Wednesday, September 19, 2018

OCMA Blog

BPA and Its Effects

In recent years, more and more people have become more conscious about the foods they eat. Everyone expects their food to be healthy and safe for themselves and their families. Unfortunately, food packaging may be harboring hidden chemicals that many would like to avoid. One of the most well-known is the toxic chemical known as bisphenol A (BPA). This chemical is found almost everywhere, especially in common household products like water bottles and tin cans. A new report released by the Breast Cancer Fund found that 67% of nearly 200 food cans samples tested positive for BPA, a well-known hormone disruptor. Hormone disruptors are chemicals that, at certain doses, can interfere with the hormone system in mammals. These disruptions can cause certain tumors, birth defects and, other developmental disorders. 

Why is this an eye-opening discovery?  The Federal Drug Administration claims that low levels of BPA are safe, and well below what it takes to cause breast cancer in lab animals. However, its potential health effects were not found until recently, when researchers investigated the case of Canadian women who worked in factories that produced plastics for cars (See ref. below). When thoroughly researched, these women were found to have a five times higher chance of developing premenopausal breast cancer when compared to the control group. This risk is the equivalent of carrying a BRCA gene mutation, which is responsible for many cases of breast cancer. The Federal Drug Administration may argue that this study can’t apply to the general public because levels of exposure to factory workers are so much higher than people in the general environment. While that may be the case, this study clearly shows a correlation between BPA and risk of developing breast cancer. 

While the Canadian study showed a strong correlation between high levels of BPA and the development of breast cancer, it left one question unanswered: What effect would high BPA levels have the factory workers’ daughters? 

While there was no way to test this directly, there have been other promising studies done to see if BPA had effects on fetuses. Some of these studies looked closely at the potential risks of BPA by exposing pregnant lab animals to what the FDA would consider a “safe level” of BPA. These studies showed that even low levels of exposure during early fetal development correlate with cellular changes that predispose the fetus to an increased chance of breast cancer. 

Despite the results of these studies, we can’t know for sure if BPA exposure in predisposition to breast cancer. Even so, the concern is there, and many people are calling for a change in food and water packaging to reduce the risk of exposure. Several brands have already eliminated the use of BPA in their products, while others have yet to do so. Only through careful research and action can we take steps to eliminate BPA from our food and water.

For more information, visit Breastlink at Breastlink.com



CalOptima Honors Orange County Pioneers Who Created Better Health Care System Two Decades Ago

For two decades, CalOptima has served Orange County’s low-income population with access to quality health care and on April 21, the agency honored 10 industry leaders at the center of CalOptima’s creation as a county organized health system. In a ceremony at Santa Ana’s Bowers Museum, honorees received Legacy Awards for their leadership and partnership in laying the foundation for CalOptima, which has been repeatedly recognized as the top Medi-Cal plan in California for quality care.

The Legacy Awards were developed specifically for CalOptima’s 20th anniversary and reflect the honorees’ contributions and the agency’s successful operation since October 1995.

CalOptima Legacy Award honorees include:

Mary Dewane, Founding Chief Executive Officer, now a resident of Phoenix

Kenneth E. Bell, M.D., Former Chief Medical Officer, a resident of Long Beach, California

Jean Forbath, Former Board member and Founder of Share Our Selves, a resident of Costa Mesa, California

Founding members of the CalOptima Board of Directors

John R. Cochran III, chairman of the Board and then a hospital CEO, from Portland, Oregon

Peter G. Anderson, M.D., emergency medicine specialist and physician leader, from Newport Beach, California

Art Birtcher, commercial real estate developer, from San Juan Capistrano, California

Richard Frankenstein, M.D., specialist and physician leader, from Valencia, California

Claire Heaney, then a nurse and health educator, from Tustin, California

Joyce Munsell, then a nurse and health care executive, from Santa Rosa, California

Harriett Wieder, former Orange County Supervisor (posthumous). The late Supervisor Wieder’s award was accepted by daughter Gayle Wieder-Tauber of La Jolla, California.

“Our Legacy Award recipients can be credited with helping to transform Orange County’s health care delivery system for Medi-Cal members,” said CalOptima Chief Executive Officer Michael Schrader. “Through innovation and collaboration, these leaders tackled a crisis in access to health care, overcrowded emergency rooms and unnecessary costs. They were essential in the broad community effort that launched CalOptima to fix those problems, and their legacy is alive in CalOptima’s ongoing impact of improved health for vulnerable children, adults, seniors and people with disabilities.”

Since inception, CalOptima has collaborated with myriad partners and providers to fulfill its mission of providing access to quality care. The Legacy Awards event also brought together more than 200 leaders from local health networks, hospitals, community-based organizations and government agencies to celebrate the success they share as partners in CalOptima programs.

