Vital Signs July 2013

July 2013 • Vol. 35 No. 7Official Magazine of

FRESNO COUNTYFresno-Madera Medical Society

KERN COUNTYKern County Medical Society

KINGS COUNTYKings County Medical Society

MADERA COUNTYFresno-Madera Medical Society

TULARE COUNTYTulare County Medical Society

Vital Signs

See Inside:

Social Mediafor Physicians

ProtectedHealth Information

Blood Center’sDisaster Planning

See Inside:

Social Mediafor Physicians

ProtectedHealth Information

Blood Center’sDisaster Planning

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S A N D I E G O

O R A N G E

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P A L O A L T O

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VITAL S IGNS / JULY 2013 3

Official Publication of

Fresno-Madera Medical Society

Kings County Medical Society

Kern County Medical Society

Tulare County Medical Society

July 2013Vol. 35 – Number 7

Editor, Bonna Rogers-Neufeld, MDManaging Editor, Carol Rau

Fresno-Madera Medical SocietyEditorial CommitteeVirgil M. Airola, MDJohn T. Bonner, MDHemant Dhingra, MDDavid N. Hadden, MDRoydon Steinke, MD

Kings RepresentativeTBD

Kern RepresentativeJohn L. Digges, MD

Tulare RepresentativeThelma Yeary

Vital Signs SubscriptionsSubscriptions to Vital Signs are$24 per year. Payment is due inadvance. Make checks payable tothe Fresno-Madera Medical Society.To subscribe, mail your check andsubscription request to: Vital Signs,Fresno-Madera Medi cal Society,PO Box 28337, Fresno, CA 93729-8337.

Advertising Contact:Display:

Annette Paxton,559-454-9331

[email protected]

Classified:Carol Rau,

559-224-4224, ext. [email protected]

ContentsVitalSigns

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion piecesaccepted for publication do not necessarily reflect the opinion of the Medical Society. All medicalsocieties require authors to disclose any significant conflicts of interest in the text and/or footnotes ofsubmitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118.

Cover photography: “Sunset over the Mediterranean Sea from Netanya, Israel”by Bonna Rogers-Neufeld, MD, FACREquipment used: Nikon on auto settings.

Calling all photographers:Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

CMA NEWS ................................................................................................................................5

NEWS

Webinars At-A-Glance ..............................................................................................................8

CHAT WITH THE EDITOR: Social Media for Physicians ................................................................9

PROTECTED HEALTH INFORMATION: Prepare for a New Sheriff in Town .....................................10

BLOOD CENTER: Boston and Texas Explosions Highlight Value of Blood Center Disaster Planning ................................................................11

BLOOD CENTER: Golf Tournament: September 9.....................................................................17

CLASSIFIEDS ...........................................................................................................................18

TULARE COUNTY MEDICAL SOCIETY.........................................................................................12

• What is ICD-10?

• Save the Date: Family Day 2013 – September 22

KERN COUNTY MEDICAL SOCIETY ............................................................................................14

• President’s Message: The Immortal Life of Henrietta Lacks

• Member Report: Michelle Quiogue, MD

FRESNO-MADERA MEDICAL SOCIETY .......................................................................................15

• President’s Message

• Company Assisting FMMS Members with EMR and Meaningful Use

• Walk With A Doc Dates

• In Memoriam: John E. Peckler, MD


How Successful IsYour Practice?

Let physician membersknow your practice

is availablefor referrals

Use Vital Signs to advertiseyour practice at special ratesoffered to member physicians.

contact:Annette Paxton

Vital SignsAdvertising Representative

(559) 454-9331

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CMA NEWScontrolled substances and cites a pharmacist’s correspondingresponsibility to ensure that every prescription for controlledsubstances is “issued for a legitimate medical purpose.”

This new policy appears to be in response to recentinvestigations and actions by the Drug Enforcement Agency(DEA) related to prescription drug abuse. While proper prescribingand dispensing of controlled substances must be encouraged, CMAis concerned with issues related to patient privacy, administrativeburdens and re-diagnosing by pharmacists arising from theinconsistent application and implementation of this policy.

CMA has confirmed with the Medical Board of California,other California-based health professional associations and otherstate medical societies that this policy is being implementedthroughout California and nationwide. In some states, other largechain retail pharmacies are also implementing similar policies, andit is likely that other pharmacy chains in California will follow suit.

CMA will be working with the American Medical Association,other state medical societies, and California-based groups to ensurethat disruption of legitimate patient care and physician time isminimized. CMA remains committed to addressing concerns aboutprescription drug abuse in California and is working with thelegislature, regulatory bodies and law enforcement to find effectivesolutions.

If you or your patients have difficulties filling prescriptions forcontrolled substances at any pharmacy in California, please reportp r o b l e m s t o C M A’s C e n t e r f o r L e g a l A f f a i r s a [email protected] or 800-786-4262.

CMA OFFERS CONGRESS SEVERAL SOLUTIONSTO THE OUTDATED MEDICARE PHYSICIAN PAYMENTLOCALITIESThe California Medical Association (CMA) is urging Congress tofix Medicare’s outdated geographic payment localities as part ofany effort to repeal the sustainable growth rate (SGR) paymentformula. In a recent letter to Dave Camp (R-MI), Chairman of theHouse Committee on Ways and Means, and Fred Upton (R-MI),Chairman of the House Committee on Energy Commerce, CMAproposed two solutions to this long-standing problem that hasunderpaid physicians in a number of recently urbanized areas.Reps. Camp and Upton are authoring legislation to repeal andreplace the SGR.

The first solution proposed by CMA is a pilot project limited toCalifornia that would update the California Medicare physicianpayment localities by changing them to follow the sameMetropolitan Statistical Areas (MSAs) used to pay hospitals.

The MSAs used to determine payment rates for hospitals arecontinuously updated, so that reimbursement accurately reflectslocal costs to deliver care. The physician payment localities, on theother hand, have not been updated in 15 years. As a result, 14urban California counties, such as San Diego, Monterey andSacramento, are still designated as rural. This has caused manyCalifornia physicians to be paid up to 14 percent per year belowwhat Medicare says they should be paid if they were in the correctregion.

The pilot would be a temporary, budget-neutral solution thatwould raise payment levels for urban counties misclassified as rural,while holding remaining rural counties harmless from cuts.

COVERED CALIFORNIA UNVEILS QUALIFIED HEALTHPLANS, EXPECTED PREMIUMSThe California Medical Association (CMA), has been an activepartner in the implementation process, providing feedback to theexchange board every step of the way as it works to establish theframework for the massive coverage expansion under the ACA.However, physicians are still concerned about some pieces of theexchange.

One major concern for contracting physicians is a loophole inthe ACA that could see physicians left to foot the bill for servicesprovided to patients who haven’t paid their insurance premiums.The law allows for a three month “grace period” for non-paymentof premiums, but only requires insurers to pay the claims throughthe first month of non-payment. The final version of the exchangemodel contract included a provision that requires 15 days advancenotice to physicians when a patient has entered the second monthof the grace period, but still leaves the burden of 60 days worth ofunpaid claims on the physician and the patient.

