Tuesday, August 21, 2018


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 (YesProp52.org)
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 (NoOnProp53.com)
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 (YesOn55.com)
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 (YesOn56.org)
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 (SupportProp58.com)
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 (NoOnProp61.org)
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 (SafetyForAll.com)
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 (YesOn64.org)
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 www.cmanet.org/macra.  (Click the blue “MACRA Resources” button). It is not available to non-members.

REMINDER: Deadline to Register for CURES 2.0 is July 1, 2016

Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must submit an application to register for the Controlled Substance Utilization Review and Evaluation System (CURES) by July 1, 2016.

The California Medical Association (CMA) has compiled a list of educational materials to familiarize physicians with the registration process and key features of the newly upgraded system, CURES 2.0. These resources include tips on how to register for CURES 2.0 and an on-demand webinar that walks users through that process. These resources are available at www.cmanet.org/cures.

To register with the new automated system, visit http://oag.ca.gov/cures. Physicians who experience problems with the new system should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov. Providers are also encouraged to report these technical issues to CMA's member service center at (800) 786-4262 or memberservice@cmanet.org.

OCMA Partners with Orange Coast Magazine for Physicians of the Excellence 2017

The Orange County Medical Association and Orange Coast Magazine will be partnering again in 2017 for the prestigious Physicians of Excellence recognition program.  This collaboration dates back to the beginning of the program in 2004.  The Orange County Register was the sponsor of the event the past two years.  

“We are very excited about renewing this partnership with Orange Coast Magazine,” stated Jim Peterson, OCMA’s CEO.  This is a very popular magazine that is enjoyed by thousands of readers in Orange County.”

With the change, the nomination, review and selection processes for the 2017 cycle will be accelerated to meet publication deadlines for Orange Coast Magazine’s January 2017 issue.  Nominations are being accepted now and the deadline to submit nominations is June 30, 2016.  The nomination form can be found by clicking here.  

“All of us with OCMA want to thank the Orange County Register for their support and collaboration these past two years,” stated Peterson, who added that “more than 900 Orange County physicians were recognized during that time period.”

St. Joseph Health Provides $1 Million to Address Hunger and Homelessness in Local Communities Across California

May 25, 2016, Irvine, CA –St. Joseph Health (SJH) today announced it will provide $1 million in grants to 33 non-profit organizations that help provide basic needs for the hungry and homeless in Orange County, the High Desert communities and Sonoma, Napa and Humboldt counties. 

Reaching out to the most vulnerable in the community is at the core of St. Joseph Health’s values, and this initiative puts those values into action. With every grant initiative, St. Joseph Health partners with non-profit organizations to offer solutions to pressing health concerns among low-income and underserved people. This work is made possible through the commitment of St. Joseph Health’s California hospitals, which each contribute 10 percent of their net income as part of their dedication to creating healthier communities and serving the common good. 

“This commitment to caring for our neighbors is one of the ways we translate our values into action,” said Annette M. Walker, MHA, interim president and CEO, St. Joseph Health. “We want to improve the overall health and quality of life of people in the communities we serve. This initiative is aimed at providing for their most immediate needs, the need for food and the need for shelter. Hunger and homelessness are huge obstacles to health and well-being. We know, for example, that food insecurity is connected with chronic health problems, poor performance in school and higher levels of anxiety.”

More families in California live in poverty or near-poverty than most people think: According to a recent report from the United Way of California, one in three households statewide do not have enough income to meet their basic costs of living. Those struggling families are particularly burdened by high costs for food. Even having two stable, full-time jobs does not guarantee that a family will be able to make ends meet if those jobs pay at or near the minimum wage. 

And hunger in California crosses city and county lines. “Hunger isn’t an issue confined to certain neighborhoods,” said Nicole Suydam, CEO of Second Harvest Food Bank in Irvine, which will use the funds to provide fresh produce to 34,200 people through its Mobile Pantry, School Pantry and Senior Grocery programs. “Many of the people struggling with hunger are hard-working people forced to choose between paying rent and eating. We also see lots of seniors on fixed incomes who can’t afford meals. St. Joseph Health’s support helps us provide nutritious food to these individuals.” 

Other programs that received funding include: 
• Illumination Foundation in north Orange County, which will use the funds from St. Joseph Health to transition homeless families into long-term stability by providing emergency housing and case management/care coordination for 80 clients. 

• Friendship Shelter in south Orange County will use St. Joseph Health funds to provide emergency shelter to 320 people and rehabilitative shelter to 120 people. The organization also will be able to provide supportive housing to 60 people and care coordination for 500 clients. 

• Family Assistance Program in the High Desert, which provides shelter, food and care coordination services for victims of domestic violence. The program will use the funds to provide food and shelter for 250 women and children and case management for 150 women. 

Nineteen programs in Orange County and six in the High Desert received funds, as did eight in Northern California. 

About St. Joseph Health: 
St. Joseph Health (SJH) is a not-for-profit, integrated health care delivery system that includes 16 hospitals, physician organizations, home health agencies, hospice care, outpatient services and community outreach services. Founded by the Sisters of St. Joseph of Orange, SJH remains rooted to the sisters' traditions of assessing a community's needs and adapting strategies to meet those needs. Today, SJH continues its work in the tradition of the sisters through its wide networks of outstanding services. In each region it serves, SJH reaches out to care for the poor and vulnerable, establishing and supporting many programs and services that benefit the community

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