To learn more about CalOptima, visit www.caloptima.org.

Make Sure your Practice Isn't Penalized under the New Provider Directory Accuracy Law

The new law (SB 137) not only requires payors to maintain accurate and current directories, but it also requires physicians to do their part in keeping the information up-to-date. Failure of practices to comply with the new requirements may result in payment delays, removal from directories and even contract termination.

For more information, sign up for CMA’s April 27 webinar on SB 137, at www.cmanet.org/webinars. Or you may call Mitzi Young, OCMA Physician Advocate, at (888) 236-0267.

The webinar will provide an overview of SB 137 and a pilot program, launched by America’s Health Insurance Plans, to ensure provider directories comply with the new law, while reducing the administrative burden for physician practices.



CMA-Western Health Care Leadership Academy - New Workshop Series

Continuing its mission of providing information and tools needed to succeed in today’s rapidly
changing health care environment, the Western Health Care Leadership Academy is pleased
to introduce a new series of workshops designed specifically for organizational leaders.
The academy’s “Organizational Leadership Principles” track will give you the skills you need
to be a successful leader in the workplace, whether that is a medical practice, medical
association, hospital medical staff or other organized health care group or business.

For more information on all sessions and to register, visit www.westernleadershipacademy.com

The Road Ahead: Diagnosis and Treatment of Breast Cancer

Cancer. Just hearing the word can bring you down. For many women, a breast cancer diagnosis is a reality they have to face. The thought of receiving a diagnosis can cause much distress and anxiety in women on top of all the stresses they experience every day. Fortunately, there have been great strides in breast cancer research, treatment and diagnosis. Breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis. With death rates down 34% since 1990, breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis.

The road to recovery begins with diagnosis. So, how do we do so with confidence and accuracy? Physicians employ a variety of breast imaging services including mammography, ultrasound and MRI to detect breast cancer, depending on various patient factors. However, breast cancer screening guidelines have become somewhat confusing in recent years, with multiple organizations offering different recommendations. The most common advice from radiologists and breast surgeons is for an annual mammogram starting at the age of 40. For women with denser breast tissue, tomosynthesis (3D) mammography may be beneficial and/or consideration of screening breast ultrasound. Those women whose lifetime risk of breast cancer exceeds 20% would also be screened with annual MRI. Still, I find it helpful for women to have a general sense of what is normal for them. For instance, if a new breast lump is identified by a patient that does not go away within one menstrual cycle, it is worth exploring with at least an ultrasound.  In a postmenopausal woman, a new lump warrants diagnostic breast imaging including ultrasound.
  

Once breast cancer is detected, the next step to recovery is treatment. There are three main forms available: medications, radiation therapy and surgery. Which one or ones are right for you is dependent on the type and severity of the cancer. Medications used for breast cancer include chemotherapy agents, hormone blocking drugs like tamoxifen or aromatase inhibitors, and immunotherapy. The biology and behavior of the cancer tend to influence which drugs, if any, would work best for a particular cancer. With radiation therapy, doctors take into account a patient’s age, surgery performed, and pathology characteristics to assess whether radiation is indicated, and if so, what course might be best suited for the patient. Breast surgery procedures range from lumpectomy, which conserves breast tissue, to mastectomy, which removes the majority but not all of the breast tissue. In determining which surgery is best for an individual, several factors are taken into consideration, including the size and location of the cancer, personal and family history, and the patient’s personal preferences. More and more women are benefiting from the use of oncoplastic surgery, where oncologic principles of taking out cancer with, ideally, widely clear margins, are combined with plastic surgery closure techniques. Oncoplastic breast conserving procedures and mastectomy reconstruction options have really revolutionized breast surgery, allowing women to boost their self-confidence and feel more like their usual selves. 

Reconstruction is an option for the vast majority of patients undergoing mastectomy and allows women to retain a natural, feminine appearance after surgery. Two main forms of reconstruction are available: reconstruction with implants and reconstruction with tissue. Reconstruction with implants is the most common technique used in breast reconstruction. It often involves the initial placement of a tissue expander to maximize the ability of the skin to heal, while allowing flexibility in the size of the reconstructed breast, followed by later removal and replacement with a formal implant. Some women may prefer to use their own tissue for reconstruction. In this case, tissue is taken from another part of the body, most commonly the abdomen or the back, and transferred to the mastectomy site, creating a natural texture to the reconstructed breast. 
The thought of being diagnosed with breast cancer can be frightening. Fortunately, great strides have been made in breast cancer research, and new technologies help women get back to their normal lives more quickly. 