While Covered California staff has stated that exchangeenrollees will have access to an adequate network of health careproviders, CMA has repeatedly asked that the exchange take extrasteps to ensure that provider directories submitted by plans containup-to-date and accurate networks.

A history of poorly monitored network adequacy in California,along with the fact that many physicians are likely to be hesitantto contract with exchange plans, casts doubt over CoveredCalifornia’s claim that it will provide enrollees access to “80percent of practicing physicians” in the state.

The exchange’s expected premiums could also pose a challengefor success of the new marketplace.

Under the rates announced on Thursday, the total monthlypremium for a “silver” level (basic) plan in the Sacramento regionfor a 40-year-old single individual would range from $332 to $476.Federal subsidies will be offered on a sliding scale for people withincomes up to $45,960. Individuals eligible for the highest subsidy,$276 per month, would still face out-of-pocket expenses of $56 formonthly premiums. A 21-year-old enrollee could expect to pay morethan $130 per month for the most affordable catastrophic plan.

Given that the annual penalty for not having health insuranceduring the exchange’s first year will be $95 or one percent ofincome, it remains to be seen whether healthy people will bewilling to pay the high cost of participating in the exchange.Higher premiums could also have patient delinquencyimplications, which may result in more physicians being on thehook for two months of claims submitted during the “grace period”for premium non-payment.

WALGREENS REFUSES TO FILL SOME CONTROLLEDSUBSTANCE PRESCRIPTIONS WITHOUT ADDITIONALINFORMATION FROM PRESCRIBERThe California Medical Association (CMA) has received reportsfrom physicians that Walgreens’ pharmacists are refusing to fillcontrolled substances prescriptions without additional informationfrom the prescriber. Physicians are being asked to provideinformation on diagnosis, ICD-9 codes, expected length of therapyand previous medications tried and failed.

Walgreens has also sent letters to prescribers that provide anoverview of its newly revised policy on good-faith dispensing of Please see CMA News on page 6

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CMA NEWS

Although the payment discrepancies are most egregious in ourstate, with California accounting for half of all payment anomaliesin the country, a number of other states are experiencing similarproblems. According to the Government Accountability Office(GAO), the three states with the worst payment accuracy areCalifornia, Virginia and Maryland. The second approach proposedby CMA would be a similar multi-state pilot for these three mostimpacted states.

In both instances, CMA is urging that the remaining ruralcounties be “held harmless” from cuts that would otherwise resultas the result of budget neutrality requirements.

CMA also suggested that another larger approach could be todevelop a supplemental rural payment rate to offset the ratereductions that would be experienced by physicians in the localityreconfiguration regions and to help attract physicians to rural areasacross the country.

Contact: Elizabeth McNeil, 800-786-4262 or [email protected].

CMA JOINS COALITION TO OPPOSESCOPE-OF-PRACTICE BILLSThe California Medical Association and a group of health careprovider organizations have come together to form the “Coalitionfor Patient Access and Quality Care,” working to stop three billsthat would expand the scope-of-practice of non-physicianpractitioners.

California physicians supported the ACA because it promised:first, to expand access to health coverage to all, while second,ensuring the high quality of medical practice in our state. Thosewho now invoke the ACA as the sole justification for allowingnon-physicians to perform complex medical procedures on Cali -for nia patients are attempting to achieve the first goal by under -mining the second. Allowing practitioners to perform proceduresthey simply aren’t trained to do can only lead to unpredictableoutcomes, higher costs and greater fragmentation of care.

CMA and the other coalition members are working together tomake sure lawmakers realize that providing allied health practi -tioners with independent and/or expanded practice will not pro -vide newly insured patients, who are more likely to have complexmedical conditions, with access to the health care they deserve.

Rather than expanding the scope of practice of allied healthpractitioners, California should be looking toward an integratedteam-based care led by physicians. These teams will streamlinecare, maintain and improve patient safety and decrease the costs ofcare.

Other members of the coalition include the CaliforniaAcademy of Family Physicians, Osteopathic Physicians andSurgeons of California, California Academy of Eye Physicians &Surgeons, California Society of Anesthesiologists, CanvasbackMissions Inc., Diabetes Coalition of California, Lighthouse forChrist Mission Eye Center, Union of American Physicians andDentists – AFSCME Local 206, California Psychiatric Associationand the American College of Emergency Physicians – CaliforniaChapter.

For more information about the coal i t ion vis i twww.qualitycareaccess.org.

NEW TRICARE CONTRACT MIGHT CREATE GAP INMEDICAL MALPRACTICE COVERAGEThe California Medical Association (CMA) has recently becomeaware of a broad “indemnification” clause in the UnitedHealthMilitary & Veterans Services (UMVS) TRICARE providercontracts that is causing concern. The indemnification clausestems, at least in part, from a requirement of federal regulation 32C.F.R. S. 199.17(p)(1), which relates to the Civilian PreferredProvider Network of the TRICARE program. Exact language ofthe contractual indemnity clause in question does vary from theregulatory language, is subject to interpretation and, depending oninsurance policy language, may result in liability that is excludedfrom coverage under a physician’s medical professional liabilityinsurance policy.

Contractual indemnity obligations are typically excluded fromcoverage under a medical professional liability insurance policy.However, such an exclusion would usually not be invoked forliability that the insured would have under the law in the absenceof a contract or agreement. Because medical professional liabilityinsurance policies are typically written to cover liability fornegligent acts or omissions of the insured physician in providingprofessional medical services, the contractual indemnity provisionin the TRICARE contract would typically NOT result in anexclusion from coverage of claims brought against the insuredphysician by a TRICARE beneficiary. Hence, although theamount of any uncovered liability could be significant, it wouldlikely be a low probability event.

CMA is working directly with the medical professional liabilitycarriers and UVMS on this issue. CMA strongly recommends thatphysicians contact their medical professional liability carriersdirectly regarding the indemnification provision in the TRICAREcontract and obtain information from them on what the clausemeans in terms of liability insurance coverage and exclusions fromcoverage.

As with all contracts, physicians should read the newTRICARE contract carefully and thoroughly and should considerobtaining legal advice from their personal attorney before decidingwhether to sign the TRICARE contract.

BEGIN REPORTING PQRSTO AVOID FUTURE PAYMENT ADJUSTMENTSThe Medicare Physician Quality Reporting System (PQRS) is areporting program that uses a combination of incentive paymentsand payment reductions to promote reporting of qualityinformation by eligible professionals. PQRS is mandated by federallegislation. The program provides incentive payments to practiceswho satisfactorily report data on quality measures for coveredPhysician Fee Schedule (PFS) services provided to Medicarebeneficiaries. Beginning in 2015, the program will also reducepayments to eligible professionals who do not satisfactorily reportquality measures data for 2013 professional services.

