All OCMA members are encouraged to attend. 
It was recommended and approved that DOCPAC funds be used to support Supervisor Andrew Do’s campaign. 
Dr. Khatibi announced that a physician, Dr. Sion Roy is running for a position with the Santa Monica College Board of Trustees. Though this is not an Orange County position, it benefits all physicians to have 
physicians in elected positions. Members are encouraged to support his candidacy. 

District Updates: 

The Providence/St. Joseph Health Merger was approved by the California Attorney General and is moving forward. 
CNA continues to be active in conversations with staff at St. Judes. 
OSCAR, a newer Health Insurance plan is gaining a foothold in Orange County. 
The Kaiser Permanente Medical School is slated to open in 2019 and will be located in Pasadena. 

Executive Director’s Report: 

The NEPO (Network of Ethnic Physicians Organizations) is sponsoring a conference in Southern California in September. Two registrations were offered to OCMA and members have stepped up to use them. 
The Board of Directors Retreat will take place on Saturday, September 17 at the Pasea Resort in Huntington Beach. In addition to the Board of Directors and guests, the Chiefs of Staff from all Orange County hospitals and leaders from Medical Groups and physician organizations have been invited for the educational morning session. 
A building update was provided. The OCMA Building and Conference Center was sold in February and we have been leasing back the building since then. A Building Committee was formed early last summer to evaluate the Association’s needs. It was recommended that input from the membership be obtained. A survey seeking input, opinions and preferences for the next building will be forthcoming shortly 

Video Message from County of Orange Public Health Officer, Eric G. Handler, M.D.

Earlier this month Eric G. Handler, M.D., County of Orange Public Health Officer, visited the OCMA offices to discuss issues of importance to him.  These include Zika and West Nile Virus, social determinants of health. and drowning.  Another area of focus is joining together behavioral health and primary care to provide an integrated system of care for individuals with severe behavioral issues as well as returning veterans.  

Click here to listen to Dr. Handler's entire message.

MACRA Preparation Checklist Available for Members

CMA has published a preparation checklist titled, “MACRA: What Should I Do Now to Prepare?” The checklist contains specific actions practices should take as they prepare for the implementation of MACRA in 2017. 

The preparation checklist is available free for members in CMA's MACRA resource center at  (Click the blue “MACRA Resources” button). It is not available to non-members.

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