For more information on breast cancer imaging, treatment and diagnosis, visit breastlink.com. 


Webinar: Coordinated Care Initiative: Key Information for O.C. Physicians

The Coordinated Care Initiative:  Key Information for Orange County Physicians occurs several times:

Wednesday, April 27, 2016, 12:00 noon - 1:00 p.m.

Wednesday, May 25, 2016, 12:00 noon - 1:00 p.m.

Wednesday, June 22, 2016, 12:00 noon - 1:00 p.m.

Please register for the date and time that works best for you:  https://attendee.gotowebinar.com/rt/6054087317243662596

Program Description:  This webinar is designed for physicians and will cover the Coordinated Care Initiative (CCI) and the programs within the initiative including Cal MediConnect, known as OneCare Connect in Orange County.

The CCI is a new program designed to help provide extra support for low-income seniors and people with disabilities in California, including those who are dually eligible for Medicare and Medi-Cal.

Webinar topics include:  

1.  Overview:  How the CCI is changing health care for dual eligible patients;

2. Continuity of Care:  How to keep seeing your patients if they join OneCare Connect;

3. Care Coordination:  How OneCare Connect can help support physicians in coordinating care for patients, including in-home and community based services;

4. Billing Processes: How billing works under the CCI for patients who join OneCare Connect and for those who remain in  fee-for-service Medicare and join the CCI for Medi-Cal services.

Speakers:  Rita Cruz Gallegos & Joe Garbanzos, Provider Outreach Specialists, Harbage Consulting; and Laura Grigoruk, Director of Direct Networks - CalOptima.

 


CURES On-Demand Webinar

July 1, 2016 is the deadline for mandatory CURES registration for all physicians with an active medical license and a Drug Enforcement Agency certificate. In order to help prepare physicians, CMA hosted a webinar on the CURES 2.0 registration process, which was presented by the Department of Justice. The webinar is now available on-demand in the CMA Resource Library and is free for both members and non-members. Please click here to view the CURES 2.0 webinar


Measles Outbreak Update

Measles has now been confirmed in 22 Orange County (OC) residents, signaling ongoing transmission in the community and at the Disneyland Parks. Thirteen of these cases spent time at the Disneyland Parks since mid-December, 2014. In California, as of today, 59 cases of measles have been confirmed since the end of December; 42 of these had an exposure in December at Disneyland or California Adventure Park. Additional cases have been identified that were at the park while infectious in January, including within the last week. Nine of the OC cases have no Disney or other known measles exposure. Additional cases are expected in Orange County.
 

Of the 22 Orange County cases, five are children, of whom four were not vaccinated and two were hospitalized. Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW) should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Measles is highly contagious and people can be exposed by just being in the same room as a measles case during their infectious period (4 days before onset of rash until 4 days after). Several of the cases have potentially exposed patients in healthcare facilities, resulting in large contact investigations and persons needing immune globulin administration, post-exposure vaccination, or serologic testing for immunity.

  • Any patient suspected of having measles should be masked immediately and promptly moved to a negative pressure room when available. Providers seeing patients in an office or clinic setting should consider options such as arranging to see suspect measles cases after all other patients have left the office, or assessing patients outside of the building to avoid having a potentially infectious patient enter the office.
  • Notify Orange County Public Health Epidemiology immediately at 714-834-8180 (or 714-628-7008 after hours) about any suspect cases. Do not wait for laboratory confirmation before reporting a suspect case. Do NOT refer patients to Public Health without first discussing with one of our staff.
  • DO NOT send potentially infectious suspect measles patients to a reference laboratory for specimen collection.

For more information on measles, see www.ochealthinfo.com/measles.


NOTICE to OCMA Physicians of Excellence Recipients

Congratulations to the recipients of the 2015 Orange County Medical Association Physician of Excellence award!
  
We would like to clarify that the full list of Physicians of Excellence will be published in one of the Orange County Register publications in early spring 2015. OCMA's new partnership with the Orange County Register elevates the stature of the program, broadens the recognition of the physician recipients as well as extends the reach of those who will read the list in Orange County.   
  
Today we learned that Orange Coast Magazine published a January 2015 issue of "top doctors" - this is not a list of OCMA's Physicians of Excellence. This publication is no longer affiliated whatsoever with OCMA. OCMA ended the relationship with Orange Coast Magazine in April 2014. Though we had a productive relationship for many years, OCMA's Board of Directors decided to partner with the Orange County Register beginning in 2015. 
  

Hopefully this clears up any potential confusion.  In addition, more information on the reception for all recipients in April 2015 will be forthcoming soon. We are excited about the new partnership and we look forward to celebrating the many achievements of all the distinguished recipients.


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