To participate in the 2013 PQRS, individual eligibleprofessionals may choose to report information to CMS onindividual PQRS quality measures or measures groups (a subset offour or more PQRS measures that have a particular clinicalcondition or focus in common) using: (1) their Medicare Part Bclaims, (2) a qualified PQRS registry, (3) a qualified electronic

Please see CMA News on page 8

Continued from page 5


Education Series

July 24:Protect and PreserveYour Patient RelationshipsNancy Heard, MD • 12:15-1:15pmPresented by the Department ofHealth Care Services (DHCS), thiswebinar will help you increase under -standing and awareness of the impactof fraud, waste and abuse on patientcare, and discuss methods to pre ventabuse and ways to preserve the inte -grity of the physician/patient relation -ship.

Aug. 21:HIPAA Compliance: The Final HITECHRuleDavid Ginsberg • 12:15-1:15pmThe HITECH Act created the extensivefunding incentives and standards foradopting electronic health records; italso created new HIPAA rules ormodified existing ones. This webinarwill provide an overview of thechanges to HIPAA and key stepsmedical practices can take to complywith these changes.

Aug. 28:Medicare: Proposed Changes for2014Michele Kelly • 12:15-1:15pmThis webinar will focus on proposedpolicy changes to the physician feeschedule for the year 2014 (excludingany discussion on the SGR, or revisedpayment methodology). This discus -sion will provide an opportunity forphysicians to hear how new or revisedpolicies may impact their practice, andallow them to provide input to CMAduring the Notice and Commentperiod.

CMA Center for Economic Services

WebinarsAt-A-Glance

Most webinars are FREE for CMA members,$99 for non-members.

CMA members are eligible for special discountson ICD-10-CM Training from AAPC

Questions? CMA Member Help Center:800-786-4262

Please note: this calendar is subject to change.Visit www.cmanet.org/events for updates.

health record (EHR) product or (4) a qualified PQRI data submission vendor.Individual eligible professionals who meet the criteria for satisfactory submission of

PQRS quality measures for services furnished during a 2013 reporting period will qualify toearn an incentive payment equal to 0.5 percent of their total estimated Medicare Part BPhysician Fee Schedule allowed charges for covered professional services furnished during2013.

To avoid the 1.5 percent 2015 PQRS penalty, individual physicians and group practicesparticipating in the PQRS Group Practice Reporting Option will have to satisfactorilyreport data on quality measures for services provided in 2013. Reporting during the 2013PQRS program year will be used to determine whether a PQRS payment adjustmentapplies in 2015. Alternative methods of avoiding the penalty have been made available forthe 2013 reporting year.

For more information, see CMS’s guide, “2013 Physician Quality Reporting System(PQRS): 2015 PQRS Payment Adjustment,” which provides eligible professionals withtheir options to avoid the payment adjustments in 2015. Additional information on thePQRS program is available on the CMS website. CMA is also developing a PQRS guidefor physicians, which will be available soon.

Contact: Michele Kelly, 213-226-0338 or [email protected].

DID YOU KNOW? BLUE CROSS OFFERS INTERPRETER SERVICES,INCLUDING SIGN LANGUAGE INTERPRETERSAnthem Blue Cross is one of the few payors that offer face-to-face sign languageinterpreters. According to the May 2013 issue of its Professional Network Update, AnthemBlue Cross employs a language line interpretation service for use by all of its customerservice call centers. Enrollees can call the customer service phone number on the back oftheir ID cards and a representative will be able to assist them. Additionally, physicians mayrequest an interpreter, including a face-to-face sign language interpreter, by calling 888-898-1443 (provide client code 95670). Please note, a minimum of three days’ advancenotice is needed for scheduling all face-to-face interpreters.

For more information, the Anthem Blue Cross Language Assistance Program QuickReference Guide located on the Blue Cross website, www.anthem.com/ca.

CMA HEALTH LAW LIBRARY UPDATED FOR 2013CMA On-Call, the California Medical Association’s (CMA) online health law library, isfully updated for 2013. One of CMA’s most valuable member benefits, On-Call containsover 4,500 pages of up-to-date legal information on a variety of subjects of everydayimportance to practicing physicians. The searchable online library contains all theinformation available in the California Physician’s Legal Handbook, an annual publicationfrom CMA’s Center for Legal Affairs.

New documents for 2013 include: E-prescribing (#3207), Compounding Drugs (#3208),Physician Alignment Models (#0312),Value Based Purchasing (#7103), the CaliforniaHealth Benefit Exchange (#7450), Electronic Health Records: Meaningful Use Stage 2(#4305) and Physician Use of Mobile Devices and Cloud Computing (#3301).

In addition, physicians can find answers to common physician practice questions in themost frequently referenced On-Call documents: Prescribing (#3201), Retention ofMedical Records (#4005), Medical Records: Allowable Copying Charges (#4002),Termination of the Physician-Patient Relationship (#3503), and Allied HealthProfessional Relationships: Liability Issues (#3001).

CMA members can access On-Call documents in CMA’s online resource center for freeat www.cmanet.org/cma-on-call. Nonmembers can purchase On-Call documents for $2 perpage.

The complete health law library (CPLH) is also available for purchase in an 8-volumeprint set or annual online subscription service. To order your copy, visit the CMA resourcelibrary or call 800-882-1262.

CMA members can also contact the CMA legal information line at 800-786-4262 [email protected].

CMA NEWSContinued from page 7


Please see Social Media on page 15

Editor: What is social media and how can it benefit physicians?Hayat: Social media is electronic communication through which users create online communities to

share information, ideas, personal messages, and other content. Social media is another way physicianscan connect with their patients, other physicians, and the community – near or far. Communicating iswhat physicians do on a daily basis, social media is a platform by which they can communicate to abroader base in a more efficient and effective manner. For example, if a physician has a favorite handoutdescribing the prevention/treatment of a disease or health concern they see often, they can reach a muchbroader group of people by posting it on Facebook, Pinterest or their blog/website. By doing so, physicianscan save on resources (paper, staff time to organize handouts, etc.), and don’t have to worry if the patientwill lose the handout.

People are using social media to look for answers to their health concerns. According to the latest PEWResearch Center study, 72% of internet users looked up health information online. According to the lastcensus, 240 million Americans were online in 2010. That is great number of people using the internet tolook up health information. If a physician cares about the type of health education his/her patients arereceiving, they really have no choice but to also be “on-line,” and social media is the way!

Editor: A majority of physicians are afraid of social media because they worry about medico legalexposure. Are there safeguards that can be used?

Mr. Hayat: It’s understandable for physicians (and other business owners, service providers, etc.) to beafraid of social media. However, having a strong social media presence far outweighs the negatives.

The rule to follow is called the “Elevator Rule.” Basically, if you wouldn’t say something out loud in acrowded elevator, then don’t say it online. The “Elevator Rule” should only be a starting point. Physiciansshould become familiar with HIPAA Social Media Policy. The American College of Physicians andFederation of State Medical Boards recently created a policy paper: “Online Medical Professionalism:Patient and Public Relationships” that provides some guidance on how physicians can navigate the socialmedia world safely. In a nutshell, physicians (including office staff) should never discuss a patient onlinein any manner that would identify who that patient is. For example, one should never post online: “Dan,a 43-year-old carpenter, came in the office with herniated discs….” However, a physician can post: “If youhave a profession where you have to lift or move heavy objects, learn proper techniques to avoid backinjuries such as herniated discs…” There are nuances to the rules however. For example, a person mayself-identify online as a patient. However, if they ask a specific medical question, the physician shouldtake question “off-line” by inviting the person to an appointment or asking them to call the office.Physicians should also familiarize themselves with social media policies for their employees.

Physicians shouldn’t be afraid of negative reviews. In fact, having a strong social media presence is agreat way to overcome negative reviews. A Facebook business page and website are great places to askpatients who are very happy with your care to post a review or recommendation. It is perfectly ok to doso, especially right after you or a staff member hear a positive comment or reaction. At that time, thepatient can be asked if they don’t mind posting that on your practice’s Facebook page or you can havethem sign a testimonial form that obtains their consent to post the testimonial online. Then you can postit on your practice website.

A well-managed website and social media presence will help those positive reviews outshine thenegative ones. A Google search should be regularly performed to see what is being said about yourpractice. If negative comments are found, read them and see if there is something in the comment thatcan help improve your practice’s patient service. If there is, the negative comment should be addressedsimply with an acknowledgement and what steps the practice is doing to improve care. Anything more oranything that seems like an emotional response is inviting negativity.

All websites, social media sites, etc, should have your social media policy on it. Every person visitingyour site automatically agrees to the site policies.

Social Media for Physicians

Aamer Hayat, JD

CHAT WITH THE EDITORThe Editor sat down with Aamer Hayat, JD, to learn about social media for physicians.Mr. Hayat recently provided two excellent seminars for medical office staff and physicians at the FMMS.He is a graduate of UCLA and Northwestern University School of Law and currently holds the positionof Chief Operating Officer for Avecinia Wellness Center and is CEO of AWC Management – a practicemanagement, social media strategy and brand development consulting company

ACCORDING TOTHE LATEST PEWRESEARCH CENTERSTUDY, 72% OFINTERNET USERSLOOKED UP HEALTHINFORMATIONONLINE.


In 2009, Congress greatly increased thepenalties for HIPAA violations. Earlier thisyear, CMS promulgated 563 pages of newrules for auditing providers, breaches ofProtected Health Information (“PHI”),Business Associate Agreements, Notices ofPrivacy Practices, genetic PHI, patient accessto their PHI, marketing, sale of PHI, researchstudies, and more. “PHI” either identifies thepatient or there is a reasonable basis tobelieve it could be used to identify thepatient. These new rules were effective on March 26, 2013 and,with limited exceptions, compliance is required by September 23,2013. HIPAA rules generally apply unless California law isequally or more protective of patient privacy.

Frustrated with CMS’s lack of significant enforcement ofHIPAA, Congress also moved enforcement responsibility to theOffice of Civil Rights of the Department of Health and HumanServices. The OCR director has stated, “We hope that healthcareproviders pay careful attention…and understand that HIPAAPrivacy and Security Rules have been in place for many years, andOCR expects full compliance no matter the size of the coveredentity.”

Here are the new penalties for a HIPAA violation:

• Did not know and with exercise of reasonable diligencewould not have known of violation = $100 to 50,000

• Violation due to reasonable cause and not willful neglect =$1,000-$50,000

• Willful neglect, but timely corrected within 30 days aftershould have known = $10,000-$50,000

• Willful neglect not timely corrected = $50,000

• Yearly maximum of $1.5M for identical violation

• Can be a crime in some cases, e.g., unauthorized sale of PHI

• Liable for acts of Business Associate (“BA”) if BA an agent.

California’s separate civil remedy and penalty schemescompound potential liability. Some of California’s penaltiesinclude that a patient will receive a minimum of $1,000 against aperson or entity who negligently releases PHI and can alsorecover actual damages; the State can recover additional civilpenalties in such cases. In 2011 it was discovered that a BA ofStanford Hospital and Clinics had posted on a homework websitethe PHI of some 20,000 patients. A $20 million class action forthe $1,000 civil remedy per patient was promptly filed.

Prepare for A New Sheriff In TownDaniel O. Jamison, Esq.

Chair of the Health Law Section at Dowling Aaron Incorporated

Even stricter California rules apply to hospitals, licensedclinics, skilled nursing facilities, home health agencies, andhospices. If any of these has a breach, notice must be given toboth the patient and the California Department of Public Healthwithin five business days after detection of the breach or there is,among other penalties, a penalty of $100 per day per patient upto a maximum of $250,000 until the notice is given. HIPAA’snotification requirements also apply. In fall 2010, Kern MedicalCenter was fined $250,000 under this law for theft of 596 patientrecords from an unsecured outside locker; Kaweah ManorConvalescent Hospital was fined $125,000 when an employeeaccessed and used medical information on five patients for allegedidentity theft; Delano Regional Medical Center was fined$60,000 when and employee disclosed a patient’s PHI.

OCR recently imposed a $50,000 penalty on an Idaho Hospiceprovider when a laptop with PHI of 441 patients was stolen. OCRconcluded the provider failed to do a risk analysis to safeguard e-PHI and did not have policies and procedures to address mobiledevice security. A corrective action plan with ongoinggovernment oversight was also imposed. HIPAA sets forthdetailed requirements for the e-security risk analysis thatproviders must meet do.

Malpractice policies typically do not cover HIPAA liability,but optional coverage for HIPAA civil penalties (to the extentinsurable by law) may be available from the malpractice insureror obtainable from another insurer.

HIPAA is the law. Mandatory random audits are coming; anypatient complaint may trigger an audit; required reporting of abreach may trigger an audit.

WHAT SHOULD A PROVIDER DO?1. Have good policies, procedures and forms that address both

federal and California law.2. Do the e-PHI security risk analysis and have a risk

management plan.3. Periodically update the risk analysis and risk management

plan.4. Properly train new employees and refresh/update existing

employees.5. Establish a Governing Board Compliance Committee or

assign a Board member to oversee compliance.6. Respond quickly to breaches of PHI.7. Review with legal counsel alternatives to update HIPAA

compliance to try to insure that what is done is not onlypractical, efficient, and economical, but effective tominimize risk of HIPAA violations.

Daniel O. Jamison can be reached at [email protected].

Daniel O.Jamison, Esq.

PROTECTED HEALTH INFORMATION


BLOOD CENTER

Boston and Texas Explosions HighlightValue of Blood Center Disaster Planning

Patrick Sadler, MDMedical Director, Central California Blood Center

This April brought two unexpected and tragic disasters – thebombing at the finish line of the Boston Marathon, followed a fewdays later by a massive explosion at a fertilizer plant north of Waco,in West Texas. While first responders and hospital staff worked onthe front-lines to treat the victims, blood centers worked behind thescenes, coordinating with one another, hospitals, America’s BloodCenters, and other national blood organizations to ensure that theneed for blood was met in these areas. All the while, blood centersin New England and Texas tried their best to manage the outpouringof blood donors following these catastrophic events.

Three people were killed and more than 260 were injured onApril 15 in the Boston Marathon bombing, with many incurringserious injuries which resulted in amputation of limbs. As many as 14people were killed and about 200 others were injured in the April 17fertilizer plant explosion. It was evident that the large number ofinjuries caused by these disasters would necessitate blood and thatnumerous individuals looking to help out would flood donor centersin the days following these events.

The blood centers in the affected areas, along with the AABBInterorganizational Task Force on Domestic Disasters and Acts ofTerrorism, acted quickly to assess the situation and determine if anyadditional blood would be needed from other parts of the country.Despite the willingness of blood centers all over the US to lend ahelping hand, both the blood services in the Boston area and Texasannounced shortly after each of the events that the blood supply inthat region was sufficient to handle the immediate demand for blood.The blood communities’ swift response to these tragedies served as areminder of the importance of disaster preparedness, and furthermorewas as a testament to the well-oiled machine that is the US bloodsupply.

Members of the AABB task force include America’s BloodCenters (ABC) (All ABC members, including Central CaliforniaBlood Centers, participate through the ABC liaison to the taskforce.), Blood Centers of America (BCA), the American Red Cross(ARC), other blood and tissue organizations, and governmentalagencies. The task force collaborates to prepare for and respond todomestic disasters and acts of terror, working together to ensure thata safe and adequate blood supply is in place at all times in preparationfor disasters. This creates an efficient and unified response from USblood services in the case of such emergencies.

The Immediate Response. The AABB (formerly AmericanAssociation of Blood Banks) task force mobilized quickly after theBoston bombing, with task force members quickly putting the areablood centers in contact with one another to conduct an assessmentof the blood supply first with the primary blood providers of that area(ARC), and then with the secondary provider, Rhode Island BloodCenter (RIBC). Once it was determined that the immediate needscould be met with the blood already on the shelves in Boston, thetask force determined the blood supply status in the rest of thecountry, ensuring that more blood could be provided quickly if it wasneeded. RIBC worked with BCA to backfill O-negative RBCs. The

task force staff at AABB also kept government agencies andother members in the loop, such as the Department of Healthand Human Services and the Department of Defense.

The blood center response to the explosion in Texas, just dayslater, unfolded similarly to that in Boston, with blood centerleaders and distribution staff at Carter BloodCare in Bedford,Texas, immediately making phone calls to the hospitals in theWaco area and assessing its blood supply at the donation centerin Waco.

A National Network Mobilizes. “What these events showedwithin the blood community is that the task force is a greatconcept and that it works well,” said Mr. Lawrence Smith, CEOof RIBC. “It’s a network that allows for quick, coordinatedresponse to disasters. The bombing in Boston and explosion inTexas are classic examples of how the task force works. There isa willingness to share information within and among themembers of the task force, so that the best decisions can be madeand so blood centers can meet the needs of hospitals during thesesituations. Affiliations and institutional egos are set aside – thetask force is accomplished in responding to disasters. This issomething that the blood community should be proud of andtake comfort in; there is a mechanism in place that works well.”

Managing the Media and ‘Disaster’ Donors. “When disastersoccur that cause a large number of injuries, such as the events lastweek, people want to help. It happens here in the U.S. and ithappens in other countries as well. People want to do something,and the one thing they feel they can do is donate blood,” said Ms.Ruth Sylvester, director of regulatory services at ABC.“Unfortunately, with today’s testing requirements, the reality isthat the blood drawn today will not be available for 24-48 hours,and it is really the blood on the shelves that saves lives. After adisaster, blood will be needed in the weeks following the event toreplenish the supply. To have masses of donors show up at centersoverwhelms the collection capacity and floods the supply. Excesscollections end up expiring 42 days down the road. So what isimportant is to have a steady supply of blood donors donating theright products on an ongoing basis.”

The Key to Disaster Response – Be Prepared. As part of theAABB task force, ABC and BCA participate in a yearly nation-wide disaster drill, including practicing the response to situationsthat may threaten the blood supply, said Wendy Trivisonno, aBCA director who coordinates with both ABC and BCAmembers during emergency situations. Some drills have includedscenarios in which blood services are unable to communicatewith the AABB task force members in Washington, DC. Sheadded that disaster preparedness and planning is just as vital atthe local blood center level.

Current blood center disaster response tools are available onAABB’s website at http://bit.ly/Zn2sBu.

Author can be reached at [email protected].• See page 17 for CCBC’s events.


Tulare

3333 S. FairwayVisalia, CA 93277

559-627-2262Fax 559-734-0431

website: www.tcmsonline.org

TCMS OfficersSteve Cantrell, MD

President

Thomas Gray, MDPresident-elect

Monica Manga, MDSecretary/Treasurer

Gaurang Pandya, MDImmediate Past President

Board of DirectorsVirinder Bhardwaj, MDCarlos Dominguez, MDPradeep Kamboj, MD

Christopher Rodarte, MDAntonio Sanchez, MD

Raman Verma, MD

CMA Delegates:Thomas Daglish, MD

Roger Haley, MDJohn Hipskind, MD

CMA Alternate Delegates:Robert Allen, MD

Ralph Kingsford, MD Mark Tetz, MD

Sixth District CMA TrusteeJames Foxe, MD

Staff:Steve M. BeargeonExecutive Director

Francine HipskindProvider Relations

Thelma YearyExecutive Assistant

Dana RamosAdministrative Assistant

What Is ICD-10?ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in

1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost everycountry in the world, except the United States. This code set is scheduled to replace ICD-9-CM, ourcurrent U.S. diagnostic code set, on Oct. 1, 2014 (aapc.com).

Why is the United States moving to ICD-10-CM? (Pat Brooks – CMS, [email protected])• ICD-9 is 30-year-old and technology has changed• Many categories are full and cannot be expanded• Not descriptive enough• Reimbursement – would enhance accurate payment for services rendered• Quality – would facilitate evaluation of medical processes and outcomes

How is ICD-10-CM different from our current system? (aapc.com)

Issue ICD-9-CM ICD-10-CM

Volume of codes approximately 13,600 approximately 69,000

Composition of codes

Duplication of code sets

Mostly numeric, with E and Vcodes alphanumeric. Valid codesof three, four, or five digits.

Currently, only ICD-9-CM codesare required. No mapping isnecessary.

All codes are alphanumeric,beginning with a letter and with amix of numbers and lettersthereafter. Valid codes may havethree, four, five, six or seven digits.

For a period of two years or more,systems will need to access bothICD-9-CM codes and ICD-10-CMcodes as the country transitionsfrom ICD-9-CM to ICD-10-CM.Mapping will be necessary so thatequivalent codes can be found forissues of disease tracking, medicalnecessity edits and outcomesstudies.

What about ICD-10-PCS? (aapc.com)ICD-10-PCS is a code set designed to replace Volume 3 of ICD-9-CM for inpatient procedure

reporting. It will be used by hospitals and by payers. ICD-10-PCS is significantly different fromVolume 3 and from CPT® codes and will require significant training for users. The system wasdesigned by 3M Health Information Management for the Centers for Medicare and Medicaid.

When will ICD-10-CM and ICD-10-PCS be implemented? (aapc.com)October 1, 2014

What is the grace period for the use of ICD-9 codes submitted after imple mentation of the newICD-10 codes? (aapc.com)

• No delays in implementation • No grace periodIn preparation for the October 1, 2014 conversion, the Tulare County Medical Society (TCMS) is

planning workshops for clinical and administrative staff. A flyer with the information to reserve yourspots will be mailed directly to TCMS members. Please note that TCMS members will have priorityover other county medical society members for attendance to these events.

ICD-10-CM CODING WORKSHOP DATES: • Thursday, September 18, 2013 – 9am-4 pm – Visalia Convention Center

• Thursday, September 19, 2013 – 9am-4 pm – Visalia Convention Center

If you have any questions, please feel free to call Dana Ramos at the Tulare County MedicalSociety office, 559-627-2262.


Tulare


Member ReportMICHELLE QUIOGUE, MD ON THE ROLE OF KERN COUNTY MEDICAL SOCIETY

Doctor Michelle Quiogue speaks about the role of the Kern County MedicalSociety in the community effort to promote for the Kern Medical Center’s FamilyMedicine residency program. Doctor Quiogue was recently honored as the FamilyPhysician of the Year by the California Academy of Family Physicians due to herefforts regarding the residency program.

Dr. Quiogue gives credit to the role that the local medical society played. Shesaid, “Kern County Medical Society (KCMS) was instrumental in our efforts toorganize family physicians in the community. Kathy Hughes (the AdministrativeAssistant and Membership Secretary for KCMS) provided the meeting room andtook care of every detail. We met regularly to create strategy and talking pointsfor the County Board of Supervisors’ meeting. We continued to hold follow-up meetings after thedecision was reversed to discuss the progress of the external review of the residency program.

The whole experience was a testament to the value of membership in a medical society. More oftenthan not, physicians focus on the primary business of caring for patients without regard to communityevents. Yet when the rare occasion presents itself and there is a need for physicians to come together,the KCMS office provides the best location and administrative support.”

2229 Q StreetBakersfield, CA 93301-2900

661-325-9025Fax 661-328-9372

website: www.kms.org

KCMS Officers

Wilbur Suesberry, MDPresident

Alpha J. Anders, MD President-elect

Eric J. Boren, MDSecretary

Ronald L. Morton, MDTreasurer

Joel R. Cohen, MDImmediate Past President

Board of DirectorsBradford A. Anderson, MDLawrence N. Cosner, MD

John L. Digges, MDJ. Michael Hewitt, MD

Susan S. Hyun, MDMark L. Nystrom, MD

Sameer Gupta, MDEdward W. Taylor, MD

CMA Delegates:Jennifer Abraham, MD

John Digges, MDRonald Morton, MD

CMA Alternate Delegates:Lawrence Cosner, Jr., MD

Staff:Sandi Palumbo, Executive Director

Kathy L. HughesAdministrative Assistant

Kern

IMMORTALITY AND SCIENCE

A book about Henrietta Lacks is being read as a community in KernCounty. Henrietta Lacks was a patient at Johns Hopkins Hospital. Shedied on October 4, 1951 and was buried in an unmarked grave on herfamily’s land. However, her cells are still alive, being propagated inmany laboratories. Her cells, known as “HeLa Cells” became one of themost important tools in medicine, vital for developing the poliovaccine, cloning, gene mapping, and more. Her cells were takenwithout her knowledge during a surgery for invasive cervical carcinoma.Her family also did not know of the existence of her cells and that theywere being used for scientific research throughout the world. It was onlymany years after her death that her family came to know of theexistence of her cells.

The story of the life of Henrietta Lacks, her death, her family and herimmortality is in a New York Times Bestseller titled “The Immortal Lifeof Henrietta Lacks” by Rebecca Skloot. This book has been selected bythe Kern County community organization, “One Book, OneBakersfield, One Kern.” This organization promotes community-wideinteraction through the reading and discussion of a book of greatliterature and of societal importance. The reading and discussion willoccur from September to November 2013. The highlight will be anevening with the author, Rebecca Sklott, on Wednesday, November 6,2013 at 7pm at the Icardo Center of California University ofBakersfield (CSUB).

Let’s read this book together about Henrietta Lacks. For questions,contact Portia Choi, MD at 661-717-1346 or [email protected].

MichelleQuiogue, MD

THE STORYBEHIND THEMOSTIMPORTANTMEDICALDISCOVERYYOU’VE NEVERHEARD OF!

EVENING WITHTHE AUTHORWEDNESDAY,NOV. 6, 20137PMCSUB ICARDOCENTER

For moreinformation, visitkerncountylibrary.orgor call Andie Appleat 661-868-0723.

President’s Message

WILBUR SUESBERRY, MD


President’s Message

RANJIT RAJPAL, MD

REFLECTIONS ON OUR FMMS WALK WITH A DOC PROGRAM

Walking is man's best medicine.– Hippocrates

One of my favorite things about practicing medicine in the Central Valley are the lifelongrelationships and bonds I have been so fortunate to make with my patients and their families over theyears. Being able to connect and forge strong interpersonal relationships with individuals andcommunities is one of the great privileges of being a physician, and is for me, a matter of tremendouspride and joy.

Our local FMMS “JustWalk, a Walk With a Doc Program,” provides an ideal space and mediumfor building such relationships while simultaneously promoting healthy and active lifestylesthroughout the community. The non-profit program, which was created by Dr. David Sabgir, a boardcertified cardiologist based in Ohio, is catching on in communities across country. The concept issimple really; once a month, doctors and other healthcare partners organize and facilitate free onehour walks at convenient and accessible locations with patients and local community members. Theexercise component is generally preceded by a brief presentation and discussion by a team of localdoctors which emphasizes the health benefits of daily walking and physical activity.

Indeed, the experience and discipline of a simple daily walking regimen can have immeasurablehealth benefits. As noted by the American Heart Association, walking for as little as 30 minutes a daycan significantly decrease and prevent the risk of a plethora of diseases and health ailments includingcoronary heart disease, breast and colon cancer, osteoporosis and Type 2 diabetes. Furthermore,walking has been shown to foster greater psychological and mental well-being. It can also helpbalance blood pressure and blood sugar levels, maintain healthy body weight and reduce the risk ofobesity in at risk individuals. Now more than ever, with the pervasive spread of sedentary habits andlifestyles, we must empower our patients to incorporate a daily brisk walking routine into their lives.For optimum health benefits, the AHA provides a metric of 10,000 steps (or roughly 5 miles) a day,as a guiding goal to prevent heart disease and enhance overall health. Walking is arguably the mosteffective, accessible, low-impact and natural form of exercise for the human body and the planet’secosystems.

Since FMMS initiated “JustWalk Fresno” last year, we have been able to reach out to hundreds ofcommunity members who participated in our walks amidst the serene landscapes of Woodward Park.The walks are held on the last Saturday every month. Last month, at the annual CMA CaliforniaHealth Care Leadership Academy in Las Vegas, I had the opportunity to promote the WWADprogram and share stories of our successes with healthcare leaders from across the state and I was ableto recruit many of them to start WWAD programs in their communities. This program provides aunique opportunity to engage with our patients and communities and helps to build a culture of healthand wellness, by establishing a strong community and support structure, while enabling us asphysicians to practice what we preach. I would like to see a WWAD program in every community inour Valley; if you would like to start a program the CMA Foundation can provide you with a “StartingKit” which has all of the tools and resources you will need. So set your pedometers and lace up yourshoes and let’s walk together towards good health and community.

Dr. Rajpal can be reached at [email protected].

Fresno-Madera

Post Office Box 28337Fresno, CA 93729-8337

1040 E. Herndon Ave #101Fresno, CA 93720

559-224-4224Fax 559-224-0276

website: www.fmms.org

FMMS OfficersRanjit Rajpal, MD

President

Prahalad Jajodia, MDPresident Elect

A.M. Aminian, MDVice President

Hemant Dhingra, MDSecretary/Treasurer

Sergio Ilic, MDPast President

Board of GovernorsS.P. Dhillon, MD

Ujagger-Singh Dhillon, MDWilliam Ebbeling, MDBabak Eghbalieh, MDAhmad Emami, MD

Anna Marie Gonzalez, MDDavid Hadden, MDS. Nam Kim, MD

Constantine Michas, MDTrilok Puniani, MD

Khalid Rauf, MDMohammad Sheikh, MD

CMA DelegatesFMMS President

A.M. Aminian, MDJohn Bonner, MDMichael Gen, MDBrent Kane, MDKevin Luu, MD

Andre Minuth, MDShazia Maghal, MD

Roydon Steinke, MDToussaint Streat, MD

CMA Alternate DelegatesFMMS President-electPraveen Buddiga, MD

Surinder P. Dhillon, MDDon H. Gaede, MDPeter T. Nassar, MDTrilok Puniani, MDOscar Sablan, MD

Dalpinder Sandu, MDMickey Sachdeva, MD

CMA YPS DelegatePaul J. Grewall, MD

CMA YPS AlternateYuk-Yuen Leung, MD

CMA Trustee District VIVirgil Airola, MD

Staff:Sandi PalumboExecutive Director


JOHN E. PECKLER, MD57-year member

John Peckler, MD, a retired familypractice physician, passed awayJune 6, 2013 in Fresno at the age of92.

Dr. Peckler was born in Indianain 1921. He received his medicaldegree from the University ofNebraska School of Medicine inOmaha in 1952, did his internshipat Sacramento County Hospital andcompleted his residency at San LuisObispo County Hospital in 1955.After serving as Acting ChiefMedical Officer for the CaliforniaMen’s Colony in San Luis Obispo,Dr. Peckler moved to Fresno in1956 to open his private familypractice. He retired in 1999.

'Walk with a Doc’ strives to encourage healthyphysical activity in people of all ages and reversethe consequences of a sedentary lifestyle in orderto improve their health and well-being.

GRAB A FRIEND AND HEADTO THE PARK

2013 SATURDAY DATES:• July 27 • August 24 • September 28

7:30-8:30am Registration begins at 7:15am at Woodward Regional Park

Sunset View Shelter

WHO CAN ATTEND:Participation is open to anyone interested in taking

steps to improve their health.

ENCOURAGE YOUR PATIENTSTO PARTICIPATE!

In addition to the health benefits of walking, youwill receive:

• Healthy Snacks• Healthy Lifestyle Tips/Resources• Chance to Talk with a Doc

FURTHER INFORMATION:Contact the Fresno-Madera Medical Society at

224-4224, ext. 110 or at [email protected].

Find us on Facebook:Fresno-Madera Medical Society

http://www.facebook.com/pages/Fresno-Madera-Medical-Society/107731015917068

Fresno-Madera Medical Societyto Host Free Community Health Walks

WALK WITHA DOC

COMMUNITY OUTREACH PROGRAM

PO Box 1029Hanford, CA 93230

559-582-0310Fax 559-582-3581

KCMS Officers

Jeffrey W. Csiszar, MDPresident

VacantPresident-elect

Mario Deguchi, MDSecretary Treasurer

Theresa P. Poindexter, MDPast President

Board of DirectorsBradley Beard, MDJames E. Dean, MD

Thomas S. Enloe, Jr., MDYing-Chien Lee, MDUriel Limjoco, MD

Michael MacLein, MDKenny Mai, MD

CMA Delegates:Ying-Chien Lee, MD

StaffMarilyn Rush

Executive Secretary

Fresno-Madera Kings

Company AssistingFMMS Members withEMR and Meaningful Use

Gold Coast Health IT has beguncontacting FMMS members offering theirservices to assist them with EMRimplementation and achieving Meaning -ful Use.

Lumetra was originally designated bythe Regional Extension Center to assistphysicians from our area, however,Lumetra focused their attention onNorthern California.

Gold Coast Health IT has beenauthorized to step in to assist localphysicians at no cost. To date, they haveassisted over 200 physicians in Kern andVentura counties.

Contact FMMS for further informationat 559-224-4224 ext 110.


Editor: Where does someone start?

Hayat: The first thing to do is reviewwhat your practice currently has in place.Do you have a website, a Facebook page, atwitter profile? The next step is to identifywho your current patients are, who youwant to reach out to, and what type ofinformation you want communicate. Thatwill help you design (or re-design) yourwebsite and help you decide what othersocial media platforms are best suited foryour practice. Regardless of the platform,you should familiarize yourself withHIPAA and Social Media guidelines suchas the one offered by ACP. You can havean attorney review your site policy forextra assurance. You can also contact yourmalpractice insurance company to see ifthey have any guidance. You shoulddesignate a responsible office staff to assistyou with postings and replies. You can hirea company to help you design andimplement a social media strategy. Look atwhat your colleagues have done. A goodsocial media plan, which should be a partof your overall marketing plan, can helphave a great social media experience.

Aamer Hayat, JD, may be reached [email protected].

Social Media

Continued from page 9

PLAN TO ATTEND CENTRAL CALIFORNIA BLOOD CENTEREVENTS THAT RECOGNIZE DISASTER PLANNING

At Central California Blood Center in Fresno, we recognize disaster planning asan important part of our blood center’s vital life-saving mission of providing bloodand blood services in the central valley. Two events are being held in Septemberthat will help support the blood center’s work. Please know that we’ll be honoredto have your support of either or both events!

Monday, September 11 – The Central California Blood Center is proud tohave been named the beneficiary of the Tachi Palace Hotel & Casino’s 11thAnnual Golf Tournament. The event will be held on Monday, September 9 atKings Country Club in Hanford. We are grateful to our friends at Tachi for theirpast and continued support of our efforts to provide excellent service to our donors,as well as safe, reliable blood products to the 31 hospitals we serve in the CentralValley. For more information on sponsorship, or how you can participate in thetournament, please visit www.donateblood.org. Then, join us for a beautiful dayon the course - and know that your golf and participation support the life-savingwork of the Central California Blood Center!

Friday, September 25 – In addition, please join us at Tachi Palace Hotel &Casino in Lemoore for their Community Breakfast. You’ll enjoy an amazing break -fast – with all the trimmings – and your $5 breakfast donation will be matched bythe great folks at Tachi and will benefit the Central California Blood Centeragain! Hope to see you there! Thanks for your support!


MEDICAL OFFICES

Gar McIndoe (661) 631-3808David Williams (661) 631-3816Jason Alexander (661) 631-3818

FOR LEASECrown Pointe Phase II – 2,000-9,277 rsf.

3115 Latte Lane – 5,637 rsf.3115 Latte Lane – 2,660-2,925 rsf.

Meridian Professional Center – 1,740-9,260 rsf.9300 Stockdale Hwy. – 3,743 - 5,378 rsf.9330 Stockdale Hwy. – 1,500-7,700 rsf.

2323 16th St. – 1,194 rsf.2323 16th St. – 1,712 rsf.

2323 16th St. – 2,568 rsf.4939 Calloway Dr. – 1,795 sf.

3941 San Dimas St. – 9,000 rsf. SUB-LEASE

1902 B Street. – 1,698 sf.4100 Truxtun Ave. – Can Be Split

Medical Records & OfficesSprinklered – 4,764 rsf.

Adm. & Billing – 6,613 rsf.FOR SALE

1911 17th Street – 2,376 sf.2019 21st Street – 2,856 sf.2204 Q Street – 4,600 sf.

Crown Pointe Phase II – 2,000-9,277 rsf.Meridian Professional Center – 1,740-9,260 rsf.

9900 Stockdale Hwy. – SOLD OUT!3941 San Dimas St. – 9,000 rsf.

MEMBERS: 3 months/3 lines* free; thereafter $20 for 30 words.NON-MEMBERS: First month/3 lines* $50; Second month/3 lines* $40; Thirdmonth/3 lines* $30. *Three lines are approximately 40 to 45 characters per line.Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

University Psychiatry Clinic: A slidingfee scale clinic operated by the UCSFFresno Dept. of Psychiatry at CRMC M-F8am-5 pm. Call 559-320-0580.

LQMG Medical Group is seeking BoardCertified, Internal Medicine physicians tojoin its group. Call 559-450-5703.Avecinia Wellness Center is hiring board certi-fied FP/IM physicians for its integrative med-ical practice. Visit www.avecinia.com and emailquestions/cv's to [email protected].

Complete suite of office furn. 1 desksw/return & file draws; 2 guest chairs; 10exam rm. chairs; 9 rolling stools for examrms; 6 footstools; 8 desk chairs; 4 examrm tables. Call 559-432-7700.

ANNOUNCEMENT

PHYSICIAN WANTED

FOR SALE

CLASSIFIEDS

Medical office space; 1476 W. Shaw Ave.between Fruit & West. 1200sf, great loca-tion. Call Shannon Mar, Guarantee RealEstate, 999-6165, [email protected] office; 1046 E. Shields, 1,331 sf,close to Fwy 41 & Manchester Mall. CallShannon Mar, Guarantee Real Estate, 999-6165, [email protected] new (model) home near Willow Intl.campus. 2,760 sf, numerous upgrades, 5bdrms/3bths. Available early to midAugust. Call: 559-273-5336.Shared office space; physician privateoffice & space for NP/PA; 6 exam rms. + X-ray. Enjoy turn-key opportunity close toSAMC. Call Deanna at 559-320-0032.

FOR LEASE OR RENT

“SAVE THE DATE”33rd ANNUAL

CENTRAL VALLEY CARDIOLOGYSYMPOSIUMNovember 9, 2013

Madera Municipal Golf Center8:00am - 3:30 pm

Featured Speakers:

Hossein Almassi, MDProfessor, Cardiothoracic Surgery,

Med. Col of Wisconsin

Norman M. Kaplan, MDProfessor, Dept. of Internal Medicine

Univ. of Texas

Jordan M. Prutkin, MDAssistant Professor, Cardiology

Univ. of Washington

Six (6) hours, Category 1 CMECredit

No charge for Fresno-MaderaMedical Society members

Information: 559-224-4224 x 118:[email protected] orvisit www.fmms.org


This is how Dr. Eubanks got paid for Meaningful Use.

A fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an

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“When it comes to

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made it easy for

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–Dr. Reavis Eubanks

Visit athenahealth.com/FMMS or call 800.981.5085

Cloud-based practice management, EHR and care coordination services

VITAL SIGNSPost Office Box 28337Fresno, California 93729-8337

HAVE YOU MOVED?Please notify your medical society ofyour new address and phone number.

PRSRT STDU.S. Postage PAIDFresno, CAPermit No. 30

NORCAL Mutual is owned and directed by its physician-

policyholders, therefore we promise to treat your individual

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call 877-453-4486 today. Visit norcalmutual.com/start

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A N O R C A L G R O U P C O M PA N Y

N O R C A L M U T U A L .C O M

P R O U D T O B E E N D O R S E D B Y T H E F R E S N O - M A D E R A M E D I C A L S O C I E T Y A N D T H E K E R N , K I N G S A N D T U L A R E C O U N T Y M E D I C A L S O C I E T I E ST H E K E R N ,A N D

T O B E E N D O R S E D B Y P R O U D

A N D K I N G S T H E K E R N ,

T O B E E N D O R S E D B Y

O U N T Y M E D I C A L CU L A R E TA N D

T H E F R E S N O - M A D E R A M E D I C A L

O C I E T I E SSO U N T Y M E D I C A L

O C I E T YST H E F R E S N O - M A D E R A M E D I C A L

O C I E T I E S

O C I E T Y

A N O R C

N O R C

YA NO M PCL G R O U P AA N O R C

C O ML .AL M U T UAN O R C

Vital Signs July 2013

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